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Overtime for Nurses? It Depends (FLSA Rules in 2024)

Nurses are generally eligible for overtime pay under the Fair Labor Standards Act (FLSA) in the United States. The FLSA requires that covered employees, including nurses, be paid at least one and a half times their regular rate of pay for any hours worked over 40 in a workweek, unless they are exempt from overtime pay based on specific criteria.
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Overtime Rule and the Alternative Work Week for Nurses

According to Coast Employment, the standard nonexempt worker is entitled to overtime compensation for any hours worked beyond eight in a single workday and beyond 40 in a workweek [1]. Overtime is compensated at a rate of 1.5 times the employee’s regular hourly wage (“time-and-a-half”). If an employee works over 12 hours in a workday, any additional hours must be remunerated at double their standard hourly pay.

Moreover, workers are entitled to a 30-minute unpaid meal break every five hours and a 10-minute paid rest break every four hours, with a few exceptions for shortened shifts. In situations where the nature of the work prevents employees from being relieved of their duties during breaks (e.g., a solitary security guard during a late-night shift), they and their employers can agree to on-duty meal breaks.

Nurses, like other employees, can opt for an alternative workweek plan allowing them to work up to 12 hours per shift without incurring overtime. However, such a schedule can only be established through a secret ballot election conducted among the nurses. For the alternative schedule to be valid, it must be consistent and regular, and the employer must register it with the California Division of Labor Statistics and Research. Failure to register the workweek renders it invalid.

Regardless of whether it’s a typical workweek or an alternative workweek schedule, employers must pay nurses overtime for any hours worked beyond 40 in a given workweek. Any hours worked past 12 in a given day must still be paid at double the hourly rate – Agency stated.

What is Mandatory Overtime in Nursing?

According to NurseJournal, mandatory overtime laws were put in place to ensure that employees are fairly compensated for working beyond the standard 40-hour workweek [2].

The federal Fair Labor Standards Act (FLSA) requires employees to be paid 1.5 times their regular hourly pay rate for any additional hours worked. States have enacted their own laws but, if the pay rate is lower than the federal standard, the employee is paid according to the federal law – Nurse Journal.

Under federal regulations, Medicare-certified hospitals must ensure they have a “sufficient number” of nurses to provide necessary patient care. This somewhat ambiguous language has led to state-level laws concerning nurse staffing levels, including specific ratios of nurses to patients. A nationwide shortage of nurses has resulted in hospitals and clinics enforcing mandatory overtime to meet these legal requirements.

Also Read: What is an Alternative Work Schedule?

What are the Highest Paid Nursing Specialties?

Highest-paid nursing specialties in the United States include:

  1. Nurse Anesthetist – $189,000
  2. Neonatal Nurse – $127,000
  3. Emergency Room Nurse – $116,000
  4. Cardiac Nurse – $116,000
  5. Orthopedic Nurse – $115,000
  6. Family, Home Care, Urgent Care, Oncology Nurse – $113,000
  7. Psychiatric, Pediatric, Surgical Nurse – $109,000
  8. Women’s Health Nurse – $107,000
  9. Pain Management Nurse – $104,000
  10. Gerontology Nurse – $96,500
  11. Nurse Educator – $94,000
  12. Research Nurse – $88,000

Highest Paying States for Nurses (average):

  1. California: $57.96; $120,560
  2. Hawaii: $50.40; $104,830
  3. Massachusetts: $46.27, $96,250
  4. Oregon: $46.27, $96,230
  5. Alaska: $45.82, $95,270

Source: U.S. Nursing [3].

Why are Nurses Forced to Work Overtime?

Even before the pandemic exacerbated the strain on healthcare facilities, there was already a shortage of healthcare workers.

Since COVID first made its appearance in the U.S. in early 2020, the problem has only increased. Understaffing is one of the main reasons why nurses and CNAs are forced to work overtime. If healthcare facilities do not have enough credentialed staff available, workers are forced to take on more hours in addition to more responsibilities

Apart from the challenges brought about by the pandemic, common reasons for understaffing include:

  • High turnover rates among staff. Studies suggest that one in six RNs leave their initial nursing job within a year, and approximately one-third leave within two years.
  • An aging population. As the Baby Boomer generation ages, their demand for medical services grows. However, the number of individuals entering the healthcare profession has not kept pace with this increased demand for services.
  • A scarcity of instructors and clinical sites to train additional healthcare workers.

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