Healthcare HR: 3 Solutions To Implement Now

healthcare HR
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Liz Strikwerda

Content strategist and corporate blogger (2000+ posts). Her work has been featured on G2's Learning Hub, Human Resources Today, Better Buys and over 500 business websites. She plays bluegrass mandolin and enjoys sailing her catamaran and hiking in the red rock wilderness of southern Utah. Connect with me on LinkedIn

The Essential Guide to Healthcare Workforce Management

Healthcare Human Resources teams face daunting challenges every day. Tough problems call for smart solutions.

Here’s an in-depth guide to help you face those challenges head-on. We’ll look at how the latest HR software helps hospitals, clinics, and home health services proactively solve HR problems.

Table of Contents

  1. Healthcare Workforce Management
    • Reduce Nurse Fatigue and Burnout
  2. Mobile Healthcare Timekeeping
  3. Healthcare HR Compliance
    • Payroll Based Journal
    • State Overtime Regulations

The Employee Scheduling Solution For Healthcare Managers

Healthcare employees are a diverse group with unique requirements. 24/7 shift arrangements complicate budget restrictions, and job roles magnify compliance issues. Is there one employee scheduling solution for healthcare managers that is up to the task?

The answer is “Yes.”

Unified HR portals are the employee scheduling solution for healthcare managers. A wide array of user features allows employees to concentrate on work. Efficient management tools make WorkforceHUB a capable solution for overwhelmed managers.

One Scheduling Solution To Rule Them All

Healthcare is a complex industry. There are legal and compliance issues, medical knowledge requirements, finance and care concerns. Employees have specialty skills but must fill many roles to meet job expectations.

Limited budgets and legal restrictions offer a tight working space for managers.

Without the right tools, managers are often overwhelmed with scheduling complications. The problem becomes an issue of which scheduling software to adopt.

Scheduling software provides solutions in 7 critical areas.

7 Critical Healthcare Scheduling Problems

Scheduling software doesn’t have to be complex to be complete.

But it does have to address these seven critical scheduling problems in healthcare:

  1. Easy Scheduling: you don’t want to spend extra time trying to figure out how to manage your software.
  2. Payroll Based Journal: don’t let compliance issues bring you down.
  3. Overtime Warnings: you have enough to do than worry about who is available to cover shifts.
  4. Mobile Access: give your road warriors the freedom to clock in during house calls or at remote sites.
  5. Self-Service: empower your employees to take some of the load off your shoulders.
  6. Document Management: post critical information with automatic readership tracking for worry-free staff educating.
  7. Payroll Integration: tracking time and attendance doesn’t have to stop before payroll.

If your scheduling software isn’t handling these seven problems, it’s time to upgrade.

Let’s do a deep dive on each of these…

1. Scheduling Your Healthcare Staff

Let’s get the first one out of the way: your scheduling software should help you schedule. It should be easy, fast, and efficient.

Schedule templates help you create new schedules in seconds. Need to adjust? No problem: click-and-drag employee names or job roles to fill empty shifts.

You can even create new templates from new schedules. Easy.

Scheduling software is easy to use for small or large workgroups.

There are SaaS solutions for the largest hospitals and the smallest patient care homes.

Custom scheduling modes let you schedule by employee name, job role, group, or location. Whatever makes sense for your organization.

Efficient scheduling helps you save time as a manager. Wouldn’t you rather be doing something else, anyway?

Scheduling software makes it easy to schedule your healthcare employees.

2. Payroll-Based Journal (PBJ) Compliance

Payroll-Based Journal is a critical compliance rule in healthcare. As a manager, you need to track specific skills to assure coverage.

HUR portals with compliance tools help you fulfill your PBJ duties with role-based scheduling. You can assign roles to each of your employees and define coverage needs.

Alerts will show you where you have empty gaps, and templates will make them easy to fill next time.

Track your PBJ and create a compliance history. In the event of an audit, you are always ready with an accurate report. No more worries about reporting or assembling complex records.

In Chapter 3, we discuss Payroll-Based Journal in depth.

3. Overtime Alerts For Unplanned Expenses

Another critical area of healthcare schedule management is overtime. Managers are under constant pressure to keep budgets tight and expenses low. Scheduling is one of the areas in which you can save the most, but it often gets overlooked.

When you change schedules, add employees, or allow shift swaps, you risk overtime. Unplanned overtime can swamp your budget or cause gaps later in the period. Automatic alerts warn you when a schedule will generate overtime.

The system will flag employees who are approaching overtime limits. You won’t have to do any quick calculations or miss an opportunity to save. Your budget will remain intact, and you’ll avoid overtime restrictions on your schedule.

4. Mobile Access For Remote Healthcare Employees

Healthcare isn’t restricted to hospitals and care centers. Mobile employees comprise a large part of the healthcare workforce.

Managers need an effective way to track employees on home visits or remote locations. You need mobile scheduling software. The latest apps have geofencing capability. This ensures your mobile employees are where they should be.

Scheduling software with companion mobile apps allow full access to clock-in and clock-out functions. They also provide access to the hub for schedule swapping and profile maintenance. All on the go.

Mobile healthcare employees are better representatives when they feel connected. Mobile scheduling software allows constant connection and interaction.

Even better, mobile scheduling solutions provide remote management features. Employees aren’t the only ones on the road; sometimes managers are mobile, too.

Managers can access schedules, approve swaps, and watch the workforce in real time. From any location!

You’ll never feel disconnected again. Employees will know you are on the job, even when you aren’t at the job.

5. Employee Self-Service (ESS) For Healthcare Scheduling

Employee Self-Service is a healthcare industry miracle. With so many diverse employees and job roles, it makes sense to empower employees to take part.

Managers shouldn’t spend valuable time on routine maintenance and employee account upkeep. Employees can do that for you.

Employee Self-Service lets employees log into the WorkforceHUB to interact. Interactions include updating their profile and tax exemption status. That alone will save you countless hours of interruptions.

Employees can also make their own schedule requests or volunteer for open shifts.

As a manager, you only need to make simple approvals. As we have discussed, overtime alerts will assure you aren’t going over budget. PBJ tracking and alerts will warn you when job roles are missing from scheduled blocks of time.

Your job will be a lot easier with Employee Self-Service.

6. Document Management In Scheduling Software

Document management and scheduling are a unique consideration in the healthcare industry. Regulations in our industry motivate us to document certifications, continuing education, and experience.

One way managers can do this is by managing documents. Let me explain:

An HR portal provides document management between managers and employees. As a manager, I can upload a document such as an employee manual, and I can track employee readership.

This can be a big help in scheduling because I can post a document for certification in the hub. I can then track the employee’s readership and completion of the document.

When an employee finishes a document, I am notified. The system will apply a certification or achievement to their profile. This qualifies the employee for a job role in my scheduling software.

Now I have more resources to fill job role-based scheduling.

Document management allows for expanded management options that enable me to better schedule. In the end, I can schedule faster and with greater accuracy. Job roles help fill gaps and meet PBJ requirements.

Managers produce better schedules in less time, and employees have confirmed skills.

7. Payroll Integration With Healthcare Scheduling

The purpose of your scheduling software is to help you manage your workforce. Your workforce fills shifts and records time.

Now what?

Payroll integration is a critical end-result of scheduling. Without payroll integration, scheduling software is only doing half the work.

Make sure you can get your time and attendance information all the way to your payroll software. Without all the work. Payroll integration makes it easy to complete the process/

Your scheduling software talks to your time and attendance recording. Import time and attendance data into payroll with a simple step.

Payroll Integration with scheduling software saves time and helps you avoid mistakes.

Reduce Nurse Fatigue and Burnout With Healthcare HR Solutions

There is little consensus about how to fix our broken healthcare system. But one problem acknowledged universally is nurse burnout and fatigue. This issue has been building for decades and has become particularly acute in the past ten years. Healthcare facilities have slashed staffing budgets which have increased nurse-patient loads. It has also led to mandatory overtime among nurses and laws governing nurse schedules.

The problem of nurse fatigue is most severe in hospitals. Because they need around-the-clock staffing, long shifts are the norm. Better shift scheduling can relieve nurse fatigue. But it is difficult to schedule creatively with substandard scheduling tools.

Cloud-based healthcare HR software allows scheduling managers to create fatigue-reducing schedules.

Scheduling managers are usually nurses. Creating schedules is only one of their many duties. To care for patients, they use sophisticated medical technology. They need sophisticated workforce management technology to radically improve nurse scheduling.

What is Workforce Management for Healthcare?

Workforce management software simplifies nurse timekeeping and scheduling. Systems integrate with a physical time clock or online clock-in portal. When nurses (whether hourly or salary) clock in and out, the system records it. It creates time cards for each nurse. The payroll manager imports the hours data into the payroll system. Healthcare HR systems track PTO accruals automatically according to hospital policy.

Healthcare Schedule Templates For Fatigue-Reducing Shifts

The scheduling tools have healthcare templates. Scheduling managers use the templates to set up standard schedules. The system track certifications (RN, LPN, etc.). And employee type (hospital employee, independent contractor, agency). The manager can copy schedules forward. They can also view them by department, shift, or team.

Healthcare HR Systems Helps Managers Limit Overtime

Overtime is a major contributor to nurse fatigue. Nurses often work overtime after a demanding 12-hour shift—it’s the nature of the job. The manager is rarely aware of which nurses continue working after the end of their shifts. Integrated HR systems alert the scheduling manager when a nurse is approaching an hours threshold. The manager can adjust the schedule going forward to prevent or limit the overtime.

Accommodate Nurse Schedule Preferences

Large hospital departments have dozens of nurses on staff. Specialized healthcare HR software makes it easier for the scheduling manager to accommodate nurse preferences. When a nurse is hired, the scheduling manager enters shift availability and preferences into each nurse’s profile. These rules guide the scheduling. It would be impossible for a manager to keep track of 50 nurses’ availability and preferences. Even if these were written down somewhere, it would be tedious to consult them when creating complex schedules. WFM for healthcare automates the scheduling process. When the scheduling manager schedules a nurse for a shift, it triggers an alert if the nurse is not available.

Allow Nurses to Self-Schedule

When nurses can pick their shifts, it immediately improves their work/life balance. This helps nurses physically and mentally. With old-school spreadsheets, it is nearly impossible for nurses to self-schedule. Cloud-based WFM for healthcare allows nurses to view the online schedule board from any mobile device.

Healthcare HR software has online nurse shift trade boards. These make it easy for nurses to handle much of their own scheduling. They request shifts and trade shifts. All team members can see the schedule modifications in real time. The scheduling manager customizes the shift trades rules. They can be set for auto-approve or manager-approve. The system sends an email and/or SMS messages to confirm shift trades.

Post Nurse Schedules Early

WFM nurse scheduling software allows schedulers to create schedules farther in advance. Schedules can be copied forward indefinitely. The manager creates a base schedule and then allows the nurses to swap shifts to suit individual needs. When nurses know their schedule weeks or months ahead of time, less trading is required. Fatigued nurses who need a lighter schedule can give up shifts. Nurses who want more hours can pick up the shifts. This improves nurse retention for hospitals.

Make Sure Nurses Take Breaks

Whether by choice or by a manager’s direction, nurses often miss their breaks. This contributes to fatigue. WFM systems alert nurses and team leads when breaks are due. WFM break enforcement prevents nurses from clocking back in too early from a break. Hospitals should require all nurses—salary or hourly—to clock in and out from breaks. This helps managers plan shifts and protects the hospital from compliance violations.

Hire More Part-time Nurses

Some managers don’t want to add complexity to nurse staffing by hiring part-timers. But part-timers help in many ways. They relieve the fatigue problem for the entire staff. They help full-time nurses stay on a healthy schedule. They can cover for breaks. Hospitals can overcome nursing shortages by hiring semi-retired former full-time nurses. And they can hire those who want to work part-time while their children are young. Workforce management helps nurse scheduling managers create complex team schedules with varying shift lengths. These are spread among a mix of full-time and part-time nurses.

Healthcare HR systems allow hospitals to customize their scheduling according to their needs. In this way, they can relieve nurse fatigue while maintaining a high quality of patient care.

Mobile Healthcare Employee Timekeeping

If you own a home healthcare business or work in HR and have not explored the latest mobile HR tools, keep reading.

New mobile time clocks ensure timekeeping accuracy wherever your employees are working throughout the day or night.

Your supervisors will appreciate how easy it is to see what’s going on with everyone in their department. What’s more, these mobile tools can be set up quickly for your staff and are surprisingly affordable.

Mobile Healthcare HR Software For Home Health Aides

When your workers are mobile, the ordinary employee timekeeping and scheduling tasks are more complex. It’s hard enough to track rotating nurse schedules in a busy LTF, but when workers are spread across town, you need convenient mobile apps.

These apps should allow them to clock in, check their schedule, access time card data, and request shift trades. They need to be able to do this quickly and conveniently so that patient care isn’t compromised due to a clunky time and attendance system.

Mobile Workers Have No Time For Admin Hassles

A home healthcare worker wakes up and hits the ground running. They check their patient roster and medication chart. “Do I have the necessary supplies for Mrs. Parker’s post-surgical needs?”  “Is Mr. Jones still on the route, or was he transferred to residential care?”

They may battle commuter traffic to get to their first appointment. When the aide arrives, he or she helps the patient get bathed and dressed, which often requires heavy lifting. The caregiver then takes the patient’s blood pressure and other vital signs, administers meds, makes breakfast, and does some housekeeping.

A Difficult Job Requires An Easy Mobile App

Keep in mind that many patients are dealing with chronic pain, restricted mobility, and the limitations of aging, so it’s understandable that they are not always happy campers. (Who can blame them?) Working as a home health aide can be rewarding, but it’s definitely not easy to care for people with physical, mental, and emotional challenges.

The last thing a mobile worker needs to deal with is difficulty logging work hours, uncertainty about scheduling, or time card hassles. Burnout due to excessive overtime is common in the industry and, like many healthcare employees who work long hours; they live for their vacations. (“I better not get shorted on my PTO!”)

GPS Tracking Is A Supervisor’s Best Friend

Being a supervisor is not a walk in the park, either. What if an aide wakes up with the flu when two others are on vacation? The sick one certainly can’t risk transmitting their illness to a patient whose immune system is already compromised. How can the supervisor quickly find a replacement so that all patients are visited on schedule?

Unified HR solutions help mobile healthcare companies manage large teams efficiently so their patients receive the care they deserve. Effective management is also key for controlling labor expenses.

Scheduling Mobile Workers

If you are responsible for scheduling, you know it can be pretty tricky. You have to take into account, oh, maybe a hundred variables. (I may be exaggerating, but it seems like it.) When creating schedules, you have to keep track of your employee’s certifications, patient visit durations, adequate shift coverage, patient status, travel time, and route details.

Scheduling impacts patient outcomes, profitability, employee satisfaction, and compliance.

Mobile HR solutions provide a comprehensive solution:

  • Capture hours and compile time cards
  • Track accruals
  • Mobile employees can punch in from their smartphone or the tablet they are already using to record patient data
  • GPS tracking records location of clock in/out
  • Aides can check schedules, request shift trades, receive automatic schedule updates and company announcements, approve time cards, and monitor accruals from any mobile device, any time of day
  • Supervisors have real-time, location-specific oversight with pinpoint GPS tracking
  • Supervisors can create schedules in minutes using job codes, patient and employee locations, and hours thresholds to ensure efficiency and compliance

Here is how one mobile healthcare time clock user described their experience with a popular mobile timekeeping solution:

“By far, the biggest benefit of using TimeWorksPlus and TimeSimplicity is having visibility to ensure we have the right people, in the right places, at the right times to provide the best care possible.”

Healthcare HR Compliance for 2022

Now that we’ve discussed timekeeping and scheduling, let’s focus on compliance.

Payroll Based Journal

The decision to put a loved one into a nursing home is a difficult and emotional decision. Fortunately, there are facilities that provide the loving care and treatment needed for short term recovery, or long term care.

If your facility provides medicaid or medicare services, then you are familiar with the Five Star rating system and the surveys sent to care facilities.

The Centers for Medicare and Medicaid Services (CMS) provides a Five Star rating system so that consumers can compare nursing homes in three categories. These categories are: Nursing Staffing, Annual Inspection Results, and Quality Measures.

Did you know?

Critics of the system have pointed out that much of the data used for the ratings are based on information that is self reported.

The CMS has long believed that the quality of care is directly related to a nursing home’s staffing. It is considered so important that it has a one-third weight of the rating calculation for the Five Star rating system.

As a result, The Affordable Care Act (ACA), Section 6106,  now requires skilled nursing facilities (SNFs) to electronically submit direct staffing information based on payroll and other auditable data.

The purpose of this is to standardize recording requirements and to collect information more regularly. This includes staffing information, which includes agency and contract staff, and facility census. PBJ allows for not only transparency in the ratio of caregivers to patients, but also provides information on employee turnover, which also affects care.

  • Standardize reporting to audit verifiable information
  • Collect information more regularly
  • Provides information on the ratio of caregivers to patients and the turnover of the caregivers

CMS named their reporting system Payroll-Based Journal (PBJ). Because the reporting information is verifiable and and auditable, it should reduce fraudulent reporting. This helps to keep competition fair among long-term care facilities.

This is great for both providers and residents.

Facilities That Are Required to Use Payroll-Based Journal Requirements

Who has to comply with PBJ?

Long term care facilities that are required to meet the Requirements for Participation as specified in 42 CFR Part 483, Subpart B.

This means that, any skilled nursing facility that participates in Medicaid is required to participate in PBJ requirements.  

Which Staff Members are Direct Care Staff Required by Reporting to the CMS?

Direct Care Staff are staff members who provide care and services to residents that allow them to attain or maintain the highest well being. This includes the highest physical, mental, and psychological well-being.

In addition, Direct Care Staff includes those individuals who care for staff personally through contact with residents and those in resident care management.

Yet, it does not include housekeeping and maintenance staff.

Often staff members have more than one role. Some of their roles would not qualify them as Direct Care Staff and other roles would.

Although this often happens, the CMS requires that jobs be reported according to the faculties primary job role. Faculties should report the total number of hours based on their primary role.

It is important to note, that this is based on primary role during their shift, not the employee’s primary role overall.

The CMS states that; “CMS recognizes that staff may completely shift their primary role in a given day. For example, a nurse who spends the first four hours of a shift as the unit manager, and the last four hours of a shift as a floor nurse.”

In other words. . .

This scenario describes, not a nurse who spends a few minutes on various roles, but a nurse whose primary work is as a manager and then a concentrated amount her shift occurs doing another primary work of directly caring for residents.

Fortunately, the CMS explains what should happen in this scenario; “In these cases, facilities can change the designated job title and report four hours as a nurse with administrative duties, and four hours as a nurse (without administrative duties).”

PBJ Reporting Frequency

While CMS previously collected information annually vía surveys, PBJ now requires quarterly reporting. Mandatory reporting started on July 1, 2016. All long term care facilities can access the system at no cost to the facility. Facilities must report by the 45th day after the quarter ends.

  • Quarter 1 January – March: Due May 15
  • Quarter 2 April – June: Due August 15
  • Quarter 3 July – September: Due November 15
  • Quarter 4 October – December: Due January 15

If a facility misses the deadline, the PBJ system will still accept a submission, but the reports will not be considered timely and will not be used to calculate a facilities staffing measures.

Therefore, facilities should upload reports with enough time to verify that it has been received. The Final File Validation Report can be accessed through the CASPER (Certification and Survey Provider Enhanced Reports).

This takes 24 hours so facilities should upload their reports at least a few days prior to the deadline.

Requirements for PBJ

Payroll Based Journal Reporting requires many pieces of information. First, each direct staff care provider needs an individual ID number. Reports cannot use social security numbers.

For example, if a facility is using a system like WorkforceHub’sTime & Attendance, then each employee can easily be assigned a specific number for timekeeping and payroll purposes. This means that a new ID number won’t have to be created for PBJ reporting.

It is vital that facilities keep and maintain an accurate record for each facility location that identifies their direct care staff and medical personnel. This includes registered nurses, physical therapist, licensed nurse practitioners, and other medical staff that participates in direct care.

Facilities can to maintain a record of direct care staff start and end dates of employment. Inputting this information into the PBJ system is optional.

In addition, tenure also needs to be recorded. , a record of the start and end days and the hours worked for each faculty must be kept.

It is optional for facilities to enter the resident census into the system.

Facilities need to maintain records of hours of care by category per direct staff member, each day.

Categories can be include physician, nurse, pharmacy, dietary, therapeutic, dental, podiatry, mental health, vocational, clinical laboratory, diagnostic x-ray, and other services.

  • Category of work for direct care staff member
  • Resident census data
  • Information on direct care staff turnover and tenure

Who is Responsible for Payroll Based Journal?

Admin staff at the facility, usually those responsible for payroll should be the ones to input the reports for PBJ.

This can include Human Resources or Payroll staff.

Plus, it can also include vendors or accountants that provide payroll services for the facility.

Getting Registered to Report PBJ

The system for PBJ reporting is called Quality Improvement and Evaluation System (QIES). Facilities must register and obtain ids. Each facility is allowed 2 logins.

While using QIES, the user must have a file to upload or they will have to manually enter the data. It must be an XML file.

It does not allow users to copy and paste information.

However, facilities using SwipeClock’s healthcare HR software can simply upload PBJ reports directly to QIES.

It is also important for the PBJ administrator to map job titles to the CMS-defined codes to ensure they are in sync for reporting.

Common Compliance Issues

There are several common practices that the CMS has found to be out of compliance. One of these practices includes the use of manual timesheets.

That’s is because of the non-specific nature of manual timekeeping. Studies have found that manual time cards have the greatest amount of error.

Another mistake that facilities are making is to count hours that exempt employees spend in direct care.

Exempt employees can provide exempt care for residents, but it is important that they be paid a reasonable amount for those hours.

If an exempt employee provides care that is overtime care and they are not paid a “bonus” for the service, then those hours cannot be counted for PBJ.

Lastly, facilities that use contract or temporary workers often mis-document direct care hours. For contract workers, there is often a contract and various employees perform the work provided.  There are several ways that contract direct care hours can be counted.

First, facilities can provide contract employees with logins so they can log in and out for work performed.

Second, contractors can provide an invoice with documentation for the specific hours that were direct care.

Third, contract staff can enter hours as a designee of the PBJ system for the facility.

Fourth, the contract staff can provide a XML file that meets the technical requirements of PBJ for submission.

Make Payroll Based Journal Simple and Affordable

Unfortunately the requirements of PBJ require a certain amount of data entry (creating IDs for each employee, categorizing job functions, and preparing the files for upload).

However, much of the cost of PBJ can either be offset of reduced.


Facilities that use a timekeeping system such as SwipeClock’s TimeWorksPlus can have PBJ reports automatically formatted and ready for upload to the CMS system.

Plus, facilities can use geo-timekeeping to track when direct care providers are at various locations. This makes it seamless to track hours per location for PBJ.

SwipeClock’s timekeeping suite comes with an Employee Self Service Portal, plus the tools you need for other employment law compliance!

Furthermore, our advanced time clocks can save you 8-10% of your payroll cost by eliminating buddy punching.

The Comprehensive Guide To State Healthcare Employee Overtime Laws

Laws regarding mandatory overtime have become increasingly popular across the United States. In 2017, the U.S. House introduced a bill that would have placed restrictions on healthcare employees across the country.

While the law did not pass, many employers find themselves with restrictions regarding healthcare employees. Employers who are located in multiple states find themselves complying with different rules and regulations.

Why have overtime restrictions on nurses?

The usual reason for overtime restriction laws centers around patient safety. In 2004, researchers at the University of Pennsylvania School of Nursing found that nurses who worked more than 12 hours were three times more likely to make errors than nurses who worked a standard eight-hour shift.

In Michigan, one study showed that 63% of nurses were aware of medical mix-ups.

To skip directly to your state, click below.

To check out steps you can take to avoid mandatory overtime check out this section

Alaska Limitations On Mandatory Overtime Work For Nurses and CNAs

What is Alaska’s law on nurses working overtime?

Healthcare employers in Alaska are restricted from requiring mandatory overtime of nurse employees.

Who is protected from working mandatory overtime in Alaska?

In Alaska, the law covers both nurses and a certified nurses aide.

What is mandatory overtime?

Mandatory overtime is defined as any work that the nurse is asked to work beyond a “regularly scheduled shift.” Scheduled shifts must be agreed to by the nurse or CNA and the healthcare facility.

All exceptions cover both nurses and CNAs. For the purpose of the article if the word nurse is used it includes CNA.

Did you know that Alaska has maximum shifts for nurses?

Even when a nurse voluntarily works overtime, the maximum shift allowed is 14 consecutive hours.

Furthermore, after a nurse’s shift, the employer is required to provide at least 10 consecutive hours of off-duty time. This is with or without overtime.

The law doesn’t prohibit nurses from voluntarily working overtime hours.

There are exceptions to this law (HB 170 section 10.20.400). These exceptions cover both the ability for employers to force overtime. They also place restrictions on the 14-hour maximum shift.   

  • Nurses can volunteer for overtime up to 14 consecutive hours
  • After a 14 hour shift, 10 hours of off-duty must be immediately provided
  • Voluntary overtime is prohibited if overtime would result in jeopardy employee or patient safety

Exceptions to the 14 Hour Shift Limitations

Are school nurses exempt from a 14-hour shift?

Alaskan nurses who are employed by an educational institution are exempt. This including schools, school districts, and other educational institutions.

Overtime is allowed when the nurse is on duty for more than 14 consecutive hours during a special occasion or event. These occasions can include school field trips.

These special occasions and events must be sponsored by the employer (the educational facility).

Who else is exempt from long shifts?

Secondly, a nurse who is voluntarily working overtime on an aircraft in use for medical transport. If the shift is allowed under regulations adopted by the Board of Nursing. This exception is an exception to the 14-hour shift maximum length requirement.

  • School nurses covering a special occasion that lasts over 14 hours
  • Medical Transport flights: Nurses can volunteer for over a 14-hour shift

In addition, there are emergency situations when a nurse can be required to provide mandatory overtime.

Alaska’s Exception to Mandatory Overtime Restrictions

An employer can require a nurse to work overtime if the nurse is participating in a medical procedure or surgery that has begun but has not completed.

Additionally, mandatory overtime can be required if there is an unforeseen emergency situation.

An emergency situation is defined as a situation that could jeopardize patient safety. It must be an emergency situation that is unusual, unpredictable, or unforeseen. That can include an act of terrorism, disease outbreak, natural disaster, major disaster, or disaster emergency.

  • Act of terrorism
  • A disease outbreak
  • Natural disaster or major disaster
  • Disaster emergency

It does not include any situations where the healthcare facility had a reasonable knowledge of increased patient volume. It also doesn’t cover a situation where there is foreseeable inadequate staffing.

Furthermore, Alaska also provides another exception to mandatory overtime.

When can employers require mandatory overtime of Alaskan nurses?

Unlike many other states, Alaska allows mandatory overtime when there is a scheduling issue due to an unforeseen event. If a situation prevents a second nurse from reporting to work and relieving the first nurse, then mandatory overtime can be required.

What types of situations qualify for mandatory overtime?

Situations that could cause this exception include “unforeseen weather conditions.” These conditions include weather that is so extreme that it impairs someone from traveling to the healthcare facility.

Yet, it doesn’t include extreme weather conditions that the health care facility had prior knowledge of. They, they had enough time to avoid the scheduling problem.

Do you know how rural health care providers can deal with nursing shortages?

Some healthcare facilities in rural areas can force overtime. This is allowed when it declares a temporary staffing emergency. This is probably due to the difficulty in immediately recruiting staff or agency nurses.

Facilities that declare a temporary staffing emergency must follow certain procedures to attempt to fill staffing needs. Once an emergency has been declared, a report must be sent up to the Department of Labor.

Temporary staffing emergencies can last only up to 30 days. If more than 2 emergencies in 6 months occur or more than 3 in a year, then the facility must send a report to the Alaska Legislative Council.

  • A nurse is participating in a medical procedure that has not completed
  • Unforeseen emergency situation
    • Terrorism
    • Outbreak of disease
    • Natural or major disasters
  • When an unforeseen event such as weather causes a scheduling issue. (Does not cover weather events that were forecasted ahead of time)
  • Rural facilities call a temporary staffing emergency
  • Federal Government employed nurses are exempt
  • Tribes employing nurses are exempt from the requirements of the law

Voluntary Overtime is Allowed Providing These Conditions Apply:

There are many situations when voluntary overtime is allowed by Alaska law.

Overtime is allowed anytime a nurse wants to volunteer for overtime. Of course, the employer must also agree.

The only exception is if the voluntary overtime creates a risk to the physical safety of someone. This includes the nurse (or CNA), a patient, or an employee.

Overtime cannot cause the work to exceed 14 consecutive hours in a shift.

Overtime is allowed when a pre-scheduled on-call time is agreed to and scheduled. In those situations, the nurse can fulfill the on-call time and work overtime.

  • Nurses can volunteer unless it causes a danger to someone (such as extreme fatigue can cause)
  • If it doesn’t go over 14 consecutive hours
  • If it is part of an on-call schedule that was agreed to and scheduled
  • If a 10-hour rest break is given immediately after the shift ends.

Exceptions for Psychiatric Treatment Hospitals

Here’s another exception:

Psychiatric treatment nurses can work more than the 14-hours in a shift. But, several conditions must occur. Only specific schedules allow for shifts with over 14 hours of work. The law specifies the overtime pay and the rest required after the shifts.

If a nurse works over 14-hour shifts, then the nurse must voluntarily agree to work a 16-hour shift. This shift must be between Friday night and Monday morning. It covers Friday at 5:00 pm to Monday at 8:00 am. Any nurse who works a 16-hour shift must receive the same benefits and pay as a nurse working 20 hours. The law assumes these two nurses are in the same position.

Plus, nurses who work a 16-hour shift must be given 8 hours of rest before working another 8 hour shift.

  • The 16-hour shift must occur over the weekend
  • Nurses who work 16-hour shift must be paid as much or more than if they worked 20 hours in the same position
  • 16-hour shifts cannot be combined with an 8-hour shift without at least 8 hours of rest between shifts.

Although the law may seem complex, for most nurses mandatory overtime is prohibited. It is vital for employers to properly manage nursing schedules.

The ability to predict patient volume and shift needs for nurses is vital to patient recovery and nurse effectiveness.

Healthcare providers (including hospitals) can use predictive scheduling and workforce management tools to maximize nurse schedules. These tools will alert managers when nurses approach certain thresholds.


Managers can keep an electronic list of nurses who are available for extra shifts.  They can sort the list by those who would like to volunteer for more hours, various skill and education levels. That way all staffing needs can be quickly accessed and met.

Check out this section for a comprehensive guide of steps managers can take to avoid mandatory overtime in a pinch.


HB 0170

Arkansas Overtime Restrictions

Does Arkansas have a law against mandatory overtime of nurses?

That’s a great question! Many online articles include Arkansas as one of the states that have laws against mandatory overtime of nurses.

However, the author of this article has not been able to locate a single reference to such a law.

The Arkansas Department of Labor:

The author called the Arkansas Department of Labor and was told that Arkansas has no labor law restricting nurse overtime of any sort. That employers can require nurses to work as long as possible.

The Board of Nursing

According to the Arkansas State Board of Nursing, the board does not oversee overtime of nurses.

If a reader of this article is aware of a specific law, please contact SwipeClock so we can update this information.

Check out this section for a comprehensive guide of steps managers can take to avoid mandatory overtime in a pinch.


Department of Labor

California Nurses Mandatory Overtime Law Restrictions

Does California have restrictions on nurses working overtime?

California employment law has specific guidelines around nurse overtime. This is important for healthcare providers to understand. AB-2155 prohibits mandatory overtime of nurses.

Who is protected from mandatory overtime?

The law covers registered nurses, licensed-vocational nurses, and certified nurse assistants. There are exceptions in specific situations.

Starting on January 1, 2016, California law prohibits mandatory overtime of nurses.

  • Registered nurses
  • Licensed-vocational nurses
  • Certified nursing assistants

Specific Restrictions on Overtime

The law prohibits scheduled overtime and on-the-spot overtime requests.

The law prohibits employers from using mandatory overtime as a scheduling tool. It also forbids using it as a tool to overcome the failure to properly staff facilities.

As a result, employers can only require nurses to work overtime in an “emergency situation”. This includes a declared national, state, or municipal emergency.

What Emergency Situations Allow For Mandatory Overtime?

Emergency situations also include unusual or extraordinary situations that are unpredictable or unavoidable and that affects health care. It can include acts of terrorism, natural disasters, widespread diseases, and declared emergencies.

Plus, a warden, superintendent, and executive director can also declare an emergency. Emergency situations are exceptions to the prohibition on mandatory overtime for nurses.

  • National, state or city declared emergency
  • Unpredictable situations that affect healthcare
    • Acts of terrorism
    • Natural disasters
    • Widespread diseases
  • Hospital declared emergencies

When Can Employers Schedule Nurses for Overtime?

But, that does not mean that nurses can’t work overtime. Employers can still schedule nurse overtime if they follow the guidelines.

First, the nurse must volunteer or agree to work overtime. Employers scheduling overtime must give priority to employees who volunteer to work overtime.

When employers need more nurse coverage, then they must give the extra hours to part-time or intermittent employees.

Next, employers can assign extra hours to standby or on-call employees.

  1. Volunteer Nurses who want overtime hours
  2. Part-time and Intermittent employees
  3. Standby and On-call employees

Did you know?

Employers cannot retaliate against nurses who refuse to work scheduled overtime. This includes dismissal, discrimination against, or otherwise forms of penalties.

Can an exhausted nurse refuse to work overtime during emergencies?

Even in an emergency situation, a nurse may refuse to work mandatory overtime if they have worked 72 hours or more during the previous week.

Mandatory overtime is mandatory to a point. But, once extreme overtime has occurred, the nurse can even refuse overtime in emergency situations. This helps to maintain the quality of healthcare service.

California Pay Requirements for Overtime Work Are Steeper Than Federal Law

Check this out:

California labor law requires overtime pay for nurses who work overtime hours. When nurses work overtime, overtime pay is required. This applies whether the nurse works it voluntarily or mandatorily in emergencies. California law provides several mandatory breaks.

California Labor Code (sections 500-511) requires that employers pay nurses time-and-a-half for any hours over 8 that are worked in a 24 hour period. Employers must pay overtime for the last 4 hours of a 12-hour shift. If a nurse works over 12 hours in a day, then double time must be paid for that extra time worked.

In addition, employees must be given at least 2 rest days off in a single week.

  • Over 8 hours in a day > 1 ½ times the regular wage
  • Over 12 hours in a day > 2 times the regular wage
  • Nurses can refuse mandatory overtime when already worked 72 hours in a week.
  • 2 days break provided per week

Unless . . .

Even so, employers and nurses can have an agreement for an alternative work week. This allows up to 12 hours in a shift. Even with an alternative agreement, employers must pay overtime pay for all hours worked over 40 hours in a week.

What Steps Employers Should Take to Stay Compliant

It is vital for Healthcare Employers to understand and follow California regulations.

Check out this section for a comprehensive guide of steps managers can take to avoid mandatory overtime in a pinch.

Managers must use a checklist to protect against violations. It should include double-checking employees schedules for the required 2-day breaks, overtime hours, and any employee requests.
Fortunately, it doesn’t have to be that difficult. California employers using SwipeClock are able to set the rules for employees.

This can include break guidelines, scheduling laws, and even employee preferences. When shifts are vacant, `WorkforceHub suggests the best employees to fill in for specific shifts. This makes compliance much easier and alerts the manager when overtime hours are scheduled.


Mandatory Overtime Law

Bill 2155

California Labor Law Regarding Overtime Pay

Connecticut Restrictions on Overtime for Nurses

Connecticut has complex overtime laws.

Are you aware of how they work?

Overall, the law allows employees and employers to set up any type of a work week. Yet, it sets overtime hours at 80 hours in a 2 week period. The law requires overtime pay for any hours above that.

But, the state places restrictions on some employers and the overtime placed upon employees.

One of those exceptions is for nurses.

In the law, the term “nurse” refers to any registered nurse, a licensed practical nurse, and a certified nurses aide. The law allows nurses to voluntarily work overtime but restricts mandatory overtime.

What does this mean?

Connecticut defines “mandatory overtime” as overtime without at least a 48-hour notice before the shift starts.

In addition, it provides nurses with the ability to refuse mandatory overtime without any fear of retaliation, discipline, dismissal, or discrimination. Employers cannot penalize nurses who refuse to work mandatory overtime.

This means that:

It is more vital than ever for employers of nurses to be able to stay on top of schedules and schedule changes. Nurse managers stay busy and it can be difficult to stop and fix scheduling issues when someone calls in sick or other emergencies occur.

In Which Situations Can Employers Require Overtime From Nurses?

There are several exceptions to the prohibition on mandatory overtime for nurses.

First, employers can require nurses to work overtime if the nurse is involved in a surgical procedure until the procedure is completed.

Second, any nurse that is working in a critical care unit can be required to work overtime until that nurse is relieved by another nurse starting a shift.

Third, any public health care emergency can warrant mandatory overtime.

Fourth, any institutional emergency allows for mandatory overtime. An institutional emergency includes conditions such as poor weather conditions, catastrophic events, or widespread illness. These events will significantly reduce the number of nurses available for a shift. The hospital administrator makes the decision regarding a specific circumstance. They must have also made good faith efforts to mitigate the shortage of nurses through other actions.

Fifth, the last exception is that any union nurse. When a nurse has a collective bargaining agreement that addresses mandatory overtime, then the employer can require the nurse to work mandatory overtime according to the agreement.

  • An ongoing surgical procedure the nurse is involved in
  • Critical care unit nurses can be required to stay until replacement nurse arrives
  • Public healthcare emergencies
  • Institutional emergencies that would affect the supply of nurses
  • Union nurses whose collective bargaining agreement allows it.

Steps Employers Can Take To Stay Compliant And Still Have Needed Coverage

Employers can take several steps to protect themselves from violating this law while maintaining the needed coverage.

Check out this section for a comprehensive guide of steps managers can take to avoid mandatory overtime in a pinch.


Connecticut Mandatory Overtime Law

Illinois Restrictions on Nurse Mandated Overtime

Can employers require nurses to work overtime?

In Illinois, Senate Bill 201 places restrictions on health care employers regarding mandatory overtime and scheduling of nurses.

Who is protected from mandatory overtime?

The law covers:

  • Advanced practice nurses
  • Registered professional nurses
  • Licensed practical nurses who received an hourly wage and who carry out nursing duties.

Plus, the Illinois law oversees restrictions on mandatory overtime and required rest breaks. The law restricts employers from requiring mandatory overtime of nurses.

The law defines mandatory overtime as any time that extends past an “agreed-to, predetermined work shift.” There are several restrictions on mandatory overtime.

It is prohibited, except for under specific circumstances.

What is the maximum overtime a nurse can work?

Second, it cannot extend to more than 4 hours beyond the shift.

What breaks must nurses be provided with?

When a nurse works 12 consecutive hours in a shift, they must be immediately given at least 8 consecutive hours of rest following the shift.

Employers cannot retaliate against nurses who refuse to work mandatory overtime. This includes discrimination against, discipline, and discharge.

  1. Mandated overtime only allowed in emergency situations
  2. Overtime cannot extend past 4 hours of a shift
  3. Maximum shift length is 12 hours
  4. If a shift is 12 hours long, then a mandatory rest period of 8 hours must immediately follow
  5. Employers cannot retaliate against nurses who refuse to work mandatory overtime that is not due to an emergency.

Instances of Allowable Mandatory Overtime

During an “unforeseen emergent circumstance,” the law allows mandatory overtime. Like other states, Illinois recognizes that certain emergencies make it necessary for nurses to work mandatory overtime for the good of the public health.

Unforeseen emergencies include any declared state, federal or city emergency.

It also includes any situation that causes an implementation of a hospital’s disaster plan. These situations must affect or increase the need for health care services.

It includes times when patient care needs require specialized nursing skills through the completion of a procedure.

  • Federal, State or Municipal Declared Emergency
  • When the hospital’s disaster plan is initiated
  • Nurses involved in patient care that needs specialized nursing skills

Exceptions to Mandatory Overtime Allowances

Situations, where the hospital failed to have enough nurses to cover the usual and reasonably predictive nursing needs of its patients, are not covered.

Thus mandatory overtime cannot be used as a “scheduling tool.”

Further, the law does not prohibit hospitals from requiring off-duty nurses to report to duty. It also doesn’t prohibit overtime in general if the overtime is agreed to or volunteered.

Although nurses can refuse to work mandatory overtime, they can’t refuse to work during scheduled hours.

  • Does not cover failure to schedule enough nurses for the predictable needs of the hospital
  • Voluntary overtime is allowed
  • Nurses cannot refuse work during scheduled hours

Illinois Employers, Fill Vacancies Through These Steps

This is very important!

Illinois hospitals should get a signed release consenting to overtime. This should be done for all nurses who sign up for the volunteer list. This is vital when a nurse alleges that overtime was mandatory and not voluntary.

Employers are you aware that. . .

On-call lists cannot be used to fill scheduling gaps when the need was foreseeable or chronic.

But, volunteer lists can be used to fill schedule vacancies. They can also be used as a first resource during emergencies.

Too, hospitals can use on-call nurses, agency and per diem nurses to fill in during emergencies.

This can be a manual process. But, hospitals using specialized HR systems find the process becomes quicker and simpler. Schedules can be done in advance and shared with all interested individuals. Managers obtain more time for other responsibilities.

Check out this section for a comprehensive guide of steps managers can take to avoid mandatory overtime in a pinch.

  • Maintain a voluntary list of nurses seeking overtime
  • Obtain a written consent to protect against dispute
  • Use on-call nurses for emergency situations
  • Use per diem and agency nurses to cover shortages
  • Employ SwipeClock’s TimeSimplicity to optimize scheduling


Illinois Law

Maine Overtime Law

Maine labor law restricts employers from requiring employees to work overtime. The law defines overtime as more than 80 hours in a 2 week period.

Do you know the exception to Maine’s overtime law?


What does that mean?

Nurses can be required to work more than 80 hours in a two week period.

But, that’s not all. 

The law allows nurses to refuse mandatory overtime after working 12 required hours.

When a nurse has worked 12 hours, then they must be given at least 10 hours following the work period.

  • Maximum shift of 12 hours
  • 10-hour rest required after a 12-hour shift

Nurses who refuse mandatory overtime cannot be punished.

Check Out These Situations Where Mandatory Overtime Must Be Accepted

Did you know that nurses can’t always refuse mandatory overtime?

When there is an emergency, nurses can be punished for refusing to work overtime.

The law allows for work in response to an emergency declared by the Governor under the laws of the state.

Employer Alternative Options to Mandatory Overtime Use

Check out this section for a comprehensive guide of steps managers can take to avoid mandatory overtime in a pinch.


Maine Overtime Law

Main Labor Law

Maryland Labor Code: Involuntary Overtime Prohibition for Nurses

Maryland wage and employment law (2010 Title 3, Subtitle 4 Section 3-421) expressly prohibits involuntary overtime.

Maryland law covers both licensed practical nurses and registered nurses.

Are employers prohibited from using nurse overtime?

Nurse overtime is not forbidden. But, it must be scheduled overtime.

Employers cannot require a nurse to work additional overtime above what is scheduled. The schedule must be a predetermined work schedule.

When Can Employers Require Nurse Overtime in Maryland?

There are many exceptions that allow mandatory overtime. But, the following points must be met to qualify.

1-  An emergency situation occurs that can not be reasonably anticipated.

2- It is not recurring. The emergency cannot be caused or aggravated by the employer’s inattention or lack of contingency planning.

Did you know?

Failure to plan for “sick” employees around holidays doesn’t count as an acceptable reason to mandate overtime.

3- The employer has exhausted all good faith, reasonable attempts to use voluntary workers during the succeeding shifts.

4- The nurse has critical skills that are required for the work

5- The standard of care for a patient requires continuity of care until completion. This can include completion of a case, treatment, or procedure. When that happens, the employer must inform the nurse of the basis of the employer’s direction to require mandatory overtime. Plus, that decision must include and satisfy the other conditions required above.

  • Unanticipated emergency situation
  • Emergency is non-recurring
  • The employer has exhausted all good faith efforts to get other help for the shift
  • The nurse has critical skills needed for the work
  • The employer must inform the nurse of the basis for their decision

There are other scenarios when employers can require mandatory overtime.

It is allowed if the nurse’s contract allows for mandatory overtime.

It is also allowed if a condition of employment included involuntary overtime.

  • The nurse’s condition of employment included on-call rotation
  • When the nurses works in a community-based hospital

Important Information for Employers!

The law also makes employers responsible for patient care after a nurses predetermined work schedule is over.

Maryland law releases nurses from patient care once two things have happened. The nurse must notify another nurse of the patient’s status and transferred responsibility.

Scheduling Solutions for Maryland Employers

Some of the good faith efforts that employers can use are to maintain a volunteer list of nurses who are willing to work additional overtime.

This list can be as simple as an excel spreadsheet, but can also be a seamless as information stored in a workforce management system.

Employees can update the list regularly according to their own needs and preferences.

Employers can also utilize on-call nurses, per diem nurses, and agency nurses to fill in for emergencies.

Check out this section for a comprehensive guide of steps managers can take to avoid mandatory overtime in a pinch.


Maryland Labor & Wage Law

Massachusetts Law Restricts Nurse Schedules and Overtime Requirements

Massachusetts law restricts hospitals from requiring mandatory overtime, except in certain situations. The law restricts scheduling of nurses to a maximum shift of 12 hours per 24 hour period.

Don’t forget also,

The law restricts employers from scheduling nurses to work outside of regularly scheduled shifts.

Do you know the one exception to the rule?

The exception occurs during emergencies. In an emergency where the care of a patient will be compromised, mandatory overtime is allowed.


The hospital must make a good faith effort to get overtime filled by volunteers, even when mandatory overtime is required.

Understand this:

Mandatory overtime cannot be used as a scheduling tool.

When Can Employers Require Nurses to Work Mandatory Overtime?

Following the law’s passing, the commission defined allowable emergencies that are rare and unusual.

Examples that don’t qualify include cold and flu season and staff shortages.

Events qualifying for mandatory overtime include municipal, state, and national emergencies.

Allowable emergencies include major catastrophic events. They include major storms, acts of terrorism, or a major internal hospital disaster.

Catastrophic events would include the Boston Marathon bombing and events involving multiple injuries. Other examples include major fires, multiple auto accidents, or a building collapse.

What else?

It includes chemical spills and widespread outbreaks of disease or illness. It includes other major events requiring hospitalizations by many people in the hospital’s area.

Internal hospital disasters include events like a power outage, a riot inside the hospital, or an unexpected system outage.

Other emergencies include ongoing medical procedures that a nurse is actively engaged. But that nurses continued presence was unforeseen and necessary to ensure the health and safety of the patient.

  • National, State, and City emergencies
  • Major catastrophic events
  • Acts of terrorism
  • Major internal hospital disaster
  • Major storm

Further Limitations on Nurse Schedules

Even when employers require mandatory overtime, they cannot require nurses to work longer than a 16-hour shift in a 24 hour period.

When a nurse works a 16-hour shift, the employer must provide a rest period of at least 8 consecutive time-off hours

The Process Employers Must Take To Require Mandatory Overtime  

Can you name the steps employers must take before using mandatory overtime?

Before using mandatory overtime, hospitals must first seek reasonable alternatives. This is the case, even in emergencies.

But it also works during schedule shortages.

Employers must post schedules 4 weeks out, utilize float pools and per diems.

Will a spreadsheet do the job?

While this is feasible with manual or excel spreadsheets, it can be cumbersome.

Hospitals must maintain a spreadsheet of all nurses who are willing to work additional hours. This includes who is available when, and who is willing to be on-call.

A column with nurse certification and skills should also be maintained so that if specific shortages require a skill set, the list can be organized to meet that need.

There is an easier way!

Fortunately, hospitals using TimeSimplicity can easily manage all these requirements.

Schedules can be published ahead of time and electronically sent to all involved. Plus time off requests, schedule limitations and other factors can be electronically tracked.

When shift shortages occur, the system can track and organize a list of who is available and who qualifies for the required skill level. It tracks who may have exceeded overtime allowances and other pertinent information.

This makes it seamless for a manager who is trying to fill a gap in the schedule.  

Lastly, when hospitals do require mandatory overtime, they are required to report it the Department of Public Health. Those reports are considered public property.

Check out this section for a comprehensive guide of steps managers can take to avoid mandatory overtime in a pinch.


Massachusetts Nurse Association

Michigan Lawmakers Look at Law Regarding Nurse Schedules

What’s happening with Michigan law?

Michigan legislators have a proposed bill that would ban involuntary overtime of nurses.

Two bills, 4629 and 4630 would restrict mandatory overtime by employers of nurses. HB 4629 required hospitals to create a staffing plan. The bill requires specific ratios of nurses to patients.

This means that:

Critical care patients, operating rooms, and advanced labor patients must have at least a ratio of 1:1.


It limits patients such in the nursery, surgical, telemetry to 3 or 4 patients to nurses. It depends of the specific patient status.

The bill penalizes hospitals who use mandatory overtime in any situation that is not an “unforeseen emergent situation.” Hospitals can be fined a minimum of $10,000 and a maximum of $50,000 per incident of mandatory overtime.

When could employers require overtime?

Qualifying emergency situations must be unpredictable, unavoidable, and unscheduled intervals.


The bill specifically states that emergencies that result from labor disputes does not qualify as an emergency.

HB 4630 protects registered nurses from administrative action for refusing to “work more than his or her regularly scheduled hours.” It also prohibits employers from requiring a nurse to work more than their required schedule.

Shift limitations?

The bill would restricts shifts of more than 12 hours.

Rest requirements?

If a nurse does work 12 or more consecutive hours, then the hospital must provide the nurse with at least 8 consecutive hours of off-duty time. That time must be provided immediately following the shift.

HB 4630 also defines three specific situations that would allow mandatory overtime. Any unforeseen emergency situations count but are not defined in the bill. Another situation includes an ongoing medical treatment that the nurse is involved with. It also allows nurses to voluntarily agree to overtime.

Alternatives to Mandatory Overtime that Employers Can Use

Check out this section for a comprehensive guide of steps managers can take to avoid mandatory overtime in a pinch.


Proposed Michigan Bills

Minnesota Regulations Regarding Nurses Overtime and Shift Limitations

Minnesota overtime law varies from most other state laws and from federal law.


Minnesota, overtime is set at 48 hours a week instead of the usual 40 hours a week.

So I don’t have to pay overtime for 40-48 hours a week?

Not, exactly, . .

The law only applies to businesses that are not interstate companies and are small employers.

That’s not all.

Minnesota has another important part of their overtime law. It pertains to healthcare employers and the nurses employed. Minnesota law defines a normal work week as a predetermined shift of 12 or fewer hours in a day.

This is important because employers must realize that nurse shifts should be scheduled. Furthermore, the maximum shift allowed is a 12 hours shift.


The law prohibits healthcare employers from taking any action against a nurse who refuses to work mandatory overtime. This includes both state nurses and private employer nurses.

Can nurses volunteer to work overtime?

The law does not forbid voluntary overtime, but it does limit the maximum hours to 12 in a shift.


It prevents employers from taking negative action against a nurse who refuses to stay after a shift to work more hours.

Minnesota Allows Nurse Overtime in These Situations

The one exception that allows mandatory overtime is in the case of an emergency.

What counts as an emergency?

An emergency is defined as anytime replacement staff is not able to report to duty or an event that causes an increase in patient need.

These events have to be unusual, unpredictable, and unforeseen circumstances. It includes events like acts of terrorism, disease outbreaks, adverse weather conditions or natural disasters.

  • Emergency
    • Acts of terrorism
    • Disease outbreaks
    • Adverse weather conditions
    • Natural disasters

Employers, Be Aware of These Protections

Minnesota law protects nurses that refuse to work mandatory overtime in non-emergency situations.

Employers cannot report them to the Board of Nursing.

They cannot discipline, threaten, or discriminate against those nurses. The law bars other forms of penalization of benefits, pay, terms of employment, or other privileges of employment.

What if they refuse to work during emergency situations?

The law only protects nurses who refuse overtime during non-emergency situations.

What’s the Best Way For Healthcare Employers To Stay Compliant and Have the Needed Coverage?

Check out this section for a comprehensive guide of steps managers can take to avoid mandatory overtime in a pinch.

Did you know?

One of the easiest ways for employers to juggle nurse scheduling is through specialized healthcare HR or workforce management tools. Yes, nurse schedules can also be done manually also. WFM (workforce management) allows managers to quickly schedule.

Employers should maintain volunteer lists. They can be sorted out by availability, existing hours scheduled, seniority, and education and skill level.

Here’s another important thing to do:

Employers should also consider having on-call nurses available during potential higher volume times, poor weather, and other conditions that are predicted. Agency and per diem nurses are another alternative to mandatory overtime.

  • Schedule effectively through Workforce Management Tools
  • Maintain volunteer lists
  • Use on-call nurses
  • Agency and per diem nurses to cover for shortages


Minnesota Regulations

Missouri Department of Health Rules Against Mandatory Overtime for Nurses

Missouri health code restricts employers from requiring mandatory overtime from nurses.

The law defines overtime as any shift past a scheduled, predetermined shift. It must also not exceed 12 hours a day or 80 hours in a 2 week period.

  • In excess of a scheduled shift
  • More than 12 hours in a day
  • More than 80 hours in 2 weeks

Did you know?

There is an exception.

It is when an “unexpected nurse staffing shortage” arises and possess a substantial risk to patients. This can be due to emergencies and other unexpected situations.

Before Missouri employers require mandatory overtime, they must first exhaust all reasonable efforts to secure staffing. The need for nurses must not be due to chronic staffing shortages.

  • The employer must exhaust all reasonable efforts to secure staffing
  • The need must not be due to secure staffing

Employer Responsibilities During Nursing Shortages

When a shortage happens, employers must make a reasonable effort to secure replacement staff before requiring mandatory overtime.

Employers who need to secure extra nursing staff must take several steps first.

Do you know what those steps are?

The employer can re-assign qualified staff that is currently on-duty.

In addition, volunteers for overtime can be asked for from among the qualified staff that is working.If any nurses want to stay longer to cover needed gaps, this is allowed.

Next, managers must contact all the off-duty staff that has made themselves available for extra hours.

This list of staff that has volunteered for additional hours can be maintained manually. It can be in an excel spreadsheet or a matrix.

But, it can be more easily managed through a workforce management tool. SwipeClock’s scheduling software allows employees to update availabilities at any point.

This makes it easier for managers to quickly find substitutes.

Employers can also utilize per diem nurses, float pool and flex team nurses.

Lastly, when local laws and union agreements allow it, the employer can seek substitute nurses from a temporary staffing agency.

  • Reassign on-duty staff
  • Seek voluntary overtime from staff currently working
  • Contact off-duty staff who made themselves available for extra work time
  • Utilize per diem, float pool, and flex team nurses
  • Seek extra staff from a temporary staffing agency

After an employer has tried to fill vacancies, the employer can require nurses to stay and continue caring for patients.

Exceptions to the Restriction on Mandatory Overtime

Check out this section for a comprehensive guide of steps managers can take to avoid mandatory overtime in a pinch.

Did you know?

There are several exceptions to the restrictions to mandatory overtime.

First, employers can use a section of nurses who commit, in writing, to a predetermined staffing schedule or an on-call schedule. These nurses can be called and required to work overtime during nurse shortages.

  • Nurses agree, in writing, to an on-call schedule

Additionally, an unforeseeable emergency allows for mandatory overtime. This is defined as a situation that is unusual, unpredictable, and unforeseeable. It includes any national, state or municipal declared state of emergency. It includes acts of terrorism, a disease outbreak, adverse weather conditions, and natural disasters.

  • State of emergency
  • Act of terrorism
  • Disease outbreak
  • Adverse weather conditions
  • Natural disaster

When a nurse does work a 12-hour shift, they must also be provided with a minimum of 10 consecutive hours of off-duty time.

Missouri employers are also required to have a list of nurses who are available for staffing that can be shared with the Department of Health.

Missouri Nurse Code

Amendment to the law

New Hampshire Mandatory Overtime for Nurses and Assistance Regulations

New Hampshire’s labor law prohibits mandatory overtime for nurses.

It covered all registered nurses, licensed practical nurse, and licensed nursing assistants.

What is the definition of overtime in New Hampshire?

The state sets the definition of mandatory overtime at 12 consecutive hours in a shift.

This means that. . .

Employers cannot retaliate against nurses for refusing to work overtime. The law states that nurses shall not be “disciplined, or lose any right, benefit, or privilege” for refusing to work.

And, did you know that,

When a nurse works over a 12-hour shift, the employer must provide them at least 8 consecutive hours off-duty immediately following.


There are a few exceptions to the law against mandatory overtime. If a nurse refuses to work mandatory overtime in certain exceptions, then the nurse may be disciplined for refusing to work.

Exceptions to the Prohibition of Mandatory Overtime in N.H.

There are 5 exceptions to the law.

A nurse that is participating in a surgery must work until the surgery is complete. Nurses working in a critical care unit must work until another employee beginning a scheduled work shift relieves them.

Home healthcare nurses must work until another qualified nurse or customary caregiver relieves him or her.

Nurses covered by a collective bargaining agreement that contains provisions addressing the issues of mandatory overtime is exempt from the law. This is because the law recognizes the union agreement and rights of the nurses.

Finally, during a public health emergency, nurses can be required to work mandatory overtime.

New Hampshire law doesn’t define public health emergencies. Situations that can be reasonably assumed to count are natural disasters, federal, state or city declared states of emergency, widespread outbreaks of disease and other major crisis’.

  • Nurse in an ongoing surgery
  • Critical care unit nurse until a replacement comes
  • Home health care setting until a replacement comes
  • Public health emergency
  • Union nurse

Employer Solutions

Check out this section for a comprehensive guide of steps managers can take to avoid mandatory overtime in a pinch.


New Hampshire Legislation

New Hampshire law

New Jersey Mandated Overtime Restrictions for Health Care Facilities. 

The New Jersey law that covers overtime is called the “Mandated Overtime Restrictions for Health Care Facilities.” It places restrictions on overtime worked by employees of a healthcare facility.

The law restricts healthcare employees from working more than 40 hours a week.

What’s unique about New Jersey’s law?

New Jersey is unique because its law does not just cover nurses.

Who is covered?

Hourly workers who are involved in direct patient care or clinical services are covered. There are several exceptions to employees covered by the law.

Who is exempt from the law’s coverage?

Physicians, volunteers, and on-call employees are exempt from the restrictions of the law.

In addition, employees who volunteer to work overtime are exempt.

Licensed employees who work for an assisted living facility and receive room and board as part of their compensation are also exempt.


Employees who are participating in a surgical procedure that is in process. The procedure can be a surgical one or a therapeutic interventional process.

Lastly, employees not directly involved with patient care are exempt from the protections of the law.

Employees NOT covered

  • Physicians
  • Volunteers
  • Employees working voluntary overtime
  • Employees are given room and board as part of their compensation
  • On-call duty employees
  • Employees involved in a surgical or therapeutic procedure
  • Employees not involved with direct patient care

Exceptions to New Jersey’s Overtime Law

The exception to this is in an “unforeseeable emergent circumstance.”

The law defines those as situations that are unpredictable, unavoidable, and unscheduled intervals. In unforeseeable emergencies, employers must make a good faith effort to avoid mandatory overtime.

What Qualifies as an Emergency as it Pertains to Mandatory Overtime

In any situations of national, state. or municipal emergencies, employers are not required to take good faith efforts to avoid mandatory staffing.

State or municipal emergencies include disasters or catastrophic events that drastically increases the need for health care services.


Any emergency that causes a facility to activate its emergency or disaster plan.

Situations That Don’t Require Good Faith Efforts Before Utilizing Mandatory Overtime

  • National, State or municipal emergency
  • Disasters or catastrophic emergencies
  • Situations that activate the facilities emergency or disaster plan

Employer Responsibilities to fill Vacancies During Emergencies

Reasonable efforts include four main steps to fill the needed shifts.

These steps include seeing for volunteers from staff currently working at the time of the emergency.

It includes contacting all qualified employees who have made themselves available to work extra hours.

It also Includes the use of per diem staff is another effort employers should make.

Lastly, seeking help from a temporary agency when that is allowed by law, regulations, or collective bargaining agreements.

  1. Volunteers from qualified staff currently working at the time of the emergency
  2. Contacting all the staff that have made themselves available for extra hours
  3. Per Diem staff
  4. Temporary agency staff

Here’s another thing you can do as an employer:

Employers can maintain an excel spreadsheet and update it manually quarterly or monthly.

Were you aware that?

It is especially easy with SwipeClock to maintain a list of staff that has made themselves available for overtime purposes. Staff can log into an employee portal and change their availability anytime they have free time.

Employer Responsibilities When Using Mandatory Overtime (Documentation)

Check out this section for a comprehensive guide of steps managers can take to avoid mandatory overtime in a pinch.

Employers must be careful not to require mandatory overtime to fill vacancies from chronic short staffing.

In addition, when overtime is required, the employer must give the employee up to a full hour, to arrange for the care of the employee’s minor children or disabled or elderly family.

Don’t forget this requirement

Employers who do require mandatory overtime must document the use and situation of the mandatory overtime. They must document the good faith efforts that were made to avoid required overtime. New Jersey is specific in the details and documentation requirements for mandatory overtime. They include:

  • Employees name and title
  • Name of employees work area or unit
  • Date the overtime was worked, including start time
  • Number of hours that were mandated
  • The employee’s entire daily schedule for any week that the employee was required to work overtime
  • The reason why the overtime was necessary
  • A description of the “good faith” effort that the employer exhausted. This includes the names of employees contacted to work voluntary overtime, a description of the efforts to secure per diem staff, and a list of the temporary agencies contacted.
  • A signature of the person authorizing mandatory overtime.

This documentation must be provided to the employee. Employees are protected against retaliation for complaining to anyone and in any manner for working mandatory overtime. Employees have 2 years to file a complaint about mandatory overtime.

This means that:

It is important for employers to maintain automatic records such as the employee’s schedule, worked hours, and whether or not the employee volunteered for overtime.

Employers should date and retain volunteer lists so that if an employee un-volunteers later, there is still a record that they didn’t work mandatory overtime because they did volunteer.

Healthcare facilities that use SwipeClock find that employees can go into the system 24/7 and update their volunteer status. That makes it seamless and keeps managers up-to-date on whose available.

Additionally, the records are automatically retained for future use and recall.


New Jersey Labor Law

New York Employment Law Restricts Involuntary Overtime of Nurses

The New York Department of Labor restricts mandatory nurse overtime. Healthcare employers cannot assign mandatory nurse overtime except in specific circumstances.


Unlike other states, New York does not limit the restriction on overtime to nurses or hospital employers.

Employees Protected From Mandatory Overtime in NY

Did you know?

N.Y. law includes any entity who provides health care services. It includes those licensed under article twenty-eight of the health care law.

That means,

It includes hospitals, nursing homes,  and outpatient clinics. It includes rehabilitation hospitals, residential health care facilities, and residential drug and alcohol treatment facilities. Plus, it includes adult day health care programs and diagnostic centers.


This list is not all-inclusive.

What employees are covered?

The law covers all nurses. This includes part-time, full time, and per diem nurses. It includes registered professional nurses and licensed practical nurses.

  • Part-time, full time, per diem nurses
  • Registered professional nurses
  • Licensed practical nurses

What Shifts Are Illegal for Nurses in New York?

It’s important for employers to understand this:

The law makes it illegal for an employer to require a nurse to work beyond their regularly scheduled work hours.

Which means,

Regularly scheduled hours are defined as the hours a nurse has agreed to work and is normally scheduled to work.

It includes pre-scheduled on-call time and time spent communicating shift reports and patient status.

What does this mean for overtime hours?

The law does not forbid overtime work by nurses. It allows for scheduled overtime, as well as voluntary overtime.

  • Scheduled overtime is ok
  • Voluntary overtime is ok

Overtime is not restricted.


The New York State Board of Nursing seeks to preclude nurses from voluntarily working more than 16 hours in a 24 hours period.

  • Shifts longer than 16 hours are discouraged

Nurses who volunteer for long shifts are at risk of being found with “willful disregard for patient safety.” They can be subject to “potential charge of unprofessional conduct.”

As a result, employers must be aware that;

Nurses who work extreme overtime place themselves at potential risk of unprofessional conduct.

This is especially true if a nurse makes a mistake due to fatigue. Extreme overtime is working a 16-hour shift.

It also places the employer at risk.   

And, did you know?

New York also protects part-time nurses. Because mandatory overtime is defined as any work beyond the scheduled shift, part-time nurses are also covered.

Regularly scheduled hours for a part-time nurse means the hours a nurse is normally scheduled to work pursuant to the employees budgeted hours. It can also be defined by the percentage of the nurse’s full-time equivalent.

Exceptions to Overtime Restrictions

When can employers require overtime?

New York law has one exception that allows for required overtime. That is in an emergency. This can cover many different types of situations.  

One of those situations would be a health care disaster.

This includes natural disasters.

It includes any other disasters including series of fires, automobile accidents, or a building collapse.

It would include chemical spills.

It includes widespread outbreaks of illnesses.

It includes any disaster that increased the need for healthcare personnel in the county or neighboring county, where the nurse is employed.

Another situation would be in a declared state of emergency. This would include any national, state or county declared emergencies.

A third situation is an emergency requiring overtime to provide safe patient care. This situation requires that the employer has implemented and utilized a Nurse Coverage Plan. And the use of that plan has failed to produce staffing adequate to meet the emergency.

Lastly, when a nurse is actively engaged in an ongoing medical procedure, overtime can required. This is true if their continued presence is required to ensure the health and safety of the patient.

The nurse’s manager or supervisor must make that determination, not administrators or physicians.

  • Healthcare disaster: natural disasters
  • Declared State of Emergency: county, state or nation
  • “Emergency requiring overtime to provide safe patient care”
  • Ongoing medical or surgical procedure

Employer Responsibility to Create Staffing Plans

Did you know there is more?

As an addition to Section 167, then Governor Pattersen, signed “emergency” regulations into law. They require health care employers to create and implement Nurse Coverage Plans.

Plans must identify and describe alternative staffing methods that a healthcare provider will use instead of mandatory overtime.

Plans must take into account regular patterns of absences by nurses and typical skill level of care usually required by patients. The plans must be available to staff, union reps, and state officials.

Healthcare facilities who require mandatory overtime must document the steps taken in an attempt to avoid mandatory overtime.

  • Nurse Coverage Plans
    • Identify alternative staffing methods
    • Account for regular patterns of absences
    • Account for skill level required by patients
    • Available to staff, union reps, & state officials

Employer Responsibilities To Protect Against Overtime

Did you know?

New York law lists acceptable steps employers can be taken to avoid mandatory overtime. Alternative staffing mechanisms can include contracts with per diem nurses, nurse registries, and employment agencies.

Plus, it includes assignments for nursing floats.

And, it includes requesting an additional day of work from an off-duty nurse.

It also includes developing and posting a list of nurses seeking voluntary overtime.

  • Use of Per diem nurses, agency and nurse registry staff
  • Nurse floats that can be assigned
  • An extra day of work for day-off nurses
  • Voluntary overtime list
  • Scheduling on-call nurses

Check out this section for a comprehensive guide of steps managers can take to avoid mandatory overtime in a pinch.


NYS Labor Law

NYS Nursing Practice

Ohio House Proposes 2018 Bill To Restrict Mandatory Overtime

Did you know?

In March 2018, Ohio legislatures proposed a bill that would make mandatory overtime for nurses illegal.

HB 456 would give nurses the right to refuse mandatory overtime.

Currently, nurses face discipline for abandoning a patient. The proposed law would change that so when a nurse feels too fatigued to work more, they can refuse.

The bill covers registered nurses and licensed practical nurses.

Additionally, the bill would require hospitals to create a staffing nursing plan that ensures the minimum number of nurses needed for patient care.

Similar to other states, the bill defines mandatory overtime as any work that in excess of a scheduled shift.

If the nurse receives notice during the shift of the required overtime and it extends the shift’s length, then the extra time is considered mandatory overtime. It does not cover excess shift lengths that are scheduled ahead of time.

The bill provides several exceptions to hospitals requiring mandatory overtime. First, any national, state or county declaration of an emergency that covers the hospital’s service area qualifies for mandatory overtime. Second, an emergency, unforeseen event, or influx of patients that results in patients beyond reasonably predictable levels.

This event must increase the need for healthcare personnel at the hospital and could not have been predicted.

Lastly, if the nurse is involved in an ongoing medical treatment or surgical procedure and the continued presence of the nurse is needed to ensure the health and safety of the patient, then the nurse can be required to stay and complete the procedure.

Check out this section for a comprehensive guide of steps managers can take to avoid mandatory overtime in a pinch.


The entire bill and the status of the bill can be found here.

Oregon Nurse Staffing Law

In 2016, Oregon’s Nurse Staffing Law went into effect.

The law covers two main components. First, hospitals must create a Nurse Staffing Advisory Board.

What does the board do?

The board must provide advice on how to comply with the law. It must identify trends concerning nurse staffing.

It submits an annual report to the Oregon Health Authority. There are other duties the board must also do.  

The second component of the law covers mandatory overtime of nurses.

The law prohibits employers from requiring a nurse to work “beyond the agreed upon and prearranged shift.”

It specifically states that this rule applies “regardless of the length of the shift.”

Thus, it covers even part-time shifts.


The law does not prevent a nurse from volunteering to work overtime.


If a nurse volunteers to work overtime, then the nurse is responsible to ensure that they are competent and able to provide safe care.

Oregon Shift Restrictions for Nurses

Know this:

When a nurse works a 12 hours shift, then the hospital must provide the nurse with a minimum of 10 consecutive hours off.


Nurse shifts are limited to a maximum shift of 12 hours in a 24 hours period.

The 24 hours period starts at the beginning of the shift.

And, nurse work hours must be limited to 48 hours in a week.

  • 12 Hrs maximum shift
  • 10 hours of time-off duty required afterward
  • 48 Hrs maximum work hours in a week

What Situations Allow Employers to Require Mandatory Overtime From Nurses?

There are a few exceptions to the law.

First, if a hospital learns of staff vacancy for the next shift, then they may require the nurse to stay an additional hour.

Secondly, if there is potential harm to the patient if the nurse leaves or assigns care to another, then the hospital can require the nurse to stay.

Lastly, if the hospital can require extended shifts in the case of a national, or state emergency. This exception also works if the hospital implements a facility disaster plan due to sudden unforeseen adverse weather conditions or infectious disease epidemic that is suffered by the hospital staff.

  • Vacancy in the next shift allows for 1 hour of mandatory overtime for working nurse
  • An on-going surgical procedure that affects the care of the patient
  • Declared emergency: national, state or local
  • A situation that activates the hospital’s disaster plan

What Happens When Mandatory Overtime is Used?

Check out this section for a comprehensive guide of steps managers can take to avoid mandatory overtime in a pinch.

This is important for employers to understand.

The law requires records to be kept regarding nursing staff. While the law isn’t specific in the exact information required, it would be wise for employers to retain records regarding nurse schedules, agreed upon shifts, actual hours worked, and pay information.

  • Nurse schedules
  • Agreed upon shifts
  • Actual hours worked
  • Pay information

In addition, hospitals should maintain records regarding any volunteer lists for overtime, situations of emergencies when mandatory overtime was required and the steps taken to avoid mandatory overtime.

  • Volunteer nurses for overtime
  • Records of when mandatory overtime was used
    • Steps were taken to avoid mandatory overtime

Employers can utilize on-call nurses, per diem, and agency nurses to fill in for unexpected shift vacancies.

  • On-call nurses
  • Per diem nurses
  • Agency nurses

The law doesn’t allow more than one hour of mandatory overtime due to a shift vacancy so creating a plan is essential for patient care.


(SB 469)

The following resources must be cut and pasted into your browser to correctly pull because they are PDF documents.

Pennsylvania’s Prohibition of Excessive Overtime in Health Care Act

In Pennsylvania, a “health care facility cannot require an employee to work in excess of an agreed to, predetermined and regularly scheduled daily work shift.”

Employers cannot require employees, who have an 8-hour shift, to work more than their scheduled shift.


Employers cannot retaliate against employees who refuse to work overtime.

  • Mandatory work beyond a scheduled and agreed to shift is prohibited
  • On-call cannot be used to substitute for mandatory overtime
  • Employers cannot retaliate against an employee who refuses to work overtime

Employers, it’s important for you to know this.

The law does not stop healthcare providers from scheduling employees for shifts that are more than 8 hours.

It’s important to understand;

The law doesn’t prevent employees from volunteering for overtime. And, employers are still allowed to hire part-time or per diem employees.

  • Employees CAN volunteer for overtime
  • Employers CAN schedule employees for more than 8-hour shifts
  • Employers CAN use part-time and per diem employees
  • On-Call overtime IS allowed

Covered Employers and Employees Under the Act

Pennsylvania employers that fall under the law include hospitals of all kinds.

This includes psychiatric or rehabilitation hospitals, hospice, ambulatory surgical facilities, nursing facilities, cancer treatment centers using radiation therapy and inpatient drug and alcohol treatment facilities.


Public facilities that provide clinically related health services are included. This includes the Department of Corrections, the Department of Health, the Department of Military and Veterans Affairs, and the Department of Public Welfare.

This law broadens the scope of similar laws because it includes state-run or funded facilities. The law also covers facilities operated by the Department of Public Welfare for mental retardation.

  • Private healthcare facilities
  • Department of Corrections
  • Department of health
  • Department of Military and Veterans Affairs
  • Department of Public Welfare

Covered Employees Protected From Mandatory Overtime

Employees protected under the those who provide patient care.

There are three qualifications for employees who are covered.

Do you know what those qualifications are?

This includes individuals employed by a healthcare facility. It includes state employees, state instrumentalities, or political subdivisions.

In other words,

It covers city and county-run health care providers. Political subdivisions include a county, municipality or town, school district, or a local government.

It also covers,

Employees that provide direct patient care or clinical care services.


Covered employees must receive an hourly wage.

If the employee is a union employee then they must be classified as a nonsupervisory employee in the collective bargaining agreement.

  • Employees of private and government-run facilities
  • Employees who provide direct patient and clinic care and services
  • Employees who receive an hourly wage

Pre-Scheduled Longer Shifts

What happens when employees work 12 hours or more?

The law requires a 10 hour rest period for employees who work 12, or more, hours.

This means that,

Immediately following the shift, employees must be given 10 hours of consecutive off-duty time.

But, it’s also important to know that,

Employees can waive their time to time off.

What Qualifies as an Unforeseeable Emergent Situation and Allows for Mandatory Overtime of Nurses and other Healthcare Staff?

“Unforeseen emergent circumstance” is legal code for an emergency. It can include an unforeseeable national, state, or city declared emergency.

It can also include an unusual or extraordinary event that is unpredictable and unavoidable. The event must also affect the provisions of needed health care services. Or, it must increase the need for health care services.

Plus, it includes “unexpected absences.”

This does not include shortages from chronic staffing shortages. While it must be affected patient safety, it cannot be something that could be prudently planned for by the employer.


Vacation leave by employees does not count.

  • National state or city emergency
  • Act of terrorism
  • Natural disasters
  • Widespread disease outbreak

Employer Solutions for Compliance

Check out this section for a comprehensive guide of steps managers can take to avoid mandatory overtime in a pinch.

Employers don’t require overtime because of a lack of regard or appreciation for employees. Usually required overtime is a result of scheduling conflicts.

Overtime costs employers higher hourly wages than regular shifts. This makes it undesirable for most employers.


Healthcare employers care deeply about patient care. When a provider calls in sick, goes on vacation or has another unexpected emergency, the employer often has little choice but to ask for overtime.

Let’s not forget,

The difficulty that employers have in hiring and training quality care providers in an ever increasing world of competition.


There are several steps that employers can take to avoid imposed overtime. Some of these steps are outlined in Pennsylvania law and others are not, but make the process easier for employers.

  1. Seek employees to volunteer to work extra time from all available qualified staff working at the time of the emergency
  2. Contact all employees who have made themselves available to work extra time
  3. Use per diem staff
  4. Use staff from a temporary staffing agency

It is important for healthcare facilities to stay compliant. Pennsylvania penalizes employers between $100 and $1000 per violation.

Healthcare providers will find that while manual scheduling is always an option, innovation HR software will maximize scheduling effectiveness. Employees can volunteer for extra hours. Managers can sort employees by voluntary availability for overtime, qualifications, and other information.


Pennsylvania Law regarding mandatory overtime


Other resources

Rhode Island Department of Labor Nurse Staffing Law Regarding Overtime

Mandatory overtime for nurses is prohibited in Rhode Island.

What employees does the law cover?

The law covers hourly nurses and certified nurse assistants that are involved in direct patient care or clinical services.

  • Hourly nurses
  • Certified Nurse Assistants

It does not cover:

  • Resident physicians
  • volunteers
  • certified nurse anesthetists
  • salaried employees
  • employees who volunteer to work overtime
  • prescheduled surgical employees working “on-call time.”

Which employers are covered by the law?

Employers who are required to abide by the law include all hospitals, private, public, and state.

What does the law require?

Rhode Island law requires that employers have a predetermined and agreed-upon schedule. Those schedules can be for 8, 10 and 12-hour shifts.

Rhode Island Restrictions on Healthcare Employers

Employers are not allowed to required employees to work more than those shifts except in an unforeseeable emergent circumstance.

It is important to understand that:

Even in an emergency, health care employers cannot require a nurse to work more than a 12-hour shift.

Nurses can volunteer to work more than a 12-hour shift, but all work over 12 consecutive hours must be voluntary.

Protection Against Overtime Refusal Retaliation

Employees who refuse to work overtime cannot be punished, discriminated against, retaliated against, dismissed or penalized.

Exceptions That Allow Mandatory Overtime

The restriction on mandatory overtime has one exception. The law waives the restriction in “unforeseeable emergent circumstances.”

During an emergency, employers can use mandatory overtime as a last resort.

Employers, take note.

Chronic short staffing does not count as an emergency. Employers must make reasonable efforts to fill vacancies.

What Counts as “Reasonable Efforts” to Find Replacement Staff?

Reasonable efforts include seeking volunteers from staff that is currently working at the time of the emergency.

It also means contacting staff that has made themselves available to work extra time. Employers can also utilize per diem staff.

  1. Seek volunteers from on-duty staff
  2. Contact off-duty staff who have made themselves available for extra work
  3. Use per diem staff

Did you know?

Unforeseeable emergent circumstances include other unpredictable or unavoidable situations that require immediate action.

This includes situations such as a major power outage, a public health emergency, or an irregular increase in patients. It includes an irregular increase in the number of employees who don’t report for work.

In these situations, healthcare employers must make reasonable efforts to avoid mandatory overtime. The maximum shift is 12 consecutive hours.

  • Power outage
  • Public health emergency
  • Irregular increase in patients
  • Irregular increase in no-show employees

Here’s another exception.

Employers are not required to make reasonable efforts to avoid mandatory overtime in the event of national, state, or municipal declared emergency. It is also waived in any disaster or catastrophic event which substantially affects or increases the need for health care services or that causes a facility to activate its emergency or disaster plan.

  • National, state, city declared emergency
  • Catastrophe or disaster that drastically increases the need for health care services
  • An event that causes a hospital to activate its emergency plan

Employers can pre-schedule on-call time in the surgical department that can be used for mandatory overtime. Otherwise, on-call time cannot be used as a substitute for mandatory overtime.

Don’t forget this.

Another requirement that the law requires is that employers must keep good records. This includes records of all mandatory overtime. It should include when employees worked over 40 hours in a week or any excess work beyond the pre-scheduled shift.

Employers must track many things including:

  • The employee’s name
  • Job title
  • The name of their work area
  • Date overtime was worked, including start time
  • The number of mandated overtime hours
  • The employee’s work schedule for the week overtime was required
  • The reason that overtime was necessary
  • A description of all reasonable efforts made to avoid mandatory overtime
    • The names of all employees contacted for voluntary overtime
    • A description of all efforts to secure per diem staff
    • A list of temporary agencies contacted
    • The signature of the individual who authorized mandatory overtime

Employers must give a copy of the documentation to any employee who is required to work overtime. This must occur within 10 days of the mandatory overtime. Records must be kept for at least 30 days. Longer, if a complaint is in process.

Be aware that.

Employers who violate the law are subject to a $300 fine per violation.

There is an easy solution.

Employers can more effectively respond to unexpected absences and other issues regarding nurse coverage through SwipeClock’s workforce management system.

Click here to find out more information.


Texas Staffing Law Prohibits Mandatory Overtime by Nurses

Texas’ Staffing Law protects nurses from the requirements to work past their scheduled shifts. Plus,

The law adds sections 257 and 258 to the Texas Health and Safety Code. These sections address nurse staffing and mandatory overtime by nurses.

This means that:


Hospitals must adopt, implement and enforce a written nursing staffing policy. They must also create a nurse staffing committee. The committee must evaluate how many and what skill levels are needed for patient care. The policy must take into consideration the committee’s recommendations and evaluations.


Hospitals must enforce the staffing plan, use the plan to create a nursing staff budget, and encourage nurse input.

They must protect nurses from retaliation for input. And, they must ensure compliance with other regulations.  

That’s not all.

In addition, section 128 prohibits mandatory overtime requirements of nurses. The law defines mandatory overtime as any required time outside of a scheduled shift that a nurse is required to work.

The law cites concerns over the care provided by fatigued nurses but doesn’t define a limit on the number of nurse hours scheduled.

Situations That Allow Mandatory Overtime of Nurses by Employers

Did you know?

There are several exceptions to mandatory overtime. These emergencies apply to the county of the nurse’s occupation, not the residential county of a nurse.

The first exception is a health care or natural disaster. It must unexpectedly affect the county or a neighboring county. It must increase the need for healthcare professionals.

In other words,

The emergency doesn’t “regularly occur.”

The second exception is a federal, state, or county declared emergency.

The third exception is irregular emergencies and unforeseeable events which increase the need for safe patient care and which could not be predicted by the hospital.

The last exception is if the nurse is engaged in an ongoing medical or surgical procedure and the continued presence of the nurse through the completion of the procedure is necessary to ensure the health and safety of the patient.

  1. Healthcare or natural disaster which increases the need for healthcare personnel
  2. Federal, state, or county declaration of emergency
  3. Irregular emergencies & unforeseen events that increase the need for safe patient care
  4. The nurse is actively engaged in a procedure and the presence of the nurse through the completion is required to ensure the health and safety of the patient.

Employer Responsibilities During Emergency Situations

This is important.

Even in an emergency, the hospital must try to meet the staffing needs through good faith efforts.

This can include voluntary overtime, per diems, and agency nurses. It can include assigning floaters or requesting an additional day of work from off-duty employees.


Hospitals are prohibited from suspending, terminating, disciplining or discriminating against a nurse who refuses to work overtime.

Strategies Employers Can Use to Maintain Enough Nurses on a Shift and Remain Compliant

Check out this section for a comprehensive guide of steps managers can take to avoid mandatory overtime in a pinch.

Hospital management must do several things to stay compliant with this law.

First, they must ensure that nurses aren’t asked to come in earlier or stay later than their regular shift.

Managers can have a list of employees who are willing to come in and work extra hours. It can include those who are on part-time status, on-call or agency nurses. When the volume of patients increases, managers can look to the list to find substitute nurses for a shift.

Texas hospitals who use staffing software can quickly pull a list of nurses who are available or have volunteered to work overtime. SwipeClock’s TimeWorksPlus is ideal for this type of situation. It will provide recommendations of the best-suited nurses to fill in.

Workforce management provides predictive scheduling. It makes it easier to accurately schedule nurse staff.


Texas Law Part 1

Texas Law Part 2 


Washington’s Law Restricting Mandatory Overtime For Nurses

In Washington, RCW 49.28.130-150 prevents health care facilities from requiring nurses to work in excess of their agreed upon regularly scheduled shifts. To do so is considered overtime.

Who is covered under the law?

The law covers both licensed practical nurses and registered nurses.

This would include diabetic educators, staff educators, clinical specialists and pain-management nurses. It includes research nurses, lab nurses, case managers, and telephone consulting nurses.

This list is non-exhaustive but provides examples of non-bedside nurses that are covered under the law.

Employers Obligated Under the Law

The law includes health care facilities that operate 24 hours per day, 7 days a week.

These facilities include private, public and state-run facilities.

It also includes hospices, hospitals, and rural health care facilities. It includes psychiatric hospitals, facilities run by the department of corrections, and some nursing homes.

  • Hospitals
  • Hospices
  • Rural health care facilities
  • Psychiatric hospitals
  • Healthcare facilities run by the Department of Corrections
  • Nursing homes regulated under chapter 18.51 of a home health agency

Mandatory Overtime Definition Under the Law

Overtime means hours beyond a regularly, predetermined, agreed upon shift.

Did you know that,

Shifts cannot exceed 12 hours in a 24-hour period. Overtime is also 80 hours in a 14 day period. Overtime is anytime that the employee works in excess of their regular shift.

For example,

If the employee works 13 hours and was scheduled for a 12-hour shift, then 1 hour of overtime has occurred.


If the employee works 10 hours but was scheduled for 8 hours, then 2 hours of overtime has occurred.

Exceptions to Mandatory Overtime Restriction

There are several exceptions to mandatory overtime.

Do you know what they are?

If an unforeseeable emergency occurs, overtime can be required. In the law, it is called an “unforeseeable emergent circumstance.”

It includes situations of a national, state or city declared emergency. It includes when a facility disaster plan is activated and unforeseen disaster or catastrophic events.

  • National, state or municipal declared emergency
  • Any situation that causes the facility to activate their disaster plan
  • Unforeseen disaster or catastrophic event that alters the need for health care services

Another exception is when pre-scheduled on-call time causes overtime.

Employers should document reasonable efforts to obtain staffing and still cannot avoid overtime.

Lastly, nurses who must work overtime to complete an ongoing procedure already in process. The procedure must be detrimental to the patient if the employee left.

  • Emergency Situations
  • Pre-scheduled on-call time turns into overtime
  • Efforts to obtain staffing has not eliminated the need for overtime
  • Nurses involved in a procedure already in progress

It is important to note:

Chronic staffing shortages cannot be used to require overtime, even when reasonable efforts have been made.

On-going Procedures that Can Require Mandatory Overtime of Involved Nurses

There are specific situations when a nurse who is involved in a critical and ongoing procedure must stay to complete the procedure, even if it involves mandatory overtime. Those instances are outlined below.

  • There is an emergency code in process
    • Trauma
    • Cardiac arrest
    • Stroke
  • A nurse needs to complete documentation after an emergency situation
  • A nurse has skills that no other nurse would have
  • A nurse is the only nurse with knowledge of a piece of equipment or procedure
  • A nurse is completing outpatient surgical or specialty procedures
  • In outpatient surgery or specialty clinic that operate with a single shift, the nurse may need to stay long enough for the patient to recover and be released

Reasonable Efforts Defined by Washington Law

Employers who make reasonable efforts and still cannot fill required staff can use mandatory overtime except in the case of chronic staffing shortages.


It is important to understand what reasonable efforts are required by Washington law.

Employers must seek for volunteers from qualified staff. They must contact staff who has made themselves available for extra work. They must seek for qualified per diem staff to fill in. They must also seek staff from a temporary staffing agency.


Employers cannot use mandatory overtime to fill holes in the schedule resulting from vacant positions. They cannot use it to fill gaps caused by planned vacation, medical leave or other types of leaves.

Did you know?

Employers can use mandatory overtime for a same-day sick call or other unanticipated absence. It can also be used for unanticipated increases in the census that demands additional staffing.

This is important!

Washington employers who violate the law can be penalized as much as $1000 for the first three violations. Then, a maximum penalty of $2,500 applies for the fourth infraction.

After that, a penalty of $5,000 per violation applies.

Paying penalties becomes extremely expensive for employers. They are caught between the difficult situation of ensuring adequate staff for the patient care and avoiding mandatory overtime for nurses.

Fortunately, one of the steps that employers can take to maximize scheduling effectiveness is to use SwipeClock’s employee scheduling tools.

Managers can sort employees who are available for additional hours by qualification, existing scheduled hours, and other criteria. Schedules can be created to maximize FTE and nurse coverage.

Check out this section for a comprehensive guide of steps managers can take to avoid mandatory overtime in a pinch.


Washington Law

Workplace Rights

West Virginia Nurse Overtime And Patient Safety Law

West Virginia law prohibits hospital employers from mandating a nurse to accept an assignment of overtime.

It also prohibits employers from taking action against a nurse who refuses to accept an assignment of overtime if the nurse declines to work because it may jeopardize patient or employee safety.

What does West Virginia law define as overtime?

Overtime is defined as any hours worked in excess of an agreed upon, predetermined, regularly scheduled shift.

Which employees are covered under the law?

The law covers most nurses. It covers certified or licensed practical nurses and registered nurses who provide nursing services and are involved in direct patient care.

Are there nurses who are excluded from the law?

Nurse anesthetists are excluded.


Nurse managers are included with respect to their direct patient care but not regarding their 24-hour management of a unit, area or service.

Check out this requirement:

Any nurse who works 12 or more consecutive hours must be provided with at least eight consecutive off-duty time immediately following the end of the shift.


Except for in specific instances, nurses cannot work more than 16 hours in a 24 hour period. When an on-call nurse has actually worked 16 hours in a hospital, then the hospital must make efforts to find a replacement nurse.

  • Employers must provide 8 hours of rest after a shift of 12+ hours
  • Maximum shift of 16 hours per 24 hours
  • Hospitals must find replacement nurse when an on-call nurse has worked 16 hours

Exceptions to the Mandatory Overtime Restriction

Did you know?

Nurses can be scheduled for over 16 hours of duty or required to stay for mandatory overtime in an unforeseen emergent situation.

This means a situation that is unusual, unpredictable or unforeseen. It can include an act of terrorism, a disease outbreak, adverse weather conditions, or natural disasters.

  • Act of terrorism
  • Disease outbreak
  • Adverse weather conditions
  • Natural disasters


It does not include any situation in which the hospital had a reasonable knowledge of an increase in patients or of decreased staffing.

On-call nurses can also be required to work more than 16 hours in a 24 hour period and to work overtime. However, as stated above, when an on-call nurse has worked 16 hours in a 24 hour period, then hospitals must make efforts to find a replacement nurse.

This is important:

Employers cannot use on-call nurses as a substitute for mandatory overtime.

When a nurse is involved in single-patient care procedure already in process, then they can be required to work mandatory overtime to complete the procedure. In this situation, a nurse can be required to work over 16 hours in a 24 hour period.

That does not mean that

Hospital employers can use a staffing pattern that uses this exception as a means to replace mandatory overtime.

In other words,

Employers can’t purposefully schedule nurses for procedures with the intent that the procedure will force them to stay longer than their scheduled shift.

What happens if a Union agreement addresses overtime?

Let’s look at what happens when a hospital has a collective bargaining agreement with the nurses that incorporates a procedure for the hospital to require overtime. In this instance, the agreement can allow for over 16 hours of work in a 24- hour period.

Did you know?

The law allows voluntary overtime. If a nurse volunteers to work overtime then the 16 maximum consecutive hours rule does not apply.

  • Emergency situations that are unforeseeable
  • On-call nurses
  • An ongoing patient procedure is in progress
  • Union agreement substitutes processes and instances when hospitals can require overtime
  • Voluntary overtime is allowed

Hospitals must provide an anonymous way for nurses and patients to make staffing complaints related to patient safety.

Hospitals must also post notices, in a conspicuous place, regarding the law.

Employers who violate the law will be issued a reprimand. At the second violation, the employer can be fined up to $500. Any further violations require a minimum of a $2500 fine, which can go up to $5,000.

Check out this section for a comprehensive guide of steps managers can take to avoid mandatory overtime in a pinch.


West Virginia Labor Law

Employer Alternatives to Using Mandatory Overtime

Many healthcare employers struggle to maintain enough nursing staff. There are many reasons why this occurs. In some cases, rural locations simply do not have enough qualified candidates.

Other employers struggle due to budget constraints.

Still, others struggle with unexpected absences due to sickness or physical injury.

But, there are things employers can do to minimize nursing shortages

The following sections provide options for employers. Employers in states that restrict mandatory overtime, as well as other states, face penalties, legal action and reputation risks that arise from nurse fatigue. These employers have local and federal labor laws with individual requirements.

Strategies Against Shift Vacancies

Sick leave is one major reason that employers use mandatory overtime.

Employers can offer a program that buys back unused sick days at the end of the year.

This encourages nurses to only use sick days when actually needed.

Check out your nursing staff for this:

Anticipate medical needs of older nurses. According to the 2008 National Sample Survey of Registered Nurses, the overall average age of a nurse is 50.

This means that employers should anticipate the additional medical needs of nursing staff, as well as looming retirement.

Needs should be anticipated for nurses who are out for 3 months for a knee replacement surgery. Employers should not expect to fill large gaps with short-term measures.

Don’t forget to do this:

Employers can actively try to keep all vacancies filled. This reduces the burden of staffing needs on nurses. It also ensures that fewer gaps because the shift-load is spread among the right number of nurses.

  • Consider PTO buy back programs to discourage false sick time absences
  • Anticipate the physical needs of older nursing staff when juggling nursing schedules
  • Quickly fill nurse vacancies

Volunteer Overtime List

Did you know?

Employers can collect a list of nurses willing to work overtime or to take on extra shifts.

Create a volunteer list and a nurse availability list.

This list can include a list of nurses who are generally able and willing to take overtime shifts. A nurse availability list is available for nurses who want to take on an extra half or full shift during the week.


Nurses can sign up for the times they would be available to take extra shifts.

Create additional nurse lists of per diem nurses, on-call nurse schedules, and agency nurses that can be called on in an emergency.

If you are using on-call nurses, be sure to check your specific state as some of the mandatory overtime restrictions also have guidelines for on-call nurses.

Don’t forget!

Employers should also compile a checklist of information that should be checked before scheduling nurses for overtime.

Employers should check for any nurses who are on a partial leave program such as FMLA that may be restricted from working overtime or above a certain number of hours. They should also check for nurses who are scheduled for less than 40 hours.


Managers can check for nurse availability based on the day of the week, or shift. They should check for skill level required for the shift against nurse certifications and skill level.   

Employers can also check for available nurses against those who have had fewer hours of rest since the closing of their last shift. This helps to ensure that fatigued nurses aren’t the first called to fill for a vacancy.

  • Look for nurses who are scheduled for less than 40 hours
  • Make sure nurses aren’t scheduled above any FMLA or other intermittent leave allows
  • Check for nurse availability based on schedule or day of the week
  • Check nurse skill level against the skill level needed for the shift
  • Verify that nurses who have had adequate rest time since their last shift are the first ones called for overtime needs

Volunteer lists and the matrix of skills and availability can be handled inside of an excel spreadsheet.

However, healthcare providers using TimeSimplicity can automatically maintain volunteer lists. The scheduling software checks for skill level, availability, education and other criteria the employer must check.

It also checks for available employees who are not working an alternative schedule based on intermittent FMLA leave. It will check for nurses that have not reached overtime thresholds.


SwipeClock’s employee self-service portal allows employees to update availability daily. This makes it much easier for managers to quickly see who is available for a vacant shift.  

Other Options for Healthcare Employers that Don’t Include Overtime

Check out these alternatives

Healthcare employers have other alternatives to both mandatory overtime and voluntary overtime. These options include the use of per diem nurses, part-time nurses, on-call nurses, and agency nurses.


Some states have restrictions on the employer’s ability to use on-call nurses for scheduling shortages. Other employers are restricted from the use of agency nurses by union contracts.

That’s why it is important to have more than just one or two options to fill nurse vacancies.

  • Per diem nurses
  • Call in part-time nurses
  • On-call nurses
  • Agency nurses

The Importance of Documentation When Using Nurse Overtime Cannot be Overstated

Did you know?

Most employers lose litigation because of lack of documentation. Unlike the criminal court system, employers are not considered innocent until proven guilty.

When an employer is taken to court the employer is assumed to be guilty unless sufficient documentation exists to prove the employer’s compliance. This is the case in both private litigations or by a prosecutor for employment law violations.  

But, there’s a problem.

Many employers do not have a system in place that automatically tracks and retains the required information. Manual time cards and payroll make it easy for mistakes to occur. It also makes it easy for information to be misplaced or lost.

There is a solution.

SwipeClock healthcare HR tools automatically track employee information, schedules, actual hours worked. It tracks pay information, employee information and other payroll information.

This means that employers are prepared to defend themselves in court. Managers can make notes about schedule changes and the steps taken to avoid overtime.

That’s not all. . .

Schedule changes can be electronically published. This means that employees are immediately notified of changes. Employees can more easily check and plan for schedule changes.

WFM notifies nurses of schedule changes immediately compliance

Be aware:

In some states, hospitals are required to maintain a nurse staffing plan. While this can be done manually, it is much easier with scheduling software. SwipeClock’s TimeSimplicity will provide analytics and HR data that provides the data for a nurse scheduling plan.

Employee Information to Track

  • The employee’s name
  • Job title
  • The name of their work area
  • Date overtime was worked, including start time
  • The number of mandated overtime hours
  • The employee’s work schedule for the week overtime was required
  • The reason that overtime was necessary
  • A description of all reasonable efforts made to avoid mandatory overtime
    • The names of all employees contacted for voluntary overtime
    • A description of all efforts to secure per diem staff
    • A list of temporary agencies contacted
    • The signature of the individual who authorized mandatory overtime

Employers using SwipeClock HR software can automatically this information. 

We hope this guide will help you overcome healthcare HR challenges. Talk to a SwipeClock partner for more information about our innovation healthcare HR solutions.

By Liz Strikwerda, Cary Snowden, and Annemaria Duran

Last update September 20, 2019

Simplify HR management today.

Simplify HR management today.

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