Nursing overtime rules. what you're owed

Federal overtime law. The FLSA basics

The Fair Labor Standards Act (FLSA) is the federal law that governs overtime pay. Under the FLSA, non-exempt employees must get overtime pay of at least 1.5 times their regular hourly rate for any hours over 40 in a workweek. For nurses:

• CNAs are always non-exempt: CNAs are non-exempt under the FLSA. You must get overtime pay for hours over 40 a week.
• LPNs are generally non-exempt: LPNs are typically non-exempt and entitled to overtime. Some states or employers try to classify LPNs differently. That's often incorrect.
• RNs may be exempt or non-exempt: Hourly RNs are non-exempt and get overtime. Salaried RNs in certain management roles (like a Director of Nursing) may be exempt. The test is whether you use independent judgment and discretion in your primary duties.

How to calculate overtime pay

The math is simple in the basic case. It gets messier when shift differentials are in the mix:

• Basic calculation: Regular rate × 1.5 = OT rate. A CNA earning $18/hr makes $27/hr for overtime hours.
• With shift differentials: Your OT rate has to be based on the actual rate you earned that week, including differentials. If you earned $18/hr base plus $3/hr night differential, your regular rate for that week is a blended one, and your OT rate has to reflect that blended rate, not just the base.
• Annual impact: Even 4 hours of overtime a week at $27/hr (CNA OT rate) adds about $5,616 a year. At 8 hours of OT a week, you're at $11,232.

Mandatory overtime. State-by-state rules

Mandatory overtime is when your employer requires you to work beyond your scheduled shift. It's one of the most contentious issues in nursing. Federal law doesn't ban it, but many states have their own restrictions:

• States that ban or restrict mandatory OT for nurses: Alaska, California, Connecticut, Illinois, Maine, Maryland, Massachusetts, Minnesota, Missouri, New Hampshire, New Jersey, New York, Oregon, Pennsylvania, Rhode Island, Texas, Washington, and West Virginia (as of 2026)
• Common exceptions: Most state bans carve out exceptions for declared emergencies, natural disasters, and situations where patient safety would be at risk if a nurse left
• Penalty for refusal: In states without mandatory OT protections, refusing overtime can be grounds for discipline or termination. Many states do protect nurses from retaliation for refusing unsafe overtime.

Check your state's nursing board website or department of labor for the rules that apply to you. State laws change often, so verify the current regulations.

Double-time pay

Double-time (2× your regular rate) isn't required by federal law, but some states and facilities offer it:

• California: State law requires double-time for hours worked over 12 in a single day
• Holidays: A lot of facilities voluntarily offer double-time for major holidays (Christmas, Thanksgiving, New Year's Day)
• Union contracts: Unionized facilities often have double-time provisions in their collective bargaining agreements for excessive overtime or specific situations
• Critical staffing bonuses: During severe shortages, some facilities offer double-time or "crisis pay" to get extra shifts covered

Common overtime violations

Overtime violations in healthcare are common. Watch for these red flags:

• Automatic clock-out deductions: Some facilities automatically deduct 30 minutes for lunch even if you worked through your break. If you didn't take a break, those minutes should be paid, and they may count toward overtime.
• Off-the-clock work: Being asked to clock out but keep charting, attend a meeting, or finish training is illegal. All work time has to be paid.
• Rounding violations: Time rounding (to the nearest 5 or 15 minutes) is legal, but it has to be neutral over time. If the rounding consistently shorts employees, it's a violation.
• Misclassification: Classifying hourly nurses as "exempt" salaried employees to dodge overtime. Unless you're in a real management role with hiring/firing authority, you're likely non-exempt.
• Averaging hours across weeks: Under standard FLSA rules, overtime is calculated per workweek. An employer can't average 50 hours one week and 30 the next to claim you averaged 40. (The 8/80 exception is the only legal alternative.)

How to report violations

If you believe your employer is violating overtime laws:

1. Document everything: Keep your own records of hours worked, including start times, end times, and breaks. Screenshots of your timecard or schedule can be useful evidence.
2. Raise it internally first: Talk to your supervisor or HR. Some violations are errors, not intent, and can be fixed quickly.
3. File a complaint with your state labor department: If internal resolution doesn't work, your state's department of labor investigates wage and hour complaints at no cost to you.
4. File with the U.S. Department of Labor: You can file a complaint with the DOL's Wage and Hour Division online, by phone, or in person. They investigate FLSA violations and can recover back wages.
5. Know your protections: The FLSA prohibits retaliation against employees who file complaints. If you're disciplined or fired for reporting a violation, that's a separate legal violation on its own.