Do Nurses Get Paid Overtime? Rates, Rules, and Your Rights

Yes, most nurses get paid overtime. Under federal law, nurses who aren’t exempt earn at least one and one-half times their regular rate of pay for every hour worked beyond 40 in a workweek.¹ Whether you personally qualify depends on how you’re paid, what kind of nurse you are, and whether your hospital uses a standard weekly pay period or a special 14-day system the Fair Labor Standards Act allows for healthcare employers.

Which Nurses Qualify for Overtime

The FLSA assumes every employee is entitled to overtime unless the employer can fit them into a specific exemption. For nurses, that exemption is the “learned professional” category, and it has two parts: a salary test and a duties test.²

The salary test is the easier one to apply. To be exempt, a nurse must receive a fixed, predetermined salary of at least $684 per week ($35,568 annually) that doesn’t fluctuate based on hours worked or work quality. A federal court vacated a 2024 Department of Labor rule that would have raised this figure, so the 2019 threshold still controls.³

Here is the rule that decides most nurses’ status in one line: any nurse paid on an hourly basis is non-exempt and entitled to overtime, regardless of education, experience, or job responsibilities. Hourly pay fails the salary test by definition.²

The duties test then asks whether the job requires advanced knowledge in a field of science or learning, acquired through prolonged specialized academic instruction, and calls for consistent independent judgment.⁴ Where different types of nurses land:

Registered Nurses (RNs) generally satisfy the duties test because becoming an RN requires a specialized academic degree and licensing exam. In practice, though, most RNs are paid hourly, so they remain overtime-eligible.²
Licensed Practical Nurses (LPNs) and Certified Nursing Assistants (CNAs) almost never qualify as exempt. Their roles don’t require a specialized advanced academic degree, so they fail the duties test and are entitled to time-and-a-half for all hours over 40.²
Advanced Practice Registered Nurses, including nurse practitioners, certified nurse-midwives, and certified registered nurse anesthetists, easily clear the duties test. Some may fall under a separate “practice of medicine” exemption that has no salary threshold at all. Whether they actually end up exempt depends on their pay structure.⁵

When Overtime Kicks In

For most workplaces, the trigger is simple: hours over 40 in a fixed, recurring workweek of 168 hours. Federal law does not require overtime for working more than eight hours in a single day. If you pull a 12-hour shift but your weekly total stays at or under 40, the FLSA doesn’t require premium pay for those long hours.⁶

The Hospital 8-and-80 System

Hospitals and residential care facilities have an alternative available under Section 207(j) of the FLSA. If the employer and employee agree in advance, the employer can use a fixed 14-day work period instead of the standard workweek.¹ Under this “8-and-80” system, overtime pay is required for any hours over eight in a single day and any hours over 80 across the 14-day period.⁷

This changes the math for long shifts. Three 12-hour shifts in a week come to 36 hours, which triggers no overtime under the standard 40-hour rule. Under 8-and-80, those same shifts generate 12 hours of daily overtime (four extra hours per shift, three shifts). On the other hand, 8-and-80 lets an employer spread hours unevenly, such as 48 one week and 32 the next, without owing weekly overtime.

Two things to check if your hospital uses this system. First, you should have agreed to it before the pay period started; an employer can’t impose it retroactively. Second, the 14-day period has to be genuinely fixed and recurring, not shifted around to avoid paying overtime.⁷

Daily Overtime in Some States

A small number of states require overtime pay when a single shift exceeds a set number of hours, regardless of weekly totals. The most common daily threshold is eight hours, though at least one state sets it at 12, and one requires double-time pay after 12 hours in a single day. Those extra hours count toward both daily and weekly overtime, but employers don’t pay twice for the same hour.

What Your Overtime Rate Should Include

The overtime premium is calculated from your “regular rate,” which isn’t always the same as your base hourly wage. The regular rate equals total compensation for the workweek divided by total hours actually worked.⁸ Several common nurse-pay items get folded in before the multiplier is applied.

Shift differentials, hazard pay, and non-discretionary bonuses must all be included in the regular rate.⁹ A non-discretionary bonus is any bonus you expect to receive, such as a promised payment for picking up extra shifts or hitting attendance targets. If you earn a $2/hour night differential, that raises your regular rate for the week, which raises your overtime rate.

Truly discretionary bonuses, gifts, vacation and holiday pay, employer contributions to retirement or insurance plans, and reimbursed expenses are excluded.⁹ A bonus is only discretionary if the employer has complete control over whether to pay it and how much. Any bonus tied to a metric or promised by policy stops being discretionary and must be included in the calculation.

Hours That Quietly Count Toward Overtime

Some of the biggest overtime disputes involve hours the employer treated as unpaid but should have counted.

On-Call Time

If you’re required to stay on the employer’s premises or close enough that you can’t realistically use the time for yourself, you’re working, and the time counts toward your overtime threshold.¹⁰ If you’re simply carrying a phone or pager and can otherwise live your life, that time generally isn’t compensable, though you must be paid for time actually spent responding to calls.¹¹ Restrictions like unreasonably short response windows, geographic limits, or a no-alcohol rule can push on-call time into compensable territory.

Travel Between Job Sites

Your normal commute isn’t paid. But travel during the workday between job sites, such as driving between patients’ homes or from one facility to another, counts as hours worked and feeds into overtime.¹¹ Home health nurses should track those inter-patient drives carefully; they add up.

Interrupted Meal Breaks

A meal break of 30 minutes or longer can be unpaid only if you’re completely relieved of all duties for the entire break. You don’t have to be allowed to leave the building, but you can’t be responsible for monitoring patients, answering call lights, or staying available for tasks.¹² A nurse who eats at the station while watching monitors, or who gets pulled away mid-meal to help with a patient, has not received a bona fide meal period. If your facility auto-deducts 30 minutes for a break you never actually get, those deductions are shaving compensable hours off your paycheck every shift.

Can Your Employer Force You to Work Overtime?

The FLSA governs pay, not scheduling. It does not cap how many hours an employer can require you to work. But more than a dozen states have stepped in with laws restricting or banning mandatory overtime for nurses in healthcare settings.

The typical state restriction prohibits requiring a nurse to work beyond a pre-scheduled shift or agreed weekly hours. Many set a hard cap, commonly 12 consecutive hours, and require a mandatory rest period (frequently at least 10 consecutive hours off) before the nurse can return. Every state with these restrictions carves out emergency exceptions, such as mass casualty events, declared emergencies, or situations where leaving mid-procedure would put a patient at immediate risk.

Most of these laws also include anti-retaliation provisions, so an employer generally cannot fire or discipline a nurse for refusing overtime that doesn’t fall within an emergency exception. Check your own state’s rule for the specific trigger and the exact rest-period requirement, since the details vary.

If You Weren’t Paid the Overtime You Earned

If your employer shorted your overtime, whether by misclassifying you as exempt, leaving shift differentials out of the regular rate, or auto-deducting meal breaks you didn’t actually take, you can recover the unpaid amount plus an equal amount in liquidated damages. That effectively doubles what you were owed.¹³

The filing deadline is two years from the date the unpaid wages were due, or three years if the violation was willful (the employer knew its pay practices violated the law or showed reckless disregard).¹⁴ Some state laws allow claims reaching back further, up to six or even ten years.

You can file a confidential complaint with the Department of Labor’s Wage and Hour Division at 1-866-487-9243, or bring a private lawsuit in federal or state court, individually or on behalf of similarly situated coworkers.¹⁵

Federal law also protects you from retaliation for raising overtime concerns. Your employer can’t fire, demote, cut your hours, or otherwise punish you for filing a DOL complaint, complaining internally to a supervisor, or participating in someone else’s wage investigation.¹⁶ The complaint can be oral or written; no special form is required. If retaliation happens anyway, the remedies mirror the wage claim: reinstatement, back pay, and liquidated damages equal to the lost wages. The protection extends to former employees as well.

1
Office of the Law Revision Counsel. 29 USC 207 – Maximum Hours
2
U.S. Department of Labor. Fact Sheet #17N – Nurses and the Part 541 Exemptions Under the FLSA
3
U.S. Department of Labor. Earnings Thresholds for the Executive, Administrative, and Professional Exemption
4
eCFR. 29 CFR 541.301 – Learned Professionals
5
U.S. Department of Labor. Fact Sheet #17D – Exemption for Professional Employees Under the FLSA
6
eCFR. 29 CFR Part 778 – Overtime Compensation
7
U.S. Department of Labor. Fact Sheet #54 – The Health Care Industry and Calculating Overtime Pay
8
eCFR. 29 CFR 778.109 – The Regular Rate Is an Hourly Rate
9
eCFR. 29 CFR Part 778 Subpart C – Payments That May Be Excluded From the Regular Rate
10
eCFR. 29 CFR 785.17 – On-Call Time
11
U.S. Department of Labor. Fact Sheet #53 – The Health Care Industry and Hours Worked
12
eCFR. 29 CFR 785.19 – Meal
13
Office of the Law Revision Counsel. 29 USC 216 – Penalties
14
Office of the Law Revision Counsel. 29 USC 255 – Statute of Limitations
15
U.S. Department of Labor. How to File a Complaint
16
U.S. Department of Labor. Fact Sheet #77A – Prohibiting Retaliation Under the FLSA