Understanding Mandatory Overtime for Nurses: Which States Enforce Mandatory Overtime?

Hospitals and clinics have implemented mandatory overtime policies to help ease nursing staff shortages. While effective at achieving its goal, mandatory overtime for nurses can be detrimental to the quality of patient care and lead to stress and burnout among nurses.

If you are a current or aspiring nurse researching mandatory overtime laws, keep reading for information about mandatory overtime for nurses and its impacts, applicable state laws, and tips on avoiding burnout.

Mandatory overtime laws were established to ensure that workers received compensation for hours that exceeded the standard 40-hour work week. The federal Fair Labor Standards Act (FLSA) requires employees to be paid 1.5 times their regular hourly pay rate for any additional hours worked. States have enacted their own laws but, if the pay rate is lower than the federal standard, the employee is paid according to the federal law.

Federal regulations require Medicare-certified hospitals to ensure that “adequate numbers” of nurses are staffed to provide patient care “as needed.” This vague regulatory language has led to state-enacted legislation regarding nurse staffing levels, including those mandating specific nurse-to-patient ratios. A nationwide nurse shortage has created situations where hospitals and clinics impose mandatory overtime to meet these legislative requirements.

Currently, 18 states have enacted laws or regulations applicable to nurses that either prohibit or limit mandatory overtime 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.

While mandatory overtime can offer a solution to the nursing shortages, it does so with costs that negatively impact nurses and patient care. In some situations, such as temporary staff shortages, mandatory overtime benefits nurses who desire extra working hours and time-and-a-half pay rates, while it can be detrimental to nurses who do not have the ability to accommodate those scheduling demands easily.

However, chronic or ongoing mandatory overtime takes a toll on nurses and, ultimately, their patients. Nurses who work longer than 12-hour shifts on a regular basis or without enough time off between shifts become fatigued, which can lead to mistakes. They also may feel resentful or dejected, which can lead to subpar patient care.

Burnout is a common result for nurses who must work long hours.

Currently, 32 states impose mandatory overtime with the goal of ensuring optimal staffing levels that meet patient care demands:

Healthcare workers in states that have not enacted legislation making mandatory overtime illegal or prohibited can be forced to work overtime. Employers in these states must comply with the FLSA, which designates 40 hours per week as the minimum for full-time employees, not the maximum. But employees who work in excess of 40 hours a week must be compensated with time-and-a-half pay.

In states where mandatory overtime is legal, you can be fired for refusing to work overtime if you are an “at-will” employee and your employer follows the laws and regulations in your state. “At-will” employees can be fired for any reason at any time unless the reason is discriminatory or retaliatory.

But if you work in states with nursing labor laws that address mandatory overtime—such as California, Connecticut, Maine, Maryland, Massachusetts, Minnesota, New Hampshire, New Jersey, New York, Rhode Island, Texas, Washington, and West Virginia—you cannot be fired for refusing to work overtime.

Mandatory overtime for nurses can alleviate nursing shortages and bolster shrinking bank accounts, but it can also have negative effects. Nurses forced to work long hours over extended periods of time suffer from burnout, which leads to emotional, mental, and physical exhaustion. Burnout can also lead to a condition known as “compassion fatigue,” where nurses experience the inability to empathize with their patients.