Overtime Pay for Nurses & Healthcare Workers (2026): 8/80 Rule, On-Call & Mandatory OT

The Short Answer

Most hospital and nursing home employees are non-exempt under the FLSA and are entitled to overtime pay. But healthcare has one unique wrinkle: under 29 U.S.C. § 207(j) — the "8/80 rule" — hospitals and residential care facilities can use a 14-day work period instead of the standard 7-day workweek, paying overtime for hours over 8 in a day or 80 in the 14-day period (whichever is greater). Everything else — on-call time, sleep time, mandatory overtime — is layered on top of that framework and varies by state.

This 2026 guide walks through every rule that affects a nurse's paycheck, from the regular rate formula to state mandatory-overtime bans.

Who Counts as a "Healthcare Worker" Under the FLSA

The FLSA doesn't have a single "healthcare" carve-out. What matters is:

• . Your employer's classification — is it a hospital or "establishment primarily engaged in the care of the sick, aged, or mentally ill"? If yes, the 8/80 election under § 207(j) becomes available.
• . Your exemption status — RNs paid on a salary basis at $684+/week *may* qualify for the professional exemption (29 CFR § 541.301). LPNs, CNAs, MAs, and hourly-paid RNs are almost always non-exempt and owed overtime.
• . Your pay method — hourly, salaried non-exempt, per-shift, or per-visit each affect the regular rate calculation.

Nurse practitioners and physicians are typically exempt learned professionals. Staff RNs paid hourly are not exempt — the DOL is explicit on this point in 29 CFR § 541.301(e)(2).

The 8/80 Overtime Rule — 29 U.S.C. § 207(j)

Under the default FLSA rule, overtime = hours over 40 in a 7-day workweek. Section 207(j) lets a qualifying healthcare employer choose a 14-day work period instead, with two overtime triggers:

• Daily trigger: more than 8 hours in one day, or
• Period trigger: more than 80 hours in the 14-day period

Whichever produces the higher overtime pay applies. See DOL Fact Sheet #54.

Conditions the employer must meet

• . There is a prior agreement or understanding with the employee (in writing or via policy) *before* the work is performed.
• . The employer is a hospital or care establishment as defined in § 207(j).
• . Overtime is paid at 1.5× the regular rate for all qualifying hours.

If the 8/80 election is not properly established, overtime defaults back to the standard 40-hour workweek — often producing more overtime, not less.

Worked Example — 12-hour shift nurse

An RN works three 12-hour shifts in week 1 (36 hours) and four 12-hour shifts in week 2 (48 hours). Total for the 14-day period: 84 hours.

• Standard 40-hour workweeks: Week 1 = 0 OT; Week 2 = 8 OT hours.
• 8/80 method: Daily overtime = 4 hours per shift × 7 shifts = 28 hours over 8/day. Period overtime = 84 − 80 = 4 hours. The employer must pay the greater — 28 OT hours.

8/80 usually helps 12-hour shift nurses because the daily trigger fires on every shift.

Regular Rate of Pay for Nurses in 2026

Your OT premium is 0.5× × regular rate × OT hours (on top of straight time). The regular rate must include:

• Shift differentials — night, weekend, evening, charge nurse pay
• Non-discretionary bonuses — sign-on retention, attendance, referral bonuses tied to hours
• On-call pay *if* the on-call time is considered "hours worked" (see below)
• Preceptor / certification pay and specialty premiums (ICU, ER, OR)

Excluded from regular rate under 29 U.S.C. § 207(e): discretionary bonuses, gifts, reimbursements, PTO cash-outs, and premium pay already paid at 1.5×+.

See our full breakdown in Regular Rate of Pay (FLSA 2026) Complete Guide.

On-Call, Sleep Time & Waiting Time for Nurses

Nurses are one of the most common groups affected by on-call rules under 29 CFR §§ 785.14–.23:

• On-call at the hospital: always hours worked.
• On-call from home: hours worked only if restrictions are so tight you can't use the time for your own purposes (short callback windows, geographic limits, high call frequency).
• Sleep time on shifts of 24+ hours: up to 8 hours of scheduled sleep can be excluded only if there is an express agreement and you get at least 5 uninterrupted hours (29 CFR § 785.22). Interruptions to answer calls are compensable.
• Home health & live-in care: special rules under 29 CFR § 552.102 — sleep time and meal periods can be excluded only with a written agreement.

For deeper mechanics see Hours Worked Under the FLSA (2026).

Mandatory Overtime Laws for Nurses (2026)

The FLSA itself does not cap the hours an adult employee can be required to work — but a growing number of states restrict mandatory overtime for nurses:

• California — Cal. Bus. & Prof. Code § 2717: no mandatory OT for RNs except in declared emergencies.
• New York — NY Lab. Law § 167: prohibits mandatory OT for nurses in patient care.
• Pennsylvania — Act 102 of 2008: bans mandatory OT for direct-care healthcare workers.
• Illinois — Nurse Staffing by Patient Acuity Act, 210 ILCS 85/10.10.
• Washington — RCW 49.28.140: no mandatory OT for licensed nurses.
• Texas & Florida — no state cap; only federal FLSA applies.
• Ohio — no direct cap, but ORC § 4113.85 bans retaliation for refusing OT that would compromise patient safety.

Where the state limits mandatory overtime, "voluntary" OT and the 8/80 rule still apply — the cap is on being *forced* to stay, not on being paid extra when you choose to.

Salaried Nurses & Weekly Salary → OT Conversion

A staff RN paid $2,000/week for a scheduled 36-hour workweek who works 44 hours has a regular rate of $2,000 ÷ 44 = $45.45/hr. OT premium for 4 hours (44 − 40) = 4 × $45.45 × 0.5 = $90.91 on top of salary — unless the fluctuating workweek method (29 CFR § 778.114) applies, which has strict conditions.

Common Nurse Overtime Violations in 2026

• . Automatic meal-break deductions when the nurse actually worked through lunch (Kuznyetsov v. West Penn Allegheny Health).
• . Off-the-clock charting at shift change or documentation completed at home.
• . Failure to include shift differentials in the regular rate before computing OT.
• . Improper use of 8/80 without a prior agreement — reverts overtime to the 40-hour standard.
• . Excluding on-call callback minimums from hours worked.

How to Calculate Your Own Hospital Overtime

Use the free overtime pay calculator — set the workweek length to 40 hours for a standard employer, or compute per shift and per period separately if your hospital uses 8/80. State-specific daily overtime (California 8-hour rule) is baked in.

Sources & Further Reading

• 29 U.S.C. § 207(j) — hospital/care 14-day work period
• 29 CFR §§ 785.14–.23 — on-call, sleep time
• DOL Fact Sheet #54
• 29 CFR § 541.301 — learned professional exemption

*Last reviewed July 14, 2026.*