Mandatory Overtime: Summary of State Approaches

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  • Alaska is the latest state to pass mandatary overtime restrictions for nurses in health care settings.


  • Texas passed mandatary overtime restrictions for nurses in health care settings. Texas included mandaory overtime prohibition language in their staffing law.


  • In Pennsylvania, the "Prohibition of Excessive Overtime in Health Care" Act (HB 834) was signed into law in October. The new law states that a healthcare facility may not require an employee to work in excess of an agreed to, predetermined and regularly scheduled daily work shift unless there is an unforeseeable declared national, State or municipal emergency or a catastrophic event which is unpredictable or unavoidable and which substantially affects or increases the need for healthcare services. This is not to be construed as preventing an employee from voluntarily accepting work in excess of the predetermined scheduled hours. The prohibition applies to those personnel providing direct clinical care services in any healthcare facility other than an office based practice or a facility operated by a religious organization in which the care provided is solely based upon prayer. It does not apply to those care givers who are compensated for "on call" time. Refusal of an employee to accept work in excess of the limitations set forth in the law shall not be subjected to discrimination, dismissal, discharge or any other employment decision adverse to the employee. The regulatory department may levy an administrative fine on a healthcare facility or employer that violates this act or any regulation issued under this act. The fine shall be not less than $100 nor greater than $1,000 for each violation.

  • New York enacted legislation that prohibits a healthcare employer (excluding home care) from requiring a nurse to work more than their regularly scheduled hours, except during a healthcare disaster, natural or other that increases the need for healthcare personnel unexpectedly, affecting the county in which the nurse is employed or in a contiguous county; or where a healthcare employer determines there is an emergency and has made a good faith effort to have overtime covered on a voluntary basis including, but not limited to calling per diems, agency nurses, assigning floats or requesting an additional day of work from off duty employees. Another exception includes an ongoing medical or surgical procedure in which the nurse is actively engaged and whose continued presence through completion is essential to the health and safety of the patient. Nothing in the law shall prohibit a nurse from voluntarily working overtime. Refusal to work beyond the regularly scheduled hours shall not constitute patient abandonment or neglect.


  • Minnesota legislation extends protections to nurses deemed to be employees of the state, although it does not apply to nurses employed by the state at a facility operated by the Department of Corrections. The law describes "normal work period" as meaning 12 or fewer consecutive hours consistent with predetermined work shift with mandating of hours excluding an emergency. The definition of emergency refers to a period when replacement staff are not able to report for duty for the next shift or increase patient need, because of unusual, unpredictable, or unforeseen circumstances such as, but not limited to, an act of terrorism, a disease outbreak, adverse weather conditions, or natural disasters which impact the continuity of patient care.

  • New Hampshire legislation, effective January, 2008 prohibits an employer from disciplining or removing any right, benefit, or privilege of a registered nurse, licensed practical nurse or licensed nursing assistant for refusing to work more than 12 consecutive hours, except under specific circumstances. Those circumstances include: a nurse participating in surgery, until the surgery is completed; a nurse working in a critical care unit, until another employee beginning a scheduled work shift relieves him or her; a nurse working in a home healthcare setting, until another qualified nurse or customary caregiver relieves him or her; a public health emergency; or a nurse covered by a collective bargaining agreement containing provisions addressing the issue of mandatory overtime. A nurse may be disciplined for refusing mandatory overtime in a case when overtime is required as mentioned previously. Any nurse who is mandated to work more than 12 consecutive hours, as “permitted”, shall be allowed at least 8 consecutive hours of off-duty time immediately following the worked overtime. Employers shall be exempted from the provisions of the law if there is a written agreement between the employer and employee, made without coercion or pressure, and provided the agreement is submitted to the commissioner of the department of labor. The agreement may be terminated by the employee by written notice to the employer and the commissioner of the department of labor. Said termination shall be effective 14 days after notice is provided.

  • Effective March 2008, no healthcare facility in Rhode Island shall require an employee to work in excess of the agreed to, pre-determined work shift, and never shall the shift exceed 12 hours. Prohibition of mandatory overtime does not apply in instances of a "bona fide" emergency such as a declared disaster or catastrophic event nor may it be used to fill vacancies from chronic short staffing. It is expected that the employer has exhausted reasonable efforts to avoid use of overtime and gives the employee at least one hour to make personal arrangements (child care etc). Employees are protected from disciplinary actions/ retribution for refusing to work overtime and monetary penalties can result from employers failure to adhere to the law.

  • West Virginia, having already secured mandatory overtime protections in 2004, passed new legislation, the "Nurse Overtime and Patient Safety Act", amending the Code of WV. The 2007 amendment reduces the maximum hours a nurse may be required to work and includes certified registered nurse anesthetists in the definition of nurse, while adding a definition of unforeseen emergent situation. No nurse shall work more than 16 hours in 24 hours and any shift of 12 or more hours requires at least 8 consecutive hours off before working again. The amended language also prohibits a hospital from taking actions against a nurse who refuses and requires posting of the nurses rights. Additionally, hospitals are required to have a process for complaints related to patient safety.


  • Although not legislated, Missouri has regulations found in Chapter 20 – Hospitals, requiring polices developed regarding the use of overtime, stating, "Overtime shall not be mandated for any licensed nursing personnel except when an unexpected nurse staffing shortage arises that involves a substantial risk to patient safety, in which a reasonable effort must be applied to secure safe staffing before requiring the on-duty licensed nursing personnel to work overtime." Reasonable efforts are defined.


  • Legislation to prohibit mandatory overtime was enacted in Illinois and Oregon law was amended. The Illinois Nurses Association was instrumental in the enactment of legislation in IL that allows hospitals to mandate a nurse to work overtime only in unforeseen emergent circumstances. Even if they must do so, no nurse may work more than 4 hours beyond her/his regularly scheduled work shift. A nurse may not be punished for refusing to work overtime, and if a nurse works 12 hours there must be an 8 hour rest period before working again. The Oregon Nurses Association promoted the amendment of an OR mandatory overtime law (enacted in 2001) by prohibiting a hospital from requiring a nurse to work more than 48 hours in a week or more than 12 consecutive hours in a 24-hour period. There are a few specific exceptions to the limits on mandatory overtime. Nothing in the bill prevents voluntary overtime.


  • West Virginia enacted legislation prohibiting a hospital from mandating a nurse to accept an assignment of overtime. The commissioner of labor is charged with the enforcement of the law and shall administer a penalty for any violations.

  • Connecticut enacted legislation prohibits a hospital from requiring a nurse to work in excess of a predetermined scheduled work shift except in certain circumstances such as participating in a surgical procedure until the procedure is completed, public health emergency and similar circumstances.


  • Maryland law states that an employer may not require a nurse to work more than the regularly scheduled hours according the predetermined work schedule. There are some exceptions including an emergency situation that could not be reasonably anticipated and if a nurse has critical skills and expertise that are required for the work.

  • Minnesota law prohibits action against a nurse who refuses mandatory overtime because it would jeopardize patient safety.

  • New Jersey enacted legislation prevents a healthcare facility from requiring an employee to work in excess of an agreed to, predetermined and regularly scheduled daily work shift, not to exceed 40 hours per week.

  • Texas regulations require hospitals to develop policy and procedures for mandatory overtime.

  • Washington's language states that acceptance of mandatory overtime by a nurse is strictly voluntary and refusal is not grounds for adverse actions against the nurse.


  • Legislation enacted in 2001 in Maine would prevent a nurse from being disciplined for refusing to work more than 12 consecutive hours except in certain circumstances and must be given 10 consecutive hours off following overtime.

  • Oregon enacted legislation prevents a nurse from being required to work more than 2 hours beyond a regularly scheduled shift or 16 hours in a 24 hour time period.

  • Regulations adopted in California prior to 2001 prevent an employee scheduled to work a 12 hour shift from working more than 12 hours in a 24 hour period except in a healthcare emergency.

Last updated 3/7/2011

Disclaimer: Every effort has been made to include all legislation enacted, but omissions are possible.

[1] Rogers A, et al. The working hours of hospital staff nurses and patient safety. Health Affairs 2004;23(4):202-12.