Overtime Pay for RNs, LPNs/LVNs, Dental Assistants, Sleep Techs, PAs, NPs, and similar Medical / Healthcare Workers

The general rule under federal overtime labor law is that all non-exempt employees must receive time and one-half the regular rate of pay after 40 hours of work in a 7-day workweek. With regard to certain healthcare workers employed by a hospital, nursing home, or certain other residential facilities, a system referred to as 8 and 80 may also be used for determining overtime pay.

Who is Exempt in the Healthcare Industry?

The primary issue for healthcare and medical workers is determining if their particular job is or is not exempt from the overtime pay rules. If “exempt”, the job is not one that must be paid overtime. If “non-exempt”, the job is one that must be paid overtime wages. An employee is exempt only if the employee meets ALL of the requirements of a specific exemption. The professional exemption is the focus of most cases involving healthcare workers. Merely paying an employee on a per visit or salary basis does not make them exempt from overtime pay – while pay is a factor, it is not the only requirement that must be met.

Is a Registered Nurse (RN) Overtime Exempt?

RNs, depending on their job duties and how they are paid, may be exempt or non-exempt. If an RN is paid a salary, supervises at least 2 employees and can hire and fire, they may meet the requirements for the executive exemption.

If an RN is performing professional nursing duties and is paid on either a salary basis or a fee basis, they may meet the requirements for the professional exemption.

However, if an RN is paid on an hourly basis, they will almost always be considered non-exempt and thus entitled to overtime pay.

Is a Licensed Practical Nurse (LPN) & Licensed Vocational Nurse (LVN) Overtime Exempt?

Licensed practical nurses, licensed vocational nurses and other similar medical workers generally do not qualify as exempt learned professionals, regardless of work experience and training, because having a specialized advanced academic degree is not a standard prerequisite for entry into such occupations.

In other words, even though they may be highly trained and experienced, they do not meet the formal educational requirements for the professional exemption. While it is possible for them to fall under another exemption, they are typically entitled to overtime pay, even if they are paid on a per visit or a salary basis.

Are Nurse Practitioners Overtime Exempt?

Courts have repeatedly held that nurse practitioners are not exempt as “medical professionals” and are entitled to overtime pay, particularly where they are being paid hourly instead of on a salary basis. This has also been the position of the U.S. Department of Labor, as stated in an opinion letter that concluded that nurse practitioners do not “practice medicine” as the Fair Labor Standards Act understands that term.

Are Utilization Management Nurses and Utilization Review Nurses Exempt from Overtime?

In many cases, the answer is NO, meaning Utilization Review Nurses should be paid overtime, even if they are paid on a salary basis.

Utilization Management Nurses and Utilization Review Nurses (aka Medical Management Nurses, Nurse Reviewers, Care Management Nurse, or similar job titles), working for insurance companies or service providers to insurance companies, are commonly misclassified as exempt from the overtime pay laws and paid a set salary with no overtime premium.

Nurse Reviewers have been found to be non-exempt and entitled to overtime pay by several courts. The proper classification of Utilization Review Nurses as non-exempt does not focus solely on their licensing and qualifications, but rather on the “standardized” and structured type of “production” work they perform.  Even where an RN license is required, if the duties performed mainly involve reviewing authorization requests and applying pre-determined guidelines and criteria to determine if the requested benefit, procedure, treatment, equipment, etc. should be covered by insurance, neither the exemption requirement for consistent exercise of independent judgment and discretion or administrative management/business operation are met.

Are Dental Hygienists Overtime Exempt?

Dental hygienists are entitled to overtime pay unless they have successfully completed 4 academic years of pre-professional and professional study in an accredited college or university approved by the Commission on Accreditation of Dental and Dental Auxiliary Educational Programs of the American Dental Association.

Are Sleep Techs & Medical Technologists Overtime Exempt?

Unless they have successfully completed 3 academic years of pre-professional study in an accredited college or university plus a 4th year of professional course work in a school of medical technology approved by the Council of Medical Education of the American Medical Association, Sleep Techs, Lab Technicians and registered or certified medical technologists will generally NOT meet the duties requirements for the learned professional exemption.

Are Physical or Occupational Therapy Assistants Overtime Exempt?

Therapy assistants do not meet the educational requirements necessary for the professional exemption. Therefore, physical therapy assistants and certified occupational therapy assistants are usually entitled to overtime pay.

Are Physician Assistants (PA) Overtime Exempt?

Physician assistants who have successfully completed 4 academic years of pre-professional and professional study, including graduation from a physician assistant program accredited by the Accreditation Review Commission on Education for the Physician Assistant, and who are certified by the National Commission on Certification of Physician Assistants generally meet the duties requirements for the learned professional exemption and are not required to be paid overtime.

Common Overtime Pay Violations in the Healthcare World

Overtime pay violations commonly occur when healthcare employers:

  • Pay a salary to non-exempt employees, but do not pay overtime – misclassification as exempt employees.
  • Fail to pay overtime after 8 hours of work in a day for workers (both full time and part time) who are under the “8 and 80” system.
  • Pay overtime after 80 hours worked during a biweekly period rather than after 40 hours in a workweek to employees NOT under the “8 and 80” system (see below*).
  • Fail to combine hours worked in more than one department or at more than one facility when determining the total overtime hours worked.
  • Fail to include the time spent or hours worked during meal breaks or while attending staff meetings and compensable training sessions or performing on-call assignments.
  • Automatically deduct time from employees’ time for meal breaks even when they worked through those breaks.
  • Alter time records and/or pressure workers to work “off the clock” and not record overtime
  • Fail to include shift differential, bonuses or on-call fees in calculating an employee’s regular rate.

Recent Case Example: Over 250 healthcare workers recovered back overtime wages where a large employer in long-term care and rehabilitation violated the Fair Labor Standards Act by failing to include earned sign-on bonuses, retention bonuses and bonuses for working extra shifts in the calculation of overtime pay. By not including bonuses in the overtime calculation, workers were paid overtime at rates lower than what is required by federal law.

Healthcare workers should not rely on their supervisor or Human Resources for critical information regarding the laws on overtime pay and how such apply to their specific job.

*8 and 80 Overtime Exception: Hospitals and other healthcare facilities may elect to use the Eight and Eighty Overtime system for paying overtime. Under this system, an employee must be paid time and a half pay for any hours worked over 8 in a workday and 80 in a 14-day period.  For further details, see this page.

Have You Been Unfairly Classified as Exempt?

Because of the strict time limits imposed by overtime pay laws, procrastination can be costly. If you have any doubts as to your entitlement, contact the experts at The Lore Law Firm for a free and confidential review.

Call 1-866-559-0400 or submit your information using our convenient Case Evaluation form for a FREE and CONFIDENTIAL review of your circumstances – because time is money.