Standard Overtime in Healthcare: The 40-Hour Rule
For most healthcare workers (except those under an 8-80 agreement), standard FLSA applies: 1.5× after 40 hours per workweek. Three 12-hour shifts = 36 hours — no overtime. A fourth 12-hour shift = 48 hours — 8 overtime hours owed at 1.5×. Many healthcare workers mistakenly believe daily overtime kicks in after 8 or 12 hours — this is only true in California and certain states.
The 8-80 Rule: Hospital Sector Exception
Hospitals and residential care facilities can use an alternative overtime calculation: the 8-80 rule. Under a valid 8-80 agreement: employees earn overtime for hours over 8 in a single day OR hours over 80 in a 14-day period — whichever produces more overtime. This must be agreed upon in a written agreement with the employee BEFORE the work is performed. Without the agreement, standard 40-hour rules apply.
Healthcare overtime: standard 40-hr rule vs. 8-80 rule comparison
| Schedule | Weekly Hours | Standard OT (40-hr) | 8-80 OT (if applicable) |
|---|---|---|---|
| 3 × 12-hr shifts | 36 hours | 0 OT hours | 0 OT hours (under 80/14 days) |
| 4 × 12-hr shifts | 48 hours | 8 OT hours | 4 OT hours (48 − 8 hrs day premium × 4 shifts) |
| 5 × 10-hr shifts | 50 hours | 10 OT hours | 10 OT hours (2/day × 5 days) |
| 3 × 12 + 1 × 8 | 44 hours | 4 OT hours | 3 OT hours (8-80 different calc) |
Travel nurses work through staffing agencies, with complex pay packages including taxable base pay + tax-free stipends. Overtime is calculated based on taxable wages only (not tax-free stipends). A travel nurse at '$50/hr' where $20/hr is a stipend pays overtime on $30/hr — the taxable hourly portion. Understanding this is critical for calculating overtime correctly in travel assignments.
Shift Differentials and Healthcare Overtime
Healthcare shift differentials (night, weekend, charge nurse premium) must be included in the regular rate for overtime calculations. A nurse at $42/hr base + $4/hr night differential = $46/hr effective rate. Overtime rate = $46 × 1.5 = $69/hr for any overtime hours worked during that shift. Employers who calculate overtime only on the base rate without the differential are under-paying overtime.
Calculate Healthcare Worker Overtime Pay
Enter your base rate, shift differential, and weekly hours to find your correct gross overtime pay.