By Mudassir Khan
Most workers earn overtime after 40 hours in a week. Hospital and nursing home workers can be paid under a different system: overtime after 8 hours in a day, or 80 hours in 14 days. Here is how it works and what it costs you.
Rules verified November 2026 · Sources: U.S. Department of Labor
Under FLSA section 7(j), hospitals and residential care establishments may replace the 40 hour workweek with a fixed 14 day period for overtime, by prior agreement. Overtime is then owed for hours over 8 in any workday and over 80 in the period. Long weeks can be offset by short weeks, which employers like.
The FLSA's normal rule counts overtime per workweek: every hour over 40 in the week earns time and a half, and weeks never average together. Section 7(j) creates a narrow exception for hospital and residential care employment. With a prior agreement or understanding, the employer may use a fixed 14 day period instead of the workweek, and pay time and a half for all hours over 8 in any workday within the period and over 80 in the period as a whole.
The practical effect is week averaging, which the FLSA otherwise forbids. A nurse who works 44 hours one week and 36 the next earns 4 hours of overtime under the standard rule, but zero under 8 and 80, as long as no single day exceeds 8 hours and the 14 day total stays at 80. The trade is daily overtime: any day over 8 hours earns the premium even in a short week.
A nurse earning $30 per hour works 44 hours in week one and 36 hours in week two of a 14 day period, with no day over 8 hours. Total: 80 hours.
The 8 and 80 election cost this nurse $60 on this schedule, while giving her daily overtime protection she did not need. Run your own schedule under both systems before deciding the system is neutral.
A nurse earning $40 per hour works seven 12 hour shifts in a 14 day period: 84 total hours.
Without the crediting rule, 4 of those hours would have been counted twice. The regulation forbids that: daily overtime hours count toward the 80 hour obligation first.
The 8 and 80 system is a federal floor, not a ceiling. When a state rule is more generous, the state rule wins for those hours. California nurses get daily overtime after 8 hours and double time after 12 regardless of any 14 day election, which makes the federal system nearly pointless there. Several states also restrict mandatory overtime for nurses, which is a separate protection from how overtime is computed. Always check both layers.
Pay rules on this page follow DOL Fact Sheet 54: The Health Care Industry and Calculating Overtime Pay and the regulation at 29 CFR 778.601.
No. It is optional. An employer can use the standard 40 hour workweek system and the 8 and 80 system for different employees, but never both systems for the same employee. Many nurses work under the standard weekly rule.
It does not have to be in writing, but the agreement must be made before the work is performed. If it is not written, the employer must keep a special record of it, so in practice written agreements are the norm.
No. Hours already paid as daily overtime can be credited toward the 80 hour period overtime, so no hour is paid at the overtime rate twice. Only the shortfall, if any, adds more overtime.
No. It applies only to employees of hospitals and residential care establishments, institutions primarily engaged in the care of the sick, the aged, or the mentally ill who reside on the premises. Other health care employers use the standard 40 hour rule.
Then the employer cannot use the 14 day period. Overtime must be computed on the standard workweek basis, and a prior agreement is one of the most litigated issues in hospital overtime cases, so records matter.
Compare your schedule under both systems with the overtime calculator, and see our California overtime guide if you work there, since state daily rules change the answer entirely.