State Mandatory Overtime Regulations and Newly Licensed Nurses' Mandatory and Voluntary Overtime and Total Work Hours

A nurse checks a newborn's vital signs with a stethoscope

Award Recipient: This article was awarded the 2013 Excellence in Policy award by the Nursing Outlook editorial board.

The Issue:

How states regulate nurses’ work hours does relate to whether nurses work mandatory versus voluntary overtime, as well as the total number of hours worked. But research is needed to determine how these relationships impact nurse and patient outcomes.

Studies have shown that both nurses and patients suffer when nurses are fatigued from working too many hours. By 2010, sixteen states were regulating hospital nurse overtime, either through: rules that set maximum mandatory overtime; or rules that set maximum “total work hours”, whether those hours are base hours, or voluntary or mandatory overtime.

Key Findings:

  • Nurses who work in states that instituted any type of overtime restriction after 2003, or that restricted mandatory overtime, have a lower probability of working mandatory overtime than nurses who work in states without any overtime restrictions.
  • Nurses who work in states that restrict mandatory overtime work fewer total hours per week.
  • Regulations that restrict only mandatory overtime do not have any relationship to the level of voluntary overtime worked by nurses. Voluntary overtime is related to factors such as total work hours, unionization, nurse age and organizational commitment.
  • Nurses who work mandatory overtime are less likely to work voluntary overtime.


While limits on mandatory overtime seem effective in reducing both overtime and total hours worked by nurses, regulations targeting hospital compliance overlook regulating nurses themselves, who can choose to increase their work hours (and fatigue) by working multiple jobs. Additional research is needed to evaluate the relationships between overtime regulations and patient outcomes.

About the Study:

This secondary analysis of data from a study of “newly licensed” registered nurses (NLRNs) examined relationships between overtime regulations, and mandatory and voluntary overtime and “total hours worked.” The sample consisted of 1,706 NLRNs from across the country who worked full-time in a hospital in January 2006.

The RN Work Project

  1. 1. Newly Licensed RNs' Characteristics, Work Attitudes, and Intentions to Work
  2. 2. Addressing the Complexities of Survey Research
  3. 3. A Comparison of Second-Degree Baccalaureate and Traditional-Baccalaureate New Graduate RNs
  4. 4. Understanding New Registered Nurses' Intent to Stay at Their Jobs
  5. 5. The Nursing Career Process from Application Through the First 2 Years of Employment
  6. 6. What Newly Licensed Registered Nurses Have to Say about Their First Experiences
  7. 7. Moving on, Up, or Out
  8. 8. Generational Differences Among Newly Licensed Registered Nurses
  9. 9. New Nurses Views of Quality Improvement Education
  10. 10. Newly Licensed RNs Describe What They Like Best about Being a Nurse
  11. 11. Early Career RNs' Perceptions of Quality Care in the Hospital Setting
  12. 12. Commuting to Work
  13. 13. State Mandatory Overtime Regulations and Newly Licensed Nurses' Mandatory and Voluntary Overtime and Total Work Hours
  14. 14. Work Environment Factors Other Than Staffing Associated with Nurses' Ratings of Patient Care Quality
  15. 15. The Relative Geographic Immobility of New Registered Nurses Calls for New Strategies to Augment that Workforce
  16. 16. Predictors of Actual Turnover in a National Sample of Newly Licensed Registered Nurses Employed in Hospitals
  17. 17. Charting the Course for Nurses' Achievement of Higher Education Levels
  18. 18. Verbal Abuse From Nurse Colleagues and Work Environment of Early Career Registered Nurses
  19. 19. Early-Career Registered Nurses' Participation in Hospital Quality Improvement Activities
  20. 20. Positive Work Environments of Early-Career Registered Nurses and the Correlation with Physician Verbal Abuse