Healthcare is one of California’s largest and most heavily regulated industries, employing hundreds of thousands of workers who often work long, demanding shifts. Hospitals, clinics, and nursing facilities must balance patient care needs with strict labor law requirements. Among the most complex areas for compliance are 12-hour shifts and the use of meal and rest break waivers.

Unlike many industries where an eight-hour day is the norm, healthcare employees often work longer schedules—sometimes voluntarily, sometimes as a matter of staffing necessity. California law allows this flexibility, but only under very specific conditions. Employers who misunderstand the rules risk costly lawsuits and penalties under both the Labor Code and the Private Attorneys General Act (PAGA).

Why Healthcare Is Treated Differently

California’s Industrial Welfare Commission (IWC) Wage Order 5 governs the public housekeeping industry, which includes hospitals, nursing homes, and similar facilities. Recognizing the unique demands of healthcare, Wage Order 5 includes provisions that permit alternative workweek schedules (AWS) and 12-hour shifts—but only if employees and employers follow strict adoption procedures.

For example, a hospital may implement a 12-hour shift model for nurses, giving them three or four longer workdays each week instead of five 8-hour days. This can improve scheduling efficiency and provide employees with more days off. But if the schedule is not properly adopted and documented, those “extra” hours beyond 8 in a day can trigger overtime liability.

Overtime Rules for 12-Hour Shifts

Under standard California rules, employees earn overtime at:

• 1.5 times the regular rate for hours worked over 8 in a day or 40 in a week.
• 2 times the regular rate for hours worked over 12 in a day

Healthcare employees on a valid 12-hour shift agreement may avoid daily overtime for hours 9–12, but double time still applies after 12.

For example, if a nurse works a properly adopted 12-hour shift, hours 9 through 12 can be paid at the regular rate. But if that nurse stays late to cover an emergency and works 13 hours, the 13th hour must be paid at double time.

Meal and Rest Break Waivers

California’s standard rules require a 30-minute unpaid meal break for shifts over 5 hours and a second meal break for shifts over 10 hours. Healthcare employees working long shifts may voluntarily waive one of their meal breaks, provided:

• The shift does not exceed 12 hours, and
• The waiver is mutual between employee and employer, and
• The waiver is in writing.

This means an employee working less than a 12-hour shift can choose to waive their second meal break if they prefer to leave earlier at the end of the day. If that employee works 12 or more hours, the waiver is invalid and the second meal break must be provided.

Differences in Waiver Requirements for Patient Care Providers per Wage Order 5

Under Wage Order 5, however, healthcare employees who provide patient care (e.g., nurses, certified nursing assistants, medical technicians, and others covered under the Wage Order’s definition) may voluntarily waive either their first or second meal period—but never both—when they work more than eight hours in a day.

Importantly, this flexibility extends beyond 12-hour shifts:

• Patient-care employees may still waive either their first or second meal period even when their shifts exceed 12 hours, up to 15 hours worked.
• After 15 hours, a third meal period must be provided, and it cannot be waived.

This distinguishes healthcare workers from employees in other industries, who generally cannot waive a meal period once their shift exceeds 12 hours.

Examples

Here’s how this plays out in practice, assuming the employee has signed a valid written healthcare meal waiver under Wage Order 5:

1. Employee works up to 9 hours and 59 minutes

• Must take the first meal period before the end of the 5th hour.
• Not eligible for a second meal period.
• If no compliant first meal appears in the records, a meal period premium applies.

2. Employee works between 10 hours and 14 hours, 59 minutes

• May take the first meal before the 5th hour and waive the second; or
• May waive the first and take the second before the 10th hour.
• Employers should plan for employees to take the first meal whenever possible to ensure compliance, using flexibility only for patient-care emergencies.

3. Employee works 15 hours or more

• Must take a third meal period before the end of the 15th hour.
• The third meal cannot be waived.

If the time records do not show a compliant first or second meal period—or the third meal period for shifts over 15 hours—a meal period premium must be paid.

Rest Break Requirements

Rest breaks remain mandatory—typically a paid 10-minute break for every four hours worked or major fraction thereof—and cannot be waived.

Employers must ensure that rest periods are duty-free. If an employee must remain on call, carry a pager, or respond to calls during a rest period, that time does not qualify as a compliant break.

The Role of Collective Bargaining

Many healthcare workers in California are unionized, and collective bargaining agreements (CBAs) may establish different rules for overtime and breaks. For example, some CBAs allow modified overtime thresholds or alternative scheduling systems, provided they meet or exceed California’s minimum protections under state law.

This creates a dual compliance challenge: Employers should review CBAs carefully to confirm alignment with both Wage Order 5 and the Labor Code. Failing to honor either can result in grievances, arbitration, or litigation.

Litigation Risks in Healthcare Scheduling

Healthcare employers have been frequent targets of wage and hour lawsuits, especially around break compliance. Courts and the DLSE have consistently emphasized that breaks must be duty-free. If an employee is required to carry a pager, phone, or otherwise remain available during a break, that break is not considered compliant.

For example, in Augustus v. ABM Security Services (2016)—not a healthcare case but widely applied—security guards required to keep radios on during breaks were found not to have been relieved of duty. Similar reasoning has been applied in healthcare settings where nurses remain “on call” during meal or rest periods.

Even technical violations, such as failing to provide a second meal break on a 13-hour shift when no waiver is in place, can trigger penalties and fuel PAGA claims.

Best Practices for Healthcare Employers

To minimize risk and ensure compliance:

• Adopt alternative schedules correctly. Secure a two-thirds employee vote and file results with the DLSE.
• Use clear, written meal period waivers. Keep copies in personnel files and ensure employees understand they can revoke waivers at any time.
• Track time precisely. Document every shift and meal period in detail.
• Train supervisors. Managers must understand they must never pressure employees to waive breaks or skip them in practice.
• Audit records regularly. Ensure waivers are valid and meal periods are properly recorded.
• Plan for emergencies. Encourage employees to take the first meal break to ensure compliance while maintaining patient care flexibility.

Document, Train, Audit

Long shifts are part of the reality of healthcare work, but they come with heightened compliance obligations. Employers who use alternative schedules or meal period waivers without following the rules risk costly litigation, reputational harm, and regulatory penalties.

By documenting agreements properly, training managers, and auditing practices regularly, healthcare employers can support their workforce, deliver quality patient care, and stay compliant with California’s wage and hour laws.

This post is for informational purposes only and does not constitute legal advice. California’s meal and rest break laws are complex and vary by industry and workforce. Consult an experienced employment attorney for guidance tailored to your business. Cal Comply is a paid training provider mentioned for illustrative purposes; other compliance resources are available.