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.
• Double time for hours over 12 in a day.

Healthcare employees on valid 12-hour shift agreements 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 requires a 30-minute unpaid meal break for shifts over 5 hours and a second meal break for shifts over 10 hours. In healthcare, employees working shifts longer than 8 hours 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.

For example, a nurse working a 12-hour shift can choose to waive their second meal break if they prefer to leave earlier at the end of the day. But if that nurse works a 13-hour shift, the waiver is invalid and the second meal break must be provided.

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

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 standards.

This creates a dual compliance challenge: Employers must align not only with the Labor Code and Wage Orders but also with their negotiated agreements. 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, particularly around break compliance. Courts and regulators 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 12-hour shift when no waiver is in place, can trigger penalties and fuel PAGA claims.

Best Practices for Healthcare Employers

Healthcare employers can reduce liability by:

• Adopting alternative schedules correctly. A valid AWS or 12-hour shift model requires a two-thirds secret ballot vote of affected employees and filing results with the Division of Labor Standards Enforcement (DLSE).
• Using clear, written meal period waivers. Keep copies in personnel files and ensure employees understand they can revoke waivers at any time.
• Auditing time and break records. Courts expect precise, minute-by-minute tracking of shifts and breaks.
• Training supervisors. Managers must understand they cannot pressure employees to waive breaks or skip them in practice.
• Reviewing CBAs. Ensure union agreements are consistent with state law and enforced fairly.

Document, Train, Audit

Long shifts are part of the reality of healthcare work, but they come with heightened compliance obligations. Employers who use 12-hour 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.