Who this is for: Registered nurses, LPNs and LVNs, and nurses in desk jobs (case management, utilization review, prior authorization, appeals) who are paid a salary and no overtime.
What's going on: Employers call nurses exempt because they hold a license. A license is not the test. Pay basis and the work you actually do are.
What you can do: Check two things: how you're paid, and whether your job requires real nursing judgment or applying criteria and passing hard calls to a doctor.
A registered nurse is exempt from overtime only if paid a true salary of at least $684 a week and the job's primary duty requires advanced nursing judgment; LPNs, LVNs, and hourly RNs generally aren't exempt.
The rule starts in the employer's favor: "Registered nurses who are registered by the appropriate State examining board generally meet the duties requirements for the learned professional exemption".1 The DOL adds that they, "if paid on a salary basis of at least $684 per week, may be classified as exempt."2
Note the words: "generally" and "may." Both conditions have to be true. And the work you actually do has to require the judgment of a registered nurse. The Second Circuit puts it this way: an employee uses advanced knowledge "if the employee acts in a manner that requires the discretion and judgment characteristic of an employee practicing the profession at issue" (Isett, below).
Fact Sheet 17N is direct: "Licensed practical nurses and other similar health care employees, however, generally do not qualify as exempt learned professionals, regardless of work experience and training, because possession of a specialized advanced academic degree is not a standard prerequisite for entry into such occupations, and are entitled to overtime pay."
Years of experience don't change it. A salary doesn't change it.
"Registered nurses who are paid on an hourly basis should receive overtime pay."2 Some employers call nurses salaried but cut pay for slow weeks or partial days. That can mean the pay isn't a true salary at all. A salary is “a predetermined amount ... which amount is not subject to reduction because of variations in the quality or quantity of the work performed,” and “[i]f the employee is ready, willing and able to work, deductions may not be made for time when work is not available.”7
These jobs move nurses from the bedside to a screen. You review a request against criteria (InterQual, MCG, or the plan's own guidelines). If it meets them, it's approved. If it doesn't, it goes to a medical director. Employers say that's still nursing. Sometimes a court agrees. Sometimes it doesn't. Two questions usually decide it:
More: utilization review nurses · case managers · health plan cases.
Clark: not exempt. Centene's case managers did utilization review. The job required a license as a registered, practical, or vocational nurse. Case managers couldn't deny a request. They referred it to a medical director. The court said "Centene's entire utilization review process seems designed to minimize the amount of discretion and independent judgment employed by Case Managers." Because vocational nurses could hold the job, the professional exemption failed too. The court affirmed for the nurses on both exemptions.3
Isett: exempt. We won't hide this one. Isett was an appeals nurse consultant at Aetna. Her job required an RN license. LPNs did a separate job, paid hourly with overtime, and their work had to go up the chain. Isett could make "a final affirmative determination of medical necessity" that bound Aetna to pay. She worked from home and talked to her supervisor less than once a week. The court held her exempt.4
The difference is the facts. RN-only job, final approval power, and little oversight point toward Isett. A job open to LPNs or LVNs, no power to decide, and tight criteria and audits point toward Clark. The cases we bring involve nurses who apply criteria checklists and send judgment calls to physicians. If your job looks like Isett's, your claim is harder, and we'll tell you so.
| Nurse | How paid | Likely status |
|---|---|---|
| RN | Hourly | Owed overtime |
| RN | Salary under $684/week | Owed overtime |
| RN, bedside or clinical | True salary, $684+/week | Usually exempt |
| RN, desk job open to LPNs or non-nurses, no final authority | Salary | Often not exempt (Clark) |
| RN, RN-only desk job with final approval authority | Salary | Harder claim (Isett) |
| LPN / LVN | Any | Generally owed overtime |
Siegel Law Group has recovered more than $100 million for workers in federal overtime cases, including a $38.7 million class and collective settlement in Pruess v. Presbyterian Health Plan,5 where the firm was lead counsel. Past results do not guarantee future outcomes.
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Not automatically. If the role is open to LPNs or LVNs, or the nurse applies criteria and refers decisions to a physician, the exemption is weak. Clark is the example.
No. Salary is required, but it isn't enough. The job's primary duty also has to require professional nursing judgment.
Generally no. The DOL says LPNs are entitled to overtime pay regardless of experience and training.
Isett binds federal courts in the Second Circuit (New York, Connecticut, Vermont). Courts elsewhere may follow it or not. The facts of your job still decide.
Your employer does: login data, case-system timestamps, and productivity reports. Those records can prove hours you never wrote down.
Free, confidential case review: (214) 790-4454.
We take overtime cases on contingency. We advance the costs of the case, and if we recover, those costs are repaid out of the recovery. If we do not recover, you owe us nothing — no attorney's fee and no costs.
Automated chat. Not legal advice, not a substitute for an attorney, and using it does not create an attorney-client relationship. Send your job title and how you are paid — no documents, no detailed case facts. An inquiry does not by itself stop the firm from representing someone else in a related matter.
Attorney advertising. Jack L. Siegel of Siegel Law Group PLLC, Dallas, Texas, is responsible for this content.
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