FMLA Use is Skyrocketing in Nursing

By Rose O. Sherman, EdD, RN, NEA-BC, FAAN

There is a growing trend in nursing that is not being discussed at the national level: the skyrocketing use (and sadly abuse) of FMLA by nurses, especially in acute care environments, and its impact on nurse staffing. Almost every health system I have worked with over the past year has reported the same phenomenon—a growing percentage of nurses on FMLA, sometimes intermittently and sometimes for long periods. It is not unusual for a nurse manager to tell me that she has 5-10 nurses on FMLA or Intermittent FMLA at any given time.

As budgets tighten and reimbursement declines, nurse leaders’ ability to backfill positions held by nurses on FMLA will become much more challenging. The Family and Medical Leave Act (FMLA) in nursing has a significant, multi-faceted impact on staffing, primarily by creating unplanned, unpredictable, and intermittent absences that are often difficult to manage. While FMLA is a crucial and legally protected right for employees, its operational effect, particularly intermittent FMLA, which has become much more common, presents a challenge for nurse managers. The impact lies not in the leave itself, but in its effects on unit stability, costs, patient care outcomes, and team morale.

How did we get here?

After decades of legislative discussion beginning in the 1980s, presidential candidate Bill Clinton made passing the Family and Medical Leave Act a central part of his domestic policy platform in the 1992 election. True to his promise, after winning the election, the FMLA was the very first bill President Bill Clinton signed into law on February 5, 1993. The final law was a compromise. It was not the paid leave that many advocates originally wanted, but it established the critical federal standard that employers must provide unpaid, job-protected leave for qualifying medical and family reasons. The federal FMLA provides the minimum standard, or the “floor,” for employee leave. States were free to pass their own laws that provide more generous or expansive benefits. Some state Laws (e.g., CA, NY, MA, CO, WA) created a Paid Family and Medical Leave (PFML) program. This is a state-run insurance benefit, funded by payroll taxes, that provides you with partial wage replacement (typically 60-90% of your average weekly wage, up to a state cap) while you are on leave. Where state laws are more generous such as California, more FMLA leave use is being reported.

What are the key reasons for the use of FMLA?

1. The employee’s own serious health condition – This is the most common reason for FMLA use across the general U.S. workforce, and it is a critical factor for nurses due to the high rate of on-the-job injuries. The Department of Labor has clarified that mental health conditions, such as severe anxiety or major depression, can qualify as a “serious health condition” under the FMLA. With Generation Z experiencing lower baseline mental health, nurse leaders now report that many nurses use intermittent FMLA and take a day off to manage stress and burnout without facing disciplinary action.
2. The birth and bonding with a newborn child – FMLA provides 12 weeks of job-protected leave for the birth of a child and to bond with the newborn. For the vast majority of nurses who give birth, FMLA is the primary legal mechanism that protects their job during maternity leave. 
3. Caring for an immediate family member (spouse, child, or parent) with a serious health condition – The same demographics that make parental leave a major factor also position nurses as primary caregivers for other family members. Nurse managers report that an increasing number of nurses now take intermittent FLMA sometimes reducing their shifts to 6-8 hours to take children or parents to medical appointments. Sometimes when an employee is in jeopardy with their time and attendance, union representatives will counsel them to take intermittent FMLA often with limited justification.

What can nurse leaders do?