Healthcare Overtime Conflict

When Overtime Becomes a Conflict: What Healthcare Practice Managers Need to Know

By Kimberly Best, RN, MA, St. Louis, MO

I was recently interviewed by Cathy Cassata for Medical Assisting Today on a topic that comes up constantly in my work with healthcare teams: overtime. Specifically, the tensions that build when staff feel overworked, undervalued, or caught in systems that aren't working for anyone.

The article, "Working Around the Clock: The Pros and Cons of Overtime" explores the legal, practical, and relational dimensions of overtime in healthcare settings. I was glad to contribute my perspective as a conflict resolution professional who has spent years working alongside healthcare teams navigating these exact challenges.

Here's what I want practice managers and healthcare leaders to take away.

Overtime Frustration Is Rarely Just About the Hours

When employees are unhappy about overtime, whether there's too much or too little of it, the real issue almost always runs deeper. What I've seen again and again is that overtime dissatisfaction is a signal. It's telling you something about communication, workload distribution, or whether your team feels like they have a voice in how things run.  There can also be a real tension between expectation and appreciation. 

That's why I encourage practice managers to resist the urge to assume they already know the problem. Instead, ask your team directly:

• What is not working about our current system?

• What would make this more manageable?

• What do you need from management?

• What can you do, and what is asking too much?

• 
  

The answers might surprise you. The solution might be hiring additional help, adjusting your scheduling process, or simply redistributing responsibilities. But you won't find out until you ask and truly listen.  Your teams might very well have creative suggestions that you never even considered.

Off-the-Clock Work Is a System Problem, Not a People Problem

One issue that came up in the article is staff working off the clock, finishing charting or prepping for the next day without logging that time. This is problematic for both legal and cultural reasons. If people feel they need to work off the clock, something in your system needs attention. Everyone's time is valuable and should be respected.

This is where I always come back to a core belief: there aren't "people problems"; there are communication and systems issues. When off-the-clock work is happening, it's worth approaching the situation with curiosity rather than judgment. A simple question like, "I'm noticing work is happening off the clock; help me understand what's driving that," opens the door to real problem-solving.

Buy-In Makes All the Difference

People are willing to stretch when they feel genuinely invested in the success of their practice. But that buy-in doesn't happen by accident. It comes from feeling heard, valued, and treated as a partner in problem-solving, not as an interchangeable resource.

I've seen this play out in healthcare settings where teams faced major transitions, like switching to a new electronic health records system. When leadership was transparent about the challenges ahead and offered fair compensation for extra effort, staff stepped up willingly. They felt respected, and that made all the difference.

Building a Culture That Works

If you're a practice manager dealing with overtime tensions, here are some practices I recommend:

Communicate regularly. Don't wait for crisis mode. Build ongoing conversations about workload and capacity into your routine.

Negotiate and be flexible. What works for one person might not work for another. Consider who can opt in to overtime and who can't, and whether you can rotate who covers extra shifts.

Be genuinely appreciative. Recognition and compensation matter, but a sincere acknowledgment of your team's hard work also goes a long way.

Create real buy-in. Help your team understand why overtime is needed and involve them in finding solutions.

Set healthy boundaries. I always advocate for work-life balance as a leader and manager, so it's important to ask yourself: am I streamlining work processes so that my employees can have that balance?

And remember, for every "no," offer a "yes." Know what you can't do, and then name what you can do. That's healthy boundary setting in action.

The Bigger Picture

Overtime conflicts in healthcare are never just about labor law compliance or schedule management. They're about relationships, communication, and whether your workplace culture supports people in doing their best work without burning out.

When you build a culture where people can be honest about their capacity, where workload is negotiated rather than mandated, and where staff feel like valued partners in the practice's success, that's how you create teams willing to step up when it really matters.

I was interviewed in Medical Assisting Today on this topic. Read the full article, "Working Around the Clock: The Pros and Cons of Overtime," by Cathy Cassata, in the Mar/Apr 2026 issue of Medical Assisting Today.

Citation: Cassata C. Working around the clock: the pros and cons of overtime. Medical Assisting Today. 2026;59(2):20-21.

(Permission to reproduce this article granted by the American Association of Medical Assistants.)

Kimberly Best, RN, MA, is a dispute resolution expert, mediator, and founder of Best Conflict Solutions. She works with healthcare teams, organizations, and families to navigate conflict and build stronger communication. Connect with her on LinkedIn.