1. Lopez, Patricio BBA, PHR
  2. Blair, Samantha MS, RN, CMSRN

Article Content

Leaves of absence and how they impact the department and, ultimately, patient care are a hot topic for nurse leaders. We provide an overview of Family and Medical Leave Act (FMLA) leave, intermittent FMLA leave, and the effect of the Americans with Disabilities Act (ADA) Amendments Act, along with tips for nurse leaders.

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The basics: Continuous or intermittent

Established in 1993, the FMLA is a federal law that protects employment for up to 12 weeks. Employees are eligible if they've worked at least 1,250 hours in the 12-month period preceding the first day of FMLA leave.1 The employee must also work at a location where the company employs 50 or more employees within 75 miles of the location. For remote employees, the office to which they report is considered the work location. The FMLA applies to private employers if they employ 50 or more employees for at least 20 workweeks a year. Federal, state, and county employers, including schools, must comply with the FMLA.2


Employees may take up to 12 workweeks' unpaid FMLA leave in a 12-month period for the following reasons:


* birth and care of a newborn child


* adoption or foster care


* care of an immediate family member (spouse, child, or parent) with a serious health condition


* when unable to work because of a serious health condition


* when the employee's spouse, child, or parent is a service member on covered active duty (deployment to a foreign country) or called to covered duty status (known as exigency leave).2



An eligible employee who's the spouse, child, parent, or next of kin of a service member or veteran with a serious injury or illness may also take up to 26 workweeks' unpaid leave in a 12-month period to care for him or her (known as military caregiver leave).2


Employees needing to use FMLA leave under certain circumstances can choose intermittent FMLA leave, which consists of taking leave in separate blocks of time or having a reduced work schedule for a specified period of time (for example, a change from full time to part time). Intermittent leave can be used for serious health conditions and the treatment for such conditions. Intermittent leave for the birth or adoption of a child must be approved by the employer.1 Employees must make a reasonable effort to schedule intermittent leave without disrupting operations and provide 30 days' notice of known leave times if possible or notify their employer as soon as possible if leave times are unpredictable. In addition, an employer may require the employee to temporarily transfer to an alternate position to better accommodate recurring periods of intermittent FMLA leave as long as he or she is qualified for the alternate position.1


The ADA Amendments Act

The ADA of 1990 prohibits discrimination against individuals with disabilities in several areas, including employment (such as recruitment, pay, hiring, firing, promotion, job assignments, training, leave, and layoffs).3,4 Title I of the ADA protects the rights of both employees and job seekers, requiring covered employers (those with 15 or more employees and federal, state, and local employers) to provide reasonable accommodations for qualified applicants and employees with disabilities. Reasonable accommodations include restructuring jobs, making work sites and work stations accessible, modifying schedules, providing services such as interpreters, and modifying equipment and policies.3,4


The ADA Amendments Act of 2008 broadened the definition of disability-"a physical or mental impairment that substantially limits one or more major life activities, a record (or past history) of such an impairment, or being regarded as having a disability"-by allowing a lower degree of functional limitation to be regarded as having a disability.5 The ADA Amendments Act also determined that work leave is a reasonable accommodation. If an employee has used up his or her 12 weeks of FLMA leave and is covered by the ADA, the employer is expected to accommodate work leave.6


Tips for nurse leaders

Start by partnering with your human resources (HR) representative/department. HR employees have the knowledge to help ensure compliance and offer alternative business solutions. As a nurse leader, you may experience staffing difficulties. A tip to combat this is to routinely review your workforce planning data. If FMLA leave is resulting in increased overtime and/or contract labor, team up with HR personnel to help justify a request for full-time equivalents to drive down labor costs. Also, if your organization has a float pool, work together to preassign nonovertime personnel to help cover employees on leave.


Next, set aside time to communicate with your employees who are taking FMLA leave so that you both stay up-to-date throughout the leave period. This also helps builds trust and encourages open communication. Create and develop a form to track consecutive or intermittent time to ensure compliance with applicable laws. And remember that when employees are on FMLA leave, you must maintain strict confidentiality. It isn't required that you know why an employee is taking leave; this information is only needed by your HR department. Ensure that negative comments about and/or retaliation against an employee regarding his or her FMLA leave don't occur.7


Lastly, there's a great deal of information regarding FMLA regulations. If your organization doesn't have annual refresher courses, you can access U.S. Department of Labor E-tools at


Reduce frustration

Although employee leaves of absence can be frustrating at times from a staffing perspective, by partnering with your HR department and utilizing best practices, you can reduce staffing concerns and ensure better outcomes for your employees and nursing operations.




1. Electronic Code of Federal Regulations. Part 825-the Family and Medical Leave Act of 1993. [Context Link]


2. U.S. Department of Labor. Family and Medical Leave Act. [Context Link]


3. U.S. Department of Justice. Information and technical assistance on the Americans with Disabilities Act. [Context Link]


4. U.S. Equal Employment Opportunity Commission. The ADA: your responsibilities as an employer. [Context Link]


5. U.S. Equal Employment Opportunity Commission. The Americans with Disabilities Act Amendments Act of 2008. [Context Link]


6. ADA National Network. Work-leave, the ADA, and the FMLA. [Context Link]


7. Fisher Phillips. Employer tips for managing FMLA compliance. [Context Link]