Working-time rules are sometimes treated as a scheduling constraint. In hospitals, they are better understood as a workforce, safety and resilience framework: long hours, insufficient rest and poorly designed on-call systems affect professionals, service continuity and ultimately patient care.
European Union | 22 October 2026
Directive 2003/88/EC establishes minimum working-time standards across the European Union, including limits on average weekly working time, minimum daily and weekly rest, paid annual leave and additional protections for night work.
The Directive is not new. Its management relevance remains high because healthcare operates around the clock, relies extensively on shift work and on-call arrangements and often faces staffing shortages that create pressure to extend working hours.
The European Commission’s 2023 Interpretative Communication consolidates important Court of Justice case law and provides practical guidance on how concepts such as on-call and standby time should be understood.
Working time is more than roster compliance
A roster can meet short-term service demand while creating long-term workforce risk. Working time should therefore be considered together with fatigue, retention, occupational safety, clinical continuity and workforce planning.
The management question is not only “Is the shift legally permitted?” It is “Does our working-time model protect sufficient rest, remain sustainable and support safe care?”
What are the EU minimum standards?
48 hours
Average working time for each seven-day period must not exceed 48 hours, including overtime, calculated over the applicable reference period.
11 hours
Workers are entitled to at least 11 consecutive hours of daily rest in every 24-hour period, subject to lawful derogations and compensatory arrangements.
Weekly rest
For each seven-day period, workers are entitled to at least 24 uninterrupted hours of weekly rest in addition to the daily-rest entitlement.
Night work
The Directive includes additional protections for night workers, including limits and rights to health assessment.
The Directive also provides a rest break where the working day exceeds six hours and at least four weeks of paid annual leave.
National law and collective agreements determine important details, including reference periods, permitted derogations and how compensatory rest operates.
When does on-call duty count as working time?
This question has particular importance in healthcare.
The Court of Justice has held that time spent on-call must count in its entirety as working time where a worker is required to remain at the workplace or another place determined by the employer and be ready to provide services when required.
The well-known Jaeger judgment concerned a hospital doctor who was required to remain at the hospital and was permitted to sleep when his services were not needed. The Court held that the whole on-call period constituted working time.
The Commission’s 2023 Interpretative Communication reflects this case law and distinguishes on-call duty from standby arrangements where the worker is not required to remain at a place determined by the employer.
On-call and standby are not the same
- On-call at the workplace: where physical presence at a place determined by the employer is required, the full period generally counts as working time.
- Standby away from the workplace: time actually spent providing services is always working time.
- Highly restrictive standby: the remaining standby period may also count as working time where employer-imposed constraints very significantly limit the worker’s ability to manage personal and social time.
- Classification matters: hospitals should review the practical restrictions imposed, not simply the contractual label given to the arrangement.
Why response time and other restrictions matter
A worker who is technically “at home” may still face such restrictive obligations that the entire standby period qualifies as working time. Court of Justice case law assesses the objective constraints imposed by the employer and their effect on the worker’s ability to use the period freely.
Hospitals should therefore review:
- required response time;
- required location or geographical restrictions;
- frequency of actual calls;
- need to carry equipment or remain in uniform;
- restrictions on personal activities;
- the practical ability to organise personal and family time.
The legal classification depends on the circumstances and applicable case law. A contractual label such as “standby” does not determine the answer by itself.
Derogations do not remove the safety objective
The Directive allows derogations in defined circumstances and Member States may also permit an individual opt-out from the 48-hour average weekly limit subject to strict conditions.
Hospitals should not interpret derogations as a general permission to design permanently excessive working patterns. The Directive’s purpose is protection of workers’ health and safety, and compensatory rest can be required where minimum rest is lawfully derogated from.
The precise rules depend on national implementation and collective agreements, making local legal and HR review essential.
Why this is a management issue during workforce shortages
When staffing is insufficient, the easiest short-term response is often to ask existing staff to work more. That can stabilise the rota today while increasing fatigue, sickness absence and turnover tomorrow.
Repeated dependence on overtime or exceptional on-call arrangements can therefore be a signal of structural workforce risk.
Hospital leaders should distinguish between:
- temporary surge capacity;
- predictable seasonal pressure;
- persistent vacancy-driven overtime;
- service models that depend structurally on extended hours;
- rostering practices that repeatedly compress rest.
Working time should connect with patient-safety governance
The Working Time Directive is an occupational safety measure, not a clinical guideline. Hospitals should nevertheless recognise that fatigue, workload and insufficient recovery can interact with clinical risk.
Where an organisation records repeated rest exceptions, extreme working hours or chronic overtime in a specific service, that information should be visible not only to HR but also to operational, quality and workforce governance.
A practical 90-day agenda for hospital leaders
Map real working time
Analyse actual hours, overtime, on-call arrangements, missed rest and high-risk services rather than relying only on planned rosters.
Identify where contractual labels may not match the practical legal classification of on-call or standby time.
Review risk and exceptions
Review national derogations, collective agreements, opt-outs and compensatory-rest rules with HR and legal teams.
Identify services where repeated exceptions indicate a workforce or service-design problem.
Redesign and monitor
Introduce Board-level indicators for excessive hours, rest breaches and overtime dependency. Redesign schedules or staffing where risk is structural.
Connect working-time governance to fatigue, occupational health, retention and patient-safety processes.
What should hospitals monitor?
- average weekly hours and employees approaching applicable thresholds;
- frequency of daily- and weekly-rest exceptions;
- overtime concentration by service and professional group;
- on-call and standby hours, including actual call frequency;
- night-work exposure;
- compensatory rest provided;
- staffing models that depend structurally on opt-outs or repeated derogations;
- fatigue-related incidents or near misses, where captured appropriately.
Key EU rules and interpretation
Seven questions for every hospital board
- Do we know actual working time, not only scheduled working time?
- Which services rely most heavily on overtime, on-call work or exceptional arrangements?
- Are on-call and standby periods classified correctly under EU and national rules?
- Where are minimum rest periods repeatedly compressed or derogated from?
- Where national law permits opt-outs, are they genuinely voluntary and governed correctly?
- Do recurring working-time exceptions indicate an underlying workforce-capacity problem?
- How are working time, fatigue, retention and patient safety connected in our governance?
From scheduling to sustainability
Hospital services must operate continuously. That makes flexibility essential, but it also makes robust working-time governance essential.
The strongest approach is to treat excessive hours and insufficient rest not only as potential compliance breaches, but as signals that workforce planning, service design or organisational resilience may need attention.
Measure. Protect rest. Review on-call. Redesign. Sustain.
Safe working time is part of safe hospital management.
Official resources
This article provides general information, not legal advice. Working-time rules include national transposition, collective agreements, derogations and case-specific Court of Justice interpretation. Hospitals should obtain advice on the arrangements applicable in their jurisdiction and workforce groups.
Secretary-General perspective
Working-time rules should not be seen as an obstacle to hospital operations. They are a reminder that continuity of care cannot be built indefinitely on fatigue. Sustainable services require sustainable working models.
Leandro Luís · Secretary-General, European Association of Hospital Managers