Healthcare operates 24 hours a day, 7 days a week, and that reality drives every leave management decision. Multiple modern awards cover healthcare workers — the Health Professionals and Support Services Award 2020, the Nurses Award 2020, and others depending on classification — and the overlap creates complexity no other industry faces.
This guide covers leave management for Australian healthcare employers: entitlements under the applicable awards and the Fair Work Act 2009, how to manage 24/7 rostering, shift worker leave, and the compliance mistakes most common in the sector.
Key takeaways
- Full-time healthcare employees generally receive 4 weeks annual leave, with 5 weeks for qualifying shift workers.
- Nurses and midwives under the Nurses Award receive 5 weeks annual leave as a minimum — more generous than the NES.
- Most healthcare awards require 17.5% leave loading on annual leave, with the “greater of” rule comparing loading to penalty rates.
- Healthcare’s 24/7 rostering means leave coverage is critical — deny leave unreasonably and you face adverse action claims; approve too much and patient safety is compromised.
- Personal/carer’s leave accrues at 10 days per year for full-time employees and accumulates year to year.
Which award applies?
Healthcare employers must first determine which award covers each employee. The primary instruments are:
| Award | Covers |
|---|---|
| Nurses Award 2020 | Enrolled nurses, registered nurses, midwives |
| Health Professionals and Support Services Award 2020 | Allied health professionals, health support workers, administrative staff |
| Aged Care Award 2010 | Employees in residential aged care facilities |
| Social, Community, Home Care and Disability Services Award 2020 | Community care and disability support workers |
Getting the classification wrong means applying the wrong pay rates and leave entitlements. An enrolled nurse incorrectly classified under the Health Professionals Award may be underpaid — or overpaid — depending on the direction of the error.
Award leave entitlements
Leave entitlements vary by award, but the core framework under the NES and the applicable awards is:
| Leave type | Full-time (standard) | Part-time (pro-rata) | Casual |
|---|---|---|---|
| Annual leave | 4 weeks (5 weeks for shift workers) | Pro-rata by ordinary hours | None (loading compensates) |
| Personal/carer’s leave | 10 days per year | 10 days pro-rata | None (2 days unpaid per occasion) |
| Compassionate leave | 2 days per occasion | 2 days per occasion | 2 days unpaid per occasion |
| Family & domestic violence leave | 10 days paid per year | 10 days pro-rata | 10 days paid per year |
The Nurses Award is more generous than the NES — it provides 5 weeks annual leave to all nurses and midwives who are shift workers, which includes most nurses who rotate across days, evenings, and weekends.
The shift worker advantage
Healthcare’s rostering model means most clinical staff qualify as shift workers. The NES definition of “shift worker” for annual leave purposes is an employee who works shifts that rotate across all seven days of the week, including weekends and public holidays.
In healthcare, this is the norm — not the exception. A nurse who works a rotating roster of day, evening, and night shifts across Monday to Sunday qualifies for 5 weeks annual leave under both the NES and the Nurses Award.
Worked example: shift worker leave calculation
A registered nurse works a rotating roster including weekends and nights.
| Metric | Value |
|---|---|
| Ordinary hours per week | 38 hours |
| Annual leave entitlement | 5 weeks = 190 hours |
| Leave loading (base rate of $40/hour) | $40 × 17.5% = $7.00/hour |
| Or penalty rate differential | Check per employee |
If the nurse’s Saturday rate is 150% ($60/hour) and they would normally work one Saturday per week, the penalty differential is $20/hour — greater than the 17.5% loading ($7/hour). The employee receives $20/hour during leave.
Leave loading in healthcare
Most healthcare awards require 17.5% leave loading on annual leave. The loading applies to the employee’s base rate, not gross pay.
Healthcare’s complexity lies in the penalty rate structure. Nurses, in particular, earn significant penalty rates for evenings (115–125%), weekends (125–150%), and public holidays (150–175%). When a nurse takes leave during a week that includes a weekend shift, the “greater of” rule may mean the employee receives more than 17.5%.
Healthcare employers must make this comparison per employee, per leave period based on the shifts the employee would have worked.
Managing 24/7 leave coverage
Healthcare’s round-the-clock requirement creates a leave management challenge unique to the sector. You cannot approve leave that leaves a ward, department, or facility understaffed — but you also cannot refuse leave unreasonably.
Best practice for 24/7 healthcare leave coverage:
- Set minimum staffing ratios — document the minimum number of clinical staff required per shift, per ward, per shift type (day, evening, night)
- Use a leave coverage matrix — when a leave request is received, check whether coverage is available before approving
- Rotate leave opportunities — apply objective criteria so leave is distributed fairly across shifts and departments
- Provide adequate notice periods — most healthcare awards require at least 4 weeks’ notice for leave requests
- Document every refusal — state the operational reason (minimum staffing would be breached) and offer alternative dates
Aged care specific considerations
Aged care operates under additional pressures. The Aged Care Award 2010 covers workers in residential aged care, and the sector faces chronic staffing shortages. Leave management in aged care requires:
- Coordination with agency and casual pool staff to cover leave
- Awareness of mandatory staffing ratios under the Aged Care Act 1997
- Documentation of leave approvals to satisfy aged care quality standards
Long service leave in healthcare
Healthcare workers tend to have longer tenures than the average industry, making long service leave a significant operational and financial consideration.
Long service leave is governed by state and territory legislation, not the Fair Work Act. Entitlements vary:
| State | Entitlement after 10 years | Pro-rata available after |
|---|---|---|
| New South Wales | 8.67 weeks | 5 years |
| Victoria | 8.67 weeks (after 7 years) | 7 years |
| Queensland | 8.67 weeks | 7 years |
| South Australia | 13 weeks | 7 years |
| Western Australia | 8.67 weeks | 7 years (limited grounds) |
A nurse who has worked in NSW for 15 years is entitled to approximately 13 weeks of long service leave. This must be accrued and tracked separately from annual leave.
Common compliance mistakes in healthcare
1. Misclassifying employee award coverage
Applying the wrong award — for example, classifying a registered nurse under the Health Professionals Award rather than the Nurses Award — results in incorrect pay rates and leave entitlements. This is the most common source of underpayment in the sector.
2. Failing to pay the “greater of” on leave loading
Healthcare penalty rates frequently exceed 17.5%. Applying a flat 17.5% leave loading without comparing to penalty rates creates systematic underpayment for shift workers.
3. Forcing employees to use annual leave instead of personal leave
If an employee is ill, they are on personal/carer’s leave — not annual leave. Forcing employees to use annual leave for illness is a breach of the NES.
4. Not tracking long service leave separately
Long service leave accrues under state legislation and is distinct from annual leave. Failing to track it separately creates liability that surfaces on termination — and can be substantial for long-tenured employees.
5. Blanket leave refusals during peak periods
Refusing all leave during periods of high demand (flu season, holiday periods) without individual consideration exposes the business to adverse action claims. Each request must be assessed on its merits.
Practical steps for healthcare employers
- Map every employee to the correct award and classification level — document the basis for each determination.
- Calculate leave loading per employee based on their actual roster and penalty rates.
- Build a leave coverage matrix tied to minimum staffing requirements per ward and shift.
- Track long service leave separately under the applicable state legislation.
- Maintain records for 7 years — including leave balances, leave taken, and leave loading paid.
- Conduct an annual leave audit to identify employees with excessive balances or incorrect accruals.
For more on your core obligations, see our guide to annual leave entitlements in Australia, long service leave by state, and the Fair Work compliance checklist.
Frequently asked questions
How much annual leave do nurses get?
Under the Nurses Award 2020, registered nurses and midwives who are shift workers receive 5 weeks of paid annual leave per year. This is more generous than the NES minimum of 4 weeks.
Can healthcare employers refuse annual leave?
You can refuse leave requests based on genuine operational requirements — such as minimum staffing ratios — but you must apply objective criteria and cannot refuse unreasonably under the NES.
Do casual healthcare workers get paid sick leave?
No. Casual employees do not receive paid personal/carer’s leave. They receive a casual loading in their hourly rate and are entitled to 2 days unpaid carer’s leave per occasion.
How is long service leave calculated?
Long service leave is governed by state and territory legislation. After 10 years of continuous service, most states provide approximately 8.67 weeks, with an additional 4.33 weeks for each subsequent 5 years. South Australia provides the most generous entitlement at 13 weeks after 10 years.
What is the penalty for getting leave wrong?
Under the Wage Theft laws effective 1 January 2025, intentional underpayment carries penalties of up to AUD $1.65 million for individuals and up to 10 years imprisonment. Civil penalties of up to AUD $4.95 million apply to serious contraventions.
Sources
- Health Professionals and Support Services Award 2020 — Fair Work Commission
- Nurses Award 2020 — Fair Work Commission
- Aged Care Award 2010 — Fair Work Commission
- Annual leave — Fair Work Ombudsman
- Long service leave — Fair Work Ombudsman
- Fair Work Act 2009
This article is general information, not legal advice. Confirm entitlements with the Fair Work Ombudsman and the applicable modern award or enterprise agreement.