Duke University Health System (DUHS) provides staff time off for personal, family, community, and other outside needs and obligations through the "Paid Time Off" (PTO) plan, which combines vacation, holiday, bereavement, and sick leave into one program. DUHS staff accrue or earn time off based on years of service and whether they are in an hourly-paid or monthly-salaried position. Time away from work must be approved and recorded in a manner that protects the interests of both the institution and its staff.