Mar 31, 2025

March 31, 2025 Wells is the director of research and a senior fellow at Groundwork Collaborative. Ustek Spilda is a senior lecturer in the Department of Digital Humanities at King’s College London. Dana, a 29-year-old nurse in St. Louis, checks her phone to see if the gig nursing app CareRev still has her scheduled at the local hospital. She’s already arranged child care for her son, but cancellations are common. “It’s a gamble. … I’ll wake up at 5 in the morning, and I’ll find out if I’m canceled or not,” she told us. Cancellation means Dana will miss out on a day of pay. (Note: All names have been changed to protect privacy.) Dana also worries about what will happen at the hospital if her shift doesn’t get canceled. Sometimes, she shows up and finds out that she’s caring for 30 patients on her own or that she should have brought her own thermometer and blood pressure cuff. Most times, Dana doesn’t have an orientation before she works for a new health care facility, and too often, she can’t find the supply closets or figure out how to log into patient portals to check medical histories and current medication lists. advertisement The gig economy’s labor model and its algorithmic management technologies now have a foothold in one of the largest labor sectors in the country: health care. Starting around 2016, some of the largest U.S. hospital systems began integrating “gig” nurses into their day-to-day health care operations. New Uber-style apps use algorithmic scheduling, staffing, and management technologies — software often touted by companies as cutting-edge artificial intelligence — to connect understaffed medical facilities with nearby nurses and nursing assistants looking for work. Through dozens of interviews with nurses and nursing assistants in 27 states, our research team  dove into this new industry of gig nursing . We found these apps are facilitating a race to the bottom among health care workers. On-demand nursing firms like CareRev, Clipboard Health, ShiftKey, ShiftMed, and nearly a dozen others are using apps to match nurses and nursing assistants with hospitals and health care facilities in need of workers. These firms are attractive to nurses and nursing assistants who seek more control over their work hours and schedules, especially in the wake of the Covid-19 pandemic. The idea of “gig nursing” has begun to garner widespread praise. FastCompany named ShiftKey one of the most innovative companies of 2024, and  Business Insider  recognized Clipboard Health as one of the most promising startups of 2023. Billed as an opportunity to “set your own schedule” and “transform the way you work,”  the reality of gig nursing is far different. advertisement To win shifts on many of these apps, workers bid against one another — essentially, who will provide care at the lowest rate? As a result, nurses are paid different amounts for the very same work, creating what legal scholar Veena Dubal  calls  “algorithmic wage discrimination.” To make matters worse, ShiftKey workers like Ashley — a 35-year-old nursing assistant in rural Pennsylvania — pay roughly $7 in miscellaneous fees for every shift they work. Ashley is classified as an independent contractor, which means she is responsible for taxes and not protected by minimum wage standards. Ashley regularly takes home less than $8 an hour—just barely over Pennsylvania’s $7.25 an hour. If she were working in the state as an employed certified nursing assistant, she would likely be paid closer to $20 an hour. Ashley also faces legal risks. Many gig nursing firms require their health care workers to arbitrate any issues outside a court of law. In a rare move that a former Department of Labor attorney has called “ crazy, ” workers for CareRev and Clipboard Health are now required to indemnify the companies and the facilities that use the companies. Gig workers must pay for any potential losses or damages that they may cause. Patients suffer under the gig nursing model, too. At hospitals, surgical centers, and long-term care facilities, gig nurses often do not know whom to contact in the chain of command. One worker described the circumstances as “a rotten situation because [the patients] just have all these random folks taking care of them.” Another put it this way: “I just feel like I am on an island by myself a lot.” There are no interviews as part of the job application — just algorithmic software systems that screen potential health care workers. Performance management, too, has been reduced to a series of metrics from a machine. A nurse for Clipboard Health said the most difficult part of the job is “seeing the care that is provided is not adequate.” Imagine being a patient getting handed off to a nurse who is doing their best but has never been inside the hospital, can’t easily access information about your condition and treatment, and doesn’t know to whom to go for help. That’s a nightmare for most of us. advertisement Shakayla, a 38-year-old nurse in Los Angeles, sees risks in patient safety when she works through the ShiftMed app. For the past year, she has picked up shifts using ShiftMed to supplement her income as a regular travel nurse for a health care staffing agency. Shakayla likes the stability, benefits, and rapport with her coworkers at her regular job and dislikes how work booked through ShiftMed can pose risks to patient safety. However, inflation and increases in the cost of living mean that she keeps opening the ShiftMed app. Related Story Gig nursing firms are lobbying regulators to sanction their business model. Just as Uber convinced municipal regulators over the past decade that digitally dispatched chauffeurs needed a new business category and exemptions from existing regulatory structures, on-demand nursing companies are trying to convince state-level regulators that they should be exempted from existing legislation. While some attempts in California, Minnesota, and Ohio have met resistance, gig nursing firms found success in Colorado. In 2022, the Colorado state legislature  passed  a law to preempt any local regulation of “health-care worker platforms” and to prevent the types of misclassification lawsuits that ShiftKey and Clipboard Health face in other jurisdictions. Health care institutions are struggling. Fifty years of financialization and consolidated corporate power have built a new for-profit health care empire organized around capital-intensive procedures and risk-intensive working conditions. The Silicon Valley plan to “Uberize” nursing only worsens our crisis. Katie J. Wells, Ph.D., is the director of research and a senior fellow at Groundwork Collaborative. Funda Ustek Spilda is a senior lecturer in the Department of Digital Humanities at King’s College London. Letter to the editor