The ‘Uber Model’ Comes for Nursing

The “gig” model of labor popularized by Uber has found a new sector to upend: health care. On-demand nursing companies likeCareRev, Clipboard Health, ShiftKey, and ShiftMed promise understaffed hospitals more control and overworked nurses more flexibility. But this labor model and the companies that push it endanger workers and patients alike.

In a recently published brief for the Roosevelt Institute, Groundwork Collaborative Fellow Katie J. Wells and Funda Ustek Spilda, senior lecturer at King’s College London, dig into the harms and pitfalls of what is being called “Uber for nursing.”

Through interviews with 29 “gig” nurses and certified nursing assistants, the researchers found a long list of poor and unsafe working conditions.

On-demand nursing companies require workers to bid for shifts by offering to work for the lowest wage. The companies rate workers through an opaque process, charge inexplicable fees, and typically don’t provide benefits. Nurses aren’t even required to receive training or orientation when placed at new facilities, with one worker reporting instances “when I’ve been unable to access patient records or find supply closets.” As a result, patients — according to another nurse — are stuck in “a rotten situation” with “all these random folks taking care of them.”

The rise of app-based gig nursing threatens not only to worsen the quality of patient care, but to destabilize a workforce overwhelmingly made up of women. This shift could exacerbate existing racial inequalities in the industry — for example, more than half of the country’s certified nursing assistants, who are among the lowest-paid health-care workers in the country, identify as Black or people of color.

On-demand nursing companies seek “to solve a nursing shortage that doesn’t really exist,” Jacobin’s Helen Santoro writes in coverage of the study. What many have misidentified as a lack of qualified nurses is actually a shortage of good, quality nursing jobs, driving a mass exodus from the sector — especially since the COVID-19 pandemic.

“The only reason that I’m doing this right now is because I have no choice,” Dana, a 29-year-old nurse based in St. Louis, Missouri, told researchers. “I love being a nurse. But I hate being a nurse right now with [what] these greedy, immoral, corporate companies have done to health care.”

“We don’t take care of these workers in a way so they can take care of their families . . . many of these workers [turn] to the gig economy because they need some semblance of control over their own lives, because they haven’t had it otherwise,” Wells told The Guardian.

Like Uber, on-demand nursing companies have lobbied state legislators to ensure minimal regulation and oversight of their business models — efforts that make these types of nursing jobs worse. In 2022, Colorado passed a bill that classified health-care workers who find jobs through these types of online platforms as independent contractors.

“Wall Street’s takeover of US health-care infrastructure and Silicon Valley’s introduction of gig nursing apps are a dangerous duo that is eroding our health-care system and eviscerating our ability to take care of each other,” Wells and Spilda write.

On-demand nursing companies position themselves as a disruptive solution to a broken health-care system. Much of ShiftKey’s promotional materials include phrases such as “transform the way you work” and “set your own schedule.”

Nurses and all health-care workers deserve dignified workplaces that allow them to earn a livelihood and care for the public without being overworked. But gig nursing solidifies the grip of corporations on our hospitals, surgical centers, and long-term care facilities. It is up to legislators, policymakers, civic leaders, and community organizations to stop these predatory actors and, just as importantly, solve the real problems at the root of this crisis: the corporatization of healthcare.