New Paper from Groundwork’s Dr. Katie Wells Sheds Light on Pervasiveness & Pitfalls of Gig Nursing Apps

“Uber for Nursing: How an AI-Powered Gig Model Is Threatening Health Care” Details How Gig Nursing Risks Patient and Worker Safety, Erodes Working Conditions, and Pits Workers Against Each Other

Today, the Roosevelt Institute published a new paper from Groundwork Collaborative Senior Fellow Dr. Katie Wells and Dr. Funda Ustek Spilda of King’s College London with the support of Fairwork about the rise and risks of gig nursing apps, “Uber for Nursing: How an AI-Powered Gig Model Is Threatening Health Care.”

Uber-styled apps like CareRev, Clipboard Health, ShiftKey, ShiftMed, and more mark a growing trend of gig nursing. Health care facilities use these AI-powered apps to schedule shifts for gig nurses and nursing assistants, and some apps require workers to bid on shifts.

“Gig nursing erodes working conditions and risks patient and worker safety,” said Wells. “Policymakers need to be proactive and step in to regulate these platforms and provide proper labor protections for all nurses, gig and non-gig alike. But these apps are a symptom of broken health care infrastructure that is now victim to corporate takeovers. Failing to act on both fronts poses risks to our health care system and the workers who power it.”

Deteriorating working conditions during and after the pandemic caused many nurses and nursing assistants to leave the profession. To fill this gap, gig nursing stepped in. Billed as an opportunity to “Set your own schedule,” and “Transform the way you work,” the reality is far different.

When signing up for a gig nursing app, nurses and nursing assistants upload their required documentation and qualifications and then compete for a shift. Through this process, they compete with other workers for shifts, often lowering rates and creating a race-to-the-bottom effect for wages and shifts. Through interviews with 29 “gig” nurses, the authors detail the hazards of gig nursing:

• Work for less pay: Nurses and nursing assistants bid each other down for shifts, and after the apps take their cut through required fees, one worker surveyed earned $13 an hour. Fourteen out of the 29 workers said they could not rely on gig nursing apps as their only source of income.
• Less certainty about scheduling, workload, or nature of work: Gig nursing apps offer little transparency about how their AI and algorithms assign shifts, creating a black box. This “algorithmic wage discrimination” means workers are paid different wages based on information asymmetries and fast-changing calculations. Often, nurses show up to their shift finding that they’re being assigned work they didn’t sign up for or are being required to work past their shift time.
• Risks to worker and patient safety: Workers are often thrown into a new facility and don’t know where to find essential supplies and there is limited management and oversight. Some workers bring their own equipment, which demonstrates the significant expenses these workers have to bear on their own. The lack of management also creates lapses in information sharing when caring for patients – a major safety risk.

A number of proposals have been put forward to define “digitally dispatched health care workers” as independent contractors but most efforts have stalled, except for Colorado. Their law preempts local regulation and prevents misclassification lawsuits that have plagued workers for ShiftKey and Clipboard Health. The failure of states to enact better protections doesn’t just hurt workers, it also lets gig companies get away with not paying into Social Security, unemployment insurance, and other programs.

The paper concludes that an Uber-style approach to nursing poses a series of threats – worsening working conditions in health care, erosion in the quality of patient care, and more.

Email press@groundworkcollaborative.org to speak with Dr. Katie Wells about gig nursing.