• Gig work has expanded to include nurses at hospitals and medical facilities, per a new report.
• Many nurses who work this way face challenges similar to Uber drivers, the report found.
• Nursing represents a high-stakes use case of gig work apps, one of the researchers said.

Gig work has expanded to the nurses who care for patients in hospitals and care homes — and it's coming with some of the same challenges that delivery and rideshare contractors have already pointed to, according to a new report.

Apps like CareRev, Clipboard Health, and ShiftKey have taken an approach similar to the one companies like Uber and Instacart have used to build up their workforces, and applied it to nursing at hospitals, care homes, and other medical facilities.

But the report, which the Roosevelt Institute released a summary of this week, found that medical facilities often turn to gig nursing services as a way to cut expenses, especially under the tutelage of private equity firms.

Medical professionals on the apps, which the report collectively calls "Uber for Nursing," also face many of the same issues that other gig workers do, from low pay to having their accounts on the platforms deactivated with little or no explanation.

The apps make pitches that are attractive to the nurses themselves, Katie Wells, a senior Fellow at think tank Groundwork Collaborative and one of the report's authors, told Business Insider in an interview. Wells wrote the report with Funda Ustek Spilda, a senior lecturer at King's College London and a research associate at the University of Oxford's Oxford Internet Institute.

Full-time nursing jobs often involve putting in long hours as well as working night or weekend shifts. COVID's strain on hospitals and other medical facilities also pushed many nurses to quit or consider finding other work.

Like rideshare and delivery companies, the apps say that they offer nurses more choices over how and when they work. ShiftKey's website, for instance, says that its users have "the freedom to make choices best suited to their lives" including how much they earn and "their relationship with work."

For a burned-out nurse, that can be an appealing pitch, Wells said.

"There is almost no flexibility and control," Wells said. "So it is no wonder that these apps become attractive."

Wells and Spilda interviewed 29 nurses and nursing assistants for their study. The interviewees all used at least one gig work app to find nursing shifts.

Like delivery and rideshare contractors, nurses who use the apps must claim jobs through them. The nursing apps often charge a fee for access, and workers bid with their pay rates. The user who offers the lowest pay gets the shift, according to the report.

Working the shift, however, can be tricky. When they show up for a gig, the nurses often have to navigate the facility themselves — even if they have never worked there before.

"At most hospitals and medical facilities, no orientations are required for gig nurses and nursing assistants," the report reads. "Workers do not know where supply closets are located, how to access patient portals with medical histories and current medication lists, and whom to contact in the chain of command."

And like Uber drivers or Instacart delivery workers, nurses who use the apps don't have a boss to contact when things go wrong. One Oregon-based nurse interviewed for the study said that she was barred from Clipboard Health's app for two weeks after she had a hernia on the job and had to leave early.

In another instance, the same nurse said that she went to work with COVID after learning that she couldn't cancel her shift without losing "attendance points" and hurting her chances of getting gigs in the future, the report reads.

"It sucks that there's nobody that you can get ahold of immediately," the nurse told Wells and Spilda.

"It's really as if AI has eaten the managers," Wells said.

The apps also advertise that nurses can make more on their platforms than at other jobs. One nurse interviewed by the researchers said she made gross pay of $23 an hour on ShiftKey. That dropped to around $13 an hour after accounting for fees that she paid to ShiftKey.

Despite the challenges, the report found that 19 of the 29 people interviewed planned to continue working for the apps, though some also said they also had jobs in other industries to make enough money to live.

The report says that gig nursing apps are often used by facilities that are trying to save money and are under pressure to produce returns for investors.

Wells told BI that bringing the gig economy to medical care creates risks not present in food delivery or rideshare.

"The stakes are higher because this has to do with patient safety, and the immediacy of health and care makes things more palpable," she told BI.

ShiftMed, which employs its nurses as W2 employees but still offers them much of the flexibility of gig work, said that it deactivates nurses' accounts for various reasons, from patient safety to legal violations.

"Nurses file an appeal by submitting a formal review through the app or support channel, after which ShiftMed conducts an internal investigation, reviews records, and determines the next steps," CEO Todd Walrath said in a statement to BI.

The company said that it also offers an orientation so that users "are fully prepared for any clinical setting by aligning health system-specific requirements, such as training or shadowing before they begin shifts," Walrath said.

CareRev, Clipboard Health, and ShiftKey did not respond to requests for comment.

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