More nurses are entering into gig work

Although "gig work" has largely been associated with companies like  Uber or  DoorDash, healthcare organizations are joining the gig economy as they continue to struggle with persistent staffing shortages.

Some companies, including  ShiftKey and  CareRev, are offering apps to connect nurses with shifts at different hospitals. These apps allow nurses more flexibility and control over the shifts they work since they don't have to commit to long-term agreements or full contracts. Nurses can also take shorter shifts between four and eight hours instead of the typical 12.

"[T]he gig economy offers alternative, flexible options to retain nurses in the profession while eliminating budget-draining travel contracts," said Susan Pasley, VP of clinical solutions at CareRev. According to Pasley, around 64% of nurses and other healthcare professionals use the platform to augment their main full-time or part-time job.

"It's a big win for health systems and patients because it will enable caregivers to take advantage of the gig economy within their own industry instead of seeking opportunities elsewhere," Pasley said. To ensure a sustainable workforce going forward, "[h]ealth systems that want to attract and retain talented nurses must embrace an on-demand, flexible gig economy to augment traditional models."

How some hospitals are using gig workers

Several large hospital systems around the country have begun using apps to hire gig workers to fill in their staffing gaps, particularly for shifts that may be difficult to fill, such as holidays or overnights.

For example, Providence began using gig workers a year ago and has so far filled 13,000 shifts for nurses and other medical professions. According to Mark Smith, who oversees workforce analysis, staffing, and optimization at Providence, the system is planning to expand gig work from 12 hospitals and nursing homes to 19.

Advocate Health has also employed gig workers since August 2022. Since then, the health system has filled 5,000 shifts in its Wisconsin hospitals and is considering plans to expand the model to its hospitals in Illinois.

Mercy, which has hospitals in four states, has used a gig labor model for its nurses since 2021, originally piloting it in its Missouri hospitals before expanding it to all its hospitals in 2022. Through the program, gig workers can work up to 30 hours a week and can take on shifts of varying lengths.

"They are Mercy nurses," said Betty Jo Rocchio, Mercy's SVP and CNO. "They are hired by us, into this flexible workforce … they just can pick up the hours that suit them."

Although night shifts have historically been less popular and more likely to be short-staffed, Rocchio said the gig worker program has allowed the hospital to fill these shifts more easily. "We're fully staffed, on these units," she said. "We're filling our shifts at anywhere from 95% to 100% of the time."

Could gig work be detrimental for nurses?

Although some nurses may prefer the flexibility of gig workers, there are also potential downsides. Unlike regular staff nurses, gig nurses are often considered independent contractors and do not receive benefits. They are also not guaranteed shifts and may have the hours they can work limited.

According to National Nurses United, legislation has been proposed to classify nurses who use apps or platforms to schedule work as independent contractors, which could limit the federal rights they are guaranteed. Compared to W-2 workers, independent contractors are not guaranteed minimum wage, overtime pay, workers' compensation, or health and safety protections. They also have to pay higher rates for unemployment insurance and manage their own income taxes.

Tony Braswell, who created  Gale Healthcare Solutions to connect nurses with available shifts, has spoken out against classifying healthcare workers as independent contractors. Unlike some companies that offer gig work, Braswell hires employees as W-2 workers and offers some benefits, including workers' compensation.

According to Braswell, labeling nurses as independent contractors would only further worsen the ongoing nursing shortage and leave older patients both neglected and underserved. "We can't lose nurses," he said, noting that many nurses "want to work full time. They just want to work on their own terms." (Evans, Wall Street Journal, 4/18; Gelinas, American Nurse Journal, 3/1; Pasley, HealthLeaders, 11/10/22; Merrilees, St. Louis Post-Dispatch, 5/22/22; National Nurses United, accessed 4/18; Hilgers, New York Times Magazine, 4/17)

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