Hospitals are becoming part of the Gig Economy as administrators turn to staffing apps to fill shifts when internal staffing is low. The transition to more temporary nurses is fueled by a shortage that has given nurses more control over their schedule. Nurses are turning to the apps to manage when they work or pick up extra shifts as the gig work invades hospitals like it has other areas of the economy.
Most people are probably familiar with Uber and Lyft, ride-hailing services used to schedule rides to the airport or anywhere you may need to go. Uber and Lyft are little more than matchmaking services, connecting drivers with people needing rides. Both companies use congestion pricing. Fares charged are a function of how many drivers are available and the demand for their services. For example, on a trip back from Costa Rica I discovered Uber is much more expensive on a Friday evening when there is both a concert and a major sporting event competing for drivers. My ride home from the airport ended up costing double the cost of my initial ride to the airport. Health care staffing apps are similar, balancing supply and demand for nurses with variations depending on the shift. The Wall Street Journal explained how the apps work:
Some of the nation’s largest hospital systems including Providence and Advocate Health are using apps similar to ride-hailing technology to attract scarce nurses. An app from ShiftKey lets workers bid for shifts. Another, CareRev, helps hospitals adjust pay to match supply, lowering rates for popular shifts and raising them to entice nurses to work overnight or holidays.
The embrace of gig work puts hospitals in more direct competition with the temporary-staffing agencies that siphoned away nurses during the pandemic. The apps help extend hospitals’ labor pool beyond their employees to other local nurses who value the highly flexible schedules of gig work.
Pay is always higher for less desirable shifts when fewer nurses prefer to work. Back in the day before smartphones the hospital I worked for had a program allowing nurses to work two 16-hour shifts on Saturday and Sunday and get paid for 40 hours. Apps allow hospitals to request nurses only hours before they are needed and adjust pay on a daily or even shift basis.
“We’re still short,” said Elaine Zemel, business analyst for nursing administration at Henry Mayo Newhall Hospital, a Los Angeles-area hospital that offered gig workers at one point $106 an hour for a 12-hour intensive-care shift on Easter Sunday. “Nurses know that the ball is in their court.”
Gig apps give nurses even more control than other common temporary-employment options that lock in workers for multiweek contracts, at least. It opens shifts to a broader labor pool, too, but also a more fluid one, hospital executives said.
One of the reasons for the gig economy in nursing is that there is a nursing shortage, affording nurses more say in when they work. During Covid an estimated 100,000 nurses left the profession for other occupations as their work got harder and more dangerous. Some nurses joined travel nurse agencies but those require working out of town for weeks or months at a time.
Staffing agencies providing temporary nurses have been around for many years. What has changed is that technology now allows hospitals to communicate their staffing needs much more quickly than calling a staffing agency. In the past a nursing manager would have to call several staffing agencies, which in turn would have to get on the phone and call numerous nurses to see if any were willing to work. Some hospitals are breaking up 12-hour and 8-hour shifts into shorter shifts, like four to six hours, to entice nurses who otherwise would not be willing to accept a longer shift.
An algorithm within one of the apps calculates pay based on supply and demand. Nursing managers can override the app and manually plug in a higher wage if no nurses accept a shift a hospital needs filled. This comes with a downside, however. Nurses can game the system if they’re brave enough to risk losing a shift they may actually want.
Hospitals that use the apps risk encouraging nurses to hold out for higher rates and a last-minute rush to fill schedules, said Maribeth McLaughlin, the chief nurse executive for UPMC, based in Pittsburgh.
Staffing apps also allow nurses who have full time jobs to accept shifts outside of their normal working hours if they want additional money.
Jecoliah Jackson has signed up for two apps that match her with open nursing shifts in the Los Angeles area, she said. She picks up extra shifts when she isn’t scheduled at her full-time hospital job. She said she earned $108 an hour during a recent shift.
“It’s the market,” she said. “We all take advantage of it.”
Nurse staffing apps have increased the pool of nurses willing to pick up additional shifts by giving them more control over their schedule. Staffing apps also give hospitals more control over their nursing needs without having to coordinate with multiple staffing agencies. Now if only hospitals would provide prices and allow patients to bid on medical services like on eBay. For that matter, I wish more primary care physicians would sign up with OnCall Physician apps allowing patients to schedule same-day office visits like scheduling a ride with Uber.