While many nurses work set schedules with occasional overtime, Martha Mendez, a registered nurse (RN) in El Centro, California, prefers a more flexible approach to patient care. It’s the same way an Uber driver decides when they want to turn on their app and drive clients.
Mendez signs up for shifts days — and sometimes hours — in advance and works for multiple health systems to care for patients all over Southern California. She is one of a growing number of nurses who have joined the gig economy.
“After being in a traditional role for many years, I was looking for…more control over my career, my schedule, and my earnings,” Mendez told Medscape Medical News. “When I learned about the logistics of [gig work], it really caught my attention, and I gave it a shot.”
The use of contract or gig workers in healthcare grew 18% from 2014 to 2021, and up to 53% of nurses planned to take on more temporary nursing shifts. Nurses can register with platforms like Float Health, CareRev, ShiftMed, and Clipboard Health to choose shifts that fit their schedules.
The model, also known as per diem or float nursing, has been hailed as a potential solution to staffing shortages, allowing health systems to fill short-term staffing gaps and meet immediate patient needs.
“Every state has a nursing shortage…and that shortage is projected to increase,” said Katie Jett, DNP, RN, MSN, dean of the School of Nursing at Ponce Health Sciences University in St. Louis. “A lot of nurses don’t want to work 12-hour shifts and mandatory overtime… [Gig work allows nurses] to book around their schedules or come in for a 4-hour shift, and that is very enticing.”
About Medscape Data
Medscape continually surveys physicians and other medical professionals about key practice challenges and current issues, creating high-impact analyses. For example, in Medscape’s Nurse Career Satisfaction Report 2023,
- 13% of RNs and 15% of nurse practitioners (NPs) said that work-life balance was the most rewarding part of their job.
- 10% of RNs and 11% of NPs said that poor work-life balance was the least rewarding part of their job.
- If they could do it again, only 1 in 8 nurses would choose the same practice setting.
The ‘Uber of Nursing’
Healthcare is struggling with nursing shortages, widespread burnout, and low job satisfaction, leaving health systems struggling to attract and retain nurses and fill shifts. Currently, 66% of healthcare facilities are not able to operate at full capacity due to staffing shortages.
The gig model, once limited to rideshare drivers and food deliveries, has entered healthcare.
Nurses choose a gig work platform and complete an onboarding process that often includes proof of licensure and certifications, background checks, and drug screens. Upon approval, platforms post open shifts, and nurses can claim those that match their credentials and specialties.
Mendez started picking up shifts through Float Health in 2022. She’d worked in hospital emergency rooms, medical-surgical units, and correctional facilities for more than a decade and loved being at the bedside but felt that working conditions, including mandatory overtime, were “unacceptable.”
At first, Mendez only picked up one or two shifts per month doing at-home infusions for patients and continued to work in her full-time nursing role. The option for a flexible schedule, one-on-one patient care, and higher pay led her to leave that staff role and make the switch to per diem nursing.
“There was no comparison [with pay]; I would absolutely give up a 12-hour shift to take a Float patient for a few hours,” she said. “But one of the biggest drivers is not money; it’s being able to have the peace of mind that I have the balance to care for my family, not only financially, but to be there for them and offer the same care that I offer to others.”
Signing bonuses and improved compensation and benefits packages are common approaches to attracting nurses, but nurses also crave flexibility. The latest data show that 33% of nurses wanted to pick up shifts on an as-needed basis and cited the ability to work partial shifts and pick up additional work at different facilities as key areas of career interest.
The recognition that gig platforms account for a growing part of the healthcare workforce has led some health systems, including St. Louis-based Mercy Health, to create their own gig work platform.
In 2022, Mercy Hospital in Springfield, Missouri, launched Mercy Works on Demand, a cloud-based platform that enables nurses to pick up shifts. More than 50 nurses signed up for the 2022 pilot, including full-time school nurses who wanted to earn extra income and RNs who took time off to raise children but wanted to return to the bedside for a few hours per month. The internal float pool concept expanded to other hospitals within the Mercy system.
Bon Secours Mercy Health in Cincinnati followed with Andgo in 2024. The program sends text messages about available shifts and allows nurses to claim the gigs. Since going live, the hospital has seen an increase in the number of shifts picked up, resulting in decreased costs and safe patient care, according to Jodi Pahl, RN-BC, DNP, the system chief nursing officer of Workforce, Outcomes, and Experience of Care at Bon Secours Mercy Health.
Pahl points to the advantages of an internal model, citing consistent care from nurses trained within the organization and aligned with its culture and standards, adding, “These nurses are more engaged, adaptable, and cost-effective than gig workers, avoiding the high fees and variability associated with external staffing.”
Internal float pools also serve as a retention pipeline for future permanent hires.
Critical of the Care Model
The expanding gig work in healthcare has raised some concerns. A recent report from the Roosevelt Institute, New York City, called the model a “Wall Street takeover of US healthcare infrastructure” and warned that gig nursing platforms offer lower rates, fail to guarantee available shifts or offer certainty about the nature of the work, and fail to account for worker safety and patient well-being.
Jett is familiar with the concerns.
“We have to take it back to [patient] outcomes,” she said. “The literature is well documented that consistent care by knowledgeable nurses improves health outcomes for patients, so there’s no doubt that you’re more likely to get better care with a nurse that knows the unit, knows the policies, knows the procedures, has an orientation…that is the best for our patients.”
But she adds that burnout is also linked to lower patient safety, quality of care, and patient satisfaction.
There is also some debate about the fees paid to RNs who work on a per diem basis. The average rate for RNs picking up shifts through gig work apps is $59 per hour, according to the Roosevelt Institute report (compared with a median wage of $41.38 per hour), according to nurse.org. However, some apps have a bid-for-gigs model that allows health systems to hire nurses willing to work for the lowest rates. Jett called it “algorithmic wage discrimination” and noted that it can drive down rates for gig workers. In addition, nurses working as independent contractors may lack protections like sick leave and unemployment insurance.
Despite the criticisms — and the need for real solutions to address nursing shortages, burnout, and unsafe work environments — Jett believed gig work is “here to stay” in healthcare and encourages solutions that balance the needs of nurses, patients, and health systems.
“My hope is that there is a way to…provide flexibility and work-life balance and fair compensation to nurses,” she said. Gig work might be it.
Jodi Helmer is a freelance journalist who writes about health and wellness for Fortune, AARP, WebMD, Fitbit, and GE HealthCare.
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