App-Based Nursing: “A Rotten Situation”

The “gig” model of labor popularized by Uber has found a new sector to upend: health care. In a new brief, Groundwork Collaborative Fellow Katie J. Wells and Funda Ustek Spilda, senior lecturer at King’s College London, interview 29 gig nurses taking jobs through on-demand nursing apps and explain how this labor model endangers workers and patients alike.

These apps require nurses and nursing assistants to bid for shifts by offering to work for the lowest wage, rate workers through an opaque process, and typically don’t provide benefits. Nurses aren’t required to receive training or orientation when placed at new facilities, with one nurse reporting “times when I’ve been unable to access patient records or find supply closets.” Patients, according to another nurse, are in “a rotten situation” with “all these random folks taking care of them.” 

These platforms (which, in this study, include ShiftMed, ShiftKey, Clipboard Health, and CareRev) were created “to solve a nursing shortage that doesn’t really exist,” Jacobin’s Helen Santoro wrote in coverage of the brief this week. The real shortage is one of good nursing jobs. “I love being a nurse,” said 29-year-old Dana. “But I hate being a nurse right now with [what] these greedy, immoral, corporate companies have done to health care.”

Report coauthor Katie J. Wells told The Guardian, “We don’t take care of these workers in a way so they can take care of their families . . . many of these workers [turn] to the gig economy because they need some semblance of control over their own lives, because they haven’t had it otherwise.” And like Uber, gig nursing companies have lobbied state legislators to ensure minimal regulation and oversight over their business models—efforts that will only make these types of nursing jobs worse. 

“Wall Street’s takeover of US health-care infrastructure and Silicon Valley’s introduction of gig nursing apps are a dangerous duo that is eroding our health-care system and eviscerating our ability to take care of each other,” Wells and Spilda write.

Read the brief: “Uber for Nursing: How an AI-Powered Gig Model Is Threatening Health Care”

Looking Back to Look Ahead: The 2024 Rundown

The Roosevelt Institute’s mission in 2024 was, as always, to work toward the ideal of a government that actually serves its people. This year, our experts dug into the what, why, and how of making this vision a reality.

A democratic state should empower and protect, not exclude and dominate, but doing so will likely require new or transformed governing institutions. The recent embrace of industrial policy—the state taking an active role in shaping markets—is a start, and can be enhanced by policy tools that have proven effective globally, from corporate guardrails to state financial institutions.

As for when and where the government should intervene—well, some problems just cannot be fully solved by private companies. That includes services that the public needs, from banking to electricity transmission. Roosevelt research dug into how the government can coordinate the quick and equitable deployment of solar energy, facilitate a transition away from fossil fuels, and boost necessary care work services like elder care and childcare.

To achieve these big ideas, we have to change how we think about government and its most common functions. Take taxation: Decades of trickle-down economics that prioritized slashing taxes for the rich have only worsened the societal peril that is economic inequality. What if, instead, we viewed taxes as a way to increase well-being and repair trust in government?

Entrenched political damage and a culture of despair and isolation are the resounding consequences of the past 50 years of economic policy. Roosevelt is charting a new path for the 50 years to come. We look forward to continuing to dig into these issues with you in the coming year.

What We're Talking About

What We're Reading

• Roosevelt Senior Fellow Beverly Moran writes in The Conversation about all the little ways in which the Tax Cuts and Jobs Act (TCJA) disproportionately harms Black Americans.
  • Multiple provisions of the TCJA expire in 2025. Drawing upon the report she authored for Roosevelt earlier this year, Moran calls on Congress to build a fairer tax code.
• The Fed lowered interest rates to a range of 4.25–4.5 percent, which totals to a one percentage point decrease since its first cut in September.
  • For a refresher on why we want lower interest rates, Roosevelt’s Ira Regmi has you covered.
• The FTC’s latest stand against corporate power is a rule banning companies from hiding hotel and ticket price junk fees from consumers.
• Insurance companies are dropping their contracts with homes in wildfire- and flood-prone areas—stranding their customers to face climate disasters with no protection.
• Amazon warehouse and delivery workers are on strike as of Thursday.

Note: The Roosevelt Rundown will be on hiatus until January 10. Happy New Year!