The Markup looks at what it’s like when you start hiring nurses the way you catch a ride from Uber:
Gig nursing apps have become hugely popular with both nurses and investors, as an estimated 100,000 nurses have left the profession since 2020 and demand for their labor remains high. Clipboard and ShiftKey—a similar nursing app—say tens of thousands of facilities now use their services. Clipboard has been valued at more than $1.3 billion by investors, and more recently, ShiftKey was valued at more than $2 billion.
But Howell eventually started to sour on Clipboard. The attendance policy runs on a points system. If a nurse fails to show for a shift, it deducts 85 of 100 points until workers earn them back through consistent attendance—over weeks or even months of shifts, depending on how often a person works. Once, when Howell was driving from Salinas, California, to a shift an hour away in San Jose, she missed a request from the app to confirm her attendance on the commute. By the time she showed up, another nurse had been assigned to the shift, and Howell was on the verge of temporary suspension from the app—she only had 15 points to spare. Eventually, she was restricted for a week after being late for a different shift.
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As a result of the one-off gig structure, nurses sometimes only work at a facility once, and care for patients they’ve never met before and won’t see again. This also means patients are sometimes receiving care from strangers, according to nurses who have used the apps, as well as inspection reports obtained by The Markup. Nurses also told us that they sometimes receive less training than they expect. The Markup found multiple reports in which facilities hiring nurses through ShiftKey and Clipboard did not provide training.
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The problems that existed with temporary workers may be exacerbated even further with a “hyper-contingent” staff, she said. Effective training requires time that quick-turnaround gig work doesn’t incentivize, [National Nurses United’s Michelle] Mahon said.
In the short-term, nurses assigned to shifts also may not know where to find important equipment during an emergency, Mahon said. Nurses may also not be from the community where they’re working and feel less connected to their patients.
When a patient requires long-term care, nurses hired for brief periods may have less of an understanding of their routine and needs, Mahon said. If a nurse doesn’t understand a facility’s records system, they might fail to realize when a patient needs a specific type of medication. “Getting it right is always really a matter of life and death in health care,” she said. That type of training, she argues, can’t be given in a short training session.