Last spring, after six years working as a nurse in care homes around Ohio and making between US$500 to US$600 a week, Sadie decided she needed to try something new. On the advice of a colleague, she downloaded Clipboard Health, an Uber-style app that allowed her to book short-term stints in elderly care facilities, for as much as twice the pay of some of the previous jobs she worked. “I needed more money – I live paycheck to paycheck,” said Sadie, who asked to withhold her real name, in a phone interview.
But she soon found herself penalised by the platform – including having her account frozen – for alleged infractions such as cancelling a shift due to illness, leaving her unable to book new shifts on the app. Clipboard is part of a growing constellation of gig apps that are trying to bring the Uber-style model of independent contracting to healthcare, as care homes face worsening staff shortages.
“This is one of the many sectors that is being increasingly gig-afied,” said Valerio De Stefano, a professor at York University who studies algorithmic management and app-based work.
Although nursing home workers like Sadie are promised flexible jobs, over half a dozen of them working for apps like Clipboard and ShiftKey told the Thomson Reuters Foundation they felt “controlled” by the platforms’ rules and parameters, with little scope to push back. Nurses reported being told almost nothing about the facilities they were booked in – only to arrive and realise most of the staff were also gig nurses without enough of them to properly care for patients.
A Clipboard spokesperson said in emailed comments that the platform helps healthcare workers “find work that fits their schedule and does not interfere with their other commitments, including personal and family obligations”. The company said that it encourages workers to report any safety incidents, and allows nurses to mark facilities as “Do Not Return” on the app if they no longer want to pick up shifts. ShiftKey did not respond to a list of questions.
Nursing gig platforms are growing in popularity, just as the US experiences an acute labour shortage in nursing homes. Certified nursing assistants (CNAs) are some of the lowest paid workers in healthcare, where a combination of burnout and low wages have forced staffing levels to a 15 year-low, according to the American Health Care Association (AHCA). Over 80% of facilities are reporting “moderate to severe” staffing shortages, the AHCA found. That is pushing nursing homes to rely on more temporary staff, explained Deb Emerson, a consultant with CliftonLarsonAllen who works with nursing home owners.
“Most of our clients are in that position where they would love to be able to hire more staff, but the workforce just isn’t there,” she said. “And so they are forced to make a decision either to utilise agency staff or reduce the occupancy in their facility.”
The healthcare outsourced labour market – which includes apps like Clipboard – has more than tripled in size over the past four years, growing from US$18.8 billion in 2019 to US$64.4 billion in 2023, according to Staffing Industry Analysts, a trade publication.
Although there are dozens of contracting agencies for nursing home staff, Clipboard and ShiftKey have expanded rapidly in recent years – both notching valuations over US$1bil. Clipboard calls itself a “transformative solution to staffing problems”. ShiftKey has said it is “tackling a labour shortage that is crippling the medical system”. Other platforms, such as CareRev and Papa, have made similar claims for other healthcare jobs such as hospital nursing or in-home health aids.
The new platforms resemble gig economy models such as Uber, where workers are matched with jobs through an app or online platform and then managed through algorithms and rating systems. For facilities that have a sudden influx of new patients, or staff on leave or off sick, the model offers an enticing option.
