Uber for Nurses: How the Gigification of Healthcare Has Affected Nurses

Gig nursing platforms, a type of on-demand staffing app, let healthcare facilities post open shifts for nurses to claim (and even bid on, in some cases).

The biggest platforms in the US market include:

• ShiftMed
• CareRev
• ShiftKey
• Clipboard Health
• IntelyCare
• Nursa

People have compared these apps to rideshare platforms like Uber and Lyft, and they operate somewhat similarly, although for obvious reasons, they have much stricter registration requirements.

For instance, ShiftMed, which is currently Siener’s preferred app, requires applicants to hold an active nursing license or certification, have at least 6 months of clinical experience, and meet all of their state and facility regulations.1

The rise of the “Uber for nurses” model

Gig nursing platforms have been around for over a decade, but they became much more popular in the wake of the COVID-19 pandemic, according to Algorithm Watch, a nonprofit human rights organization.2

Many nurses left the profession after the global health crisis due to burnout and poor working conditions, causing staffing shortages in medical facilities. Gig nursing platforms provided a solution, helping hospitals find new staff quickly and offering nurses an alternative work model.2

Siener first signed up with a gig app around that time, mainly out of curiosity. She was working nearly full-time as a PRN nurse at Mercy, and wanted to explore other, more flexible options.

Her first app was CareRev, which she began working for in 2021 while keeping her job at Mercy. She eventually switched to ShiftMed in 2023 after many local shifts in her area transferred to it from CareRev.

Siener told us that the transition from staff to gig nurse was a breath of fresh air. “I had been with Mercy for many years, and this was just the change I needed,” she said.

She’s far from the only nurse to have switched things up lately. Sarah Carter, a Wisconsin-based emergency room RN, downloaded CareRev in early 2023 out of a mix of financial necessity and a desire for flexibility.

While some nurses like Dana use the apps purely out of necessity and have reservations or complaints about them, both Siener and Carter willingly chose to use them.

In late 2024, Siener left Mercy because her shift gigs and another part-time job as a clinical instructor were taking up all her time. As of 2026, she relies on ShiftMed as her sole source of income. Carter continues to balance CareRev shifts with her transport nurse job, but uses the app heavily to supplement her income.

Both agree that while the apps aren’t perfect, they offer several perks.

Autonomy and flexibility

According to an AI Now Institute study, many nurses want “greater flexibility and more control over their time and working conditions.”

Siener and Carter are among them. They both told us that the ability to control their own schedules is one of their favorite things about using gig apps.

“I don’t have to work any holidays or weekends unless I want to,” Siener said, adding that she can also choose which hospital she feels like driving to that day.

Siener is currently in a long-term assignment (LTA), which she said has less flexibility and requires more conformity. She has to, for example, choose schedules that fill gaps in the floor staff’s hours well in advance.

But even so, her role still has much more freedom than those of staff nurses, who she noted often have to endure more micromanagement and the “drama” of each floor.

Quick payments

Most gig nursing apps offer weekly, daily, and even instant payment methods—a feature that Siener said she always takes advantage of.

She admitted that this perk can be double-edged for people who have trouble saving money, something she’s struggled with herself. “When I get paid each day, I tend to spend it faster,” she said.

It’s a good idea for those with similar spending habits to create firm budgets and track their daily expenses.

Higher pay rates

A 2024 study from the Roosevelt Institute found that gig nurses’ earnings averaged $59 per hour, compared to $45.42 per hour for permanent staff.6

In Siener’s and Carter’s experiences, gig app pay is, indeed, significantly better than standard hospital pay.

“I love the higher pay,” Carter said. For her, the income boost made the transition to gig work well worth it. Echoing the sentiment, Siener told us, “I was making really good money and paying off debts as fast as I wanted to.”

However, she noted that, unlike hospital staff, gig nurses don’t receive incentives to pick up more demanding shifts. It’s something that she hopes the apps will change.

“When our floor only has 3 nurses and needs 6, our pay should be incentivized to pick up that shift, but it never is,” she said.

Using gig nursing apps isn’t all sunshine and rainbows, as Dana told the Roosevelt Institute.6 Her complaints were echoed by the AI Now Institute, which claims that widespread use of the apps may compromise worker pay, rights, and protections.2

Even Siener, who’s largely happy with the apps, pointed out some downsides of using them.

Potential hidden platform fees and other expenses

While gig nursing apps often offer higher rates, some cut into their gig workers’ paychecks with various fees.

Ashley, a certified nursing assistant quoted in the Roosevelt Institute report, said that in 2024, her hourly pay was higher than what she made as a substitute teacher, but that she had to pay $6 per shift in fees.6

On her chosen app, ShiftKey, that has climbed to nearly $9 per shift in 2026. Here’s a breakdown of where the fees come from:78

• Occupational accident insurance: $2.57
• Medical malpractice insurance: $2.33
• Platform safety fee: $3.89

Fortunately, Siener told us that neither app that she’s used—CareRev and ShiftMed—charges nurses those fees.

In addition to platform fees, gig nurses also need to factor in the material expenses they’re responsible for (e.g., equipment, licenses, and uniforms), the Roosevelt Institute study noted.6

The upshot is that depending on the app a gig nurse uses, their take-home pay may be lower than they anticipated.

Payment issues

While gig nurses usually receive their pay quicker than staff nurses, some have experienced occasional payment issues with some of the apps.

Ashley said that ShiftKey doesn’t always send her the right wages. When that happens, she has to message the app in her free time to sort it out—time that they don’t compensate her for.6

Siener noted that ShiftMed’s payout system can also be glitchy. That was especially true when she first joined in 2023. It has gotten much better over the years, she added, and she didn’t run into any payment issues with CareRev, which she said offers a better overall user experience.

Carter also vouched for CareRev’s reliability. “I have never had any payment issues with CareRev,” she said, adding that the app generally has always worked smoothly for her.

Lack of employment benefits and worker protection

Ashley doesn’t have health insurance because ShiftKey categorizes workers as 1099 independent contractors (who don’t receive employment benefits), and she can’t afford private insurance.

She also isn’t entitled to labor protections, such as a guaranteed minimum wage, overtime pay, and unemployment insurance.

Not all gig nursing platforms categorize workers as 1099 contractors, but the AI Now Institute study believes this practice shouldn’t happen at all.2 It argues that gig nurses don’t have the freedom that 1099 contractors should have, such as the ability to negotiate rates, discuss their working conditions, or decide when and where to complete their work.29

Working as a 1099 contractor does have certain perks, too, and Carter told us she actually prefers it, explaining that her contractor status with CareRev allows her to write expenses, such as mileage for her 1.5-hour commute to the hospital, off from her taxes.

Still, 1099 status means forgoing traditional benefits. For nurses need them, platforms like ShiftMed that categorize workers as W-2 employees offer an alternative, though Siener said the insurance plan the app offers isn’t very good.

As much as she enjoys using the apps, she told us she wouldn’t recommend them to someone who needs cheaper insurance, paid time off (PTO), retirement matching, sick days, and other employment benefits.

“I pay a lot for private insurance in order to cover my whole family,” Siener said, adding that a gig nurse on a 1099 contract must pick up extra shifts to cover sick days and vacations that would otherwise go unpaid.

Tax obligations for independent contractors

Independent contractors are fully responsible for their own tax liabilities, as companies don’t withhold or pay taxes on their behalf.10

Siener recalled having to set aside extra money for tax season while she was using CareRev—a practice that was new to her, and required a mental adjustment.

Carter told us she suggests newcomers get a tax advisor and learn about “all the benefits and challenges of 1099 tax stipulations.” Doing so can make the transition smoother.

Check out the following table to find out how major gig nursing apps classify workers and what benefits they offer.

Less stability and support at work

While Siener has had better luck than Dana at securing shifts—she told us her hospital rarely cancels them, and she has never lost a shift before—she agrees that gig nurses have less stability than hospital staff members.

“We are at the mercy of the hospital,” she said. She elaborated that gig nurses usually are the first to have their shifts canceled if a hospital has enough staff.

Siener said she has heard that both CareRev and ShiftMed give gig nurses payouts when they cancel shifts. However, Dana, who has been canceled several times, said that CareRev has only compensated her when the hospital canceled the shift with less than two hours to go.6

Carter confirmed this, and said that in her experience, CareRev has paid for the equivalent of four hours of work when a hospital cancels a shift that abruptly. Fortunately, she also said she has rarely experienced this.

Day-to-day stability (even when working)

Gig nurses have less stability in their day-to-day work, according to Siener. “I could pick up on a cardiac floor and get pulled to ortho and would have no say in where I would like to be that day,” she said. She added that gig nurses may be assigned heavier workloads or unfamiliar specialties.

Moreover, Siener noted that because gig nurses often float between units, they may take more time to build relationships with other workers. In some cases, gig nurses may feel excluded or judged by permanent staff, all while not having a dedicated manager to address their workplace concerns.

Those issues don’t actually bother Siener that much, she said. “That’s just the nature of the program.” She told us she’s built just as many relationships at her hospital as she would have if she were a staff member.

Carter agreed, saying, “I have always had great interactions with facility staff.” She added that full-time workers usually welcome gig nurses because they would otherwise be short-staffed and overworked.

Opaque wages and shift competition

Most major gig nursing apps use AI-powered systems to set workers’ rates, allocate shifts, track worker behavior, send paychecks, and create performance metrics.2

All of that worker data feeds back into the algorithms, allowing them to decide the nurses’ future shift availability and pay rates.2 However, nurses don’t know exactly how the systems make these decisions.

Siener told us that canceling a shift can theoretically hurt your chances when competing with others for work, but she doesn’t think the ratings actually mean anything.

“I’ve seen coworkers with less than 50% show rates, and they’re still standing right next to me, who has a 97% show rate,” she said, adding that she wishes ShiftMed’s rating system rewarded workers who perform better.

On CareRev, ratings carry clearer incentives, according to Carter. She told us that nurses with high reliability scores get early access to newly posted shifts on the app.

Some gig nursing apps actually encourage workers to bid for shifts against each other. Neither CareRev nor ShiftMed allows this, so it’s never been an issue for Siener, Carter, or Dana. However, ShiftKey does allow bidding, and users like Ashley struggle with it.

Ashley said she often has to keep cutting her rate until it drops well below a living wage to land a shift.6 Competing for shifts can feel like “a race to the bottom.”2

The gigification of healthcare has, for better or for worse, changed the way many nurses manage their careers today.

Both Siener and Carter think the apps are here to stay and encourage others to try them out.

Despite the apps’ drawbacks, Siener said using them allowed her to attain a lifestyle that simply wasn’t available to her as a staff nurse.

“I loved my Mercy family and may someday return to them,” she said. But right now, she thinks working through gig nursing apps fits her current lifestyle better.

Dana isn’t as enthusiastic about gig apps taking over the healthcare industry. She said she would much rather find a full-time nursing job that offers decent pay and weekends off.6

As labor experts have noted, it will require regulation to make nursing gig work a reliable model for all. For now, whether becoming a gig nurse is worth it seems to depend on the app, the hospital, your priorities, and perhaps a sprinkle of luck.