Uber for nurses: how gig work apps are pushing to deregulate healthcare in the US
The concept of Uber for nurses has gone from a curious metaphor to a billion-dollar business model that is reshaping — and undermining — healthcare work in the United States.
A new report from the AI Now Institute has raised alarms about how tech platforms are using artificial intelligence to manage nurses the same way ride-hailing apps manage drivers.
The difference is that what is at stake here is not just a car ride.
It is patient safety and the rights of healthcare workers who care for people during their most vulnerable moments.
The study, titled Uber for Nursing Part II: How Gig Nursing Companies Are Lobbying States to Deregulate Healthcare, reveals how these companies are not just growing — they are actively pressuring state and federal governments to strip away regulations that protect both workers and patients.
And the numbers show this movement is already far more advanced than most people realize. 👇
How gig work apps for nurses actually work
Platforms like Clipboard Health, Nomad Health, and ShiftMed operate similarly to what you already know from Uber or DoorDash. A nurse downloads the app, registers their qualifications, and starts receiving shift offers at hospitals, clinics, and nursing homes. Accept the shift, work it, get paid. It seems simple, convenient, and even appealing at first glance — especially for professionals who want schedule flexibility or who are between full-time jobs. But the model hides a series of pitfalls that go well beyond the surface.
What sets these platforms apart from a simple staffing agency is precisely their intensive use of artificial intelligence in healthcare. Algorithms determine which nurses receive which offers, how much each shift pays, which professionals get prioritized in searches, and even who can be deactivated from the platform based on ratings. This automated scoring system creates an invisible hierarchy that very few workers can challenge — simply because it has no face, no manager, no HR department to contact. It is AI making decisions that directly impact the income and careers of real people.
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According to the report, the industry even allows nurses to participate in reverse auctions, where professionals bid on their hourly rate — and the lowest bid wins the shift. Clipboard Health, for example, shows nurses the option to choose a rate as a bid, with the lowest bid winning the assignment. In practice, this means healthcare professionals are pitted against each other in an automated price war, where whoever agrees to earn less is the one who gets to work.
Another critical point is that because nurses are classified as independent contractors, the companies do not have to offer traditional employment benefits like health insurance, paid time off, sick leave, or retirement contributions. This means the professional bears the full cost of being self-employed, while the platform takes a substantial cut of every transaction and transfers all the risk to the person actually delivering care. For many nurses — especially those who rely entirely on these platforms — the math just does not work out at the end of the month.
Scoring systems and algorithmic punishment
The report details an aspect that really stands out: the point-based disciplinary systems these platforms use. Clipboard Health, for example, deducts points from nurses who cancel shifts, applying steeper penalties when the cancellation notice comes with little advance warning. Showing up late also results in lost points. This system works like a kind of digital track record that determines the professional’s future on the platform.
Dr. Katie J. Wells, co-author of the report and senior researcher at the AI Now Institute, put it bluntly: AI is embedded in all of these workforce management systems, and for nurses that means being sent to all kinds of facilities without prior orientation, without workers compensation insurance, and without any protection if they get sick and need to cancel a shift. According to her, these platforms also use AI technologies to facilitate a bidding war against nurses themselves.
This dynamic creates a vicious cycle. The more a professional depends on the platform to make ends meet, the more they submit to conditions that erode their quality of life and their ability to provide adequate care. And the more they accept those conditions, the more they feed a system that pushes standards downward, dragging the entire profession along with it.
The push to deregulate healthcare
The AI Now Institute report goes beyond analyzing the business model and ventures into even more troubling territory: the active lobbying by these companies to deregulate healthcare at both the state and federal levels. According to the document, since 2022, lawmakers in at least 17 US states have introduced bills designed to exempt gig nursing platforms from the regulations that apply to other healthcare staffing agencies.
This pressure has already produced concrete results. Exemption bills have advanced in Colorado, Illinois, Iowa, Louisiana, Minnesota, Missouri, Nevada, and Rhode Island. On top of that, the platforms have also lobbied in favor of policies that exempt them from worker protection laws, with those proposals advancing in Georgia, Ohio, California, Pennsylvania, Missouri, and Wisconsin.
In two states, things have already gone beyond the bill stage. In West Virginia, gig nursing platforms are already exempt from worker protection laws. In Louisiana, these companies have secured exemption from unemployment insurance laws. This means nurses who work through these platforms in those states have no safety net if they lose access to work.
Part of the lobbying strategy involves framing deregulation as a benefit for the workers themselves, using arguments about freedom and professional autonomy. The pitch is that nurses gain more choice, more flexibility, and better per-shift pay. And in certain specific scenarios, that can even be true. But what the report makes clear is that, in the aggregate, weakening regulations creates an environment where worker rights become increasingly fragile, where competition among platforms drives pay down over time, and where accountability for errors and accidents becomes increasingly diluted.
The report compares these lobbying strategies to the ones previously used by ride-hailing companies, which sought to avoid being regulated as transportation companies or taxi services. The parallel is direct and intentional: if it worked for Uber and Lyft, gig nursing platforms are trying to run the same playbook.
Federal lobbying and government contracts
These companies are not limiting their efforts to the states. At the federal level, the industry is also pushing for legislation that would favor the growth of so-called independent work. A bill has already been introduced in the US Congress that would allow gig nursing platforms to be contracted by the government in emergency situations, while also shielding these companies from liability for patient injuries.
That last point is especially alarming. If passed, it would mean a platform could send a nurse without proper orientation into a facility in crisis, and if something went wrong with a patient, the company would bear no legal responsibility for what happened. The risk would fall entirely on the professional and, ultimately, on the patient.
The report also reveals that three gig nursing platforms have already reached the 1 billion dollar market valuation milestone. These companies have received significant investment from private equity funds and are securing government contracts to supply staff to public facilities, including ICE detention centers.
For patients, the impact is direct. When regulations that establish minimum qualifications, limits on hours worked, and safety standards are weakened, the risk of medical errors goes up. An exhausted, underpaid nurse with no institutional support is in far worse shape to deliver quality care than a professional with stable employment, proper supervision, and access to ongoing training. This equation is not speculation — it is what decades of patient safety research have already documented.
Artificial intelligence as a tool of control
One of the most revealing aspects of the report is the analysis of how artificial intelligence in healthcare is being used not to improve care, but to maximize operational efficiency for the platforms. These companies’ algorithms track nurse performance metrics including shift acceptance rates, employer evaluations, cancellation history, and even behavioral patterns within the app. Based on this data, the system decides who moves up or down in the platform rankings, who gets the more lucrative offers, and who gradually gets pushed to the margins.
This algorithmic logic creates constant pressure on professionals to accept more shifts, decline fewer offers, and avoid any behavior the system might flag as problematic — even when that behavior is perfectly justifiable from a human standpoint, like turning down a shift because you are sick or need to care for a family member. A worker who tries to balance personal needs with the platform’s demands often finds themselves penalized in ways they cannot even clearly identify, because the algorithm does not explain its decisions. It is a black box that determines your livelihood.
What makes this situation even more complex is that the companies argue AI is merely facilitating connections between supply and demand, without exercising real control over workers. This argument is central to maintaining nurses’ classification as independent contractors and avoiding the costs and legal obligations of an employment relationship. But the AI Now Institute report dismantles that narrative by showing that the level of monitoring, evaluation, and behavioral influence exerted by the algorithms is functionally equivalent to the control of a traditional employer — just without the responsibilities that role entails.
New York as a regulatory counterpoint
Not all the news is bad. The report highlights the state of New York as an example running counter to the deregulation trend. In 2025, the state passed a law requiring gig nursing platforms to comply with the same regulations that apply to traditional healthcare staffing agencies. This includes licensing requirements, quality standards, and worker protections that platforms had been trying to dodge in other states.
This legislation could serve as a model for other states weighing how to handle the rapid growth of these platforms. New York’s decision signals that it is possible to embrace technological innovation without sacrificing the fundamental protections that exist for a reason: ensuring healthcare professionals work in dignified conditions and patients receive safe care.
What is at stake for workers and the healthcare system
The rapid growth of gig work apps in healthcare is not an isolated phenomenon. It is part of a broader trend of platformization of work that has already transformed sectors like transportation, food delivery, and domestic services. The difference is that in healthcare, the consequences of a precarious model go far beyond the worker’s financial instability. They reach directly to the patient’s bedside, the elderly resident’s room, the emergency stretcher.
Dr. Wells noted that these trends are particularly concerning given that the healthcare sector has been one of the few areas of the American economy with reliable and consistent job growth in recent years. Allowing this sector to be hollowed out by the gig model means eroding one of the most solid foundations of the US labor market.
For nurses, the current landscape presents a deep contradiction. On one side, platforms often offer hourly pay that is higher than full-time positions, which especially attracts early-career professionals or those in transition. On the other, that higher pay does not come with the protections that make a career sustainable in the long run. Without benefits, without stability, without effective union representation, and with all income variability absorbed by the worker themselves, many professionals end up in a more financially vulnerable position than the raw hourly wage numbers suggest.
As Dr. Wells herself concluded in the report: there is enormous concern that if this model continues gaining acceptance or regulatory exemptions, many jobs could follow the same path. According to her, the focus tends to be on how AI will replace jobs — and maybe that will happen at some point. But before that, AI will completely degrade those jobs and leave workers without protections.
The report sends a clear message to lawmakers, unions, and society at large: the debate about worker rights in the era of digital platforms needs to reach the healthcare sector urgently. Allowing gig economy logic to fully take root in such a critical sector — without adequate regulation and without minimum guarantees for those who work in it — is a choice whose consequences the entire population will feel. 🏥
