Health systems turning to ‘gig nurses’ to ease staffing issues

Gig workers are making their way into hospitals in the form of nurses picking up shifts and working alongside staff clinicians caring for patients.

Their arrival comes as health systems try to decrease their reliance on expensive travel nurses and other temporary workers needed during the COVID-19 pandemic. Some systems created internal staffing agencies and float pools, while others are embracing per-diem structures where clinician gig workers—much like Uber and DoorDash drivers—use apps to choose what shifts they work, and where.

Related:Health systems turn to virtual nursing to close care gaps

The practice isn't as well known as travel nurses and it's unlikely to be a strategy universally embraced, regardless of hospitals' staffing woes. Detractors worry it financially exploits clinicians working as independent contractors and jeopardizes patient care quality.

Providence Health & Services has used gig workers to fill more than 21,000 nursing shifts since March 2022. The system works with CareRev, a virtual staffing company that connects clinicians with daily work opportunities at hospitals nationwide.

On average, nurses looking for gig work at Renton, Washington-based Providence cover 465 shifts per week across 15 of its locations.

“This does provide a relief,” said Mark Smith, executive leader of insights, optimization and staffing at Providence. “It reduces workload for our own caregivers and it also reduces some of the reliance on traditional contingent workforce investments that we've made.”

At Providence, the gig workforce's pay rates are typically 10% to 20% lower than agency nurses and it allows people to work who aren’t able to commit to part-time employment or 13-week travel contracts, Smith said. Agency rates in the area average between $85 and $125 per hour, depending on nursing specialty.

“These workers are going through the same onboarding process, learning modules and preceptorships that our Providence caregivers would go through,” he said. “They're very acclimated to our care protocols, to the unit and its expectations, and are working frequently.”

Before they can attend orientation sessions at health systems, clinicians looking to find work through the CareRev app undergo extensive background checks and drug screens by the company, and must show proof of certification and credentialing in their care area.

“We actually interview every single person in a one-to-one telephonic interview that is directed by a registered nurse, where we verify their education and experience,” said Susan Pasley, vice president of clinical solutions at CareRev.

CareRev was established in 2015 and today the company works with more than 46,000 providers and 70 health systems across 32 metropolitan areas. Other competitors in the healthcare gig economy space include staffing companies ShiftMed, IntelyCare, Nursa, ShiftKey and Gale Healthcare.

Clinicians are paid by CareRev, with pay rates set by the health systems. CareRev offers a machine learning feature that helps hospitals calculate the most competitive rates in their market.

More than 66% of clinicians who take shifts are supplementing their full-time income, and 24% use the gig work as their primary form of income, Pasley said. The remainder pick up occasional shifts.

For Sarah Carter, a registered emergency room nurse in Wisconsin with nearly eight years of nursing experience, switching from a travel nurse to a gig nurse has meant greater career flexibility and more free time.

Carter uses CareRev to find shifts at hospitals within the Wauwatosa, Wisconsin-based Froedtert Health system. While she participates in annual education sessions at hospitals, keeps track of updated departmental policies and communicates with charge nurses on a daily basis, Carter said her workdays mainly consist of caring for patients. 

“I've had even more acceptance as a CareRev nurse than I did as a travel nurse, because the staff realizes we're there to help,” she said. “We're picking up on what would be holes on days that they're extremely short. I really feel like I'm part of the team.”

But there are drawbacks. She must pay for her own life support certification renewals and, because she doesn't receive any healthcare benefits, Carter also works as an advanced life support 911 responder so she can receive benefits to cover her daughter’s prenatal care check-ups.

Labor unions like National Nurses United oppose hospitals' use of nurses working as independent contractors, arguing that the employment status means no overtime pay, workers’ compensation, paid sick days or protections against health risks and workplace discrimination.

"With the employers going for real-time staffing, it just creates more problems," said Zenei Triunfo-Cortez, a registered nurse and president of National Nurses United. "You cannot predict what will happen if [hospitals] do not staff correctly, right off the bat."

Some staffing companies classify gig clinicians as employees, offering them insurance and other benefits.

Another concern surrounding gig work is how the lack of consistent staffing might affect a hospital’s culture of patient safety and care quality.

“If it were me, if it was my loved one, I would rather have someone that's super familiar with the environment, electronic medical record, equipment and the supplies that they have on site, and actually knows the team,” said Erica DeBoer, chief nursing officer at Sanford Health, based in Sioux Falls, South Dakota.

When Sanford Health uses agency nurses to fill staffing gaps, there are a number of systems in place to ensure no lapses occur in high quality care, she said. All temporary staff have an assigned “buddy” during their shift, and are held to the same standards as regular employees when it comes to patient rounds, fall risk prevention and hospital-acquired conditions.

The health system has tried using gig work in a few of its long-term care facilities but is trying to move away from the need for external workers by using its internal staffing agency and predictive analytic tools to anticipate present and future shift needs, DeBoer said.

Overall, gig work should be seen as just one part of a larger workforce strategy, said Seth Lovell, vice president of nursing for SSM Health, based in St. Louis. The system has been using gig work since 2019 to fill gaps in the ranks of certified nursing assistants, respiratory therapists, behavioral health providers and patient access representatives.

The health system has recruited some gig workers to become full-time employees.

“It's really important for organizations to think about what percentage of on demand professionals should be supporting their shifts,” Lovell said. “I don't foresee a short-term future where the majority of the unit staff is coming from this gig space.”