Nurse Shortage Pushes Hospitals Into The Gig Economy


By Melanie Evans

Hospitals are joining the gig economy.

Some of the nation’s largest hospital systems including Providence and Advocate Health are using apps similar to ride-hailing technology to attract scarce nurses. An app from ShiftKey lets workers bid for shifts. Another, CareRev, helps hospitals adjust pay to match supply, lowering rates for popular shifts and raising them to entice nurses to work overnight or holidays.

The embrace of gig work puts hospitals in more direct competition with the temporary-staffing agencies that siphoned away nurses during the pandemic. The apps help extend hospitals’ labor pool beyond their employees to other local nurses who value the highly flexible schedules of gig work.

The shift is among many ways hospitals are revamping hiring, schedules and pay to give nurses more control and to fill staffing gaps created by persistent labor shortages. Vacancies are straining many hospitals’ operations despite recent hiring gains at hospitals and reports of softer demand from some temporary-staffing companies.

“We’re still short,” said Elaine Zemel, business analyst for nursing administration at Henry Mayo Newhall Hospital, a Los Angeles-area hospital that offered gig workers at one point $106 an hour for a 12-hour intensive-care shift on Easter Sunday. “Nurses know that the ball is in their court.”

Many nurses retired or left the field after the pandemic made their jobs far harder. Others switched hospitals for jobs with higher pay or more flexible schedules. Nurse employment dropped by more than 100,000 workers between 2020 and 2021, the largest decline in four decades of available data, a study showed.

Gig apps give nurses even more control than other common temporary-employment options that lock in workers for multiweek contracts, at least. It opens shifts to a broader labor pool, too, but also a more fluid one, hospital executives said.

That means less certainty for employers.

“There’s no guarantee that shift is going to be filled,” said Jane Dus, Midwest chief nursing officer for Advocate Health hospitals in Wisconsin and Illinois, which has used gig workers since August 2022. Advocate has filled 5,000 hospital shifts in Wisconsin using gig nurses and nurses’ aides and is exploring plans to expand the model to its Illinois hospitals, Ms. Dus said.

SSM Health, based in St. Louis, uses two apps to offer premium pay and shifts as short as four hours. Its contracts prohibit staff from picking up gig jobs for 12 to 18 months to avoid competing for its own employees, said Seth Lovell, SSM Health’s vice president of nursing.

Providence, based in Renton, Wash., added gig nurses a year ago and has filled 13,000 shifts for nurses and other medical jobs, said Mark Smith, who oversees workforce analysis, staffing and optimization for the system. Providence plans to expand gig work to 19 hospitals and nursing homes from 12. To attract more workers, Providence wants to break a typical 12-hour shift into six-hour gig jobs, Mr. Smith said. He tracks pay at other hospitals and adjusts the gig rate every two weeks, if needed, he said.

Henry Mayo in the Los Angeles area is using a CareRev algorithm to nudge pay for gig workers lower or higher by 5% based on the likelihood the shift will attract workers. “It’s so much easier to find a nurse on a Wednesday than it is a Saturday night,” she said.

For urgent openings, she can override the algorithm and raise the rate manually, she said.

Hospitals that use the apps risk encouraging nurses to hold out for higher rates and a last-minute rush to fill schedules, said Maribeth McLaughlin, the chief nurse executive for UPMC, based in Pittsburgh.

UPMC is hiring nurses through its own year-old temporary agency instead. Nurses in the system are employed by UPMC but are paid higher rates to travel to openings within the UPMC system. Half the in-house agency’s 700 nurses and surgical technicians are new hires. UPMC has canceled contracts with temporary-staffing companies for 64 nurses this year. The switch has saved the system $48 per hour, per worker on shifts filled with flexible workers, UPMC said.

Jecoliah Jackson has signed up for two apps that match her with open nursing shifts in the Los Angeles area, she said. She picks up extra shifts when she isn’t scheduled at her full-time hospital job. She said she earned $108 an hour during a recent shift.

“It’s the market,” she said. “We all take advantage of it.”


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