TL;DR
Turn your wind-down time into listening time
- Thousands of audiobooks, podcasts and originals
- Listen on your phone, tablet or Echo — also offline
- Cancel anytime
An AI Now Institute report published April 21 says nursing shift apps are backing state efforts to exempt platforms from rules for healthcare staffing agencies and worker protections. The report also raises concerns about contractor status, algorithmic pay and surveillance; the scope and effects of proposed laws remain subject to state decisions.
The AI Now Institute says nursing shift platforms are lobbying state lawmakers to change rules governing healthcare staffing and worker protections, a development that could affect how nurses are paid and classified. Its report, published April 21, 2026, describes bills that would exempt app-based companies from requirements applied to traditional staffing agencies and warns that contractor classification and algorithmic pay systems may weaken protections for nurses.
The report, titled Uber for Nursing Part II, identifies Clipboard Health, ShiftKey, CareRev and IntelyCare among the prominent platforms filling shifts at hospitals and long-term care facilities. The apps let nurses seek available shifts, while platforms can rate workers and use pricing systems that vary with demand and performance. According to the institute, CareRev’s “Smart Rates” recommends hourly rates using market demand and past performance. Some platforms also use “Quick Bid” systems in which nurses compete for shifts, with the lowest bid potentially winning.
The institute says that, since 2022, lawmakers in at least 17 states have introduced bills to exempt gig nursing apps from rules for conventional staffing agencies. It reports that eight states advanced exemption bills, while bills in six states sought to carve platforms out of worker-protection laws. The state lists in the report overlap, and the status and scope of individual proposals vary. The report also says Clipboard Health and ShiftKey together spent more than $1.1 million on federal lobbying, and that platforms work with Amazon and Uber through the Coalition for Workforce Innovation.
The report estimates that the ten largest nursing platforms have raised about $1.4 billion in funding, citing valuations of $2 billion for ShiftKey and $1.3 billion for Clipboard Health. Those figures describe company financing and valuations, not the amount spent on staffing or lobbying. A companion Roosevelt Institute brief, as summarized in the source report, says some platforms use data brokers to estimate nurses’ debt and may offer lower pay to those with higher debt loads. These are researchers’ findings and concerns; the supplied material does not provide company responses or independent verification of every practice.
How App Rules Affect Nurses
The dispute concerns more than how shifts are advertised. The report says platforms classify nurses as independent contractors, a status that can exclude workers from minimum-wage and overtime protections, workers’ compensation and unemployment insurance. If lawmakers exempt apps from staffing-agency rules or worker protections, nurses could have fewer routes to challenge pay practices, shift cancellations or workplace problems. The exact consequences would depend on each bill’s language and other applicable laws.
Researchers also warn that app-based bidding and variable rates could put pressure on wages across the workforce. Nurses interviewed in earlier research reportedly described arriving at facilities without paid orientation, while ratings or cancellations could affect access to future shifts. For facilities and patients, the policy question includes how responsibility is assigned when a worker has not received adequate preparation or a shift is disrupted. The report raises these risks but does not establish that every platform or facility operates in the same way.
The financial figures cited suggest the model is already being used at scale in some places: the source report says a Colorado nursing home spent $2.9 million in 2022 on platform staffing and a Chicago hospital spent $2.7 million annually. Those examples are not presented as a national total. They illustrate why rules governing app-based staffing may affect facility budgets and the balance between permanent staff and temporary labor.
Popular right now
De'Longhi Dinamica Plus Fully Automatic Espresso Machine
Jura E6 Automatic Espresso Machine, Piano Black (15622)
Ninja CREAMi 7-in-1 Ice Cream Maker, NC301
As an affiliate, we earn on qualifying purchases.
States Take Different Paths
State governments are approaching app-based staffing differently. In 2025, New York treated gig nursing platforms as healthcare staffing agencies, requiring annual registration and quarterly wage reporting and barring independent-contractor classification under the law described in the report. The report says Clipboard Health, Nursa and KARE then stopped operating in the state. It does not provide company statements explaining those decisions.
Other states have considered exemptions, according to the institute. The source lists Colorado, Illinois, Iowa, Louisiana, Minnesota, Missouri, Nevada and Rhode Island among states where exemption bills advanced; it also names Georgia, Ohio, Pennsylvania, California, Missouri and Wisconsin among those with bills targeting worker-protection rules. Because Missouri appears in both lists and some bills may cover different provisions, the categories should not be read as a single, uniform legislative outcome.
These proposals come as care facilities use apps to fill staffing gaps and as platforms compete with traditional agencies. The report frames current legislative activity as a contest over whether app companies should face the same rules as established healthcare staffing businesses. It is not a finding that every proposed bill has passed or that all platforms use identical employment, pay or rating practices.
““Uber for Nursing Part II””
— AI Now Institute
Bill Status and Pay Practices
The report describes bills introduced or advanced, but the supplied material does not establish the current final status of each proposal, which provisions remain in pending bills, or whether any additional measures have passed since publication. State-by-state differences matter: a staffing-agency exemption is not necessarily the same as an exemption from wage, safety or other worker protections.
It is also unclear from the source material how commonly platforms use debt data to set pay, how often nurses bid against one another, or how ratings and cancellations affect workers’ future access to shifts. The report raises concerns about algorithmic wage discrimination and surveillance, but the available summary does not include platform responses, detailed methodology or enough data to quantify effects across the industry. The broader effect on wages, patient care and permanent staffing remains uncertain.
State Decisions to Watch
The next developments will come through state legislative debates and decisions about whether app-based nursing companies must register as staffing agencies, how they classify workers, and which employment protections apply. The report specifically points to proposals in Colorado, Illinois, Wisconsin and other states as areas to watch, but the supplied information does not give dates for upcoming votes or hearings.
Further reporting would also be needed to establish how the companies respond to the report’s claims and whether lawmakers amend, pass or reject specific bills. For nurses and facilities, the practical effects will depend on enacted law, platform policies and contract terms, including rules for pay, ratings, cancellations and on-site orientation.
Key Questions
What does the report say nursing platforms are asking states to change?
The AI Now Institute says platforms are supporting bills that would exempt app-based staffing companies from some rules applied to traditional healthcare staffing agencies or from worker-protection laws. The proposals differ by state, and the source does not say every bill has passed.
Which companies are named in the report?
The report identifies Clipboard Health, ShiftKey, CareRev and IntelyCare as prominent platforms. The source also says Clipboard Health, Nursa and KARE stopped operating in New York after the state adopted its 2025 law.
Why does contractor classification matter to nurses?
According to the report, independent-contractor status can leave nurses outside protections such as minimum wage, overtime, workers’ compensation and unemployment insurance. The precise rights available depend on the law that applies in a worker’s state and circumstances.
Have the report’s claims about algorithmic pay been independently confirmed?
The supplied material attributes concerns about variable rates, bidding and debt-related pay to the AI Now Institute and a companion Roosevelt Institute brief. It does not provide company responses or independent data measuring how widespread these practices are.
Source: nurse.org
