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An AI Now Institute report published April 21 says gig nursing platforms are backing state legislation to exempt app-based staffing from rules governing traditional agencies and worker protections. The report raises concerns about contractor status, algorithmic pay and oversight, while the full effects of the bills remain uncertain.
The AI Now Institute says app-based nursing staffing companies are lobbying state lawmakers to change rules governing healthcare staffing, a push that could affect nurses’ pay, benefits and control over shifts. Its report, published April 21, examines platforms including Clipboard Health, ShiftKey, CareRev and IntelyCare, and describes legislation that could treat them differently from traditional staffing agencies.
The report, titled Uber for Nursing Part II, describes a staffing model in which nurses use apps to find shifts, receive performance ratings and, in some cases, bid against other workers. It says platforms use algorithmic pricing; CareRev’s “Smart Rates,” for example, recommends hourly rates based on market demand and past performance. Some platforms also use “Quick Bid” systems in which nurses compete for a shift and the lowest bid may win, according to the report.
Researchers say the ten most prominent platforms have raised roughly $1.4 billion in funding. The report lists ShiftKey’s valuation at $2 billion and Clipboard Health’s at $1.3 billion. It also says that since 2022, lawmakers in at least 17 states have introduced bills to exempt gig nursing platforms from rules applied to traditional healthcare staffing agencies. Eight states have advanced exemption bills, while bills targeting worker-protection rules have appeared in six states, according to the report; some states appear in both groups.
The report says federal lobbying by Clipboard Health and ShiftKey exceeds $1.1 million combined, and that the platforms work with Amazon and Uber through the Coalition for Workforce Innovation. These figures and descriptions are findings presented by the institute, not a separate accounting in the supplied material. The report also cites large facility spending on platform staffing: a Colorado nursing home spent $2.9 million in 2022, while a Chicago hospital spent $2.7 million annually.
How App Rules Could Affect Nurses
The central issue is whether nurses working through these services are treated as independent contractors or employees, and whether the platforms fall under staffing-agency regulations. The AI Now Institute says contractor classification can leave workers outside minimum-wage and overtime protections, workers’ compensation and unemployment insurance. The report also describes potential consequences from shift cancellations and ratings, which it says may affect access to future work.
Researchers warn that algorithmic rates and competitive bidding could put downward pressure on pay across the profession. They also raise the possibility that platforms use personal data to set different rates for nurses doing similar work. A companion brief from the Roosevelt Institute says some platforms use data brokers to assess nurses’ debt and offer lower pay to those with higher debt loads. These are reported concerns and allegations; the supplied material does not establish how broadly such practices occur or independently verify their effects.
For healthcare facilities, the rules could shape how they fill staffing gaps and what obligations apply when app-based workers provide care. The report also flags possible displacement of permanent staff at unionized workplaces. Those implications matter beyond nurses because staffing arrangements affect facility oversight and accountability, though the source material does not quantify any resulting changes in care quality.
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States Set Different Staffing Rules
States are taking different approaches. The report says Colorado, Illinois, Iowa, Louisiana, Minnesota, Missouri, Nevada and Rhode Island have advanced bills exempting gig nursing platforms from certain healthcare staffing requirements. It separately identifies Georgia, Ohio, Pennsylvania, California, Missouri and Wisconsin among states where bills have sought exemptions from worker-protection laws. The material does not specify the current status or final outcome of each measure.
New York took a different path in 2025, classifying gig nursing platforms as healthcare staffing agencies and requiring annual registration and quarterly wage reporting, while barring independent-contractor classification, according to the report. It says Clipboard Health, Nursa and KARE stopped operating in the state after the law took effect. The contrast illustrates how state legislation can influence both the legal status of platforms and where they operate.
““Uber for Nursing Part II””
— AI Now Institute report
What the Report Cannot Establish
The report raises concerns about wage-setting algorithms, surveillance, contractor classification and facility oversight, but the supplied material does not establish how frequently each practice occurs across platforms or how much it changes nurses’ earnings. It also does not provide a state-by-state accounting of which bills have passed, remain active or have been amended. Claims about debt data and individualized wage offers are attributed to the companion Roosevelt Institute brief.
It remains unclear how many nurses or facilities use these apps, whether platforms will change their business models in response to new laws, and what measurable effects the model has on patient care. The material also does not give responses from the named companies to the report’s findings.
State Bills Will Shape the Rules
The next developments will depend on state lawmakers’ decisions about staffing-agency requirements, worker classification and protections. Bills in states named by the report could determine whether platforms register as healthcare staffing agencies and whether app-based nurses qualify for employment protections. The report provides no timeline for votes or implementation across those states.
For now, the institute’s findings put state legislation and platform labor practices at the center of the debate. Further reporting, legislative records and responses from the companies would help clarify the bills’ status and test the report’s claims about pay, ratings, cancellations and worker protections.
Key Questions
What are gig nursing platforms?
They are apps that connect nurses with available shifts at healthcare facilities. The report names Clipboard Health, ShiftKey, CareRev and IntelyCare as major platforms.
What changes are the platforms seeking?
According to the AI Now Institute report, companies are lobbying for state laws that would exempt app-based nursing services from some rules for traditional staffing agencies or worker-protection laws. The bills and their status vary by state.
Why does worker classification matter?
The report says classifying nurses as independent contractors can exclude them from protections such as minimum wage, overtime, workers’ compensation and unemployment insurance. The exact legal effects depend on the applicable law.
Have states adopted a different approach?
Yes. The report says New York classified gig nursing platforms as healthcare staffing agencies in 2025, requiring registration and wage reporting and barring independent-contractor classification. It says three named platforms then ceased operations in the state.
Source: nurse.org
