App-based shift marketplaces do by phone what a nurse registry did by telephone a century ago: match a facility that is short with a nurse who is available. What is new is the speed, the scale, and the fact that the platform usually maintains it is not the employer of anyone.
What the platforms are
The prominent names in the United States include ShiftKey, Clipboard Health, CareRev, ShiftMed and IntelyCare, alongside a dozen smaller ones. The ten most prominent have raised roughly $1.4 billion between them; ShiftKey has been valued at $2 billion and Clipboard Health at $1.3 billion.
They are used most heavily in long-term care and skilled nursing, and by nursing assistants as well as licensed nurses, though hospital use is growing. That concentration matters, because long-term care is the one setting where agency use is measured: contract staff were 7.5 percent of nursing home nurse hours nationally in early 2024, down from 10.1 percent a year earlier but still roughly double the 3 to 4 percent of 2019. By state the range in mid-2025 ran from 25.1 percent of nurse hours in Vermont to 1.0 percent in Alabama. Where a facility sits in that range says more about how it staffs than any national average does.
Some hospital systems run internal versions of the same idea, posting their own open shifts to their own staff and per diem roster, which is a different arrangement with none of the classification questions.
How the pay is set
On a conventional per diem roster the rate is posted and the same for everyone at that grade. On several platforms it is not: workers bid for shifts, and the shift goes to a low bidder, so two people doing identical work on the same unit can be paid differently. The legal scholar Veena Dubal calls this algorithmic wage discrimination.
Fees are the other half of the arithmetic. Platform charges, background check costs and payment processing come out of the shift, and researchers documented a nursing assistant in rural Pennsylvania earning roughly $8 an hour after about $7 of per-shift fees, against roughly $20 an hour for the same work as a directly employed assistant in the same state.
That is the extreme end rather than the norm, and it is documented rather than alleged, which is why it is worth knowing before signing up. For comparison, the measured agency premium in long-term care runs the other way: in 2023 a registered nurse employed by a staffing agency earned a median $48.30 an hour against $38.37 for one employed by a nursing home. A platform arrangement that pays below the facility's own staff rate is not the arrangement that data describes.
Classification, and the litigation
Platforms typically engage workers as independent contractors. The consequences are set out in per diem employment status: both halves of payroll tax, no withholding, no overtime protection, generally no workers' compensation, and liability cover the nurse must arrange.
Whether that classification is lawful is contested. Clipboard Health paid $2.2 million in 2021 to settle claims by former workers who said they had been misclassified and denied overtime and breaks, and misclassification suits have been filed against other platforms in several states. Some legislatures have been asked to define app-dispatched health care workers as contractors by statute; most of those efforts have stalled, and the picture differs state by state.
Registration law is moving faster than classification law. New York's staffing agency registration regime applies expressly to online platforms as well as to conventional agencies and nursing registries, with contract filing and quarterly rate reporting. See nurse staffing agencies.
What the research says
The most substantial independent work on this is a study by Katie J. Wells and Funda Ustek Spilda, published through the Roosevelt Institute, based on interviews with nurses and nursing assistants across 27 states. Its findings concern pay variability, fees, the absence of employment protections and the effects on facilities that come to depend on app coverage.
Professional organisations have raised a separate concern about who is verifying competence. Conventional staffing firms can be certified by the Joint Commission under its Health Care Staffing Services programme, which reviews on site how a firm checks credentials, assesses clinical competency and handles complaints, and requires certified firms to report standardised performance measures for their per diem and travel staff. A platform that describes itself as a technology marketplace rather than a staffing agency is describing a position outside that framework, in which nobody has taken responsibility for orientation or for confirming that the person arriving can do the work.
What to check before taking app shifts
Whether you are engaged as an employee or a contractor, and what tax form you will receive.
What fees are deducted from a shift, and whether the advertised rate is before or after them.
Who carries workers' compensation if you are injured, and who carries professional liability cover.
What the cancellation policy is in both directions, including whether a facility can cancel on arrival and what penalties apply if you cancel.
What orientation the facility provides, and what you are expected to be independent on from the first hour.
Whether the platform verifies licences, whether it is registered in your state where registration is required, and whether it holds any external certification.
For facilities
Same-day coverage from an app is the fastest option available and the one with the least continuity attached. A nurse or assistant arriving through a marketplace has had no orientation, does not know the residents or patients, and may have been selected on price rather than fit.
It is also expensive per hour in a way that is now documented. By 2021 an hour of contract registered nurse time cost a nursing home $68.41 against $42.95 for its own employee, with contract hours across all nursing categories costing about 75 percent more than employed ones.
Facilities relying on it also carry the regulatory exposure. Where a state registers and rate-reports staffing intermediaries, platforms are frequently covered, and the facility's own obligation to verify licensure and competence is unaffected by the platform's description of itself. Licence status can be confirmed independently and at no cost through the national verification service.
The staffing problem underneath does not change. Shift-by-shift coverage fills a gap in a rota; it does not substitute for the permanent staffing a unit is built around. See nurse staffing and patient outcomes and, for the alternative a facility builds itself, building a per diem roster.
Related
- Per diem nursing
- Per diem employment status
- History of per diem nursing
- Nurse staffing agencies
- Nursing home staffing requirements
Sources
- The gig economy has come for nursing. STAT, 31 March 2025, for platform names, funding, valuations, bidding, the Pennsylvania pay example and the research behind it. Accessed September 9, 2026.
- New paper sheds light on the pervasiveness and pitfalls of gig nursing apps. Groundwork Collaborative, on the Roosevelt Institute study by Katie J. Wells and Funda Ustek Spilda. Accessed September 9, 2026.
- The use of contract staff in nursing homes. Office of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services, January 2025, for contract hours, contract labour costs and wages by employer type. Accessed September 9, 2026.
- Nursing home staffing data. Long Term Care Community Coalition, for contract staffing by state. Accessed September 9, 2026.
- Nurses sound alarm as "Uber for nursing" apps push to deregulate healthcare. Nurse.org, on the profession's response and state legislative efforts. Accessed September 9, 2026.
- Health Care Staffing Services certification. The Joint Commission, on what certification reviews and requires. Accessed September 9, 2026.
- Temporary health care staffing agencies now required to register in New York. Garfunkel Wild, on registration covering online platforms and nursing registries. Accessed September 9, 2026.
- Nursys licence verification. National Council of State Boards of Nursing. Accessed September 9, 2026.