Gig work apps are pushing to loosen healthcare rules as they expand gig work in the sector, a new report warns.
The report looks at how artificial intelligence is being used to staff hospitals and other healthcare facilities, warning that wider use of the technology is coming at the expense of workers’ rights, protections and pay.
Like ride-share companies, the “Uber for nurses” model uses AI to set shift pay, monitor performance and use that data to shape a worker’s future access to shifts and rates. Nurses can also bid on shifts, with the lowest rate winning the work.
Published by the AI Now Institute and titled Uber for Nursing Part II: How Gig Nursing Companies Are Lobbying States to Deregulate Healthcare, the report found that since 2022 lawmakers in at least 17 US states have introduced bills aimed at making gig nursing platforms exempt from the rules applied to other healthcare staffing agencies.
Lobbying by gig companies has led to exemption bills moving forward in Colorado, Illinois, Iowa, Louisiana, Minnesota, Missouri, Nevada and Rhode Island.
The platforms have also lobbied for policies that would exempt them from worker protection laws, with these carve-out measures advancing in Georgia, Ohio, California, Pennsylvania, Missouri and Wisconsin.
Gig nursing platforms are already exempt from worker protection laws in West Virginia and unemployment insurance laws in Louisiana.
The model has proved lucrative for its backers.
Three nurse gig platforms have reached a US$1bn valuation, according to the report, after attracting investment from private equity firms and securing government contracts to staff public facilities, including Immigration and Customs Enforcement detention centres.
Dr Katie J Wells, co-author of the report and a senior fellow at AI Now, said the technology was being used to place nurses in unfamiliar workplaces without enough safeguards.
“AI is incorporated into all these human management software systems, and for nurses that means dropping them into all kinds of places, without orientation, without workers’ comp, without any way to protect themselves if they’re sick and they need to cancel,” she said.
“That also means, for a lot of these apps, using AI technologies to facilitate a bidding war against nurses.”
A screenshot of a quick-bid auction from nurse gig platform Clipboard Health states: “You can choose the rate you’d like as a bid, and the lowest bid wins!”
The auction lets gig nurses submit an hourly pay bid for shifts at a medical facility, with the lowest bid securing the role.
Clipboard Health also uses disciplinary point systems for gig nurses, including deducting points for cancelling a shift, with more points taken off when less notice is given. Further deductions apply for arriving late to shifts.
Wells said the trend was becoming more worrying because healthcare has been one of the few sectors to see reliable and consistent job growth in the US.
The report compares these lobbying efforts to those of ride-share companies, which sought to avoid being regulated as part of the transport or taxi sector.
“I’m really hoping that we can protect healthcare from what I fear is a sort of more aggressive attack, at least if we look since 2022 at just how much ground these companies have traveled,” Wells added.
“They’ve made such headway in so many places about pushing back worker protections, but also public safety concerns and in patient wellbeing.”
The industry has also been lobbying at federal level, pushing for legislation to grow and expand “independent work”, including a bill that would allow gig nursing platforms to be contracted by the government during emergencies and indemnify those platforms from liability for patient injury.
The report contrasts those efforts with New York state, which passed a law in 2025 requiring gig platforms to comply with state rules for healthcare staffing agencies.
Wells concluded: “There’s a huge concern that if this model continues to gain acceptance or carve-outs, a lot of jobs, I think, could go this way.
“We focus so often on how AI is going to replace your jobs, and, OK, maybe. But also, first AI is going to totally degrade it and leave you without protections.”