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Finally, a big change is coming for the nursing industry. Is it safe staffing ratios at last? How about an increase in pay for the staff nurses that have endured literal years of a worldwide pandemic? Protections for nurses at work and policies that don’t require them clocking in while infected with a dangerous virus?

Nope.

It’s Uber for nurses. Yup, that’s right.

Instead of policies at the leadership level that could enact positive and lasting change for both current and future nurses, there is a push to introduce legislation that will make nurses independent contractors working in an “on-demand” fashion with hospitals and facilities as they are needed. But some are concerned the move could further exploit nurses and negatively impact the travel nursing industry especially.

Here’s what nurses need to know about the movement towards making RNs independent contractors.

How it Works

It would work like this: instead of being hired by a standalone staffing agency, nurses could become independent contractors and get hired directly by hospitals on an on-demand basis. For instance, the CareRev app is already offering this service. According to CareReve’s website, the platform is one that “seamlessly connects healthcare facilities and local, flexible healthcare professionals.” A facility posts open shifts and then healthcare professionals can book the shifts directly from the app, without any staffing agency, contracts, or max or minimums involved.

Because the healthcare workers that use the service are acting as independent contractors, that also means that they will have zero protections or benefits from either the facility they work at or a staffing agency. The nurse as an independent contractor is then responsible for:

  • Deducting and paying their own taxes
  • Purchasing all insurance coverage, including health insurance, other medical insurances, and liability insurances
  • Setting up their own retirement plan

Additionally, the nurse may not have access to any employee-only benefits or services, such as mental health or wellness resources, educational benefits, and training. Some reviews of the app have also warned that there are no placement protections and nurses have been placed in unsafe staffing conditions and working placements outside of the scope of their practice.

On the flip side, some nurses have raved about the flexibility the app provides. It doesn’t require signing with a travel agency, they can book shifts only as they want or need them, and if they aren’t in need of benefits, it’s an easy way to make their own schedule and build the income that they want .

The Legislation

With the advent of apps like CareRev and other nurse-for-hire services popping up, California has introduced legislation to legally declare that any nurse or healthcare worker using digital services to book shifts be classified as an independent contractor. The primary purpose of the bill is to classify healthcare workers who use digital platforms and meet certain criteria, as independent contractors. That means, just like an Uber driver, they will not be classified as employees and will not have access to the protections and benefits provided to employees.

The measure was filed last week with the state’s attorney general’s office and was submitted by the same law firm that was involved with the Uber campaign (Proposal 22) to keep DoorDash, Uber, Lyft, and Instacart workers as independent contractors instead of employees. Coincidence? Maybe not, especially considering that the firm is probably well aware of the fact that the healthcare industry is projected to be one of the fastest-growing in the entire nation.

And as we all know, the nursing shortage, only exacerbated by the pandemic, is also expected to grow to critical levels. California alone is expected to have a need for 40,567 full-time equivalent RNs, or a 13.6% gap, until 2026.

MarketWatch revealed that the group proposing the ballot initiative is called Californians for Equitable Healthcare Access and has not revealed its backers yet. But Silicon Valley is already heavily involved in healthcare staffing technology, pouring millions of dollars into apps and websites that will match healthcare workers directly with open shifts.

MarketWatch also pointed out that California tends to lead the rest of the nation in terms of healthcare policies and legislation, so if the initiative passes, it could very well have an impact on the rest of the country’s nurses and healthcare workers very soon.

How Could This Affect Nurses?

The biggest concern with a piece of legislation like this is that it could further exploit nurses, who some argue, are far more than gig workers.

“Nursing…is fundamentally different from gig work,” Sarah Gray, founder of Trusted Health, an on-demand staffing agency that treats nurses as employees, not contractors, told Market Watch. “There’s a high barrier to entry. It’s a professional career, and in order to sustain that career and provide high-quality care, nurses need to have that proper care themselves in the form of employee benefits.”

Other experts took their caution even further, warning that turning nurses into gig workers will only make the understaffed for-profit model that hospitals operate on even worse. There’s also concern that the initiative could have a ripple effect, impacting all healthcare workers, from nursing assistants to home health workers, stripping them of protections, benefits, and even lowering pay. Currently, California nurses make the highest wages in the entire country, with an annual salary of over $120,000, according to the Bureau of Labor and Statistics. Turning the nurses in the state into gig workers could significantly impact pay and of course, benefits.

Notably, the move to reclassify nurses utilizing digital services to book work as independent contractors would also take them away from unions, which offer protection. And while flexibility is marketed as the primary benefit of on-demand work, it also leaves out the bigger picture: that “flexibility” means taking shifts that may not be ideal if nothing else is available, and a marketplace that, by definition, puts workers in constant competition with each other.

Plus, as another source pointed out, it’s important to remember that the customer market of apps that hire nurses for open shifts is not actually nurses—it’s hospitals that are looking to save on labor costs.

So the real question – Is that really in nurses’ best interests?

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