As nurses seek flexibility, some hospitals are turning to gig work

Since the onset of the Covid-19 pandemic, health systems have faced a dual challenge, responding not only to acute staffing shortages, but also an increased desire for flexibility among their staff.

Some 94% of hospital and healthcare executives described the nursing shortage in their health systems as “critical,” according to a June analysis from Incredible Health. Still, just 11% of health systems said they offered flexible nursing schedules, even though 80% of younger nurses were requesting them.

Some HR leaders are seeking to address this disconnect by investing in technology that allows healthcare workers to take on gig shifts—an approach that has been called the “uberization” of the profession.

Relying on gig labor. In allowing workers to pick up shifts on demand, some health systems are following an approach akin to companies like Uber or Amazon, using technology to hire independent contractors and fill labor demands.

In 2022, Mercy Health, which is headquartered in Cincinnati, rolled out an app that allows nurses to pick up on-demand work.

Nurses hired by the Mercy network can pick up work on a mobile app. The tool has a credentialing system that displays where they’re eligible to work, as well as licensures and competencies, according to Tracey Grimshaw, Mercy’s chief talent and organizational effectiveness officer.

Since the app was introduced last year, nurses have picked up more than 300,000 hours of so-called “incentive shifts,” meaning their work is priced based on the level of demand, Betty Jo Rocchio, SVP and chief nurse executive, said at the HR Healthcare conference in Austin this October.

Northwell Health invested in an internal staffing system in 2014 that ended up being vital for the health system during the Covid-19 pandemic, CHRO Maxine Carrington told HR Brew. The system, called FlexStaff, was founded in part to reduce dependency on outside staffing agencies, as well as to lean into gig work.

“We knew that people want gig-work opportunities,” she said. “And so we figured, well imagine if we could provide that for our team members?” FlexStaff draws from a pool about 5,000 workers who can take on short-term or contract assignments within Northwell. Full-time employees can also find moonlighting opportunities at Northwell through FlexStaff, and the health system recently introduced an alumni network so former employees can take on gig work using the technology, as well.

Carrington described the system as “a pipeline back and forth.” If an employee needs to take on a contingent role due to lifestyle changes, they don’t have to leave the organization altogether. “Wherever I am in life, maybe I started out at flex and then I pipeline in permanently to Northwell,” she explained. She said other health organizations have reached out in the years since the pandemic to ask for advice on building something similar for their workers.

Tradeoffs of gig work. Executives with RightSourcing, a company that helps hospitals build contingent labor programs, expect to see HR health leaders become more interested in such staffing schemes going forward.

“These health systems are looking for different ways to attract labor,” said Matt Jensen, SVP client services. “And they’re realizing just the normal status quo of how they used to attract and hire labor pre-pandemic has changed significantly.”

Nursing offers one lens into the changing status quo for healthcare employees. During the pandemic, many nurses took on travel assignments that paid much better than full-time employment. While pay for travel nurses has come down since, Jensen said, these workers “have found that they enjoyed the flexibility of not working for one particular health system and moving around.”

There are tradeoffs to taking on gig work in healthcare. Typically, contract workers employed through the systems RightSourcing helps design don’t receive healthcare benefits, though they may receive paid time-off or sick leave depending on state regulations, Jensen said.

National Nurses United, a union and professional association representing registered nurses, has spoken out against healthcare gig work apps, arguing they’re seeking to capitalize on a staffing crisis that worsened during the pandemic. When nurses are considered independent contractors, the organization wrote in a statement, they’re deprived of “rights and benefits granted to regular employees, including the right to organize in a union.”

In a follow-up email via PR rep Kirra Courchesne, RightSourcing said it does not recommend or utilize clinicians working as “1099s,” meaning independent contractors. “Providing a great worker experience for both full-time employees (FTE) and extended talent depends on knowing how they differ and understanding what contingent talent values,” the team said.

Despite concerns about gig work in the health sector, HR leaders with both Northwell and Mercy Health expressed optimism that this approach can help health systems build their talent pipelines in the future. When speaking at HR Healthcare, Grimshaw acknowledged the new system has been an adjustment for Mercy employees, but said she believes it will help boost talent attraction and retention by offering “flexibility that we know our current generations are looking for.”