A new report from the AI Now Institute, released April 21, 2026, is raising alarms about a growing segment of the healthcare workforce market: gig-based nursing apps that use AI-driven pricing, bidding auctions, and performance surveillance to fill hospital and long-term care shifts — and that are now lobbying aggressively in state legislatures to exempt themselves from the rules that govern traditional healthcare staffing agencies.
The report, titled Uber for Nursing Part II, identifies platforms like Clipboard Health, ShiftKey, CareRev, and IntelyCare as the dominant players in this space, and documents a coordinated push to reshape the legal environment around how nurses are hired, classified, and paid. For nurse practitioners, PAs, and other advanced practice providers who may use — or be tempted by — these platforms, the details are worth understanding closely.
The Scale of the Gig Nursing Market
This is not a niche or emerging phenomenon. The AI Now Institute found that the ten most prominent gig nursing platforms have collectively raised roughly $1.4 billion in venture funding. ShiftKey is valued at $2 billion. Clipboard Health is valued at $1.3 billion.
Healthcare facilities are already spending heavily on these services. A single Colorado nursing home spent $2.9 million in 2022 on platform staffing. A Chicago hospital spends an estimated $2.7 million annually. The infrastructure is embedded — which makes the regulatory fights happening right now particularly consequential.
Inside the 'Uber for Nursing' Playbook
The report describes a system that closely mirrors rideshare models: nurses download an app, create a profile, get assigned a rating based on performance metrics, and compete for available shifts. Several specific mechanisms deserve attention:
AI-Driven Dynamic Pricing
CareRev operates a "Smart Rates" system that recommends hourly shift rates based on real-time market demand and past worker performance. Rather than a posted wage, nurses see an algorithmically generated suggested rate that shifts with supply and demand — much like surge pricing in ride-sharing.
"Quick Bid" Auctions
Some platforms run auction systems where nurses literally bid against each other for the same shift. The lowest rate wins the shift. For nurses who depend on consistent income, this creates a race-to-the-bottom dynamic that can systematically suppress wages across the profession.
Surveillance Wages and Algorithmic Discrimination
The report raises concerns about what it calls "surveillance wages" — algorithmic systems that may use personal financial data to set different pay rates for nurses doing identical work. A companion Roosevelt Institute brief found that some platforms "use data-brokers to determine nurse debt levels and offer lower wages to those with highest debt loads." Put plainly: a nurse carrying more student loans may be targeted with lower shift offers on the same platform.
The contractor classification problem. Workers on these platforms are classified as independent contractors — which excludes them from minimum wage protections, overtime, workers' compensation, and unemployment insurance. Nurses also report arriving at facilities with no paid training or orientation, and say that low ratings or shift cancellations can permanently affect their access to future work.
The Major Players
Where the Fight Is Happening
Since 2022, lawmakers in at least 17 states have introduced bills designed to carve gig nursing apps out of the regulations that apply to traditional healthcare staffing agencies. Eight states have already advanced exemption bills: Colorado, Illinois, Iowa, Louisiana, Minnesota, Missouri, Nevada, and Rhode Island. Six additional states have seen bills aimed at blocking these platforms from being classified under worker protection laws: Georgia, Ohio, Pennsylvania, California, and Wisconsin.
The lobbying effort is backed by Clipboard Health and ShiftKey's combined federal lobbying expenditure of more than $1.1 million, and is coordinated in part through the Coalition for Workforce Innovation — an organization that also includes Amazon and Uber.
Active exemption bills to watch: Colorado, Illinois, Iowa, and Wisconsin currently have pending legislation that could determine whether gig nursing platforms are treated as staffing agencies or exempt tech companies — a classification that directly affects pay, benefits, and legal accountability.
The most significant counterexample so far is New York, which in 2025 classified gig nursing platforms as healthcare staffing agencies, requiring annual registration and quarterly wage reporting, and blocking independent contractor classification. Following the law, Clipboard Health, Nursa, and KARE ceased New York operations entirely — suggesting the platforms' business model depends on regulatory exemptions to remain viable.
What Advanced Practice Providers Need to Know
For NPs, PAs, and CRNAs considering these platforms — especially those in the post-residency phase who may be building clinical hours or supplementing income — there are several specific issues to evaluate:
- Understand the rating system. Platform ratings directly affect access to future shifts and, in some cases, the rates offered. Understand what behaviors are being tracked and how complaints are adjudicated before you're locked into a low rating with limited recourse.
- Know your classification. As an independent contractor, you are responsible for your own malpractice coverage, taxes, and healthcare. There is no employer-paid workers' comp if you're injured on a shift, and no unemployment if a platform deactivates your account.
- Watch for bidding dynamics. If a platform uses a bidding or auction model for shifts, be aware that accepting consistently low rates sets a floor that harms your peers as well as your own long-term earning trajectory.
- Orientation and patient safety. Nurses using these platforms report arriving at facilities with no paid training or orientation to site-specific protocols. For APPs, this creates both patient safety concerns and liability exposure.
- Follow state legislation. Whether your state classifies these platforms as staffing agencies or exempt tech companies will directly affect your rights and protections as a user.
The bigger picture for APPs: These platforms are primarily staffed by RNs, LPNs, and CNAs — but the model is expanding. The regulatory precedents being set now in nursing will shape how similar platforms targeting NPs and PAs are eventually regulated. The outcome of these legislative fights matters to the entire advanced practice workforce.
What This Means for the Residency-to-Career Pipeline
For NP and PA graduates entering the workforce — many of whom are completing residencies precisely to build the confidence to practice independently — the gig nursing economy presents a complicated picture. These platforms offer flexibility and quick access to clinical hours. But contractor classification, algorithmic pricing, and the absence of benefits create a fundamentally different employment relationship than a traditional position.
As this market matures and state-level regulation evolves, APPs who understand the mechanics of these platforms will be better positioned to use them strategically — and to advocate for the regulatory protections that keep gig work from becoming a race to the bottom on pay and patient safety.
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