A new report published on Tuesday is sounding the alarm on the rise of “Uber for nursing” – a growing gig industry in which artificial intelligence is being used by hospitals and other healthcare facilities to aid nurses.

The report published by the Roosevelt Institute argues: “These apps encourage nurses to work for less pay, fail to provide certainty about scheduling and the amount or nature of work, take little to no accountability for worker safety, and can threaten patient wellbeing by placing nurses in unfamiliar clinical environments with no onboarding or facility training.”

The report comes as the murder of Brian Thompson, the CEO of United Healthcare, the largest health insurer in the US, has incited debate and anger over the flaws and immense costs of the US healthcare system.

Twenty-nine workers interviewed reported having to pay fees to bid on shifts and winning those bids by offering to work at lower pay rates than other workers. Others reported experiencing app issues that resulted in missed pay for work they did.

“We have so many facilities that are stuck between a rock and a hard place, and turn to these gig nursing apps as a short-term solution,” said Dr Katie Wells, senior fellow at GroundWork Collaborative, and co-author of the report. “We have a problem with care. We don’t pay it well enough. We don’t take care of these workers in a way so they can take care of their families. And that’s what so many of these workers, they turn to the gig economy because they need some semblance of control over their own lives, because they haven’t had it otherwise.”

Wells said that data isn’t released by these gig companies, and the industry is unregulated, so the true extent to which gig nurses are being used is unknown. But, she said, it was clearly a fast-growing trend based on the growing capital valuations of these nurse gig platforms and surveys. Similar to gig companies in other industries, workers are marketed with promises of flexibility and freedom.

Workers are subjected to a rating system deterring the canceling of shifts due to illness or personal conflict, and are often not compensated if an employer cancels or shortens shifts.

“The only reason that I’m doing this right now is because I have no choice. This is what I went to school for and this is what is going to pay my bills in this … scary economic, you know, crisis that we have going on right now where you can barely afford to be alive,” said Ashley, one of the interviewed nurses in the report. “So, this is what I have to do in order to survive, even though, you know, it’s not what I really want to do. But I hate saying that because I love being a nurse. But I hate being a nurse right now with [what] these greedy, immoral, corporate companies have done to healthcare.”

The interviewed workers explained they often work shifts in facilities where they receive no training and aren’t familiar with the operations or where supplies are located. Several also said they have had to bring and use their own medical supplies for patients, such as stethoscopes, thermometers, and blood pressure monitors.

They also claimed they are often treated poorly by permanent staff at the facilities where their shifts are located and given the most difficult job tasks and the gig model puts costs often incurred by the employer, such as taxes, uniforms, supplies and benefits like health insurance, on to the worker.

“That a person who is not familiar with a hospital, its patients, its patient histories, or its management structures, can just arrive one day and pick up from the previous worker who finished their shift would be unimaginable only a few years ago,” the report argues.

Gig companies in nursing surged in popularity coming out of the Covid-19 pandemic and industry claims of nursing shortages, though the report noted the US currently has over 5 million licensed registered nurses, more than ever in the US, and claims understaffing in workplaces and issues in hiring and retaining nurses are due to workers refusing to accept poor pay and poor working conditions.

“Human frailty – the essential subject of nursing – defies algorithmic management,” claimed the report.