Apps that let nurses pick up hospital and care-home shifts the way drivers accept rides are spreading in health care. A new review warns that the laws governing these jobs haven’t caught up in Canada, the United States or the United Kingdom.
The review, published in the journal Policy, Politics, & Nursing Practice, looked at what is known about “gig nursing”: short-term, on-demand shifts, usually arranged through a digital platform or staffing agency, that can last from a single shift to a few days. Its four authors are nurse researchers based in Australia, the U.K., the U.S. and Canada, including one at the University of Calgary and the University of Alberta.
Their conclusion is that the model gives nurses real flexibility, but its unchecked growth risks making precarious work normal in nursing. It also leaves unclear who is responsible when something goes wrong.
Thin evidence, especially in Canada
The authors searched six research databases and several sources of grey literature for material from 2005 to 2025. They found only 16 relevant sources: seven peer-reviewed studies, five pieces of grey literature, a policy document, a literature review, a book chapter and a doctoral thesis.
No one tracks how many nurses work through gig platforms in any of the three countries. In the U.S., apps such as CareRev, Clipboard Health, ShiftKey and Medely match nurses with open shifts. In the U.K., the NHS has long relied on internal “banks” of on-call nurses and on private agencies, and platforms such as Patchwork Health and Lantum now let nurses book shifts across several hospital trusts.
In Canada, the term “gig nursing” is rarely used. Temporary work happens mostly through private staffing agencies, which charge hospitals and long-term care homes far more than they pay the nurse. Despite an extensive search, the authors found only anecdotal evidence of app-based platforms here. One example is Alberta Health Services’ Vocantas scheduling app, which lets casual and part-time nurses pick up shifts and lets full-time staff choose overtime.
The authors also point to immigrant nurses who are still working through Canada’s licensing process. Some of them take jobs as health-care aides or personal support workers through care platforms, which the authors say reinforces the “deskilling” of trained professionals.
Employee or contractor?
The central legal question is whether a gig nurse is an employee or an independent contractor. Contractors generally aren’t covered by the protections and benefits employees get, such as pension and health plans, overtime and paid sick leave. They typically need their own liability insurance, and they’re personally on the hook if something goes wrong. The authors note that one U.S. platform, CareRev, has been reported to classify its nurses as contractors, which leaves them to arrange their own malpractice insurance.
Canada has no single legal test for employment. Courts and tax authorities weigh several factors, such as who controls the work, who supplies the equipment and who bears the financial risk. The authors say immigrant health workers who find work through platforms here are often treated as independent contractors.
California has gone further than most places. Its 2019 law, AB 5, presumes most workers are employees, and it doesn’t exempt nurses the way it exempts doctors and dentists. A class action against a nursing gig platform in California alleges that nurses were wrongly classified as contractors. In the U.K., a 2009 tribunal ruling found that a hospital “bank” worker who worked regularly for more than 15 years wasn’t an employee, because neither side was obliged to offer or accept work.
Patient safety
Research on platform-based nursing specifically is limited. So the authors draw on studies of temporary and agency nurses, who work in similar ways.
That research has linked heavy reliance on temporary staff to more patient falls, more back injuries among nurses and more medication errors in the U.S. In the U.K., it has been linked to a higher risk of patient deaths and more care left undone. A Canadian study associated higher use of temporary staff with higher hospital death rates. An ethnographic study of a U.S. nursing home found that gig shifts hurt teamwork and care standards and left permanent staff picking up the slack.
The authors also say it isn’t clear how platforms verify that a nurse’s licence is current or that they have the right clinical experience for the unit they’re sent to. Nurses can list their credentials on a profile, but it’s unclear who checks them.
Who ends up doing gig work
In the U.S., gig nursing roles are mostly filled by women and people of colour. In Canada, early evidence shows platforms relying heavily on immigrant health workers who can’t find other work. In the U.K., temporary staff have reported discrimination because of their work status and sometimes their ethnicity, and fear of losing future shifts keeps many from speaking up.
The authors argue that platforms may be benefiting from the same barriers that push these groups into precarious work, such as slow recognition of foreign credentials, hiring discrimination and caregiving responsibilities. They also note that nurses on some platforms can be rated down by algorithms if they cancel a shift because they’re sick.
What the authors recommend
- Change labour laws so gig nurses are explicitly recognized as employees, not independent contractors.
- Require platforms to verify credentials, scope of practice and continuing education in real time, and to guarantee minimum wages.
- Have hospitals keep registries of vetted gig nurses who already know the facility, and require standard onboarding for unit protocols, medication safety and access to electronic health records.
- Use gig nursing as a stopgap, not as a replacement for keeping permanent staff through better pay, benefits and career development.
The authors note that all three countries are already experimenting with alternatives. U.S. hospitals are building their own internal agencies. The NHS is expanding its staff banks and tightening rules on agency pay. In Canada, Healthcare Excellence Canada has outlined options including banning staffing agencies, creating regional float pools and offering more flexible permanent schedules.
Limitations
This is a narrative review, not a systematic one, and it relies partly on grey literature. The authors caution that its conclusions should be read with that in mind. Because so little research looks at app-based nursing specifically, they say it’s hard to separate the effects of platforms from those of temporary staffing in general. The authors declared no conflicts of interest and received no funding.
Source: Bayuo, J., Baffour, P. K., Oduro, E. B., & Marfo, E. A., “Gigification of Nursing Services in the United States, the United Kingdom, and Canada: Legal, Ethical, and Policy Implications,” Policy, Politics, & Nursing Practice 27(3), first published April 21, 2026. doi:10.1177/15271544261441590 (open access, CC BY 4.0)
