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nurses
New Report Sheds Light on the Pitfalls of AI-Powered 'Gig Nursing'
"These apps are a symptom of broken healthcare infrastructure that is now victim to corporate takeovers. Failing to act on both fronts poses risks to our healthcare system and the workers who power it," wrote one of the researchers.
Dec 17, 2024
While gig work is fairly common in a number of sectors in the American economy, a brief released Tuesday by the progressive-leaning think tank the Roosevelt Institute details how the gig model now has its tentacles in the healthcare industry, and argues it is creating new hazards for workers and patients.
The brief, authored by Groundwork Collaborative fellow Katie Wells and King's College London lecturer Funda Ustek Spilda, sounds the alarm over "on-demand nursing firms" such as CareRev, Clipboard Health, ShiftKey, ShiftMed, and others which have gained traction by promising hospitals more control and nurses and nursing assistants more flexibility.
Practically speaking, these "new Uber-style apps use algorithmic scheduling, staffing, and management technologies—software often touted by companies as cutting-edge 'AI,' or artificial intelligence—to connect understaffed medical facilities with nearby nurses and nursing assistants looking for work," according to the brief.
The authors, whose research was largely based on interviews with 29 gig nurses, argued that these apps "encourage nurses to work for less pay," do not offer nurses clarity when it comes to scheduling and amount or type of work, are not sufficiently concerned with worker safety, and "can threaten patient well-being by placing nurses in unfamiliar clinical environments with no onboarding or facility training."
These platforms are also using the same tactics asthe ride-hailing serviceUber when it comes to lobbying state legislatures in order to shield themselves from labor regulations, according to the authors, who noted that larger hospital systems in the country have included gig nurses in their operations since 2016.
The researchers argued that while the rates on a platform like ShiftKey can be higher for nurses and nurses assistants, nursing on-demand platforms can create a race to the bottom for wages: "The nurses and nursing assistants who use these apps must pay fees to bid on shifts, and they win those bids by offering to work for lower hourly rates than their fellow workers."
When the nursing on-demand firms classify the workers as self-employed, nurses and nursing assistants are also exposed to higher risk because they are "excluded from the protections of local, state, and federal law on minimum wage, overtime pay, workers' compensation, retirement benefits, employment-based health insurance, and paid sick days."
Workers are also rated based on facility feedback and determinations made by the algorithm, and can be penalized if they cancel a shift because they are sick or have a conflict, per the report.
"In at least one case, a nursing assistant went into work at a hospital while sick with Covid-19 because she could not figure out how to cancel a shift without lowering her rating," according to the authors.
By way of background, the authors of the brief also argue that the often-invoked "nursing shortage" is actually misleading term. In fact, there is no shortage of available nurses and nursing assistants, but rather a "growing number of nurses and nursing assistants who refuse to accept chronically understaffed, underpaid, unsafe, and high-stress workplaces," according to the brief, which cites outside research.
In fact, many of the workers interviewed said they would continue working for nursing on demand services because broadly speaking they like the work. According to the brief, interviewees said "over and over again how important flexible schedules are to their lives, especially their own caregiving, be it for children, spouses, or elders"—though the authors of the study wrote that this does not mean the concerns expressed by the workers are not worth paying attention to.
The rise of gig nursing is taking place on the backdrop of increasing corporate ownership over the healthcare industry writ large, including the rise of private equity ownership of medical facilities and medical staffing agencies.
"Policymakers need to be proactive and step in to regulate these platforms and provide proper labor protections for all nurses, gig and non-gig alike," said Wells in a Tuesday statement. "But these apps are a symptom of broken healthcare infrastructure that is now victim to corporate takeovers. Failing to act on both fronts poses risks to our healthcare system and the workers who power it."
Wells also toldThe Guardian that the gig companies don't release data and the industry is unregulated, meaning the true extent to which the U.S. healthcare system is leaning on gig nurses is unknown—but she said it is clearly a growing trend.
These on-demand nursing apps can also have a negative impact on patients, according to sources the authors spoke with. One nurse recounted that "there have been times when I've been unable to access patient records or find supply closets."
"Other workers report that the lack of management and resources can result in major safety lapses for patients, such as gig nurses not being able to get updated information on patient medications or instructions about whether patients need help with feeding," the authors wrote.
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What a Nurses’ Strike Says About the Meaning of Work Under Capitalism
The strike has led many of the nurses to discuss the ways that understaffing, paperwork, and the bottom-line efficiency fixation that are inherent in capitalist organizations eat into the quality of care they can give.
Oct 22, 2023
Since the nurses of RWJBarnabas hospital in New Brunswick, New Jersey, first struck early in August, I have had many conversations with them while visiting their picket lines. From the beginning, I have been struck by the extent to which they miss their work and their patients, and by their desire to increase the ratio of nurses to patients so the patients can get the care they need.
This obviously does not fit the stereotype that people only work for the paycheck. It also raises questions about the meaning of work, and about why capitalism creates pressures that operate to destroy the worthwhile and even fun parts of jobs.
Marxist and other theories of alienation often seem to say that workers hate their jobs because capitalism has created alienated work. In its narrowest sense, “alienation” simply means that much of the value of the work that workers do is taken away from the worker and becomes profit for the employers. More broadly, alienation means that employers control what workers do, the conditions in which they do it, and the product of the labor, and that the result is to remove control, creativity, and joy from the job.
The pleasure they should get from taking care of the patients is whittled away day by day as paperwork and understaffing mean they cannot give the patients the care they need.
Yet this is not what I am hearing from the nurses. And, I might add, it is not what I heard from truck drivers when I studied one of their Los Angeles local unions 50 years ago. (See Teamsters Rank and File, Columbia University Press, 1982.) Drivers saw what they were doing as useful, enjoyed “building up their routes” and pleasing the people to whom they made deliveries, and resented it when employers took action that might have increased their profits, but hurt their customers and the drivers’ relationships with the customers.
What does all this mean? To me, it means that people get joy and pleasure out of helping other people. This is particularly evident with the nurses: The ways they help their patients are very meaningful to them, and, when they are striking, they miss those patients who have recurrent need for care and who they have come to know. As they tell me, the replacement (scab) nurses do not know these patients and will not take as good care of them.
I think this goes very deep into who people are and what society is like. In Marx’s terms, I think helping other people is part of our “species-being,” built into our history and our cultures by many centuries of experience. We like to produce use values for other people, whether this is by taking care of them when they are sick or by delivering goods to them. Undoubtedly, nurses feel this more that truck drivers, since their involvement with other people is more intense and concrete.
Unfortunately, capitalism is a system built to produce and increase profits by focusing on exchange value rather than use value. In terms of the nurses, even though they work for what is ostensibly a nonprofit hospital, they are under constant pressure to work harder, and to serve more patients, and sicker patients, with fewer nurses, while the chief executive officer and other higher-ups make $10 million and even more each year. As one nurse phrased it to me, what they care about is the records we enter into our computers more than the patients. These records, it should be noted, are the basis for the billing that brings the money in. Record-keeping also takes nurses’ time away from the patients.
One nurse told me about what the pressure to do more with fewer people means in practice. She is one of a few workers assigned to an intensive care unit for children. One day, another unit had a staff shortage, so the employer moved all the nurses from her unit to another floor to work with other patients. Her primary assignment that day had been intake—to admit children who needed intensive care to the unit, including filling out the relevant paperwork on the computer. On this particular day, she was admitting a child to the unit when alarms went off for two other children on the unit. In human terms: One child needed to be admitted, and two others had potentially life-threatening emergencies at the same time. Although a particularly bad instance of how understaffing works, this ethical dilemma and associated pain and trauma to the nurses occurs in less acute forms every few days. Yet the paperwork gets filled out, the money comes in, and, in spite of the understaffing, some of the children do get good care even if others end up dead or seriously harmed by inadequate care.
What does this mean for the nurses? They feel guilt and conflict over the decisions their employers force them to make about who does and who does not get seen when. They see their dignity attacked, and their professional knowledge debased, when their supervisors ignore their warnings and their concerns. And the pleasure they should get from taking care of the patients is whittled away day by day as paperwork and understaffing mean they cannot give the patients the care they need.
One of the potential ways in which this strike can help is by forcing safe staffing legislation through the state legislature—although so far, the governor and legislature seem cool to this idea, perhaps because of their economic and personal ties to RWJBarnabas management and to the “healthcare” industry more generally. Another is that they may win contractual provisions that help them defend safe staffing levels. A third is that the heightened solidarity they have built up with each other will let them resist managers’ bad decisions more effectively on a day-to-day basis.
In addition, the strike has led many of the nurses to think and discuss the meaning of their jobs and the ways that understaffing, paperwork, and the bottom-line efficiency fixation that are inherent in capitalist organizations eat into the quality of care they can give, their sense of dignity, and the joy they should get from taking care of the sick. In my view, the only way to solve these problems for them and for future generations is to replace capitalism with a new system that some of us call “socialism,” with the understanding that we will only come to understand this new system as we build it. I hope some of these nurses, and billions of other people in addition, will come to agree with me on that before capitalism creates an unlivable environment for humanity.
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Sanders Announces 'Historic' Bipartisan Bill to Confront US Primary Care Crisis
"It is unacceptable that millions of Americans throughout our country do not have access to affordable, high-quality primary care and are unable to get the healthcare they need when they need it."
Sep 14, 2023
After weeks of negotiations, Independent Sen. Bernie Sanders of Vermont and Republican Sen. Roger Marshall of Kansas announced Thursday that they have reached an agreement on a bill to confront the United States' primary care crisis, which has left millions of people across the nation without access to critical healthcare.
Sanders, the chair of the Senate Health, Education, Labor, and Pensions (HELP) Committee, said in a statement that the new legislation marks a "historic" effort "to expand primary care and to reduce the massive shortage of nurses and primary care doctors in America."
According to a report released earlier this year by the National Association of Community Health Centers, more than 100 million people in the U.S. face difficulty accessing primary care, which is often the initial point of contact for patients seeking care.
The U.S. underinvests in primary care compared to other wealthy nations, despite spending more on healthcare overall.
"It is unacceptable that millions of Americans throughout our country do not have access to affordable, high-quality primary care and are unable to get the healthcare they need when they need it," the Vermont senator said. "Every major medical organization understands that our investment in primary care is woefully inadequate. They understand that focusing on disease prevention and providing more Americans with a medical home instead of relying on expensive emergency rooms for primary care will not only save lives and human suffering, it will save money."
The new bipartisan legislation includes nearly $6 billion in mandatory annual funding for community health centers over the next three years, according to a summary of the measure. If Congress doesn't act by the end of the month, community health centers—which provide primary care to tens of millions of vulnerable Americans—will face steep funding cuts.
The Sanders-Marshall legislation also includes funding that would support an estimated 2,000 primary care physicians over the next decade.
Additionally, the measure would boost funding for the National Health Service Corps to support scholarships and debt relief for doctors, nurses, and other healthcare professionals.
Recent data suggests the U.S. could see a shortage of up to 124,000 physicians over the next decade. Elisabeth Rosenthal of KFF Health News noted last week that "the percentage of U.S. doctors in adult primary care has been declining for years and is now about 25%—a tipping point beyond which many Americans won't be able to find a family doctor at all."
The nursing shortage is also severe and could soon get much worse. One study released earlier this year estimated that around 100,000 registered nurses in the U.S. left their jobs over the past two years—often due to pandemic-related stress—and more than 610,000 more intend to leave over the next four years.
Sanders and Marshall's legislation, which is set to be marked up in the Senate HELP Committee on September 21, would provide $1.2 billion in grants to state universities and community colleges with the goal of boosting the number of students enrolled in registered nursing programs.
Marshall, the top Republican on HELP's Subcommittee on Primary Health and Retirement Security, said in a statement that the new bill "recognizes and addresses the challenges our healthcare industry is facing, like the shortage of nurses and primary care doctors, and includes programs to bolster the workforce in a fiscally responsible way."
According to Sanders' office, the legislation would be "fully paid for by combating the enormous waste, fraud, and abuse in the healthcare system, making it easier for patients to access low-cost generic drugs, and holding pharmacy benefit managers accountable, among other provisions."
In remarks on the Senate floor on Thursday, Sanders noted that "in Vermont and all over this country, our people often have to wait months in order to get an appointment with a doctor and, in some cases, they have to travel very long distances to get the healthcare they need."
"It is literally insane," said Sanders, "that millions of Americans with nonemergency healthcare needs get their primary care in a hospital emergency room."
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