“Uber for Nurses” May Soon Be on the Ballot in California

Following the Prop 22 model, a ballot proposal in California seeks to strip app-based health care workers of employee status. Silicon Valley yet again wants to exempt apps from labor laws — but capital may have a real fight on its hands this time.

Nearly one in five nurses have left the field entirely since the start of the pandemic, with more than 500,000 health care workers quitting just in December of 2021. (Hush Naidoo Jade / Unsplash)

US health care workers are in a crisis. Nearly one in five have left the field entirely since the start of the pandemic, with more than 500,000 health care workers quitting just in December of 2021. One recent study found that around 40 percent of nurses are thinking of leaving the profession. Long overworked and understaffed, the people who care for the rest of us cannot take it any longer.

But for capital, where there is crisis, there is opportunity. With the explosion of contract work, particularly that of traveling nurses who move from one facility to the next on limited-term contracts — the pandemic has seen travelers’ pay skyrocket — employers see a chance to reconfigure health care work into a gig model. Venture capitalist–backed startups have long advanced the transformation of stable employment into precarious independent contracting — Uber and Lyft are only the most well-known examples. Now, the push is coming to the country’s fastest-growing industry: health care.

A measure filed late last month with the California attorney general’s office aims to ask the state’s voters for approval to reclassify nurses, dental hygienists, and other health care workers who find employment through apps as independent contractors — a shift long sought by app-based employers. Funding for such apps has increased exponentially as health care facilities look further afield to temporarily plug holes in their existing labor force (another solution for such employers is to import health care workers from other countries, an arrangement that some workers allege amounts to human trafficking).

As MarketWatch first reported, the law firm behind the California measure is the same one tied to Proposition 22, the gig company–backed state initiative that sought to exclude such companies’ drivers from employee status, preventing them from accessing basic workers’ rights, from minimum wage to antidiscrimination protections. The financial backers of Californians for Equitable Healthcare Access, the advocacy group behind the new ballot initiative, are not yet known.

Voters passed Proposition 22, thanks to a $200 million propaganda campaign by the gig companies, but it was overturned by a state court; the initiative’s architects are appealing that ruling. After their victory at the polls, they have been exporting the model across the country — in Massachusetts, gig companies are expected to break records for campaign spending in pushing a similar ballot initiative.

The push to reclassify app-based health care workers looks at the existing problems that are driving workers from the field and asks, “What if we made it worse?” It is no mystery why these workers are fed up: for-profit hospitals in particular have moved to a lean-staffing model that places too few workers on the floor at any particular shift, stressing those workers to minimize labor costs, which comprise around half of the budget at a hospital. Rather than stabilizing these jobs by increasing compensation and staffing levels, this further shifts risk onto health care workers, fueling, rather than mitigating, stress and burnout.

While there are more licensed nurses in the United States than ever before, hospitals simply aren’t hiring them. For those that are employed, the feeling that they are being asked to provide inadequate care to patients is unbearable. If one actually wanted to rectify the situation, in the short term that would mean legislative solutions such as safe-staffing ratios, limiting the number of patients with which a nurse can be tasked. California has one such law, which resulted in better outcomes for both patients and nurses. Similar bills are pending in Pennsylvania and Illinois; in Massachusetts, a safe-staffing law was defeated in 2018 after a $25 million campaign against it by the hospital lobby.

But in introducing the Uber-for-nurses bill in California, capital is setting itself up for a battle against the state’s unionized nurses. Gig-company drivers did not have such preexisting organization, which made it easier for Prop 22’s proponents to monopolize the debate over their initiative. As Renée Saldaña, a spokeswoman for the SEIU–United Healthcare Workers (SEIU-UHW) West, told MarketWatch, “This proposed initiative seems like the worst possible idea in the middle of a pandemic. It would further devalue the jobs of the essential front-line caregivers we depend on.”