When AI eats the manager

How private equity gets its cut from “Uber for nursing”

In March, Private Equity Stakeholder Project was proud to co-sponsor an event launching a new report by Fairwork: “When AI Eats the Manager.”

The report examineshow algorithmic management technologies are shaping the healthcare workforce and what happens when nurses use AI to bid against each other for shifts. 

One of the 11 of the largest digital platforms in the U.S. profiled in the report is ShiftKey, which claims to have 6,000 facilities and over 140,000 workers (CNAs, RNs, LPNs, LVNs, RTs, PTs) in its network. 

ShiftKey is majority owned by private equity firm Lorient Capital, with minority backing from Ares Management, Pantheon, and others. 

Dubbed “Uber for nursing,” ShiftKey and other on-demand nursing companies use algorithmic scheduling, staffing, and management technologies to connect nurses looking for work with healthcare facilities experiencing staffing shortages. 

ShiftKey markets itself to nurses and other healthcare professionals with messaging like “Work on your own terms” and “Opt for independence.” Nurses are told they can “Set the rate you prefer” for shifts based on the hourly rate they are willing to accept. 

The reality is that bidding on shifts results in a race to the bottom for wages. According to a 2024 report by the Roosevelt Institute, ShiftKey and its peers “encourage workers to join in on personalized pay schemes by bidding against each other.” 

One ShiftKey worker interviewed by the report authors described how she indicates on the app the lowest wage she is willing to accept and “To win the shift, she lowers and lowers her rate until it’s well below a living wage.”

The Fairwork report also describes how much of ShiftKey’s employee management is automated:

“Performance management for ShiftKey workers is largely conducted by automated rating systems. Some of these ratings are given by the medical facilities for attendance, timeliness, and onsite performance. Other ratings are given by the on-demand nursing companies based on how many shifts a worker completes, how early they cancel shifts, and whether they stay late on a job (which can hurt one’s score). Higher reliability scores lead to earlier access to shifts while lower ratings result in temporary or permanent suspensions and, it is suspected, lower pay offerings.”

A different ShiftKey worker told researchers about the feeling of isolation and lack of a chain of command. She described showing up for a night shift at a long-term care facility where the doors were locked, and she could not get in contact with anyone at the facility to open them. 

While ShiftKey is one of the largest companies using algorithmic staffing models for healthcare facilities, there is a growing landscape of similar companies entering the market including

Clipboard Health, KARE, IntelyCare, Gale Healthcare, ConnectRN, Nursa, and NurseDash – all of which are backed by venture capital firms. 

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The Fairwork report launch event took place in Washington, D.C. and featured panelists and featured Veena Dubal (University of California, Irvine), Mark Graham (University of Oxford), Funda Ustek Spilda (King’s College, London), David Seligman (Towards Justice), Katie J. Wells (Groundwork Collaborative) and moderator Chenjerai Kumanyika (New York University).

See the 2025 Fairwork report, “When AI Eats the Manager,” here. 

See Roosevelt Institute’s December 2024 report, “Uber for Nursing: How an AI-Powered Gig Model Is Threatening Health Care,” here.