Stop Saying There’s a Nursing Shortage

Yet rather than add nurses, many hospitals are paring back, sometimes turning to apps where they can hire nurses as gig workers. Such apps often allow hospitals to avoid paying for benefits for these workers, says Katie Wells, a senior fellow at the AI Now Institute, which has studied gig apps for nursing. “Lean staffing has just become the norm,” Wells says. Some of the lean staffing can likely be attributed to the wave of private equity takeovers of hospitals in recent years. Hospitals that were acquired by private equity reduced full-time employees staffing by 11.6%, while control hospitals—those that were not taken over—increased staffing in the same time period, according to one 2025 study. The study also found that hospitals acquired by private equity reduced hospital-wide salary expenditures. Lean staffing has also been embraced by for-profit hospitals that aren’t owned by private equity, Wells says. About one-quarter of hospitals were for-profit in 2020, but that share is growing. For-profit hospitals had “statistically significant” lower investments in nursing services, higher nurse staffing ratios, worse nurse job outcomes, and worse patient safety outcomes when compared to non-profit hospitals, one 2025 study looking at hospitals in Illinois found.

Yet rather than add nurses, many hospitals are paring back, sometimes turning to apps where they can hire nurses as gig workers. Such apps often allow hospitals to avoid paying for benefits for these workers, says Katie Wells, a senior fellow at the AI Now Institute, which has studied gig apps for nursing. “Lean staffing has just become the norm,” Wells says.

Some of the lean staffing can likely be attributed to the wave of private equity takeovers of hospitals in recent years. Hospitals that were acquired by private equity reduced full-time employees staffing by 11.6%, while control hospitals—those that were not taken over—increased staffing in the same time period, according to one 2025 study. The study also found that hospitals acquired by private equity reduced hospital-wide salary expenditures.

Lean staffing has also been embraced by for-profit hospitals that aren’t owned by private equity, Wells says. About one-quarter of hospitals were for-profit in 2020, but that share is growing. For-profit hospitals had “statistically significant” lower investments in nursing services, higher nurse staffing ratios, worse nurse job outcomes, and worse patient safety outcomes when compared to non-profit hospitals, one 2025 study looking at hospitals in Illinois found.

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