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Nursing ethics for a gig economy


To: Ethics Advisory Board
From: Overworked RN

Subject: Freelance nursing

I’m exhausted. My unit is always short staffed. I’m asked to work longer hours and come in on my day off. I need more control over my life and schedule. I wish there was an Uber-like employment option for nurses. How does the Code of Ethics for Nurses with Interpretive Statements (the Code) apply to freelance work? 

From: ANA Center for Ethics and Human Rights

Free agent or freelance work is a part of the gig economy (job-to-job employment). Several technology sites enable nurses to browse open shifts, sign up, work, and get paid the same day. The more common model is for nurses to serve as full-time, semi-permanent employees in a single organization.

Layoffs, downsizing, mergers, acquisitions, and nursing shortages have resulted in nurses exploring different employment and career options. The days of benevolent organizations providing career advancement and educational opportunities are dwindling. Individual nurses are relying on themselves to develop their skills and expertise to grow their careers.

Free agency is incredibly empowering because nurses build their reputations based on their own knowledge, skills, contributions, and outcomes. Nurses have long enjoyed the flexibility of transferrable skills, providing the ability to move among organizations, cities, and states with confidence that they’ll secure a good job. Freelance work enables nurses to have full control over their schedules, work in care areas they enjoy, and optimize their work-life balance. Skill variety offers a competitive edge. A nurse who’s competent across multiple care continuums is highly sought.

The free agent model is mutually beneficial. Organizations benefit from having a more flexible staffing model with the ability to staff up when census and acuity rise, and staff down as it falls. The freelance nurse takes responsibility for his or her own professional and career development and can be more independent and resilient.

Free agency isn’t limited to frontline, direct care positions. Consider the needs of an organization adopting a new electronic health record or completing annual training and competency education. Freelance nurse educators can support organizational transformation. The opportunities are endless.

The freelance mindset might be uncomfortable for some. The skills associated with marketing yourself, networking, collaboratively working in a team where relationships are shorter term, and building your career portfolio are new skills for some nurses. And the security of full-time employment and benefits remains an attractive option for many. Others embrace flexibility and are less risk-averse. Advance preparation for uncertainties can mitigate concerns and raise confidence.

The Code establishes the ethical standard for the profession and guides nurses in decision making. The nursing profession “encompasses the protection, promotion and restoration of health and well-being; the prevention of illness and injury; and the alleviation of suffering in the care of individuals, families, groups, communities, and populations.” The Code explicitly states the primary obligations, values, and ideals of the profession. In every work environment, adherence to the nine provisions of the Code ensures the nurse is practicing ethically. There’s no conflict between the freelance model and the Code.

The gig economy offers exciting possibilities for nursing to advance independent practice, individual accountability, and self-care.

— Response by Donna Casey, member of the ANA Center for Ethics and Human Rights Advisory Board.


Caulfield C. Forbes The gig economy has arrived in the world of nursing. Forbes. September 27, 2019.

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