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Under a new, automated system in place at some hospitals, employees can sign up for extra shifts from home, work, or anywhere else with Internet access. Nurses see only shifts that they are qualified to fill.

Until late September, when open nursing shifts at Christus St. Joseph’s Hospital in Houston were posted each Wednesday, nurses who were working that day quickly snapped up the most desirable extra shifts. Under a new, automated system called BidShift, employees can sign up for shifts from home, work, or anywhere else with Internet access.

“You don’t have to be here, and you don’t have to make phone calls,” says Laura Fortin, RN, chief nursing officer/chief operating officer. “Nurses get an e-mail when the schedule is posted, so they all have an equal chance to select shifts.”

Based on a qualifications profile, nurses see only shifts that they are qualified to fill. At St. Joseph’s, shifts are first opened to the float pool and, a week later, to all qualified employees. There is a set minimum and maximum pay rate, and the bidding works like a reverse eBay: Nurses place a bid, usually the maximum, then others can bid down by 50-cent increments.

“Managers don’t necessarily choose the lowest bid,” Fortin says. “They’ll award shifts to the most-needed, most-qualified person. If you have two nurses who are equal in tenure, experience, and proficiency, then you take the lowest bid.”

Typically, there is little competition, with perhaps only two nurses bidding for the same shift, and managers go online every day or two to award shifts.

In addition to this best-bid method, the system can be based on fixed, current pay rates, on flat rates plus a bonus, or other variations, says Bruce Springer, president and CEO of BidShift. It can even be set up for multiphase bidding, in which shifts are offered based on seniority or to only a specific unit, then to a cluster of units, and finally to the full pool of eligible employees.

“We try to help hospitals understand their staffing patterns, wage rates, agency rates, and so forth, and the best way to meet those demands and other requirements in their environment,” Springer says. “It isn’t about bidding, it is about staffing optimization, retention, and recruitment.

“We’re trying to reduce preferential staffing, inequality in priority time, and frustration on the part of nurses — to increase satisfaction and keep nurses in the hospital. Every nurse has the ability to know what shifts are available and which ones they are capable of working, and to bid on those.”

Easy to use

Nurses had little difficulty in learning to use the system, Fortin says. “BidShift has a brochure to take home that walks them through it. Once nurses are awarded a shift, they get an e-mail, and they can print out their schedule,” she says.

“The program is easy to use,” says Heidi Elkins, RN, who works in St. Joseph’s neonatal intensive care unit. “The pay is a little better, which is nice. So is being able to check from home.”

Nurses can withdraw a bid before a shift is awarded, and Fortin allows them to switch one shift awarded through the system with another, although not for a regular shift.

St. Joseph’s immediately saw a drop in agency costs, and Fortin expects that to continue. “We aren’t even fully implemented,” she says. “We should start to see financial results in six months.”

The centralized staffing office at Sharp Healthcare System of San Diego implemented BidShift for its seven hospitals and three medical groups in May 2003. Sharp has filled about 3,000 shifts through the system.

“We’re saving money on staffing costs, and our staff is making more on extra shifts,” says Angela Athis, director of staffing. “It has helped us recruit new nurses. Our turnover rate is 12%, compared to a statewide average of 14.3, and there are a lot of factors, but I’ll say BidShift is one.”

Morale booster

“I work as much as I want,” says Sharp BidShift user Kate Adams, RN. “It gives me flexibility and more money. We are paid every other Friday, and a nice option is that you can get paid for your BidShifts on Friday even if it isn’t a regular payday.”

St. David’s Medical Center in Austin is testing a StaffBid shift bidding system from Decision Critical Inc. “We are using it in some units and hope to soon open it to all nursing units,” says chief nursing officer Bonnie Clipper Salzberg, RN, MA, MBA. “The pilot has shown that filling shifts with our own staff is definitely less expensive. The staff likes it because it gives them more autonomy and control.”

Clarian Health Partners, a three-hospital system in Indiana, has been using BidShift for three years. Martha Allen, RN, BSN, clinical manager of operations, says, “It has really given the accountability and flexibility back to the staff. It’s also a morale booster, because I am able to share the wealth among the staff.”

Clarian has gone from a 19% RN vacancy rate in 1999 to 5.3% in 2003, and Allen believes initiatives for staff retention like the shift bidding system contributed to that. “There is zero percent vacancy in my unit, labor and delivery/high risk maternal care, with a waiting list. I see shift bidding as one of many tools managers use to retain staff.”

The American Organization of Nurse Executives has not discussed the pros and cons of shift bidding systems specifically, says Pamela Thompson, RN, MS, FAAN, chief executive officer of AONE, but in general is supportive of creativity in management. “There are creative approaches in the field for managing nursing environments and for shared decision-making on things that are important to staff nurses,” Thompson says. “Work hours and how one works are part of that.”

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