Name Your Price
Online scheduling systems allow staff nurses to bid on open shifts

By Heather World
April 15, 2004

When Jim Hardin, RN, creates a work schedule to accommodate the demands of his four-child family, he doesn’t hash it out with his manager six weeks in advance. Instead, a week or two before, he sits down at his computer and bids on open shifts in a new system being used by a growing number of health care employers.

“My family situation is not conducive to a straight day shift or night shift,” said Hardin, who works for Spartanburg Regional Healthcare System in North Carolina. “Sometimes I have to have time off with relatively short notice.”

Shift bidding systems have become the latest incentive to recruit nurses in a tight labor market and a way to cut costs. Some nurses say the system gives them more control over their schedules and better pay. Executives say the system saves money spent on agency nurses and the supplemental pay meant to entice employees to fill last-minute open shifts. Critics call the system a Band-Aid that fails to address the growing nursing shortage.

“You never get bored,” said Hardin, who had spent the past week going from pediatrics to neurology to the heart center. “I’m developing my skills in the manner I want to.”

In a typical shift bidding setup, prequalified nurses who log on to Spartanburg’s system through the Internet can peruse open shifts. Nurses may bid only on the facility in which they work, but they may bid on any unfilled shift if they have the credentials, which are spelled out in detail next to the bid. They are asked—but not limited—to bid on shifts within their own units first.

The top rate of pay is set at a price less than the total cost of an agency nurse but near the rate an agency nurse would earn. Hours worked through the bidding system do not count toward an employee’s benefits.

Bids are taken within a posted time frame, much like bids on the online auctioneer eBay. But in a reverse of the standard auction, nurses bid down in 50-cent increments. The lowest bidder wins the shift and is notified through e-mail. Managers have the discretion to override the bidding process if an unqualified nurse has won the shift.

Working eight or nine shifts every two weeks (plus one day a week for the float pool), Hardin has nearly doubled his income, he said.

“It’s a win-win situation for everyone,” he said.

Spartanburg developed the system to encourage its own nurses to cover extra shifts rather than picking up hours at other hospitals, and to decrease use of agency nurses, said Darby Douglas, RN, Spartanburg’s RN staffing coordinator.

Offering up extra shifts to inhouse nurses saves an average of $10,000 per week, Douglas said. The average winning bid, between $35 and $39 an hour, costs $14 to $20 an hour less than the fee for an agency nurse. The system fills more than 300 shifts per two-week pay period, she said.

“Since we started a newer version, we’ve done without crisis pay and double crisis pay,” Douglas said, referring to the additional money she must offer to entice Spartanburg nurses to work extra shifts.

Nursing agencies, which stand to be the most adversely affected by the new system, do not express much concern. The nurse shortage that leads to open shifts is still growing, said Michelle Catalano, RN, of Medical Staffing Network, the placement agency used by Spartanburg.

“They are starting an auction, but that doesn’t mean they are hiring nurses,” Catalano said. “It’s the same people, but they’re just working them harder.”

Spartanburg has gone from being the biggest to the smallest client for Catalano’s branch of Medical Staffing Network, she said. Nonetheless, the company is big. Its 200 branches supply other types of medical staff as well as nurses, and its well-trained nurses will always be in demand, especially as the shortage grows, she said.

Cheryl Johnson, RN, president of the 100,000-member union United American Nurses, said she wishes hospitals would focus the same amount of innovation and attention to improving workers’ health and safety or staffing ratios rather than paying nurses as little as possible.

“Sometimes these things sound wonderful but they don’t play out,” Johnson said, though she said she would withhold final judgment on the system for now. “We really do have to look at all kinds of solutions.”

Mark Genovese, spokesman for the New York State Nurses Association, said bidding systems do not get to the root of the nursing shortage and can harm nurses in the long run.

“It devalues the work a nurse does and undermines the gains we try to make through collective bargaining,” he said. “They need to focus on the root of the problem: creating a work environment that will attract registered nurses to full-time staff positions.”

Some in the health care industry hope the flexibility of shift bidding will lure nurses back to the workforce. Kim Job, RN, JD, works as an attorney in private practice and as a per diem nurse for Sharp HealthCare in San Diego. Before, Job found she could rarely adjust her legal calendar to work the last-minute shifts offered by supervisors. Since Sharp started its shift bidding system called BidShift in May 2003, Job is picking up many shifts.

“I think this is perfect for people who work per diem who have other jobs,” she said. Shift bidding allows a nurse to plan her schedule without having to commit to times a month in advance, she said.

Comfortable and convenient

Convenient Internet technology also may lure much-in-demand nursing school graduates, said Bonnie Clipper Salzberg, RN, MA, MBA, chief nursing officer at St. David’s Medical Center in Austin, Texas.

“It helps to reduce the phone interactions they don’t want to make,” Salzberg said. “If we make this easy, they can sit in their pajamas at home and look through available shifts.”

St. David’s is seeking to implement a shift bidding system developed by Decision Critical, a company that creates Web-based systems to support the work processes of health care organizations.

Kenneth Dion, RN, MSN, MBA, founder and CEO of Decision Critical, said his company already offers an education data repository, which allows organizations to deliver and track nursing education.

“We always knew an extension of that would be scheduling nurses,” he said.

Qualified nurses using Decision Critical’s StaffBid system are notified by e-mail, pager or Web-enabled cellular phone that a shift is open. Nurses who have been outbid and winners are then notified, freeing nurse managers from finding emergency staff. of making 50 phone calls, you’re making one Internet posting,” Dion said.

Like its cousins, StaffBid requires no hardware or software, nor does it need a connection to the education data repository. An organization need only have a Web browser and access to the Internet. Managers can customize the system to limit the number of shifts in a row worked, or the number of shifts taken by one employee, for example.

Furthermore, Dion said, the potential for continuity of patient care by inhouse nurses is consistent with better patient outcomes.

Glori Civitello, LPN, staffing coordinator at St. Clare’s Hospital in Schenectady, N.Y., agreed that shift bidding has reduced the chance for nursing errors. Not only is the hospital staffing its open shifts with nurses familiar with its procedures, physicians and patients, but it also no longer requires nurses to cover second “mandated” shifts on the heels of a
regular shift.

The national Institute of Medicine issued a report in November advising state regulatory bodies to limit nursing shifts to 12 hours a day and 60 hours a week. Working longer hours poses one of the most serious threats to patient safety because fatigue slows reaction time, decreases energy, diminishes attention to detail and otherwise contributes to errors, the report said.

“When I first came here, every other day people were staying on,” Civitello said. “Now they get to go home on time and they get to have their days off.”

St. Clare’s based its shift bidding system, which is open to the hospital’s 250 nurses, on one at nearby St. Peter’s Hospital. St. Clare’s still uses agency nurses, who cost between $49 and $60 an hour, but the majority of empty shifts are filled through bidding, capped at $35 an hour on weekdays and $45 an hour on weekends. In January, for example, the hospital paid for 68 agency nurse hours and 2,304 bidded hours to fill shifts.

Civitello said she also has anecdotal evidence that physicians are happier working with familiar nurses.

“I get a lot of phone calls from people saying, ‘They’re not going to get rid of this, are they?’ ” she said.

Contact Heather World at h_world@yahoo.com.