[gwenith]

Nurses Bid With Their Pay in Auctions for Extra Work

June 6, 2004
By DAVID KOEPPEL

Every two weeks, Tiffany Clark, a registered nurse, logs onto her hospital's Web site and enters a bidding war with her co-workers.

Ms. Clark, 34, a full-time staff nurse at Spartanburg Regional Medical Center in South Carolina, usually works three 12-hour days a week and is paid $20.11 an hour. But she can bid for more hours in areas where she is qualified by posting an offer to work available shifts at a specific rate. When she does so, she usually gets her asking price of $39 an hour.

"We're generally very underpaid," said Ms. Clark, who is raising two children and taking seven hours of master's level classes at the University of South Carolina. "Shift bidding helps out my family and presents a great opportunity for nurses to take advantage of."

Spartanburg Regional has joined a growing number of
hospitals around the country in using auctions, which
several administrators described as "eBay in reverse."
Instead of bidding for shifts based on seniority, an
opportunity that has long existed for some other workers, like emergency medical technicians and corrections officers, the auctions award shifts to employees who ask the lowest prices for their work. Hospitals say the new shift bidding system lets nurses set their own schedules and helps hospitals deal with a severe nursing shortage while keeping costs in check. Without the auctions, many hospitals say, they would have to hire nurses supplied by agencies at $50 an hour or more.

Several hospital administrators said they expected more hospitals to begin using shift bidding based on pay. They also thought it could become available to more health care workers, like pharmacists,respiratory therapists or home health aides.

Many nurses' unions strongly oppose the practice, saying it has enormous potential for abuse. Almost none of the hospitals that use pay-based bidding for shifts have unions.

Rose Ann DeMoro, the executive director of the California Nurses Association, denounced shift bidding by pay as a threat to patient care and continuity and to the image of nurses as professionals.

"It's essentially turning nurses into a commodity. It's outrageous and predatory," she said. "It might be good for the bottom line but not for patients. It treats patients like a widget on an assembly line and nursing as casual labor."

Carol Cooke, a spokeswoman for the American Nurses Association, said that while shift bidding gives nurses
more flexibility and helps keep hospital costs down, it is only a stopgap approach to staffing. Several union officials said improved wages and working conditions would be a better long-term solution to the nursing shortage.

At Spartanburg, a nonunion hospital, nurses can bid for a specific shift in any department, as long as they have the proper skills and certification. Ms. Clark generally likes to bid on shifts in the pediatric and neonatal units. Bidding for all shifts begins at $40.50 and works downward. The average winning bid is $36 an hour, said Catherine Whelchel, the center's chief nursing officer, and Spartanburg usually auctions 350 to 500 shifts every two weeks. Theoretically, nurses can bid below their base rate, but this has not happened, Ms. Whelchel said. There is no maximum hour limit on employees, although the hospital is considering setting one, she said.

Since Spartanburg began bidding in 2002, some 400 of its 1,200 nurses have used the service, and the hospital has saved $1.2 million, Ms. Whelchel said. "It's really the answer to a nursing manager's prayer," she said.

Many hospitals are struggling with a nursing shortage that began in the late 90's, administrators said. The number of graduates of American nursing schools taking the national licensing exam for registered nurses for the first time was down 20 percent in 2003 from the 1995 number, the National Council of State Boards of Nursing said.

A 2002 report by the Department of Health and Human Services said the shortage would become worse because "increasing numbers of nurses are retiring, while too few others are entering the profession."

Against this backdrop, programs like the one at Spartanburg are being marketed to other hospitals. Spartanburg has a deal with Flexestaff, based in Chicago, to market its shift-bidding system.

St. Peter's Hospital in Albany began using a pay based
shift-bidding program for nurses in 2000, and now markets it to other hospitals. It has found buyers at hospitals in Pittsburgh, Miami and Camden, N.J. Richard Chady, a spokesman for St. Peter's, said shift bidding has helped shrink the hospital's nursing vacancy rate so that only 5 percent of its shifts go unfilled. Several years ago, he said, some units at the hospital had vacancy rates of 20 percent.

Health care consultants are also developing shift-bidding systems.

Per-Se Technologies, a health care consulting firm based in Atlanta, recently announced plans to market shift-bidding technology to hospitals and physician groups. Robert Wells, a senior vice president at the firm, said he was negotiating contracts with hospitals in New York, New Jersey, Chicago and Massachusetts.

Per-Se's system will allow hospital managers to choose winning bids using a variety of criteria, Mr. Wells said. "It could reward people based on seniority or high performers," he said. "It can be opened up to outside labor or closed to those you don't want bidding."

In Camden, Our Lady of Lourdes Medical Center began a pilot shift-bidding system on March 14 for nurses with appropriate qualifications. In its first two months, the system has been used by 350 of the hospital's 900 nurses, including Miriam Ziegler, 32, of Mount Laurel, N.J.

Ms. Ziegler works three 12-hour shifts and has been adding one 8-hour shift a week since the bidding began, she said, at wages well above the average hospital nurse's pay of less than $30 an hour. She said she liked the freedom of logging onto the site at any hour and the ability to control her schedule. Ms. Ziegler said any overtime pay she received was based on her average hourly pay for the week and the shifts she works.

Amy Gladstein, an assistant for strategic organizing for 1199/SEIU, New York's largest health care union, said shift bidding based on pay was not used at any of the centers covered by 1199. She said the nurses using these systems had few options. "In a nonunionized setting, they are working within a system which is not of their design," she said.

Virginia Treacy, the executive director of District Council 1 of JNESO, which represents 5,000 nurses in New Jersey and Pennsylvania, said shift bidding for pay would never be permitted in a union hospital.

The bidding program at Our Lady of Lourdes, she said, helps management keep employees under its thumb: "Keep them down. Keep them dumb. Keep them divided."

http://lists.iww.org/pipermail/iww-news/2004-June/005411.html

[rollingstone]

I bet administration loves seeing the nurses underbid each other for the extra shifts. You'd never see physicians doing this. It's asinine.

[chris_at_lucas_RN]

Brings to mind something an American astronaut (Michael Collins) said once: it's a little disconcerting realizing that the only thing between you and certain death was built by the lowest bidder.

or words to that effect....

[BBFRN]

Yeah, this is a way to generate cohesiveness in the work environment- not. Yet another way to pit nurses against each other- in a bidding war for undesireable shifts. It's insulting, really.

[Sheri257]

I don't really see a problem with this, particularly if the pay is ultimately better. But why is this nurse only making $20 an hour for her regular shift, and makes so much more by bidding on these other shifts/assignments?

Is it because these are tough shifts/assignments that would have to go to travelers/agency anyway? And why not just pay the staff nurses more in the first place?

[BBFRN]

Well, it sucks because this practice kind of makes nursing care seem equivalent to casual labor- these are human beings, and not a city road that needs fixing...kind of insulting to what it is we do, and insulting to the patients as well. It can also put the nurse in the position of being grateful for the extra cash they are making by picking up the extra shift, like they won the prize or something. It's not a long term solution to filling undesireable shifts, like retaining new hires, or offering across-the-board incentives. My floor offers a bonus for short-staffed days, and a good shift-diff. If a nurse picks up an extra shift on a short-staffed night, they are making time and a half, PLUS $5-$10/hr bonus pay, PLUS 12%-15% shift diff. I'll bet that's a lot more $ than one would get by being the lowest bidder.

[chris_at_lucas_RN]

Trust you, lgflamini, to see both sides of it....

I noted in the OP that one can also put in one's requested rate of pay (the example was significantly higher) and get it, which is kinda cool in a way, since you can be rewarded for your competence, and not just your years in a job.

I like that side of it, myself.

[chris_at_lucas_RN]

Originally Posted by lizz

I don't really see a problem with this, particularly if the pay is ultimately better. But why is this nurse only making $20 an hour for her regular shift, and makes so much more by bidding on these other shifts/assignments?

Is it because these are tough shifts/assignments that would have to go to travelers/agency anyway? And why not just pay the staff nurses more in the first place?

Because no matter how much you pay your staff, if you are understaffed, you are still understaffed.

These are for overtime shifts, I believe, according to the OP's article.

[BBFRN]

OK, I just did the math...lol. Say an is RN making $20/hr. If she were to be working an extra shift on my floor 7P-7A (and let's take the low bonus pay on this scenario), she would make $30/hr OT pay + $5/hr bonus pay, plus 12% shift diff from 7P-11P ($22.40/hr if the shift diff is based on the regular $20/hr wage) and 15% shift diff ($23/hr) from 11P-7A. That's $35/hr (x12 hrs= $420), plus $22.40x4 ($89.60), plus $23x8 ($184)= $599.20/12= an average of $49.93 an hour, if my math was correct...lol. That's more than the average winning bid of $36/hr posted in the OP.

[BBFRN]

Originally Posted by chris_at_lucas

Trust you, lgflamini, to see both sides of it....

I noted in the OP that one can also put in one's requested rate of pay (the example was significantly higher) and get it, which is kinda cool in a way, since you can be rewarded for your competence, and not just your years in a job.

I like that side of it, myself.

Lol...I would like that side of it if it wasn't a way to get around GUARANTEEING an experienced nurse a significant wage reward. I wouldn't want my wages determined on a day-by-day basis- I want it in writing.