Bidding systems address U.S. nursing shortage

Leaders realize significant savings, boost safety

While nursing shortages are seen in nearly every market in the United States, the state of Louisiana has been hit with a double-whammy, following Hurricane Katrina and the attendant loss of health care professionals through relocation. To help address this shortage — while at the same time cutting costs and enhancing patient safety — two hospitals have introduced bidding systems that enable existing staff to vie for open shifts.

With the systems, nurses are given schedules that cover the next four to six weeks, and then are allowed to bid 1.1 to 1.5 times their current salary, with the lowest bidder the winner. Nurses who are particularly anxious to win a shift will bid low at the outset, in hopes of beating out the competition.

Interestingly enough, the same nursing leader was responsible for the implementation at both hospitals. Debbie Ford, RN, MSN, vice president of patient care and chief nursing officer at Our Lady of the Lake Hospital in Baton Rouge, introduced the first bidding system in May 2006 when she was at Lafayette General Medical Center. She subsequently introduced another system at Our Lady of the Lake late last year.

In both cases the systems were developed internally. "We had heard of a company called BidShifts [which provides web-based shift scheduling technology] and they gave us a demonstration," recalls Ford. "But it would have cost $9,000 a month to maintain the system."

But, she says, she really liked the idea, and thought it could be used as a tool for recruitment and retention. So she had Firefly Digital, a local firm, design a system for the facility.

Filling needs

The system, called I-bid, has addressed several important needs, says Ginger Broussard, RN, director of nursing administration at Lafayette General.

"We had unfilled shifts throughout the hospital and we were using contract labor to fill those needs, but even with that help — which was very expensive — we still had shifts that needed to be filled," she explains. Since contract labor was usually several times as costly as regular staff (on average $55-$65 an hour), "we wanted to replace the contract labor," she says.

The system works like this: When the nurse manager makes out her staffing schedule for the next four weeks and there are unfilled shifts, the information is sent to the staffing coordinator. "They put it into the I-bid program, which is only open to our nurses," says Broussard, adding that nurses can enter the password-protected system from any computer. "They look at what shifts are available, either on their unit or on another one, and actually bid on the shift."

Depending on the day of the week and time of day, the shift is posted with a monetary value. "It basically works like eBay," Broussard explains. "If the job is posted at 1.5 and a nurse makes $10 an hour, they can bid up to $15 an hour."

The system, Broussard says, "has allowed us to totally eliminate the use of per diem agency nurses," which, she says, has saved several million dollars.

"In addition, having our staff working those shifts — nurses who are familiar with our policies, know our patients and our physicians — gives us a consistency in the delivery of patient care, which is absolutely a patient safety benefit," she continues. "We know that it has decreased patient and physician complaints, because those things are measurable in our [Press Ganey] satisfaction surveys."

The nurses, she adds, have responded very well to the system. "It allows them to plan and pre-book their hours," she notes.

'Tweaking' existing system

When Ford got to Our Lady of the Lake, she realized that the system already in place — from Vastech Inc. — already had a bidding component. "We just tweaked it and educated people to generate excitement around it," she says.

In fact, she notes, the existing system was a bit more sophisticated than what had been created at LaFayette General. "You can put in the skill mix and competency of nurses; it's sophisticated enough that if you do not have the skills to do cardiovascular shifts, for example, it won't let you bid for those shifts," Ford explains.

When a nurse keys in her identification number, Ford continues, she will see only the shifts for which she is qualified. "Previously [at LaFayette General] you had to attest you would not sign up for a shift if you were not qualified," notes Ford.

Testing began on the new system in November 2007. "I wanted it to be a recruitment and retention tool," notes Ford. "Vastech already showed that if you pick up additional shifts, you could get additional incentive pay, but I tweaked it based on base pay so that it rewarded someone with more experience. So basically, the message was that the longer you stay with us and the more you participate in the program, the more you tend to make."

The marketing message to those nurses who were not working at Our Lady of the Lake, says Ford, was: "This is something new and different; come try us, come check us out." A marketing mailer was sent out around Thanksgiving, and it seems to have been effective, she says.

"We set up a phone number and put it in the flier, so if people called specifically about Vastech, there was one person who managed and logged the calls," Ford explains. "And between nine and 12 people have come on staff as a result of the flier."

A telethon was held to generate additional interest, Ford says, and those people who were contacted are now being tracked.

The staff, says Ford, have been very receptive to the new program. "The premise was that if this was their personal time off and it was worth it to us [to have them work] we needed to make it worth it to them," she says. "We can ensure we give qualified patient care, and if we get one shift filled, it's a success because nobody has to give up free time off."

At Our Lady of the Lake, a six-week schedule is published. "The whole premise behind it is that it allows you as a nurse to plan your life ahead of time," says Ford. "People can check their calendar and plan their shifts. For younger gen-x'ers, their social life is planned around it. For older nurses, the shifts can be planned around family events. It appeals across generations."

The timing couldn't be better for the hospital, which recently signed a major contract that shifted business in the city and gave it a large number of new patients, Ford concludes.

[For more information, contact:

Ginger Broussard, RN, Director of Nursing Administration, Lafayette General Medical Center, 1214 Coolidge Blvd., Lafayette, LA 70503. Phone: (337) 289-7792.

Debbie Ford, RN, MSN, Vice President of Patient Care and Chief Nursing Officer, Our Lady of the Lake Hospital, 5000 Hennessy Blvd., Baton Rouge, LA 70808. Phone: (225) 247-7980.]