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Would You Bid for a Job?
Roland Piquepaille writes "Several U.S. hospitals have found an innovative way to deal with nursing shortage. They post shift openings and the highest hourly rate they're willing to pay on their internal networks. Then, the nurses bid online for these extra shifts. The lowest bidders get the shifts and are notified by e-mail. This bidding process is almost certainly a good thing for the hospitals, but is it good for the nurses? Or safe for you? And what will happen if other industries also adopt auction systems? Imagine a company telling you, "Hey, you want to make some extra dollars by building this car or writing this piece of software? Name your price, and you'll make some more cash." What do you think of this bidding process? Read more before posting your comments."
But remember that nursing is a regulated field. That is to say, this system is only open to RNs, Registered Nurses, who the hostpital deals with on a regular basis. Anybody of sub-standard quality should be ejected from the system and not be allowed to bid.
There is a minimum rate that if you opt for, you are guaranteed the shift. The variance seems to be about 10% from the top rate. So I really don't see a problem when the minimum you can be paid is 90% of what the max is. This won't lead to constantly lowered pay until you are basically working for free, it means you will work the shift for always a minimum of 90% of the market rate. I would venture to guess that the 90% rate is probably more than the standard hour rate. I see it as a win-win both for the nurses and for the hospital.
You will also likely see no decline in care quality, maybe even an increase as it is mostly people who are bored or have nothing better to do on that shift because they CHOOSE to be.
*Of course, this only isolates the lowest bidder, not the person/entity best suited for the job, a major flaw in this system that I see
Well, in the area I work in (Heavy Civil construction - roads, bridges, tunnels, etc.) contractors are usually required to be prequalified. In fact, the more technical the work, the stricter the prequals get. Tunnel prequals and cable stay / suspension bridge prequals are quite intimidating.
Things like: contractor shall have performed similar work in the past five years, still employ key personnel (cable stay engineer, TMB superintendent) and make them available for the job.
You are required to submit these with the bid, or your number gets thrown out and it goes to the second lowest guy.
Now, most jurisdictions do this, but it's a state-by-state kind of thing so YMMV.
I think I need a new sig here.
I am an EMT, and I have to correct the parent's explanation of the triage system. He is correct that there are four different triage categories, green, yellow, red, and black. However, he is incorrect regarding the disposition of patients between the categories and how patients within the various categories are treated.
Triage begins by pointing, and asking all people who can walk to go over to where we are pointing. This will correspond to the area we've decided to establish as the green triage area. Any patient who can follow directions and walk to a location we indicated is presumably relatively okay, and treatment of them can wait till last. Therefore, anybody who walks over there is automatically classified as green, or "walking wounded." This step is critical, as it saves a lot of assessment time, often clearing out 90% of potential patients, and allowing us to locate and evaluate the 10% of patients who need care urgently much faster.
Next, a triage crew goes around evaluating all remaining patients, classifying them as either black, red, or yellow.
This determination begins by checking if they have a pulse and are breathing. If they are not breathing, we will reposition the head once to open the airway, hoping that restarts their breathing. Here is the big difference in treatment between a triage (mass casualty, number of patients overwhelming the system) and a normal setting. Normally, if a patient is not breathing, we would attempt to resuscitate them using CPR, etc. However, in a triage situation, CPR is not viable, as devoting several EMT's to extended treatment of one individual who most likely will not survive will almost definitely result in the death of several other patients. So, in a triage situation, patients are declared dead and ignored who we would normally attempt to save. However, a key difference from what the parent claimed is that we would black tag these individuals, officially declaring them dead/unsalveagable.
Red is used exclusively for those patients who are most critical, such as altered mental status, difficulty breathing (but breathing), etc., that will die without immediate medical care. The odds of survival of a patient who is not breathing are too low to justify spending time treating them, because for every one that you could save, you'd most likely lose several additional red tagged individuals on average. If you remember, I mentioned we try repositioning the airway once for all individuals who aren't breathing before we black tag them as dead. Repositioning the airway takes neglible time, and if doing so restores their breathing, then they are red tagged, because their odds of survival are sufficient to justify spending time on them. Red tagged patients are the only patients treated until there are no more red tagged patients. We do have to make tough choices (following protocol... We don't make decisions about who lives or dies, we follow protocol of how to choose who to treat to save the most lives.). Nor do we conceal that we are doing so, we clearly label as dead (black tag) individuals who we have negligible hope of saving when the attempt would cost others their lives.
If you are breathing (and hence not black tagged), but will live if you do no receive immediate treatment, then you are tagged yellow, or "delayed", as the only remaining option. (Remember, "walking wounded" or green, have already been cleared out, so the only options are black, red, or yellow.)
I have first-hand experience with this - I'm a developer involved with software that enables this and is being used nationwide.
Here's three things I know to be fact about this practice:
1. In our case - the nurses in question are all RN's and are all contract nurses. These hospitals are being billed $60+/hr and the nurses paid $30+/hr. On the low end, $30/hr is $57,600 per year. That's way more than most occupations pay so for the people that said nurses are underpaid - you're way wrong. On the flip side, the hospital is paying $115,200/yr for that same nurse. That's a big bill to pay.
2. Since these nurses are all contract nurses, there aren't very many that actually work 40 straight hours in a week - there are a few that do and there are a few that work more than that but they are a very small percentage.
3. The reason for this practice in the first place is due to the national nursing shortage. If you think there is an over-abundance of nurses in the U.S., you're wrong. Nursing shortages are approaching a crisis level in many parts of the country. Nurses are being offered big time incentives such as apartments, cars, per-diem, and good wages to travel to different hospitals within certain regions. If there weren't such a disparity in supply and demand, this wouldn't even be an option or sustainable for that matter.
Also, since they are contract and part of a pool, most of them get to demand what hours they work, what department they work, and what days they work. How would you like to say, I'll work MWF, 6a-3p in the dept of my choice and that's all I'll work - perfect for mom's and dad's or anyone else that needs a flexible schedule.
At first glance, it sounds like a terrible, capitalist, predatory practice. In reality, it's a necessity for these hospitals to be able to staff their departments to the minimum standards. It allows nurses that are more flexible and willing to work the chance to pick up the hours when they want them and the hospitals to keep staffing levels adequate. I'm not saying there aren't nurses that pick up their 50th hour (or more) this way but the actual times that happens is extremely low - I have payroll figures to back me up.
I wouldn't get overly concerned about it or start comparing it to IT or trying to draw any other conclusions other than the obvious supply and demand conclusion.
I invite you to google for variations "Nursing Pool", "Contract Nursing Pool", "Traveling Nurses", etc. and read up on how this works.
If you do what you always did, you get what you always got.
That explains all the headlines:
...
Doctor shortage cripples Canadas free health care
Broken health care system
Canadian health care deal adds $14 billion to ailing fund Pact
Just because people want something for free, doesn't mean they can actually get it.
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