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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."
Nurses are unique creatures in that they require a four year education and above-average intelligence, but are managed like factory workers. It won't take long for peers to figure out who the low bidders are and to educate them as to the protocol to be followed, i.e. a minimum bid.
I too have felt the cold finger of injustice.
We keep playing the game like it's an open system, and it never was, and now we are quickly discovering the end stops.
Designing an economic model which awards wealth to those who grow, is doomed when a company, any company reaches market saturation.
The American economy no longer exists, American business is multinational, global, and not limited to our borders. It finds cheap labor and brings the saving in production back to the U.S. where American consumers rejoice at the low cost of service and goods. Sadly it's all a sham. It's as unsustainable as a constant diet of junk food. It tastes good while you're eating it, but it's slowly killing you. It's all take and no give, the dollars fly out of the country faster and faster, until the nations fundamental wealth is gone, and the citizens of the nation notice they are now the collective bag holders.
* Money that leaves never supports U.S. economy and infrastructure. * Money that leaves undermines U.S. labor, costing jobs and quality of living. * The growing gap between haves and have nots in the U.S. suggest a growing economic instability. Loss of jobs starting with manufacturing, but now quickly moving up through intellectual "white collar" professions, points to a growing joblessness with no end in sight. As the government services fail (and if you haven't been reading the paper or watching the news at 11:00, local government everywhere in this country is on the verge of collapse), the means to manage and provide basic life needs to the growing disenfranchised evaporates. The middle class vanishes. We are all reduced to the same level of living enjoyed by billions of starving people all over the world. Already 3% of our population owns 75% of the wealth, this is the greatest desparity in wealth in our history. And still the insanity accelerates. This is just the beginning ladies and gentlemen. What will you do, when your kids fresh out of college, with hundred thousand dollar college loans to pay, can't find work. What will you do, when you haven't received a raise in 4 years, and the boss says "Sorry, the work is heading to China."
I've personally spent the last 6 months looking for work, I've had my resume tuned, I have 25 years of technical experience, and I've made it clear I'll do almost anything, and I have not had a single interview. I'm not alone, I have a couple hundred friends and acquaintances who've been unemployed for between 2 and 3.5 years.
I keep hearing neocons mouthing the lines of Scrooge from a Christmas Carol... "the surplus population shold just get on with the business of dying...", or some variation of that. It's not bad yet. It may well get there. If it does, our government, is going to have a very bad time. Our society is going to have a very bad time. We need to begin addressing sustainable business practice from an economic, environmental, and ethics based context. To simply let the train go where it will is to insure a crash none of us will walk away from.
bw
Welcome to our hospital, where you'll be looked after by the lowest bidder - guarenteed!
It doesn't seem that the nurses are "paying" for the extra hours, but more like bidding a lower price for their labours - I suppose in the same vain that contractors bid for government contracts*. A little difference, but a difference nontheless.
*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. Of course, all of the bidding nurses are employees already, and this shouldn't affect the quality of care.
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I dare to stand against the prevailing mythos of anti-corporatism and say that this is an economically efficient solution for nurses who want overtime and hospitals who are often in financial distress, not to mention keeping all of our health care costs lower.
Why don't they have online queues for hospital waiting rooms? That's because they *want* you to bleed out in the Emergency room so that the hospital can help ensure they get better funding, or at least that's the way it is in Canada. They spend all kinds of money on eShift to get it running and all the nurses buy into it because they are either too tired to realize they're being screwed by the system, or they have no choice. *sigh*
Okay... somebody doesn't know what triage is. When somebody shows up in the an emergency room, the first person they see is always the triage nurse. The process of triage is a simple concept that's hard to execute... putting people into one of three groups.
- Those who are in such extreme need they must be treated right away in order to save their life. These get treated first.
- Those who are in need of treatment, but aren't going to die or suffer much if their treatment is delayed a bit. Those are the people who have to wait until all of the people in the first category have been taken care of.
- Those who can't be treated. They're already beyond hope, and any effort spent on them would be wasted.
The waiting in the emergency room isn't due to lack of funding... it's a random thing based on whether a higher-priority case is in your way at the moment.
Another example of what happens when the primary corporate philosophy is predatory and parasite friendly.
it is a result of black and white accounting values, instead of seeing a full spectrum color photo of the situation, which means acknowledging more than personal selfish goals as important.
Survival is a multidimensional activity. Otherwise you sacrifice everyone else's quality of life for your selfish ends. Do that too often and you end up living inside a toliet bowl with the only rope out tied off to the toilet handle.
"It is a greater offense to steal men's labor, than their clothes"
No, then the hospital hires a nurse from a temporary nurse service just like they had been doing previously.
"What happens if a shift gets left on the board with nobody willing to bid under the max posted?"
Um, the hospital administration takes note of that fact and raises the max available rate for those particular slots until enough workers are found, and/or outsources to an outside agency if really desperate, or even forces staff nurses to work overtime in unfilled critical slots (as they already do now)?
Really, I don't know what so many of you are so disgusted by; this is Capitalism 101 "supply and demand" in fairly benign form (given the relative shortage of nurses). Frankly, it seems like a pretty good win-win solution to fill chronically unfilled spots for everybody except the temp agencies (aww... poor middlemen.)
What? You say nurses deserve more stability, and should only work if they've got guaranteed full-time jobs? Fine. $37/hr (or whatever rate is negotiated by the local nursing union for that particular type of nursing) still gets them that full-time work. How? Why? Because none of this eliminates the power of the unions, and overall system stability is still in everybody's best interest, most definitely including that of the hospitals.
As to the idea that nursing quality will suffer any if the lowest bids determine who works, I've gotta say that you've either never worked in a hospital or never paid attention. If you had, you'll know that it's not like many not-so-great nurses are being weeded out by existing market forces; if you've got the necessary quals for a particular job (ER, critical care, scrub, floor, dialysis, whatever) and you do that job without doing anything egregiously stupid/dangerous, you remain employed. Nothing in this system of labor allocation gives nurses the power/right to work in positions they're not already fully qualified for.
Listen to what I say, not what I mean...
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.)
Capitalism 101?
Even modern capitalism is really not defined by these terms any more than modern communism mean no corruption and the state is really run for the good of ALL people.
Why? because idealism is dangerous. I have a lot off beliefs that are great beliefs by themselves, but put into practice by imperfect people, would be a recipe for disaster.
This is one of those recipes.
I worked in a nursing home several years ago as a security guard while putting myself through college. I also work with nurses designing licensure exams in my day job. So I've seen the worst and the best of this area. The ones in my current professional day job are what
Supply and demand does not work. Imagine if a trucking firm decided that supply and demand was all that was needed to get a job. They'd work their guys at the lowest price that they could get away with ensuring the good guys look for better paying jobs in another industry, make sure that the guys that are willing to work the lowest will get as many hours as they want, and get there in the fastest time. This is how it use to work. My grandfather was a truck driver and it wasn't uncommon for guys to switch log books for guys on vacation with as little regulation as it needed.
Then the 'damn liberals' came along with their socialist rules. They started requiring only so many hours a week. So the guys would still pull allnighters to get the deliveries, and since they could only work so much, they had nice long weekends. I use to love when my grandfather would stop over at my place, rig in tow, simply because he burned off most of his hours and decided to spend time with me in the midwest until he could get hours to drive back to Pennsylvania. And then the damn liberals changed it again...not only a specific maximum a week, but only so many hours a day.
Did the fucking liberals not get the Cap 101 course? Or are they in fact fucking red commies disguised as gawd blessed Americans???
So back to nursing. When I was working with the nurses, this was one of those bid out to the lowest employee kinda places. The head nurse was great... unfortunately she had no hiring rights. That was done by the administrator. Out of a staff around 15 nurses, I could count 3 that I would have wanted to care for my dying relative (or in this case, my drug addled relative that got fucked up in a gangbang shooting and has to have round the clock care -- it was half nice old people, half stupid motherfuckers that should have been left on the side of the road). Ok, maybe if they could have just kept the incompetent folks on the druggie floor, I wouldn't have minded.
The incompetent were the ones that got all the extra shifts. They were they ones that couldn't do the job in the first place -- they did pass the licensure boards, but were at the low end of the acceptability range. Imagine how well they could do working 80 to 100 hours -- still within the legal range (or so they told me).
I saved at least one patient as I overheard an idiot trying to convert an intracardial injection into imperial units. The two nurses were arguing about this and the one that was most correct was STILL a magnitude off. Jeez...isn't this why we use solely the metric system in a hospital setting? I got the 'fucking know it all college boy' speech when I said something, and then paged the head nurse immediately. She fired the duty nurse on the spot when she dropped her dinner with her doctor husband 2 blocks away at the hospital -- and the idiot was back within the week because of the administrator. Her excuse? She was working too many shifts between this place and a temp service (and she was getting 70 hours already at this job). She quit the temp service and they allowed her to pick up a few more hours here.
Finally, and this was the whole reason they hired a security guard, old women were being sexually molested -- raped -- and meds were disappearing at a rate that they shouldn't. It turns out the nurses were supp
Here everyone wins, the hospital gets their hard to fill slots staffed, the nurses can command a higher rate for those premium shifts.
The healthcare industry has to be creative to cover those hard to fill shifts. my mom works at an RN at a nursing home, the home had a hard time getting weekends covered, people would call in sick etc, so they offered her a sweet deal. She contracts to work every weekend, no excuses, for 2 15 hours shifts, inexchange they pay her for 40 hours. This way she gets her whole week free, the home gets the shift filed, and the residents win because they have a consistent presences every weekend with a nurse who knows them and their history. If they used a agency nurse or rotated the schedule, the patients would have different nurses every weekend. As anyone who has worked with alzheimers patients can attest, a very structured, consistent environmnet can help immensely,