By DAVID KOEPPEL
The NEW YORK TIMES
Published June 6, 2004

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…

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."

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