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The demand for nurses continues to outstrip supply in Louisiana and around the country, a scenario that shows no signs of improving and is projected to get much worse.

The state has about 50,000 licensed nurses, according to the Louisiana Board of Nursing—about 6,000 shy of what we ought to have, a local nursing administrator says.

The situation is forcing creative thinking on the part of organizations that rely on nurses. Our Lady of the Lake Regional Medical Center, for instance, is bursting at the seams with patients, a situation that’s only gotten worse since Hurricane Katrina.

In an effort to plug holes in its nursing schedule, the Lake has instituted “shift bidding,” which allows employees—even nurses from other hospitals—to bid against each other to pick up extra work. The incentive is a percentage of base pay on top of the regular rate.

To date, the Lake and Lafayette General are the Louisiana hospitals conducting shift bidding. Jason Rogers, an ICU nurse manager with 40 employees under him, has seen positive changes as more shifts are getting filled, even though the program was only implemented in November.

“I’ve seen the morale of the staff go up with the shift bidding,” he says. “They’re being paid well to work these extra shifts. Before they would do it to help their unit out. Sometimes they would get their incentive pay and sometimes they wouldn’t. It would just be overtime for them. Now they know up front they’re going to get the premium pay, so they come in with a better attitude.”

“It’s kind of like bidding on eBay,” says Cathy Guay, the Lake’s assistant vice president of patient care services.

A manager posts an open shift—say 7 a.m. to 3 p.m. Saturday. The bidding opens with 1.5—base pay plus an additional 50%. The next bidder bids 1.4 and so on down to 1.1, or base pay plus 10%. It’s good because it allows nurses to plan for extra shifts, Guay says.

“It really works very well,” she says. “Now I can tell you there are some staff that doesn’t like it as much as others. There’s always a certain number of nurses that’ll come in and do overtime. They really like it because they can really plan their life rather than us calling and begging.”

Chris Franklin, a registered nurse at the Lake for the past 10 years, has noticed units are less short-handed these days. Shift bidding works for him because he was compiling a lot of overtime, but he says not everybody is in a position to take advantage of it.

“There’s no downside for me, but there are a lot of folks who don’t want to work overtime,” he says. “And folks trying to raise a family and what not, it just doesn’t fit for them. A lot of single moms just can’t do that too much.”

“Nursing is not an easy job,” Rogers says. “You’re on your feet all day. It’s stressful dealing with illness and dying and all that.”

Debbie Herlevic, a registered nurse who’s been with the Lake for 27 years, says the extra incentive attached to shift bidding encourages nurses to sign up for extra shifts when they might not otherwise.

“Personally I think it’s worked out really well,” she says. “I’ve participated in it a lot.”

Guay says the Lake has tried various things to attract and keep nurses, including sign-up bonuses—a plan that was dropped after an outcry from existing full-time staff. It’s common for hospitals in major markets to lavish sign-up bonuses as much as $1,000.

“We’re fighting Houston and Dallas, which have huge shortages,” Guay says. “They do some very attractive offers.”

But the Lake has devised other incentives to encourage nurses to stick around, such as paying for them to go to school. A licensed practical nurse, can get money to become an RN. Likewise, RNs with an associate’s degree can get money to get their bachelor’s and/or master’s. New graduates get reimbursed for the money they spent on nursing school. Nurses who have their school paid for by the Lake are required to work one calendar year for every credit hour the hospital covers.

“We do all of that to try to get nurses in, to keep them for our community,” Guay says.

What’s responsible for the nursing shortage? Guay thinks it goes back to the country’s experiment with managed care in the 1990s. Hospitals started closing their doors and laying off nurses to the point that far fewer people went to nursing school. Today it’s opposite: A good nurse can write his or own ticket.

“You work when you want,” Rogers says. “Job security is huge with nursing.”

While the number of actively licensed nurses in the state grows each year, many could be working in other states, speculates Carl Nagin, an analyst with the Louisiana State Board of Nursing. He says one reason hospitals are experiencing shortages is that so-called travel nursing pays much better than working for a single hospital.

Guay says the Lake uses travel nurses—represented by agencies—and contract nurses who sign contracts with the hospital on their own. Both kinds are expensive, she concedes, which is one reason behind shift bidding. Guay poses another reason for the shortage: Nursing programs don’t have enough faculty to teach everyone who wants to go to nursing school, which puts a damper on potential enrollment.

“They have waiting lists of people trying to get in,” she says.

Those instructors, meanwhile, are 50 years old on average, and it’s unlikely there will be enough new ones to fill the void left when they retire. Also, the average age of today’s hospital nurse is late 40s. So you’ve got a dwindling pool of nurses and nursing faculty on one hand, and an approaching tsunami of retiring boomers, guaranteed to send demand for nursing services ever skyward, on the other.

Shift bidding isn’t a cure-all by any means. But it helps—as it might in any industry with similar staffing shortages.

“I don’t think anything’s ever going to take care of the total problem with the number of nurses that we’re down, but it sure has made our life a lot simpler,” Guay says. “We had times it had gotten to the point where out managers were having to come and cover medical shifts. We rarely see that happening now.”