The Gig Is Up: UNC Health Does an About-Face on BidShift

When UNC Health invited the 4,000 nurses working in its Chapel Hill hospitals to join a new system in July to pick up extra shifts, it did not go over well.

Using the software program BidShift, UNC’s hospitals planned to match nurses who were willing to work extra hours with units that needed more help during hard-to-fill shifts.

These shifts—mostly on nights, weekends, and holidays—were offered at premium rates, roughly $10.50 above normal hourly pay. They were entirely optional and available only after nurses hit their baseline hours. 

But that was less than the roughly $13-an-hour premium UNC Health had been paying most nurses to fill coverage gaps, and it was about a third of the $35-per-hour premium the hospital offered before the pandemic, one senior UNC charge nurse told The Assembly. 

“I guess they thought we couldn’t do basic math,” said the nurse, who requested anonymity to avoid retaliation.

The extra compensation would also decrease incrementally as nurses “bid” against each other for the shifts. UNC staffing assured its nurses that it would consider other factors, such as skill levels, when making final decisions. But, generally speaking, if a nurse volunteered to work on Thanksgiving for $10.50 an hour above their normal rate, he or she could “lose” that shift to someone willing to work for less. 

Word of UNC’s plan to implement BidShift went viral soon after it posted the first open shifts July 22. In a swarm of online skepticism, critics described it as “dystopian” and “cartoonishly evil.” 

“Work more, for less!” one nursing content creator sarcastically told his 8,000 TikTok followers. “What’s not to love?”

UNC Health initially defended its use of the platform. “Participation is completely voluntary,” spokesperson Alan Wolf wrote in an August 4 statement to The Assembly. But by August 7, the health system relented. In an email to employees, UNC Medical Center’s president, Min Lee, called its initial description of how BidShift worked “a mistake.”

“I am truly sorry for the confusion and angst this has caused,” she wrote. 

Between statewide nursing staffing shortages and growing skepticism over the role artificial intelligence will play in health care, UNC’s timing couldn’t have been worse. Some nurses fear algorithmic staffing signals what’s ahead.

A ‘Desperation Premium’

Staffing a hospital is unlike other workplaces. Patient traffic can be unpredictable, skill sets are specialized, the stakes are high, and the doors never close. Nurses are the backbone of any hospital setting. 

And, compared with many other professionals, state-licensed nurses have considerable flexibility in where and when they work. Demand in certain regions is often so high that nurses can supplement their incomes by hopping between facilities and taking temporary assignments where they’re needed most, instead of staying in a full-time role at one location. 

Hospital managers can expect certain units to be busier at certain times, and they know which shifts will be tougher to fill. They typically set work schedules six weeks in advance, balancing each unit for skills and experience levels. But when someone calls out, or there’s an unexpected rush, it can be a scramble to fill shifts.

That is the problem BidShift, which launched in 2002, was created to address. Its algorithm lets hospitals fill shifts more reliably and for less money than they’d shell out for travel nurses, who often make considerably more than staff nurses. While that might have seemed like a great idea two decades ago, the cultural optimism about how technology can make life easier and more efficient has since soured. 

Amanda Daering, a Florida-based staffing strategist, said the dawn of artificial intelligence-driven software programs has tempted executives to implement such platforms more broadly. 

“This was rolled out in a time in which people are feeling particularly cautious,” she said. “AI is moving really quickly. What does that mean for me? What does that mean for my job?”

Daering warns that the cost savings for employers may come with unintended trade-offs: She compared BidShift to “cog work,” where workers feel replaceable, similar to what customer service reps have experienced with offshoring.

Just before the BidShift news spread, author and activist Cory Doctorow, a guest on comedian Jon Stewart’s podcast, criticized the use of different platforms that also invite nurses to bid for shifts. These gig nursing apps offer nurses single shifts at participating facilities, unlike BidShift, which employers can offer internally to their own nurses. 

Doctorow cited findings claiming some gig nursing platforms use personal data, like nurses’ credit card debt, to offer lower hourly rates. 

“It’s a desperation premium,” he said in a clip that garnered 2.2 million views on TikTok.

It’s unclear whether gig nursing platforms are actually mining nurses’ data to pay them less. A representative of ShiftKey, one of the largest such platforms, told The Assembly it doesn’t use data in this way. 

A representative of symplr, the Texas-based software firm that owns BidShift, said the firm doesn’t and has never had access to the personal financial data of its client’s employees.

Researchers who have studied other platforms, like ride-sharing, have long warned of the potential for algorithmic wage discrimination. Some scholars assert that companies use large personalized datasets purchased by third parties that can include their employees’ shopping habits, credit reports, and more to determine how much they are paid.

And in recent months, federal regulators have taken notice of variable pricing schemes that charge customers different prices for hotel rooms or plane tickets based on their personal data. 

While UNC quickly walked back from BidShift, the ordeal has left some still on edge. 

‘Moral Distress’

While BidShift has been around for decades, its use in North Carolina appears relatively rare.

Bonnie Davis Meadows, president of the North Carolina Nurses Association, hasn’t encountered BidShift or other similar platforms like ShiftKey. As far as Meadows knows, most staffing decisions are still made the old-fashioned way—by humans. And that has generally worked.

“The only time it’s hard is when you are in the thick of it,” she said. 

But nursing is an incredibly difficult job, and even before the pandemic, Meadows said, nurses were overburdened. Then COVID-19 triggered an exodus of skilled nursing labor, with many choosing early retirement over increasingly stressful work conditions. That put more work on the nurses who stayed.

A recent policy paper in the North Carolina Medical Journal highlighted how low staffing can, in turn, limit the level of care nurses can offer their patients, putting them in a state of “moral distress.”

“At some point, you get so beaten down with the moral injury of knowing you’re being asked to do more than is humanly possible that you change professions,” said Hannah Drummond, National Nurses United’s chief nursing representative at Mission Hospital in Asheville. “I know people who left to go work in breweries and in food service.”

A survey of health care employers in North Carolina found that close to half of their registered nurses quit in 2024 and that one in eight open positions remained unfilled. If that trend continues, researchers estimate the state will face a deficit of 12,500 registered nurses by 2033. 

Stakeholders often describe the labor mismatch as a “shortage.” But Drummond said that framing is misleading. There’s a shortage of good nursing jobs, she said–not a shortage of good nurses.

“The hospital industry has manufactured this shortage,” she said. “That’s one less body that you have to pay to be on the unit.”

Federal data show a statewide surplus of people qualified to work as nurses. As of May, more than 111,100 registered nurses were employed in North Carolina, earning a median annual wage of $84,350. About 170,000 nurses have an active license, which must be renewed every two years. That means about 59,000 are effectively sitting on the sidelines. 

“Everyone says, ‘Oh, they’re just waiting to come back,’” said Matthew Kuhn, a Pinehurst-based traveling nurse practitioner. “That’s not the case. I think that many of these folks are burnt out.”

Since the pandemic, hospitals have tried to reduce their reliance on travel nurses. But for that to happen, executives need to hire—and retain—more full-time nurses. 

“It feels like a spiral,” Kuhn said. 

A Scarce Resource

Whether the price of a scarce resource is going up or down, auctions can be efficient tools for distributing it, said Alfredo Romero, chair of the Department of Economics at North Carolina A&T State University.

In the case of BidShift, the hard-to-fill shifts—rather than a nurse’s labor—are treated as the scarce resource.

“Efficiency is not a bad thing,” Romero said. “But from the fairness point of view, it might be, depending on how the rules of the game were set.”

For nurses who have been working under a traditional staffing model, changing the system can prompt distrust, Romero said. “If I don’t know how these shifts are being allocated, then the outcome is unfair.”

Online, incensed commenters frequently suggested the UNC nurses should unionize. But as a state-owned health system, UNC Health’s nurses in Chapel Hill are considered state employees who aren’t allowed to bargain or collectively negotiate the terms of their employment.  And yet, they managed to effectively shut down UNC’s plan.

“Even without the ability of workers to organize, they were still able to create enough social backlash,” Romero said. 

‘The Same or Higher’

After the online dustup, UNC Health leaders introduced a different program using symplr’s platform that it calls Carolina Premium Shifts, according to internal materials The Assembly obtained. Under the system rolled out August 7, nurses don’t bid against each other, and the advertised price for unfilled shifts doesn’t drop as demand rises. It hasn’t announced the change publicly.

According to the internal memo, pay for these rebranded extra shifts is “the same or higher” than the rates offered through previous systems. Depending on a nurse’s experience level, it amounts to a premium of roughly $14 an hour.

UNC Health declined to make someone available for an interview or to address what prompted the change, but Wolf, the system spokesperson, sent a statement: “UNC Health strives to be a great place to work for all our teammates. Any new policies or initiatives are done to support our teammates and ensure we remain competitive.”

A Chapel Hill charge nurse, who also requested anonymity to avoid retaliation, said her colleagues readily scooped up shifts as soon as they were posted under the new system. “They were picking them up on the spot,” she said. 

Many critics worried that BidShift could undermine nurses’ base pay—not just at UNC, but everywhere. If hospitals more widely embrace reverse auctions to award extra shifts, they fear it could eventually drive wages down, since priority goes to the lowest bidder. 

The charge nurse feels those anxieties are overblown. Still, she was grateful the ordeal prompted UNC to take her team’s concerns seriously. 

“We felt like they smoothed it over,” she said.