In Spartanburg, nurses eagerly log on to computers to bid for extra-pay shifts the way collectors scout for trinkets on eBay.

In Greenville, nurse educators plan a virtual hospital where high-tech mannequins will take the place of patients — and won’t say “ouch” when a nervous nursing student has trouble finding a vein.

In Florence, every newly hired nurse has a “new best friend” on the job, a liaison who has helped to reduce the nurse vacancy rate by 12 percentage points.

And in Columbia, a male nurse leads an annual camp for middle-school boys from all over the state to convince them that, yes, guys can be nurses, too.

Though South Carolina lacks a comprehensive statewide approach to the nursing shortage, employers and educators are trying myriad maneuvers to attract and keep nurses.

They have to. South Carolina is a nurse-importing state, not producing enough nurses to care for its own people. And other states also have to work hard to recruit nurses and keep their own close to home.

“You can’t really look at one strategy and think that will take care of everything,” said Suzanne White, vice president and chief nursing officer for the Greenville Hospital System.

“It has to be more than salary,” said Peggy Deane, senior vice president for patient care services at Anderson Area Medical Center. “It has to be the culture and the environment.”

Culture: That’s a word you hear often when you talk to people who work to recruit and retain nurses. They might speak of “a nurturing culture” or “a supportive culture” or “a culture of no blame.” Essentially, they’re trying to create a culture in which nurses feel valued.

Three other “C” words come into play: creativity, collaboration and cash. A lot of the employers of the state’s 41,617 nurses are trying similar tactics. These include competitive pay and perks, flexible schedules, reducing paperwork, enhancing patient safety, and buying special lifting equipment to spare nurses’ backs.

They’re all lavishing attention on student nurses.

In fact, to be a nursing student today is to feel more doted on than Sally Field at the 1985 Oscars. Hospitals and other prospective employers like you, they really like you, and well before graduation they’ll ply you with information, offers, freebies, scholarships and sign-on bonuses.

“If you’re going to be a nurse today, you can find someone to send you to school,” said Caroline Seigler, chief nursing officer for Palmetto Health.

Leslie Britten did. Britten, 32, a one-time education major from Myrtle Beach, decided she really had a passion for nursing. The Georgetown Hospital System is paying for her associate’s degree training, about $4,000 worth.

“I went, ‘Where do I sign?’” said Britten, who already works part time at Waccamaw Hospital in Murrells Inlet.

Here’s a look at some other strategies that are being tried and planned around the state.

BIDDING FOR SHIFTS

Kathryn Price logged on to a computer and considered her options.

She wasn’t a hobbyist looking for online bargains. She was a nurse in turquoise scrubs and a white lab vest, looking to pick up an extra shift at Spartanburg Regional Medical Center.

“I see two that I could possibly work Friday,” said Price, 32, who is qualified to work in several areas including emergency and neonatal intensive care.

“I love the variety of it,” she said. “If I’ve just done three weeks in the ER, I can go be with the babies for a change of pace.”

Among all the things being done in South Carolina to recruit and retain nurses, Spartanburg’s “shift auction” has to be one of the most creative.

And one of the more successful. Catherine Whelchel, vice president of nursing, said the hospital has done away with high-cost agency nurses and has a nurse vacancy rate of only 3 percent.

“Our staff feel more valued because we’re giving them the shifts that they’re interested in,” she said. “And they have better productivity (than the agency nurses).”

The extra shifts needed are posted for premium pay, usually $40 an hour. (Normal pay is about $22.) Nurses offer to work the extra shifts by placing online bids for less than $40 an hour.

For example, one nurse might bid $39. In sort of a reverse version of a conventional auction, another nurse could come in with a still lower bid to “win” the shift.

There’s an “instant win” bid of $31. Most shifts go for about $37 an hour, but they might go as low as $27 in popular units. The computer determines who made the latest, lowest bid and lets everyone know.

“We were trying to make it as fun to use as eBay,” said Darby Douglas, RN staffing coordinator, adding that employees can bid from home or from hospital computers during breaks.

NURTURING NURSES

“If you take care of your nurses, the nurses will take care of your patients,” Marie Segars said.

She’s not the only one saying that. But Segars has won respect around the state for the way she and others have implemented those words at McLeod Regional Medical Center in Florence. She’s the top nurse and vice president for patient services.

Of all the regions in the state, the Pee Dee has the smallest number of nurses, the lowest nurse-to-population ratio, and rates of chronic illnesses that give McLeod the highest occupancy rate among S.C. hospitals.

Yet it has cut its nurse vacancy rate from 15 percent to 3 percent during the past few years. McLeod’s leaders studied hospital trends, improved technology, won the support of doctors and analyzed why nurses were leaving.

“What I learned is that if I can keep a nurse three years, I can pretty much keep her (long-term),” Segars said.

Every hospital has nurse managers who supervise and mentor nurses. McLeod also has a “nurse liaison,” Renee Kennedy, who makes 860 nurses’ problems her business.

A new nurse has trouble adjusting? An experienced nurse has a conflict with her supervisor? Kennedy is there, trying to mediate little problems before they become big ones.

Tony Derrick, a nursing director in the emergency department, said having a nurse liaison helps him. Sometimes nurses will talk to her about troubles they’re not comfortable broaching with a supervisor, he said.

“I’m nursing nurses, now,” Kennedy said. “And just like with patients, you have to nurse them one at a time.”

DRAWN TO ‘MAGNET’

No hospital in South Carolina has attained magnet status, but at least seven are exploring the possibility — and the first to submit for the honor might well be a facility in the Midlands.

“It’s a big thing with nursing students,” said the CEO of that hospital, Mike Biediger. “When I speak to students, someone will ask, ‘Is it true Lexington Medical Center is applying to be a magnet hospital?’ When I say yes, they go, ‘Ooooohhh.’”

Magnet designation is conferred by the American Nurses Credentialing Center, a subsidiary of the American Nurses Association. Through a process that takes years, magnet hospitals enact programs and procedures that empower and respect nurses, such as providing continued education and putting nurses in leadership positions.

“When you want to choose a hospital for your family’s care or a place to work, these magnet hospitals are really the gold standard,” said Laurie Zone-Smith, magnet coordinator for the Medical University of South Carolina.

Like Lexington, MUSC has filed a letter of intent to seek magnet status, as have Greenville Hospital System and Spartanburg Regional Medical Center. Lexington hopes to submit its application this summer.

Since the first magnet hospital was designated 10 years ago, the program has proved that policies to enhance nursing also promote patient care, Zone-Smith said.

For example, she said, magnet hospitals have lower death rates, shorter stays, and fewer post-surgery lung problems, heart attacks, infections, patient falls, medication errors and bedsores.

Magnet policies also address the cherished “culture” issue, promoting a teamwork atmosphere that some hospitals describe as familylike.

Nurse practitioner Angie Fontana, who has worked in about 10 hospitals in various parts of the country, sensed that at Lexington where she was hired last year.

“When I was there getting my blood test, I had about four people greet me, smile and say, ‘Can I help you?’ It was great — I was so impressed,” Fontana said.

HIGH-TECH HELP

Stan has software where his soul should be, but S.C. nursing educators would like to see a lot more guys like him.

“Stan D. Ardman” is the name of a patient simulator — think of the android Data on “Star Trek: The Next Generation.”

In the latest, $200,000 version (from Medical Education Technologies in Florida), Stan can be put on a ventilator or be given anesthesia. Future doctors and nurses can check his pulse and pupils, treat him for convulsions, listen to his heart, start him on an IV or insert a urinary catheter.

“Students can get some experience with the simulators in a risk-free environment,” said Gayle Heller, dean of nursing at Greenville Technical College.

“They can learn critical thinking skills, and they can make mistakes if they need to.”

The college is partnering with Greenville Hospital System to develop the Upstate Center for Advanced Patient Simulation. Nursing students at USC Upstate would use it, as well.

“Sim centers” could ease the faculty shortage by substituting for some of nursing students’ labor-intensive clinical rotations — when the faculty-to-student ratio must be 1-to-8.

The hope is to open the center in about two years. Hospitals in Columbia and Charleston want simulation centers in their regions, too, and Midlands Technical College just got a spiffy new version of “Stan.”

Gail Stuart, dean of nursing at the Medical University of South Carolina, said setting up a center there would cost about $2.5 million.

MUSC leads the state in another innovative program: online education for nurses. That has enabled MUSC to double its bachelor’s degree program, Zone-Smith said. The university also has three master’s programs online, including a neonatal nurse practitioner program that draws students from as far away as California.

A GUY THING?

Some boys in Kevin Ballance’s summer camp had never seen a male nurse — until they considered becoming one.

Ballance and his employer, Palmetto Health, started the camp in 2002 to introduce boys to nursing.

Inviting a middle-school boy from each county in the state, they provide role models, medical information, hands-on health instruction and a lot of pizza. Boys are intrigued by activities such as learning to give shots and sewing up wounds on pigs’ feet. Parents are intrigued by the good job market for nurses, Ballance said.

“I think we’re slowly seeing progress,” said Ballance, director of nursing at Palmetto Health Baptist. “The thing I would love to see us do is help guidance counselors in middle school and high school really understand nursing as a profession.”

Other hospitals offer job shadowing to students, as well as volunteer opportunities, making it clear that boys and girls are both welcome.

“Remember the candy stripers?” said David Wilson, human resources director at Newberry County Memorial Hospital. “Well, we don’t call them that anymore. They’re junior volunteers.”

WHAT THE STATE CAN DO

State Rep. Bobby Harrell and his wife own an assisted-living facility in Charleston. Harrell, R-Charleston, who chairs the House Ways and Means Committee, said he and other legislators are aware that the state faces a nursing shortage.

“Ultimately, the market will solve the problem,” Harrell said, suggesting that rising salaries for nurses and faculty will boost the numbers of both.

He also said that with the shortage widespread, it’s important for South Carolina to increase its “homegrown” nurses through plans such as enhancing the nursing school at Midlands Technical College. Last year, the Legislature approved a special appropriation of $613,000 to help Midlands Tech hire instructors and boost its number of nursing students.

“There isn’t enough money to do all the things that everyone would like the state to be doing,” Harrell said.

Will Folks, spokesman for Gov. Mark Sanford, said the governor is “open to discussing public-private partnerships that could get the ball rolling on putting more folks in these (nursing) positions.”

Folks pointed out that Sanford’s proposed budget for 2005-06 maintains $5.4 million for nursing education in the state: “That made the cut.”

Meanwhile, said Jim Walker, vice president of the S.C. Hospital Association, “what we see now is that we’re being asked to backfill the funding gaps from the state. Hospitals just can’t continue to do that.”

New numbers from an association survey highlight the increasing demand for medical services and nurses, Walker said. For example, there were 403,810 inpatient admissions in 1998, and 456,180 in 2003. There were 970,102 emergency room visits in 1998, and 1,161,172 in 2003.

The hospital association supports the center for nursing idea championed by so many nurses around the state; Walker points to the concept’s success in North Carolina.

“They have been successful at getting increased funding for their educational programs, as we have not here,” he said.

And the association wants:

• Passage of the Nursing Multistate Compact, which would make it easier for nurses from other states to have their credentials accepted here. (Though not a major factor, the measure could help hospitals near the state’s borders hire nurses more easily, said Sylvia Whiting, who chairs the S.C. Board of Nursing.) The bill has passed a House committee and is before a Senate committee.

• More funding for nursing programs in universities and technical colleges

• Incentives such as salary stipends that would draw more nurses into faculty positions.

Columbia health economist Lynn Bailey said it’s important to remember the nursing shortage is a patient-safety issue.

“Patients, fundamentally, go to the hospital for nursing care,” she said. “When you give highly qualified, experienced nurses too many patients to take care of, mistakes happen, and patients die.”

Reach Lamb at (803) 771-8454 or llamb@thestate.com.