Title
a. Authorize the Purchasing Manager for Natividad Medical Center (NMC) to extend the Master Agreements between the County of Monterey (County), on behalf of NMC, and Agostini Nurse Staffing, American Traveler Staffing, Aureus Nursing, Axis Healthcare Staffing, Randstad Professionals US, LP, Cross Country Staffing, Emerald Health Services, Healthcare Pros, Rise Medical Staffing, HRN Services, Medical Solutions, Medical Staffing Network, PPR Healthcare Staffing, Supplemental Health Care, Cirrus Holdings USA and T.G. Health Care Services. (collectively, Nurse Registry Agencies currently providing services at NMC) for an additional one year term from July 1, 2013 through June 30, 2014, pursuant to the terms and conditions of RFP #10093; and
b. Authorize the Purchasing Manager for NMC to enter into Renewal and Amendment No. 2 to the Master Agreement (RFP #10093) with each of the Nurse Registry Agencies currently providing services at NMC, for a total aggregate amount of $2,000,000 for all contracts issued pursuant to RFP #10093 for the period July 1, 2013 to June 30, 2014.
Report
RECOMMENDATION:
It is recommended that the Board of Supervisors:
- Authorize the Purchasing Manager for Natividad Medical Center (NMC) to extend the Master Agreements between the County of Monterey (County), on behalf of NMC, and Agostini Nurse Staffing, American Traveler Staffing, Aureus Nursing, Axis Healthcare Staffing, Randstad Professionals US, LP, Cross Country Staffing, Emerald Health Services, Healthcare Pros, Rise Medical Staffing, HRN Services, Medical Solutions, Medical Staffing Network, PPR Healthcare Staffing, Supplemental Health Care and T.G. Health Care Services. (collectively, Nurse Registry Agencies currently providing services at NMC) for an additional one year term from July 1, 2013 through June 30, 2014, pursuant to the terms and conditions of RFP #10093; and
- Authorize the Purchasing Manager for NMC to enter into Renewal and Amendment No. 2 to the Master Agreement (RFP #10093) with each of the Nurse Registry Agencies currently providing services at NMC, for a total aggregate amount of $2,000,000 for all contracts issued pursuant to RFP #10093 for the period July 1, 2013 to June 30, 2014
DISCUSSION/SUMMARY:
In 1999, California became the first state to mandate minimum nurse-to-patient ratios for every unit in general acute care hospitals such as NMC. These nurse-to-patient ratios were phased in, beginning 2004, and require:
- One licensed nurse for every two patients in the intensive care, critical care, and neonatal intensive care units, in post-anesthesia recovery, labor and delivery, and when patients in the emergency room require intensive care.
- One licensed nurse for every three patients in step-down units.
- One licensed nurse for every four patients in ante-partum (not active labor), postpartum (1:4 mother-baby couplets) pediatric care, and in the emergency room, telemetry, and other specialty care units.
- One licensed nurse for every five patients in medical-surgical units.
- One licensed nurse for every six patients in psychiatric units.
In addition, under Emergency Medical Treatment and Labor Act (EMTALA) regulations, NMC cannot refuse to provide treatment to patients who arrive at the hospital with an emergency medical condition or are in active labor.
NMC must predict how many nurses will be needed during multiple shifts of the day and staff accordingly. Nurse staffing needs cannot always be met by regular NMC staff. NMC utilizes the services of seventeen (15) Nurse Registry Companies to ensure:
- The required number of nurses is in place on each unit.
- NMC meets its obligations under EMTALA.
- NMC is properly staffed during peak times.
- In order to cover temporary absences of regular staff, and
- When needed due to emergency situations.
The majority of NMC nurse registry staff is utilized in the Emergency Room and on the Labor & Delivery Unit when Emergency Room visits or Labor & Delivery' censuses (number of patients daily) are at peak. Nurse Registry Staff is also utilized on the Intensive Care Unit (ICU) and the Medical Surgical Unit (MSU) to cover unexpected loss of temporary staff or regular staff turn-over.
NMC continuously assesses staffing needs based on volume. We are currently evaluating the feasibility and cost-effectiveness of using a staffing management program to coordinate the procurement of registry nurses. If this program if adopted, would resolve the need to contract with each registry on an individual basis, so we are requesting approval for a one-year extension to the current agency agreements.
OTHER AGENCY INVOLVEMENT:
County Counsel has reviewed and approved this Renewal and Amendment No. 2 as to legal form and risk provisions. Auditor-Controller has reviewed and approved this Renewal and Amendment No. 2 as to fiscal provisions. The Renewal and Amendment No. 2 has also been reviewed and approved by Natividad Medical Center's Board of Trustees.
FINANCING:
The cost for this Renewal and Amendment No. 2 is $2,000,000 and is included in the Natividad Medical Center Fiscal Year 2012-13 Adopted Budget. There is no impact to the General Fund.
Prepared by: Shirley McJohnston, NMC, Interim Chief Nursing Officer, 783-2560
Approved by: Harry Weis, Chief Executive Officer, 783-2553
Attachments: Renewal and Amendment No. 2 for all vendors. Attachment A; Nurse Registry History & Vendor Spend Breakdown thru 12/13, All Vendor Agreements and 2012/13 Amendment No. 1 Extension Approval.