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a. Authorize the Purchasing Manager for Natividad Medical Center (NMC) to exercise the option 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, Cirrus Holdings USA, Clinical One, Cross Country Staffing, Emerald Health Services, GSN Inc., Healthcare Pros, Health One Staffing, HRN Services, Med Staff Inc., Medical Solutions, Medical Staffing Network, PPR Healthcare Staffing, Premier Healthcare Professionals, 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, 2012 through June 30, 2013, pursuant to the terms and conditions of RFP #10093, and;
b. Authorize the Purchasing Manager for NMC to enter into Amendment No. 1 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, 2012 to June 30, 2013.
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RECOMMENDATION:
It is recommended that the Board of Supervisors:
a. Authorize the Purchasing Manager for Natividad Medical Center (NMC) to exercise the option 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, Cirrus Holdings USA, Clinical One, Cross Country Staffing, Emerald Health Services, GSN Inc., Healthcare Pros, Health One Staffing, HRN Services, Med Staff Inc., Medical Solutions, Medical Staffing Network, PPR Healthcare Staffing, Premier Healthcare Professionals, 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, 2012 through June 30, 2013, pursuant to the terms and conditions of RFP #10093, and;
b. Authorize the Purchasing Manager for NMC to enter into Amendment No. 1 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, 2012 to June 30, 2013.
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:
1. 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.
2. One licensed nurse for every three patients in step-down units.
3. 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.
4. One licensed nurse for every five patients in medical-surgical units.
5. 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 twenty-one (21) 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 wishes to exercise the option to extend the Nurse Registry Contracts for an additional one-year period to June 30, 2013 and to enter into an Amendment No. 1 to each of the contracts with Nurse Registry Agencies listed on Attachment A, for a total aggregate amount of $2,000,000 for all contracts issued pursuant to RFP #10093 for the period July 1, 2012 to June 30, 2013.
Attachment A; "Nurse Registry History & Vendor Spend Breakdown." includes information through the life of all contracts pursuant to RFP #10093. The total annual not to exceed amount for all years of the Master Agreement is $8,786,309. The total annual "spend to date" for the life of all contracts is $6,922,080. Also included is the Fiscal Year 2012-2013 purchase order beginning amounts for each nurse registry company that currently contracts with the NMC.
See Attachment B: "Nurse Registry History & Board of Supervisors Chronological Approvals" for a written history and fiscal year change request approvals over the life of RFP #10093.
NMC will be issuing a new RFP for nurse registry services in early 2013, for services beginning in fiscal year 2013/2014.
OTHER AGENCY INVOLVEMENT:
County Counsel has reviewed and approved this Amendment as to legal form and risk provisions. Auditor-Controller has reviewed and approved this Amendment as to fiscal provisions. The Amendment has also been reviewed and approved by Natividad Medical Center's Board of Trustees.
FINANCING:
The cost for this Amendment No. 1 is $2,000,000 and is included in the Natividad Medical Center Fiscal Year 2012-13 Recommended Budget. There is no impact to the General Fund.
Prepared by: Carol Jordan, Chief Nursing Officer, 783-2560
Approved by: Harry Weis, Chief Executive Officer, 783-2553
Attachments: Attachment A; "Nurse Registry History & Vendor Spend Breakdown, Attachment B: "Nurse Registry History & BOS Chronological Approvals (RFP#10093". ) All Agreements and Amendment #1 for all vendors.