Title
Adopt a Resolution to:
a. Amend Personnel Policies and Practices Resolution (PPPR) No. 98-394 Appendix A and B to retitle the classification of Physician Assistant to Clinic Physician Assistant and create the classifications of Hospital Physician Assistant and Psychiatric Physician Assistant with the salary ranges as indicated in the attached Resolution effective retroactive to July 6, 2019; and
b. Amend Personnel Policies and Practices Resolution (PPPR) No. 98-394 Appendix A and B to retitle the classifications of Nurse Practitioner II to Clinic Nurse Practitioner and Nurse Practitioner III to Hospital Nurse Practitioner, create the classification of Psychiatric Nurse Practitioner and abolish the classification of Nurse Practitioner I as indicated in the attached Resolution effective retroactive to July 6, 2019; and
c. Amend the Health Department Budget 4000-HEA007 Units 8097, 8099, 8100, 8105 and 4000-HEA012 Unit 8410 to reallocate positions and reclassify incumbents as indicated in Attachment A and the attached Resolution effective retroactive to July 6, 2019; and
d. Direct the Auditor-Controller to make retroactive payment to impacted employees effective July 6, 2019; and
e. Direct the County Administrative Office and the Auditor-Controller to incorporate the approved position changes in the FY 2019-20 Adopted Budget and the Human Resources Department to implement the changes in the Advantage HRM system.
Report
RECOMMENDATION:
It is recommended that the Board of Supervisors:
a. Amend Personnel Policies and Practices Resolution (PPPR) No. 98-394 Appendix A and B to retitle the classification of Physician Assistant to Clinic Physician Assistant and create the classifications of Hospital Physician Assistant and Psychiatric Physician Assistant with the salary ranges as indicated in the attached Resolution effective retroactive to July 6, 2019; and
b. Amend Personnel Policies and Practices Resolution (PPPR) No. 98-394 Appendix A and B to retitle the classifications of Nurse Practitioner II to Clinic Nurse Practitioner and Nurse Practitioner III to Hospital Nurse Practitioner, create the classification of Psychiatric Nurse Practitioner and abolish the classification of Nurse Practitioner I as indicated in the attached Resolution effective retroactive to July 6, 2019; and
c. Amend the Health Department Budget 4000-HEA007 Units 8097, 8099, 8100, 8105 and 4000-HEA012 Unit 8410 to reallocate positions and reclassify incumbents as indicated in Attachment A and the attached Resolution effective retroactive to July 6, 2019; and
d. Direct the Auditor-Controller to make retroactive payment to impacted employees effective July 6, 2019; and
e. Direct the County Administrative Office and the Auditor-Controller to incorporate the approved position changes in the FY 2019-20 Adopted Budget and the Human Resources Department to implement the changes in the Advantage HRM system.
SUMMARY/DISCUSSION:
The Health Department Clinic Services Bureau operates clinics, providing comprehensive primary medical care, obstetrics, internal medicine, low acuity behavioral health, communicable disease and disease prevention services so that every resident in Monterey County has access to health care. Natividad Medical Center provides for comprehensive inpatient, outpatient, emergency, diagnostic, and specialty health care as well as being a Level II Trauma Center providing services to treat the most severe and critical injuries. Incumbents in the Physician Assistant and Nurse Practitioner classifications are critical in providing services to the community in the clinic and acute care hospital settings and without the benefit of the services and skills of the incumbents, the County would be at a distinct disadvantage in being able to provide these services for the community.
Several years ago, concerns were raised pertaining to the Physician Assistants’ performing essentially the same work as Nurse Practitioner II’s and III’s while the Nurse Practitioner III’s receive a higher pay. In order to identify whether the positions were classified appropriately, Cooperative Personnel Services (CPS) was contracted to conduct a classification and compensation study. The study was completed in July of 2015. The recommendations, in part, included consolidating and retitling the Physician Assistant I and II to a single classification of Physician Assistant and the adoption of a new salary range which was approved by your Board on December 15, 2015. The salary at the time of the consolidation placed the Physician Assistant at the same rate as the Nurse Practitioner II classification, as the study found the positions provide essentially the same services to County Clinic patients.
Subsequently, the Monterey County Registered Nurses Association (MCRNA) completed negotiations on two contracts which resulted in salary increases for nursing classifications including Nurse Practitioners. As the Physician Assistant is represented by Service Employees International Union (SEIU) Local 521, the Physician Assistant received negotiated increases that did not match those negotiated for the Nurse Practitioners. To address this issue, the Board of Supervisors approved increases to place the Physician Assistant salary range at the same rate as the Nurse Practitioner II on two separate occasions. These salary increases and those negotiated with SEIU will continue to cause salary discrepancies between the classifications of Physician Assistant and the Nurse Practitioner II.
As Service Employees International Union (SEIU) continued to raise concerns pertaining to the similarity of work being performed and the compensation of the Physician Assistants and Nurse Practitioners, the County contracted with Management Strategies Group in 2018 to conduct a further study. This second independent classification study determined essentially the same findings as the 2015 CPS study. However, the 2018 study also recommended the creation of Psychiatric Nurse Practitioner and Psychiatric Physician Assistant to recognize the specialty practice of serving moderately to severely mentally ill patients in an outpatient setting and to allow those individuals to provide inpatient care on an intermittent/as needed basis.
The recommendations concluded the Physician Assistant should be retitled to Clinic Physician Assistant and new classifications created for the Hospital Physician Assistant and Psychiatric Physician Assistant. Further recommendations included retitling the Nurse Practitioner III to Hospital Nurse Practitioner, the Nurse Practitioner II to Clinic Nurse Practitioner and the creation of a Psychiatric Nurse Practitioner. An analysis of the work being performed by the incumbents was conducted resulting in employees recommended to be placed in the appropriate classification for the level of work being performed. Lastly, it is recommended that the base salary ranges between the Nurse Practitioner and Physician Assistant job classifications are at the same level.
The retitling of classifications has a neutral effect on employees and there will be no new probationary period, no change in salary step, no change in step advancement date and no loss of seniority. Furthermore, provisions (to include special pays) for the retitled and newly created Physician Assistant and Nurse Practitioner classifications that are outlined in the Memorandum of Understanding between County of Monterey and SEIU Local 521 for the term July 1, 2019 through June 30, 2021 and MCRNA for the term February 1, 2017 through January 31, 2020 shall remain in effect.
OTHER AGENCY INVOLVEMENT:
The Human Resources Department, Health Department, and Natividad Medical Center have reviewed and concur with the recommendations. The Human Resources Department has consulted with SEIU Local 521 and MCRNA on these recommendations.
FINANCING:
The estimated increased Fiscal Year 2019-20 cost for the Health Department is $79,708 and will be covered within the Health Department’s existing appropriations (4000-HEA007 $19,927 and 4000-HEA012 $59,781). There is no increased cost for Natividad Medical Center.
BOARD OF SUPERVISORS STRATEGIC INITIATIVES:
The proposed recommended actions address the Board of Supervisors Administration Strategic Initiative. The actions demonstrate the County’s commitment to meeting the Board’s initiatives in recruiting, retaining, and attracting a diverse, talented workforce that supports the mission of Monterey County.
__ Economic Development
_x_ Administration
__ Health & Human Services
__ Infrastructure
__ Public Safety
Prepared by: Kim Moore, Assistant Director of Human Resources, x5353
Approved by: Irma Ramirez-Bough, Director of Human Resources, x5043
Attachments:
Resolution
Attachment A