COUNTY OF SAN MATEO

Inter-Departmental Correspondence

San Mateo Medical Center

DATE:

April 23, 2004

BOARD MEETING DATE:

May 11,2004

TO:

Honorable Board of Supervisors

FROM:

Nancy J. Steiger, Chief Executive Officer, San Mateo Medical Center

SUBJECT:

Amendments to the Nursing Agreements with First Call Nursing Services, Starmed Health Personnel, Inc., dba Starmed Staffing Group, HRN Services, Inc., Maxim Healthcare Services, Inc., Medical Resource Network, Medstaff, Nurse Providers, Relief Nursing, Registry Network, and TravCorps, Inc., a Delaware Corporation (dba Cross Country Staffing) (on behalf of itself and its affiliates, NovaPro, Inc., Cross Country Local, Inc. and Assignment America, Inc.)

Recommendation

Adopt a resolution authorizing the President of the Board to execute amendments to the Nursing Agreements with First Call Nursing Services, Starmed Health Personnel, Inc., dba Starmed Staffing Group, HRN Services, Inc., Maxim Healthcare Services, Inc., Medical Resource Network, Medstaff, Nurse Providers, Relief Nursing, Registry Network, and TravCorps, Inc., a Delaware Corporation (dba Cross Country Staffing) (on behalf of itself and its affiliates, NovaPro, Inc. (previously Cross Country TravCorps, Cross Country Local, Inc. and Assignment America, Inc.),

Background

On July 24, 2001, your Board approved a Resolution authorizing the execution of agreements with Agostini Nurse Staffing, First Call Nursing Services, Starmed Health Personnel, Inc., HRN Services, Inc., Maxim Healthcare Services, Inc., Medical Resource Network, Medstaff, Nursefinders, Nurse Providers, Registry Network, and Relief Nursing for temporary nursing services for various programs of the Health Services Agency. An agreement with Cross Country TravCorps was subsequently approved and executed. The term of the 12 agreements was July 1, 2001 to June 30, 2004 with a collective maximum amount of $1,494,900.

The agreements with Starmed Health Personnel, Inc. and Medstaff were subsequently amended to include Rehabilitation Therapy Services, licensed Ultrasound Radiologic Technologists and Respiratory Therapists. These amendments also increased the collective maximum amount of the agreements to $1,606,900.

On November 18, 2003, 11 of the 12 agreements were amended to increase the collective maximum amount of the agreements by $1,292,000 from $1,606,900 to $2,898,900. In addition the agreement with First Call Nursing Services was amended to reflect a new option for staffing known as "No Fee, Permanent Placement RN". This option provides for an unpaid orientation and long term placement (8 months) of a Registered Nurse after which time, the Medical Center has the option to hire the nurse as a permanent employee.

In January 2004, Nursefinders declined to provide San Mateo Medical Center with nurses due to professional liability issues. We have not requested nurses from Nursefinders since that time and are not including Nursefinders in this amendment.

Discussion

Registries provide San Mateo Medical Center and Health Services with access to nursing staff available to fill in for vacancies when necessary. Because nurses usually register with only one registry at a time, agreements with several registries are maintained to have maximum access to the available work force.

The Medical Center is experiencing a 12% vacancy rate in the nursing department. The majority of vacancies are in the critical care areas of Emergency Department (ED) and the Intensive Care Unit (ICU). The Medical Center uses an average of 8 "Traveler Registered Nurses (RNs)" (contract RNs who work an 8-13 week contract) to cover shortages in the ED and ICU. The ED has experienced a 30% increase in the number of patients seen and the ICU is staffed to support a census of 6.

All other nursing units also use day-to-day registry (an RN, LVN or CNA who works one shift at a time) for the following reasons: 1.) To cover medical leaves, education, sick days and resignations; 2.) To staff 1:1 and 1:2 patients in the medical surgical area; 3.) Additional registry staffing has been needed to provide support to the Burlingame HealthCare Center; 4.) Registry staff is also used to avoid emergency department diversion by providing staff for units to accept patients from the Emergency Department in a timely manner so as to improve patient flow and decrease patient wait times; 5.) To provide quality care to existing patients; and 6.) To adjust to quick increases in census.

The implementation of the Nursing Ratio Legislation in January of 2004 has caused the Medical Center to increase access to this type of short-term registry staff to meet the required ratios and avoid citations and fines from the Department of Health Services who will be monitoring this issue closely.

In addition, we have not raised registry salaries for a 2-year period. In this healthcare environment where hospitals compete for registry staff, we need to remain competitive with salaries and add new registries to access new staff.

All these factors have contributed to depleting the maximum amount in the nursing agreements. These amendments increase the maximum collective amount of the agreements.

We are currently in a Request for Proposals process for nursing and ancillary registries. All submitted proposals have been evaluated and a decision will be reached within the next month regarding contracts with the multiple registries that meet San Mateo Medical Center's needs.

County Counsel and Risk Management have reviewed and approved these Amendments.

Vision Alignment

These agreements keep the commitment to Ensure Basic Health and Safety for All and goal number 5: Provide residents access to healthcare and preventive care. The Agreements contribute to this commitment and goal by continuing to provide nurse coverage where needed at San Mateo Medical Center.

Fiscal Impact

The term of the ten agreements remains the same, three years, from July 1, 2001 through June 30, 2004. The maximum amount the County shall be obligated to pay collectively for all ten agreements is increased by $1,215,000 from $2,898,900 to $4,113,900. Funds to cover this cost have been included in San Mateo Medical Center's and in the Health Services (AIDS Program) budget for FY2003-04.