The Medical Center is experiencing a greater than 14% vacancy rate in the nursing department. The majority of vacancies are in the critical care areas of Emergency Department (ED), the Intensive Care Unit (ICU), and the Operating Room (OR). Vacancies also exist in all other nursing units. 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, ICU, some OR and Medical/Surgical units. Travelers are also used to support programs that we are expanding, for example, opening the third Operating Room for one to two days a week.
All 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. Recently, the Governor has held implementation of new regulations slated for January 1, 2005. This will certainly help SMMC but SMMC is still obligated to meet the ratio requirements it has striven to maintain. Our long-term strategy for recruiting foreign RNs has been held because of the recent changes in the Visa process.
Increased usage due to vacancies and the implementation of the Nursing Ratio Legislation has depleted the collective maximum amount of the 11 agreements. The cost of nursing services has average $200,000 per month. An increase of $2,000,000 is being requested to allow San Mateo Medical Center to continue to provide nursing at the Medical Center.
At this time, SMMC would also like to adjust the rate level for surgical technicians. The surgical technician rate is below the standard for registry. This rate was adjusted, from the $21 to $23 dollar range to the $41 to $43 dollar range, in the contract with Cross Country Travcorps, Inc. on October 19, 2004. SMMC would now like to extend the $41 to $43 rate level to the other ten registry contracts. This will allow SMMC to recruit registry staff to run the current two operating rooms and begin expansion into third operating room.
Authorization to allow the Chief Executive Officer to approve these amendments is also being requested. This authorization will expedite the process of sending the documents to 11 vendors for signature, ensuring timely delivery of services to SMMC patients.
County Counsel and Risk Management have reviewed and approved these amendments.
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