COUNTY OF SAN MATEO

Inter-Departmental Correspondence

San Mateo Medical Center

 

DATE:

July 28, 2005

BOARD MEETING DATE:

August 16, 2005

SPECIAL NOTICE/HEARING:

None

VOTE REQUIRED:

Majority

 

TO:

Honorable Board of Supervisors

FROM:

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

SUBJECT:

Amendments to the Agreements with AMN Healthcare, Inc., Arcadia Health Services, Inc., Cross Country Travcorps, Inc., First Call Nursing Services, Medstaff, Nurse Providers, Nurses PRN, Pelican Resources Registry, Relief Nursing Services, Stat Nurses International, and United Nursing International

 

RECOMMENDATION:

Adopt a Resolution:

    1.

Authorizing an increase of $2,500,000, amending the collective maximum amount of the Agreements with AMN Healthcare, Inc., Arcadia Health Services, Inc., Cross Country Travcorps, Inc., First Call Nursing Services, Medstaff, Nurse Providers, Nurses PRN, Pelican Resources Registry, Relief Nursing Services, Stat Nurses International, and United Nursing International, bringing the total collective obligation to $6,145,000

2.

Authorizing the Chief Executive Officer of San Mateo Medical Center to execute these Amendments

 

VISION ALIGNMENT:

Commitment: Ensure Basic Health and Safety for All and goal number

Goal(s): 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.

 

Performance Measure(s):

Measure

FY 2004-05
Actual

FY 2005-06
Projected

Nursing vacancy rate

14%

12%

A decreased nursing vacancy rate helps to decrease registry cost and helps maintain the required nursing ratio in California.

BACKGROUND:

On July 6, 2004, your Board approved agreements with 11 nursing registries

to augment permanent Nursing staff at San Mateo Medical Center and the Health Department. The maximum amount of the eleven agreements was $1,645,000. Two of these agreements, Cross Country Travcorps, Inc. and Stat Nurses International, were subsequently amended on October 19, 2004, by Resolution No. 66997, to change the rates for surgical technicians and to add a charge nurse differential.

On February 8, 2005, your Board approved a Resolution increasing the collective maximum amount of the 11 agreements by $2,000,000, bringing the total collective obligation to $3,645,000. The Resolution also authorized the Chief Executive Officer of SMMC to execute these Amendments.

Registries are used to fill nursing vacancies, meet unexpected increases in census and patient acuity, and to substitute for employees’ illnesses, extended leaves of absences, and workers’ compensation.

Registries provide San Mateo Medical Center (SMMC) and Health Department 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.

 

DISCUSSION:

The Medical Center is experiencing a greater than 12% vacancy rate in the nursing department. The majority of vacancies are in the critical care areas of Emergency Department (ED), 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.) to provide support to the Burlingame HealthCare Center; 4.) 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. Increased recruitment efforts with out-of-state recruitment and

relocation packages have greatly assisted in filling vacancies, particularly in the Intensive Care (ICU) and Medical/Surgical Units.

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 $243,000 per month. An increase of $2,500,000 is being requested to allow San Mateo Medical Center to continue to provide nursing at the Medical Center.

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.

 

FISCAL IMPACT:

The term of the eleven agreements remains the same from July 1, 2004 through June 30, 2006. The maximum amount the County shall be obligated to pay collectively for all eleven agreements is increased by $2,500,000, from $3,645,000 to $6,145,000. Funds are included in SMMC’s and Health Services’ FY2005-06 Recommended Budgets.