COUNTY OF SAN MATEO

Inter-Departmental Correspondence

San Mateo Medical Center

DATE:

June 6, 2006

BOARD MEETING DATE:

June 27, 2006

SPECIAL NOTICE/HEARING:

None

VOTE REQUIRED:

Majority

TO:

Honorable Board of Supervisors

FROM:

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

SUBJECT:

Agreements with AMN Healthcare, Inc., Arcadia Health Services,

Inc., Cross Country TravCorps, Inc., dba Cross County Staffing on Behalf of Itself and Affiliates, Novapro, Inc. and Assignment America, Inc., Emerald Health Services, First Call Nursing Services, Inc., Medstaff, Inc., Pelican Resources Registry, Relief Nursing Services, Stat Nurses International, and UNI for the term July 1, 2006 to June 30, 2008, in an amount not to exceed $3,830,000 collectively for the ten Agreements.

RECOMMENDATION:

Adopt a Resolution:

1)

Authorizing the President of the Board to execute Agreements with AMN

Healthcare, Inc., Arcadia Health Services, Inc., Cross Country TravCorps, Inc.,

Emerald Health Services, First Call Nursing Services, Inc., Medstaff, Inc., Pelican Resources Registry, Relief Nursing Services, Stat Nurses International, and UNI

2)

Authorizing the Chief Executive Officer of San Mateo Medical Center (SMMC) to execute subsequent Amendments and minor modifications not to exceed $25,000 and to make minor changes in the type of services and activities provided under the agreements.

VISION ALIGNMENT:

Commitment: Ensure Basic Health and Safety for All

Goal 5: Residents have 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 2005-06
Actual

FY2006-07

Projected

FY 2007-08
Projected

Nursing vacancy rate

14%

14%

14%

Hours/month that Emergency Department was in Diversion Status

52

60

60

BACKGROUND:

San Mateo Medical Center uses nursing registries to augment permanent

Nursing staff. Registries are used to fill nursing vacancies, meet unexpected increases in census and patient acuity, and as substitution for employees’ illnesses, extended leaves of absences.

DISCUSSION:

Registries provide San Mateo Medical Center (SMMC) and Health Services (AIDS Program) 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 greater than 12% 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. 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 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 Burlingame Long Term Care; 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 are monitoring this issue closely.

A Request for Proposal for nursing registries was sent to 45 registries in May of this year. Ten registries were selected out of 19 registries that responded. These ten registries were determined to meet SMMC’s needs.

With the recent increase in nurses’ pay, SMMC will work closely with Employee and Public Services and a staff recruiter. Aggressive efforts will be made to recruit nurses to fill the vacancies in SMMC’s specialized areas with the goal of reducing the use of registry staff.

The Agreement includes all provisions that are required by county ordinance and administrative memoranda, including but not limited to insurance, hold harmless, non-discrimination, equal benefits and jury service policy.

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

FISCAL IMPACT:

The term of the ten Agreements is from July 1, 2006 through June 30, 2008. The maximum amount the County shall be obligated to pay collectively for all ten agreements is $3,830,000. Funds to cover this cost have been included in SMMC’s and in the Health Services (AIDS Program) budgets for FY2006-07. Funds will be included in SMMC’s and Health Services’ FY2007-08 budget requests.

1.

General Description of RFP

Three proposals for short term, long term, and permanent placement registry personnel.

2.

List key evaluation criteria

1. Salary requirements

2. Personnel policies

3. Quality

4. Regulatory requirements

5. Experience

6. County Requirements

3.

Where advertised

The RFP was sent to 45 known registries.

4.

In addition to any advertisement, list others to whom RFP was sent

N/A

5.

Total number sent to prospective proposers

45 registries

6.

Number of proposals received

19 Proposals

7.

Who evaluated the proposals

Director of Nursing

Administrative Nursing Supervisor

Two San Mateo Medical Center Nurse Managers

8.

In alphabetical order, names of proposers (or finalists, if applicable) and location

AMN Healthcare, Inc.

12400 High Bluff Dr.

San Diego, CA 92130

Arcadia Health Services, Inc.

1375 Sutter, Suite 110

San Francisco, CA 94109

Cross Country Staffing

6551 Park of Commerce Blvd., Suite 200

Boca Raton, FL 94030

Emerald Health Services

1333 2^nd St., Suite 403

Santa Monica, CA 90401

First Call Nursing Services

1115 South Park Victoria Drive

Milpitas, CA 95035

Medstaff, Inc

297 So. Newton Street Road

Newtown Square, PA 19073

Pelican Resources Registry

475 El Camino Real, Ste. 206

Millbrae, CA 94030

Relief Nursing Services

151-87^th Street, #9

Daly City, CA 94015

Stat Nurses International

950 Harrison St., Ste. 104

San Francisco, CA 94107

UNI

268 Bush St., #3146

San Francisco, CA 94104