36C26120Q0479-001.docx

PERFORMANCE WORK STATEMENT (PWS)

TEMPORARY NURSING STAFF

March 28, 2020

1. SERVICES REQUIRED: The Contractor shall provide personnel for the following health care systems: VA San Francisco Health Care System, VA Northern California Health Care System, VA Palo Alto Health Care System, VA Central California Health Care System, VA Pacific Islands Health Care System, VA Sierra Nevada Health Care System, and VA Southern Nevada Health Care System. The contract personnel will have access to and the use of all required patient care equipment, supplies, and computer access for performing services required by this contract. All services shall be provided in accordance with the specifications, terms and conditions contained herein.

PLACES OF PERFORMANCE:

1.1 VA Palo Alto Healthcare System (VAPAHCS) – consists of three main campuses: (1) Palo Alto Division (PAD) located at 3801 Miranda Avenue Palo Alto, CA 94304; (2) Menlo Park Division (MPD) located at 795 Willow Road Menlo Park, CA 94025; and (3) Livermore Division (LD) located at 4951 Arroyo Road Livermore, CA 94550. The VAPAHCS is also comprised of various veteran centers and community clinics. See link at: https://www.paloalto.va.gov/ for additional information.

1.2 San Francisco VA Healthcare Center (SFVAMC) - is located at 4150 Clement Street San Francisco, CA 94121. The SFVAMC is comprised of various veteran centers and community clinics. See link at: https://www.sanfrancisco.va.gov/ for additional information.

1.3 VA Northern California Healthcare System (VANCHCS) – consists of the Valley Division (Sacramento VA Medical Center) located at 10535 Hospital Way Mather, CA 95655 and the East Bay Division – Martinez Outpatient Clinic located at 150 Muir Road Martinez, CA 94553. The VANCHCS is comprised of various veteran centers and community clinics. See link at: https://www.northerncalifornia.va.gov/ for more information.

1.4 VA Pacific Islands Healthcare System (VAPIHCS) – the Spark M. Matsunaga VA Medical Center is located at 459 Patterson Road, Honolulu, HI 96819. The Spark M. Matsunaga VA Medical Center is co-located on the Tripler Army Medical Center (TAMC) Department of Defense Army base. The VAPIHCS is also comprised of various veteran centers and community clinics located throughout the Hawaiian Islands, Guam, American Samoa, and Saipan. See link at: https://www.hawaii.va.gov/locations/other_facilities.asp for additional information.

1.5 VA Sierra Nevada Healthcare System (VASNHCS) – is located at 975 Kirman Avenue Reno, NV 89502. The VASNHCS consists of veteran centers and community clinics. See link at: https://www.reno.va.gov/ for more information.

1.6 VA Central California Healthcare System (VACCHCS) – is located at 2615 E. Clinton Avenue Fresno, CA 93703. The VACCHCS consists of veteran centers and community clinics. See link at: https://www.fresno.va.gov/ for more information.

1.7 VA Southern Nevada Healthcare System (VASNHS) – is located at 6900 North Pecos Road North Las Vegas, NV 89086. The VASNHS consists of veteran centers and community clinics. See link at: https://www.lasvegas.va.gov/ for more information.

GENERAL: The Contractor shall provide temporary personnel on an as-needed basis for the VA Northern California Health Care System (hereafter known as the VANCHCS). The contract personnel will have use of all required patient care equipment, supplies, and computer access for performing services required by this contract. All services shall be provided in accordance with the specifications, terms and conditions contained herein.

Authority, Policy, and Handbooks: Title 38 United States Code (USC) 8153, Health Care Resources (HCR) Sharing Authority.

Policies and Regulations: The Contractor shall comply with all applicable policies and regulations, including, but not limited to the following:

42 Code of Federal Regulations (CFR) Part 482: Conditions of Participation Hospitals, including Sub-Part E Requirements for Specialty Hospitals. http://ecfr.gpoaccess.gov/cgi/t/text/text-idx?c=ecfr;sid=aceca18b9fbe0110ffa37c08075c2b0e;rgn=div5;view=text;node=42%3A5.0.1.1.1;idno=42;cc=ecfr

VA Directive 1663: Health Care Resources Contracting - Buying http://www1.va.gov/vapubs/viewPublication.asp?Pub_ID=347

VHA Handbook 1100.17: National Practitioner Data Bank Reports - http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=2135

VHA Handbook 1100.18: Reporting and Responding to State Licensing Boards - http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=1364

VHA Handbook 1100.19: Credentialing and Privileging - http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=1806

Privacy Act of 1974 (5 U.S.C. 552a) as amended http://vaww.vhaco.va.gov/privacy/Documents/5USC552a.htm

Definitions and Acronyms used in this Performance Work Statement:

ACLS: Advanced Cardiac Life Support

BLS: Basic Life Support

CAC: Cardiac Ambulatory Center

CDC: Centers for Disease Control and Prevention

CFR: Code of Federal Regulations

CLC: Community Living Center

CLIN: Contract Line Item Number

CNA: Certified Nurse Assistant

CO: Contracting Officer

COR: Contracting Officer’s Representative

CPARS: Contractor Performance Assessment Reporting System

CPRS: Computerized Patient Recordkeeping System- electronic health record system used by the VA.

CPT: Current Procedural Terminology

EKG: Electrocardiogram ePER: Electronic Patient Event Report

FAR: Federal Acquisition Regulation

FIPS: Federal Information Processing Standards

FOIA: Freedom of Information Act

FTEE: Full time Employee Equivalent

HCR: Health Care Resources

HHS: Department of Health and Human Services

HIPAA: Health Insurance Portability and Accountability Act

HR: Human Resources

ICC: Infection Control Committee

ICD: International (Statistical) Classification of Disease

ICU: Intensive Care Unit

IDIQ: Indefinite Delivery, Indefinite Quantity

ISO: Information Security Officer

IV: Intravenous

JC: Joint Commission

LMS: Logistics Management Services

LPN: Licensed Practical Nurse

LVN: Licensed Vocational Nurse

MAB: Management of Assaultive Behavior

MMR: Measles, Mumps, Rubella

NARA: National Archives and Records Administration

NIST: National Institute of Standards and Technology

OIG: Office of the Inspector General

OPC: Out Patient Clinic

OR: Operating Room

OSHA: Occupational Safety and Health Administration

PICC: Peripherally Inserted Central Catheter

POC: Point of Contact

PPD: Purified Protein Derivative (of tuberculin)

PWS: Performance Work Statement

QASP: Quality Assurance Surveillance Plan

RN: Registered Nurse

SAC: Security Agency Check

SAM: System for Award Management

SP: Special Publications

TJC: The Joint Commission

TMS: Talent Management System

TPN: Total Parenteral Nutrition

USC: United States Code

VA: Veterans Affairs

VA-FSC: VA Financial Service Center

VAMC: Veterans Affairs Medical Center

VANCHCS: VA Northern California Health Care System

VETPro: A federal web-based credentialing program for healthcare providers.

VHA: Veterans Health Administration

2. QUALIFICATIONS:

2.1 Staff/Facility: Contract personnel shall be licensed in a State, Territory, or Commonwealth of the United States or the District of Columbia.

2.2 Contractor Personnel Requirements/Specifications: The Contractor shall ensure that all contract personnel meet the qualifying criteria outlined in this section.

2.3 Registered Nurses (RN)s, Licensed Practical Nurse (LPN), Licensed Vocational Nurse (LVN), Nurse Practitioner (NP), and Certified Nurse Assistants (NA): All Nurses must have certification in cardiopulmonary resuscitation (CPR) by an American Health Association vendor. Personnel must be able to demonstrate competency in providing CPR, and have current basic life support (BLS) certification. Critical care Nurses shall have advanced cardiac life support (ACLS) certification.

Licensure: The contract RNs and LPN/LVNs must have a current license in at least one state, territory, or commonwealth in the US or the District of Columbia. Proof of current license must be provided five business days prior to their first shift, and at the licensure renewal rate. This also applies to all other required certifications.

Current Curriculum Vitae: A review of individual education and professional qualifications must be available for the healthcare system’s review to assure appropriate placement in a medical discipline commensurate with the contract personnel’s qualifications and experience.

2.4 Uniforms: All contract personnel will provide their own uniforms and nametags, and will wear them anytime the personnel are on any Department of Veterans Affairs’ (VA) Medical Center (VAMC) grounds.

2.5 Health Tests: All contract personnel will provide proof of tuberculosis testing, rubella testing, and immunizations that are current within one year prior to working any shift. Other tests may be required by the local facility.

2.6 Health Restrictions: The contract personnel will have no health or physical disability restrictions that interfere with the performance of their duties.

2.7 Competencies: The Contractor will keep a file of validated competencies, and training program records, to include Health Insurance Portability and Accountability Act (HIPAA) training for all contract personnel. This file must be available to the VA facility 24-hours-per-day, and seven- days-per-week.

2.8 Experience: All contract personnel will have a minimum of one year direct patient care experience within the last three years in the field.

2.9 Computer Literacy: The contract personnel shall have the knowledge and ability to use computers and other technology.

2.10. Nursing Assistants: The contract Nursing Assistants must provide proof of certification by the California State Department of Consumer Affairs as a Nursing Assistant.

2.11. Contractor Personnel Responsibility: The Contractor shall assume full responsibility for the protection of their personnel who are providing services under this contract, therefore, the Contractor will provide the following to their contract personnel:

Worker’s Compensation Professional Liability Insurance Health Examinations Income Tax Withholdings Social Security Payments

2.12. Payment for Leave Time: Sick leave, vacation time, and any other type of leave is considered the sole responsibility of the Contractor. The Contractor shall comply with all existing local, state, federal, and union laws and regulations relevant to fringe benefits and premium pay for their employees. Such personnel shall not be considered VA employees for any purpose and shall be considered employees of the Contractor.

2.13. Unacceptable Assignee: Contractor employees that report for work but are unable to perform will result in a four-hour penalty deduction from an outstanding invoice. The corresponding hourly rate will apply. The Contracting Officer (CO) may also terminate this contract at his or her sole discretion for repeated no-shows or tardiness of contract personnel.

2.14. Right of Refusal: The Government reserves the right to reject any contract personnel and refuse them permission to provide services if they fail to perform in accordance with the contract requirements. The contract personnel must always display personal and professional conduct in a manner that does not jeopardize patient care or interfere with the regular and ordinary operation of the facility.

2.15. Acceptance of Personnel: The Contractor shall ensure that all contract personnel have met the qualifying criteria, including current and valid licenses and certifications. These qualifying criteria shall be met by completing VETPro certification; VETPro is an Internet-enabled data bank for the credentialing of Veterans Health Administration (VHA) personnel. It facilitates the completion of a uniform, accurate, and complete credentials file. The Contractor shall initiate VETPro data within 72 hours of selecting their contract staff. Contracted Staff shall not work on VA facilities until VETPro data has been initiated. It is the Contractor’s responsibility to ensure that Contract staff is current with their licenses and certifications. This information shall be relayed to the CORs as it becomes available. The decision to reject and accept Contract Staff ultimately rests with the Department of Veterans Affairs (VA).

The Contractor shall provide personnel who will provide scheduled services throughout the contract period. If the Contractor’s personnel cannot perform services for any reason, the Contractor shall bear the responsibility of providing replacement personnel to provide the scheduled services. Replacement personnel are expected at the time initially scheduled. Non-acceptance of contract personnel does not relieve the Contractor from satisfying and fulfilling the contract requirements.

The VA shall provide the Contractor with the names, titles and telephone numbers of individuals authorized to request staffing. It shall also provide the name, title and telephone number of the COR at the time of contract award.

The Contractor shall designate a person from their agency to act as a Point-of-Contact (POC) for the VA within ten business days of contract award. The Contractor’s POC will be responsible for the overall conduct of the contract. The name and telephone number of the POC shall be provided to both the CO and the COR. The Contractor’s POC shall not be one of the care providers rendering services under this contract. The COR or the evening and night Nursing Supervisor in the Nursing Department, or the individual in charge in other departments where duties are to be performed, will contact the Contractor’s designated POC concerning personnel staffing problems or other issues requiring immediate attention. The Contractor shall respond to telephone calls from the COR within 30 minutes twenty-four-hour-per day, seven days-per-week.

The Government reserves the right to refuse acceptance of contract personnel whose personal or professional conduct jeopardizes patient care or interferes with the regular and ordinary operation of the facility. Breaches of conduct include intoxication from alcohol or drugs, theft, patient abuse, dereliction or negligence in performing directed tasks, or other conduct resulting in formal complaints by patients or other staff members to designated Government representatives. Standards for conduct shall mirror those prescribed by current federal personnel regulations. The Contractor and COR will deal with issues raised concerning contract personnel’s conduct. The CO is the final arbiter on questions of acceptability.

Complaints concerning contract personnel’s relations with the Government employees or patients will be resolved by the CO. The CO has the final authority on validating complaints. If contract personnel are involved and named in a validated patient complaint, the Government reserves the right to refuse acceptance of the services of such personnel. This does not preclude refusal in the event of incidents involving physical or verbal abuse.

VA personnel such as the CO, the COR, a VA POC, will brief contract personnel on VA Healthcare System policies and procedures on the first scheduled duty day.

The contract personnel rendering services are subject to professional or technical direction from the COR.

2.16. Orientation: The Contractor shall provide eight hours of orientation time to each nurse at no charge to the VA. Orientation will include required Security Agency Check (SAC) background check completed with Human Resources (HR). The Contractor shall not work on VA facilities until the orientation and the SAC background check are completed.

Employment Packet: An employment packet shall be submitted to the COR for each contract employee five business days prior to his or her first duty shift. The packet shall consist of names, social security numbers, and copies of the curriculum vitae, Purified Protein Derivative (of tuberculin) tests, MMR or Rubella Titer, and any other locally required health care test, license numbers, expiration dates, and at least two current references reflecting current professional practice. The COR will notify the Contractor of acceptance or unacceptability of proposed employees within two business days of the receipt of the packets. The determination will be based on the contents of the packet evidencing that all qualification requirements are met.

Healthcare Industry Standards: Contractor personnel shall perform services in accordance with ethical, professional and technical standards of the healthcare industry consistent with VA policies, regulations, procedures and protocol. The Contractor’s personnel shall be technically proficient in the skills necessary to fulfill the requirements stated herein.

Personal Hygiene and Clothing: Contract healthcare providers shall be neat, clean, well-groomed and will exercise good personal hygiene. Appropriate and professional attire shall be work always while caring for patients.

Health Restrictions: Contract personnel shall have no health or physical disability restrictions which interfere with the performance of duties and shall have a current physical completed within the past 30 business days.

2.17. Health Requirements:

Health care providers shall not perform services under this contract unless a pre-assignment medical examination has been performed within 30 business days of their first scheduled shift. Pre-assignment medical examinations shall be the responsibility of the Contractor at no cost to the Government.

As a condition of employment, the Occupational Safety & Health Administration (OSHA) requires that all contract staff that will have occupational exposure to blood, body fluids, and other potentially infectious materials, shall receive Hepatitis B vaccine, provide documented proof of immunity to the Hepatitis B infection, or sign a voluntary declination of the Hepatitis B vaccine. The immunization declination shall be the responsibility of the Contractor at no cost to the Government. As a condition of employment, the contract health care providers will obtain an annual PPD skin test. Those with a positive skin test history shall complete an annual respiratory assessment questionnaire. The skin test or respiratory assessment will be the responsibility of the Contractor at no cost to the Government.

Contract health providers having patient contact or exposure to biological or pathological specimens shall be immunized against, be granted an immunization waiver to, or have documented proof of immunity to chickenpox, measles, rubella, mumps, polio and Hepatitis B. In addition, the contract health care providers shall be free of infectious diseases (to include but not limited to active Tuberculosis and Viral Hepatitis) that might reasonably be expected to place the other workers, patients or the public at risk.

The Contractor shall provide the Government with all the information necessary to ensure that government records are maintained correctly and in compliance with The Joint Commission (TJC), OSHA, and the Centers for Disease Control and prevention (CDC) health records requirements, for each contract health care provider.

The Contractor shall provide the COR with certification that contract health care providers have completed the medical evaluation required above, a minimum of five business days prior to the performance of contract services. This certification shall state the date that the examination was completed, the name of the Doctor who performed the examination, a statement concerning the physical health of the individual and the following statement: [Name of contract health care provider] is suffering from no contagious diseases to include Tuberculosis, Hepatitis and Venereal Disease.

The government may take nose and throat cultures from contract health care providers when required by the government’s Infection Control Committee (ICC).

When a health care provider has been found medically unfit to provide the services required under this contract, they shall be required to discontinue working immediately. Contract health care providers will not return to work until given clearance by an appropriate Physician.

The Government will provide emergency health care for injuries sustained while on duty for contract health care providers.

3. HOURS OF OPERATION:

3.1 Work Schedule

Coverage

a) Day Shift 7:30 a.m. – 4:00 p.m.

b) Evening Shift 3:30 p.m. – 12:00 12:00 a.m.

c) Night Shift 11:30 p.m. – 8:00 a.m.

3.2. Federal Holiday days: The Government observes the following ten National Holiday days:

New Year’s Day Martin Luther King’s Birthday Washington’s Birthday Memorial Day Independence Day Labor Day Columbus Day Veteran’s Day Thanksgiving Day Christmas Day

**Any other day specifically declared by the President of the United States to be a Federal Employee holiday, or when Congress declares a National holiday. When a holiday falls on a Sunday, the following Monday will be observed as a National Holiday. When a holiday falls on a Saturday, the preceding Friday is observed as a National Holiday by United States Government agencies. An administrative closure of federal offices by Executive Order is not a national holiday for holiday pay.

3.3. Request for Service: The Contractor shall provide qualified and approved staffing within 24 hours’ notice from the COR or VA POC. This is a per diem staffing requirement, so most of the shifts are as needed.

3.4. Shift Cancellation: The COR or VA POC will give the Contractor notification of available shifts no less than one week in advance for scheduled shifts exclusive of emergencies. The Contractor’s personnel may be released from duty after a minimum of four hours if their services are no longer required, however contract personnel will only be paid for their actual hours worked. Any tour of duty for the Contractor’s personnel may be canceled two hours prior to the assigned shift, without penalty if staffing permits. The VA is not required to make payment after an employee has been released from duty. Contract personnel brought in under a term contract (i.e. Travel/Per-Diem Nurses) will be subject to reassignment if patient care needs dictate.

3.5. Changes in Work Requirements: Only those services specified herein are authorized. Changes to the resulting contract are not authorized, unless in writing by the CO. The Contractor shall keep the CO informed in writing, of any unusual circumstances in conjunction with the contract.

3.6. Tardiness and No-Shows: The VA may excuse tardiness more than one hour on a case-by-case basis; however, payment to the Contractor will be for the actual hours worked. Unacceptable patterns of tardiness or no-shows may result in a poor performance rating of the Contractor. This can adversely affect future government contracts. After one hour of tardiness, a Contractor’s employee will be considered a no-show. The Contractor will have a back-up plan to provide needed staff in the event of a no-show.

3.7. Overtime: Compensation for services rendered will be on a per-shift basis. The scheduling, tracking and compensation of Nurses in accordance with the State or Federal Law is the sole responsibility of the Contractor. The Contractor will not include any overtime on the invoice that is sent to the VA unless authorized by the CO.

3.8. Record Keeping System: The VA has established a record keeping system and will maintain it for verification of the actual hours worked by the Contractor’s employee each day. The Contractor’s personnel must be present at the VA Medical Center and be performing services required by the contract during the scheduled work period to be paid for that period. Contract personnel shall sign in and out at the Central Nursing Office (CNO) as a method of accounting for hours worked.

4. CONTRACTOR RESPONSIBILITIES: The Contractor will provide personnel who can perform the required functions described in paragraphs below. The following paragraphs in this section describe the types of Nurses, the required skills needed, and the functions of those positions:

4.1. Registered Nurses: The Contractor shall provide RNs who are certified in Peripherally Inserted Central Catheter (PICC) Lines, Critical Care, Med/Surgery, Chronic Hemodialysis, Radiology, Post Anesthesia Care, Operating Room Work, Emergency Room Care, Chemotherapy.

4.2. Licensed Practical Nurses/Licensed Vocational Nurses (LPN/LVN)s, Nursing Assistants (NA)s and Nurse Practitioners (NP)s: The Contractor shall provide LPN/LVNs, NAs and NPs to augment in-house staffing in accordance with the requirements herein. The Contractor’s personnel shall provide staffing for shifts as designated by the COR or the COR’s POC.

4.3. Critical Care RNs, Emergency Room RNs, Post-Anesthesia Care Unit RNs, and Operating Room RNs:

Introduction: This type of RN provides direct and indirect nursing care in the following areas of assignment: Intensive Care Units, Recovery Rooms, Cardiovascular Labs, Emergency Rooms, Operating Rooms, and Gastro-Intestinal (GI) Labs by contributing to patient assessments, setting priorities, identifying therapeutic objectives and nursing measures, and evaluating outcomes. Essential skills to this position are independent judgment and nursing actions, flexibility, organizational skills, and the ability to utilize an interdisciplinary approach in the provision of nursing care.

Organizational Relationship: This type of RN is subject to the professional direction of the VA Nurse Manager or designee during the workweek. The RN reports to the Nursing Supervisor through the Charge Nurse during evening and nightshifts, holiday days, and weekends.

Functions: The services of Critical Care Registered Nurses shall be provided in accordance with the policies of the VA Healthcare System where assigned. Nurses shall have professional and legal responsibility to the patient. The RN provides the following services:

Provides critical care nursing to Intensive Care Unit (ICU) patients.

Performs scrub and circulating duties in the Cardiovascular Lab and the Operating Room.

Assists with the GI Lab procedures and demonstrates competency in monitoring patients undergoing conscious sedation.

Obtains patient history and pertinent family history.

Assesses patient and plan appropriate nursing care.

Documents plan of care and care given in patient’s medical record.

Verifies transcription of physician’s orders, no verbal orders are to be accepted.

Carries out prescribed Physician’s orders and documents inpatient medical record.

Communicates pertinent patient data to the Charge Nurse and/or Physician as appropriate.

Re-assesses patient’s condition and revises plans-of-care based on problems that the Nurse Identifies.

Administers medications and Intra-venous (IV) therapies.

Possesses knowledge of actions and usual dosages of the most commonly used emergency drugs and their location on the crash cart.

Assesses and documents patient responses to medications that have been administered.

Can interpret cardiac rhythms and their implications.

Reorganizes and initiates the appropriate measures in emergencies/therapies and surgical/diagnostic procedures that must be accomplished.

Instructs patients and their families regarding prescribed medications/therapies and surgical/diagnostic procedures that must be accomplished.

Assesses patient/family knowledge level, implements plan of instructions, and records the patient’s family’s demonstrated level of understanding.

Operates defibrillator, electrocardiogram (EKG) machines and cardiac monitors, and other technical emergency equipment.

Cares for patients with Swan-Gans catheters, arterial lines and mechanical ventilators.

Participates in discharge planning.

Can initiate life saving measures in the absence of Physicians.

Assures the content and correctness of a prepared report and signs the document to validate its content.

Maintains a neat personal appearance and maintains professional decorum.

Consistently applies the VA’s customer service standards, always demonstrating helpful, courteous, and respectful conduct.

Respects patient’s rights, including but not limited to visual and auditory privacy.

May accept a verbal order in compliance with the facility policy.

Critical Care RNs must have a minimum of two years’ current experience in this field and hold BLS and ACLS and/or certification.

Intake and output of fluids assessed every shift, and more frequently if indicated by specific standard nursing drug care.

Reviews all laboratory data, and electronic medical records.

Can titrate medications.

Can be responsible for feeding tubes which are aspirated for gastric residue prior to every intermittent feed, and every four hours for continuous tube feedings.

Performs urinary catheter care by using soap and water cleaning technique every 12 hours, or as required.

Ensures that medication orders from the previous shift have been noted and either carried out or transcribed onto the medical records.

Must be able to rotate through the following areas and perform associated functions of these areas:

Catheterization Laboratory, Cardiac Ambulatory Center (CAC), Electrophysiology (EP) Lab, Interventional Radiology, Magnetic Resonance Imaging (MRI) Lab and Gastroenterology Lab.

4.4. Functions of the Medical/Surgical (Med/Surg) RN, the Chronic Hemodialysis RN, Radiology RN, and the Psychiatry RNs:

Introduction: In any area of assignment within the health care system, the RN provides direct and indirect nursing care, through assessing patient status, determining priorities, identifying nursing measures, identifying therapeutic objectives, and evaluating outcomes. The position requires independent judgment and nursing actions, flexibility, organizational skills, and the ability to utilize an interdisciplinary approach in the provision of nursing care.

Organizational Relationship: The RN is subject to the professional direction of the VA Nurse Manager or their designee during the workweek. On evenings, nights, holiday days, and weekends, the RN reports through the Charge Nurse to the Nursing Supervisor designee.

Functions: The services of Med/Surg RNs, Radiology Nurses RNs, and Chronic Hemodialysis RNs shall be provided in accordance with the policies of the VA Healthcare System where assigned. Nurses shall have professional and legal responsibility to the patient. The RN provides the following services:

Utilizes the nursing process and an interdisciplinary approach to provide direct, continuous, and comprehensive patient care.

Performs nursing functions related to physician prescribed treatments.

Performs the function of a scrub nurse.

Assists patients with activities of daily living.

Performs the functions of a circulating nurse.

Administers medications and IV therapies in compliance with local facility policies.

Obtains patient history and pertinent family histories.

Assesses patients and plans appropriate nursing care.

Documents patient’s medical record with the plans-of-care and the care provided to the patients.

Verifies transcriptions of Physician’s orders, and does not accept verbal orders.

Carries out Physician’s orders and documents the patient’s medical record.

Communicates pertinent patient data to the Charge Nurse and/or Physician as appropriate.

Re-assesses patient’s condition and revises plans-of-care based on problems that the Nurse Identifies.

Assesses and documents patient’s responses to medications and all treatments administered.

Recognizes and initiates the appropriate measures in emergencies and assists with surgical/diagnostic procedures.

Instructs the patients and their families regarding prescribed medications/therapies and surgical/diagnostic procedures.

Assesses the patient/family knowledge level, and implements a plan of instructions and records the patient’s and family’s demonstrated level of understanding.

Cares for patients with a variety of catheters and prostheses.

Participates in discharge planning.

Can initiate life saving measures in the absence of a Physician.

Maintains a neat and clean personal appearance with professional decorum.

Consistently applies the VA’s customer service standards, and always demonstrates helpful, courteous, and respectful conduct.

Respects patient rights, including but not limited to visual and auditory privacy.

Med/Surg RNs, Radiology RNs, and Chronic Hemodialysis RN and Psychiatric RNs, must be experienced in this field.

Psychiatric RNs working in Acute Locked Psychiatry shall possess current ProAct or equivalent Management of Assaultive Behavior (MAB) training and or certification.

4.5. Functions of the Certified Chemotherapy RNs:

Introduction: In assignment within the VISN 21 Healthcare Systems, Oncology units or Chemo clinics, the RN provides direct and indirect nursing care by contributing to the patient’s assessment, determining priorities, identifying nursing measures and therapeutic objectives and evaluating outcomes. The position requires independent judgment and nursing actions, flexibility, organizational skills, and the ability to utilize an interdisciplinary approach in the provision of nursing care.

Organizational Relationship: The RN is subject to the professional direction of the VA Nurse Manager or designee during the workweek. During evenings, nights, holiday days and weekends, the RN reports through the Charge Nurse to the Nursing Supervisor.

Functions: The services of Chemotherapy Registered Nurses shall be provided in accordance with the policies of the VA Healthcare System where assigned. Nurses shall have professional and legal responsibility for the patient. The RN provides the following services:

Performs administration of chemotherapy to patients on Oncology Units or in Chemo Clinic in accordance with Medical Center Policies and Procedures from the Lippincott Manual of Nursing Practice.

Understands the principles of chemotherapy and the various chemotherapeutic agents.

Demonstrates knowledge of the fundamentals of chemotherapy administration, safety measures for administration of chemotherapy, treatment schedules, and pretreatment and treatment.

Possesses knowledge of complications of Cytotoxic Therapy and the correct interventions to initiate for them.

Demonstrates competency in the management of patients receiving chemotherapy with specific skills in assessment, patient education, toxicity management and oncologic emergencies.

Obtains patient history and pertinent family history.

Assesses patient and plans appropriate nursing care.

Documents plan of care and care given in patient’s medical record.

Verifies transcription of Physician’s orders, and does not accept verbal orders.

Carries out prescribed Physician’s orders and documents inpatient medical record.

Communicates pertinent patient data to the Charge Nurse and/or Physician as appropriate.

Re-assesses patient’s condition and revises plans-of-care based on problems that the Nurse Identifies.

Administers medications and IV therapies.

Possesses knowledge of actions and usual dosages of most commonly used emergency drugs and their location on crash cart.

Assesses and document patient response to medication that have been administered.

Reorganizes and initiates appropriate measures in emergencies.

Instructs patient/family regarding prescribed medications/therapies and surgical/diagnostic procedures that must be accomplished.

Assesses patient/family knowledge level, implement plan of instructions and record patient/family demonstrated level of understanding.

Operates defibrillator, EKG machines and cardiac monitor.

Participates in discharge planning, as appropriate.

Can initiate life saving measures in the absence of Physicians.

Maintains a neat personal appearance and maintains professional decorum.

Consistently applies the VA’s customer service standards, always demonstrating helpful, courteous, and respectful conduct.

Respects patient’s rights, including but not limited to visual and auditory privacy.

4.6. Functions of the Licensed Practical Nurse/Licensed Vocational Nurse (LPN/LVN):

Introduction: In any area of assignment within the health care system, the LPN/LVN provides direct and indirect nursing care by contributing to the patient’s assessment, determining priorities, identifying nursing measures and therapeutic objectives, and evaluating outcomes. The position requires independent judgment and nursing actions, flexibility, organizational skills, and the ability to utilize an inter-disciplinary approach in the provision of nursing care.

Organizational Relationship: The LPN/LVN is subject to the professional direction of the VA Nurse Manager/Charge Nurse or designee during the workweek. On evenings, nights, holiday days and weekends, the LPN/LVN reports through the Charge Nurse or Nurse Manager or to the Nursing Supervisor/designee.

Functions: The LPN/LVN functions within the policies of the VA where assigned and has professional and legal responsibility to the patient. The LPN/LVN provides the following services:

Serves as a member of the nursing team. and participates in the planning, implementation and evaluation of nursing care provided.

Serves as a direct patient care provider and carries out nursing care for assigned patients. Is alert to physical and emotional changes and complications related to patient disease process and reports such immediately to the RN.

Observes patient’s changing condition and reports and records changes on the nursing progress note and care plan. Enters accurate, complete information in the medical record about patient’s condition and responses to treatment and actions taken to carry out nursing care.

Reinforces instructions to patient scheduled for invasive, diagnostic, or pre/post-operative procedures. Instructs patients on the use of equipment (e.g. oxygen, suction, incentive spirometry, etc.). Reinforces instructions to patients and families on the use of prescribed medications.

Performs a range of treatment and procedures that include but are not limited to changing sterile dressings, inserting urinary drainage catheters, irrigating catheters and/or nasogastric tubes, irrigation wounds, giving enemas, using various forms of body temperature control, administering oral, topical and intramuscular medications and reporting information concerning adverse effects, caring for patients in isolation, and/or continuous observation status, and giving treatments that requires use of specialized oxygen, suction or other supplies.

Serves as a module/team leader if assigned to the Nursing Home Care Units.

Observes, promptly reports, and documents observations regarding the physical and emotional status of patients, including such things as changes in vital signs, bodily functions, clarity of speech and/or orientation to time, place or person.

Performs a range of diagnostic support duties which include taking vital signs during neurological checks, collecting specimens, obtaining laboratory reports, and assisting in a variety of examinations such as lumbar punctures, paracentesis, liver biopsies, thoracentesis and bone marrow examinations by positioning and draping patients and providing other assistance as necessary.

Recognizes emergency situations (e.g. cardio-pulmonary arrest, choking, etc.) and takes prompt, appropriate action.

Initiates emergency measures to control patient’s disruptive or violent behavior. Assumes responsibility for patients requiring constant observation, including those placed on legal holds as a danger to themselves, others, or gravely disabled, which includes15 minute documentation of patient’s condition on appropriate forms.

Prepares, administers and records prescribed medications in accordance with Medical Center’s Policy and Procedure. Observes and reports physical and emotional reactions to medications.

Counts narcotics and assumes responsibility for narcotic security and the accuracy of narcotic records. Administers narcotics in accordance with established Medical Center policy.

Reports to the RN completion of care rendered, changes in patient’s response or condition and care needs remaining prior to leaving the clinical area.

Maintains completeness and accuracy of all continuing patient records, including intake and output, vital signs, and activities of daily living.

Performs a range of personal care that includes feeding, bathing, lifting, and turning patients, providing for personal hygiene and performing preventative, rehabilitative, and therapeutic care/procedures within the scope of the LPN/LVN.

Accompanies patients on diagnostic or therapeutic trips, assuming responsibility for nursing decisions while away from the nursing unit, within the scope of the LPN/LVN.

Always meets the safety and security needs of patients.

Promotes a sense of dignity and self-worth for all patients and staff.

Consistently applies VA Customer Service Standards, demonstrating helpful, courteous, respectful conduct always.

Respects patient’s rights, including but not limited to, visual and auditory privacy.

Licensed Practical/Vocational Nurses must be experienced in this field.

Licensed Practical/Vocational Nurses Psychiatric RNs working in Acute Locked Psychiatry shall possess current ProAct or equivalent MAB training and or certification.

4.7. Functions of the Nursing Assistant (NA):

Introduction: In the area where assigned within the health care system, the Nursing Assistant (NA) provides direct nursing care under the direct or indirect supervision of a VA Registered Nurse. The position requires the ability to follow directions, determine priorities as they relate to basic patient care needs within the scope of a Nursing Assistant, uses organizational and observational skills.

Organizational Relationship: The NA is subject to the professional direction of the VA RN responsible for the team of patients to which the NA is assigned, at times, reporting through a LPN/LVN to the RN.

Functions: The NA functions within the policies and procedures of the VA facility where assigned and provides the following services:

Serves as a member of the nursing staff and carries out routine nursing care and other personal services to assigned patients on any ward or tour assigned.

Performs a range of personal nursing care which includes activities of daily living, such as feeding, bathing, lifting and turning patients, providing oral, nail, hair related hygiene care, and performing preventive, rehabilitative, and therapeutic care/procedures within the scope of a Nursing Assistant.

Records all care provided in the appropriate clinical records.

Observes significant conditions, both physical and emotional that are relevant to the health status of the patient. Provides timely and accurate reports to their team leader or designated superior and records all relevant information in the clinical record. Gives special attention to details of care since patients are often too ill or confused to speak for themselves.

Performs a range of diagnostic support duties such as taking vital signs during neurological checks, collecting specimens, and preparing patients for tests, examinations, treatments and/or surgery per established procedures.

Performs a range of treatment procedures that include changing dressings, giving enemas, colostomy care, tracheotomy care, and caring for patients in isolation, and/or continuous observation status.

Maintains a safe and therapeutic environment; observes all policies pertaining to universal precautions. Provides for safety needs of patients.

Recognizes emergency situations such as cardiopulmonary arrest, choking, seizures, dysreflexia, etc., and takes appropriate action, and reports situations immediately.

Accompanies patients on diagnostic or therapeutic trips assuming responsibility for basic decisions within the scope of a Nursing Assistant while away from nursing units.

Initiates emergency measures to control disruptive or violent behavior.

Assists in the delivery of patient care as directed by the RN or LPN/LVN.

Respects patient’s rights, including but not limited to visual and auditory privacy.

Consistently applies VA customer services standards, and always demonstrating helpful, courteous, and respectful conduct.

Nursing Assistants must have experience in this field.

Nursing Assistants working in Acute Locked Psychiatry shall possess current ProAct or equivalent MAB training and certification.

4.8. Functions of the Nurse Practitioner (NP):

Introduction: In the areas of assignment within the health care system, the NPs provide diagnosis, treatment, consultation, and follow-up patient care. Participates in the care of inpatient and outpatient clients in an independent and interdependent role as directed by the NP Professional Leader or Chief of Patient Care Services.

Organizational Relationship: The NP is subject to the professional direction of the VA Nurse Manager/Charge Nurse or designee during the workweek. During evenings, nights, holiday days and weekends, the NP reports through the Charge Nurse or Nurse Manager or to the Nursing Supervisor/designee.

Functions: The NPs functions within the policies of the VA where assigned and has professional and legal responsibility to the patient. The NPs provides the following services:

Executes position responsibilities independently and collaboratively in accordance with the scope and standards of nursing practice within the specialty area.

Works in an independent and interdependent relationship with members of the medical staff.

Effectively identifies, evaluates, and addresses disease prevention and health promotion issues while administering quality patient care.

Demonstrates advanced assessment and decision-making skills.

Maintains legible, accurate, and confidential medical records. Documents all medical evaluations, diagnoses, treatment, outcomes, education, referrals, and consultations.

Documents care/visit in CPRS appropriately, accurately and concisely.

Follows clinical guidelines and standards of practice for health promotion, maintenance and illness prevention.

Completes health histories and other clinical documentation consistently and with pertinent information.

Responsible for the diagnosis and treatment of acute, chronic, and long-term healthcare issues.

Ensures that care and treatment plans are consistent with assessments. Orders and interprets diagnostic tests appropriately.

Selects/furnishes (prescribes) or recommends pharmacological agents and durable medical equipment appropriately.

Sets priorities to provide care in an organized and timely manner.

Presents cases in a concise, organized manner. Participates in formal and informal performance evaluations and professional development.

Evaluates own performance per the APN Scope of Practice standards of professional and regulatory bodies and takes actions to improve practice.

Maintains mandatory requirements and competency standards.

Treats staff, patients and family with respect and dignity.

Uses clinical research techniques in decision-making and in making recommendations. Identifies and documents appropriate International (Statistical) Classification of Disease (ICD) and current Procedural Terminology (CPT) coding for patient encounters.

Educates patients and/or families about preventive care, medical issues, and use of prescribed medical treatments and/or medications.

Complies with safety facility patient guidelines and other mandatory requirements as directed.

4.9. Functions of the PICC Line Certified RNs:

Introduction: The PICC Line certified RN provides direct and indirect nursing care in all units by contributing to the patient’s assessment, determining priorities, identifying nursing measures, therapeutic objectives, and evaluating outcomes. The position requires independent judgment and nursing actions, flexibility, organizational skills, and the ability to utilize an interdisciplinary approach in the provision of nursing care.

Organizational Relationship: The RN is subject to the professional direction of the VA Nurse Manager or designee during the workweek. On evenings, nights, holiday days and weekends, the RN reports to the Nursing supervisor through the Charge Nurse.

Functions: The services of PICC Line Registered Nurses shall be provided in accordance with the policies of the VA Healthcare System where the RN is assigned. Nurses shall have professional and legal responsibility for the patient. The RN provides the following services:

Performs administration of the PICC Line in accordance with Medical Center Policies and Procedures, Lippincott Manuel of Nursing Practice.

Performs IV services on cases ranging from IV antibiotic infusion, to total parenteral nutrition (TPN), and determines the severity on a case-by-case basis.

Sees an average of one to five patients per week, depending on the facility’s requirements.

Provides services as needed when ordered by a Physician 24 hours-per-day/seven days-per-week.

Begins work as soon as possible after clearance through VETPro.

Uses the VA provided PICC line kit, Ultrasound Device and X-ray services. All supplies needed for procedure will be included in the PICC kit.

Provides the PICC line services at the patient’s bedside at the VA facility.

Works without assistance except in the case of an emergency, such as patients who become restless and altered, where assistance in holding the patient may be required.

The PICC may have single or multiple lumens. This depends on how many intravenous therapies are needed. A PICC line can be used for antibiotics, pain medicine, chemotherapy, nutrition, or for the drawing of blood samples. PICCs are inserted by radiologists, physician assistants, or certified registered nurses. They are inserted using ultrasound technology at the bedside or ultrasound with fluoroscopy. Chest radiographs are also used to confirm placement of the PICC tip if it was not inserted using fluoroscopy.

Obtains patient history and pertinent family history.

Assesses patients and plans appropriate nursing care.

Documents patient’s medical record with the plan-of-care and all care given.

Verifies transcription of Physician’s orders. No verbal orders are to be accepted.

Communicates pertinent patient data to the Charge Nurse and/or Physician.

Re-assesses patient’s condition and revises plans-of-care based on problems that the Nurse Identifies.

Operates defibrillator(s), EKG machines and cardiac monitors.

Can initiate life saving…