Attachment C - PWS Registered Nurse.pdf

PERFORMANCE WORK STATEMENT

Registered Nurse (Ambulatory Nursing Services)

Fort Yuma Health Care Center (FYHCC)

BPA - Multi-Specialty Ambulatory Care Services

1. Background and Purpose

Fort Yuma Health Care Center (FYHCC) is an Indian Health Service (IHS) facility located in Winterhaven, California, serving a primarily Native American patient population. FYHCC requires contractor-provided ambulatory nursing services from time to time to maintain continuity of outpatient clinical operations, patient safety, and timely access to care. This Performance Work Statement (PWS) defines the required service outcomes, performance standards, deliverables, and operating constraints for contractor-provided Registered

Nurse (RN) ambulatory care services in FYHCC ambulatory care settings.

This PWS is structured as a nonpersonal services requirement. It does not establish a requirement to fill

Government staffing vacancies or to augment Government supervisory chains. The contractor remains responsible for managing and supervising its workforce while the Government evaluates whether BPA call services meet applicable BPA, call, and PWS requirements.

2. Scope and Required Service Outcomes

The contractor shall provide ambulatory nursing services at FYHCC during BPA call coverage periods through qualified, cleared, competency-validated, and authorized Registered Nurse clinicians. Services shall be performed in accordance with applicable licensure, validated competencies, valid provider orders, standing orders or protocols authorized for use at the facility, FYHCC policies and procedures provided during onboarding, current

IHS requirements, applicable privacy and security rules, and current accreditation standards applicable to the facility.

• Perform patient intake, nursing assessments, triage, medication administration, treatments, immunizations, specimen collection, patient monitoring, and other nursing interventions within the RN scope of practice, validated competencies, and applicable provider orders or authorized protocols.

• Recognize changes in patient condition; initiate appropriate nursing response; and promptly notify or escalate to the appropriate licensed independent practitioner, emergency response team, or higher level of care when clinically indicated.

• Document patient encounters, assessments, vital signs, medications, treatments, education, telephone or triage advice, hand-offs, and follow-up instructions accurately and timely in the Government electronic health record (EHR).

• Carry out ordered nursing tasks safely and timely, including medication reconciliation support, patient education, discharge instructions, referrals, and coordination of follow-up services as applicable to the BPA call coverage.

• Support safe clinic flow, timely patient access, and continuity of care during BPA call coverage periods while applying independent professional nursing judgment to each patient interaction.

• Protect patient rights, informed consent, privacy, dignity, and cultural considerations in all interactions.

• Comply with infection prevention, medication safety, mandatory reporting, workplace safety, exposure control, and emergency response requirements applicable to the clinic setting.

• Participate in required orientation, patient safety, competency validation, quality activities, and other administrative requirements reasonably associated with the BPA call services.

• Meet the measurable performance standards and deliverable requirements stated in this PWS and the applicable BPA call.

3. Nonpersonal Health Care Services and Independent Contractor Relationship

This requirement is for nonpersonal health care services. The contractor and all contractor personnel perform in the capacity of independent contractors and are not Government employees. Contractor personnel shall not receive Government employee benefits, shall not be integrated into Government personnel-management systems, and shall not be supervised or managed as Government employees.

The Government may identify required workload, clinic coverage periods, patient access requirements, service outcomes, Government-furnished systems and facility rules, and performance expectations. The Government may also evaluate the quality, timeliness, completeness, and acceptability of services for contract administration, competency validation, credentialing or privileging when applicable, quality assurance, patient safety, and compliance purposes. These functions do not create an employer-employee relationship and do not authorize

Government personnel to perform contractor supervisory functions.

The contractor is solely responsible for recruiting, employing, compensating, scheduling, directing, supervising, training, evaluating, disciplining, retaining, and replacing its personnel. Government personnel shall not assign daily work to contractor employees, approve contractor employee leave, prepare contractor employee performance appraisals, discipline contractor employees, direct contractor staffing decisions, or otherwise exercise employer authority over contractor personnel.

Routine contract administration, staffing continuity, leave coverage, backfill, performance deficiencies, corrective action, and personnel matters shall be communicated through the Contracting Officer, COR, and the contractor's designated contract manager. Communications needed for patient scheduling, clinic workflow, provider orders, authorized nursing protocols, emergency response, referral pathways, EHR use, infection control, safety, privacy, or compliance with facility rules are clinical and operational coordination only and do not constitute Government supervision of contractor personnel.

The Government retains no control over professional nursing judgment or patient care decisions within the RN scope of practice. Contractor clinicians remain responsible for exercising independent professional nursing judgment within their licensure, scope of practice, validated competencies, and authorized orders or protocols, while complying with applicable facility rules, patient safety requirements, and clinical policies.

4. Place of Performance

All services shall be performed on-site at Fort Yuma Health Care Center (FYHCC), 401 Picacho Road, Winterhaven, California 92283.

Remote or telework performance is not authorized unless specifically ordered in writing by the Contracting

Officer. FYHCC does not provide housing.

5. Period of Performance and BPA Calls

• Services shall be performed during the period of performance identified in each BPA Call issued under the resulting BPA.

• Each BPA call will identify required clinic coverage dates, shift or session times, anticipated start and end dates, required service outcomes, and any unique operating constraints.

• The contractor shall submit a complete candidate package for each proposed nurse at least forty-five (45) calendar days before the proposed start date unless a shorter lead time is expressly approved by the

Contracting Officer.

• No contractor employee may begin performance until all required security, onboarding, competency validation, credentialing or privileging actions when applicable, and access requirements are completed and the Government issues written authorization to start.

• The Government will not direct which contractor employee must be assigned to a BPA call. The contractor may use any qualified, cleared, competency-validated, credentialed or privileged when applicable, and authorized personnel who meet BPA, call, and PWS requirements.

6. Clinic Coverage, Scheduling, and Staffing Responsibility

Normal clinic operating hours are Monday through Friday, 0800-1700 Pacific Time, excluding Federal holidays, unless otherwise stated in the BPA call. BPA call coverage may consist of full-day, partial-day, or intermittent shifts or clinic sessions. The Government will identify required clinic coverage windows, service requirements, and performance expectations. The contractor is responsible for scheduling and managing its personnel to meet those requirements.

The contractor shall maintain staffing continuity sufficient to perform all BPA call nursing coverage with personnel who are qualified, cleared, competency-validated, oriented, and authorized to begin performance. The contractor shall designate a contract manager and an alternate contract manager responsible for staffing plans, schedule coordination, coverage continuity, leave coverage, backfill, and prompt communication with the CO and

COR.

During BPA call coverage periods, contractor personnel shall be available to provide direct nursing services, complete required EHR documentation, communicate clinically necessary patient instructions and hand-offs, and coordinate with FYHCC staff regarding patient flow, valid provider orders, referrals, and emergency response requirements. Workload may vary based on patient acuity, case mix, appointment demand, walk-in demand, provider orders, documentation requirements, interpreter needs, facility workflow, and system availability. Patient safety and professional nursing judgment govern the pace and sequence of care.

Coverage beyond BPA call periods, including after-hours care, on-call coverage, weekends, holidays, or additional shifts or sessions, requires prior written authorization under the BPA or applicable BPA call.

If a contractor employee becomes unavailable for a BPA call coverage period, the contractor remains responsible for maintaining or restoring required service coverage through any qualified and authorized personnel. The

Government may coordinate patient-care priorities and clinic-flow needs, but the contractor determines how to staff the BPA call requirement.

7. Minimum Qualifications and Credentials

• Graduate of an accredited school of nursing; Associate Degree in Nursing (ADN) or higher.

• Active, unrestricted Registered Nurse licensure in any U.S. State, the District of Columbia, the

Commonwealth of Puerto Rico, or a U.S. Territory.

• Minimum two (2) years of recent nursing experience in ambulatory care, primary care, urgent care, outpatient specialty care, or a closely related clinical setting.

• Current Basic Life Support (BLS) certification from an American Heart Association or American Red Cross approved provider.

• Demonstrated ability to document care in an electronic health record system.

• Ability to obtain and maintain FYHCC security access and all required onboarding, competency validation, and any credentialing or privileging requirements applicable to the position under local policy.

• Compliance with continuing education, immunization, and mandatory training requirements applicable to the clinician and the facility.

8. Security, Credentialing, Competency Validation, and Onboarding

The contractor shall submit complete and accurate onboarding material for each proposed nurse as required by the

Contracting Officer, the FYHCC Security Office, and the offices responsible for credentialing, competency validation, and access processing. Required material may include, as applicable, resumes, licenses, certifications, immunization records, exclusion screening results, fingerprint paperwork, identification documents, mandatory training records, and any other documents identified in the solicitation, BPA, applicable BPA call, or onboarding instructions.

The contractor is responsible for ensuring all credentials and required documents remain current throughout the period of performance and for immediately notifying the Contracting Officer and COR of any adverse licensure action, exclusion, sanction, lapse, investigation, loss of certification, failed competency validation, or other status change that could affect performance.

The Government may deny a proposed start date, suspend system or facility access, reject services, or require removal from performance when security, training, onboarding, licensure, competency validation, safety, privacy, conduct, or any applicable credentialing or privileging prerequisites are incomplete, expired, inaccurate, or no longer meet BPA, call, or PWS requirements. Such action is a contractual, facility access, competency validation, credentialing, privileging, or patient-safety action and does not constitute Government discipline of contractor personnel.

9. Performance Standards and Quality Assurance Surveillance Plan (QASP)

The following outcome-based standards establish the basis for Government acceptance and surveillance of BPA call services. Surveillance will focus on service outcomes, compliance, deliverables, and BPA/call performance rather than day-to-day supervision of individual contractor employees. The Government may assess performance through document review, schedule and coverage verification, invoice reconciliation, EHR audit, compliance review, quality review, incident review, deliverable review, and other surveillance methods consistent with the

BPA, applicable BPA call, and applicable law and policy.

If performance does not meet BPA, call, or PWS standards, the Contracting Officer may require a written corrective action plan within three (3) business days or another stated period. Continued failure to meet standards may result in rejection of services, denial or suspension of access, nonpayment for unaccepted services, removal from performance, or other contractual remedies available under the BPA or applicable BPA call.

Communications regarding performance deficiencies shall be made through the contractor's designated contract manager, except where immediate patient safety, privacy, security, or facility access action is required.

Performance Objective Performance Standard Government Surveillance / Acceptance

Method BPA call nursing coverage 100% of BPA call shifts or clinic sessions covered by qualified, cleared, competency-validated, and authorized contractor personnel. Any anticipated coverage gap reported to the CO and COR as soon as known with a proposed continuity plan.

Review of BPA calls, coverage reports, access rosters, contractor coverage and credential-status records, and invoice support records.

Licensure, security, onboarding, and competency status

100% current before start of performance and maintained throughout performance for each nurse providing services.

Document review; verification of licensure, exclusions, security status, mandatory training, competency validation, and required onboarding status.

Nursing services within scope and authorized orders or protocols

100% compliance with RN scope of practice, validated competencies, applicable provider orders or authorized protocols, and current facility policies.

Chart audit, incident review, quality review, and compliance review.

Medication administration and treatment safety 100% compliance with medication safety requirements, applicable treatment verification procedures, and documentation requirements.

Chart audit, medication administration record review, incident review, and compliance review.

Patient access and clinic-flow support Contractor nurse available during BPA call coverage windows and performs services consistent with local triage, patient safety, clinic-flow procedures, validated competencies, and applicable provider orders or authorized protocols.

Coverage verification, encounter review, EHR timestamps, patient-flow documentation, complaint review, incident review, and COR review of outcome data.

EHR documentation timeliness At least 95% of required encounter documentation completed on the day of service; 100% completed within 24 hours absent documented system outage or emergency circumstances.

EHR audit and sample record review.

Patient education, hand-offs, and care coordination At least 95% completed and documented the same day or by the next business day, as clinically appropriate.

EHR audit and review of discharge, referral, hand-off, and education documentation.

Patient rights, privacy, and informed consent support 100% compliance with applicable patient rights, consent support, privacy, confidentiality, and culturally respectful care requirements.

Complaint review, compliance review, privacy incident review, and sample chart audit.

Infection prevention and safety 100% compliance with applicable infection control, occupational safety, exposure response, and emergency response requirements.

Observation of service outcomes, incident review, safety documentation review, and compliance review.

Required orientation, training, and quality activities 100% completion of mandatory orientation and training and participation in required patient safety, competency validation, and quality activities reasonably associated with the BPA call services.

Training records, attendance records, competency validation records, and quality documentation review.

Deliverable timeliness and completeness 100% of required reports, invoice support records, incident notices, and corrective action responses submitted by the due date and containing the required information.

Deliverable log, invoice reconciliation, COR review, and CO/COR acceptance records.

Corrective action responsiveness Written corrective action response submitted within the required timeframe when requested, with root cause, immediate corrective action, preventive action, responsible contractor official, and implementation status.

CO/COR review of corrective action response, follow-up evidence, and subsequent performance data.

10. Government-Furnished Support and Interfaces

The Government will provide access to clinic space, nursing stations, Government-furnished equipment and supplies customarily available to FYHCC nursing staff, and access to the Government EHR and required systems necessary to perform BPA call services.

The Government will provide orientation to local clinical procedures, emergency response procedures, security and safety rules, documentation requirements, medication administration systems, referral pathways, standing orders or protocols authorized for use, facility-specific administrative processes, and other operating constraints required for integration into FYHCC operations. Such orientation is limited to facility-specific operating requirements and does not constitute contractor employee training, supervision, performance management, or personnel administration.

The Contracting Officer, COR, and any designated BPA call ordering or technical points of contact will address

BPA/call administration, acceptance, surveillance, ordering, and performance matters.

FYHCC staff may coordinate patient flow priorities, rooming needs, valid provider orders, authorized nursing protocols, referrals, EHR documentation procedures, emergency response requirements, and local operating procedures necessary to furnish the BPA call service. Such coordination does not authorize Government supervision of contractor personnel, contractor employee scheduling, contractor employee discipline, or control over professional nursing judgment.

The Government may communicate directly with contractor nurses when necessary for immediate patient care, safety, privacy, emergency response, competency validation, facility access, medication safety, or equipment/supply safety matters. Routine personnel-management and performance-deficiency communications shall be routed through the contractor's contract manager.

11. Contractor Management, Staffing Continuity, Removal, and Substitution

The contractor shall designate a contract manager and an alternate contract manager with authority to resolve staffing, coverage, performance, and administrative issues. The contractor shall provide the names, titles, telephone numbers, and email addresses of both individuals and shall update the Government within one (1) business day of any change.

The contractor's contract manager is the primary interface with the Contracting Officer and COR for scheduling coordination, staffing continuity, leave coverage, backfill, corrective action, performance management, and substitution decisions affecting contractor personnel. The contractor remains responsible for employee supervision, schedule management, work assignments, internal performance management, corrective actions, and any employee-relations matters.

If the Government determines that a contractor employee fails to meet BPA, call, or PWS requirements, poses a patient safety or security risk, lacks required credentials or competency validation, violates privacy or conduct rules, or otherwise is unsuitable for continued performance, the Contracting Officer may require removal from performance or may deny continued access. For immediate patient safety, security, privacy, or compliance concerns, removal or access suspension may be effective immediately.

The requirement is continuity of BPA call services, not replacement of any specific individual. When a nurse is removed, unavailable, or otherwise unable to perform, the contractor shall maintain or restore compliant coverage using any qualified, cleared, competency-validated, and authorized personnel who satisfy BPA, call, and PWS requirements. The contractor shall acknowledge any Government removal or coverage-deficiency notice within one (1) business day and provide an interim coverage plan within one (1) business day unless a shorter period is required for immediate patient safety or security concerns.

Any proposed substitute or additional nurse must satisfy all security, onboarding, competency validation, training, and any required credentialing or privileging requirements before beginning performance. The contractor shall submit a complete candidate package for any proposed substitute as required by Section 8 and the applicable BPA call. The contractor shall not provide services through unapproved personnel.

12. Deliverables

Deliverable Content / Description Due Date Recipient Contract manager contact information Name, title, phone number, and email address for the contractor's primary and alternate points of contact.

Within 2 business days after award and within 1 business day of any change.

CO and

COR

Candidate package Complete security, onboarding, qualification, competency validation, and any required credentialing or privileging documentation for each proposed nurse.

At least 45 calendar days before proposed start date, unless otherwise approved by the Contracting Officer or

BPA call.

CO/COR

and designated

FYHCC

offices Monthly Coverage and Credential Status Report

Nurse name(s), BPA call coverage dates, scheduled coverage, actual coverage provided, qualification/licensure/competency status, and any anticipated staffing risks affecting BPA call services.

Monthly, by the fifth (5th) business day after the end of the service month, unless otherwise stated in the BPA call.

CO and

COR

Monthly coverage report BPA call shifts, sessions, or hours; completed shifts, sessions, or hours; unfilled or partially filled coverage;

explanation for any coverage gap; and contractor action taken to maintain or restore coverage.

Monthly, with invoice support record or by the fifth (5th) business day after the end of the service month.

CO and

COR

Monthly Service

Performance Summary Summary of required quality, patient safety, documentation, training, competency validation, and compliance participation for the reporting month; include known issues, trends, and corrective actions when applicable.

Monthly, by the tenth (10th) business day after the end of the service month, unless otherwise stated in the BPA call.

CO and

COR

EHR encounter documentation Complete documentation for each patient encounter, including assessments, vital signs, medications, treatments, education, telephone or triage advice, hand-offs, follow-up instructions, and disposition as applicable.

Same day of service; 100% within 24 hours absent documented system outage or emergency circumstances.

Entered in

Governmen t EHR

Incident or status notification Notification of any patient safety incident, privacy issue, security issue, medication event, credentialing or competency problem, exclusion, licensure action, lapse, failed competency validation, or other event affecting performance.

Within 1 business day of discovery, or sooner when immediate patient safety, privacy, security, or facility access action is required.

CO and

COR

Corrective action response Written plan or response describing root cause, immediate corrective action, preventive measures, responsible contractor official, and implementation status when requested by the Government.

Within 3 business days of request unless another period is stated.

CO and

COR

Monthly invoice support record Dates of service, authorized shifts, sessions, or hours completed, nurse name(s), BPA call or line item reference, coverage confirmation, and any other information needed for acceptance and reconciliation.

Nurse names are included for credentialing, competency validation, EHR reconciliation, invoice reconciliation, and acceptance verification only.

With each monthly invoice. CO/COR/I

PP as applicable

13. Invoicing and Payment

Invoices shall be submitted electronically through the Invoice Processing Platform (IPP) or other Government-designated payment system. Each invoice shall include, at a minimum, the invoice number and date, BPA number and BPA call number, applicable BPA or call line item number, dates of service, nurse name(s), authorized shifts, sessions, or hours actually ordered and performed, unit prices, total charges, and the supporting service record required for Government acceptance and reconciliation.

Nurse names are required for credentialing, competency validation, EHR reconciliation, encounter verification, invoice reconciliation, and acceptance verification only. Inclusion of nurse names in invoice support records shall not be used to establish Government supervision, labor-hour control, or employee-management authority over contractor personnel.

The Government will pay only for accepted services that were ordered and performed. Additional coverage beyond ordered quantities or periods requires prior written authorization under the BPA or applicable BPA call.

The contractor shall not bill IHS patients or third-party payers for services covered by this BPA or applicable

BPA call.

14. Applicable Requirements

• Applicable provisions of the Indian Health Manual relating to nursing services, onboarding, credentialing or competency validation, peer review or quality activities, medical records, patient rights, infection control, pharmacy and medication safety, emergency response, and security.

• Current FYHCC clinical policies, standing orders or protocols, medication administration procedures, referral procedures, and local operating procedures provided at onboarding. Contractor nurses remain responsible for exercising independent professional nursing judgment within their licensure, validated competencies, and authorized provider orders or protocols. Facility procedures establish operating requirements but do not constitute contractor personnel supervision.

• Current accreditation standards applicable to FYHCC ambulatory care services.

• The Health Insurance Portability and Accountability Act (HIPAA), the Privacy Act, and applicable Federal information security and privacy requirements.

• Applicable Federal and State licensure, certification, workplace safety, child protection, and immunization requirements.

• Applicable HHS and IHS mandatory training, tobacco-free workplace, and facility access rules.

• Applicable solicitation, BPA, and BPA call terms, including inspection, acceptance, invoicing, security, privacy, and service-performance requirements.

• The solicitation, resulting BPA, and applicable BPA calls shall include FAR 52.237-7, Indemnification and

Medical Liability Insurance, with the required medical liability insurance amount inserted by the Contracting

Officer, as applicable to the nonpersonal health care services requirement.

This PWS states the required results and operating constraints for the service requirement. Solicitation clauses, BPA terms, pricing terms, insurance requirements, and other legally operative terms shall be addressed in the solicitation, resulting BPA, and applicable BPA calls.