IHS1488587 - PWS.pdf

PBWS No. CPSU-ED

Crownpoint Service Unlt Performance Base Work Statement (PBWS)

For Personal Services

REGISTERED NURSING SERVICE _ EMERGENCY DEPARTMENT

August 3 2022 l4

Table of Contents

Section Page

1.0 General 1-3

2.0 Def initions 3-6

3.0 Government Furnished lnformation, Property, & Services 6-7

4.0 Contractor Furnlshed Property QO

5.0 Performa nce Based Requ irements 9-13

6.0 Contractor Qua lification Req u irements 13

7.0 FederalTort Claims 13

8.0 Cha llenge of Conflict

9.0 52.249 -t2 1 ermination (Personal Services) {Apr. 1984)

10.0 Tech n ical Direction 14- 15

1 1.0 Health Req uirement/Cond ition of Employees 15

L2.0 Language Requirement and Cultural Awareness 15

11.0 List of Attachments and Exhibits 17-18

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PBWS No CPSU-ED August 3 2022

REGISTERED NURSING SERVICE _ EMERGENCY DEPARTMENT

1.0 General: This performance base work statement describes the requirements for a PersonalService

Contract- Registered Nursing Services to support the mission of the lndian Health Service (lHS).

1.1 Background: IHS is an agency within the U.S. Department of Health and Human Services and is responsible for providing federal health services to American lndians and Alaska

Natives. The provision of health services to members of federally recognized tribes grew out of the special government to government relationship between the federal government and lndian tribes. The IHS is the principal federal health care provider and health advocate for the lndian people. The goal is to assure that comprehensive, culturally acceptable personal and public health services are available and accessible to American lndians and Alaska Natives. The IHS currently provides health services to approximately

1.5 million American lndians and Alaska Natives who belong to more than 557 federally recognized tribes in 34 states.

There is a nationwide shortage of nurses which is amplified by the remote and rural areas served by the lndian Health Service. The nursing vacancy rate within IHS has been consistently at 32%. These vacancies are being filled through the use of contracts.

Scope: The Contractor shall provide nursing services for the Navajo Area lndian

Health Service (NAIHS) in accordance with section 5.0, performance base requirements.

1.2.L. Duties and responsibilities will encompass outpatient, inpatient and community health nursing services to all patients.

1.2.2 Place of Performance: Services will be performed at various NAIHS facilities (Service Units, llealth Centers) located throughout the State of Arizona, New

Mexico and Utah. The NAIHS administers health centers, and hospitals, providing health care to approximately 201,583 members of the Nava.jo Nation. The Nava.io

Nation is the largest lndian tribe in the United States and has the largest reservation, which encompasses more than 25,516 square miles in northern Arizona, western New Mexico, and southern Utah, with three satellite communities in central New Mexico. The NAIHS is the primary provider of inpatient, ambulatory care, preventive and community health, and environmental health services for members of the Navajo Nation and the San Juan Southern

Pa iute Tribe.

PBWS No CPSU-ED

1.3

August 3 2022

1.2.3 Point of Contact: The Contractor shall provide a point of contact that will be responsible for the performance of the work. This individual shall have full authority to act for the Contractor on all matters relating to the daily operation of the contract. The point of contract may be a provider providing care in a ccordance with this Performance Ease Work Statement. The Contractor shall designate this individual in writing to the Contracting Officer (CO) before the contract start date.

An alternate may be designated, but the Contractor shall identify those times when the alternate shall be the primary point of contact.

L.2.5 Arrange for Replacement Staff: The Contractor shall arrange for pre-credentialed replacement staff when their health care provider(s) is unable to provide services for one (1)or more consecutive scheduled shifts.

r. t.6 Work Roster: The point of contact shall provide a list by date, time, and individual nurse's name for those days the contractor shall be providing services. The work roster shall be provided to the Project Officer by the 20th of each month of the preceding month. Any proposed workschedule changesshall be su bmitted to the Project Officer at least 48 hours in advance.

7.2.7 Continuity of Services: The Contractor shall ensure that qualified backup nurses are available to provide coverage during scheduled and unscheduled absences to primary contract providers. Absences without backup coverage will be subject to deduction in accordance with FAR Part 52-2D-aQ)

Applicable Documents: Please see the web link listed unless document is listed as an attachment.

1.3.1 The Joint Commission on Accreditation of Healthcare Organizations. The loint Commission (TlC) http //wvrw. iointcom m ission.org

1.3.3 Accreditation Association for Ambulatory Health Care (AAAHC) http://www. aaa hc. org

1.3.4 Section 231 of Public Law 101-647, the Crime Control Act of 1990 http;//www.policvalmanac.org/crime/archive /crs federal crime policv.sh tml

Section 4087 of Public Law 101-630, the lndian Child and Family Violence Act http://www. n icwa .org/ ooltcv /law / p rotection/index.asp

1.3.5

L.2.4 Availability: The point of contact shall be available via telephone 24 hours a day, seven days a week including federal holidays.

1.3.2 Centers for Medicare and Medicaid Services (CMS) Standards http ://lvww.cms. hhs. gov

PBWS NO: CPSU.ED

2.0 Definitions

2.7

2.2

August 3 2022

1.3.6 Health lnsurance Portability and Accountability Act (HIPAA) of L996 httol /www.cms.hhs.sov/hipaa

7.3.7 Privacy Act of 1974. htto://www. usdoi ovloiolorivstat. htm

1.3.8 Revised American Nurses Association Code of Ethics and Standards of Practice and Care (1995) http://www. n u rsingworld.ore

1.3.9 State Nurse Practice Act for the Contractor's licensing state. http:1/med i -s m a rt. com/p ra ct ice. htm

1.3.10 Navajo Area IHS Service Unit and Health Center Policies, Procedures and Protocols. (See section 11.0 for a list of attachments and exhibits)

1.3.11 Location Map (attached)

1.3.12 Sample Task Order (attached)

1.3.13 Customer Evaluation Form (attached)

1.3.14 Computer Security Act of 1980

btp.ll44Cf b514= y1adminmggrresouces/computersecu rityact

1.3.15 Federal Code of Conduct htto://www. ihs.eov

1.3.16 I HS General Directives http://www.lhs.eov/adminmggrresouces

1.3.17 IHS Computer Security Directives htto:l/www. ihs.sov/ad m in msgresou rces

1.3.18 Nurse License Look up htto://y{ww. n u rsvs.cor0

Acceptance: Constitutes acknowledgement that the supplies or services conform to the applicable contract quality and quantity requirements, except as provided in FAR subpart

46.5 and subject to other terms and conditions of the contract.

Approval: Acknowledgment by the designated Government official that submittals, deliverables, or administrative documents (e.9., insurance certificates, installation schedules, planned utility interruptions, etc.) conform to the contractual requirements.

Government approval does not relieve the Contractor from responsibility for compliance with contract requirements.

Area: A defined geographical region for lndian Health Service administrative purposes

Each Area Office may administer several Service Units.

PBWS No: CPSU-EO August 3 2022

2.4 Code of Ethics: The Revised American Nurses Association Code of Ethics and Standards of

Practice and Care, published in 1996 by the American Nurses Association which makes explicit primary goals, values and obligations of the nursing profession.

2.6. Contractor: The individual awarded a legal binding contract to provide supplies and services.

2.1 Contracting Office/s Representative (COR) or Project Officer (Po): A federal employee who assists the ordering/issuing activity contracting officer in the administration of task orders issued under this contract. The COR is primarily responsible for the technical assistance and day-to-day program mana8ement of the ordering activity's task orders. Ordering activities may have different designators for this employee (e.g. GTR - Government Technical Representative, CoTR-Contracting Officer's Technical Representative, or PO-

Project Officer).

2.8. Cooperative Attitude: Behavior that is positive and displays a willingness to perform assigned patient care tasks and to be a team player.

Cultural Awareness: Realization and respect for American lndian and Alaska Native

2.70. Customer: Patients, staff and visitors of an NAIHS service unit and NAIHS health center

2.71-.

2.1-2

Customer Evaluation: Written comments made to the Contracting Officer regarding the Contractors performance. This is one of the criteria used to evaluate the Contractor's performance.

Dependability: Qualities of beinB trusted and being able to repeat the same task to yield the same result.

2.L3. Federa I Acqu isition Regulation (FAR): The FAR is the primary regulation for use by all Federal

Executive agencies in their acquisition of supplies and services with appropriated funds.

2.74. Government Vehicle: A NAIHS owned motor vehicle or a vehicle leased by NAIHS through agreements with the General Services Administration (GSA) or through commercial rental agreements.

Pueblo Pintado Health Clinic & Thoreau Health Station, (THS): A facility physically separated from a hospital, with a full range of ambulatory services including at least primary care physicians, nursing, and laboratory, and x-ray which are available at least 40 hours a week for outpatient care.

2.15.

2.5. Contracting Officer (CO): A Government employee with the authority to enter into, administer, and/or terminate contracts and make related determinations and findings.

2.9.

PBWS No: CPSU-ED August 3 2022

2.L6. Non-Personal Services Contract: A contract under which the personnel rendering the services are not subject, either by the contract's terms or by the manner of its administration, to the supervision and control usually prevailing in relationships between the Government and its employees, as defined in FAR 37.

2.77. Ordering Activity: An authorized user of NAIHS that may issue a task order to obtain required services u nder this contract.

2.78. ordering Activity Contracting Officer: A Government employee of NAIHS authorized and warranted to issue task orders and to make subsequent task order modification(s) under this contract. The Ordering Activity (CO) has the authority to make initial deterrninations on all matters of dispute regarding task orders.

2.79. Orientation: An activity designed to provide basic familiarization of the facility and transition the nurse into the NAIHS Service Unit and/or Health Station and the nursing unit where the services will be provided.

2.20. Past Performance lnformation: Relevant information regarding a contractor's actions under previously awarded contracts. This includes the contractor's record of conformance to specifications and to standards of good workmanship; the contractor's record of containing and forecasting costs on any previously performed cost reimbursable contracts;

the contractor's adherence to contract schedules, including the administrative aspects of performance; the contractor's history for reasonable and cooperative behavior and commitment to customer satisfaction; and generally, the contractor's business-like concern for the interest of the customer.

2.22 Performance based Matrix: Lists the services to be monitored and the standards to be applied.

2.23 Personal Protective Equipment (PPE): The equipment used to protect medical personnel from exposure to biological, chemical, and radioactive hazards.

2.24 Quality Assurance Surveillance Plan (OASP): Service Unit: Written document prepared and used by the government for Quality Assurance surveillance of the contractor's performa nce.

Quality Control Plan (QCP): Those actionstaken by the Contractor to control thequalityof services provided. The Contractor's QCP must be equivalent to the Government's Quality Assurance Plan.

Standards of Practice and Standards of Care: Authoritative statements by which the nu rsing profession describes the responsibilities for which its practitioners are accountable. The

2.26

2.2L. Patient Outcome: End result of nursing care.

2.75.

PBWS No: CPSU-ED August 3,2022 standards provide direction for professional nursing practice and a framework for the evaluation of practice. The standards of professional nursing practice may pertain to genera I or specialty practice.

2.27 Supervisor: Government employee authorized to provide verbal and written performance direction to the Contractor that the Contractor must follow without exception.

2.28. Task Order: An order issued in accordance with the terms of the contract that details an ordering activity's specific requirements. An ordering activities written order to obtain services, at a minimum will include the following where applicable: description of services, skill categories, hours, price, period of performance, contract number, and the ordering activities task order number.

2.29 Technical Direction: A directive to the Contractor that approves approaches, solutions, designs, or refinementsj fills in details or otherwise completes the general description of work or documentation items; shifts emphasis among work areas or tasksj or furnishes similar instruction to the Contractor. Technical direction includes requiring studies and pursuit of certain lines of inquiry regarding matters within the general tasks and requirements in Section 5 of this contract.

2.30. Tour of Duty: The time of day the nurse is scheduled to perform nurslng care duties; also considered the shift of the day. The time can vary according to the needs of each NAIHS facility and/or clinic, e.g. 11.5 hour Tour of Duty, with one shift at 11 hour Tour of Duty totaling 80 hours every two weeks. There may be a mid-shift scheduled from 1100 to 2330 or 1500 to 0330.

2.31. Valid Patient Complaint: Justifiable accusation made by a patient and supported by investigation.

2.32 Verifiable Emergency: An unexpected/unplanned absence by the contractor requirinB valid documentation to confirm the occurrence.

3.0 Government Furnished lnformation, Property and Services

3.1. lnformation: Government unique information related to this requirement, which is necessary for Contractor performance, will be made available to the Contractor. The

ContractinB Officer or designee will be the point of contact for identification of any required information to be supplied by the Government.

Joint Use by the Government and the Contractor: Except for the property and service listed in 3.3 and 4.0, the Government will provide, for joint use by the Government and the Contractor, all necessary equipment, supplies, and clinic space to perform the services u nder this contract.

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3.2.1 GSA Vehicle: lf required bv the position, authorization shall be in accordance with NAIHS Chapter 12, Section 13 Motor Vehicle Management. Contractors may ride in Government vehicle but not authorized to drive a Government vehicle.

3.2.2 Government Housing: No government housing is available, unless there is a vacancy. This will be determined by the Housing Committee

3.3 Contractor Exclusive Use:

3.3.1 Personal Protective Equipment (PPE): The Government will furnish the Contractor with appropriate PPE other than specified in paragraph 4 of the PBSOW.

The Government will be responsible for any repair, cleaning, and inventory required for the PPE. This does not include any type of uniform or laboratory coat.

3.3.2 The Government will provide facility specific contractor identification badges for each contractor. A minimum fee of 55.00 will be charged for lost or destroyed badges.

Training: Facility specific orlentation/training necessary for the Contractor to perform the required duties, e.g., NAIHS information technology (lT) systems and operational procedures. Training will be provided ONLY if the subject matter is necessary to improve or enhance the quality of nursing services or includes mandates made by the NAIHS Service

Units/Health Centers while the nurse is working under this contract. Training will not be provided for the purpose of continuing education, career development or individual development.

Supervisor: The contractor is subject to the supervision and direction of Dorothina Francisco, Supervisory Nurse (5N) for Emergency Department or her designee, Fern Detsoi, SN, for this order.

3.5.1 Contracting Officer Representative (COR): lames Tom, Health System Specialist is primarily responsible for monitoring the technical progress including surveillance and assessment of performance for this order.

3.5.2 Point of Contact (POC): Dorothina Francisco, Supervisory Nurse (SN) (505) 786-

Protection of Government Buildlng, Equipment, and Vegetation: The Contractor shali use reasonable care to avoid damaging existing building, equipment, and vegetation on the Government installation. lf the Contractor's failure to use reasonable care causes damage to any of this property, the Contractor shall replace or repair the damage at no expenses to the Government as the Contracting Officer directs. lf the Contractor fails or refuses to make such repair or replacement, the Contractor shall be liable for the cost, which may be deducted from the contract price.

3.4

3.5

3.6

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PBWS No: CPSU.ED August 3,2022

4.0 Contractor Furnished Property

4.7. Except for the property specified in paragraph 3 as government furnished, the Contractor shall provide all uniforms and other personal medical instruments subject to the following:

4.7-1. Uniforms and Lab coats: Uniforms and Lab Coats shall conform to the requirements of the lndian Health Service Manual, Part 3 Chapter 4 and meet the approval of the Chief Nurse Executive at each IHS facility.

4.7.2. Other personal medical instruments: "Other personal medical instruments" are defined as Contractor owned items may include but not limited to stethoscope, scissors, as appropriate to the work unit. The Contractor shall not use unsafe equipment or supplies at any time during performance of this contract. All

Contractor furnished equipment and supplies shall be sub.iect to inspection by the Government and must be approved by the COR prior to use by the Contractor. The Government reserves the right to prohibit the use of any materials, supplies, or equ ipment.

4.7.3 lndemenification and Medical Liability lnsurance:

(a) lt is expressly agreed and understood that this is a personal services contract, as defined in Federal Acquisition ReBulation (FAR) 37.101, under which the professional services rendered by the Contractor are rendered in its capacity as an independent contractor. The Government may evaluate the quality of professional and administrative services provided, but retains no control over the professional aspects of the services rendered, including by example, the Contractor's professional medical .judgment, diagnosis, or specific medical treatments. The Contractor shall be solely liable for and expressly agrees to indemnify the Government with respect to any liability producing acts or omissions by it or by lts employees or agents. The Contractor shall maintain during the term of this contract liability insurance issued by a responsible insurance carrier of not less than 51,000.000 per specialty per occurrence, $3,000.000 aggregate.

(b) An apparently successful offer or upon request by the Contractor Officer, shall furnish prior to contract award evidence of its insurability concerning the medical liability insurance required by paragraph (a) of the clause.

(c) Liability insurance may be on either an occurrences basis or on a claims-made basis. lf the policy is on a claims-made basis, an extended reporting endorsement (tail) for a period of less than 3 years after the end of the contract term must also be provide.

PBWS No: CPSU.ED August 3, 2022

(e) The policies evidencing required insurance shallalso contain an endorsement to the effect that any cancellation or material change adversely affecting the Government's interest shall not be effective until 30 days after the insurer or the Contractor gives written notice to the Contracting Officer, lf, during the performance period of the contract the Contractor changes insurance providers, the Contractor must provide evidence that the Government will be indem nified to the limits specified in pa ragraph (a ) of th is cla use, for the entire period of the contract, either under the new policy, or a combination of old and new policies.

(f) The Contractor shall insert the substance of this clause, including this paragraph (f), in all subcontracts under this contract for health care services and shall require such subcontractors to provide evidence of an maintain insurance in accordance with paragraph (a) of this clause. At least 5 days before the commencement of work by any su bcontractor, the Contractor sha ll furnish to the Contracting Officer evidence of such insurance.

4.7.4 Housing/per diem/travel and other assocaated cost

(a) Contractor shall be responsible for housing, per diem, travel and other associated cost for their employee. Government housing will be available

ONLY if there is a Vacancy.

5.0 lqfgrmance Based Requirements: The Contractor shall provide nursing services in the delivery of patient care to the NAIHS. A specific tasks include the following:

5.1. Nursing Duties

5.1.1 The Contractor shall perform nursing duties and manage patient's needs as described in the attached Position Description (PD) - identified by the Service Unit and as directed by the Supervisory Nurse.

5.1.2. The Contractor shall perform in accordance with the competency standards listed in Exhibits, paragraph 11.2.

(d) Evidence of insurance documenting the required coverage for each health care provider who will perform under this contract shall be provided to the

Contracting Officer prior to the commencement of services under this contract. lf the insurance is on a claims-made basis and evidence of an extended reporting endorsement is not provided prlor to the commencement of services, evidence of such endorsement shall be provided to the

Contracting Officer prior to the expiration of this contract. Final payment under this contract shall be withheld until evidence of the extended reporting endorsement is provided to the Contracting Officer.

PBWS No: CPSU.ED August 3 2022

5.1.3. The contractor shall provide professional nursing service in direct patient care as follows:

(a) Contractor shall provide full range of Emergency services to patients in the Emergency Department.

(b) Contractorshall exercise knowledge of thenursingprocessanditsapplication to clinical practice in order to provide individualized, goal-orientated nursing care to the adult/ pediatric patient.

(c) Contractor shall exercise knowledge of scientific and psychosocial nursing theory, principles, practices and techniques in order to plan and provide quality nursing care which meets the physical, spiritual, and social-cultural needs of the lndian patient.

(d) Contractor shall exercise knowledge of biological aspects of disease processes and illness in order to recognize complications and implement appropriate therapeutic interventions required.

(e) Contractor shall exercise knowledge of the medications and dosages in order to recognize their desired effects, side-effects, and complications of their use.

(f) Contractor shall analyze the results of various medical procedures and translate them into appropriate nursing interventions.

(g) Contractor shall work effectively and harmoniously within the health care team and with lndian patients and their families.

(h) lnterFacility Transports

(i) Provide appropriate documentation regarding care rendered using Crownpoint Service Unit (CPSU) Electronic Health Record (EHR) & RPMS system. All documentation by the provider shall be entered electronically using the Electronlc Health Record system. The provider is responsible for utilizing the EHR/RPMS system to obtain pertinent patient information in assisting care. lt is the responsibility of the provider to use the training resources provided to develop competency in utilizing the Electronic Health Record system/RPMS.

(j) Follows facility policies and procedures, The .loint Commission (TJC), Occu pationa I Safety and Health Administration (OSHA), lndia n Health Services (lHS) and other federal licensing, accreditation and regulating body standards.

5.7.4 Contractor shall be subject to peer review per The loint Commission standards.

PBWS No CPSU-ED Augusl 3 2022

5.1.5 Contractor shall meet the Safety management reporting requirements in accordance with the Service Unit Safety Measure Policy.

5.1.6 Contractor shall be responsible for all applicable Federal, State, And Local Taxes, Meals, Travelf ransportation. Lodging is provided but must be paid for by the contractor or contract agency. Government quarters are available at prevailing rental rates plus utilities, as applicable, if government quarters are utilized. The contractor shall be responsible and liable for the proper care of government owned or leased property furnished in occupied quarters.

5.2 Work Schedule

5.2.1. Work shift: The Supervisor at each NAIHS facility will provide technical direction on the specific tour of duty. The Contractor shall work 100% of the contracted h ou rs.

5.2.2. Work Flexibility. As directed by the Supervisor, the Contractor shall rotate into other duty sections as needed to support patient care.

5.2.3. The Contractor shall obtain approval of the department Supervisor or designee prior to any absence from work. lf the length of the absence exceeds eight (8) work hours the Contractor shall request approval at least fifteen (15) days, (the exception is verifiable emergencies) in advance of the desired absence.

5.2.4. Approval of leave is contingent upon availability of a qualified replacement

5.2.5. The Contractor shall provide written documentation from a qualified health care provider for a bsences of th ree (3) or more consecutive days, due to illness, stating:

A. The cause ofthe current illness or incapacitation AND

B. lndicating the Contractor as contagious or non-contagious

The Government reserves the right to examine and or re-examine any Contractor who meets the criteria.

5.3. Conduct: The Contractor shall meet standards as listed in the Federal CodeofConduct

5.3.1. The contractor shall be su bject to cha racter investigation as required by Pu blic Law 101-360, the lndian Health Child Protection and Family Violence Prevention Act prior to performance of a contract by utilizing the U5 Office of Personnel Management (OPM), Electronic Questionnaire for lnvestigation Processing (eQlP) system and this shall include all fingerprinting procedures and clearances. The contractorshall provide all requested information necessary to perform Level land Level ll background checks. The contractor shall comply with the requirement to obtain security investigations. The contractor shall work with the l.H.S. to ensure

PBWS No CPSU-Eo August 3,2022 that the pre-employment screening process includes the appropriate investigation questionnaires and forms to be completed. All completed forms will be reviewed by the contractor and forwarded to the government personnel. The contractor will be immediately removed from the position if at any time the investigation receives unfavorable adjudication, or, if other unfavorable information that would affect the investigation becomes known.

5.4. PerformanceEvaluation:

5.4.1 The Contractor's performance will be evaluated in accordance with the standards set forth in the contract and Performance-based Matrix of section 11.0.

5.4.2 Substantiated reports written by any customer dealing with patient safety, infection control, or other procedure that adversely affects patient outcome constitutes a breach of contract.

5.5. ldentificationofContractor:

5.5.1. The Contractor shall wear a government issued contractor identification badge during performance of duty. PIV cards are issued after 6 months at Service Unit.

5.6 Management of Medical lnformation: The Contractor shall manage all patient information in accordance with HIPAA standards, Privacy Act, and NAIHS Service Unit and/or Health Center specific policies and protocols.

5.6.1. The Contractor shall ensure adherence to DHHS lT system security policies and procedures. The lT policies and procedures will be made available to the Contractor.

5.6.2. The Contractor shall immediately report to the Contracting Officer or COR for any information or circumstances that may violate any statute, policy, or procedure.

5.7. IHS lnformation Technology Systems

5.7.7. ln performance of this contract, the Contractor shall adapt to and successfully utilize IHS information technology systems that are deemed by the Supervisor as necessary for acceptable contractor performance.

5.7.2. The Contractor shall ensure that NAIHS information technology system security policies and procedures are adhered to. The lT policies and procedures wiil be made avallable to the Contractor at each NAIHS facility.

The Contractor sha ll follow all appropriate federal and locally required information Technology security requirements and will be operating under Health lnsurance Portability and Accountability (HIPAA) and Privacy Act regulations.

5.7 .3

PBWS No CPSU-ED August 3 2022

5.7.4. lnformation Tech nology Skills. The Contractor shall possess basic knowle dge, skills, and abilities to use a computer

6.0 ContractorQualificationRequirements:

Experience. The Contractor shall have thirty-six {36) months of nursing experience, with a minimum of two (2) years in the specialty required by the.

contract, unless otherwise approved by the Contracting Officer.

6.2 License/Registration. All nurses shall possess a current, valid, unrestricted nursing license in a state, the District of Columbia, the Commonwealth of Puerto Rico, or a Territory of the United States, throughout the term of this contract.

6.5 Orientation: All nurses providing service under this contract shall attend mandatory orientations and lraining specified by the government.

6.6 Background Checks: As directed by the Contracting Officer, the Contractor shall provide all requested information necessary to perform Level I and Level ll background checks. The Contractor shall comply with the requirement to obtain security investigations. The Contractor shall work with the NAIHS to ensure that the pre-employment screening process includes the appropriate investigation questionnaires and forms to be completed. All completed forms will be reviewed by the Contractor and forwarded to the Supervisor. The Contractor will be immediately removed from the position if at any time the investigation receives unfavorable adjudication, or, if other unfavorable information that would affect the investigation becomes known.

An Agreement to a Temporary Waiver of character investigation form shall be signed and used pending completion of background investigation.

FederalTort Claims Act (28 USC 1346 (B) 1946): FTCA is not extended to Non-Personal Service Contractors, refer to clause 52.237 -7 lndemnification and Medical Liability lnsurance.

7.0

6.1

6.3 Motor Vehicle Operator's License. lf required by the position, the Contractor shall possess a valid state driver's license throughout the term of this contract.

6.4 Certifications: Current Basic Life Support (BLS) is mandatory for all specialties.

Pediatric Advanced Life Support (PALS), Newborn Life Support (NLS), Advanced Trauma Care Nurse (ATCN) or Trauma Nurse Critical Care (TNCC), and Advanced Cardiac Life Support (ACLS) are required for each appropriate duty section at the time of selection for contract award. The contractor shall ensure that the contract nurse's certifications remain valid throughout the term of this contract.

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8.0 Challenges to Conflicts: For any inconsistency between supervisor directions, this Performance Work Statement, attachments and exhibits, the following order of precedence will apply:

(a) First Priority: Supervisor's directions

(b) Second Priority: Position Description (attached)

(c) Third Priority: Performance Work Statement Exhibits

(d) Fourth Priority: Performance Work Statement Narrative

9.0 .249-12 Termination Personal Services 't984 The Government may terminate this contract at any time upon at least 15 days'written notice by the Contracting Officer to the Contractor. The Contractor, with the written consent of the Contracting Ofiicer, may terminate this contract upon at least 15 days' written notice to the Contracting Officer.

9.1. Any Contractor employee demonstrating impaired judgment shall not be allowed to continue working immediately on the contract. The Government reserves the right to remove from the facility any Contractor employee who in the judgment of a licensed healthcare practitioner is impaired.

'10.0 TechnicalDirection

10.1 Performance of the work under this contract is subject to the written and verbal technical direction of the Nursing Supervisor.

10.2 The Nursing Supervisor does not have the authority to, and shall not, issue any instructions purporting to be technical direction that:

Constitutes an assignment of additional work outside the performance work statement, Constitutes a change as defined in the changes;

ln any manner causes an increase or decrease in the total estimated contract cost, fixed fee (if any), or the time required for contract performance;

Changes any of the expressed terms, conditions, or specifications of the contract;

or the terms and conditions of the contract.

10.3 All technical direction shall be issued in writing by the Nursing Supervisor. All verbal drrection will be confirmed in writing within 24 hours (one business day). The Contractor shall proceed promptly with the performance of technical direction duly issued by the Nursing Supervisor in the manner prescribed by this clause and within the authority. lf, in the Contractor's opinion, any instructions or direction by the Nursing Supervisor falls within any of the categories defined in paragraph above, the Contractor shall not proceed but shall notify the Contracting Officer in writing within 5 working days after receiving it and shall request the Contracting Officer to take action as described in this clause. Upon receiving this notification, the Contracting Officer shall either issue an appropriate contract modification within

PBWS Nor CPSU-ED August 3 2022 a reasonable time or advise the Contractor in writing that the instruction or direction is within the requirements of the contract and does not constitute a change under the changes clause of the contract and that the contractor shall proceed promptly with its performance.

'10.4 A failure of the Contractor and Contracting Officer to agree that the instruction or direction is both rescinded in its entirety; or within the requirements of the contract and does not constitute a change under the changes clause, or a failure to agree upon the contract action to be taken with respect to the instruction or direction shall be subject to the Disputes clause of this contract.

'10.5 Any action taken by the Contractor in response to any direction given by any person other than the Contracting Officer or the Nursing Supervisor shall be at the Contractor's risk

11.0 Health Requirements/Conditionsof Employment

11.1 Medical Evaluation. The Contractor shall provide a fitness for duty certificate issued by a licensed physician to perform the proposed job without significant risk to personal health or the health and safety of others.

11.2 lmmunization. The Contractor shall also provide the following documentation prior to RN Candidate selection: .lmmunityto Rubella, Mumps, and Rubeola (Measles);

. Proof of Hep B vaccination x3 OR positive titer OR a signed declination of the Hep B vaccinations will also be accepted; . Documented history of chicken pox OR varicella vaccination x2 OR positive varicella titer; . History of Tdap vaccination, with subsequent Td vaccination if older than 10 years; . Documentataon of Tuberculosis testing (TB skin test or IGRA) within the past 12 months with documentation of chest x-ray and follow-up for a positive history; '12 months with documentation of follow-up for a positive test. . Proof of influenza vaccination from October -1 thru March 31, per IHS Mandatory lnfluenza Vaccrnation Policy. Proof of Vaccination against SARS-COV-2, the virus that causes COVID 19

12.0 Language Requirements and Cultural Awareness. The Contractorshall read, understand, speak, and write English to effectively communicate with patients and other health care workers, and shall be respectful of the local, American lndian and Alaska Native culture.

PWS No r CPSU-AC Branch February 23,2021

11.0 Performance - based Matrix

I Standard

List Pos,tive and Negative lncentives- Addres! method of linkinB payment to quality of

State the end results or outputs that you, the customer willformally accept or reject.

for each "andicator," state a performance levelthat, when met, means the task has been performed setisfactorily.

Ihis Standard describes "What Slccess Looks Like."

For each 'Standard", state the method used to check performance (i.e.

randorn samplinB, 10096 anspection, periodic inspection, customer complaints).

Payment ofcontract price for satisfactory rervice.

Contractor performance will be evaluated using the Contractors Performance Assessment RePort

(CPAR). The evaluation wlll be consldered when future IHS

Contract selections are made, See QASP. Surveillance systems will lnclude periodic inspections and customer complaints.

Contractor shall provid€

NursinB services in the delivery of patient care to the Navajo Area lndian

Health Service.

Patlent Outcomes

Service Quallly

Cornpllance

Cred€ntr. ng

Perform 1O0% required tasks at 100% of the requrred competencies (refer to 11.0)

100% compJ ance with IHS Service Units and/or He.hh Centers published Policles; Procedures; Standards of care;

and hospital and nursinB Protocols.

No repo(s of breached patlent safety, infection control, and other procedures that might adversely affect patient outcome.

Performance characteozed by continual cultural awarenesa and focus on customer service. 1o0 percent adherence to the NursinS code of Ethics and Federalcode of Conduct.

Unrnterrupted credentialing as defined in 6.0 to 6-8 for period of contract.

100% percent of all documentation meets estabhshed lHs

Medlcal Facilrty, TJC, and CMS standards to include, but are not limlted to, timellness, legibility, accuracy, content, date, time, signature and desrgnated profession.

Satisfaction with quality of service is evidenced by vald customer lnputs.

Perfo.mance- based Ta6k Indlcator QualltyAs5urane lncentlves

Forthe requirement, state the featLire(sl of end resultthat will be surveilled.

PWS No.:CPSU'ED Match 4.2421

11.1. Attachments

1. Position Description (Service Unit specific)

1,7.2. Exhibits Applicable to the Navajo Area HIS

11.2.1. Written Competency Assessments

a. Confidentia lity/H IPAA/Patient's Rights

b. EMTALA Compliance Exam, 2004

c. Age Specific Competency Verification

d. RN Medication Administration Competency Examination

e. RN Medication Administration Competency Verification

f. lntravenous Therapy Exam

g. Venipuncture Procedure Skills competency Verification

h. Pain Management Competency Verification

i. Restraints

j. Soft Restraint Application Competency Verification

k. Hard Leather Restraint Application

11.2.2.

77.2.3.

1-1-.2.4.

17.2.5.

r L.l.b.

L1.2.7.

11.2.8.

t1..2.9.

11.2.70.

11.2.LL.

77.2.t2.

L7.2.13 .

1-1.2.t4.

t'J".2.1.5.

LL.2.1-6.

1-1-.2.17 .

11.2.18.

Contract Nurse Orientation Check List

Contract Nurse Orientation Competency Verification lnstructions

Contract Nurse Billing lnformation

Sta ndard Emergency Codes

Confidentiality: Legal and Ethical Concerns in Healthcare

EMTALA - Emergency Medical Treatment and Labor Act What are Age-Specific Competencies?

An lntroduction to the Navajo Culture

Verbal and Telephone Orders

Medication Administration

Pain Management Latex Allergy Focus Charting

Patient Restraints

Charge Nurse Duties: Responsibility and Expectation

Nu rsing Sta ndards

Standa rds of Nursing Practice

11.2 List of Attachments and Exhibits. To be provided by the Contracting Office r u pon request.

QUALTTTaSSURANCE SURVETLLANCE pLAx (OASP) for ER Nursing Services rhis is a non-personar ER nursins service:jffi::ffiiffffii;!:lJ::

Ij;i: i::,,,T s€rv,ce (rHS) by providins accessibre, safe, hish

1. PURPOSE

This Quality Assurance Surveillance Plan (QASP) provides the assessment methodology for performance of the stated contract. This QASP explains the following:

. Provide full range of emergency care to patients of all age ranges.

. Exercise Knowledge of the nursing process and its application to clinical practices in order to provide individualized, goal oriented nursing care to the adutt patient.

. Exercise knowledge ofscientifrc and psychosocial nursing theory, principles, practices, and techniques in order to plan and provide quality nu6ing care which meets the physical, spiritual, and social-cultural needs ofthe lndian patient.

. Exercise knowledge of biological aspects ofdisease processes and illness in order to recognize complications and implement appropriate therapeutic intervention required.

. Exercise knowledge ofthe medications and dosages in order to recognize their desired effeds, side effects. and complications oftheir use.

. Analyze the results ofvarious medical procedures and translate them into appropriate nursing interventions.

. Work effeclively and harmoniously, ,ithin the heatth care teams and with Native American patients and their families.

. Contractor shall follow facality policies and procedures, JACHO, OSHA, l.H.S. and other federal licensing, accreditations, and regulating body standards.

. Coordinate care teams, offer guidance, and support to team members.

. Teach and offer appropriate health education to staff, patients, and customer owners.

. Perform clinical procedures, intravenous access, and phlebotomy, point of care laboratory testing, lV lnfusions/lv Medications, EKG, SVN Respiratory Treatments and response to emergency codes.

How monitoring willtake place.

DIRECT OBSERVATION - Observation can be performed periodically or through 100% surveillance bythe Supervisory Clinical Nurse.

PERIODIC INSPECTION - Evaluate outcomes or chart reviews on a periodic basis - lnspedions may be scheduled as required by the Supervisory Clinical Nurse.

Who will conduct the monitoring?

The Supervisory Clinical Nurse is responsible with monitoring and assessing the contractor's performance specific to lndicators a through g in Section 10 ofthe Performance work Statement

How monitoring efforts and results will be documented.

Metrics and methods are designed to determine if performance exceeds, meets, or does not meet a given standard and acceptable quality level. A rating scale shall be used to determine a positive, neutral, or negative outcome. The following ratings shall be used:

ACCEPTABLE PERFORMANCE - The Government shalldocument positive performance. Any report may become a part ofthe supporting documentation for any contradual actaon.

UNACCEPTABLE PERFORMANCE - When unacceptable performance occurs, Key Government Personnel and the COR shall inform the CO. The CO will notfy the Contracto/s Company. This will normally be in writing unless circumstances necessitate verbal communication. ln any case the COR shall document the discussion and place it in the COR file.

lf formal written communic2tion is required, the CO shall prepare a cure notice, and present it to the Contractor's Company. The contractor shall acknowledge receipt ofthe cure notice in writing. The cure notice will specify ifthe contractor is required to prepare a correclive adion plan to document how the contraclor shall correct the unacceptable perfomance and avoid a recurrence. The cure notice will also state how long afler receipt the contractor has to present this correclive action plan to the CO. The Government shall review the contractor's corrective action plan to determine acceptability.

Any cure notice may become a part ofthe supporting documentation for any contractual ac{ion deemed necessary by the CO.

. What will be monitored?

POSITION DESCRIPTION lPledte rcad instructions on the bo.kl 183050 2.. Reason tor Subhission

! neaerrior on ! rc*

I n""'toui'r,."nt I ottrer E Reorsanization

E Headquanefi I Fieid

4. Employing Office Location

Window Rock AZ

5,DutyStation

Crownpoint, NM

2b.Positionlnformation{Completeilllhatapply)

Er* E Dt!9 X Phys <arExam Requred

6.FairLrbor5tandard5 Acr

! r,e.pr ffi rone,e.pt

7. Financial Statements Requned f] oGE 278 ! ocE-aso E N/a 8"* n*.

E competirive

J E\cepted lspe.ily ih rc o*t)

! srs tcrrut ! srstcnl n supetuiso'/Manaeer (code 2) f] sup€ryi'or<sRA (code 4)

-1 Manaqemen t OffEial (CSBA)

Li tcoa" st f] w6* Leade, (code 6) f] ream Leader (code 7)

El Neither icode 8)

1 2. Position Sen3itivity

E l-Non*nrnive

LJ s.n.,t',"

! 3-citicat sensrtive n a-special S€nritive

I il'lilT'*" n

6-PkublklrurvHigh i$" ruzo 000 FPL 1O tr tr tr

2. Exol.nrtion ashow .nv Dositions reola..dl

15 OPM Ce.tificalion No

OFA lpdale. 07/27/17 implemented 600 std to est 183050 which replaced Clini€al Nurse GS-610-l0/9/7 kaa1240/ 1 /2 est'd 02/U /93

10a. Adm nittrative Code

GFJ B3 B

! Limited term I Limireu rme,qency

NTE Date:

l0b,.lob Bequisition/Po5ition Numbe.

16. Classified/Graded by Offi.ial Title of Position Pay Plan Occupational Series Code

Grade lnitials Date

a. U.S. Office ofPersonnel Management

b. Department, Agency or Establishment

Nurse (ER) G5 610 10 v5 01/25/18

c. Recommended by Supervisor or lnitiating Office

17. Organizational Title of Position (if differcnt frcm officialtitle) 18. Name ofEmployee lif vacont, specify)

19, DEPARTMENTOF HEALTI.IAND HUMAN SERVICES

c. Third subdivision

Div of Nursing

a. First Subdivision

IHS/ NAIHS

d. Fourth subdivision

Emergenry Room Branch

b. Second subdivision

Crownpoint Service Unit

e. Fifth 5ubdivi5ion oppointnent ond payment of publi. fhds,and that falte otmisleoding srotenents may connituteviolotions of such notutesor theh implenenting rcgulotions.

a.Typed Namdfi e/trnployee IDof Immediote SupeNisot

Dorothina Francisco, Supv Nurse b fyp.d None/tub,Enployee lO ol Highet L.vel Supdnot ot Mo.oget (optio.ol)

Signat!re Dorothina A. 3i'LllljT?',"'I* "Francisco -S ?if,'.:T:":'

Date Signature Dat€

2r. Cl.rrm..ton/Job Cr.ding C.rtflr..(6. / certi, that this position hdsbeen<ta$ified/gtaded as rcquned W the Title 5, U.5. Code, in .anformonce with stondokh published by the U.5. Affice of Peqonnel Monog.nent aL if no publithed noodo.ds opply dnedt, cons4ently with the non oppkobte pubt i thed no nd odt

22 Position al.$ification Standads Uted in Cla$itin9/Grading Porition tJSOPM Job Family Position Classiflcation Standard for Profer5iona I Work in the Medicaland Healthca re 610 up, 0600, Sept 2017 fyped Nom. ond Tnle ol Olfi.iol faki.g Actian

Verna scott, HR Spec (Classi0

Signalure Verna Scott - g* 'Fd 'y "-

Irlmrion ior aFploys rh. na1dotdt and ihlot4otia. onthenapptkotiqate oeatobtetnthe hutun Eeutc6 afri.E ftu.totsnroion afthe patiion noy be Evt@d ohd.oied.d br the ogqq ot rh. U.5 Oflic. alP. bnh.l Mahoqe eat- tnLmonon m.lot\ifi.eri.ntob qddihq appdlt".nd @dpldihts an.kdpoan hoh FISA, tt.voildble hoh th. hundn isout..t.fii.e ol rh. u.5. Afri.. ol P..annel Monag.a.nt

,3. u"."r., uruS, r.r ! roI

24 D?t dp.ta^ otMajot Drtd dM t.santibitua.nd Elduotbn stot n dt lsQ Ankn.d) ot 3 lndl'.d Ausu't 2o!a) D.?:dh6r.rB.rltfi:ndHUDn5.Ei.3

NUGl

183050

NURSE (ER)

GS-610-10

The purpose of the position is to provide a range of nursing care procedures and treatments for Urgent Care or Emergency Services to a variety of patients.

II. MAJOR DUTIES AND RESPONSIBITITIES

900/o

Assesses all patients presenting for care and triages based on history physical assessments and chief complaint.

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Administers therapeutic measures as prescribed by the physician such as medications, treatments, intravenous fluids, blood transfusions, nasogastric tubes and diagnostic interventions.

Observes, assesses, and stabilizes critically ill pediatric, adults, and geriatric patient health status by physical assessment and examination, interviewing, reviewing health & medication history and monitoring. Stabilizes patlent for transfer to other facilities as necessary.

Records observations, nursing interventions, therapeutic measures, hemodynamic monitoring data, and other relevant data to the patient's care.

lnterprets data obtained from observations, examination, monitoring, and laboratory values, Distinguishes between normal and abnormalfindings, and provides appropriate care measures.

Provides nursing services to meet the physical, emotional, spiritual, social, and cultural needs of the critically ill patient and family.

Operates and monitors specialized equipment such as vital sign monitors, cardiac monitors, e lectroca rd iograp h, suction, hypothermic devices, ventilator, respiratory nebulizer, defibrillator, etc.

lnitiates, participates and presents cases in multi-disciplinary quality and safety discussions

Coliaborates with members of the multi-disciplinary team in assessing, planning, implementing and evaluating health care and educational needs.

Functions as the care provider, while patients are in transport mode, by ground ambulance, to other facilities, for admission or diagnostic testing and other procedures.

I. INTRODUCTION

This position is located in the Emergency Room Branch at the Crownpoint Service Unit. The facility provides services in General Medicine, Obstetrics (Labor/Delivery/Postpartum), Newborn, Pediatrics, Ambulatory Care, and Emergency Care.

DIRECT PATIENT CARE D UTIES:

l.

Functions in any segment of nursing servjce and performs other duties as assigned such as, responding to other areas in the facility where/when a cardiac…