Performance Work Statement_Draft.pdf

PERFORMANCE WORK STATEMENT (PWS)

NON-PERSONAL SERVICE - NURSING

TABLE OF CONTENTS

Page

1.0 General 2

1.1 Background 2

1.2 Scope 2-3

1.3 Applicable Documents 3-4

2.0 Definitions 4-7

3.0 Government Furnished Information, Property & Services 7

3.1 Information 7

3.2 Joint Use by the Government and the Contractor 7

3.3 Contractor Exclusive Use 7

3.4 Training 7-8

3.5 Protection of Government Buildings, Equipment and Vegetation 8

4.0 Contractor Furnished Equipment 8

4.1.1 Uniform and Lab Coat 8

4.1.2 Other Personal Medical Instruments 8

5.0 Performance-Work Statement (PWS) Requirements 8

5.1 Nursing Duties 8

5.2 Work Schedule 8-9

5.3 Conduct 9

5.4 Performance Evaluation 9

5.5 Identification of Contractor 9

5.6 Management of Medical Information 9

5.7 IHS Information Technology Systems 10

6.0 Business Associate Agreement 10

7.0 Contractor Qualification Requirements 10

7.1 Experience 10

7.2 License/Registration Certifications 10

7.3 Certifications 10

7.4 Health Requirements/Conditions of Employment 10-11

7.5 Language Requirement and Cultural Awareness 11

7.6 Information Technology Skills 11

7.7 Orientation 11

7.8 Background Checks 11

8.0 Termination for Cause 11

9.0 Technical Direction 12

10.0 Indemnification and Medical Liability Insurance 12-13

11.0 Performance Work Statement (PWS)-Matrix 14

12.0 List of Attachments and Exhibits 15

1.0 General: This performance work statement describes the requirements for Non-Personal

Service Contract for Nursing Services to support the mission of the Indian Health Service (IHS).

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

The IHS currently provides health services to approximately 1.5 million American Indians and Alaska Natives who belong to more than557 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 Indian Health Service. This performance work statement covers requirements for the Navajo Area. The positions to be filled include: Registered Nurse(RN) for the provision of outpatient and inpatient nursing services.

1.1.1 Navajo Area Indian Health Service (NAIHS) administers health centers and hospitals providing health care to approximately 201,583 members of the Navajo Nation. The Navajo Nation is the largest Indian tribe in the United States and has the largest reservation, which encompasses more than 25,SlGsquare 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 Nationand the San Juan Southern Paiute Tribe.

1.1.2 Gallup Indian Medical Center (GIMC) is a Service Unit under the jurisdiction of Navajo Area Indian Health Service located in Gallup, New Mexico. GIMC is a 74-bed inpatient which provides clinical specialties inclusive of Internal Medicine, Cardiology, Anesthesia, OB/GYN, General Surgery, Orthopedics, Podiatry, Ophthalmology, ENT, Radiology, Pathology, Pediatrics, Psychiatry, Emergency Medicine, and Family Medicine. The workload at Gallup is one of the largest hthe Indian Health Service with 250,000 outpatient encounters and 5,800 inpatient admissions annually. GIMC has the largest staff of all Navajo Area IHSfacilities and is considered a Level 3 trauma hospital.

1.2 Scope: The Contractor shall provide nursing services in accordance with section 5.0, performance work statement requirements.

1.2.1. Duties and responsibilities may encompass outpatient and inpatient nursing services to IHS patients.

1.2.2. Place of Performance: Services are to be performed at hospitals, clinics, other locations as determined by the GSU to provide needed services and other healthcare facilities ofthe Navajo Area Indian Health Service within the Gallup Indian Medical

Center. The award pricing schedule will identify the exact place of performance.

1.2.3 Period of Performance: Will be on a 3-month increment due to the funding allotment received by the unit, with options at a 3-month increments up to a maximum 1 to 3 years.

1.3 Applicable Documentsl Please see the web link listed unless document is listed as an attachment.

1.3.1 The Joint Commission {TJC) http://www.jointcommission.org/

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

1.3.3 Accreditation Association for Ambulatory Health Care

(AAAHC) http://www.aaahc.org

1.3.4 Section 231 of Public Law 101-647, the Crime Control Act of 1990.

http://www.icctc.org/Crime%20Control%20Act%20of%201990.pdf

1.3.5 Section 4087 of Public Law 101-630, the Indian Child and Family Violence Act. http:ljwww.icctc.org/1HS-BIA%20CPT%20Handbook/PL%20101-630.pdf

1.3.6 Health Insurance Portability and Accountability Act (HIPAA) of 1996. http://www.cms.gov/HIPAAGenlnfo/

1.3.7 Privacy Act of 1974. http://www.justice.gov/opcl/privacyact1974.htm

1.3.8 Revised American Nurses Association Code of Ethics and Standards of Practice andCare (1996) http://www.nursingworld.org

1.3.9 State Nurse Practice Act for the Contractor's licensing state.http://www.medi-smart.com/

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

1.3.11 Computer Security Act of 1980 http://security.ihs.gov/index.cfm

1.3.12 Federal Code of Conduct:

https://www.ihs.gov/lHM/index.cfm?module=dsp ihm pc p3c23

1.3.13 IHS General Directives

http://www.ihs.gov/index.cfm?module=AtoZ&option=index

1.3.14 IHS Computer Security Directives: http://security.ihs.gov/index.cfm

2.0 Definitions

2.1 Acceptance: Constitutes acknowledgement that the supplies or services conform to the applicable contract quality and quantity requirements,,!;and subject to other terms and conditions of the contract.

2.2 Approval: Acknowledgment by the designated Government official that submittals, deliverables, or administrative documents (e.g., 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.

2.3 Area: A defined geographical region for Indian Health Service administrative purposes.

Each Area Office may administer several Service Units.

2.4 Business Associate: Any company or person that is exposed to, handles, or works with the data in medical records is a "Business Associate" of the medical entities they work for.

2.5 Business Associate Agreement (BAA): A business associate agreement (BAA) is a contract between a HIPAA-covered entity and a HIPAA business associate (BA). The contract protects personal health information (PHI) in accordance with HIPAA guidelines.

2.6 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.

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

2.8 Contractor: The Company awarded a legal binding contract to provide supplies and services.

2.9 Contracting Officer's Representative (COR): 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 management of the ordering activity's task orders. Ordering activities may have different designators for this employee (e.g. COR-Contracting Officer's Representative or GTR

- Government Technical Representative,).

2.10 Contractor Performance Assessment Report: A report that assesses a contractor's performance and provides a record, both positive and negative, on a given contract for specificperiod of time.

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

2.12 Cultural Awareness: Realization and respect for all ethnic backgrounds e.g American Indian and Alaska Natives

2.13 Customer: Patients, staff and visitors of an IHS service unit and health center.

2.14 Customer Evaluation/Input: Written comments made to the Contracting Officer regarding the Contractors performance. This is one of the criteria used to evaluate the

Contractor's performance.

2.13 Dependability: Qualities of being trusted and being able to repeat the same task to yieldthe same result.

2.14 Federal Acquisition 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.

2.15 Federal Tort Claims Act (FTCA): The Federal Tort Claims Act (FTCA) is the waiver of sovereign immunity by the United States and provides the exclusive remedy for personal injury,death, and property damages resulting from the negligence of federal employees.

2.16 Government Vehicle: An IHS owned motor vehicle or a vehicle leased by IHS through agreements with the General Services Administration (GSA) or through commercial rental agreements.

2.17 Health Center: A facility physically separated from a hospital, with a full range of ambulatory services including at least primary care providers, nursing, laboratory, and x-ray which are available at least 40 hours a week for outpatient per Health and Human Services

Acquisitions Regulations - the Department of Health and Human Services' supplement to the

FAR.

2.18 Health Insurance Portability and Accountability Act (HIPAA): A US law designed to provide privacy standards to protect patients' medical records and other health information provided to health plans, doctors, hospitals and other health care providers.

2.19 Non-Personal Service Contracts: means 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 37.4.

2.20 Ordering Activity: An authorized user of IHS that may issue a task order to obtain required services under this contract.

2.21 Ordering Activity Contracting Officer: A Government employee of IHS 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 determinations on all matters of dispute regarding task orders.

2.22 Orientation: An activity designed to provide basic familiarization of the facility and transition the nurse into the IHS Service Unit and/or Health Center and the nursing unit wherethe services will be provided.

2.23 Past Performance Information: 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 andforecasting 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.

2.24 Patient Outcome: End result of nursing care.

2.25 Performance Work Statement Matrix: Lists the services to be monitored and the standards to be applied.

2.26 Personal Protective Equipment (PPE}: The equipment used to protect medical personnelfrom exposure to biological, chemical, and radioactive hazards.

2.27 Quality Assurance Surveillance Plan (QASP}: A written document prepared and used bythe government for Quality Assurance surveillance of the contractor's performance.

2.28 Quality Control Plan (QCP}: Those actions taken by the Contractor to control the quality of services provided. The Contractor's QCP must be equivalent to the Government's Quality Assurance plan.

2.29 Service Unit: The local administrative unit of IHS.

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

The standards provide direction for professional nursing practice and a framework for the evaluation of practice. The standards of professional nursing practice may pertain to general or specialty practice.

2.31 Technical Direction: A directive to the Contractor that approves approaches, solutions, designs, or refinements; fills in details or otherwise completes the general description of work ordocumentation items; shifts emphasis among work areas or tasks; or furnishes similar instructionto 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.

2.32 Tour of Duty: The time of day or night the nurse is scheduled to perform nursing care duties; also considered the shift of the day. The time can vary according to the needs of each facility and/or clinic, e.g. 12 hour Tour of Duty, 10 hour Tour of Duty, 8 hour Tour of Duty.

Includes weekends and holidays.

2.32.1 Nursing Departments requiring contract staff requiring the above tour of duty:

2.32.2 Ambulatory Clinics: Internal Medicine, Family Medicine, Pediatrics, OB/Gyn, Podiatry, Orthopedics, General Surgery, Endoscopy, Day Surgery (Wound Care Ostomy

Clinic), Walk-in Primary Care Clinic and Tohatchi Clinic. Monday-Friday, requiring 8/10 hour shifts daily, occasional weekends.

2.32.2 Walk-in Primary Care Clinic. Nursing Department requiring 8/12 hour shifts daily, 7 days a week including weekends and Holidays for patient care nursing coverage.

2.32.3 Specialty departments: Nurse Education, Case Management, 8/10 shifts week days, may require weekends or Holidays for patient care.

2.32.4 Inpatient Pediatrics/ Med Surg overflow unit, requiring day and night 12 hour shifts for 24/7 nursing coverage for patient care.

2.32.5 Women's Health Unit, requiring 12 hour shifts with 24/7 nursing coverage for patient care.

2.32.6 Women's Health Unit Scrub Techs 80 hrs per pay period, 8 hr flex day shifts Monday thru Friday, includes weekends and holidays, NO stand/call rotation.

2.32.7 Medical/Surgical Units requiring seven (7) 12 hour shifts day and/or night per pay period for 24/7 nursing coverage for patient care.

2.32.8 Intensive Care Unit, Requiring seven (7) 12 hour shifts with 24/7 nursing coverage for patient care. Subject to shift rotation (day/night), weekend and holiday work.

2.32.9 Operating Room/Post-Anesthesia Care Unit/Day Surgery requiring 8/10 hour shifts daily, 7 days a week including weekends and Holidays for patient care nursing coverage: Operating Room evening, weekend and holiday coverage for Standby call and PACU- on-call coverage. Day surgery open 6am-5:30pm.

2.32.10 Infusion Clinic, Flex 8 hour day shift Monday-Friday, occasional weekends and holidays.

2.32.11 Women's Health Unit Scrub Techs 80 hours per pay period, 8 hr flex day shifts Monday thru Friday, includes weekends and holidays, NO stand/call rotation.

2.32.12 OR Scrub Techs: 80 hours per pay period, 8 hours flex day shifts, Monday thru Friday, includes weekends and holidays, stand-by/call rotation.

2.32.13 Emergency Department Nursing Departments requiring 12 hour shifts with 24/7 nursing coverage as needed for patient care. Subject to shift rotation (day/mid-shift/night), weekend and holiday work.

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

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

3.0 Government Furnished Information, Property and Services

3.1 Information: Government unique information related to this requirement, which is necessary for Contractor performance, will be made available to the Contractor. The Contracting Officer or designee will be the point of contact for identification of any required information to be supplied by the Government.

3.2 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 under this contract.

3.2.1 Government Vehicle: If required by the position, authorization shall be in accordance with IHS Chapter 12, Section 13 Motor Vehicle Management.

3.2.2 Contractor Exclusive Use:

3.2.3 Personal Protective Equipment (PPE). The Government will furnish the Contractorwith appropriate PPE other than specified in paragraph 4 of the contract.

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.

3.2.4 The Government will provide facility specific contractor identification badges for each contractor. A minimum fee of $10.00 will be charged for lost or destroyed badges.

3.3 Training: Facility specific training necessary for the Contractor to perform the required duties, e.g., IHS information technology {IT) systems and operational procedures. Training willbe provided ONLY if the subject matter is necessary to improve or enhance the quality of nursing services or includes mandates made by GIMC while the nurse is working under this contract. Training will not be provided for the purpose of continuing education, career development or individual development.

4.0 Contractor Furnished Property

4.1 Except for the property specified in paragraph 3.0 as government furnished, the Contractor shall provide all uniforms and other personal medical instruments subject to the following:

4.1.1 Uniforms and Lab Coats: Uniforms and Lab Coats shall conform to the requirements of the Indian Health Service Manual, Part 3 Chapter 4 and meet the approval of the Chief Nurse Executive at GIMC.

4.1.2 Other personal medical instruments: "Other personal medical instruments" aredefined 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 subject 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 equipment.

5.0 Performance Work Statement (PWS) Requirements.

5.1 Nursing Duties:

5.1.1 The Contractor shall perform nursing duties and manage patient care needs as described in the Statement of Duties and at full duty status as documented in a physical exam after RN selection for that particular position and department.

5.1.2.1 The Contractor shall perform in accordance with the following competency standards:

5.1.2.2 Confidentiality/HIPAA/Patient's Rights/Privacy/ Confidentiality: Legaland Ethical Concerns in Healthcare

5.1.2.3 Contract Nurse Orientation Check List/ Health Stream

5.1.2.4 Contract Nurse Orientation Competency Verification Instructions

5.1.2.5 Contract Nurse Billing Information

5.1.2.6 Standard Emergency Codes

5.1.2.7 Blood Component Administration

5.1.2.8 EMTALA- Emergency Medical Treatment and Labor Act

5.1.2.9 Unit-specific Competencies

5.1.2.10 An Introduction to the Navajo and Zuni Cultures

5.1.2.11 Verbal and Telephone Orders

5.1.2.12 Medication Administration Competency Exam/Verification, IVTherapy, Venipuncture

5.1.2.13 Pain Management

5.1.2.14 Latex Allergy

5.1.2.15 Charting/Documentation/ Electronica Health Record (EHR)

5.1.2.16 Patient Restraints

5.1.2.17 Charge Nurse Duties: Responsibility and Expectation

5.1.2.18 Nursing Standards

5.1.2.19 Standards of Nursing Practice

5.1.2.20 Basic Cardiac Arrhythmia test for ED, ICU and PACU contract nurses

5.1.2.21 Care of patients who report sexual or physical assault

5.2 Work Schedule:

5.2.1 The Nursing Supervisor for each department will provide technical direction onthe specific tour of duty the contract nurse will work.

5.2.2 Work Flexibility. The Contractor shall coordinate with the Nursing Supervisor to rotate into other duty sections/departments that they have documented skills for as needed to support patient care. If the Contractor has work experience in anotherarea of the health care system identified through their resume, the Contractor, maybe assigned to those areas of patient care need.

5.2.3 The Contractor shall coordinate with the department Nursing Supervisor or designee prior to any absence from work. If the length of the absence exceeds eight (8) work hours and beyond, the Contractor shall coordinate and provide notificationto the department Nursing Supervisor (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.

A qualified security cleared placement. The qualified replacement will need to be interviewed, accepted, security cleared and on scheduled confirmation to act as the replacement during the time of such approved leave.

5.2.5 The Contractor shall provide written documentation from a qualified healthcare provider for absences of three (3) or more consecutive days, due to illness, stating:

The cause of the current illness or incapacitation AND Indicating the Contractor as contagious or non-contagious.

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

5.2.6 The Contractor shall comply with the Indian Health Service Special General Memorandum, SGM No. 18-01, that provides limitations to the number of direct patient care hours that a nurse can provide to a maximum of five consecutive 12.5 hour shifts and no more than 70 hours within 7 days (except in emergency situations.

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

5.4 Performance Evaluation:

5.4.1 The Contractor's performance will be evaluated in accordance with the standardsset forth in the contract and Performance Work Statement Matrix of section 11.0.

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

5.5 Identification of Contractor:

5.5.1 The Contractor shall wear a government issued contractor identification badgeduring performance of duty.

5.6 Management of Medical Information: The Contractor shall manage all patient information in accordance with Health Insurance Portability and Accountability Act(HIPAA) standards, Privacy Act, and IHS Service Unit and/or Health Center specific policies and protocols.

5.6.1 The Contractor shall ensure adherence to Department of Health and Human Services Information Technology system security policies and procedures. The Information Technology policies and procedures will be made available to the Contractor.

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

5.7 IHS Information Technology Systems:

5.7.1 In performance of this contract, the Contractor shall adapt to and successfullyutilize IHS information technology systems necessary for acceptable contractor performance.

5.7.2 The Contractor shall ensure that IHS information technology system security policies and procedures are adhered to. The IT policies and procedures will be madeavailable to the Contractor at each IHS facility.

6.0 Business Associate Agreement:

Pursuant to 45 C.F.R. § 164.502(e), the Indian Health Service (IHS), as a covered entity,is required to enter into an agreement with a "business associate," as defined by 45

C.F.R. § 160.103, under which the business associate must agree to appropriately safeguard

Protected Health Information (PHI) that it will use and disclose when performing functions, activities or services pursuant to its contract with the IHS. Theattached Appendix A: Business Associate

Agreement shall be completed by the Contractor upon award and become an integral part of this contract.

7.0 Contractor Qualification Requirements for each Nursing Unit/Department:

7.1 Ambulatory Clinics: Internal Medicine, Family Medicine, Pediatrics, OB/Gyn, Podiatry, Orthopedics, General Surgery, Endoscopy, Day Surgery (Wound Care Ostomy Clinic), Walk-in

Primary Care Clinic and Tohatchi Clinic.

7.1.1 Experience: One (1) year experience in the department/specialty/position with minimum of 3 years nursing experience.

7.1.2 Certification: Basic Life SU1)port and Advance Life Support Certification.

7.1.3 License/Registration: All nurses shall possess a current, valid, unrestricted nursinglicense 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. All applicants must have passed the National Council Licensure Examination.

7.2 Walk-in Primary Care Clinic.

7.2.1 Experience: One (1) year experience in the department/specialty/position with minimum of 3 years nursing experience.

7.2.2 Certification: Basic Life Support and Advance Cardiac Life Support Certification.

7.2.3 License/Registration: All nurses shall possess a current, valid, unrestricted nursinglicense in a state, the District of Columbia, the Commonwealth of Puerto Rico,

7.3 Specialty departments: Nurse Education, Case Management

7.3.1 Experience: One (1) year experience in the department/specialty/position with minimum of 3 years nursing experience.

7.3.2 Certification: Basic Life Support and Advance Cardiac Life Support

Certification.

7.3.3 License/Registration: All nurses shall possess a current, valid, unrestricted nursinglicense in a state, the District of Columbia, the Commonwealth of Puerto Rico,

7.4 Inpatient Pediatrics/ Medical Surgical overflow unit,

7.4.1 Experience: One (1) year experience in the department/specialty/position with minimum of 3 years nursing experience.

7.4.2 Certification: Basic Life Support, Advance Cardiac Life Support Certification, Pediatrics Advance Life Support, Neonatal Resuscitation Program.

7.4.3 License/Registration: All nurses shall possess a current, valid, unrestricted nursinglicense in a state, the District of Columbia, the Commonwealth of Puerto Rico,

7.5 Women's Health Unit

7.5.1 Experience: Two (2) year experience in the department/specialty/position with minimum of 3 years nursing experience.

7.5.2 Certification: Intermediate Fetal Monitor Course completion required, Basic Life Support, Advance Cardiac Life Support Certification, Pediatrics Advance Life Support, Neonatal Resuscitation Program and Intermediate or Advance Fetal Monitor Course.

7.5.3 License/Registration: All nurses shall possess a current, valid, unrestricted nursinglicense in a state, the District of Columbia, the Commonwealth of Puerto Rico,

7.6 Women's Health Unit Scrub Techs

7.6.1 Experience: Two (2) year experience in the department/specialty/position with

7.6.2 Certification: Basic Life Support

7.7 OR Scrub Tech:

7.7.1 Experience: Two (2) year experience in the department/specialty/position with

7.7.2 Certification: Basic Life Support

7.8 Medical/Surgical Units

7.8.1 Experience: One (1) year experience in the department/specialty/position with minimum of 3 years nursing experience.

7.8.2 Certification: Basic Life Support, Advance Cardiac Life Support Certification

7.8.3 License/Registration: All nurses shall possess a current, valid, unrestricted nursinglicense in a state, the District of Columbia, the Commonwealth of Puerto Rico,

7.9 Intensive Care Unit

7.9.1 Experience: Two (2) year experience in the department/specialty/position with minimum of 3 years nursing experience.

7.9.2 Certification: Basic Life Support, Advance Cardiac Life Support Certification, and Trauma Nurse Critical Care.

7.9.3 License/Registration: All nurses shall possess a current, valid, unrestricted nursinglicense in a state, the District of Columbia, the Commonwealth of Puerto Rico,

7.10 Operating Room/Post-Anesthesia Care Unit/Day Surgery

7.10.1 Experience: Two (2) year experience in the department/specialty/position with minimum of 3 years nursing experience.

7.10.2 Certification: Basic Life Support, Advance Cardiac Life Support Certification, Pediatric Advance Life Support and Trauma Nurse Critical Care (TNCC).

7.10.3 License/Registration: All nurses shall possess a current, valid, unrestricted nursinglicense in a state, the District of Columbia, the Commonwealth of Puerto Rico,

7.11 Infusion Clinic

7.11.1 Experience: One (1) year experience in the department/specialty/position with minimum of 3 years nursing experience.

7.11.2 Certification: Basic Life Support, Advance Cardiac Life Support Certification, and Pediatrics Advance Life Support.

7.11.3 License/Registration: All nurses shall possess a current, valid, unrestricted nursinglicense in a state, the District of Columbia, the Commonwealth of Puerto Rico,

7.12 Emergency Department Nursing Departments

7.12.1 Experience: Two (2) year experience in the department/specialty/position with minimum of 3 years nursing experience.

7.12.2 Certification: Basic Life Support, Advance Cardiac Life Support Certification, Pediatrics Advance Life Support, and/or Neonatal Resuscitation Program and /or Emergency Nursing Pediatric Course (EMPC)/Trauma Nursing Care Course (TNCC) and/or Advance Trauma Nursing Course (ATCN).

7.12.3 License/Registration: All nurses shall possess a current, valid, unrestricted nursing license in a state, the District of Columbia, the Commonwealth of Puerto Rico,

7.13 The contractor shall ensure that the contractor nurse's certification remain valid throughout the term of this contract.

8.0 Health Requirements/Conditions of Employment:

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

8.2 A medical statement will be provided to acquisitions from the vendor to clear the contract to return to work at full duty status without limitations.

8.3 Immunization. The Contractor shall also provide the following documentation 10 days after RN selection.

8.3.1 Immunity to Rubella, Mumps, and Rubeola (Measles);

8.3.2 The Safer Federal Workforce certification of vaccine form must be completed by each contract staff member and kept on their person while at a HHS site location.

8.3.3 Proof of Hep B vaccination x3 OR positive titer OR a signed declination of the Hep B vaccinations will also be accepted;

8.3.4 Documented history of chicken pox OR varicella vaccination x2 OR positive varicella titer;

8.3.5 History of Tdap vaccination, with subsequent Td vaccination if older than 10 years; and subsequent Tdap every 10 years due to pertussis outbreaks.

8.3.6 Documentation 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.

8.3.7 Proof of influenza vaccination from October -1 thru March 31, per IHS Mandatory Influenza Vaccination Policy.

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

8.5 Information Technology Skills. The Contractor shall possess basic knowledge, skills,and abilities to use a computer.

8.6 Orientation. All nurses providing service under this contract shall attend mandatory orientations and training specified by the government. The contract will submit their timesheet through their specific company.

8.7 Background Checks: As directed by the Contracting Officer, the Contractor shall provide all requested information necessary to perform background checks. The Contractor shall comply with the requirement to obtain security investigations. The Contractor shall work with the IHS to ensure that the pre-employment screening processincludes 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 informationthat would affect the investigation becomes known.

8.8 e-QIP: Required Background Investigation Information:

Executive Orders 10450, 12968, and HSPD-12 require a background investigation as acondition of employment. This investigation will be processed utilizing the US Officeof Personnel Management (OPM), Electronic Questionnaire for Investigation Processing (eQIP) system.

8.9 FINGERPRINT CARD - FBI FD-258 (provided by the Federal Government) Fingerprint MUST be cleared and approved prior to contract assignment. Contractassignment(s) are conditional on a cleared background check.

8.10 Impairment Drugs or Alcohol Any Contractor demonstrating impaired judgment shall not be permitted to work in the NAIHS. The Government reserves the right to remove from the facility any Contractor, who in the judgment of a licensed healthcare provider, is impaired by drugs or alcohol.

9.0 Technical Direction:

9.1 Performance of the work under this contract is subject to the written and verbaltechnical direction of the Nursing Supervisor.

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

9.2.1 Constitutes an assignment of additional work outside the performance work statement;

Constitutes a change subject to 52.212-4(c);

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

9.2.3 Changes the terms and conditions of the contract.

9.3 All technical direction shall be issued in writing by the Nursing Supervisor. All verbal direction will be confirmed in writing within 24 hours (one business day).

9.4 The Contractor shall proceed promptly with the performance of technical directionduly issued by the Nursing Supervisor in the manner prescribed by this clause and within the authority. If, in the Contractor's opinion, any instructions or direction bythe Nursing Supervisor falls within any of the categories defined in paragraph 8.1 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 a reasonable time or advise the Contractor in writing that the instruction or direction iswithin 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.

9.5 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 shallbe subject to the Disputes clause of this contract.

9.6 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.

PWS No GIMC 23.01 2/27/2023

I

10.0 Performance Work Statement Matrix

Performance-based Task Indicator Standard Quality Assurance Incentives

For each "in sta e t rfo man Fore ,utP,L.1,.1 )11 1\ ve ethod of iinking pavme nf "''

'-it,_'! t 1?11e1 th.: whe,, r.,et. rr>e,rn', i·,e task has then . J L ,.,<J l _l," 'II., ,.·.. rn11r."' t be n pcrforn tori;•,. pNfr ur r• J 1C l

Jf

This Standard . " ., .. c, cccs, s,im , l ;; i.pc •i·. n, p--ric I\' :•r 'l& i-\ custr

Contractor shall provide J

Nursing services in the delivery of patient care to

Competency Perform 100% required tasks at 100% of the required competencies (refer to 5,1.2.1)

See QASP. Surveillance systems will include periodic inspections and customer

Payment of contract price for satisfactory service.

Contractor performance will be evaluated using the Contractor Performance Assessment Report. The evaluation will be considered when future IHS contract selections are made.

Gallup Indian Medical Center. Compliance complaints.

100% compliance with IHS Service Units and/or Health Centers published Policies;

Procedures; Standards of Care; and hospital and nursing Protocols.

Patient Outcomes

No reports of breached patient safety, infection control, and other procedures that might adversely affect patient outcome.

Professionalism

Performance characterized by continual cultural awareness and focus on customer service. 100 percent adherence to the Nursing Code of Ethics and Federal Code of Conduct.

Credentialing

Uninterrupted credentialing as defined in

7.0 to 7.8 for period of contract.

Documentation

100% percent of all documentation meets established IHS Medical Facility, JAC, and CMS standards to include, but are not limited to, timeliness, legibility, accuracy, content, date, time, signature and designated profession.

Service Quality

Satisfaction with quality of service is evidenced by valid customer inputs.

PWS NO. GIMC 22-01 April 2022

11.0 List of Attachments: The position description will be provided by the Contracting

Officer upon request. The BAA will be provided to the Contractor upon award for their completion/signature. The signed BAA shall be returned to the Contracting Officer for internal filing.

11.1 Attachments

11.1.1 Position Description

11.1.2 Business Associate Agreement (BAA)

11.1.3 The Safer Federal Workforce certification of vaccine form

11.1.4 Nurse and Scrub Tech Skills Inventory Checklist (Sample attached)

11.1.5 Exit Interview-RN-Scrub Tech Exit Interview Survey

11.1.6 Contract Nurse Clearance on the last day of work

11.1.7 Two week/Mid/Final evaluation for RN and Scrub Tech

11.1.8 Requirements for pre-onboarding, which the company needs to provide 1 week before start date; all required certifications, emergency contact information, and physical exam within a year,

11.1.9 First day instruction and expectation to include successful completion of the medication test and Basic Cardiac Arrhythmia test.