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5. PROJECT NUMBER (if applicable)CODE7. ADMINISTERED BY2. AMENDMENT/MODIFICATION NUMBERCODE6. ISSUED BY8. NAME AND ADDRESS OF CONTRACTOR4. REQUISITION/PURCHASE REQ. NUMBER3. EFFECTIVE DATE9A. AMENDMENT OF SOLICITATION NUMBER9B. DATEDPAGEOF PAGES10A. MODIFICATION OF CONTRACT/ORDER NUMBER10B. DATEDBPA NO.1. CONTRACT ID CODEFACILITY CODECODE Offers must acknowledge receipt of this amendment prior to the hour and date specified in the solicitation or as amended, by one of the following methods:The above numbered solicitation is amended as set forth in Item 14. The hour and date specified for receipt of OffersE. IMPORTANT:is extended, (a) By completing Items 8 and 15, and returning __________ copies of the amendment; (b) By acknowledging receipt of this amendment on each copy of the offer submitted; or (c) By separate letter or electronic communication which includes a reference to the solicitation and amendment numbers. FAILURE OF YOUR ACKNOWLEDGMENT TO BE RECEIVED AT THE PLACE DESIGNATED FOR THE RECEIPT OF OFFERS PRIOR TO THE HOUR AND DATE SPECIFIED MAYis not extended.12. ACCOUNTING AND APPROPRIATION DATA(REV. 11/2016)is required to sign this document and return ___________ copies to the issuing office.is not,A. THIS CHANGE ORDER IS ISSUED PURSUANT TO: (Specify authority) THE CHANGES SET FORTH IN ITEM 14 ARE MADE IN THE CONTRACT ORDER NO. IN ITEM 10A.15C. DATE SIGNEDB. THE ABOVE NUMBERED CONTRACT/ORDER IS MODIFIED TO REFLECT THE ADMINISTRATIVE CHANGES SET FORTH IN ITEM 14, PURSUANT TO THE AUTHORITY OF FAR 43.103(b). RESULT IN REJECTION OF YOUR OFFER. If by virtue of this amendment you desire to change an offer already submitted, such change may be made by letter or electronic communication, provided each letter or electronic communication makes reference to the solicitation and this amendment, and is received prior to the opening hour and date specified.C. THIS SUPPLEMENTAL AGREEMENT IS ENTERED INTO PURSUANT TO AUTHORITY OF:D. OTHERBYContractor16C. DATE SIGNED14. DESCRIPTION OF AMENDMENT/MODIFICATION16B. UNITED STATES OF AMERICAExcept as provided herein, all terms and conditions of the document referenced in Item 9A or 10A, as heretofore changed, remains unchanged and in full force and effect.15A. NAME AND TITLE OF SIGNER16A. NAME AND TITLE OF CONTRACTING OFFICER15B. CONTRACTOR/OFFERORSTANDARD FORM 30 PREVIOUS EDITION NOT USABLEPrescribed by GSA - FAR (48 CFR) 53.243(Type or print)(Type or print)(Organized by UCF section headings, including solicitation/contract subject matter where feasible.)(Number, street, county, State and ZIP Code)(If other than Item 6)(Specify type of modification and authority)(such as changes in paying office, appropriation date, etc.)(If required)(SEE ITEM 11)(SEE ITEM 13)(X)CHECKONE13. THIS ITEM APPLIES ONLY TO MODIFICATIONS OF CONTRACTS/ORDERS,IT MODIFIES THE CONTRACT/ORDER NO. AS DESCRIBED IN ITEM 14.11. THIS ITEM ONLY APPLIES TO AMENDMENTS OF SOLICITATIONSAMENDMENT OF SOLICITATION/MODIFICATION OF CONTRACT(Signature of person authorized to sign)(Signature of Contracting Officer)1680000212-22-20170612MCPDepartment of Veterans AffairsNetwork Contracting Office (NCO 21)6900 North Pecos Road, Bldg 6North Las Vegas NV 89086612MCP To all Offerors/Bidders 36C26118R0080 XXX1The purpose of this amendment is to answer questions from interested offerors. See following pages for responses to 36questions. In addition, this amendment revises the contract line items for both health care stations to add a line item forholiday rates. Third, this amendment revises the Performance Work Statements for both health care systems. Changes are shown in redfont. Fourth, this amendment revises Attachments A and C to the solicitation. Changes are shown in red font.The due date for proposals remains January 16, 2018, at 1:00 PM PST.No further changes. Be sure to acknowledge this amendment with proposal submission!Amanda J. SimmonsContracting OfficerTemporary Nursing Staff 36C26118R0080QUESTIONS AND ANSWERSQuestion 1: I was wondering if i could get more information about the different categories. Is there something that describes the differences in an RN 1 and RN2?Answer 1: The Department of Labor (DoL) has developed a SCA Directory of Occupations available at HYPERLINK "" . DoL’s descriptions for RN I and RN II are as follows: 12311 REGISTERED NURSE IThe Registered Nurse I provides comprehensive general nursing care to patients whose conditions and treatment are normally uncomplicated, follows established procedures, standing orders, and doctor's instructions, uses judgment in selecting guidelines appropriate to changing patient conditions. Routine duties are performed independently; variations from established routines are performed under specific instructions. Typical assignments include:Staff: Prepares hospital or nursing home patients for tests, examinations, or treatment; assists in responding to emergencies; records vital signs and effects of medication and treatment in patient charts; and administers prescribed medications and intravenous feedings.Operating Room: Assists in surgical procedures by preparing patients for less complex operations (e.g., appendectomies); sterilizes instruments and other supplies; handles instruments; and assists in operating room, recovery room, and intensive care ward.Psychiatric: Provides routine nursing care to psychiatric patients. May observe and record patient behavior.Health Unit/Clinic: Administers immunizations, inoculations, allergy treatments, and medications in a clinic or employer health unit; performs first aid for minor burns, cuts, bruises, and sprains; obtains patient histories; and keeps records, writes reports, and maintains supplies and equipment.12312 REGISTERED NURSE IIThe Registered Nurse II plans and provides comprehensive nursing care in accordance with professional nursing standards, uses judgment in assessing patient conditions, interprets guidelines, and modifies patient care as necessary, recognizes and determines proper action for medical emergencies, e.g., calls physician or takes preplanned emergency measures. Typical assignments include the following:Staff: In addition to the duties described at Level I, usually performs more complex procedures, such as: administering blood transfusions, managing nasal-pharyngeal, gastric suction, and other drainage tubes, using special equipment such as ventilator devices, resuscitators and hypothermic units; or closely monitoring postoperative and seriously ill patients.Operating Room: Provides nursing service for surgical operations, including those involving complex and extensive surgical procedures, confers with surgeons concerning instruments, sutures, prostheses and special equipment, cares for physical and psychological needs of patients; assists in the care and handling of supplies and equipment; assures accurate care and handling of specimens; and assumes responsibility for aseptic technique maintenance and adequacy of supplies during surgery.Psychiatric: Provides comprehensive nursing care for psychiatric patients. In addition to observing patients, evaluates and records significant behavior and reaction patterns and participates in group therapy sessions.They also have descriptions for the other categories as well. Contractors are responsible for determining which category their employees fall under and ensure that they are paying the minimum required by the SCA as shown on the wage determinations.Question 2: The pricing sheet includes specific specialties for the base and option periods.?Confirm if the government intends to request additional pricing if/when purchase orders are issued for new specialties not included in the BPA initial pricing.Answer 2: This RFP is to establish an Indefinite Delivery Indefinite Quantity (IDIQ) contract. Task orders will be issued against the IDIQ for needed services. Task orders will only have line items that are in the base IDIQ contract, so there will be no opportunity to request specialties other than those in the IDIQ. Question 3: Should pricing be all includes, or will the government provide a separate line item for overtime and holiday pay for holidays worked?Answer 3: The contract line items are revised to include a separate line item for holiday pay. Overtime is not authorized for this contract.Question 4: Vol 3 Past Performance: Provide up to five (5) recent and relevant past performance references. Recent is defined as within three (3) years of the proposal due date. Relevant is defined as providing temporary medical staffing services. Will the government consider the past performance of subcontractors and key personnel as equally relevant?Answer 4: The Government will give some consideration of the past performance for subcontractors if the offeror provides a signed subcontracting agreement with the subcontractor, and the subcontractor signs a letter saying their past performance record may be utilized for this procurement. Past performance for a subcontractor will not be given the same weight or consideration as that of a prime contractor. As to key personnel, there is no key personnel requirements for this acquisition, so that will not be taken into consideration.Question 5: Section states “2.8 Experience: All contract personnel will have a minimum of one-year direct patient care experience within the last three years in the field.”Section states- “4.3. Critical Care RNs, Emergency Room RNs, Post-Anesthesia Care Unit RNs, and Operating Room RNs”Critical Care RNs must have a minimum of two years’ current experience in this field and hold BLS and ACLS and/or certification. a. Confirm if one or two years’ experience is required. b. Confirm what’s considered as “current” for Critical Care RNs.Answer 5: All personnel will have the basic 1 year, but for the specialized field such as critical care 2 years is required. Current means within the last two years.Question 6: Section 2.2 Classroom and/or bedside orientation may be required at the discretion of the COR/designee. The Contractor employee will be paid for the orientation; however, if the Contractor employee is not scheduled to work within 60 days of clearance to work, the Contractor will reimburse the VA for the orientation hours billed/paid.Section 2.6.1. Orientation: The Contractor shall provide eight hours of orientation time to each nurse at no charge to the VA. Confirm if the orientation is billable.Answer 6: Orientation is two days. The VA will pay for one day, and the contractor will be required to pay its employee for the second day. Question 7: Section 3.4. Shift Cancellation: The COR or VA POC will give the Contractor notification of available shifts no less than one week in advance for scheduled shifts exclusive of emergencies. The VA is not required to make payment after an employee has been released from duty. a. Confirm if the government will complete/manage the schedules or will the contractor. b. If the healthcare worker reporting to work, released from duty at the government’s request during the shift, and are the hours worked billable?Answer 7: As a per diem staffing requirement, the VA’s COR or POC will notify the contractor of its needs to fill a shift(s). It is the contractor’s responsibility to fill that shift(s). The VA will not be managing the contractor’s employees in any way, to include scheduling.For part b, hours worked are billable.Question 8: 15. Liability and Insurance:15.1 Liability for damages resulting from the official conduct of Contractor personnel providing services under this contract shall be governed by applicable federal laws, rules and regulations. Such damages might include, but are not limited to loss of equipment or property and medical malpractice damages for personal injury or death. Tort Claims against the government under this contract shall be filed in accordance with the Federal Tort Claims Act, 28 U.S.C. 2671-2680.Confirm if the Federal Tort Claims Act is applicable.Answer 8: The Performance Work Statement is revised to remove the reference to the Federal Tort Claims Act, because it is largely irrelevant for this procurement. The solicitation and resulting contract will require the contractor to have medical liability insurance as per VAAR 852.237-7 Indemnification and Medical Liability Insurance. The contractor personnel will in no way be considered VA personnel, so the contractor will be liable for any issues associated with its employees.Question 9: Most of our RNs are per diem and maintain more than one job as some of them work fulltime jobs at other places and work for us on nights and weekends. In addition, letters of intent are difficult to maintain with nursing staff when the start date of the position is more than 8 weeks away. Will you consider eliminating the need for the letter of intent as long as we can provide the other key information listed in attachment B?Answer 9: This is a per diem staffing requirement, so it is generally anticipated that the contractor staff will have more than one job. Nonetheless, a letter of commitment is required to ensure that the offeror is submitting a list of bona fide candidates who will be submitting background check paperwork immediately upon award to begin working on the contract in April. Question 10: Are you able to provide the annual spend on the contract for the past fiscal year for each Facility? Answer 10: The revised Attachment C represents the information we have available as to estimated quantities based on historical usage.Question 11: Are you able to provide the total hours used during the last fiscal year for each facility for each position (RN, LPNs, CNA, etc.)Answer 11: The revised Attachment C represents the information we have available as to estimated quantities based on historical usage.Question 12: Volume 3 Past Performance ask that we provide up to 5 references. What is the minimum that is required?Answer 12: There is no minimum.Question 13: May the due date be extended by 2 weeks to allow us proper time over the holidays to review Q&As, properly respond, gather letter of intents, and get both proposals final?Answer 13: The proposal due date was extended by one week to January 16, 2018, at 1:00 PM PST as per Amendment A0001. As explained during the pre-proposal conference, the VA is on a tight timeline to allow adequate time for background checks and credentialing prior to the work beginning on April 1, 2018. Question 14: Copies of Licenses- Will you take online license verification because California State Board no longer issue hard copy license?Answer 14: Yes, you may provide a screenshot or any other means of validating that the employee has a current license. Question 15: What is your email size limitation or capacity for the attachment? For example; 1GB or less or more.Answer: To the best of my knowledge the size limitation for email is 10GB. Please send your proposal in advance of the due date/time to permit trouble-shooting if need be.Question 16: How many awards do you anticipate?Answer 16: One contract per health care system for a total of two contracts from this RFP.Question 17: Do you have records or historical data that indicates when your surge/per diem needs occur? (i.e. holidays, weekends, special events, flu and/or flu shot season, etc.)Answer 17: The needs vary; there is no clear pattern. Question 18: Are the facilities all currently listed in the solicitation or are there additional outlying clinics involved?Answer 18: All hospitals and CBOCS within each health care system are subject to this requirement. Question 19: Does the government prefer a specific number of resumes/candidates submitted per labor category?Answer 19: Attachment B to the solicitation indicates the minimum number of candidates for different labor categories. If you have more candidates you should list them, because having more than the minimum will lead to a higher rating for that sub-factor.Question 20: Does the government anticipate an opportunity for conversion from a per diem contract position to a full time position?Answer 20: No.Question 21: What specialties or departments are considered in each of the categories listed in the RFP pricing Grid -RN I-RN II-RN III-LVN I-LVN II-LVN IIIAnswer 21: The needs for the health care systems vary, and there is no certainty with estimates. The contractor is responsible for reviewing the job requirements of each position in comparison with the DoL’s directory and position descriptions and determine what labor category applies. Since this is the contractor’s responsibility, through its compliance with the Service Contract Act, the VA is not in a position to advise the contractor which one applies nor does the VA have any historical data to share with respect to the different categories within the occupations.Question 22: Are all the shifts for all the assignments 8 hour shifts, not 12 hours, even the shifts in the Hospitals?Answer 22: 8Question 23: Do you want pricing for only 8 hour shifts, not 12 hour shifts also – if 12 hours shifts are staffed, how would 12 hour shifts be paid? Answer 23: There is no requirement for a 12-hour shift.Question 24: Do you want only the classifications listed on the price sheet included in our roster of 50 employees for each HCG? Answer 24: Each health care system requires different labor categories, which are listed in the price schedule in section B of the solicitation, Attachment A, and Attachment C. Attachment B takes some of those labor categories and requires candidate submissions for evaluation. Attachment B requires a minimum of 10 registered nurses, 10 licensed practical nurses, 20 nursing assistants, and 10 surgical technologists as a minimum. If you have more than the minimum, you should identify them, because offerors who exceed the minimum will achieve a higher rating. Question 25: Are the hours listed for each classification the real hours needed for one year? Answer 25: The hours listed in attachment C to the solicitation are estimates only. This is a procurement for an Indefinite Delivery Indefinite Quantity (IDIQ) contract. In other words, the VA cannot anticipate with any degree of certainty what its needs are this year or future years. It can only estimate its needs based on historical information and an estimation of what is to come. As an IDIQ contract, the only guarantee that the VA makes is the minimum guarantee shown in the price schedule in section B of the solicitation. Question 26: What are the needs for the CBOC’s? Are the CBOC needs longer term or day by day per diem?Answer 26: This is primarily a per-diem staffing requirement. As such, most of it will be by day. There may be some scheduled, long-term requirements but those are not as common since the VA has its own intermittent log. Question 27: What CBOC’s are using or needing agency employees and what classifications of personnel do they need?Answer 27: It varies, so the requirement is for the contractor to provide any of the listed labor categories to any of the locations in the health care systems.Question 28: How long does it take VISN 21 to credential a candidate employee through VetPro clearance?Answer 28: Generally it takes 4-6 weeks. There may be instances where it takes longer than 6 weeks.Question 29: What specialty do you need the Nurse Practitioners to be licensed in?Answer 29: General Question 30: Where are the Nurse Practitioners needed to work – in the Hospitals or in the CBOC’s?Answer 30: Nurse Practitioners may be needed at the hospital and some may be needed at the CBOCs.Question 31: Do you want 5 References for each of the 2 Proposals = 10 References – or will you use the 5 References for both Proposals submitted.Answer 31: You may use the same references for both proposals. You should use the best references in terms of relevance, recency, and performance.Question 32: Do you have an incumbent contractor(s) providing the services requested in your solicitation? If yes, please provide the name of the contractor(s) the contract number(s), the service hour(s) staffed for each classification by location, the billing rate(s) for the requested classifications and the contract value(s) for each incumbent contractor. Answer 32: Yes, there are several incumbent contractors in place. The remainder of the questions must be requested through Freedom of Information Act.Question 33: Do you currently have contractor staff working shifts other than 8 hour assignments at VASF and VA Mather ? Please specify any alternative shift start and end times (7:30a-8p, 7:30p-8A or other 10 or 12 hour shifts?) Answer 33: NoQuestion 34: What are the greatest staff needs in terms of disciplines? Which facilities have the greatest need for services requested in your solicitation?Answer 34: For VANCHCS, the greatest need is for CNAs as shown on the estimated quantities on Attachment C. The locations that have the most need is Mather, McClellan, Martinez, Fairfield, and Oakland. The need for the outlying CBOCs is not as great as the facilities in the more populous areas.For SFVAMC, the greatest need is for CNAs and the SPS technicians, also shown on the revised Attachment C. Over the past several years, all the needs have been at the SF hospital on Clement street. None of the CBOCs have had to use any of the listed labor categories. Notwithstanding the historical need, the VA wants to be able to request shifts at those CBOCS in the future if need be.Question 35: Does this solicitation require agencies to pay per diem employees 8 hours of holiday pay even if they are not assigned to work on the holiday?Answer 35: The contractor is required to pay their employees in accordance with all applicable federal laws. Service Contract Act is included in this requirement at 52.222-41. It is up to the contractor to determine what is required of those labor laws and maintain compliance with them. If contractors are unsure, questions should be directed to Department of Labor as that is the federal entity responsible for enforcement.Question 36: Does this contract allow assignments for Travel Nurse Personnel? (Page 24)Answer 36: Travel nurses are not required. The language is revised in the PWS to remove reference to travel nurses.PRICE SCHEDULE VA NORTHERN CALIFORNIA HEALTH CARE SYSTEMThe guaranteed minimum award amount for this contract is $2,000. The maximum aggregate value of orders that can be placed under this contract is $15,000,000. The Government does not guarantee that it will place any orders under this contract in excess of the guaranteed minimum award amount.Performance Period One: April 1, 2018 – March 31, 2019CLIN NODESCRIPTIONUNITUNIT COST0001Registered Nurse I0001aRegular HoursHour0001bHoliday HoursHour0002Registered Nurse II0002aRegular HoursHour0002bHoliday HoursHour0003Registered Nurse III0003aRegular HoursHour0003bHoliday HoursHour0004Licensed Practical Nurse I0004aRegular HoursHour0004bHoliday HoursHour0005Licensed Practical Nurse II0005aRegular HoursHour0005bHoliday HoursHour0006Licensed Practical Nurse III0006aRegular HoursHour0006bHoliday HoursHour0007Nursing Assistant IV0007aRegular HoursHour0007bHoliday HoursHour0008Surgical Technician0008aRegular HoursHour0008bHoliday HoursHour0009Nurse Practitioner0009aRegular HoursHour0009bHoliday HoursHour0010Medical Instrument Technician0010aRegular HoursHour0010bHoliday HoursHour0011Electrocardiogram Technician0011aRegular HoursHour0011bHoliday HoursHour0012Sterile Processing Services Technician0012aRegular HoursHour0012bHoliday HoursHourPerformance Period Two: April 1, 2019 – March 31, 2020CLIN NODESCRIPTIONUNITUNIT COST1001Registered Nurse I1001aRegular HoursHour1001bHoliday HoursHour1002Registered Nurse II1002aRegular HoursHour1002bHoliday HoursHour1003Registered Nurse III1003aRegular HoursHour1003bHoliday HoursHour1004Licensed Practical Nurse I1004aRegular HoursHour1004bHoliday HoursHour1005Licensed Practical Nurse II1005aRegular HoursHour1005bHoliday HoursHour1006Licensed Practical Nurse III1006aRegular HoursHour1006bHoliday HoursHour1007Nursing Assistant IV1007aRegular HoursHour1007bHoliday HoursHour1008Surgical Technician1008aRegular HoursHour1008bHoliday HoursHour1009Nurse Practitioner1009aRegular HoursHour1009bHoliday HoursHour1010Medical Instrument Technician1010aRegular HoursHour1010bHoliday HoursHour1011Electrocardiogram Technician1011aRegular HoursHour1011bHoliday HoursHour1012Sterile Processing Services Technician1012aRegular HoursHour1012bHoliday HoursHourPerformance Period Three: April 1, 2020 – March 31, 2021CLIN NODESCRIPTIONUNITUNIT COST2001Registered Nurse I2001aRegular HoursHour2001bHoliday HoursHour2002Registered Nurse II2002aRegular HoursHour2002bHoliday HoursHour2003Registered Nurse III2003aRegular HoursHour2003bHoliday HoursHour2004Licensed Practical Nurse I2004aRegular HoursHour2004bHoliday HoursHour2005Licensed Practical Nurse II2005aRegular HoursHour2005bHoliday HoursHour2006Licensed Practical Nurse III2006aRegular HoursHour2006bHoliday HoursHour2007Nursing Assistant IV2007aRegular HoursHour2007bHoliday HoursHour2008Surgical Technician2008aRegular HoursHour2008bHoliday HoursHour2009Nurse Practitioner2009aRegular HoursHour2009bHoliday HoursHour2010Medical Instrument Technician2010aRegular HoursHour2010bHoliday HoursHour2011Electrocardiogram Technician2011aRegular HoursHour2011bHoliday HoursHour2012Sterile Processing Services Technician2012aRegular HoursHour2012bHoliday HoursHourPerformance Period Four: April 1, 2021 – March 31, 2022CLIN NODESCRIPTIONUNITUNIT COST3001Registered Nurse I3001aRegular HoursHour3001bHoliday HoursHour3002Registered Nurse II3002aRegular HoursHour3002bHoliday HoursHour3003Registered Nurse III3003aRegular HoursHour3003bHoliday HoursHour3004Licensed Practical Nurse I3004aRegular HoursHour3004bHoliday HoursHour3005Licensed Practical Nurse II3005aRegular HoursHour3005bHoliday HoursHour3006Licensed Practical Nurse III3006aRegular HoursHour3006bHoliday HoursHour3007Nursing Assistant IV3007aRegular HoursHour3007bHoliday HoursHour3008Surgical Technician3008aRegular HoursHour3008bHoliday HoursHour3009Nurse Practitioner3009aRegular HoursHour3009bHoliday HoursHour3010Medical Instrument Technician3010aRegular HoursHour3010bHoliday HoursHour3011Electrocardiogram Technician3011aRegular HoursHour3011bHoliday HoursHour3012Sterile Processing Services Technician3012aRegular HoursHour3012bHoliday HoursHourPerformance Period Five: April 1, 2022 – March 31, 2023CLIN NODESCRIPTIONUNITUNIT COST4001Registered Nurse I4001aRegular HoursHour4001bHoliday HoursHour4002Registered Nurse II4002aRegular HoursHour402bHoliday HoursHour4003Registered Nurse III4003aRegular HoursHour4003bHoliday HoursHour4004Licensed Practical Nurse I4004aRegular HoursHour4004bHoliday HoursHour4005Licensed Practical Nurse II4005aRegular HoursHour4005bHoliday HoursHour4006Licensed Practical Nurse III4006aRegular HoursHour4006bHoliday HoursHour4007Nursing Assistant IV4007aRegular HoursHour4007bHoliday HoursHour4008Surgical Technician4008aRegular HoursHour4008bHoliday HoursHour4009Nurse Practitioner4009aRegular HoursHour4009bHoliday HoursHour4010Medical Instrument Technician4010aRegular HoursHour4010bHoliday HoursHour4011Electrocardiogram Technician4011aRegular HoursHour4011bHoliday HoursHour4012Sterile Processing Services Technician4012aRegular HoursHour4012bHoliday HoursHourPRICE SCHEDULE SAN FRANCISCO VA MEDICAL CENTERThe guaranteed minimum award amount for this contract is $2,000. The maximum aggregate value of orders that can be placed under this contract is $25,000,000. The Government does not guarantee that it will place any orders under this contract in excess of the guaranteed minimum award amount.Performance Period One: April 1, 2018 – March 31, 2019CLIN NODESCRIPTIONUNITUNIT COST0001Registered Nurse I0001aRegular HoursHour0001bHoliday HoursHour0002Registered Nurse II0002aRegular HoursHour0002bHoliday HoursHour0003Registered Nurse III0003aRegular HoursHour0003bHoliday HoursHour0004Licensed Practical Nurse I0004aRegular HoursHour0004bHoliday HoursHour0005Licensed Practical Nurse II0005aRegular HoursHour0005bHoliday HoursHour0006Licensed Practical Nurse III0006aRegular HoursHour0006bHoliday HoursHour0007Nursing Assistant IV0007aRegular HoursHour0007bHoliday HoursHour0008Surgical Technician0008aRegular HoursHour0008bHoliday HoursHour0009Nurse Practitioner0009aRegular HoursHour0009bHoliday HoursHour0010Medical Supply Technician0010aRegular HoursHour0010bHoliday HoursHour0011Sterile Processing Services Technician0011aRegular HoursHour0011bHoliday HoursHourPerformance Period Two: April 1, 2019 – March 31, 2020CLIN NODESCRIPTIONUNITUNIT COST1001Registered Nurse I1001aRegular HoursHour1001bHoliday HoursHour1002Registered Nurse II1002aRegular HoursHour1002bHoliday HoursHour1003Registered Nurse III1003aRegular HoursHour1003bHoliday HoursHour1004Licensed Practical Nurse I1004aRegular HoursHour1004bHoliday HoursHour1005Licensed Practical Nurse II1005aRegular HoursHour1005bHoliday HoursHour1006Licensed Practical Nurse III1006aRegular HoursHour1006bHoliday HoursHour1007Nursing Assistant IV1007aRegular HoursHour1007bHoliday HoursHour1008Surgical Technician1008aRegular HoursHour1008bHoliday HoursHour1009Nurse Practitioner1009aRegular HoursHour1009bHoliday HoursHour1010Medical Supply Technician1010aRegular HoursHour1010bHoliday HoursHour1011Sterile Processing Services Technician1011aRegular HoursHour1011bHoliday HoursHourPerformance Period Three: April 1, 2020 – March 31, 2021CLIN NODESCRIPTIONUNITUNIT COST2001Registered Nurse I2001aRegular HoursHour2001bHoliday HoursHour2002Registered Nurse II2002aRegular HoursHour2002bHoliday HoursHour2003Registered Nurse III2003aRegular HoursHour2003bHoliday HoursHour2004Licensed Practical Nurse I2004aRegular HoursHour2004bHoliday HoursHour2005Licensed Practical Nurse II2005aRegular HoursHour2005bHoliday HoursHour2006Licensed Practical Nurse III2006aRegular HoursHour2006bHoliday HoursHour2007Nursing Assistant IV2007aRegular HoursHour2007bHoliday HoursHour2008Surgical Technician2008aRegular HoursHour2008bHoliday HoursHour2009Nurse Practitioner2009aRegular HoursHour2009bHoliday HoursHour2010Medical Supply Technician2010aRegular HoursHour2010bHoliday HoursHour2011Sterile Processing Services Technician2011aRegular HoursHour2011bHoliday HoursHourPerformance Period Four: April 1, 2021 – March 31, 2022CLIN NODESCRIPTIONUNITUNIT COST3001Registered Nurse I3001aRegular HoursHour3001bHoliday HoursHour3002Registered Nurse II3002aRegular HoursHour3002bHoliday HoursHour3003Registered Nurse III3003aRegular HoursHour3003bHoliday HoursHour3004Licensed Practical Nurse I3004aRegular HoursHour3004bHoliday HoursHour3005Licensed Practical Nurse II3005aRegular HoursHour3005bHoliday HoursHour3006Licensed Practical Nurse III3006aRegular HoursHour3006bHoliday HoursHour3007Nursing Assistant IV3007aRegular HoursHour3007bHoliday HoursHour3008Surgical Technician3008aRegular HoursHour3008bHoliday HoursHour3009Nurse Practitioner3009aRegular HoursHour3009bHoliday HoursHour3010Medical Supply Technician3010aRegular HoursHour3010bHoliday HoursHour3011Sterile Processing Services Technician3011aRegular HoursHour3011bHoliday HoursHourPerformance Period Five: April 1, 2022 – March 31, 2023CLIN NODESCRIPTIONUNITUNIT COST4001Registered Nurse I4001aRegular HoursHour4001bHoliday HoursHour4002Registered Nurse II4002aRegular HoursHour402bHoliday HoursHour4003Registered Nurse III4003aRegular HoursHour4003bHoliday HoursHour4004Licensed Practical Nurse I4004aRegular HoursHour4004bHoliday HoursHour4005Licensed Practical Nurse II4005aRegular HoursHour4005bHoliday HoursHour4006Licensed Practical Nurse III4006aRegular HoursHour4006bHoliday HoursHour4007Nursing Assistant IV4007aRegular HoursHour4007bHoliday HoursHour4008Surgical Technician4008aRegular HoursHour4008bHoliday HoursHour4009Nurse Practitioner4009aRegular HoursHour4009bHoliday HoursHour4010Medical Supply Technician4010aRegular HoursHour4010bHoliday HoursHour4011Sterile Processing Services Technician4011aRegular HoursHour4011bHoliday HoursHourPERFORMANCE WORK STATEMENT (PWS) VANCHCS NURSE REGISTRYDecember 22, 2017SERVICES REQUIRED: The Contractor shall provide personnel on an as-needed, per diem, basis for the VA Northern California Health Care System (hereafter known as the VANCHCS). The contract personnel will have access to and the use of all required patient care equipment, supplies, and computer access for performing services required by this contract. All services shall be provided in accordance with the specifications, terms and conditions contained herein.PLACES OF PERFORMANCE: Northern California Healthcare System, VA Medical Center: 10535 Hospital Way, Mather, CA 95655. Martinez Community Living Center (CLC): 150 Muir Road, Martinez, CA 94553 Chico Outpatient Clinic (OPC): 280 Cohasset Road, Chico, CA 95926 Fairfield OPC: 103 Bodin Circle, Travis AFB, Fairfield, CA 94535 McClellan OPC: 5342 Dudley Avenue, McClellan, CA 95652 Mare Island OPC: 201 Walnut Avenue, Mare Island, CA 94592 Martinez OPC: 150 Muir Road, Martinez, CA 94553 Oakland OPC: 2221 Martin Luther King Jr. Way, Oakland, CA 94612 Redding OPC: 351 Hartnell Avenue, Redding, CA 96002 Yuba City OPC: 425 Plumas Boulevard, Yuba City, CA 95991 Oakland Behavioral Health Clinic: 525 21st Street, Oakland, CA 94612 Yreka Rural Health Clinic: 101 E. Oberlin Drive, Yreka, CA 96097 GENERAL: The Contractor shall provide temporary personnel on an as-needed basis for the VA Northern California Health Care System (hereafter known as the VANCHCS). The contract personnel will have use of all required patient care equipment, supplies, and computer access for performing services required by this contract. All services shall be provided in accordance with the specifications, terms and conditions contained herein.Authority, Policy, and Handbooks: Title 38 United States Code (USC) 8153, Health Care Resources (HCR) Sharing Authority.Policies and Regulations: The Contractor shall comply with all applicable policies and regulations, including, but not limited to the following:42 Code of Federal Regulations (CFR) Part 482: Conditions of Participation Hospitals, including Sub-Part E Requirements for Specialty Hospitals. HYPERLINK "" VA Directive 1663: Health Care Resources Contracting - Buying HYPERLINK "" VHA Handbook 1100.17: National Practitioner Data Bank Reports - HYPERLINK "" Handbook 1100.18: Reporting and Responding to State Licensing Boards - HYPERLINK "" Handbook 1100.19: Credentialing and Privileging - HYPERLINK "" Act of 1974 (5 U.S.C. 552a) as amended HYPERLINK "" and Acronyms used in this Performance Work Statement:ACLS: Advanced Cardiac Life SupportBLS: Basic Life SupportCAC: Cardiac Ambulatory CenterCDC: Centers for Disease Control and PreventionCFR: Code of Federal RegulationsCLC: Community Living CenterCLIN: Contract Line Item NumberCNA: Certified Nurse AssistantCO: Contracting OfficerCOR: Contracting Officer’s RepresentativeCPARS: Contractor Performance Assessment Reporting SystemCPRS: Computerized Patient Recordkeeping System- electronic health record system used by the VA.CPT: Current Procedural TerminologyEKG: ElectrocardiogramePER: Electronic Patient Event ReportFAR: Federal Acquisition RegulationFIPS: Federal Information Processing StandardsFOIA: Freedom of Information Act FTEE: Full time Employee EquivalentHCR: Health Care ResourcesHHS: Department of Health and Human ServicesHIPAA: Health Insurance Portability and Accountability ActHR: Human ResourcesICC: Infection Control CommitteeICD: International (Statistical) Classification of DiseaseICU: Intensive Care Unit IDIQ: Indefinite Delivery, Indefinite QuantityISO: Information Security OfficerIV: IntravenousJC: Joint CommissionLMS: Logistics Management ServicesLPN: Licensed Practical NurseLVN: Licensed Vocational NurseMAB: Management of Assaultive BehaviorMMR: Measles, Mumps, RubellaNARA: National Archives and Records Administration NIST: National Institute of Standards and TechnologyOIG: Office of the Inspector GeneralOPC: Out Patient ClinicOR: Operating RoomOSHA: Occupational Safety and Health Administration PICC: Peripherally Inserted Central Catheter POC: Point of ContactPPD: Purified Protein Derivative (of tuberculin)PWS: Performance Work StatementQASP: Quality Assurance Surveillance PlanRN: Registered NurseSAC: Security Agency CheckSAM: System for Award Management SP: Special PublicationsTJC: The Joint CommissionTMS: Talent Management SystemTPN: Total Parenteral Nutrition USC: United States CodeVA: Veterans AffairsVA-FSC: VA Financial Service CenterVAMC: Veterans Affairs Medical CenterVANCHCS: VA Northern California Health Care SystemVETPro: A federal web-based credentialing program for healthcare providers. VHA: Veterans Health AdministrationQUALIFICATIONS:2.1 Staff/Facility: Contract personnel shall be licensed in a State, Territory, or Commonwealth of the United States or the District of Columbia. 2.2 Contractor Personnel Requirements/Specifications: The Contractor shall ensure that all contract personnel meet the qualifying criteria outlined in this section. 2.3 Registered Nurses (RN)s, Licensed Practical Nurse (LPN), Licensed Vocational Nurse (LVN), Nurse Practitioner (NP), and Certified Nurse Assistants (NA): All Nurses must have certification in cardiopulmonary resuscitation (CPR) by an American Health Association vendor. Personnel must be able to demonstrate competency in providing CPR, and have current basic life support (BLS) certification. Critical care Nurses shall have advanced cardiac life support (ACLS) certification. Licensure: The contract RNs and LPN/LVNs must have a current license in at least one state, territory, or commonwealth in the US or the District of Columbia. Proof of current license must be provided five business days prior to their first shift, and at the licensure renewal rate. This also applies to all other required certifications.Current Curriculum Vitae: A review of individual education and professional qualifications must be available for the healthcare system’s review to assure appropriate placement in a medical discipline commensurate with the contract personnel’s qualifications and experience.2.4 Uniforms: All contract personnel will provide their own uniforms and nametags, and will wear them anytime the personnel are on any Department of Veterans Affairs’ (VA) Medical Center (VAMC) grounds.2.5 Health Tests: All contract personnel will provide proof of tuberculosis testing, rubella testing, and immunizations that are current within one year prior to working any shift. Other tests may be required by the local facility.2.6 Health Restrictions: The contract personnel will have no health or physical disability restrictions that interfere with the performance of their duties.2.7 Competencies: The Contractor will keep a file of validated competencies, and training program records, to include Health Insurance Portability and Accountability Act (HIPAA) training for all contract personnel. This file must be available to the VA facility 24-hours-per-day, and seven- days-per-week.2.8 Experience: All contract personnel will have a minimum of one year direct patient care experience within the last three years in the field, unless otherwise specified herein.2.9 Computer Literacy: The contract personnel shall have the knowledge and ability to use computers and other technology.2.10. Nursing Assistants: The contract Nursing Assistants must provide proof of certification by the California State Department of Consumer Affairs as a Nursing Assistant.2.11. Contractor Personnel Responsibility: The Contractor shall assume full responsibility for the protection of their personnel who are providing services under this contract, therefore, the Contractor will provide the following to their contract personnel: Worker’s CompensationProfessional Liability InsuranceHealth ExaminationsIncome Tax WithholdingsSocial Security Payments2.12. Payment for Leave Time: Sick leave, vacation time, and any other type of leave is considered the sole responsibility of the Contractor. The Contractor shall comply with all existing local, state, federal, and union laws and regulations relevant to fringe benefits and premium pay for their employees. Such personnel shall not be considered VA employees for any purpose and shall be considered employees of the Contractor.2.13. Unacceptable Assignee: Contractor employees that report for work but are unable to perform will result in a four-hour penalty deduction from an outstanding invoice. The corresponding hourly rate will apply. The Contracting Officer (CO) may also terminate this contract at his or her sole discretion for repeated no-shows or tardiness of contract personnel. 2.14. Right of Refusal: The Government reserves the right to reject any contract personnel and refuse them permission to provide services if they fail to perform in accordance with the contract requirements. The contract personnel must always display personal and professional conduct in a manner that does not jeopardize patient care or interfere with the regular and ordinary operation of the facility.2.15. Acceptance of Personnel: The Contractor shall ensure that all contract personnel have met the qualifying criteria, including current and valid licenses and certifications. These qualifying criteria shall be met by completing VETPro certification; VETPro is an Internet-enabled data bank for the credentialing of Veterans Health Administration (VHA) personnel. It facilitates the completion of a uniform, accurate, and complete credentials file. The Contractor shall initiate VETPro data within 72 hours of selecting their contract staff. Contracted Staff shall not work on VA facilities until VETPro data has been initiated. It is the Contractor’s responsibility to ensure that Contract staff is current with their licenses and certifications. This information shall be relayed to the CORs as it becomes available. The decision to reject and accept Contract Staff ultimately rests with the Department of Veterans Affairs (VA). The Contractor shall provide personnel who will provide scheduled services throughout the contract period. If the Contractor’s personnel cannot perform services for any reason, the Contractor shall bear the responsibility of providing replacement personnel to provide the scheduled services. Replacement personnel are expected at the time initially scheduled. Non-acceptance of contract personnel does not relieve the Contractor from satisfying and fulfilling the contract requirements.The VA shall provide the Contractor with the names, titles and telephone numbers of individuals authorized to request staffing. It shall also provide the name, title and telephone number of the COR at the time of contract award.The Contractor shall designate a person from their agency to act as a Point-of-Contact (POC) for the VA within ten business days of contract award. The Contractor’s POC will be responsible for the overall conduct of the contract. The name and telephone number of the POC shall be provided to both the CO and the COR. The Contractor’s POC shall not be one of the care providers rendering services under this contract. The COR or the evening and night Nursing Supervisor in the Nursing Department, or the individual in charge in other departments where duties are to be performed, will contact the Contractor’s designated POC concerning personnel staffing problems or other issues requiring immediate attention. The Contractor shall respond to telephone calls from the COR within 30 minutes twenty-four-hour-per day, seven days-per-week. When the contract personnel do not report for their scheduled shift, the Contractor shall provide a fully qualified replacement within four hours of the notification.The Government reserves the right to refuse acceptance of contract personnel whose personal or professional conduct jeopardizes patient care or interferes with the regular and ordinary operation of the facility. Breaches of conduct include intoxication from alcohol or drugs, theft, patient abuse, dereliction or negligence in performing directed tasks, or other conduct resulting in formal complaints by patients or other staff members to designated Government representatives. Standards for conduct shall mirror those prescribed by current federal personnel regulations. The Contractor and COR will deal with issues raised concerning contract personnel’s conduct. The CO is the final arbiter on questions of plaints concerning contract personnel’s relations with the Government employees or patients will be resolved by the CO. The CO has the final authority on validating complaints. If contract personnel are involved and named in a validated patient complaint, the Government reserves the right to refuse acceptance of the services of such personnel. This does not preclude refusal in the event of incidents involving physical or verbal abuse.VA personnel such as the CO, the COR, a VA POC, will brief contract personnel on VA Healthcare System policies and procedures on the first scheduled duty day.The contract personnel rendering services are subject to professional or technical direction from the COR.2.16. Orientation: The Contractor shall provide eight hours of orientation time to each nurse at no charge to the VA. (Orientation is two days; the VA will compensate the contractor for one day, and the contractor will pay for the second day.)?? Orientation will include required Security Agency Check (SAC) background check completed with Human Resources (HR).? The Contractor shall not work on VA facilities until the orientation and the SAC background check are completed.? Oriented Nurses shall be available and expected to perform their scheduled assignments for a minimum of three months following said orientation.?Employment Packet: An employment packet shall be submitted to the COR for each contract employee five business days prior to his or her first duty shift. The packet shall consist of names, social security numbers, and copies of the curriculum vitae, Purified Protein Derivative (of tuberculin) tests, MMR or Rubella Titer, and any other locally required health care test, license numbers, expiration dates, and at least two current references reflecting current professional practice. The COR will notify the Contractor of acceptance or unacceptability of proposed employees within two business days of the receipt of the packets. The determination will be based on the contents of the packet evidencing that all qualification requirements are met. Healthcare Industry Standards: Contractor personnel shall perform services in accordance with ethical, professional and technical standards of the healthcare industry consistent with VA policies, regulations, procedures and protocol. The Contractor’s personnel shall be technically proficient in the skills necessary to fulfill the requirements stated herein.Personal Hygiene and Clothing: Contract healthcare providers shall be neat, clean, well-groomed and will exercise good personal hygiene. Appropriate and professional attire shall be work always while caring for patients.Health Restrictions: Contract personnel shall have no health or physical disability restrictions which interfere with the performance of duties and shall have a current physical completed within the past 30 business days.2.17. Health Requirements: Health care providers shall not perform services under this contract unless a pre-assignment medical examination has been performed within 30 business days of their first scheduled shift. Pre-assignment medical examinations shall be the responsibility of the Contractor at no cost to the Government.As a condition of employment, the Occupational Safety & Health Administration (OSHA) requires that all contract staff that will have occupational exposure to blood, body fluids, and other potentially infectious materials, shall receive Hepatitis B vaccine, provide documented proof of immunity to the Hepatitis B infection, or sign a voluntary declination of the Hepatitis B vaccine. The immunization declination shall be the responsibility of the Contractor at no cost to the Government. As a condition of employment, the contract health care providers will obtain an annual PPD skin test. Those with a positive skin test history shall complete an annual respiratory assessment questionnaire. The skin test or respiratory assessment will be the responsibility of the Contractor at no cost to the Government. Contract health providers having patient contact or exposure to biological or pathological specimens shall be immunized against, be granted an immunization waiver to, or have documented proof of immunity to chickenpox, measles, rubella, mumps, polio and Hepatitis B. In addition, the contract health care providers shall be free of infectious diseases (to include but not limited to active Tuberculosis and Viral Hepatitis) that might reasonably be expected to place the other workers, patients or the public at risk.The Contractor shall provide the Government with all the information necessary to ensure that government records are maintained correctly and in compliance with The Joint Commission (TJC), OSHA, and the Centers for Disease Control and prevention (CDC) health records requirements, for each contract health care provider.The Contractor shall provide the COR with certification that contract health care providers have completed the medical evaluation required above, a minimum of five business days prior to the performance of contract services. This certification shall state the date that the examination was completed, the name of the Doctor who performed the examination, a statement concerning the physical health of the individual and the following statement: [Name of contract health care provider] is suffering from no contagious diseases to include Tuberculosis, Hepatitis and Venereal Disease.The government may take nose and throat cultures from contract health care providers when required by the government’s Infection Control Committee (ICC). When a health care provider has been found medically unfit to provide the services required under this contract, they shall be required to discontinue working immediately. Contract health care providers will not return to work until given clearance by an appropriate Physician.The Government will provide emergency health care for injuries sustained while on duty for contract health care providers. HOURS OF OPERATION:3.1 Work Schedule Weekday Coverage a) Day Shift 7:30 a.m. – 4:00 p.m.b) Evening Shift 3:30 p.m. – 12:00 12:00 a.m.c) Night Shift 11:30 p.m. – 8:00 a.m.Weekend Coverage a) Day Shift 7:30 a.m. – 4:00 p.m.b) Evening Shift 3:30 p.m. – 12:00 12:00 a.m.c) Night Shift 11:30 p.m. – 8:00 a.m.3.2. Federal Holiday days: The Government observes the following ten National Holiday days:New Year’s Day Martin Luther King’s BirthdayWashington’s BirthdayMemorial DayIndependence DayLabor DayColumbus DayVeteran’s DayThanksgiving DayChristmas Day **Any other day specifically declared by the President of the United States to be a Federal Employee holiday, or when Congress declares a National holiday. When a holiday falls on a Sunday, the following Monday will be observed as a National Holiday. When a holiday falls on a Saturday, the preceding Friday is observed as a National Holiday by United States Government agencies. An administrative closure of federal offices by Executive Order is not a national holiday for holiday pay.3.3. Request for Service: The Contractor shall provide qualified and approved staffing within 24 hours’ notice from the COR or VA POC. This is a per diem staffing requirement, so most of the shifts are as needed. 3.4. Shift Cancellation: The COR or VA POC will give the Contractor notification of available shifts no less than one week in advance for scheduled shifts exclusive of emergencies. The Contractor’s personnel may be released from duty after a minimum of four hours if their services are no longer required, however contract personnel will only be paid for their actual hours worked. Any tour of duty for the Contractor’s personnel may be canceled two hours prior to the assigned shift, without penalty if staffing permits. The VA is not required to make payment after an employee has been released from duty. Contract personnel brought in under a term contract (i.e. Travel/Per-Diem Nurses) will be subject to reassignment if patient care needs dictate. 3.5. Changes in Work Requirements: Only those services specified herein are authorized. Changes to the resulting contract are not authorized, unless in writing by the CO. The Contractor shall keep the CO informed in writing, of any unusual circumstances in conjunction with the contract.3.6. Tardiness and No-Shows: The VA may excuse tardiness more than one hour on a case-by-case basis; however, payment to the Contractor will be for the actual hours worked. Unacceptable patterns of tardiness or no-shows may result in a poor performance rating of the Contractor. This can adversely affect future government contracts. After one hour of tardiness, a Contractor’s employee will be considered a no-show. The Contractor will have a back-up plan to provide needed staff in the event of a no-show.3.7. Overtime: Compensation for services rendered will be on a per-shift basis. The scheduling, tracking and compensation of Nurses in accordance with the State or Federal Law is the sole responsibility of the Contractor. The Contractor will not include any overtime on the invoice that is sent to the VA unless authorized by the CO. 3.8. Record Keeping System: The VA has established a record keeping system and will maintain it for verification of the actual hours worked by the Contractor’s employee each day. The Contractor’s personnel must be present at the VA Medical Center and be performing services required by the contract during the scheduled work period to be paid for that period. Contract personnel shall sign in and out at the Central Nursing Office (CNO) as a method of accounting for hours worked. CONTRACTOR RESPONSIBILITIES: The Contractor will provide personnel who can perform the required functions described in paragraphs below. The following paragraphs in this section describe the types of Nurses, the required skills needed, and the functions of those positions:4.1. Registered Nurses: The Contractor shall provide RNs who are certified in Peripherally Inserted Central Catheter (PICC) Lines, Critical Care, Med/Surgery, Chronic Hemodialysis, Radiology, Post Anesthesia Care, Operating Room Work, Emergency Room Care, Chemotherapy. 4.2. Licensed Practical Nurses/Licensed Vocational Nurses (LPN/LVN)s, Nursing Assistants (NA)s and Nurse Practitioners (NP)s: The Contractor shall provide LPN/LVNs, NAs and NPs to augment in-house staffing in accordance with the requirements herein. The Contractor’s personnel shall provide staffing for shifts as designated by the COR or the COR’s POC.4.3. Critical Care RNs, Emergency Room RNs, Post-Anesthesia Care Unit RNs, and Operating Room RNs:Introduction: This type of RN provides direct and indirect nursing care in the following areas of assignment: Intensive Care Units, Recovery Rooms, Cardiovascular Labs, Emergency Rooms, Operating Rooms, and Gastro-Intestinal (GI) Labs by contributing to patient assessments, setting priorities, identifying therapeutic objectives and nursing measures, and evaluating outcomes. Essential skills to this position are independent judgment and nursing actions, flexibility, organizational skills, and the ability to utilize an interdisciplinary approach in the provision of nursing anizational Relationship: This type of RN is subject to the professional direction of the VA Nurse Manager or designee during the workweek. The RN reports to the Nursing Supervisor through the Charge Nurse during evening and nightshifts, holiday days, and weekends. Functions: The services of Critical Care Registered Nurses shall be provided in accordance with the policies of the VA Healthcare System where assigned. Nurses shall have professional and legal responsibility to the patient. The RN provides the following services:Provides critical care nursing to Intensive Care Unit (ICU) patients.Performs scrub and circulating duties in the Cardiovascular Lab and the Operating Room.Assists with the GI Lab procedures and demonstrates competency in monitoring patients undergoing conscious sedation. Obtains patient history and pertinent family history.Assesses patient and plan appropriate nursing care.Documents plan of care and care given in patient’s medical record.Verifies transcription of physician’s orders, no verbal orders are to be accepted.Carries out prescribed Physician’s orders and documents inpatient medical municates pertinent patient data to the Charge Nurse and/or Physician as appropriate.Re-assesses patient’s condition and revises plans-of-care based on problems that the Nurse Identifies.Administers medications and Intra-venous (IV) therapies.Possesses knowledge of actions and usual dosages of the most commonly used emergency drugs and their location on the crash cart.Assesses and documents patient responses to medications that have been administered.Can interpret cardiac rhythms and their implications.Reorganizes and initiates the appropriate measures in emergencies/therapies and surgical/diagnostic procedures that must be accomplished.Instructs patients and their families regarding prescribed medications/therapies and surgical/diagnostic procedures that must be accomplished.Assesses patient/family knowledge level, implements plan of instructions, and records the patient’s family’s demonstrated level of understanding.Operates defibrillator, electrocardiogram (EKG) machines and cardiac monitors, and other technical emergency equipment.Cares for patients with Swan-Gans catheters, arterial lines and mechanical ventilators.Participates in discharge planning.Can initiate life saving measures in the absence of Physicians.Assures the content and correctness of a prepared report and signs the document to validate its content.Maintains a neat personal appearance and maintains professional decorum.Consistently applies the VA’s customer service standards, always demonstrating helpful, courteous, and respectful conduct.Respects patient’s rights, including but not limited to visual and auditory privacy.May accept a verbal order in compliance with the facility policy.Critical Care RNs must have a minimum of two years’ current experience in this field and hold BLS and ACLS and/or certification.Intake and output of fluids assessed every shift, and more frequently if indicated by specific standard nursing drug care. Reviews all laboratory data, and electronic medical records.Can titrate medications.Can be responsible for feeding tubes which are aspirated for gastric residue prior to every intermittent feed, and every four hours for continuous tube feedings.Performs urinary catheter care by using soap and water cleaning technique every 12 hours, or as required.Ensures that medication orders from the previous shift have been noted and either carried out or transcribed onto the medical records. Must be able to rotate through the following areas and perform associated functions of these areas: Catheterization Laboratory, Cardiac Ambulatory Center (CAC), Electrophysiology (EP) Lab, Interventional Radiology, Magnetic Resonance Imaging (MRI) Lab and Gastroenterology Lab.4.4. Functions of the Medical/Surgical (Med/Surg) RN, the Chronic Hemodialysis RN, Radiology RN, and the Psychiatry RNs:Introduction: In any area of assignment within the health care system, the RN provides direct and indirect nursing care, through assessing patient status, determining priorities, identifying nursing measures, identifying therapeutic objectives, and evaluating outcomes. The position requires independent judgment and nursing actions, flexibility, organizational skills, and the ability to utilize an interdisciplinary approach in the provision of nursing anizational Relationship: The RN is subject to the professional direction of the VA Nurse Manager or their designee during the workweek. On evenings, nights, holiday days, and weekends, the RN reports through the Charge Nurse to the Nursing Supervisor designee.Functions: The services of Med/Surg RNs, Radiology Nurses RNs, and Chronic Hemodialysis RNs shall be provided in accordance with the policies of the VA Healthcare System where assigned. Nurses shall have professional and legal responsibility to the patient. The RN provides the following services:Utilizes the nursing process and an interdisciplinary approach to provide direct, continuous, and comprehensive patient care.Performs nursing functions related to physician prescribed treatments.Performs the function of a scrub nurse.Assists patients with activities of daily living.Performs the functions of a circulating nurse.Administers medications and IV therapies in compliance with local facility policies.Obtains patient history and pertinent family histories.Assesses patients and plans appropriate nursing care.Documents patient’s medical record with the plans-of-care and the care provided to the patients.Verifies transcriptions of Physician’s orders, and does not accept verbal orders.Carries out Physician’s orders and documents the patient’s medical municates pertinent patient data to the Charge Nurse and/or Physician as appropriate.Re-assesses patient’s condition and revises plans-of-care based on problems that the Nurse Identifies. Assesses and documents patient’s responses to medications and all treatments administered.Recognizes and initiates the appropriate measures in emergencies and assists with surgical/diagnostic procedures.Instructs the patients and their families regarding prescribed medications/therapies and surgical/diagnostic procedures.Assesses the patient/family knowledge level, and implements a plan of instructions and records the patient’s and family’s demonstrated level of understanding.Cares for patients with a variety of catheters and prostheses.Participates in discharge planning.Can initiate life saving measures in the absence of a Physician.Maintains a neat and clean personal appearance with professional decorum.Consistently applies the VA’s customer service standards, and always demonstrates helpful, courteous, and respectful conduct.Respects patient rights, including but not limited to visual and auditory privacy.Med/Surg RNs, Radiology RNs, and Chronic Hemodialysis RN and Psychiatric RNs, must be experienced in this field.Psychiatric RNs working in Acute Locked Psychiatry shall possess current ProAct or equivalent Management of Assaultive Behavior (MAB) training and or certification.4.5. Functions of the Certified Chemotherapy RNs: Introduction: In assignment within the VISN 21 Healthcare Systems, Oncology units or Chemo clinics, the RN provides direct and indirect nursing care by contributing to the patient’s assessment, determining priorities, identifying nursing measures and therapeutic objectives and evaluating outcomes. The position requires independent judgment and nursing actions, flexibility, organizational skills, and the ability to utilize an interdisciplinary approach in the provision of nursing anizational Relationship: The RN is subject to the professional direction of the VA Nurse Manager or designee during the workweek. During evenings, nights, holiday days and weekends, the RN reports through the Charge Nurse to the Nursing Supervisor.Functions: The services of?Chemotherapy Registered Nurses shall be provided in accordance with the policies of the VA Healthcare System where assigned.? Nurses shall have professional and legal responsibility for the patient. The RN provides the following services:Performs?administration of chemotherapy to patients?on Oncology Units or in Chemo Clinic in accordance with Medical Center Policies and Procedures from the Lippincott Manual of Nursing Practice.Understands the principles of chemotherapy and the various chemotherapeutic agents.Demonstrates knowledge of the fundamentals of chemotherapy administration, safety measures for administration of chemotherapy, treatment schedules, and pretreatment and treatment.Possesses knowledge of complications of Cytotoxic Therapy and the correct interventions to initiate for them.Demonstrates competency in the management of patients receiving chemotherapy with specific skills in assessment, patient education, toxicity management and oncologic emergencies.Obtains patient history and pertinent family history.Assesses patient and plans appropriate nursing care.Documents plan of care and care given in patient’s medical record.Verifies transcription of Physician’s orders, and does not accept verbal orders.Carries out prescribed Physician’s orders and documents inpatient medical record.?Communicates pertinent patient data to the Charge Nurse and/or Physician as appropriate.Re-assesses patient’s condition and revises plans-of-care based on problems that the Nurse Identifies. Administers medications and IV therapies.Possesses knowledge of actions and usual dosages of most commonly used emergency drugs and their location on crash cart.???Assesses and document patient response to medication that have been administered.Reorganizes and initiates appropriate measures in emergencies. Instructs patient/family regarding prescribed medications/therapies and surgical/diagnostic procedures that must be accomplished.Assesses patient/family knowledge level, implement plan of instructions and record patient/family demonstrated level of understanding.Operates defibrillator, EKG machines and cardiac monitor.Participates in discharge planning, as appropriate.Can initiate life saving measures in the absence of Physicians.Maintains a neat personal appearance and maintains professional decorum.Consistently applies the VA’s customer service standards, always demonstrating helpful, courteous, and respectful conduct.Respects patient’s rights, including but not limited to visual and auditory privacy. 4.6. Functions of the Licensed Practical Nurse/Licensed Vocational Nurse (LPN/LVN):Introduction: In any area of assignment within the health care system, the LPN/LVN provides direct and indirect nursing care by contributing to the patient’s assessment, determining priorities, identifying nursing measures and therapeutic objectives, and evaluating outcomes. The position requires independent judgment and nursing actions, flexibility, organizational skills, and the ability to utilize an inter-disciplinary approach in the provision of nursing anizational Relationship: The LPN/LVN is subject to the professional direction of the VA Nurse Manager/Charge Nurse or designee during the workweek. On evenings, nights, holiday days and weekends, the LPN/LVN reports through the Charge Nurse or Nurse Manager or to the Nursing Supervisor/designee. Functions: The LPN/LVN functions within the policies of the VA where assigned and has professional and legal responsibility to the patient. The LPN/LVN provides the following services:Serves as a member of the nursing team. and participates in the planning, implementation and evaluation of nursing care provided.Serves as a direct patient care provider and carries out nursing care for assigned patients. Is alert to physical and emotional changes and complications related to patient disease process and reports such immediately to the RN.Observes patient’s changing condition and reports and records changes on the nursing progress note and care plan. Enters accurate, complete information in the medical record about patient’s condition and responses to treatment and actions taken to carry out nursing care.Reinforces instructions to patient scheduled for invasive, diagnostic, or pre/post-operative procedures. Instructs patients on the use of equipment (e.g. oxygen, suction, incentive spirometry, etc.). Reinforces instructions to patients and families on the use of prescribed medications.Performs a range of treatment and procedures that include but are not limited to changing sterile dressings, inserting urinary drainage catheters, irrigating catheters and/or nasogastric tubes, irrigation wounds, giving enemas, using various forms of body temperature control, administering oral, topical and intramuscular medications and reporting information concerning adverse effects, caring for patients in isolation, and/or continuous observation status, and giving treatments that requires use of specialized oxygen, suction or other supplies.Serves as a module/team leader if assigned to the Nursing Home Care Units. Observes, promptly reports, and documents observations regarding the physical and emotional status of patients, including such things as changes in vital signs, bodily functions, clarity of speech and/or orientation to time, place or person.Performs a range of diagnostic support duties which include taking vital signs during neurological checks, collecting specimens, obtaining laboratory reports, and assisting in a variety of examinations such as lumbar punctures, paracentesis, liver biopsies, thoracentesis and bone marrow examinations by positioning and draping patients and providing other assistance as necessary.Recognizes emergency situations (e.g. cardio-pulmonary arrest, choking, etc.) and takes prompt, appropriate action.Initiates emergency measures to control patient’s disruptive or violent behavior. Assumes responsibility for patients requiring constant observation, including those placed on legal holds as a danger to themselves, others, or gravely disabled, which includes15 minute documentation of patient’s condition on appropriate forms.Prepares, administers and records prescribed medications in accordance with Medical Center’s Policy and Procedure. Observes and reports physical and emotional reactions to medications.Counts narcotics and assumes responsibility for narcotic security and the accuracy of narcotic records. Administers narcotics in accordance with established Medical Center policy.Reports to the RN completion of care rendered, changes in patient’s response or condition and care needs remaining prior to leaving the clinical area.Maintains completeness and accuracy of all continuing patient records, including intake and output, vital signs, and activities of daily living.Performs a range of personal care that includes feeding, bathing, lifting, and turning patients, providing for personal hygiene and performing preventative, rehabilitative, and therapeutic care/procedures within the scope of the LPN/LVN.Accompanies patients on diagnostic or therapeutic trips, assuming responsibility for nursing decisions while away from the nursing unit, within the scope of the LPN/LVN.Always meets the safety and security needs of patients.Promotes a sense of dignity and self-worth for all patients and staff. Consistently applies VA Customer Service Standards, demonstrating helpful, courteous, respectful conduct always.Respects patient’s rights, including but not limited to, visual and auditory privacy. Licensed Practical/Vocational Nurses must be experienced in this field.Licensed Practical/Vocational Nurses Psychiatric RNs working in Acute Locked Psychiatry shall possess current ProAct or equivalent MAB training and or certification.4.7. Functions of the Nursing Assistant (NA):Introduction: In the area where assigned within the health care system, the Nursing Assistant (NA) provides direct nursing care under the direct or indirect supervision of a VA Registered Nurse. The position requires the ability to follow directions, determine priorities as they relate to basic patient care needs within the scope of a Nursing Assistant, uses organizational and observational anizational Relationship: The NA is subject to the professional direction of the VA RN responsible for the team of patients to which the NA is assigned, at times, reporting through a LPN/LVN to the RN.Functions: The NA functions within the policies and procedures of the VA facility where assigned and provides the following services:Serves as a member of the nursing staff and carries out routine nursing care and other personal services to assigned patients on any ward or tour assigned.Performs a range of personal nursing care which includes activities of daily living, such as feeding, bathing, lifting and turning patients, providing oral, nail, hair related hygiene care, and performing preventive, rehabilitative, and therapeutic care/procedures within the scope of a Nursing Assistant.Records all care provided in the appropriate clinical records.Observes significant conditions, both physical and emotional that are relevant to the health status of the patient. Provides timely and accurate reports to their team leader or designated superior and records all relevant information in the clinical record. Gives special attention to details of care since patients are often too ill or confused to speak for themselves.Performs a range of diagnostic support duties such as taking vital signs during neurological checks, collecting specimens, and preparing patients for tests, examinations, treatments and/or surgery per established procedures.Performs a range of treatment procedures that include changing dressings, giving enemas, colostomy care, tracheotomy care, and caring for patients in isolation, and/or continuous observation status.Maintains a safe and therapeutic environment; observes all policies pertaining to universal precautions. Provides for safety needs of patients.Recognizes emergency situations such as cardiopulmonary arrest, choking, seizures, dysreflexia, etc., and takes appropriate action, and reports situations immediately.Accompanies patients on diagnostic or therapeutic trips assuming responsibility for basic decisions within the scope of a Nursing Assistant while away from nursing units.Initiates emergency measures to control disruptive or violent behavior.Assists in the delivery of patient care as directed by the RN or LPN/LVN.Respects patient’s rights, including but not limited to visual and auditory privacy.Consistently applies VA customer services standards, and always demonstrating helpful, courteous, and respectful conduct. Nursing Assistants must have experience in this field. Nursing Assistants working in Acute Locked Psychiatry shall possess current ProAct or equivalent MAB training and certification.4.8. Functions of the Nurse Practitioner (NP):Introduction: In the areas of assignment within the health care system, the NPs provide diagnosis, treatment, consultation, and follow-up patient care. Participates in the care of inpatient and outpatient clients in an independent and interdependent role as directed by the NP Professional Leader or Chief of Patient Care anizational Relationship: The NP is subject to the professional direction of the VA Nurse Manager/Charge Nurse or designee during the workweek. During evenings, nights, holiday days and weekends, the NP reports through the Charge Nurse or Nurse Manager or to the Nursing Supervisor/designee.Functions: The NPs functions within the policies of the VA where assigned and has professional and legal responsibility to the patient. The NPs provides the following services:Executes position responsibilities independently and collaboratively in accordance with the scope and standards of nursing practice within the specialty area. Works in an independent and interdependent relationship with members of the medical staff.Effectively identifies, evaluates, and addresses disease prevention and health promotion issues while administering quality patient care.Demonstrates advanced assessment and decision-making skills. Maintains legible, accurate, and confidential medical records. Documents all medical evaluations, diagnoses, treatment, outcomes, education, referrals, and consultations. Documents care/visit in CPRS appropriately, accurately and concisely. Follows clinical guidelines and standards of practice for health promotion, maintenance and illness prevention. Completes health histories and other clinical documentation consistently and with pertinent information. Responsible for the diagnosis and treatment of acute, chronic, and long-term healthcare issues. Ensures that care and treatment plans are consistent with assessments. Orders and interprets diagnostic tests appropriately. Selects/furnishes (prescribes) or recommends pharmacological agents and durable medical equipment appropriately. Sets priorities to provide care in an organized and timely manner. Presents cases in a concise, organized manner. Participates in formal and informal performance evaluations and professional development. Evaluates own performance per the APN Scope of Practice standards of professional and regulatory bodies and takes actions to improve practice. Maintains mandatory requirements and competency standards. Treats staff, patients and family with respect and dignity. Uses clinical research techniques in decision-making and in making recommendations. Identifies and documents appropriate International (Statistical) Classification of Disease (ICD) and current Procedural Terminology (CPT) coding for patient encounters.Educates patients and/or families about preventive care, medical issues, and use of prescribed medical treatments and/or plies with safety facility patient guidelines and other mandatory requirements as directed. 4.9. Functions of the PICC Line Certified RNs:Introduction: The PICC Line certified RN provides direct and indirect nursing care in all units by contributing to the patient’s assessment, determining priorities, identifying nursing measures, therapeutic objectives, and evaluating outcomes. The position requires independent judgment and nursing actions, flexibility, organizational skills, and the ability to utilize an interdisciplinary approach in the provision of nursing anizational Relationship: The RN is subject to the professional direction of the VA Nurse Manager or designee during the workweek. On evenings, nights, holiday days and weekends, the RN reports to the Nursing supervisor through the Charge Nurse.Functions: The services of?PICC Line Registered Nurses shall be provided in accordance with the policies of the VA Healthcare System where the RN is assigned.? Nurses shall have professional and legal responsibility for the patient. The RN provides the following services:Performs?administration of the PICC Line in accordance with Medical Center Policies and Procedures, Lippincott Manuel of Nursing Practice.Performs IV services on cases ranging from IV antibiotic infusion, to total parenteral nutrition (TPN), and determines the severity on a case-by-case basis.Sees an average of one to five patients per week, depending on the facility’s requirements.Provides services as needed when ordered by a Physician 24 hours-per-day/seven days-per-week.Begins work as soon as possible after clearance through VETPro.Uses the VA provided PICC line kit, Ultrasound Device and X-ray services. All supplies needed for procedure will be included in the PICC kit.Provides the PICC line services at the patient’s bedside at the VA facility.Works without assistance except in the case of an emergency, such as patients who become restless and altered, where assistance in holding the patient may be required.The PICC may have single or multiple lumens. This depends on how many intravenous therapies are needed. A PICC line can be used for antibiotics, pain medicine, chemotherapy, nutrition, or for the drawing of blood samples. PICCs are inserted by radiologists, physician assistants, or certified registered nurses. They are inserted using ultrasound technology at the bedside or ultrasound with fluoroscopy. Chest radiographs are also used to confirm placement of the PICC tip if it was not inserted using fluoroscopy.Obtains patient history and pertinent family history.Assesses patients and plans appropriate nursing care.Documents patient’s medical record with the plan-of-care and all care given.Verifies transcription of Physician’s orders. No verbal orders are to be municates pertinent patient data to the Charge Nurse and/or Physician.Re-assesses patient’s condition and revises plans-of-care based on problems that the Nurse Identifies. Operates defibrillator(s), EKG machines and cardiac monitors.Can initiate life saving measures in the absence of Physicians.Maintains a neat personal appearance and maintains professional decorum.Applies VA customer service standards consistently by always demonstrating helpful, courteous, and respectful conduct.Respects patient’s rights, including but not limited to, visual and auditory privacy.4.10. Functions of the Electrocardiogram (ECG/EKG) TechnicianIntroduction: The ECG/EKG Technician Performs EKGs/Stress on patients utilizing cardiology and Nuclear Medicine protocols, assuring each record is standardized and the lead placements are properly positioned to obtain quality recording and appropriate data for adequate assessment of anizational Relationship: The ECG/EKG Technician is subject to the professional direction of the VA Nurse Manager or designee during the workweek. On evenings, nights, holiday days and weekends, the EKG Technician reports to the Nursing Supervisor through the Charge Nurse.Functions:Performs EKGs/Stress on patients utilizing cardiology and Nuclear Medicine protocols, assuring each record is standardized and the lead placements are properly positioned to obtain quality recording and appropriate data for adequate assessment of results. Notifies provider immediately upon observation of unexpected or serious arrhythmias or ST/T wave changes, even if not life threatening. Responds to codes and STAT requests to perform STAT EKG/stress testing as directed by cardiology providers. Assists provider with stress testing in Nuclear Medicine, Cardiac Catheter Lab and Cardiology clinics utilizing protocols.Monitors and observes patients’ physiological status throughout test and recovery period, and notifies provider immediately of adverse symptoms. Instructs and prepares patient appropriately, ensures all necessary paperwork is completed prior to starting test. Stress test includes instruction, demonstration, and assessment of entering, walking and exiting moving treadmill to ensure safety. Prepares patient for diagnostic testing. Instructs patient about logging time/activities/and symptoms into diary. Operates Holter scanner and printer. Detects and records abnormal EKG complexes. Notifies provider immediately of serious or unexpected EKG findings. Ensures test are reviewed and signed by the Cardiologist, and completes data input into computer accurately within two weeks after test completion to provide timely access of test results to all providers. 4.11. Functions of the Medical Instrument Technician (Echocardiography)Introduction: Echocardiography technicians at this level identify and record anomalies indicative of disease, injury, or other medically significant condition from ultrasound imaging and simultaneous recordings of the Doppler. They incorporate the causes and results of a variety of symptoms and conditions into a plan of ultrasonic diagnostic examination. They change and develop sounding techniques to accommodate such variables as limited patient mobility, variation in physical condition or dimension of the patient, presence of prosthesis or foreign objects, and ultrasonic response of different body parts. They produce diagnostic quality images and Doppler frequency recordings using M-mode, two-dimensional, and Doppler anizational Relationship: The Medical Instrument Technician (Echo Tech) is subject to the professional direction of the VA Nurse Manager or designee during the workweek. On evenings, nights, holiday days and weekends, the Medical Instrument Technician reports to the Nursing supervisor through the Charge Nurse.Functions:Performs diagnostic quality images and Doppler frequency shift recordings using M-mode, two dimensional, pulsed and continuous wave Doppler spectral display and color flow Doppler imaging.Performs complex procedures such as cardiac studies of the four chambers of the heart and valves using sector scanning techniques to detect stenotic and incompetent valves, chamber enlargement and pericardial effusion and cardiovascular studies deriving pressure gradients across obstructed valves, etc.Performs complementary ultrasonic examinations including stress echocardiography and transesophageal echocardiography.Adapts transducer positioning, instrument controls and examination techniques to the individual patient being studied and the problem being evaluated including recognizing pertinent abnormalities and documenting abnormal findings. Administers contrast agents (e.g. agitated saline and optison) to improve yield of diagnostic echocardiogram. Monitors patient’s condition during procedure and administration of medication.Triages inpatient and outpatient cardiology procedure consults, prioritizes and coordinates care for patients in the Cardio Lab. Accurately documents assessment, interventions and outcomes in CPRS and other applications.Technical expert in the operation, calibration and maintenance of the specialized equipment in the Cardio Lab.Performs quality assurance reviews on cardiology diagnoses including Acute Coronary Syndrome (ACS)monitors.Participates in Facility and VISN conferences, task forces and committees as assigned to implement performance standards at the local level.4.12. Functions of the Sterile Processing Services (SPS) TechnicianIntroduction: The SPS ensures that all instruments and equipment are properly clean and sanitized to VA facility anizational Relationship: The SPS Technician is subject to the professional direction of the VA Nurse Manager or designee during the workweek. On evenings, nights, holiday days and weekends, the SPS Technician reports to the Nursing supervisor through the Charge Nurse.Functions:Plans for the required items for each procedure, and discusses them with the circulating RN to ensure that they are available in the room before the patient is brought in; begins the day by damp dusting all horizontal surfaces, and includes surgical tables, booms, wainscoting ledges, whiteboards, surgical lights and the arms (within reach), and equipment adjacent to the OR bed and sterile fields. Organizes sterile tables and equipment in the room in such a way that allows other team members to work without contaminating the sterile items. Sets up rooms and sterile tables with necessary instrument sets, powered equipment if applicable, supplies, and intraoperative medications per the surgeon preference cards (Pick List). Ensures that instruments and supplies on the sterile fields are free from bio-burden (tissues and remains of particles from previous operations) and defects (broken or missing components) and notifies the circulating RN immediately so the patient can be protected from accidental exposure to infectious material. Verifies the sterility of surgical instrument sets, peel-pack items, and other supplies by actively validating chemical indicators, filters, instrument wrappers, package integrity, and expiration dates.? Participates in pre-procedural verification and timeout.Follows basic safety standards always.? These include, but are not limited to labeling medication and fluid containers and syringes with the right labels, reading back when passing medications, maintaining sharp safety, managing fire sources (cautery devices, laser fibers, and fiber optic cords). Maintains the pace of operations by anticipating and passing surgical instruments with speed and accuracy in collaboration with the RNs, and performs surgical instrument accounting accurately to prevent retained surgical items.? Responsible for the accountability for all surgical instruments and soft goods used during the surgical procedure.? This includes but is not limited to, instruments from the sets, individual peel-pack items, single use miscellaneous items that came with sterile packs, sutures, towels, surgical sponges, supply wrappers, needle caps, and guide wires.? The surgical technician retrieves all instruments from the sterile fields and the surgical drapes at the end of the procedure.Provides complete and accurate hand-off reports to incoming nurses and technicians to maintain continuity of care.? The hand-off reports will include, but are not limited to medication and fluid on the field (containers and syringes), amount used, amount of irrigation used, specimens if any, anticipating specimen for microbiology or pathology, any surgical sponges or soft goods inside the wound, and any sharps being used by the surgeons at the time of reports. Assists the surgeon by performing such procedures as suctioning, holding retractors, applying skin staples, and cutting sutures. Performs pre-cleaning of instruments including endoscope per hospital policy and regulatory/professional organization guidelines (i.e., the Joint Commission, Office of Inspector General, Sterile Processing Service, and Association of perioperative registered nurses). Returns excess supplies to their original storage at the end of every operation. Performs room turn-over cleaning and terminal cleaning of rooms by wiping down soiled equipment with appropriate disinfectants per Reusable Medical Equipment policy, and returning disinfected equipment to appropriate storage.? The surgical technician will assist in team cleaning by supporting Environment Management Service (EMS) functions; Utilizes universal precautions and follows all infection control policies and procedures when handling specimens, supplies, and equipment always.? Assists the team members with care of the patient, i.e., positioning, padding, peri-care, prepping, maintaining I&O/Estimated Blood Loss, and obtaining supplies. Provides transportation of patients to and from the OR, as assigned; Assists in maintaining adequate supplies in specialty carts and supply cabinets.? This includes but is not limited to re-stocking the OR cabinets, specialty carts, and other secondary storage containers; Assists other surgical team by delivering specimens to pathology, morgue, microbiology, or Blood Bank as assigned by the RNs or Charge Nurse. Performs non-technical maintenance of equipment to prevent malfunctions. Recognizes potentially hazardous situations (e.g., frayed cords, water on floor) and takes corrective action. Responds to medical emergencies including disaster and code blues. Assists the surgical team members in quality improvement (QI) activities. Updates personal knowledge regarding current trends in surgical technology through continuing education courses. Assists in developing and maintaining appropriate and cost-effective practices. Standards of practice: The Contractor shall be responsible for meeting or exceeding the VA’s and The Joint Commission’s (or equivalent) standards. The Joint Commission and Other Special Requirements: The Contractor will be responsible to ensure that contracted employees providing work on this contract are fully trained and completely competent to perform the required work. The Contractor is required to maintain records that document competence/performance level of the contract employees working on this contract in accordance with The Joint Commission and other regulatory body requirements. The Contractor will provide a current copy of the competence assessment checklist and annual performance evaluation to the COR at the time of award, annually, on the anniversary date of the contract award, or upon request, for each Contractor employee working on this contract. Where the contract does not require The Joint Commission accreditation or other regulatory body requirements, the Contractor must perform the required work in accordance with the Joint Commission standards. A copy of these standards may be obtained from the Joint Commission on Accreditation of Healthcare Organizations, One Renaissance Blvd., Oakbrook Terrace, IL 60181 or HYPERLINK "" . GOVERNMENT RESPONSIBILITIES6.1. Contract Administration/Performance Monitoring: After award of the contract, all inquiries and correspondence relative to the administration of the contract shall be addressed to the assigned Contracting Officer (or assigned contract specialist) for this Contract.The CO is the only person authorized to approve changes or modify any of the requirements of this contract. The Contractor shall communicate with the CO on all matters pertaining to contract administration. Only the CO is authorized to make commitments or issue any modification to include (but not limited to) terms affecting price, quantity or quality of performance of this contract. The CO shall resolve complaints concerning Contractor relations with the Government employees or patients. The Contracting Officer is final authority on validating complaints. In the event the Contractor effects any such change at the direction of any person other than the CO without authority, no adjustment shall be made in the contract price to cover an increase in costs incurred thus thereof. If the contracted services do not meet quality and/or safety expectations, the best remedy will be implemented, to include but not limited to a targeted and time limited performance improvement plan; increased monitoring of the contracted services; consultation or training for Contractor personnel to be provided by the VA; replacement of the contract personnel and/or renegotiation of the contract terms or termination of the contract.6.2. Contracting Officer’s Representative’s Responsibilities:The COR shall be the VA official responsible for verifying contract compliance. After contract award, any incidents of Contractor noncompliance as evidenced by the monitoring procedures shall be forwarded immediately to the CO.The COR will be responsible for monitoring the Contractor’s performance to ensure all specifications and requirements are fulfilled. Quality Improvement (QI) data that will be collected for ongoing monitoring includes but is not limited to: door to doctor time, average length of stay, percent left without being seen. The COR will maintain a record-keeping system of services both electronically and in hard copy. The COR will review this data monthly when invoices are received and certify all invoices for payment by comparing the hours documented on the VA record-keeping system and those on the invoices. Any evidence of the Contractor's non-compliance as evidenced by the monitoring procedures shall be forwarded immediately to the CO.The COR will review and certify monthly invoices for payment. If in the event the Contractor fails to provide the services in this contract, payments will be adjusted to compensate the Government for the difference.In the event of a discrepant or erroneous invoice, the COR will immediately contact the Contractor to remind them of the terms of the contract. If the Contractor has used the wrong PO number, the charges must be resubmitted on a new invoice. If the Contractor has left off the information required by the FAR, the invoice will not be certified for payment until the omission or error is corrected by the contractor. Only one invoice per month in arrears will be accepted by the COR. All contract administration functions will be retained by the VA. Special Contract Requirements7.1. ORDERS: Orders shall be placed with by issuance of individual purchase/delivery orders or verbal orders and may be transmitted electronically, via mail or in any manner consistent with accepted business practices. Verbal orders may be placed by an individual other that a CO, such as the delegated COR, the COR’s Supervisor, and in emergencies, the service’s LMS Representative. Verbal orders shall be followed with a written request. One or more CORs will be designated by the CO and will work directly with the Contractor to order service (refer to COR Delegation of Authority included herein). The ordering facility placing orders under this IDIQ will do so on an as-needed basis and will provide the appropriate purchase/delivery order number, the quantities required, the delivery date and the delivering and billing addresses, to include invoicing requirements and compliance of the prompt payment procedures. 7.2. VENDOR ELECTRONIC INVOICE SUBMISSION METHODS: Invoices will be electronically submitted to the Tungsten website at HYPERLINK "" Tungsten direct vendor support number is 877-489-6135 for VA contracts.? The VA-Financial Service Center (VA-FSC) pays all associated transaction fees for VA orders. During Implementation (technical set-up), Tungsten will confirm your Taxpayer ID Number with the VA-FSC. This process can take up to five business days to complete to ensure your invoice is automatically routed to your Certifying Official for approval and payment. To successfully submit an invoice to VA-FSC please review “How to Create an Invoice” within the how-to guides. Clarification of additional requirements should be confirmed with your Certifying Official (your CO or buyer). The VA-FSC requires specific information in compliance with the Prompt Pay Act and Business Requirements. For additional information, please contact:Tungsten SupportPhone: 1-877-489-6135Website: HYPERLINK "" of Veterans Affairs Financial Service CenterPhone: 1-877-353-9791 Email: HYPERLINK "mailto:vafscched@" vafscched@” All invoices submitted through Tungsten to the VA-FSC must be itemized with the following items in accordance with FAR 52.2 12-4(g) to meet the requirements for payment: Name and Address of ContractorInvoice Number and Invoice Date Contract Number with Purchase Order (PO) NumberContract Line Item Numbers (CLIN)sNames of Contract Personnel and Description of ServicesQuantity (QTY) and Unit of MeasureUnit Price and Extended PriceShipping Terms (If applicable)Name, Title, and Email of Contractor’s Representative to whom payment is to be sent. Name, Title, Phone Number and Email of person to notify in the event of a defective invoice.NOTE: PAYMENT OF INVOICES MAY BE DELAYED IF ALL INFORMATION THAT IS REQUIRED BY FAR 52.2 12-4(g) IS NOT INCLUDED ON INVOICE. 7.3. FIRE ALARM TRIP CHARGES: A fee will be assessed against any outstanding invoice or collected from the Contractor when Contractor or subcontract personnel trip a fire alarm due to negligence, fault, or failure to properly coordinate and request a system shutdown. This fee is necessary to defray the cost of VA personnel responding to the false alarm, disruption of Medical Center operations, false alarm response, and any fines imposed by the Fire Department and any other costs incurred by the Healthcare System. The amount of the penalty will be that of the local and/or administrative costs.7.4. System for Award Management (SAM): Pursuant to FAR Clause 52.212-4, para (t), System for Award Management (SAM), after initial registration, the Contractor is required to update registration data as changes occur and must re-register annually to ensure all data remains current. Noncompliance with this requirement will preclude contract payments. Refer to cited Clause for more details.7.5. CONTRACTOR Security Requirements (HAndbook 6500.6): The Office of Security and Law Enforcement provides Department-wide policy on the assignment of appropriate position sensitivity designations associated with VA positions involving national security and public trust responsibilities and determination of the level of background investigations required for both applicants and incumbents of those positions. Contractor personnel are also subject to the policy and investigative requirements when they require access to VA computer systems designated as sensitive.The Contractor and Subcontractor personnel who require access to VA computer systems shall be subject to all necessary background investigations and receive a favorable adjudication from the VA Office of Security and Law Enforcement to ensure compliance with such policy. If such investigation has not been completed prior to contract commencement, the Contractor shall be responsible for the actions of those individuals performing under the contract. Should the contract require Contractor personnel to maintain U.S. citizenship, the Contractor shall be responsible for their compliance. Regardless of U.S. citizenship requirements, Contractor personnel are required to read, write, speak, and understand the English language, unless otherwise specified in this contract or agreed to by the Government.The Contractor shall be required to furnish all applicable employee information required to conduct the investigation, such as, but not limited to, the name, address, and social security number of Contractor personnel. The VA will provide all the necessary instructions and guidance for submission of the documents required to conduct the background investigation. Background investigations shall not be required for Contractor personnel who will not be required to access VA computer systems nor gain access to sensitive materials.7.6. AUTOMATED DATA PROCESSING SECURITY RESPONSIBILITIES: If the Contractor or their personnel has access to printed and/or electronic files containing sensitive information in the performance of official duties, all information or data must be protected under the provision of the Privacy Act of 1974 and other applicable laws and regulations. The Contractor is responsible for: 1) protecting the information from unauthorized release, from loss, alteration or unauthorized deletion, and 2) following applicable regulations and instructions regarding access to computerized files, release of access codes, etc., as set out in the computer access contract and VA Policy Memorandums. 7.7. ANNUAL OFFICE OF INSPECTOR GENERAL (OIG) STATEMENT: To ensure that the individuals providing services under the contract have not engaged in fraud or abuse regarding Sections 1128 and 1128A of the Social Security Act regarding federal health care programs, the Contractor is required to check the Health and Human Services - Office of Inspector General (HHS/OIG), List of Excluded Individuals/Entities on the OIG Website (oig) for each person providing services under this contract. The Contractor is required to certify in its proposal that all persons listed in the Contractor’s proposal have been compared against the OIG list and are NOT listed. During the performance of this contract the Contractor is prohibited from using any individual or business listed on the List of Excluded Individuals/Entities. PERFORMANCE WORK STATEMENT NURSING REGISTRY SERVICES SAN FRANCISCO VA MEDICAL CENTERTask Order for December 22, 20171. Requirements: 1.1. The Contractor shall provide qualified employees in accordance with the requirements provided for in this Performance Work Statement.2. Statement of Work: 2.1. Contractor personnel shall be under the direction of the Chief of Staff or designee. Services provided under this agreement will be similar to those provided in a comparable civilian health care facility in accordance with the terms and conditions contained herein. 2.2. Contractor personnel shall, by virtue of training, experience, and relevant licenses or certifications perform nursing care and related services according to standards of practice for the identified role(s) for which they are contracted and Veterans Health Administration (VHA) regulations.2.3 Contracted services are required for Nurse Practitioners, Registered Nurses, Licensed Vocational Nurses/ Licensed Practical Nurses, Monitor Technicians, Instrument Technicians, Surgical Technicians, Medical Support Assistants /Medical Unit Clerks and Certified Nursing Assistants. However, selected services/responsibilities may be excluded from the registry personnel role due to clinical area/manager preference and/or administrative reasons. Additionally, contractor personnel may be assigned to work anywhere within Nursing Service of the San Francisco VAMC, as determined by competency, the Staffing Office, or by request from the Nurse Managers.Units where registry services may be needed are as follows:1A (Medical Surgical), 2B (Medical Surgical), ICU, TCU, TELEMETRY, PICU, CLC-G, CLC-1, ER, OR, ASU, PACU, HDU, Specialty Clinics, GIDC, Radiology, SPS, CCHT, Telephone Linked Care, Medical Practice, Business Office, and Community Based Outpatient Clinics (CBOC) in Downtown San Francisco, San Bruno, Santa Rosa, Ukiah, Clearlake, and Eureka. 2.4. Contractor personnel, will have of all required patient care equipment, supplies, and computer access for performing services required by this contract. Contractor employee shall maintain their work area in a safe and orderly manner and use all protective clothing when required. Protective clothing shall be provided by the VA facility and will remain the property of the VA facility. All contractor personnel who are or may be assigned to inpatient units are required to provide evidence of fit-testing for National Institute for Occupational Safety and Health (NIOSH)-approved, N-95 respirators (mask), specific to those provided by the VA facility. 2.5 Contractor personnel will complete all requirements for security clearances before starting to work at the VA facility. This includes wearing a VA facility-specific, identification badge on the front of their clothing, as is required of other employees working at the VA facility (See Section II – 2 below). 2.6 Contractor personnel will complete all orientation or training requirements specified by each VA facility. 2.6.1.Orientation: The Contractor shall provide eight hours of orientation time to each nurse at no charge to the VA. Orientation will include required Security Agency Check (SAC) background check completed with Human Resources (HR). The Contractor shall not work on VA facilities until the orientation and the SAC background check are completed. Oriented Nurses shall be available and expected to perform their scheduled assignments for a minimum of three months following said orientation. 2.7. Work hours will vary depending on clinical and administrative needs.2.8. Contractor shall be responsible for payment of any leave, including sick leave, vacation time, or holiday pay if employee is working in an area that is closed on holidays.2.9. Contractor shall bill and be paid for actual services provided by Contractor personnel. Exceptions include:a. Late call - facility request after the start of the shift up to four hours. The contractor worker will be scheduled to work for at least four (4) hours and guaranteed at minimum four (4) hour work shift.b. Cancellations – facility dismissal of the contractor employee within two hours of the beginning of the shift; the contractor may bill for two (2) hoursc. Orientation – length to be determined according to needs/policy of the assigned unit, Staffing Office, and/or designee. d. Performance remediation – The Staffing Office and/or designee may offer the Agency the opportunity for their personnel to “re-orient” at the agency’s expense when performance has been marginal and it is believed that reorientation may improve performance. 2.10. Contractor personnel shall be available to furnish required services as needed 24 hours per day, 7 days per week, 365 day per year including local, State, and Federal holidays. Regular work hours will be Monday through Friday 7:30 A.M. – 4:00 P.M, but contractor may be required to work 3:30 PM – 12:00 PM, 12:00 PM – 8:00 AM, or other shifts deemed necessary by the Nurse Manager. Contractor employees will be required to furnish services on national holidays as listed below if needed. The contractor will be required to fill a shift within 24 hours’ notice from the facility on an as needed basis. 2.11. The ten (10) holidays observed by the Federal Government are as follows: New Years Day, Martin Luther King’s Birthday, Presidents Day, Memorial Day, Independence Day, Labor Day, Columbus Day, Veterans Day, Thanksgiving, Christmas, AND any other day specifically declared by the President of the United States to be a federal holiday. In clinical areas that are closed on holidays that fall during the week, e.g. clinics; contractor staff assigned to those areas will not be paid for the holiday unless reassigned and working in another clinical area.3. Contractor Personnel: 3.1. The Contractor shall assign to this contract personnel approved by the Contracting Officer (CO), Contracting Officer Technical Representative (COR), or other designee once a clearance submittal by the contractor agency on the employee’s behalf has been successfully accepted and cleared. All current security clearance requirements, which may change from time to time, must be met at initiation of any assignment and must stay current.3.2 The VA has the right to refuse, dismiss, or “DNR” (do not return) agency personnel for clinical or administrative reasons in consultation with the COR and the Contracting Officer (CO).3.3 Substitutionsa. The Contractor shall provide a detailed explanation of the circumstances necessitating proposed substitutions, resumes for the proposed substitutes, and any additional information requested by the CO, COR, or designee. Proposed substitutes shall have comparable qualifications to those of the persons being replaced. The contract will be modified to reflect any approved changes of personnel. b. For temporary substitutions where the agency personnel will not be reporting to work for three (3) consecutive work days or more, the Contractor will provide a qualified replacement. This includes dismissals due to performance or other work-related issues, as well as personal reasons, e.g., illness, family emergencies, etc. This substitute shall have comparable qualifications to the person. Any period exceeding two weeks will require a new written agreement.3.4. The Contractor will furnish evidence of insurability of the healthcare providers who will perform under the contract to ensure that VA will not be held liable for any negligent acts of the Contractor or it employees. See Veterans Affairs Acquisition Regulation Clauses 852.237-7, Indemnification and Medical Liability Insurance (January 2008). 4. Qualifications4.1 Contractor personnel shall perform services in accordance with ethical, professional, and technical standards of the healthcare industry consistent with VA policy, regulations, procedures, and protocol. Contractor personnel shall be technically proficient in the skills necessary to fulfill the requirements stated herein including the ability to understand, speak, read, and write the English language. 4.2. Contractor personnel shall be licensed and certified as required for the assigned role.4.3 The parties agree that the contractor, its employees, agents, and subcontractors, shall not be considered VA employees for any purpose.5.Personnel Policy:5.1. The Contractor shall be responsible for protecting the personnel furnishing services under this contract. The Contractor shall provide the following:Workers CompensationProfessional liability insuranceIncome tax withholding,Social Security payments 5.2. The Contractor shall verify, and document, that all employees who provide patient care services at the VA have the following before they provide any service related to this contract:Health examinations including annual TB skin test result,Annual Flu vaccinations,Either has received the Hepatitis B vaccine series, or are immune as a result of acquired infection, or have been offered and refused the vaccinations.Received measles-mumps-rubella (MMR) vaccine. (Combined vaccine (MMR) is the vaccine of choice if individuals are likely to be susceptible to more than one of the three diseases and is required for all persons born after 1956.A negative PPD within the last year, or, if a known reactor, a negative chest X-Ray within the past year.A history of varicella (chicken pox) or, if unknown, results of a varicella antibody test. If non-immune, must be vaccinated with Varivax (Chicken pox).Received training in Universal Precautions and Blood Borne Pathogens, Hazardous Material Management, and Life Safety Management (fire preparedness).5.3. Current Basic Cardiac Life Support (BCLS)/ (CPR) card. If required for clinical assignment, current Advanced Cardiac Life Support (ACLS) card.5.4. Fit-testing for National Institute for Occupational Safety and Health (NIOSH)-approved, N-95 respirators (mask)5.5. Current license and/or certification as required for the assigned role.5.6. Eligibility to legally work in the US through the US Citizenship and Immigrations Services “E-Verify System”. Vendors can use this web site for registration and begin verifications. ? HYPERLINK "" . Proof of Training: Contract employees through their agency are responsible for submitting proof of completion of two trainings, “Information Security Awareness” and “Privacy Policy” or HR Security Office approved substitute which should be completed annually. 6. Contractor Personnel Security Requirements—Information Systems Access 6.1. All Contractor employees, who require access to VA computer under this contract, shall be the subject of a background investigation and must receive a favorable adjudication from the VA security investigation/clearance (SIC). This requirement is applicable to all subcontractor personnel requiring the same access. 6.2. Contractor personnel who previously received a favorable adjudication as a result of a Government background investigation may be exempt from this contract requirement provided documentation to support the previous adjudication is available. Proof of previous adjudication will obtained through the HR Security Officer, Contract Security Specialist, or the SIC by the COR/designee. 6.3. Position Sensitivity—Position sensitivity has been designated as: Low Risk 6.4. Background Investigation—the level of background investigation commensurate with the required level of access is: NACI (National Advisory Council on Innovations) 6.5. Contractor Responsibilities—In order to conduct a background investigation the Contractor shall submit or have their contract employee submit the following to the COTR/designee: a. Standard Form 85, Questionnaire for Non-Sensitive Positions. b. Standard Form 86A, Continuation Sheet for Questionnaires. (if needed)c. Optional Form 306, Declaration for Federal Employment. d. Evidence of fingerprints taken. The COR/designee will facilitate arrangement for contract personnel to complete fingerprint verification at a VA facility. 6.6 Agency personnel will work with the COR/designee to ensure timely submission of documents and other information request.7. Access to and Safeguard of VA Information/Computer Systems: 7.1. VA may provide contract personnel with access to VistA, CPRS, and/or other files maintained on VA computer systems via personalized VA access codes. These access codes are confidential and are to be protected by the end user. Sharing of these access codes or misuse of VA information/computer systems is a Federal crime and may result in criminal penalties. When contract personnel no longer provides services to VA under the contract or no longer needs access to VA information systems, the Contractor shall immediately inform the COR so that the appropriate access codes can be deactivated. The COR/designee will be responsible for ensuring that such access codes are deactivated. 7.2. All contract personnel accessing VistA, CPRS, or any other VA information/computer systems, will be required to complete VA Information Security Awareness Training and VHA Privacy Policy Training (or HR Security Office-approved substitute) annually and sign a “Confidentiality of Sensitive Information Non-Disclosure Agreement (VA Form 0752).” The COR will be responsible for ensuring and documenting that this requirement is satisfied. Contract personnel shall maintain, access, release, and otherwise manage the information contained on VA information/computer systems in accordance with all VA/VHA security policies, applicable VA confidentiality statutes (Title 38 U.S.C. Section 5701 and Title 38 U.S.C. Section 7332) and the respective regulations implementing these statutes, and Federal statutes and/or regulations applicable to Federal agency records. Copies of this information discussed in the aforementioned paragraphs can be provided to the Contractor and contract personnel upon request. 7.3. Contract personnel with access to VA information/computer systems shall take reasonable safeguards, both physical and electronic, to safeguard the information and prevent unauthorized disclosures. Should contract personnel know, or suspect, that VA information/computer security was compromised or that VA information was, or could possibly be, disclosed to an unauthorized party, contract personnel must immediately report such knowledge or suspicion to the COR, who will then immediately notify the appropriate VA officials. 7.4. The Contractor shall make its internal policies and practices regarding the safeguarding of medical and/or electronic information available to VA, and any other Federal agencies with enforcement authority over the maintenance and safeguard of such records, upon request. 7.5. Any changes in the laws, regulations, or VA/VHA policies or procedures governing the information covered by this section of the contract, during the term of this contract, shall be deemed to be incorporated into this contract. 8. Handling of Records 8.1. By performing services under this contract, the Contractor is considered part of the VA healthcare activity for purposes of the following statutes and respective regulations implementing these statutes: Title 5 U.S.C Section 552a (Privacy Act), Title 38 U.S.C. Section 5701, Title 38 U.S.C. Section 5705, Title 38 U.S.C. Section 7332, and Public Law 104-191 (HIPAA). Contract personnel shall have access to patient medical records and general files only to the extent necessary to perform their contractual duties. Contract personnel shall only release medical information obtained during the course of this contract to those VA medical staff members involved in the necessary care and treatment of the individual patient in which the information pertains. Notwithstanding any other clause and/or provision of this contract, if a request for release or disclosure of information is not necessary for the care and treatment of an individual patient, the Contractor and contract personnel shall not disclose any information contained in general files, patient records, and/or any other individually identifiable health information, including information and records generated by the Contractor in performance of this contract, except pursuant to explicit instruction and written approval from VA. For the purposes of this paragraph, instruction to disclose or copy such records and/or information may only be provided by the following: VA Regional Counsel and Chief, Health Information Management Service/Privacy Officer through the VA Contracting Officer. Violation of the aforementioned statutes may result in criminal and/or civil penalties.8.2. Any changes in the laws, regulations, or VA/VHA policies or procedures governing the information covered by this section of the contract, during the term of this contract, shall be deemed to be incorporated into this contract. 9. HIPAA Compliance: Under HIPAA Privacy and Security Rules, the Contractor providing services under this contract is considered to be a “covered entity,” and thus is not required to enter into a Business Associate Agreement with VA. However, the Contractor must observe Public Law 104-191 and all respective regulations implementing this law while providing services under this contract. 10. QUALITY MANAGEMENT1. Quality Assurance 1.1. The Contractor shall perform services under this contract in accordance with the ethical, professional, and technical standards of the healthcare industry, and must meet, or exceed, the current quality assurance standards recognized by Joint Commission and mandated by VHA quality assurance policies and/or performance measures. A copy of these standards, policies, and performance measures may be obtained or viewed by contacting the Contracting Officer Representative who will facilitate access to the requested documents.1.2. The Contractor will not participate in, nor be a party to, any activities that are in conflict with Federal and/or State guidelines. In the event the Contractor encounters said conflicting situations, the Contractor will notify the COR or the Contracting Officer to resolve such issues. The Contracting Officer will document and be responsible for resolution of any such situations. Neither the VA nor the Contractor will be responsible for any delays or failures to perform due to causes beyond each party's control. 1.3. All services provided under this contract will be subject to Quality Assurance and Utilization Review procedures of the VA facility. 1.4 The VA facility may cancel an existing Contractor employee agreement if the Contractor employee is found to be unsuitable to continue at the facility or if administrative reasons warrant. Opportunity to improve performance before cancelling an employee agreement is at the discretion of the VA facility after consultation with the COR and CO.1.5 The Contractor should notify the COR/designee as soon as reasonable of any known incidents or problems related to their personnel at the VA facility that may compromise the employee’s safety, adequate performance, or jeopardize fulfilling other requirements of the contract.2. Contract Monitoring Procedures: 2.1. In order to adequately document services provided under this contract, the COR/designee will collect and manage data related to contract costs and performance. The COR/designee is responsible for certifying invoices for services provided. To facilitate prompt payment, the contractor is encouraged to submit all invoices to the VA facility for certification before being sent to Austin for payment. A system for clear and accurate documentation of hours worked for billing purposes will be established with agreement between the COR/designee and the Vendor.2.2 Classroom and/or bedside orientation may be required at the discretion of the COR/designee. The Contractor employee will be paid for the orientation; however, if the Contractor employee is not scheduled to work within 60 days of clearance to work, the Contractor will reimburse the VA for the orientation hours billed/paid. 2.3. All record keeping and documentation collected and maintained by the COR shall be accurate, complete, and current, and is subject to review by the Contracting Officer at any time. After contract award, any incidents of contractor noncompliance with the terms of this contract, as supported by record-keeping documentation, shall be forwarded in a timely manner to the Contracting Officer. Quarterly, the COR will provide a written statement to the VA Contracting Officer to include a summary of Contractor actions and a statement indicating whether all requirements of the contract have been fulfilled as agreed. 11. Personnel Other Requirements1. Infection Control Requirements: 1.1. In general, all contract personnel must comply with Occupational Safety and Health Administration (OSHA) requirements for healthcare facilities. All contract personnel are required to have an annual tuberculosis skin test screening (tuberculin PPD test), current immunizations, and record of having been offered Hepatitis B vaccine prior to commencement of work. 1.2. A record keeping system that confirms compliance with these OSHA requirements and VA medical center memoranda shall be established and maintained by the Contractor. Such records will be made available to the COR or Contracting Officer upon request. 1.3. Health Tests: Contractor attests that assigned personnel have fulfilled all testing and screening evaluation requirements as described below within the past year prior to providing services at first duty shift. a. Tuberculosis testing—All contractor personnel shall provide proof of purified protein derivative (PPD) testing. If negative, the PPD test will be repeated annually. If positive, a negative chest radiographic report for active tuberculosis shall be provided. If a negative chest radiographic report is provided with a positive PPD test, a symptom checklist, negative for TB symptoms will be completed annually. A new negative chest radiographic report will be required at the 3-year anniversary of the previous negative radiographic report.b. Rubella testing—All contractor personnel shall provide proof of immunization for measles, mumps, rubella, or a rubella titer of 1.8 or greater. If the titer is less than 1.8, a rubella immunization must be administered with follow-up documentation to the COR. c. Varicella (chicken pox) testing— All contractor personnel shall provide a history of varicella or, if unknown, results of a varicella antibody test; and if non-immune, vaccination with Varivax. d. Seasonal Flu Vaccinations—All contractor personnel shall provide proof of vaccination for the seasonal flu.1.4. OSHA regulation concerning occupational exposure to blood-borne pathogens: The contractor shall provide a generic self study training module to its personnel, provide Hepatitis B vaccination series at no cost to its personnel who elect to receive it, maintain and distribute an exposure determination and control plan to its personnel, maintain required records, and ensure that proper follow-up evaluation is provided following an exposure incident. The Contractor will provide evidence of the above requirements before the first duty shift.1.5. Contractor employees shall receive training in universal precautions and blood borne pathogens, hazardous material management, and life safety management (fire preparedness). Training will be provided prior to the first duty shift, annually thereafter, and as needed. As in Section I, 2.6, other training or orientation requirements may be required. 2. Identification, Parking, Smoking, and VA Regulations: 2.1. Contract personnel shall maintain a neat personal appearance and maintain a professional decorum. Contract personnel shall wear protective clothing as required. 2.2. Contract personnel shall wear visible identification badges while on Government property. 2.3. It is the responsibility of contract personnel to park in designated parking areas only. Parking information and parking decals and stickers will be available from the VA Police. The Government will not invalidate or make reimbursement for parking violations of the contract personnel. 2.4. Intoxication, debilitation resulting from drug use, insubordination, theft, patient abuse, dereliction or negligence in performing directed tasks, and possession of weapons is prohibited and grounds for immediate removal from the VA facility. Closed containers, of any nature, are subject to search. 2.5. Violations of VA regulations may result in a citation answerable in the U.S. Federal District Court, not a local district, State, or municipal court. 12.Identification, Parking, Smoking, and VA Regulations:The Contractor employees shall wear visible identification at all times while on the SFVAMC/Santa Rosa CBOC premises. It is the responsibility of the Contractor employees to park in the appropriate designated parking areas. Information on parking is available from the Police Section. The SFVAMC will not invalidate or make reimbursement for parking violations of the Contractor under any conditions. Smoking is prohibited inside any buildings at the SFVAMC. Possession of weapons, illegal drugs or alcohol is prohibited. Enclosed containers, including tool kits, shall be subject to search. Violations of SFVAMC regulations may result in citation answerable in the United States (Federal) District Court, not a local district, state, or municipal court.13.Universal Precautions:By signing this instrument, the Contractor certifies that all Contractor’s employees assigned to work at the SFVAMC are current in Universal Precautions and are aware of pertinent OSHA and Universal Precautions Regulations.14.Responsibility:The Government may evaluate the quality of professional and administrative services provided, but retains no control over the medical, professional aspects of services rendered (e.g., professional judgments, diagnosis for specific medical treatment).15.Liability and Insurance:15.1Liability for damages resulting from the official conduct of Contractor personnel providing services under this contract shall be governed by applicable federal laws, rules and regulations. Such damages might include, but are not limited to loss of equipment or property and medical malpractice damages for personal injury or death. Tort Claims against the government under this contract shall be filed in accordance with the Federal Tort Claims Act, 28 U.S.C. 2671-2680. 15.2 Contractor shall provide worker’s compensation, professional liability insurance, health insurance, and Federal and State income tax withholding and any other employee requirements mandated by local, state and federal law or agencies.16. Job Descriptions: 1. General RN: RN is aligned under Hospital Care Services and provides care to veterans who present with acute or chronic medical / surgical problems. The scope of care includes cardiac, pulmonary, orthopedic, podiatry, renal, ENT, dermatology, oncology and neurology.The Nurse II registered nurse has leadership in delivering and improving holistic care through collaborative strategies with others. S/he has the ability to manage complex patient situations. S/he is responsible and accountable for all elements of the nursing process when providing and/or supervising direct patient care. S/he assesses, plans, implements and evaluates care based on age-specific components. S/he assumes responsibility for the coordination of care focused on patient transition through the continuum of care, patient and family education, patient self-management after discharge, and supporting factors that impact customer satisfaction. S/he considers all characteristics of the individual, including age and life stages, state of health, race and culture, values, and previous experiences in the provision of care. S/he administers medications and procedures per established policies and guidelines. S/he influences care outcomes by collaborating with members of the interdisciplinary team. S/he assumes leadership responsibilities at the patient and unit levels. Core elements of performance include ability to recognize cardiac arrhythmias and respond appropriately, knowledge and active participation in unit/program level quality improvement processes, and initiatives as well as customer service programs. S/he will be required to float as determined by Nursing Service needs and nurse’s competencies. 2. Specialty RN:Assesses, plans, implements and evaluates nursing care for a specific patient or group(s) of patients with attention to their physical and psychosocial needs. Assesses and reports changes in the patient’s condition. Provides emergency care as indicated and/or as needed. Ensures continuity of care by collaborating with co-workers, reviewing pertinent patient information, conducting nursing rounds and conferences, and updating nursing plans of care. Documents nursing care in the electronic record according to service standards which accurately reflects the patient’s condition and maximizes continuity of care efforts within the tour of duty. Utilizes Bar Code Medication Administration (BCMA) to accurately document medications and follow-up effectiveness. Performs treatments and procedures consistent with approved standards and the needs of individual patients in an organized, timely manner. Fosters a holistic approach to patient care through collaboration with others during multidisciplinary rounds and then updating nursing plans to facilitate desired patient outcomes. Demonstrates respect for the patient and family while administering nursing care and maintaining confidentiality of patient information. Maintains a safe and therapeutic environment.3. Operating Room RN:Demonstrates ability to work effectively with others; Accepts accountability for decisions related to program management; Actively solves clinical problems with other team members to improve outcomes of care or unit functions; Assumes lead role in care coordination with interdisciplinary team including anticipating patients’ needs and making necessary arrangements to promote optimal outcomes; Identifies patient care issues/learning opportunities and improve care through group approach; Demonstrates technical, clinical, team leading skills, and procedural knowledge necessary to function independently and effectively ; Responds to medical emergencies effectively including disaster, complete evacuation, and code blues; Demonstrates safe expert knowledge and care relevant to surgical patients; Provides patient care according to nursing standards and with attention to physical, emotional, social, spiritual, cultural, and age-specific needs while preserving personal dignity and autonomy; Actively contributes to managing patient care and environment with the interdisciplinary team and individual patient; Uses sound judgment in assessing, planning, implementing, documenting and evaluating patients’ responses to his/her actions; Documents nursing care as specified by unit/Nursing Service policy; Identifies patient/SO learning needs and ensures that those needs are addressed; Periodically reassesses and modifies priorities in implementing planned care according to patients’ changing needs; Ensures that practice of self and others complies with hospital policies, and relevant regulations (i.e. JC, AORN, OSHA); Ensures that reporting mechanisms are followed, and reports are completed promptly ; Demonstrates relevant computer knowledge and application of the clinical setting; Initiates or participates in systematic evaluation of care provided in the unit ; Participates in peer review as requested ; Consistently communicates changes in patient conditions and treatment plans with the interdisciplinary team with recommendations for change’ Facilitates the provision of continuity of care with other team members through accurate and timely hand-off reporting, documentation, and follow-up; Develops and maintains positive relationships with colleagues and co-workers; Adapts to changing accreditation standards and patient/family expectations by complying with new standards and serving as a role model4. Surgical Technician:Plans/discusses required items for each procedure with the circulating registered nurses (RNs) or preceptors, and ensures that they are available in the room before the patient is brought into the room; Begins the day by damp dusting all horizontal surfaces. This includes surgical tables, booms, wainscoting ledges, whiteboards, surgical lights and the arms (within reach), and equipment adjacent to the OR bed and sterile fields; Organizes sterile tables and equipment in the room in such a way that allows other team members to work effectively without contaminating the sterile items; Sets up rooms and sterile table/s with necessary instrument sets, powered equipment if applicable, supplies, and intraoperative medications according to surgeon preference cards (Pick List); Ensures that instruments and supplies on the sterile fields are free from bio-burden (tissues and remains of particles from previous operations) and defects (broken or missing components) and notifies the circulating RN immediately so the patient can be protected from accidental exposure to infectious material; Verifies sterility of surgical instrument sets, peel-pack items, and other supplies by actively validating chemical indicators, filters, instrument wrappers, package integrity, and expiration dates. The Surgical Technician only uses supplies and sets with acceptable conditions in patient care; Participates in pre-procedural verification and timeout; Follows basic safety standards at all times. These include but not limited to labeling medication and fluid containers and syringes with the right labels, reading back when passing medications, maintaining sharp safety, managing fire sources (cautery devices, laser fibers, and fiber optic cords); Maintains the pace of operations by anticipating and passing surgical instruments with speed and accuracy; In collaboration with the RNs, performs surgical accounting accurately to prevent retained surgical items. Responsible for the accountability for all surgical instruments and soft goods used during the surgical procedure. This includes but not limited to instruments from the sets, individual peel-pack items, single use miscellaneous items that came with sterile packs, sutures, towels, surgical sponges, supply wrappers, needle caps, and guide wires. The surgical technician retrieves all instruments from the sterile fields and the surgical drapes at the end of the procedure; Provides complete and accurate hand-off reports to incoming nurses and technicians to maintain continuity of care. The hand-off reports will include but not limited to medication and fluid on the field (containers and syringes), amount used, amount of irrigation used, specimens if any, anticipating specimen for microbiology or pathology, any surgical sponges or soft goods inside the wound, and any sharps being used by the surgeons at the time of reports ; Assists the surgeon by performing such procedures as suctioning, holding retractors, applying skin staples, and cutting sutures; Performs pre-cleaning of instruments including endoscope according to hospital policy and regulatory/professional organization guidelines (i.e., the Joint Commission, Office of Inspector General, Sterile Processing Service, and Association of perioperative registered nurses); Returns excess supplies to their original storage at the end of every operation; Performs room turnover cleaning and terminal cleaning of rooms by wiping down soiled equipment with appropriate disinfectants according to Reusable Medical Equipment policy, and returning disinfected equipment to appropriate storage. The surgical technician will assist in team cleaning by supporting Environment Management Service (EMS) functions; Utilizes universal precautions and follows all infection control policies and procedures when handling specimens, supplies, and equipment at all times; Assists the team members with care of the patient, i.e., positioning, padding, peri-care, prepping, maintaining I&O/Estimated Blood Loss, and obtaining supplies; Provides transportation of patients to and from the Operating Room, as assigned; Assists in maintaining adequate supplies in specialty carts and supply cabinets. This includes but not limited to re-stocking the OR cabinets, specialty carts, and other secondary storage containers; Assists other surgical team by delivering specimens to pathology, morgue, microbiology, or Blood Bank as assigned by the RNs or Charge Nurse; Performs non-technical maintenance of equipment to prevent malfunctions; Recognizes potentially hazardous situations (e.g., frayed cords, water on floor) and takes corrective action; Responds to medical emergencies including disaster and code blues; Assists surgical team members in quality improvement activities; Updates personal knowledge regarding current trends in surgical technology through continuing education courses; Assists in developing and maintaining appropriate and cost-effective practices 5. Nursing Assistant:Provides wide range of personal care for patients in keeping with Department of Nursing standards and with attention to preserving personal dignity, autonomy, religious preferences, cultural values and age appropriate needs. Performs a range of diagnostic support duties which includes preparing patients for tests, examinations and treatments, and basic functions (i.e. vs., weights, heights etc.)Performs treatment procedures which include topical creams, changing basic dressing, and other specified functions. Implements use of urinary drainage devices as directed and completes intake and output records accurately. Performs actions targeted to the maintenance/restoration of skin integrity. Properly prepares oxygen dependent patients for transport to procedures. Appropriately uses protective devices as ordered. Provides emotional support in patient and family care. Collects patient data including observation of patient/client status. Monitors neurological signs.Implements seizure precautions as directed. Responds appropriately to emergency situations. Complies with universal precaution and with all infection control policies and procedures. Assists/completes clerical and transport functions as assigned. Continues Patient Assistant (CPA) duties as assigned. Engaging the resident in activities to optimize levels of functioning, independence and comfort, maximizing the Veterans' ability to adapt and adjust to living as independently and safely as possible and with dignity. 6. Licensed Vocational Nurse (LVN):The LPN/LVN, in Primary Care provides skilled and individualized practical nursing care to all levels of patients including most complex patients who are acutely and/or chronically ill, in the outpatient setting. Care is provided to patients who exhibit a variety of most complex physical and/or behavioral problems. This person functions under the direct supervision of the PACT Team RN who is responsible for the coordination of the patient’s care. The LPN/LVN has the knowledge and skills necessary for self-direction in carrying out simple to the most complex practical nursing care. The incumbent serves as a member of a health care team/teamlet in Primary Care. The LPN/LVN recognizes the need for and seeks guidance when necessary to ensure quality patient care. In organizing and delivering care, the LPN/LVN recognizes and considers emotional, cultural, spiritual, and age related factors. The incumbent actively seeks out educational opportunities to enhance nursing knowledge and skills, sharing new knowledge gained with other staff to improve and advance nursing practice. 6. Medical Supply Technician:The Medical Supply Technician conforms to and assures that infection control policies, Universal Precautions, traffic control policies and procedures of the preparation section, decontamination and Operating Room are adhered to; and may include functioning as a Lead Technician in Preparation/Decontamination area and/or the Operating Room supply areas during normal work?hours along with?assisting in training of new employees. Medical Supply Technician will perform, but may not be limited to the following duties:? Operates and regularly monitors operation of steam sterilizers and with prescribed tests, verifies cycle printout, conduct air leak tests, and prepares biological tests. Operates a "low temp" sterilization system according to manufacturer’s guidelines. Selects correct sterilizing medium and cycles when operating either the steam or alternative "low-temp" sterilization system. Selects the correct tray, wrapper, and required instruments; assembles all necessary items for the specific treatment tray and sets used in the OR; arranges them in proper sequence and in the manner for effective sterilization; adds a sterilization indicator to each tray, wraps, seals, and labels tray appropriately and selects proper method of sterilization. Decontaminates a full range of reusable medical devices and various patient care equipment used in the Medical Center's wards, clinics, and Operating Rooms. Cleans and processes flexible?endoscopes, performs leak test prior to sterilization. Ensures the?correct cleaning methods for?different pieces of equipment has been completed. Accounts for items that are cleaned and returned, maintains?production records for the decontamination area, checks in equipment, checks for?current Biomed calibration and safety inspection tag, and separates defective units for required upkeep and repair. Monitors daily Operating Room schedule. Determines appropriate casecart picklist and attaches to the Operating Room buckslip for use in pulling for casecart. Assists in room set up and insures casecarts are delivered to the surgical suites in time to meet the surgical schedule. Maintains emergency casecarets such as mediastinal exploration, craniotomy, abdominal aortic aneurysm and emergency acute abdomen casecarts. Maintains levels of surgical instruments and consumable supplies required by surgical suites.ATTACHMENTS See attached document: S06 Sol Attachment A Employee Compensation.See attached document: S06 Sol Attachment C Price Workbook. ................
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