Service:RN – Level 3 Specialty

Locations:

• Tripler Army Medical Center
• Warrior Ohana Medical Home, and Desmond Doss
• Health Clinic, Island of Oahu, Hawaii

The Military Treatment Facility provide services 24 hours a day, 365 days a year (366 days during leap years) including holidays. Clinics and units have designated operating hours.

PERFORMANCE REQUIREMENTS

Labor Category: Nursing Services, Registered Nurse

• Registered nurses in this Labor Category are considered Level III Nurses and may be assigned or rotated between the following areas (both inpatient and outpatient wards):
  • Intensive Care Unit (ICU) Emergency Department
  • Gastroenterology Labor & Delivery
  • Operating Room (OR) Critical Care Units
  • Progressive Care Unit (PCU) Post Anesthesia Care Unit (PACU)
  • Pediatric Intensive Care Unit (PICU) Neonatal Intensive Care Unit (NICU)

HCW Qualifications (Contract PWS 5.2; 5.2.3; 5.2.4; 5.2.6.4.4):

Minimum Qualifications: Exhibit 5

• Degree: Associates Degree of Nursing

Core Duties:

• Coordinate patient care in collaboration with a wide array of healthcare professionals. Facilitate the achievement of optimal outcomes in relation to clinical care, quality and cost effectiveness.
• Ensure compliance with standards of care and practice in accordance with all established policies, procedures, and guidelines used in the MTF.
• Perform physical exam and health histories.
• Provide health promotions, counseling, and education.
• Administer medications, wound care, and numerous other personalized interventions.
• Direct and supervise care provide by other healthcare professionals.
• Accountable for making patient care assignments based on the scope of practice and skill level of assigned personnel.
• Recognize adverse signs and symptoms and quickly react in emergency situations.
• Communicate and collaborate with a diverse group of people for the purpose of informing the healthcare team of plans/actions, for teaching/education to benefit the patient/family and organization.
• Make referral appointments and arrange specialty care as appropriate.
• Perform nursing services identified in the TO.
• Conduct research in support of improved practice and patient outcomes
• Experience:
  • ICU/Critical Care/Progressive Care areas, minimum one year of experience within the last five years in a critical care area of four or more beds as a registered nurse.
• the Emergency Department, minimum one year experience within the last five years in an Emergency Room or in a critical care area of four or more beds as a registered nurse.
• Labor & Delivery unit areas, minimum one year experience within the last five years caring for high-risk labor and delivery patients as a registered nurse.
• the Operating Room, minimum of one year experience, within the last five years of operating room nursing experience and must demonstrate age-specific competency in the care of pediatric and adult patients with medical and/or surgical problems.
• the PACU area, minimum of one year experience within the last five years in PACU setting, providing care to patients ranging in age from infancy to geriatric: possess ability to multi-task and manage one to two patients simultaneously.
• the PICU area, minimum one year experience within the last five years in a PICU or critical care area for pediatric patients as a Registered Nurse.
• the NICU area, experience caring for neonates in a Level III NICU as a registered nurse.
• Degree/Education(5.2.4):See Exhibit 5. In addition, Contract RNs must be a graduate of a nursing program accredited by the American Association of Colleges of Nursing or the National League for Nursing. If candidate is an international nurse graduate from jurisdictions other than the U.S., must possess a valid certification for Full Education Course-by-Course Report by the Commission on Graduates of Foreign Schools.
• Certificationsin addition to Basic Life Support (5.2.3): Must possess and maintain current course completion documentation for Basic Life Support (BLS) with hands-on training through an American Heart Association approved training program; and maintain current certification in Advanced Cardiovascular Life Support (ACLS) unless otherwise indicated below; online certifications are unacceptable.
• In addition, ICU/Critical Care/Progressive Care areas, HCW must have a passing score of 85% or greater on the basic cardiac rhythm telemetry test within three weeks of performance.
• Emergency Department, PACU, PICU, OR, and/or Clinical areas that provide moderate sedation or general anesthesia to infants, children, and/or adolescents (before age of 18), must have and maintain current certification in Pediatric Advanced Life Support (PALS). Online certification is unacceptable.
• Labor & Delivery, NICU, Mother/Baby Units, and Pediatrics Clinic/Ward areas, must have and maintain current certification Neonatal Resuscitation Program (NRP).
• BoardCertification(5.2.6.4.4): See Exhibit 5
• Licensure/Registration:See Exhibit 5. In addition, must possess a current, unencumbered RN license from any state or territory of the United States.

1.6.25 Competency-Based HCW Interviews: Prior to HCW placement, the Government ?will

• will not contact the HCW to determine if the HCW meets the requirements set in the contract and/or task order.

Scheduling: The schedule or scheduling process is as follows: The contract personnel shall provide services within their assigned duty sections. Contract personnel may be scheduled for up to 80 hours bi- weekly. Contract personnel shall perform services on a schedule established by the health care facility personnel. Services may include 8, 10 and 12-hour shifts, 7 days per week including weekends and federal holidays.

At no time will contract personnel perform consecutive 12-hour shifts. Contract personnel must have a complete shift off in-between assignments. All shifts include a 30-minute (non-paid) meal break and two 15-minute breaks (paid). Actual unit schedules for contract personnel will be specified by the respective nursing managers with overall oversight by the COR. Hours are subject to change. There is no overtime rate for this contract. The normal hourly rate shall apply when contract personnel are required to remain on duty past their scheduled shift in order to support emergent requirements. The contractor shall be reimbursed for the actual hours worked each time their personnel are required to work longer than the scheduled shift. At the mutual agreement of the Contractor and the designated Government representative, alternative schedules may be implemented such as a compressed work schedule. Any changes in the schedule shall be coordinated between the HCW and the Government supervisor. Any planned absences of the HCW shall be communicated to the Government supervisor in advance of the absence in order to ensure that clinical operations are not adversely affected. The Government reserves the right to change shift hours with a five-day notice to accommodate patient care needs and mission requirements.

1.5.7.1. Recording HCW Time:

PWS are as follows: The HCWs will be required to personally record the time worked in the Defense Medical Human Resources System internet (DMHRSi) as required by the MTF. Timecards must be signed by HCW’s and their government unit supervisors.

RecognizedHolidays: Contract HCWs ?will ? will not be required to work on federally recognized holidays.

New Year’s Day, January 1st

Martin Luther King’s Birthday, 3rd Monday in January President’s Day, 3rd Monday in February

Memorial Day, Last Monday in May

Juneteenth National Independence Day, June 19th Independence Day, July 4th

Labor Day, 1st Monday in September Columbus Day, 2nd Monday in October Veteran’s Day, November 11th

Thanksgiving Day, 4th Thursday in November Christmas Day, December 25th

1.5.7.5 Closures: During a planned closure of the facility due to training, holiday or unplanned

closure due to unusual and compelling circumstances (e.g., natural disasters, military emergencies, severe weather), the Contractor will: be compensated only for the actual hours the HCW provided services

1.5.7.5.1 Unplanned Closures: Other than the federal holidays listed in paragraph 1.5.4, the following are considered training days or days where the HCW will not be required to work on this TO: N/A

1.6.6. Contractor Travel: Reimbursement will not be provided for travel within a 40- mile radius of the place of performance. HCW travel requirements are as follows: N/A

Note: For travel outside of the 40-mile radius, the travel shall not be conducted prior to the appropriate funding being obligated.

1.6.9.2. Computer Skill Competency: Each HCW shall demonstrate competency as required in the contract and as follows:

The contractor shall ensure that all contract HCWs providing services under this contract shall be able to read, write, and speak English well enough to effectively communicate with all parties and other health care providers. In addition, if the position requires the use of computers, the contract HCWs shall be computer literate and be able to type a minimum of 40 words per minute.

1.6.10. MTF Training: Additional training requirements are as follows:

Annual training requirements. The Contractor shall ensure that contract personnel complete any mandatory annual training requirements in accordance with HRP procedures. Government unique training. The government may elect to provide unique government training to contract HCWs who are performing services under this contract. If the government elects to provide such training, the government will provide such training at no additional expense to the contractor or to the contract HCW. When directed by the contracting officer, contract HCWs shall attend all such training in a paid status as part of the normal services required and billed under the contract. Such training shall require a performance commitment by the contractor and the contractor shall reimburse the government (by means of a reduction in an invoice) if a contract HCW fails to satisfy the performance commitment after the contract HCW receives the unique government training. The amount of the reimbursement shall be the prorated cost of training, calculated based on the total cost of the training and the number of months by which the contract HCW fails to complete the performance commitment. The length of the performance commitment shall be 12 months or until the end of all performance under this contract, whichever occurs first.

1.6.12. MTF Standards: Specific policies, procedures, and instructions/regulations for the place of performance are as follows: None

The individual will be required to provide documentation to the Occupational Health Clinic.

Positive tuberculin reactors will provide normal results of a chest x-ray.

CW Duties (5.1 Task 1): The duties for the HCW are as follows: In addition to duties in Exhibit 5:

Knowledge of interpersonal relationships and the ability to maintain composure and react

appropriately while relating to patients and families; to manage distraught, irritable,

unreasonable or angry individuals; and to maintain positive rapport with all individuals

involved in patient care.

Ability to react with alertness and skill in any emergency situation, e.g., cardiac or respiratory arrest, hemorrhage, shock, severe physical trauma and psychiatric reaction. Serves as member of the resuscitation team. Assess patients' conditions for potential or life-threatening crises. Distinguish between normal and abnormal physical findings (from physical assessment and vital sign assessment). Plan appropriate nursing care. Obtain patient history and pertinent family history. Document plan of care and care given in patient's medical record. Utilize appropriate nursing personnel to assist in delivery of care when indicated (LPNs/paraprofessionals).

Transcribe or verify transcription of physician orders.

Carry out prescribed physician orders and document in patient medical record.

Communicate pertinent patient data to charge nurse and/or physician as appropriate.

Reassess patient's condition and revise plan of care based on identified nursing problems.

Possess knowledge of the pharmacology of emergency drugs, anticipated results, usual dosages, and their location on crash cart (for ACLS, PALS, & NRP required areas).

Administer medications by any ordered route.

Assess and document patient response to medications administered.

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

Give inhalation therapy treatments, with knowledge of medications utilized in this treatment and reactions.

Be able to interpret and intervene cardiac rhythms to include recognizing lethal rhythms and their implications (Critical Care Unit, Progressive Care Unit, Medical Telemetry units to include those on remote telemetry, Emergency Room, Post Anesthesia Care Unit (PACU)).

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

Operate defibrillator, EKG machine and cardiac monitor.

Shall administer blood and their competencies for blood administration will be verified.

Interpret pertinent lab values.

Use electronic thermometers, infusion and Patient Controlled Analgesia pumps and various other pieces of medical equipment.

Participate in Discharge Planning as appropriate.

Provide nursing care to a group of patients with other individuals assisting him/her, which may include making patient care assignments.

Ability to initiate life saving measures in the absence of a physician.

Identify impending or existing emotional or psychiatric crisis and provide appropriate intervention.

Provide nursing care and monitoring related to moderate sedation.

Additional duties for Intensive Care/Critical Care/Progressive Care Unit areas,

Successful completion of certification for the following tasks:

o Critical Care Medications (monitor, mix in emergency situations, administer/titrate);

o Dysrhythmia Recognition;

o Moderate Sedation

o Arterial Blood Gas Sampling and Interpretation;

o Hemodynamic Pressure Interpretation;

o Assists with Synchronized Cardioversion; Apply noninvasive external pacemaker;

o Perform emergency defibrillation; Demonstrate use and operation of defibrillator;

perform as a member of the code team,

o Administer thrombolytic agents; i.e. cathflo

o Perform the Postoperative Recovery and discharge within established criteria;

o Draw blood from invasive monitoring lines; Care and maintenance of central lines

o Assists with Procedures To Obtain Hemodynamic variables;

o Provide intensive nursing care to critically ill patients of all ages with medical and/or surgical problems and/or Infectious Disease related problems;

o Administer prescribed medications to include multiple medication drips and intravenous push drugs;

o Care for patients on ventilators;

o Care for patients receiving CRRT, operate CRRT equipment safely and effectively

o Operate hemodynamic equipment safely and effectively.

o Monitor and maintain invasive neurologic monitoring

o Conduct Performance Improvement/Evidenced Based Practice in support of improved practice and patient outcomes

? May be required to work in the Emergency Room, Cardiac Catheterization Lab, Interventional Radiology, GI Clinic, Progressive Care Unit, Post Anesthesia Care Unit (PACU), Medical Wards/Clinics, Surgical Wards/Clinics and Obstetrics/Gynecology Wards/Clinics or serve as a Patient Safety Attendant for pediatric or adult patients.

Additional duties for Emergency Department:

o Successful completion of certification for the following tasks:

o Recognition of life-threatening arrhythmias;

o Defibrillation; Emergency cardioversion;

o independent administration of emergency drugs (monitor, mix, administer, titrate);

o Drawing and interpretation of arterial blood gases;

o Suctioning;

o Operation of Emergency Room equipment;

o Observes, manages patient flow through the Emergency Room. Triage patients, referring to appropriate level of care;

o Uses cardiac monitoring equipment; interprets and responds appropriately to data.

o Perform arterial punctures

o Perform moderate sedation

Additional duties for Labor & Delivery unit areas:

o Perform and record skilled physical assessments of normal and complicated gravid women and newborn infants to include vital and neurological signs with fetal heart tones, vaginal and speculum exams with determination of dilation, effacement, station, presentation and rupture of amniotic membranes, and symptoms/history associated with alterations in the pregnancy/delivery process.

o Apply, operate, and accurately interpret external fetal monitors for purposes of fetal assessment during non-stress tests, contraction stress and labor; and with unit verification applies fetal scalp probes.

o Operate complex monitoring and resuscitation equipment including bag/valve/mask ventilation, cardiac monitors, infusion pumps, pulse oximeter, radiant warmers, and nasopharyngeal gastric suction devices.

o Perform emergency vaginal precipitous deliveries, titrate Magnesium Sulfate, Tocolytic, and Pitocin infusions in response to labor patterns and fetal well-being, function as circulating nurse during operative deliveries. Assist the physician with placement of intrauterine pressure catheters, fetal scalp sampling, amino infusions, regional anesthesia, caesarean and vaginal deliveries, include infant resuscitation, forceps and vacuum extraction.

o Perform peripheral phlebotomy, IV catheter placement, cord blood sampling, electrocardiograms and urinary catheterization.

o Provide post anesthesia recovery and postoperative care for patients under regional and general anesthesia to include post-op cerclage, and for patient's postdelivery.

o Care for patients undergoing specific testing and routine labor monitoring such as Oxytocin Challenge Test, Non-Stress Test and amniocentesis.

o May be required to work on the Mother/Baby and Obstetrics/Gynecology Wards/Clinics.

Additional duties for the Operating Room:

o Operates/monitors/manages patient care requiring highly complex technical equipment and interventions.

o Responsible for direct patient care and coordinates with interdisciplinary personnel for additional patient care activities.

o Use and instruct others in the use of simple and specialized equipment appropriate to the clinical area.

o Use appropriate interview and observations skills to obtain pertinent patient information.

o Communicate patient’s progress to patients, families, and members of the health care team.

o Teach and inform patients and families about disease processes, pre and postoperative care, diagnostic procedures, equipment in use, health maintenance, illness prevention, and actual and potential adverse reactions to medications.

o Be able to recognize and respond appropriately to any changes in a patient’s condition.

o Administer simple and complex medications via oral, intramuscular, subcutaneous, intradermal, topical, rectal, respiratory and intravenous routes, and make interdisciplinary referrals.

o Perform treatments as ordered using aseptic technique and assist with procedures when necessary.

o Maintain clinical competency and increase knowledge by attending in-services and continuing education programs and obtain laboratory specimens as needed to include venipuncture.

o Operate emergency resuscitative equipment.

o Assess pre, inter and post-operative progress of the patient, identify deviations from the expected outcomes, and respond with appropriate action.

o Additional duties for the Post Anesthesia Care Unit (PACU) area

o Demonstrate knowledge of hemodynamic monitoring systems

o ACLS protocols and dysrhythmia recognition

o Able to perform a 12-lead EKG with proper lead placement

o Perform the post-operative recovery and discharge within established criteria for ages from infancy to geriatric

o Management through the continuum of care for patients who receive spinal anesthesia

o Management through the continuum of care for patients who receive general anesthesia

o Management through the continuum of care for patients who receive local and regional anesthesia

o Management through the continuum of care for patients who receive IV sedation anesthesia

o Knowledge of the Post Anesthesia Recovery (PAR) score and its use in the PACU

o Demonstrate alternate techniques for pain control/relief (positioning, heat, cold, relaxation, distraction)

o Perform venipuncture for various post-operative blood draws as per physician orders

o Management of patients with chest tubes placed in the OR

o Administration of IV fluids and/or IVPB medications

o Demonstrate proper use and operation of defibrillator

o Proper application of noninvasive external pacemaker pads

o Airway management to include various adjuncts (oropharyngeal, nasopharyngeal) and oxygen delivery devices

o Advanced assessment skills to recognize non-verbal signs of patient distress or discomfort

o Narcotics (IV administration, monitoring, side effects)

o Anti-emetics (IV administration, monitoring, side effects)

o Knowledge of set up of facility PCA pump

o Management of epidural catheter with or without continuous infusion pump

o Management of patients with arterial lines/catheters in place

o Management of patients with central venous catheter in place

Additional duties for Pediatric Intensive Care Unit (PICU) areas:

o Able to perform advanced cardiopulmonary resuscitation, mixing and administering special, potent and potentially lethal drugs (i.e. Atropine, dopamine, dobutamine) based on weight.

o Perform various pulmonary ventilation treatments such as administration of oxygen through various invasive and noninvasive means.

o Assist physician with complex and potentially life-threatening procedures as cardioversion, insertion of central lines and intubation.

o Operate and monitor highly complex technical equipment such as hemodynamic monitoring devices, ventilators, oxygen monitors etc.

o Provide patient and family teaching and counseling to possible reactions to medications, health maintenance and illness prevention.

o Manage nursing care of the patient on multiple medications and technical equipment, complete thorough assessments and determine abnormalities, make decisions and take corrective action immediately.

o Possesses the knowledge of a wide range of nursing care principles, practices and procedures required to perform highly specialized nursing assignments to assess the needs of the critically ill infant, child, adolescent and teenage patient o May be required to work in the Pediatric Ward, Neonatal Intensive Care Unit, or Mother Baby Unit (infants only) or serve as a Patient Safety Attendant for Pediatric or Adult patients.

Additional duties for Neonatal Intensive Care Unit (NICU) areas:

o Perform and record comprehensive physical assessments of critically-ill term and premature infants to include monitoring of vital signs, cardiovascular, respiratory, and neurological status, intake and output, potential complications associated with birth and/or prematurity, family interactions and bonding behaviors.

o Recognize significant changes in the neonates' status, which are indicative of complications and/or the need for emergency treatment; take nursing action, and/or reports changes to physician, as appropriate.

o Operate complex monitoring equipment to include pulse oximetry, infant care systems, cardiovascular monitoring, phototherapy, bedside glucose monitoring, chest tube/replogle/oral/nasal/gastric suctioning devices, oxygen therapy equipment to include ventilators, high-flow nasal cannula, nasal cpap, high frequency oscillators, and nitric oxide delivery.

o Administers ophthalmic and intramuscular medications, IV medications via peripheral and central indwelling catheters to include PICC lines utilizing syringe pumps.

o Obtain blood samples from heel sticks, peripheral and central arterial and venous sampling.

o Participate as part of the health care team in preparing families to care for their infants at home through individualized education regarding diagnoses as well as basic infant care and safety and breastfeeding.

May be required to work on Pediatric Wards/Clinics or the Pediatric Intensive Care Unit (PICU).