HomeMy WebLinkAboutMINUTES - 11141989 - T.1 TO. , BOARD OF SUPERVISORS
FROM ra
Mark Finucane, Health Services Director "
Costa
DATE: November 8, 1989 C
SUBJECT: PHN Reductions/Reorganization
SPECIFIC REWEST(S) OR RECOMMENDATION(S) & BACKsROUND AND JUSTIFICATION
RECOMMENDED ACTION
1. Eliminate one Supervising PHN II position and one RN Clinic Supervisor
position.
2. Direct the Health Services Department to appoint an evaluation team headed by
Dr. William Walker to monitor the fiscal and clinical impacts of the proposed
reductions.
FINANCIAL IMPACT
Annualized savings of approximately $175,000 in the Public Health Division, $130,000
of which will be realized from the above reductions and an additional $45,000 from the
Public Health budget which had been designated for a training position.
BACKGROUND
As directed by your Board at the October 17, 1989 Beilenson Hearing, the Health
Services Department has prepared a comprehensive report or) the reorganization and
reduction of Public Health Nursing Supervisors.
Also, as directed by your Board we looked at three options to realize the required
savings:
1. The reductions proposed in the Beilenson notice: 1 PHN Supervisor I , 1 PHN
Supervisor II , and 1 RN Clinical Supervisor.
2. Elimination of 1 PHN Supervisor II , 1 RN Clinical Supervisor and elimination of
$45,000 which had been budgeted for training.
3. Reductions proposed by the PHN Director and included in the Beilenson notice:
elimination of 4.5 PHN direct service positions and of a .5 RN position.
Since October 17, the following actions have been taken to ensure that all questions
raised at the Beilenson Hearing have been addressed and that my recommendation to you
is a sound one:
1. Medical Director, William Walker, M.D. , has conducted a separate review of the
clinical impact of these reductions.
CONTINUED ON ATTACHMENT: _ YES SIGNATURE:
RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMMENDATION OF BOARD OMMITTEE
APPROVE OTHER
SIGNATURE(S):
ACTION OF BOARD ONv�pber1A , 1999 APPROVED AS RECOMMENDED X OTHER X
The Board ACCEPTED the above report; APPROVED recommendations 1 and 2, eliminating one
Supervisino Public Health Nurse II position and one RN Clinic Supervisor Dosition, and
one budgeted Training Coordinator; formation of a Public Health Nursina Duality of Care
Review Committee, and ADOPTED Resolution 89/732 amending Resolution *E93 adopted on
October 17, 1989.
VOTE OF SUPERVISORS
1 HEREBY CERTIFY THAT THIS IS A TRUE
X UNANIMOUS (ABSENT AND CORRECT COPY OF AN ACTION TAKEN
AYES: NOES: AND ENTERED ON THE MINUTES OF THE BOARD
ABSENT: ABSTAIN: OF SUPERVISORS ON THE DATE SHOWN.
cc: Health Services Director ATTESTED November 14, 1989 _
County Administrator PHIL BATCHELOR, CLERK OF THE BOARD OF
SUPERVISORS AND COUNTY ADMINISTRATOR
M382/7-83 BY ,DEPUTY
2. Chief Financial Officer, Patrick Godley, has reviewed the possible impact on
revenues.
3. Public Health Director, Wendel Brunner, M.D. ; has prepared a "Question and
Answer" document to respond to the issues which were raised regarding nurse to
supervisor ratios, Public Health Nursing program projects, PHN training and the
, student nursing program.
4. Dr. Walker, Dr. Brunner, and I met with all Public Health Nursing staff in a
three-hour meeting to listen to their concerns.
5. We have also met on three separate occasions with Public Health Nursing Director,
Irma Anderson.
After reviewing the separate reports from Dr. Walker, Mr. Godley, and Dr. Brunner,
which are attached for your review, I have concluded that option #2 can best achieve
the required savings without affecting service. In summary, I can tell you that we
anticipate no adverse clinical impact with this reduction/reorganization, nor will
there be any negative impact on revenues. The public health nurse to supervisor ratios
will be well within the Title 22 requirements and U.C. School of Nursing academic
standards.
Future Health Services Department Actions
As a result of the recent reviews of the public health nursing program, we have
identified areas where additional support to the program is needed and other areas that
will require further study within the next year. We have already responded to the
immediate need for facsimile machines and will make every effort to fill vacant
clerical positions without delay.
Within the next year we intend to conduct a comprehensive review of Public Health
Nursing data processing needs. A most important project, and one for which we will
engage an outside consultant, will be a thorough examination of our public health
nursing system, from the job classification of all personnel from managers to support
staff, to the work load, duties and assigned locations of public health nurses. We
must ensure that staff who are trained and paid to do direct patient care are not
performing clerical duties that should be done by other classifications. Location
assignments will be particularly critical as the 1990 census identifies geographical
areas at risk and that may be in great need of public health nursing services. In
short, we will ensure that the public health nursing program in Contra Costa County
is prepared to respond to the demands of the next century.
Finally, I want to reiterate the Department's position that if any additional resources
become available in the future from any funding source, I would recommend increasing
direct service staff. I realize the impact this would have on administrators, but
for five years we have followed the policy in the Health Services Department that
administrative positions are the first to be reduced and direct service positions are
the first to be added.
Contra
The Board of Supervisors Cwa Health Services Department
Tom Powers,1st District County
Nancy C.Fandon,2nd District OFFICE OF THE DIRECTOR
R~1.SchnxW,3rd District .
.
.
.. .
........
•
Sunny WrIght Mcftak 4th District
Mark Flnucane,Director
Tom Toriskson,5th District
Administrative Offices
County Administrator 2D Allen Street
Martinez,California 94553
(415)646-4416
PhN Batchelor .......
County Administrator
DATE: November 7, 1989
TO: Mark Finucane, Director
Health Services Department
QC.-tk':'
FROM: Patrick Godley, Chief Financial Officer
SUBJECT: Public Health Nurse Supervision Reduction
-----------------------------------------------------------------
We have reviewed the workload and related revenue aspects
concerning the proposed modification in Public Health Nursing
Supervision. Based upon our review and the program assessment of
minor, if any, impact on the current units of service production
we foresee no loss of revenue resulting from the action.
A-345 (11/87)
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r
CONTRA COSTA COUNTY
HEALTH SERVICES DEPARTMENT
November 8, 1989
To: Mark Finucane
Health Services Director
From: William B. Walker, M.D. 'J
Medical Director/Health Officer
Subj: Clinical Review of Recommended Public Health
Administrative and Supervisory Cuts
Attached, as requested, is a report outlining my recommendations
with regard to the Public Health administrative and supervisory
cuts. If you have questions, please give me a call.
WW:hh
Attachment
A-41 3181
CLINICAL REVIEW OF RECOMMENDED PUBLIC HEALTH
ADMINISTRATIVE AND SUPERVISORY CUTS
by William B. Walker, M.D.
Medical Director/Health Officer
It has been proposed that the following reductions be made in
Public Health Nursing supervision and administration:
1 Supervising PHN II
1 Supervising PHN I
1 RN Clinic Supervisor
I have reviewed the clinical consequences of -making these
reductions. I have consulted the Director of Public Health
Nursing, the Director of Public Health, and Public Health
supervisors and line staff in the context of a general meeting as
well as individual contacts. I have also reviewed the proposed
cuts relative to staffing ratios of supervisors to line staff
currently existing in surrounding counties. The fact that we have
a Home Health Agency makes these ratios somewhat difficult to
compare, but I have taken that into account.
The main concern of line staff PHN's as expressed in the meeting
held with them is that there will be a lack of direct supervisory
clinical support for their activities in the field. There was
concern raised that this would jeopardize quality of care. I took
this as the most serious consequence possible in the reductions and
I feel that we must guard closely against jeopardizing the quality
of our Public Health Nursing program. It was also apparent,
however, in the review that PHN superviors are currently spending
more than the appropriate amount of time doing clerical tasks which
could be done by less qualified personnel. It is also apparent
that some of their activities are spent in administering and
monitoring projects funded by State grants, some of which could be
accomplished by line staff or other forms of contract
administration.
It should be noted that the overall goal of these reductions was
to save approximately $200,000 in the Public Health Nursing budget
while at the same time not affecting hours committed to deliver
services to clients in the field or in our Public Health Clinics.
I also note that there currently exists a $45,000 line item in the
Public Health budget which has been directed toward the hiring of
a Training Coordinator. This position has yet to be filled.
Based upon this review, I am making the following recommendations:
1. I recommend removing the Supervising PHN I from the list of
reductions. This position is the most direct supervisory position
affecting PHN's in the field and I was unable to propose a totally
satisfactory reorganization of supervisors to fill this gap. I
recommend that the $45,000 Training Coordinator position is of a
lower priority and therefore that this money be used to offset,
partially, the lack of making this reduction.
2. I recommend that we eliminate the Supervising PHN II position.
The activities of the supervisor can be covered by redirecting the
activities of the remaining PHN II as well as the Director of
Public Health Nursing. It may also be possible to involve line
staff in some of the grant administration activities. The backup
that this position has provided to Supervising nurses in Central
and East County will have to be supplanted by the remaining PHN II,
the Director of Public Health Nursing or line staff working
temporarily out of class during vacation or sick leave.
3. I recommend the elimination of the RN Clinic Supervisor
position. I feel that the remaining RN Supervisor is capable of
supervising the RN staff in Public Health Clinics county-wide.
However, to partially offset the consequences of this reduction,
I am recommending the reclassification of a current vacant full
time staff level RN to a Charge Nurse position. This would then
make available one Charge Nurse on site in Richmond, Concord and
Pittsburg with overall supervision by the RN supervisor based in
Martinez.
I feel that the above reductions can be made without jeopardizing
quality of care in the clinics or in the field Public Health
Nursing activities . However, to assure that there is no
deleterious consequence, I am recommending the formation of a
Public Health Nursing Quality of Care Review Committee consisting
of myself, the Director of Public Health, the Director of Public
Health Nursing and a representative of line staff PHN's from each
of the regions of the county. We will put in place a monitoring
process to monitor ongoing quality of care issues as well as to
assure that any quality issues which come to our attention from any
source are adequately addressed. We will report back to the Board
of Supervisors if any of these reductions appear to compromise
quality of care.
I am also concerned about the suggestions that too much PHN
supervisory time is consumed by clerical activities . I am
recommending the institution of a review of PHN supervisory
activities to determine which activities are clearly clerical and
could be efficiently provided by increasing clerical support. If
this analysis shows that clerical staff need to be added to current
staffing levels, then we will make that recommendation.
In conclusion, I am confident that the above reductions are
clinically appropriate. I am appreciative of the comments and
concerns of line staff in these proposed reductions and will commit
to an ongoing process to address those concerns .
WW:hh
phncuts
CONTRA COSTA COUNTY
HEALTH SERVICES DEPARTMENT
November 8, 1989
To: Mark Finucane
Health Services Director
From: Wendel Brunner, M.D. tJ '"
Director of Public Health
Re: Public Health Nursing Reorganization/Reductions
As requested, my analysis of the Public Health Nursing
reorganization/reductions is attached.
WB:rm
PUBLIC HEALTH NO ING REORGANISATION PROPOSAL
1. Why consider Public Health Nursing reorganization?
The requirement to .make $300,000 reductions in the Public
Health Division prompted a close look by the Public Health
Division at all parts of administration, to identify areas
where cost savings could be made while still preserving public
health programs and patient services. Forty-six thousand
dollars ($46,000) of administrative reductions were made in
Communicable Disease and central administration, and an
additional $52,000 reductions were made in AIDS and the Miller
Centers Programs.
That division analysis also showed that $200,000 savings could
be made in Public Health Nursing administration without
seriously impacting nursing programs or services. That
savings can be made because there are an excessive number of
nursing administrators for the number of line staff (one
nursing administrator for every 4.2 staff nurses overall) and
unnecessary and substantial duplication of administrative
functions . Even if fiscal imperatives to reduce expenditures
lessen, Public Health Nursing reorganization provides an .
opportunity to significantly expand needed public health
services within the constraints of a fixed public health
budget.
2. How are Public Health Nursing field services organized?
Most Public Health Nurses in the Public Health Division are
assigned to a nursing pool. Nurses in this pool perform work
assignments in two basic program areas. One area is the Home
Health Agency (HHA) , which provides skilled nursing and
professional services in the home reimbursed by third party
payors (mostly Medicare) and is organized under Title 22. The
other program area is Generalized Public Health Field Nursing
as mandated and described in Section 1253 of Title 17 .
Most health agencies that provide services in both program
areas (only Generalized Public Health Nursing is mandated for
local health departments) have separate nursing staff as well
as separate supervisors for each program. In our agency
almost all the nurses in the pool work part-time in both
programs . Each program area is assigned, not specific nurses,
. but the appropriate number of full-time equivalent (FTE)
nurses to meet work loads, which vary somewhat from day to day
and week to week. This pool procedure provides our agency
flexibility to meet shifting work and case loads, and is
recognized as legitimate by our Medicare Fiscal-Intermediary
and sections 74705 of Title 22. The nurse FTE's in the
Geneialized Program are under the supervision of Public Health
Nursing Supervisors, and the nurse FTE's involved in the HHA
are under the direction of HHA Supervisors. Nurse time is
accounted for and charged between the two programs .
In addition to the field nurses, there are clinic RN's who
provide clinic nursing services in Public Health clinics such
as Family Planning, 'Well-Baby, Sexually Transmitted Disease,
Older Adult Clinic, and Occupational Health. The clinic RN's
are under the direction of Supervising Clinic RN's.
3. What is the existing Public Health Nursing administrative
structure?
The Public Health Nursing -pool contains 48.4 FTE (full-time
equivalent) paid field nurses who work in the two major
program areas, Home Health Agency and Generalized Field
Nursing. Approximately 21 .6 FTE nurses work in the Home
Health Agency, and 26 . 8 FTE's are in Generalized Field Nursing
(based on the average utilization for the first six months of
1989 ) . In addition there are 6 .7 FTE clinic RN's who staff
Public Health clinic programs .
Public Health Nursing administration consists of:
1 Public Health Nursing Director
1 Home Health Agency Director
3 Home Health Agency Nursing Supervisors
4 Supervising Public Health Nurse I's
2 Supervising Public Health Nurse II's
2 Supervising Clinic RN's
13 Administrators
Public Health Nursing staff consists of:
26 .8 FTE PHN's working in Generalized Nursing
21 . 6 FTE Nurses working in the HHA (incl. 1 .8 FTE RN's)
6 .7 FTE Clinic RN's
55. 1 FTE Nurses
In addition there are social workers, physical and
occupational therapists, and home health aides working in the
Home Health Agency under the direction of HHA Supervisors.
Field nursing utilizes public health aides, and both programs
are served by clerical staff.
J
1
2
4. What are the existing staff nurse to supervisor ratios?
Overall there are:
4.2 nurses per nursing administrator
For direct supervisors (excluding the Nursing Director and HHA
Coordinator) there are:
3.35 Clinic RN's FTE's/Supervisor
4 .47 PHN FTE's/PHN Supervisor
7 .19 HHA Nurse FTE's/HHA Supervisor
S. What are the proposed changes in Public Health Nursing
organization?
We propose to eliminate:
1 RN Clinic Supervisor
1 Public Health Nurse Supervisor II
1 Public Health Nurse Supervisor I
These changes will save $200,000 per year and will leave:
6. 69 RN's FTE's/Supervisor (including 2 charge nurses)
6 .7 PHN's FTE's/Supervisor Generalized Nursing
7 . 19 Nurses FTE's/Supervisor in the Home Health Agency
(unchanged)
6. How do these nurse/supervisor ratios compare to legal
requirements and community standards?
o Title 22, Section 74705, requires that there be at least
one registered nursing supervisor for every 12 nurses or
full-time equivalents in a Home Health Agency. Title 17,
Section 1253, specifies that there be a Director of
Public Health Nursing" and such additional supervisors,
who are necessary to provide effective service" , without
specifying any specific ratio.
o Dorothy S. Oda, RN, DNSC, Professor and Acting Department
Chair of Community Health Nursing at the University of
California School of Nursing at San Francisco recommends
that "currently accepted maximum first level supervisory
assignment in Public Health Nursing is one supervising
PHN to 15 staff PHN's (1:15 ratio) ", in a letter sent to
Supervisor Torlakson as a result of a consultation
request by the Director of Public Health Nursing.
7
3
• o In comparing supervisor ratios in ten other Bay Area
health departments, they range from a low of 3.45
nurses/supervisor in Marin to 16 nurses/supervisor in San
Francisco, with the largest nursing program in Santa
Clara having 8..2 nurses/supervisor. The proposed ratios
in Contra Costa of 6 .7 nurses/supervisor are well within
this range. The highest ratio in our county is 7.19
nurses/supervisor in the HHA. We do not propose to
reduce the HHA supervisory staff.
It is evident that our proposed supervisory ratios are
well within legal, academic, and community standards.
7. Who will provide supervision to Public Health Nurses under
this reorganization plan?
Clinical and professional leadership for Public Health Nursing
will be provided by Public Health Nursing Supervisors and the
Nursing Director in the Public Health Nursing Program. All
PHN's in the Public Health Division, including the nurses
assigned to the Communicable Disease and Maternal and Child
Health Programs, will be under the supervision of certified
Public Health Nurses in management positions, who in turn are
supervised by Public Health physicians.
8. What will happen to the existing Public Health Nursing
programs?
Public Health Nursing has a contract with the State Department
of Health Services for refugee programs in the amount of
$65,000, a refugee SNAP grant for $35,880 which ends January,
1990, and one contract of $54,500 for Preventive Health Care
for the Aging, for a total of $155,380. These nursing
programs can be assigned among the four Public Health Nursing
Supervisors. In addition, the PHN job specification allows
a staff PHN to direct the work of aides and ancillary
personnel and perform data analysis. Staff PHN's can
participate in the running of these projects.
Typically, the Public Health Division grants and programs
ranging from $140,000 to over $800,000 are managed by a Public
Health Program Specialist I or II, management classes
substantially lower in pay than PHN Supervisor I. A number
of these program specialist positions in the Communicable
Disease and Maternal Child and Adolescent Health Sections are
flagged to be filled only by someone with a valid PHN
certificate, because of the nursing expertise required. The
$155,380 of contracts in Public Health Nursing should be able
to be managed by Public Health Nursing Supervisors.
s
4
Public Health Nursing also provides Public Health Nursing
staff time to a state-funded High-Risk Infant Project and a
Child Health and Disability Prevention nursing contract,
totaling approximately $509,845. Both of these contracts with
State Department of Health Services are currently funded,
managed, and monitored by the Maternal and Child Health
Section of Public Health. The management of these programs
is not the responsibility of the Public Health Nursing Section
and is not affected by changes in the administrative structure
of Public Health Nursing.
9. What will happen to PHN training and the student nursing
program if a PHN Supervisor I is eliminated?
In response to concerns from the Public Health Nursing
Director and the Home Health Agency Coordinator about training
needs in Public Health Nursing, Mark Finucane authorized
$40,000 additional funds in June, 1989 for Public Health
Nursing administration to enhance training. The utilization
of those funds, sufficient for a part-time nursing management
position, awaits only the submission of a proposal by the
Public Health Nursing Director on how these funds should be
used. This proposal, which the' Nursing Director was
instructed to prepare last June, will undoubtedly be quite
comprehensive and will provide for enhanced nursing and
student training.
10. How will the nursing supervisors be distributed geographically
over the county?
Approximately one-half of the PHN's are assigned to the
Richmond office, with the remainder distributed between the
Concord and Pittsburg offices, reflecting the general
distribution of need for PHN's in those communities. The
seven nursing supervisors, 3 HHA and 4 PHN will be distributed
geographically according to need. One possible distribution
is 1 HHA Supervisor and 1 PHN Supervisor each in Pittsburg and
Concord, and 2 PHN Supervisors and an HHA Supervisor in
Richmond. Other distributions are possible. For example, the
work load of the 15 nurses at the Concord office is mostly
HHA. The Concord PHN Supervisor could be moved elsewhere with
the minimal General Nursing function at Concord handled by a
PHN charge nurse supervised from Martinez or Pittsburg.
11. How will this Nursing Reorganisation be evaluated?
There will be a one-year evaluation period during which the
impact of the nursing reorganization will be assessed. The
evaluation will be conducted by the Public 'Health Director in
consultation with the Public Health Nursing Director and other
staff. In addition, a parallel assessment will be made by the
Health Officer with the assistance of an independent nursing
5
consultant, all under the oversight of the Health Services
Director.
Evaluation reports will be prepared quarterly during the
evaluation year and will focus on Public. Health Nursing field
services, Public Health clinic services, co-ordination of
nursing programs and services with other Public Health
programs, particularly Communicable Disease and Maternal Child
and Adolescent Health, and impact on revenue in Public Health.
WB:rm
z.phar.or8
J
i
6
BACKGROUND ANALYSIS FOR PUBLIC HEALTH
• NURSING REORGANIZATION PROPOSAL
If we are required to make substantial reductions in Public Health, a
significant portion of that reduction will have to come from the $3.2
million county cost associated with public health nursing. This
analysis is to consider the feasibility of saving public health nursing
program services by making cost-savings in nursing administration.
The number of paid PHN FTEs is obtained from the department payroll runs
and averaged over the first six months of 1989 . This figure represents
the actual number of FTEs employed, rather than the number of positions
available. The number of FTEs involved in the HRA is provided by
Deborah Card based on actual workload statistics. That figure includes
1.8 FTE RNs on the HHA team. The equivalent number of paid FTEs is
calculated using the average percentageproductive time. For
comparison, PHN nursing/supervisor ratios in the Bay Area counties are
included from the public health nursing survey conducted by Carol Spain.
The 3.0 FTE High-Risk Infant Project nurses are primarily directed by
Norma Kruse, PHN and Kathy Malloy, M.D. , and are subtracted from numbers
of PHNs in the pool directly under the responsibility of nursing
administration. The nurse/supervisor ratios in the Public Health
Nursing Reorganization Proposal, however, are more conservative than
those generated below, and consider the three High-Risk Infant nurses
as under the responsibility of nursing administration. The CCHP advice
nurses and Healthy Start PHNs are fully included in PHN nursing
administration's responsibility in this analysis .
Average number paid PHN FTEs 1/87-6/89 46.56
Average % productive 83.5%
Average number FTEs used in HHA (productive) 18.00
Average number of paid FTEs used in HHA 18.00 — 21 .56 (estimate)
.835 (incl. 1.8 FTE RNs)
CURRENT NURSING STAFFING
Total Field Nursing Pool
46.56 PHN FTEs paid
-3 .00 High-Risk nurses
43.56 PHN FTEs in pool t
+1 .8 FTEs RNs on HHA team
45.36 Total Field Nurses
7 Supervisor I's
2 Supervisor II's 5.04 nurses/supervisor
HHA 21 .56 FTE Nurses 7 .19 nurses/supervisor
3 Supervisor I's
1 HHA Director (not included 'in ratio)
Non-HRA
PHN Pool 46 .56 PHN FTEs paid
-19 .76 PHN FTEs paid in HHA
26 .80 PHN FTEs in pool
-3.00 High-Risk nurses
23.80 PHN FTEs in pool
4 Supervisor I's
2 Supervisor II's 3.97 nurses/supervisor
1 Director (not included in ratio)
Clinic RNs 6.69 paid clinic FTE RNs
2 Supervising
clinic RNs 3.35 clinic nurses/supv.
PROPOSED NURSING SUPERVISOR REDUCTIONS
Reduce: 1 Supervising PHN I from public health nursing pool
1 Supervising PHN II
1 Supervising clinic RN
RESULTING NURSING STAFFING PATTERN
AFTER PROPOSED REDUCTIONS
Total Field
Nursing pool 46.56 PHN FTEs paid
-3 .00 PHN High-Risk nurses
43.56 FTEs in pool
+1 -80 FTEs RN on HRA team
45.36 FTEs Field Nurses
6 Supervisor I's
1 Supervisor I1 6 .48 nurses/supervisor
HRA Unchanged, as HHA supervisors are not affected.
7.19 nurses/supervisor
Non-HHA
PHN Pool 23.80 PHN FTEs in non-HRA programs
3 Supervisor I's
1 Supervisor II 5.95 nurses/supervisor
Clinic RNs 6 .69 paid clinic FTE RNs
1 Supervising clinic RN
6 .6 clinic nurses/supervisor
2
FINANCIAL IMPACT OF SUPERVISOR REDUCTIONS
(including 24% benefits)
Supervisor I (top step) 4473/mo 661562/yr
Supervisor II (bottom' step) 4263/mo 63,436/yr
(top step) (5282) (77,107)
Supervising Clinic Nurse
(top step) 4127/mo 61,409/yr
Total analyzed savings: 191,407
(bottom step - Supervisor II)
Assuming 10% Cola January 1, 1990 200,978
(top step - Supervisor II) (215,332)
CONCLUSIONS
Reducing one Supervisor I, one Supervisor II, and one Supervising Clinic
RN will save about 200K on an annualized basis.
The resulting nurse/supervisor ratios in the non-HRA programs of 5 .95
nurse/supervisor are within reasonable management guidelines and compare
favorably to other public health nursing programs in the Bay Area (see
Table A) . It is noteworthy that the HHA functions on a 7
nurse/supervisor ratio, and the HHA places major demands on supervisors
for clinical direction and adherence to third-party payor guidelines
(Medicare) . The HHA supervisors also bear the burden of directing
aides, social workers, therapists and clerks. The supervisors in the
HHA are not affected by this proposed reduction, so the supervisor
burden in the HHA would remain unchanged.
7 •
3
PHN MANAGEMENT ANALYSIS
Sr. Sup/ Sup Sr. Managers/
County Assoc.Dir Suu II PHN I PMNs PHNs Field Staff
Alameda 1 3 9 2 64 .75 1/5.56
(District)
Berkeley 3 4 7 1/3.67
Contra Costa 1 2 7 53.7 1/5.97
(HHA Coord) (3-HRA)
Marin 4 13.8 1/3. 45
S.F. 5 80 1/16
San Mateo 3 5 31 1/12
Santa Clara 1 it 2* 90.5 1/8 .41
Santa Cruz 1 2 6 27 N/A**
(+4 pgm. mgrs . )
Solano 2 14 1/4 . 67
(+i HRA Sup)
Sonoma 2 18 1/9
*In the field nursing staff, there is one additional Sr. PHN (PHNIII) in the
MCAH specialist program in nursing.
**PHN staff distributed among various public health programs . There are 13.4
field PHN's under the field nursing supervisor.
NB:rm
11/6/89
bgrd.wb
4
TABLE "A"
TOTAL PUBLIC HEALTH NURSING FTEs
USED PER MONTH PER OFFICE (HRA)
FY1988-1989
RICHMONDOC NCORD PITTSBURG TOTAL
1988
July 4.61 8.37 4.62 17.60
August 4 .31 8.03 6.02 18.36
September 3.68 7.16 4 .68 15.52
October 4 .42 6 .76 5.10 16.28
November 5.06 6 .90 5.02 16 .98
December 5 .45 7 .26 5.92 18.63
1989
January 3. 85 7 .80 6 .13 17.78
February 5.45 7.60 6 .55 19 .60
March 7 . 97 8.50 7 .45 23.92
April 4.73 7 .4.2 5.50 17 .65
May 6 .46 7.72 4 .71 18.89
June 4 .65 5.78 4 .46 14 . 89
YEARLY 5.05 7.44 5.51 18.00
AVERAGE
(Productive)
YEARLY 6.05 8.91 6 .50 21 .56
AVERAGE
(Paid)
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THE BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA
Adopted this Order on November 14, 1989, by the following vote:
AYES: Supervisors Powers , Fanden, Schroder, McPeak and Torlakson
NOES: None
ABSENT: None
ABSTAIN: None
SUBJECT: Amendment to Health and )
Safety Code S 1442.5 ) RESOLUTION NO. 89/732
Hearing Findings ) (Amendment to Resolution
(Beilenson Hearing ) No. 89/693 . )
Findings) )
Pursuant to Health and Safety Code section 1442.5, the Board
conducted a further public hearing on November 14, 1989 on the proposed
reduction of Public Health Nursing supervisory staff positions . This
hearing was a continuation of the public hearings conducted on October 17 ,
1989 .
I. The Board received additional written and oral evidence as
follows:
A. Written documents were received into the record and are
filed with the Clerk of the Board of Supervisors as follows:
1. A report dated November 7, 1989 to Mark Finucane, Health
Services Director, from Patrick Godley, Chief Financial
Officer, on the Public Health Nurse Supervision
Reduction.
B. The additional oral testimony received is summarized as
follows:
1. Mark Finucane, Health Services Director, summarized the
November 7, 1989 report received into the record.
2 . William Walker, M.D. , recommended the elimination of
only two supervisory positions instead of the proposed
elimination of three positions and recommended the
appointment of an evaluation team, to be headed by
Dr. Walker, to monitor the fiscal and clinical impacts
of the recommended supervisory staff reductions .
3 . Elaine G. Swenson, R.N. , M.P.H. , 37th and Bissell,
Richmond, representing the Public Health Nursing Unit,
spoke on the proposed staffing cuts .
I I .
Findings .
On the basis of the evidence presented on October 17 and
November 14, 1989, as summarized herein and in Resolution No.
89/693, the Board makes the following findings:
A. The public health nursing supervisory staff reductions were
considered at the public hearings on October 17 and November
14, 1989 and were included in the Notice of Public Hearing
posted on or before September 17, 1989 in compliance with
Health and Safety Code Section 1442.5.
RESOLUTION NO. 89/732
B. As to the public health nursing supervisory staff reductions
considered at the public hearings on October 17 and November
14, 1989, the Board finds that the elimination of two public
health nursing supervisory staff positions will not reduce
any mandated medical services and will not affect the level
of medical care services to indigents .
C. There will be no detrimental impact on the health care needs
of the County's indigents from the reductions approved
herein.
III . The recommendation of the Health Services Director to eliminate
two supervisory positions in Public Health Nursing, specifically
one Supervising Public Health Nurse II position and one
Registered Nurse Clinic Supervisor position, is approved.
IV. If any finding herein is held invalid, such invalidity shall not
affect findings which can be given effect without the invalid
provision, and to this end, the invalid finding is severable.
THERFORE BE IT RESOLVED that neither the inclusion of a proposed
change in a program in the Notice of Public Hearing, the holding
of a hearing with respect to a change in a program included in
the Notice of Public Hearing, nor the making of a finding as to
such a change, is to be construed as an admission by the County
of Contra Costa or by the Board that any of the program changes
covered by the Notice are subject to the provisions of Health and
Safety Code sections 1442 or 1442.5 .
IT IS FURTHER RESOLVED that this resolution be included as a part
of the official public hearing record and that the Health
Services Director is directed to implement the reductions
approved herein and submit such further action to the Board as
may be necessary.
VLD:seb
Orig. Dept:
cc: State Department of Health Services
County Administrator
Health Services Director
County Counsel I,tlereby certify that this is a true and corcect copy of
an action taker+ No entered dam shown lnutea of tl�
Bose m su � � , ��
.,rJ � 9
ATIES % —
PHIL BATCHELOR,Clerk of the 3oard
pf gnpenrlaors and County Administrator
BY Deputy
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