Title
Human Resources Department and the Health and Human Services Agency recommending the Board:
1) Approve and adopt the revised Health and Human Services Agency department-specific class specification of Registered Nurse; and
2) Adopt and authorize the Chair to sign Resolution 071-2020 to:
a) Approve the addition of 1.0 FTE Registered Nurse allocation in the Health and Human Services Agency;
b) Approve the deletion of a vacant 1.0 FTE Licensed Vocational Nurse I/II allocation in the Health and Human Services Agency; and
c) Abolish the classifications of Licensed Vocational Nurse I and II.
FUNDING: State and Public Health Realignment Revenue.
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DISCUSSION / BACKGROUND
The professional Registered Nurse classification provides better utility for meeting accepted public health standards and greater service flexibility. The critical differentiations between Registered Nurse and Licensed Vocational Nurse is the ability of the Registered Nurse to perform assessments beyond basic symptoms and biological parameters; administer independent nursing interventions based on that assessment; exercise independent judgment and decision making within the realm of preventive health intervention; and to provide education and assess client understanding to achieve the "informed consent" threshold and to do so without direct supervision, direction, or an established care plan. The Health and Human Services Agency, Public Health Division, has identified two main benefits to using the Registered Nurse classification, rather than the Licensed Vocational Nurse classification:
1. Significantly reduces potential County liability related to the Licensed Vocational Nurse exceeding scope of practice either intentionally or unintentionally given that the public health practice arena is much more fluid than the very structured acute care or facility oriented practice setting. In carrying out basic assessment (data collection) and executing interventions, the Licensed Vocational Nurse is dependent upon direction by a physician, Registered Nurse, or a prescribed plan of care. These actions are predicated on the fact that a provider Medical Doctor or Registered Nurse has assessed the client, determined the intervention needed, and directed the Licensed Vocational Nurse to administer the care be it medication, injection, or other form of intervention. The use of standing orders are also dependent on the provider assessment step as carried out in an organized health care setting as defined by Health and Safety Code section 1250. While a provider does not need to be physically present for the Licensed Vocational Nurse to administer an immunization, the required provider assessment and informed consent still has to be carried out prior to the intervention. Public Health prior practice for community based clinics has always utilized a Public Health Nurse (provider) and Licensed Vocational Nurse deployment satisfying the assessment and informed consent requirements stipulated in the Licensed Vocational Nurse practice act. Remote administration of medication/immunization by injection outside of a mass clinic setting is accomplished by client specific orders or direction from a Medical Doctor, Nurse Practitioner, or Public Health Nurse. Continued deployment of both a Public Health Nurse and a Licensed Vocational Nurse is not cost efficient.
2. The greater scope of practice allows the Division to deploy the Registered Nurse to carry out certain functions/interventions for the purpose of surge capacity, backup, coverage, etc. that would normally be carried out by a Public Health Nurse and cannot by law be carried out by a Licensed Vocational Nurse. The Licensed Vocational Nurse has no ability to undertake the prevention, treatment, or cure of disease, pain, injury, deformity, or physical condition in lieu of direction from a provider greatly restricting function in the public health setting. The deployment of a Registered Nurse also allows that individual to independently address other health related concerns that typically come up during a client encounter that starts out as an immunization intervention.
For these reasons, Human Resources and the Health and Human Services Agency recommend that the appropriate classification going forward is Registered Nurse and that continuing to utilize a Licensed Vocational Nurse in this capacity, given the ever advancing science of immunization, potential increased liability, and restricted efficiencies and flexibility is not in the best interest of public health or the county in general.
After discussion and consultation with the Health and Human Services Agency, Public Health Division, Human Resources made revisions to the current Registered Nurse class specification to identify areas of clarification and improvement to better represent the utilization of this classification, as well as the qualifications, knowledge, and abilities to do such- which are reflected in the updated class specification.
With the revisions to the Registered Nurse classification, and operational needs of the Health and Human Services Agency, the Licensed Vocational Nurse classification is no longer needed and is being recommended to be abolished.
ALTERNATIVES
The Board could choose not to adopt the revised class specification of Registered Nurse and/or choose to retain the proposed abolished classifications of Licensed Vocational Nurse I and II.
PRIOR BOARD ACTION
N/A
OTHER DEPARTMENT / AGENCY INVOLVEMENT
El Dorado County Employees’ Association, Local 1
CAO RECOMMENDATION
Approve as recommended.
FINANCIAL IMPACT
The deletion of 1.0 FTE Licensed Vocational Nurse I/II allocation and the addition of 1.0 FTE Registered Nurse allocation in the Health and Human Services Agency, Public Health Division, increases salary and benefits appropriations by approximately $18,000 annually. The increase for the remainder of Fiscal Year 2019-20 will be covered by salary savings in the division, and the increase will be included in the Fiscal Year 2020-21 budget, funded with Realignment revenues.
CLERK OF THE BOARD FOLLOW UP ACTIONS
Upon Board adoption and approval, please provide a copy of the executed Resolution to Katie Lee in Human Resources.
STRATEGIC PLAN COMPONENT
Good Governance
CONTACT
Tameka Usher, Director of Human Resources
Don Semon, Health and Human Services Agency