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5.10. SCI Center Personnel & Staff Ratios

  1. Chief, Assistant Chief, or Acting Chief, SCI Service. The position of SCI Chief is a full-time position, and no one may be appointed to this position on less than a full-time basis.
    1. Recruitment and concurrence with appointment for these positions is undertaken, with the involvement of the Chief Consultant, SCI/D Services, with consultation from appropriate Veterans service organizations. NOTE: The Chief Consultant, SCI/D Services must approve exceptions to these criteria.
    2. The candidate needs to meet existing VA requirements for physicians including credentialing and privileging requirements. NOTE: Board certification in SCI Medicine is strongly encouraged. In accordance with VA qualification standards, non-citizens may be appointed to these positions if qualified United States citizens are not available. The candidate needs to:
      1. Have demonstrable clinical and administrative knowledge and experience in SCI/D medicine enabling the candidate to successfully direct an SCI Service, and to have completed either: an SCI fellowship training, or equivalent training in the care of persons with SCI/D.
      2. Present evidence or formal training or proven competence in leadership, administration, quality improvement, and risk management (e.g., executive medicine course, accrediting organizations) for the position of Chief.
      3. Present evidence of interest and involvement in research and teaching.
      4. Qualify for a faculty appointment if the medical center is affiliated with a university.
      5. Be aware that the Chief, SCI/D has input into the annual performance evaluation of each SCI Staff and other staff assigned to SCI Service.
      6. Provide frequent contact and outreach to the facilities in the SCI catchment area for educational, consultative, advisory, and broad clinical oversight purposes.
  2. Professional Staff Assigned to SCI Service
    1. All key staff, such as nurse manager, clinical nurse specialist, psychologist, social worker, and therapists must be assigned and dedicated to the SCI Service by the respective supervisors in consultation and with the approval of the Chief, SCI Service. All SCI staff are responsible to the Chief, SCI Service. Rotations and assignments recommended by supervisors outside of the SCI Service line must have the concurrence of the Chief, SCI Service.
    2. In each SCI Center the Veteran is served by a team. The membership of the team is determined by the individual's needs, assessment, planning process, predicted outcomes, medical needs, and rehabilitation needs.
    3. The nurse manager and clinical nurse specialist for SCI must have SCI nursing and rehabilitation experience.
    4. Individual team members provide services consistent with state practice acts, licensure requirements, registration requirements, certification requirements, requirements of their educational degrees, professional training to maintain established competency levels, on-the-job training requirements, and professional standards of practice.
    5. The SCI interdisciplinary team composition must have adequate staffing to efficiently meet Veterans' identified needs and all facets of the SCI Program. The SCI Service needs to establish and document a system for determining the types and number of personnel needed by each discipline based on the needs of the patients and efficient achievement of projected outcomes. Present VHA policy mandates a minimum number of staff for certain aspects of the SCI program. The SCI team includes staff with SCI/D experience, which is not limited to the following minimum requirements for physicians, nurses, psychologists, social workers, and therapists. Additional staff need to be provided based on local factors in order to meet all program elements. The staff minimum requirements include:
      1. Physician Staff. One physician with SCI expertise needs to be assigned to or dedicated to SCI for every ten staffed SCI beds and an additional 0.5 physician to account for management activities as Chief.
      2. Nursing Staff. Minimal inpatient nursing staff need to be calculated based on required staffed beds (1.42 full-time employees (FTE) per required staffed bed). Additional nursing personnel need to be provided consistent with local expert panel recommendations based on patient acuity and other local factors. SCI Nurse Managers are not to be included in calculating direct care hours. When SCI unit occupancy exceeds 85 percent, or patient acuities exceed the national average, nursing staff needs to be increased accordingly. Rehabilitation nurses with SCI experience are necessary for accreditation. The nursing staff mix will approximate 50 percent Registered Nurses.
      3. Health Technician. Use of SCI health technician position descriptions are encouraged for inpatient and outpatient SCI nursing staff to create advancement opportunities for the nursing assistant staff with SCI experience serving inpatients. SCI health technicians provide personal care and technical assistance to Veterans with SCI/D. SCI technicians have defined criteria and specialized training and skills. The SCI Chief must establish training guidelines and continuing education, and shall define the scope of practice for SCI health technicians.
      4. Management of Information and Outcomes (MIO) Coordinator. At each SCI Center there is a MIO Coordinator who:
        1. Promotes the use of valid outcomes and program evaluation measures;
        2. Shares outcomes information for strategic planning and to recognize program accomplishments;
        3. Positively influences the SCI team members regarding the importance of outcomes in program evaluation and improving quality of patient care;
        4. Uses outcomes to develop feedback, monitoring, translational, and Quality Improvement Programs;
        5. Emphasizes consumer and accreditation perspectives regarding outcomes measurement;
        6. Implements effective disability management strategies from outcomes-informed perspectives; and
        7. Coordinates activities with the National MIO Team in the Office of SCI/D Services.
      5. Psychologist. One psychologist needs to be assigned for every twenty acute or sustaining available SCI beds and an appropriate corresponding panel of outpatients.
      6. Social Worker. One social worker needs to be assigned for every twenty acute or sustaining available SCI beds and an appropriate corresponding panel of outpatients.
      7. Vocational Rehabilitation Specialists. Vocational rehabilitation specialists need to be assigned to serve inpatients and outpatients.
      8. Rehabilitation Therapist. One rehabilitation therapist (from a rehabilitation therapy mix of physical therapy (PT), occupational therapy (OT), kinesiotherapists (KT), and certified therapeutic recreation specialists (CTRS) must be available for every five available beds.
        1. Physical therapists with SCI experience serving inpatients and outpatients.
        2. Occupational therapists with SCI experience serving inpatients and outpatients.
        3. Kinesiotherapists with SCI experience (per local practice) serving inpatients and outpatients.
        4. CTRS with SCI experience serving inpatients and outpatients.
      9. Other Team Members. Physician Assistants, Nurse Practitioners, SCI Urology Nurse, Administrative Officers, Secretaries, Clinic Clerks, Program Support Assistants, Telehealth Program Support, SCI HC staff, Vocational Rehabilitation Specialists, Pharmacists, Dietitians, Respiratory Therapists, Outpatient Nurses, Outpatient Health Technicians, and Chaplain staff are also important team members, and need to be hired as part of the dedicated SCI team to ensure that all aspects of the SCI Center program are operable.


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