To: Board of Health
Through: Jennifer Ludwig, Public Health Director, Arapahoe County Public Health
Prepared By:
prepared
Talitha Appel, Immunization Program Nurse Manager, Arapahoe County Public Health
Melissa Spencer, Director of Community Health Nursing, Arapahoe County Public Health
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presenter
Presenter: Jennifer Ludwig, Public Health Director, Arapahoe County Public Health
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Subject:
title
Clinical After-Hours Pay for Exempt Clinical Employees
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Purpose and Request:
recommended action
To increase access to services among our most disparate communities, our funders are requiring us to change our clinic model to have more flexibility outside our normal clinic hours and be mobile, which means we need clinical staff to pick up additional shifts and be appropriately compensated to do so. While non-exempt staff are eligible to receive time and a half for hours worked over 40 hours per week for events outside of normal business hours, exempt staff are not currently compensated for afterhours coverage.
This request is to incentivize through appropriate compensation exempt clinical employees to participate in an approved clinical event outside of normal business hours. Examples of clinical events that take place on the weekends or during evening hours include, but are not limited to:
• Vaccination clinics (e.g.: Shots for Tots & Teens or back-to-school immunization clinics)
• Outbreak events (e.g.: Hepatitis A Immunoglobulin administration at homes or businesses and vaccination administration in jails or long-term care facilities)
• Providing immunization-specific clinical education at schools and childcare center events (e.g.: back-to-school nights, childcare enrollment fairs)
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Background and Discussion:
The COVID-19 pandemic taught us that we must increase access to core public health services to increase equity in the BIPOC population. Additionally, over the past three years of the pandemic Colorado vaccination rates have decreased with the most pronounced decreases observed among kindergartners. The Aurora Public Schools district, which includes 72 schools, many of which are in the heart of Arapahoe County, is one of the least vaccinated districts in the Denver metro area. Currently, it is more important than ever to facilitate fact-based strategies to improve vaccination rates.
To meet the needs of the community, the Colorado Department of Public Health and Environment specifies that some clinical services must be scheduled outside of normal business hours, including evening hours (after 5:00pm) and during weekend hours. This requirement is in addition to the work that public health programs already conduct Monday through Friday at Arapahoe County clinical sites in Englewood and Aurora, as well as in schools, childcare centers, and the jail.
Currently, clinical shifts outside of normal business hours are filled on a volunteer basis making it difficult to strategically determine the number of events outside of normal business hours that can be provided to the community nor staff events sufficiently. Providing clinical after hours pay to exempt providers of clinical services allows the program to strategically budget, clearly communicate with the community on resources available, and sufficiently staff events outside of normal business hours.
Utilizing elements of the Department of Human Services Division of Child and Adult Protection Services After Hours Coverage Policy, Arapahoe County Public Health has created its own policy related to clinical events outside of normal business hours including evenings and weekends. We have made every effort to mirror the Human Services After Hours policy, and have only deviated when necessary to address the unique needs of our services and financial resources.
Clinical After Hours pay is defined as a predetermined amount of compensation for a task and is not intended to correlate in any way with an employee’s hourly rate.
The amounts suggested are:
• Level 1: Limited staffing of response/event (up to 3 hours) $100
• Level 2: Involved staffing of response or event (up to 5 hours) $170
• Level 3: Detailed staffing of response or event (up to 7 hours) $230
• Level 4: Comprehensive staffing of response or event (more than 7 hours) $280
Employees may also have the option to flex their time as allowable to maintain necessary work functions of the agency. Employees may choose either flex time or clinical after-hours pay per shift worked at an after-hours clinical event.
Expanding and modifying clinic hours to include more family-friendly times such as evenings and Saturdays and compensating the highly experienced and knowledgeable clinical staff to work the events provides capacity to work towards increasing access and improving equity in Arapahoe County.
Fiscal Impact: No public health funds will be utilized in FY24 or FY25. This expense will be absorbed into current contracts. ACPH will use this first year to determine how much needs to be budgeted in subsequent years to sustain efforts.
Alternatives:
Alternative A: Requiring clinical staff to work events outside of normal business hours without clinical incentive pay.
• This decision may lead to low employee morale and potential turn-over of highly experienced and knowledgeable clinical staff.
Alternative B: Decline community requests for clinical services after normal business hours. This could result in lower vaccination rates, especially among our most vulnerable populations.
Staff Recommendation: We recommend implementing clinical after-hours pay for exempt clinical employees. A policy will be executed to ensure adherence to the qualifications and requirements for clinical after hours pay for exempt clinical employees.
Motion(s): No formal motion needs to be made.