Bonner County weighs hybrid contract and new hiring plan after jail nursing shortages

The Bonner County jail’s leadership told commissioners that chronic gaps in nursing coverage are driving expensive ambulance transports and straining deputies, and asked the board to authorize a personnel-and-budget package to recruit nurses and preserve medical oversight.

Jail administrator (speaker 1) told the board the facility relies on a county-contracted medical director, Dr. Guymon, for orders but that nurses on site are essential to assess inmates. "If that professional is not there…65, 70% of the time we don't have a medical professional there, it's a trip to the ambulance," the jail administrator said, arguing that the lack of on-site nurses increases medical and transport costs.

Commissioners and staff discussed two broad approaches: recruiting additional county nurses (keeping one RN full time to supervise LPNs) or contracting with a private vendor. Staff described an Aspen proposal that would place an on-site nurse five hours a day, five days a week and support the facility with a HIPAA-compliant tablet for virtual physician calls afterward. Staff said Aspen charges a contract fee plus a per-inmate daily rate and that referenced clients reported fewer hospital visits under Aspen’s model.

Why it matters: Commissioners noted the county faces both short-term operational risk (daily coverage gaps) and longer-term recruitment challenges. Multiple speakers emphasized a statewide shortage of physicians willing to serve as jail medical directors and a labor market that pays higher rates outside correctional settings, making recruitment difficult without restructured pay or alternative hiring models.

Board direction and next steps: Commissioners asked jail leadership to work with HR to draft a hiring package that includes (a) job descriptions and recommended salaries for a full-time RN and for part-time LPN/LPN-equivalent positions, (b) an apples-to-apples budget comparison that combines current nursing payroll with the medical director contract, and (c) a contingency plan (for example, an Aspen-style vendor contract) in case the county cannot retain a medical director. The board also asked for worst-case and expected-cost scenarios so hiring can proceed within an approved envelope.

Key details from the discussion: staff said Aspen’s proposal would provide an on-site nurse during an initial five-hour window and virtual coverage thereafter; staff cited a contract fee and an $8 per-inmate daily charge as components of the vendor’s pricing, and described a referenced reduction in hospital visits from other jurisdictions that use the vendor. The jail administrator described a recruit-and-retain option that would convert two full-time slots into multiple part-time positions (with higher hourly pay and no benefits) while keeping one RN full time to provide oversight and training.

Unresolved items: Commissioners requested a clear comparison of total nursing and medical-director costs (current budgeted amount versus vendor pricing), a recommended pay scale that could attract part-time retirees or traveling nurses, and clarity from HR on benefit thresholds (discussed as a 20-hours-per-week threshold affecting PERSI/benefit status). No formal vote was recorded; the board’s direction was to return with a written package for approval.

"We are scrambling day after day," the jail administrator said, urging the board to allow staff to test hiring options and report back. The board confirmed the direction and adjourned the meeting at 03:40.