The American Nurses' Association has been vitally concerned with nursing care for our armed forces since it was organized. An infant organization, 2 years old when the War with Spain was declared, one of its first acts at its first convention was to offer the services of its delegates, in a body, to the Government for nursing service in the Army.

In spite of the valiant effort of the trained nurses who rose to meet the emergency, the nursing care was not what it could have been with proper organization. As a result, in December 1898 the association helped to formulate a bill on Army nursing. This bill failed to pass, but public opinion had been aroused, and when, a year later, the bill to create the Army Nurse Corps was passed, the corps had already been organized and functioning for several months with a nurse superintendent. The association has continuously supported legislation to improve the status and effectiveness of nurses in military service the final result being the commissioning of Army and Navy nurses in February and June of 1944, respectively.

To protect the public, nursing practice in this country is controlled by State nurse practice acts which establish recognized minimum standards of professional education and performance and provide for the licensing of properly qualified men and women as registered professional nurses. From the beginning the association, and especially its constitutent State associations, have actively sponsored and promoted proper legislation toward the control of the practice of nursing.

Since representatives of the Red Cross Nursing Service have testified at these hearings, I shall touch only briefly on the relationship between us. Cooperative relationship between the Red Cross and the American Nurses' Association goes back at least to 1904. In 1909 the American Red Cross asked the American Nurses' Association to assist it in developing a nursing service to provide a reserve for military and disaster nursing that would meet the standards of both societies. Shortly thereafter, a national director of Red Cross nursing service was appointed, and a plan for State and local committees on Red Cross nursing service to receive applications of nurses for enrollment in the service and forward them to the central office in Washington, with the necessary credentials, was put into effect. In World War I, the entire quota of nurses (21,480) needed for military service was raised with the help of these voluntary committees a magnificent record. Nursing began to prepare for World War II long before Pearl Harbor. More than 2 years before that date the American Journal of Nursing, the official publication of the American Nurses' Association, began to call upon nurses to increase the reserve in the Red Cross nursing service.

In July 1940 the American Nurses' Association called together a representative group of nurses to consider the place of nursing in national defense. The ultimate outcome was the National Nursing Council for War Service, made up of representatives of the American Nurses' Association, the National League of Nursing Education, the National Organization for Public Health Nursing, the Association of Collegiate Schools of Nursing, the National Association of Colored Graduate Nurses, and of the Federal agencies and related groups. The council's purpose is to coordinate the wartime activities of all these organizations.

The council's first act was to sponsor a national inventory of nurses, in 1941, to determine where the nurses were, how many new student nurses must be enrolled, and how military quotas should be assigned to the States. United States census figures are of little value here since they do not differentiate between registered nurses, graduate nurses, and student nurses. The United States Public Health Service sponsored the survey, with financial help from the Red Cross. The American Nurses' Association, the National League of Nursing Education and the National Organization for Public Health Nursing acted as cosponsors. A second national survey of registered nurses was made in 1943 by the United States Public Health Service. These surveys provided data by States on the numbers of nurses in this country active and inactive, married and unmarried, meeting military requirements as to age, and the numbers of each in the major fields of nursing.

The recruitment of student nurses has been a major activity of the National Nursing Council for War Service and the State nursing councils since before Pearl Harbor. After the Bolton bill was passed in June 1943, creating the United States Cadet Nurse Corps, the National Nursing Council for War Service continued a large part of its student recruitment activity under special contract with the United States Public Health Service, which administers the corps.

These student nurses have given a large part of the nursing care to patents in civilian hospitals in place of the graduate nurses who have gone into the military. As senior cadets they are increasingly becoming available to the Federal hospitals. As graduate nurses they will be available for military and essential civilian nurs

ing service. Relatively few cadet nurses had graduated up to January 1945, since the corps is less than 2 years old, but beginning with this year, they will make an important addition to the nurse census.

Early in 1942, the National Nursing Council for War Service established a national committee on supply and distribution of nurses to work with State committees in providing nurses for military service and safeguarding nursing care of civilians. The council was financially unable to carry on this tremendous task and, at its request, the project was placed in the Procurement and Assignment Service of the War Manpower Commission, an appropriate mechanism was established, and a nurse director appointed. The former State and local committees on supply and distribution then became State and local committees on procurement and assignment.

Procedures for classifying nurses according to their availability for military services or essentiality in civilian service were formulated, as were procedures for notifying the Red Cross nurse recruitment committees when nurses were classified as available.

By January 1, 1945, approximately 235,000 nurses had been classified as to their availability for the military and essentiality in civilian services. Practically all of this work was accomplished by nurses, the majority of whom were on full-time duty in their own profession, and who volunteered to give the extra time for this important effort. Federal funds provided for only some 65 clerical workers throughout the entire country.

Plans were formulated for a national registration by the Procurement and Assignment Service, to be held in February 1944. Scarcely had the proposed registration been publicized when on January 8, 1944, the War Department notified the Procurement and Assignment Service that "appointments to the Army Nurse Corps will be curtailed after 3,500 nurses needed early in 1944 have been procured. Thereafter, replacements only will be needed." Accordingly the proposed registration of nurses was dropped as was the Office of War Information's over-all public information plan. To the consternation of everyone, in May 1944, the War Department advised the Procurement and Assignment Service that the total ceiling for the Army Nurse Corps had again been raised from 40,000 to 50,000.

The confusion of nurses over this rapid change in directives can be readily understood, but procurement and assignment committees kept on working. The Nursing Information Bureau of the American Nurses' Association with the National Nursing Council for War Service circulated thousands of leaflets telling nurses the story of procurement and assignment.

The American Nurses' Association, with the National League of Nursing Education and the State boards of nurse examiners, works continuously to make the maximum number of registered nurses available for military service as rapidly as possible. For example, one State is now holding examinations as often as once a month.

A clearing bureau of State boards of nurse examiners has been functioning at American Nurses' Association headquarters since August 1943. As a result of conferences arranged by the American Nurses' Association and National League of Nursing Education for State boards of nurse examiners, licensing examinations have been speeded up and simplified. Broader interpretations and amendments of nurse practice acts and modifications of board rules have hastened the process of licensing professional nurses.

In addition, the clearing bureau and the State boards are simplifying licensing by reciprocity. This is of great importance in providing nursing care for civilians as our population has shifted to centers for defense industry, and as specially qualified nurses have been needed in hospitals and schools of nursing in States other than those in which they were originally licensed. Also, this has helped to provide nurses to replace those who enter military service.

The American Nurses' Association has persistently and continuously kept the needs of the armed forces for nursing service before the nursing profession by means of its monthly magazine, the American Journal of Nursing, which has a circulation of 78,000, and a monthly bulletin Professional Nursing, going to 30,000 busy medical, hospital, and nursing executives. It has provided innumerable leaflets and other materials for distribution by the local Procurement and Assignment Service committees. The association has also used its publications as media for coordinating information on nursing procured form the Federal and voluntary agencies.

As a result of the efforts which I have described, in the period between Pearl Harbor and through 1944, 81,145 registered professional nurses voluntarily and

without recourse to any draft were certified to the Army and Navy Nurse Corps by the Red Cross. A total of 53,267 assignments were reported to the Red Cross by the Army and the Navy in this same period. Over 10,000 have been separated from the services, chiefly for physical reasons and marriage. There are at present approximately 42,000 nurses serving the Army and approximately 9,000 the Navy.

Voluntary recruitment during 1944 was seriously hampered by the fact that between November 1943 and May 1944, the quotas called for were first raised, then sharply lowered, then raised again as described earlier, and raised again, I might add, since these hearings were opened. Such recruitment has further been hampered by the fact that civilian hospitals now have greatly increased numbers of patients, and that there are many more student nurses to be prepared than at any time in history.

A test survey in 1944 of hospitals in all geographic areas of this country indicated that the hospitals replying had an increase in average patient census in 1944 over 1940 of 29.6 percent.

Industrial casualties from Pearl Harbor to January 1, 1944, amounted to 37,600 American workers killed on the job, 7,500 more than the miltiary dead for the same period. More than 200,000 workers were permanently disabled and 4,500,000 were temporarily disabled.

Sixty-five thousand student nurses were admitted to schools of nursing in this country in the year ending June 30, 1944; 60,000 student nurses is the goal for the year ending June 30, 1945. These young women are our future graduate nurses. It will not be possible to prepare them as nurses if the supply of nurseteachers, supervisors, and administrators is further reduced. Indeed, in addition, we must be continuously preparing nurse-teachers, supervisors, and administrators.

I have tried to show you the deep concern of the American Nurses' Association and organized nursing that safe and adequate nursing care be provided our soldiers and sailors. I have tried also to show the feeling of responsibility which the American Nurses' Association and organized nursing has toward our civilian population.

It is the belief of the American Nurses' Association that the problem now presented may be dealt with by some Federal agency, adequately implemented with funds, personnel and authority, and a federally financed recruitment program promptly instituted-this program to be at least comparable in scope to those employed in the recruitment of WAC's and WAVES. The War Manpower Commission has in the past, together with the Red Cross Nursing Service, provided an effective mechanism for the selection of nurses for the armed forces on a voluntary basis and for the stabilization of civilian nursing services and we think it can do so in the future if properly strengthened.

If the committee does not agree that the plan I have just outlined can be put into immediate effect, then the only other suggested method of attacking the problem is through the medium of a draft. The association would accept a draft of nurses as a first step, but only as a first step, in a Selective Service Act for all women. This should be supplemented by a General Service Act in order that our drastically reduced civilian nursing service may be augmented by help from other groups of women.

Actually, we are faced with a fourfold problem:

1. The needs of the military.

2. The needs of veterans.

3. The needs of civilians; and

4. The need for educational and training programs, which are of two types: (a) Basic to maintain a continuous supply of new graduate nurses, and (b) Advanced to secure teachers, supervisors and administrators.

These phases of the problem are not separate, but are interrelated and interdependent. They do not affect nurses alone, but are vital to physicians, hospitals, industry, public health agencies, and indeed to the entire American people. We believe, therefore, that to be acceptable, legislation must treat the problem comprehensively. The two legislative measures now under consideration by the committee, standing alone, are designed to care for only one part of the problem, and are therefore incomplete.

Draft legislation should, as a minimum, provide for

1. Commissioning of nurses.

2. Proper safeguards for nursing standards, including the restriction of induction to graduate registered professional nurses and to graduates of State accredited schools of nursing who are eligible for State examinations.

3. Prohibition against discrimination with respect to race, color, creed or sex. 4. Administration either wholly or in part through some Federal agency, such as the Procurement and Assignment Service of the War Manpower Commission, with proper provision for essential civilian requirements and the educational necessities of the profession, including deferments for teachers, supervisors, certain classes of graduate students and those in essential key positions.

5. Proper credit to the States for voluntary recruitments.

6. Power to grant deferments based on family relationship, with permission granted for voluntary enlistment.

7. A commissioned nurse corps for the Veterans' Administration, with the same provisions applicable to this corps as are applied to the military. 8. Limited service for all women.

AMERICAN NURSES' ASSOCIATION

REGISTERED MEN NURSES

According to 1940 United States Population Census, there are 8,169 men nurses (graduates and students) in the United States. On the basis of figures reported in a study of registered men nurses in the United States, conducted by the American Nurses' Association as of January 1943, the number of registered men nurses serving in the armed forces was between 2,000 and 2,500.

The registered men nurses at present in the armed forces are not being used advantageously as they are not given an opportunity to assume duties and responsibilities consonant with their professional training as nurses.

Under the regulations of the Army and the Navy, the Army Nurse Corps and the Navy Nurse Corps are confined to registered women nurses so that a registered man nurse on induction into the armed forces has no official status as a registered nurse. He is lost among the total personnel of the armed forces and frequently is assigned to duties that have no relation to the practice of nursing.

Instances can be cited of registered men nurses receiving elementary medical training when they were already thoroughly grounded in such training through their preparation for nursing.

Furthermore, when a registered man nurse is commissioned as an officer, it usually is in a field outside that of nursing.

If recognition were given to the registered man nurse and if he were commissioned as an officer in the field of nursing, he would be of great value and use in. the armed forces.

At present with the great need for registered nurses in the armed forces, it would seem imperative to make the fullest and most advantageous use of the 2,000 or more registered men nurses in the armed forces in the field for which they are trained, that is, nursing.

Registered men nurses would be of particular value in caring for men patients in certain fields of nursing, such as psychiatry. They also could be used in teaching and supervising enlisted men assigned to the care of the injured and sick service

men.

Following are statements of two authorities regarding the need for utilizing the services of men nurses in caring for men patients:

"Dr. Thomas Parran, Surgeon General, United States Public Health Service: We recognize the need for men nurses in psychiatric institutions and for genitourinary nursing for male patients.' 1

"Dr. Edward A. Strecker, former president of the American Psychiatric Association: 'Nowhere is the need for well-trained men nurses more pressing than in dealing with psychiatric war casualties in veterans' hospitals. Serious as the situation is now it will undoubtedly grow to greater proportions than anyone is yet ready to handle. Only if a large number of men nurses become available for work with psychiatic patients can we hope for maximum results in restoring many of our veterans to normal living'." la

During the post-war period many problems relating to care of war veterans will arise. Men nurses who have had an opportunity to develop as leaders and teachers during the period of the war will be of great service in helping to meet these problems.

The leaders and teachers among registered men nurses for the post-war period will have to come from the present number of registered men nurses and not from

I Bulletin, National Nursing Council for War Service, Inc., October 19, 1944. la Bulletin, National Nursing Council for War Service, Inc., October 18, 1944.

those at present preparing to be nurses as there has been a great decrease in the number of men students in schools of nursing.

In 1939 a total of 78 schools of nursing, which admitted men students, reported 725 men students.2 In 1944, 69 of the 78 schools reported only 169 men students. The other 9 of the 78 schools reported having no men students. The 169 students reported for 1944 represents a decrease of 77 percent from the number of men students in 1939. Furthermore, these 69 schools reported they expected to admit only 12 men students in the spring of 1944.

This large decrease in the number of men students and the further loss of the male teaching personnel has seriously affected the nursing service of hospitals having schools of nursing which admit men students.

It would now require at least 2 years, if sufficient suitable men applicants were available for the schools of nursing, to bring the enrollment of students and nursing service back to a satisfactory level.

EXHIBIT B

AMERICAN NURSES' ASSOCIATION

Attached hereto are amendments to H. R. 2277, which amendments have been prepared under the sponsorship of the American Nurses' Association. These amendments are not intended to indicate that the association approves or supports H. R. 2277 but are designed solely to remove certain specific objections to the bill as it now stands.

The attitude of the association is comprehensively set forth in the statement by Miss Katharine J. Densford, registered nurse, president of the association, before the House Committee on Military Affairs on February 9, 1945.

ment remains the official policy of the association.

That state

Section 1 of H. R. 2277 should be amended to read as follows: "(a) The Congress hereby declares that it is imperative, for the successful prosecution of the war, to increase the personnel of the armed forces of the United States by the selection and induction of women for limited service.

"(b) The Congress further declares that it is imperative, for the successful prosecution of the war, to provide for the compulsory service of men and women in civilian industry, agriculture, and other occupations which are necessary to the prosecution of the war or constitute essential civilian activities.

"(c) The Congress further declares that, as a first step in the selection and induction of women into the armed forces of the United States and in order to provide adequate nursing care for such armed forces, it is necessary to increase the personnel of such armed forces by the selection and induction of trained and qualified graduate and professional nurses."

Section 2 (a) of H. R. 2277 should be amended to read as follows:

"SEC. 2 (a). Every female residing in the United States who, on the day or days fixed for the first or any subsequent registration under this Act, has reached the twentieth anniversary of her birth but has not reached the forty-fifth anniversary of her birth and (1) who has been, or on such day or days is, a graduate registered, professional nurse in any State, Territory or possession of the United States or in the District of Columbia, or (2) who on such day or days is (a) a graduate of a State-accredited school of nursing and (b) eligible to apply for examination for registration as a graduate registered, professional nurse in the jurisdiction in which such school is situated or in which she resides, is hereby made subject to registration and selection for and induction into the land and naval forces of the United States under the Selective Training and Service Act of 1940, as amended. As used in this Act, the term 'graduate registered, professional nurse' shall be deemed to include the following designations which are in official usage and are protected by law in the various States, Territories, possessions, and the District of Columbia: Registered nurse, graduate nurse, trained nurse, certified nurse, licensed nurse, professional nurse; except as provided in this Act, and except as may be provided in regulations issued pursuant to this Act, such registration, selection, and induction (including the classification and deferment of such females) shall proceed in accordance with the same procedures and be subject to the same

2 Report of National League of Nursing Education, November 1943. * Report of National League of Nursing Education, February 1944.