exemptions, rights, penalties, and obligations provided for male registrants by said Act and regulations thereunder."

NOTE.-At the meetings of the American Nurses' Association board of directors and conference of members of the advisory council of the American Nurses' Association and State executive and elected secretaries held in Washington, D. C., March 7-8, 1945, it was voted to delete reference to a "graduate of a State accredited school of nursing and eligible to apply for examination for registration as a graduate, registered, professional nurse" and to include only graduate, registered, professional nurses.

Subdivision (a) of section 2 of H. R. 2277 should be amended by adding at the end thereof the following language:

"Quotas of nurses to be inducted for service under this Act shall be determined for each State, Territory, and the District of Columbia, and for subdivisions thereof, on the basis of the actual number of nurses in the several States, Territories, and the District of Columbia, and the subdivisions thereof, who are liable for such service but who are not deferred after classification, except that credits shall be given in fixing such quotas for residents of such subdivisions who are in the land and naval forces of the United States on the date fixed for determining such quotas. After such quotas are fixed, credits shall be given in filling such quotas for residents of such subdivisions who subsequently become members of such forces. Until the actual numbers necessary for determining the quotas are known, the quotas may be based on estimates, and subsequent adjustments therein shall be made when such actual numbers are known. All computations under this subsection shall be made in accordance with such rules and regulations as the President may prescribe."

H. R. 2277 should be amended by the deletion of subdivision (b) of section 2 and the last sentence of paragraph (1) of subsection (c) of section 2. These sections provide for the preferential induction of graduates of the United States Cadet Nurse Corps.

. H. R. 2277 should be amended by the deletion of the words "Procurement and Assignment Service" in section 2, subsection (c), paragraph (1) (p. 3, lines 10 and 11), and the substitution therefor of the following language: "Nursing Division of the Procurement and Assignment Service of the War Manpower Commission."

Section 3 of H. R. 2277 should be amended by the addition of the following language:

"Each person accepted by and inducted into the armed forces of the United States under the provisions of this Act shall, if inducted into the Army of the United States, be commissioned in the Army of the United States at a grade not lower than that of second lieutenant, and if inducted into the United States Navy shall be commissioned in the United States Naval Reserve (or appointed to a relative rank in the Navy Nurse Corps) at a grade not lower than that of ensign." Section 4 of H. R. 2277 should be amended by adding at the end of the second sentence thereof the words "other than nurses" and by inserting between the second and third sentences thereof the following clause: "Provided, That in the selection, induction, and commissioning of persons under this Act and in the interpretation and execution of the provisions of this Act there shall be no discrimination against any person on account of race, color, creed, or sex".

Section 4 of H. R. 2277 should be amended by the addition of the following language at the end of said section:

"The President is hereby authorized and directed immediately to provide for the expansion and implementation of the existing program for the voluntary recruitment of graduate, registered, professional nurses into the Army of the United States and the United States Navy. Such program shall be comparable in scope and magnitude to those heretofore employed in the recruitment of members of the Women's Army Corps and of the United States Navy Women's Reserve (Women Accepted for Voluntary Emergency Service); and $ hereby appropriated for the purposes of such program. Pending the completion of such program, the remainder of this Act shall be suspended, unless and until the President shall determine, upon certification by the Secretary of War or the Secretary of the Navy, that the needs of the armed forces cannot be satisfactorily met by such program of voluntary recruitment."

are

70840-45- -7

By no means are all the 221,000 nurses available for actual nursing. Many are too old; many physically unfit. Many are needed in administrative, teaching, operating and supply room, clinic, and similar activities. Of the 42,000 nurses classed as I-A, Basil O'Connor, director of the American Red Cross, stated that a revaluation left a probable 15,000 as eligible for military service.

Therefore, it is our fixed opinion that a mandatory census of nurses is an utterly essential first step in a move involving a major shift in nursing power.

The second essential step is, in our opinion, a consideration of our over-all nursing needs both at home and abroad, with control in both areas. The two fronts are actually inseparable. A soldier's family, as well as the man himself, must be assured of care. An uncontrolled nursing residue at home can readily become concentrated in areas of power with health disaster as a constant threat. Few realize how great are the routine demands on nursing right here at home. In industry for example, our worker population jumped from 38,240,000 in 1940 to 50,570,000 in 1944-this includes agricultural workers. Of these fifty millions, 17,250,000 are women. Many of these workers are over-age, handicapped, and new to shop life. Despite the faithful work of industrial nurses, industrial illness, injuries, and deaths, still reach appalling heights. In the third quarter of 1944 there was a 37 percent increase in absentee illness over the same period rate for a decade before.

In the 2 years following Pearl Harbor there were 37,600 industrial deaths. A marked disturbance of the nurse power in this area without planning and control could be very serious indeed.

This is equally true in other areas. Our very remarkable freedom from devastating epidemics, so often a concomitant of war, can in part, be attributed to the work of our public-health nurses whose ranks are already seriously depleted.

The CHAIRMAN. May I break in there for a minute? This is for the purpose of getting some information. It will help us in other things that we are doing.

Does an industrial nurse in the personnel organization in a big industry card index the employees and keep track of the absentees, whether it is because of sickness, and so on, so we can find out what the cause of an increase in absenteeism is some institutions is?

Miss DEMPSEY. Yes; I think in many of our industries worker health is guarded by preplacement physical examination, by periodic examinations, where workers clear through the medical department on 1 day's absence or more. That varies with the policy of the company, but in many companies there is a complete record of the cause of absenteeism. It might not be true in every industry but it can be found in many.

The CHAIRMAN. Do you know of any studies being made now on increased absenteeism, whether there are clinical studies or not?

Miss DEMISEY. I do not know of any recently. I think about 4 years ago the United States Public Health Service made a study in many industries. I have never seen a report of that. I happen to know, because the company with whom I am connected, was one company having records of absenteeism, the causes for absenteeism. The CHAIRMAN. Have you done that somewhat in your company?

Miss DEMPSEY. We do in our monthly reports and yearly reports, we try to estimate. We have three times as much absenteeism from causes other than occupational reasons.

The CHAIRMAN. What are those causes? Drunkenness, for example?

Miss DEMPSEY. Not too much; no. For instance, there are very few women in industry today whose job in industry is their only job. Most of them have another 6 or 8 hours, if not more, work at home. That causes some illnesses. I think workers are working long hours, they have many strains, and they are getting more money than they have gotten before, and it perhaps does not hurt their pocketbook quite so much to take a day to rest. But I have no figures here on that.

The CHAIRMAN. That would affect many of the bills that are before us.

Miss DEMPSEY. Yes. Our civilian hospitals with almost one and a quarter million beds and an unprecedented bed occupancy, are already operating with skeleton nursing staffs. These and other routine needs of our civilians, are a part of the whole scene that must be brought under control.

Thus we believe that a grasp and control of the entire nursingneeds situation is essential. Civilian health cannot be left to the hazards of chance, especially if 16,000 additional nurses are to join the fifty-odd thousands already drained off.

The third step that we believe to be essential is a national-service act, which, among other things, would provide the adequate and free-flowing pool of supplementary aid nurses must have. We are prone to believe that the nursing load, both civilian and military, has already reached a point beyond the capacity of our present nursing supply. It must be remembered that before the war we had no marked unemployment among nurses. Now, in addition to a marked increase in civilian hospital-bed occupancy, we have over one-half million military patients.

It is true that new nurses are being made, but even with the shortened course, it takes 21⁄2 years to make a nurse. And it is equally true that older nurses are wearing out. Nursing is not a desk job, and the strain of war is heavy. In our opinion, it is an anomaly to draft nurses and to leave the matter of their aides to the volunteer method. Our womanpower has already been heavily drained by industry and the armed forces. We believe that the failure to conscript women now can only be a postponement, and that lives can be saved in realizing this fact.

Mr. Chairman, I wish to thank you for the privilege of presenting this testimony to the Senate Military Affairs Committee. The CHAIRMAN. Thank you for coming before us.

your testimony.

Dr. Donald Smelzer, please.

We appreciate

STATEMENT OF DR. DONALD C. SMELZER, PRESIDENT, AMERICAN HOSPITAL ASSOCIATION

The CHAIRMAN. For the record, Doctor, will you make whatever statement you want to make?

Dr. SMELZER. For the record, my name is Dr. Donald C. Smelzer. I am president of the American Hospital Association, and managing

88

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 From the beginning the association, and women as registered professional nurses. and especially its constitutent State associations, have actively sponsored and promoted proper legislation toward the control of the practice of nursing. Cooperative Since representatives of the Red Cross Nursing Service have testified at these hearings, I shall touch only briefly on the relationship between us. 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 More raised with the help of these voluntary committees a magnificent record. Nursing began to prepare for World War II long before Pearl Harbor. 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 The council's Association of Collegiate Schools of Nursing, the National Association of Colored Graduate Nurses, and of the Federal agencies and related groups. 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 The United States Public Health nurses, graduate nurses, and student nurses. Service sponsored the survey, with financial help from the Red Cross. The A American Nurses' Association, the National League of Nursing Education and the National Organization for Public Health Nursing acted as cosponsors. 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