TABLE 2.-Estimated average cost per student to the institution in 1957–58 of a typical master's degree program in nursing as revealed by the study in 5 sample schools

TABLE 3.-Average tuition income per student in 1957-58 for a typical master's degree program as revealed by the study in 5 sample schools

A striking similarity among the nonweighted averages and medians in both tables 2 and 4 is immediately apparent. Conference officers and the other institute advisers are agreed that $2,500 is a reasonable estimate of the average cost in the United States per full-time master's degree student of nursing in 1957-58.

Reading overall meanings into the tuition figures is difficult. Theoretically, the statistically sound procedure would be to conclude that, since the nonweighted average and median from the five-school study was used to establish average cost, the nonweighted average and median of the tuitions in the five schools should be used, also. That would mean a rounded average tuition of $900 which is 36 percent of a $2,500 cost.

Yet a compilation of the tuition figure gleaned from the questionnaire returned by the 17 nonstudy schools is arresting. This is shown in table 5.

It is immediately evident that while tuitions varied widely in the sample group, the range is broader among the 17 nonstudy schools. The basic reason is that 7 of the 17 schools returning the questionnaire are tax-supported as compared with 1 in 5 of the sample studied. The proportion of institutional cost that is covered by tuition income in all 22 programs ranges for 3 percent in a tax-supported university to 63 percent in a privately supported institution. Obviously, such widely ranging figures do not yield a statistically indisputable average. Yet the 36-percent coverage by tuition of institutional costs indicated by the sample five-school study seems fair in light of percentages reached by other computational methods. Thus, total tuition income in the five sample schools is 45 percent of total costs. But total tuitions in the 17 programs providing data through questionnaires cover only 32 percent of the total costs these institutions estimated. On the other hand, add the total tuition income in both sample and nonsample programs and it proves to be 39 percent of the total costs in the two programs.

TABLE 4.-Summary of data from 17 schools not included in study sample indicating estimated average cost per student to the institution in 1957-58 of a typical master's degree program in nursing

TABLE 5.-Summary of data from 17 schools not included in study, sample to show average tuition income per student per year in 1957-58 for a typical master's degree program in nursing

It would seem that "however you slice it" tuition meets well under half and little more than a third of the cost to the institution of graduate education for nursing.

Officers of the Conference of Nurse Administrators of Accredited Graduate Education Programs in Nursing and other institute advisers are satisfied that $2,500 is a reasonable average for the cost to the enrolling institution of a master's degree in nursing, and that-again as a national average-some $900 of the amount is met by tuition income.

Tuitions rose nearly 14 percent between 1957 and 1958 (the program year studied) and 1959 and 1960 in most of the 20 programs providing the information. Only 1 of these 20 programs reduced the tuition figure; 5 held the line; 14 increased, more or less, their tuition charges. It is a safe guess that costs have risen

at least a similar 14 percent in the past 2 years, and the study averages remain, therefore, a reasonable guide to the national bill for graduate nursing education.

A little brisk arithmetic will indicate to the statistically minded that in 1957-58, when the equivalent of 1,561 nurses were studying full time for master's degrees, the national institutional bill was $3,902,500. The figure rose to $4,510,000 in 1958-59 when equivalent full-time enrollment increased to 1,804.

However, these enrollments are only a fraction of what they should be if yawning vacancies in the teaching staffs of all types of nursing schools are to be filled, and hospital and health agency demands for well-prepared administrators and supervisors are to be met. Taking account of annual attrition, the Public Health Service has estimated the number of masters and doctoral graduations that should be sought each year if enough nurse leaders are produced during the coming decade to meet the mounting needs of a growing population and fill the places of nurses leaving the profession."

Enrollment must, of course, be well ahead of graduations, yet the graduations needed in 1965 are estimated at nearly 5,000, indicating that the institutional cost for that number will have risen to over $12 million for the 1 year alone. By 1969, graduations should rise to more than 6,000, with a relative jump in the annual institutional bill of over $15 million, taking no account of rising costs.

Substracting 36 percent (the tuition income) from each of these figures leaves $7,680,000 in 1965 and $9,600,000 in 1969, as the bills that the institutions will need a great deal of public help in meeting.

Such figures take no account of the funds that must be found for nursing research if procedures and curriculums are to keep in step with the march of medical science, or of the probability that graduate nursing education in 1957-58-pioneering, evolutionary, feeling its way as it has been-was totally inadequate. For one example, a study recently completed by the U.S. Office of Education shows nursing to be near the bottom rung of the university faculty salary ladder. Can it remain there if nursing services are to meet the growing demands that changing methods of health care and an "exploding" population are making on them?

On the other hand, many factors besides costs will make it hard to build the graduate enrollments to the desired levels. Not the least of these is the difficulty that short-staffed hospitals experience in releasing the professional nurses in their employ for further study, in spite of an avowed need for a higher proportion with more preparation than they now have. How great this need is was indicated by returns from a questionnaire cosponsored by the American Hospital Association and the Division of Nurses Resources, Public Health Service." Hospitals were asked the number of nursing personnel in different types of positions by actual level of preparation and also the level desired by the hospital. In nearly all categories the hospitals desired better preparation than their personnel, in fact, had. For example, while only 32 percent of the hospitals with schools of nursing had a director of nursing service with a master's or higher degree. 76 percent desired such preparation.

WHAT'S TO BE DONE?

Instead of trying to fix exactly the financial needs of graduate nursing education for the future, it would seem to be more fruitful to seek immediate modest dependable aid for our already overtaxed masters programs, and more public understanding that some nurses must have advanced preparation.

More people-nurses themselves and professional associates of nurses as well as the general public-need to realize that medical advances and larger hospitals and health services make different kinds of nurses necessary and require many nurses to be highly trained administrators, supervisors, teachers, nursing specialists, and researchers if any nursing is to be efficient or even safe. Good supervision is essential to best use of the nursing services available today. Without more good teachers, neither the quality nor the greater quantity of nursing can be assured.

7 Adams, op. cit.

8 Bokelman, W. R.

1959.

Faculty salaries, 1958-59. Higher Education, 15: 85-88, January Adams, Apollonia O., "Professional Nurse Traineeships, Pt. II: Facts About the Nurse Supply and Educational Needs of Nurses." (U.S. Public Health Service Publication No. 676), Washington, D.C., U.S. Government Printing Office, 1959, pp. 28-32.

With understanding cooperation and more budget leeway to release faculty for research efforts, the graduate programs can shape more definitely their future goals, financial and otherwise.

Even a $15 million bill for graduate nursing education looks small in comparison to an annual cost of higher education in the United States estimated by the Council for Financial Aid to Education at $9 billion by 1969-70.10 It seems probable that at no point in American life can so small a share of the Nation's philanthropic dollar be expected to bring so large a return in human well-being as it can in preparing leaders for our numerically largest specialty group in the administration of progressively improved patient care.

Mr. ROBERTS. This will conclude today's hearings. The committee will be in recess until 10 o'clock tomorrow morning at the main committee room, 1334, on this same floor.

(Thereupon, at 3:55 p.m., the subcommittee was recessed, to reconvene at 10 a.m., Tuesday, June 7, 1960.)

10 Council for Financial Aid to Education, "Where's the Money Coming From?" New York, the Council, 1959.