Miss AUSTIN. I am certain that we have studies. When you mentioned attrition rates, we have had studies over the years of attrition rates. I have seen some where a report of the number of years that the average nurse practices in her profession. I am not very good at hanging on to figures of this sort, and I would hesitate to say; but I think if you take a look around at some of us here you will see there are some who stay forever.

Mr. O'BRIEN. I think I might challenge that statement.

Well, I do not think it is terribly important, because the fact remains, regardless of attrition or no attrition, that there still is a shortage of nurses. Bu I was just curious as to whether there had been a trend in recent years toward longer service in the profession, and I know the difficulty of getting those figures, because I could assume someone might think they had retired from the profession and might return to it 5 years later through some circumstances beyond their control.

Miss AUSTIN. There was a study made in one State, which pointed to some information that gave some indication of the number of years and some of the characteristics of people who tended to remain active in their profession. But this was only in one State, and a number of years ago.

I do not know that this may be included in a study that is going on

now.

Mr. NELSEN. I have no questions.

I wish to thank the lady for the very fine statement.

Mr. O'BRIEN. Thank you very much for your contribution.

The next witness, and I believe the final witness, will be Mrs. Walter Walker, National League for Nursing, Inc., of Minneapolis, Minn. Mr. Nelsen?

Mr. NELSEN. I am happy to welcome Mrs. Walker. She is from the State of 10,000 lakes.

STATEMENT OF MRS. WALTER W. WALKER, MINNEAPOLIS, MINN. Mrs. WALKER. I am pleased to be here, from the great State of Minnesota.

I am Mrs. Walter W. Walker, from Minneapolis, Minn., and I come before the committee as a community citizen, with an active concern for the health and hospital needs of the community, the county, and the State in which I live, and it is therefore my privilege to testify in support of H.R. 10042 to establish the Nurse Training Act of 1964. My interest and concern in behalf of H.R. 10042 stem from the following: It is my privilege to serve as a member or officer of four hos pital boards in the county of Hennepin: The first, a voluntary general hospital of 400 beds, with a school of nursing of 200 students; the second, a general public hospital of 400 beds, with a basic nursing education program; the third, a children's hospital, in the planning stage, to incorporate an active affiliating program of student and graduate nurse education in the field of pediatrics; the fourth, a rehabilitation hospital, which carries an intensive education program in rehabilitation for graduate nurses.

Two further community responsibilities underscore my interest and concern in behalf of H.R. 10042. Presently I serve as president of the University of Minnesota School of Nursing Foundation, a foundation

founded to assist in the support of the needs of the school of nursing at the university and to aid in the identification and interpretation of the needs of the school for program and facilities.

It is the role and responsibility of this foundation to supplement and to seek means of support for the school which extend beyond those that are supported by the State legislative appropriation.

As chairman of the Governor's Citizens' Council on Aging of Minnesota, the health and nursing needs of the large aged population of the State of Minnesota are my continuing concern in the council's planning for the older citizen.

Therefore, in the capacity of an interested, concerned community citizen, I should like to speak in behalf of H.R. 10042, authorizing $350 million in Federal aid to nursing.

The proposed Federal appropriation of $350 million to "increase the opportunities for training professional nursing personnel, and for other purposes" recognizes that in order to meet the needs for nurses and nursing which the Surgeon General's report, "Quality in Nursing, Needs and Goals," identified in 1963, a multiplicity of programs is required to enable the Nation and its communities to meet, not only its present nursing needs, but to make some inroads in the goal of an additional 130,000 nurses by 1970.

The requirement that applicants for grants should have accredited programs in nursing assures that quality in education and service by the participating institutions will be maintained.

If our communities, our schools for nursing, our colleges, our universities, our hospitals, are to meet the needs for nursing service today, caused by our burgeoning population, our increase in hospital beds, chronic care facilities, our community nursing needs, if our communities are expected to plan to provide the estimated 680,000 professional nurses required for practice by 1970, section 801 of H.R. 10042 is a vital factor in enabling our communities to meet these needs.

The University of Minnesota School of Nursing, which is the only school in the State of Minnesota which prepares students for administration and education positions at a graduate level, has an education facility woefully inadequate to meet its present needs.

The school of nursing foundation, to which I previously referred, has submitted a resolution to the board of regents of the university calling attention to the fact that in order to maintain the quality of nursing education, in order to enable the school to increase its enrollment to meet anticipated nursing needs, a new education facility for the school of nursing is a priority in development of a nursing education program.

The diploma schools in the State of Minnesota are presently faced with limited facilities as they endeavor to educate students to meet these nursing needs of the hospitals. Most of the communities in our State which have nursing education programs, diploma, associate degree, or collegiate, do not have the financial resources available within the community to finance new construction for nursing education.

To illustrate that this is a critical need, in the past 5 years the United Hospital Fund of Hennepin County and 13 participating voluntary general hospitals raised, in the community, $34 million to meet the patient-bed needs of the county.

Following the completion of the hospitals' building programs, which were prescribed by a carefully executed and studied community

plan for hospital needs, several hospitals were unable to open floors or stations because nursing personnel could not be secured to staff these stations.

Those hospitals which have been built with the assistance of HillBurton funds throughout the State of Minnesota have faced similar problems in staffing with professional nurses.

And I do not need to inform you as to what this does to the quality of nursing service.

Therefore, that section of H.R. 10042 which provides grants for construction of educational facilities will assist in the provision of additional nurses to meet the local community needs for nursing service.

Section 806 of the bill 10042, which authorized grants for the improvement in nurse training and services, may very well be the section of the bill which can make the most vital community impact.

Already, the scientific advances in health care, increased impact of chronic illness and aging on health services, changes in concepts of patient care, have indicated an urgency for the development and examination of alternative methods for the utilization of nursing personnel.

New insights into strengthening, improving, as well as expanding programs of nurse training are vital to the provision of nurses and nursing services to meet modern health needs.

The University of Minnesota School of Nursing, for example, has already identified as a priority a patient floor devoted to clinical nursing research for the purpose of developing new insights into basic patient needs for nursing care as an integral part of the new trend in hospital service.

Appropriations for planning for the improvement of nursing will be a vital factor in the development of appropriate and sound future nursing education programs.

Today the recruitment for nursing education programs at each level of qualified educators to teach the basics of nursing education in the various fields of nursing, the recruitment of administrative nursing personnel, poses a problem and is a deep concern for each institution which either provides a nursing education program or provides nursing service to its community.

Section 821, which provides traineeship for advanced training of professional nurses, can and will serve as a means to encourage graduates of basic nursing programs to continue their education. Opportunities for financial support for advanced education programs are presently markedly limited.

The creation under section 822 of a scholarship program for students in basic baccalaureate nursing programs can and will serve as a stimulant of nationwide qualified secondary school graduates to attend collegiate schools of nursing.

The University of Minnesota School of Nursing Foundation is constantly impressed by the fact that so many of the students in the baccalaureate degree program require financial assistance to complete their education.

The scholarships that are presently available at the school are usually granted on a tuition only basis, and many of the students must deplete their energies and efforts which should be directed

toward their education in nursing through having to secure employment in order to finance their education.

The fact that neither the State of Minnesota nursing scholarship fund, nor other scholarship funds which are available through schools of nursing and foundation and other grants can adequately serve the demands made upon them is concrete testimony for the need for such a scholarship program.

Student aid funds which are available through many of the hospital schools of nursing, as well as the collegiate program, also are heavily drained by students' requests.

For the reasons listed above, because we are seeing new trends and needs in nursing education and nursing service, because of the impact of scientific advances, increasing life span, the increased incidence of chronic illness, the need for community-based nursing services, for these reasons, and for the fact that in the main all of our communities recognize and support the need for increased nurses and nursing education, while at the same time the traditional means for supporting these services have long since been stretched beyond their capacities to meet the financial demands for such, for these reasons I am testifying in support of H.R. 10042, and wish to thank the committee for having had the privilege to testify before it.

I shall be very happy to answer any questions which you may have. Mr. ROBERTS (presiding). I am sorry I was not privileged to hear all of your statement. I have been trying to read it hurriedly.

I will recognize Mr. O'Brien first for any questions he may have. Mr. O'BRIEN. I do not have very many.

I would like to congratulate Mrs. Walker not only for the statement, but for the evidence of the broadness of her interest in the public welfare, particularly in the field of health, and also to point out that she does come from a State which has a very wonderful record in the field of health.

But from time to time-and this is a rather broad philosophical question-those of us in here who hear these arguments for national programs, and are convinced of the need for them and the desirability of them, go to the floor of the House and are confronted with this question: Well, anything the Federal Government spends comes from the States in the first instance. The Federal Treasury has a deficit, and why isn't this done by the States individually?

I think I know the answer, but I would be curious as to the reply that someone with the broadness of your interest in this field might make to a colleague who would rise up and object to the Federal Government doing what the States should do.

Perhaps I can help you a little bit in your answer.

Is it not a fact that what the Federal Government does in a field like this is not the total answer, but accelerates private donations and State activities? Would that be an answer?

Mrs. WALKER. I think that would be one answer, Mr. O'Brien, and I thank you for what you have just said.

I think I indicated a little earlier that the private opportunities for financing and funding for these have already been pretty much stretched to the limit. Demands on foundations, for example, that are received for various areas, health and welfare and others, are so broad and are so pressing, and the funds from these sources are relatively so

limited, that we have received, in our State, at least, almost as many public or foundation funds and grants as could be made available from these to assist the schools and to assist the nursing students themselves. From the State of Minnesota's financial situation, it, too, was very hard pressed, as a State, in terms of its potential for extending the funds recevied from taxation, and the State has been very generous in Minnesota in that it does happen to be one of the States that does have a student nurse scholarship fund.

It also does support to a major degree, in fact it does support, the University of Minnesota School of Nursing. But this is a part of a very large university, and the funds available for all the schools are very limited.

So that the sources of moneys, including from those moneys that are provided to the schools of nursing by the receipts from patient care, are becoming increasingly limited. They are becoming increasingly called on, not only by nursing, but by other professions and other health areas, and with the increased demand for nursing today, and the increased need for nursing service of a more intensive type and of a different type, perhaps, from some of those that we have seen in the past, no longer can these other resources really meet that need, and particularly that resource of the patient income to the hospital. Mr. O'BRIEN. I have one other.

This is perhaps a little tougher.

Please do not misunderstand. I am looking for answers to questions that might be thrown at me.

Let's take the State of New York. I do not know what share of the national tax bill it pays, but I have heard 20 percent, so let's take that. Twenty percent of $350 million would be $70 million.

A great many people from New York strongly support this. The Commission is appointed by the Governor, as quoted in the record. But what would I say to someone who would say: "Well, why doesn't New York, the Legislature of New York, appropriate $70 million over this same period of time, and take care of its own needs?" Mrs. WALKER. I think that is a very good question, Mr. O'Brien. Mr. O'BRIEN. I am looking for an answer. I know the question. Mrs. WALKER. I would like to answer it in this way.

Let's take what happens to the nursing population of New York. Let's take what happens to the nursing population of Minnesota. I think that when we are talking about patient care and nursing service, we cannot draw State lines by any manner of means, because the nursing population, educated, say, in the State of New York, is going to be found in every State in the United States. Therefore the results of the cost of that education and the service resulting from that education have been distributed throughout every State in the United States.

And this is equally true of Minnesota. In fact, I understand, and there are others here who could really answer this better than I, that there is no State in the United States which does not have a substantial number of graduates of the schools of nursing of the State of Minnesota.

By the same token the State of Minnesota has benefited from students and nurses who have graduated from programs in New York, from programs in Washington, and from programs in Massachusetts.