PART B. ASSISTANCE TO NURSING STUDENTS Part B of the new title VIII would provide assistance to students in the several kinds of educational programs preparing nurses. Traineeships for advanced training of professional nurses The draft bill would provide for extension and improvement of the present traineeship program for professional nurses seeking preparation in teaching, supervision, and administration. The report of the Surgeon General's Consultant Group on Nursing and the Professional Nurse Traineeship Evaluation Conference both recommended that enrollment in advanced programs in nursing be tripled by 1970. More vigorous effort is indicated along the lines which have already been found successful. The bill authorizes the appropriation for fiscal year 1965 and for each of the 4 succeeding years of sums necessary for meeting the costs of these traineeships. Undergraduate scholarships The purpose of this provision is to stimulate nationwide interest among a greater number of highly qualified secondary school graduates in attending collegiate schools of nursing. It will also attract public attention to the urgency of this need. The draft bill proposes to do this by establishing nationwide competitive scholarships. These scholarships would be allocated among the States in proportion to the number of high school graduates. The draft bill provides for 1,000 scholarships (increased to the extent needed to provide a minimum allocation of 5 per State and to avoid State allocations of fractional scholarships) to be made available each year for entering students, and that students continue to receive scholarships until the completion of their educational program. It provides that the amount of an individual scholarship shall be based on need for financial assistance, with a maximum of $1,000 a year. The cost of this provision is estimated at $750,000 the first year, rising to $3 million in the fourth year. Loan funds To remove the financial barrier to entering schools of nursing, this part of the draft bill includes a loan program patterned after that contained in Public Law 88-129. Loan funds would be established in schools of nursing wishing to participate in the program under agreement with the Secretary of Health, Education, and Welfare. The school would be required to provide $1 for every $9 of Federal contribution to the loan funds. Loans would carry no interest while the student continues in nursing education and for 1 year after the completion of that education. A 10-year repayment period would be established. Interest would be 3 percent per annum or the going Federal rate, whichever rate is higher, computed only for the period during which the loan was repayable. Ten percent of the amount of the loan would be canceled for each complete year (up to a maximum of 6 years) of full-time employment as a professional nurse in any public or nonprofit private institution or agency. The 60-percent forgivable loan is proposed because salaries for nurses are notably low, and because nurses come largely from low-income families. The profession is composed predominantly of women, many of whom expect early marriage and would not readily assume a debt which might impede such a marriage. Since a high proportion of nurses, however, continue to work after marriage, the forgiveness feature would help to keep them in nursing. The draft bill would authorize $3.1 million for Federal contributions to student loan funds during the first year of operation of the program, increasing to $30.9 million in the fifth year. PART C. ADVISORY COUNCIL, EXPERT REVIEW COMMITTEE AND Part C of the draft bill would establish a National Advisory Council on Nursing Education and an Expert Review Committee. It would also provide for noninterference with educational institutions. The proposed Advisory Council would advise the Surgeon General of the Public Health Service in the preparation of general regulations, in the review of applications for construction grants in the review of applications for project grants, and in other policy matters arising in the administration of this title. The Council would consist of the Surgeon General of the Public Health Service, who would be Chairman, the Commissioner of Education, and 16 members appointed by the Secretary-4 from the general public and 12 from among leading authorities in the fields of nursing, higher, and secondary education, and from representatives of institutions and organizations which provide nursing services. The Expert Review Committee would evaluate the programs authorized by the draft bill and make recommendations to the Secretary by November 1, 1967, with respect to the continuation, extension, and modification of any such program. The Committee would consist of members of the public and of various groups interested or expert in matters related to the education of nurses. This part provides that nothing contained in the proposed title of the Public Health Service Act shall be construed as authorizing any department, agency, officer, or employee of the United States to exercise any direction, supervision, or control over, or impose any requirement or condition with respect to the personnel, curriculum, methods of instruction, or administration of any institution. In compliance with Public Law 801, 84th Congress, there is enclosed a statement of cost estimates and personnel requirements that would be entailed by enactment of this proposed legislation. We would appreciate your referral of the enclosed draft bill to the appropriate committee for consideration. We are advised by the Bureau of the Budget that enactment of the enclosed draft bill would be in accord with the program of the President. Sincerely, ANTHONY J. CELEBREZZE, Secretary. Nurse Training Act of 1964, estimate of additional cost, 1965-69 This section provides that the act may be cited as the Nurse Training Act of 1964. SECTION 2 This section adds a new title VIII, "Nurse Training," to the Public Health Service Act. Grants for expansion and improvement of nurse training (pt. A) Authorization of appropriations for construction grants (sec. 801) Subsection (a) of section 801 authorizes appropriations of the following amounts for grants for construction, replacement, or rehabilitation of facilities for the following types of nursing schools: (1) For collegiate schools of nursing, $5 million for fiscal year 1966 and $10 million each for fiscal years 1967 through 1969; and (2) For associate degree and diploma schools of nursing, $15 million for fiscal year 1966 and $20 million each for fiscal years 1967 through 1969. For fiscal years 1967 through 1969, appropriations would also be authorized for grants specified in clause (1) or (2) in the amount by which the sums authorized to be appropriated under that clause exceed the aggregate of the appropriations thereunder for those years. Sums appropriated pursuant to clause (1) or (2) for a fiscal year would remain available for grants specified in that clause until the close of the next fiscal year (subsec. (b)). Approval of applications for construction grants (sec. 802) Subsection (a) of section 802 provides that applications for construction grants must be submitted to the Surgeon General before July 1, 1968. Subsection (b) sets forth the requirements which the Surgeon General must find to have been met before he can approve an application for a construction grant. Paragraph (1) of subsection (b) provides that the applicant must be a public or nonprofit private school of nursing providing an accredited program of nursing education. Paragraph (2) of this subsection provides that the application must contain reasonable assurances that for not less than 10 years the facility will be used for the purposes for which constructed and will not be used for sectarian instruction or as a place for religious worship; that sufficient funds will be available to pay the non-Federal share of the cost of construction; and that sufficient funds will be available for operation of the facility after construction. Paragraph (3) of this subsection requires that funds granted for construction of a new facility must be utilized for construction of a new school of nursing or to expand substantially the training capacity of an existing school of nursing. In the case of grants to replace or rehabilitate facilities, such replacement or rehabilitation must be necessary in order to prevent a substantial curtailment of enrollment or quality of training otherwise available. Paragraph (4) of this subsection provides that the construction must meet minimum standards prescribed under this part, and paragraph (5) requires that prevailing rates of wages, as determined in accordance with the DavisBacon Act, must be paid laborers or mechanics employed on such construction. The Surgeon General is required to obtain the advice of the National Advisory Council on Nurse Training (established pursuant to sec. 841) before finally approving or disapproving any application. Subsection (c) of this section specifies matters which must be taken into account by the Surgeon General in determining which of the applications filed with him will be approved, and the priorities to be followed by him in granting such approval. Paragraph (1) of this subsection provides that in case of projects for new schools or for expansion of existing schools the Surgeon General shall give consideration to the relative effectiveness of the proposed facilities in providing such expansion and the relative effectiveness of such facilities in promoting an equitable geographical distribution of opportunities for such training. If the application is for replacement or rehabilitation of existing facilities, subparagraph (B) of this paragraph requires that the Surgeon General take into account the relative need for such replacement in order to prevent curtailment of the school's enrollment, or deterioration of quality of training provided, and the relative size of such curtailment and its effect upon the geographical distribution of opportunities for such training. In making the determinations referred to under this paragraph, the Surgeon General is required to give due consideration to population, relative unavailability of nurses of the kind to be trained by the school, and available resources in various areas of the Nation for training such nurses. Paragraph (2) of this subsection (c) provides that where there is a State or local area planning agency, or where the State participates in a regional or other interstate planning agency, the Surgeon General shall consider the relationship of applications for construction to the program being developed by such agency, taking into account any comments on the application submitted by the State, local area, regional, or other interstate planning agency. Amount of construction grant; payments (sec. 803) Section 722 covers the amount of each Federal grant, and the manner of its payment, and provides for offsets against such grant for other Federal programs with respect to the same facilities. Subsection (a) of this section provides that, in general, grants may not exceed 50 percent of the necessary cost of construction. Where the grant is for a new school or for new facilities at an existing school which will provide a major expansion of training capacity, the amount of the grant may not exceed 66% percent of the necessary cost of construction. Subsection (b) of this section provides that where an application has been approved, the Surgeon General shall reserve from appropriations the amounts of grants to be made, and may pay the amounts so reserved in advance, or by way of reimbursement, in such manner as he may determine. Subsection (c) of this section provides that in determining the amount of any construction grant, the Surgeon General shall exclude from the amounts otherwise payable with respect to a project an amount equal to the sum of (1) any other Federal grant which the applicant will receive, or has received, with respect to the same construction, and (2) the amount of any non-Federal funds required to be spent or to be available as a condition of such other Federal grant. Recapture of payments (sec. 804) This section provides for recovery by the United States of its proportionate share of the current value of any facility constructed or rehabilitated with the aid of funds under this part A if, within 10 years after construction or rehabilitation is completed, the school ceases to be a public or nonprofit private school, or ceases (without being released from this requirement upon a determination of good cause by the Surgeon General) to be used for the teaching purposes for which it was constructed, or if the facility is used for sectarian instruction or as a place for religious worship. Planning grants and technical assistance (sec. 805) Subsection (a) of section 805 authorizes the appropriation of $4,400,000 to enable the Surgeon General to make grants during fiscal years 1965 and 1966 to State, interstate, regional, or local area agencies, to pay not more than 66% percent of the cost of planning new, expanded, or improved programs of nurse training, including the cost of surveying their needs for construction of facilities and of developing programs for construction of needed facilities. Subsection (b) authorizes the Surgeon General to provide technical assistance and consultative services to State, interstate, regional, or local area planning agencies to further the planning of programs by such agencies for relieving shortages of nurses or nurse training capacity through constructing teaching facilities, providing adequate financial support for schools, or otherwise. Improvement in nurse training and services (sec. 806) Subsection (a) of section 806 authorizes appropriations for grants to public or nonprofit private agencies for (1) projects to develop improved methods of training nurses or of recruiting students of nursing, or improve the utilization of nurses, and (2) projects to enable schools of nursing to strengthen or expand their programs of nurse training. The sums authorized to be appropriated for these projects are $3,800,000 for fiscal year 1965, $10 million for fiscal year 1966, $15 million each for fiscal years 1967 through 1969, and such sums for each of the next 4 fiscal years as may be necessary to complete projects for which a grant was made from funds appropriated for fiscal years 1965 through 1969. Subsection (b) sets forth the factors which the Surgeon General must consider in determining whether to approve applications for projects to enable schools of nursing to strengthen or expand their programs of nurse training, the order in which to approve these applications, and the amount of the grants therefor. He must consider the extent to which the project will contribute to general improvement of the quality of training of nurses of the kind involved and aid in attaining a wider geographical distribution of high quality schools of the type involved, and the relative need in the area in which the school is situated and surrounding areas for nurses of the type trained in the school. Subsection (c) prohibits the making of a grant under this section for any project for any period after grants have been made with respect to the project for 5 fiscal years. Assistance to nursing students (pt. B) Traineeships for advanced training of professional nurses (sec. 821) Subsection (a) of section 821 authorizes appropriations, for fiscal years 1965 through 1969, of sums as may be necessary to pay the cost of traineeships to train professional nurses to teach, to serve in administrative or supervisory capacities, or to serve in other professional nursing specialties determined by the Surgeon General to require advanced training. Subsection (b) provides that the Surgeon General shall award these traineeships through grants to the public or nonprofit private institutions which provide the training. Under subsection (c), payments to institutions for traineeships awarded under the section may be made in advance or by way of reimbursement, and at such conditions as the Surgeon General finds necessary. These payments may not exceed such amounts as he finds necessary to cover the cost of tuition and fees, and a stipend and allowances (including travel and subsistence expenses) for the trainees. Undergraduate scholarships for students of nursing (sec. 822) Subsection (a) of section 822 authorizes appropriations, for fiscal years 1965 through 1969, of such sums as may be necessary to permit the Secretary of Health, Education, and Welfare to award scholarships to highly qualified secondary school graduates who are in need of the amount of the scholarship to undertake full-time training in public or other nonprofit collegiate schools of nursing of their choice. Subsection (b) provides for allotting among the States the scholarships to be awarded under subsection (a). During each fiscal year each State will be allotted a number of scholarships which bears the same relation to 1,000 as the number of secondary school graduates in that State for that year bears to the number of secondary school graduates in all the States for that year. If, however, the number so allotted to any State is less than 5 it must be raised to five; and if the number allotted to any State is not a whole number it must be raised to the next higher whole number. Subsection (c) provides that these scholarships may be awarded for a period not in excess of the time required by the recipient to complete his basic course of study. The amount of any scholarship for any academic year may not exceed $1,000 and must be based on the recipient's need for financial assistance. Subsection (d) provides that the selection of scholarship recipients must be made according to their relative ability to complete successfully a program of nurse training in a collegiate school of nursing, as determined on the basis of nationwide objective tests. The Secretary of Health, Education, and Welfare is authorized to enter into contracts with recognized college examining agencies for the conduct of these tests, and for the obtaining of information concerning the financial need of applicants. Loan agreements (sec. 823) Subsection (a) of section 823 authorizes the Secretary of Health, Education, and Welfare to enter into an agreement for the establishment of a student loan fund with any public or nonprofit private school of nursing. Subsection (b) of this section sets forth the provisions which a loan agreement entered into under this section must contain. Each loan agreement must (1) Provide for the establishment of a student loan fund by the school, and for deposit in the fund of (a) the Federal capital contribution, (b) an amount from other sources equal to not less than one-ninth of the Federal capital contribution, (c) collections of principal and interest on loans made from the fund, and (d) any other earnings of the fund; (2) Provide that the fund shall be used only for loans to students and for the costs of collection of the loans; (3) Provide that loans from the fund may be made only to full-time students, and that while the agreement remains in effect no student who has attended the school prior to July 1, 1969, shall receive a loan from a loan fund established under section 204 of the National Defense Education Act of 1958; and (4) Contains such other provisions as are necessary to protect the financial interests of the United States. Loan provisions (sec. 824) Subsection (a) of section 824 limits the amount of loans which may be made for any academic year to $1,000 in the case of a student in a collegiate school of |