of the problems and watch the wonderful way in which you represented not only the United States but a great many other countries who call themselves free nations. I was particularly pleased with the way you handled different situations, and the way in which you met some very difficult problems. problems that could have had worldwide implications had they not been adequately met and handled in, I thought, a very wonderful way. I might say that this has been the first time that this committee has been designated to go and, while I have great respect for other committees of the Congress, I did feel that we had a part to play in the health field and that this committee should have some bit of recognition for the work that we do. Again, I would like to congratulate you and all the members of your staff for the fine work you did in Geneva, which you do all the time in your chosen field. It was a real privilege to have had the opportunity of sitting with you and taking some part in your deliberations. Dr. TERRY. Mr. Chairman, I am duly appreciative of your modesty. However, I would not like to sit by and allow it to stand on the record that the two of you did not advise us, because you certainly did. You participated in our delegation meetings each morning. You discussed many of our thorny problems with us and gave us some very valuable advice in how to cope with the problems. I just wanted to be sure that the record shows this. Thank you, sir. Mr. ROBERTS. Thank you. Mr. JONES. Mr. Chairman, may I have the opportunity at this point to do two things? One is to also express appreciation, for Dr. Terry's leadership in international health affairs. I had the privilege of attending the first World Health Assembly at which he was chairman of the delegation. He performed with a maturity of judgment which possibly indicated he had been to many of these before, although he hadn't. We are very pround in the Department over his leadership in the international health field and we think this is most important. In terms of the bill, may I make a statement that will be responsive to Mr. Nelsen's comments concerning the availability of space for students in schools? Approximately 8,500 more students could be accommodated in present nursing school facilities throughout the country. This is about one-fourth of the total increase in admissions needed by 1966-68 to meet what has been proposed as the feasible goal for the number of nurses needed. This feasible goal is 680,000 nurses, in contrast with the desirable goal of 850,000 nurses recommended in the report of the Surgeon General's Consultant Group on Nursing. To provide for the number of admissions needed, we need to increase admissions by 31,500. Subtracting the 8,500 places now available, we still need 23,000 additional places in all 3 types of nursing to meet the feasible goal of 680,000 nurses by 1970. This program in its entirety, including the construction of new facilities, contemplates that particular goal. Thank you, Mr. Chairman. Mr. ROBERTS. One other thing, if the gentleman from Texas will indulge me, on page 11 it might serve to clear up a little confusion, if there might be confusion, as to a traineeship section which you mentioned will expire this June. I would like, if you would, that you devote some time to that part, section 821 (a) of the bill. Mr. JONES. This section of the bill, Mr. Chairman, was the result of legislation authorizing a program for 3 years beginning July 1, 1956. For fiscal year 1957 there was an appropriation of $2 million for this program. The success of the traineeship program in producing well-trained nurses for teaching, supervision and administrative duties in the field of nursing was so great that the Congress in 1959, extended the program for 5 years. This program now expires in June of this year. I can provide for the record, if you like, or read now the numerical results and some comment on the value of the program during the years since 1956. We are proposing in this legislation, Mr. Chairman, that this program be extended and also that the categories for which the traineeships can be made available be extended to include certain nursing specialties in which shortages exist. This recognizes the complexity of professional requirements for nurses now. These new categories will be determined by the Surgeon General. (The following data was subsequently supplied for the record.) PURPOSE OF THE PROFESSIONAL NURSE TRAINING PROGRAM The purpose of the professional nurse traineeship program is to improve the quality of patient care by increasing the number of graduate nurses with preparation for positions as administrators, supervisors, and teachers in hospitals and related institutions, public health agencies, and schools of nursing. The program provides long-term traineeships for full-time academic study in universities and colleges and traineeships for short-term intensive training courses sponsored by certain public and nonprofit institutions. LONG-TERM ACADEMIC TRAINING This training is intended to increase the number of graduate nurses qualified for positions as teachers and administrators in schools of nursing, and as supervisors and administrators of nursing services in hospitals and in public health agencies. Traineeships are awarded through grants to institutions offering training in teaching, administration, and supervision which are approved for participation in the program. Trainees are selected by the institution in accordance with the intent of the traineeship program and the established admission policies of the school. A traineeship provides for tuition, a stipend, travel, and required fees and allowance for dependents. From 1957 to 1963 a total of 105 schools located in 38 States have participated, and traineeships for full-time study have been awarded to over 11,000 nurses from all States. SHORT-TERM TRAINING A program of traineeships for graduate nurses to undertake full-time study in short-term courses was established in July 1959. This resulted from the recom mendations made to the Surgeon General by the 1958 evaluation conference. The purpose of the short-term program is to assist nurses to update management and teaching skills most needed to improve the quality of patient care in the institutions or agencies in which they are employed. It offers short-term training courses to nurses in administrative, supervisory, and teaching positions who may be unable to undertake longer periods of full-time academic study. Such courses provide a means by which nurses are enabled to meet new develop ments in patient care and in community health practice. Educational institutions, health agencies, or other nonprofit organizations (except departments and agencies of the Federal Government) may apply for traineeship grants to sponsor short-term courses for nurses. The sponsor is responsible for the selection and appointment of trainees. From 1960-63, approximately 275 grants were made to over 100 sponsoring agencies located in 39 States. These grants provided for over 400 courses to different groups of nurses, and an estimated 14,000 nurses attended these courses. Mr. NELSEN. Mr. Chairman, I have a question at this point on this extension. The act presently in force and effect expires in June, is that not right? Mr. JONES. That is correct, yes. Mr. NELSEN. Has there been any assessment as to the total cost of this package as it is prepared, as compared to what has been spent? We usually run into the problem on the floor of the danger of having a bill analyzed with a total dollar figure, not having in mind the total dollar figure that has been spent in some of these same areas before. I just wondered how much additional money would be added here. Mr. JONES. Well, the traineeship program for fiscal year 1965 as contemplated in the legislation under discussion would require an appropriation of $8,825,000. Mr. NELSEN. Previous to that, what was it? Mr. JONES. For fiscal 1964 it was $7,325,000. I can give you either orally or for the record the amounts appropriated from 1956 through 1964. Mr. NELSEN. I have in mind in the air pollution legislation much of that was a consolidation of activities that had previously been conducted, and what we tried to do, as I recall, was to streamline operations so that the total dollar figure, which might appear to be quite staggering, was an accumulation of many activities that had previously been conducted. I wanted to be sure that we were fortified with the information, so that when we go on the floor we can tell them. Mr. JONES. That, Mr. Nelsen, is a very important point. In this proposal, we would actually be increasing expenditures over what we are now doing for this program by only $1,500,000, rather than the $8,825,000. Thank you very much for making this point. We will work with the staff to provide for the record these adjustments, if that is appropriate. Mr. NELSEN. Thank you. (The following data was subsequently supplied for the record :) APPROPRIATIONS FOR THE PROFESSIONAL NURSE TRAINING PROGRAM The professional nurse traineeship program was originally authorized for a 3-year period, beginning July 1, 1956, under title II, Public Law 911 (84th Cong.), the Health Amendments Act of 1956. This added section 307 to the Public Health Service Act. In July 1959, Congress amended the Health Amendments Act of 1956 'to extend certain traineeship provisions" by continuing the professional nurse traineeship program for 5 years. Appropriations have been authorized for each fiscal year through June 30, 1964, in such sums as Congress determined, as follows: Appropriation | Fiscal year-continued Fiscal year: 1957 1958 1959. 1960 $2, 000, 000 1961. Appropriation $6, 600, 000 6,250,000 7,325,000 7,325,000 Thus, the fiscal year 1965 projected cost of $8,825.000 for the extension of this traineeship program for the advanced training of nurses (sec. 821 of H.R. 10042) represents an increase of only $1,500,000 over the appropriation level of the program for fiscal year 1964. The net increase for fiscal year 1965 over 1964 projected for all programs included in H.R. 10042 is $11,960,000. Mr. ROBERTS. Now I have one other question, and then I will recognize the gentleman from Texas. I have talked to some physicians who are quite interested in the field of pediatric nursing. I wonder if you have given any thought to the special need in this field. Mr. JONES. This has been done, Mr. Chairman, in relation to the advanced training of nursing. I feel that pediatric nursing as a specialty would perhaps be one of the categories for extension of the traineeship program, if this were determined to be a critical area by the Surgeon General. I do not know whether he is prepared to speak to this now or not. It would be his judgment as to whether this was needed. Dr. TERRY. Mr. Chairman, I think one of the real deficiencies. in our existing traineeship program is that it has been directed in such a way that it has not allowed us to support the training of advanced leaders in the clinical fields particularly, whether it be pediatrics or surgery or whatever. It has been in the teaching and administrative fields of nursing that the traineeship program has been authorized, active, and effective. One of the things that we visualize as a part of this legislation would be a definite encompassment of advanced training in the various clinical fields, including pediatrics. Mr. JONES. I think it might be well to say, Mr. Chairman, that the advanced training contemplated here would provide a specialist in the field of nursing that would be comparable to the specialist in medicine. Beyond this, Mr. Chairman, there is no special consideration that has been given in this legislation to a comparable need other than at the advanced level. It is at this point where nursing becomes highly specialized to the point that it requires a particular orientation. Pediatrics, of course, is included in all curriculums for the training of nurses. Mr. ROBERTS. I do not know that I have enough background and it may be that after we get in another session that I will call you back and we can develop this more fully. Mr. JONES. I will be happy to respond, Mr. Chairman. Mr. ROBERTS. I am convinced, from what they say, that there may be reluctance on the part of highly skilled and highly trained nurses to enter this field and perhaps we could, if there were a shortage, we could fill this with people with a little less training than it takes certainly for the baccalaureate or even for the 2-year schools. But we will leave that for the time being. The gentleman from Texas. Mr. PICKLE. Does the American Medical Association favor this proposed nursing bill? Mr. JONES. I have not been in direct contact. I think in general. they do. I don't know whether they are on the witness list or not. They will appear later at which time they will state their position. Dr. TERRY. I am not certain of the AMA's position on specific provisions in the bill. They have manifested a very definite interest 31-912-645 in the implementation and expansion of the training of nurses, but I am not sure whether there will be any disagreement with individuaľ portions of this bill. Mr. PICKLE. Would this be true also of the American Hospital Association? Mr. JONES. Yes, sir. The American Hospital Association will also appear to express their views. We know that the American Hospital Association is deeply concerned about the shortage of nurses; but here again, whether they agree with the specifics of the proposals, we are not sure. But they will have opportunity to express themselves. Mr. PICKLE. Since they will appear, I will withhold any further questioning at this time. I am concerned that the trend has been downward in the available supply. I know this must be in the phase of some sort of a public relations program that the nursing, hospital, and medical professions have been pursuing. In spite of the fact that in 1963 you had passed a Professional Training Act which provided along with the general category of training of nurses, it does not seem to have given you any increase or any encouragement in the number of available nurses that you are going to have. You have to pick up a 70-percent increase between now and the next 5 to 6 years. What is the profession doing? You come to Congress and you want us to appropriate several million dollars for these grants for construction and planning, and a large sum on loans. What is your general public relations program, outside of Congress? What is your profession doing on this? Can you enlighten me on that? Mr. JONES. Yes. First, I would like to respond to your opening statement. Actually, the number of nurses has gone up. Mr. PICKLE. Percentagewise? Mr. JONES. No, sir; in actual numbers. Mr. PICKLE. I am sure of that. Mr. JONES. Yes. In 1950 there were 375,000 professional nurses in practice. In 1956-these are just selected years the total was 450,000 In 1960, 504,000; in 1962, 550,000. Mr. PICKLE. By 1970 you will need 680,000, a very large increase. Mr. JONES. That is correct. This takes into account a number of factors. One is the increase in population alone, which accounts for some demand. Another is that with advances in the economy and standard of living the American people use more nursing care than might have been true previously. The advances in medicine require skilled assistance in the nursing field beyond that which has been true previously. For example, open-heart surgery, which was not known just a few years ago would require a team in the operating room of perhaps 15 people, some 10 or 12 of whom would be nurses, for example. Then we have a larger number of people who are in the aging population and this is increasing. They are the ones most susceptible to the chronic diseases or infirmities which can be handled appropriately by nurses. Mr. PICKLE. I appreciate that surely with the growth of population your overall number of nurses has increased. Are you saying to me that we need more nurses just because our population is growing and because medical skill is advancing and new fields are opening |