The next amendment would be the accreditation of nurses' education program. The American Nurses' Association supports the amendment of section 843 (f) of the Public Health Service Act which would delete the authority of the Commissioner of Education to accredit programs of nursing education programs. And then we would like to speak to the authorization for cooperative activities between the Public Health Service hospital and community facilities. Inherent in the partnership for health concept is the cooperative relationships of all agencies and services in a locality. This relationship should include Federal facilities as well as those in private or local governmental structure. Such interaction should generate better care on a more economical basis. It should also foster better working conditions for all health personnel and act as a recruitment stimulant. Comprehensive planning can point the way to a more economical health service by avoiding duplication and fragmentation of health services; by providing for more skilled health personnel; and more efficient utilization of manpower resources. We thank the committee for this opportunity to present the views of the American Nurses' Association on H.R. 6418. We urge that you report favorably on this legislation. Mr. ROGERS. Thank you, Miss Thompson. Mr. Van Deerlin. Mr. VAN DEERLIN. No thank you, Mr. Chairman. Mr. ROGERS. Mr. Devine. Mr. DEVINE. No questions, Mr. Chairman. Mr. ROGERS. Mr. Pickle. Mr. PICKLE. Miss Thompson, I notice you comment on the improvements in the performance of clinical laboratories. You represent the Nurses' Association and this question may be a little broader than your group, but I am concerned about clinical laboratories privately operated by such institutions as life insurance companies. I have had objection that they feel that this act is not intended for life insurance groups, that is, clinical laboratories operating for underwriting purposes where there is merely a need of establishing their desirability to take a certain insurance risk and it really has nothing to do with a clinical laboratory in the broad sense of the word. Would you feel that those companies would be exempt or should be exempt? Miss THOMPSON. I would choose not to comment on that. Our statement related to the fact that we believe that any laboratory test should be of a quality that would provide the physician with accurate information for a diagnosis rather than in terms of which laboratories should be included in the standards set. We feel that all of them should have the same standards so that all tests would be safe. Mr. PICKLE. I recognize, Miss Thompson, that your position and views would probably be limited in this general field. I wanted the record to show that I have had this correspondence from two or three companies in my State and they think it is unnecessary they be included, and I am simply stating that viewpoint. I am also concerned about the statement you made that you would like to see the deletion of the authority of the Commissioner of Educa tion to approve the general programs in the field of nurse training. If we take this away from the Commissioner of Education, who is going to have this authority? Miss THOMPSON. The Commissioner of Education now has the authority to name an accrediting agency. It is my understanding that it is the recommendation of the Department that this language be removed because the Commissioner did not wish to have the responsibility of accrediting institutions. Mr. PICKLE. Why would you want this removed from the Commissioner of Education? Miss THOMPSON. We are merely supporting the language that was in the original Nurse Training Act. Mr. PICKLE. Let me pursue that further. Why do you support the original language? What is your reason? Miss THOMPSON. We believe that any institution that is to secure Federal money should meet some kind of criteria prior to the money being allocated. The Commissioner of Education now has the privilege of naming any accrediting body to establish the criteria to be met. Mr. PICKLE. I don't know that this is the time and place to pursue this except I do feel that the Nurses' Association, accredited schools, associated schools, the Office of Education, and the HEW in general have come coordination to work out before we can feel secure, at least in my opinion, to pursue this particular section. Thank you, Mr. Chairman. Miss THOMPSON. I might add that conferences to resolve the problem that arose several years ago are still being carried on and the National Commission on Accreditation has submitted a proposal for consideration by all of the people that are concerned with the problem. This month the groups involved are meeting with the Regional Accrediting Association to see whether some reasonable compromise can be attained in relation to the accreditation statement. Mr. ROGERS. Mr. Brown. Mr. BROWN. Miss Thompson, I would like to hit two or three different scattered points in the testimony we had previously about the level of nurses' salaries in New York City. Do you have any judgment as to whether that makes those salaries high or low nationally? Miss THOMPSON. I would say that they are in competition with the urban areas of the country. Many of the less populated areas have much lower salaries. Mr. BROWN. $6,200 and $7,400 is a pretty high salary for the Nation on the total average, urban and rural? Miss THOMPSON. That is right. I believe that the latest average figure is about $90 a week. Mr. BROWN. It occurs to me that if those figures get out in general circumstances in my part of the country we might lose a lot of nurses on their way to New York until they find out how much it costs to live in New York and that would send them back home, but maybe there is a basic problem here that the Congress ought to give some attention to, as to why it costs that much to maintain one's self in New York. The suggestion has been made that we ought to go to more automation in hospitals. Do you have any feeling about this? This would reduce the nurse contact with the patient. Has the nursing association given any thought to this or have you given any thought to the desirability of this as a means of solving the nurse shortage? Miss THOMPSON. There are many activities in a hospital that could be automated without reducing the nurse contact with the patient. There could be recordkeeping done automatically, electronic methods of dispensing of the drugs, and there are a variety of things that could be done without reducing the contact. Mr. BROWN. Is it your thought that this work should be done by nurses, or that it should be done by administrative personnel who are not necessarily trained as registered nurses? Miss THOMPSON. I would think it should be done by persons trained in this particular kind of activity rather than by nurses who do not have this training. Mr. BROWN. And this would be one of the objectives of this comprehensive health planning program, it would seem to me, because I would concur with your view that the training of nurses either is going to have to change to include some EDP courses or else the nurses are going to have to be left with the patient contact area and somebody else is going to have to be trained in the areas of reading of remote instruments and data processing kinds of information. Miss THOMPSON. We believe that some of the problem related to the shortage has to do with utilization, and that was referred to by Dr. Brown earlier this morning in his statement. The nurse was the first person who was constant in the hospital and she assumed many, many tasks that weren't necessarily the kinds of things that nurses were prepared to do. Many of the personnel in hospitals are daytime personnel, such as pharmacists and physiotherapists, and others whose duties very often are taken over by the nurse after the day shift is over. We believe if we had better utilization of those that we have, that we could give better nursing care to the persons in institutions. Also when you have an occupation that is primarily female you have to oversupply all the time because of the other activities that women engage in. Mr. BROWN. I don't trust myself to speak to that. But I gather that your feeling, Miss Thompson, is that the nurses ought to be administering to patients rather than manning the mops. Miss THOMPSON. Yes. Mr. BROWN. Thank you. Mr. ROGERS. Mr. Ottinger. Mr. OTTINGER. No, thank you, Mr. Chairman. Mr. ROGERS. Mr. Kyros. Mr. KYROS. Mr. Chairman, I just want to thank Miss Thompson of the American Nurses' Association for her clear and concise testimony. No questions, sir. Mr. ROGERS. Dr. Carter? Excuse me. Mr. CARTER. Thank you, Mr. Chairman. It happened I was out during your presentation. However, I had already read it. I am interested here the chairman may have mentioned this-in your support of the amendment of section 843 (f) of the Public Health Service Act which would delete the authority of the Commissioner of Education to accredit programs of nursing education. Would you explain that please? Miss THOMPSON. We have agreed that the language that gave the Commissioner the responsibility for approving institutions for the purposes of Federal funding should be dropped because the Commissioner himself believes that this should not be a function of his Office and we concur in this decision. Mr. CARTER. You really think that that should be left up to the American Nurses' Association itself? Miss THOMPSON. No, the Commissioner, according to the language of the law, has the privilege of naming any national body that he chooses to be the accrediting body and at this particular time he has designated the National League for Nursing. Mr. CARTER. National League. Miss THOMPSON. National League for Nursing. Mr. ROGERS. Miss Thompson, of course we all know of the fine job you are doing for the nurses here in Washington. Miss THOMPSON. Thank you. Mr. ROGERS. Now, I am very much concerned about the position that is taken in the bill by the Department and, of course, by the association on the accreditation, because I don't think there has yet been realized evidently by the Department nor by the nurses association, the National League of Nursing, the urgency for us to do something on the training of nurses. We have just had additional testimony today, which perhaps you heard, that in New York City in the city hospitals only 25 percent of the positions are filled and this is shocking, and instead of accelerating that program we seem to be still in limbo, not deciding what to do and not really having an accelerated program of training of nurses as we should, partly, I think, because of a reluctance to settle this accreditation program. Some junior colleges don't know whether they they can proceed with nurse programs because they can't get Federal aid that others can, so it just seems to me that there must be some recognition. I understand this amendment was put in because they thought they had reached an agreement to settle this problem, but then they agreed and evidently fell apart, or it never was agreed to although they thought they were close to an agreement, according to Under Secretary Wilbur Cohen. It is my own personal opinion, and probably a number of others, that this should not be taken out or, if anything, we should take it away completely and put it in the Surgeon General and just go ahead. I am not sure that the Nation can afford to wait in getting schools accredited where they can receive funds to build these programs and turn out adequate nurses on some technicality of how we are going to accredit these. We all want the standards high, but certainly it can be seen to by the Surgeon General that established standards be high enough if necessary. I would suggest that you explain the urgency of this matter to those involved and ask that they do get together because I certainly would be opposed to striking out this language at all until there has been a definite solution to the problem. And further, I would be inclined to suggest an amendment to the committee to turn over the entire matter to the Surgeon General to allow Federal funds to go into institutions that wanted them in order to turn out adequate nursing facilities and to train nurses for this Nation, because our need is increasing and the supply is evidently dropping. Miss THOMPSON. I might add here that out of the 218 associate degree schools 103 of them have reasonable assurance and 32 are fully accredited, which give us a total of 135. Twenty-two out of 218 are not eligible yet for reasonable assurance because the school itself is not accredited by the regional association. Mr. ROGERS. I wonder though if you get them into a problem of philosophy of whether the school that needs the help that is not yet accredited should be the one to have the funds to build it up where it can turn out proper people. Miss THOMPSON. The reasonable assurance does provide for schools to have money even though they are not ready for full accreditation. They would have to submit data that would mean that they were setting up an adequate program. If at the time the school graduates the first class they haven't carried out the reasonable assurance promises, then they would not be fully accredited. During the time in which they were developing a program they could have money with having met criteria for reasonable assurance. Mr. ROGERS. I am not sure but what the Surgeon General should have this authority if this can't be worked out very quickly, and I would urge that the problem be met with urgency to try to get a solution before this committee reports out this legislation. Miss THOMPSON. I think that there needs to be a solution to the problem. I agree with you. Mr. ROGERS. Thank you so much. Your testimony has been most helpful. Any other questions? Miss THOMPSON. Thank you. Mr. ROGERS. The next witness is Dr. Robert W. Coon, chairman of the National Committee for Careers in Medical Technology. Dr. Coon, we are pleased to have you. I might say that the House is now in session, that if you would like to submit your statement and just give us a quick statement it would be helpful to the committee. We will put your full statement in the record at this point without objection. If you could just give us a quick statement of your point of view here it would be most helpful. STATEMENT OF DR. ROBERT W. COON, CHAIRMAN, NATIONAL COMMITTEE FOR CAREERS IN MEDICAL TECHNOLOGY Dr. Coon. Thank you very much, Mr. Chairman. In view of the shortage of time and the meeting of the House I would request that you submit this statement into the record. (The statement referred to follows:) STATEMENT OF DR. ROBERT W. COON, CHAIRMAN, NATIONAL COMMITTEE FOR CAREERS IN MEDICAL TECHNOLOGY I am Robert W. Coon, a pathologist. I am Chairman of the Department of Pathology at the University of Vermont College of Medicine and am Director of Laboratories at the Medical Center Hospital of Vermont in Burlington, Vermont. I am Chairman of the National Committee for Careers in Medical Technology, an organization sponsored by the American Society of Medical Technologists, the College of American Pathologists, and the American Society of Clinical Pathologists. Our Committee was formed some years ago in an attempt to improve the recruitment into the field of medical technology. |