ternity nursing, 15 institutions reported 152 students; in nursing in the care of children, 13 institutions reported 144 students; in medical nursing, 13 institutions reported 282 students; and in surgical nursing, 14 institutions reported an earl ment of 343 students. With your permission, I should now like to discuss methods for strengthening professional nursing standards in order that nursing may function most ef tively in the administration of S. 1606, should the bill become law. These methods involve the development and expansion of nursing education programs br the use of grant-in-aid funds for special educational and research projects ar scholarships, and by the utilization of national nursing organizations, educativ ca and nursing service institutions, and agencies for these several purposes. Fundamental to the improvement in the training of students, both undergraduate and graduate, in all branches of nursing is the extension and devem pe ment of clinical practice fields and the securing of qualified administrative. instructional, and supervisory personnel. Since title I and title II both provide for the training of additional nursing personnel in order that such personnel be available for the more extensive le2 1 services proposed in S. 1606, special studies or projects which should be carred on are listed below. Some work has already been begun on all of these profes by the national professional nursing organizations; more should and would done were the necessary funds available. 1. Survey of clinical facilities to determine their suitability as practi fields for training both undergraduate and graduate nursing personzel. 2. Curriculum studies related to the training of undergraduate nurses and especially to the training designed for graduate nurses. 3. Expansion of the present existing programs on accreditation of profes sional nursing schools. 4. Expansion of testing services-those for use of schools of nursing. State boards of nurse examiners, and merit systems. 5. Intensive and comprehensive studies of nursing service, both as rel-te! to quality and quantity of nursing care. 6. Survey of present personnel policies and practices in nursing education institutions and nursing services to determine how such can be improved 7. Surveys basic to estimating the numbers of graduate nurses needed t hospitals and other institutions, clinics, public-health agencies, and nureducation programs-such surveys to be made in terms of different types ? personnel. 8. Extension of the recruitment program for all types of well-qua'i-i nursing personnel needed in a national health program. Throughout the bill S. 1606, reference is made to standards for training personnel. Such standards, we believe, should be secured direct from the appropr professional nursing-education organizations. If these organizations do not hav the standards that are indicated, then it is urgently important that grants-A be made to the appropriate professional organizations, as well as to the ap priate educational institutions and nursing-service agencies-Government asi the student who should meet the requirements of the institution. The National League of Nursing Education believes that all scholarshins shea” be arranged, insofar as possible, directly between the educational institution and the student who should meet the requirements of the institution. In order to meet current as well as future Nation-wide service demands, it is essential that: 1. Grants-in-aid be provided to selected institutions to improve clic courses in undergraduate nursing education. 2. Grants-in-aid be provided to improve, expand, and develop new per grams for graduate nurses who are preparing to become teachers or aduşla istrators in schools of nursing and administrators or supervisors in a types of nursing services. The league also believes that, in general, all grants-in-aid for special research projects in nursing education and nursing service to national professiona" orgarizations, educational institutions, and nursing service agencies should be granted through direct allocation to the institution or agency concerned and not through a State health department." Since nurses are essential in large numbers to the operation of the provisions of S. 1606, it would be most important that: 1. Appropriate nurse representation be included in every proposed advisory council-Federal, State, and local. This principle has been approved by the National Nursing Council. See exhibit 2. 2. Such nurses be proposed by the appropriate National, State, or local professional organizations. 3. Preparation of these nurses be such that each can interpret the needs for nursing service and nursing education, both undergraduate and graduate, in their respective fields. 4. Nursing regulations in the specific fields be safeguarded by providing that each nurse representative on a council have the advice and support of an advisory technical committee composed of nurses. While the intent of part A of title I, grants to States for health services, is clear, we venture to suggest that part A apply not only to nurses in the publichealth field but to nurses in hospitals and sanatoria operating tuberculosis or venereal disease nursing services and also to nurses in educational institutions designed for the preparation of undergraduate nurses and graduate nurses in these two specific fields. Other amendments we desire to present are the following: Page 41, line 24, delete the word "medical" and substitute the word "health." The same revision should be made wherever reference is made to the National Advisory Medical Council. Page 45, lines 2 and 3, delete the words "legally qualified” and substitute the words "meeting requirements in regulations for administration of act as proposed by representatives of the appropriate national nursing organizations on advisory council." Page 64, line 21, insert after the words "dental practitioners" the words "or nurses." In conclusion, may I say again that the National League of Nursing Education is deeply concerned with the implications for nursing contained in S. 1606, should this bill become law. EXHIBIT 1 ECONOMIC IMPLICATIONS OF S. 1606 WITH REFERENCE TO HOSPITAL NURSING AND NURSING EDUCATION In a comprehensive national health program, such as proposed in S. 1606, which emphasizes standards of service and well-trained personnel to make effective these standards, there are economic factors in hospital nursing which merit review and deliberation. Section 204 of title II specifically refers to "standards to apply to participating hospitals" (p. 44, line 8) and "studies and surveys of personal health services and of the quality and adequacy of such services" (p. 44, lines 14 and 15). One highly important factor in the rendering of service in a hospital is that of nursing. A good quality of nursing requires a well-trained personnel with enough nursing time to make it possible to give good care. Since the intent of the bill appears to be to provide service of good quality, provision for sufficient nursing time becomes af paramount importance. Has such provision been given its due consideration in the prescribed remuneration method for hospitalization as outlined on page 68, lines 2-9? Or would some other remuneration arrangement, such as payment of actual costs per diem care as stated by each hospital and as evidenced by an accounting system agreed upon by the administering agency and the hospital, safeguard more effectively the quality of the nursing care the patients receive and the health of the nursing personnel? The policy of a 48-hour week has been pretty well established for graduate nurses1 and also for student nurses, although there are schools of nursing in this country which, as late as January 1, 1946, reported student schedules of 60 hours or more weekly, exclusive of classes. One of the inevitable results in a hospital where the expense incurred for patient care exceeds the payment received for that care is the lengthening of the weekly hour schedule of the nursing personnel. The seriousness of this practice, both in relation to the quality of care received by the patients and the physical fatigue imposed on the nursing personnel, was pointed out in a nursing time study carried on in Bellevue Hospital, New York, N. Y.2 1944. Personnel Practices for General Staff Nurses, American Nurses' Association, New York, B. Pfefferkorn and M. Rottman, Clinical Education in Nursing, The Macmillan Co., New York, 1932, p. 55. More than 1,300 of the 6,600 hospitals in this country either operate or are connected with professional schools of nursing. In these hospitals—where approximately half of all the patients in non-Federal general hospitals are cared for student nurses provide by far the major proportion of the nurs g care. Exactly how much of the nursing service in the Nation is student service not known. But since there are now approximately 135,000 nursing students with about 80 percent of this number providing from 24 to 48 hours, or even more than 48 hours, of service weekly, it is an incontestable fact that students provide a considerable bulk of the hospital nursing care given to patients. While t dollar value of this service has never been estimated on a national scale, tifollowing data may give some indication of the economic value of student serve to hospitals. In a comprehensive study of methods for analyzing nursing education a nursing service costs, these costs were studied in three hospitals, all thres which conducted their own schools of nursing. These three schools were gi erally regarded as good schools. In one of them the annual net contrib per student, in terms of nursing service rendered to the hospital, was $+1 ** in another $81.35, and in the third $241.40. The total net contribution by r schools to their respective hospitals in student service for the year was $2.6769 $10,250.81; and $21,146.13, respectively. These contributions were over and above any expense incurred by the hospitals in the conduct of their schools It is not intended to imply that every one of the 1,300 professional scho's of nursing represents a financial asset to its associated hospital. Much extensive analyses would be needed to support such a statement. But from evidence available, it is likely that the majority of schools of nursing Labdefinite economic contributions, varying in amount and depending on the e`% « tional program offered, to their associated hospitals. To summarize briefly: In a national health program which emphasizes stare ards of service and well-trained personnel, financial provision should be ma se fa enough nursing time to safeguard patient care and to assure reasonai le te schedules for the nursing personnel. Because so large a proportion of hars service is provided by students, the economics of undergraduate student ser and its relation to their total training for a broad community service is a m which well deserves attention in a national health program of the sweep dimensions proposed in S. 1606. EXHIBIT 2 EXCERPTS FROM THE STATEMENT OF THE NATIONAL NURSING COUNCIL ON B1s POLICY IN REGARD TO FEDERAL AID TO NURSING EDUCATION,' JANUARY 21, 196 Nursing is a profession essential to the health and well-being of citizens of the United States, yet the burden of the education of nurses has traditional been left largely to private institutions. For the most part, young women w wished to become nurses have paid their tuition partly in cash but chiefly in ser ice to the hospital while their schooling was in progress. War pressures for 22 precedented numbers of nurses brought about establishment of the Div.sin e Nurse Education in the United States Public Health Service with its exte scholorship aid both for basic and advanced nursing education and format t the United States Cadet Nurse Corps. Public Law 74 under which the U- --States Cadet Nurse Corps is administered is a war measure. The aid it aa ro will cease when students admitted before October 15, 1945, have completed the courses. Sweeping changes are needed in many schools of nursing to make of them am ine educational institutions. a Administrative Cost Analysis for Nursing Service and Nursing Education. A stat sponsored by the American Hospital Association and the National League of Nursing Edan tion in cooperation with the American Nurses' Association. 1940, p. 103. 1 Member organizations of the National Nursing Council are: American Nurses Le ciation. National League of Nursing Education. National Organization for Publie H«s*? Nursing. Association of Collegiate Schools of Nursing, National Association of Chi mi Graduate Nurses, American Red Cross Nursing Service, Council of Federal Nursta » Kore ices, International Council of Nurses, Division of Nursing-U. S. Publie Health Servic American Hospital Association. National Association for Practical Nurse Education Ameri can Medical Association, Nursing Unit-U. S. Children's Bureau, American Associatum «/ Industrial Nurses. SCHOLARSHIPS Scholarships should be arranged so far as possible directly between the educational institution and the student who should meet requirements of the institution. Such scholarships should be arranged: 1. For qualified students in basic professional nursing education in schools which meet criteria set by appropriate national professional nursing organizations. 2. For qualified students in advanced programs in universities and colleges where programs and courses meet criteria set by appropriate national professional nursing organizations. 3. For qualified students in practical nurse education in schools which meet criteria set by appropriate national nursing organiztions. Grants should be made: GRANTS 1. To universities and colleges for development of advanced programs in nursing education which meet criteria set by appropriate national professional nursing organizations. It is especially important that facilities be developed in certain clinical fields such as tuberculosis, pediatric, and psychiatric nursing including mental hygiene and also for administrative, supervisory, and teaching positions in educational institutions and nursing services. 2. To schools of basic professional nursing education only if selection of schools is based on criteria set by appropriate national professional nursing organizations. 3. To schools of practical nurse education only if selection of schools is based on criteria set by appropriate national nursing organizations. 4. For research and experimentation in nursing as it relates to education of professional and practical nurses, carried on either by a Government agency administering the Federal-aid program or by allocation of funds to national professional nursing organizations and to educational institutions. 5. To make possible the assignment of Federal nursing education personnel for furtherance of studies and demonstrations and educational program development. 6. For promotion of nursing education in geographic areas where there is special need and local funds are limited; these special grants to be distributed at the discretion of the Federal administering agency to educational institutions and agencies which meet criteria set by appropriate professional national nursing organizations. ADVISORY COMMITTEE In the administration of all these programs it is believed that an advisory committee should be formed with representatives recommended by the appropriate professional nursing organizations. [American Journal of Nursing, December 1943, p. 1061, vol. 43, No. 12] HEALTH INSURANCE STUDIED BY ANA American Nurses Association headquarters is a busy place. As announced elsewhere, the association has just published a study of organization, control, and financing of nurses' professional registries. It is an opportune moment, as it may be assumed that registry boards and committees are making plans for the time, sooner or later, when the armed forces will no longer need so many nurses. The article on page 1066 is based on data collected, tabulated, and analyzed in the American Nurses Association office for the men nurses section. An outline of the Status of Nursing in Relation to Health Insurance has just been released to the members of the American Nurses Association and National Organization for Public Health Nursing committee to study health insurance, and to the headquarters of State nurses associations and State presidents. It will undoubtedly stimulate further study. To quote from the outline, health insur ance means: "The provision of curative care in illness through insurance (or prepayment plans) and this may include any or several of the following: services of a phys cian; hospitalization; medicines; surgery; appliances, such as casts, braces, et cetera; use of x-ray and/or other mechanical equipment for treatment or tests; and services of the pathological laboratory." Nurses are interested in health insurance from two diametrically opposite points of view, viz, as consumers and as practitioners who may be called upon to render some part of the service required by other consumers. The nurse as cosumer, it will be recalled, was discussed in some detail in relation to group bas pitalization plans by C. Rufus Rorem in the July 1941 Journal. The participation of private (special) duty nurses in programs for providing care for patients was discussed briefly, but negatively. The concept of provision for nursing care through the application of the insur ance principle is by no means new. It goes back to the initial experiment of "be Metropolitan Life Insurance Co., in 1909. At the present time, to quote again from the American Nurses Association Outline. is a Some 70 companies offering health and accident policies issue a variety of po” cies which provide for nursing care in full, in part, or in lieu of hospital surgical fees and with other provisos. The Outline points out that studies of health insurance have been made br American Nurses Association committees at intervals since the initial one in 1917. They seem to parallel major activities in the general field of social insurance An American Nurses Association committee was set up in 1935. This was he year the Social Security Act was adopted, an event which was followed, sucres sively, by the National Health Survey and the National Health Conference Tie American Nurses Association and National Organization for Public Heath Nurses merged their interests and formed a joint committee in 1936 and the committee prepared a study guide on health insurance in 1937. In 1941 a study of the functioning of health insurance plans was made. Special effort was made to secure information on provisions for special duty nursing. Further data were secured in July of this year. The outline points out that with some 70 types of insurance or prepayment plans (including that provided by the Harmon Ass ciation for the Advancement of Nursing): Insurance or prepayment plans to cover illness in varying degrees should be available to the majority of nurses. The second conclusion is: Provision for special nursing under prepayment plans is apparently not feasible on an actuarial basis at the present charges made for most prepayment health insurance plans. Presumably a plan to provide special duty nursing could be set up on a sund actuarial basis, but the costs would make the service unattractive and the coplexities of special duty nursing would create very difficult administrative prob lems. [Reprinted from the American Journal of Nursing, vol. 44, No. 12, December 1944] IS PREPAID NURSING CARE POSSIBLE? Nursing service in prepayment medical care organizations Many nurses, recalling the lack of employment opportunities in the 1930's are asking, "What of the future?" what are the prospects of individual security when the war ends and the thousands of nurses newly trained to meet war needs are demobilized from service with the armed forces? How many registered nurses can earn an adequate living in the United States? 1 Rorem, C. Rufus: Nurses and Hospital Service Plans, American Journal of Nursing. vol. 41, p. 783 (July) 1941. *Miss Klem is Chief, Medical Economics Section, Bureau of Research and Statistics Social Security Board, and the author or coauthor of many articles and reports in the eld of medical, nursing, and health economics. Her most recent article for the Journal Whe Purchase Private Duty Nursing Services?, appeared in October 1939. The opinions pressed in this article are those of the writer, and do not represent the official views of the Social Security Board. |