hospital. A girl might aspire to a nursing carrer, but she applies for a job on the day that there is a need for a houseworker. She takes the houseworker job. This is the one offered to her. It is impossible for her to become a nursing employee unless she terminates and reapplies on a day that there is an opening in the nursing sector. On the lateral career ladder, it is possible for her to make that transfer on the basis of her knowledge of the hospital and so forth. This gives her some advantage over the entry level person. As our workers move up the career ladder, the vacancies are created at the bottom. It is to these entry level positions that we hope the Government will attract the hard-core unemployed. It is our experience that training is more important at the level above the entry level if we are to provide incentive and recruitment for the jobs at the bottom. This country has had a considerable amount of experience with training programs where there is a high percentage of dropouts. We feel that the higher percentage of dropouts was due to the fact that training was for broom-pushers and bed-makers. There is no incentive to stay on the job. We have found in our own program that for a 17- or 18-year-old boy to come into a program and begin training for a custodial job, and he looks around and sees men of 40 and 50 still working in that job, he realizes this is the only career that is being opened to him. It is impossible to keep that young man on the job. Whereas, if you say to him, as we have been able to in these jobs, that if you stay here for several months, you can apply for training for moving upward, you are providing an incentive and a means. You are making it possible for him to get training to move upward and he stays in that employment situation. The testimony of the hospitals where we have been with our program is that we have drastically reduced turnover. In our national program where we will train a thousand workers, we contract with the hospitals so that the worker takes the training during the regular working day, usually on a 4-hour release time basis, while receiving his full salary. The significance of attending class on the job while the worker is paid is great. These workers in the lower level jobs are usually characterized by one of two conditions: Either she is a woman who goes home after the job to take care of the family with several children or he is a man who is holding down a second job in order to make ends meet. As a result, there is not a good possibility for a low-wage-earning employee to attend training classes after working hours, even if such classes were made available. Training on the job at the regular salary is the only real opportunity that he has. For instance, the usual licensed practical nurse course demands that a candidate must attend training school full time for 1 year. Such a requirement is completely beyond the reach of most of the lower level workers in the hospital. A second provision of our program is a guarantee that the worker who is trained for a job will get it. We are becoming familiar with training programs which train workers for nonexisting jobs. In 1 such cases, the institution has the advantage of an apprentice who is paid by Federal funds, and when the training period is over the institution seeks another apprentice and here the newly trained worker is let go. Under our union program the vacancy is established first and then the worker is trained for the vacancy. A third principle of the union program is selection of trainees by a joint union-management selection committee. When outside workers are given the opportunity for training to a job above the level of the present employee, it results in a situation fraught with danger to job security and morale. In our program, when workers are selected for upgrading training, it is on the basis of seniority. Those workers who have been there longest and have established good work habits are chosen first. Hospitals were skeptical at first, but they have found this is a valid way to relieve personnel shortages. It is too soon to say what we think will be proven in the areas of recruitment and retention. We believe the workers given the opportunities for training and upward movement will not terminate their jobs at the present high rate, and as I say, since we wrote this, we have found the statistics bear us out. The normal turnover rate in hospitals today is startling. It runs 60 percent overall, 70 percent for registered staff nurses, 80 percent for aids, and orderlies, attendants, and 38 percent for licensed practical nurses. The direct cost of turnover is $300 per person. This is a staggering $324 million, based on number of employees. Senator NELSON. These percentages are per year? But with opportunity provided for advancement, the entry level jobs become more attractive. There is also problems of rigid, outmoded requirements. When there is job restructure, it is possible to view the job performance in terms of the tasks which are necessary for it, and to write the requirements for the job based on the performance, rather than on any abstract concept. It is not necessary to be a high school graduate for instance to sweep floors. It should be possible to set up equivalents in experience for a nurses aid to become a licensed practical nurse. I would like to digress briefly to point out that, except for some pilot projects in New York and California, the 1-year training required for a licensed practical nurse is required by every licensing board throughout the Nation. The nurses aid who has functioned in the hospital for 20 years and has performed every nursing task is not permitted to take the examination without the year's training. That puts her on a level with a young girl coming out of high school who has never set foot in a hospital. There is no equivalency for experience, nor is there any progression on any kind of ladder, though in many cases the tasks are precisely the same. According to a recent study by the National Planning Association, there are now more than 100,000 budgeted positions for nurses which Hospitals react to these shortages by assigning tasks normally performed by registered nurses to licensed practical nurses or nurses aids. Thus although it has been stated that an inadequate level of patient care requires fifty percent for the nursing staff to be licensed nurses and 20 percent aids, in some hospitals up to 80 percent of the nursing services are performed by nurses aids. are vacant. We have put emphasis on career ladders. Perhaps more important is the need to improve patient care. There is another reason for career ladders, and that is to relieve the shortages of manpower in the middle level personnel jobs. Let us glance at the figures in health manpower. These include a projected 100-percent growth in the occupations over the next decade. There will be an increasing emphasis on using subprofessional personnel to both increase efficiency and make up for the shortage of professionals. The proliferation of new occupations required by expanding technology, in terms of training, will require not only more training opportunities but an equal emphasis on curriculum modification to meet the learning needs of the under utilized and educationally disadvantaged labor supply. The changing occupational structure in the health service field is characterized by two major trends, substitution and specialization. These trends have resulted in the development of new occupations and new careers. According to the National Planning Association, "there are now more than 100,000 budgeted positions for nurses which are vacant. Hospitals react to these shortages by assigning tasks normally performed by registered nurses to licensed practical nurses or to nurse aides. Thus, although it has been stated that an adequate level of patient care requires 50 percent of the nursing staff to be registered nurses and only 20 percent nurse aides, in some hospitals up to 80 percent of the direct nursing services are performed by nurse aides." The increasing use of technology results in the developing of assistants in the form of medical technicians who specialize in diagnostic and monitoring equipment. More and more of the bedside patients care has been taken over by the nurse aide or licensed practical nurse and the record housekeeping functions are centered in other assistants. The function of the old-style registered nurse is now taken over by such workers as a dietician, a medical social worker, a center supply technical worker, a registered medical record librarian, a medical record assistant, a recreation therapist and volunteers, physical therapist, occupational therapist, operating room technician, surgical technician, licensed practical nurse, aide, orderly, volunteer, inhalation therapist, and biomedical technician. Even the personnel director interviews for employment in the Nursing Service where this used to be a function of the registered nurse. Again, according to the National Planning Association, the 591,000 professional nurses in 1962 will need to grow to 1,091,000 by 1975. Two hundred fifty-four thousand practical nurses will have to more than double to 575,000. Ten thousand dental hygienists must grow to 21,000; 25,000 lab technicians must become 46,000; 69,000 dental assistants must increase to 127,000; medical technicians will have to go from 35,000 to 72,000; medical X-ray technicians from 60,000 to 124,000. Other clinical and lab technicians from 66,000 to 135,000; 3,000 medical librarians will have to become 4,000; 458,000 hospital attendants will have to grow to 1,229,000. A total of nearly 2 million positions will be available if we are to reach these goals. These include nearly 700,000 at the junior college level, nearly half a million in 1 year of special training and 800,000 jobs for which less than 6 months special training is required. In 1967 there werre less than 20 programs each to train medical record technicians, medical record librarians, and dietician assistants in this country. The NPA report with which we thoroughly agree, goes on to state, "We must not assume that a sufficient manpower supply will exist just because jobs and training are available. Unless upward mobility is built into the entry level occupations, a dead-end, low-status, and low-paying job may have too many of the characteristics of servitude to attract the economically depressed nonwhite population." According to the Public Services career program general description issued by the U.S. Department of Labor in August of 1969 "many full-time workers could be classified as poor or near poor." Data for 1966 showed that 6.8 million persons worked 50 to 52 weeks per year but earned less than $3,000. We take issue with the basic allowance principle as proposed in S. 2838. This subsidy fails to guarantee inservice training on a continual basis to implement career ladders. In other words, so long as the institution receives Federal funding, it trains. When there are no Federal funds, it fails to train. There is no bonus to the institution for maintaining training. Further and far more importantly, the basic allowance principle handicaps the present low-income worker who is being asked to subsidize his own education and training at the rate of 60 percent the first year, decreasing to 50 percent in 1973. Most low-income workers cannot afford to cut their standard of living. Inservice training for professionals is at the present time wholly employer subsidized. If incentives must be provided to the employer so that he will arrange for inservice training, these incentives should not come out of the pocket of the employee. Rather than a stipend program we would prefer to see a program where the institution would be reimbursed for the costs of training the employee. Included would be salary time which was expended in the training period. However, such reimbursement would be made in the year following training in proportion to the amount of time that the upgraded employee spent in the new job. In orther words at the conclusion of the second year of employment the entire training course of the first year would be reimbursed. In connection with career ladders we would propose that training money for upgrading would be granted only on the basis that the institution submitted with its training proposal a career ladder implementation of one step above that job which is to be trained. Included in this proposal would be the curricula for the second step and the obligation to train as many people in the second step as have been upgraded in the first step. This would work somewhat as follows: Hospital A applying for training funds for 25 nurse aides would submit not only curriculum and plans for upgrading of the 25 nurse aides to seniors, but also curriculum and plans for upgrad ing 25 senior nurse aides to be trained for licensed practical nurse in the second year. Similarly funds for renewing the training in the second year for the 25 senior nurse aides and the upgrading of the 25 senior nurse aides to licensed practical nurse would include curriculum and implementation for upgrading 25 licensed practical nurses to registered nurse or whatever other steps might be included in a true career ladder. All training should be for positions where there are vacancies and satisfactory completion of training would guarantee the worker the job for which he is trained. All training should be given on paid time at the regular rate of pay at which the employee is reimbursed. We should insure seniority in the selection of employees and avoid leapfrogging which tends to wipe the opportunities for presently employed lower level personnel. Basic education should be a definite requirement of a training program, available for those workers who need it. Such basic education to include all of the academic skills of the job for which they are being trained. If we look at the figures in health manpower, which projects 100percent growth in the next decade, we would see a rather startling amount of growth required, and I am not going to read all of those figures for you, but I will say that there must be an increasing emphasis on using subprofessional personnel to both increase efficiency and make up for the shortage of professionals. The proliferation of new occupations required by expanding technology will require more training opportunities, and equal emphasis must be made on curriculum modifications to meet the learning needs of the under utilized labor. Substitution and specialization are two trends which will result in the devlopment of new occupations and new careers. Although we have dealt with health personnel, the same conditions of vacancies and the same dead-end jobs apply to much public service employment. The same guidelines that we propose for health could be applied to all other employment areas. Our union anticipates a new program next year in which we hope to develop career ladders in all phases of municipal employment. We believe that public service training must be implemented with opportunities for learning, training and advancement on the job, including academic as well as skills training. We believe this is the look for the future. When these opportunities are instituted for every job ladder, we believe that the true road upward and outward from poverty will have been established. Senator NELSON. Now in how many hospitals does your union have employees? Mrs. MILLER. We are working with three city hospitals in Boston, with three county hospitals in Cuyahoga County outside of Cleveland, and the nine State hospitals in Maryland, so we are trying city, State, and county systems to see how this would be applied. Senator NELSON. Do you find, in all hospitals where your union has been involved, that they do not have a career ladder system, so to speak, for progressing up to higher jobs? |