Chairman HILL. It might promise well.

I notice, Doctor, that you are shaking your head in agreement. I am delighted. [Referring to Dr. Keefer.] I believe that we are all in agreement on this.

Secretary HOBBY. We are.

Chairman HILL. We are all in agreement. I hope that we may have that conference, that the President may call it, and we may have it right away. We are in agreement.

Senator BENDER. We are.

Chairman HILL. Now, another thing, too, Doctor, occurs to me. This is such an epochal development, I imagine that many of our friends across the sea will be watching us very closely in this matter. Is that not true?

Dr. SCHEELE. That is true.

Chairman HILL. Many of them will be asking us for vaccine; is that not true?

Dr. SCHEELE. That is true. The committee will be interested to know, also, at this very moment our staff back in our building is discussing the problem of the dissemination of information overseas, as well.

Chairman HILL. I think that might well be considered by your conference, too, because, surely, that is going to be a problem for those who are immediately and directly responsible in this matter.

Dr. SCHEELE. That is correct.

It is possible, you see, that we can send detailed information on the results of the trial and also the method of manufacture, that will be very valuable to these other countries, because many of them can probably produce some of this vaccine for themselves in due time. We understand that several countries are already in production. They were merely awaiting the result of the trial in the United States before beginning to market their product abroad.

Chairman HILL. Of course, they will be tremendously interested in watching everything that we do now about the distribution and the use that we make of it. I certainly hope that we will have that conference, Mrs. Secretary.

Secretary HOBBY. Thank you.

Chairman HILL. It is now 12:30. Is it agreeable to be back at 1:45?

Secretary HOBBY. Yes, sir.

Chairman HILL. Well, then, the subcommittee will stand in recess until 1: 45 o'clock.

Thank you very much, again.

Secretary HOBBY. Thank you.

(Whereupon, at 12:30 p. m., the subcommittee recessed, to reconvene at 1: 45 p. m. of the same day.)

AFTERNOON SESSION

Chairman HILL. The committee will kindly come to order.

I may say that we are delighted to have with us this afternoon the ranking minority member of the committee, and the former distinguished chairman of the committee, Senator Smith of New Jersey. It is nice to have you here.

Senator SMITH. Thank you, Mr. Chairman.

Chariman HILL. Mrs. Hobby, would you just proceed in your own way, please, with your testimony?

STATEMENT OF HON. OVETA CULP HOBBY, SECRETARY, DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE-Resumed

Secretary HOBBY. Thank you, Mr. Chairman.

I want to take this opportunity to thank the chairman and Senator Smith for your patience in letting us come back this afternoon to finish with this.

Chairman HILL. We appreciate your coming back.

Secretary HOBBY. With respect to practical nurses, however, the situation is considerably different. This difference results from a marked change in the qualifications and duties of the practical nurse that has come about in the last decade. In the past, the term "practical nurse" was commonly applied to an unlicensed group of workers-not clearly identifiable with widely varying skills and experience. Today, largely as the result of laws enacted during the last decade, 46 States have established licensing requirements for practical nurses. These laws provide that, as of specified dates, in the near future, new licenses will be issued only to applicants who meet statutory training require

ments.

The typical training program for practical nurses covers a 1-year period including 3 months of classroom and laboratory instruction and 9 months of supervised experience with patients in a hospital. The instructional staff of the school, composed principally of professional nurses, provides both the classroom teaching and the supervision of practice in the hospital.

These recent developments in the licensure and training of practical nurses have a twofold significance from the standpoint of the supply and utilization of nursing personnel.

First, the requirement of formal preparatory training as a basis for licensure enhances the value of the practical nurse as a member of the nursing team. Her basic training qualifies her to perform many skilled nursing services which would otherwise require the time of a professional nurse. Thus, an increase in the number of trained practical nurses offers great promise in relieving total shortages of nursing personnel.

Second, the very training requirement that adds to the competence of practical nurses is also the principal factor limiting increases in the supply of this type of nonprofessional nurse. From now on, increased supply can be achieved only through expanded training programs. It is essential, therefore, that we review the capacity and limitations of our existing practical nurse training institutions and programs. Some 400 training schools or programs are now in operation. About two-thirds of these are operated by public vocational education agencies, in cooperation with nearby public or private hospitals. In addition, there are some 150 practical-nurse schools operated by other agencies-usually large hospitals.

Chairman HILL. I realize this might be a difficult question to answer, because it might depend a good deal on the size of the training school or the program. You speak of the 400 training schools or programs now in operation.

Have you any estimate as to how many training schools or programs we really ought to have today to meet the need? I appreciate that might depend a good deal on the size of the particular schools. Secretary HOBBY. Mrs. Leone tells me about double.

Chairman HILL. About double, Mrs. Leone?

Mrs. LEONE. Yes.

Secretary HOBBY. The number of these schools or training programs may give a somewhat misleading impression of their total training capacity. In fact, these 400 programs combined graduated only about 7,000 students last year-an average of approximately 17 graduates per program.

These graduates are in great demand. Typically, there are 3 or 4 offers of employment for every graduate. There is a particular need for more trained practical nurses in chronic-disease hopsitals and nursing homes. In view of the increasing national need for such facilities which we discussed with your committee in connection with last year's extension of the hospital survey and construction program-this particular demand for practical nurses is a nationwide significance. Another limitation is the fact that training programs are not available in many parts of the country. For example, I State has no school in operation, and 6 States have only 1 school.

This factor of distribution or location of training opportunities has a special significance in practical-nurse training. Most of the students interested in such training are mature women, usually in their thirties, with family and other community ties. As a consequence, they are not a mobile group. They will enroll for training only when it can be obtained nearby. After their training is completed they usually accept employment in their home communities-often in the hospital where they obtain their supervised experience. To assure increased enrollment and an adequate distribution of trained personnel we must therefore give particular attention to the establishment of training programs in additional communities.

To summarize, Mr. Chairman, we have focused our proposal for increasing the nursing supply on the expansion of practical nurse training programs for the following reasons:

(1) The basic training of the practical nurse makes her the key nonprofessional worker-the one who can do most to release professional nurses for duties requiring advanced skills.

(2) There is a general shortage of trained practical nurses.

(3) These shortages can be overcome only by expanding enrollment capacities and by establishing new training programs in communities which do not have them now.

Title III of S. 886 would establish a program designed to meet these needs for additional trained practical nurses.

PRINCIPAL PROVISIONS OF TITLE III

The program proposed in title III is essentially an extension-with new emphasis of the existing Federal-State program of vocational education.

It will require little new administrative structure either in the Federal Government or in the States. Every State now has a vocational education agency, with a staff skilled in the administration of training programs which combine preemployment instruction with

supervised experience. Almost all of these State agencies have had some experience in the training of practical nurses.

The administration of the program by a single State agency assures the widest and most equitable distribution of training funds. It also offers assurance that the training will be of high quality and will be geared to State licensure requirements for practical nurses.

Specifically, title III would authorize a 5-year program of earmarked grants to the States for projects which would extend or improve their activities in the vocational training of practical nurses. Appropriations of $2 million would be authorized for this purpose for the first year of the program, $3 million for the second year, and $4 million for each of the remaining 3 years. These grant funds would supplement any existing grant funds now being used by the States for the training of practical nurses.

Funds appropriated for such grants would be allotted among the States on the basis of their respective populations. The minimum grant to any State would be $7,500.

For the first 2 years of the program the matching provisions of title III would require at least 1 State dollar for every 3 Federal-grant dollars. For the remaining 3 years, dollar-for-dollar matching would be required as in the existing vocational education grant programs. These matching provisions are designed to stimulate an immediate expansion of practical nurse training programs, and yet to assure sufficient State participation to provide a basis for later consolidation of this categorical program into the general State program.

State expenditures under the program would be made in accordance with an approved State plan. Most of the State plan conditions specified in section 303 are based upon provisions relating to existing programs. The only new feature is the requirement that—

the individual supervising the functions of the State board under the plan shall be a registered nurse or shall have the consultative services of a registered professional nurse available to him ***.

The number of these plan conditions has been kept to a minimum, and their terms will permit maximum flexibility in State operations. The program would be administered at the Federal level by the Commissioner of Education. In practice, of course, there would be close cooperation between the Office of Education and the Public Health Service-both being constituent units of the Department of Health, Education, and Welfare.

We believe that this intensive emphasis on practical nurse training for the next 5 years will result in a substantial expansion of existing training programs and in a continuing increase in the supply of trained practical nurses. According to our best estimates, it should increase the number of graduates from public vocational training programs from the present level of 5,000 per year to approximately 15,000 per year by the end of the 5-year period. By that time, we believe that practical nurse training will be so well established and developed in all States that categorical aid may no longer be required. I should now like to ask Mr. James H. Pearson-Director of the Division of Vocational Education in the Office of Education-to present some additional charts relating to the training and employment of practical nurses and showing how title III would help meet current shortages.

61995-55- -3

Chairman HILL. We will be glad to have you, Mr. Pearson, present these charts.

Mr. PEARSON. Mr. Chairman and members of the committee, this chart, Practical Nurse Training, Proposal Title III, shows first the "Purpose: To extend and improve practical nurse training." That is now operated by State boards for vocational education.

And the method to be used is making grants to States on a matching basis, with 75 percent of the cost to be paid from Federal funds the first 2 years, and then dollar-for-dollar matching basis on the next 2 years, as provided in the bill.

Also, it is proposed that there will be a grant of $2 million the first year, $3 million the second year, $4 million for each of the following 3 years.

In setting $2 million for the first year, it was assumed that is about the amount that the States would be in a position to use effectively and efficiently. We had the feeling that if they had a larger amount the first year that the States might not be in a position to match that money and there might be a very rapid growth the first year, rather than a gradual development over a period of years. And this change from $2 million, $3 million, and $4 million gives the States an opportunity to make a survey of the needs in their State, and where the program could be operated to be most effective.

(The chart referred to, entitled "Practical Nurse Training," appears in the prepared statement at p. 44.)

Mr. PEARSON. This chart, entitled "Practical Nurse Employment,” shows where the practical nurses are employed.

(The chart referred to appears in the prepared statement at p. 44.) Mr. PEARSON. About 60 percent are employed in general hospitals. They are usually employed in the hospitals where they are trained. About 10 percent of them are employed in the homes. About 6 percent, represented by this group, are employed in chronic hospitals and nursing homes.

The remaining 24 percent are employed in doctors' offices, industrial plants, and other establishments.

This clearly shows that the practical nurse graduate actually serves in the occupation for which they are trained and where there is a demand for their services.

The next chart is entitled "Vocational Education Programs."

(The chart referred to appears in the prepared statement at p. 45.) Mr. PEARSON. We have the vocational education program in existence in this country. This program was developed as a result of the Smith-Hughes Act of 1917, and the George-Barden Act of 1946.

These programs were developed to serve to train for positions in the fields of agriculture, distributive occupations, home economics, and trades and industry.

These programs are developed in these fields to meet the needs of persons who are going into those occupational fields.

Also, these programs meet the needs of the occupations requiring people with specialized training.

Recognizing a need of both the occupations and the needs for people with specialized training about 10 years ago practical nurse training was developed as a part of the trades and industrial education program. During the past 10 years much know-how with respect to the