administration of the program, the supervision, teacher training, and actual instruction, both in the hospital and in the classroom, have been developed.

You will see that there were only, in 1954, out of the 3 million persons enrolled in these vocational education programs, about 5,500 practical nurse graduates. One of the reasons was because this program, which was relatively new, had to meet the competition of trades and industrial education, which had been established over a long period of years, and therefore only with this small number of the trades and industrial fund was used for practical nurse training.

Chairman HILL. When did that practical nurse training terminate?
Mr. PEARSON. It started really about 10 years ago.
Chairman HILL. It is dwindling; would you say?

Mr. PEARSON. It is increasing each year.

Chairman HILL. The practical nurse training is increasing?
Secretary HOBBY. But there still is not enough emphasis on it.
Chairman HILL. Not enough emphasis on it?

Mr. PEARSON. There has been a gradual increase in that.

Chairman HILL. It has been stepped up through the 10-year period; has it?

Mr. PEARSON. Yes. We will show a gradual increase in enrollment each year over this 10-year period.

Our next chart is entitled "Community Gets a Practical Nurse Program."

(The chart referred to appears in the prepared statement at p. 46.) Mr. PEARSON. Here are people in the community who decide that they should have a practical nurse training program to meet their needs. They make this known to the local board of education.

The local board of education makes an application for a program to the State board of vocational education.

The State board of vocational education is responsible for the regular vocational education program in the State.

The State has submitted a state plan for practical nurse training to the Office of Education, and that plan has been approved.

Then the Office of Education sends to the State board for vocational education its allotment of money for practical nurse training. The community operates the practical nurse training program, using the facilities of the schools and the hospital.

Then these persons are trained as practical nurses, and they go into the community for employment in the field for which training was provided.

The next chart is entitled "Goal of 5-Year Program."

(The chart referred to appears in the prepared statement at p. 46.) Mr. PEARSON. Goals have been set for the 5-year program provided in this bill.

Last year there were 5,500 graduates in practical nurse training. It is anticipated that at the end of the 5-year period there will be at least 9,500 additional graduates. This will give us at the end of the 5-year period an estimated 15.000 practical nurses graduating from these training programs each year, or by the end of 1961.

Chairman HILL. The acquisition of the 15,000 is dependent upon the present legislation; is it not? That is, the passage of this legislation?

Mr. PEARSON. I think it would.

Chairman HILL. That is your best judgment; in other words, you do not think we would get that number or would hardly hope to get that number under the program as we have it today? Experience would not justify any such optimism; would it?

Mr. PEARSON. No; because the thing that is holding back the program is the lack of funds for the development of the program. Chairman HILL. Thank you, Mr. Pearson.

You may proceed.

Secretary HOBBY. This completes our presentation of the objectives and provisions of title III, Mr. Chairman. Before concluding this statement, however, I should like to mention very briefly two related proposals which round out our program for Federal participation in the alleviation of nursing shortages.

Earlier in this statement I pointed out the need for a twofold approach: (1) Increasing the supply of nursing personnel, and (2) utilizing the available supply more effectively. Title III is aimed at increasing the supply. The two related proposals are directed primarily toward better utilization.

The first proposal, which requires no additional legislative authorization, is for an intensive program of Federal aid and participation in the development of improved methods for the utilization of available nursing skills. Our proposed budget for 1956 includes additional funds: (1) For studies and technical services by the nursing resources staff of the Public Health Service, and (2) for research grants and fellowships to stimulate nurse utilization studies and demonstrations by non-Federal organizations and individuals. We believe that this investment of Federal dollars in the development of improved administrative techniques will pay substantial dividends in the utilization of available nursing personnel.

The second proposal, embodied in title IV of S. 866, would authorize Federal traineeships to permit more professional nurses to take advanced training for supervisory, administrative, and teaching positions. The real key to more effective utilization lies in better supervision and administration. The value of specialized training for such positions is becoming increasingly recognized. A number of schools are now offering programs directed toward this end.

The principal obstacle to increasing the number of graduates of such programs is that comparatively few professional nurses can afford to leave their jobs for a year of full-time advance training. The traineeships authorized in title IV will therefore contribute substantially to increasing the number of nurses prepared for key administrative and training positions.

In summary, Mr. Chairman, we are faced with a serious imbalance between nurse supply and demand. There is no simple or easy solution to this problem. We believe, however, that the Federal Government can make an effective contribution (1) through special grants to extend training opportunities for practical nurses; (2) through the development of improved utilization methods; and (3) through traineeships to increase the supply of administrative and supervisory personnel. We therefore recommend enactment of title III of S. 886 and early consideration by your committee of the related provisions of title IV. Chairman HILL. With reference to title IV, do you not have the authority under the law, Mrs. Hobby?

Secretary HOBBY. We have the authority now, Senator Hill, as I remember and I will ask Dr. Scheele to correct me if I am wrong— for the traineeships, but not for the training of administrative professional nurses in these key jobs. Is that correct?

Dr. SCHEELE. Yes, we have some traineeships but not for nurses in these fields.

Chairman HILL. What is that?

Dr. SCHEELE. Nursing is not a category that we now have authority for. We have authority for cancer and heart, and other fields in which an institute has been established. We can train nurses in those fields, but we could not train nurses in the fields that we mention here, nursing supervision and teaching.

Chairman HILL. You have no authority for the practical nurse? Dr. SCHEELE. We have no authority for that either.

Chairman HILL. Or for what we term the graduate nurse?

Dr. SCHEELE. No.

Chairman HILL. Are there any questions?

Senator BENDER. I would like to ask a question.

Secretary Hobby, I notice that S. 929 includes both practical nurses and other auxiliary hospital personnel, while title III is limited to practical nurses. Does this mean that your Department is opposed to Federal aid for the training of other hospital personnel, or simply that you do not believe there is a comparable need for Federal assistance in the training of these other types of workers?

Secretary HOBBY. Senator Bender, we are not opposed in principle to Federal assistance for training other personnel.

As I recall these provisions--and I think I recall them adequately— the training of nursing aides does not lend itself to the vocational education program.

The training of practical nurses through this device or mechanism is really, as we brought out earlier, an extension, one which the States are now geared to do. I will be glad to have any of my colleagues comment on the technicalities of it, but I believe that you would find a very great administrative difficulty in trying to provide Federal aid for the training of most auxiliary hospital personnel. I would question the need for Federal aid where it is training on the job.

There is a distinction, as I hope I made clear this morning, between the training on the job and the year's training of a practical nurse, of 3 months in the classroom and laboratory, and 9 months in a hospital. I believe our facts are correct when we say that the greatest shortage of nurses is in the practical nurse field.

Mr. Chairman, I do not want to make a categorical statement here, unless some of my colleagues could support it, but if you will notice from the charts here, we have 150,000 nursing aides, attendants, and orderlies, and 41,000 practical nurses.

Senator Hill brought out when he asked Mrs. Leone the question as to this, that this 150,000 is not all of the nursing aides. That does not include the voluntary nursing aides, such as the Red Cross, in many communities, and many other organizations.

So we do not know the real figure. I suppose you could take the Red Cross nurse aides in hospitals across the country, and add them to this, but then you would not get a complete picture because there are women's organizations, as you know, throughout the country that do nursing aide work.

So I would say that the basic difference between the approach in title III and the approach in Senator Hill's bill is that we believe that the practical nurse training is a ready-made picture for the Federal program.

Senator BENDER. Another question that I would like to ask Secretary Hobby. I notice that S. 929, the practical nurses bill, would not require any State matching funds at all for the first 2 years, that is, no State is required to match funds for 2 years.

Do you believe that 100 percent Federal aid is necessary or appropriate to stimulate practical nurse training; in other words, why should the States not participate financially in the first 2 years?

Secretary HOBBY. Well, as a general proposition I do believe in Federal-State matching.

I think, too, there is something involved here that is quite important. I know I do not need to point it out to this committee, because all of you know it so much more accurately than I, but in watching, as I have over the past 22 years, what happens in Federal matching with States' funds, you watch the Federal program begin and then over a period of time the States pick it up. And in our assistance to States generally, I think you will remember, Senator Hill, in the appropriations last year, on the bars-how the States overmatch us now, I believe, in every category. Is that not true, Dr. Scheele ?

Dr. SCHEELE. Yes.

Secretary HOBBY. One of the things that I would consider essential here is that the States get in on this program as soon as they can and develop it as their own.

This, as you know, is for a 5-year plan.

Then I think this committee should review the effectiveness of this program and weigh what I call the leadership of the Federal dollar and see if it really has stimulated the expansion of nurse training programs. That is an essential difference, I would say.

Senator BENDER. Regarding the 5-year period, as I understand title III of S. 886, which is known as the administration bill, I believe -I think that is correct?

Secretary HOBBY. That is correct.

Senator BENDER. Authorizes categorical grant for a 5-year period only. A similar title, No. VI, contains a 5-year limitation on the categorical grants for mental health purposes.

As I understand it, this reflects the general policy that any categorical grant should provide for a periodic review to determine whether it should be continued on a categorical basis.

Is my appraisal of that correct?

Secretary HOBBY. Well, yes, if I might add one statement to it, Senator Bender. There is no doubt in my mind, and I believe it is the experience and the history of categorical grants that they place emphasis, stimulate action among the States. And so I am sure that is the best way to get a program started. I feel that the Congress should always review these things and see at what point the Congress could give greater flexibility in the operation of the State programs. That is the reason for the 5-year term here, whether it is 5 years or 4 years or 7 years. I think that it is the principle of reviewing a categorical grant which is always a sound one.

Senator BENDER. One last question. The State plan conditions specified in section 202, Senator Hill's bill, appear to be much more numerous and detailed than the comparable provisions of title III of S. 886.

Do you believe this more detailed enumeration is necessary or desirable?

Secretary HOBBY. Well, I believe that the provisions in Senator Hill's bill-I rely on the Senator to correct me if I am in error-were based on the vocational education bills that Mr. Pearson referred to, the Smith-Hughes Act, which I think was in 1917, and the GeorgeBarden Act.

Chairman HILL. There have been several amendments to the SmithHughes basic act.

Secretary HOBBY. Yes. And that does call for a more cumbersome State plan than the one we propose.

Chairman HILL. It would be more detailed, would it not?
Secretary HOBBY. Yes.

(Discussion off the record.)

Chairman HILL. Mrs. Hobby, I want to go back for one instant to S. 849. You heard Senator Bridges' testimony this morning? Secretary HOBBY. Yes, sir.

Chairman HILL. That is the research facilities bill.

Do you not feel there is a need for grants for research facilities? Secretary HOBBY. Senator, as you know, we have reported on S. 849. I think I can read our general conclusion to you more expertly than I can tell it to you, and certainly in fewer words.

The question that we raised on the authorization of $30 million for research construction said that in the light of all the relative priorities of need in the health field in general, and in the field of medical research in particular, we are unable to concur in the implication of S. 849 that annual appropriations of $30 million for construction grants alone are necessarily justifiable for the next 3 fiscal years.

May I just go back and highlight the report in the areas that we commented favorably upon and in the areas that we commented adversely upon?

One, the consolidation of the existing categorical authorizations for research grants, which was a favorable comment.

Two, on the creation of a single national council on medical research. to review grant applications. This is very sound, indeed, in our opinion.

Chairman HILL. You approve of that, as you did the former? Secretary HOBBY. Yes. And the addition of some statutory requirement that the Federal-grant funds be matched by some nonFederal funds.

Now the areas in which we commented adversely, Senator Hill, were (a) the regional geographical allocation provision dividing the country into four statutory regions; (b) the mandatory, rather than the discretionary phraseology of the Surgeon General's authority to make grants; and (c) the one that I have just read to you which we would have to say in the light of all of the knowledge that we could not say that necessarily the $30 million was justified for research grants.

Chairman HILL. Do you feel that some aid is justified even if it not be in the amount of $30 million a year for the next 3 years?