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Now the second greatest need is for increased numbers of the several categories of nursing personnel. Included in this personnel is the practical nurse, the principal subject of the legislation being considered today. The practical nurse cannot be considered as a substitute for the professional nurse, but she is a very essential complement to the professional nurse in today's health services.

Recognizing the valuable contribution to practical-nurse education made by the United States Office of Education, and by the various State departments under their vocational education programs, the American Nurses' Association supports title III of S. 886. We urge that favorable consideration be given to the stated appropriation of funds for grants to States to enable them to extend and improve vocational education in the field of practical nursing. However, we believe certain additional safeguards should be included in the requirements which States must meet in order to qualify for Federal funds.

First, in the interest of sound-nursing education, a State plan should provide that the program be supervised by a qualified-registered-professional nurse. We recommend therefore that in section 303 (a) (2) the words “or shall have the consultative services of a registered professional nurse available to him” be deleted.

We further recommend that States be required to submit plans in which the programs for practical nurses meet the minimum requirements of State-licensing laws, including accreditation by the licensing agency where State law requires this.

I think that has been amply spoken to before today.

Chairman Hill. Do you lave a national accreditation agency, or not?

Miss Olson. No, we do not.
Chairman HILL. You do not have one?
Miss Olson. The State constituency accredits the program.
Chairman HILL. Yes.

Miss Olson. We also recommend that States be required to submit plans which include not only minimum qualifications for teachers, but provisions for preparing teachers where qualified persons are not available. We believe that, where necessary, a portion of the funds allocated should be used for educating registered nurses to teach practical-nurse students. Programs cannot be expanded, nor improved, without first increasing the supply of teachers competent to teach and to direct vocational programs in practical nursing:

Section 305 gives certain duties and powers to the Commissioner of Education including that of delegating certain functions of the practical-nurse program to employees in his Department, but makes no specific provision for the appointment of a registered professional nurse to the program on the national level.

The American Nurses' Association has long urged the appointment of a qualified specialist in practical nurse education to a position in the Office of Education. We now recommend that specific provision be written into the bill for professional nurse direction of the practical nurse program on the national level as well as in the States. We believe the present program suffers from the lack of professional nurse direction.

Beginning in 1949, the Public Health Service detailed a professional nurse to the Office of Education for 31/2 years. We believe the program

profited immeasurably from her services and have urged that this position become permanent in the Office of Education as long as that department administers a program in practical nurse education.

As this committee knows, there is a critical shortage of prepared nonprofessional nursing personnel in public mental hospitals. Experimentation is needed to determine whether or not it is possible to alter the present practical nurse curriculum in order to prepare persons to meet this great need.

We are pleased to find included in section 305 a provision for studies and investigations into matters relating to practical nursing. Should title III be enacted into law, we believe considerable study should be given to means of making practical nurse education fit persons to practice in the areas where the need is greatest: mental hospitals, nursing homes, and programs for the care of long-term illness.

The American Nurses' Association requests that favorable consideration be given to title III of S. 886 and to our recommendations for strengthening this bill. We believe this legislation presents the most satisfactory proposal for increasing the country's supply of trained nonprofessional workers in nursing. This bill would provide for expanding and improving an existing program of demonstrated effectiveness.

S. 929 appears to be a departure from the established role of vocational education in preparing nursing personnel. The American Nurses' Association does not support this bill where it goes beyond the provisions of title III of S. 886.

The on-the-job training of what is termed auxiliary hospital personnel is an essential function of employing agencies. During the past several years the National League for Nursing, the American Hospital Association, and the Public Health Service have conducted a successful project to help hospitals and related agencies to prepare members of their professional nurse staff to develop and conduct on-the-job training of nursing aids.

Through this project 139 teacher-trainers have been prepared in 15 regional workshops. These teacher-trainers have held 155 workshops in which they have prepared 1,143 instructors from 837 hospitals and nursing homes in 27 States. Employed by the institutions served to date by this program are 36,826 nursing aids, a very sizable progress in so short a time.

Chairman Hill. Quite a bit of progress. Yes, indeed.

Miss Olson. We believe the preparation of professional nurses for their responsibilities in the inservice training of nursing personnel to be the function of professional schools, and not the function of vocational education. Additional Federal funds to carry this activity in vocational education are not indicated. Rather the emphasis should be placed on meeting the urgent need for financial aid to increase the number of qualified professional and practical nurses.

Thank you very much,

Chairman Huli. You have no fear that this additional financial aid that you have just spoken of will in any way cause the States or cause the local communities to do less than they should do in meeting their responsibilities?

Miss Olson. I have every reason to believe that as has been stated before, that additional funds will provide added stimulus so that they can expand and improve the type of education now available. It has been amply stated before that there are various problems involved in the practical nurse's preparation that requires many centers in order that they will be prepared near their homes, and serve the communities in which they live. I think it would stimulate rather than detract.

Miss Marchant has a prepared statement from her Department of Education that she would like to leave for your committee members.

It can be put in the record and will give you further information on the specific question you have raised.

Chairman Hill. Good, that will go in the record following your statement.

Miss OLSON. Yes.

Chairman Hill. Do you have anything you would like to add, Miss Carroll?

Miss CARROLL. No.

Chairman Hill. You brought us most helpful information here today, splendid testimony, and we deeply appreciate you ladies coming

Do you have anything you would like to put in the record, Miss Carroll?

Thank you all very much. (The prepared statement of Miss Helen M. Marchant follows:)

STATE DEPARTMENT OF EDUCATION,

Hartford, Conn., April 12, 1955. Mr. Emmett O'Brien, Director, Division Vocational Services. By: Miss Helen M. Marchant, R. N., State supervisor licensed practical nurse

program and member of the interdivisional committee on practical nursing and

auxiliary nursing services, National League for Nursing. To: United States Senator Lister Hill, Chairman, Senate Committee on Labor

and Public Welfare.

Sir: Information has been received that the Congress of the United States is considering assistance, on a nationwide basis, to programs of practical nurse training conducted by State boards of education through departments of vocational education.

In our State we have been conducting a 1-year program of practical nurse training through the division of vocational services of the State department of education since 1942. It was organized to help meet the urgent social need for additional nursing care and was conducted in 1 vocational school in cooperation with 2 hospitals.

The graduates fulfilled expectations so well that expansion of the program was requested. We now conduct the program in 3 vocational schools and 5 hospitals. Of these four 'are general hospitals large enough to provide learning situations for both students in professional nursing and students in practical nursing. They include 3 nonsectarian and 1 Catholic hospital. The fifth is a smaller hospital without professional nurse students. Another center is being developed and will begin to function in September of 1956. Still another center has been requested and awaits consideration.

In addition to very acceptably meeting the original purpose of increasing nursing care manpower, opportunity is given to many individuals to practice nursing who would otherwise be unable to do so.

Our students include young women and a few men of 18 and older up to 50 years of age and in some instances beyond 50. There is, of course, no race or religious discrimination. We have found our older graduates surprisingly able and in as much demand for employment as the younger ones and are thus able to support themselves and contribute to society instead of being an additional responsibility to the State.

The department of education delegates the responsibility for the program through the division of vocational services to a registered nurse with a nursing education and administrative background. The rest of the faculty is composed of registered nurses with teaching qualifications and home economics in

structors, all on the staff of vocational education plus qualified registered nurse coordinators and instructors in the hospitals who are on the hospital staff and cooperate fully with the State supervisor of the State department of education program.

The division of vocational services is counseled in the development and scope of the program by an advisory committee composed of representatives of the State associations concerned, the State board of examiners for nursing, the State department of health and the public,

We believe this program is indicative of what can be accomplished through vocational education programs throughout the Nation. We know that it is a sound method of contributing additional safe nursing care to meet the urgent social need.

Chairman HILL. Mr. E. B. Whitten, executive director of the National Rehabilitation Association: Mr. Whitten.

Mr. WHITTEN. It looks like I am your cleanup witness.

Chairman HILL. Well, the Good Book says the last shall be first and the first shall be last. You are an old friend and we are most delighted we could have you this morning.

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STATEMENT OF E. B. WHITTEN, EXECUTIVE DIRECTOR, NATIONAL

REHABILITATION ASSOCIATION, WASHINGTON, D. C. Mr. WHITTEN. I am very glad I could come because I am interested in this very much as are all the members of our association. I have a statement I am going to file for the record and speak off the cuff.

Chairman HILL. We will have that statement go in the record in full.

Mr. WHITTEN. My reasons for being interested in this are twofold really. In the first place, as you know, inspired by legislation which was passed by this Congress last year, as well as inspiration from other sources, rehabilitation facilities are springing up all over the country, aimed to rehabilitate the handicapped.

These institutions are having more than average difficulty in getting people and when they are able to find nurses, orderlies and so forth to help them, very frequently it just means that they are taking them from some other facility and bringing them over to theirs, and therefore the total medical picture is no different.

Chairman Hill. Robbing Peter to pay Paul.

Mr. WHITTEN. Yes. We feel this program to train nurses through the vocational training program of the country is certainly a big step toward the solution of this shortage. We have this feeling, Senator, that the proper utilization of medical personnel is almost as important in this program as the training of additional personnel, that physicians are in many instances doing work that nurses were trained to do, nurses are doing work that orderlies and practical nurses could do just as well, and that the whole thing can be loosened up tremendously by an effective program for training practical nurses and other nursing or other auxiliary personnel. So that is the first reason for our interest.

Now, in the second place, we believe that these schools for training practical nurses and other personnel will be training resources for vocational rehabilitation divisions for training handicapped people.

1 Connecticut Licensed Practical Nurse Association, Connecticut State Nurses Association, Connecticut League for Nursing, Connecticut Medical Association, and Connecticut Hospital Association.

You

may know—I am sure you do—that the United Mine Workers is in the process of erecting a series of 10 hospitals in the coal-mining regions of Kentucky, Virginia, and West Virginia. The philosophy of this organization is that they want to place handicapped people in these hospitals wherever they can be used effectively.

In planning for this they are working with the Woodrow Wilson Rehabilitation Center and Vocational School at Fishersville, Va., in studying hospital jobs to see which ones handicapped people can do. They have found no less than 40 such jobs, and the vocational department of Woodrow Wilson School is attempting to train people to meet the needs of these particular hospitals when they open, and this will be in the fall and in the spring.

It is interesting to me to note some of the jobs that can be filled by severely handicapped people and I mention this particularly because I thought and think that one of the chief advantages of S. 929 over the other bill is the fact that it does broaden the base of the training to include more than just the practical nurses.

For instance, it was found that among the jobs for which people could be trained assistant laboratory technicians, laboratory helper, tissue technician, practical nurse, nurse's aid, or orderly, darkroom helper, baby-formula worker, occupational-therapy attendent, physical-therapy attendent, clinical technician, and so forth, which makes it appear there is a very broad opportunity for training under S. 929, and we think that provision is very important to retain.

We want to make one suggestion though with respect to the bill. We think that we are somewhat concerned about what is going to happen to the program during this first 2-year period if the States have to match their money dollar for dollar, with legislatures not in session in many of the States again for a 2-year period.

I hope that the committee as it drafts its own bill from these two will bear that in mind. One witness has already emphasized that this morning, but I don't think but one has mentioned this fact that there are going to be a good many States that cannot get into this program at all for 2 years, if they have to have straight dollar matching during this period of time.

Chairman HILL. Mr. Whitten, you realize that under S. 929, you would not have to do that under the first 2 years. Under S. 929 you have a 100-percent grant for the first 2 years and then after the 2-year period the matching provisions of the bill would become operative.

Mr. WHITTEN. Is that in the original print of that bill?
Chairman Hill. Yes; that is in S. 929.

Mr. WHITTEN. I am confused somehow. I thought that one of them had 25 percent for the first 2 years and the other was straight matching.

Chairman Hill. No; it is S. 929.

Mr. WHITTEN. Well, that meets my desire then on that, Senator, and I am glad that is true.

Chairman Hill. If you will look on page 9 of the bill, S. 929, it states:

Such payments to any State for any fiscal year ending after June 30, 1957, shall be made upon condition there will be provided from State or local funds, and so forth.

Mr. WHITTEN. Yes, I see.

Chairman Hill. In other words, up to June 30, 1957, the first 2 years no matching is required by State or local funds.

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