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Mr. WHITTEN. Well, that certainly is fine and I did not read it closely enough to detect that exception.

Well, Senator, that is all we have to say about it. We hope you will go right on through with this legislation because we think it is another big step that you are taking to solve this whole problem.

Chairman HILL. And you have watched these Federal-aid programs for some time, Mr. Whitten.

Mr. WHITTEN. I am familiar with most of them.

Chairman HILL. You are familiar with most of them. You have no qualms or fears, do you, about the Federal Government relieving the States or local communities of their responsibility ?

Mr. WHITTEN. Absolutely none. In fact my observation has been it always works exactly the opposite way.

Chairman HILL. Doesn't the whole record show that it works the opposite way? In other words, you are surprised at how much stimulation and encouragement will come from a small amount of Federal aid.

Mr. WHITTEN. That is the way I find it.
Chairman HILL. It is

very true. Mr. WHITTEN. Yes.

Chairman Hill. I sometimes say that Federal aid was priming the pump.

Did you ever live on a farm? Mr. WHITTEN. Yes. I think, Senator, everyone ought to have to prime a pump on a really cold morning to really understand that philosophy.

Chairman Hill. Then they would appreciate Federal aid a little Mr. WHITTEN. I believe they would.

Chairman Hill. They would appreciate farm life a little more, wouldn't they?

Mr. WHITTEN. Yes, they would.

Chairman Hill. As I said, you are an old friend and whenever you come to us you are very fine and very helpful, as you have been this morning. We deeply appreciate your being with us.

Mr. WHITTEN. Thank you very much.
(The prepared statement of Mr. Whitten follows:)

more.

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

REHABILITATION ASSOCIATION The National Rehabilitation Association is interested in this proposed legislation for two reasons. In the first place, the shortage of medical and allied personnel affect those institutions that are carrying on rehabilitation activities, just as it does general and specialized hospitals which do not include rehabilitation facilities, and we believe the legislation that is proposed will make an important contribution toward relieving this shortage. Although there is beyond doubt a serious shortage of physicians, nurses, and therapists, we are firmly convinced that the shortage would be much less, if professional personnel were practicing at their highest skills. The truth is that the physicians are doing work that nurses and therapists are trained to do, nurses and therapists are doing the work that practical nurses and orderlies could do as well. No group of professional workers deserves any particular censure for this situation. Although professional groups, for various reasons, have sometimes been reluctant to delegate responsibility to persons of lower skills, it has also been true that it has been difficult, and sometimes almost impossible, to get properly trained aids, and to train such people on the job presents many difficulties. Incidentally, we are told that Europeans make far greater use of auxiliary medical personnel than we do in this country.

We believe that a formally organized vocational training program for practical nurses and other aids is a way to get this needed personnel. It is logical that established vocational education agencies should organize and direct this training program and that the Office of Education should be the Federal agency to work with the States in carrying out Federal law.

Another reason we are interested in the legislation is that vocational education classes organized under the program will be training resources for rehabilitation agencies and will provide training opportunities for many handicapped people.

As members of this committee know, the United Mine Workers Welfare and Retirement Fund is in the process of establishing 10 hospitals in the coal mining areas of Kentucky, West Virginia, and Virginia. As a matter of philosophy, the organization has decided to make maximum use of handicapped people in staffing these new hospitals. In cooperation with the Woodrow Wilson Rehabilitation Center and Vocational School at Fisherville, Va., it has surveyed the types of jobs available in hospitals and found at least 40 that can be filled with persons of varying degrees of physical disability. Among them are a number for which training could be provided under S. 929. They include assistant laboratory technician, laboratory helper, tissue technician, practical nurse, nurses' aide or orderly, dark room helper, baby formula room worker, occupational therapy attendant, physical therapy attendant, clinic technician. The Woodrow Wilson Rehabilitation Center has already made arrangements to train workers for these and many other types of hospital jobs.

A hospital provides an excellent work environment for many handicapped persons, particularly those who require regular medical attention, as may be true of the epileptic, the diabetic, the paraplegic, etc. So we are extremely hopeful that the establishment of this new program of vocational education will offer new job opportunities for many handicapped persons.

With respect to the two bills before the committee, I would like to make a few comments. The purpose and content of the two proposals are so similar that it doesn't seem important which is used as a base for the committee bill. We strongly urge that the bill you report include the provision of S. 929 that specify that auxiliary hospital personnel can be trained under the act as well as practical nurses. We think this can be very important, particularly in areas where there is a concentration of hospitals and classes might be organized for training people for a number of auxiliary type jobs.

On the other hand, we feel that title II of S. 886 is more realistic with respect to financing the program in the beginning years, that is, if the programs are going to get underway in all the States as early as possible. Most of the State legislatures meet this year and will have made appropriations for vocational educational before this legislation is completed. In many States, appropriations are of the line-item type, which do not permit transfers from one item to another. Accordingly, there may be a number of States where State funds will not be available until the 1957-58 year. The way to get the program rolling the quickest would be not to require any Federal matching for the first biennium. If a 25-percent Federal share is required, as is provided in S. 886, it may be that local schools in a good many instances might provide the State share, until State legislatures have an opportunity to act. We believe that careful consideration should be given to this problem.

In conclusion, let me say that we sincerely hope that the committee will act promptly on this measure, for it is of great importance to the health and wellbeing of the American people.

Chairman Hill. The committee will now stand in adjournment.

(By direction of the chairman the following is made a part of the record :) NATIONAL ASSOCIATION FOR PRACTICAL NURSE EDUCATION, INC.,

New York, N. Y., April 13, 1955. To the Committee on Labor and Public Welfare:

GENTLEMEN: The National Association for Practical Nurse Education is the national accrediting agency for schools of practical nursing that meet its standards.

In this capacity the accrediting committee has had an opportunity to visit schools of practical nursing throughout the country and to work with thousands of trained and untrained practical nurses.

There is urgent need for more and better schools of practical nursing and for greatly increased enrollment. The financial support of the schools is a problem in every State.

Dr. A. P. Merrill, superintendent of St. Barnabas Hospital for Chronic Diseases, New York City, and a member of the Commission on Chronic Illness, states the situation as follows:

“Experts on chromic illness estimate that at the present time there are 28 to 30 million persons in the United States suffering from chronic disease, of whom over 25 percent are disabled by their ailment for at least 7 consecutive days in every 12-month period and that among these persons almost 2 million are chronic invalids with disabilities of over a year's duration. The country as a whole needs at least 200,000 well-trained licensed practical nurses."

As a professional nurse who has been engaged in promoting practical nurse education for the past 15 years, I feel it to be highly desirable that schools should be sponsored by more than one type of agency. Many superior schools are sponsored by nonprofit hospitals and community agencies. Therefore provision should be made for inclusion of these schools in Senate bill 929. It is a matter of grave concern that,

1. Schools with standards below a safe minimum are at present receiving State funds.

2. In many schools there is no person employed as director to supervise instruction, recruit students, maintain records, and interpret practical nurse service to the community.

3. Unprepared consultants have given advice resulting in substandard programs.

4. Equipment is below acceptable educational standards for nursing programs.

5. Schools exist with 3 or 4 students as their total enrollment. It is therefore urged

1. That State standards for practical or vocational education be sufficiently high to prevent these situations.

2. That scholarships be provided to prepare registered nurses to teach in schools of practical nursing.

3. That admission requirements insure students capable of successfully completing the program.

4. That student scholarship aid be available for all who can qualify.

5. That nursing-in-the-home experience be included in the curriculum to supply a reservoir of trained practical nurses available for employment by

private patients or by public-health agencies. Respectfully submitted.

HILDA M. TORROP, Executive Director.

FUNCTIONS OF THE NATIONAL ASSOCIATION FOR PRACTICAL NURSE EDUCATION 1. Maintains an accrediting program through survey services available to

(a) Practical nursi programs in States that do not have licensing laws and an approving authority.

(6) State-approved schools that wish to be identified as meeting NAPNE standards. 2. Provides consultation service to aid practical nursing programs during the planning stages, to advise on facilities, equipment, policies, curriculum, staffing, etc.

3. Carries on practical nursing curriculum research.

4. Prepares and publishes informational and educational materials for use in the practical nursing field. (See list of NAPNE publications.)

5. Prepares and publishes a manual for use as a guide in organizing practical nurse training programs.

6. Prepares and publishes semiannually a list of approved schools of practical nursing in the United States and its territories.

7. Plans and provides materials and resource personnel for institutes on practical nursing.

8. Promotes summer-school courses for directors and instructors in practical nursing schools, and for practical nurses.

9. Serves as a clearinghouse for practical nursing information in the United States and abroad.

10. Seeks funds for pilot experiments and demonstrations in the field of practical nurse education.

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11. Provides field service to practical nurse organizations in the interest of practical nurse education.

12. Publishes a bimonthly magazine on practical nursing affairs.

ANDERSON, S. C., April 12, 1955. Senator STROM THURMOND,

Senate Office Building, Washington, D. C.: Understand that hearings will be held by Senate Labor and Public Welfare Committee on S. 929 which is to provide aid to States in line of practical nursing and auxiliary personnel services to be conducted through vocational services of respective States. Would appreciate your support of the bill and your informing chairman of committee handling legislation of this telegram.

ROBERT C. O'BRIEN, ANDERSON MEMORIAL HOSPITAL.

PAWTUCKET, R. I., April 8, 1955. Senator THEODORE GREEN :

The Hospital Association of Rhode Island directly recognizes the urgent need throughout the country for additional practical nurses. Federal funds are sorely needed and are of great importance to promote the development of adequate sound effective programs. The hospitals of Rhode Island through the hospital association strongly urge your support for the prompt passage of S. 929, the bill to provide for aid to States in the field of practical nursing and auxiliary hospital personnel service, concerning which hearings are to be held by the Senate Labor and Public Welfare Committee.

The Hospital Association of Rhode Island urgently needs your support on this legislation and requests that you make this communication available to the chairman of the committee concerned with the legislation. The hospitals of Rhode Island are most appreciative of your interest and cooperation in the past and urge your continued support. With kindest regards.

ROBERT P. MATHIEU, Secretary.

GREENVILLE, S. C., April 21, 1955. Senator LISTER HILL,

Care Senate Office Building, Washington, D. C.: Will appreciate your support of bill S. 929. Great need for better facilities and advance courses.

LOUISE POTTER, President, Greenville County Association for Practical Nurses.

NEVADA STATE BOARD FOR VOCATIONAL EDUCATION,

Carson City, April 11, 1955. Hon. ALAN BIBLE, United States Senator, Senate Office Building,

Washington, D. C. DEAR SENATOR BIBLE: We have been advised that hearings will be held by the Senate Labor and Public Welfare Committee on S. 929, a bill to provide for aid to the States in the fields of practical nursing and auxiliary hospital personnel service.

The only school in Nevada which offers any kind of training for nurses is the Southern Nevada School of Practical Nursing which was organized by the State Board for Vocational Education in cooperation with the Las Vegas High School and the Southern Nevada Memorial Hospital in 1952. Thirty-five practical nurses have been graduated to date and another class of 17 is scheduled to complete the 12-month course about August 31, 1955.

The school has been financed almost 100 percent from Federal and State vocational funds allocated to the trade and industrial division. However, with the increased enrollment in other day and evening classes, it will not be possible to continue the school on that basis, and neither the Las Vegas School District or the Southern Nevada Memorial Hospital are in a position to give much, if any, aid toward financing the school.

A grant in Federal aid to Nevada for the promotion, organization, and maintenance of the practical nurse training program would help to insure the continuation of the present school. Additional funds could also be used to a good advantage toward organizing similar schools in other parts of the State. Any support that you may be able to give to S. 929 will be greatly appreciated. Sincerely yours,

JOHN W. BUNTEN,
State Director Vocational Education.

F. I. WALLACE,
State Supervisor trade and Industrial Education.

STATEMENT OF THE NATIONAL TUBERCULOSIS ASSOCIATION

Because it is acutely aware of the continuing shortage of nursing personnel throughout the country, the board of directors of the National Tuberculosis Association unanimously went on record at its meeting in February in support of title III Senate bill 886, and Senate bill 929 concerned with grants for training of practical nurses.

The National Tuberculosis Association, a voluntary organization composed of medical and lay persons interested in the control of tuberculosis for the past 51 years, has worked closely with nursing associations and hospital authorities for many years to attempt to utilize available personnel and resources to the best advantage of the tuberculous patient and his family. It has assisted in the conduct of studies regarding the nursing situation and has cooperatively worked out guides for staffing tuberculosis units for the promotion and improvement of nursing services.

According to most recent figures there are approximately 100,000 practical nurses most of whom are employed in general hospitals. Only about one-sixth of them are graduates of practical nursing schools. We believe that the proposed legislation which authorizes a program of grants to State vocational education agencies for the extension and improvement of practical nurse training will add to the nursing supply and hopefully believe that some of these might be diverted to take positions in tuberculosis hospitals.

The acuteness of the nursing shortage with respect to the care of tuberculous patients is attested to by the fact that while the nurse-patient ratio for general hospital patients has been bettered over the years as a result of the gradually increasing number of women entering the nursing profession and the ranks of practical nurses the ratio of nurses to patients in tuberculosis hospitals bas remained static for the past 20 years.

While it is difficult to establish a standard nurse-patient ratio for tuberculosis hospitals because of the changing picture in the functions of nurses, the type of nursing care required by medical and surgical tuberculous patients should be of the same quality as that found necessary for general medical and surgical patients.

In the treatment of the tuberculous patient, bed rest continues to be an essential feature requiring close nursing supervision of the patient. The advent of new drugs and the utilization of surgical procedures have added to the responsibilities of nursing personnel and increased the complexity of care requiring not only more nurses but better trained nurses. While the period of hospitalization for some tuberculous patients has been shortened to some extent because of the great strides made in medical research in tuberculosis, the length of hospitalization still runs on the average from 3 months to a year.

The professional nurse is responsible for supervision of all nursing care and for much of the instruction of the patient, his family, and his friends concerning the therapeutic and preventive program. In order to utilize to full advantage the skills of the professional nurse the services of the trained practical nurse become vitally important if physical care of the tuberculous patient is not to be neglected. Besides the routine physical care that every hospital patient needs, the practical nurse may also perform night duty in convalescent wards, be in charge of supply rooms, assist in treatment rooms, and in clinics.

In our opinion the best hope for improving the nursing situation in tuberculosis hospitals in the near future is by closing the gap between supply and demand for all types of nurses.

The NTA recommends enactment of legislation to provide grants for the training of practical nurses. We recommend that for technical assistance in the

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