U. S. Congress. | House. Comm, on inter! state and foreign Commercl Recruting. I RECRUITING AND TRAINING OF NURSES HEARING BEFORE A SUBCOMMITTEE OF THE COMMITTEE ON INTERSTATE AND FOREIGN COMMERCE HOUSE OE REPRESENTATIVES SEVENTY-EIGHTH CONGRESS FIRST SESSION ON H. R. 2326 A BILL TO PROVIDE FOR THE TRAINING OF NURSES FOR THE ARMED FORCES, GOVERNMENTAL AND CIVILIAN HOSPITALS, HEALTH AGENCIES, AND WAR INDUSTRIES, THROUGH GRANTS TO INSTITUTIONS PROVIDING SUCH TRAIN- ING, AND FOR OTHER PURPOSES MAY 6, 1943 Printed for the use of the Committee on Interstate and Foreign Commerce UNITED STATES GOVERNMENT PRINTING OFFICE WASHINGTON ; 1943 86366 COMMITTEE ON INTERSTATE AND FOREIGN COMMERCE CLARENCE F. LEA, California, Chairman ROBERT GROSSER, Ohio ALFRED L. BULWINLKE, North Carolina VIRGIL CHAPMAN, Kentucky LYLE H. BOREN, Oklahoma MARTIN J. KENNEDY, New York LINDLEY BECKWORTH, Texas THOMAS D’ALESANDRO, Maryland FRANCIS J. MYERS, Pennsylvania J. PERCY PRIEST, Tennessee OREX HARRIS, Arkansas GEORGE G.iSADOWSKl, Michigan RICHARD f: HARLESS, Arizona JOHN P. NEWSOME, Alabama CHARLES A. HALLEGE, Indiana PEHB G. HOLMES, Massachusetts K. CARROLL REECE, Tennessee CARL HINSHAW, California CLARENCE J. BROWN, Ohio EVAN HOWELL, Illinois HARVE TIBBOTT, Pennsylvania LEONARD W. HALL, New York THOMAS D. WINTER, Kansas JOSEPH P. O’HARA, Minnesota Elton J. Layton, Clerk F. P. Randolph, Assistant Clerk ALFRED L. BULWINKLE, North Carolina, Chairman Subcommittee THOMAS D’ALESANDRO, Jr., Maryland FRANCIS J, MYERS, Pennsylvania J. PERCY PRIEST, Tennessee B. CARROLL REECE, Tennessee CLARENCE J. BROWN, Ohio HARVE TIBBOTT, Pennsylvania II CONTENTS Statements of— Pase Bolton, Hon. Frances P., Member of Congress from the State of Ohio. 7, 30 Parran, Dr. Thomas, Surgeon General, United States Public Health Service, Federal Security Agency 13 McAfee, Brig. Gen. Larry B., Acting Surgeon General, United States Army 18 Wolfe, Miss Anna D., director of nurses, Johns Hopkins School of Nursing, Baltimore, Md 19 Munger, l3r. Claude W., director, St. Lukes Hospital, New York City, representing the American Hospital Association 21 Gosstray, Miss Stella, president, National League of Nursing Educa- tion, Boston, Mass 25 Davison, William C., dean, Duke University School of Medicine, Durham, N. C 27 James, Mrs. Henry, chairman, women’s board, Bellvue Hospital School of Nursing, Nesw. York City, N. Y.„ m „ 28 Haupt, Miss Alma C., executive secretary, subcommittee on nursing of Health and Medical Committee, Federal Security Agency 29 Butler, Eugene, assistant director, legal department of National Catholic Welfare Conference, Washington, D. C 31 Odom, Edward E., solicitor, U. S. Veterans’ Administration 33 Communications submitted— Hon. Paul V. McNutt, letter from, relative to proposed bill 2 Resolution of board of trustees, American Hospital Association 21 Resolution of National League of Nursing Education 26 Resolution of executive committee of the board of directors of the National Organization for Public Health Nursing 29 Catholic Hospital Association of the United States and Canada, state- ment on behalf of 31 Brig. Gen. Frank T. Hines, Administrator, Veterans’ Administration, letters from 34, 35 Group off telegrams and tetters inserted bythe chairman (in addenda at end of oral statements during hearing) 37 Text of the bill, H. R 2326 1 Amendments proposed— By Dr. Thomas Parran 16, 17 By American Hospital Association 22 By Mr. Edward E. Odom 34, 34 III RECRUITMENT AND TRAINING OF NURSES THURSDAY, MAY 6, 1943 House of Representatives, Subcommittee of the! Committee on Interstate and Foreign Commerce, Washington, D. C. The subcommittee met, pursuant to call, at 10 a, m., in the commit- tee room, New House Office Building, Hon. Alfred L. Bulwinkle presiding. Mr. Bulwinkle, The committee will come to order. The Subcommittee on Public Health of the Committee on Interstate and Foreign Commerce, will consider in open hearings H. R. 2326, a bill introduced by Mrs. Bolton of Ohio, to provide for the training of nurses for the armed forces, governmental and civilian hospitals, health agencies, and war industries, through grants to institutions providing such training, and for other purposes. (The bill H. R. 2326 is as follows:) [H. R. 2326, 78th Cong., 1st sess.] A BILL To provide for the training of nurses for the armed forces, governmental and civilian hospitals, health agencies, and war industries, through grants to institutions providing such training, and for other purposes Be it enacted by the Senate and Home of Representatives of the United States of America in Congress assembled, That for the purpose of assuring a supply of nurses for the armed forces, governmental and civilian hospitals, health agencies, and war industries, there is hereby authorized to be appropriated for the fiscal year ending June 30, 1043, and for each fiscal year thereafter, sums sufficient to carry out the purposes of this-Act. Such sums shall he used for making payments to schools of nursing or other institutions which have submitted, and had ap- proved by the Surgeon General of the Public Health Service (hereinafter referred to as the Surgeon General), plans for nurses’ training, and for all necessary expenses of the Public Health Service in administering the provisions of this Act. Seo. 2. A plan for training of nurses may be limited to student-nurse training, or to postgraduate or refresher-nursing courses, or may include both. A plan submitted by any institution may be approved only if it provides— (a) That no student or graduate nurse will be included under the plan unless in the judgment of the head of the institution such nurse will be available for military or essential civilian services for the duration of the present war, and such nurse so states in her application for inclusion under the plan ; (b) That nurses under the plan will be provided courses of study and training meeting standards prescribed by the Surgeon General; (c) That the institution will furnish student nurses under the plan (without charge for tuition, fees, or other expenses) courses of study and training, uni- forms, including street uniforms, and maintenance in accordance with regulations of the Surgeon General; (d) That the institution will pay student nurses under the plan a stipend at not less than the following monthly rates: $15 for the first nine months of study; $20 for the following fifteen to twenty-one months of combined study and practice, depending upon the curriculum of such institution; and 2 RECRUITING AND TRAINING OF NURSES (e) That the institution will either afford student nurses under the plan an opportunity to complete their course of training until graduation at such institution and will pay such student nurse a stipend at a monthly rate not less than $30 for the period following the period of combined study and practice and prior to graduation, or will transfer such student, after completion of the period of combined study and practice and prior to graduation, for training in some other institution, but only if such training may he credited toward graduation, and the institution to which the nurse is transferred agrees to pay her a stipend at a monthly rate of not less than $30 until graduation. Sec. 3. (a) From the sums appropriated therefor the Secretary of the Treasury shall pay each institution, with a plan approved under section 2— (1) with respect to items furnished student nurses thereunder, amounts determined by the Surgeon General to compensate such institution for— (A) reasonable tuition and fees for the courses of study and training; (B) reasonable maintenance provided pursuant to section 2 for the first nine months of their course of study and training; (C) uniforms and insignia, provided in accordance with section 2; and (D) the minimum rate of stipend specified in section 2 for periods prior to completion of the course of combined study and training referred to in such section: and (2) with respect to items furnished graduate nurses thereunder, amounts determined by the Surgeon General to compensate such institution for reasonable tuition and fees for postgraduate and refresher course of study, and reasonable maintenance for graduate nurses undertaking postgraduate courses, or such portion of such amounts as may be determined in ac- cordance with regulations of the Surgeon General. (b) Determinations by the Surgeon General under this section of amounts which any institution shall receive shall he conclusive upon such institution and upon the General Accounting Office. Sec. 4. The method of computing and paying the amounts referred to in section 3 shall be as follows: (a) The Surgeon General shall from time to time, on a prepayment or re- imbursement basis, estimate or make determination of the amount for each institution, which amount shall be reduced or increased, as the case may be, by any sum by which he finds that unadjusted payments with respect to any prim- period were greater or less than the amount which should have been paid to such institution pursuant to section 3 for such prior period, and shall certify the amount so estimated or determined and so reduced or increased to the Secretary of the Treasury. (b) The Secretary of the Treasury shall thereupon through the Division of Disbursement of the Treasury Department and prior to audit or settlement by the General Accounting Office pay the institution at the time or times fixed by the Surgeon General the amount so certified. Seo. 5. In lieu of payment therefor under section 3 (a), the Surgeon General is authorized to procure and provide insignia for student nurses under a plan approved under section 2. Sec. 6. The Surgeon General with the approval of the Federal Security Ad- ministrator is hereby authorized to promulgate such rules and regulations as may be necessary to carry out the purposes of this Act. Mr. Bulwinkle. The committee has 2 clays set apart for this hear- ing, today and tomorrow. Of course, if we can finish it in 1 day, so much the better. If we cannot we will go over until tomorrow morning at 10 o’clock. I would like to submit the following letter for the record; Feukrat, Security Agency, Washington. March 29. J9J/S. The Speaker, House of Representatives. Washington, D. C. Dear Mr. Speaker : I wish to submit for the consideration of the Congress the enclosed draft of a proposed bill to provide for the training of nurses for the armed forces, governmental and civilian hospitals, health agencies, and war industries, through grants to institutions providing such training, and for other purposes. RECRUITING AND TRAINING OF NURSES' 3 I am also enclosing in support of this proposal the following exhibits: Exhibit A, proposal to meet wartime nursing needs; exhibit B, plan for a student war nursing reserve approved by the health and medical committee; exhibit C, state- ment showing estimated cost to the United States Public Health Service for the fiscal years 15)44, 1945, and 194t>; exhibit D, statement showing estimated cost of preparation of 100 student nurses by years, subdivided to show the cost to the Public Health Service and to the school or hospital which will provide the training. These exhibits explain in considerable detail the need for the enactment of the suggested legislation. I am convinced of its necessity and request that it be referred to the appropriate committee of the House of Representatives for consideration. I have been advised by the Bureau of the Budget that there is no objection to the submission of this proposal to the Congress. Sincerely yours, Paul V. McNutt, Administrator. Exhibit A.—Propose to Meet Wartime Nursing Needs A serious shortage of nurses both for civilian and military needs exists in this country today. With the increasing competition for womanpower, this short- age will rapidly be aggravated. The situation is such as to threaten a collapse of nursing care for the civilian population. There is doubt that the needs of the armed forces can be met. Nursing care in civilian hospitals has deteriorated to a dangerous level. These hospitals are carrying a peak load of patients. Some hospitals have closed sections because of nurse shortage. Among these are Harper Hospital, Detroit; City Hospital, Baltimore; Glendale, District of Columbia; Postgraduate, Philadelphia; Sydenham, Baltimore; and Strong Memorial. Rochester, N. Y. Unless prompt action is taken to deal with the problems in a comprehensive way, the war effort will be imperiled. This problem has been given careful consideration during recent months by the hospital authorities and the professional nursing organizations in consultation with the governmental agencies concerned. A plan (exhibit B) has been developed which meets the approval of the hospital and nursing groups and has been endorsed by representatives of the Army, Navy, and Public Health Service. Formal endorsement of a plan for the establishment of a ‘‘Student War Nursing Reserve” has been given by the Health and Medical Committee of the Office of Defense Health and Welfare Services. It is proposed that all student nurses in approved schools enrolled from January 1, 1941, be eligible for enlistment in the proposed reserve; that they obligate themselves to make their services available after graduation for the armed services or for civilian nursing work essential to the war effort; that tuition and a small monthly stipend be paid to enrolled students and that the schools of nursing speed up and shorten the period of training. To accomplish these purposes it is recommended; 1. That there be established by the United States Public Health Service a Student War Nursing Reserve, in order to assure a supply of nurses for the Army and Navy, for other governmental and civilian hospitals and health agencies, and for the war industries. 2. That student nurses enrolled since January 1, 1941. and hereafter enrolled in approved schools of nursing, which are willing to participate, be eligible for membership in the Student War Nursing Reserve. 3. That members of the Reserve agree to make their services available—after a training period of 24 to 3ft months—to the military forces, to other Federal agencies, and civilian nursing services as needed, for the duration of the war and 6 months thereafter. 4. That the members be classified in three grades, viz, junior grade, senior grade, and-cadet, be authorized to wear a distinctive insignia and uniform and be paid a monthly stipend while in training. During the fiscal year 1942, the Congress appropriated $1,800,000 and during the current fiscal year $3,r»00 000 to the Public Health Service for the training for nurses (national defense). Under this authorization, 309 basic schools of nursing are being aided in proportion to the increased admissions in each school over the pre-war level. As a result, 11.911 additional student nurses have been admitted to schools of nursing. In addition, aid has been given to inactive nurses to take refresher courses and to other graduate nurses for postgraduate training. (See table I.) 4 RECRUITING AND TRAINING OF NURSES The goals which were possible within the limits of the available appropriation have been reached. However, it is believed that the same plan and a similar amount of money next year will not meet the needs because— 1. The competition for womanpower is becoming very acute. The women’s auxiliaries of the military forces and war industries are attracting many of the women who would ordinarily enter schools of nursing. The Employment Se- curity Review for December 1942, indicates: Women needed for war industries, 2,COO,000 to 2,500.000; women needed for nonwar industries, 1,000,000; women’s auxiliaries of the military forces, 200,000. While it is estimated that there are 7,000,000 women in the country who would be available for full-time work, potential candidates for nurse training are limited largely to girls between IS to 21 years of age who have graduated from high school, and who are physically tit for this strenuous career. It is estimated that 95 percent of all admissions to schools of nursing come from the ranks of girls graduating that year from high school. In 1910 the total number of girls graduating from high school was 643,793. Normally only 10 percent of these complete a college education. It is in this limited group of high school and college graduates that there is the greatest competition for employment in other types of war work. 2. In normal times, girls have been willing to pay for the cost of nurse training. Under present and prospective competitive conditions, they will not and cannot be expected to so so when opportunities are offered for many types of war service with pay during training. 3. The current plans of the Army and Navy to enlist male students and con- tinue their training in college and medical schools and the active recruitment campaigns of the Army and Navy for physically fit young women in the auxiliaries point to the need for governmental action on a comprehensive scale if those skills needed in wartime are to be produced in sufficient numbers. Unless a com- prehensive plan for aiding students in schools of nursing is put into effect promptly, it is certain that enrollments this year will drop below pre-war levels. It is probable that enrollments will drop to only a fraction of such levels. 4. The current Public Health Service plan for nurse training was based on the incentive principle, viz, schools receive assistance in training nurses in excess of their pre-war numbers. This plan worked satisfactorily during the past 2 years. It was conceived at a time when the maximum strength of the armed forces was estimated at 3,000,000. The situation now is changing so radically that a different approach is imperative. 5. Only 80 percent of the admissions which were expected in federally aided schools for the spring classes materialized. 6. Only 67 percent of the planned spring admissions in all schools materialized. 7. In the federally aided schools of nursing admitting February classes in 1942 and 1943, there was a 10.4 percent reduction in the February 1943, admis- sions as compared with the February 1942, admissions. If an appropriation could be made available immediately, the prospects are excellent for attracting a considerable number of the high school graduates and college students who will be available early in May (because of the accelerated high school and college programs). It is thought that the new plan will attract young women because: 1. Uniforms, insignia, and organized Government service will attract young women who would otherwise be attracted to other employment. 2. The stipend, while small, will make it possible to pay for all personal expenses in connection with a nursing education. 3. The opportunity to enter military service in 24 or 30 months instead of the usual 36 months will attract additional students. 4. The stipend during the cadet period plus provision for full maintenance will offset to a degree the high salaries paid by industry. 5. The plan makes it possible to receive an education for a life profession. The proposed bill also authorizes appropriations for refresher and post- graduate nursing courses. The authority for such courses has been included in the Federal Security Agency Appropriation Acts for the fiscal years 1942 and 1943, and the Budget for 1944 proposes an appropriation for this purpose. These appropriations are a part of the appropriation entitled “Training for Nurses, Public Health Service, National Defense.” Because the need for addi- tional teachers in schools of nursing and in the field of public health is very acute, it is proposed that this program be continued along the lines heretofore followed. RECRUITING AND TRAINING OF NURSES 5 Table I.—Nursing education goals and achievements in accordance with Federal appropriations granted to the Public Health Service 1942, appropriation Deficiency appro- priation 1943, appropriation Total Antici- pated Actual Antici- pated Actual Antici- pated Actual Antici- pated Actual Refresher Basic Postgraduate Total, students 3.000 3, 000 1.000 7,000 2,160 2,487 1,296 5,943 3,800 759 4, 559 140 3, 755 910 4,805 3,200 5,000 1,250 9,450 1,362 5,669 2,116 9,147 6, 200 11,800 4, 259 22, 259 3,662 i 11,911 4, 322 19, 895 1 Increase over 1940. As of Feb. 1, 1943. Exhibit B. Plan for the Organization of a Student War Nursing Reserve A Student War Nursing Reserve is to be organized to meet the present critical shortage of nursing service in military, other governmental, and civilian hospitals and health agencies. The reserve will attract well-qualified young women to nursing because it recognizes the student nurse as one who has been summoned by the Government for essential wartime services and provides funds for her training and personal expenses. The usual 36-month program will be adjusted so that all the essential courses, including required clinical experience, will be com- pleted in 24 to 30 months, making the student available for full-time nursing service under supervision during the last 12 or 6 months in approved civilian or military organizations. In brief, the establishment of the Student War Nursing Reserve will— 1. Aid in the recruitment of well-qualified young women for schools of nursing. 2. Make possible the further expansion of schools of nursing by providing increased clinical facilities in existing governmental and civilian hospitals not now operating schools of nursing. 3. Increase the availability of nursing service by providing a pool of cadet nurses (third-year students) to replace the large number of general staff nurses who have gone or will go to war. 4. Meet the housing shortage, which is one of the most serious handicaps to a further expansion of our schools of nursing, by enabling the third-year students to vacate dormitory facilities. Any school of nursing which meets the requirements outlined in the regulations of the Surgeon General, Training for Nurses (national defense), may participate in the plan, provided the curriculum of that school is adjusted in accordance with the suggestions for acceleration made by the subcommittee on nursing of the health and medical committee, Office of Defense Health and Welfare Services, and the National Nursing Council for War Service. The hospitals and agencies to which the cadet nurses are assigned must provide supervised experience accept- able to the school of nursing and the State board of nurse examiners. Assign- ment of students during the cadet period shall be made by the school in accordance with minimum standards as established by the appropriate governmental agency. Schools adopting either of the following plans (or modifications of these plans which are acceptable to the Public Health Service) will retain authority for the selection, promotion, and graduation of students according to their own policies. Any student who enrolled in one of these schools after January 1, may elect to become a member of the Student War Nursing Reserve. Each student must agree to serve wherever needed for the duration of the war and 6 months thereafter. To be eligible for membership each student must be physically fit and must maintain a satisfactory scholastic standard throughout the program. As evidence that she is in training for national service, she shall wear a distinc- tive street uniform with appropriate insignia during the period of training. The insignia will also be worn on the left sleeve of the indoor uniform. Membership in the Student War Nursing Reserve shall be voluntary. It is conceivable that every eligible student might elect to become a member. Upon completion of the training period and registration in their respective States, the nurses either will enter the armed forces with the full rank and pay REQUIREMENTS FOR PARTICIPATION 86366—43 2 6 RECRUITING AND TRAINING OF NURSES of a second lieutenant or ensign or will be assigned, by the appropriate Govern- ment agency, to other governmental or civilian nursing services essential to the war effort. Exhibit C. Student War Nursing Reserve Estimated cost to United States Public Health Service for 3 fiscal years Class Cost per student 1944 1945 1946 Number in class Total cost Number in class Total cost Number in class Total cost 24-month curriculum,,. Third year (cadet). Second (year sfenior). First year (junior).. Total > $1,230 18, 000 as, ooo 50.000 2 $1, 260, 000 / 11,220,000 \ 2 2, 310, 000 44,500,000 30, 525 } 40,000 55,000 37, 000 44,000 60. 000 340 890 $13, 600,000 48.950,000 $14, 960, 000 53, 400.000 101,000 59, 290,000 587 125, 525 62, 550,000 498 141, 000 68, 360,000 485 Average cost per stu- 30-month curriculum,.. Third year (cadet), Second year(S3nior). First year (junior) ,. Total ,, i 1, 250 135 275 840 18.000 33.000 50.000 f 2,430,000 \ 21,280,000 f 9,075,000 \ 2 2,310,000 42,000,000 | 30,525 } 40,000 55,000 4,375, 125 11,000,000 46, 200,000 37.000 44.000 60.000 4,995,000 12,100,000 50,400,000 101,000 57,075,000 565 125, 525 61, 575,125 491 141,000 67,495,000 479 Average cost per stu- 1 Total erst to the Public Health Service for 1 student for total training period. 2 In 1944 outdoor uniforms at approximately $70 each must be provided for 18,000 third-year students and 33,000 second-year students. Thereafter all uniform costs occur in cost of first-year studentsonly. Estimated cost of preparation of 100 student nurses, by years Exhibit D First year Second year Third year Total Public Health Service School or hos- pital Public Health Service School or hos- pital Public Health Service School or hos- pital Public Health Service School or hos- pital 24-month curriculum: Maintenance at $45 per month (Public Health Service first 9 months) ... _ $40, 500 IS, 000 $13, 500 $54,000 $54, 000 $40,500 25,000 $121,500 Instructional costs . . $10, 000 7, 500 9,000 5,000 21,500 14,000 14,000 2, 500 7,500 1,200 2,500 1,200 4, 900 10, 000 36,000 Classroom facilities. . 19, 500 24,000 36,000 43, 500 89, 000 31,000 34,000 66, 700 96, 200 123,000 193,900 30-month curriculum: Maintenance at $45 per month (Public Health Service first 9 months). 40, 500 15,000 13, 500 54, 000 54,000 40, 500 20,000 121, 500 3, 500 $1, 500 Clinical supervision 7.500 6,000 2.500 7.500 9,000 5,000 21, 500 5,000 4, 900 10,000 18,000 Uniforms, books, ct cetera 9,009 9, 000 Clerical services, et cetera 1, 200 2,500 1,200 Classroom facilities.. _ ... . Stipends to students 19,500 24, 000 12, 000 18,000 55, 500 Total .... 84,000 36, 000 27, 500 66,700 13, 500 78, 200 125,000 180,900 Mr. Bulwinkle. The first witness that I shall call will be the gen- tlewoman from Ohio, Mrs. Bolton, author of the bill. RECRUITING AND TRAINING OF NURSES 7 STATEMENT OF HON. FRANCES P. BOLTON. A REPRESENTATIVE IN CONGRESS FROM THE STATE OF OHIO Mrs. Bolton. Mr. Chairman and members of the committee, this bill is the result of very careful and somewhat prolonged study on the part of all the agencies who are interested in adequate care of the sick and of the wounded, not only for the armed forces but for the civilian population in an all-out war and it comes to you this morn- ing with the enthusiastic support of these organizations. As a background I would like to give you a little picture of what has been done under the Public Health Service with the moneys that were appropriated 2 years ago, and 1 year ago, to make it possible for us to have an increased nurse personnel in the country. In 1941, in July, there was appropriated $1,200,000 with a deficiency appropriation later of $600,000. In July 1942, there was appropriated $3,500,000 for the training of nurses. That was for refresher courses, for graduate nurses, special courses and graduate courses like mid- wifery, and so on, and for student nurses. Thus from these appropriations 309 schools of nursing have received aid, the amount being determined by the increase of enrollment over the pre-war enrollment; whatever school could increase the most in a certain district would get the money. Equipment and supplies for libraries and laboratories and salaries for instructors were provided in that manner. Nearly 12,000 student nurses are being aided. More than 4,000 nurses have taken the graduate courses. Nearly 4,000 retired nurses have taken the refresher courses which have made it possible for them to come back, some for full time, but many for part time service in the hospitals and in the communities. Similar achievements cannot be hoped for through similar pro- cedures in the war year ahead. The national picture has changed very materially. Competition for the Nation’s womanpower has become so acute that thousands of the young women who in normal times would begin nursing educations, are, instead, going into war industry or into the new military auxiliaries. War industry is asking for between two and two and one-half million women and non war industry wants another million. They are all paying high salaries and it is a very attractive field. Two hundred thousand women are sought by the new military auxiliaries and only about half of those have already been recruited. Auxiliary services offer pay even during training, and supply the uniforms required. Federal financial aid under Public Law 647 is available to students of medicine, including veterinary, dentistry, pharmacy, engineering, physics, and chemistry. It seems, therefore, quite justifiable that there should be aid given to students in nursing. The present needs are very grave. We need 65,000 new students to be admitted before the beginning or during this school year, be- ginning June 1, and going through until next year. These numbers will meet only minimum needs, not at all the maximum needs. It looks small compared with other demands, but last year’s goal (fiscal year 1943) of 55,000 new students was not met. We got only 49,000.' 1 The number of new students admitted in 1941 was 35,000 and in 1942, 45,000. 8 RECRUITING AND TRAINING ,0'F NURSES The fact that there was only a 14,000 increase over peacetime average shows how the times are changing, and proves that we must have a new recruitment method and we must have something more to offer if we are going to compete. The witnesses whom we have asked to testify will give you the de- tailed figures, each in their own field of knowledge of the situation. May I say further just a word. This law is definitely not designed to turn nursing standards nor nursing education over to Government control. It is definitely a war-emergency bill. For instance, we pro- pose and we hope that there may be definitely in the bill a provision that no student shall be admitted under the plan after the present war ends. We cannot say that it should be cut off at the first moment, be- cause up to the time of cutting off, the girls would be going into train- ing, There would be a definite obligation to the thousands of girls who would go in, say, in June 1944, and who, if the war should end that fall, would have every right to feel that they should be able to finish their course. But that does not mean that it is a permanent structure. It is definitely a war-emergency measure and as such would offer tuition, uniform, maintenance, a modest stipend for the young women who want to become nurses, but who feel that they cannot continue to spend money on their education when other important and remunera- tive war work is open to them. The measure looks not merely toward liberalizing the amount of Federal aid available to students of nursing, but it also eliminates the necessity for the candidates to declare themselves in need of financial aid. which is a very difficult situation to put a young woman into. This new plan asks only that the students receiving such aid agree to make their services available—after a training period of 24 to 30 months—to the military forces, to other Federal agencies, and to essen- tial civilian nursing services, for the duration of the war and 6 months thereafter. The plan provides that student nurses enrolled in approved schools since January 1,1941, should be included in this category. We must see that students continue their training as well as financing new recruits who come in. Mr. Bulwinkle. May I interrupt there? Mrs. Bolton. Yes. Mr. Bulwinkle. You said it includes 1941. You would make the provisions of this bill retroactive? Mrs. Bolton, Simply as to those girls coming along. They will all share in this. Mr. Bulwinkle. Not to reimburse them; this is not to go back and do that? Mrs. Bolton. No ; but as they continue. Mr. Brown. May I ask, would it be compulsory for them to join? I mean, after a girl who is already in nursing training, and has been since 1941, if this act is passed, would she be compelled to sign up and agree to go in ? Mrs. Bolton. If she desires to participate in the benefits ? She would have to agree to go into one of these services. Mr. Brown. Woiild she be forced to go into the service? Mrs. Bolton. She would have to agree to go into the military forces or to the other Federal agencies if she desired to benefit. RECRUITING AND TRAINING OF NURSES 9 Mr. Brown. Even though she started her training in 1941? Mrs. Bolton. Yes, but Jet me remind yon that it is voluntary. Mr. Brown. That is right, I am asking if it is voluntary. Mrs. Bolton. Yes; it is. Mr. Bulwinkle. Let me ask just along that line, did she not, when she volunteered in 1941, did she not then sign up in order to get some of that aid? Mrs. Bolton. I do not think so, sir; no. Mr. Bulwinkle. That is what I wanted to know. Mr. Brown. In other words, she could become a civilian nurse if she wanted to or go ahead and volunteer for military nursing. Mrs. Bolton. But if she wanted to participate in this she has to sign up. Mr. Tibeott. Mr. Chairman. Mr. Bulwinkle. Mr. Tibbott. Mr. Ttrrott. If she would enter during the period of war, and tlie war should end, would she be compelled to complete her course? Mrs. Bolton. No: she could discontinue, but we should hope she would finish. In order to make that possible we should want to be able to finish those who are in training when the war ends. Mr. Brown. Complete your contract, in other words? Mrs. Bolton. Yes, sir. If I may continue: The student nurse is a highly important factor in solving the total nursing problem. After the preliminary period of from 6 to 9 months after her entrance into the hospital the student is giving some service to that hospital, which increases with her training and makes her more valuable. The hospital superintendents know that to be true. The Students' War Nursing Reserve that we propose will give the student an understanding of and a regard for her important part in the war situation. There has been so much emphasis and drama put upon the other services that women are going into that this old service has just been allowed to go along. When you realize that the nurses are the only group that conies to the Army and the Navy fully prepared, that is an interesting little sidelight, and it is high time that we do some- thing to make it possible for other girls to contribute the thing they have within them to give and to make their training possible. I trust, gentlemen, that we will present a clear and comprehensive picture to you so that you will get the wide application of this and realize that we are endeavoring to do just one thing: Make it possible for the young women of the country to serve to the greatest possible extent, not only in the care of our wounded and our sick in the mili- tary services, but in the solution of all the health problems in an all-out war on the home front. Mr. Priest. May I ask a question ? Mr. Bulwinkle. Mr. Priest. Mr. Priest. Mrs. Bolton, you said we would need some 65,009 new student nurses. Mrs. Bolton. Yes, sir. Mr. Priest. Is it your opinion that if this legislation is passed we will be able to obtain that many; do you feel reasonably assured that we might obtain that many with this legislation? 10 RECRUITING AND TRAINING OF NURSES Mrs. Bolton. Reasonably sure, Mr. Priest. Mr. Priest. Reasonably sure? Mrs, Bolton. It will make possible certain attractions of money and uniform, and so on, that will tip the scales. The thing we have been up against lias been we have nothing of that kind to offer. Mr. Priest. And without this legislation we can feel reasonably sure we would not obtain nearly that number in your opinion? Mrs. Bolton. I think we have proved that in these 2 years. Mr. Priest. That is all, Mr. Chairman. Mr. Brown. Mr. Chairman. Mr. Bulwinkle. Mr. Brown. Mr. Brown. Mrs. Bolton, I know that you have given a lifetime of study to these particular problems, and I think we are very fortunate to have a Member of Congress who is as well informed as you are on the subjects of public health and nursing. I have to leave here in just a few minutes for another committee meeting, and I have several questions in my mind that I would like to ask you, because I know that you can give the answers. I was out of the room for a moment when you spoke of the length of time this law will be effective. Now, as I understand it, this act runs for the duration of the war and not longer than 6 months there- after, except as it applies to those nurses who are in training at the time the war ends. Is that correct? Mrs. Bolton. Yes; it would seem that it would be a very wise stip- ulation, shall I call it. Mr. Bulwinkle. You mean to have an amendment ? Mrs. Bolton, To have some amendment to the language so that it will be definitely understood. Mr. Brown. It is not in the bill at the present time; there is no limitation, is there? Mrs. Bolton. No. Mr. Brown. I asked that, because I believe there is a feeling gen- erally in the Congress that we do not want to establish any more permanent agencies than we absolutely have to, and that we want to return endeavors of this kind to civilian control just as rapidly as possible. Mrs. Bolton, I am sure, Mr. Brown, that I concur in that very definitely. My feeling is that it should so provide. Mr. Brown. I am sure you feel that way. Let me ask you if the—I think it was the American Hospital Asso- ciation, is it not? Mrs. Bolton. Yes. Mr. Brown. And, what is the name of your national nurses’ asso- ciation? Mrs. Bolton. American Nurses’ Association. Mr. Brown. American Nurses’ Association? Mrs. Bolton. Yes. Mr. Brown. Do both organizations approve this bill ? Mrs. Bolton. Yes. Mr. Brown. And they will cooperate in the operation of this endeavor ? Mrs. Bolton. They are to be witnesses to that effect this morning, Mr. Brown. RECRUITING AND TRAINING OF NURSES* 11 Mr. Brown. Ami you have assurance also that they will be given full cooperation b}r the Surgeons General? Mrs. Bolton. Yes, sir. Mr. Brown. Let me ask you what the total cost of this will be, if you have any idea. Of course, you do not know how long the war will last, and I do not either. Mr. Bulwinkle. What are your estimates? Mrs. Bolton. We have estimated, as we have gone along, that per capita, and so on, working very closely, in the way that it has devel- oped in these 2 years, and 1 think that total comes to between sixty and sixty-five million dollars per annum. Mr. Brown. Per year? Mrs. Bolton. Yes, sir, Mr. Brown. That is, if it continued on up to 1946? Mrs. Bolton. It will be $60,000,000 a year, because it would, of course, serve the schools throughout the country. Mr. Brown. Yes. Mrs. Bolton. It is Nation-wide. Mr. Brown. Now, T notice here in section 2, subsection (c), on page 2, that you have provided for training, uniforms, and maintenance in accordance with the regulations of the Surgeon General. Of course, I realize the nurses have their regular uniforms when on duty, but is it the thought, your thought, that we will set up some sort of a new organization, a uniformed organization, something such as the WAAC’s or the WAVES? In other words, what I am wondering is, Is it your idea to put them in uniform? I am saying that, because I think I know, and you do, too, something of the temper of the House right now on the creation of more uniformed women’s organizations. Mrs. Bolton. Yes; I do recognize that there is a growing prejudice in the House in the matter of uniformed women’s organizations. But in view of the fact that these students will constitute a student war nursing reserve it would seem to me no more than right to give them this recognition of their patriotic service. Mr. Brown. And I am just wondering if this is setting up an- other organization of women on the streets in uniform, such as the WAVES and WAAC’s today, or the SPARS. Mrs. Bolton. I see the gentleman’s point. Mr. Brown. But is it to be a regular uniform ? Mrs. Bolton. This bill does set up a student war nursing reserve, and I feel the uniform to be a necessary and legitimate request. Mr. Brown. Of course, it is your thought that this required program has been made necessary by the demands for women in industry, and also because of the heavy demand we are getting from the WAAC’s and the WAVES that are in direct competition with the hospitals? Mrs. Bolton. That is not the sole reason, Mr. Brown. The reason is this heavy demand upon the nursjng profession for services. Mr. Brown. Yes. Mrs. Bolton, There has been a tremendous increase in the demand. Mr. Brown. That is the first thing. Mrs. Bolton. There has been a tremendous increase in the demand from the Army; increase in demand from the Navy, and other or- ganizations as well as a desperate situation in civilian hospitals. 12 RECRUITING AND TRAINING O'F NURSES Mr. Brown. But the very fact that these other organizations are taking so many girls makes it a greater problem. Mrs. Bolton. Yes, sir. Mr. Brown. To induce the young women to join. Mrs. Bolton. Yes. Mr. Brown. And that makes your nurses training problem very different from what it has ever been before. Mrs. Bolton, Very much more difficult. Mr. Brown. And in order to meet that situation it is necessary to have help of this kind so that the hospitals in turn can hold out some incentive for girls to come and take nursing training? Mrs. Bolton. Yes, sir. Mr. Brown. Thank you very much. Mr. Tibbott. Mr. Chairman. Mr. Bulwinkle, Mr. Tibbott. Mr. Tibbott. Mrs. Bolton, are there any restrictions as to who shall receive this training? 1 have had inquiries by some who are inter- ested in becoming nurses, but are unable to pay the tuition asked by their local hospitals. Are there any restrictions as to who shall make application for student nursing ? Mrs. Bolton. No group is restricted at all. There are only the restrictions as to the girl’s own capacity and whether the hospital she is attending is an accredited hospital accepted because of the standards by the whole plan. Mr. Tibbott, What are the limitations? Mrs. Bolton, There has always been, Mr. Tibbott, an accredited hospital list and those hospitals have perhaps a certain number of beds and certain standards of teaching, and with the increase of the need for subsidiary services, like auxiliary volunteer aides, paid aides, it is necessary that the standards of the professional nurse be kept at a high level, because she is going to be responsible for the supervision of these subsidiary groups, as well as doing her own work. There- fore, it seems advisable, and the only part of wisdom, to protect the standards of the future professional-trained registered nurse that this covers. Mr. Tibbott. Can all accredited hospitals participate? What are the educational qualifications? Mrs. Bolton. High school. Mr. Tibbott. And can all accredited hospitals participate? Mrs. Bolton. There are many things involved in requirements for becoming accredited hospitals. The hospital of, say, 10 beds would not be an accredited hospital because it must give—the hospital must give—training in a broad field. A 10-bed hospital, or a 25-bed hospital, might have 25 beds, for instance, and might only have 10 patients, and they might all have measles, and the hospital might not have any other patients. We must train in a general field. Accrediting hospitals is an effort to protect that situation. Mr. Tibbott. But they must be accredited hospitals? Mrs. Bolton, They must be accredited hospitals. Mr. Bulwinkle. We thank you, Mrs. Bolton. (See page 30) 13 RECRUITING AND TRAINING OF NURSES. STATEMENT OF BE. THOMAS PARRAN, SURGEON GENERAL, PUBLIC HEALTH SERVICE Mr. Bulwinkle. Dr. Parian. Dr. Parran. Mr. Chairman, 1 appear in support of H. R. 2326, introduced by Mrs. Bolton, and should like to endorse and underline the statements that she has made concerning the importance of this bill. I shall not repeat the detailed statistical evidence which we have accumulated showing the grave shortage of nurses. Suffice it to say that there is a grave shortage at the present time, a shortage which threatens the quality of civilian medical care, and possibly imperils the needs of the armed forces for nurses. 1 may say, Mr. Chairman, that this proposal has been worked up very carefully by consultation with the various groups concerned— the professional organizations, training schools, the hospital author- ities—and I think it fair to state that it represents the concensus of those who are best in position to know the needs and to know the possibilities of meeting these needs. In this connection I should refer to the present nurse-training program which the Public Health Service is conducting. As Mrs. Bolton has said, we now have an appropriation of $3,500,000 for this purpose. With those funds it has been posisble to increase sub- stantially the number of nurses entering training schools. Mr. Bulwinkle. Doctor, at that point—would you rather get through with your statement before we interrupt you ? Dr. Parran. Just as you prefer, Mr. Chairman. Mr. Bulwinkle. Then I would like to ask what methods do you use to obtain these extra nurses that you have? Dr. Parran. There has been a very intensive educational campaign carried on by the National Nursing Council for War Service. That council is composed of representatives of all of the nursing organiza- tions and the hospitals of the country. In addition, the Federal funds have been used to encourage training schools to admit a larger quota of nurses than formerly. Payments have been based on the incentive principle, that is, we paid a part of the additional cost to the training school for training the additional nurses over and above their peacetime level. Secondly, aid has been given to bring back into active nursing duty nurses who had retired because of marriage and inclination, but who are anxious to render a service in the war effort. And, finally we have given postgraduate training to nurses so as to increase the numer of qualified teachers and supervisors of nurses in order to take care of the larger teaching load in the hospitals. The general picture will be, if I may say, that in pre-war there was admitted to the training schools of the country about 35,000 nurses per year. The goal of last year was 45,000, and that goal was met. The goal for the current year has been 55,000, but as Mrs. Bolton has pointed out, we have fallen short; just barely attaining the 49,000 figure. We anticipate, Mr. Chairman, that in the future it is going to be even more difficult to get the nurses in training, nurses who are sorely 86360—43—3 14 RECRUITING AND TRAINING OF NURSES needed, and that is because of the intense competition for woman- power. One should recall that the nurse training schools draw 95 percent of their students from the classes of girls currently graduating from high schools. There are only about 450,000 of those. Therefore, to attain the goal of 55,000 or 05,000 nurses, you can see that between 10 and 15 percent of all girls graduating from high school will need to enroll. Mr. Tibbott. About what percentage is that again, Doctor? Dr. Parran. Between 10 and 15 percent. Mr. Priest. Mr. Chairman, I would like to ask one question just at this point. Mr. Bulwinkle. Mr. Priest. Mr. Priest. General, do you have any figures on the average annual cost of tuition and fees that would be paid by the student nurse if she paid them herself? Dr. Parran. Yes, sir. Those fees vary from $75 to $150 for the first year on the average in a nurse training school, and in the uni- versity schools, tuition is comparable to tuition charged in the other departments of the university. Mr, Priest. Thank you, Doctor. Dr. Parran. As I said, Mr. Chairman, we have had very fine coop- eration from all of the professional groups concerned. The training schools have exerted themselves to the utmost. Moreover they have adopted speed-up courses under which instead of requiring the full 36 months of training practice, the didactic and laboratory training is given in a period of 24 or 30 months, enabling the nurses to be available for full-time nursing duties under supervision, for that additional period of 6 or 12 months. The bill before you, Mr. Chairman, provides for a very decentral- ized plan of administration. As you will note from section 2, the nurse training school submits a plan which is approved by the Sur- geon General only if it meets certain stated conditions. The pri- mary responsibility of determining the eligibility and qualifications of the girls who are admitted is left with the training school. The kind of instruction which the school gives is subject only to the general standards which have been recommended by the professional societies concerned. The girls who enroll voluntarily—all of them will enroll volun- tarily—obligate themselves to make their service available to the Gov- ernment or for civilian nursing duty during the war, and for 6 months thereafter. In compensation for this obligation, which after all can really be only a moral obligation on the part of these girls, the Gov- ernment undertakes to pay their tuition; to pay them a small stipend per month of $15 for the first 9 months and $20 per month for the following 15 or 21 months, which is combined in study and practice. Under general plans which we have worked out, the hospitals and the nurse training schools will continue to bear a part of the cost of training. This bid is not intended to be a subsidy to the hospitals of the country; its purpose is to recruit and train an additional quota of nurses needed for military and civilian war service. The major part of the costs will be in payments made directly to the student nurses or on their behalf for tuition and instructional expenses. The only 15 RECRUITING AND TRAINING OF NURSE® payments made to the hospital will be for board and room of the student nurse during the first 9 months of her training. We have estimated that and we hope that it will be possible to give the full training to a nurse at a cost to the Government of not more than $1,250 each. Mr. Bulwinkle. Doctor, may I ask you, how do you propose to establish your recruitment of these volunteers ? Dr. Parran. The recruitment will be done first by the nurse train- ing schools themselves; by the Federal Government, and by the pro- fessional nursing societies. In fact, if the present bill does not au- thorize the Public Health Service to enter into a contract with the private organizations, such as the National Nursing Council for War Service in order to aid in recruiting, I would suggest that an appro- priate amendment be added to make clear that that authority is carried in the measure. Mr. Brown. Doctor, would not' some of this recruitment be done through newspaper and radio publicity? Dr. Parran. By all means, Mr. Brown. That is your best way to reach the needed girls. As a newspaper man I know, of course, that is the best way to reach the interested parties. Dr. Parran. Last spring, and again this spring, the Office of War Information has secured the cooperation of the newspaper and radio stations, so that the recruitment of student nurses is given a top prior- ity right in national war publicity. Mr. Brown. You have found both the radio and the newspapers more than willing to be called upon in this work, and in other matters in connection with the war effort ? Dr. Parran. We have, indeed. Mr. Brown. That settles it. Dr. Parran. Also I can say that we have had very fine cooperation from many other groups in the country. The General Federation of Women’s Clubs has taken up collections with which to aid in payment of tuition for needy nurses. The Rotary clubs in a number of com- munities have done the same thing. Mr. Brown, The school system itself, I suppose, helps ? Dr. Parran. Yes; although the school system is bombarded from many sources competing for their graduates. The question was asked earlier, Mr. Chairman, concerning the cost. We are uncertain, first, as to whether the goal of 65,000 nurses can be reached with this relatively small financial inducement. We are optimistic that it can be. The second point of uncertainty is -whether or not all of the eligible nurses now in training or hereafter enrolled will want to join this corps. Some girls are studying nursing because they have jobs back home in a particular hospital. Others expect to get married, or have family responsibilities, or for other rea- sons may be unwilling to commit themselves to this service. We are uncertain as to what that total will be. If all eligible nurses seek admission to and are admitted to this corps, the cost may run as high as $75,000,000 a year. If, as is more likely, we think, 50,000 is the more probable figure, then the cost would be proportion- ately less, perhaps around $60,000,000 a year. Mr. Brown. Mr. Chairman. Mr. Bulwinkle. Mr. Brown. 16 RECRUITING AND TRAINING O'F NURSES Mr. Brown. Let me ask you one question, if I may, General. It is your understanding—is it—that this bill should be limited to the duration of the war and 6 months thereafter? Dr. Parran. As now drafted, it is not so limited. That, however, was the intention, and I would be agreeable to an amendment as suggested by Mrs. Bolton. Mr. Brown, In other words, you consider this an emergency mat- ter for the duration of the war ? Dr. Parran. That has been the concept of the proposal from the outset. I should explain further, Mr. Chairman, that these student nurses will not be Government employees, in any sense. The hospitals will pay them their stipends and will furnish them with uniforms. The hospitals will be reimbursed by the Federal Government. Initially it was proposed to have a federalized corps, but the device as proposed in this bill seemed to us to be the preferable method. Mr. Brown. Let me ask you again, going back to subsection (c) of section 2, is it your idea that the wording here on uniforms and so forth does not contemplate the establishment of a new woman’s organ- ization such as the WAVES, WAAC’s, and other such groups? Dr. Parran. The organization which is proposed has been known as the Student Nurse Reserves. I think it is contemplated, Mr. Brown, that there would be a uniform, one standard uniform, rather than the diversity of street uniforms which the student nurses now may wear. While on duty in the hospitals, working in the wards or class rooms, the nurses traditionally, as you know, wear a cotton uniform, Mr. Brown. I am talking about an insignia. Dr. Parran. An arm band has been thought of in that connection. Mr. Brown, Or a lapel button, or something of that kind ? Dr. Parran. Yes. Mr. Brown. I ask that, Doctor, because there seems to be some oppo- sition in the Congress to establishing more of these uniformed organ- izations of women, and I ask it because I want to be helpful, rather than critical, of the measure. I do not want to see any side issue develop that might cause trouble in the House. Dr. Parran. I appreciate your interest, Mr. Brown, although the best information we have from the student nurses themselves is that a uniform would be a very cheap way of insuring additional nurses. Mr. Brown. I can see that it might attract them. Dr. Parran. It would be a recognition that they are rendering es- sential war services. In my opinion a uniform would buy more additional student nurses than a much larger payment of money. Mr. Brown. Do you think that a special uniform might help meet the competition that you run into with the other organizations? Dr. Parran. Yes, sir. Mr. Chairman, there may be a few amendments of a somewhat tech- nical nature, in addition to that which Mrs. Bolton has suggested. Specifically I refer to the authority of the Surgeon General to enter into contracts. In that connection I would suggest for the considera- tion of the committee a rough draft only of section 1; at the end of the section, add the words: The Surgeon General is authorized to enter into contracts with private and nonprofit corporations or organizations for the recruitment of student nurses. RECRUITING AND TRAINING OF NURSES 17 Mr. Bulwinkle. Have you a copy of that for the reporter? Dr. Parran. I have, Mr. Chairman. Also attention has been called to the fact that under section 2 it is not definitely stated that the Federal Government, military and civilian hospitals of the Federal Government, would have a first call on the student nurse once she had finished a total of 24 or 30 months’ service, and an amendment has been suggested—this is only in rough form, Mr. Chairman, for later consideration by your com- mittee and legal counsel—that at the end of section 2, take out the period and add a semi-colon and add the following wording under subsection (f) : (f) that unless extramural credit toward graduation cannot be given because of a provision of the law of the State where the institution is located, such institution will make transfers of student nurses to military and civilian hos- pitals of the Federal Government, under the conditions specified in subsection, (e), in any case where the student nurse desires such transfer and such transfer is requested by the Federal department or agency concerned. Suggestions have been made also, Mr. Chairman, from the pro- fessions concerned to insure that the general intent of the bill pre- serve to the nurse training institutions responsibility for the stand- ard of nurse training, I think there may be some amendment sug- gested by representatives of the professions to provide for an ad- visory board to consult with the Surgeon General or otherwise. I shall not attempt to give you the detailed language, thinking that some of the other witnesses will be in a better position than I to do that. Mr. Chairman, we have a large number of communications from people indicating the specific needs of the community and with your permission I would like to read just an excerpt or two and then file in the record the more important of them. Mr. Bulwinkle. Very well. Mr. Parran. From Maryland the director, John Hopkins Hospital: I heartily support the bill, believing that only in this way will it be possible to recruit a sufficient number of nurses to meet the needs of the Army, Navy, Public Health Service, and civilian population during war emergency. From Louisiana State Nursing Council for War Service: Louisiana suffering keenly from acute shortage of graduate and student nurses. Many irreplaceable vacancies existing in hospitals, health agencies, institutes, schools of nursing. Best means of meeting nurse shortage is training more students. Funds urgently needed to attract qualified applicants to nursing schools. At present competition with other fields most keen. From Rochester, N. Y., superintendent, Strong Memorial Hospital: Due to nurse shortage Strong closed two floors, 58 beds, in July 1942, re- opened 15 December. February 29, 1943, one floor closed. Now admission lim- ited; nurse shortage acute; 130 general floor nurses 1941, 58 in 1943. Other Rochester hospitals, Genesee closing 16 beds, General considering closing floor; county 75 beds closed. Others no change. From the west coast. Long Beach, Calif.: Most of our hospital beds are occupied by injured defense workers from the Long Beach-Los Angeles Harbor area or Army dependents and Navy dispensary cases. We are now caring for 350 patients with the same number of nurses that we formerly used for 150 patients. I have other communications, Mr. Chairman, along the same line, indicating the tremendous and growing shortage. All parts of the country are represented in these communications. 18 RECRUITING AND TRAINING OF NURSES Mr. Bulwinkle. We will be glad to have them in the record. Dr. Parran. I have nothing further, Mr. Chairman, unless you have some questions. Mr. Bulwinkle. Any questions, Mr. Priest ? Mr. Priest. I have no questions. Mr. Bulwinkle. We thank you very must. You may be called again before the committee in executive session. STATEMENT OF BRIG. GEN. LARRY B. McAFEE, ACTING SURGEON GENERAL, UNITED STATES ARMY Mr. Bulwinkle, General McAfee, will you give your full name and position for the record ? General McAfee. Larry B. McAfee, brigadier general, Medical De- partment, United States Army; assistant to the Surgeon General, and representing the Surgeon General. Mr. Bulwinkle. You may proceed. General McAfee. Mr. Chairman, I wish to express the approval of the Surgeon General and the Secretary of War, of the provisions of this bill. Naturally the Medical Department of the Army is vitally interested in the training of nurses in the interest of maintaining women in the nursing profession not only to furnish us our required number during the emergency, but after the emergency has passed. We appreciate that there is great competition for women in indus- try and in the armed services and that the salary, perhaps the glamor, has attracted from the number of young ladies entering training as nurses. We believe that this bill will appeal to a large number of young women. The training it proposes identifies them with the war effort and assures them a profession which will be useful to them after the was is past. At the present time under our system of recruiting, we are almost current with our nurse requirements. We appreciate, however, that the local communities are making a marked sacrifice to keep this num- ber up to our requirements, and that there is a limit beyond which the procurement of nurses from civil life will drop down to a point that will not satisfy our needs. For this reason we feel that this bill will stimulate nursing and the study of nursing and make available to civil hospitals partially trained women still in course of training and in that way relieve the nurse situation in the immediate future. We also appreciate that during the post-war period there will be an unusual demand for nurses both in civil life, public-health service, and in the care of veterans of this war. The provisions of the bill if enacted will stimulate interest in the study of nursing and thus provide a source of recruit- ment to satisfy hospital staff requirements. I can add nothing more to the remarks of the Surgeon General as to public health. I will be pleased to answer any questions that I can. Mr. Bulwinkle. Mr. Tibbott. Mr. Tibbott. No questions. Mr. Bulwinkle. Mr. Priest. Mr. Priest. I have no questions. RECRUITING AND TRAINING OF NURSES 19 Mr. Bulwinkle. General, we thank you very much, sir. Should you have anything further that yon would like to put in, you may insert it in the record, with your remarks. General McAfee, Yes, sir; thank you. Mr. Bulwinkle. We thank you. STATEMENT OF MISS ANNA D. WOLFE, DIRECTOR OF NURSES, THE JOHNS HOPKINS SCHOOL OF NURSING, BALTIMORE, MD. Mr. Bulwinkle. At this time the Chair wishes to present to the committee a lady whom lie lias known for some years, Miss Anna I). Wolfe. Miss Wolfe. Mr. Chairman, my name is Anna D. Wolfe, director of nursing, Johns Hopkins School of Nursing, Mr. Bulwinkle. And do you hold another official position? Miss Wolfe, I am consultant to the United States Public Health Service on nursing education and to the Subcommittee on Nursing, Health and Medical Committee, Federal Security Agency. Mr. Bulwinkle. You may proceed, then. Miss Wolfe. I should like to discuss this matter from the stand- point of schools that have participated in the nursing education pro- gram as administered by the United States Public Health Service, and one which has been supporting the program and that has been written up for us in the bill H. R. 2326. Our school, to begin with, was able to make a plan for the accelera- tion of the program which is one of the essential factors of this bill for those schools which will participate in the program. I should like to state, as director of a school, that the accelerated) program on the basis of 30 months has seemed to be a particularly desirable thing, because in doing that we can still retain a high profes- sional standard of education which is so essential at this time and we still appeal to a quality of students that is essential for the kind of work that we are going to require of them at this particular critical period of our country’s need. We have had very good response to recruitment in our schools. In fact, participating with the Federal Government we have found that our recruits have increased over 100 percent for 1942. However, right now, during the past 4 months of this year, we have noticed a marked decline in both the applicants to the school and the requests for ad- mission to the school and also from the standpoint of the type of stu- dent who is asking to be admitted. We have reason to feel that these facts are very significant in relation to the fact that we do not have in nursing a program to offer students similar to that which they may receive in almost any one of the other services of the Government or through industry. It is also quite notable that the students who have been added to the school last year, of the 159 students we admitted, over 50 percent of them required financial aid, which is indicative of the very fact which has been pointed out over and over again, that you cannot expect stu- dents to go into the schools of nursing at this time unless we are pre- pared to give them similar assistance to which we give other students in other lines of w7ork. I do not know that there are any particular questions that you have to ask. I want to speak especially on this subject, because I think there 20 RECRUITING AND TRAINING OF NURSES are possibilities and I think that we can have increased enrollments if we get the funds. Mr. Bulwinkle. When will the students enroll; when should they enroll for the next year? Miss Wolfe. One of our most serious problems right now is that we have nothing to offer students whom we are trying to enroll for June and for September and that we are meeting a great problem in that respect. Mr. Bulwinkle. Your enrolling period is in June? Miss Wolfe. Our enrolling periods now—we have three classes a year of course—spring, summer, and fall in order to get the number of students we need; but we are experiencing great difficulty because we have nothing positive to offer students and that is one of the things we want in this bill so that we can have something we can say to students that it will be possible for them to remain for their period of training. Mr. Bulwinkle. That will necessitate a little expedition of the bill by Congress? Miss Wolfe. Very definitely. Mr. Bulwinkle. In order to get it out. Miss Wolfe. So that the students this year can have some of its benefits. Mr, Bulwinkle. Mr. Priest, do you have any questions? Mr. Priest. I do not believe I have any questions. It seems very clear to me. I agree with you that we need acceleration in handling the bill as well as acceleration in the training program. I think we might proceed with a vote. Mr. Tibbott. Mr. Chairman Mr. Bulwinkle. Mr. Tibbott. Mr. Tibbott. You say you notice a decline, or there is a decline in the number of students coming into the nurses training schools. Miss Wolfe. Yes, sir. Mr. Tibbott. It is obvious that the other governmental organiza- tions are attracting them, I presume, and not a lack of interest in this wonderful work. Miss Wolfe. The students who do come to us have that interest; but I think the attractive feature of the other opportunities for women are such that they are diverted from the field that they ordi- narily would go into. We did not have this to contend with in the past or in World War I, you see. We had none of that to contend with, whereas now we do have it, and we are feeling it, and I think perhaps our school has been favored considerably in relation to getting students. We never had any difficulty, and we were holding out for 200 students this year, which is approximately the same as last year. We are not getting them, and will not get them unless we get the funds. We know that, unless we reduce the quality of the students, this is not a time to reduce the quality of the students in schools of this kind. Mr, Priest. Mr. Chairman, I have one question. Do you know whether the enrollment period or recruitment period through the Na- tion corresponds generally with that of Johns Hopkins? Miss Wolfe. Yes. Mr. Priest. That is, summer, fall, and spring? Miss Wolfe. Yes; those schools that have been able to have summer programs or have them, because they feel the pressure of the need. RECRUITING AND TRAINING OF NURSES 21 We all have that in Baltimore, and we have it in our other commun- ities. Mr. Priest. Thank you. Mr. Bulwinkle. J ust a minute. Where were you educated ? Miss Wolfe. In nursing ? Mr. Bulwinkle. Yes. Miss Wolfe. Johns Hopkins Hospital School of Nursing. Mr. Bulwinkle. Yes. 1 am asking what experience have yon had in your work ? Miss Wolfe. I was an instructor at Johns Hopkins and assistant, and then I went to China, then the University of Chicago, and then to the New York Hospital, and then back to Johns Hopkins. Mr. Bulwinkle. Thank you very much. Dr. Munger. STATEMENT OF DR. CLAUDE W. HUNGER, DIRECTOR, ST. LUKE’S HOSPITAL, NEW YORK CITY, REPRESENTING THE AMERICAN HOSPITAL ASSOCIATION Dr. Munger. Mr. Chairman and gentlemen of the committee. Mr. Bulwinkle. Doctor, will you give your full name and repre- sentation ? Dr. Munger. Claude W. Munger. I am representing the American Hospital Association, by authorization of its board of trustees. I am chairman of the council on Government relations of that association and have been quite familiar with the thinking that has gone into this bill; that is, the preliminary discussions which have led up to the framing of the bill. I am instructed by the American Hospital Association, through a poll of its board of trustees, within the last 48 hours, to express the general attitude of approval toward this bill of the association. I have to present a resolution of the board of trustees at this time, if I may. This resolution reads: Resolution of the Board of Trustees of the American Hospital Association Whereas the present supply of graduate nurses for military and civilian hos- pitals is inadequate to meet basic needs ; Whereas this shortage will tend to increase because of the heavy demand by both the military and civilian populations for graduate nurses; Whereas the competition of other war activities is likely to reduce rather than permit the necessary increase in normal recruitment of young women for the nursing profession; Whereas every effort must be made to increase the enrollment of schools of nursing in order that the present shortage may be met before there occurs a serious break-down in the health and hospital services of the Nation; Whereas the American Hospital Association considers this to be one of the most critical problems facing the hospitals of this country; therefore, be it Resolved, That the board of trustees of the American Hospital Association approves in principle House bill 2326, which provides “for the training of nurses for the armed forces, governmental and civilian hospitals, health agencies, and war industries” and urges your favorable action with minimum delay. The bill, as it has been studied by the representatives of onr asso- ciation, has, as that would imply, met with very general approval. You have heard from previous witnesses of the needs of certain amendments. We have seen those same needs. We would like par- 86366—43 4 22 RECRUITING AND TRAINING OF NURSES ticularly to suggest an amendment which I would now like to present and which would apply to the bill on page 5 of the bill, section 6. AMENDMENT PROPOSED BY AMERICAN HOSPITAL ASSOCIATION Section 6, page 5, delete and substitute: “The Surgeon General, upon recom- mendation of an advisory committee of not less than five members appointed by the Federal Security Administrator, consisting of representatives of the nursing profession, hospitals, and educational institutions concerned, and with the approval of the Federal Security Administrator, is hereby authorized to promulgate such standards, rules, and regulations as may be necessary to carry out the purposes of this act.” I believe you will see that that changes the intent of that section only insofar as it includes an advisory committee from the professional and educational groups that are concerned with nursing education. Mr. Bulwinkle. Right there, Doctor, let me ask you this question. In your amendment, the Surgeon General acts on recommendation of the advisory committee. Dr. Munger. Yes, sir. Mr. Bulwinkle. Here is one difficulty, and I think your idea is all right. I think it should be worded differently from what you have it, because you make it so—suppose the advisory committee does not act The Surgeon General has to act. He has to get it through. I would rather put it in something like this, the Surgeon General, after conference with the advisory committee, of not less than five members appointed by the Federal Security Administrator, consisting of rep- resentatives of the nursing profession, hospital, and educational in- stitutions, etc., and with the approval of the Federal Security Administrator, is hereby authorized to promulgate such, and so forth. Dr. Munger. I see your point, sir. Mr. Bulwinkle. Because you are making it depend upon promul- gating these rules, on both. Dr. Munger. I am coming here under instructions in presenting this. Mr. Bulwinkle. Yes. Dr. Munger. But I will say for my own experience, I see your point, and I have no doubt that that could be worked out to the satisfaction of all concerned. Of course, I do not think I need to explain to the committee why the professions would be interested nor to make any excuses for sug- gesting that there be a committee to advise, let us say advise with the Surgeon General of the Public Health Service only. It, of course, is a vital matter to the country as a whole and it is a vital matter to these organizations such as hospitals and the schools of nursing that they have some hand in this planning. We know we would have with General Parran, but this is something that is going into the law of the land and may be in for a long time. Mr. Bulwinkle. Not unless the war continues, which we hope it will not. Dr. Munger. Now, I would like to say, too, that about 90 percent— that is an estimate, but I believe it is within reasonable accuracy, about 90 percent of the schools of nursing in this country not only are con- trolled, but they are owned by the hospitals and the hospitals do have a deep interest in what happens to them and what they do. That is the reason that in our resolution here we include a hospital member on that advisory committee. RECRUITING AND TRAINING OF NURSES. 23 We know there must be nurses, so we feel there ought to be someone representing pretty much the thought of the hospital ownership and management, as well as nurses and people in other educational lines. I believe we would concede that the majority of the people on that committee ought to be nurses. I want to tell you—maybe you know it—but the situation in the civilian hospitals in relation to the shortage of nursing personnel is serious. There is no doubt about it. And, in some places it is really desperate. I know there is no point to my belaboring something that you prob- ably know from your own observation or from newspaper accounts, but it is urgently necessary that the supply of nurses be augmented and augmented rapidly, and I have every reason to believe from communi- cations from all over the country that this is a Nation-wide condition. The situation is a little worse in some places than in others. Of course, the most difficulty seems to exist in the defense areas where defense industries are extremely active, but in my city of NewT York, where we are supposed to be very much without defense industries or industries are not supposed to be very much accelerated, we are having a great deal of difficulty. Of course, the reason is that the nurses have gone into the armed forces and to other war work. Our losses have been terrific, and the administrators of hospitals in large hospitals are very discouraging at times in fact they are at a loss to know what to do about this lack of nurses. The hospitals that have schools of nursing, of which there is a large number of beds represented in the hospitals that have schools of nursing, are interested in cooperating with this program primarily from a patriotic motive; but they have had to give up their graduate nurses in tremendous numbers, and if they can increase the enrollments in their schools of nursing there will be some replacement in the hos- pitals of the graduate nurses who have had to go to the military. The trend in occupancy in the civilian hospitals are interesting too. That again is spotty, but in the defense areas particularly there have been terrific increases in occupancy due to various causes. You know that there has been a marked increase in the birth rate in the country. Certainly hospitals with maternity cases have been very hard pressed to meet the public demands. The increased industrial activity even with no increase in population increases the amount of hospital work that has to be done. Then, we are beginning to find that the improved economic condi- tions among the general population is enabling more people to take care of their health and to use hospitals more. Then, we have our voluntary hospitalization insurance plans which have been so successful and so helpful—the Blue Cross—that for instance is sending more people to the hospitals. In some of the defense areas the crowded housing situation is mak- ing the hospitals necessary in illnesses where in times when people not crowded as to housing, the sickness would be taken care of at home. All those things are added together and added up puts a heavier load on the hospitals than we formerly had which we expected to do with much fewer nurses. We want to do it. I mean, we are going to get through this and do our duty to the country and to the mili- tary, but this particular help would be most fortunate. 24 RECRUITING AND TRAINING OF NURSES Another thing that has created a further demand for nurses is our loss of doctors. Some hospitals have lost half of the doctors on their staff and we have used nurses, of course. Of course, the nurse is the handmaiden of the physician and there are a lot of things that she can do to replace the activity of the doctor and we have used nurses for quasi-medical duties, and that, of course, increases the demand as to the number of nurses. I was interested in the telegrams that the Surgeon General read about the closing of hospital beds. That has been happening over the country and it has been happening in places where hospital beds are sorely needed. The one and only reason that I have known for this request, the bed capacity, has been that inability to get staffs, and particularly nursing staffs. I think we are really in a dangerous situation in that we have no, practically no nursing reserve in case of any disaster. We are really trying very hard now to just keep up with what is the wartime normal need for nurses. That is another reason for augmenting the number. The hospitals know that the country expects them to take care of the civilian sick and they cannot do it unless the ranks of nurses are filled and augmented. I have heard a prediction from a Member of Congress—at least a former Member of Congress—that we might even have hundreds of thousands of wounded being brought back to this country. We are not thinking about that even in connection with this bill. We would like to think about that, perhaps, but the bill is necessary without any thought of what the visitation from the other side of the wounded may be. The hospitals want to keep educational control of their schools and I think their patriotism is boundless. I think that has been exemplified by what they have done already to aid in the war. We have given freely of the flower of our staffs of doctors and nurses and other technically trained people, whom we have had ready to hand over to the services, and we are just as proud as we can be about that, but we hope we might have this help in augmenting the supplies of nurses. Proper education of nurses is expensive and hospital funds are not adequate to the degree of the expansion which is desired. Therefore, this assistance which the bill gives—some hospital people think rather niggardly assistance—is very necessary. The subsidy to the students is necessary, as has been brought out, because of the competition of other women’s activities, particularly women’s military groups. With regard to housing facilities, for nurses in hospitals. Pro- verbially they have lived in. It is not going to be adequate to increase the number and the grade for maintenance, so that a good many of them live out, though being fed at the hospitals, perhaps. That is very necessary. If it were possible for the hospitals to keep and use for themselves the output of their schools of nursing, this bill and the appropriations necessary for it would not be necessary, of course, but the country wants and takes every nurse we can produce, and we want our fighting RECRUITING AND TRAINING OF NURSES 25 men to have enough nurses; but, of course, the cost of the production of a nurse has to be the responsibility of the Government. I believe this situation is very urgent, and the official board of my association, the American Hospital Association, feels the same. We endorse the bill. We have suggested an amendment, and we are—this representative, at least—in general agreement, with other small changes in the bill, which have been suggested by previous witnesses. Mr. Priest. Mr. Chairman. Mr. Bulwinkle. Mr. Priest. Mr. Priest. Dr. Munger, I wonder if you would give the committee the approximate number of accredited hospitals or nurses’ training institutions that might be available for consideration by the Surgeon General for participation in this bill ? Dr, Munger. Nurses’ schools? Mr. Priest. Yes. Dr. Munger. Now, some of the nurses will correct me if I am wrong, but I think it is about 1,400. Mr. Priest. About 1,400? Dr. Munger. Not all hospitals, you know, have schools of nursing. They are usually found in hospitals of 100 beds or more, and it is very difficult to operate a school successfully in a hospital where you do not have enough clinical material to teach, where a nurse has to have experience in different kinds of cases, you see. Mr. Priest. That is all. Mr. Chairman. Thank you. Mr. Bulwinkle. Thank you, Doctor. Dr. Munger. Thank you. STATEMENT OF MISS STELLA GOOSTRAY, PRESIDENT, NATIONAL LEAGUE OF NURSING EDUCATION, BOSTON, MASS. Mr, Bulwinkle. Miss Goostray. Will you please state your name for the record ? Miss Goostray. Stella Goostray, president of the National League of Nursing Education and chairman of the National War Council of Nursing Services; superintendent of nurses and personnel of the school of nursing, Children’s Hospital, in Boston. The National League of Nursing Education, which I represent to- day, is a membership organization which is composed of those who are engaged in administrative and executive and teaching positions in our schools of nursing, in our public health agencies and hospitals, and in the Government agencies. Its chief concern is with the prepa- ration of nurses for various branches of nursing, and, of course, that leads right into the promotion of better nursing services to the public, because, after all, there is no point to nursing education if it does not lead to better care of the sick. Last fall its board of directors, realizing that there was this great demand for nurses for both the military and civilian services recom- mended to the membership and to all of the schools of nursing that they give immediate consideration to making adjustments in their educational programs. You know, of course, that in schools of nursing we do not have long vacations as they do in colleges and universities or in the medical 26 RECRUITING AND TRAINING OF NURSES schools, and we could not telescope our course in the way that these other groups are doing. , We believed also we ought to maintain a sound preparation for nursing, but at the same time we knew that we had to face the fact that civilian hospitals were depending more and more on the student nurses to care for their patients and to meet any civilian emergency. So the national league recommended that there be an adjustment of the educational program so that the last 6 months would be free for service within the hospital or if it were so decided, by the Army and Navy, the young women could go to the Army and Navy camps for their last 6 months. The league promoted that acceleration and has been doing it all winter, also supported by the National Nursing Council. We found, however, in getting our information for the schools of nursing, that there were certain impediments to this program. First of all, with large numbers, more students, we lacked teachers. Housing facilities were lacking and clinical facilities. And we believe many of the schools are already started on this accelerated program. We know they have. They have made good progress toward it. But we believe that the bottleneck that we ran into can be relieved by this provision—the provisions of this bill. And the National League of Nursing Education has gone on record as approving House bill 2826 in principle. I have a formal resolution if you wish it. Mr. Bulwinkle. We will be glad to have it. You may insert it in the record or we will be glad to hear you read it. Miss Goostray. The resolution reads: Whereas the National League of Nursing Education recognized that conditions are unusual because of the war; and Whereas more students are needed in schools of nursing to meet the military and civilian demands; and Whereas the National League of Nursing Education recognizes that many opportunities have been opened to high-school and college graduates to aid the war effort thus creating competition; and Whereas many desirable applicants may lack funds to finance the course in nursing and for that reason are diverted to other fields; and Whereas the National League of Nursing Education believes that everything should be done to increase the number of desirable applicants for schools of nursing; and Whereas the National League of Nursing Education is of the opinion that the course should be adjusted wherever State laws permit so that basic prepara- tion may be accelerated in order to free students for service during the last 6 months: Therefore be it Resolved, That the board of directors of the National League of Nursing Edu- cation go on record as approving bill H. R. 2326 in principle. Stella Goostkay, President. May I also say that the National Nursing Council for War Service is also in favor of this bill, with the suggested amendments. This council has been working now for 2 years. It has had three points in its program. One, the getting back of older nurses into our hospitals. It has been concerned with getting nurses into the Army and with recruiting stu- dent nurses. We have maintained a clearing bureau in New York which has received thousands of letters a week from young women throughout the country and it is our opinion that many of these young RECRUITING AND TRAINING OF NURSES 27 women do not go into schools of nursing because they have not the financial means, and would go if they could get some help. Mr. Bulwinkle. Mr. Priest. Mr. Priest. I have no questions. Mr. Bulwinkle. Mr. Tibbott. Mr. Tibbott. Miss Goostray, are there many available for the re- fresher nursing courses ? Miss Goostray. There have been a large number of nurses who have taken these refresher courses and have been able to do so because the United States Public Health Service has provided the funds for them. We believe that there is still opportunity to get more women into re- fresher course and back in to help meet the situation. Mr. Tibbott. Thank you. Mr. Bulwinkle. We thank you very much. Miss Goostray. Thank you. Mr. Bulwinkle. If you have anything additional you wish to put into the record, you may do so when you revise. You may extend your remarks. Miss Goostray. Thank you. STATEMENT OF DR. WILLIAM C. DAVISON, DEAN. DUKE UNIVER SITY SCHOOL OF MEDICINE, DURHAM, N. C. Mr. Bulwinkle. Mr. Davison. Dr. Davison. My name is William C. Davison, clean, Duke Univer- sity Medical School. Durham, N. C. Mr. Bulwinkle. Do you hold any other position or are you engaged in any other work besides that, Doctor? Dr. Davison. Vice chairman, division of medical science, National Research Council. Mr. Chairman, I have read this bill, and would like to emphasize everything that the preceding witnesses have brought out, particularly in regard to the shortage of nurses and the stimulus which I believe this bill will give to the recruiting of student nurses. The experience which we have had in Durham has been similar to that Miss Wolf brought out, that under the help of the United States Public Health Service we were able to increase the number of student nurses, but during the past 6 months, due to competition of other groups, the recruiting has diminished in spite of the great efforts that have been made through the radio and women’s clubs, and so on. It seems to me that most young women want to be in some effort that is sponsored by the Federal Government. We can tell them that nursing is just as important to the health of the country and the health of the troops as any other activity, but unless there is something definitely sponsored by the Federal Government, with a uniform, they do not feel they are quite as much in the war effort as other people who go into the WAAC’s and the WAVES, and I believe that this bill will greatly stimulate the numbers of young women who will go into the schools of nursing. Mr. Bulwinkle. Doctor, Mr. Priest just now asked the question, how many accredited nursing schools are there in the hospitals in the United States? 28 RECRUITING AND TRAINING OF NURSES Dr. Davison. Well, Dr. Monger gave the figure of about 1,400, which I think is about correct. Mr. Bulwinkle. How many are there in North Carolina, sir? Dr. Davison. I think 32. There are 60 general hospitals and I think 32 schools of nursing. Mr. Priest. How many are there in Tennessee ? Dr. Davidson. I do not know how many there are in Tennessee. Miss Wolf could probably give you that figure, or Miss Goostray. Mr. Priest. They have a very good one at Vanderbilt. Mr. Bulwinkle. They ought to have a few more than one at Van- derbilt. Mr. Priest. We have. Mr, Bulwinkle. Doctor, is there anything else you wish to say ? Dr. Davidson. No, sir; except I believe all university schools with nursing schools such as ours will endorse this bill equally enthusiasti- cally and hope that it receives consideration, Mr. Bulwinkle. We are very glad to have you with us, sir, and if there is anything further you wish to put into the record, you may do so. I will ask you to do so as quickly as possible. Dr. Davison. Yes, sir. Mr. Bulwinkle. Because we do not want to hold up the printing of this record, for anyone. Dr. Davison. Thank you very much. Mr. Bulwinkle. Thank you. STATEMENT OF MRS. HENRY JAMES, CHAIRMAN, WOMEN’S BOARD, BELLEVUE HOSPITAL, SCHOOL OF NURSING, NEW YORK, N. Y. Mr. Bulwinkle. Mrs. James. Mrs. James. Mr. Chairman and gentlemen of the committee. Mr. Bulwinkle. Will you give your name and representation for the record ? Mrs, James. Mrs. Henry James, chairman, woman’s board, Bellevue Hospital School of Nursing. I am here as lay representative president of the board of managers of Bellevue, New York City, one of the oldest training schools of the country. I have been for many years closely connected with the education and hospital management of the nursing schools, and I wish to concur in everything that has been said today in support of this bill. It seems to me—I know that in Bellevue—we are very much crippled by the fact that the young women from whom we can draw and ordi- narily have drawn our recruits are entering the paid services that the Government offers. Mr. Bulwinkle. Right at that point, would you give us something definite, because we will be asked questions on the floor. Mrs. James. I will try. Mr. Bulwinkle. We are asked questions on the floor when a bill comes up. Now, you say that you have been handicapped by that. How much of a handicap is it? How many nurses have you lost? Mrs. James. We could have taken 150 more nurses, had we been able to get the applicants during this past year, but because of the com- petition we have not been able to get the applicants. RECRUITING AND TRAINING OF NURSES 29 In our graduate staff we are short some 885 positions at the moment. That means that pupils cannot be properly taught or so well taught, so that we are crippled in every way in the operation of the great civilian hospital which has so many patients. 1 think that quite apart, rather beside the remuneration that will be given, should this bill be passed which in itself will bring many more applicants to the school, I think that what the last witness said, the recognition that it would bring the young women would go very far. There is no lack of willingness to give the service, but there is great difficulty in meeting the financial costs and in the competition with industry and the other services established, and the feeling that they are doing their utmost and are recognized to be a part of the necessary services to the country at this time, but have no recognition from the Government. And I think that would go a very long way, and I would like to emphasize that very strongly. I think, too, that the men in the service would take great satisfaction in knowing that their people at home were being cared for, but under present conditions, and things are going to be more and more difficult, and we cannot do too much to rectify that condition. Mr. Bulwinkle. Anything further? Mrs. James. Nothing further. Mr. Bulwinkle. Thank you very much. Mrs. James. I neglected to say that the Bellevue School of Nurs- ing now has an affiliation with the New York University College of Medicine, so we are affiliated with that college. That should have gone in. STATEMENT OF MISS ALMA C. HAUPT. EXECUTIVE SECRETARY, SUBCOMMITTEE ON NURSING OF HEALTH AND MEDICAL COM- MITTEE, FEDERAL SECURITY AGENCY Mr. Bulwinkle. Miss Haupt. Will you please give your full name and position for the record? Miss Haupt. Alma C. Haupt, executive secretary, subcommittee on nursing of the health and medical committee, Federal Security Agency. Mr. Bulwinkle. You may proceed. Miss Haupt. Mr. Chairman, I have a resolution which has been sent from the national organization for public health nursing, if you wish to have it read. Mr. Bulwinkle. You may read it or insert it in the record. Miss Haupt. The resolution reads: Resolution Passed by the Executive Committee of the Board of Directors, National Ogranization foe Public Health Nursing, April 30, 1943 Whereas the National Organization for Public Health Nursing recognizes that the total need for graduate nurses in military and civilian services has greatly expanded because of war and that the present supply is inadequate; and Whereas shortages of physicians, hospital, and other community health facilities have increased the need for graduate nurses in the public-health field, par- ticularly in communities where there has been a sudden growth of population around military camps and war industries; and 30 RECRUITING AND TRAINING OF NURSES Whereas public health nurses will be needed also for post-war programs of domestic and foreign rehabilitation : Be it Resolved, That the National Organization for Public Health Nursing en- dorses the principle embodied in bill H. R. 2826 that further Federal aid for individual students and for institutions of nursing education, including those offering post-graduate programs in public health nursing, will assure an ade- quate supply of nurses. Mr. Chairman, I also have a number of letters, copies of letters here from various parts of the country and telegrams which are available for the record if you wish them. Mr. Bulwinkle. Yes; we will be glad to look over them. I also have quite a number which we will put in. Miss Haupt. May I report that the league says there are 1,304: accredited schools of nursing in the country. Mr. Priest. One thousand three hundred and four? Miss Haupt. One thousand three hundred and four, Mr. Bulwinkle. Any further questions, Mr. Priest? Mr. Priest. No; I have no questions. Mr. Bulwinkle. Thank you. Miss Haupt. Thank you. Mr. Bulwinkle. Mr. Randolph, Colonel Longfellow, is to be heard. Is there anyone else who* wishes to be heard on this bill that have not been heard ? The Chair will state that the representatives from the Navy De- partment wTere in here this morning and can probably come back tomorrow. The Chair suggests to the clerk of the committee that he will ascertain whether he is coming back or not and if he wishes to put something in the record he can do that, unless it is a matter of amendment, which we may want to ask him some questions about. Then we will call the committee together after the clerk finds out about that. The Veterans’ Administration states that they are appearing be- fore the Senate Committee on Education and Labor today and they wish to submit a statement for the record, which will be accepted. STATEMENT OF HON. FRANCES P. BOLTON, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF OHIO—Resumed Mrs. Bolton. Mr. Chairman, I want to express on behalf of the nurses of the country and of the organizations involved, the very deep appreciation of the understanding that this committee has given to the emergency need making it possible to come before you today in these hearings. We know that you are carrying an exceed- ingly heavy calendar at this moment and we deeply appreciate your giving us an opportunity to present this bill. I feel certain that you recognize the emergency that does exist that you have the intention to see to it that there be as much expedition as possible with the main committee and then realizing that in ad- dition this legislation must go through the Appropriations Com- mittee to make it effective, and I have nothing to add, except our repetition of our appreciation. Some of the facts that we tried to bring out, I feel sure have been due to you. Many of them, however, you were well aware of. Again, I want to thank you for your great courtesy to us all. Mr. Bulwinkle. Thank you, Mrs. Bolton. RECRUITING AND TRAINING OF NURSES 31 The Chair wishes to put in the record a telegram from Charles S. Dabbs, president of the South Carolina Hospital Association. A telegram from Henrietta Brink, president, New Orleans Dis- trict Nurses Association. I do not know whether Dr. Parran had that or not. A telegram from Mrs. Sue Fabregas, president, Louisiana State Nurses Association. Ann S. Nyquist, president, Minnesota Organization for Public Health Nursing; Catherine J. Densford, Minneapolis, Minn. A letter from Marie I. Bestul, president, sixth district, of the Minne- sota Nurses Association. I have a letter containing the resolution which has been read by Dr. Munger. These telegrams and letters will be placed at the end of these hear- ings with such other as may be received and which are added for the record. (The telegrams and letters and resolutions referred to appear at the end of the hearings under addenda.) Mr. Bulwinkle. The Chair will insert at this place in the record a statement on behalf of the Catholic Hospital Association of the United States and Canada: A Statement on Behalf of the Catholic Hospital Association of the United States and Canada Regarding H. R. 2326 PRESENTED ON BEHALF OF THE ASSOCIATION AND ITS PRESIDENT BY MB. EUGENE BUTLER, ASSISTANT DIRECTOR OF THE LEGAL DEPARTMENT, NATIONAL CATHOLIC WELFARE CONFERENCE, WASHINGTON, D. O. The Catholic Hospital Association of the United States and Canada wishes hereby to record its endorsement of H. R. 2326 to provide for the training of nurses for the armed forces, governmental and civilian hospitals, health agencies, and war industries through grants to institutions providing such training, and for other purposes. The association respectfully requests the approval of this bill by the Senate Committee on Education and Labor and its subsequent passage by the Senate. The Catholic Hospital Association of the United States and Canada is an as- sociation of Catholic hospitals, 710 in number in the United States, and of the schools of nursing, 391 in number in the United States. This association, repre- senting as it does in its organization and administration the viewpoints of both the hospital administrator and of school executives and faculties, considers itself particularly well qualified to express an opinion upon this bill since the national need which this bill has been planned to meet, and the method contempated in the bill for meeting that need are of particular concern to both the hospital ad- ministrator and the nurse educator. The bill not in its present form, but in its principles and provisions, has been studied, first of all, by the Council on Nursing Education of this association and by two of its committees, the committee of ex- aminers and the committee on institutional counseling, as well as by the executive board of the association. In each of these committees and in the board, there is representation from the various sections of the country as well as from the various sisterhoods conducting Catholic hospitals and schools of nursing in this country. The various committees and the board have taken the position that, as is said in one of their resolutions, “The winning of the war is our first concern, and that therefore, the partial sacrifice of the individual’s professional development is a justifiable sacrifice in the face of the national need.” The various committees and the board are of the opinion that the acceleration of the educational processes contemplated in the bill as well as the partial segregation of the periods of study and practice would be difficult to justify under conditions existing in peacetime when educational and training processes can be pursued with leisure and with full attention to the demands of the soundest achievable educational policies. 32 RECRUITING AND TRAINING OF NURSES Under conditions existing today, however, it is recognized that the need for nurses available for national service either with our military or civilian people is so great that the profession of nursing must be ready to make a temporary sacrifice in order that our national welfare may be safeguarded. The committees and the board of the Catholic Hospital have, therefore, given considerable attention and study to the possibility of maintaining satisfactory professional standards, even though the time-honored educational procedures must be set aside for the time being. These committees and the hoard are con- vinced that with careful planning and with increased emphasis upon student personnel practice, many of the threatened disadvantages which would other- wise result from premature professional practice can be successfully fore- stalled. In the official opinion of the Catholic Hospital Association of the United States and Canada, H. R. 2326 effectively meets many of the difficulties which the nursing groups have encountered in increasing their enrollment and in in- tensifying their recruitment procedures. It has long been recognized that com- petition and rivalry between the nursing professions and the branches of the military forces open to women have done much to impede the enrollment of young women in the schools of nursing. The establishment of a Victory Corps with its quasi-military organization, with its uniforms, insignia, rank, and remunera- tion, will go far to reduce the effectiveness of that rivalry in impeding recruit- ment for nursing education. It is hoped, moreover, that the judicious nnd wise utilization of techniques necessarily connected with the Victory Nurse Corps, might result in an increase in professional morale which should also prove greatly effective in keeping at a minimum the disadvantages which might other- wise result from a too hasty acceleration of the educative processes. Finally, if the project of increasing the enrollment of our schools of nursing were placed upon the hospitals without the aid of the Federal Government, it is readily conceivable that an intolerable burden might result for the hospitals which for the most part have borne the burden of the financial costs of nursing education. With the aid of the funds contemplated in H. R. 2326, the hospitals of the country should be able to assume the larger educational responsibilities implied in meeting the national needs. It is true that many of the hospitals will still feel a great burden to meet the obligation of paying the $30 a month to the Victory nurse cadet in her third year. It may be confidently hoped, however, that both as a contribution to the national war effort, and as a partial compensa- tion to the Government for payments made to the Victory student nurses of junior and of senior grades, the hospitals will probably make every effort to meet this obligation. In view of the foregoing and on behalf of the executive board of the Catholic Hospital Association of the United States and Canada, I wish herewith to present the resolution which has been formulated by the association’s executive com- mittee as expressing the mind of the association : “The executive committee of the Catholic Hospital Association of the United States and Canada, speaking for the executive board, wishes hereby heartily to endorse H. R. 2326 and to urge upon the Committee on Interstate and Foreign Commerce the favorable recommendation of this legislation to the House of Representatives. In the opinion of the executive committee, this Hill makes provision for effectively meeting many of the nursing problems, especially the nursing shortage in the Nation, and should go far toward enabling the schools of nursing to relieve the critical need for nurses in both the military and civil population. The executive board urges all the Catholic hospitals to which schools of nursing are attached to accept the responsibilities implied in an endorsement of this bill.” Furthermore, I wish here to present as relevant to the present discussion the resolution adopted by the Council on Nursing Education and its committees on February 7, with reference to the Victory Nurse Corps. The resolution reads as follows: “Whereas this plan in the mind of all those responsible for it gives well- achievement of the combined wisdom of official nurse groups in response to the national need of nurses for both military and civil purposes in the present war emergency: and “Whereas this plan in the mind of all those responsible for it gives well- founded hope of effectively achieving the purposes for which it was planned; and “Whereas the Council on Nursing Education of the Catholic Hospital Associa- tion, with its committee of examiners and its committee on institutional coun- seling, has carefully studied the plan and has convinced itself of the plan’s RECRUITING AND TRAINING OF NURSES 33 adaptability to the promoting of national purposes in our Catholic schools of nursing; therefore he it unanimously “Resolved by the Council on Nursing Education of the Catholic Hospital Asso- ciation and by the committee of examiners and the committee on Institutional counseling as follows: “1. That the plan as now proposed for the effective organization of the Victory Student Nurse Corps be endorsed in its principles. “2. That the same plan be endorsed as a practical program in the emergency even though it is recognized that it may carry with it certain educational and professional disadvantages to our schools of nursing. “8. That the difficulties which may be encountered in introducing the program are to he regarded as relatively unimportant in the face of the emergency which the program was designed to meet. “4. That with reference to the two plans; that is, the basic professional cur- riculum extending through 24 or through 80 months, this council and its com- mittees recognize that the 24-month plan will favor the recruitment of nurses, will offer more effective and speedy help in the national emergency to both the military and the civilian interests, and will prove more immediately effective in accelerating the progress of the student nurse toward professional usefulness, while the 30-month plan represents a minimal concession to the emergency as compared with present standards, guarantees a safer educational procedure, and will demand fewer compromises with existing legislation and the policies of State hoards. “5. That while it encourages the Catholic schools of nursing to adopt one or the other of these plans as each school may deem proper and practical and while it recognizes that the conflict between educational considerations and the Nation’s need are probably to some extent inevitable, nevertheless, it recom- mends to the Catholic schools of nursing the adoption of the 24-month program to increase the contribution of nursing education and nursing to the war effort. “0. That this recommendation is hereby made with the approval of the prin- ciple which permeates American life today, that the winning of the war is our first concern, and that, therefore, the partial sacrifice of the individual's pro- fessional development is a justifiable sacrifice in the face of the national need. “7. That this council and its committees have assured themselves thajt effective educational influences can he introduced into the third, that is, the apprentice- ship year, of the student's basic professional curriculum, such as seminars, con- ferences, journal clubs, clinical conferences, and similar educational helps, and that thus many of the disadvantages otherwise resulting from premature pro- fessional practice can be successfully forestalled. “8. That the schools should he urged to make the necessary curricular adjust- ments for the 24 months’ program only after the most careful consideration and with the advice of competent consultors, thus to achieve to the fullest practical extent the purposes for which the program was instituted. “9. That the Catholic schools of nursing are insistently urged to remit in no way in the accelerated program their emphasis upon their teaching of religion and their religious practice; rather to strengthen their teaching of religion and to intensify their religious practice at this time when sound and supernatural attitudes toward life are so indispensable in meeting the needs of the world and in protecting the ideals of a liberty-loving civilization. “10. That finally, the differences in educational effectiveness between the two plans, great as they are, do not seem to justify deferral of service to the country for a period of 6 months on the part of approximately 27,000 nurses annually.” STATEMENT OF EDWARD E. ODOM, SOLICITOR, VETERANS’ ADMINISTRATION, WASHINGTON, D. C. Mr. Bulwinkle. Mr. Odom of the Veterans’ Administration has just come in. We will be glad to hear you, Mr. Odom. Will you please give your full name and representation for the record? Mr. Odom. Edward E. Odom, solicitor, Veterans’ Administration. General Hines, the Administrator of the Veterans’ Affairs, is in Indianapolis for the Legion’s executive committee meeting, and there- fore could not be here. He would have liked to have come over if he could have done so. 34 RECRUITING AND TRAINING OF NURSES Mr. Bulwinkle. We would have been glad to have him. Mr. Odom. But, he did ask that I leave the committee a copy of a letter which is addressed to Hon. Clarence F. Lea as chairman of the Committee on Interstate and Foreign Commerce of the House, pur- suant to your request for a report on H, R. 2326, a bill identical with S. 983, Seventy-eighth Congress. If I may offer that, Mr. Chairman. Mr. Bulwinkle. Have you an extra copy ? Mr. Odom, I will give it to the clerk. Mr. Bulwinkle. Have you an extra copy besides that? Mr. Odom. Not with me. I will send you one. Will that be all right ? Mr. Bulwinkle. We might need that. Mr. Odom. I will send it to the clerk. I will see that he gets one this this afternoon. Mr. Bulwinkle, Would you mind letting me see it now, sir? The gist of this is that he wishes also to provide for the Veterans’ Administration. Mr. Odom. We are so short of nurses with no effective means of procuring them, in spite of the recruiting of nurses that we are carry- ing on now, that we know will be needed in the future, because of the increases, that General Hines would like to be able to participate in this program both from the standpoint of training and also from the standpoint of selecting and securing nurses. Mr. Bulwinkle. Have you any amendments to propose ? Mr. Odom. Yes; we propose an amendment and this was discussed with the Senate committee; on page 2, line 13, of this bill, insert after the word “military” the words “Veterans’ Administration,” so that that section would read: “(a) That no student or graduate nurse will be included under the plan unless in the judgment of the head of the institution such nurse will be available for military, Veterans’ Administration, or essential civilian services for the duration of the present war, and such nurse so states in her application for inclusion under the plan.” That is so we can participate in the allocation of the student nurses and nurses when they are graduated. Mr. Bulwinkle, Would you care to read this letter, because I think the audience might desire to hear it ? (Thereupon, Mr. Odom read the letter:) Veterans’ Administration, Washington, I). C., May 6', 19^3. Hon. Clarence F. Lea, Chairman, Committee on Interstate and Foreign Commerce, House of Representatives, Washington, D. C. My Dear Mr. Lea : Pursuant to the request of the chairman of the subcom- mittee having under consideration H. R. 2326, Seventy-eighth Congress, a bill to provide for the training of nurses for the armed forces, governmental, and civilian hospitals, health agencies, and war industries, through grants to institu- tions providing such training, and for other purposes, this report is submitted for consideration and inclusion in the record of the hearings, if desired. There are enclose ! two copies of a proposed report on the bill to your commit- tee which, as you will note from the second paragraph thereof, has not as yet been coordinated with the Bureau of the Budget. Your committee will be further advised as to the relationship of the proposed legislation to the program of the President as soon as advice has been received from the Bureau of the Budget in this respect. Very truly yours, Frank T. Hines, Administrator. 35 RECRUITING AND TRAINING OF NURSES Hon. Clarence F. Lea, Chairman, Committee on Interstate and Foreign Commerce, House of Representatives, Washington, D. C. My Dear Mb. Lea ; This is in response to the request of the chairman of the subcommittee having under consideration H. R. 2826, Seventy-eighth Congress, a bill to provide for the training of nurses for the armed forces, governmental and civilian hospitals, health agencies, and war industries, through grants to institutions providing for such training, and for other purposes, for a report from the Veterans’ Administration. This letter may be considered as a report on the bill, but it should be stated that due to the limited time the report has not been coordinated with the Bureau of the Budget to ascertain the relationship of the proposed legislation to the program of the President. The bill has for its general purpose authorization of funds to be appropriated for the fiscal year ending June 80, 1948, and for each fiscal year thereafter, to provide for the training of nurses for military or essential civilian services for the duration of the war. The plan may be limited to student nurse training, or to postgraduate or refresher nursing courses, or may include both. The bill makes provision for certain monthly rates of pay to student nurses and also pro- vides for payment to each institution with a plan approved by the Surgeon General, Public Health Service, under section 2 of the bill. The bill further provides that the Surgeon General, with the approval of the Federal Security Ad- ministrator, is authorized to promulgate such rules and regulations as may be necessary to carry out the purposes of the act. It should be stated at the outset that while the Veterans’ Administration is in accord with the general purposes of the proposed legislation, it is suggested that the bill be amended to specifically provide for the needs of the Veterans’ Adminis- tration. As a background to the present and prospective needs of the Veterans’ Adminis- tration for hospital personnel, including nurses, there are 93 facilities of the Veterans’ Administration furnishing hospitalization and domiciliary care, with a total of 80,176 beds presently operated. Construction to increase existing facili- ties to provide 1,379 beds is under way and plans for further construction to pro- vide 2,419 additional beds have been approved. The Federal Board of Hos- pitalization has made, and is making, a continued study of governmental hospital needs. The Federal Board of Hospitalization includes represeutives of the Veterans’ Administration, Army, Navy and Public Health Service, and the studies are conducted under the President’s order envisaging complete correlation of the Government building program. In addition to veterans of prior wars, and veterans of World War II not now in active service but eligible under existing laws, the existing agreement made in pursuance with law, requires that the Veterans’ Administration afford needed hospitalization to all veterans of the present war released by the Army and Navy as soon as it is determined that they cannot be returned to active service. Several thousand have already been given this care and the load is being increased. The personnel shortage at the Veterans’ Administration hospital facilities in- cludes physicians, nurses, technical personnel, attendants, utility and supply personnel, etc., and this condition has become acute. If the service is to be maintained, drastic steps must be taken to secure the needed personnel. This bill seems to offer an approach to future, not present, solution of the problem as to nurses. During the past year the Nursing Service of the Veterans’ Administration has been faced with increased difficulty in filling vacancies with qualified nurses. Many of the nurses who are being recruited are beyond 55 years of age and have either been engaged in private duty or have been entirely out of the field of nursing for the last 5, 10, or 15 years. These nurses are unable to stand the hard grind of institutional work; they are slower and less apt to meet the emergency load with calm, clear thinking, even though they may be willing. The work is beyond their physical capacity. We are also getting the nurses who have not been actively engaged in nursing for the last 5 years. This group, though younger, presents a similar problem in institutional nursing. At the present time our hospitals require a total of 4,474 nurses, and the ex- panded program will add to this need. With almost 500 vacant positions at the present time, it can be easily seen what will result unless the Veterans’ Admin- istration can have access to the pool of trained nurses, including those newly trained under the contemplated plan. Between May 1, 1942, and May 1, 1948, 1.394 nurses resigned from the Veterans’ Administration. Only 101 gave as their 36 RECRUITING AND TRAINING OF NURSES reason for resigning the. fact that they were entering the military service. To till these vacancies it has been necessary to give the managers authority to recruit nurses locally as the United States Civil Service Commission is unable to cer- tify enough applicants to meet the demand. The situation has been gradually becoming worse until today, from the United States civil-service certificate of 328 names, only 7 have been assigned. Managers are unable to recruit locally enough nurses to fill vacancies. Some indication of the gravity of the situation may be indicated by the fact that for 1943 it is expected that 2,000 nurses will be required to fill vacancies; for 1944, based on increased utilization, it is expected that approximately an additional 1,190 over and above the number needed for filling vacancies will be required. The Veterans’ Administration, under the existing laws and under present conditions, cannot employ and retain an adequate number of qualified physicians, dentists, nurses, attendants, utility and supply personnel, etc., to operate its hospital facilities. The functions of treatment and care cannot be discharged on a proper basis because of such conditions and the impracticability of adapting new employees to the particular work involved, even with continued supervision. Due to the fact that such appointments as can be made are made under wartime conditions, where the Veterans’ Administration cannot compete with the salaries paid in private industry, there is a large turn-over incompatible with sound prin- ciples of personnel management and serious impairment of medical and hospital services to our war disabled. The sources of supply of nurses, and this is gen- erally true with reference to medical and other personnel, which, before the national emergency, were generally suitable to meet the needs, have been re- moved. and those sources, by virtue of war conditions, have been absorbed into the Military and Naval Establishments. In considering the facts contained in this explanatory letter, it should be borne in mind that the Veterans’ Administration facilities are utilized not only for the discharged disabled of the present war and prior wars but are also utilized wher- ever necessary for persons disabled and while still in the active service. It is obvious that further Impairment of the functions of Veterans’ Administration facilities should not under any circumstances he permitted. It is a recognized principle that a major obligation of the Federal Government is to care for its war disabled, and nothing short of the most efficient medical care of these persons can be contemplated. The responsibility of the Veterans’ Administration is fixed under the statutes, and it is in the conscientious discharge of this responsibility that I have made, and am continuing to make, every effort to insure the accom- plishment of the purposes of those laws. It is my desire to impress upon the committee what I consider to he not oidy the appropriate but necessary place the Veterans’ Administration should occupy in a sequence of priority on a supply of nurses. Considering the Federal obliga- tion to the war-disabled veterans and the other veterans whose rights to hos- pitalization have been provided by law, it is believed that the position of the Veterans’ Administration should be second only to the War and Navy Depart- ments in such priority. Recognizing my full responsibility in the matter, it is believed preferable that this sequence of priority for the Veterans’ Administra- tion be made a matter of law. This statement is made without prejudice to any program involving civilian needs. In my opinion, the civilian problem should be treated separately so that under no conditions will the needs of the War and Navy Department and the Veterans’ Administration be impaired. For the foregoing reasons, it is the recommendation of the Veterans’ Adminis- tration that your committee give favorable consideration to the amendments to the bill as outlined herein. Very truly yours, Frank T. Hines, Administrator. Mr. Bulwinkle. Have you a copy of that amendment here ? Mr, Odom. Yes, sir. Mr. Bulwinkle. Just let me see it for just a minute. Mr. Odom. Yes, sir. Mr. Bulwinkle. I do not think that the amendment is put in at the right place. Mr. Odom. Well, it could go in on the first page, sir, but all that we want is RECRUITING AND TRAINING OF NURSES 37 Mr. Bulwinkle (interposing). I mean this amendment in that par- ticular paragraph: Unless in the judgment of the head of the institution such nurse will be avail- able for military, Veterans’ Administration, or essential civilian services for the duration of the present war. You would hold it down to that to the Veterans’ Administration during the present war. Mr. Odom. We do not worry very much about our ability to secure nurses after the war ends. We cannot be sure about it. Mr. Buiavinkle. Mr. Odom, we will be glad to give consideration to what you have stated and what General Hines says in his letter. Mrs. Bolton. May I be permitted to say a word before the gentle- man leaves ? Mr. Bulwinkle. Yes, Mrs. Bolton, Mrs. Bolton. In the consideration of the whole proposition and the whole program, the Veterans’ Administration was taken into consid- eration all down the line, and 1 think that if the amendments were studied, it would be found that the wording of one of them states “other Governmental agencies,” which does include very definitely the Veterans’ Administration. Mr. Bulwinkle. We thank you very much, Mr. Odom. Mr. Odom. On behalf of General Hines, 1 want to thank the com- mittee for the opportunity of presenting this letter, Mr. Bulwinkle. Tell him we are very sorry that he could not be here. The committee will adjourn until tomorrow morning. There will be no other witnesses to be heard except an officer from the Navy Department, if he is prepared to go on. Then the committee in executive session will immediately give consideration to the bill. Mr. Priest. At 10 o’clock tomorrow morning? Mr. Bulwinkle. Yes. (Thereupon, at 12:10 p. m,, the committee adjourned as above in- dicated.) ADDENDA The Chairman. The following communications received are here inserted as a part of this record of hearing: (The telegrams and letters referred to are as follows:) [TELEGRAMS] Roanoke, Va., May 4, 1942. Hon. C. F. Lea, House of Representatives: South Carolina Hospital Association in meeting assembled urges passage H. R. 2326. Charles Dabbs, President. New Orleans, La., May 5, 19^3. lion. Alfred L. Bulwinkle. Chairman, Subcommittee of Public Health Committee on Interstate and Foreign Commerce, House of Representatives, Washington, D. C.: The New Orleans District Nurses Association 1760 urges you to give whole- hearted support to bill H. R. 2326, providing training of nurses, and companion bill S. 983. Henrietta Brink, President, New Orleans District, Nurses Association. 38 RECRUITING AND TRAINING OF NURSES New Orleans, La„ May WtS- Hon. Alfred L. Bulwinkle, House of Representatives, Washington, D. C.: Louisiana State Nurses Association, membership 3,000, urges you to give whole- hearted support to bill H. R. 2326, providing for the training of nurses and companion bill S. 983. Critical situation developing in State due to nurse shortage. Funds needed to attract qualified applicants to nursing school. Com- petition with industry keen. Mrs. Sue Fabkegas, President; Minneapolis, Minn., May 5, 1943. Hon. Alfeed L. Bulwjnkle, Chairman, Subcommittee on Public Health, Committee on Interstate and Foreign Commerce, House of Representatives, Washington, D. C.: May I urge endorsement of student nurse bill H. R. 2326? Katharine J. Denford. Minneapolis, Minn., May }, 19^3. Hon. Alfeed L. Bulwinbxe, Chairman, Subcommittee on Public Health, House of Representatives, Washington, J). The Minnesota Organization for Public Health Nursing, representing a large number of public health nurses and lay members, enlists your favorable support of H. R. 2326, relating to war nurses’ reserve. Ann S. Nyquist, President New York, N. Y., May 6, W).i. Hon. Clarence F. Lea, Chairman Committee on Interstate and Foreign Commerce, House of Representatives: Hospital Management, a magazine of national circulation among hospitals of all types, wishes to record its complete support of proposed Federal legisla- tion for a student war nursing reserve and to urge that your committee report favorably on it, to assure Government aid in the increasingly serious nursing situation. Kenneth C. Crain, Vice President. Portland. Oreo., May 7, 1943. Hon. Alfred L. Bulwinklb, Chairman, Subcommittee on Public Health, Committee on Interstate and Foreign Commerce, House of Representatives: We ui’ge your support of bill H. R. 2326 because of serious nursing shortage. Oregon State Nurses Association. [LETTERS] Sixth District of the Minnesota Nurses Association, Rochester, Minn., May 4, 19J/3. Hon. Alfred L. Bulwinkle, Chairman Subcommittee on Public Health, Committee on Interstate and Foreign Commerce, . House of Representatives, Washington, D. C. Dear Sir : In view of the urgent need for graduate and student nurses at this time, we wish to voice our opinion in favor of the bill H. R. 2326 which will provide for financial grants to institutions providing training for nurses. RECRUITING AND TRAINING OF NURSES 39 The directors of the schools of nursing and the nursing superintendents of the hospitals in our district are finding it increasingly more difficult to secure adequate nursing service. The schools of nursing are also finding it difficult to secure qualified student applicants, since so many financially attractive positions are available in industry. We hqpe that it will Ik; possible for you to give your support to this legislation. Very truly yours, Marie I. Bestul, President, Sixth District, Minnesota Nurses Association. Resolution Rb H. R. 2326, To Provide for the Training of Nurses, American Nurses’ Association, New York, N. Y. Whereas the American Nurses’ Association is the professional membership organization of graduate registered nurses in the United States, with approxi- mately 183,000 members and with constituent State associations located in all States in the United States, including the District of Columbia, Puerto Rico, and Hawaii: and Whereas this association has gone on record as offering its support and strength in any nursing activity in which the association can be of service to the country; and Whereas global war has created unprecedented demands for qualified nurses for service with the armed forces and for industrial nursing positions; and Whereas the needs of the armed forces have rightly been given priority by the nursing profession but at the cost of very grave depletion of nursing service for the civilian population; and Whereas the most liberal use of voluntary and other auxiliary nursing person- nel cannot balance the loss of qualified nurses; and Whereas the American Nurses’ Association, recognizing its grave responsibility for providing adequate nursing care wherever needed, has made maximum use of all of its resources, including its publications, in support of a comprehensive utilization of existing nurse power; and Whereas the sum total of all efforts to meet both military and civil demands for nursing is still inadequate and there is urgent need for the enrollment of larger numbers of students in schools of nursing since such students, under super- vision, supply useful nursing service and when graduated will contribute to es- sential national and international health programs: Therefore be it Resolved, That the American Nurses’ Association go on record as approving, in principle, bill S. 983. Julia C. Stimson, President. American Hospital Association, Chicago, III., May If, 191/3. Hon. Clarence F. Lea, Chairman, House Committee on Interstate and Foreign Commerce, House of Representatives, Washington, D. C. My Dear Sir; I am enclosing a resolution covering action by the board of trustees of the American Hospital Asosciation in regard to H. R. 2326, which we understand is to be considered by your Committee on Interstate and Foreign Commerce on Thursday, May 6. We will very much appreciate your submitting this resolution to your com- mittee. Very truly yours, George Bugbee, Executive Secretary. Resolution of the Board of Trustees op the American Hospital Association Whereas the present supply of graduate nurses for military and civilian hos- pitals is inadequate to meet basic needs ; Whereas this shortage will tend to increase because of the heavy demand by both the military and civilian populations for graduate nurses; Whereas the competition of other war activities is likely to reduce rather than permit the necessary increase in normal recruitment of young women for the nursing profession; [ 40 RECRUITING AND TRAINING OF NURSES Whereas every effort must be made to increase the enrollment of schools of nursing in order that the present shortage may be met before there occurs a serious break-down in the health and hospital services of the nation; Whereas the American Hospital Association considers this to be one of the most critical problems facing the hospitals of this country; therefore be it Resolved, That the board of trustees of the American Hospital Association approves in principle H. R. 2326 which provides “for the training of nurses for the armed forces, governmental and civilian hospitals, health agencies, and war industries,” and urges your favorable action with minimum delay. Government of the District of Columbia, May 8, 1943. Hon. Clarence F. Lea, M. C., Chairman of Interstate and Foreign Commerce Committee, United States House of Representatives, Washington, D. C. My Dear Mr. Lea; Circumstances unfortunately prevented my personal ap- pearance before your committee on the bill to “provide for the training of nurses for the armed forces, governmental and civilian hospitals, health agencies, and war industries, through grants to institutions providing such training, and for other purposes”. I wish to say that I heartily endorse this bill and its objectives. I believe that such mass training of a large number of women will be a contribution to the advancement of public health, even after the present demand for hospital nursing care has passed. With highest personal regards. Very truly yours, GeoROe O. Ruhland, M. D., Health Officer. Bellevue School of Nursing, New York, May 7, 19^3. Hon. Clarence Lea, Chairman, Committee on Interstate and Foreign Commerce, House of Representatives. Washington, D. C. Dear Congressman ; Having been at the hearing before the committee of the House on May 6 to consider bill H. R. 263fi. I reported the purpose and content of the bill at a meeting of my executive committee this morning. I write to express the deep concern of the executive committee of the board of managers of the Bellevue School of Nursing in the city of New York that this bill with the amendments proposed be given early and favorable consideration. The board of managers of the Bellevue schools represents a body of laywomen, in existence since 1872, when the first school of nursing in a general hospital was established. Over the years it has been a group selected for Its interest in the care of the sick and the education of the nurse, in particular. At the present time it has been taking an active part in the considerations to increase the supply of nurses for the Nation’s needs. That the desired success in recruitment has not been achieved is, in our judgment, largely due to the competition of the well-paid work in industry calling for women and also to the recognition given to the auxiliary services of the armed forces by the Government and hitherto not extended to the nursing services. Many young women who, in normal times, would have turned to nursing as a-career now are drawn to other work; it is evident that the Army, Navy, and civilians will suffer if something is not done promptly to enable the schools to supply the quota of students asked for by the Government. The students of today are the nurses for the future, and we must be vigilant not to let the stream dry up. Heavy responsibilities for health pro- tection and care face the profession after the war. There is one more point that might well be made, and that is the help to the men in service to know that their families are being well cared for, and this can only be assured by a constant supply of well-trained nurses. It is for these reasons that we most earnestly hope that the passage of this bill will be expedited. Yours sincerely, Dorothea James, President, Board of Managers, Bellevue School of Nursing. RECRUITING AND TRAINING OF NURSES 41 District No. 5, Minnesota State Registered Nurses Association, Mankato, Minn., May 4, 19JfS. Hon. A [ Fred L. Bulwinkle, Chairman, Subcommittee on Public Health, Committee on Interstate and Foreign Commerce, House of Representatives, Washington, D. C. Honorable Bulwinkle; Nurses as well as others interested in health and wel- fare are happy to see the introduction of the above bill to provide for the training of nurses for the armed forces, governmental and civilian hospitals, health agencies, and war industries, through grants to institutions providing such training, and for other purposes. Hospitals are short of nurses, health agencies are handicapped through lack of nurses, and the demands are great. The above bill gives us hope that we shall be able to continue to give care to those who need our services. Yours truly, Laura Hbgstao, President, Fifth District, Minnesota Nurses Association. Department of State, Atlanta, Ga„ May 7, 19J,S. Hon. Alfred L. Bulwinkle, Chairman, Subcommittee on Public Health, Committee on Interstate and Foreign Commerce, House of Representatives, Washington, D. C. Dear Mr. Bulwinkle: It lias been brought to my attention that H. R, 2326 is a bill pending before the Congress to provide for the training of nurses for the armed forces, governmental and civilian hospitals, health agencies, and war industries, through- grants to institutions providing such training, and for other purposes. I am sure you will be interested to know that the Georgia State Nurses Association and the Georgia Hospital Association have both given their approval to this bill. You know, also, that under the examining boards division in my department the State Board of Examiners of Nurses for Georgia operates, and through this board I am in contact with the problem of securing sufficient trained nurses for the war effort. I would deeply appreciate it if you will look into this bill and urge its adoption if you can consistently do so. As the problem now stands, comparatively, girls upon graduation from high school can immediately join either the WAAC’s or the WAVES . id begin receiv- ing compensation of $50 per month, whereas the nurses are required to complete a long period of training before being eligible to receive compensation. This difference in inducement confronts us with a serious problem in securing the proper number of trained nurses, and it seems to me that something has got to be done and done now if we meet fully the job of securing trained nurses in sufficient numbers in the near future. Again, I will appreciate your looking into this matter and hope you can give this problem your favorable consideration. With regards and best wishes. Sincerely yours, John B. Wilson, Secretary of State. North Carolina State Board of Health, Raleigh, Mug 7, 19/,3. Hon. Alfred L. Bulwinkle, Chairman, Subcommittee on Public Health, House of Representatives, Washington, I). (7. Dear Mr. Bulwinkle : I feel it unnecessary for me to set forth a brief in behalf of H. R. 2326 as to the importance and the necessity for an affirmative action on the bill, which will enable us to meet the needs of the emergency which will assure us a supply of nurses so badly needed in the armed forces, as well as the civilian population. I simply want to be placed as of record as your State health officer favoring same. With kindest personal regards, I am Very sincerely, C. V. Reynolds, Secretary and State Health Officer. 42 RECRUITING AND TRAINING OF NURSES Visiting Nurse Association, Waterbury, Conn., May 7, 19JtS. Hon. Alfred L. Bulwinkle, Chairman Subcommittee on Public Health, Committee on Interstate and Foreign Commerce, House of Representatives, Washington, D. C. Dear Mr. Bulwinkle: As a member of the board of directors of the Connecticut State Nurses’ Association, I should like to urge your support of H. R. 2326 and S. 9£3 as bills which seem to us workable. Thank you for your attention to these bills. Sincerely yours, Alice Peak. Fifth District, Georgia State Nurses’ Association, Atlanta, Ga., May 6, 19^3. Hon. Alfred L. Bulwinkle, Chairman, Subcommittee on Public Health, Committee on Interstate and Foreign Commerce, House of Representatives, Washington, D. C. Dear Sir : Will appreciate your help in the passage of the bill H. 11. 2326, to provide for the training of nurses for the armed forces, governmental, and civilian hospitals, health agencies, and war industries, through grants to institutions providing such training, and for other purposes. Thanking you for your cooperation. Very truly, Miss Llewellyn Wood, R. N., Member of State Nurses’ Legislative Committee. Elizabeth, N. J.. May 8, lSJt3. Hon. Alfreb L. Bulwxnkee, Chairman, Subcommittee of House Interstate and Foreign Commerce Committee, Washington, D. C.: Enclosed find a clipping from the New York Times, May 8, 1943. I was more than shocked to learn more schools of nursing had been closed since 1937. Was the committee given the following information? There were 22,000 students grad- uated from schools of nursing that offered the basic course in 1943: this number was reduced to 18,600 in 1936, and the number of schools of nursing decreased to 1,385 from 1,472 (1935). The number of schools was reduced because it was thought at that time that there was an oversupply of nurses and because many of the schools that were discontinued could not meet the standards set hy State boards of examiners. Believe as a citizen this committee should thoroughly inves- tigate the nursing situation and clear up the conflicting publicity given this matter. At a public hearing on Senate No. 20, held in Trenton on April 2, 1943, a state- ment was made that there was no shortage of nurses for civilian or military needs. Have decided to send along another clipping from the Elizabeth Daily Journal, with a statement marked. Miss Twidale, now president of New Jersey State Nurses Association and member of League of Nursing Education, until very recently would not permit a nurse on duty unless she was registered in New Jersey. We older women, knowing of this condition, approached both the secre- tary of the State board of nurse examiners and Miss Twidale. We were assured after the war something would be done regarding our status. We sought legal advice and introduced a bill that would put, roughly, 2,000 nurses back on duty with the recognition which is rightfully theirs. Senate No. 20, this bill, is still in committee. We wonder if there really is a need for nurses and if we should concentrate our efforts in inducing our friends’ young daughters to enter training schools or believe the testimony we heard at Trenton and just be war workers. Several graduates of accredited schools of nursing have entered war plants, due to the conflicting statements regarding their need. Feel sure you gentlemen will do all in your power to clear up this confusion. Sincerely yoxxrs, Mrs. Henry J. Drake. 43 RECRUITING AND TRAINING OF NURSES Witnesses Tell War Nursing Need—Thirteen Urge Senate Committee to Support the Bailey Subsidy Bill—O. W. I. Enters the Campaign—Statement Says Students Answering Call fob 65,000 Will Free Others for Front Lines Washington, May 7.—While 13 witnesses testified at a Senate committee’s hearing on legislation to make nursing as attractive as women’s new military organizations, the Office of War Information entered the campaign today for more nurse power by reminding girls who answer the country’s call for student nurses that they are releasing other women for the front. Although the campaign’s goal is 65,000 student nurses this year, the Office of War Information said that “many more” are needed “but this is the maximum number that can be trained at any one time.” This statement, it says, is based on figures released by the nursing subcommit- tee of the erstwhile Office of Defense Health and Welfare Services, now the Office of Community War Services. There are 1,300 nursing schools in the country’s leading hospitals, the Office of War Inqformation reported. “While the number of nurses available to care for civilian patients is on the decrease,” the Office of War Information stated, “the number of hospital patients is increasing. The girl who answers the 1913 appeal to become a student nurse will be signing up for a war job of top importance. She will release another woman for the front lines, one who may take care of her own brother or sweet- heart or former school chum in some far-off base or field hospital. At the same time she will be fitting herself for a career in a field where the average pay is better than in many professions open to women.” Meanwhile Miss Mary Beard, national director of the American Red Cross, testified before the Senate Education and Labor Committee hearing on the Bailey nursing-subsidy bill. She said that more than 30,000, or one-third, of the coun- try’s graduate nurses are serving with the armed forces and 20,000 more must be recruited to military service by Christmas. Representative Frances I’. Bolton, of Ohio, author of a similar bill, said that student nurses should not be required to pay their way while in training when the Government gives training to other women bound for military service. [Prom the Elizabeth Daily Journal, Friday. April 30, 1043] 23 More Nurses Enlist to Serve—Army Gets 11. Navy 7, Red Cross Reserves 5 Twenty-three nurses from Elizabeth and adjacent areas have enlisted for serv- ice with the armed forces or as Red Cross reserves during the past month, it was announced by Miss Josephine Zbikowski, secretary of the nurse recruitment com- mittee, at a meeting of the committee at Red Cross headquarters here last night. Eleven of the 23 will serve with the Army, 7 with the Navy. The remaining 5 have enrolled as Red Cross reserves and will be called upon only in case of disaster. Miss Zbikowski urged every registered nurse, whether or not she is able to serve with the armed forces, to register for Red Cross emergency service. Miss Bertha E. Wildman, of Summit, reported that 28 nurses from that area are now serving with the armed forces. At a recent meeting of all nurse recruitment committees in the North Atlantic area, the Elizabeth committee was commended for its activities, it was revealed in a report of the regional meeting by Mrs. Michael J. Dwyer, cochairman of the committee. Although Elizabeth does not rank first in the number of nurses re- cruited, the committee has reached a large number of civic and school groups and has made a good showing, considering the shortage of nurses in civilian hospitals in this area, Mrs. Dwyer said. Miss Wilhelraine A. H. Twidale, chairman of the nurse recruitment committee and supervisor of nurses at Elizabeth General Hospital, told the committee of a retired graduate nurse who recently returned to the hospital to serve from 7 to 11 o’clock each evening, after her husband gets home from work and can care for their children. “That woman is making a real sacrifice to help,” said Miss Twidale. “I wish I could impress upon inactive graduate nurses that their decision to return to active duty should not be based on whether or not they need a job. Those women are trained. It takes 3 years or more to give a student nurse the same training. No one can substitute for a graduate nurse. [Prom the New York Times, May 8, 1043] 44 RECRUITING AND TRAINING OF NURSES “If nurses who are inactive could just look into our hospitals and sense the strain which our overworked nurses are undergoing, they would make sacrifices to come back into service, if only for part time.” High-school graduates now can enroll for nurse training at the age of 17%, it was announced. Hundreds of girls are needed to help fill the gap left by nurses entering the armed forces, it was stated. Nurses’ aides were praised again for their work by the St. Elizabeth and Elizabeth General Hospital staffs. Miss Zbikowski urged nurses who desire to enlist in the Army or Navy to make their application through the Red Cross nurse recruiting station at C44 Salem Avenue, rather than writing direct to Washington. The Red Cross was given the recruiting task to relieve overburdened Army and Navy headquarters, she said, stating that a number of girls have delayed their own enlistment by not sending their papers through the proper channels. Swift County Hospital, Benson, Minn., May 5, 19J/3. Hon. Alfred L. Bulwinkle, Chairman, Subcommittee on Public Health, Committee on Interstate and Foreign Commerce, House of Representatives, Washington, I). C. Dear Chairman Bulwinkle: This is in regard to the hill to provide for the training of the nurses for the armed forces, and so forth, through grants to in- stitutions providing such training, H. R. 2326 and S. 9S3 now pending. As presi- dent of a nursing district and superintendent of a hospital, I am in a position to know that more trained nurses are urgently needed both for civilian and war- time nursing. Therefore, I urge that you give this bill your careful and consider- ate support. Yours very truly, Amy G undersen. President, Eighth District. Carolinas-Viroinias Hospital Conference, Charleston, W. Va., May 6, 191/3. Hon. A. L. Bulwinkle, House of Representatives, Representatives Office Building, Washington, D. G. Dear Sir: At the annual meeting of the Carolinas-Virginias Hospital confer- ence held in Roanoke, Va., on May 3 and 4, the following resolution was passed: Whereas a serious shortage of nurses both for civilian and military needs exists; and Whereas the shortage is rapidly increasing, due to greater competition for womanpower; and Whereas it is apparent that the shortage of nurses will reach an alarming figure by the end of the present year; and Whereas this challenging problem has been given careful consideration during recent months by the hospital authorities and the professional nursing organi- zations in consultation with the governmental agencies concerned; and Whereas a proper and successful solution must be found to this pressing problem in order not to jeopardize the success of our armed forces, hospitals, and the health work generally : Be it Resolved, That we pledge anew our earnest cooperation in seeking to overcome shortages in the nursing profession by— (a) Increasing, where possible, the number of student nurses enrolled in the approved nurses’ training schools of our States. (b) Accelerating, intensifying, and shortening the period of training where consistent, without sacrificing essential contents of the curriculum. (c) Urging the early passage by Congress of House bill No. 232G. a bill intro- duced in the House of Representatives for the purpose of asserting a supply of nurses for the armed forces, governmental and civilian hospitals, health agencies, etc., and further urging all member institutions and individualsto contact their RECRUITING AND TRAINING OF NURSES 45 respective Senators in Washington in behalf of an early passage of this bill, thus making possible an expanded nurses’ training program at the earliest possible date. Very truly yours, Chas. E. Vadakin, Secretary-Treasurer, Carotinas-Viryinius Hospital Conference. Mountain Iron, Minn., May 5, 19JfS. Hon. Alfred L. Bulwinkle, Chairman, Subcommittee on Public Health, Committee on Interstate and Foreign Commerce, House of Representatives, Washington, D. C. Dear Sir; As president of the tenth district, representing some 80 nurses, I am writing to urge you to assist in the passage of bills H. R. 2326 and S. 983, which provides for the training of nurses for the armed forces, governmental and civilian hospitals, health agencies, and war industries through grants to insti- tutions providing such training and for other purposes. It has the approval of the hospital and nursing groups and has been endorsed by representatives of the Army, Navy, and Public Health Service. Sincerely, Mrs. Lillian Fuller, R. N., President, Tenth District Nurses. Visiting Nurse Association, New Haven, Conn., May1 6, 1943. Hon. Alfred L. Bulwinkle. Chairman. Subcommittee on Public Health, Committee on Interstate and Foreign Commerce, House of Representatives, Washington, D. C. Dear Sir: Knowing well the pressure on Connecticut hospitals and health agencies resulting from the great expansion of war industries and our com- plete inability to stretch our peacetime supply of nurses to cover these new burdens as well as the needs of the Army, I urge your support of House bill 2326. Very truly yours, Elizabeth G. Fox, Executive Director. Visiting Nurse Association of New Britain, Inc., New Britain, Conn., May 8, 1943. Hon. Alfred L. Bulwinkle, Chairman, Subcommittee on Public Health, Committee on Interstate and Foreign Commerce, House of Representatives, Washington, D. C. Dear Sir : Yesterday H. R. 2326, providing for the training of nurses for the armed forces, governmental and civilian hospitals, health agencies and war industries through institutions providing this training, came to my attention through the legislative committee of the Connecticut State Nurse’ Association. I am heartily in favor of the passage of this bill, and respectively urge your favorable consideration of its passage. Your respectifully, Rachel C. Colby, Nursing Director. 46 RECRUITING AND TRAINING OF NURSES i' Hospital Association of Pennsylvania, HarrisbvrO, May 3, 1043. Hon. Clarence F. Lea, Chairman, House Committee, House of Representatives, Washington, D. C. Dear Mr. Lea: The Hospital Association of Pennsylvania,"in assembly at a war conference in Philadelphia, April 16, 1948, unanimously adopted a resolu- tion on the serious shortage of nurses both for civilian and military needs. I have been instructed to send you a copy of this resolution, enclosed here- with, and direct your attention particularly to paragraph C of the resolution, urging the early passage by Congress of House bill No. 2326. This resolution also has been sent to Hon. Elbert D. Thomas, chairman of the Senate committee. Your very favorable acceptance of this resolution and earnest cooperation in seeking to overcome shortages in the nursing profession will be greatly respected and most appreciated by the Hospital Association of Pennsylvania, representing the approximate three hundred hospitals in this State. Very sincerely yours, S. H. Armstrong, Executive Secretary. A Resolution of the Hospital Association of Pennsylvania in Assembly at a War Conference in Philadelphia April 15-16. 1943 April 16, 1943. Whereas a serious shortage of nurses, both for civilian and military needs, exists in the country today; and Whereas the shortage is rapidly being aggravated by the increasing competi- tion for womanpower; and Whereas it is apparent that the shortage of nurses will reach a figure well above the 60,000 mark by the end of the present year; and Whereas this challenging problem has been given careful consideration during recent months by the hospital authorities and the professional nursing organizations, in consultation with the governmental agencies concerned; and Whereas a proper and successful solution must be found to this pressing problem in order not to jeopardize the success of our armed forces, hospitals, and health work generally; be it Resolved, That, as members of the Hospital Association of Pennsylvania, we pledge anew our earnest cooperation in seeking to overcome shortages in the nursing profession by— (а) Increasing, where possible, the number of student nurses enrolled in the approved nurses training schools of our State. (б) Accelerating, intensifying, and shortening the periods of training where consistent, without sacrificing essential contents of the curriculum. (c) Urging the early passage by Congress of House bill No. 2326, a bill intro- duced in the House of Representatives for the purpose of assuring a supply of nurses for the armed forces, governmental and civilian hospitals, health agen- cies, etc., and further urging all member institutions and individuals to contact their respective Senators and Representatives in Washington in behalf of an early passage of this bill, thus making possible an expanded nurses training program at the earliest possible date. Attested: [seal] S. H. Armstrong, Executive Secretary, Hospital Association, of Pennsylvania. Florida Hospital Association—Resolution Whereas the hospitals of this State find themselves under a handicap in taking care of their patients because of the demand upon nurses from military and in- dustrial fields; and Whereas the number of applicants for nurses training is affected by the un- usual opportunities for young women to make good livings in commercial life; and Whereas we understand that the same problems have been the subject of RECRUITING and training of nurses 47 concern and consideration by Qur hospital authorities and nursing organizations generally throughout the country; and Whereeas we are anxious to effect a proper solution which will afford relief to hospitals and at the same time supply essential nursing service to the armed forces, industrial establishments and public health work; Therefore be it now Resolved by the Florida Hospital Association in assembly, That we give our support to efforts to increase the number of student nurses enrolled in approved nurses’ training schools of our State; that we are in favor of the training of nurses by intensifying the class practice work wherever it can be done without sacrifice of the essentials of nursing education, and that we are in favor of the terms of House bill No. 2828, or Senate bill No. 983, introduced into the House of Representatives and the Senate, respectively, providing a system of training nurses for the armed forces, governmental and civilian hospitals, health agencies, and war industries through Federal grants to institutions which are willing and qualified to give such training, and for payment of a stipend to those nurses who undertake to go through with training under this act; and that as an associa- tion we urge all member institutions and individuals to send an expression of their interest and approval to our Senators and Representatives in Washington, in be- half of the passage of this bill. 1 hereby certify that this is a true copy of resolution unanimously adopted by the Florida Hospital Association at its annual meeting held April 26, 1943. W. E. Aenold, President, St. Luke's Hospital, Jacksonville, Fla. The Connecticut State Nurses’ Association, Hartford, Conn., May 6, 194$. Hon. Alfred L. Bulwinkle, Chairman, Subcommittee on Public Health, Committee on Interstate and Foreign Commerce, House of Representatives, Washington, D. C. My Dear Mr. Bulwinkle : The Connecticut State Nurses’ Association with a membership of more than 5,000 registered nurses is in favor of the passage of H. II. 2826, a bill to provide for the training of nurses for the armed forces, gov- ernmental and civilian hospitals, health agencies, and war industries, through grants to institutions providing such training, and for other purposes. This bill, we believe, will encourage and stimulate young women to enter schools of nursing who, because of lack of funds, might otherwise be unable to do so. With the increased demand for more registered nurses for H e armed forces, it is essential that the number of young women entering schools of nursing be in- creased and we believe this bill will aid greatly in the increase. We hope, therefore, that your committee will report favorably on it. Sincerely yours, Margaret K. Stack, Executive Secretary. Fourth District Minnesota Nurses’ Association, St. Paul. Minn., May 1943. Hon. Alfred L. Bulwinkle, Chairman, Subcommittee on Public Health, Inter Mate and Foreign Commerce, House of Representatives, Washington, D. C. Dear Sib: Fourth district Minnesota Nurses’ Association, covering the follow- ing counties: Isanti, Chisago, Anoka, Scott, Rice, Goodhue, Dakota, Ramsey, and Washington, feels that the passage of House file No. 2326 and Senate file No. !)38 will help to meet a situation that is growing more difficult here, daily. During the past months, we have had great difficulty in meeting the need for nurses to call for the serious ill patients and to supply the hospitals with the staff nurses needed. While filling only the very necessary calls has reduced the number of calls filed hy our nurses’ official registry over 30 percent, we have not been able to fill from 10 to 15 percent of such calls. Our quota per month for nurses for military service is 36. and is being met. Practically all students of schools of nursing in the district graduating this spring are members of the Red Cross Student Reserve, and as such will he going directly into military service. It is essential, if we are to be able to 48 RECRUITING AND TRAINING OF NURSES meet the growing needs for nursing services, that more young women must be recruited as students and many will need financial assistance. Very truly yours, Fourth District Minnesota Nurses’ Association, Thelma Dodds, It. N., President. City of Duluth, May 4, J9J/3. Alfred J. Bulwinkle. Chairman, Subcommittee on Public Health, Committee on Interstate and Foreign Commerce, House of Representatives, Washington, D. C. Dear Sir: My attention lias been called to House bill 232G, Senate file 983, which provides for appropriations for the training of nurses for the armed forces, governmental and civilian hospitals, health agencies and war industries, through grants to institutions providing such training. Our city health department is much concerned over the passage of this bill as it will provide for an increase of student nurses in training and this will help to meet the shortage of trained nurses in Duluth. Since January 1941. the northern part of the State, has sent to the armed service 125 registered nurses and as this naturally decreases the nursing power of this area, it is now necessary to provide for the education of more girls to take their place. Anything you can do to help will be greatly appreciated by our nursing force in Du uth. Very truly yours, Edward H. Hatch, Mayor. Pennsylvania State Nurses’ Association, Harrisburg, Pa., May 5, 1943. Hon. Alfked L. Bulwinkle, Chairman, Subcommittee on Public Heallh Committee on Interstate and Foreign Commerce, House of Representatives, I Washington, D. C. Dear Congressman Bulwinkle: We are writing to ask-your support of House bill 2328 and to urge you to press for speedy action on the measure. Pennsylvania lias more schools of nursing than any other State and provides over 10 percent of the nurse strength of the entire country. Pennsylvania must provide also 330 nurses every month for military service; this means that more and more students must be recruited for schools of nursing and the State quota for this year is 6.500 students. Unless there is some assistance to overcome the stiff competition nursing is experiencing with industry and the auxiliary military services, urgent military and civilian nursing needs will not be met. The prompt passage of this legislation is imperative if we are to secure quali- fied students for fall classes. It will facilitate,' too, the visits we must make to high schools and colleges before the end of May for we shall be able to give concrete answers to the many questions that students and parents are asking about nursing. Yours sincerely, M. Naomi Houser, R. N., Secretary-Treasurer. Health Department of the City of Duluth, Duluth. Minn., May \, J9J/3. The Honorable Alfred L. Bulwinkle, Chairman, Subcommittee on Public Health, Committee on Interstate and Foreign Commerce. House of Representatives, Washington, D. C. Re S. 983 and H. R. 2326. Dear Sir : Information has come to me that H. R. 2326 and its companion bill S. 983 will presently be given consideration. The goal of these measures, as you know, is to stimulate the training of nurses to help snub the ever-growing shortage created in the ranks of that profession through the enormous demands being made upon it, not alone by the armed forces but by war industries, public health agencies and civilian institutional and private needs. The modus operand! is through subsidies. RECRUITING AND TRAINING OF NURSES 49 Without burdening yo\i with a monograph detailing the rationale thereof, may I, nevertheless, offer it as my sincere conviction that adoption of H. R. 2326 and S. 983 at this time will substantially contribute to the health and wel- fare of all American citizens, both in and cut of uniforms. Accordingly, I respectfully urge favorable consideration and adoption of these companion bills. Very truly yours, M. McC. Fishkr, M. D., Director of Public Health. The Minnesota Nurses’ Association, St. Paul, Minn., May 3, 19J$. Hon. Alfred L. Bulwinkle, Chairman, Subcommittee on Public Health. Committee on Interstate and Foreign Commerce, House of Representatives, Washington, D. C. My Dear Mr. Bulwinkle; The Minnesota Nurses’ Association (5,000 members) would like to see H. R. 2326 and S. 9S3 passed into law. This bill “To provide for the training of nurses for the armed forces, governmental and civilian hospitals, health agencies, and war industries, through grants to institutions providing such training, and for other purposes,” is a plan that has been developed to meet the serious shortage of nurses both for civilian and military needs. The nurses of Minnesota urge you to work for its passage. Respectfully yours, Caroline M. Rankietxoub, General Secretary. North Carolina State Nurses’ Association, Raleigh, N. C., May 19J,3. Hon. A. L. Bulwinkle, Chairman, Subcommittee on Public Health, Committee on. Interstate and Foreign Commerce, House of Representatives, Washington, D. C. My Dear Mb. Bulwinkle: The North Carolina State Nurses’ Association, with a membership of 2,859 graduate registered nurses residing and practicing in every county of the State of North Carolina urgently requests your support of bill H. R. 2326, which provides for the training of nurses for the armed forces, gov- ernmental and civilian hospitals, health agencies, and war industries, through grants to institutions providing such training. The North Carolina Nursing Council for War Service, which is composed of leaders of the different groups of nurses, representatives of the North Carolina Hospital .Association* North Carolina- Board of Health, and North Carolina Council on National Defense,-f*lse requests your support of this bill. Sincerely yours, Flora Wakefield, R. N.. President. Hospital Association of West Virginia. Charleston, W. Va-., May 6, 191(3. Hon. C. F. Lee, Chairman, Interstate and Foreign Committee, House of Representatives, Washington. D. C. Dear Sir: At the annual meeting of the Hospital Association of West Vir- ginia held in Roanoke, Va., on May 3 and 4, the following resolution was passed: “Whereas a serious shortage of nurses both for civilian and military needs exists; and “Whereas the shortage is rapidly increasing, due to greater competition for woman power; and “Whereas it is apparent that the shortage of nurses will reach an alarming figure by the end of the present year; and “Whereas this challenging problem has been given careful consideration dur- ing recent months by the hospital authorities and the professional nursing or- ganizations in consultation with the governmental agencies concerned; and RECRUITING AND TRAINING OF NURSES “Whereas a proper and successful' solution must he found to this- pressing problem in order not to jeopardize the success of our armed forces, hospitals, and the health work generally : Be it ; “Resolved, That we pledge anew our earnest cooperation in seeking to overcome shortages in the nursing profession by— “A. Increasing, where possible, the number of student nurse's enrolled in the approved nurses’ training schools of our States. “B. Accelerating, Intensifying, and shortening tin' period of training where con- sistent, without sacrificing essential contents of the curriculum. “C. Urging the early passage by Congress of House bill No. 2326. a bill intro- duced in the House of Representatives for the purpose of assuring a supply of nurses for the armed forces, governmental and civilian hospitals, health agencies, etc., and further urging all member institutions, and iudividukls to contact their respective Senators in Washington in behalf of an early passage of this hill, thus making possible an expanded nurses’ training program at the earliest possible date.” Very truly yours, v.v ' Chas. E. Vadaktn, , Secretary-Treasurer, Hospital Associatum of West Virginia. Carolina,s-Vjrginias Hospital Conference, Charleston. W. Va,. Mop 6‘, J9J3. Hon. G. F. Lee, v: Chairman, Interstate and Foreign Committee, House of Representatives, Washington, D. C. Dear Sir; At the annual meeting of the Carolinas-Virginias Hospital Confer- ence held in Roanoke, Va., on May 3 and 4, the following resolution was passed. ■‘Whereas a serious shortage of nurses both for civilian and military needs exists; and, - • ‘ Whereas the shortage is rapidly increasing due to greater competition for woman power; and — “Whereas it is apparent that the shortage of nurses will reach an alarming figure by the end of the present year ; and I “Whereas this challenging problem has been given careful consideration dur- ing recent months by the hospital authorities and the professional nursing or- ganizations in consultation with the governmental agencies concerned; and “Whereas a proper and successful solution must be found to this pressing problem in order not to jeopardize the success of our Armed Forces, hospitals, and the health work generally : Be it “Resolved. That we pledge anew our earnest cooperation in seeking to over- come shortages in the nursing profession by— “A. Increasing, where possible, the number of student nurses enrolled in the approved nurses’ training schools of our States. “B. Accelerating, intensifying, and shortening the period of training whe.re consistent, without sacrificing essential contents of- the curriculum. “C. Urging the early passage by Congress of House bill No. 232(5, a bill intro- duced in the House of Representatives for the purpose of assuring a supply of nurses for the armed forces, governmental and civilian hospitals, health agencies, etc., and further urging all member institutions and individuals to contact their respective Senators in Washington in behalf of an early passage of this bill, thus making possible an expanded nurses’ training program at the earliest possible date.” Very truly yours, . Chas. E. Vadakin, Secretary-Treasurer, Carolinas-Virginia Hospital Conference. (ADDITIONAL TELEGRAMS) JJew York, N. Y., May 6, 19\2. Hon. Auprjcd Buxavinklb, . Chairman. Subcommittee on Public Health. House of Representatives: Hospital Management, a magazine of national circulation among hospitals of all types, wishes to' record its complete support of proposed Federal legislation RECRUITING AND TRAINING OF NURSES 51 for a student war nursing reserve and to urge that your committee report fa- vorably on it, to insure Government aid in the increasingly serious nursing situation. Kenneth G. Crain, Vice President. San Francisco, Calif. Hon. Clarence F. Lea, Chairman. House Committee on Interstate and Foreign Commerce, House of Representatives, Washington, D. C. In behalf of 200 member hospitals in California, we urge your favorable consideration to early passage of House bill 2326 introduced for the purpose of assuring nurses for Army forces, hospitals, and health agencies of the Nation by making possible expanded nurses’ training program. Clifford W. Mack. President Association of California Hospitals. Minneapolis, Minn. Chairman House Committee Alfred L. Bulwinkle, House of Representatives. Washington. D. C.: Minnesota Federation of Women’s Clubs urge your support of House tile 2326. Mrs. James Blake, Chairman. Nursing. Mrs. Geo. W. Sugden, President, Minnesota Federation of Women's Clubs. Lansing, Mich. Alfred L. Bulwinkle, House of Representatives. Washington. 1). V.: Members of Michigan State Nurses Association endorse bill H. B. 2326 which provides for training of nurses for armed forces, Government and civilian hos- pitals, etc., and respectfully request your support, Ella McNeil, President. Baltimore, Md., May 6, 1942. Hon. Alfred L. Bulwinkle, Chairman, Subcommittee on Public Health Committee on Interstate and Foreign Commerce, House of Representatives: The Maryland State Nurses Association endorses bill H. R. 2326 and asks "your support this bill. Blanche G. Powell, Executive Secretary, Maryland State Nurses Association.