MEASURING NURSING RESOURCES 
FEDERAL SECURITY AGENCY 
PUBLIC HEALTH SERVICE 
DIVISION OF MEDICAL 0 HOSPITAL RESOURCES 
DIVISION OF NURSING RESOURCES MEASURING NURSING RESOURCES 1/ 
CONTENTS 
Page 
Introduction 1 
Section I# Estimating the Number of Nursing Personnel 
Currently Employed . 7 
Introduction 7 
Public Health • • . 8 
Industry • • . • 9 
Offices and Private Practice . .... 10 
Hospitals 17 
Summary: Section I 23 
Section II. Estimating the Number of Nursing Personnel 
Required to Meet Current and Future Needs 2£ 
Introduction. 2£ 
Public Health . 26 
Industry ••••..••. 29 
Offices and Private Practice .33 
Hospitals 35 
Introductory Statement 35 
General and Allied Special Hospitals ... 37 
Tuberculosis Hospitals 61 
Mental Hospitals 6h 
Chronic Hospitals .68 
Total number of nursing personnel 
needed in hospitals 70 
Summary 72 
Summary: Section II* . . 73 
l/,Prepared by Lois E. Gordner, Nurse Officer (R), Public Health Service, 
~ Federal Security Agency, Washington, D.C. Page 
Section III. Planning to Meet the Needs for Nursing Personnel. ... 80 
Introduction . 80 
Educational Qualifications of Nursing Personnel 
Currently Snployed. ....81 
Basic Professional Programs (Diploma and/or Degree 
Programs for Undergraduate Student Nurses). ...... 90 
Advanced Professional Programs (Programs for 
Graduate Nurses Leading to a Degree). . 97 
Approved Training Programs for Non-Professional 
Nursing Personnel 99 
Financial Support for Preparing Nursing Personnel • . .101 
Computing the Annual Number of Students who must 
be Enrolled in Basic Schools of Nursing and 
Training Programs for Non-Professional Nursing 
Personnel to meet Estimated Needs 102 
Computing the Average Percent of High School 
Graduates who must be Enrolled in Nursing Programs 
to Produce the Number of Nursing Personnel Needed • • .108 
Summary: Section III 110 
ii - FEDERAL SECURITY AGENCY 
PUBLIC HEALTH SERVICE 
l/yashington 2£, D, C, 
August 4, 1949 
Col. J. J. McNinch 
Director 
Army & Medical Library 
7th and Independence Ave. 
Ifliashington 25, D. C. 
Dear Col. McNinch: 
Enclosed is a copy of “Measuring Nursing 
Resources'*, prepared by Miss Lois E, Gordner, 
hospital nursing consultant, of our staff. 
This is intended as a guide to a method 
for nurses and others who contemplate studies 
to determine nursing needs and resources on an 
area basis. It represents to date the method 
that has evolved as a result of assistance given 
by the Public Health Service to several States 
in measuring their nursing resources. 
Copies are available upon request. 
Sincerely yours, 
Lucile Retry 
Chief Nurse Officer 
Public Health Service 
J. R, McGibony, Medical Director 
Chief, Division of Medical and 
Hospital Resources 
Enclosure - Page 
Example of a covering letter to accompany a mailed questionnaire 
Example of a covering letter to accompany a 
mailed questionnaire to employers of nursing 
personnel in offices • • • . • 12 
Questionnaires 
!• Self-addressed, stamped post card to be mailed 
to individual employers of nursing personnel 
in offices • 13 
2, Self-addressed, stamped post card to be mailed 
to the registrar of individual licensed nurses’ 
registries 
3* Mailed questionnaire to individual hospitals to 
obtain a record of the number of nursing 
personnel currently employed 21 
h* Mailed questionnaire to individual hospitals 
selected to participate In a sample study of 
general hospitals to obtain: 
Record of the number of administrative 
nursing personnel on duty . i|2 
Record of nursing personnel giving direct 
patient care during 2i+ hours. k3 
5. Mailed questionnaire to individual hospitals 
to obtain: 
Record of the educational qualifications 
of graduate professional nurses currently 
emploved 65 
Record of the educational qualifications 
of non-professional nursing personnel 
currently employed 86 
Worksheets 
Worksheets to be used in conjunction with 
Questionnaire its 
Worksheet 1 - Summary of data relative to the 
ratios of administrative nursing personnel to 
daily average patient census (including newborn) 
in (Hospital A), on (Date: month, day, year) fag Page 
Worksheet 2 - Summary of data relative to hours of 
bedside care per patient in 2k hours and ratio of 
professional to non-professional nursing personnel 
giving this direct patient care in (Hospital A) on 
(fhte: month, day, year) 1*8 
Worksheet 3 - Summary of data relative to hours of 
bedside care per patient in 21* hours and ratio of 
professional to non-professional nursing personnel 
giving this direct patient care according to size 
of hospitals 53 
Formulae 
1* Current unit of population per public health 
staff nurse 26 
2. Number of public health staff nurses required 
to meet the selected standard of population 
unit per nurse • . • • 27 
3* Number of public health nurses in supervisory 
positions required to meet the standard for 
staff nurses per supervisor. 28 
k» Estimated future daily average patient census 36 
5* Ratios of administrative nursing personnel to 
daily average patient census (including newborn) .... 1*6 
6a. Equivalent number of patients cared for by 
other than hospital staff in a 2ii hour period • • • • • i*9 
6b. Adjusted census (patients cared for by hospital 
staff in a 21* hour period) 1*9 
7* Average hours of nursing care per patient in 
2li hours 50 
8. Hours of bedside care per patient by type of 
nursing personnel 5l 
9. Ratio of Professional to Non-Professional 
nursing personnel giving direct patient care 52 
10. Number of administrative nursing personnel required 
per day to meet the selected standard of daily average 
patient census (including newborn) per type of admin- 
istrative nursing personnel in general and. allied 
special hospitals on a State-wide basis •••••••• 55 Page 
11a* Number of bedside nursing personnel required per 
day to meet the selected standard of average hours 
of bedside care per patient in 2k hours in general 
and allied special hospitals on a State-wide basis ... 56 
11b. Number of professional or non-professional bedside 
nursing personnel required per day to meet the 
selected ratio of professional nurses or non-profes- 
sional nursing personnel to total nursing personnel 
giving bedside care in general and allied special 
hospitals on a State-wide basis 56 
12a. Number of nursing personnel required to replace 
the contribution made to nursing service by basic 
professional student nurses 58 
12b. Number of graduate professional nurses or non- 
professional nursing personnel required to replace 
the contribution made to nursing service by basic 
professional student nurses 58 
13. Total number of nursing personnel needed in 
hospitals ........ 71 
Tables 
1. Estimated number of nurses employed by public 
health agencies in (State x), (date) • • • 9 
2. Estimated number of nurses employed by industrial 
establishments (State x), (date) 10 
3. Estimated number of nursing personnel employed 
in offices in (State x), (date) lii 
U. Estimated number of nursing personnel engaged in 
private practice, registered in and employed through 
licensed nurses' registries in (State x), (date) • • • . 1? 
5. Estimated number of nursing personnel enployed by 
(registered and unregistered or registered only) 
hospitals (exclusive of or including Federal 
hospitals) in (State x), (date) • ••••••••... 22 
6. Estimated number of nursing personnel currently 
employed in (State x), (date) 23 
7. An estimated of the current and future number of 
nurses needed by public health agencies in (State x) . . 29 Tables Page 
8* An estinate of the number of nurses needed by- 
industrial establishments in (State x), (date) 31 
9, An estimate of the current and future number of 
nurses needed by industrial establishments in 
(State x) • • 32 
10. An estimate of the current and future number of 
nursing personnel needed in (offices or private 
practice) in (State x) 3h 
11. An estimate of the number of nursing personnel 
currently needed per day by general and allied 
special hospitals (exclusive of or including 
Federal hospitals) in (State x), (Date) . • • • 60 
12. An estimate of the number of nursing personnel 
currently needed per day by (registered and 
unregistered or registered only) tuberculosis 
hospitals (exclusive of or including Federal 
Hospitals) in (State x), (Date). . • • • 63 
13* An estimate of the number of nursing personnel 
currently needed per day by (registered and 
unregistered or registered only) mental hospitals 
(exclusive of or including Federal hospitals) 
in (State x), (Date) 6? 
lk» An estimate of the number of nursing personnel 
currently needed per day by (registered and 
unregistered or registered only) chronic hospitals 
(exclusive of or including Federal hospitals) in 
(State x), (Date) 69 
An estimate of the total number of nursing personnel 
currently needed by (registered and unregistered or 
registered only) hospitals (exclusive of or including 
Federal hospitals) in (State x), (Date) 72 
16. An estimate of the total number of nursing personnel 
needed in the future by hospitals (exclusive of or 
including Federal hospitals) in (State x), (future 
date). 72 
17• An estimate of the number of nursing personnel 
required to meet current (date) and future (date) 
needs in (State x) 73 
18. An estimate of current deficits of nursing personnel 
in (State x), (Date) 7A Tables. Page 
19* Educational qualifications of full-time nurses 
employed by public health agencies in (State x), 
(Date) 81 
20. Educational qualifications of full-time registered 
nurses employed by industry in (State x), (Date) ... 83 
21. Educational qualifications of graduate professional 
nurses employed by (registered and unregistered or 
registered only) hospitals (exclusive of or including 
Federal hospitals) in (State x), (Date). ••••••• 88 
22. Educational qualifications of non-professional nursing 
personnel employed by (registered and unregistered 
or registered only) hospitals (exclusive of or 
including Federal hospitals) in (State x), (Date) ... 89 
Charts 
1. Probable sources of information for obtaining an 
estimate of the number of nursing personnel currently 
employed in a State according to place of service • • • 2h 
2. Suggested criteria and probable sources for obtaining 
essential information for estimating the number of 
nursing personnel required to meet current and future 
needs on a State-wide basis 75 
3. Questions, probable sources for obtaining information, 
and references pertinent to an overall gross evalua- 
tion of the present system of nursing education in a 
State according to type of program 112 
- vii - Introduction 
During "the past ten years the demands for nursing services have been 
unprecedented. Some of the major developments which have contributed to 
these increasing needs are: the rapid expansion of prepayment hospital 
plans; Increased emphasis on early diagnosis; greater awareness of the 
preventive aspects of disease; acceptance of the relationship between physi- 
cal and mental states; and recent discoveries in drugs and medical therapies. 
The additional number of hospital beds and other health facilities which will 
become available within the next few years (as a result of construction under 
the "Hospital Survey and Construction Act" as well as construction outside 
of this program) will further increase the need for professional and non- 
professional nursing personnel. The extent and urgency of the situation 
indicate the necessity of planning on a State and regional basis if the 
vital needs for nursing services are to be met effectively and economically. 
The scope of a State survey of nursing needs and resources as described 
in this Manual Includes the following factors: 
1. An estimate of the number of nursing personnel currently employed. 
2. An estimate of the number of nursing personnel required to meet 
current and future needs. 
3. An evaluation of the quantitative and qualitative adequacy of the 
present system of nursing education. 
U. Recommendations which will improve the quantity and quality of 
nursing personnel so that current and future needs for nursing 
personnel can be met effectively and economically. 
The conclusions of the study will reveal present nursing resources; cur- 
rent ar>d future need for nursing personnel; current and future deficits of 
nursing personnel; extent to which the present educational system can quantita- 
tively and qualitatively meet current and future needs for professional nurses and 2 
non-professional nursing personnel; annual number of students who must be enrolled 
in basic schools of nursing and training programs for non-professional nursing 
personnel for a specified period of time to meet estimated needs; and the average 
percent of high school graduates mho must be enrolled in nursing programs to 
produce the number of nursing personnel needed. These conclusions mill lead to 
recommendations concerning: 
1. The extent to which the nursing service needs of all kinds 
should and can be met, 
2. The kind of educational system which mill produce the 
type of nursing personnel needed. 
3. Methods of financing this educational system. 
lu Horn the needed number of candidates can be attracted to the schools. 
£. What community. State, and regional action is necessary to 
initiate and advance the objectives. 
The approach to this type of survey (discussed in the following sections) 
is to be considered only as a guide. It is primarily a method of assembling 
available data and utilizing existing standards and techniques to emphasize the 
necessity of comprehensive planning to meet estimated needs for nursing personnel. 
The limitations apparent in this approach stress the necessity of additional 
research in nursing. 
The purpose of the following discussion is to emphasize specific considera- 
tions. General principles of the survey method will not be mentioned unless 
there is special significance for a State survey of nursing needs and resources 
which should be stressed. The Methodology of Educational is but 
one example from extensive published material which comprehensively presents 
the techniques of scientific research. 
1/ Good, Carter; Barr, A. S.; Scates, Douglas: The Methodology of Educational 
Research. D. Appleton - Century Company, Inc., New York, 19i*l. The director of the study should be appointed as soon as the need for 
the survey has crystallized. This nurse should possess a comprehensive knowledge 
of professional problems and community health needs, an understanding of present 
trends in education and the ability to work cooperatively with others. The 
selection of the individual to direct the study is the responsibility of the 
nursing organizations of the State. Belated professional organizations (State 
Medical Association, State Hospital Association, etc.) should concur in the choice 
The participation of representative committee members in formulating a 
precise plan for the survey and in initiating and sustaining community interest 
in the project which will be capable of translating the recommendations into 
action will largely determine the effectiveness of the project. 
Committees should be organized as soon as a need for this type of 
survey has been recognized and expressed. The stimulus for this expression 
of need may come from a number of sources. It is imperative that all of the 
groups involved in the study be made a part of the project from the initial 
phase# This widely representative group will function more effectively if 
organized into advisory, executive, and technical committees. 
Advisory Committee 
The advisory committee should include State representatives from: 
Nursing organizations; related fields; and consumers of nursing service# 
Appropriate members in these three categories are: 
1# Nursing Organizations 
a# Nurses* Association 
b# League of Nursing Education 
c. Organization for Public Health Nursing 
d. Board of Nurse Examiners 
e. Organization for Non-professional nursing personnel. 2. Related Fields 
a. Medical Association 
b. Hospital Association 
c* Agency administering Hospital Surrey and Planning 
Program 
d. Board of Health 
©. Department of Education (Vocational, Secondary, and 
Higher Education) 
3* Consumers of Nursing Service 
a* Federated Woman's Club 
b. Parent-Teacher Association 
c. Industry (management, labor) 
d. Farm groups 
e• Press 
Executive Committee 
The Executive Committee may be chosen from the Advisory Committee. It 
Is advisable to limit this group to 5 - 7 members* The members should be 
selected on the basis of ability, pertinent knowledge, and administrative 
effectiveness. The function of this committee Is to facilitate the progress 
of the survey and to be readily available for consultation with the director 
of the study. 
Technical Committee 
The Technical Committee should be composed of professional nurses with 
specialized interests, since a large part of the survey involves decisions 
relative to standards, practices, and policies in the several fields of 
nursing. Members should represent the following Interests: 5 
1* Nursing groups 
a. Public Health 
b. Industry 
c. Offices 
d. Private Practice 
e. Men nurses 
f. Non-professional nursing personnel 
2. Clinical fields 
a* Medical nursing 
b. Surgical nursing 
c. Tuberculosis nursing 
d. Psychiatric nursing 
e. Nursing care of chronic patients. 
3. Educational programs 
a. Hospital operated school of nursing 
b. College or university controlled school of nursing 
c. Advanced professional nursing education program 
d. Approved training program for non-professional nursing 
personnel. 
This group of expert professional personnel is primarily a "working committee". 
In view of this, the director of the study may find it expedient to appoint 
sub-committees from the membership to formulate policies and develop material 
in specified areas (current and future needs for nursing personnel in hospitals, 
construction of questionnaires, etc.) for the consideration of the technical 
committee as a whole. 6 
It is advisable to have the three committees (advisory, executive, 
technical) meet together at the beginning of the project to formulate the plan 
and method of the survey. A combined meeting is equally desirable after the 
necessary data have been compiled and evaluated. At this second meeting it 
is essential that a majority of the membership concur with the analysis, accept 
the implications, and make definite plans to activate the recommendations. In 
the interim between the two meetings, distribution of the minutes of all the 
individual committees1 meetings to the entire membership will keep the various 
committees informed of the others1 activities. 
There are certain practical factors which must be considered in making 
a detailed plan within the defined scope of the survey. Such matters as time, 
money, and personnel must be faced realistically in the planning stage of the 
project* If a deadline must be met, if funds are limited, clerical assistance 
is inadequate, it is essential to acknowledge the handicap and devise the 
most effective plan possible to fulfill the objectives of the survey. 
It is reemphasized that the effectiveness of the survey relies to a 
great extent upon the acceptance and support of the groups concerned. It is 
important that the report be written with consideration for varying back- 
grounds and diversity of Interests. 
The recommendations of the survey should be reviewed periodically. 
This appraisal at specified intervals will accomplish two purposes. First, 
it will reveal the progress made toward achievement of the stated objectives. 
Second, it will provide a means by which the objectives can be modified in 
terms of emerging msdical, social and economic trends. SECTION I. ESTIMATING THE NUMBER OF NURSING PERSONNEL CURRENTLY EilPLOYSD 
In an appraisal of nursing needs and resources, the number of nursing 
personnel currently employed should be estimated as accurately as possible. Esti- 
mates should include both professional nurses and non-professional nursing personnel. 
It is suggested that data on nursing personnel be limited to those 
individuals who give direct care to patients* 
It is desirable to assemble the final estimate according to "place of 
service**. Such a classification should includes public health , industry, private 
practice, offices, hospitals, and "others**. This last category includes nurses 
employed by professional nursing organizations, nurses* registries, county institu- 
tions, college infirmaries, nursery schools, etc. The preceding classification is 
indicated because the sources for obtaining the required data vary, and the existing 
standards for nursing care are applicable to specific fields of nursing* 
To arrive at an estimated total, existing data should be used whenever avail- 
able. An example is the recent count and classification of professional registered 
nurses made by the American Nurses' Association. This is probably the most complete 
enumeration of professional nurses per State available. Reports can be obtained from 
the State Board of Nurse Examiners or the American Nurses* Association (1790 Broadway, 
New York City, N.Y.). If additional data are desired, interviews, conferences, and 
questionnaires are methods to be considered* 
Held visits are generally more satisfactory in obtaining homogeneous data 
than information received through mailed questionnaires. Conversation is conducive 
to greater uniformity in the collected data because of the opportunity to clarify 
and interpret the information desired. Homogeneity is more difficult to achieve in 
a mailed questionnaire despite the most thoughtfully phrased and explicit instructions* 
If a mailed questionnaire is unavoidable every effort should be made to facili- 
tate the receipt of the necessary data. A favorable response wLlldbpend to a large extent on the following factors* a covering letter which embodies the purpose of the 
survey, contains an endorsement from appropriate professional organizations, and gives 
assurance that the data, obtained will be considered confidential; concise inquiries 
clearly defined and easily answered; and the enclosure of a self-addressed, stamped 
envelope or post card. A plan of “follow up“ for unreturned questionnaires is in>- 
portant. An effective method is a telephone reminder from the local group concerned 
with the data requested. 
The following discussion will present for each classification! 
1. probable sources of existing information 
2. sample questionnaires and tables 
3* certain factors which will influence the collection, compilation, 
and/or interpretation of the material. 
Public Health 
A yearly census of public health nurses in each State can be obtained from the 
State Department of Health. This count is current as of January first. The number 
of public health nurses employed can be obtained for each county or as a State total. 
It is possible to obtain the number of nurses employed! by type of public health 
agency (State health department, local departments of health, boards of education, 
other official agencies, norv-official agencies, and schools of nursing); and by type 
of position (supervisory or staff). Each year, the States1 annual census of public 
health nurses is incorporated into a consolidated report, which provides a comparison 
among States. The consolidated report can be obtained either from the Division of 
Nursing, State Department of Health, or by writing directly to the Federal Security 
Agency, Public Health Service, Office of Public Health Nursing, 4th and C Streets, S.W., 
Washington 25> D. The following table illustrates how this information might be compiled* 
Table 1* Estimated number of nurses employed by public health agencies in 
(State x), (Date) 
Type of 
Agency 
Number of nurses 
Supervisors Staff 
Total 
Official agencies - 
Boards of education 
Non-official agencies —————— 
Sourcet 
Industry 
The Division of Nursing, State Department of Health or the State Department 
of Labor will have information on the number of registered nurses employed full time 
by industries as of January first of each year* This report shows the type of ser- 
vice in nhich the nurses are engaged (according to the one to itoich the nurse devotes 
the most time)* The type of service includes the following categories: in-plant; 
home or visiting nurse; industrial hospital nurse; personnel department; and con- 
sultant or advisory nurse* The nurses are further classified by type of position 
(supervisory and staff)* A consolidated report which provides a comparison among 
the States, can be obtained either from the above sources or from the Federal 
Security Agency, Public Health Service, Nursing Section of the Industrial Hygiene 
Division, 4th and C Streets, S*W*, Washington 25, D* C* Table 2 shows how this material can be assembled* 
Table 2* Estimated number of nurses employed by industrial establishments in 
(State x), (Date) 
Type of 
Service 
Number of nurses 
Supervisors 
Staff 
Total - - 
In-plant 
Home or visiting nurse 
Industrial hospital nurse 
Personnel department - 
Consultant or advisory nurse - 
Source: 
Offices and Private Practice 
The number of nurses currently employed in these tiro categories is difficult 
to estimate* The State Nurses1 Association and the State Board of Nurse Examiners 
are probably the two best sources of information* An analysis of the types of nursing 
activities of the members of the State Nurses* Association is one basis that can be 
used* It must be kept in mind, however, that membership in this organization is 
voluntary and available only to the registered professional nurse* The State Board 
of Nurse Examiners may have the desired information, if registration in the State 
requires the registrant to indicate the field of nursing in which currently engaged* 
It is important to determine whether non-professional nursing personnel are included 
in the registrants. Whether membership in the State Nurses* Association or regis- 
tration in the State is used as the basis for making the estimate, there are certain considerations which apply to Doth* These pertain to the number of nurses included 
in the counts who are inactive or who function outside of this State* If existing 
data are not sufficient, it may be necessary to secure the information through other 
means* 
The best method of obtaining additional information relative to nursing 
personnel currently employed in offices should be discussed with appropriate 
State societies (medical,dbntal, etc*)* Such conferences should result in a 
cooperative plan to obtain the required material* A. subsequent activity of such 
a meeting might be the participation in this project hy the respective county 
societies* If a questionnaire is contemplated, the number of licensed physicians, 
dentists, etc, in the State may indicate the feasibility of a representative sampling 
rather than a complete canvass* The following questionnaire and the accompanying 
covering letter is one method that can be used to obtain the desired information* Example of a covering letter to accompany a mailed Questionnaire to employers 
of nursing personnel in offices* 
(Dote) 
(Addressee) 
Dear (name of individual physician, dentist, etc*) 
The (State medical, dental, etc*) Association is cooperating with the 
(name of the group sponsoring the survey) in making a study of the number of 
nursing personnel currently employed in (doctors1, dentists', etc*) offices* 
This project is an important aspect of the survey of nursing needs and 
resources of (State)* 
In order to estimate the total number of professional and non-professional 
nursing personnel currently employed, it is necessary to know the number of nursing 
personnel in offices* Since this information cannot be obtained from any existing 
data, (number) of (physicians, dentists, etc*) have been selected to assist in the 
study by answering the questions on the enclosed post card* Information received 
from the participating (physicians, dentists, etc*) will be considered confidential 
Tour response to this request will be of inestimable value* We will 
appreciate it if you will mail the enclosed post card not later than (date)* 
Sincerely yours, 
(Chairman of the group sponsoring 
the survey) 
Enclosure 
(individually addressed, stamped post card) Questionnaire I: Self-addressed, stamped post card to be mailed to individual 
employers of nursing personnel in offices* 
Date 
To (Name of group 
sponsoring survey) 
The following nursing staff is now 
employed in my officet 
Type of Nursing No* of Average 
Personnel Persona Hrs. per 
Graduate Nurse (RN) 
Non-Professional 
Nurse 
This nursing staff is shared with: 
(Identifying Code number of physician, 
dentist, etc*} Table 3 suggests a method of summarizing the data collected by 
Questionnaire 1* 
Table 3* Estimated number of nursing personnel employed in offices in 
(State X), (Date)* 
Type of 
office 
Number of nursing personnel 
Professional 
Non-professional 
Total 
Doctors 
Dentists - - 
Others (specify) - 
Sources 
Detailed information about the number of nursing personnel engaged in 
private practice may be secured from professional and commercial nurses1 registries* 
A list of licensed nurses1 registries can be secured from the State Department of 
Labor or the appropriate State agency whose responsibility is to define, regulate 
and provide for the licensing and registration of employment agents* Material 
from the individual registries can be more effectively collected through personal 
interviews with the employers because of the variance in record keeping and the 
possible duplication of registrants* The amount of duplication can be revealed 
by selecting several letters of the alphabet and cross matching the names of the 
personnel appearing on the active rolls of the individual registries* If the number of nursing personnel engaged in private practice is obtained 
only from licensed nurses’ registries, the data will not be complete. This source 
•will not include those nurses -who are placed -without charge through the activity 
of such agents as hospitals, alumnae associations, private physicians, etc* It 
may not be possible to obtain information on the number of nurses in private 
practice who are placed in this way. If this is the case, the omission in the 
total count must be acknowledged* 
Questionnaire 2 is an example of how information in the number of nursing 
personnel engaged in private practice can be obtained from licensed nurse 
registries* Questionnaire 2* Self-addressed, stamped post card to be mailed to the 
registrar of individual licensed nurses1 registries* 
(Date). 
To (Name of group 
sponsoring survey) 
This registry has currently registered 
and placed nursing personnel as follows: 
graduate Nurses (RlO 
Total number currently 
registered 
Number on cases today: 
Total 
In hospitals 
In homes 
Other 
Noifc-Professional Nurses 
Total number currently 
registered 
Number on cases today: 
Total 
In hospitals 
In homes 
Other 
(Identifying Code number of licensed 
nurse registry) Table 4 shows how the information obtained through Questionnaire 2 can be 
compiled* 
Table 4* Estimated number of nursing personnel engaged in private practice, 
registered in and employed through licensed nurses* registries in 
(State X) (Date)* 
Type of 
registry 
Number of nursing personnel 
Professional Non-professional 
Total Total Total Total 
registered employed registered employed 
Total - 
Professional 
Conmercial - 
Source: 
Hoapltala 
It is desirable to assemble data relative to the number of nursing personnel 
employed by the folloning types of hospitals: 
1. General and allied special 
2* Tuberculosis 
3. Mental 
4, Chronic 
Utilization of the preceding classification facilitates the computations involved 
in estimates of present and future needs for nursing personnel in two ways. First, 
existing standards of nursing care can be more easily applied* Second, future 
needs for nursing personnel based on the anticipated construction of hospital bods 
as proposed by the State hospital plans correspond with the suggested categories 
State hospital plans in this Manual refers to the plans developed under the 
Hospital Survey and Construction Act. (Public Law 725, 79th Congress) Since the number of nursing personnel currently employed in hospitals will be 
compared with the number of nursing personnel estimated as needed by hospitals, 
the advantage of having similar data is obvious# 
An existing source of information for the' number of nursing personnel 
employed by hospitals is Hospital Service in the United States 1/• This annual 
statistical summary is pub3ished each year in the Hospital Number of the Journal 
of the American Medical Association, and can be obtained as a reprint from the 
Council on Medical Education and Hospitals, 535 North Dearborn Street, Chicago 10, 
Illinois. It is based on reports submitted by registered hospitals, both civilian 
and governmental. The latest twelve month period for which statistics are avail- 
able represents the reporting period* The table **Nursing Personnel and Schools 
of Nursing Education* contains a State total of each of the following categories 
of nursing personnel* 
1* Student nurses 
2* Administrative nursing personnel 
3* Full time instructors 
4* Supervisors and assistant supervisors 
5. Head nurses and assistant head nurses 
6. General duty nurses (part time and full time) 
7* Nurses not classified 
8. Private duty nurses 
9* Practical nurses and attendants 
10* Volunteer nurses* aides 
11* Orderlies 
12* Ward maids 
Arestad, F# H#, Leveroos, E# H#, Albus, W, R*, and Corbett, W# W,j Hospital 
Service in the United States. Council on Medical Education and Hospitals of 
the American Medical Association, Chicago, Illinois# Ihile the published material contains the preceding information as a 
total for each State, it has been possible to obtain the information for each 
category of nursing personnel in the individual hospitals in the State from 
unpublished material on file with the Council on Medical Education and Hospitals# 
If the data from the Council on Medical Education and Hospitals is utilised, 
the following suggestions should be considered* 
1* Student Nurses 
This category of nurses should not be included in an estimate of 
the number of nursing personnel employed* However, in estimating 
the number of nurses needed it is necessary to know the number of 
student nurses so that their contribution to nursing service may 
be included in terms of replacement equivalents of professional 
nurses and non-professional nursing personnel* 
2* Part Time General Duty Nurses 
It would seem reasonable to count the services of each part time 
general duty nurse as equivalent to one-half of the service of a full 
time general duty-nurse* 
3* Nurses Not Classified 
These nurses might be assumed to be staff nurses in special hospital 
departments such as central supply room, operating room, etc* 
4* Private Duty Nurses 
This group of nurses should be excluded from the hospital tally* 
As discussed previously, the professional and non-professional 
nursing personnel engaged in private practice in homes and hospitals 
should be considered as a separate group and so enumerated in the 
total count* 
5# Volunteer Nurses* Aides and Ward Maids 
If the non-professdLonal personnel is to be limited to those who give direct care to patients then these two groups should be omitted# 
The statistical material from the Council on Medical Education and 
Hospitals pertains only to registered hospitals and sanatoriums, and related 
institutions# The number of nursing personnel in unregistered hospitals and 
sanatoriums, and related institutions can be obtained by means of a questionnaire# 
Probably the most recent data relative to the number and location of unregistered 
hospitals can be secured from the State agency administering the Hospital Survey 
and Planning Program* When the individual hospitals in the latest State survey 
are cross matched with the individual registered hospitals in the State listed 
in Hospital Service in the United States for the corresponding period of time, 
the number of unregistered hospitals in the State will be revealed# 
If the data compiled by the Council on Medical Education and Hospitals 
relative to the number of nursing personnel employed by hospitals are not used, 
similar information can he secured through a questionnaire to all hospitals, 
sanatoriums, and related institutions in the State# Flans for such a project 
should be made in cooperation with the State Hospital Association# An endorse- 
ment from this agency to hospital administrators will be of inestimable help in 
the collection of the desired facts# 
Whether information on the number of nursing personnel is requested from 
registered and unregistered or only registered hospitals in the State, the solicited 
data should include all nursing personnel employed by the hospitals# The following 
questionnaire (which is to be mailed to individual hospitals) illustrates how a 
total count of nursing personnel employed by a single hospital can be obtained* Questionnaire 3* Mailed questionnaire to individual hospitals to obtain a record 
of the number of nursing personnel currently employed. 
TO: (Name of group 
sponsoring survey) 
HOSPITAL 
ADDRESS 
Record of the number of nursing personnel currently 
employed 1/ (Date: month, day, year) 
Number of Nursing Personnel 
Full frjme Part Time " 
Total Total 
A* Graduate Nurses (R.N.) - list each nurse in the 
following classifications according to 
the one in which she devotes most time. 
I. Administrative Nursing Personnel 
a. Superintendent or assistant superinten- 
dent of hospital 
b* Superintendent and assistant superinten- 
dent of nurses and/or nursing school - 
II* Instructors - - 
III. Supervisors, assistant supervisors (charge 
of more than one nursing unit) 
Head nurses, assistant head nurses (charge 
of one nursing unit only) 
a. General services: medicine; surgery; 
obstetrics; pediatrics - 
b. Tuberculosis service 
c. Psychiatric service 
d. Operating room 
e. Central supply room 
f. Out-patient department - 
g. Other (specify) 
IV. Staff nurses (include those nurses giving a 
minor part of their time to head nurse 
duties or other supervisory function) 
a. General services: medicine; surgery* 
obstetrics; pediatrics -------- 
b« Tuberculosis service 
c. Psychiatric service 
d. Operating room — 
e. Central supply room 
f. Out-patient department - ■ 
g. Other (specify) 
B. Non-professional Nursing Personnel (those who 
spend the major part of their time 
assisting -with nursing duties) 
Attendants, Practical Nurses, etc. - 
Include nursing, personnel on afternoon-and-night duty as well as those off duty 
because of days off, vacation, or illness* Should the number of nursing personnel in Federal hospitals in the State be 
included in the total estimate of the number of nursing personnel employed by hospi- 
tals in the State? Recruitment for these hospitals is generally on a regional or 
national basis -with personnel subject to transfer in accord with different personnel 
policies, State may be assumed to have special responsibility to provide nursing 
personnel to care for its citizensin the Veterans Administration hospitals within its 
borders. However, there is no known standard by which to estimate the degree of this 
responsibility. Since the count of nursing personnel currently employed is to be 
used in relation to the number of nursing personnel estimated as needed, the various 
staffing patterns of the Federal hospitals preclude the application of existing 
standards by which the number of nursing personnel needed in civilian hospitals is 
calculated. Moreover, anticipated construction of hospital beds as proposed by the 
State hospital plans (which serves as the basis for estimating the number of nursing 
personnel needed in the future) does not include the needs of the Federal hospitals. 
Table 5 Is a convenient way of assembling the data on the number of nursing 
personnel currently employed by hospitals. 
Table 5. Estimated number of nursing personnel employed by (registered and un- 
registered or registered only) hospitals (exclusive of or including 
Federal hospitals) in (State X), (Date). 
Type of hospital 
Number of nursing personnel 
Professional Non-professional 
Total 
General and allied special 
Tuberculosis • 
Mental - - 
Chronic - - 
Source: Summary: Section I 
Table 6 summarizes the estimates of the number of nursing personnel 
currently employed in the State according to place of service (see Tables 1, 2, 
3* 5)« 
Table 6. Estimated number of nursing personnel currently employed in 
(State X), (Date). 
Place of 
Service 
Number of nursing personnel 
Professional Non-professional 
Total — 
Public Health - - 
Industry - - - — - 
Offices - - 
Private practice - 
Hospitals 1/ 
Other 
1/ Registered and unregistered or registered only$ exclusive of or including 
Federal hospitals# 
Source: 
The follcwing chart is a condensation of the discussion in Section I relative 
to the probable sources of information for obtaining an estimate of the number of 
nursing personnel currently employed in a State according to place of service. Chart 1# Probable sources of information for obtaining an estimate of the number of 
nursing personnel currently employed in a State according to place of service 
Place of 
Probable sources of information Contributory material 
service Existing data relative to the 
number of nursing personnel 
currently eisployed. 
Notes 
Field of employ- 
ment for professional 
registered nurses 
American Nurses' Association Count 
and Classification of professional 
• 
registered nurses 
!• State Board of Nurse Examiners 
2* American Nurses'Association 
Public Health 
Census of Public Health Nurses 
!• State Department of Health, 
division of Nursing 
2* Federal Security Agency, 
Public Health Service, 
Office of Public Health 
Nursing 
Industry 
Census of Industrial Nurses 
1. State Department of Health, 
Division of Nursing or State 
Department of Labor 
2* Federal Security Agency, 
Public Health Service, 
Nursing Section of the 
Industrial Hygiene division 
Offices 
1* State Nurses' Association 
2m State Board of Nurse 
Examiners 
list of individual employers 
of nursing personnel in office 
from the appropriate State 
associations such as the State 
Medical and Dental Societies* 
Private practice 
1. State Nurses' Association 
2m State Board of Nurse 
Examiners 
list of licensed nurses* 
registries from the State 
Department of Labor, or the 
appropriate State agency whose 
responsibility is to define, 
regulate, and provide for the 
licensing and registration of 
employment agents* 
Hospitals 
1* Council on Medical 
Education and Hospitals of 
the American Medical Associa- 
tion 
list of unregistered hospitals 
from the State agency adminis- 
tering the Hospital Survey 
1 and Planning Program* SECTION II. ESTIMATING THE NUMBER OF NURSING PERSONNEL REQUIRED TO MEET 
CURRENT AND FUTURE NEEDS. 
Having estimated the number of nursing personnel currently employed, 
an appraisal of the number of nursing personnel required to meet current and 
future needs is indicated. When this need has been estimated, it -will then be 
possible to see the present situation by subtracting the number of nurses 
currently employed from the number of nurses currently needed. What is dis- 
closed in the preceding computation must also be considered in conjunction 
with future needs for nursing personnel. Such an analysis will define the 
quantitative aspect of the relationship between the supply of and the need for 
nursing personnel. 
Estimates of current and future needs should include the number of 
professional and non-professional nurses required to give direct patient care 
as well as the quota of professional nurses required for administrative and 
supervisory positions. The question of what constitutes adequate nursing 
service is difficult to determine in the absence of firmly established standards 
in certain areas of nursing. Hhtil research provides guides for these situations, 
logical assumptions can be made and must be plainly identified as assumptions. 
The following discussion will present! 
1. suggested criteria for estimating current and future needs 
2. formulae for computing the number of nursing personnel required 
to meet the suggested criteria 
3* factors influencing the estimate of needs. Public Health 
The need for public health nurses is computed on a ratio of public 
health nurses to population. Local Health Units For The Nation 1/ suggests a 
ratio of 1 public health nurse to 5>000 population. This ratio is based on a 
generalized public health program* It includes school nursing, but not bedside 
care of the sick. If the public health nurse is to give health guidance and 
bedside care to the entire family. Desirable Organization of Public Health 
Nursing For Family Service 2/ recommends that 1 public health nurse should be 
provided for approximately every 2000 people. This same article states that 
nadequate provision should be made for nursing supervision in the ratio of 
1 qualified supervisor for every 10 nurses11. 
The selection of the standard to use in estimating the unit of population 
per public health staff nurse should be based on the current situation. Applica- 
tion of Formula 1 will reveal the current unit of population per staff nurse. 
Formula 1 - Current Unit of Population Per Public Health 
Staff Nurse 
Current population 
current number of 
public health staff 
nurses 
m current unit of population per 
public health staff nurse 
Examplel 
current 
population 
of State X 
current number 
of public health 
staff nurses 
7000 current unit of population 
per public health staff nurse. 
1/ Emerson, Havent Local Health Units For The Nation. Commonwealth Fund, 
“ New York, 19h$ 
2/ Committee representing National and Federal agencies concerned with public 
"" health nursing! Desirable organization of public health nursing for family 
service. Public Health Nursing 38*387-389 (August 1938) In addition to the preceding computation, answers to the following 
questions (obtained through conferences with the directors of nursing of 
public health agencies in the State) will influence the decision involving a 
choice of the 1- £000 or 1 - 2000 ratio. Do the functions of the public health 
agencies indicate an overlapping of nursing activities? Is the nursing service 
provided geographically adequate? How much bedside care is being given? Is 
there a demand for care for the chronically ill patients at home? Are non- 
professional nursing personnel included in the public health team? How many 
budgeted nursing positions are unfilled? 
Having determined the standard to use in estimating the current need for 
public health staff nurses to population (based on the practical consideration 
of the current situation). Formulae 2 and 3 will disclose the number of staff 
nurses and supervisors needed. 
Formula 2. Number of public health staff nurses required to meet 
the selected standard of population unit per nurse. 
Population 
selected standard of 
population unit per 
public health staff 
nurse 
Number of public health staff 
* nurses required to meet the selected 
standard of population unit per nurse 
Example: 
10,000,000 current 
population 
of State X 
£000 selected standard 
of population unit 
per public health 
staff nurse 
s 2000 public health staff nurses 
currently needed to meet the 
1 - £000 ratio of public health 
staff nurses per population. Formula 3. Number of public health nurses in supervisory positions 
required to meet the standard for staff nurses per supervisor 
Required number of 
public health staff nurses 
Standard for public health 
staff nurses per supervisor 
Number of public health nurses 
in supervisory positions required 
to meet the standard for staff 
nurses per supervisor 
Example: 
2000 public health staff nurses 
currently needed to meet the 
1 - £000 ratio of public 
health staff nurses per 
population 
10 standard for the number of 
staff nurses per supervisor 
200 public health nurses 
in supervisory positions 
currently needed to meet 
the 1-10 ratio of 
supervisors per staff nurses* 
To use Formula 1 and 2 it is necessary to have an estimate of: 
1* current population of the State 
2* projected population of the State as of a future date. 
The most recent copy of Current Population Reports (published 
annually by the Bureau of the Census, United States Department of Commerce) 
is the most reliable source for obtaining an estimate of the current population 
of the State. The State Planning Committee (or its counterpart) will probably 
be the best source to secure an estimate of the projected population of the 
State as of a future date. The following table shows a convenient way to assemble the estimate 
current and future number of nurses needed by public health agencies. 
Table 7* An estimate of the current and future number of nurses 
needed by public health agencies in (State X). 
Type of Number of nurses needed 
Current (Date) Future (Date) 
Agency 
Supervisors Staff Supervisors Staff 
Total 
Official agencies. 
Boards of education. . 
Non-official agencies. 
Source: 
Industry 
The number of nurses needed by industrial establishments depends to 
great extent on the number of workers. Nursing Practice In Industry 1/ 
recommends (for the maintenance of complete health services in an industry) 
the following ratios of nurses per employees: 
1 nurse .up to 300 employees 
2 or more nurses up to 600 employees 
3 or more nurses up to 1,000 employees 
1 nurse per each additional 1000 employees up to £000$ and 
1 nurse per additional 2000 employees. 
1/ Whitlock, Olive M., Trasko, Victoria M., and Kahl, F. Ruth: Nursing 
“ Practices in Industry. Public Health Bulletin No. 283s U. S. Government 
Printing Office, Washington, 19lU*. Utilization of the preceding standard involves a tabulation of the 
number of industrial establishments and employees according to the size of the 
establishment* It will also be necessazy to make a decision relative to the 
minimum size of an establishment to be included in the category Mup to 300 
employees *• 
The following factors also have an Influence on the estimate of the 
number of nurses needed by industrial establishments: 
1. Extent of medical and health programs 
2. Occupational hazards 
3* Additional shifts 
h* Amount of nursing participation in health education activities 
and home nursing service 
5* Utilization of part-time nursing services in establishments employing 
less than 100 woxkers 
6* Tendency to employ non-professional nursing personnel 
?♦ Provision for nursing supervision (furnished either by a member 
of the nursing staff at the plant or by advisory service from the 
State department of health, insurance companies, etc.)* 
Estimates of future needs will depend upon plans for industrial expansion. 
Discussions relative to this potential growth should also include a consideration 
of the social and economic trends in the State, as well as possible technological 
advances in the major types of industry represented* 
It is evident from the preceding discussion that realistic estimates of 
present and future needs for nurses in industry require considerable auxiliary 
information. The State Industrial hygiene Personnel (to be found either in the 
Board of Health or the Department of iabor) will probably be the best source* 
The State Chamber of Commerce, Manufacturers1 Association, and the State Planning 
Commission (or its counterpart) are other contacts which may prove helpful* The following table is suggested as a pattern for estimating either 
current or future needs for nurses in industrial establishments* 
Table b. An estimate of the number of nurses needed by industrial 
establishments in (State X), (Date). 
Size of industrial 
es tabli shments 
Number 
of 
Plants 
Number 
of 
Employees 
Number 
of 
Nurses Needed 
Total 
to 300 
301 - 600 
601 - 1,000 
1,001 - 2,000 
2,001 - 3,000 
3,001 - U,000 
1*,001 
5,000 ♦ . . 
5,001 and over 
Source: Table 9 summarizes the current and future needs for nurses in 
industrial establishments* 
Table 9* An estimate of the current and future number of nurses needed 
by industrial establishments in (State X)* 
Size of industrial 
Number of nurses needed 
establishment 
Current (Date) 
Future (Date) 
Total 
to 300 
301 - 600 
601 - 1000 
1001 - 2000 
2001 - 3000 
3001 - 1*000 
Uooi _ 5000 
5001 and over 
Sourcei Offices and Private Practice 
There are no known standards for determining the number of nursing 
personnel needed in offices and private practice. 
Therefore, it is suggested that the present needs for nursing personnel 
in offices and private practice be held constant with the number of nursing 
personnel currently employed in these two categories* 
Estimates of future needs for nursing personnel in offices should take 
into consideration the following factors: 
1. inclination to utilize nursing personnel in offices* 
2* an appreciable increase or decrease in the number of doctors, 
dentists, etc** 
3* trend in group practice* 
The utilization of nursing personnel in offices in recent years may 
provide a clue to the extent of future requests for this type of nursing service* 
Information on the number of professional nurses in offices over a period of 
time can probably be obtained from the State Nurses* Association* This data 
can be secured by coinparing the number of their members engaged in this type 
of nursing activity over a consecutive number of years. It may be possible to 
obtain similar information for non-professional nursing personnel from the 
State Board of Nurse Examiners (or the appropriate licensing agency). It will 
depend upon whether the licensure law in the State includes non-professional 
nursing personnel and if the registrants are requested to indicate the field 
of nursing in which they are engaged. The deans of medical, dental, etc. schools 
and the appropriate State associations (medical, dental, etc.) are the groups 
which will be helpful in estimating: an appreciable increase or decrease in the 
number of doctors, dentists, etc. (who may be potential employers of nursing 
personnel in offices); and the trend in group practice (which may influence 
/ 
the number of nursing personnel needed in offices)* Estimates of future needs for nursing personnel in private practice 
should recognize the difference between demand and need* Need is distinguished 
from demand in that it is a response to a real necessity arising from the 
patient*s physical and mental condition rather than a desire for continuous 
individual care* The future need for the number of nursing personnel engaged 
in private practice in either homes or hospitals will probably be diminished 
as hospitals provide more adequate nursing service and are increasingly used. 
The preceding considerations may indicate the feasibility of maintaining the 
number of nursing personnel currently engaged in private practice constant for 
future needs. 
The following table can be used to record estimates of current and 
future needs for nursing personnel in either offices or private practice. 
Table 10* An estimate of the current and future number of nursing personnel 
needed in (offices or private practice) in (State X). 
Type of 
Number of nursing personnel needed 
nursing personnel 
Current (Date) 
Future (Date) 
Total 
Professional 
nurses 
Non-professional 
nursing personnel 
Source: Hospitals 
As stated previously (see pages 18), it is advantageous to estimate 
current and future needs for nursing personnel in hospitals according to the 
following types of hospitals: 
1* General and allied special 
2* Tuberculosis 
3* Mental 
iu Chronic 
There are no known standards (pertinent to a study on a State-wide basis) 
by which to estimate needs for nursing personnel in special hospital departments 
such as the operating room, central supply room, outpatient department, etc* 
In the absence of such overall standards, the number of nursing personnel 
currently employed might be used as a criteria* 
The index of ‘‘hours of care per patient per day” is the standard 
recommended as a guide in estimating the number of nursing personnel needed 
to give bedside care to patients in general, allied special, and chronic 
disease hospitals. The construction and arrangement of the hospitals, avail- 
ability of desirable equipment, administrative skill of the executive personnel 
and other factors have a definite influence on the preceding standard. However, 
these factors cannot be included in the standard as there are no quantitative 
measures of their effect available. 
An estimate of the number of nursing personnel needed in tuberculosis 
and mental hospitals iwill be more practicable if based on ratios of nursing 
personnel (professional and non-professional) per daily average patient census. 
Whether hours of care per patient per 2k hours or ratios of nursing 
personnel per daily average patient census is used, estimates of future needs for nursing personnel will be based on an estimated future daily average 
patient census. To estimate the future daily average patient census it will 
be necessary to know: 
1. Anticipated number of hospital beds 
2. Expected occupancy rate. 
The State agency administering the Hospital Survey and Planning Program will 
probably be the best source for obtaining the anticipated number of hospital 
beds. The expected occupancy rate should be estimated in consultation with 
representatives of both State agency and the State Hospital Association. 
When the anticipated number of hospital beds and the expected occupancy 
rate have been obtained, the following formula can be used to arrive at an 
estimated future daily average patient census. 
Formula U* Estimated future daily average patient census 
Anticipated 
number of 
hospital beds 
X 
expected 
occupancy 
estimated future daily 
average patient census. 
Example: 
25>000 anticipated number 
of hospital beds in 
• State X in 1955 
expected 
occupancy rate 
in hospitals in 
State X in 1955 
20,000 estimated daily- 
average patient census in 
State X in 1 955* 
X General and Allied Special Hospitals 
A recent study. Nursing Service in One Children’s and Twenty-one General 
Hospitals, 1/ gives detailed information which is useful in computing nursing 
service needs for a single hospital. This publication presents nursing service 
needs for specific clinical areas according to type of accommodation. It is 
improbable that this information will be available on a State-wide basis. 
Therefore, the following criteria (adapted from this study) are suggested: 
Administrative nursing personnel per daily average patient census 
(including newborn) 
Type of administrative 
nursing personnel 
Daily average patient census 
(including newborn) 
1 day supervisor 
1 evening supervisor .... 
57 
1 night supervisor 
1 head nurse . 
Nursing personnel giving direct patient care 
3*5 average number of bedside hours per patient during 2k hours; 
the proportion of professional nurses to non-professional nursing 
personnel giving this direct care to patients in the ratio - 
2 professional nurses* 1 non-professional nursing personnel. 
Distribution of Nursing Service during War 2/ suggests 2 nurses as the central 
administrative staff (exclusive of day supervisors and head nurses; and night 
supervisors) in a general hospital with an all-graduate staff and having a 
daily average of 100 patients. 
1/ National League of Nursing Education, Department of Studies* A Study of 
” Nursing Service in One Children’s and Twenty-one General Hospitals. National 
League of Nursing Education, 1790 Broadway, New York City, New York, 19^8. 
2/ National Nursing Council for War Servicer Distribution of Nursing Service 
** during War, 1790 Broadway, New York City, New York, 19U2. A comparison of current practices with the preceding criteria may reveal 
a wide discrepancy between what actually exists and what is needed. If this is 
so, it may be considered feasible to gradually increase the average number of 
bedside hours per patient in 2k hours and the ratios of administrative nursing 
personnel per daily average patient census (including newborn) until the desired 
standards are met. 
The status of current practices in general hospitals in the State can be 
revealed by collecting certain data from a selected number of representative 
hospitals. The following section discusses pertinent factors in such a study: 
****** 4 (•***** A Study of a Sample of General Hospitals *********** 
A sample of general hospitals in a State should include an adequate 
number of hospitals representing variations in: 
1* size of community in which they are located 
2. those with and without schools of nursing 
3* ownership or control 
average census (including newborn) 
Information relative to the above items can be obtained from the mos t 
recent copy of Hospital Service In The United States (published annually by 
the Council on Medical Education and Hospitals). Utilization of information 
appearing in this publication for the purpose of a sample study of general 
hospitals in a State will involve the following steps: 
1. Segregation of general ’’hospitals and sanatoriums” and ’’related 
institutions” from other categories listed under ’’type of service”. 
2. Classification of general ’’hospitals and sanatoriums” and ’’related 
Institutions” according to: a* Location. 
The individual hospitals in the State are listed alphabetically 
according to location. The size of the population and the county 
immediately follow the location. 
b. Those with schools of nursing. 
The hospitals having schools of nursing accredited by the 
State Board of Nurse Examiners are designated by a symbol 
following the name of the individual hospital. 
c. Ownership or control. 
The various auspices under which the institutions are conducted 
are identified under the column ”ownership or control” ♦ 
d. Average census (Including newborn). 
The average census (excluding newborn) of the individual hospitals 
can be found under the column waverage census”. Since the figures 
in this column do not include newborn, it will be necessary to 
estimate the daily average newborn census. This can be approximated 
by multiplying the number of births (see column 11 number of births”) 
by the most recent ”average length of stay per patient in general 
hospitals” (refer to the table with this heading) and dividing by 
365 (days in year). 
Example: 
100 number of births in 
Hospital A, a non-profit 
general hospital 
X 
9 average length of 
stay per patient in 
all nonprofit general 
hospitals in 19U7 
2*5> estimated 
daily average 
newborn 
census 
365” days in year 
INhen the daily average newborn census has been estimated, this 
figure added to the average census (excluding newborn) will 
approximate the average census (including newborn). The preceding method classifies the general hospitals in a State accord- 
ing to the four categories suggested as a basis for the sample study. The next 
consideration is the number of hospitals which will constitute a valid sample. 
This decision will depend upon the individual pattern of each State as revealed 
by the range and distribution of the hospitals within each category. It is 
recommended that statistical assistance be requested in making this determination. 
Since the purpose of the sample study is to compare current practices 
with the suggested criteria, it is obvious that the data collected should 
correspond to the classifications of the criteria# Therefore, the specific 
information requested from each hospital participating in the sample study will 
relate to the following items for a specified 2h hour period: 
1. Daily average patient census (including newborn) 
2. Number of administrative nursing personnel on duty classified 
according to 
a# central administrative staff 
b. supervisors (day, evening, night) 
c# head nurses 
3* Number of hours of direct patient care by type of nursing personnel 
a# professional nurses 
b# non-professional nursing personnel. 
When the preceding data have been obtained, subsequent mathematical computations 
will reveal: 
1. Current ratios of specific groups of administrative nursing personnel 
to daily average patient census (including newborn) 
2. Current average number of bedside hours per patient in 2h hours, and 
the current ratio of professional to non-professional nursing personnel 
giving this direct care to patients. The effectiveness of a sample depends upon accurate and complete 
information from the participating hospitals. Since a relatively small number 
of hospitals are selected for a project of this type, it is strongly recommended 
that the desired data be obtained through field visits. It may be expedient to 
have several nurses share the field work* If this is the case, it is advantageous 
to hold a conference with the group prior to their visits. Uniformity in the 
interpretation and collection of information will facilitate subsequent compila- 
tion and correlation of the material obtained. 
If a mailed questionnaire is unavoidable, the information requested 
in the form should be clearly understood by the respondent. Questionnaire h 
(Parts 1 and 2) illustrates how the data needed for the sample study might 
be collected. Questionnaire U: Mailed questionnaire to individual hospitals selected to 
(Parts 1, 2) participate in a sample study of general hospitals to obtains 
Record of the number of administrative nursing 
personnel on duty. 
Record of nursing personnel giving direct patient 
care during 2h hours. 
Questionnaire U 
Part 1 
To: (Name of group 
sponsoring survey) 
Hospital 
Address 
Daily average patient census 
(including newborn) 
Record of the number of administrative nursing personnel on duty 
(Date: month, day, year) 
Administrative nursing personnel 
Number of nurses 
!• Central administrative staff (director 
and assistant director of nurses and/or 
nursing school) 
II. Supervisors 
(Charge of more than one ward or patient 
unit) 
a. day. • • 
b. evening. 
c. night. • 
III. Head nurses 
(Charge of one ward or patient unit 
only) NURSING PERSONNEL GIVING DIRECT PATIENT CARE (Include full & part time) 
(W (5) (6) (7) 
Private duty Graduate Professional Non-Professional Nursing 
Nurses Professional Student Personnel c/ giving direct 
Nurses b/ Nurses care to patients 
No. Total ” No”. Total Nol Total Nol Total’ 
Hours Hours Hours Hours 
of of of of 
Care Care Care Care 
a/Do not include special departments, e.g.t operating room, central supply room, out-patient department, etc. 
B/lnclude any time given to direct patient care by head nurses and/or assistant head nurse. 
c/Practical nurses, attendants, nurses1 aides, orderlies, etc. 
"Example j 
B-2 Medical 20 6 1+8 2 16 2 6 3 2h 
Hospital 
Address 
Record of Nursing Personnel Giving Direct Patient Care 
During 2h Hours of (Date* month, day, year) 
— t+s 
Questionnaire li 
Part 2 
CENSUS 
(3) 
No. of 
patients 
in unit 
today 
Tot (Name of group 
sponsoring survey) 
SERVICE 
(2) 
e.g. med., 
surgical, 
OB, T.B., 
psychiatry 
UNIT, e.g. 
WARD, FLOOR 
WT 
Areas in 
which direct 
nursing 
service is 
given a/ The following worksheets (to be used by the director of the survey 
or a designate) serve two purposes: 
1. orderly method of compiling, computing, and correlating the 
collected data 
2. systematic way of retaining essential data for reference. 
The explanatory material accompanying each worksheet identifies the source 
of the information used, and illustrates the mathematical procedures involved 
by means of formulae and examples. (1*) 
Ratios of administrative 
nursing personnel to daily 
average patient census 
(including newborn) 
1:100 
Worksheet !• Summary of Data Relative to the Ratios of Administrative Nursing Personnel 
to Daily Average Patient Census (including newborn) in (Hospital A), on 
(Date: month, day, year) 
(3) 
Daily average 
patient census 
(including newborn) 
200 
(2) 
Number of 
adminis trative 
nursing personnel 
UforamplA 
2 
(X) 
Specific groups of 
Admin is tra tive 
nursing personnel 
Central Administra- 
tive staff 
Supervisor: 
Day 
Head nurses Explanatory material. Worksheet 1. 
This worksheet utilizes data obtained through Questionnaire 1* (part 1). 
The summarization in Worksheet 1 reveals ratios of administrative nursing 
personnel to daily average patient census (including newborn) in a hospital, 
formula 5> shows the mathematical procedures employed in Worksheet 1. 
Formula Ratios of administrative nursing personnel to daily 
average patient census (including newborn). 
Number of administrative nursing 
personnel: 
Central administrative nursing staff 
or 
supervisors (Hay, evening, night) 
or 
head nurses. 
Daily average patient census 
(including newborn) 
Ratios of administrative 
nursing personnel to daily 
average patient census 
(including newborn). 
Example: 
2 number of Central administrative 
nursing staff in Hospital A 
200 daily average patient census in 
Hospital A (including newborn) 
1:100 ratio of central 
administrative nursing staff 
to daily average patient census 
(including newborn) in Hospital A, Note: 
The data in Worksheet 1 pertains to a single hospital. To arrive at 
the average ratio for any one group of administrative nursing personnel for all 
hospitals participating in the sample study it will be necessary to: 
!• individually total the specific groups of administrative 
nursing personnel: 
a. central administrative staff 
b. supervisors - day, evening, night 
c. head nurses 
2. total the daily average patient census (including newborn). 
When the preceding steps have been completed, the total number of individual 
groups of administrative nursing personnel divided by the total daily average 
patient census (including newborn) will reveal the average ratios of specific 
groups of administrative nursing personnel to daily average patient census 
(including newborn). 
Example: 
Statement of problem: To determine the average ratio of central admin- 
trative nursing staff to daily average patient 
census (including newborn) in the sample study of 
general hospitals in State X. 
Individual institutions 
Number of central 
Daily average patient 
participating in the sample 
administrative nursing 
census (including 
study of general hospitals 
staff 
newborn) 
Hospital A 
2 
200 
Hospital B 
8 
95o 
Hospital C 
1 
50 
Hospital D 
3 
300 
Hospital E 
2 
100 
16 
1555“ 
Solution: 
16 total number of central 
administrative nursing staff 
1600 total daily average patient 
census (including newborn) 
r 1:100 average ratio of central 
administrative nursing staff 
to daily average patient census 
(including newborn). (it) 
Ratio of Professional to Won- 
professional Nursing Personnel 
Professional Non-Profes- 
(Graduate profes- sional 
sional nurses and nursing 
professional stu- personnel 
dent nurses) 
1 1.1 
Worksheet 2. Summary of Data Relative to Hours of Bedside Care per Patient in 2h Hours and Ratio of 
Professional to Non-Professional Nursing Personnel Giving this Direct Patient Care in 
(Hospital A) on (Date: month, day, year) 
(3) 
Hours of Bedside Care per Patient 
by Type of Nursing Personnel 
Graduate Professional Non-Profes- 
Professional student sional nurs- 
ing person- 
nel 
•9 .3 1*3 
(2) 
Bedside Nursing 
Care in 2k Hours 
Sum total Average 
Hours of hour’s of 
Care care per 
patient 
h6 2.5 
(i) 
Adjusted 
Census 
Grand 
total 
Examples 
18 Explanatory material. Worksheet 2. 
This worksheet utilizes data obtained through Questionnaire U (Part 2)* 
The summarization in Worksheet 2 reveals the hours of bedside care per patient 
in 2k hours and the ratio of professional to non-professional nursing personnel 
giving this direct patient care for each unit in a hospital. 
The mathematical procedures in Worksheet 2 are the following j 
a. ADJUSTED CENSUS 
Source: Adjusted census (Colunn 1, Worksheet 2) is computed from 
census (Column 3, Part 2 of Questionnaire k) and total hours 
of. care of private duty nurses (Column k9 Part 2 of 
Questionnaire b) 
Formula 6a - Equivalent number of patients cared for by other than 
hospital staff in a 2b hour period. 
Total hours of service of 
private duty nurses 
2k hours 
equivalent number of patients 
cared for by other than hospital 
staff in a 2k hour period. 
Formula 6b - Adjusted census (patients cared for by hospital 
staff in a 2k hour period) 
Census of - Equivalent number of 
Unit patients cared for by 
other than hospital 
staff in a 2b hour 
period 
adjusted census 
(patients cared for by 
hospital staff in a 2k hour 
period) 
■i 
Example? 
U8 total hours of 
service of private 
duty nurses (6 nurses 
at 8 hours each) 
2k hours 
2 equivalent number of patients 
cared for by other than hospital 
staff in a 2k hour period 
20 (census 
of unit) 
- 2 (equivalent number 
of patients cared 
for by other than 
hospital staff in a 
2k hour period) 
18 adjusted census 
(patients cared for by 
hospital staff In a 
2k hour period) 
s b. AVERAGE HOURS OF BEDSIDE NURSING CARE PER PATIENT IN 2U HOURS 
Source: The average hours of bedside nursing care per patient in 
2h hours (Column 2, Worksheet 2) is computed for each unit 
(Column 1, Part 2 of Questionnaire U) from the adjusted census 
(Column 1, Worksheet 2) and the sum total hours of bedside 
nursing care (Column 2, Worksheet 2). The sum total hours 
of bedside nursing care (Column 2, Worksheet 2) is the combined 
total hours of care of: graduate professional nurses 
(Column 5, Part 2 of Questionnaire h); professional student 
nurses (Column 6, Part 2 of Questionnaire 1*); and non- 
professional nursing personnel (Column 7, Part 2 of 
Questionnaire ii). 
Formula 7. Average hours of nursing care per patient in 2ii hours. 
Sum total of hours 
of bedside nursing 
care 
adjusted census 
average hours of 
nursing care per patient 
in 2li hours. 
Example : 
16 total hours, graduate professional nurses 
6 total hours, professional student nurses 
2h total hours, non-professional nursing personnel 
U6 sum total of hours of bedside nursing care 
U6 
l8 (adjusted 
census) 
2.5 average hours of nursing care 
per patient in a 2h hour period. c. HOURS OF BEDSIDE CARE PER PATIENT IN 2k HOURS BY TYPE OF NURSING 
PERSONNEL. 
Sources Hours of bedside care per patient in 2k hours by type of 
nursing personnel (Column 3, Worksheet 2) is computed for 
each unit (Column 1, Part 2 of Questionnaire 1;) from the 
adjusted census (Column 1, Worksheet 2) and the total hours 
of bedside nursing care of each category of nursing personnels 
Graduate professional nurses (Column 5, Part 2 of Questionnaire U); 
Professional student nurses (Column 6, Part 2 of Questionnaire 1*); 
Non-professional nursing personnel (Column 7, Part 2 of 
Questionnaire U)• 
Formula 8. Hours of bedside care per patient by type of nursing personnel. 
Total hours of bedside nursing cares 
Graduate professional nurses Hours of Bedside 
or 
Professional student nurses care per patient by 
or 
Non-professional nursing personnel 
Adjusted Census 
= type of nursing 
personnel 
Examples 
16 total hours, graduate profes- 
sional nurses 
18 adjusted census 
.9 Average hours of bedside 
care per patient by praduate 
professional nurses 
6 total hours, professional 
student nurses 
l8 adjusted census 
= .3 Average hours of bedside 
care per patient by 
professional student nurses 
2k total hours, non-professional 
nursing personnel 
l6 adjusted census 
“ 1.3 Average hours of bedside 
care per patient by non- 
professional nursing 
personnel. d. RATIO OF PROFESSIONAL TO NON-PROFESSIONAL NURSING PERSONNEL GIVING 
DIRECT PATIENT CARE 
Source: 
The ratio of professional to non-professional nursing personnel giving 
direct patient care (Column U, Worksheet 2) is computed for each unit 
(Column 1, Part 2 of Questionnaire U) from the total hours of care of 
graduate professional nurses (Column 5, Part 2 of Questionnaire h) and 
professional student nurses (Column 6, Part 2 of Questionnaire h) and 
non-professional nursing personnel (Column 7, Part 2 of Questionnaire U)• 
Formula 9* Ratio of Professional to Non-Professional Nursing Personnel 
Giving Direct Patient Care. 
Total hours of bedside care by 
non-professional nursing personnel 
Total hours of bedside care by 
professional nurses (graduate 
professional and professional 
student nurses) 
s ratio of professional to 
non-professional nursing 
personnel giving direct 
patient care. 
Example: 
2h total hours of bedside care 
by non-professional nursing 
personnel 
22 total hours of bedside care 
by professional nurses (graduate 
professional nurses 16; profes- 
sional student nurses 6) 
1 professional nurse to 1.1 
non-professional nursing 
personnel giving direct patient 
care. “W 
Ratio of professional to 
Non-professional nursing 
personnel 
Professional Non-Professional 
(gradua te Nur sing 
professional Personnel 
nurses and 
professional 
student nurses) 
Summary of Data Relative to Hours of Bedside Care Per Patient in 21; Hours 
and Ratio of Professional to Non-Professional Nursing Personnel Giving this 
Direct Patient Care According to Size of Hospitals 
a*) 
Hours of Bedside Care 
per Patient by Type of 
Nursing Personnel 
Graduate Profes- Non- 
Profes- sional Profes- 
sional Student sional 
Nursing 
Personnel 
(3) 
Bedside Nursing Care 
in 2k Hours 
Sum total) Average 
Hours of Hours of 
Care Care per 
Patient 
(2) 
Number of 
Ho spitals 
Worksheet j• 
Grand total 
Below 25 
26 - 50 
51 - 100 
101 - 200 
201 - 300 
3CQ. and over 
a) 
Size of 
Hospital Explanatory Material, Worksheet 3. 
This worksheet classifies certain items compiled in Worksheet 2 according 
to size of hospitals. The selected data utilized in Worksheet 3 are: bedside 
nursing care in 2h hours (Column 2, Worksheet 2); hours of bedside care per 
patient by type of nursing personnel (Column 3, Worksheet 2)j and ratio of 
professional to non-professional nursing personnel (Column Ii, Worksheet 2). 
The data from Worksheet 2 pertain only to a single hospital. Therefore, 
to utilize this data on Worksheet 3 two steps are necessarys 
1. sort all Worksheets 2 according to size of hospital 
2. summarize within each category of size the selected items on all 
Worksheets 2 to be used in Worksheet 3* 
When this intermediate phase has been concluded, the results can then 
be entered in the appropriate columns in Worksheet 3* The calculations necessary 
to complete this worksheet are identical to those which have been discussed 
previously (refer to explanatory material accompanying Worksheet 2, sections b, 
c, d). 
Notes Worksheet 3 can be used as a model for summarizing the other factors 
which served as a basis for selecting the general hospitals to participate 
in the sample study. This can be accomplished by changing the "size of 
hospital" (Column 1, Worksheet 3) tos 
1. size of community in which the hospitals are located 
2. hospitals with schools of nursing 
3. hospitals without schools of nursing 
iu ownership or control. 
Summaries resulting from the preceding classification will not only permit 
more refined comparisons within each category, but may also disclose 
significant correlations between categories. When current practices (revealed by the sample study) have been compared 
with the suggested criteria and a decision reached relative to the standards 
which are to be used in estimating present and future needs for nursing personnel 
in general and allied special hospitals on a State-wide basis. Formulae 10 and 11 
(a and b) will disclose the number of administrative and bedside nursing personnel 
required per day. 
Formula 10. Number of administrative nursing personnel required per day to meet 
the selected standard of daily average patient census (including 
newborn) per type of administrative nursing personnel in general 
and allied special hospitals on a State-wide frisis. 
Bally average patient census 
(including newborn) in 
general and allied special 
hospitals 
X 
selected standards for 
administrative nursing 
personnel per daily 
average patient census 
(including newborn)I 
Central administrative 
nursing staff 
or 
supervisors (day, evening, 
night) 
or 
head nurses 
number of adminis- 
trative nursing 
personnel required 
per day to meet the 
selected standard 
of daily average 
patient census 
(including newborn) 
per type of admin- 
istrative nursing 
personnel in general 
and allied special 
hospitals on a 
State-wide basis 
Example: 
19*000 current daily 
average patient 
census (including 
newborn) of general 
and allied special 
hospitals in State X 
2 central administrative 
nursing staff per 100 
daily average patient 
census (including newborn) 
380 central adminis- 
trative nursing staff 
currently needed per 
day in general and 
allied special hospitals 
in State X to meet 
the selected standard 
of 2 central adminis- 
trative nursing staff 
per 100 daily average 
patient census 
(including newborn) 
X Formula 11 a. Number of bedside nursing personnel required per day to meet the 
selected standard of average hours of bedside care per patient 
in 2k hours in general and allied special hospitals on a State- 
wide basis.!/ 
Daily average patient 
census (including new- 
born) in general and 
allied special hospitals 
X 
selected standard of 
average hours of bedside 
care per patient in 2k hours 
in general and allied special 
hospitals 
Number of bedside nursing 
personnel required per 
day to meet the selected 
standard of average hours 
of bedside care per 
patient in 2h hours in 
general and allied 
special hospitals on a 
State-wide basis. 
Average number of hours worked per day 
by nursing personnel giving bedside care 
in general and allied special hospitals. 
Formula 11 b. 
Number of professional or non-professional bedside nursing 
personnel required per day to meet the selected ratio of professional 
nurses or non-professional nursing personnel to total nursing 
personnex giving bedside care in general and allied special 
hospitals on a State-wide basis. 
Number of bedside nursing 
personnel required per day 
to meet the selected standard 
of average hours of bedside 
care per patient in 2k hours 
in general and allied special 
hospitals on a State-wide basis 
Selected ratio of 
professional nurses 
or non-professional 
nursing personnel to 
total nursing personnel 
giving bedside care in 
general and allied 
special hospitals on a 
State-wide basis 
Number of professional 
or non-professional bed- 
side nursing personnel 
required per day to meet 
the selected ratio of 
professional nurses or 
non-professional nursing 
personnel to total nurs- 
ing personnel giving 
bedside care in general 
and allied special hos- 
pitals on a State-wide 
basis• 
X 
1/ This formula is adapted from an equation in the Manual of the Essentials of 
Good Hospital Nursing Service published by the American Hospital Association 
and National League of Nursing Education; 1790 Broadway, New York City, 
New York, 19L2, page U3 Example: 
Statement of problems 
20,571 - daily average patient census (including newborn) in 
general and allied special hospitals in State X 
8 - average number of hours worked per day by nursing personnel 
giving bedside care in general and allied special hospitals 
in State X 
Selected criteria for estimating needs for nursing personnel 
3*5 average number of bedside hours per patient during 2k hours, 
the proportion of professional nurses to non-professional nursing 
personnel giving this direct care in the ratio of 2si (total 
nursing personnel 3 9 2/3 professional nurses and 1/3 non- 
professional nursing personnel) 
Solution: 
20,571 x 3*5 
8 average number of hours 
worked per day by nursing 
personnel giving bedside 
care 
9000 number of nursing personnel 
required per day to meet the 
selected standard of 3*5 average 
hours of bedside care per patient 
in 2k hours in general and allied 
special hospitals in State X* 
9000 x 2/3 factor for com- 
puting profes- 
sional nurses 
B 
6000 professional nurses required 
per day to meet the selected ratio 
of professional to non-professional 
nursing personnel giving 3*5 average 
hours of bedside care per patient 
in 2k hours in general and allied 
special hospitals in State X. 
9000 x 1/3 factor for compu- 
ting non-profes- 
sional nursing 
personnel 
3000 non-professional nursing 
personnel required per day to Beet 
the selected ratio of professional 
to non-professional nursing personnel 
giving average hours of bedside 
care per patient in 2k hours in 
general and allied special hospitals 
in State X. Another factor which must be considered in estimates of need for nursing 
personnel in general hospitals is the contribution to nursing service made by 
student nurses in basic professional nursing education programs. It is suggested 
that this calculation be made in terms of replacement equivalents of professional 
nurses or non-professional nursing personnel* Formula 12 (a and b) illustrates 
a method of estimating these replacement equivalents. 
Formula 12 a Number of nursing personnel required to replace the contribution 
made to nursing service by basic professional student nurses. 
Total 
students 
currently 
enrolled 
X 
percent of 
students 
giving direct 
care to 
patients 
X 
percent of student 
service which is as 
productive as profes- 
sional and non-profes- 
sional nursing service 
m 
number of nursing 
personnel required 
to replace student 
nurse service. 
Formula 12 b Number of graduate professional nurses or non-professional 
nursing personnel required to replace the contribution made to 
nursing service by basic professional student nurses. 
Number of nursing 
personnel required 
to replace student 
nurse service 
percent of student 
service which replaces: 
graduate professional 
nursing service 
or 
non-professional 
nursing service. 
Number of graduate 
professional nurses 
or non-professional 
nursing personnel 
required to replace 
student nurse service. 
X Example: 
Statement of problem: 
3000 student nurses currently enrolled in basic professional 
nursing education programs associated with general hospitals 
in State X* 
Assumptions: 
!• 2/3 (66 2/3$) of the total students enrolled are giving 
direct care to patients. 
2. An hour of student service is 3A (75$) as productive 
as a combined hour of professional and non-professional 
nurse service# 
3* Student nurse service replaces 
a* Professional nursing service 60$ 
b. Non-professional nursing service i*0$. 
Solution: 
3000 students 
currently 
enrolled 
X 
66 2/3$ 
(see 1 above) 
X 75$ (see 
2 above) 
1500, number of nursing 
personnel required to 
replace student nurse 
service 
1500 number of nursing 
personnel required 
to replace student 
nurse service 
X 60$ (see 
3 a above) = 
900, graduate professional 
nurses required to 
replace student 
nurse service 
1500 number of nursing 
personnel required 
to replace student 
nurse service 
600, non-profes- 
sional nursing 
personnel required 
to replace nurse 
service• 
X k0% (see 
3b above) If Formula 12 (a and b) is used as' the method for estimating replacement 
equivalents for the contribution made by basic professional student nurses on 
a State-wide basis, it will be necessary to obtain an estimate for the following 
factors: 
1. percent of the students currently enrolled who are giving direct 
care to patients 
2. percent of student service which is as productive as a combined 
hour of professional and non-professional nurse service 
3* percent of student service which replaces professional nursing 
service and non-professional nursing service. 
Counsel in regard to the preceding items should be sought from the State Board 
of Nurse Examiners, State Nurses* Association, and State League of Nursing 
Education. 
The following table may be used to summarize the number of nursing 
personnel currently needed per day by general and allied special hospitals. 
Table 11. An estimate of the number of nursing personnel currently needed 
per day by (registered and unregistered or registered only) general 
and allied special hospitals (exclusive of or including Federal 
hospitals) in (State X), (Date). 
Type of 
Nursing personnel 
Number of nursing personnel 
currently needed per day 
Total 
Professional nurses • • • 
Central administra- 
tive staff . . . • . 
Supervisors . • • 
Head nurses 
Staff nurses • • 
Non-professional nursing 
personnel • • • • • 
Source: Tuberculosis Hospitals 
The following ratios of nurses per patients (based on three major 
classifications of patient activity) are cited in Minimal Medical and 
Administrative Standards for Tuberculosis Hospitals and Sanatoria 1/: 
infirmary patients: 1 nurse per 3 patients 
semi-ambulant patients* 1 nurse per 8 patients 
ambulant patients: 1 nurse per 30 patients 
The preceding source does not indicate the number of professional and 
non-professional nursing personnel which constitute the above ratios. For the 
purpose of a State-wide survey, the following ratios (or a variation) might be 
assumed: 
Type of Patient 
Professional 
Non-Profe s s ional 
Activity 
Nurses 
Nursing Personnel 
infirmary 
1 
2 
semi-ambulant 
1 
3 
ambulant 
1 
5 
1/ American Trudeau Society, Committee on Sanatorium Standards: MlnimAi Medical 
and Administrative Standards for Tuberculosis Hospitals and Sanatoria* 
American Review of Tuberculosis Ll, No. 5 (May 19h£) page 1*8£. Example: 
Statement of problem: 
3000 daily average patient census in registered tuberculosis 
hospital in State X, 19h9 
300 estimated daily average census of infirmary patients 
1200 estimated daily average census of semi-ambulant patients 
estimated daily average census of ambulant patients 
Selected criteria for estimating needs for nursing personnel 
Infirmary patients 
1 nurse per 3 patients, ratio of professional nurses to 
non-professional nursing personnel 1:2 
Semi-ambulant patients 
1 nurse per 8 patients, ratio of professional to 
non-professional nursing personnel 1:3 
Ambulant patients 
1 nurse per 30 patients, ratio of professional nurses 
to non-professional nursing personnel 1:5 
Solution: 
Infirmary patients 
300 infirmary patients require 100 nurses at the ratio of 1 nurse 
per 3 patients; on the assumption of 1 professional nurse to 
2 non-professional nursing personnel these 100 nurses will consist of: 
33 professional nurses (l/3 x 100) 
6? non-professional nursing personnel (2/3 x 100) 
Semi-ambulant patients 
1200 semi-ambulant patients require 150 nurses at the ratio of 
1 nurse per 8 patients; on the assumption of 1 professional nurse to 
3 non-professional nursing personnel these 150 nurses will consist of: 
37 professional nurse {l/k x 15>0) 
113 non-professional nursing personnel (3/U x 150) • 
Ambulant patients 
1500 ambulant patients require 50 nurses at the ratio of 1 nurse per 
30 patients; on the assumption of 1 professional nurse to 5 non- 
professional nursing personnel these 50 nurses will consist of: 
8 professional nurses (l/6 x 50) 
U2 non-professional nursing personnel (5/6 x 50)* Since the ratios of nurses per patients are based on three major classi- 
♦ 
fications of patient activity, it will be necessary to estimate the number of 
hospitalized tuberculosis patients in the State according toi infirmary; semi- 
ambulant; and ambulant* A conference with the State administrative agency 
responsible for the supervision of State tuberculosis sanatoria should provide 
a logical basis for this supposition. 
Table 12 presents a method of compiling an estimate of the number of 
nursing personnel currently needed per day by tuberculosis hospitals. 
Table 12. An estimate of the number of nursing personnel currently needed per 
day by (registered and unregistered or registered only) tuberculosis 
hospitals (exclusive of or including Federal hospitals) in (State X), 
(Date)• 
Classification of patients 
in tuberculosis hospitals 
according to activity 
Number of nursing personnel 
currently needed per day 
Professional Non-professional 
Total 
Infirmary 
Serai-ambulant 
Ambulant • • 
Sourcet Mental Hospitals 
A minimum standard for nursing personnel in mental hospitals (based on 
Standard for Psychiatric Hospitals and Out-Patient Clinics Approved by the 
American Psychiatric Association 1/ is: 
1 professional nurse per 25 patients 
1 non-professional nursing personnel per 1; patients. 
If the preceding standard is considered inadequate, the need for nursing 
personnel might be estimated on the basis of the number of psychiatric patients 
who require: 
1. intensive therapeutic care 
2. custodial care. 
The number of nursing personnel needed for psychiatric patients who require 
intensive therapeutic care can be computed in terms of hours of bedside care* 
In this respect, it would seem reasonable to use the same criteria (average hours 
of bedside care per patient in 21; hours, and ratio of professional to non-profes- 
sional nursing personnel), which have been selected as standards for general and 
allied special hospitals on a State-wide basis. The number of nursing personnel 
needed for psychiatric patients requiring custodial care can be computed by using 
uhe minimum standard (ratios of nursing personnel to patients) suggested in the 
preceding paragraph. 
1/ Committee on Psychiatric Standards and Policies: Standards for psychiatric 
hospitals and out-patient clinics approved by the American Psychiatric 
Association 19A5 - 19U6. American Journal of Psychiatry 102:261; - 269 
(September 19h5) Example: 
Statement of problems 
3086 daily average patient census in registered mental hospitals 
in State X, 19U9« 
686 estimated daily average census of patients requiring 
intensive therapeutic care. 
21*00 estimated dally average census of patients requiring 
custodial care. 
8 average number of hours worked per day by nursing personnel 
giving bedside care in mental hospitals in State X. 
Selected criteria for estimating needs for nursing personnel 
Patients requiring intensive therapeutic care. 
3.5 average number of bedside hours per patient during 
2i* hours, the proportion of professional nurses to non- 
professional nursing personnel giving this direct care in 
the ratio of 2:1 (total nursing personnel 3* 2/3 professional 
nurses and l/3 non-professional nursing personnel). 
Patients requiring custodial care. 
1 professional nurse per 25 patients. 
1 non-professional nursing personnel per 1* patients. 
Solution 
Patients requiring intensive therapeutic care, 
686 patients require 300 nursing personnel per day to provide 
3*5 average hours of bedside care per patient in 21* hours; on 
the basis of 1 professional nurse to 2 non-professional nursing 
personnel the 300 nursing personnel will consist of: 
100 professional nurses. 
200 non-professional nursing personnel. 686 estimated 
daily average 
patient census 
3*f> average number 
of bedside hours 
per patient In 21* hours 
300 number of nursing personnel 
required per day to provide 
3*5 average hours of bedside 
care per patient in 2i* hours. 
X 
8 average number of hours worked 
per day by nursing personnel 
giving bedside care 
m 
300 x 2/3 factor for 
computing 
professional 
nurses 
200 professions! nurses required per day 
to provide 3*5 average hours of bedside 
care per patient in 21* hours. 
s 
300 x 1/3 factor for 
computing 
non-profes- 
sional nursing 
personnel 
100 non-professional nursing personnel 
required per day to provide 3*5 average 
hours of bedside care per patient in 
21* hours* 
■ 
Patients requiring custodial care 
21*00 patients require 696 nursing personnel per day to meet 
* 
the minimum standard of 1 professional nurse per 
25 patients and 1 non-professional nursing personnel 
per 1* patients; on the basis of the preceding ratios 
the 696 nursing personnel will consist of: 
96 professional nurses (21*00 4. 25) 
600 non-professional nursing personnel (21*00 7 1*) If the need for nursing personnel is based on the number of psychiatric 
patients who require intensive therapeutic or custodial care, it will be necessary 
to estimate the respective number of patients in the State in these two categories. 
The State Mental Health Authority will probably be the best source to obtain 
assistance in making this estimate. 
The following table illustrates one way by which the estimate of the 
number of nursing personnel currently needed per day by mental hospitals can 
be assembled. 
Table 13. An estimate of the number of nursing personnel currently needed 
per day by (registered and unregistered or registered only) mental 
hospitals (exclusive of or including Federal hospitals) in (State X), 
(Date)• 
Classification 
of patients in 
mental hospitals 
according to type 
of care required. 
Number of nursing personnel currently needed 
per day 
Professional 
Non-Professional 
Total 
Intensive therapeutic 
Custodial 
Source: Chronic Hospitals 
There are no firmly established standards for computing the number of 
nursing personnel needed tc provide adequate nursing care to patients in chronic 
hospitals. The following assumed criteria are suggested for consideration: 
1.5 average number of bedside hours per patient during 2k hours; the 
proportion of professional nurses to non-professional nursing personnel 
giving this direct care in the ratio - 
1 professional nurses 5 non-professional nursing personnel. 
Example: 
Statement of problems 
500 daily average patient census in registered chronic hospitals 
in State X, 19i*9. 
8 average number of hours worked per day by nursing personnel 
giving bedside care in chronic hospitals in State X. 
Selected criteria for estimating needs for nursing personnel. 
1.5 average number of bedside hours per patient during 2k hours, 
the proportion of professional nurse to non-professional nursing 
personnel giving this direct care in the ratio of 
Is5 (total nursing personnel 6, 1/6 professional nurses and 
5/6 non-professional nursing personnel). 
Solution: 
500 daily average 
patient census 
X 
1.5 average number 
of bedside hours 
per patient in 
2k hours 
9i+ number of nursing 
personnel required per day 
to provide 1*5 average hours 
of bedside care per patient 
in 2k hours 
8 average number of hours worked 
per day by nursing personnel 
giving bedside care 
9U x l/6 factor for computing professional 
nurses 
16 professional nurses 
required per day to provide 
1.5 average hours of bedside 
care per patient in 2k hours 
9k x 5/6 factor for computing non-profes- 
sional nursing personnel 
78 non-professional nursing 
personnel required per day to 
provide 1.5 average hours of 
bedside care per patient in 
2k hours. Table ll* may be used to record the estimates of the number of profes- 
sional nurses and non-professional nursing personnel currently needed per day 
by chronic hospitals. 
Table ll*. An estimate of the number of nursing personnel currently needed per 
day by (registered and unregistered or registered only) chronic 
hospitals (exclusive of or including Federal hospitals) in (State X), 
(date)* 
Daily average 
patient census 
in chronic 
Number of nursing personnel 
currently needed per day 
Professional Non-professional 
hospitals 
Sourcej Total number of nursing personnel needed in hospitals 
Estimates of the number of professional and non-professional nursing 
personnel required to meet a selected standard of nursing care in hospitals have 
been based on the number needed per day. It is necessary to compute the total 
number needed to include the additional number required to supplement those away 
from duty for the following reasons* 
1* Vacation, holidays, and illness 
2* Days off each week. 
When the preceding factors are used in relation to current needs they 
should reflect average current practices. If some of these practices are not 
considered adequate, estimates of future needs should envisage progress in 
deficient personnel practices. 
The State Nurses* Association, State Hospital Association, and an agency 
representing pre-payment hospital plans should be consulted in estimating the 
current average days away from duty each year of every member of the nursing 
personnel in hospitals. 
Formula 13 shows how the total number of nursing personnel needed in 
hospitals can be computed. Formula 13, Total number of Nursing Personnel needed in hospitals. 
days in year 
average number of days 
worked per year by each 
member of the nursing 
personnel in hospitals 
X 
number of nursing 
personnel required 
per day to meet 
selected standards 
of nursing care in 
hospitals for 2k hours* 
total number of 
nursing personnel 
needed in hospitals. 
Example: 
Statement of problem 
5300 - number of nursing personnel required to meet the 
selected standards of nursing care per day in hospitals 
in State X in 19^9• 
100 - average days away from duty each year of every member 
of the nursing personnel for vacation, holidays, 
illness, and days off each week. 
28 days ( h weeks) away from duty because of vacations, 
holidays, illness. 
72 days away from duty because of days off each week 
52 weeks in year 
- k weeks away from duty for vacation, holidays, illness 
5H weeks on duty 
U8 x lj days off s 72 
265 average number of days worked per year by each member 
of the nursing personnel in hospitals 
365 days in year 
100 average days away from duty each year for vacations, 
holidays, and days off each week 
265 
Solutioni 
36g x 5300 = 7300 total number of nursing personnel needed 
2&S in hospitals in State X in 19i*9* Summary: Estimated total number of nursing personnel needed by hospitals. 
Table 15 summarizes the estimates of the total number of nursing personnel 
currently needed by hospitals. 
Table 15• An estimate of the total number of nursing personnel currently needed 
by (registered and unregistered or registered only) hospitals 
(exclusive of or including Federal hospitals) in (State X), (Date)* 
Type 
of 
hospital 
Daily average 
patient 
Number of nursing personnel needed 
census Professional Non-professional 
Total ... 
General and allied special. • 
Tuberculosis. ..•••••• 
Mental. 
Chronic ...... 
Source: 
Table 16 summarizes the estimates of the total number of nursing personnel 
needed by hospitals in the future * 
Table 16. An estimate of the total number of nursing personnel needed in the 
future by hospitals (exclusive of or including Federal hospitals) in 
(State X), (future date)* 
Type 
of 
beds 
Anticipated daily Number of nursing personnel needed 
average patient 
census Professional Non-Professional 
Total 
General and allied special. 
Tuberculosis. • •••••• 
Mental. 
Chronic 
Source: Summary: SECTION II 
Table 17 summarizes the estimates of the current and future number of 
nursing personnel needed by the State according to place of service (see 
Tables 7, 9, 10, 1$, 16) 
Table 17. An estimate of the number of nursing personnel required to 
meet current (date) and future (date) needs in (State X). 
Place of service 
Number of nursing personnel needed 
Current need (date) Future need (date) 
Professional Non-Pro?. Professional Non-Pro?. 
Total • ••••• 
Public Health • 
Industry • • • • 
Offices 
Private practice. • • • . • 
Hospitals 1/ 
1/ Registered and unregistered or registered only; exclusive of or including 
Federal hospitals 
Sources An estimate of the current deficits of nursing personnel in the State 
is revealed in Table 18 when the number of nursing personnel currently needed 
(Table 1?) is matched with the number of nursing personnel currently employed 
(Table 6)• 
Table 18» An estimate of the current deficits of nursing personnel in 
(State X), (Date) 
Place of 
Service 
Currently 
needed 
Number of nursing personnel 
Currently 
employed 
Current 
deficit 
Prof. Non-prof. Prof. Non-prof. Prof* Non-prof. 
Total 
Public Health • • 
4 
Industry ••••••• 
Offices 
Private practice • 
Hospitals 2/ •••••• 
1/ Currently needed - currently employed a current deficit 
2/ Registered and unregistered or registered only; exclusive of or 
including Federal hospitals. 
Sources The following chart is a condensation of the discussion in SECTION II 
relative to suggested criteria and probable sources for obtaining essential 
information for estimating the number of nursing personnel required to meet 
current and future needs on a State-wide basis. 
Chart 2. Suggested criteria and probable sources for obtaining essential 
information for estimating the number of nursing personnel required 
to meet current and future needs on a State-wide basis* 
Place of 
Service 
Suggested Criteria 
Probable sources of‘essential 
information 
Public Health 
1 public health nurse per 2000 
Most recent copy of '‘Current 
or 5000 population 
1 supervisor for every 10 public 
Population Reports" relative 
to the current population of 
the State* 
health nurses 
State Planning Commission (or 
its counterpart) relative to 
an estimate of the projected 
population of the State as of 
a future date* 
Directors of nursing of the 
public health agencies in the 
State relative to: 
1* overlapping of nursing 
activities 
2# geographical coverage 
3* amount of bedside care given 
!*• demand for care of chroni- 
cally ill patients 
5* use of non-professional 
nursing personnel 
6* vacancies in budgeted 
positions 
Industry 
1 nurse*...up to 300 employees 
State Industrial hygiene 
Personnel*State Chamber of 
2 or more nurses .. up to 600 
Commerce! Manufacturers' 
Association; State Planning 
employees 
3 or more nurses •• up to 1000 
Commission (or its counterpart) 
employees 
relative to: 
1 nurse per each additional 
!• minimum size of an 
1000 employees up to 5000; 
industrial establishment 
and 1 nurse per additional 
to be included in the 
2000 employees* 
category "up to 300 
employees"• 
2. present number of plants 
and employees according to 
size of industrial 
establishment.  
• 
3* extent of medical and health 
programs 
U. accident frequency 
5* number of additional shifts 
6* amount of nursing participation 
in health education and home 
nursing service 
7* utilization of part-time 
nursing services in industrial 
establishments employing less 
than 100 workers 
8* tendency to employ non-profes- 
sional nursing personnel 
9* extent of supervision of nurses 
by nurses 
10. plans for industrial expansion 
11. social and economic trends in 
the State 
12. possible technological advances 
in the major types of industry 
represented. 
Offices 
current need held constant with 
State Nurses1 Association relative 
tEe number of nursing personnel 
to the number of -their members 
currently employed* 
future need dependent upon the 
engaged in office nursing over a 
consecutive number of years. 
consideration of the following 
State Board of Nurse Examiners 
factors in the Statej 
(or appropriate licensing agency) 
relative to the number of non- 
1. inclination to utilize 
professional nursing personnel 
nursing personnel in offices 
2. an appreciable increase or 
employed in offices over a 
consecutive number of years. 
decrease in the number of 
Deans of medical, dental, etc. 
doctors, dentists, etc. 
schools; State Medical, JJental, etc. 
Associations relative to an estimate 
3* trend in group practice. 
ofT“ 
1. an appreciable increase or decrease 
in the number of doctors, dentists, 
etc. (who may be potential employ- 
ers of nursing personnel in 
offices) 
2. trend in group practice iwhich may 
influence the number of nursing 
personnel needed in offices). 77 
Private 
practice 
current and future need held 
constant with the number of 
nursing personnel currently 
employed 
Hospitals 
Nursing personnel in special 
hospital departments (operating 
room, central supply, out-patient 
department, etc.) held constant 
with the number of nursing 
personnel currently employed. 
State Agency Administering the 
hospital Survey and Planning 
Program relative to the antici- 
pated number of hospital beds 
in the following categories: 
1. General and allied special 
2. Tuberculosis 
3* Mental 
Chronic 
State Agency Administering the 
Hospital Survey and Planning 
Program; State Hospital Association 
relative to an estimate of the 
expected occupancy rate as of a 
future date. 
State Nurses* Association; 
State Hospital Association; 
Agency representing prepayment 
hospital plans relative to an 
estimate of the average days 
away from duty each year of 
every member of the nursing 
personnel for vacation, 
holidays, illness, and days 
off each week. 
General and 
allied 
special 
Hospitals 
Central Administrative nursing 
personnel: 
Most recent copy of ’’Hospital 
Service in The United States’* 
'type of administrative Daily 
nursing personnel average 
patient 
census 
(including 
newborn) 
2 central administrative 
staff 100 
1 day supervisor 57 
1 evening supervisor 57 
1 night supervisor 80 
1 head nurse 19 
relative to: 
1. Classification of general 
hospitals in the State 
according to 
a. size of the community 
in -which they are located 
b. those with and without 
schools 
c. ownership or control 
d. average census (includ- 
ing newborn)  
Nursing personnel giving direct 
State Board of Nurse Examiners; 
patient caret 
State Nurses’ Association; State 
3*5 average number of bedside 
hours per patient during 2l| 
hours; the proportion of pro- 
fessional nurses to non-profes- 
sional nursing personnel giving 
this direct care in the ratio - 
2 professional nurses 1 non- 
professional nursing 
personnel 
League of Nursing Education 
relative to an estimate of the: 
1* percent of basic profes- 
sional student nurses 
currently enrolled who are 
giving direct care to 
patients. 
2. percent of basic profes- 
sional student service which 
is as productive as a com- 
bined hour of professional 
and non-professional nurse 
service. 
3. 
percent of basic profes- 
sional student service 
which replaces professional 
nursing service and non- 
professional nursing service* 
Tuberculosis 
Type of Number Ratio of 
patient of professional 
State Administrative Agency 
responsible for the supervlsion 
Hospitals 
activity patients nurses to non- 
of State tuberculosis sanatoria 
per 1 professional 
nurse nursing 
personnel 
infirmary — 3 1j2 
semi-ambulant 8 ls3 
ambulant 30 1:5 
relative to an estimate of the 
number of hospitalized tuber- 
culosis patients in the State 
according to the classification 
of patient activity: 
1. infirmary 
2* semi-ambulant 
3. ambulant Mental 
Hospitals 
1 professional nurse per 
25 patients 
1 non-professional nursing 
personnel per k patients 
State Mental Health Authority 
relative to an estimate of the 
number of patients in mental 
hospitals in the State who 
requires 
or 
1. intensive therapeutic care 
patients requiring intensive 
therapeutic care - 3*5 average 
number of bedside hours per 
patient during 2k hours; the 
proportion of professional 
nurses to non-professional 
nursing personnel giving this 
direct care in the ratio - 
2• cus to dial care• 
2 professional nurses: 1 non- 
professional nursing 
personnel 
patients requiring custodial 
care 
1 professional nurse per 
25 patients 
1 non-professional nursing 
personnel per i* patients 
Chronic 
Hospitals 
average number of bedside 
hours per patient during 2k 
hours; the proportion of pro- 
fessional nurses to non-pro- 
fessional nursing personnel 
giving this direct patient 
care in the ratio 
1 professional nurses £ non- 
professional nursing 
personnel 
V SECTION III. PLANNING TO MEET THE NEEDS FOR NURSING PERSONNEL 
Both quality and quantity must be considered in planning to meet the 
needs for nursing personnel. The present system of nursing education in the 
State first must be examined both quantitatively and qualitatively. For the 
purpose of the present study, it is suggested that this analysis should include: 
1. Nursing education programs for professional nurses 
a* Basic professional 
(Diploma and/or degree programs for undergraduate student nurses) 
b. Advanced professional 
(Programs for graduate nurses leading to a degree* Supplementary- 
work to strengthen inadequate basic programs in nursing is not 
included.) 
2. Training programs for non-professional nursing personnel 
(Approved training programs for non-professional nursing personnel. 
Inservice training programs are not included.) 
An analysis of the existing pattern of nursing education will be evaluated 
to determine its adequacy in meeting present needs and also to guide policies 
regarding adjustments to be made to meet future needs. This evaluation may 
indicate the advisability of reviewing the entire structural plan for higher 
nursing education in the State. 
Consideration should also be given to the coordinated hospital system 
envisaged in the State hospital plan. This design has implications for the 
distribution and location of nursing education facilities. 
Another factor which has an influence on the adequacy of the present 
system of nursing education is the number of nurses presently employed in 
positions for which they lack preparation. It is necessary to ascertain the 
extent of this deficiency so that plans can be made to improve the situation. Experience in nursing as well as educational preparation contributes to effective 
nursing practice. However, in the absence of standards by which to evaluate 
nursing experience, it is suggested that educational qualifications serve as the 
major basis for judgment. The following section will discuss sources and methods 
for obtaining data pertinent to educational qualifications of nursing personnel 
currently employed and suggest tables for compiling the acquired material. 
Educational Qualifications of Nursing Personnel Currently Employed 
The annual census of public health nurses contains information relative 
to the educational qualifications of professional nurses currently employed by 
public health agencies. Table 19 illustrates a method of compiling this 
information. 
Table 19 — Educational qualifications of full time nurses employed by 
public health agencies in (State X), (Date). 
Full time nurses 
Total Supervisors Staff 
dumber Percent dumber Percent dumber Percent 
Educational qualifications 
Total 
Less than high school 
graduation 
High school but no college 
degree 
One or more collegiate 
degree. •••• 
Total 
None .»•.•••• 
Less than one academic 
year 
One or more academic years. • • • • 
General education 
Public Health program of study 
Source: The yearly census of industrial nurses includes information relative 
to general education and post-graduate professional education for registered 
nurses (supervisors and staff) employed full time by industry. Utilization i 
this material involves a recognition of the following factors* 
1. Both general education and post-graduate professional education 
are recorded only for those for whom data are known. 
2. Post-graduate professional education of those for whom data 
are known states that the total nurses are included in one or 
more of the following subdivisions* 
clinical courses 
industrial hygiene courses 
public health program of study. 
Table 20 shows how this material might be compiled. Table 20 — Educational qualifications of full time registered nurses 
employed by industry in (State X), (Date) 
Educational qualifications 
Full time registered nurses 
"Total ~ Staffi" ~~ 
dumber Percent Humber Percent Dumber” yiroent 
General Education 
Total ••••••••<> 
Less than high school 
graduation • ••••••••• 
Higfr school graduation 
only .... 
Some college • • 
One or more academic 
degrees 
Total 
Clinical courses 
less than 1 month • 
more than 1 month but less than 
3 months • 
3 months or more 
Industrial hygiene courses 
without credit 
with credit 
less than 1 full-time 
academic year 
one or mors full-time 
academic years 
Public Health Program of study 
less than 1 full-time 
academic year • •••••••• 
one or more full-time 
academic years* * 
Post-graduate professional education 
Sources The State Board of Nurse Examiners will probably have information 
pertinent to the educational qualifications of instructional personnel in 
approved basic schools of nursing and training programs for non-professional 
nursing personnel. The arrangement of this data in a table will of course 
depend upon the specific categories of educational qualifications for which 
the information was collected. 
Existing data relative to the educational qualifications of graduate 
professional nurses (acquired from the preceding sources) may be considered 
inadequate. If the collection of additional information is contemplated, the 
following questionnaire (designed to be mailed to individual hospitals to 
obtain the educational qualifications of professional and non-professional 
nursing personnel) might be considered as a pattern. 
Questionnaire £s Mailed questionnaire to individual hospitals to 
(Parts 1, 2) obtain a record of the educational qualifications 
of t 
graduate professional nurses currently 
employed 
non-professional nursing personnel 
currently employed. Hospital 
Address 
Professional preparation beyond basic course 
(9) 
One or more 
academic 
years 
1/ Include: a* part time and full time graduate professional nurses 
b. graduate professional nurses on afternoon and night duty as well as those off duty because of 
days off, vacation, or illness* 
2/ Record only the highest level in general education (Columns 3 to 6) for each graduate professional nurse. 
(8) 
Less than 
one academic 
year 
Distribution by educational qualifications 
Record of the educational qualifications of graduate professional 
nurses currently employed 1/ (Date: Month, day, year) 
(7) 
None 
(6) 
One or more 
academic 
degrees 
Questionnaire £ 
Part 1 
a 
0 
•H 
P 
1 
a> 
■d 
o 
a 
C5 
(5) 
Some 
College 
No 
Degree 
(U) 
High 
school 
only 
1(3) 
Less 
than 
ligh 
school 
Number of 
graduate 
professional 
nurses 
(2) 
To: (Name of Group 
sponsoring survey) 
Total 
Director and 
assistant 
director of 
nurses and/or 
nursing school 
Instructors 
Supervisors and 
assistant super- 
visors (charge 
of more than one 
uard unit) 
ftead nursesand 
assistant head 
nurses (charge 
of one ward unit 
only 
Staff nurses 
Position 
(i) Questionnaire- 5> 
Part 2 
To: (Name of group 
sponsoring 
survey) 
Hospital 
Address 
Record of the educational qualifications of non-professional 
nursing personnel currently employed l/ (Date: Month, day, year) 
Number of 
non-prof ess icnal 
nursing personnel 
(2) 
Distribution by Educational Qualification 
Position 
(i) 
Less 
than 
gighth 
grade 
(3) 
Complet- 
ed eighth 
grade 
only 
(h) 
Some 
high 
school 
(5) 
On the 
Job 
train- 
ing 
only 
(7) 
Grad- 
uated 
from 
high 
school 
(6) 
Graduated 
from an 
approved 
school foi 
practical 
nurses 
(8) 
Non-professional 
nursing personnel; 
practical nurses, 
attendants, etc. 
(those who spend 
the major part of 
their time assist- 
ing with nursing 
duties) 
1/ Includes a* part-time and full-time non-professional nursing personnel 
b. non-professional nursing personnel on afternoon and night duty 
as well as those off duty because of days off, vacation or illness. 
2/ Record only the highest level in general education (columns 3-6) for each non- 
professional nursing personnel. If Questionnaire 5 (or a variation) is used. Tables 21 and 22 are 
suggested as guides for assembling the collected information. TO 
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Table 21. Educational qualifications of graduate professional nurses employed by (registered and unregistered or 
registered only) hospitals (exclusive of or including Federal hospitals) in (State X), (Date). 
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Sources Table 22, Educational qualifications of non-professional nursing personnel 
employed by (registered and unregistered or registered only) hospitals 
(exclusive of or including Federal hospitals) in (State X), (date). 
Educational qualifications 
Non-professional nursing personnel 
Number Percent 
General education 
Training 
Total 
Less than eighth grade 
Completed eighth grade only 
Some high school. •••••••••• 
Graduated from high school. • • • • • 
Total 
On-the-job training only • 
Graduated from an approved 
school for practical nurses • • • • 
Sources 
It is highly desirable that the appraisal of the system of nursing educa- 
tion in the Sthte be based on an individual assessment of each program. If such 
a detailed review is not possible, there are certain gross measures applicable 
to the total nursing education system which have qualitative inferences. Con- 
clusions reached through this less refined method will not be sufficient as a 
basis for a thorough revision of the existing pattern of nursing education. If the results of an overall evaluation indicate the necessity of making 
drastic and extensive changes, plans should be made for a comprehensive and 
detailed review of the theory and practice of each program of study. 
The following section emphasizes considerations pertinent to an overall 
gross evaluation of the present system of nursing education. Reference is 
made, however, to published material which will be useful as a guide if a 
detailed review is contemplated. 
Basic Professional Programs (Diploma and/or Degree Programs for Undergraduate 
Student Nurses) 
The State Board of Nurse Examiners is the best source for obtaining data 
relative to the basic professional schools of nursing. If it is expedient to 
compare selected items in basic schools in the State with other States, Facts 
About Nursing 1/ State Accredited Schools of Nursing 2/, and Some Qualitative and 
Quantitative Factors in Nurse Education 3/ should be utilized. The National 
League of Education (1790 Broadway, New York City, N.T.) may have 
material (compiled in recent national studies), which is available for use by 
a State. 
As stated previously, quality is difficult to appraise without an 
individual assessment of each program. However, a gross evaluation based on 
answers to the following questions will give some indication of the effective- 
ness of the basic professional schools in producing the quality of professional 
nurses needed. 
1/ American Nurses1 Association: Facts About Nursing. 1790 Broadway, 
” New York 19, New York. 
2/ National League of Nursing Education, Department of Studies: State 
Accredited Schools of Nursing. National League of Nursing Education, 
New York, 19U6. 
3/ Vreeland, Ellwynne M.s Some Qualitative and Quantitative Factors in Nurse 
~ Ed^9abi°n. Public Health Reports, Vol. 63, No. $2• U. S. Government Printing 
Office, Washington, D.C., 191*8, 1. Are there sufficient opportunities for able potential students from all 
groups to enroll in schools of nursing? 
nWe recommend that nurses everywhere seek to recruit students and 
personnel without regard to sex, marital status, economical back- 
ground, or ethnic, racial, and religious origins. We recommend 
particularly that positive steps be taken by the profession to 
create an atmosphere conducive to attracting carefully selected 
representatives of a true cross-section of the population to 
nursing”.!/ 
2. What percent of the schools are accredited by: 
a* State Board of Nurse Examiners? 
b. National Nursing Accrediting Service? 
3. How many of the schools have been accredited as graduating nurses 
eligible for staff positions in Public Health nursing agencies? 
i*. How many of the collegiate schools providing degree programs for under- 
graduate nurses are recognized by the Association of Collegiate Schools 
of Nursing as beings 
a. Active members? 
b. Associate members? 
,fWe recommend that nursing make one of its first matters of important 
business the long overdue official examination of eveiy school; that 
the list of accredited schools be published and distributed as far as 
possible to every town and city of the United States as an avowed 
substitute (except legally) for the inadequate lists of schools accredited 
by State boards of nurse examiners; that an unequivocal statement be included 
in the published document to the effect that any school not named had failed 
to meet minimum requirements for accreditation or had refused to permit 
examination; that a Nation-wide educational campaign be conducted for the 
purpose of rallying broad public support for accredited schools and for 
subjecting slow moving State boards and non-accredited schools to strong 
social pressure. 
1/ Brown, Esther L.: Nursing For The Future. Russell Sage Foundation, 
” New York, 19US* page 197* wife recommend,further, that provision be made for periodic re-examination 
of all schools listed or others requesting it, as well as for first examina- 
tion of new schools, and for publication and distribution of the revised 
lists.” 1/ 
”Its requirements (Association of Collegiate Schools of Nursing) ... are 
so reasonable, that any school established on a base that educators 
generally consider sound would have little difficulty in securing membership 
”Under such circumstances the task of the future is decisive. It is to 
strengthen further schools that hold or are eligible for membership in the 
Association of Collegiate Schools of Nursing; to reconsider whether schools 
that are unlikely to be able to meet some such reasonable standards within 
the next few years should continue; and to establish new professional schools 
where surveys indicate they are most needed, would receive substantial 
financial support, and would attract sufficiently large student bodies”.2/ 
5* Tlhat percent of the hospitals associated with schools of nursing are approved 
by* 
a* Council on Medical Education and Hospitals fors 
internships? 
residencies? 
both internships and residencies? 
neither internships or residencies? 
b. American College of Surgeons? 
The quality of medical care determined through approval by appropriate 
agencies gives some indication of the opportunities provided in the 
clinical facilities used by the schools which may contribute to breadth 
of nursing knowledge and technical competence* 
How many of the schools are controlled bys 
What proportion of the total student enrollment is ins 
a* Colleges or universities? 
b. Hospitals with a daily average patient census of l£0 or more? 
c. Hospitals with a daily average patient census of less than 150? 
1/ Brown, Esther L.s Nursing For The Future. Bussell Sage Foundation, 
” New York, 19U8, page 116. 
2/ Ibid., page 177 ff* (Writer*s parenthetical insert) 7* What percent of the students have planned experience ins 
a. Nursery school? 
b. Psychiatry? 
c • Tuberculosi s ? 
d. Other communicable disease? 
e. Outpatient department? 
f. Community health? 
8. How many of the students have experience in a: 
a. Large medical center? 
b* Small rural hospital? 
"Nursing schools should be operated as far as possible by colleges 
and large hospitals (with an average daily census of at least 
l£0 patients), which should develop affiliations with other general 
and special hospitals serving contiguous areas (including tuber- 
culosis sanatoria and hospitals for nervous and mental diseases 
and contagious illness) and with public health agencies in both 
rural and urban communities".1/ 
,!In the light of current needs for graduate bedside nurses and 
current opportunities for their education,we recommend that those 
hospital schools here designated as relatively good make concerted 
effort through various types of experimentation to increase their 
vitality and social usefulness and to point the way to an ultimate 
solution of the 'hospital school problem1 ." 2/ 
"We recommend not only that there be expressed conviction that 
provision should be made within the university for the continuing 
undiminished contribution of distinguished hospital schools; but 
that they be given wholehearted assistance in achieving this 
reorganization by the entire nursing profession, medical and 
hospital associations concerned with nursing, university and 
hospital administrator, university faculties, administrators and 
faculties of schools of medicine and public health, foundations, 
and those members of the laity influential in effecting policy and 
influencing public opinion"^/ 
1/ The Commission on Hospital Cares Hospital Care in the United States. 
~ Commonwealth Fund, New York, page 87. 
2/ Brown, Esther L.J Nursing For The Future, Russell Sage Foundation, 
New York, 19U8, page 12?. 
3/ Ibid, p. 132 "To improve hospital service along its three major fronts - 
preventive, diagnostic, therapeutic, all States are now developing 
their 'coordinated hospital system'. Such a plan proposes tying 
all hospitals into a cooperative hook-up, in which there would be 
constant exchange of information, training, consultation service 
and personnel, and in which patients would be referred from one 
hospital to another." 1/ 
9* How many schools are operated by the following types of specialized 
hospitals: 
a* Mental? 
b. Tuberculosis? 
c. Children's? 
”The question ... should be raised of whether the future function 
of these particular hospitals (mental, tuberculosis, children's) 
does not lie entirely in providing affiliation, rather than in 
attempting to operate small schools.” 2/ 
10. Ytoat percent of the schools have a total enrollment of less than 100 
students? 
”The highest percentage of poor and very poor schools are among 
those having an enrollment of less than 100 students”,3/ 
11. What is the average ratio of nurse administrators and instructors to 
students? 
"The average ratio of nurse administrators and instructors to 
students was 1 to 6.£”, h/ 
12. Are. there centralized teaching plans? 
13. Do central schools of nursing exist? 
1/ Federal Security Agency, U.S. Public Health Service, Division of Hospital 
Facilities* Plans of General Hospitals For The Coordinated Hospital System, 
Reprinted from Architectural Record, January 19U8, page 6* 
2/ Brown, Esther L,i Nursing For The Future. Russell Sage Foundation, 
New York, 191*8, page 137 , 
3/ Vreeland, Ellwynne M.s Some Qualitative and Quantitative Factors in Nurse 
Education* Public Health Reports, Vol. 63, No* £2. U* S* Government 
Printing Office, TSashington, D.C*, 19U8, p, 1689* 
h/ Ibid, page 1688. 111* Are the teaching resources of junior colleges utilized? 
’’Especially recommended as transitional steps toward the future 
are the creation of central schools of nursing, and utilization 
of the teaching resources of junior colleges.” 1/ 
15. What percent of the administrative and instructional nursing personnel 
have one or more academic degrees? 
’’General qualifications for faculty positions in schools of 
nursing and related nursing service positions: 
A broad general education equivalent to at least two 
years of general college work. 
Advanced professional study in a college or university of 
good standing with academic recognition in the form of at 
least the bachelor's (preferably the master's) degree to 
include not less than one year of specialized, professional 
preparation in a particular field with adequate related 
experience in this area.” 2/ 
16. What correlations are revealed when State Board examination results over 
a period of time are analyzed in relation to such factors as: 
a. Size of the hospitals in which students receive their major 
clinical experiences? 
b. Size of student enrollment? 
c. Number of clinical services provided each student? 
d. Qualifications of administrative and instructional nursing 
personnel? 
”It is believed that the educational achievement (performance 
in licensure examination) of the graduates of the schools with- 
in a State as determined by the respective State boards of nurse 
examiners is an important criterion in evaluating the educational 
program of a State”. 
17* What is the ratio of diploma to degree students? 
’’Two thirds of the States had in 19kk~h5 less than 1 student in 
lU or no students at all (the case in 7 States) enrolled in pro- 
grams leading to an academic degree. To meet the need for better 
patient care and to provide for better prepared instructors, admin- 
istrators, and leaders in nursing, this ratio is far too small.”!;/ 
1/ Brown, Esther L.s Nursing For The Future, Bussell Sage Foundation, New York, 
19U8, p. 127. 
2/ National League of Nursing Education, Committee on Revision of the Faculty 
Pamphlet: Faculty Positions In Schools of Nursing and How to Prepare For Them 
National League of Nursing Education, 1790 Broadway, N.Y. 19* 19U6, p. 13• 
3/ Vreeland, Ellwynne M. j Some Qualitative and Quantitative Factors in Nurse 
Education, Public Health Reports, Vol. 63, No, 52. U.S. Government Printing 
Office, mshington, D.C,, 19R8. p, I68ii. 
k/ Ibid, p. 1688. Degree programs for undergraduate nurses 
18. What percent of the schools controlled by colleges or universities are: 
a. Independent administrative units? 
b. Separate departments or schools? 
19* Do specific written contracts exist between the college or university 
and the hospitals and agencies providing student experience? 
20. Are qualified members of the administrative and instructional nursing 
personnel given academic status? 
21. What is the basis for the selection of students? 
22. Are degrees in nursing granted on the same basis as other degrees? 
23. Do the curricula meet the requirements ofi 
a. College or university? 
b. Professional practice and State 
registration? 
2k» Does the college or university give recognition to the curriculum of the 
school of nursing on the same basis as other departments or divisions? 
Criterion 
"It is a complete structural and functional unit for the conduct of a 
program of nursing education and is an integral part of a college or 
university.” 
WA clearly defined agreement is in effect between the college or univer- 
sity and the affiliating agencies regarding their responsibilities in 
relation to the school.H 
"The faculty has academic status in accordance with the statutory pro- 
visions for faculty rank in the college or university.” 
‘•Students are selected according to admission requirements by the 
faculty of the school. In addition to general requirements, students 
are selected on the basis of characteristics essential to nursing. 
Students are qualified for matriculation in the college or university 
as candidates for a degree.” 
“The general requirements governing the granting of degrees as established 
by the college or university govern the granting of degrees in nursing." 
"The curriculum meets the requirements of the college or university for 
a baccalaureate or higher degree as well as the requirements for 
professional practice and State registration.” "The instruction, inclusive of class work, laboratory work, and 
clinical experience, which combined make up the content of the 
curriculum, is so related and of such quality as to command recog- 
nition comparable to that given for similar types of instruction in 
other departments or divisions in the college or university." 1/ 
If visits to the individual schools are possible, material contained 
in A Guide For Supervision of State Approved Schools of Nursing 2/ and Survey 
Methods Applied to Schools 6Y Nursing and Hospital Nursing Service 3/ (see 
Survey Methods Relating to the Basic Nursing Curriculum, in a University or 
Collegiate School of Nursing) will suggest pertinent trends of inquiry. 
Advanced Professional Programs (Programs for graduate nurses leading to a degree) 
For the purpose of the present study, it has been suggested that advanced 
professional programs should include those offered to graduate nurses, which 
lead to a degree and prepare them "for positions as administrators, supervisors, 
or teachers in schools of nursing, nursing service, or public health nursing 
agencies, and for public health nursing general staff positions", k/ 
Information pertinent to a gross evaluation of this type of program 
can be compiled from school catalogues and unpublished factual material ob- 
tainable from the colleges or universities offering such courses of study. 
The Association of Collegiate Schools of Nursing (2063 Adalbert Road, 
Cleveland, Ohio) may be able to supply additional information relative to 
the advanced curricula of active or associate members. 
An overview of the advanced professional programs should include the 
following questions: 
1. How many colleges or universities offer advanced professional programs? 
2. How many programs of each type are available? 
l/ Indiana University School of Education, Division of Nursing Education! 
“ Survey Methods Applied to Schools of Nursing and Hospital Nursing Services. 
Indiana University Bookstore, Bloomington, Indiana, 19U8, page U8 ff. 
2/ American Nurses1 Associations A Guide For Supervision of State Approved 
Schools of Nursing, New York, 19ii8, 
3/ Indiana University School of Education, Division of Nursing Education: 
Survey Methods Applied to Schools of Nursing and Hospital Nursing Services. 
Indiana University Bookstore, Bloomington, Indiana, 19i|8. 
h/ Department of Studies, National League of Nursing Education: Graduate 
Nurses Enrolled in Colleges and Universities. American Journal of Vol 
k9i page 181 (March 19U9) 3. THhat is the number of full-time and part-time students enrolled according 
to: 
a. academic level? 
b. type of program? 
c• scholarship status ? 
i*. What percent of the enrolled students are residents of other States? 
"We recommend that appropriate nursing bodies initiate planning on a 
State-wide basis for the distribution of the kinds of schools that are 
designated to meet State needs; and that planning be undertaken on a 
regional and Nation-wide basis for those higher forms of nursing 
education that require fewer units, but consequently greater selectivity 
of resources and location*” 1/ 
“Until such time as the number of students completing basic degree programs 
is vastly increased, attention must obviously be placed upon helping grad- 
uate nurses to obtain the baccalaureate* Simultaneously preparation on 
higher levels must be forwarded as rapidly as possible.” 2/ 
"Through such a study (comprehensive study of advanced curricula) univer- 
sities might be encouraged to cultivate those particular courses for which 
they were best fitted without feeling obliged to continue to offer prepara- 
tion for several kinds of specialization. Almost certainly this explora- 
tion would point to the desirability of setting aside a few centers devoted 
exclusively to the development of truly graduate work. Their faculties 
would be freed from dissipation of time and energy concomitant to helping 
graduate nurses prepare for the bachelor's degree. Instead they would be 
expected to concern -themselves through experimental teaching, research, 
and writing with the further development of content and method for all 
nursing education, and with producing teachers more fully prepared to 
staff university schools."3/ 
If a detailed study of each advanced professional program is to be 
made, suggestions contained in A Guide For The Organization of Collegiate 
Schools of Nursing h/ and Courses in Clinical Nursing For Graduate Nurses 5/ 
will be helpful. 
1/ Brown, Esther L.s Nursing For The Future, Bussell Sage Foundation, 
“ New York, 19U8, page 186. 
2/ Ibid; page 161 
3/ Ibid; page 162 ff. (Writer's parenthetical insert) 
C/ National League of Nursing Educations A Guide For The Organization of 
Collegiate Schools of Nursing. National League of Nursing Education, 
New York, 19^6. 
5>/ National League of Nursing Educations Courses In Clinical Nursing For 
Graduate Nurses. National league of Nursing Education, New lork, Approved Training Programs For Non-Professional Nursing Personnel 
The source of information for obtaining data relative to approved 
training programs for non-professional nursing personnel will depend upon the 
licensure laws of the State. 
”In states with laws for practical nurse licensure, it is expected 
that practical nurses will be prepared in schools of practical 
nursing offering programs of training approved by the state board 
of education and state board of nurse examiners, or other legally 
authorized accrediting agency which approves schools of professional 
nursing in that state**• 
"Until a single, national accrediting body for both professional and 
practical nursing schools is functioning, schools in states where the 
licensing law does not provide for the licensing of practical nurse 
schools are urged to apply for approval to the Committee on Adminis- 
tration of the Accrediting Program of the National League of Nursing 
Education which cooperates with the National Association for Practical 
Nurse Education." 1/ 
The National Association For Practical Nurse Education (6£U Madison Avenue, 
New York City, N.Y.) may be able to supply additional information relative to 
approved programs in the State* 
Answers to the following questions will Influence the conclusions 
reached as a result of a gross evaluation of approved programs of training 
for non-professional nursing personnel* 
1. How many of the programs are conducted by: 
a. boards of management or social agencies? 
b. hospitals? 
c. public vocational schools? 
"The Committee decided unanimously, after long consideration, that 
training should be provided by vocational or adult education units 
of the public school system... ".2/ 
2. How many of the programs are: 
a. less than 12 months? 
b. 12 months or more? 
1/ Joint Committee on Auxiliary Nursing Service:Practical Nurses and 
Auxiliary Workers for the Care of the Sick. American Nurses’ Association, 
New York. 19i*7, page 8. 
2/ Brown, Esther L.: Nursing For The Future. Russell Sage Foundation, 
New York, 191*8, page 10U* 3» What percent of the programs include elementary nursing care for the 
following types of patients: 
a. medical? 
b. surgical? 
c. pediatric? 
d. obstetrical or urological? 
iu How many of the programs provide instruction and supervised practice ins 
a. home nursing? 
b. care of chronic and convalescent patients? 
MIt (Professional Advisory Committee) recommended that the period of 
training be one year, divided between classroom and bedside instruc- 
tion, and that an understanding of the patient as well as nursing 
techniques be emphasized.” l/ 
UA practical nurse is a person trained to care for subacute, conval- 
escent, and chronic patients requiring nursing services at homes 
or in institutions. • 2/ 
5* What educational qualifications are required for trainees? 
,!The principal educational qualifications for trainees should be 
their ability to profit from instruction. However, it is suggested 
that the completion of 2 years of high school, or the equivalent, 
may be expected of applicants under 25 years of age, and the 
completion of the eighth grade, or its equivalent, may be required 
for applicants over 25 years of age." 3/ 
6. What are the general educational qualifications of the administrative and 
instructional personnel? 
"Director 
a good general education, with academic 
recognition of a bachelor's degree in 
nursing education. 
Instructor in nursing;- a good general education; two years or 
Supervisor of more of college are recommended, including 
Clinical Experience courses in principles of learning and 
teaching and related methods.” h/ 
1/ Brown, Esther L.tNursing For The Future.Russell Sage Foundation, 
New York, 19i;8, page lOi*. (Writer's parenthetical insert) 
2/ Federal Security Agency, Office of Education: Practical Nursing - An 
Analysis of the Practical Nurse Occupation with Suggestions for the 
Organization of Training Programs. U. S. Government Printing Office, 
Washington, D.C., page. 1 ff. 
3/ Ibid; page lUl. 
5/ Curriculum and Accrediting Committees, National Association For Practical 
Nurse Education: Practical Nurse Education. National Association For 
Practical Nurse Education, New York, 19h7, page 9. ?• Is there an active interest in practical nursing-? 
"No system of training for practical nurses is likely to succeed 
unless the public that creates broad general policy and provides 
funds, educators who design and operate instructional programs, 
hospitals and agencies that provide clinical facilities, and 
nursing associations and state boards of control that set 
standards and influence recruiting are prepared to manifest an 
active interest in practical nursing far beyond any interest 
yet shown." 1/ 
Material contained in Practical Nursing - An Analysis of the Practical 
Nurse Occupation vd.th Suggestions for the Organization of Training Programs 2/ 
will be useful as a basis for evaluating individual programs* The forthcoming 
publication of the committee appointed by the U* S* Office of Education to 
develop a practical nursing curriculum guide should also be helpful. 
Financial Support For Preparing Nursing Personnel 
It is desirable to have information on the cost of preparing profes- 
sional and non-professional nursing personnel under the present system of 
nursing education in the State. If such data are not available and a study 
of this type is contemplated, reference should be made to Administrative 
Cost Analysis For Nursing Service and Nursing Education 3/ and Cost Analysis 
For Schools of Nursing* k/ 
1/ Brown, Esther L.s Nursing For The Future* Russell Sage Foundation, 
New York, 19U8, page 10f>. 
2/ Federal Security Agency, Office of Education: Practical Nursing - An 
Analysis of the Practical Nurse Occupation with Suggestions for the 
Organization of Training Programs* U, S* Government Printing Office, 
Washington, D. C., 19^7* 
3/ Pfefferkorn, Blanche and Rovetta., Charles: Administrative Cost Analysis 
For Nursing Service and Nursing Education. American Hospital Association 
and National League of Nursing Education, New York, 19h0, 
h/ Federal Security Agency, Public Health Service: Cost Analysis For Schools 
of Nursing, U* S* Government Printing Office, Washington, D*C. The economic aspect of future plans for the education of professional 
nurses and training of non-professional nursing personnel should take cognizance 
of the recommendations pertinent to finances contained in Nursing For The 
Future l/, A Program For The Nursing Profession 2/, and Higher Education For 
American Democracy 3/. 
Computing the Annual Number of Students who must be Enrolled in Basic Schools 
of Nursing and Training Programs for Non-professional Nursing Personnel to Meet 
Estimated Needs. 
It is necessary to compute the number of professional and non-profes- 
sional nursing personnel who should be enrolled each year for a selected period 
of time in order to meet the estimated needs for nursing personnel. The length 
of time selected for this purpose will depend upon the extent of the current 
deficit of nursing personnel and the conclusions reached as a result of the 
evaluation of the present system of nursing education. Computations relative 
to annual enrollments must include the number of nursing personnel required to: 
1, maintain the current pool 
2, make up the current deficit and provide for future needs. 
The future pool of nursing personnel is composed of the number ofs 
1. professional and non-professional nursing personnel 
currently employed (minus the attrition rate). 
2, students currently enrolled in approved basic schools for 
professional nurses and training programs for non-professional 
nursing personnel (minus the withdrawal rate). 
1/ Brown, Esther Luc lies Nursing For The Future. Russell Sage Foundation, 
" New York, 19^8. 
2/ Committee On The Function of Nursing* A Program For The Nursing Profession, 
MacMillan Company, New York, 19U8• 
3/ Report of The President’s Commission on Higher Education* Higher Education 
For American Democracy, U, S, Government Printing Office, Washington, D.C. 
19U7. The attrition rate for active registered nurses has been variously 
estimated from about 6 to 10 percent per annum. In the absence of a comparable 
rate for non-professional nursing personnel it may be necessary to assume the 
same loss per year as that of the professional group. 
The average withdrawal rate for students in approved basic schools of 
nursing and training programs for non-professional nursing personnel can be 
computed by the following steps: 
!• subtract the number of students graduated annually from the 
number of students originally admitted to those classes. 
2* divide the result obtained through step 1 by the number of 
students originally admitted to those classes* 
Example: 
500 number of students admitted to approved schools of nursing 
in State X in 19U5 
350 number of students who graduated from approved schools of 
nursing in State X in (the required period of time for 
approved programs in basic schools of nursing in State X 
is 3 years). 
l50 number of students who withdrew from approved schools of 
nursing in State X, - 19U8. 
150 ♦ 500 - 30% withdrawal rate for the students admitted to approved 
schools of nursing in State X in 19^5* When the •withdrawal rate has been computed, the number of students who can be 
expected to graduate in the future can be estimated by multiplying the number 
of students admitted (currently and in the future) by the complement of the 
withdrawal rate (the resulting percentage when the withdrawal percentage is 
subtracted from 100 percent)* 
Example: 
700 number of students admitted to approved schools of nursing 
in State X in I9I4.7 
X 70$ complement of the 'withdrawal rate (100$ - 30$ (withdrawal 
percentage) = 70$) 
1*90 number of students who can be expected to graduate in 
State X in 195>0 from those admitted to approved schools 
of nursing in 19U7« 
Information relative to the number of students- admitted and graduated from 
approved basic schools of nursing and training programs for non-professional 
nursing personnel can probably be obtained from the State Board of Nurse 
Examiners or the appropriate licensing agency. The following example illustrates how the annual number of students who 
must be enrolled in basic schools of nursing in State X (1950 - 1956) was computed 
in order to meet the estimated need for graduate professional nurses in 1959* 
Example: 
Statement of problem: 
(1) 1950 - 1956 period of time selected in which to meet the 
estimated need for graduate professional nufses in State X 
in 1959. 
(2) 2600 number of graduate professional nurses currently 
employed in State X (19U9) 
(3) Uk00 estimated number of graduate professional nurses 
needed in State X (1959) 
(li) 8$ attrition rate per year for graduate professional nurses 
(5) 30$ average withdrawal rate for students admitted to approved 
basic schools of nursing 
(6) 180 number of professional student nurses who can be expected 
to graduate in 1950 
257 number of students admitted to approved schools 
of nursing in 19U7 
X 70$ complement of the withdrawal rate (100$ - 30$ = 70%) 
180 
190 number of professional student nurses who can be 
expected to graduate in 1951 
2?1 number of students admitted to approved schools 
of nursing in 19i*8 
X_70% complement of the withdrawal rate 
190 
200 number of professional student nurses who can be expected to 
graduate in 1952 
286 number of students admitted to approved schools of 
nursing in 19h9 
X 70$ complement of the withdrawal rate 
200 Solution* 
Attrition Table 
(Based on 8$ attrition rate per year for graduate professional nurses) 
At end of 1 year only 92.0$ will be left (100.0 - 8.0) 
« « H 2 years « 81*.6$ « M " ( 92.0 x 92.0) 
ti it it 3 years « 77.8$ " " « ( 81*.6 x 92.0) 
» " " ij. years M 71.6$ « 11 » ( 77.8 x 92.0) 
« « « 5 years » 65.9$ « u «i ( 71.6 x 92.0) 
« M « 6 years « 60.6$ " 11 M ( 65-9 x 92.0) 
n " "7 years " 55-8$ 11 M " ( 60.6 x 92.0) 
" 11 n 8 years « 51.3$ « 11 " ( 55-8 x 92.0) 
" 11 9 years " 1*7.2$ « « « ( 51.3 x 92.0) 
« 11 ”10 years « 1*3.1*$ 11 H " ( 1*7-2 x 92.0) 
1128 number of graduate professional nurses currently employed who 
will be left at the end of 10 years (1959). 
2600 number of graduate professional nurses currently employed 
x i*3«l*$ refer to attrition table, 10th year 
USB— 
85 number of professional nurses who will be left at the end of 9 years 
(1959) from the number of professional student nurses who can be 
expected to graduate in 1950* 
180 number of professional student nurses who can be expected to 
graduate in 1950. 
x 1*7*2$ refer to attrition table, 9th year 
"55— 
97 number of professional nurses who will be left at the end of 
9 years (1959) from the number of professional student nurses 
who can be expected to graduate in 1951* 
190 number of professional student nurses who can be expected 
to graduate in 1951 • 
x 51*3$ refer to attrition table, 8th year 
97 
112 number of professional nurses who will be left at the end of 
9 years (1959) from the number of professional student nurses 
who can be expected to graduate in 1952. 
200 number of professional student nurses who can be expected 
to graduate in 1952 
x 55*8$ refer to attrition table, 7th year 
nr 
11*22 number of graduate professional nurses available in 1959 from those 
currently employed (19l*9) plus the number remaining from those who 
can be expected to graduate in 1950, 1951* 1952. 
1*1*00 estimated number of graduate professional nurses needed in 1959• 
-11*22 
2978 number of graduate professional nurses to be supplied by 1959 from student 
nurses graduating in 1953 - 1959 'who must be enrolled in 1950 - 1956. n s number of professional student nurses who should be enrolled each 
year 1950 - 1956 
•7n ■ number of professional student nurses who can be expected to graduate 
each year 1953 ~ 1959 (based on 30$ withdrawal rate) 
• ?n (60.6$) refer to attrition table, 6th year ■> number of professional nurses aho 
will be left in 1959 from those who 
can be expected to graduate in 1953 
•7n (65*9$) refer to attrition table, 5th year - number of professional nurses who 
will be left in 1959 from those who 
can be expected to graduate in 195k 
• 7n (71*6$) refer to attrition table, kth year s number of professional nurses who 
will be left in 1959 from those who 
can be expected to graduate in 1955 
•7n (77*8$) refer to attrition table, 3rd year b number of professional nurses who 
will be left in 1959 from those who 
can be expected to graduate in 1956 
*7n (8k*6$) refer to attrition table, 2nd year s number of professional nurses who 
will be left in 1959 from those who 
can be expected to graduate in 1957 
• 7n ( 92$) refer to attrition table, 1st year = number of professional nurses who 
will be left in 1959 from those who 
can be expected to graduate in 1958 
#7n ■ number of professional nurses who 
can be expected to graduate in 1959* 
.7n (.606 / .659 / -716 / .778 / .8U6 / .92 1) = 2978. 
Adding the factors inside the parenthesis produces: 
•7n (5.525) - 2978 
Multiplying »7h times 5*525 produces 
3.8675 n - 2978 
Solving the equation for n 
n = 770 number of students who must be enrolled in basic schools of 
nursing in State X each year 1950 — 1956 to meet the estimated 
need for graduate professional nurses in 1959* Computing the Average Percent of High School Graduates who must be Enrolled in 
Nursing Programs to Produce the dumber of Nursing Personnel Needed~ 
Having estimated the annual number of students who must be enrolled (for 
a selected period of time in the future) in basic schools of nursing and training 
programs for non-professional nursing personnel, it is expedient to estimate the 
number of students who will graduate from high school for the corresponding 
projected period of time, 'When this has been accomplished, it -will be possible 
to determine the approximate percent of high school graduates who must be enrolled 
in undergraduate nursing programs to meet the quota of professional and non- 
professional nursing personnel needed. 
The annual number of high school graduates in the future can be estimated 
by subtracting the number of children who die before they enter school from the 
number of live births 18 years previous to graduation, and multiplying the 
remainder by the average percent (for the latest five year period) of students 
who entered the first grade and completed high school* Since the majority of 
nursing personnel are women, consideration should be given to including females 
only in the computations entailed in the preceding suggested method. 
Examplei 
Statement of problems 
- number of female live births 18 years 
previous to graduation (1932) in State x 
lit, - number of deaths (1932-1937) among female 
preschool children bom in 1932 in State x 
11,918 under 1 year (1933) 
1,14.69 1 year (193U) 
623 2 years (1935) 
1+67 3 years (1936) 
3l+8 it years (1937) 
hl% - average percent of female students entering first 
grade who completed high school during the last 
five years (19iUt - 191+9) in State x* Solution: 
189,1458 
- 114,825 
1714.633 estimated number of female children born 18 years 
previously who entered the first grade in 1938. 
178.633 
X \£% 
82,07bestimated number of female high school graduates 
in State x in 1950* 
Note: The example makes no corrections for migration or the number of deaths 
of preschool female children occurring in the fifth year of life. If 
information relative to these two items is available in the State, they 
should be incorporated into the estimate. 
The State registrar of vital statistics will have information pertinent 
to the number of live births, and deaths of preschool children. The annual 
statistical reports of births 1/ and deaths 2/ published (prior to I9I45) by 
the Bureau of the Census contains information for each State in the form used 
in the preceding example. The State Department of Education is the agency to 
be contacted to ascertain the average percent of students entering the first 
grade who completed high school during the latest five year period. 
The average percent of high school graduates who must be enrolled in 
nursing programs to produce the number of nursing personnel needed, is revealed 
when the total number of students who must be enrolled in nursing programs 
for a selected period of time in the future is divided by the total number of 
high school graduates for a corresponding period of time. 
1/ Bureau of the Census, United States Department of Commerces Annual Report, 
Birth, Still Birth, and Infant Mortality Statistics for the Birth Regis- 
tration Area of the United States, U. S. Government Printing Office, 
Washington, D.C. 
2_/ Bureau of the Census, United States Department of Commerce: Annual Report 
Mortality Statistics. U. S. Government Printing Office, Washington, D.C. Examples 
Statement of problems 
12000 estimated total number of students who must 
be enrolled in nursing programs to meet the need 
for nursing personnel in State x in I960 
8000 students in basic schools of nursing 
U000 students in training programs for non-profes- 
sional nursing personnel 
150,000 estimated total number of high school graduates 
in State x 1950 - I960. 
Solution: 
12,000 = g% average percent of high school graduates who must 
150,000 be enrolled in nursing programs (basic schools of 
nursing and training programs for non-professional 
nursing personnel) to meet the need for nursing 
personnel in State x in I960. 
Summary: SECTION III 
Emphasis in SECTION HI has been placed on the points 
1* evaluating the present system of nursing education in the State 
2. computing the annual number of students who must be enrolled in 
basic schools of nursing and training programs for non-professional 
nursing personnel to meet estimated needs. 
3* computing the average percent of high school graduates who must 
be enrolled in nursing programs to produce the number of nursing 
personnel needed. 
Having considered the preceding factors, the next step is to study the 
available educational and clinical resources in the State not now fully utilized* 
Tifhen these potentials are revealed, a plan should be formulated by which they can 
be woven into integrated systems of education for nursing personnel* Once having 
determined the need for nursing personnel who can care for general and psychiatric 
patients and for patients in urban and rural hospitals, then facilities for this type of preparation should be included in the educational program. Once 
having determined that public health nursing on a staff level is to be expected 
of graduates of degree programs, then facilities for the required field 
experience must be sought* The conclusions of this study should recommend the 
number, capacity, and location of professional programs (basic and advanced) 
and non-professional programs idiich the State should operate to meet estimated 
needs for nursing personnel and to prepare these professional nurses and non- 
professional nursing personnel to function effectively in the light of emerging 
standards. 
The following chart is a condensation of the discussion in SECTION III 
relative to questions, probable sources for obtaining information, and 
references pertinent to an overall gross evaluation of the present system of 
nursing education in a State according to type of program* Chart 3« Questions, probable sources for obtaining information, and references 
pertinent to an overall gross evaluation of the present system of 
nursing education in a State according to type of program* 
Type of 
Program 
Questions relevant to an overall 
gross evaluation of the programs 
Probable sources 
for obtaining 
information 
References 
Basic Professional 
1* Are there sufficient oppor- 
State Board of 
Brown, Esther L® 
tunities for able potential 
Nurse Examiners 
Nursing For The 
(Diploma and/or 
students from all groups to 
Future, Hassell T 
enroll in schools of nursing? 
National League 
Sage Foundation, 
degree programs 
of Nursing 
New York, 1948® 
2® What percent of the schools are 
Education 
for undergraduate 
accredited by: 
The Commission 
on Hospital 
student nurses) 
a* State Board of Nurse 
Publications 
Care: Hospital 
Examiners? 
Care in the 
American Nurses1 
United States® 
b® National Nursing 
Association: 
Commonwealth 
Accrediting Service? 
Facts About 
Fund, New York 
Nursing. 
1947 
3- How many of the schools have 
1790 Broadway, 
been accredited as graduating 
New York 19, 
Federal Security 
nurses eligible for staff 
New York® 
Agency, Public 
positions in Public Health 
Health Service, 
nursing agencies? 
National League 
Division of 
of Nursing Educa- 
Hospital Facil— 
4* How many of the Collegiate 
tion. Department 
itiess Plans 
schools providing degree 
of Studies: State 
of General 
programs for undergraduate 
Accredited Schools 
Hospitals For 
nurses are recognized by the 
of Nursing. 
The Coordinated 
Association of Collegiate 
National League 
Hospital System® 
Schools of Nursing as being: 
of Nursing Educar- 
Reprinted from 
tion. New York, 
Architectural 
a* Active members? 
1946. 
Record, January 
1948. 
- 
b® Associate members? 
Vreeland, Ellwynne 
M.: Some Quail- 
Vreeland, 
5* What percent of the hospitals 
tative and Quan- 
Ellwynne M.t 
associated with schools of 
titative Factors 
Some Qualitative 
nursing are approved by: 
in Nurse Educar- 
and Quantitative 
tion® Public 
Factors in Nurse 
a. Council on Medical 
Health Reports, 
Education® 
Education and Hospitals 
Vol. 63, No. 52 
Public Health 
for: 
U. S. Government 
Reports, Vol® 6; 
internships? 
Printing Office 
No® 52. U. S. 
residences? 
Washington, D#c., 
Government 
both internships and 
1948® 
Printing Office, 
residences? 
Washington, D®C®i 
b® American College of 
1948. 
Surgeons® 6. 
7. 
How many of the schools are 
controlled by: 
What proportion of the total 
student enrollment is in: 
a* Colleges or universities? 
b• Hospitals with a daily 
average patient census 
of 150 or more? 
c. Hospitals with a daily 
average patient census 
of less than,1507 
What percent of the students 
have planned experience in: 
a* Nursery school? 
b« Psychiatry? 
c. Tuberculosis? 
d. Other communicable 
disease? 
e• Out-patient department? 
f. Community health? 
Arestad, F. H., 
£everoos, E. H., 
Albus, W# r#> and 
Corbett, W. W.: 
Hospital Service 
in the United States. 
Council on Medical 
Education and Hospi- 
tals of the American 
Medical Association, 
Chicago, Illinois. 
National League 
of Nursing 
Education, 
Committee on 
Revision of the 
Faculty Pamphlets 
Faculty Positions 
in Schools of 
Nursing and How 
to Prepare For 
Them. National 
League of Nursing 
Education, 1790 
Broadway, N. T., 
19, New York, 
1946. 
Indiana Univer- 
sity School of 
Education, Divi- 
sion of Nursing 
Education: 
Survey Methods 
Applied to School 
of Nursing and 
Hospital Nursing 
Services. 
Indiana Univer- 
sity Bookstore, 
Bloomington, 
Indiana, 1948. 
8. 
How many students have 
experience in a: 
a. 
large medical center? 
b. 
small rural hospital? 
9. 
How many schools are operated 
by the following types of 
specialized hospitals: 
a* 
Mental? 
b. 
Tuberculosis? 
Cm 
Childrens? 
10, 
What percent of the schools have 
a total enrollment of less than 
100 students? 11. 
Miat is the average ratio of 
nurse administrators and in- 
structors to students? 
12. 
Are there centralized teaching 
plans? 
13. 
Do central schools of nursing 
63d st? 
14. 
Are the teaching resources of 
junior colleges utilized? 
15. 
What percent of the adminis- 
trative and instructional 
nursing personnel have one or 
more academic degrees? 
16. 
What correlations are revealed 
-when State Board examination 
results over a period of time 
are analyzed in relation to such 
factors as: 
3ize of the hospital in 
udiich students receive 
their major clinical 
experiences? 
b. 
Size of student enroll- 
ment? 
c. 
Number of clinical services 
provided each student? 
d. 
Qualifications of adminis- 
trative and instructional 
nursing personnel? 
17. 
What is the ratio of diploma to 
degree students? 
Degree oroerams for undergraduate 
nurses: 
18. 
What percent of the schools con- 
trolled by colleges or universi- 
ties are: 
a. 
independent administrative 
units? 
b. 
separate departments or schools? 19# Do specific written contracts 
exist between the college or 
university and the hospitals 
and agencies providing student 
experience? 
20* Are qualified members of the 
administrative and instructional 
nursing personnel given academic 
status? 
21* What is the basis for the selection of 
students? 
22* Are degrees in nursing granted on 
the same basis as other degrees? 
23* Do the curricula meet the require-* 
oft 
a* college or university? 
b* professional practice and 
State registration? 
24» Does the college or university 
give recognition to the curriculum 
of the school of nursing on the 
same basis as other departments 
or divisions? 
Note: If visits to the individual schools are possible and a detailed 
study of each program can be made, the following references will 
suggest pertinent trends of inquiry: 
a« American Nurses1 Association: A Guide For Supervision of 
State Approved Schools of Nursing, New York, 194B* 
b. Indiana University School of Education, revision of Nursing 
education: Survey Methods Applied to -Schools of Nursing 
and Hospital Nursing Services* Indiana University Bookstore, 
Bloomington, Indiana, 1948# Advanced 
1. How many colleges or universities 
School catalogues 
Department of 
Professional 
offer advanced professional 
and unpublished 
Studies, 
National League 
(programs for 
programs? 
factual material 
graduate nurses 
from the colleges 
of Nursing 
leading to a 
2. How many programs of each type 
or universities 
Education* 
degree) 
are available? 
offering advanced 
professional 
Graduate Nurses 
Enrolled in 
3* What is the number of full-time 
and part-time students enrolled 
programs 
Colleges and 
Universities. 
according to: 
Association of 
Collegiate Schools 
American Journal 
of Nursing Vol.hS 
a. academic level? 
b. type of program? 
c. scholarship status? 
4* What percent of the enrolled 
students are residents of 
other States? 
of Nursing 
Page 181 
(March 1949) 
Brown, Esther L», 
Nursing For The 
Future, Russell 
Sage Foundation, 
New York, 1948* 
Note: If visits to the individual schools are possible and a detailed 
study of each program can be made, the following references will 
suggest trends of inquiry: 
a. National League of of Nursing Education: A Guide For the 
Organization of Collegiate Schools of Nursing. National 
League of Nursing Education, New York, 1946. 
• 
b. National League of Nursing Education: Courses In Clinical 
Nursing For Graduate Nurses. National League of Nursing 
Education, New York, 1945* 
Approved 
1. How many of the programs are 
States with laws 
training 
conducted by: 
for uractic&l 
programs for 
non-profes^- 
a. boards of management 
nurse licensure 
* 
sional nursing 
or social agencies? 
State Board of 
Joint Con** 
personnel 
Education, and 
ndttee on 
b. hospitals 7 
State Board of 
Nurse Examiners, 
Auxiliary 
Nursing 
c» public vocational 
or other legally 
Servi ce * Prac t icy 
schools? 
authorized accre- 
diting agency 
Nurses and 
Auxiliary 
2. Row many of the programs are: 
which approves 
schools of 
Workers for 
the Care of 
a. less than 12 months? 
professional * 
nursing 
the Sick. 
American 
b. 12 mohths or more? 
in the State 
Nurses1 
Association, 
New York, 
1947 3. What percent of the programs 
States without laws 
Brown, Esther L.s 
include elementary nursing care 
for practical nurse 
Nursing For The 
for the following types of 
patientss 
a. medical? 
licensure 
Committee on 
Administration 
of the Accredi- 
Future. Russell 
Sage Foundation, 
New York, 19148. 
Federal Security 
b. surgical? 
ting Program of 
the National 
Agency, Office 
of Educations 
c. pediatric? 
d. obstetrical or 
League of Nursing 
Education 
Practical Nuraing- 
An Analysis of 
the Practical 
urological? 
National Association 
For Practical Nurse 
Nurse Occupation 
with Suggestions 
U- How many of the programs pro- 
vide instruction and super- 
vised practice in: 
a. home nursing? 
b. care of chronic and 
convalescent patients? 
Education 
for the Organiza- 
tion of Training 
Programs. 
U. S. Government 
Printing Office, 
Washington, D.C., 
19U7. 
Curriculum and 
5>. What educational qualifications 
are required for trainees? 
Accrediting 
Committees, 
National Associa- 
6. What are the general educational 
qualifications of the adminis- 
trative and instructional 
personnel? 
tion For Practical 
Nurse Educations 
Practical Nurse 
Education. 
National Associa- 
7. Is there an active interest in 
practical nursing? 
tion For Practi- 
cal Nurse 
Education, 
New York, 19147* 
Hotel If visits to the individual schools are possible and a detailed 
study of each program can be made, the following references will 
suggest pertinent trends of inquiryi 
a. Federal Security Agency, Office of Educationi Practical Nursing - 
An Analysis of the Practical Nurse Occupation with Suggestions for 
the Organization of Training Programs* U, S* Government Printing 
Office, Washington, D.C*, 19U7* 
b* Forthcoming publication of the Committee appointed by the 
Office of Education to develop a practical nursing curriculum*