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AUTHOR Foerst, Helen V.; Gareau, Florence E. TITLE Planning for Nu:rsing Needs and Resources. INSTITUTION Public Health Service (DHFW), Washington, D.C. Div. of Nursing. REPORT NO DHEW-Pub-NIH-72-87 PUB DATE Apr 72 NOTE 204p. AVAILABLE FROMSuperintendent of Documents, U.S. Government Printing Office, Washington, D.C. 20402 (Stock Number 1741-0026, $2.00)

EDRS PRICE MF-$0.65 HC-$9.87 DESCRIPTORS *Administrative Organization; Diagrams; *Educational Planning; *Educational Resources; *Manpower Needs; *Nursing; Reference Materials; Reports

ABSTRACT To aid state and local manpower planning for nursing needs and resources, this guide presents basic principles and procedures essential to identifying needs and exanining resources effectively. A wide range of resource and annotated reference lists present survey and study reports, background material, tools for planning, and a guide to statiatical data. The general nature of the planning process, initiation of planning, building and strengthening the organizational structure, and assessing needs are discussed. Developing a plan of action, data collection, and assessing requirements for nursing manpower are covered. Diagrams present five organizational structures for planning. This guide was written by two nursing consultants and their director in manpower evaluation and planning. (AG)

Plann.ing for Nursing Needs and Resources

Division of Nursing

DHEW Publication No. (NIH) 72-87

U. S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE

Public Health Service National Institutes of Health Bureau of Health Manpower Education

Bethesda, Maryland 20014

U.S. DEPARTMENT OF HEALTH, EDUCATION & WELFARE OFFICE OF EDUCATION THIS DOCUMENT HAS BEEN REPRO- DUCED EXACTLY AS RECEIVED FROM THE PERSON OR ORGANIZATION ORIG- INATING IT. POINTS OF VIEW OR OPIN- IONS STATED DO NOT NECESSARILY REPRESENT OFFICIAL OFFICE OF EDU- CATION POSITION OR POLICY. 2 )

This guide to planning for nursing needs and resources has been preparedinthe Manpower Evaluation and Planning Branch of the Division of Nursing byHELEN V. FOERSTandFLORENCE E. GAREAU,Nursing Consultants,principalauthors, and Dr.EUGENE LEVINE,Branch Chid, contributing author.

Issued April 1972 Washington, D.C.

For sale by the Superintendent of Documents, U.S. Government Printing Office, Washington, D.C. 20402 Price $2 Stock Number 1741-0028 % Foreword

This publication is intended to serve as a framework for developing and carrying out planning for nursing in a variety of situations amid changing times. Planning for nursing needs and resources is not new. Since 1945, most States have conducted one or more statewide surveys and numerous studies, in an effort to help provide adequate nursing services and to increase the supply of nurse manpower. As a result, both the quality and quantity of the nurse supply and the educational resources of those States have indeed improved. The nature of surveys and studies of nursing needs and resources has changed significantly from the stereotyped statistical approach of the 1940's and 1950's. Since 1960, the objectives, depth, and scope of the studies have become more diversified. The patterns of initiation, the organizational structure, and the methodology have varied according to locale. These changes reflect growth and development in planning techniques. They also demonstrate response to the constantly changing nature of society and its profound, yet diverse, effects on the Nation's health care system and the nature of nursing. Today, studies of nursing needs and resources are more concerned with the development of programs of action for meeting needs. Much more information on the characteristics of the nurse supply and nursing practice has become available through routine inventories, periodic studies, and research findings. Growth in health facilities and health manpower as well as changes in patterns of patient care have raised concern for the utilization of personnel, staffing, quality of nursing service, and the social and economic needs of nurses. Educational opportunities, career choices for youth, and changing concepts in education have called attention to the evaluation of nursing education resources. Thus, emphasis in planning has shifted from simple factfinding and analysis to compiling and interpreting available data, developing methods for determining nursing needs through special surveys and studies, and-- most importantfinding ways of meeting nursing needs through program innovation. experimentation, and research. For the past 20 years or more, one of the major activities of the Division of Nursing and its predecessor, Division of Nursing Resources, has been that of aiding States and local communities in studying nurse manpower needs and resources. The Division has assisted not only in conducting initial studies but also in reappraising nursing needs and resources in a number of States. In 1949, the U.S. Public Health Service issued a manual entitled Measuring Nursing Resources, to guide State groups in conducting nursing surveys. In 1956, the Public Health Service, through the Division of Nursing Resources, issued Design for Statewide Nursing Surveys, a guide for States conducting initial surveys or reappraisals of nursing needs and resources. Today, another guide iscalledfor because of the urgency for continuous and coordinated planning suited to the vast differences in nurse manpower needs among the various regions, States, and local areas, according to their populations and resources. This new book, Planning lor Nursing Nceds and Resources, prepared in the Division of Nursing, presents basic guidelines and the elements essential to effective planning for nursing. It is not a blueprint. It does not offer a detailed description of a model for planning; no single pattern will answer the needs of all areas. It does, however, present principles and methods of procedure to meet a variety of changing conditions. Although addressed primarily to the conduct of broad, in-depth planning for all fields of nursing service, nursing education, and all types of nursing personnel within designated geographic areas, the basic guidelines can be applied alsoto planning for more limited phases of nursing. This guide was prepared in response to numerous requests for assistance in planning for nursing needs and resources, and to an increasing awareness of the need for such information. State planning groups and those of other jurisdictions with whom Division personnel have been issociated have contributed significantly. Their experiences in planning efforts have provided the background for the formulationand development of these guidelines.

JESSIE M. SCOTT Assistant Surgeon General Director Division of Nursing

iv Contents

Page Foreword hi

List of Figures vi

Introduction vii

Chapter 1. The Nature of Planning 1 Concepts in Planning 3 General Purpose of Planning 4 Objectives of Planning 4 Scope and Patterns of Planning 4 Principles and Requirements of the Planning Process 5 Various Phases of the Planning Process References

Chapter 2. Initiating Planning 9 Recognizing Need for Planning 11 Getting Sanctions and Sponsors 11 Assuring Readiness for Planning 11 Alternatives to Planning 12 References 12

Chapter 3. Organizing for Planning: Building the Organizational Structure 13 Developing Planning Methodology Including Study Outlines 15 Structure of Committees 21 Other Planning Techniques 23 References 29 Chapter 4. Organizing for Planning: Strengthening the Organizational Structure 33 Participants in Planning 35 Funding 38 Timetable 40 Planning Area 40 Public Relations 42 Planning Reports 43 Other Strengthening Factors 44 References 45 Chapter 5. Assessing Needs and Developing the Plan of Action 47 Assessment Phase 49 Tools of Assessment 51 How Assessment Tasks Are Accomplished 52 Developing Recommendations 52 The Plan of Action 53 55 I. Implementing the Plan References 56

LI Page Chapter 6. Faetfinding 59 Providing for Factfinding 61 Determining Data Needed 62 Types of Data and Information Required 62 Sources of Data and Information for Planning 63 Assessing Adequacy of Data and Data-Collection Methods 66 Data Information Systems for Continuous Planning 68 References 68

Chapter 7. Assessing Requirements for Nurse Manpower 71 Concepts in Assessing Manpower Requirements 73 Methods for Measuring and Projecting Demand 74 Methods for Measuring and Projecting Need 74 Selecting a Method 76 Estimating Future Supply 77 Rderences 77 Appendix 1. Survey and Study Reports 83 Appendix 2. Background Material and Tools for Planning 127 Appendix 3. Guide to"Statistical Data 167

Index 1.93

List of Figures

Number Page

1 Organizational structure in which a task force has policy-making responsibili ty 24

2 Organizational structure in which a steering committee has policymaking and executive responsibilities 25

3 Organizational structure in which a single top-level committee or commission has combined advisory and policy-making responsibilities 26

4 Organizational structure in which a council has executive, policy-making, and advisory responsibilities 27 5 Organizational structure for areawide planning and simultaneous planning for sub-areas or regions 28

DISCRIMINATION PROHIBITEDTitle VI of the Civil Rights Act of 1964 states: "No person in the United States shall, on the ground of race, color, or nationalorigin, be excluded from participation in, be denied the benefits of, or he subjected to discrimination under any program or activity receiving Federal financial assistance." Therefore, planning for nursing needs and resources, like every program or activity receiving Federal assistance from the Department of Health, Education, and Welfare, must be operated in compliance with this law. vi Introduction One of the basic assumptions underlying concepts in health planning in the 1970's is that change is evolutionary rather than revolutionary, and as such should be con- tinually anticipated and managed. Thus, health planning seeks to tackle the urgent problems of the day and keep pace with changing health care requirements. It attempts to provide and sustain coordinated health services within the planning area. This approach requires the rational deployment of resources to meet changing conditions. In fact, all health services and educational programs require continuing adaptation, modification, and innovation. The health and nursing requirements of the Nation are determined, for the most part, outside of nursing. But itis within nursing that the means for meeting these requirements must be devised. It is nursing's responsibility to keep its programs abreast of the expanding fields of knowledge. Nursing must provide diversified services and educational programs that reflect the changing needs of patients for care as well as the educational needs of practitioners for rendering patient care. That is why there is a continuous urgency for studying nursing needs and finding practical ways to meet those needs. Constant, searching assessmentis required in many areasincluding supply and distribution of nurse manpower, educationalresources, services, organization,administration, financing, and special problems, as well as the potential of nursing. Equally urgent is the need, after assessment, to carry out the recommendationsto apply the measures and develop the programs and resources recommended. The cooperation of lay, community, and professional organizations is needed in planning for nursing. The wisdom and knowledge they contribute help greatly in developing adequate nursing services,nursing education programs,and personal resources. Planning for nursing also benefits those who participate in the planning. It provides them an opportunity to share in shaping the course of nursing. Their interests and resources are brought to bear to develop goals and strategies for nursing service and nursing education, to set priorities,to allocate and marshal resources toward objectives, and to evaluate accomplishments. Their involvement in the planning process also motivates the participants to influence change and to take action regarding the questions under study and the planning decisions they helped to make. In nursing, change comes slowly. The nursing profession needs to develop a fuller appreciation of the benefits of planning. In many cases, hesitancy to plan stems from the fact that planning involves change and change disturbs the status quo. Other obstacles to planning are varying concepts of the planning process and the lack of a specific pattern that can be applied to all situations and guarantee desired results. The planning task is large and complex. It requires strong leadership and the united efforts of nursing. The essentials of successful planning are: Attention to the basic principles of and requirements for planning. Understanding of the interrelatedness of planning components, participants, and processes. Establishment of a strong organizational structure. With the cooperation of all those involved in health care, nursing can rise to the challenge of developing and implementing new designs for improved nursing care, services, and education.

8 Chapmr 1 The Nature of Planning c.4 Chapter 1 The Nature of Planning

Planning is essentially a deliberate and calculated ning may thus be made more definite. Surveys provide process aimed at achieving goals. Health manpower only for factfinding or a description of the problem. planning has asits purpose the achievement of po- Studies describe and investigate problems and find tentials in manpower and the maintenance of a balance and recommend solutions. Planning embraces all of in recruiting, developing, and utilizing manpower re- the characteristics of surveys and studies and, in addi- sources to meet health care requirements. It is aimed tion, provides for the application of solutions and the also at uniting health workers with other professional, actual resolution of problems. lay, and political leadership in developing and promoting measures to meet health care requirements in Planning for nursing is a process in which overall particular situations and areas. or particular nursing needs are identified and resources Planning for nursing, as described in this guide, are examined. First, the nature and scope of needs and is specifically related to broad social and health goals, resources are defined, related to their influencing fac- and considersall nursing in prescribed geographic tors, and considered as a whole. Then' the means areas as opposed to operational or institutional plan- available for meeting needs and augmenting resources are interposed, and courses of action are developed to ning. Implicit in this planning is the need for effective patterns of nursing education and nursing service that achieve the goals. will ensure the progressive expansion and strengthen- When based on experience, knowledge. study, and ing of health services. Planning for nursing also seeks researchfindings,planning for nursing andother to develop continuing communication and cooperation health manpower can reshape health and educational between the various agencies involved in health and systems to meet present and future manpower chal- nursing service and educational resources. lenges. Planning's greatest value for nursing, as for all For the purpose of this publication, it is advisable otherfields, lies in the opportunity it provides for to distinguish between the terms "surveys," "studies," continuing change, experimentation, and innovation and "planning." The meaning and character of plan- in meeting needs.

Concepts in Planning

Significant concepts to he considered in planning The foundation of planning for nursing education fornursing service, nursing education, and nurse and nursing service is a clear definition of the roles manpower include the following. and functions of nursing personnel. The responsibility for taking theinitiativein Planning should be oriented to meet or exceed the planning for nursing needs and resources rests with generally accepted minimal requirements that may nursing leaders. This includes spearheading and co- already exist for program accreditation, eligibility for ordinating planning at the institutional, local, State, licensure, or staffing of health facilities. Standards for and regional levels. nursing practice and nursing education should be Planning for nursing needs snd resources is a supported or,iflacking or inadequate,should be jointresponsibility of nursing service and nursing developed. education. Both have a common goalto determine Planning for nursing recognizes the interdepend- how the highest quality of patient care and nursing ence of all types of nursing personnel and nursing's practice can be achieved. Each must focus on its own relationships to other health professions and health responsibility and role. manpower.

3 1 4 CHAPTER 1

General Purpose of Planning

The general purpose of planning for nursing is to To develop a program of action to improve the effect areawide, coordinated improvement, expansion, utilization of nursing personnel for meeting qualitative and development in health programs, services, and and quantitative needs for health care. resources.Inaddition, planningwhichisfuture- To plan and initiate a State, regional, or area- orientedshould attempt to ensure adaptation to social wide recruitment program in nursing education, to change as requirements dictate. meet requirements for nursing service. Planning groups may be established for purposes To develop a State plan for nursing education sucix as these: that will identify courses of action and schedules of To develop and implement a long-range plan for activities for expanding and developing programs to meeting the nursing needs of a metropolitan area. meet nursing needs.

Objectives of Planning

Objectives are the subsidiary aims of planning or effectively realizethe purpose of planning inthis the intermediate steps, all directed toward achieving instance, the finding of feasible answers and the de- the general purpose or ultimate goal. They are con- veloping of workable programs to overcome these sistent and closelyinterrelated with theparticular deterrents became the refined objectives of planning. circumstances and prevailing conditions in the plan- Another example, a planning activity whose purpose ning situation. There are initial and refined objectives. was to develop a State plan for nursing education had Initial objectives help the planning group to under- these initial objectives: stand the needs and the factors contribriting to those To determine the number, kinds, and qualifica- needs. They are described in terms of the questions tions of nursing personnel needed for expanding popu- that planning can be expected to answer and the type lationand changing healthservices in the decade of actions it can hope to accomplish. As planning ahead. proceeds, the objectives are refined. They propose in To identify and assess the problems of nursing detail how needs can be met and what measures can education as they relate to nursing service and the be put into effect to accomplish the purpose of plan- continuing education of nurse practitioners. ning. In other words, refined objectives are translated To devise means toeducate the number and into recommendations and become the goals of action. quality of personnel required, whether by establishing For example, the purpose of one planning group new programs or expanding existing ones, public or was to ensure adequate numbers of nursing personnel private. to meet health care requirements. The starting point To formulate a timetable and designate specific was to identify how many nursing personnel were institutions for expansion and appropriate sites for available, how many more were needed, and how they ihe development of new programs. could be obtained. These were clearly and briefly To improve methods of recruiting and educating stated as the initial objectives of the planning group. the most desirable students for nursing in requisite As study progressed, it was found that poor employ- numbers. ment conditions, mobility of p arses, and lack of stu- ; Still other examples of objectives of planning for dent resources in the area were deterrents to acquiring nursing are. contained in the reports referenced in and maintaining an adequate nurse supply. Thus, to appendix 1.

Scope and Patterns of Planning

As a continuous process and a many-sided procedure, organizational structure. The scope of planning de- planning will vary in purpose, subject matter, depth, pends upon whether the planning is to be on a local, time, geographic area, and size and characteristics of State, or regional basis, and whether it is directed to THE NATURE OF PLANNING 5

special concerns of nursing or to the entire field of nursing services, and educational resources of a local nursing. This determination is usually made in relation area, State, or region may be necessary for the wise to the following: allocation of resources or the develoment of a State The dimensions of identified nursing concerns plan for nursing education. Or special studies in con- and problems. junction with a complete reappraisal of nursing needs The extent and recency of previous planning. and resources might best be carried out to determine The availability of information and data identify- the most efficient utilization of nursing personnel. ing all aspects of nursing concerns and problems. No single or common pattern is applicable for all The need for special surveys and studies. planning. Regional, State, and local areas differ in The amount of participation and involvement of their needs,resources, leadership, traditions, social interrelated groups required to develop and carry out values, and readiness for planning. The strategy of projects and programs for meeting needs. planning varies also with the socioeconomic environ- Planning may be primarily concerned with certain ment in which planning takes place. The best approach aspects of nursing, such as the utilization of nursing and formalized organizational structure for planning personnel, nursing education resources, or quantitative are developed in relation to the objectives of the plan- needs. Specific problems, however, need to be viewed ning activity and are tailored to the resources of the in relation to the total situation. For example, a com- planning area. Various organizational structures are plete appraisal or reappraisal of the nurse supply, suggested in chapter 3.

Principles and Requirements of the Planning Process

The planning process is based on certain funda- health associations, health care facilities and services, mental principles and specific requirements that are health and welfare organizations, and agencies or known to be effective. They hold to these general institutions concerned with nursing education. These criteria: Planning cannot be done in isolation; par- relationships lead to a mutual awareness and under- ticipation in planning and involvement in decisions are standing of current nursing issues and concomitant basic to obtaining action; and planning builds im- implications. They pave the way for direct activities plementation intothe process. Planning for nursing with appropriate agencies in required program de- incorporates into the process the following basic prin. velopment. ciples and requirements. Planning must be coordinated with other planning The planning group includes representatives of the programs and groups. Planning for the development entire spectrum of health interests. Maximum use is and improvement of nursing service and nursing edu- made of talents from all units of government, educa- cation will affect and be affected by the activities of tion, business, voluntary groups, organized professions, other planning bodies in the fields of health, education, and lay leadership. Participation of agencies or groups and welfare. To avoid contradictory planning, effective that relate to nursing and have a potential for con- liaison and working relationships must be established tributing to the planning process are necessary for: withState-designated planning agencies and other Objectively identifying and assessing needs. official, nonofficial, or ad hoc planning groupsin- Setting common goals and objectives. cluding areawide, regional,State, or local groups. Coordinating efforts for developing recommenda- Coordination of planning with these groups is essential, tions and adequate programs for meeting needs. particularly in respect to the availability and use of manpower for staffing planned programs and services Influencing action. and for developing coordinated programs for the edu- The planning group establishes liaison with other cation of nurse manpower. Unless goals for nursing organizations to obtain endorsement, solicit support, are interrelated in the network of other planning for and seek cooperation for the project. A broad spectrum health manpower, health facilities, services, and educa- of relationships and liaison needs to be initiated, de- tion, the recommendations may be meaningless and veloped, and maintained with professional societies, plans of action unattainable. Such groups include:

. .41 0 6 CHAPTER 1

Hospital and health facility planning. provide a base for analyzing and assessing the charac- Regional Medical Programs. teristics of nursing and the extent of its needs and Mental health. resources, data are required. The development of data- Mental retardation. collection systems is essential for continuous evaluation, Health manpower planning in fields other than measurement of change, and projection of future needs nursing. and resources. Comprehensive health planning. Planning balances conflicting objectives and secures Vocational and higher education facilities and reasonable consensus among service and educational resources planning. agencies as to means for meeting manpower require- Urban planning. ments. Planning requires,stimulates, and develops Other health-rdated programs in social planning mutual understanding among various agencies regard- as they emerge and are developed. ing their respective roles, responsibilities, and relation- Planning has both short-term and long-range ob- ships to nursing. It fosters readiness to adapt goals and jectives and develops recommendations and courses of interests and adjust program operations to attain ob- action directed toward steady progress in meeting jectives in conformity with needs for nurse manpower needs. Short-term objectives involve urgent needs and and an adequate level of health and nursing care. This those for which immediate action is necessary and requires negotiation, compromise, and accommodation feasible. Long-range objectives are related to overall among the participants in planning. needs toward which action is directed; they encompass Planning is organized to facilitate the implementing the entire field of nursing and its resources. Long- of recommendations in active programs and projects range goals reflect persistent activity toward finding lor meeting objectives. Planning methodologies should new and more effective means for meeting needs, strengthen communications and relationships between adapting to changing requirements, and applying new the broadly representative nursing interests. Involve- knowledge. ment stimulates cooperative arrangements for develop- Planning relates needs and resources to social and ing programs to meet needs. It commits responsible economic trends. Practical and realistic planning re- leadership to find mechanisms for initiating action, and quires an understanding of all the .factors influencing to support and encourage such action. nursing. The demands for and the availability, utiliza- Planning stresses, stimulates, and endorses experi- tion, and development of nursing service, nursing mentation, special studies, and research. Research is education facilities, and nurse manpower resources will needed to test and re-test conceptual models for nursing be affected by the following: service and nursing education and for new understand- Trends in population growth, age composition, ing in the production and use of health manpower. and mobility patterns. Also, research methodology is required for assembling Patterns of commercial and industrial growth. and analyzing data,for designing and developing Employment opportunities. studies, and for translating researchfindings into Family and personal income and financialre- applicable skills. sources. Educational systems,opportunities, and attain- Planning is organized to provide for continuity of ment. planning functions. Mechanisms for a continuing eval- Morbidity trends and needs for health care. uation of progress in implementing recommendations Health care systems and availability of facilities and plans of action should be provided for in planning. and services. In addition, plans require periodic revision in response Resources for financing health care and health to changes in health and educational services or to and educational services. changes in the characteristics and needs of the popula- Shift in content or emphasis of health, education, tion for health and nursing services. and welfare programs. Planning continuallydisseminates information Planning requires the collection of adequate data through mass media to a variety of targets. This pro- and the development ol data-collection systems. To vides maximum understanding, participation, and sup- THE NATURE OF PLANNING port for nursing among cooperating organizations and should be interpreted through personal contacts, pre- individuals as well as among the lay public, for whom sentations before association or group meetings, news- nursing is established. Planning purposes and activities paper articles, and other mass media.

Various Phasesof the Planning Process

The different phases of the planning process are Collecting and analyzing data. interdependent and continuous; they frequently over- Assessing needs and resources. lap in time and are often not discrete. But for the Developing recommendations. purposesofthisguidethesephaseshavebeen separated and are discussed as though a plan is totally Developing the plan of action. developed and then implemented. This is not meant to Implementing the plan of action. convey the idea that planning always takes place in Evaluating and reviewing progress in implementing rigid and sequential steps. Viewed in phases, the plan- and in continuous planning. ning process constitutes the following: Initiating. No one phase of planning is more important than Organizing: building and strengthening the organi- another. Each has significance for bringing about the zational structure. actions needed to solve nursing problems.

References

AMERICAN HOSPITAL ASSOCIATION. 1967. Principles To Guide Development of State- 1968. The Politics of Community Health. Report wide Comprehensive Health Planning and of the Community Action Studies Project. Protocol for Health Care Planning Within By Ralph W. Conant. Washington: Public a State. Leaflet No. S 46. Chicago: The Affairs Press. 136 pp. (See "Conclusions," Association. 7 pp. pp. 97-105, for definition and essential in- gredients of community health planning.) HILLEBOE, HERMAN E., and SCHAEFER, MORRIS. 1968. "Evaluation in Community Health: Relating NATIONAL LEAGUE FOR NURSING. Results to Goals." Bulletin of the New 1967. Change, Collaboration, Community Involve- York Academy of Medicine, 44 (2) :140- ment. A synthesis of views on nursing as 158 (February). seenby the Committee on Perspectives. New York: The League. 12 pp. NATIONAL COMMISSION ON COMMUNITY HEALTH SERVICES. NEW YORK ACADEMY OF MEDICINE. 1967. Action-PlanningforCommunityHealth 1968. "Planning for Community Health Services: Services. Report of the Community Action Perspectives for Action." Bulletin of the Studies Project, pp. 17-29. Washington: New York Academy of Medicine (special Public Affairs Press. issue), 44 (2) : 83-219 (February). Chapter 2 Initiating Planning

1. 6 andleadership Istntere lead JERSEY ofIlealth NEW te Com Task force ofStamissionerGovernor's request of of Health tocreation Secretary ofHealth Nursing. of Depmeartnt on Dkvision toNursing, nursine. tostudy

GEORGIA GRANT FROM GOVERNOR'S GEORGIA EDUCATIONAL EMERGENCY IMPROVEMENTFUND ro COUNCIL. VIRGINIA - Governorappointed Committee accordance on Nursing with recitgiterommendations in l Education of Study . on OUTH 14A197.4 STATE - OARD WITH OF NURSING NURSES' IN COOPERATION ASSOCIATION... ILLINOIS NURSES ASSOCIATION AND LEAGUE U FOR PPERMIDWEST NURSING Minnesota NURSING . Nurses STUDY Association - - .

INITIATORS OF PLANNING FOR NURSING NEEDS AND RESOURCES

10 Chapter 2 Initiating Planning

Initiation of planning for nursing is not an auto- they deliverall lead to planning. But various indi- matic response to a recognized need. Concerns for the vidual and group contacts and interactions are required supply of nurses, needs and demands for nurses, their to cement shared concerns and to bring about a com- educational preparation, and the quality of services mitment to initiate planning.

Recognizing Need for Planning

The need for planning may first be recognized when programs. Another example, numerous requests to a concerns for nursing are highlighted by individuals, department of higher education to establish additional agencies, and organizations that contribute to and are nursing education programs may provide the stimulus affected by the nurse supply. For example, planning for planning for nursing. Or it can be associated with may be initiated in response to a hospital association's or be an integral part of the development of a master concern about an increasing number of vacancies on hospital nursing staffs, or a health department's recog- plan for higher education. Frequently, the need for nition ofthe unavailability of nursing servicesin planning for nursing is recognized and recommended specific areas, or the need for various health agencies by all these groups, and planning is initiated because to provide and ensure nursing services for emerging of a series of associated events.

Getting Sanctions and Sponsors

Sanction, sponsors, participants, and means for con- mitted sponsors and the establishment of a core com- ducting planning must be actively sought. This respon- mittee to initiate planning. sibility is often referred to, accepted by, or assumed Or a single organization or agency may spearhead by a committee of a State nurses' association, a State or sponsor planning and actively seek co-sponsors. league for nursing, or both. Or the State board of When concerns related to official government and its nursing or other nursing agencies may be initially departments or agencies are highlighted, the backing involved. Sometimes an ad hoc committee of varied and support of official groups are sought. Promotional nursing interest groups is established to solicit support activities often result in the appointment of a planning for planning. body or commission by an official agency or branch of government. The primary promoters of planningwhoever they Sponsors and co-sponsors work tofzether to organize aremay call a meeting with representatives from for planning, to get it financed, and i ') see it through. community,health,education,andsocialwelfare They may work as a core committee or a steering agencies, to stimulate interest in planning, interpret committee. This group is often designated later as the the need for planning, and explore possible ways to executive committee of the fully organized planning initiate planning. These meetings often result in com- activity.

Assuring Readiness for Planning

Readiness to plan is a primary factor in the success evaluate. But it is usually that point in time when the or failure of planning. It is difficult to describe and varied interest groups that need to be brought together

11 12 CHAPTER 2 for planning can he joined into a cohesive organization approve the planning by actionof their governing to work for a common purpose. Sponsors can build up boards. a readiness for planning by interpreting the need Relationships between interest groups and in- widely and persuading leaders in political, health, edu- fluential leaders are such that they arewilling to cational, and other professional fields to become in- communicate and cooperate with one another to find volved. They begin to formally organize when the need and apply solutions for meeting nursing needs and for planning is recognizedgauged by having com- improving health services. manded the attention of such a wide base of interest Groups and individuals are interested and com- groups to the point that they want to participate. mitted to the task. Readiness coincides with the development of support and cooperation in various forms. Responsibility is accepted for securing financial In other words, planning is ready to begin when: and other types of support and that support is forth- Major health agencies and professional groups coming.

Alternatives to Planning

When readiness for planning is not evident, surveys needs. Survey findings and their implications can be or studies of nursing needs and resources should be presented to other community groups and organizations considered as alternatives to planning. Although sur- as a means of achieving a better understanding of veys and studies are limited activities in terms of needs. their potential for attaining areawide nursing goals, A study may be conducted to thoroughly investigate they can develop awareness of the needs of nursing a problem area and discover the particular means for and also help develop readiness for planning. meeting a need. Interpretation of study findings and recommendations can help win support, and can in- A data survey and analysis can identify nursing fluence action toward meeting specified nursing needs.

References

ADULT EDUCATION ASSOCIATION OF THE U.S.A. Pat Malone. Atlanta: The Council. 1955. "Community Apathy" and "From Ideas to GOVERNOR'S COMMITTEE ON NURSING. COMMON- Action." Taking Actioninthe Com- WEALTH OF VIRGINIA. munity. Leadership Pamphlet No. 3, pp. 1969.Nursing in Virginia. Final Report, p. 1. 22-31. Washington: The Association. Richmond: The Committee. BROWN, RAY E. NATIONAL COMMISSIONON COMMUNITY HEALTH 1968. "Problems of tl'az Planning Process." Bul- SERVICES. letin of the New York Academy of Medicine, 1967. Action-PlanninglorCommunityHealth 94 (2) : 107-111 (February). Services. Report of the Community Action GEORGIA EDUCATIONAL IMPROVEMENT COUNCIL. Studies Project, pp. 12, 13, 20-23, and 58. 1969. Nursing Education in Georgia, p. 3. By Washington: Public Affairs Press. Chapter 3 Organizing for Planning: Buildingthe Orgmizational Structure PLANNING ACTIVITY CHECKLIST

Seek common 111 Assemble and purposes and analyze data. objectives. ElAssess needs CI Identify issues and resources. and concerns. ElDevelop 0 Identify data recommendations. and information needs and sources. ElOutline programs and courses 0 Determine of action. organizational structure. ElCoordinate efforts. 1:

0 Select ElTake action participants. ElReview and LI Hire or obtain evaluate progress staff. in meeting needs.

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14 ' Chapter 3 Organizing for Planning: Building the Organizational Structure

Because of the many facets to organizing and the techniques, such as panels, workshops, and hearings. iznportance of describing them in detail, the discussion Chapter 4on strengthening the organizational struc- of this phase of planning has been divided into two turedeals with staff, other participants to be involved, chapters. The present chapteron building the or- funding, public relations, and other means for ensuring ganizational structuredeals with the first stepsin a sound organization. formally organizing for planning. It explains how to The methodology and structural organization to be determine planning objectives and the scope of plan- used in each case are determined largely in relation to ning, and describes planning methodology including the objectives of planning. They must be tailored to study outlines, and various organizational structures the unique economic, social, and political realities of of committees and councils.Italso mentions other the area.

Developing Planning Methodology including Study Outlines

First, a stage of reflective and collective thinking by planning mechanism adapted to area conditions and the group organizing the planning is essential. During needs, one must: the "thinking phase" the group crystallizes the purpose Assess planning experience and readiness for and objectives of planning and decides who is to be planning. involved. They also determine what procedures to use Outline the perimeters of nursing concerns and for studying, analyzing, and acting on findings. As required actions and set the objectives of planning. this work proceeds, it is best to write out insa detailed Pinpoint the data and information needs and work plan the methodology that has been developed. availability. Determine what special studies or surveys may be Work Plan required. Consider and understandtheso-called power The work plan gives direction in structuring of plan- structure in the planning area. ning and later guides its operation. It provides for a Decide what tasks must be undertaken to assess step-by-step determination of: (1) the best approach needs and resources and to reach planning objectives; to planning; (2) the scope of the activity; and (3) decide what procedures are feasible and possible for the relative emphasis to be placed on the separate the assessment phase, such as committee structure. phases of factfinding, study, and program develop- Identify leaders and select participants for func- ment. Suitable committee structure and membership, tional tasks. staff requirements, and budgetary needs are detailed. Determine staff requirements. Determine the geographic planning area. Framework for Organizing Set a tentative timetable. The development of planning methodology can be Estimate budgetary requirements. fit into a broad framework from which precise methods This point must be stressed: The organizational and procedures to be used for a particular planning structure and operation as developed should serve as activity can be determined. To design and create a (1) a channel of communication, (2) a negotiation

15 16 CHAPTER 3 forum, (3) a means of setting common goals to meet horizontally, as shown on the following page, can be needs, and (4) a springboard for leadership in in- helpful. fluencing and stimulating action and developing appro- It is helpful to identify and list,in the form of priate programs to meet needs. questions or simple, clear statements, areas that need study. The focus should be on major problems related Approach to the purpose of planning. Related information and data needs should be pinpointed. The aggregate knowl- Early in the organization process, it is necessary to review and explore current and past surveys, studies, edge of the group should be drawn upon to identify and planning activities for the particular area, thus data sources and indicate where special studies or helping to develop an appropriate approach to plan- surveys may well be required. ning. Such a review can give initial clues to the area's The completed outline should be thoroughly screened status, experience, and readiness for planning. It can to determine those areas that merit study and to ex- clude those that are not essential. Some items, although also help identify groups and individuals who recognize interesting, may not be strictly relevant to the purpose responsibility and assume kadership in planning. And it can reveal strengths and weaknesses in planning and objectives of planning. They should be deleted methodologies as well as initialindications of the because every additional item not actually required adds to planning tasks, makes planning more cumber- scope of required planning activities.This review should assess: some and time-consuming, and increases the work of data and information collection, analysis, and report- The general appreciation and acceptance of planning. ing. Also, irrelevant items obstruct primary concerns. When the pressing problems, factors, and situations The organizational forms used for previous plan- ing and the effects on attaining objectives. requiring examination have been isolated, they should The development and aggregate experience of be grouped into subject categories. Each category is a major area for study. At this time, study areas should individuals and agencies in planning for healthservices, facilities, manpower, and educational resources. also be scaled and given priorities as to their significance as short-term or long-range goals. A pattern The accomplishments in implementing the recom- should develop that will indicate major and minor mendationsof previous surveys and appraisals of nursing needs and resources and special studies. objectives. The recency and relevancy of such surveys and The completed study outline provides a basis for studies. determining planning procedures and the course to be The recommendations of surveys or studies still followed. The number and kinds of study areas identi- relevant but not yet attained. fied influence the techniques to be used, such as public hearings and panels; the number and kinds of com- The scope and sponsorship of current activities in ad hoc or continuous planning for nursing. mittees to be established; and the selection of par- The trend data, special study data, and back- ticipants and committee members. Normally, public ground information available through completed and hearings, panels, or technical committees are developed ongoing surveys and studies. around each of the principal subject areas identified. The planning techniques, data requirements, and needs for special surveys and studies will, in turn, influence Determining Scope and Objectives Through staff and budgetary requirements. Use of Study Outlines Three examples of study outlines follow. These ex- To determine the scope and content of planning,a ampks are not complete outlines; each example details study outiine should be set up, including headings to only one item that could be a nursing concern of a detail:(1)nursing concerns andproblems to be planning group. In a complete study outline, however, studied; (2) influencing factors that warrant study; all items of nursing concern should be presented. As (3) data and information needed;(4) existing and items are added, there will necessarily be some duplica- possible sources of data; and (5) special surveysor tionin data requirements, influencing factors, and studies required. Work sheets with headings arranged areas to be assessed.

ty EXAMPLE OF A WORK SHEET Nursing concern or study area: a,C44,,ti y 614(...caiZe-n.a- Sources of data Special surveys or studies ete-a71/2. C..-1. 7?..-,-74v.., iVz. IV _0/.1..4_ L. FAO_ v, 14.27 ____ . 16fe't6;7 . 2il,-1,-.d (a) , 18 CHAPTER 3

STUDY OUTLINE 1

Nursing concern or study area: Quantity and Quality of Educational Resources for Nursing

Influencing factors: Changing patterns of education of youth. Changing patterns of nursing education. American Nurses' Association position on nursing education. Current supply and availability of qualified teachers, Suitable clinical facilities for student experiences. Costs to students of entering and completing programs.

Information needs and areas to be assessed: Number of schools of nursing, by: (a) type of program (b) location (c) control. Number of admissions, enrollments, and graduations, by: (a) type of program (b) location (c) controL Withdrawal rates from schools, by: (a) type of program (b) reasons for withdrawal. Capacity of schools of nursing; plans for or obstacles to expansion; plans for transition. Performance on State Board examinations of graduates from schools. Size of recruitment pool; recruitment programs; and abilities of potential recruits. Cost of programs to educational institutions. Cost of programs to students. Amount and types of financial aid available for students, and amount used. Clinical practice facilities for student experience; by number, kind, type and location, availability and use. Characteristics, educational attainment, and experience of faculty in schools of nursing. Higher educational system, existing institutions, by type, location, and planned expansion and development. Sources of data: For data on schools, programs, admissions, enrollments, graduations, tuition, fees, admission requirements: American Nurses' Association's Facts About Nursing. National League for Nursing's State-Approved Schools of NursingRN. Also State.Ap- proved Schools of NursingLPN/LYN. State Board of Nursing. For data on faculty, clinical experience facilities, withdrawa Is: State Board of Nursing. For data on higher education system: State Department of Education directory, reports, and master plan.

Special surveys or studies required: Survey questionnaire for: applicar.t experience; capacity of schools; cost data from institutions and students. ORGANIZING: BUILDING ORGANVATIONAL STRUCTURE 19

STUDY OUTLINE 2

Nursing concern or study area: Improved Utilization of Nursing Personnel in Hospitals

Influencing factors: Shortages of health personnel. New roles or ncw workcrs; e.g., nurse clinician, physician's assistant. Changing patterns of health care and increased specialization. Assumption by registered nurses of functions formerly performed by doctors. Delegation of registered nursc functions laterally to licensed practical nurses and aides. Substitution for nurses by auxiliary and allied health personnel, as: operating room technicians; inhalation therapists;in- travenous technicians; dietary aides; pharmacy aides. Organization and administration of nursing service units and other services. Organization and administration of hospitals and health services affecting utilization. Patient welfare. Hospital costs. Lit igation.

Information needs and areas to be assessed: Review of existing patterns of utilization, and determinationby committees of appropriate roles and functions of each level of nursing personnel in the hospital. Appropriate roles of allied health personnel and relationshipto nursing. Effectiveness of patient care and nursing services. Job descriptions, standards, and staffing patterns. Assigned roles and functions of nursing personnel, by type ofpersonnel and level of position. Number and use of auxiliary and allied health personnel and the effect onutilization of nurses. Extent of use of ward clerks, ward secretaries, unit managers, messengers,et cetera. Number and types of specialized units: (1) intensive care units; (2) recovery rooms; (3) coronary care units; (4) extended care units; (5) minimal care units; (6) other units. Extent of use of team nursing. Impact of automation and other technological developments. Use of unit drugs.. Central service units for supplies, maintenance, diets. Usc of disposable items.

Sources of data: Ongoing and previous stmly data on sources of nursing care per patient per day, utilization, patient classification. Established ratios for staffing. Nurse Practice Act. Characteristics of nursing service personnel from personnel folders and hospital records or hospital association data and studies: education, training, age, sex, turnover, tenure, full-time, part-time, salaries, fringe benefits, et cetera. Hospital committee reports and other reports: tissue committec, infections committee, incident and accident reports, reports by patients. Functions, Standards and Qualifications, published by American Nurses' Association for various positions and fields. Use these to compare with the existing situation.

Special surveys or studies required: Utilization studies of nursing personnel and staffing patterns in a sample of hospitals. Pilot study or special research project. 20 CHAPTER 3

STUDY OUTLINE 3

Nursing concern or study area: Need for Qualified Nursing Personnel for Extended Care Facilities

Influencing factors:

Growth in extended care facilities. Increased population in older age groups. Influence of Medicare and Medicaid.

Information needs and areas to be assessed: Nurse supply data for professional and technical nursing personnel and assistants to nurses in all fields, to include extended care facilities; by type of employing agency and geographic distribution. Staffing patterns and coverage in extended care facilities: Characteristics of current supply of nursing personnel. Budgeted vacancies. Projected needs for additional personnel. Number of facilities and beds and State certification and classification of extended care facilities. Employment incentives: Salaries and fringe benefits; training and educational needs.

Sources of data: For data on nurse manpower supply: State Board of Nursing; State Health Department; American Nurses' Association's Facts About Nursing; Division of Nursing's Health Manpower Source Book: Section 2, Nursing Personnel, Public Health Service Publication No. 263; Division of Nursing's Nurses in Public Health, Public Health Service Publication No. 785. For data on facilities: State Health Department. For data on planned facility expansion: State Health Department.

Special surveys or studies required: Structured interview or questionnaire to obtain data or gaps in information concerning: (1) budgeted vacancies; (2) projected needs for additional personnel; (3) educational preparation and background of aides; (4) needs for additional training; (5) other employment and career incentives. ORGANIZING: BUILDING ORGANIZATIONAL STRUCTURE 21

Structure of Committees

Committees provide the medium for effective plan- The Policy-Making Committee ning. They are created for specific purposes and are The policy-making committee is responsible for the given definite assignments relative to the objectives of the planning activity. Whatever the objectives, com- total planning activity and makes the ultimate decisions. mittees are basically organized for advisory, policy- The membership of this group is chosen to include: (1) representatives of the sponsors of planning; (2) making, executive, and technical functions. Various individuals responsible for establishing broad health combinations of these functions are often assigned to a policy; and (3) administrators of total programs in single committee. Committees may be established on an ad hoc or a permanent basis. Fundamentally, their health, education, or related fields. The members of this committee, by virtue of their positions, can later composition and responsibilities are as described below. implement and coordinate those plans that are developed. The policy-making committee has the follow- The Advisory Committee ing functions: Setthe purposes ofthestudy and planning The advisory committee ensures that planning is activity. developed and carried out to accomplish its basic ob- Approve policies and organizational structure. jectives. Members are chosen to provide a broad back- Delegate authorityforcarrying out planning ground of knowledge, attitudes, and experience. They tasks. usuallyrepresent health, education, nursing, labor, industry, and other vital community interests. They Exercise general supervision over planning tasks also represent geographic areas and social groups. The and advise on crucial questions inherent in planning. advisory committee usually exists only to advise and Promote public relations and liaison as required does not make policy. Its functions are to: throughout the study and later in implementing recom- Provide overall advice and guidance in the plan- mendations. ning activity and its development. Seek means for funding and supporting planning Review and evaluate ongoing planning and op- activities. erating functionsinrelationto theobjectivesof Approve all findings, recommendations, and pro- planning. posals for operational activities or action program for Assist in setting the purposes of planning and in meeting needs and resources. pinpointing the objectives. Urge, stimulate, support, and facilitate the imple- Promote public relations and liaison for carrying menting of recommendations in action programs. out planning and later implementing recommendations Periodically evaluate the effectiveness of action into action programs. and operational programs. Promote communication, collaboration, cooperation, and coordination among representative groups The Executive Committee related to and involved in meeting nursing needs and The executive committeeisresponsibleforthe resources. general operation and coordination of the planning Contribute to the understanding and interpreta- activity. It may be the original core committee desig- tion of findings and the assessment of needs and re- nated to initiate and organize planning, or it may be sources, to reflect the total spectrum of health and appointed when the core committee goes out of ex- nursing interests and resources. istence. Members include persons drawn from the Advise on the objectivity, soundness, and feasi- sponsoring and cooperating agencies and leaders in bility of proposed recommendations and programs of nursing, medicine, health, education, and civic fields. action. The chairman of each technical committee is usually Advise on setting priorities for action programs included. Executive committee members often serve on and their relative importance in meeting immediate all upper echelon committees. The executive committee and long-range goals. has these functions: 22 CHAPTER 3

Pinpoint and detail the objectives of the study the particular area of assessment and to effect involve- and planning activity. ment later in terms of implementation. Activated at Develop the structure, methodology, and work the same time or at different times, technical commit- plan for carrying out the planning activity. tees are either ad hoc or standing. Subcommittees are Develop the functions of all committees and sub- often utilized for particular tasksthat contribute to committees. overall analysis and review. Specifically, technical committees have these functions: Appoint or recommend for appointment members and chairmen of advisory, policy-making, and technical Examine and review trends, the present situation, committees. and conditions in their specific area of study. Provide general operational direction and super- Assess all resources in their area of study and the vision over planning tasks, as follows: adequacy of resources; also identify gaps and needs. (1)Facilitate the work of committees by: Determine the criteria and standards in use and (a) Receivingregularreportsfrom required for meeting needs in their area of study. committees. Assess and project current and future quantitative (b)Consideringandadvisingupon and qualitative requirements. problems encountered by commit- Identify obstacles to be overcome in meeting tees. needs, and suggest ways and means to overcome them. (c)Coordinating and reconciling inter- Formulate initial recommendations for meeting committee problems and activities. quantitative and qualitative needs for review and ap- (2) Receive,correlate,andreconciledata, proval by upper echelon committees, as directed. projections,and recommendations from Specify courses of action to be taken to implement technical or ad hoc committees. the recommendations. (3)Recognize gaps in study and planning activities and make provision for filling the Make concrete proposals for initiating action pro- gaps. grams. (4) Formulate for consideration of the ad- Outline relevant information not available -for visory and/or policy-making committees: which investigation may be necessary. (a) Issues requiring general policy con- Identify areas needing research for long-range sideration and advisement. planning. (b) Drafts of recommendations. Prepare an analytic report on their special area (c) Proposed plans of action. of study, including findings, supporting data and in- (5) Oversee the preparation and distribution formation, recommendations, and courses of action of reports of the study findings, recommen- proposed. dations, and plans for action. Stimu!ate and support the implementation of ac- Special Committees tion programs for meeting needs and resources. Specialcommitteesorsubcommittees appointed Technical Committees for administrative tasks and executive functions are worthy of mention. Their vital assignments are con- The major or central task in planning is usually cerned with finance, publicity, publications and edit- delegated to technical committees. These committees ing, the recruiting of staff, and the seeking out and one or severalexamine and analyze specific segments nominating of participants in planning. Such arrange- of the critical questions under study to which they are ments ensureessentialadministrative support, and assigned, develop recommendations, and propose plans provide for more adequate efforts in these spheres of of action. The focus of such committee appointments endeavor. and assignments may be by employment fields, by areas of demonstrated need, by resources, or by other designated areas that support the attainment of overall Committee Designations study objectives. The membership of technical com- Committees' names may not literally designate their mittees is chosen to reflect the expertise required for functions or echelon of organization. The term "task ORGANIZING: BUILDING ORGANIZATIONAL STRUCTURE 23 force" may be used for the policy-making body for instance, the advisory committee counsels on what one planning group; for another such group "task recommendations are feasible but does not have au- forces" may be the technical committees. (See figures thority to approve them. Recommendations are finally 1 and 2.) A "steering committee" may be established approved by the top-level committee having policy. as an ad hoc body to initiate planning and organize mak;ng and executive functions. Such arrangements the activity. Other "steering committees" may have estdolish the planning mechanism that best fits a plan- executive functions or policy-making functions or be ning area'sleadership resources and yet considers established for coordinating the work of several tech- incumbent positions for influencing action. nical committees. In planning for small geographic or sparsely popu- lated areas, the combining of advisory, policy-making, and executive functions into one top-level committee Variations in Committee Structure (often called a council) provides effective administra- As mentioned, committees may beorganizedin tion, cooperation, and participation for pknning. (See various patterns and with various combinations of figure 4.) When it is possible to hire a large technical functions to facilitate planning. For example, the com- or professional staff, skilled and experienced in specific mittee structure of one planning group may provide areas under study, technical committees may not be for: a single top-level committee having combined necessary. Their functions are then vested in tech- advisory and policy.making functions; an executive nical staff and the advisory committee. Since involve- committee; and three technical committees: (See figure ment is more limited, this organizational form tends 3.)In this instance, the top-level committee advises to be more suitable for conducting surveys and studies and also has the right of ultimate decision. The final than for overall planning. (A comparison of surveys, approval of all recommendations would rest with this studies, and planning is found on page 3.) body. Another example, the .committee structure of a An example of an organizational structure for area- planning group may provide for: an advisory com- wide planning and planning for sub.areas or regions mittee;atop-level committee having bothpolicy. simultaneously is shown in figure 5. making and executive functions; and two -technical Variouspatternsin which committees may be committees with subcommittees or ad hoc committees structured have been shown in figures 1 to 5. Other in special areas of interest. (See figure 2.) In that equally effective patterns are possible.

Other Planning Techniques

Various other techniques are used to complement findingsandrecommendationsoncriticalissues committee activities and to examine and appraise sig- emerge. nificant areas that need study. Hearings Panels Some planning groups conduct hearings to solicit Panels are usually designed to stimulate as much wide participation and broad support in analyzing open discussion as possible. Experts on selected panel questions under study, determining needs, and develop- subjects are asked to present their varying points of ing recommendations. Public hearingsareusually view on basic issues. In addition, technical staff may scheduled indifferent locationsinthe geographic prepare statistical data and a bibliography pertaining planning area. Attendance may be open or restricted to the subject. Panel discussions may extend over a by invitation; the agenda may be prescribed or es . 1- or 2-day period. The information presented is often sentially unstructured except for the introduction of summarized and circulated to panel participants for broad topics. From the comments, advice, and criticism further comment and criticism, and then to members of citizens, of the business community, and of public of the planning group for further study and comment. agencies, valuable insights and direction are obtained. From consideration of panel work, data collected and Public reaction thus guides decision.making and the analyzed, and deliberations in committee sessions, the development of realistic plans of action. 24 CHAPTER 3

to4, Attlitt&_.

,NN;774

Figure 11.Organizational structure in which a task force has policy-making responsibility.

31 ORGANIZING: BUILDING ORGANIZATIONAL STRUCTURE 25

SPONSORING ORGANIZATION(S)

STAFF 1111.01mm STEERING COMMITTEE

Figure 2.Organizational structure in which a steering committee has policy-making and executive responsibilities. 26 CHAPTER 3

RESOURCE PERSONS PANELS PROJECT DIRECTOR WORKSHOPS AND OTHER STAIT HEARINGS

Figure 3.Organizational structure in which a single top-level committee or commission hascombinecicd- visory and policy-making responsibilities.

?3 ORGANIZING: BUILDING ORGANIZATIONAL STRUCTURE 27

L.alatv CO-SPONSORS, SUCH AS STATE MEDICAL SOCIETY, STATE NURSES' ASSOCIATION, STATE LEAGUE FOR NURSING, STATE HOSPITAL ASSOCIATION, STATE BOARD OF NURSING, STATE NURSING HOME ASSOCIATION, STATE HEALTH DEPARTMENT, AND STATE BOARD OF HIGHER EDUCATION

THE COUNCIL (REPRESENTATIVES OF CO-SPONSORS)

1;4,1

Figure 4.Organizational structure in which a council has executive, policy-making, and advisory responsibilities. 28 CHAPTER 3

SPONSORING ORGANIZATION(S)

CORE COMMITTEE

EXECUTIVE COMMITTEE

, ADVISORY COMMITTEE

SURVEY DIRECTOR

TECHNICAL OR STANDING COMMITTEES

COMMITTEES FOR REGIONAL PLANNING

Figure 5.Organizational structure for areawide planning and simultaneous planning for sub-areas or regions. ORGANIZING: BUILDING ORGANIZATIONAL STRUCTURE 29

Workshops The greatest values of the workshop are these: the insights gained on the issues and concerns under dis- The workshop is another effective procedure for cussion that assist in making decisions and recommen. planning. This metho3 can be used during different dations;the changesinattitudes on thepart of phases of planning to bring together interested parties participants; and the encouragement afforded par- to work on particular tasks with the assistance of a ticipantstoacceptresponsibilityfor implementing staff of experts. For example, workshops have been some of the ideas growing out of the workshop ex- heid to: explore specific problems in nursing service, perience. such as the utilization of nursing personnel; develop recommendations and set priorities for action; develop Consultants and Resource Persons guidelines for action in implementing specific recommendations. Planning groups make various arrangements for the use of consultants and resource persons to supplement Standard workshop techniques are used for planning their aggregat: talents and capabilities. Frequently with: (I) large, general group sessions for presenta- staff or committees may require consultation services tions by special authorities and for sharing the prod- from professionals or specialists not represented in the ucts of work groups; (2) small work groups organized total planning group. For example, consultants in around the common interest of a number of partici- statistics, research methodology, business administra. pants for a cooperative attack on some aspect of the tion, or the social sciences may be required in de. overall workshop theme; and (3) social activities and veloping planning processess, work techniques, and interchange to encourage thinking together in formal procedures or special studies. Also, committees find and informal situations. that resource persons or experts from the various Workshop attendance depends upon the theme and health, education, and social welfare fields are helpful the number of people who should be assembled for in obtaining additional insight in clarifying issues and mutual consideration of the overall theme and related implications of trends. Or specialists may contribute to subtopics. As attendance and the number of work understanding in particular areas under study where groups increase, more pre.planning is required. In a precise data, information, or experience are lacking. 2- or 3-day retreat, ideas can be exchanged, new ideas Consultation may be arranged with resources in the generated, problems explored under skillful leadership, planning area such as universities, departments of and consensus reached concerning steps that need to State government, private practitioners, and profes- be taken to solve particular problems. Intensive work sional associations. Or formal arrangements with a on the solution of problems, however, requires longer regional, State, or national level agency may be in periods of time. order.

References

ADULT EDUCATION ASSOCIATION OF THE U.S.A. ANDERSON, BETTY JANE. 1956. Conducting Workshops andinstitutes. 1970. "Orderly Transfer of Procedural Responsi- Leadership Pamphlet No. 9. Washington: bilities from Medical to Nursing Practice." The Association. 48 pp. Nursing Clinics of North America, 5 (2) : 311.319 (June). 1957. Better Boards and Committees. Leader- ship Pamphlet ,No. 14, pp. 21.48. Wash- BARTOW, JOSEPHINE A. ington: The Association. 1965. "What Is a Leader?" Adult Leadership, 13 AMERICAN NURSES' ASSOCIATION. (8) :245.246, 264-265 (February). 1965. Educational Preparation for Nurse Prac- titionersandAssistantstoNurses: A DAVIS, R. C. W. Position Paper. New York: The Associa- 1966. "How To Prepare a Press Release."Adult tion. 16 pp. Leadership, 15 (6): 209-210 (December). 30 CHAPTER 3

GESSNER, QUENTIN H. MAYHEW, LEWIS B. 1969. "Planning Educational Conferences." Adult 1969. Long Range Planning for Higher Educa- Leadership, 18 (2) : 45-46, 65-66 (June). tion. Washington: The Academy for Edu- cational Development, Inc. 221 pp. GOODELL, FRANK C. 1969. "A Program Planning Checklist forthe MICO, PAUL R. Meeting Planner." Adult Leadership, 18 1965. "Community Self-Study: Is There a Method (6) : 180 (December). to the Madness?" Adult Leadership, 13 (9) : 288-292 (March). HAMPTON, LEONARD A. SARGENT, EDWARD H., JR. 1967."Democratic Leadership: A Philosophical 1966, "Ground Rules for Group Process."Adult Approach." Adult Leadership, 16 (3) : Leadership, 15 (4) :122 and 145 (Octo- 95-98 (September). ber). LIPPITT, GORDON L. VERI, CLIVE C. 1968. "Multiple Roles of the Meeting Planner." 1968. "How To Write a Proposal and Get It Adult Leadership, 17 (4) : 158-160, 187-189 Funded." Adult Leadership,16(9) : (October). 318-20, 343 (March). i

ORGANIZING: BUILDING ORGANIZATIONAL STRUCTURE 31 Planning techniques Pattern of Technique participation Use High degree of To administer and Committees participation operate the among members planning activity for pooling of ideas and knowledge in and assess needs order to arrive at and resources in group decisions. specified areas.

Participation withTo contribute under- Consultants and staff, committees, standing, insight, & resource persons in panels, knowledge in areas workshops, or where data, infor- other capacity mation or exper-

as required. ience is lacking.

Hearings To solicit public reaction for Citizen guiding decision- participation making and to obtain public support . 41 Systematic Lectures, To inform public, presentation of lay, and films, knowledge professional slides followed by groups of need question-andfor, purposes of, answer period and activities

for clarification . of planning.

Panels Stimulating open d iscussion, To analyze and soliciting different assess critical points of view, issues by selected participants . and stimulating

analysis.

Workshops To explore and Full participation investigate of large groups special problems through small and issues with clusters of experts and participants . stimulate action and leadership on part of participants . Chapter 4 Organizing for Planning:Strengthening the Organizational Structure I (0) cv, Chapter 4 Organizing for Planning: Strengthening the Organizational Structure

The success of planning depends primarily on the the magnitude of the planning problem; (5) clearly strength of the organizational structure; that is, on: defined roles,functions, and responsibilities of par- (1) the participants chosen for the planning group; ticipants and staff to allow for teamwork; and (6) the (2) the staff who guides planning activities; (3) ade- use of mass media tointerpret and publicize the quate support; (4) a geographic base appropriate to activities and findings of the planning group.

Participants in Planning

There is no specific pattern for the composition of Selecting Participants a planning group nor an exact formula for selecting Persons to serve in specific capacities and on par- consultants, and resource committee members, staff, committees for planning should be carefully persons. The main consideration is that persons who selected.ticular. For example, to effect change in nursing can be helpful in attaining the objectives should be service administration, persons in hospital administra- involved. Also representatives of major opposing in- tion should be selected. To identify educational trends terest groups should be included even though they, and philosophies and help design a plan for nursing through position or influence, could impede progress education, educators can help. To obtain funds and in planning. Only by including such opposition can modify and develop legislative programs, legislators differences regarding theconcerns of planning be should be selected. resolved. Broad guidelinesoften proposedfor organizing Members of the planning group should have knowl- committees and advisory groups and selecting mem- edge in the areas under study, skills related to plan- bers specify that:(1)allparticipants be officially ning processes, and talents in planning procedures. appointed by the planning body; (2) membership be The mix of members should include: requested and confirmed in writing; (3) official rep- Representatives of agencies and groups who have resentatives of organizations be nominated by the a major interest in nursing and in the specific problem organizations concerned; and (4) the size of commit- under study. tees be restricted. The number of members considered Leaders in health, education, and related fields reasonable for technical and executive committees is who have comprehensive knowledge of services, pro- from five to 10, with a maximum of 12; for policy- grams, and requirements. making and advisory committees, 15 to 30. Experience Persons who are in positions to influence actions has shown that as the size of the committees increases, and who can work for change in administration, serv- group effectiveness decreases. The scheduling of meet- ices, programs, or legislation, as may be required. ings becomes more difficult and discussion more com- Persons who can contribute considerable insight, plicated. judgment, and creativity to assessing needs and providing the means for meeting those needs. Persons who can interpret planning purposes, Potential Participants in Planning findings, and recommendations, and disseminate such The following list may be helpful in deciding upon information to the community. the representation or mix needed:

35 36 CHAPTER 3

Health profession organizations: Minority groups. Nursing organizations: Citizens at large. State nurses' association. Organizations and projects for coordinated health, State league for nursing. welfare, social planning, and related programs: State board of nursing. Areawide planning councils. Occupational health nurse groups. Regional Medical Programs. Practical nurses' association. Hospital planning councils. School nurses' associatinn. Special health, education, and community action OtherStateorganizationsforprofessional, programs spnnsored under Office of Economic technical, and other nursing personnel. Opportunity and Area Redevelopment. Medical society. Housing and Urban Development (HUD). Dental society. Metropolitan area planning councils. Official State agencies: Representatives chosen by health discipline, service Agency administering planning, construction, and field, or type of health and educational facilities: licensing of hospitals and nursing homes. Director of nursing service. Comprehensive health planning agency. Director of school of nursing. Department of education (vocational, secondary, Director of inservice education or continuing edu- and higher education). cation program. State health department. Inactive nurse. State department or office of rehabilitation. Counselor. State department of mental healthor mental Representatives of fields of nursing, such as hos- health planning council or agency. pital,nursinghome,publichealth, mental State legislature. health,occupationalhealth,schoolhealth, State department of welfare. private duty, physician's office, nursing educa- State department of labor. tion, clinical specialty, and research. Other health, welfare, and social organizations: Physician. Hospital association. Anesthetist. Mental health association. Representative of general education. Cancer Society. Social scientist or psychologist. Heart association. Social worker. Tuberculosis and respiratory disease association. Other allied health workers. Red Cross. Representatives of other special study groups on Health insurance agencies. health services or health manpower. Health careers council. Civic groups: Staff To Administer Planning Activities Rotary, Lions, Kiwanis, and similar clubs. Urban kagues. The importance of an adequate and skilled staff to Health councils. administer and guide planning activities cannot be Councils of social agencies. overestimated. Usually, the staff consists of a project Veterans' groups and auxiliaries. director, professional or technical assistants, clerks, Federated women's clubs. and typists. The size and requirements of the staff Parentteacher associations. depend, of course, upon the depth and scope of plan- Women's medical auxiliaries. ning, and vary during the different phases of planning. General community groups: Industry (management and labor). Staffing Patterns Farm groups or bureau. The demanding work of coordinating the various Press, radio, and television. planning tasks and directing and supporting committee Religious institutions and auxiliary groups. activities requires, as the minimum, a full-time project Leading influential citizens who represent con- director and a secretary. For most areawide planning sumers of health and nursing services. as, for example, statewide and metropolitan area

h 9 'I- I..) ORGANIZING: STRENGTHENING ORGANIZATIONAL STRUCTURE 37 planningan assistant project director,research as- director have a background in research and experience sociate, or administrative assistant is also employed. in conducting surveys, studies, and planning. If multiple committees are appointed, part-time staff A question frequently asked is whether the project assistants are usually provided. They are responsible director should be a nurse. Often a person having for administering the work of single committees, and experience insocial research methods in a related render technical assistance to the committee chairmen health and welfare field is chosen. In such cases, the and members. During peak workloads, as when sur- ft non-nurse"project director should be given the op- veys or special studies are conducted and reports are portunity toacquire background knowledge about prepared, additional typing and clerical assistanceis nursing and tounderstand fullyall aspects of the often needed. proposed planning activity. In addition, guidance from The staff may include also personnel of cooperating nursing should be made readily available to the project organizations and agencies, and consultants and re- director in interpreting nursing matters and drawing source persons as required. implications for nursing from data collected. All personnel, regardless of the particular staffing Duties and Responsibilities of Project Director arrangements, should have written employment con- and Staff tracts. The project director is charged with the overall management of planning, and is most often directly Sources of Staff responsible to the executive committee and the chair- Staff members are usually recruited from withinthe man of the planning body. The duties and responsibili- planning area. Nurses, nursing organizations, sponsors, ties of this crucial position, whether totally assumed and participating agencies often know and can recom- by one individual or partially delegated to associates mend qualified persons for staff positions. This type of and assistants, include the following: recruitingthrough personal and agency contacts Prepare, in cooperation with the executive com- is most often successful. mittee, the work plan for conducting the planning Cooperating agencies may contribute the full-or activity. part-time services of professional or technical staff for Obtain and provide data and information re- various tasks. A wide range of competencies is found quired as a basis for assessing needs and resources among staff members of university faculties, health and developing plans of action. departments, other departments of State government, Direct andsuperviseofficemanagement and health and welfare agencies and councils, other plan- planning staff. ning bodies, and health and professional associations. Guide, counsel, and assist in coordinating the These agencies often lend staff members to serve as activities of standing,technical, and ad hoc com- full-time project directors or as technical assistants, mittees. consultants, and resource persons. They can make Prepare minutes of committee meetings; also re- sizable contributions in collecting and analyzing nurs- ports of surveys, studies, findings, recommendations, ing information and supporting data and in conducting and publications on planning activities. special studies. En addition, they can help to establish Follow through on the suggestions and recom- identity and provide a stable base for continuing mendations of the planning body for conducting the planning activities. study as so delegated. Perform assignments related to continuous plan- Qualifications of Project Director ning and the implementing of action programs to The project director should have executive ability, meet needs. administrative skill, ability to work with groups and Tbe assumption of these functionsisnecessarily committees, knowledge of community resources and influenced by the point in time of hire of the project needs, and experience in community organization. It is director and other staff. Often the project director is desirablealthough less importantthat the project hired after the work plan has already been developed. 38 CHAPTER 4

Funding

Every planning group faces the problem of securing convincing promotional tool. It can be prepared from funds for its project, and most of the financing has to the work plan for the project. Designed to arouse be found within the planning area itself. The ability interest and win support, the prospectus concisely: of planning groups to attract capital depends largely 2 Explains the purpose of the project. on the soundness of the endeavor. Planning projects Portrays the situation to which planning isdi- must compete with other investment needs within the rected. area and with those of potential donors. Justifies the need. Various sources can be tapped to support health Anticipates the expected potential and outcome planning, surveys, studies, and research that cannot of the activity. be financed adequately under existingpublic and Outlines the budget to show how funds will be private health programs. utilized. Suggests amounts and methods of contributing Where To Look for Funds fun ds. Sometimesfunds are obtained through a project Funding for planning activities for nursing needs grant from public or private sources, in which case and resources may come from many private and public itis necessary to prepare a project proposal. Such sources and various combinations of these sources. proposals must be more detailed than a prospectus, and Financial support emanates from and through those should include, in addition, a description of: represen- interested in or intrinsically involved in the planning tation and cooperating agencies; scope of project; activity, such as: duration of activity and a timetable; organizational Professional associations. structure; plan of operation; and methods of evaluat- Voluntary health agencies and associations. ing the accomplishment of project goals. Government agencies and departments in health, The lack of funds need not retard planning or limit education, and related fields at all levels of functioning. the scope. Planning activities can be carried out with Statelegislativeappropriations from general, little cash expenditure if individual participants and emergency, or special funds. agencies represented will contribute staff, materials, or Project, contract, and grant funds under Federal other needed resources. In such a case, financial re- and State legislative programs. sponsibilityforvariousactivitiesoftheplanning Industrial,business, and labor establishments, projectiscooperativelyarranged and guaranteed groups, and organizations. accordingly. Private citizens. In projects that are substantially funded, cooperative Private foundations. arrangements are often made between participating agencies for the loan of not only staff and equipment Fund-Raising Activities but also office and meeting space, and statistical data processing,orothersupportingservices.Business Raising funds is a challenging task. All representa- groups and others also contribute services, thus lower- tives of the planning group can assist in creating ing the total cost of planning. sponsor interest. However, it is often wise to designate responsibility for fund-raising to a single committee whose members are experienced and skilled in obtain- Cost of Planning ingfinancialsupport.Fund-raising activitiesalso The cost of planning will depend upon the scope of publicize the planning and win interest and support. the activity, its organization, and local economic con- All economic possibilitiesof the area should be ditions. A budget should be drawn up, showing esti- explored and the development of promotional materials mated expenses. It should detail all activities for which and methods for fund-raising should be considered. financial or other assistance is required. Experienced planning groups report that personal Major items include: contacts are most significant in soliciting support. A Staff salaries, full or part time as required, for: prospectus is also a good information medium and a Project director. ORGANIZING: STRENGTHENING ORGANIZATIONAL STRUCTURE 39

Assistant director or research associate. health department. The staff was employed full time. Administrative assistant. Salaries: Secretary, clerks, and typists. Project Director $12,000 Travel and per diem for: Secretary 3,600 Project director and other staff within planning Office rent 1,200 Supplies and equipment 1,100 area. Travel of director 1,500 Committee members to attend meetings. Printing of reports 900 Data processing of: Total $20,300 Inventories. Special studies. Another example, the budget for a 2-year planning Mimeographing and duplicating of: activity in a metropolitan area that did not require Minutes of meetings. travel of committee members was $63,373. Expendi- Special reports. tures were as follows: Background data and informational materials. First Y ear Second Y ear Supplies and equipment: Salary of project dircctor $11,000 $11,650 Stationery. Salary of secretary 5,500 5,750 Office equipment. Fringe benefits 1,320 1,730 Stamps and postage. Travel for consultants and resource persons 500 500 Operating expenses: Office space and utilities 1,500 1,500 Office space. Supplies and office equipment rental 5,353 1,770 Telephone. Rental of meeting spare 1,000 1,000 Meeting rooms. Postage 450 650 Telephone 400 400 Production and publication of reports: Data tabulation and analysis 3,000 0 Writer and/or editor. Editorial expenses 0 2,000 Printing. Publication costs 0 4,500 Public information materials. Special publication and promotional costs 1,000 1,000 Consultation services. Cash expenditures for statewide planning for nurs- Total $31,023 $32,350 ing conducted in recent years have varied widely. For A third example: For a 2-year planning project that projects requiring 2 to 21/2 years to complete the study included six special studies, the total cost was $95,442. phase and develop recommendations, cash expenditure Most data-processing was contributed by cooperating vn nged from $10,000to$96,000, averaging over agencies. In the second year, technical committees had $50,000. These studies had a variety of contributions part-time staff members. Extra statistical and clerical in kind and no common pattern of funding. If the staff was required for processing the special studies. contributions had been given a cash value, costs might All travel expenses of committee members were paid have reached $160,000. from project funds. Office and meeting space was The costs of planning rise, of course, with the num- donated. Expenditures included: ber of special studies or research conducted, staff requirements, and the patterns of travel and support First Y earSecond Y ear provided for committee members. Salary and fthige benefits $17,416 $38,780 Supplies 4,773 4,094 Utilities 280 296 Examples of Budgets Telephone 500 862 For the first 2 years of an in-depth statewide plan- Travel of committee members, consultants, and resource persons 689 4,794 ning activity in a western agricultural State, yearly Posta ge 1,915 1,485 cash expenditures averaged $20,000. Travel expenses Data-processing and tabulation 0 8,386 of committee members to monthly meetings were paid Writing and editorial expenses 0 6,076 by the agencies they represented. Tabulation of special Publication of reports 0 6,096 studies was contributed by the State university and Total $25,573 $70,869 40 CHAPTER 4

Timetable

The length of time needed for planning will vary in staff, services, and participants. Although there may different situations and with the scope of thc planning. be overlap in the timing and sequence of the phases Considerable time isoften required just to develop of planning as described in this guide, the aveiage recognition of the need, assure readiness, and gain time required for some designated tasks is as follows: support for planning. That phase may take months or Months a year or more. Thc average time required to formally Formal!y organizing 3 organize, carry out an in-depth assessment, and de- Collecting and analyzing available data 6 velop a plan is 2 years. However, with adequate staff, Assessing needs and resources; preparing the capability to gather and analyze data quickly, and recommendations and committee repork 12 the ready commitment of time by all participants, the Writing the summary report 3 time span can he reduced. But even in ideal situations, As planning proceeds, the timetable may have to 1 year is considered a minimum amount of time. be modified. For example, special surveys and studies Preparation of a timetable for planning ises- may be needed. many of which require 1 or 2 years sential. A schedule that correlates the timing, order, for completion, thus prolonging the assessment phase and sequence of planning tasks helps to assure that of planning. It must be borne in mind, however, that planning is progressing. The time requirements of each when the assessment phase of planning does extend phase of planning will affect the budget, the relevance beyond several years, the motivation and interest of of data, and the ability to make commitments for the participants tend to dissipate..

Planning Area

The current trend is to establish the boundaries of nating nursing areas in the same pattern. In most a planning arca on the basis of a geographic area States,regions for tho delivery of servicesor for within which planning concerns can be defined, solu- planning already exist for: (1) the State Health De- tionsfound, and programs developedfor meeting partment; (2) mental health and mental retardation; needs. The geographic planning area is economically, (3) hospital and medical facilities (Hill-Burton) ;(4) socially,and functionally cohesive.Itspoliticalor trade and economics; and (5)State Department of jurisdictional boundaries do not ignore patterns in the Education school districts. The professional organiza- use of health, education, and other social services. Nor tions for registered nurses have districts for program do geographic boundaries ignore existing relationships purposes. Areawide and State Comprehensive Health among health and educational institutions. Planning agencies have designated planning areas. The planning area may be large or small,geo- Regional Medical Program planning ineas disregard raphically. It may encompass a metropolitan area,a State boundaries and are designated in terms of the State, several States, parts of a State, parts of several existing and anticipated geographic needs for health States, a county, several counties, or one ormore local services and the usage of these services. Metropolitan communities. The given area is often referred to as a area planning and service areas may cover parts of community or regionwithin which community or several counties and States that are essentially and regional planning takes place. economically dependent. A planning area can best be defined by reviewing the ftmctional relationships that exist within a given area.Mannin,: areas for nursing arc necessarily re- Statewide Planning latedtob..iltli and educational service areas. And A State is a logical study area because of significant health service areas usually follow traditional trading political considerations. Our social organization is, in a rea pa tterns. many respects, functionally structured in State units. The patterns of geographic coverage already es- The implementing of programs often require3 policy- tablished by health, education. and welfare agencies making and achievement of political actionat the may ic 'wed to determine the feasibility of desig- State level. ORGANIZING: STRENGTHENING ORGANIZATIONAL STRUCTURE 41

Public educational programs and health services are amenable to resolution on an interregional or areawide organized in statewide systems. Licensing codes are basis. enacted at the State level. State boards of education, Some examples whereinterstateandintrastate heahh, and nursing establish certification procedures regional planning is beneficial for cooperative arrange- and enforce minimum standards of practice. Profes- ments in meeting nursing needs and providing re- sionalassociations tend to organize programs and sources for education and service are: services in State constituencies. The services of volun- Development of highly specialized nursing services tary and private agencies generally conform to State associated with scientific and medical advances and patterns. diagnosis and treatment services in specialized fields Areas withina State, however, havedissimilar not feasible for all areas. characteristics and particular problems that require Continuing education programs drawing on the solutions tailored to the needs, resources, and aspira- resources of more than one State or region. tions of each locality. Yet, as different as rural and Educational resources for developing leadership urban areas may be, they have dependent relationships. Therefore, it is often advisable to organize the personnel. planning effort for coherent statewide planning that Research and demonstration projects for more considers regional nceds. Simultaneous statewide and effective distribution and utilization of all types of intrastate regional planning also properly integrates nursing personnel. and balances issues and problems that require statewide solutions and those that must be resolved on a Local Area Planning local or regional basis. Ultimately, the implementing of recommendations Increasingly,planning for nursing isbeing or- and the initiating of actions that assure adequate nurse ganized and conducted for regions of a State and for manpower, educational facilities, and resources take the State as a whole. The development of nursing place at a local level. Local areas must identify factors education resources in junior and senior colleges, for operating in theit own setting that influence the supply example, requires coherent statewide and regional of, demand for, and utilization of nursing personnel. planning. This calls for an organized planning effort Inter-institutional cooperation in local areas is required with a framework for appraising and responding to todevelop community-wide nursing programs and statewide, regional, and local needs. resources. In the newer concepts of planning, emphasis is Interregional Planning being placed on decentralized planning. Local areas As mentioned, a trend toward regionalization and are potential local planning regions. Townships, towns, concerted planning for nursing for areas that com- villages, and municipalities are amalgameted to make prise several States or parts of States is now emerging. up a reasonable planning area. Local citizens are en- In many States there are areas that are dependent couraged tohelp improve the community's health upon other States for medical care, health manpower, through their own efforts and participation in plan- and educationalservices. Consequently, such areas ning. require health planning and manpower study across Approaches to planning atthe local level vary. Statelines.Forhigh-levelprofessionals, manpower Responsibilityforplanning may be initiated and supply is often a national and regional as well as a carried out at the local level, or a State or regional State concern. Specialized professional personnel are entity may initiate and guide planning for a local area. educated in only a limited number of States, and there In the first approach, the local area carries out its own is competition between States for the employment of planning. Needs of the area are defined and coopera- such professionals. tive efforts are maintained with adjacent, related, or Interregional planning, whether it be interstate or dependent areas to develop programs and to allocate intrastate, draws and builds upon planning within resources. In the second approach, where planning is regional boundaries, and requires careful scrutiny of directed from the State or regional level,local area regional relationships. This includes identification of needs and resources are considered in relationship to problems associated with interregional planning and the State or region as a whole. 42 CHAPTER 4

Summary of Planning Area Patterns planning and concurrent planning on the State level for study and action required at the State level. In summary, the patterns for planning on the basis of geographic needs include the following: State-level planning for overall State needs with Local unit planning. statewide representation and consideration of regional Coordination of multiple local unit planning in a and local needs. regional context and planning on a regional basis for Interstate regional planning for cooperative efforts services, programs, and manpower transcending local and coordinationin program devdopment and re- control. sourceallocationnotfeasiblefor individualState Statelevel coordination of regional and/or local regions.

Public Relations

Essential to effective planning are good public rela- needs, and finally,accepting responsibilityfor the tions and the development of a communication system actions that are necessary to meet nursing needs. for winning support. An intrinsic part of organizing Special materials and information programs must for planning is establishment of a strong information be developed at various stages and at appropriate program that will stimulate interest in and acceptance intervals of planning, directed to particular groups. A of the objectives of planning. Publicity efforts should few techniques that have been successfully used are be aimed at all segments of the population but par- listed here: ticularly toward those who must support and engage Periodic written progressreports on planning in the actions that evolve as part of planning. activities are sent to sponsors, participating agencies, Initially, the understanding of professional groups and contributors to planning. must be sought. The primary sponsor should elicit the Health organizations and professional and lay endorsement and cooperation of vital interest groups groups are informed of the needs of nursing through first, before informing other groups. If this is not done, individual and personal contacts and conferences with there may be difficulty in gaining necessary support. key representatives. The so-called power structure of the planning area Group meetings are arranged with the member- should be carefully studied to search out those indi- ship of professional organizations, such as the hospital viduals and groups whose approval and participation association, medical society, and nursing organizations, are essential. Personal contact and individual approach to discuss planning for nursing in its various phases. are considered best for key individuals and groups. Public forums and hearings are conducted to After thoseclosely concerned are adequately in- solicit response and support for the needs of nursing. formed, the entire planning area must be made aware Progress reports of planning activities are sub- of the planning activity, why it is needed, and what mitted to professional journals, newsletters of health it can accomplish. Once communication is begun, it associations or agencies, and other publicity organs, must be maintained. All types of mass medianews- for publication. papers, radio, television, group meetingscan be used. Protocol visits are made to the State Governor, de- Good public relations and publicity stimulate individ- partments of government, boards of various kinds, as uals and groups to become involved and to give support well as interested institutions, to interpret the need in a number of ways, such as by contributing money, fin' and objectives of planning. pledging and providing services and work, developing Policy statements on controversial matters are concern for achievement of the goals of planning. issued and circulated widely. deepening the understanding of the capabilities which Summary reports on surveys, special studies, and can be brought to bear to provide for meeting nursing planning activities are published. ORGANIZING: STRENGTHENING ORGANIZATIONAL STRUCTURE 43

Planning Reports

Planning groups issue a variety of formal reports; groups. It highlights major findings and recommenda- most are printed publications. Planning reports serve tions, as well as the premises and reasoning which led as educational documents and instruments for solicit- to the recommendations. Such a report is issued to ing professional and public support. They are tools givedetailedinformationtoprofessional,health- for interpreting needs, findings, recommendations, and related, and other interested individuals and groups goals. In addition, they provide the basic guidelines for who can help to carry out recommendations. action and a baseline for evaluating progress in im- It is possible to give general but not specific direc- plementing recommendations. Four types of reports are tions for preparing a summary report. The format and most commonly used: style must be adapted to the audience and use for Data-compilation or source books, with or without which each report is intended. The findings and recom- an analysis. mendations are sometimes placed at the beginning. Summary or overall reports on planning activi- This is convenient; the reader need not read the whole ties, study findings, recommendations, and plans of report before he can focus on the significance of the action. findings and recommendations, and pinpoint those Popular, abbreviated reports on findings, formal- recommendations most relevant to his interests. What ized recommendations, and plans of action. is to go into the main body of the report and the Reports on specialstudies, selected phases, or length ofthereport are oftendifficulttojudge. particular concerns of planning to which it is.desirable Emphasis is usually given to a discussion of those to draw special attention. details that have to be interpreted and that can influence the reader in desired directions. Data Source Books Most summary reports follow this format: Title page. Data collection and analysis constitute an important Acknowledgments and preface or foreword. aspect of planning and are discussedin detail in Table of contents. chapter 6. Background and reference data and- infor- List of tables. mation assembled for the study of nursing concerns List of figures. by those actively engaged in planning are frequently Text, or body of report: compiled in source book or report form. These ma- Introductory chapter. terials are usually presented as a perspective on the Report of planning divided into logical chapters problems and concerns under study or to be studied. thatrepresentimportantdivisionsofthe Such source books may be widely distributed to health, problems studied. educational, and related institutions and agencies, to Summary chapter on findings, conclusions, and arouse interest in improving nursing and to secure a recommendations. wide realization of needs. Appendix: Examples of reports of data surveys and analyses are Reference and source materials. given in appendix 1. It should be noted that some data surveys are not part of broad planning for nursing Although they vary in content, summary reports but are independent activities produced as a basis for generally include the following: planning by other groups. Organizational structure and study methodology. Lists ofparticipants,committee members, resource persons, and consultants. Summary Reports Summary of primary findings, conclusions, and The most common type of report prepared by plan- recommendations. ning groups is the summary report. Although often Plans of action, or suggested measures for initiat- referred to as the final report, the summary report is ing action on recommendations. not the end product of planning. The summary report References to source materials, or a bibliography. does give an account of the origin, purpose, method Selectedstatisticaldata to highlight points of ofoperation,and guidingprinciplesof planning importance. 44 CHAPTER 4

Discussion of the nursing situation (s)to which with nursing and the changes and factors influencing planning is addressed and the relationship to: nursing practice and education. Main points of surveys Trends in the nurse supply, nursing practice, and stulies are often graphically portrayed, and major and nursing education. recommendations are enumerated and discussed to give Characteristics of the nurse supply and the information quickly and highlight findings and needed present practice of nursing. actions. Characteristics of nursing education programs and student resources. Special Reports Assumptions, standards, and criteria for nursing service and nursing education. Planning groups routinely document their proceed- Effectiveness of nursing service, facilities, and ings and assemble and compile extensive information resources. and statistical data on nursing. These materials may Factors affecting the needs and demands for be reproduced in a variety of special reports. Under- nursing. lying the preparation and issuance of special reports Projection of future needs and demands and is the need to give a broader perspective and to pro- potentials. vide greater understanding of particularaspects of Goals, recommended courses ofaction, and nursing than can be given in summary or popular plans. reports. Specialreports may detailfindings from special Popular Reports studies, surveys, or research conducted as a part of Popular reports, which are brief versions of overall planning. Records of the deliberations of committees reports, are commonly prepared for wide distribution or their assessment of particular areas of nursing may to the general public, or to individuals representing be abridged and published as a separate report. The diverse interests but sharing a common concern in proceedings of workshops and public hearings or sum- nursing. In popular reports, attention is given to the maries of other supporting materials may be compiled potential reader who may not be thoroughly familiar in report form.

Other Strengthening Factors

Traditional difficulties that can impede progress are Resistance to the introduction of new concepts. inherentin planning. Most often they arise from Refusal of committee members to compromise, conflicts of interests and philosophies; fear of loss of thus blocking action. status or autonomy of the agency, profession, or indi- Reluctance to share data and otherwise cooperate. vidual; failure to realize the importance of planning; and administrativepatternsof particular planning To confront conflicting forces, there must be strong groups. Insofar as possible, the organizers of planning leadership and support, administrative skill, personal should consider methods of weakening or eliminating persuasion, good information, and, again, good human the negative forces and strengthening positive ones. relations. Other suggestions that help to avoid pitfalls Barriers to effective planning are evidenced in: are included below. Refusal of some individuals or groups to participate in or endorse planning; the blocking of other Important Administrative Procedures support. Consideration should he given to factors that dis- Undue influence by special interest groups, and sipate personal interest of the participants, strengthen power struggles between vested interest groups. motivation, increase involvement, and enhance the Poor relationships between agencies that should contributions they can make. This requires attention be represented for integrated planning. tofundamental administrativeprocedures, suchas Apathy on the part of participants, and com- orienting participants, assigning responsibilities, and placency with the status quo. supplying needed information. ORGANIZING: STRENGTHENING ORGANIZATIONAL STRUCTURE 45

Orientation maximum participation of already busy committee Participants in planning must first clearly under- members. stand the goals of planning, the importance of the Agenda be prepared to utilize the time of par- job to be done, and how they can help. All who serve ticipants in directed activities. should be oriented to: Minutes of meetings be kept and circulated to The overall situation to which planning is ad- give continuity to planning activities. dressed. SupplyingAdevthte Information for The puz pose and objectives of planning. Participants How planning is organized and will function. The roles and responsibilities of sponsors, com- In terms of their background, knowledge, and ex- mittees, and their particular assignment. perience, individual participants and committees will, Anticipated and expected commitments of time. throughout planning, need information on various subjects relative to their assigned tasks. Such informa- Assigning Responsibilities tion may be necessary for understanding brOad or specific aspects of social, education, health, welfare, To guide their work and assure its completion, staff and nursing conditions, as well as programs, trends, and those who serve on planning committees should and developments. Staff support and other means for operate under clearly defined responsibilities and es- providing adequate information are essential to intelli- tablished procedures. Their time should be used wisely gentjudgments,decisions,andactions.Measures in meaningful activity. Requirements are that: utilized to provide background information include: Organizational structure for the planning, lines of Distribution of selected reference materials. authority, and functions and responsibilities of staff Reports to committees on special subjects. and committees be put in writing. Use of resource persons. The specific charge be developed and made to Speakers on selected subjects. each committee or group to which members are as- Site visits by staff or committee members to ob- signed. serve in particular areas of interests and to solicit Meetings be scheduled well in advance to assure information.

References

ADULT EDUCATION ASSOCIATION OF THE U.S.A. BULLOUGH, BONNIE; and BULLOUGH, VERN; eds. 1955. Understanding How Groups Work. Lead- 1966. Issues in Nursing. New York: Springer ership Pamphlet No. 4, pp. 5-14 and 33-48. Publishing Co. 278 pp. Washington: The Association. CHIN, ROBERT; and BENNE, KENNETH D. 1969. "General Strategies for Effecting Changes in Human Systems." The Planning of 1956. Getting and Keeping Members. Leader- Change, 2d ed., pp. 32-59. Edited by ship Pamphlet No. 12. Washington: The Warren G. Bennis, Kenneth D. Benne, and Association. 48 pp. Robert Chin. New York: Holt, Rinehart and Winston, Inc. CONDE-THILLET, MARIO L. 1957. Better Boards and Committees. Leader- 1965. "Dealing With Controversial Issues." ship Pamphlet No. 14. Washington: The Adult Leadership, 13 (7) :207 and 236 Association. 48 pp. (January).

DOUGHMAN, GORDON 0. 1957. EffectivePublicRelations. Leadership 1965. "Towards an Evaluation of Committees." Pamphlet No. 13. Washington: The As- Adult Leadership, 13(9): 287, 302-304 sociation. 48 pp. (March). 46 CHAPTER 4

GINZBERG, ELI; with ()STOW, MMIAM. 1967. Health Manpower 1966-1975. A Study of 1969. Men, Money and Medicine. New York: Requirements and Supply. Bureau of La- Columbia UniVersity Press. 291 pp. bor Statistics Report No. 323. U.S. De- partment of Labor. Washington: U.S. GUNNING, ROBERT. GovernmentPrintingOffice. 50pp. 1968. The Technique of Clear Writing. Revised (Available from U.S. Department of Com- edition. New York: McGrawHill Book merce,NationalTechnicalInformation Company. 329 pp. Service, Springfield, Va. 22151.) KENEALLY, HENRY J., JR. 1966. "The Inter and Intra Agency Communica- SPALDING, EUGENIA KENNEDY ; and NOTTER, LUCILLE E. Per- tion Process Used in a Community Develop- 1970. ProfessionalNursing:Foundations, ment Program." Adult Leadership, 14 spectives and Relationships. 8th ed. Phila. (9) : 294-296, 317 (March). delphia: J. B. Lippincott Co. 677 pp. KISSICK, WILLIAM L., ed. STRUNK, WILLIAM, JR., and WHITE, E. B. 1968. "Dimensions and Determinants of Health 1959. The Elements of Style,. New York: The Policy." The Milbank Memorial Fund Macmillan Company. 71 pp. Quarterly, 66 (1) : Part 2 (January). TICHY, H. J. KLARMAN, HERBERT E. 1966. EffectiveWriting: For Engineers, Man- 1965. The Economics of Health. New York: agers, Scientists. New York: John Wiley Columbia University Press. 200 pp. & Sons, Inc. 337 pp. KNOWLES, MALCOLM S., and KNOWLES, HULDA F. U.S. DEPARTMENT OF HEALTH, EDUCATION, and WEL- 1959. "Understanding Group Behavior." Intro- FARE. PUBLIC HEALTH SERVICE.HEALTH SERVICES ductionto Group Dynamics, pp.39-62. and MENTAL HEALTH ADMINISTRATION. NATIONAL New York: Association Press. CENTER FOR HEALTH STATISTICS. 1969. A State Center Pr Health Statistics: An Aid NATIONAL COMMISSIONON COMMUNITY HEALTH SERVICES. in Planning Comprehensive Health Statis- Public Health Conference on Records 1967. "Regional Organization in Integration of tics. Revised Services." Comprehensive Health Care, and Statistics Document No. 626. A Challenge to American Communities, pp. October 1969. Washington: U.S. Govern- 23 pp. (Available 63.67. Washington: Public Affairs Press. ment Printing Office. from National Center for Health Statistics, 5600 Fishers Lane, Rockville, Md. 20852.) 1968.The Politics of Community Health. Re- WATSON, GOODWIN. portofthe Community Action Studies 1969. "Resistance to Change." The Planning of Project, p. 101. By Ralph W. Conant. Change, 2d ed., pp. 488-498. Edited by Washington: Public Affairs Press. Warren G. Bennis, Kenneth D. Benne, and PRICE, ELMINA. Robert Chin. New York: Holt, Rinehart 1967. "Data Processing, Present and Potential." and Winston, Inc. (12) : American Journal of Nursing, 67 WEISS, JEFFREY H. 2558-2564 (December). 1967. The Changing Job Structureof Health ROSENTHAL, NEAL H.; LEFKOWITZ, ANNIE; and PILOT, Manpower. Cambridge, Mass.: Harvard MICHAEL. University. 267 pp. Chapter 5 Assessing Needs and Developing the Plan of Action 48 Chapter .5

Assessing Needs and Developing the Plan of Action

At the very core of planning for nursingis the facilities, services, and resources. Moreover, the plan assessment of needs and resources. The assessment should be periodically updated. There should bea phaseessentially a survey and study processlays continuing critical analysis and evaluation of major the foundation for developing a specific plan with nursing concerns. recommendations for the expansion, development, and A comprehensivenursingplancannot provide improvement in nursing programs and the translation answers to all questions. It can, however, give perspec- of these recommendations into action. tive to nursing needs; set the perimeters for opera- Every area of the country should have a plan for tional, institutional, and program planning; and guide nursinga plan that sets common goals and priorities coordinated action within the planning areas. Thus and guides action in the entire spectrum of nursing the plan offers the greatest potential for meeting needs.

Assessment Phase

Assessment is the phase of planning concerned with related to the concerns and the needs of nursing. investigating, pinpointing, and making specific recom- Becoming aware of and exploring the resources mendations on the needs of nursing. In this phase, a available to deal with specific concerns and problems. factfinding periodduring which data and information are collected,analyzed, and synthesized--is fol- Steps in Assessment lowed by a period of decision-making on the needs of Although complex, the assessment phase can be car- nursing. ried out in definite steps in a logical sequence, as follows: Framework for Assessment Collecting available data and descriptive informa- A basic framework for assessing overall health needs tion. and resources has been developed which can be ap- Conducting special surveys or studies as required plied to nursing. The framework sets the requirements for factfinding. for factfinding and furnishes guidelines for reasoning, Statistically analyzing data; summarizing descrip- judgments, and decisions. Assessment of the nursing tiveinformation; and integrating and interpreting needs and resources of any planning area must be information, data, and findings. carried out within a framework that includes the fol- Synthesizingfindings,knowledge,and under- lowing: standings, and forming concepts of the situation. Defining the nature and scope of nursing concerns Drawing implications and conclusions and mak- as manifest in the planning area. ing judgments on needs in terms of adequacy, effective- Identifying and evaluating the political, demo- ness, and efficiency of nurse manpower resources and graphic, cultural, and economic factors, conditions, services. and changes affecting nursing ingeneral and the Making decisions on approaches, methods, and specific areas of nursing under study; also recognizing measures for meeting needs. the problems they pose in the development of positive programs for meeting needs. Indices of Assessment Weighting the relative importance of all factors The preceding framework and steps in assessment

49 50 CHAPTER 5 suggest a summary index of factors to be assessed in Data on hand. determining nursingneeds.Whateverthe nursing Past and current trends. problems in need of solution, assessment would be Published reports and positions. based on understanding, review, detailed knowledge, or study of the following: Expert judgment and experience of members of Socioeconomic environmentof and associated the committee. with nursing. Counselof experts orresourcepersonsas Health needs and resources and their relationship needed and required. to nursing. Broadly consider the situations and conditions in Trends, concepts, practices, and patterns in the the specific area of study as they relate to the follow- delivery of health services, in nursing service, and in ing: nursing education. Patient care requirements. Standards, criteria, and controls on which nursing Utilization, staffing, and available resources. practice and nursing education are based. Employment incentives. Itis impossible in this publication to outlinein Career incentives. detail all the potential indices of assessment because Educational preparation of personnel. nursing conditions and needs vary widely among plan- Organizational patterns of services. ning areas and are changing constantly. Nursingcon- cerns requiring assessment by particular planning Nursing responsibilities. groups are initially identified when the study outline Assess patient and service needs in the specific is prepared. (See page 16.). Other concernsor aspects field, current and future. of issues and problems requiring analysis and study Assess the current quantitative and qualitative will emerge as planners begin to seek solutionsto direction of nursing, and project future directions, particular nursing problems. The time spent inassess- including new responsibilities for health care and for ing particular items and the depth of assessment are nursing. contingent upon the availability of data and study find- Determine the criteria and standards in use and ings and the familiarity of planners with particular required for projection of needs and resources in the areas of concern. area of study. Indices and the process of assessment may beex- Assess and estimate current and future nursing plained more clearly by the following example ofa personnel requirements, quantitative and qualitative. charge given to the technical committees ofone planning group that had as its purpose the development Assess and estimate all resources for nursing, also of a statewide plan for nursing service and nursing the adequacy of recruitment programs and of existing educational facilities for producing the required num- education. Committees were structured by fieldsof ber of nursing personnel in the specific field. nursing, such as institutionalnursing, public health nursing, office nursing, and occupational health nurs- Outlinerelevantinformationneededbut not ing. The charge, with a few adaptations, could apply available and for which special investigation may be to committees that were structured, for example, in necessary. terms of nursing needs, nursing resources, and the Identify areas needing research for long-range utilization of nursing personnel, as shown in the or- planning. ganization charts on pages 24 and 26 (figs. 1 and 3). Formulate initial recommendations for meeting The charge was as follows: quantitative and qualitative needs for review and ap- Assess the social, cultural, economic, and admin- proval by the Executive Committee and Task Force. istrative factors effective in the delivery of health and Specify courses of action to be taken to implement nursing services and nursing education, and relative the recommendations. to the specific area of study assigned to the committee. Make concrete proposals for initiating action pro- Examine and review the present situation and grams. conditions in the specific area of study assigned to the Prepare an analytical report on the special areas committee in light of the following: of study. ASSESSING NEEDS AND DEVELOPING PLAN 51

Tools of Assessment

The principal tools of assessment are a combination Classification of nursing functions by each level of both tangible and intangible instruments. They are of proficiency of the practitioner. integral devices. Three tools(1) data; (2)criteria Staffing ratios. and standards; and (3) judgments and decisions Ratios for levels of educational attainment of require special mention. practitioners. Standards of performance of practitioners. Data Criteria for educational programs. Data provide the context for forming concepts of The commissions on practice,of the American the nursing situations, thescope of problems, the Nurses' Association(ANA), establishand publish characteristics of nursing needs and the shape and functions, standards, and qualifications for practice in direction of measures and programs needed to meet the variousfields of nursing. The commission on needs. Because of the fundamental importance of an education sets criteria for the various types of nursing adequate data base for planning, data as an integral education programs. These ANA standards and cri- part of factfinding are discussed fully in chapter 6. teria can be used by planners as guidelines. Specific ANA publications are referenced in appendix 2. The Standards and Criteria use of criteria and standards in assessing quantitative and qualitative manpower needs is discussed further Program-planning techniques and evaluation meth- in chapter 6. ods frequently employed in health and education fields are essential to a critical appraisal of nursing practices, programs, and personnel resources. Quality, effective- Judgments and Decisions ness, and efficiency are inferred, judged, and measured Data, standards, and criteria form the base for from established quantitative and qualitative standards judgments and decisions on the needs of nursing and and criteria that, in addition, provide a base for im- the means for meeting those needs. The making of provement. Their application in the assessment process judgments and decisions in planning are, however, in- is focused on the following: fluenced by a number of subjective factors and implicit * A comparison of recommended standards and conditions. Planning judgments and decisions reflect criteria with those in practice as revealed by data the participants' understanding and knowledge gained survey and analysis and study finding< through the planning effort They are influenced by An appraisal of acceptable standards and criteria the effectiveness of the plutining process in resolving applicable tothe conditions and changing require- planners' conflicts and controversies in reaching comments of the planning area. mon understandings. Planning judgments andde- A determination of standards and criteria to be cisions also reflect the values, attitudes, and motivations used as a base for setting goals and formulating recom- of the planners and participantsin planning, who mendations. represent various social, economic, and political seg- When recommendations have been formulated and ments of the planning area. Judgments and decisions the nursing plan has been prepared, the standards and are also influenced by the degree to which the planning criteria set by the planners provide a frame of refer- process enables planners to set common purposes and ence for future goals, a guide to action, and yardsticks goals. againstwhichprogressand achievement can be The organizational structure, operation, and ongoing measured. activities of the planning effort should provide the An assessment of nursing needs and resources must framework for making appropriate decisions on means be founded on a clear conception or delineation of the for meeting nursing needs. In other words, when the role of nursing, to which standards and criteria are time for decision-making has arrived, these steps must then applied. The standards and criteria most fre- have been accomplished: quently used and formulated inassessing nursing Concerted concern for the needs of nursing has needs and resources are these: developed.

.5 7 ~41 52 CHAPTER 5

O The various agencies and groups have agreed Lay aside any preconceived bias, and approach upon the need to cooperate to correct deficiencies. the assigned task with an open mind. Willingness to accept the majority ruleon what Reach no conclusions until you have heard all the needs are and how they can be met have been the evidence that can he assembled from basic data, evidenced. unearthed from studies, and supplied by experts. Committees may deal with highly controversial sub- Recognize and utilize the respective knowledge jects and represent many divergent points of view. One well-known national study developed a climate and contribution which each committee member can favorable to reaching consensus on needed actions by make. establishing these commitite rules for decision-making: Listen ,to all points of view on any question.

How Assessment Tasks Are Accomplished

The main work of assessmentisusually done As previously mentioned, public hearings, work- through one or more technical committees. (See p. 22.) shops, panels, and the use of consultants and resource Not all committees work in the same way. Some persons are actually in3truments of assessment and emphasize critical thinking and the clarification of make various contributions to the process. problems in the total group. Others pay greater attention to work in subgroups. The technical job of arriv- The planning staff usually obtains the basic backing at the roles and functions of nursing personnel ground data and conducts special surveys and studies and standards for educatiun and practiceisoften concerning pertinent needs and resources to support assigned to an ad hoc or special committee of experts, technical committees in their assessment. This fact- commanding the best talent within the planning area. finding process is discussed in chapter 6.

Developing Recommendations

The search for the measures that will best meet the their best, are devoid of preconceived ideas;they needs of the planning area culminates in recommenda- specify new ways of meeting needs instead of follow- tions. The recommendations state the goals and ob- ing traditional patterns. New patterns reflect the need jectives of the plan of action and suggest measures for to keep up with changing society. meetincr them. Recommendations represent the collec- To be meaningful, recommendations must be realis- tivethinking ofthe membership ofthe planning tic in terms of the needs, capacities, and limitatiuns of group. In controversial issues, alternate recommenda- the planning area. At first,goals may have to be tions for reaching objectives are sometimes made. limited in depth to provide essential elements. For example, short-term training courses may need to be Nature of Recommendations provided while fullyqualified personnel are being Statements of recommendations should indicate the trained. Or periods of trial and pilot projects in a few probkms toward which each recommendation is di- representative agenciesfor instance, a hospital, an rected;should specify objectivesinterms of the outpatient department, or a health centermay be impact on nursing practice and nursing education and necessary to testrealistic schemes. Immediate aims the improvements anticipated; and should describe, in would be to improve nursing service and care; sec- general, the measures designed to reach the objective. ondary aims would be to strengthen and demonstrate Recommendations may (1) extend activities already methods that could be applied in implementing the present in the planning area; (2) specify approaches overall planfor meeting long-range objectives.In and activities developed elsewhere which might be developing neighborhood health center programs in applied in the planning area; or (3) specify new means urban areas, for example, one or more of these prin- and activities for meeting needs. Recommendations, at ciples have been applied for providing care while the ASSESSING NEEDS AND DEVELOPING PLAN 53 most appropriate means for extending health services ing particular attention. Specific priority factors can to socially and ,..conomically deprived areas are being be selected oy relating these needs to the objective of sought. the planning activity and the resources available for meeting needs. The designation of priority recommen- Priorities of Recommendations dations provides a starting point for developing the plan of action. As each recommendation is developed, it should be For example, the priority recommendation of onf. given a priority for action. Priorities must be based on planning group vb as directed to measures for securing considerations that reflect particular conditions and advanced educational preparation for nurses in lead- capabilities of the planning area, such as the follow- ership positions,including both nurse faculty and ing: nursing service administrators. Expansion in nursing Magnitude of the problem. education resources and improvement in the quality Relative need. of nursing education was related toin fact, depended Allocation of scarce manpower resources. uponthe availability and qualifications of the faculty. Available financial resources. The improvedutilizationof nursing personnelin The survey,analysis, and assessment of existing health care settings was directly related to the skills needs and resources should demonstrate areas requir- and preparation of nursing administrators.

The Plan of Aciion

The plan of action for nursing grows out of the stitutions, organizations,or individuals to carry out in-depth study of nursing needs and resources and each recommendation. broad planning for nursing. The comprehensive plan Specifying a timespan for achieving spc.cific provides guidelines for a rational system of nursing objectives or steps in theplan. facilities,services, and manpower that embrace all Providing methodsfor evaluating progress in aspects of nursing, including the service and educa- meeting objectives. tional components. A thorough plandetailsaco- The plan of action builds upon existing institutions, ordinated and comprehensive overall program of action services, and manpower resources. The diversity of witbin a specified geographic area and designated needs, resources., and existing patterns o: education sub-areas.Itis addressed to both quantitative and and service must be dealt with; yet innovative ap- qualitative needs. Patterns and methods of action in proaches should be tried. Efforts in several directions the improvement, expansion, and development of pro- at once may be required. In developing the plan, grams, facilities, and resources are prescribed. problems to be encountered inits phasing must be consideredas, for example, resistance to the intro- Developing the Plan duction of new concepts. Measures to surmount potential obstacles must be worked out in advance and When recommendations have been formulated and integrated into the plan. priorities have been determined, they are then incorporated into a definitive plan for meeting nursing needs. In developing the plan, attention is given to Structure and Scope of Plan the following: The plan of action for nursing should begin with a Specifyinggoals,objectives andpoliciesfor statement of the purposes and the objectives, policies, carrying out recommendations and suggestedpro- or principles on which it is based. It should also con- grams. tain the planners' objective assessment of the strengths Phasing activities so that resolution of problems and weaknesses of nursing service and education pro- requiring immediate action, on the short-term goals, grams. From such an assessment, the needs are in- leads to actions and measures for attaining long-range terpreted and substantiated. The plan should contain goals. specifically the planners' assessment of the following: Indicating the geographic location, agencies, in- Trends in the nurse supply, nursing services,

(7.4 54 CHAPTER 5 nursing practice, and nursing education; and factors other allied health professions with respect to matters influencing the supply, preparation, and utilization of which affect the practice of nursing and the education nurse practitioners. of nursing practitioners. The specific needs related to nursing and its re- Mechanisms for involving nursing representation sources, based on study findings. in the planning and coordination of health care sys- The quantity and quality of nursing personnel tems, nursing services, and nursing education pro- required to meet current needs and future projected grams. needs for nursing services; also the ratio or proportion Methods for applying research findings to the of nursing personnel required to be prepared at each appropriate health care systems, nursing services, and level. nursing education programs. The criteria and standards for sound service and Investigations, studies, and research into nursing educational programs; and capabilities for the gradual practice, the effective utilization of nursing personnel, improvement in these criteria and standards. and the education of nursing practitioners needed for attaining long-term goals. The plan for nursing should also specify the essential elements, mechanisms, and support required for implementing thespecific measures that are directed Nursing Service Goals toward program improvement and development. To Relating specifically to nursing service, the plan insure meaningful progress toward established goals, shoul d the leadership, coordination, and cooperative relation- Designate the type and kinds of new or existing ships required among major health and educational nursing service programs to be involved in the plan. resources for carrying out the plan should also be Set priorities for the expansion, improvement, or specified. The basic aspects of any plan of action for development of nursing service programs. nursing should define or specify the following: Prescribe administrative reorganization or new The modifications necessary in legislative authori- organizational mechanisms required so that the avail- zations and administrative codes for improved health able manpower can be utilized with the greatest effi- and nursing service and educational programs for the ciency and economy. best use of manpower and facilities. patterns for each type of The financial and budgetary support required Prescribe utilization from appropriating bodies for carrying out the plan. nurse in varying work situations. Establish the boundaries of nursing responsibili- Cost items for each recommended area of improvement, development, and expansion are calculated and ties in relation to other health disciplines and overall justified when possible; cost data are required, par- health effort and health needs. ticularly when requests are to be submitted to the Define new roles for nursing personnel and pat, terns of service for meeting health care requirements. legislature for support. All sources of financial assistance and the per- Recommend changesinlegislationrelativeto centage of support to be reasonably expected from licensing laws to reflect the type of practice a nurse is feasible sources. This may include Federal or other prepared to carry out. Recommend measures to improve job satisfaction assistance available for: and employment and career incentives that contribute Construction of finilities. to the quality of nursing service, such as the following: Grant funds for the development and improve- Personnel policies, practices, and procedures. ment of nursing service and nursing educa- Working conditions. tion programs. In-service and continuing education. Student loans and scholarships. On-the-job training. Payments toward operating costs. Salaries and fringe benefits. Short-term and long-term traineeships. Nursing research. Organizational mechanisms through which nurs- Nursing Education Goals ing may maintainactive, appropriate, and effective Relating specifically to nursing education, the plan communication with institutional managements and should ASSESSING NEEDS AND DEVELOPING PLAN 55

Set priorities for the expansion and development ment capabilitiesminimum and maaimum of nursing education programs by type of program, to sizeof program;(5)studelitrecruitment meet the specitic demands of the area; also prescribe potential and demand to support program. target dates for achievement of specific aspects of the Prescribe improvements needed inschoolsof plan. nursing on the basis of criteria for sound education Designate geographically and by type of program programs directed toward achievement of quality care, the proper balance in the development of programs to such as the following: include the following: Qualifications of faculty. Number of additional nursing education pro- Reasonable student-faculty ratios. grams needed, from the practical nursing pro- Clinical facilities, libraries, classrooms. gram tothemasters' and advanced degree Curriculums, curriculum enrichment, and in- programs. novations. Attainment of national accreditation. Merging, transition, or closing of programs. Recommend broad measures to support the plan Potential foi developing new and expanding and its goals, such as the following: existing education programs,including such Utilization of resources from educat;onal pro- resources as: (1) academic fields and institu- grams. tionalcapabilitiesavailable to supporteach Recruitment activities and programs. type of nursing program; (2) physical facili- Measures contributing to improvement in career ties; (3) clinical facilities; (4) student enroll- incentives.

Implementing the Plan

Plans for nursing may be no more than hopes unless Continuous Planning practical means of implementing plans are found. Ultimately, the success of planning is judged by the Ultimately, implementation is done at the community extent to which recomendations have actually been level and requires creativity and leadership. To imple- implemented and progress is being made toward meet- ment a plan, organization is still essential. Either the ing goals. There must be sustained communication, organizational structure used to develop the plan must involvement, and evaluation to attain the goals of a be sustained or another structureidentified ores- plan of action for nursing. In addition, nursing needs tablishedtoprovideforcoordination andfollow- and resources must be reassessed periodically to meet through on prescribed actions. changing needs for nursing services and to balance The implementation phase of planning provides the nurse supply and demand. guidelines for action and directs the development of The results of planning must be fed back into re- the overall plan. This requires adequate support and a planning to effect a continuous process for maintaining mechanism for the following: and improving the nurse supply and nursing resources. Interpreting nursing trends and needs and pro- Some type of mechanism must be established for viding information for locallevels and autonomous continuous planning for nursing to accomplish the units for cooperative efforts in implementing the plan. following: Stimulating the appropriate individuals and Or- Ascertain progress in implementing recommenda- ganizations to accept responsibility for action. tions and developing action programs. Allocating the recomended actions to the different regional, local, or individual health organizations or Determine whether the implemented activities or actions are achieving their intended purpose. institutionsinthe planning area who can initiate action programs. Evaluate whether the activities or actions should Designing the detailed programs for carrying out be continued. each specific recomendation needed to fulfill the ob- Suggest modificationsthat wouldbetter meet jectives of the plan. goals. 56 CHAPTER 5

Periodically re-examine the resources available in planning committees of, for example, the State nurses' order to assess the degree and direction of change. association and the State league for nursing. These Identify areas still needing continuing action and committees function to implement the recommenda- additional or expanded effort. tions of study groups, to continue to aid in planning, Project estimates of the planning area's nursing and to stimulate planning and development. needs farther into the future. An existing mechanism for continuous planning acts Determine the emerging areas that need intensive as a vehicle for recognizing the needs and demands of study. nursing as they develop, and precludes having a static Planning groups should assume responsibility for plan. Nursing needs and resources and long-range stimulating the development or establishment of some goals must be extensively evaluated in 5-year periods mechanism for continuous planning for nursing. Some so that adjustments can be made and future steps planners assign responsibility for continuous planning determined in terms of emerging trends in health to a specific agency or institution. Other planners services, nursing services, and nursing education. At appoint a committee composed of members of the such times the continuing committees, for example, organizations sponsoring planning to assume this re- may function to establish the mechanism for another sponsibility. A number of States have continuing joint in-depth study of nursing needs and resources.

References

ADULT EDUCATION ASSOCIATION OF THE U.S.A. DENISTON, 0. L.; ROSENSTOCK, I. M.; WELCH, W.; 1955.Taking Action in the Community. Leader- and GETTING, V. A. ship Pamphlet No. 3, pp. 27-48. Washing- 1968."Evaluation of Program Efficiency." Pub. ton: The Association. lic Health Reports, 83 (7) : 603-610 (July).

GREENBERG, BERNARD C. 1955. Understanding How Groups Work. Lead- 1968."Goal Setting and Evaluation: Some Basic ership Pamphlet No. 4, pp. 15-32. Wash- Principles." Bulletin of the New York ington: The Association. Academy of Medicine, 44(2) :131-139 (February). 1957.Streamlining Parliamentary Procedure. Leadership Pamphlet No. 15. Washing- HILLEBOE, H. E., and SCHAEFER, M. ton: The Association. 48 pp. 1968. "ComprehensiveHealthPlanning:Con- ceptual and Political Elements." Medical ARNOLD, MARY F. Times, 96: 1072-1080 (November). 1968. "Use of Management Tools in Health Plan- ning." Public Health Reports, 83(10) : HILLEBOE, HERMAN E., and SCHAEFER, MORRIS. 820-826 (October). 1968. "Evaluation in Community Health: Relating Results to Goals." Bulletin and HINK, DOUGLAS L. of the New 1968. "Agency Problems in Planning for Com- York Academy of Medicine, 44 (2): 140- munity Health Needs." Medical Care, VI 158 (February). (6) :454-466 (November-December). NATIONAL COMMISSION ON COMMUNITY HEALTH BENNIS, WARREN G.; BENNE, KENNETH D.; and CHIN, SERVICES. ROBERT; eds. 1968.The Politics of Community Health. Report 1969. The Planning of Change. 2d ed. New of the Community Action Studies Project, York: Holt, Rinehart and Winston, Inc. pp. 14-18 and 97-105. By Ralph W. Conant. 627 pp. Washington: Public Affairs Press. II //

IT AIN ENT 44u? II[CM `fe _ ),_; . ideas for ?111. improvement

in programs . and resources

sl\o)) Chapter 6

Factfinding

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60 Chapter 6

Factfinding

Planners develop a plan for nursing on the basis of needs, and about the feasibility of meetingthose their knowledge and linderstanding of the resources needs. This is called the factfinding phase of planning. and needs of nursing in the planning area. Because ft incorporates these procedures: (1)collecting and planners represent a mix of leadership talentfrom analyzing data; (2) conducting special surveys, stud- education, business,industry, healthfields, and the ies, and research; (3) using educational and informa- general communitythey need a wide range of statistics, data, and background material. Such information tional materials and devices; and (4) soliciting facts must be developed and disseminated to provide facts and information from persons knowledgeable in par- about nursing, about the diverse factors bearing on ticular areas of endeavor.

Providing for Factfinding

For the factfinding phase of their work, planning ment of nursing needs and resources. The source book groups make various provisions, depending upon the can have other useful purposes, as previouslynoted in availability and competence of staff or other resources. chapter 4, page 43. Data collection is a technical operation that requires Data source Looks and reports, when made available a good understanding of the subject to which itis totechnical committees before they meet, stimulate applied; therefore, a knowledgeable group is needed interest and active participation of committee members to assist in collecting and interpreting the data. Often and reduce the time required for asSessraent. In addi- statisticians or specialists from other health and related tion, such source books compile releVant data and facts fields must be called in. about nursing in an orderly fashion for current and To guide data collection and analysis, ad hoc or future use. special committees are often appointed. If statisticians As technical committees begin their assessment, they or a technical staff are provided, the members of the often identify subject areas for which data surveys ad hoc or special committee specify the data require- may be necessary. The need for such special surveys ments, supervise data collection, and assist as necessary and studies should be identified early in the planning in compiling, validating, and analyzing the data. Or or assessment processes, so that data and findings can sometimes this function is assumed by the members be made available in time to contribute to the under- of the advisory or executive committee, who act as standing, judgment, and decisions required for making consultants to the planning project staff as required. recommendations. When the planning group or par- committeesdecide they needtoundertake Some planning groups collect and assemble data ticular.special studies, they should seek appropriate technical as needed by particular planning committees. Other assistance from statistically trained people. If special groupsearly in the planning processbring together, studies are to be extensive,a full-timestatistician in a written report called a source book, data and should be hired. Part-time statistical assistance and information on the overall areas of inquiry considered consultation are often available from State or local essential for investigation. This source book is made health departments, universities, and health organiza- available to all participants in planning. It serves to tions, such as hospital associations, health planning orientcommitteemembers,givingthemessential councils, Blue Cross Associations, and health career background information for beginning theirassess- councils.

61 62 CHAPTER 6

Cooperative Arrangements for Factfinding Data Processing Factual andstatisticalinformationfor planning With the advent of the computer and other mechan- groups has also been produced through various co- ical means for transforming data from their raw state operative arrangements among segments of the health to a finished product, mostif not allof the data mre industry, the professions providing health services, collected in a planning activity will be processed by and the State agencies which share responsibility for mechanical or electronic equipment. Oi course, in very planning and for the health care of its citizens. The small data collections that involve answers to only a factfinding phase of planning has been utilized, for few questions from a small number of respondents. example, as practical educational experience for uni- hand-processing may he preferable. In all otherin- versity and graduate students who must learn how to stances, however, machine-processing should be used; identify problems and search out, collect, and analyze itis more precise, can be done more quickly and data for planning. Universities, health departments, easily, and can yield a greater amount of information and private industry have made sizabk contributions per dollar than can hand-processing. Moreover, ma- to planning groups in data-processing services also. chine-processed data can be permanently stored on cards or magnetic tape for reuse in the future. This Health agencies andinstitutionsorprofessional is a particularly desirable feature because an initial groupsfor example, the hospital association or de- planning study would, hopefully, lay the groundwork partment of mental healthoften agree to carry out for the establishment of data information system for special surveys or studies pertinent to theirfields of continuous planning. Such a system depends on an interest. Such arrangements indicate the cooperation adequate information base consisting of data from and involvement required for developing a coordinated previous years which could be periodically updated to long-range plan for nursing. establish trends and projections into the future.

DeterminingData Needed

The first step in the factfinding phase of the plan- been posed and the planning goals that have 'been set. ning process is to determine the basic and special data The development of a meaningful long-range plan for needed to meet the particular objectives of the plan- ninsing requires data that will: ning activity. Data and information that will reflect as Show past trends in nurse-manpower supply and completely and reliably as possible the situation for the various resources that contribute to the supply, which planning has been undertaken must be compiled thus shedding light on what future trends might be. and analyzed. Only on the basis of such information Reveal the dimensions of nurse manpower needs can a realistic evaluation be made and the indices of --past, present, and futureand provide clues to the need be developed. various ways of meeting those needs. The purposes for which dataare collected, the questions the data are expected to answer, and the Describe the present nurse-manpower situation, guidance the data are intended to give to the planning including the supply and needs and the resources group are specified wben the study outline is prepared. affecting supply and needs. (See page 16.) When the data are analyzed, con- Describe thesocioeconomic framework within clusions are drawn in terms of the questions that have which nurse-manpower planning will be done.

Types of Data and Information Required

In planning for nursing, an adequate data base needs.Italsoincludes data on the socioeconomic includes facts about the supply and distribution of characteristics of the area in which planning is being nursing personnel; resources for producing the sup- done, and the patterns and availability of total health ply; and projections of future resources, supply, and services and facilities. FACI FINDING 63

Although planning studies differ in their scope and (6) Inventories of nursing education programs by objectives, a basic core of data will be common to all type of program, control, geographic location, and the such studies. These data can be grouped into seven characteristics of these programs in relation to their categories, as follows: students. (I) Characteristics of the population, including its (7) Projections of future population, estimates of size, distribution, density, mobility, economic status. future needs for and plaimed expansion of health degree of urbanization, educational attainment,life facilities, services, and edoca:ional resources. expectancies, births, and deaths. The planning group will haw to determine specific (2) Healthstatusofthepopulation,including data requirements in these suggested areas relevant to morbidity and mortality rates and major health prob- the nature, scope, and specificobjectivesoftheir lems and needs. project. In additiontothe requirementsfor basic (3) Existing health programs, facilities, and serv- quantified data, the needs of the participants in plan- ices, including hospitals, nursing homes, clinics, home ning for information and other background materials health agencies, and other out-of-hospital facilities and inthese areas should be considered. For example, services; their geographic distribution, ownership and non-nurserepresentatives orthose not engaged in control, methods of financing, and functional organiza- health fields may need to become acquainted with or tion; and the identification of gaps in services. knowledgeable about nursing, the structure of health (4) Indicators of the utilization and demand for and nursing services and their operation, trends in the health services as related to the financial resources for development of heahh services and resources, and obtaining and providing these services and to the need socioeconomic influences and th:ir relationship to pre- for health manpower. vailing nursing conditions and needs. (5) Inventories of nurse manpower, including pro- Likewise, representatives of nursing and health fields fessional,technical, and auxiliary personnel;their may need to be made aware of trends and develop- characteristics, employment status, fields of practice, ments in the educational sphere or in other aspects of and geographic location. Inventories of other health society affecting nursing. All members may need back- personnel, their fields of practice, and their relation- ground information in special fields or about special ship to nurse manpower needs and utilization. situations.

Sources of Data and Information for Planning

Much, if not all, of the data needed to provide a part of Warming is usually directed to the accomplish- meaningful framework for planning for nurse man- ment of long-term planning goals and isconcerned power will be available from existing sources (referred with the development and improvement of tools for tointhis guide asexisting data).If,however, nursing administration, service, and education. specific data to meet particular objectives of the planning activity are not likely to be available from exist- Existing Data ing sources, special surveys and studies may need to be undertaken to obtain such data (referred to in this Existing data required for planning for nursing guide as original data). For insight into some special relate particularly to the socioeconomic characteristics nursing problems, research may also be essential. of the area, the health services and facilities available, Generally, a planning activity can be conducted and the nursing and related health manpower supply without collecting extensive original data. The recom- and distribution. mendations for action that stem from planning can Basic data on population, general morbidity and usually be derived from existing data and a few un- mortality patterns, health facilities,healthservices, complicated surveys. Planning decisions seldom require and health manpower are collected, coordinated, and the degree of precision and validity of supporting data synthesized from periodically conducted inventories, acquired through research. Research conducted as a surveys, or reports on the routine service functions of 64 CHAPTER 6 health facilities and agencies. For example, in most Publications in health and other social welfare fields States, hea:th departments regularly collect and some- over the years have also provided valuabk guidance in times publish data on population, births, deaths, mor- the sttidy of subjects significant to the improvement of tality and morbidity statistics,as wellasservices nursing service and nursing education. This literature provided by health agencies. covers a wide range of activities concerning nursing. Also, existing data useful in planning for nursing Selected articles, reports, books, and other publications can sometimes be found in the reports and studiesof are listed in appendix 2. Planners may find them of other planning organizations. Health facilities planning value inunderstanding and evaluating the nursing has been conducted by hospital councils and similar situation,in identifying trends, in projecting future agencies for many years. Planning activities under directions and needs, and in formulating recommenda- the Comprehensive Health Planning (CHP) program, tions and developing action programs. although of recent origin, should soon make available Two publications of the Division of Nursing, U.S. data that are pertinent not only to planning for nursing Public Health Service, ale essentially compilations of but also to planning for total health, into which plan- data from existing sources that can provide a useful ning for health manpower should be fitted. framework for planning for nursing. The two publica- In addition to data that exist in published form, a tions, Community Planning for Nursing in the District considerable amount of data exists in raw, unpublished of Columbia Metropolitan Area and Source Book for form. These data can often provide a wealth of infor- Community Planning for Nursing in South Dakota, mation if brought together by the planning group in consolidate a large amount of statistical data in the tabulated form. For example, many State boards of seven areasdiscussedpreviously.(See page 63.) nursing have considerable information derived from Available from the Superintendent of Documents, U.S. the licensure process for registered nurses and prac- Government Printing Office, these publications can be ticalnurses and from accrediting or approval pro- very helpful in pointing out to a planning group the cedures for schools of nursing. Tabulation of statistical kinds of existing data that are useful in planning, and information gathered in connection with licensure can the sources of such data. include considerable data on the characteristics and Also helpful in identifying existing sources of data working situation of nurses. Some States collect this is the material contained in appendix 3, which lists information on licenses routinely. Information from the major data areas and sources useful to planning. schools of nursing pertinent to the work of planning groups may include thefollowing: physical condi- Using Existing Data tion of schools, their capacity for expansion, clinical The use of data from existing sources presents few facilities,faculty, and the delineationof problems problems and precludeselaborate,time-consuming concerning recruitment and retention of students. data collection. Use of these data involves the follow- Special surveys and studies sponsored by governing: (1) identifying their sources; (2) assessing their mental agencies, universities, health agencies, research relevance, timeliness, and accuracy;(3)abstracting institutes, and community organizations can provide the data from the original sources for use in the plan- pertinent data and clues to present health and nursing ning documents in a way that would be most meaning- conditions and change over the years. Further infor- ful to the planning group; and(4)analyzing the mation to facilitate planning can be found in the meaning and implicaiions of the data in terms of the findings of research in nursing and other fields related planning objectives. to questions under study. Since 1960, studies of health manpower covering a wide variety of subjects have Identifying Sources been undertaken in many areas. Indexes to research Ali of the agencies, organizations, or private indi- are included in appendix 2. viduals participating in planning can identify sources In addition, information contributing to the analysis of data. At the beginning of the data-collection activity, and interpretation of data and to understanding and it is important that all other sources of existing data assessment of the nursing situation can be obtained be identified, and that agencies and planning bodies by observation, consultation, and through the use of be located and queried as to the availability of data resource persons with knowledge in special areas or useful to planning for nursing. These agencies and fields related to planning for nursing. planning bodies would include not only those in the

6 9 FACTFINDING 65 field of health but also those in related areas, such as development of the plan, and should not be thought welfare, education, and urban redevelopment, as well of as the end product of planning. as manpower planning for other industries. Planning activities in areas seemingly unrelated to health manpower planning can sometimes shed useful insight and Original Data provide valuable data for nurse manpower planning. Although, as mentioned, much of the data needed For example,inadequatetransportationlinkscan for planning will be available from existing sources, createdifficultiesin manpower recruitment, partic- special problems may arise for which no existing data ularly for health institutions that are located in subur- are available to provide appropriate guidance to their ban areas and are dependent on the central city for solution. Existing data may be too refined, of question- sources of supply. References to mass transportation able validity, or out of date. Therefore, special surveys plans may be essential for improved planning for the and studies may have to be undertaken tocollect location of health services and to make meaningful original data that will yield the information needed. projections as to the availability of manpower. Because these studies can be time-consuming and expensive, and require technical expertise, the value of Assessing, Analyzing, and Abstracting the data to be gained from such studies should be Existing data should be carefully selected, analyzed, carefully assessed before the studies are launched. and studied. Some data from existing sources may not lend themselves toa definition and descriptionof Aletlwds of Collecting Original Data particular planning situations. Measures for assessing Questionnaires,interviews,andobservationare data and the limitations of data for planning purposes used to collect original data. Any one or all of these are briefly described in the next section, pages 66.68. methods may be employed to gather data on the same As data are collected, relevant information not avail- subject. able but deemed essential should be noted as areas for Ouestionnaire.The questionnaire, perhaps the most special surveys or studies or for which special con- widely used method for original data collection, is the sultants and resource people knowledgeable in par- simplest type of data-collecting method to administer. ticular areas relevant to planning may be utilized or It is also less expensive and time-consuming than other required. methods. The questionnaire is used to elicit data on Existing data must not only be analyzed but also the following: (1) objective facts, such as the number abstracted or summarized in a form readily usable by of facilities and services available and the number of planning committees. Planning staff or those responsi- personnel employed; (2) behavioral variables that may ble for factfinding usually produce some type of report be of interest to planning groups, such as kinds of on designated subjects and particular areas of concern nursing activities performed; (3) evaluations, such as to the planning group. feelings about the quality of patient care; and (4) Descriptive information, interpretation, and analysis specified events, such as the time spent by nurses on of the data are usually presented in narrative form, clerical activities. interspersed with quantified data in statistical tables lnierview.The interview methodisused where that clarify and highlight the findings or conclusions questionnaires cannot provide the depth of response drawn from the data, and the implications. The de- required. The unstructured interview permits probing tailed tabulations of statistical materials may be com- into the responses solicited to verify meaning and to piled in statistical tables for further analysis and for obtain data in depth. The highly structured interview reference to particular items as may be necessary. AP allows for the collection of standardized data and in- of these materials may be used later in the wrinen formation and for probing to clarify and broaden documents and publications of the planning body. responses. It should be emphasized that some recommendations Observations.The observation method is used for and implications for planning action programs may studies in which evaluation is the primary objective or he suggested by the analysis of data, without need for where data required are complex, are difficult to ob- further detailed assessment or !'.udy. The statistical tain,andneedconsiderableinterpretation.Such surveys and analyses, however, are only a stage in the studies would include,for example, evaluating the 66 CHAPTER 6 activities of personnel or the quality of their perform- Research as Part of Planning ance. Data are recorded in the form of an evaluative The identification of nursing situations and problems rating of what is being observed, a narrative descrip- requiring researchis a natural outgrowth of an in . tion of what was seen, or as entries on a checklist. The depth assessmentof nursing needs andresources. use of this method requires considerable control over Planners recognize that methods of augmenting exist- the observation to ensure reliability. ing personnel resources must be developed both by The various methods available for collecting original exploring creative ways to utilize personnel and hy data cannot be described in detail here. Statistically developing pi.ocedures for education and training of trained persons who are recruited forthe planning personnel. Although the particular approach in each activity have knowledge of these methods. Also, many planning area must be guided by existing conditions. excellent books are available on data-collection and the development of nursing programs may depend data-processing. ...won study and research to determine the nature of the basic problem to be solved, the means for solving the Special Studies problem, or the means for applying a solution already found. It is difficult to anticipate the kinds of special studies Problems requiring formalized research are cited in that may have to be undertaken for a specific planning the reports of many planning groups. Among these, for activity. This will depend upon the nature of the prob- example, are the following: lems encountered in the planning process, as well as Discrepancies between current nursing practice the status of available data. and basic nursing education. To mention but a few, special studies have been Measures of the quality of nursing care and conducted in planning activities for nursing concerning services. the following: Effective information on recruitment and counsel- Utilization of nursing personnel. ing programs and techniques. Nurse staffing. Career choices and motivation. Patient's needs for services. Effectiveness of various financial and other incen- Turnover of nursing personnel in employing in- tives as a means of increasing nurse manpower. stitutions. Evaluation measures and techniques for effec- Interstate mobility among nurse manpower. tiveness of nursing service and nursing education Job and career satisfaction and incentives. programs. Salaries and fringe benefits. Processes for effecting change in personnel utiliza- Processes of recruitment for nursing. tion and nursing programs. Nature of nursing school applicants and applicant Stimulating,promoting,orsponsoringnursing experience. research geared to the particular needs of the planning Costs of nursing education to schools and students. area is an essential part of continuous planning. Re- Costs of nursing services. search is required for attaining long-term goals con- Inactive nurses. cerned with the improvement of nursing care, nursing Study techniques and methodologies developed for services, and personnel resources. References to Fed- conducting specialstudiesof particular aspects of eral assistance programs in health research fields are nursing are referenced in appendix 2. listed in appendix 2.

Assessing Adequacy of Data and Data-Collection Methods

In the data-collecting process, the adequacy of the in statistics can indeed modify the findings and the methods used, the quality of the data, and the rele- conclusions to be drawn from data. Therefore, plan- vance of the data to the planning activity should be ners should be aware of potential distortions in statis- assessed. Flaws in collection methods and inadequacies tics and error factors in collection methods. FACTFINDING 67

The following four criteria should be applied to any experience, and best judgment for making some of method of data collection to evaluate its quality: their planning decisions. Validity: The degree to which the data-collecting Existing Data method yields data that are relevant to the problems Existing data are secondary sources of data, and as being investigated. such have certain limitations. For adequately defining Reliability: The extent to wbich the method yields particular planning situations and making relevant accurate or consistent data. planning decisions, itis important that existing data Sensitivity: The degree to which the data discrim- be evaluated in terms of these possible limitations: inate. (I) definition, (2) refinement, (31 accuracy, and (4) Meaningfulness: The degreeto whichthedata timeliness. possess practical significance. Definitions.Definitions used in existing data may Attention should be given to these major sources of not correspond tothedefinitionsof the planning error in data collection: project. An example of this is the term "manpower Sampling error: Technically used to denote the shortage." In some studies, "manpower shortage" may difference between the value of a parameter of a be defined as the number of vacant budgeted positions universe and the value of the statistics derived from for healthmanpower. In other studies, "manpower the sample of the universe. shortage" might be defined as the difference between Observer error: Psychological bias or mistakes in some optimal desired number of health manpower rating on the part of observers. (based on criteria of what constitutes good health Response error: Failure of the respondents in a care) and the number actually employed in providing study to participate or to give accurate or complete health care. responses. Refinement.Existing data may be either too re- Data-processing error: Errors in collecting data, fined (detailed) or not refined enough to be of use for and inadequate editing or errorsin coding, card- planning. Groupings of data in terms of one or more punching, tabulating, and programing data. ofits variables may not coincide with descriptive The extent of error in collecting data can be mini- requirements of planning groups. Categories of data mized and precise data can be obtained and skillfully may be too broad, or data may be grouped into too interpretedif planners are critical about their data- many categories for defining a particular situation. collecting processes and provide for appropriate as- For example, data on turnover of hospital personnel sistance as required for the following: sometimes are not refined enough; they do not dif- Assessing existing sources of data. ferentiate between the various categories of nursing Determining theeffectufthedata-collecting personnel,asregisterednurses,licensedpractical methods on the data. nurses, and nursing aides. An overall turnover rate Designing original data-collection instruments. may disguise the fact that for nursing aides the turnover rates are very high, whereas for practical nurses ' Limitations of Data the turnover rates are very low. On the other hand, census data on the age distribution of the population Planners also needto be alerttothepotential are too refined; they are broken down into 5-year limitations of data which tend to impede effectiveness groups. Broader age groupings may be more meaning- in assessing needs and resources. One of the greatest ful for health manpower planning. problems in assembling available data for health manpower planning is lack of a coordinatedstatistical Accuracy.lt isdifficult to evaluate the accuracy effort for the collection of data focused on planning. of existing data. They may be incomplete or may have In addition, many gaps exist in data required for been inaccurate when originally collected. Such de- health planning. Some of the gaps are related to the ficiencies may be undetected by the user of the data, need to develop study mcthods and statistical reporting particularly if the limitations are not made known. systems, which are costly and difficulttoproduce. Timeliness.Data may be too old to be of value for Until means for overcoming these deficiencies are making relevant planning decisions. There is often a found, planners must rely on their own knowledge, 2- to 3-year lag between the time of collection of data 68 CHAPTER 6 and the time of publication. The stability ofdata. Precise measuring techniques for evaluating the however, should be assessed against the degree and impact of demographic cultural and economic influ- rate of change in the factors which the data portray. enres and change. When current data are not available, estimates of current data can be made by extrapolation and projec- Precise data and means for measuring supply tion techniques that use a series of data from a number needs. of previous years. Gaps in Data.As a basis for planning, data and Uniform standards for programing and staffing. statistics should reflect all components of the health Incomplete reporting ofdata due to varying care services and health manpower educational system requirements for reporting data among health and and their relationship to one another. Measurements educational agencies and political jurisdictions. of the amount and quality of care and services provided are needed, as well as measurements of future Designation of data as confidential by the collect- needs. The major gaps in these data requirements for ing agencies for reasons which they consider judicious planning concern the following: for carrying out their programs.

Data Information Systemsfor Continuous Planning

To improve the availability and reliability of statis- Projections of nursing supply and needs. tics, increasing recognition is being given to the need Planning groups shouldassume leadershipand to develop cooperative arrangements and systems for responsibilityfor stimulating and rendering active the centralized collection,analysis, and retrieval of support in the development of a statistical health in- data and information required for continuous health formation system for continuous planning. In coopera- planning. An area's nursing supply and needs and the tion with other planning groups and with health and resources for meeting needs could be appraised quickly related agencies, nurse planning groups can guide and and systematically if the necessary facts were gathered, assist in the following: tabulated, and analyzed on a continuous basis. More- Determining the types and kinds of data needed over, an information system for continuous planning for assessing nurse manpower needs and resources. would provide source data and other information for Establishing procedures for collecting and analyz- assessing progress in meeting planning goals and for ing nursing data. shedding light on any needed revisions in the basic Securing the cooperation and collaborationof plan, in terms of new developments that had occurred. programs of nursing service and nursing education in The major kinds of data that should be collected on the statistical information program. a continuing basis are as follows: Achieving the accurate and complete reporting of Supply and distribution of nursing personnel. required data by nursing agencies and institutions. Nursingschooladmissions,enrollments,and Re-evaluating at regular intervals the data re- graduations. quirements; the availability of new data; and the Basic socioeconomic data relevant to providing a procedures adopted for data collection, analysis, and framework for analyzing musing supply and resources. retrieval.

References

ABDELLAH, FAYE G., and LEVINE, EUGENE. AMERICAN NURSES' ASSOCIATION. 1965. Better Patient Care Through Nursing Re- 1969. Facts About Nursing, 1969 Edition. New search, pp. 311-333 and 548-558. New York: The Association. 250 pp. York: Macmillan Co. FACTFINDING 69

CALIFORNIA DEPARTMENT OF HEALTH. STATE OF CALIFORNIA DEPARTMENT OF PUBLIC 1968. The Manpower Planning Subsystem of the HEALTH. DIVISION OF PATIENT CARE FACILITIES AND California Health Information for Planning SERVICES. Service (CHIPS) System. Berkeley, Calif.: 1968. Summary Report, California Health Infor- The Department. 29 pp. mation for Planning Service. Berkeley, DEPARTMENT OF PROFESSIONALand VOCATIONAL Calif.: The Department. 137 pp. STANDARDS. BOARD OF NURSING EDUCATION and NURSE REGISTRATION. U.S. DEPARTMENT OF COMMERCE. BUREAU OF THE 1969. Profile of Registered Nurses in California. CENSUS. Sacramento: The Board. 51 pp. 1970. Statistical Abstract of theUnited States, 1970. National Data Book and Guide to Fox, DAVID J. Sources. 91st Arnual Edition. Washing- 1966. "Data Gathering Methods and Techniques." ton:U.S.GovernmentPrintingOffice. Fundamentals of Research in Nursing, pp. 1,018 pp. 199-226. New York: Appleton-Century- Crofts, Inc. U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WEL- FARE. PUBLIC HEALTH SERVICE. BUREAU OF HEALTH ILLINOIS STUDY COMMISSION ON NURSING. MANPOWER. DIVISION OF NURSING. 1968. Nursing in Illinois: An Assessment 1968 1967. Community Planning for Nursing in the and a Plan 1980, XIV, p. 23. Chicago: The Commission. District of Columbia Metropolitan Area. Source Book for Planning. PHS Pub. MINNESOTA BOARD OF NURSING. 1676. Washington:U.S.Government 1967. Nursing in Minnesota, A Statistical Review, Printing Office. 143 pp. February 1967. St.Paul, Minn.: The Board. 47 pp. PUBLIC HEALTH SERVICE. HEALTH SERVICES AND MENTAL HEALTH ADMINISTRATION. NATIONAL COMMISSION ON COMMUNITY HEALTH NATIONAL CENTER FOR HEALTH STATISTICS. SERVICES. 1969.A State Center for Health Statistics. An 1967. Action-PlanningforCommunityHealth Aidin Planning Comprehensive Health Services.Report of the Community Action Statistics. Public Health Conference on Studies Project, pp. 36-40. Washington: Records and Statistics Document No. 626. Public Affairs Press. Revised October 1969. Washington: U.S. NATIONAL LEAGUE FOR NURSING. DIVISION OF GovernmentPrintingOffice. 23pp. RESEARCH. (Available from National Center for Health 1971. State-Approved Schools of NursingR.N., Statistics,5600Fishers Lane,Rockville, 1971. New York: The League. 112 pp. Md. 20852.)

PHILLIPS, JEANNE S., and THOMPSON, RICHARD F. PUBLIC HEALTH SERVICE. NATIONAL 1967. Statistics for Nurses: The Evaluation of INSTITUTES OF HEALTH. Quantitative Information. New York: Mac- 1969.Health Manpower Source Book. Section millan Co.550 pp. 2,NursingPersonnel,. Revised1969. SCHOOL OF HOSPITAL ADMINISTRATION.MEDICAL PHS Pub. 263. Washington: U.S. Gov- COLLEGE OF VIRGINIA. ernment Printing Office. 144 pp. 1968. Nursing and Health Care in Virginia, p. PUBLIC HEALTH SERVICE. NATIONAL of the Virginia Health Science Division INSTITUTES OF HEALTH. BUREAU OF HEALTH PRO- Commonwealth University, Richmond, Va. FESSIONS EDUCATION AND MANPOWER TRAINING. SLONIM, MORRIS JAMES. DIVISION OF NURSING. 1966. Sampling. A Quick, Reliable Guide to 1969.Source Book for Community Planning lor Practical Statistics. New York: Simon & Nursing in South Dakota. Washington: Schuster, Inc. 144 pp. U.S. Government Printing Office. 232 pp. Chapter 7 Assessing Requirements for Nurse Manpower FACTORS IN ESTIMATING NURSE MANPOWER REQUIREMENTS

EE IIIIIO 1 OM

Migration Utilization Recruitment of facilities pool and nurse supply

...... Facilities, EPI1, criteriay.and standards for care and services ......

Type of Distribution educational of facilities program and nurse supply Inactive

...... ,, ::' ......

72 Chapter 7 Assessing Requirements for Nurse Manpower

Manpower planning in any field cannot proceed recommendations, and for establishing guidelines to logically without a careful assessment of manpower meet requi rcments. requirements, both qualitative and quantitative, and Intelligent planning relates requirements for nurse both current and future. Nurse manpower require- manpower to available resources. Projections of future ments must he measured in all nurse manpower plan- requirements should be supported by determinations ning projects, to provide a framework for assessing that attainment is reasonably Possible, and should indi- the adequacy of the supply of nurses. Furthermore, cate measures required for that attainment. Estimates supply requirements must be determined for broad of future supply provide a framework for assessing geographic areas as well as for particular fields of the likelihood of meeting requirements. In addition, nursing and for the various types of institutions and perspective oneducationalresourcesnecessaryfor agencies where nursing services are rendered or nurs- meeting manpower needs and demands can be obtained ing programs are carried out. Such measurement is by a careful examination of projected manpower re- essential for setting goals, for developing meaningful quirements against projected manpower supply.

Concepts in Assessing Manpower Requirements

Measurement of manpower requirements falls into tion ratios or nurse-patient ratios to express current two broad classes: demand and need. Health inan requirements. Future requirements are then projected power demand defines requirements.primarily on the in terms of supply based on some aspect of the man- basis of economic factors. In other words, demand can power-population ratio or nurse-patient ratio. be assessed by determining how many dollars are Ratios may be either a single aggregate ratio of all available from employers to pay for salaries as meas- nurses to total population or a set of demand or need ured by the. number of budgeted positions. Health ratios for different areas of nursing. Ratios that use manpower need, on the other hand, defines require- a single gross factor affecting manpower in determin- ments by considering the standards, expectations, and ing requirements are termed "crude ratios." Ratios that consider more than one factor are termed "re- values as determined by health professionals. Need can fined ratios." he assessed by applying criteria considered to produce optimal levels of nursing care or service. For clarity, Crude ratio projections, for example, assume that throughout the remainder of this chapter, the words the only factor that will affect the future demand and "demand" and "need" are used only in the context need for nurse manpower is population growth. Re- of these concepts of demand and need for measuring filled ratio projections, however, go beyond the population factor; they embrace a set of ratios for different manpower rcqui rements. areas of nursing to determine overall needs. For ex- Demand for health manpower is derived from &- am*, such sets of ratios might consider the number mild for healthcare; need for health manpower. of sAool nurses required based on the number of from need for health cam. To measure and project schools in the future; of office nurses required based both demand and need for nurse manpower, ratios for on the number of physicians' offices in the future; and current and future supply are usually derived. For of hospital nurses required based on the number of example, both demand and need estimates of man- patients in hospitals in the future. Detailed examples power requirements frequently use manpower-popula- of various levels of nurse manpower requirements for

73 74 CHAPTER 7 one State, using crude and refined ratio projection Planning lor Nursing in South Dakota, referenced at methods, are contained in Source Book lor Community the end of this chapter.

Methods for Measuring and Projecting Demand

Demand for nurse manpower is difficult to measure in each nursing service agency and institution in the because of the variety of health services and nursing geographic area for which planning is being done. The personnel from which demand is derived. The most difference between the total demand (budgeted posi- popular method utilizes crude demand ratios, and even tions)and the actual supply represents manpower these may be imprecise measurements because of dif- shortages (the budgeted vacancies). ferences in the definition and perception of the single Ratios of current demand for nursing personnel are factor of measurement used. For example, differences computed by relating total budgeted positions (supply in fiscal resources, in perception of need for personnel. plus budgeted vacancies) to some population base. The in utilization patterns, and in availability of personnel population base could he total population or some resources lead to inconsistencies in the demand esti- selected segment. such as the number of people in mates of budgeted positions from one institutionto hospitals, or the number of people 65 years of age another. and older. Other methods utilize refined demand ratios. To be precise, refined demand ratios need to be constructed Projecting Future Demand with respect to the many interrelated demand variables The most widely used method for projecting future such as philosophies toward care, institutional patterns demand for nurse manpower isto apply ratios of relating to staffing patterns, and the volumes of health' current demand for nursing personnel to population care rendered by the various health servicesin the projectionsat some futuredate. This method of planning area. estimating future demand assumes that current demand for nursing personnel will remain constant into the Measuring Current Demand future and yields a projection of the status quo. How- The usual approach to computing demand ratios is ever, changes in patterns of the delivery of health care to measure demand by determining the total number of in the future might result in significant shifts in the budgeted positions for nursing personnel. Staffing re- demand level for nursing personnel, which would not quirements are the total number of budgeted positions be reflected in the projection.

Methods for Measuring and Projecting Need

The most frequently used methods for assessing Measuring Need Based on Standards and nurse manpower need are based on the application Criteria of a set of standards or criteria that quantitatively The application of standards and criteriainthe express desirable ratios of nursing personnel to the assessment process was discussed in chapter 5. Methods population served. Other methods focus on the need of assessing nurse manpower need based on a set of of consumers for nursing care as being the primary standards and criteria require the derivation of staffing determinant of manpower requirements. Those meth- standards for determining the quantity and mix of ods, however, are extremely difficultto apply,are nursing personnel needed toattain some optimum time-consuming, require an enormous research effort. goal. Staffing ratios are determined and are applied and, in their present stage of methodological develop- as standards to the institutions and agencies inthe ment, are impractical for determining overall need for planning area. Projections of need are then based on planning purposes. estimatesof the number of persons seeking health ASSESSING MANPOWER REQUIREMENTS 75

care at some particular pointintime.Ideally,to ratios are also periodically estimated for counties and adequately estimate nurse manpower need fora total metropolitan areas, or can be derived from licensure planning area, different staffingratios for the many data available from State boards of nursing. The ratios different staffing patterns in the various fields of nurs- of the States that rank highest in their nurse population ing are required. Approaches to the derivation and distribution or the ratio of any selected State or other application of 'standards for estimating need include area can be used as a standard. Need is thus projected the following: on the basis of a selected optimum ratio that bas been Using existing staffing standards and ratios de- attained in another area. rived from previously conducted studies and research or determined as part of planning. Standards Based on Expert Judgment Constructing desirable staffing ratiosbased on Instead of current ratio projections, a setof de- the knowledge, experience, and expert judgment of sirable ratios based on assessment of future patterns planners. of nursing care and their impact on nursing need can Undertakingresearchprogramstodetermine be developed. In this approach, planners and experts staffing patterns to be. used as standards. selected for this purpose construct a model of the future organization and delivery of nursing services. Standards Based on Ex&ting Staffing Ratios Criteria arc developed based on value judgments for Standards based on existing good practice can be staffingandfortheeducationalpreparationthat used as models for making projections. Previous sur- should be required for the various nursing positions veys, studies, research or other planning activities may in cachfieldof nursing employment. By applying have derived staffing ratios that can be applied for these criteria and staffing patterns to the appropriate projecting need. Or the planning groupitself may hospital population expected, the projeeted number of derive staffing ratios through its own stuidy or studies nursing homes, the general population, and the num- of existing staffing ratios. ber of students, it is possible to estimate the number A set of model institutions in which "good" nursing of nursing personnel required for each field. care is reported to be provided can be selected. The An example of the determination of national nurs- existing staffing ratios in these institutions can be de- ing need through the use of an expert panel was the termined and applied to all institutions in the popula- Surgeon General's Consultant Group on Nursing, who tion in which the assessment of nursing need is being reported their findings in Toward Quality in Nursing. made. For example, in 1948 the National League for (See reference at the end of this chapter.) In develop- Nursing Education selected 22 hospitals in the New ing its estimates of nursing requirements for hospitals, York City arca that were reputed to be well-managed for example, the consultants believed that the numer- and were providing high-quality nursing care. An ical ratio of nursing personnel to patients in general intensive study was made of the nurse-patient ratios hospitals in 1963 would probably be adequate for in these hospitals. (See reference at end of chapter). 1970. The consultants also believed that distribution Itwas determined that the average ratio was 3.5 of nursing personnel giving bedside care should be hours of nursing care per patient per day, of which 50 percentregisterednurses,30 percentlicensed two-thirds was provided by registered nurses and one- practical nurses, and 20 percent other nursing per- third by nursing aides, practical nurses, and others. sonnel,50-30-20 mix insteadof the thenexisting Similar studies could be made by the planning group 30-20-50 mix. in other fields of nursing. For example, "good" home A fullerdescriptionofthe methodologyiscon- health agencies could be studied and their staffing tained in Part VIII of Health Manpower Source Book, patterns determined;their patterns could serve as Section 2, Revised 1969. (See reference at end of standards for projecting needs inall home health chapter.)Itis recognized that many of the criteria agencies. used, the judgments about the future status of nursing, Nursepopulation ratios of geographic areas with and the predictions about the need for nursing care highratioscan beusedasstandards.Registered in the future, all represent the values and philosophies nurse-populationratiosexistingintheindividual of the particular group of experts involved. However, States are estimated periodically from data obtained a projection of nursing needs by this method attempts from the registered nurse inventories. Nurse-population to free itself from the status quo and considers changes 76 CHAPTER 7 that are likely to occur in health care, efficient staffing Measuring Need Based on Requirements for patterns in response to these changes, and the appro- Nursing Service priate amount and mix of care. Such projections need Methods of determining manpower need by assessing to be re-examined from time to time. to assess their people's requirements for nursing service may be of continued relevance and meaningfulness. interest to planning groups who have resources for having research conducted or who must determine requirements in particular areas. Nursing requirements Standards Based on Research can be aggregated from the assessment of the needs of consumers, which would include not only people who Numerous research projects can be undertaken to areillbut also those who are well, since everyone establish standards for determining nursing needs. needs preventive care. Such studies would be aimed at determining staffing Some methodology is available for assessing patient patterns that would optimize economy, efficiency, and requirements for nursing services. (See appendix 2.) quality. These methods, however, areconcerned only with people who are ill and whose needs for health care Research conducted todevelop optimum staffing have already been identified;the objectives of the patterns suggests that no single staffing pattern would methodology are to classify the needs according to a be applicable to large groups of employing institutions. scale of intensity of illness for purposes of allocating Factors affecting nursing requirements include,for patients to different facilities or assigning staff. Among example, the form of nursing organization, the effi- such methods are the varioustools that have been ciency of the organization, and the levels of educa- developed toclassify patients for hospital, nursing tional preparation and experience of nursing personnel home, and home care, according to the intensity of providing care. Attempts to yield methods that would their illness, and to translate these classifications to need for nursing personnel. A broader approach would incorporate the significant variables related to man- assess comprehensive health care needs for all persons, power requirements have not been definitive. Much of regardless of whether theyarepatients. Although the research that could be conducted in the improve- existing methodology is confined largely to determin- ment of nursing practice and utilization could help in ing medical needs, itis also possible to conceive of providing criteria for assessing nursing requirements. methodology that would determine nursing needs.

Selecting a Method

All of the methods that have been used to estimate for esta bushing requirements of the various institu- nurse manpower requirements for the purposes .of tions and agencies in the planning area. planning have limitations. All can be criticized. There The areas or fields of nursing that may require is serious lack of precision in projection techniques. an in-depth assessment of requirements for developing Much research is needed to improve methodologies. meaningful recommendations. However, since estimates of current and future manpower requirements are essential to formulate rational The simplest approach is to base future estimates on goals and to provide guidelines for achieving these the concept of economic demand. This method usually goals, planners must select some method or methods gives the most conservative estimate. Many planning for measuring current and future manpower require- groups find the most satisfactory approach is to use ments. Such a selection will be conditioned by the standards based on expert judgment. Planning groups following: might find it useful to examine what other planning The resources and capability ofthe planning groups have done in estimating future manpower re- group to compile and quantify relevant data. quirements. A list of reports of planning groups is The method offering the best analytic framework contained in Appendix 1. ASSESSING MANPOWER REQUIREMENTS 77

Estimating Future Supply

The capability of planning areas tomeet nurse Variations in the use of this gain.loss ratio method manpower requirements, whether set by need or de- for projecting supply also permit determination of the mand measurements, should be assessed.Although number of graduations needed, supply replacements, inadequacies are implicit in all methods for estimating and growth required to attain specified goals in the the future nurse supply, the use of these methods can nurse supply. Such compilations can, for example, be give indications of whether goals will be unmet, met, related to and guide educational efforts in the follow- or exceeded. In addition, these methods can be used ing: to determine requirements for reaching desirable goals. The adequacy of existing and projected training The most frequently used methods for projecting facility capacities. nurse supply are as follows: (1) straight-line projec- The required number of admissions to education methods, which predict supply by applying trends tional programs. of recent years tothe projection date and which The required size of the future manpower pool assume that increases in the supply will continue at for training. the same rate as in past years;(2)"age-specific A full discussion of the method of computation is occupational employment rate methods," which con contained in Source Book for Community Planning sider the number of persons employed in the occupa- for Nursing in South Dakota, referenced at the end tion by age and the number of persons qualified for of this chapter. The use of the method as applied to the occupation or educational output. national nurse supply projections is further discussed The most accurate projections of future nurse supply and illustrated on pages 125-144 of Health Manpower are made by using a variation of the "age-specific Source Book, Section 2, Nursing Personnel, also refer- occupational employment rate method" provided the enced at the end of this chapter. projections are made for short periods and are fre- Much research is needed to improve techniques for quently revised. Projections of the nurse supply are projecting supply. For more refined projections for made by adding the expected output from education planning areas, variables such as the following would and training programs in the planning area to the need to be considered: current employed nurse supply after deducting attri- Migration rates in and out of the planning area. tion. Included are estimates for the number of nurses The nature and size of the manpower pool for who leave the occupation through marriage, death, training. retirement, inactivity, or transfer out of the planning Changed conditions in the future affecting de- area. mand and need for nursing personnel

References

ALBEE, GEORGE W. MEYER, BURTON. 1968. "ConceptualModels and Manpower Re- 1957. "Development of a Method for Determining quirements inPsychology," American Estimates ofProfessional Nurse Needs." Psychologist, 23 (5) : 317-320 (May). Nursing Research, 6 (1) : 24-28 (June). FOLK, HUGH ; and YETT, DONALD E. MOUNTIN, JOSEPH W.; PENNELL, ELLIOTT H.; and 1968. "Methods of Estimating Occupational At- BERGER, ANNE G. trition." Western Economics Journal, VI 1949. "Health Service Areas: Estimates of Future (4) : 297-302 (September). Physician Requirements." Public Health MAKI, DENNIS R. &Hain No. 305. Washington: U.S. Gov- 1967. A Forecasting Model of Manpower Require- ernment Printing Office. 89 pp. ments inthe Health Occupations. In- MYERS, JOHN G., and CREAMER, DANIEL. dustrialRelations Center,IowaState 1967. Measuring lob Vacancies: A Feasibility University, Ames, Iowa. 147 pp. Study in the Rochester, N.Y. Area. New 78 CHAPTER 7

York: National Industrial Conference U.S. DEPARTMENT OF LABOR.BUREAU OF LABOR Board, Inc. 278 pp. STATISTICS. NATIONAL LEAGUE FOR NURSING. COMMITTEE ON THE 1963. The Forecasting of Manpower Require- FUTURE. ments. BLS Report 248. Washington: 1957. Nurses for a Growing Nation. New York: The Department. 96 pp. (processed). The Association. 31 pp. BUREAU OF LABOR STATISTICS. NATIONAL LEAGUE FOR NURSING EDUCATION. DEPART- 1969. Tomorrow's Manpower Needs. National MENT OF STUDIES. manpower projections and a guide to their 1948. A Study of Nursing Service. New York: use as a tool in developing State and area The League. 63 pp. manpower projections. Vol.1, Developing SOMERS, ANNE R. Area Manpower Projections.Bulletin 1606 1968. "Meeting Health Manpower Requirements (February). Washington: U.S. Govern- Through IncreasedProductivity." Hos- ment Printing Office. 100 pp. pitals, Journal of the American Hospital Association, 42: 43-48 (Mar. 16). WALKER, JAMES W. 1969. "Forecasting Manpower Needs." Harvard U.S. DEPARTMENT OF HEALTH, EDUCATION, AND BusinessReview, 47:152-154(March. WELFARE. PUBLIC HEALTH SERVICE. April). 1963. Toward Quality in Nursing: Needs and Goals. Report of the Surgeon General's WEISS, JEFFREY H. Consultant Group on Nursing. PHS Pub. 1967. The Changing Job Structure of Health 992, pp. 15-23. Washington: U.S. Gov- Manpower. Cambridge, Mass.: Harvard ernment Printing Office. University. 267 pp. PUBLIC HEALTH SERVICE. NATIONAL WORLD HEALTH ORGANIZATION. REGIONAL OFFICE FOR INSTITUTES OF HEALTH. EUROPE. 1969. Health Manpower Source Book. Section 1969. Methods of Estimating Health Manpower. 2,NursingPersonnel. Revised1969. Report on a symposium convened by the PHS Pub. 263, pp. 125.144. Washington: U.S. Government Printing Office. Regional Office for Europe of the World Health Organization, Budapest, 15-19 Octo- PUBLIC HEALTH SERVICE. NATIONAL ber 1968. EUR00289. Distributed by INSTITUTES OF HEALTH. BUREAU OF HEALTH PRO- theRegionalOfficefor Europe, WHO, FESSIONS EDUCATION AND MANPOWER TRAINING. Copenhagen. 141 pp. DIVISION OF NURSING. 1969. Source Book for Community Planning for YETT, DONALD E. NursinginSouthDakota,pp.87-90. 1965. "The Supply of Nurses: An Economist's Washington:U.S.GovernmentPrinting View." Hospital Progress, 46 (2) : 88-102 Office. (February). ASSESSING MANPOWER REQUIREMENTS 79 Appendixes 1-3

Page Appendix I.Survey and Study Reports 83 Appendix 2.Background Material and Tools for Planning 127 Appendix 3.Guide to Statistical Data 167

8 04 Appendix 1 Survey and Study Reports

This appendix lists references to reports of major or typical surveys and studies on planning for health manpower needs and resources that have been carried out in the United States. No attempt has been made to include all such reports; additional ones may be found for individual jurisdictions. The reports listed here document the many changes and advances since the 1920's in health and nursing services, health manpower resources, and nursing education. They also depict the progress made in meeting needs and demands for health and nursing services. In addition, they provide a way to evaluate the various measures taken to meet the needs and demands. And finally, they point to the many old and unsolved problems in nursing, as well as the new, emerging ones. Appendix 1 is divided into two parts. Part 1 pertains to overall health manpower needs and resources; part 2, to nursing manpower needs and resources. Within each part, the oldest referenceslisted in the first sectionare of historical interest. The references are arranged, within each section or group, in chronological order. Most are annotated. In the last section of part 2, blueprints for nursing education are defined and a few examples of State blueprints are referenced. I,

Contents

Part 1

NEEDS AND RESOURCES IN OVERALL HEALTH DISCIPLINES AND MANPOWER

Page Historical Reports, 1925-38, National 85 Reports, 1948-60, National 86 Reports, 1962-70; National, Regional, State and Territorial 88 National 88 Regieual 91 State and Territorial 91

Part 2

NEEDS AND RESOURCES IN NURSING Page Historical Reports, 1923-34, National 99 Reports, 1946-61; National, Regional, State and Territorial 100 National 100 Regional 101 State and Territorial 102 Reports, 1962-71; National, Regional, State and Territorial 106 National 106 Regional 109 State and Territorial 110 Blueprints for Nursing Education 125 Group 1. Prescribing General Guidelines 126 Group 2. Prescribing Time-Phased Geographic Plans 126

84 Part 1 Needs and Resources in Overall Health Disciplines and Manpower

Historical Reports, 1925-38; National

FLEXNER, ABRAHAM. Needs for dentists were estimated at 99-179 per 100,000,com- 1925. Medical Education: A Comparative Study. pared with the existing ratio of 56. Lee and Jones doubted, New York: Macmillan Co. 334 pp. however, that the Nation was economically able to supportan increased supply of professional health personnel at that time. Flexner attempted to make a comparative study of medical The authors concluded that the provision of adequate medical educationincertainEuropean countries andinAmerica, care depended more upon revision of organization and economic againstthe background afforded by the general educational arrangements than upon increases in the number of personnel. and social systems of the respective countries. The theme of (Excerpted from Report of the National Advisory Commission this book, on the clinical side, is that internal medicine is tile on Health Manpower, Vol. H, p. 265. Washington: U.S. Gov- controllingfactor. The other branches of medicine are not ernment Printing Office. November 1967.) considered unimportant, but Flexner believed that if a sound organization is perfected and if support can be obtained and TECHMCAL COMMITTEE ON MEDICAL CARE OF THE the medical clinic is properly carried on, the requisite adjust- INTERDEPARTMENTALCOMMITTEE To COORDINATE ments in other clinics will come about. Discussion of post- HEALTH AND WELFARE ACTIVITIES. graduate education is not included because it presents other problems. Examinationsfor lieensure are omitted from the 1938. The Need for a National Health Program. discussion, although Flexner believed that if the general trend- ReportoftheTechnical Committee on of his presentation was sound, the examinations for licensure Medical Care.Washington, D.C. 36 pp. would in time be adjusted. Flexner's book did much to show (multilithed). the way for a sounder and more scientifically motivated form of medical education inthe United States.Itwas timely and "Reviewinghealthnumpowerrequirementsforeffective forward looking in 1925, and even today is considered to be modern health service, this Committee found that many areas a distinguished report. ofthecountry lacked an adequate supplyofphysicians, dentists, and nurses; and that even in better supplied areas, LEE, ROGER I., and JONES, LEWIS W. inabilitytopay for carefrequently preventedfulluse of 1933. The Fundamentals of Good Medical Care. available personnel. The supply of physicians and private.duty Chicago:UniversityofChicagoPress. nurses, if adequately distributed, appeared to be approximately 302 pp. (Known as the Lee-Jones study.) sufficientto meet the currenteffective demand for service. Public health nursing suffered from an under-supply of person- On behalf of the Committee on the Costs of Medical Care, nel, especially inrural areas. The number of dentists was Drs. Lee and Jones estimated heahh manpower requirements grossly inadequate to meet true need, althoughitsufficed to of the Nation on the basis of expert opinions on the amount of care needed to provide adequate preventive, diagnostic, and satisfy demand under current methods of payment. The com- curativeservices. By computing treatment requirements for mitteecalledfor development of a national health program specificdiseases and conditions, the authors found atotal to improve the attractiveness of practice inunder-privileged need for 134.7 doctors per 100,000 population, or 165,424 for areas and to lower economic barriers to the receipt of care." the United States(a shortage of 13,000). Nurse needs were (Quoted from Report of the National Advisory Commission on estimated at about 220 per 100,000 people, below the national Health Manpower, Vol. II, p. 265. Washington: U.S. Govern- supply hut well over the ratio in many parts of the country. ment Printing Office. November 1967.)

85 86 APPENDIX 1

Reports, 1948-60; National

EWING, OSCAR R. pected supply of physicians in 1960 would have been 227,119. 1948. The Nation's Health: A Ten-Year Program; To meet the three standards, the nation would have required an additional 45,000, 34,000 and 17,000 physicians, respectively. A Report to the President. Washington: "For purposes of computing present physician supply, Dr. U.S. Government Printing Office.. 186 pp. Mountin and his staff used health service areas outlined by "On the hasis of the National Health Assembly's deliberations them in the course of prior studies of the distribution of hos- and of consultations with many persons in and out of Govern- pitals and the adequacy of available beds. These areas included ment, Federal Security Administrator Ewing reported to the health servicedistricts(generally a nucleus county withits President that it was not enough to meet present effective de- hospital center, surrounded by several adjacent counties whose mand; we must assure people services for all their needs. As hospitalfacilitieswerelessadvanced), andhealthservice a standard of adequacy based on actual experience, Ewing pro- regions(severaldistricts fallinginto a more or less broad posed the level of supply already attained by the top 12 States trade area). Projections of future physician requirements were .1 physician for every 667 persons (150/100,000), 1dentist based on regional data. for every 1,400 persons (72/100,000), and 1 nurse (professional "Because of the length of time required to expand medical or practical).for every 280 persons(357/100,000). He cited school output, the authors noted, it would be a practical specific shortages of psychiatrists, pediatricians, public health possibility to meet even the smalkst deficit projected (17,000 workers, and certain categories of supporting personnel. ad(litional physkians) in the time available between 1949 and "Simply to staff expanded health facilities planned under the 1960. Allowing another decade for taking care of expected Hospital Survey and Construction Act of 1946, to meet military deficits, present medical training facilities would still have to and other Federal requirements, and to provide basic minimum be expanded considerably. services throughout thenation under an adequate system of "The analyses presented by Mountin et al., were intended to prepayment for health services, we would have needed by 1960 illustrate methods of preparing physician estimates for some a 40 percent increase in medkal school graduates, a 50 percent future date, if different assumptions were made, and to indicate increase in dental school graduates, and a 50 percent increase possible locationpatterns for physicians. The authors noted in the output of all types of nurses. Mr. Ewing recommended that many forces now limiting effective demand for physicians aiming first toward meeting the nation's minimum demand and, in sonic areas would have to be removed or modifiedbefore beyond that, pushing toward achieving the 12-state goal. the distribution of physicians would parallel more nearlythe "As a means of promoting the needed expansion of training distribution of population." capacity for the health professions, Ewing proposed Federal (Quoted from Report of the National Advisory Commission aid of at least $40 million a year at the outset (more in sub. (n Health Manpower, Vol. II, pp.268.269. Washington: U.S. sequent years) for the construction of new or expanded schools, Government Printing Office. November 1967.) the operation of teaching programs, and ascholarship and fellowship program for students. At the same time, he recom . HEALTH RESOURCES ADVISORY COMMITTEE(RUSK mended theFederalGovernment shouldencouragegreater COMMITTEE). efficiencyin the use of professional personnel through the 1951. "Medicine, Mobilization and Manpower." further development of group practice, the wider use of sup. By Howard A. Rusk, Chairman. Wash- porting workers, the extension of refresher and postgraduate 6 pp. training courses, and other ways." ington, D.C.: The Committee. (Quoted from Report of the National Advisory Commission "Created at the outbreak of the Korean War to advisethe on Health Manpower, Vol. II, pp. 267.268. Washington: U.S. National Security Resources Board on health resourcesessential Government Printing Office. 1967.) during the period of national emergency, theHealth Resources Advisory Committee in1950.51made a serk. of studies MOUNTIN, JOSEPH W.; PENNELL, ELLIOTT H.; and analyzing overall national needs for medical andhealth man. BERGER, ANNE G. power. These included studiesof requirements for physicians, 1949. "Health Service Areas: Estimates of Future dentists, and nurses for the period 1949.54. health Physician Requirements." Public Health "Thc Committee made three basic assumptions as to staff-population ratios Bulletin No. 305. Washington: U.S. Gov- needs. First, we should maintain 1949 and services. Second, we should meetadditional requirements ernment Printing Office. 89 pp. ofcivil ddense, industry, public health,rehabilitation, and "Inthisstudy, Dr. Mountin of theU.S. Public Health teaching in medical, dental, and nursingschools. Third, we Service and his staff estimated requirements for physicians in must meet the needs of the Armed Forces.The Committee also 1960 on the basis of three possible measures of adequacy: To assumed that for the next 10 years the nationmight be in a bring the total active physician ratitis up to those of the top state of partial or complete mobilization. in one.quarter of the inhabitants of the United States(146 per "Atexistinglevelsofproduction, substantialdeficits 100,000 civilians), tlm top third(136 per 100,000) or the top supply of physicians and dentists were foreseen.Because of straight increase half (118 per 100,000). At 1949 rates of production, theex- the time required to train these personnel, a

ciC.) (..;; SURVEY AND STUDY REPORTS 87 in school enrollments would meet only part of the need antici- panels in which experts on various phases of the health needs pated over the following few years. A larger increase could of the Nation presented views and evidence. Included also are be effected by acceleration of classes ahead of the usual and the information and reference materials collected by the tech- current schedule. i.e., eliminating summer vacations. Even with nical staff to the Commission. This volume outlines the diversi- both expansion and acceleration, however, supply was expected lied picture of health needs, facilities, and resources presented to fall behind need. The extent of the deficit by 1954 would be to the Commission, including important health needs related about 22,000 physicians and 9,200 dentists." to special health problems and population groups. (Quoted from Report of the National Advisory Commission THE PRESIDENT'S COMMISSION ON THE HEALTH NEEDS on Health Manpower, Vol. II, pp. 269-270. Washington: U.S. Government Printing Office. November 1967.) OF THE NATION. 1953..Building America's Health. A report to HEALTH RESOURCES ADVISORY COMMITTEE (RUSK the President by the President's Commission COMMITTEE). on the Health Needs of the Nation. Vol- 1951. "Dentistry, Mobilization and Manpower." ume 3,America's Health Status, Needs By Leo J. Schoeny, Member. Washington, and Resources. A Statistical Appendix. D.C.: The Committee. 10 pp. Washington :U.S.GovernmentPrinting See annotation above. Office. 299 pp.

THE PRESIDENT'S COMMISSION ON THE HEALTH NEEDS This volume presents the statisticalmaterials drawn from many sources on the health status of the American people, on OF THE NATION. health personnel andfacilities, and onutilizationof health 1952. Building America's Health. A Report to services. Itis a statistical appendix to volume 2. Included are the President by the President's Commission data on nursing personnel and supply and nursing education on the Health Needs of the Nation. Vol- for 1951 and 1952. This volume is a good example of the varied umeI,Findings and Recommendations. kinds of statistical evidence available and required to support Washington:U.S.GovernmentPrinting an in-depth study. Office. 80 pp. HEALTH RESOURCES ADVISORY COMMITTEE. 1955. "Mobilizationand The Magnuson Commission, as itis commonly known, was HealthManpower." charged with making a critical study of the total health re- Report to the Director of the Office of De- quirements of the Nation and recommending action required fense Mobilization by the Health Resources to assure an adequate supply of personnel, services, and educa- Advisory Committee. 50 pp. tional resources to meet these needs in this time of mobilization and for the future. This summary volume discusses the major "This report sumtnarized some of the more important findings of the Health Resources Advisory Committee of the Office findings of the Commission, as well as an account ofthe premises and reasoning which led to the recommendations. Six of Defense Mobilization on health resources and potentials in the United States, and the effects of military mobilization on different estimates of thetotal requirements forphysicians, specific sections of the whole. The Committee foresaw a declin- dentists, and nurses were projectedto 1960. Federal aidto schools of medicine, dentistry, nursing, and public health for ing ratio of physicians and dentists to population by 1960, and many unmet demands for nurses. Despite improved utilization modernizing and expanding theirphysicalfacilities and for helping meet operating costs was recommended. The need for of health personnel by the Armed Forces, military requirements better utilization of professional personnel and the delegation continued to be high in relation to those of the civilian popula- of tasks to auxiliary workers is stressed. Shortages in certain tion.... Among the areas of greatest need, would be medical and dentalschoolstaffings, paramedical fields were citcd. hospitalstaffing,publichealth activities. and civil defense programs." (Quoted from Report TIIE PRESIDENT'S COMMISSION ON THE HEALTH NEEDS of the National Advisory Commission on Health Manpower, OF THE NATION. Vol. II,p. 271. Washington: U.S. Government Printing Office. November 1967.) 1953. Building America's Health. A report to the President by the President's Commission HEALTH RESOURCES AI;VISORY COMMITTEE. on the Health. Needs of the Nation. Vol- 1956. Mobilizationand Health Manpower: II. ume 2, America's Health Status, Needs and A reportof the Subcommittee on Para- Resources. Washington : U.S. Government medical PersonnelinRehabilitation and Printing Office. 319 pp. Care of the Chronically Ill.Report to the Director of the Office of Defense Mobiliza- This volume gives attention to the varied and extensive data on which the Commission based the conclusions and recom- tionbythe HealthResources Advisory mendations reported in volume 1. Much of the material comes Committee. Washington:U.S.Govern- from the discussantsat 25 panelmeetings and seven joint ment Printing Office. 87 pp.

. ei 88 APPENDIX 1

The primary findings of the subcommittee, which compiled DEPARTM ENT OF HEAvrn, EDUCATION, AND WEL- extensive data on supply and resources of paramedical person- FA RE. PUMA C HEALTH SERVICE. nel, were, inpart, as follows: (ll "An undetermined number 1959. Physicians for a Growing Natim. Report of Americans suffering from physical disabilitiesand chronic illness were in need of services provided by physical therapists, of the Surgeon General's Consultant Group tecupational therapists, social workers, clinical and counseling on Medical Education. PHS Pub. 709. psychologists,speechandhearingtherapists,rehabilitation Washington: U.S.GovernmentPrinting counselors, and nurses. Identifiable trends indicated that this Office. 95 pp. number would increase.(2) There were not enough paramedical personnel of the types indicatedto meet existing needs This report of the Consultant Group is commonly known as or expected future needs.(3) The supply of personnel and theBane report. The group assessedthe quantitative and the level oftheir training didnotconstitute an adequate qualitative needs for and the supply of physicians against thc mobilization base." backdrop of socioeconomic change, technological advances, and It was thought that the program for the training of paramed- trends in health care and services. They projected the number ical personnel being carried out mainly by thc Office of Voca- of physicians required by 1975, and made specific recommenda- tionalRehabilitation andthe PublicHealthService were tions regarding the quality of medical education, the develop- sound and well administered. No new Federal legislation for ment and expansion of educational facilities, and the recruit- training paramedical personnel was needed atthat timeto mentof students. The report set future goals for medical meet national needs, and a mobilization hasc could he achieved education, and defined the supporting role of the Federal gov- through continuing and increased support of existing Federal ernment in aid for construction of facilities, operating expenses, programs. In case of a national disaster, Federal aid could be and student educational grants. substantially increased within the framework of ongoing programs. (Excerpted from Report of the Notional Advisory Commis- THE COMM ITTEEOFCONSULTANTS ON MEDICAL sion on Health Manpower, Vol. II, pp. 271-272. Washington: ESEARCH . U.S. Government Printing Office. November 1967.) 1960.Federal Support of Medical Research. Re- U.S. DEPARTMENT OF HEALTH, EDUCATION. AND WE L- port of the Committee of Consultants on FARE. OFFICE OF THE SECRETARY. Medical Research to the Subcommittee on 1958. The Advancement of Medical Research and Departments of Labor and Health, Educa- EducationThroaghtheDepartmentof tion,and Welfare, of the Committee on Health, Education., and Welfare. Final Appropriations,United States Senate. Report of the Secretary's Consultants on Washington: U.S.GovernmentPrinting Medical Research and Education. Wash- Office. 133 pp. ington: U.S. Government Printing Office. This committee was asked "to determine whether the funds 82 pp. provided by the Government for research in dread diseases Commonly called the Bayne-Jones report, this document con- are sufficient and efficiently spent in the best interests of the tains a set of principles and expresses a philosophy that was research for which they arc designated." The consultants on to provide important guides to the development of the medical thecommittee concludedthat Federalfunds provided for education and research matters of the Department of Health, medical research, w hilc substantial and efficiently used, are not Education, and Welfare. Included arc some broad conclusions sufficient for full utilization of the country's medical research relating tothefuture of medical researchconclusions that potential in the national effort to attain solutions to the prob- would provide useful guidelines for the development of public lems of serious disease. Thc report is .commonly referred to as policy in these fields during the next sm.veral years. the Jones report.

Reports, 1962-70; National, Regional, State and Territorial

National THE PRESIDENT'S COMMISSION ON HEART DISEASE, Manpower needs for the prevention and control of heart disease, cancer, and stroke were viewed by thc Commission as CANCER AND STROKE. inseparable from manpower needs for medical care, generally. 1964. Report to The President: A National Pro- A full-scale attack on these threc diseases would require ex- gram To Conquer Heart Disease, Cancer pansion of the entire work force in health services. Although and Stroke. Vol. 1. Washington: U.S. shortages existed across the entire range of health occupations, GovernmentPrintingOffice. 114 pp. the physician supply was deemed the most critical element. (Known as the DeBakey Report.)

90 SURVEY AND STUDY REPORTS 89

Because needs for trained health manpower were so great as at the core problems of the need for (1) emphasis on training to he unattainable during the decade, the Commission recom- physiciansforcooperativeeffortforoptimum,continuous, mended a twofold program. First,the greatestefforts should comprehensive health services and patient care; and (2) better he made toutilizepresent manpower resources in the most adaptationof educationand practicetothespecialization effective way possible. Secondly, the Nation should imo .3iately made necessary by greater knowledge and skill. begin a massive program for the training of additional physi- Creation of a "primary physician" for first contact practicing cians, dentists, nurses, and other health personnel as rapidly in a group arrangement is recommended, and a program for as possible. his educalion is suggested. The report recommends that general Among the Commission's specific suggestions for streng:hen- medical education terminate at graduation from medical school ing manpower resources were increased Federal appropriations and that :nternship, residency training, and graduate education tinder theHealth Professions Educational Assistance Act,a be a 'tidied sequential program of progressiveeducation. A new program of support for thecreation of 2year medical CommisFion on Graduate Medical Education is recommended schools, project grant support for health careers education and to design educational programs, establish standards, supervise recruitmentactivities,and Federal scholarshipsfor medical graduate training, and assess the quality of graduates. and dentalstudents. Tbe Commission also recommended ex- Other areas requiring further deliberation for solution are pansion of Federal support for undergraduate and advanced pointed up. The reportisa valuable tool for reshaping the clinical training in heart disease,cancer, and stroke; more course of medical education for the future to insure increased investmentinthe recruitment andtrainingofhealthtech- excellence. nicians and other paramedical personnel; and development of (Excerpted from a review by William A. Sodeman, M.D., a Public Health Service health manpower unit for continuous Dean, Jefferson Medical College,in the Journal of Medical assessment of manpower requirements for health services. Education, 42:88-89. January 1967.) (Excerpted from Report of the N,,:ional Advisory Commis- sion on Health Manpower, Vol. II, pp. 274-275. Washington: HARVARD UNIVERSITY PRESS. U.S. Government Printing Office. 1967.) 1966.Health is a Community Affair. Report of the National Commission on Community COGGESHALL, LOWELL T. Health Services. Cambridge, Mass.252 1965. Planning for Medical Progress Through Education. A report submitted tothe PP. ExecutiveCouncilof the Associationof This is a report of a 4,year study sponsored by the American Public Health Association and the National Health Council on AmericanMedicalColleges. Evanston, the provision and delivery of community health services. Com- III.: The Association. 107 pp. prehensive analysis and assessment of resources, needs, and "This report brieflyoutlines the perspective within which demands for services were carried out by sixnational task American medical education has developed, the major trends forces, 21 community health studies, and four regional health related to health care that are now emerging, and their impli- forums attended by 1,000 community leaders.Critical issues cations for medical education and the work of the Association. are raised, positions taken, and recommendations made, but The report gives specific attention to the past and present roles methods of implementation are not specified. of the Association, and the steps the Association should take The study covered many facets of hospitals, health and wel- to channel its future development along the lines that will en- fare agencies, the preparation of health and welfare personnel, able ittoprovide thepositive and effective leadership that health services and jurisdictional areas, accident prevention, the fieldof medical education will inevitably require in the family planning, urban design, and control of man's environ- years and decades immediately ahead." A bibliography is in- ment. The Commission called for support of diploma schools cluded. of nursing as a proven source of supply, and stressed the need for more registerednurseswithdegrees,two-year college AMERICAN MEDICAL ASSOCIATION. graduates, and vocational or practical nurses. Prepaid group practice plans and the development of personal physicians who 1966. The Graduate EducationofPhysicians. would emphasize health care were advocated. The report isa The Report of the Citizen's Commission on call to action. Graduate Medical Education, Commissioned (Excerpted from a review by Suzanne H. Freedman, formerly bytheAmericanMedicalAssociation. associate editor, Nursing Outlook. In Nursing Outlook, 15(7) : John S. Millis, Chairman. Chicago: The 70-76, July 1967.) Association. 114 pp. NATIONAL ADVISORY COMMISSION ON HEALTH MAN- In this report of an external examination and thoughtful, POWER. extensive study of problems in graduate medical education to- 1967.Report of the National Advisory Commis- day, this phase of medical educationa process of specializa- tionis recognized as the larger portion of the formal education .sion on Health Manpower.Vol. I.Wash- of the physician. Recommendations for improvement in this ington: U.S. Government Printing Office. education and mechanisms for their implementation are pointed 93 pp. 91 90 APPENDIX 1

Established by President Join:son in the summer of 1966, tieularly the Federal level. Effective planning for recruitment, thisCommission was charged withdeveloping appropriate education, and tbe use of personnel was urged, as well as im- recommendations for action by government and theprivate proved health manpower statistics and information. Of particular sector for improving the availability and utilization of health concern was the need to assure adequatt numbers of competent manpower. Recommendations deal primarily with present-day allied and auxiliary personnel. The use of non-physician health actions required to assure availability and quality of health service administrators educated in schools of public health was care at a reasonable cost and asbasis for the wise formulation stressed, and the establishment by the Federal Government of of future plans. Key recommendations include widespread re- minimum requirements for licensure of personnel in all health shaping of American health care, the periodic relicensing of professions was recommended. The Task Force concluded that health workers, university supervision of the education of all nursing education should be carried out primarily in institu- health professionals, and mechanisms to force the inefficient tions of higher learning, and hospital schools should continue institution or worker to improve or go out of husiness. It was training nurses until sufficient associate degree and baccalaur- re:kmmended that nursing should be made a more attractive eate programs are developed. For producing adequate numbers profession by such measures as appropriate utilization of nurs- of high quality health personnel, government support atall ingskills,increasedlevelsofprofessionalresponsibilities, levels is required and Federal funds are of greatest importance. improved salaries, more flexible hours for married women, and (Excerpted from a review in Report 01 the National Advisory better retirement provisions. Commission on Health Manpower, Vol. II, pp. 276-277. Wash- ington: U.S. Government Printing Office.) NATIONAL ADVISORY COMMISSION ON HEALTH MAN- POWER. U.S. DEPARTMENT OF HEALTH, EDUCATION, AND 1967. Report of the National Advisory Commis- WELFARE. PUBLIC HEALTHSERVICE. BUREAU OF siononHealth Manpower. Vol.II. HEALTH MANPOWER. Washington:U.S.GovernmentPrinting 1967. Education for the Allied Health Professions Office. 595 pp. and Services.Report of the Allied Health Professions Education Subcommittee of the This volume contains the key materials, data, and analytical reports which are the foundation of the Commission's study. National Advisory Health Council. PHS This includes the original reports of the Commission's seven Pub. 1600. Washington: U.S. Govern- panels: Consumer; Education and Supply; Federal Use of ment Printing Office. 61 pp. Health Manpower; Foreign Medical Graduates; Hospital Care; This reportisprimarily concerned with the problems of New Technology; and Organization of Health Services. meeting needs for health manpower through education, Lv t recognizes closely related needs for the effective use of person- NATIONAL COMMISSION ON COMMUNITY HEALTH nel, the development of new categories of workers, and im- SERVICES. provements in the organizational setting in which health servi- 1967. HealthCareFacilities,The Community ces are provided. Trends and gaps traced inthe supply of Bridge to Effective Health Services. Re- health manpower and educational program output points to a port of the Task Force on Health Care grossly inadequate supply. Need is noted for greater attention Facilities. Washington :PublicAffairs to the analysis of dutieo and qualifications required for the delivery of healthservices. Recommendations are made re- Press. 67 pp. garding the development of career ladders to reduce dead-end This Task Force examined all types of health care facilities jobs in health occupations, improvement in methods to identify for personal health care, their relationship to each other and andrecruitindividuals intothealliedhealthoccupations, to other community services, the factors influencing the health areawideplanning,andthesignificanceoflicensing and care facilities systems,itspatterns of organization, andits accreditation. The appendix includes a list of State reports on shortcomings. It assessedthe changing role and function of allied health manpower, schools of allied health professions, health care facilities,projected future availability, use,and and a State listing of the number of baccalaureate programs in demands for care. selected alliedhealth professions.(Excerpted from a review in "Credit Lines," American Journal ol Public Health and the NATIONAL COMMISSION ON COMMUNITY HEALTII Nation's Health, 58(1): 204.205, January 1968.) SERVICES. 1967.Health Mani,3wer. Action To Meet Corn- U.S. DEPARTMENT OF HEALTH, EDUCATION, AND mum:1y Needs. Report of the Task Force WELFARE. on Health Manpower. Washington: Pub- 1968. Report of the Secretary's Advisory Commit- lic Affairs Press.167 pp. tee on Hospital Effectiveness.Washington: U.S. Government Printing Office. 37 pp. This Task Force foresaw a vast increase in coming years in the need:for gm qfied health personnel at all levels of skill. It Charged with advising on action required to improve the recommended act.onsatthe local,State,regional, and par- performance of hospitals as a functioning mechanism and corn-

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41 SURVEY AND STUDY REPORTS 91 munity health service, this Committee made a few specific This is a report on estimated needs and job openings for recommendations but pointed up priority areas for creating healthprofessionals and assistantstoprofessionals obtained public pressures for action. Improvement of hospital effective- through interviews conducted by the Health Careers Council. ness was seen to lie in better planning for health facilities and The greatest need for professional personnel was for nurses. services; in a licensing or franchisement system with authority Needs for all types of sub-professional personnel were twice to effect needed improvements by controlling the flow of public as great as those for professionals. funds to health facilities and services; in improving the internal management of health care institutions, inlcuding participation ALASKA in management by physicians; in broader benefits and stronger regulations of carriers; and in capital financing and reimburse- CLARK, DEAN A., M.D., and associates. ment methods that will provide incentives for efficient manage- 1965. Health Service Resources, a Profile of the ment of the health care system. (Excerpted from "Credit Lines," State of Alaska.Prepared for the Western American Journal of NI) lic Health and the Nation's Health, Interstate Commission for Higher Educa- 58(7): 1311-1312. July J968.) tion. Graduate School of Public Health, THE CARNEGIE COMMISSION ON HIGHER EDUCATION. University of Pittsburgh, Pittsburgh, Pa. 1970. Higher Education and the Nation's Health: 53 pp. Policies for Medical and Dental Education. This is a report of a survey of the numbers and ratio to New York: McGraw-Hill Book Co.130 pp. population of professional, technical, and other categories of health workers in the State of Alaska. Comparisons with the This publicationa special report with recommendations by U.S. average reveal considerably lower ratios to population in the Carnegie Commission on Higher Educationis concerned Alaska than in other States forpractical nurses, midwives, with more and better health manpower, particularly atthe pharmacists, dietitians, dentists, and optometrists. level of physicians and dentists. The areas covered include the crises in health care delivery and health manpower, medical ARIZONA education today, financial support, the future of health care delivery, and the future of health manpower education. Goals ARIZONA HEALTH SERVICES EDUCATION ASSOCIATION. to be achieved by 1980 are outlined. 1966.Arizona Health Services Education for a New Era of Health Care. Phoenix: The Association. 55 pp. Regional In 1965, as part of the Association's planning program for HEALTH MANPOWER STUDY COMMISSION. the expansion and development of health service education, a 1966. If e al t h Manpower for the Upper Midwest. comprehensivehealth manpower survey was conducted by questionnaires,telephonecalls, and personalinterviews.It A Study of the Needs for Physicians and coveredhealthinstitutions,schools,majorindustries,and Dentists in Minnesota, North Dakota, South private practitioners. Manpower needs and educational gaps Dakota, and Montana. Sponsored by the were identified and recommendations made for meeting re- Louis W. and Maud Hill Family Founda- quirements. Among 24 professional,technical, and auxiliary tion, St. Paul, Minn. 135 pp. heahh occupations surveyed were those in the fields of nursing,medicalrecords,dentistry,X-ray,laboratory,physical Long-range planning for meeting theregional needsfor therapy, occupational therapy, social work, and dietetics.It educating physicians and related health manpower prompted included medical and surgical technicians and assistants. this in-depth study and assessment of the characteristics and distribution ofphysicians and dentists,their services, and ARIZONA STATE EMPLOYMENT SERVICE. MANPOWER educational resourcesin the fuur-State area. Needs and de- RESEARCH AND ANALYSIS SECTION. mands for physicians are projected to 1975. A brief analysis of 1968. Arizona Medical Manpower.Research and growth in the number of nurses in the four States is included. Information Series No. OCC-1-68. Phoenix : The Service.28 pp. State and Territorial National as well as local trends are examined in an attempt toidentify some of the factors contributingtothe current ALABAMA shortage of trained medical health manpower, to determine the extent of present needs and future needsto1975, and to DUNBAR, JOHN. suggest possible ameliorative resources. 1965. "Expanding NeedsintheParamedical Professions." University of Alabama Ex- ARKANSAS tension News Bulletin, No. 23,pp.1-3 THE COMMISSION ON COORDINATION OF HIGHER EDU- (August). CATIONAL FINANCE. 92 APPENDIX 1

1968. Personnel Needs in the Health and Adaptive The information presented inthisreport should he con- Behavioral Problem Service Areas in Ark- sidered only as gross estimates of health manpower needs. Much ofthedata was assembledfromalreadypublished ansas. Report of PhaseI:Manpower sources and the balance compiled or calculated fromun- Project:HealthandRelatedServices. published reports of the California State Department of Public Little Rock, Ark. 124 pp. Health and other agencies. This report was prepared for use by institutions of higher THE CALIFORNIA STATE COLLEGES AND THE CALI- education in program planning and devdopment for meeting FORNIA STATE DEPARTMENT OF PUBLIC HEALTH. Staterequirementsfor health and relatedpersonnel. This phase of a 3-part study presents State needs for professional 1968. Conference on Health Sciences at the Bac- and semi-professional personnd requiring education above the calaureate and Beginning Graduate Level. high school level for services in health care and adaptive be- California State College at Hayward. 151 havioralprobkms.Quantitativeregionalserviceneedsfor 131). optimum care by this type of manpower were identified for 1967 and projected to 1972 and 1977. This report contains the presentations and related materials, as well as the findings of a Conference on Health Sciences hehl in January 1967. The purpose of the meeting was to explore CALIFORNIA the national and regional needs for licahh science personnel, and to delineate the important policy issues relating to state- CALIFORNIA DEPARTMENT OF EMPLOYMENT. wide needs for heahh manpower atthe baccalaureate and 1964. Opportunities, San Medical Service Job beginning graduatelevels. The supply and needofnurse Francisco, Bay Area, 1964-66. San Fran- manpower was included. cisco: The Department.82 pp. Job shortages and future training needs were identified for CONNECTICUT 107 health occupations througha skill survey conductedin STATE DEPARTMENTOF EDUCATION.DIVISION OF January 1964. The survey covered 1,100 health establishments, the numbers employed in each occupation, and needs for the VOCATIONAL EDUCATION. LABOR EDUCATION CENTER. next 2 years. It revealed previously unidentified demand in the THE UNIVERSITY OF CONNECTICUT. central cities in a wide range of medical occupations. The 1967. Health Service OccupationsOccupational largest occupational category was nursing. NeedsEducational Requirements.Storrs, Conn.: The University. 117 pp. and app. CALIFORMA DEPARTMENT OF EMPLOYMENT RESEARCH AND STATISTICS SECTION. This statewide questionnaire survey, conducted in June 1967, covered personnel employed in 49 health occupations in hos- 1965. Manpower for California Hospitals, 1964- pitals,convalescent homes, physicians' anddentists'offices, 1975. Prepared for the Commission on dental laboratories, employee health clinics, and public licahh. Manpower, Automation, and Technology Personnel surveyed were those directly involved in rendering (COMMAT). COMMAT Report No. 65-6. health services and supporting personnel. The survey included Sacramento: Department of Employment. nurses but not doctors, dentists, or other occupations requiring 61 pp. (processed). a collegedegree.Itassessedpersonnel vacancies, expected withdrawals, and expansion needs for 1971 and 1976, and re- The healthfacilitiesstudiedincludedhospitals,nursing lated these data to the courses and content given in secondary homes, and convalescent homes. Data on the number of beds and post-secondary schools for training these types of personnel. and empolyment in these facilities were collected from various agencies and combined into an approximate model of the GEORGIA industry in 1964. Projections for 1965, 1967, 1970, and 1975 were based on this model. Occupations studied include the FINCHER, CAMERON. registered nurse, licensed vocational nurse, and nurse aid. The 1962. Nursing and ParamedicalPersonnelin assessment of the occupation contained adefinitionof the Georgia: A Survey of Supply and Demand. role, the job preparation, and future prospects. Atlanta: Georgia State College. 118 pp. STATE OFCALIFORNIA. DEPARTMENT OFPUBLIC This questionnaire survey, conducted from October 1961 to HEALTH. October 1962, covered the supply of health manpower in nurs- 1967. Health Manpower Needs In California: A ing and 11 paramedical occupations. It estimated demand for Source Book ol Available Information on a5-to10-year period, and the adequacy of training and educational programs. Recommendations were made for the Selected Health Occupations. Sacramento: expansion of educational programs, for the development of State Department of Public Health. 25 baccalaureate and master's programs in specific fields, and for pp. (processed). additional study of the needs and resources for instructors and 9' SURVEY AND STUDY REPORTS 93 teachers.Occupations surveyedincludedregisterednurses, INDIA.NA licensedpracticalnurses,dietitians,hospitaladministrators, laboratory and x-ray technicians, medical technologists, medical INDIANAPOLIS HOSPITAL DEVELOPMENT ASSOCIATION. recordlibrarians,medical socialworkers,occupational and 1968. Health Manpower Requirements and Re- physical therapists, and medical assistants. sources in Metropolitan Indianapolis, 1966- 1971. Indianapolis, Ind.: The Association. HAWAII 71 pp. U.S. EMPLOYMENT SERVICE, U.S. DEPARTMENT OF "Seventy-five agencies employing and training health workers LABOR, and HAWAII LABOR DEPARTMENT. were sent a questionnaire covering current and future man- 1967. Honolulu's Manpower Outlook: A Survey power strengths, needsdifficulttofill, and education and training outputs. The educational system and privateprac- of Demand and Supply for 78 Occupations. titioners,as users of health personnel, were not contacted. Honolulu, State of Hawaii. Department of Additional investigationestimated the netlossin manpower Labor and Industrial Relations, Employ- by either out-migration or abandonment of the health field. ment Service Division, Research and Statis- Data are presented and discussed. Conclusions include noting tics Office. 88 pp. not only a general need for rapid acquisition of health workers, but a need to revise licensing requirements, wage scales, and This report is based on the Manpower Skill Survey of the opportunities for advancement." (From Abstracts of Hospital Honolulu area in 1966. Seventy-eight occupations were included. Management Studies, V: 126, June 1969). The period 1965-1970 is assessed in terms of the extent of manpower demands, replacement needs, and implicationsof IOWA the survey concerning manpower training. The occupations are ranked according to demand for the years 1967 and 1970. The SMITH, JERRY L. category, registered nurse, ranked I1th and 7th respectively. 1967. PublicHealthManpower Analysis: An Shortage occupations were also ranked according to supply. Estimate of the Potential Need for Public When this was done, the registered nurse category ranked Health Personnel in the State of Iowa. 34th for both years 1967 and 1970. A summary of the findings Prepared for the Education and Training pertainingtoeach occupation and an explanation ofthe methodology employed are included. Committee. Des Moines, Iowa : State De- partment of Health. 68 pp. IDAHO This report presents an estimate of the current and potential need for public health manpower in the State for the years WESTERN INTERSTATE COMMISSION FOR HIGHER 1970-1985. Conclusions and recommendations with respect to EDUCATION. meeting the health needs of the residents of Iowa are based on 1969. Idaho Health Profile. Boulder, Colo.: The the information and data presented in the report. Commission. 387 pp. "Contains data concerning health manpower, health facilities, MARYLAND health vital statistics and certain socio-economic information for HOSPITAL COUNCIL OF MARYLAND. the state of Idaho." (From Abstracts of Hospital Management 1966. Manpower in Maryland's Hospitals: Report Studies, VI:26. June 1970.) and Recoriimendations on a Growing Crisis. ILLINOIS Baltimore: The Council.43 pp. Manpower resources and needs in Maryland hospitalsin STATE OF ILLINOIS BOARD OF HIGHER EDUCATION. January 1966 were delineated and related to educational re- 1968. Education in the Health Fields for State o/ sources and to factors influencing demand for health personnel Illinois. Prepared by James A. Campbell, and limiting the quality and quantity of the supply. Hospital M.D.; W. Randolph Tucker, M.D.; and requirements for nursing personnel and laboratory technicians were most critical. Regional planning for nursing education IreneR. Turner, M.T.Presbyterian-St. was recommended; also nurse utilizationstudies. Immediate Luke's Hospital, Chicago. Vol. I, 161 pp.; and long-range programs were proposed in the areas of recruit- Vol. II, 866 pp. ment, education, health career development, and employment Manpower and educational needs and resources for all of the and career incentives. major health service occupations were surveyed in this study to MARYLAND COUNCIL FOR HIGHER EDUCATION. determine requirements for additional facilities and educational programs in teaching of the health sciences inIllinois. The 1969. A Projection of Maryland's Health Man- report includes the recomendations on nursing education of power Needs Through the 1980's. Balti- the Illinois Study Commission on Nursing. more: The Council. 194 pp. 94 APPENDIX 1

This study was directed toward the need for health manpower MONTANA education facilities, and makes recommendations, for action to meet manpower needs projected for 1980 and 1990. The supply, DEPARTMENT OF PUBLICINSTRUCTION. RESEARCH needs and demands, and educational programs for physicians, COORDINATING UNIT. dentists, and nurses were extensively studied. Data on other 1968. Paramedical and AlliedHealthService professional, technical, and auxiliary health fields are more Occupations in Montana. A Survey of the limited. The study gives directions for the State's public and private health and educational agencies and the legislature to Occupations, Manpower Requirements, and begin to plan without delay to meet current and future needs. Training Needs Essential to the Support of General Health Services inthe State of MASSACHUSETTS Montana. Helena, Mont.39 pp. (proc- AMMER, DEAN S.; CALLAGHAN, JOH' JR.; and others. essed). 1967. Institutional Employment and Shortages of Total full- and part-time positions, vacancies, and projected Paramedical Personnel. Bureau of Busi- needs for 1973 are detailed for 52 basic paramedical and allied ness and Economic Research, Northeastern medical service occupations requiring less than 2 years post- high school training. The survey covered hospitals, nursing University, Boston, Mass. 41 pp. homes, medical clinics, and a 10 per cent sample of physicians This is a report of a detailed study of staffing patterns and and dentists. Job descriptions for the 52 occupations and entry shortages in hospitals, nursing homes, and various other institu- level salary ranges are included. The survey was intended to tions in the greater Boston area. provide information for educational and health facilities planning. It includes licensed practical nurses and nursing aides. MICHIGAN WESTERN INTERSTATE COMMISSION FOR HIGHER MICHIGAN OFFICE OF PLANNING COORDINATION. Bu- EDUCATION. REAU OF PLANNING AND PROGRAM DEVELOPMENT. 1969. Montana Health Profile. Boulder, Colo.: EXECUTIVE OFFICE OF THE GOVERNOR. The Commission. 443 pp. 1967.Michigan Technician Need Study. Tech- "Contains data on health manpower, health facilities, health nical Report No. 13. November 1967. vital statistics and certain socio-economic information for the Lansing, Mich. 191 pp. (processed). state of Montana." (From Abstracts of Hospital Management This study estimated needs for new or expanded technician Studies, VI:26, June 1970.) training programs in Michigan to help assure industry and hospitals an adequate supply of appropriately trained man- NEVADA power. It defined technician categories; set preliminary criteria for persons in various fields in these categories; assessed the WESTERN INTERSTATE COMMISSION FOR HIGHER present supply, the educational and training opportunities, the EDUCATION. adequacy of training, and the number of technicians needed for 1969. Nevada Health Profile. Boulder, Colo.: the future. The study included technician occupations within The Commission. 220 pp. thehealth-relatedfields,includingregisterednursesand "An assessment of health resources in Nevada: health man- licensed practical nurses. power, health facilities, health vital statistics and certain socioeconomic information." (From Abstracts of Hospital Manage- MISSOURI ment Studies, VI:26, June 1970.) ZIMMERMAN, T. F., and CRNIC, CAROL A. 1968. Master Facilities Inventory: A Study of NEW HAMPSHIRE HealthManpowerTrainingResources, NEW HAMPSHIRE HEALTH CAREERS COUNCIL. Jackson and Clay Counties, Missouri 1967. 1968. New Hampshire Health Manpower Study, Institute for Community Studies, Kansas 1968. Concord: The Council. 77 pp. City, Mo. 37 pp. This statistical survey of health manpower supply and needs This survey identified the number and kinds ofmanpower on a statewide, regional, and county basis covered 40 categories training resources for allied medical professions intwo counties of health manpower including registered nurses, licensed prac- of Missouri. It assessed their capacity and the level of capacity tical nurses, and nursing aides. Included is a breakdown on at which they were operating, and identified training needs and full-time and part-time employment and total supply by types priorities for development of programs. Resources for registered of health facilities and services. Thirteen major causes of health nurses and licensed practical nurses were included. The report manpower shortages are ranked by vocation and type of health also includes a directory of personnel involved with eachtype service, and needs are projected for 1970 and 1975. Data are of health manpower training program studied. reported on hospital admissions, outpatient visits, and planned SURVEY AND STUDY REPORTS 95 expansion in the number of hospital and nursing home beds. for thc same periods as a result of on-the-job training in the The questionnaire, definition of occupational titles, and list of institutions and affiliated schools was estimated. The majority health facilities surveyed are included in the report. of training requirements for workers needed by the end of 1966 were found to be concentrated in 11 health occupations. NEW YORK BUREAU OF EMPLOYMENT SECURITY RESEARCH. THE BOARD OF REGENTS. NEW YORK STATE EDUCA- 1967. Health Manpower Needs in North Carolina, TION DEPARTMENT. 1967-1973. Employment Security Com- 1963. Education for the Health Professions, A mission of North Carolina. Raleigh, N.C. ComprehensivePlanforComprehensive 64 pp. Care To Meet New York's Needs in an Age This survey was conducted to determine growth patterns in of Change. A Report to the Governor and the employment of health manpower, to evaluate the output of the Board of Regents from the New York existing programs, and to, plan for future program requirements. Committee on Medical Education. Al- The supply of personnel employed in 48 health occupations in bany, N.Y. 114 pp. 1,500 medical and health service facilities was surveyed in the spring of 1967. Turnover rates and manpower needs by 1973 This in-depth study of needs and resources for healthpro- were estimated, as compared with anticipated trainee output fessionals and health-related professions and vocations included in medical and health service occupations in 1970 and 1973. an assessment of the nursing situation in the State, and the Supply and demand data are broken down for seven areas of factors affecting it. Needs for nursing personnel and theex- the State. pansion required in educational programs to meet needswere projected to 1970. The development of baccalaureate programs OREGON in nursing was given top priority. Other recommendations for strengthening nursing education to meet nursing needs were OREGON STATE BOARD OF CONTROL. MENTAL HEALTH. made. 1965. Report of Committee on Manpower and STATE UNIVERSITY OF NEW YORK AT BUFFALO. Training (1963-1965). Salem: The State DEPARTMENT OF PREVENTIVE MEDICINE. COMMUNITY Board of Control. 20 pp. (processed). SERVICES RESEARCH AND DEVELOPMENT PROGRAM. A questionnaire survey of current available manpower in the 1967. Health Care Manpower Survey. Buffalo, traditional mental health professionspsychiatrists, psycholo- N.Y.: The University. 209 pp. gists,social workers, and psychiatric nurseswas undertaken to obtain information on their personal characteristics, present This survey, conducted by the Regional Medical Program of position, employment setting, competence, experience, training, Western New York in 1967, determined the current resources sources of professional and personal satisfaction, and salary and distribution of 22 professional categories of health care requirements. These data were collectedalsotodevelopa personnel which required formal training and were therefore comprehensive, long-range plan for utilization of current pro- significant in terms of future educational needs. Data were fessional manpower for the community mental health programs, obtained from licensure records of the State Education Depart- and to appraise what a varietyof non-traditionally trained ment, commercial listings of health professionals, and question- professional personnel could contribute to social care, in the naires to 664 health facilities and agencies. (Excerpted from event that the current numbers of traditional mental health a review in Medical Care Review, Oct. 1969.) personnel were inadequate. NORTH CAROLINA PUERTO RICO BUREAU OF EMPLOYMENT SECURITY RESEARCH. TRUSSELL, RAY E., and ARBANA, GUILLERMO. 1963.North Carolina Study of Manpower and 1962. Medical and Hospital Care in Puerto Rico. Training Needs for Medical and Health A Report Submitted to the Governor and Service Occupations.Employment Security The Legislature of the Commonwealth of Commission of North Carolina. Raleigh, Puerto Rico by The School of Public Health N.C. 63 pp. andAdministrativeM2dicine,Columbia This survey was conducted as a basis for planning and ex- University, and the Department of Health panding vocational educational facilities and curricula to meet of Puerto Rico. New York: Columbia theState's needs for health care and associatedpersonnel University Press. 427 pp. requirements.Itcovered 43 selected key occupationsthat were generally known to be in short supply for 5/6, or 417, This report of a joint study by the University and the Depart- of the medical and health service esteblibhments. Data were ment of Health appraised the quality of medical care,its obtained regarding current job vacaucies and replacement and organizationandadministration, anditsexpenditures and expansion needs by the end of 19$3 and 1966. Trainee output financing. It included hospital care, the distribution of hospitals 96 APPENDIX 1 and other facilities, their utilization, and the maintenance of TEXAS facilities and equipment. Health personnel were not overlooked; however, study was limited to physicians, dentists, nurses, social TEXAS HOSPITAL EDUCATION AND RESEARCH FOUNDA- workers, and technicians. Data were obtained from the re- TION. cipients of health careservices. A representative sample of 1969. Allied Health Manpower in T exas 1969: A island families-2,951 in numberwere interviewed, and infor- Status Report on Employment.Texas Hos- mation was recorded pertaining to patterns of utilization of medical services, aspects of care received, costs, and opinions pital Education and Research Foundation, and attitudes about care. Austin, Tex. 56 pp. COMMONWEALTH OF PUERTO RICO. OFFICE OF THE A mail questionnaire survey of all major allied health personnel employers was undertaken during a week of average GOVERNOR. PLANNING BOARD. BUREAU OF ECONOMICS activities, March 10 through 14, 1968, to collect information AND SOCIAL ANALYSIS. on a statewide basis on allied health personnel. Information was 1967. Manpower Report to the Governor: A Re- obtained on each personnel classification as to the number of port on a Society in Transition.San Juan: full.timeand part-time personnel employed, the number of The Planning Board. 130 pp. hours worked bypart-thne personnel, andthe number of budgeted vacancies that existed. Data in this report can be This report concerns many aspects of human resources and considered as a statistical base from which to project needs. manpower development in the Commonwealth. Industrial and occupational trends in the economy are assessed, with some TEXAS HEALTH CAREERS PROGRAM AND THE GOVER- consideration of the effect on future trends in the educational NOR'S OFFICE OF COMPREHENSIVE HEALTH PLANNING. system. The main objective of the report isto provide man- 1970. Allied Health Manpower in Texas, 1970. power and educational information toofficials and planners ExecutiveDepartment Office of Compre- who need to concern themselves with the manpower and human resources implications of their economic decisions. A summary hensiveHealth Planning. Dallas,Tex. of findings and conclusions is presented. 259 pp. The report contains baseline information on allied health SOUTH CAROLINA manpower and education in Texas. Fifty-four careers in the SOUTH CAROLINA HOSPITAL ASSOCIATION. alliedhealthfield were includedinthe survey. The mail 1964. Crisis in Health Care in South Carolina. questionnaire was theprimary method fordatacollection. Questionnaires were sent to all major allied health personnel Preliminary Report on Professional, Para- employers, requesting information on the number of full-time medical, and Technical Personnel, Novem- and part-time personnel employed in each classification, hours ber 9, 1964. Columbia: The Association. worked by part-time personnel, number of budgeted vacancies, 9 PP. and number of additional vacancies anticipated for 1971. A survey of the allied health educational programs was conducted The supply and needs for all categories of personnel were in a similar manner. The questions pertainedto approved surveyed in 70 non-Federal South Carolina hospitals in August student capacity, current enrollment, student body composition, 1964. Growth in hospital facilities and their use were described. number of graduates in 1970, and average attrition percentage Reported shortages of 1,381 hospital personnel in all categories over the last 3 years. approximated a 10 percent unmet need for personnel. Shortages Supply and demand, according to present evidence, will not ofprofessional and paramedical personnel approximated 20 soon be in balance. The task ahead is not only to increase the percent; for nonprofessional categories, about 6 percent. supply of well-qualified workers but also to make the best use SOUTH CAROLINA EMPLOYMENT COMMISSION. of the resources that are available. 1966. Manpower Requirements for Health Facili- ties in South Carolina. South Carolina WASHINGTON Hospital Association and South Carolina STATE OF WASHINGTON DEPARTMENT OF EMPLOYMENT Employment Security Commission.Colum- SECURITY and STATE BOARD FOR VOCATIONAL EDUCA- bia: The Commission. 54 pp. TION. The need for workersin health service occupations was 1965. Occupational Trends in Health Care Indus- surveyed to provide data for planning regional health training tries, King County, 1965-1970. Prepared centers. Shortages were detailed for registered nurses, practical by Virginia 0. Hannig. Seattle: The nurses, aides, ward clerks,anesthetists,diet clerks, medical Department. 111 pp. record clerks, and medical supply clerks. The formation of a Health Manpower Council was recommended, as well as con- This is a pilot study of manpower problems in medical in- certed recruitment, educational, and career and employment dustries of King County. The study tried out a procedure for incentive efforts. analyzing occupational shortages and training requirements on

Cq"? SURVEY AND STUDY REPORTS 97 a continuing basis for a wide range of occupations and in- capabilities for meeting these needs. Study recommendations dustries. Industrial and occupational characteristics were iden- included regionalization for health services, long.term planning, tified. Registered nurses, licensed practical nurses, nurse aides, and specific charges to institutions and agencies in the State. and orderlies were included among the 26 occupations described The study assessed the 1967 supply of registered nurses and as "demand occupations." licensed practical nurses and needs for 1971, 1976, and 1986. WEST VIRGINIA THE GOVERNOR'S TASK FORCE ON HEALTH. WYOMING 1967.Adequate Health Services for West Virginia. WESTERN INTERSTATE COMMISSION FOR HIGHER A Program To Meet the Total Health Needs EDUCATION. of the People of West Virginia. The Final 1969. Wyoming Health Profile. Boulder, Colo.: ReportforGovernorHulettC. Smith. The Commission. 215 pp. Charleston, W.Va. 107 pp. "Data on health manpower, health facilities, health vital sta. Health facilities and services, health manpower needs and tistics and certain socioeconomic information for the state of resources, and the influencing socioeconomic factors were as- Wyoming." (From Abstracts of Hospital Management Studies, sessed to determine overall health needs in the State and the VI:26, June 1970.) Part 2 Needs and Resources in Nursing

Historical Reports,1923-34; National

COMMITTEE ON THE STUDY OF NURSING. This was the first report of an interprofessional body, or- 1923. Nursing and Nursing Educationinthe ganized in 1926, on its socioeconomic investigation of the supply United States. New York: Macmillan Co. and demand of nursing services. Completed during thede- pressionthe only time when an oversupplyof nurses has 584 pp. existedthestudyrevealedvacanciesforbetterprepared Commonly known as the Goldmark Report, from the name nurses. Economic conflicts between nurses and their employers of its chief investigator, Josephine Goldmark, this report raised and between student service and school of nursing objectives questions about financing and control of nursing education by were highlighted.Itwas concluded that hospitals operated hospitals andsetgoalsforthe educational preparation of training schools because it cost less to run a poor school than nurses in administrative, supervisory, and instructor positions it did to employ graduate nurses, and because it was easier and for public health nurses. The reportisrecognized as to handle the nursing service with students, who would accept acceleratingthe developmentof bothbasic and post-basic without complaintconditions that were becoming increas- collegiate nursing education. ingly objectionable to graduates. Personnel policies for graduate Initiated to study the statusof public health nursing and nurses were deplorable. They asked for reasonable hours of propose a course of training for their preparation, the Com- work, a living wage, constructive leadership, sound administra- mittee, financed by the Rockefeller Foundation, surveyed and tive policies, and opportunities for further growth. assessed the entire fields of nursing education and nursing The Committee set forth two principles: (1) that the educa- service. Their work is recognized as the first broad-scale study tion of nurses is as much a public responsibility as isthe based on actual observations of nursing practices and for which education of physicians, teachers, or others to be engaged in recommendations are supported by data. public professional service, and the costof such education Now over 40 years old, the study recommended licensure of should be supported by private and public funds and not by a subsidiary grade of nursing personnel working under the the hospital budget;(2)that a hospital school of nursing supervision of doctors or trained nurses, and courses of training should be conducted solely on the basis of the kind and amount for their preparation for service. It pointed out the lack of of educational experience that can be offered and not upon sufficiently attractive avenues of entrance to the field of nursing, the need for cheap labor. The Committee recommended the andrecommended financialsupport andadministrationof employment of private duty nursesmany of whom were with- nursing education under separate boards of education. The out workas graduate staff to give bedside care in hospitals study also proposed elimination of the service functions of and to free students from excessive service demands. students, and shortening of hospital trainingto 28 months. (Excerpted from The Historical Development of Nursing, p. Special additional training beyond the basic nursing course 312. By Sister Charles Marie Frank. Philadelphia: W. B. was recommended for nurses in administrative, supervisory, and Siunders Co.400 pp.1953.) instructor positions and for public health nurses, as well as strengthening of university schools of nursing for the training COMMITTEE ON THE GRADING OF NURSING SCHOOLS. of nurse leaders, and endowments for university schools of 1934.Nursing Schools Today and Tomorrow. nursing. Final Report. New York: National League (Excerpted from The Historical Development of Nursing, pp. 308-311. By Sister Charles Marie Frank. Philadelphia: W. for Nursing Education.247 pp. B. Saunders Co. 1953. Also excerpted from Nursing Research: This report of the Committee's educational survey showed A Survey and Assessment, pp. 20-21. By Leo W. Simmons and that there were some good schools of nursing; many mediocre VirginiaHenderson.New York:Appleton-Century-Crofts. schools, whose principal aim was to provide cheap service for 1964.) the hospital; and some poor schools. Less than half of the schools had one full-time instructor, and only one-fourth of the BURGESS, MAY AYRES. instructors had college degrees. In 88 percent of the schools, 1928. Nurses, Patients, and Pocketbooks. New students worked more than 48 hours, exclusive of classwork. York: Committee on the Grading of Nursing Clinicalfacilities were inadequate and clinicalassignments Schools. 618 pp. haphazard.

99 100 100 APPENDIX 1

The report recommended the following for every professional pp. 318-319. By Sister Charles Marie Frank. Philadelphia: W. school of nursing: An interdisciplinary representative board; B. Saunders Co. 1953.) a separate budget, drawn inpart from tuition, endowment, gifts, or subsidies; and a director who was an educator and COMMITTEE ON THE GRADING OF NURSING SCHOOLS. also recommended other capableadministrator. The report 1934. An Activity Analysis of Nursing. New essentialconditions which schoolsshould meet, asfollows: That the majority of the faculty be registered nurses who are York: National League for Nursing Educa- college graduates with special training ina particular field tion. 214 pp. and experience in several fields of nursing; that students meet This study and analysis of nursing functions helped to define entrance requirements of a good college; that work be of such nursing and its unique position in the health professions. A character astoreceivecredit toward a degree;and that long list of nursing activities was compiled from reportsof clinical assignments be made only in light of what students actual situations previously studied by variousorganizations need to know. and agencies. The listdistinguishednursing functions from This and the other reports of the Committee stimulated the non-nursing duties that were commonly considered part of the closing of more than 500 of the poorest schools of nursing, nurses' work. Conclusions on what every nurse should know and later showed that the remaining schools could train many and do became criteria for judging a competent nurse. (Ex- more students than had been trained formerly in the larger cerpted from The Historical Development of Nursing, pp. 316- number of schools. 318. By Sister CharlesMarie Frank. Philadelphia: W. B. (Excerpted from The,Historical Development of Nursing, Saunders Co. 1953.)

Reports, 1946-61; National, Regional, State and Territorial

National well distributed to serve the needs of the entire country." Statewide planning for basic nursing education as wellas BROWN, ESTHER LUCILE. regional and national planning for higher forms of nursing 1948. Nursing for the Future. A report prepared education was urged. for the National Health Council. New (Excerpted from The Historical Development of Nursing, York: Russell Sage Foundation. 198 pp. pp. 339-347. By Sister Charles Marie Frank. Philadelphia: W. B. Saunders Co. 1953.) This study was concerned with the education needed for the responsibilities to be carried by nurses to meet community U.S. DEPARTMENT OF LABOR. BUREAU OF LABOR needs for health services, and the actions required for reaching goals defined for this purpose. It considered the probable nature STATISTICS. of nursing in the latter half of the 20th centry, and set the 1948. The Economic Status of Registered Profes- stage for research in nursing itself and in nursing as a part of sional Nurses, 1946-1947. Bulletin No. overallhealth programs. The findings and recommendations 931.Washington: U.S. Government Print- from the study have value and are applicable today. The study ing Office. 69 pp. and its report are recognized as stirring up controversies on many nursing issues that contributed immeasurably to motivat- This studyrelated the problems of nurseshortages and ing thinking and action and resulted in extensive improvements attrition from nursing to nurses' working hours, salaries, and in nursing service and nursing education. other working conditions. It compared nursing to other fields The report pointed out the following needs: Study of nursing and their socioeconomic and working conditions. Findings were (Excerpted from functions; building of integrated nursing service teams; use of detailed and remedial measures suggested. The Historical Development of Nursing,p.339. By Sister nonprofessionalassistants;mandatory licensure ofpractical Charles Marie Frank. Philadelphia: W. B. Saunders Co. 1953.) nurses;greatly expanded and improved in-servicetraining; establishment of procedures and standards for State accreditation of nursing schools; and establishment of a syitem for WEST, MARGARET; and HAWKINS, CHRISTY. recognizing excellence in nursing practice atvarious position 1950. Nursing Schools at the Mid-Century. A levels to raise the status of nursing. report prepared under the auspices of the The future role of the professional nurse, her education, and Subcommittee on School Data Analysis for the educationofnonprofessionalpersonnelwere discussed extensively.Thestudyrecommendedexperimentationinto the National Committee for the Improve- measures for reorganizing and increasing the social contribu- ment of Nursing Services. (This commit- tions of hospitalsto nursing education as well as directing teeis no longer in existence. Nursing efforts to building basic schools of nursing in universities and school libraries may be able to provide colleges as autonomous units "that are sound in organization and financial structure, adequate in facilities and faculty, and copies.) 88 pp. 101 SURVEY AND STUDY REPORTS 101

This survey report presents a detailed record of the educa- (Excerpted from Nursing Research: A Survey and Assess- tional practices in 1,156 of the 1,193 basic schools of nursing in ment, pp. 144.145. By Leo W. Simmons and Virginia Herder- existence in1949, including those offering hospitaland col- son. New York: Appleton-Century-Crofts. 1964.) legiate programs. It compares findings to specific standards set in 1937 and 1942 for a good school of nursingsuch as instruc- HUGHES, EVERETT C.; HUGHES, HELEN MACGILL; and tionalhours,studentclinicalexperience, libraryresources. DEUTSCHER, IRWIN. and appointment of faculty. The two overall impressions drawn 1958. Twenty Thousand Nurses Tdl Their Story. from the survey are as follows: (1) In 1949, the basic school A Report on the American Nurses' Associa- of nursing was not regarded as enough of aneducational institutionto define its own goals and to decide how these tion Studies of Nursing Functions. Phila- goals could be best met; (2) the major share of the nursing delphia: J. B. Lippincott. 280 pp. school program was not being predominately focused on educa- This book is a synthesis of data from more than 30 function tion, and in nrost schools of nursing the serviceto hospitals studies. The findings have implications for the nurse asa was as important an objective as was the education of students. practitioner, her relationship to others in the work situation, and the future of nursing. The present status of nursing and HEALTII RESOURCES ADVISORY COMMITTEE (RUSK where it has to go are vividly portrayed. COMMITTEE),1950-51. These studies were focused primarily on the following: who 1951. "Nurse Power in Mobilization." By Ruth nurses are, what they do, where they come from, where they P. Kuehn, Member. Washington: The work and why, how they prepare themselves for this work, Committee. 4 pp. what their relationships are with co-workers and patients, how they feel about nursing, and how others feel about them. Tne "As nearly as the Committee could estimate, 49,000 nurses major contribution of this book is the challenge itpresents over and above those in sight for 1954 would be needed to meet and the questions ol vital importance it raises concerning the requirements for this category of personnel. The Committee improvement of nursing service and nursing education. noted that the shortage of nurses could be reduced slightly by (Excerpted from a review by Gwendoline MacDonald, form- an increase in nursing school enrollment; more nurses should erly Instructor in Medical-Surgical Nasing, Vassar Hospital be trainedfor administrative, teaching, and supervisory posi- School of Nursing, Poughkeepsie, N.Y., in Nursinp Outlook, tions;the supply of trained practicalnurses should be in- 7 (1) :9. January 1954.) creased as rapidly as possible; and hospitals should expand and improve their inservice training programs for nurses' aides NATIONAL LEAGUE FOR NURSING. DEPARTMENT OF and other auxiliary nursing personnel below the practical nurse DIPLOMA AND ASSOCIATE DEGREE PROGRAMS. level." (Quoted from Report of the National Advisory Com- 1959. mission on IIealth Manpower, Vol. II, p. 270. Washington: U.S. Report on Hospital Schools of Nursing, Government Printing Office. November 1967.) 1957. New York: The League. 44 pp. This survey updated information in Nursing Schools at Mid- NATIONAL LEAGUE FOR NURSING. COMMITTEE ON THE Century and gave bases for measuring progress in the improve- FUTURE. ment of resources and practices in schools of nursing. The survey focuses primarily cm a comparison of 247 accredited and 1957. Nurses for a Crowing Nation. New York: 551 nonaccredited programs, and common educational methods. The Association. 31 pp. Deviation from traditional and rigid criteria and standards to The purpose of this study was to forecast changing needs more flexible guidelinet as marks of excellence is reflected in in nursing service and nursing education, based on examination the report,.which gives the impression that in 1957 the hospital of social and health trends in the foreseeable future. An attempt schools were regarded as educational institutions in the making. was made to estimateoverall existing needs and additional needs for nurses. Needs were forecast on the premise that Regional reasonable predictions for the future can be proposed by studying past trends, by examining present supply, and by relating WESTERN INTERSTATE COMMISSION FOR HIGHER the findings to future demands and goals. EDUCATION. Two goals were projected for the future: (1) A higher goal 1959. Nurses for the West. Western Council on of 350 nurses per 100,000 population, already reached or ex- Higher Education for Nursing. Boulder, ceeded in six States; and (2) a more conservative objective 112 pp. goal of 300 nurses per 100,000 population, to bring gradual Colo. improvement in the supply. For reaching the higher goal by This report of the first regional survey of nursing needs and 1970, an annual average increase of 6 nurses per 100,000 popula- resources in the 13 States comprising the western educational tion would be required; for the lower goal, an annual average compact presents facts on the registered nurse supply and the increase of 3 nurses per 100,000 population. Considering an resourcesfor the education of registered nurses. Projections annualattritionrate of5percent from the nurse supply. are madefor the number of nurses by levels of educational 700,000 nurses would be needed by 1970 to meet the higher preparation needed in each of the States by 1970. Recommenda- goal and 600,000 to reach the lower goal. tions are made for the development and improvement of nursing 102 APPENDIX 1 education in the West, and criteria are specified for new junior 1958. A Survey. Nursing Needs and Resources college and baccalaureate programs. in Connecticut. The Connecticut Joint State and Territorial Commission for Improvement of Care of the Patient. The Committee on Future The following list, by States in alphabetical order, Needs for Nurses. Hartford, Conn. 89 includes those surveys that assessed statewide nursing pp. (processed). needs and resources, and that for the most part em- braced allfields of nursing. Many of these study DISTRICT OF COLUMBIA reports are out of print and are available only from FEDERAL SECURITY AGENCY. PUBLIC HEALTH SERVICE. the sponsoring organizations or by library loan. The DIVISION OF NURSING RESOURCES. reports are not annotated. They are listed here merely 1952. Nursing in the Nation's Capitol: A Survey for historical considerations and forcomparability of Needs and Resources in the District of with future reports and surveys. These reports can Columbia, 1952. Washington: District of provide trend data, information regarding planning Columbia Nurses' Association. 127 pp. activities and processes used in particular States, and (processed). indications of progress and action in meeting recommended goals. HAWAII ARIZONA FEDERAL SECURITY AGENCY. PUBLIC HEALTH SERVICE. DIVISION OF NURSING RESOURCES. FEDERAL SECURITY AGENCY. PUBLIC HEALTH SERVICE. 1951. A Survey of Nursing Needs and Resources DIVISION OF NURSING RESOURCES. inHawaii. Honolulu: Hawaii Nurses' 1950. Survey of Nursing Needs, Resources, and Supply in Arizona. Phoenix: Arizona Association. 73 pp. (processed). Nurses' Association.57 pp.(processed). TERRITORIAL COMMISSION ON NURSING EDUCATION AND NURSING SERVICES. ARKANSAS 1952. The Nurse of Tomorrow: A Report on COMMITTEE ON NEEDS AND RESOURCES. ARKANSAS Nursing inHawaii. Honolulu: Hawaii STATE NURSES ASSOCIATION and ARKANSAS LEAGUE Nurses' Association.20 pp.(processed). FOR NURSING. 1958. Blue Print For Action. Arkansas Survey. ILLINOIS Nursing Needs and Resources.Report pre- FEDERAL SECURITY AGENCY. PUBLIC HEALTH SERVICE. pared by Committee on Needs and Re- DIVISION OF NURSING RESOURCES. sources, Arkansas; and Division of Nursing 1950. A Report of Current Supply, Present and Resources, Public Health Service, U.S. De- Future Needs of the People of Illinois for partment of Health, Education, and Welfare. Nursing Service. May 1950. Chicago: Little Rock, Ark.: The Association. 177 IllinoisLeagueforNursing. 73pp. pp. (processed). (processed). COLORADO INDIANA

U.S. DEPARTMENT OF HEALTH, EDUCATION, AND BIXLER, GENEVIEVE K.; FADDIS, MARGENE 0.; and WELFARE. PUBLIC HEALTH SERVICE.DIVISIONOF BIXLER, ROY W. NURSING RESOURCES. 1952. Indiana Nursing Survey. Indianapolis: 1953. Colorado Nursing Resources: A Survey of Indiana Nurses' Association.70 pp. the Nurse Supply and Needs, 1953. Den- ver: Colorado Nurses' Association. 46 pp. IOWA (processed). MILLER, J. ROBERT. 1951. "Report of the 1950 Survey for the Iowa CONNECTICUT State Nurses'Association." Bulletin of U.S. DEPARTMENT OF HEALTH, EDUCATION, AND Iowa State Nurses' Association. 5 (2) : WELFARE. PUBLIC HEALTH SERVICE. 4-7. Des Moines, Iowa: The Association.

to 3 SURVEY AND STUDY REPORTS 103

IOWA STATENURSES' ASSOCIATION,IOWA STATE Maine Nurses' Association.87 pp. (proc- LEAGUE OF NURSING EDUCATION, IOWA STATE ORGANI- essed). ZATION FOR PUBLIC HEALTH NURSING, et al. 1952. Iowa Survey: Nursing Needs; Resources. MARYLAND Des Moines, Iowa: Executive Committee for MARYLAND STATE PLANNING COMMISSION. the Iowa State Nursing Survey. 45 pp. 1953. Nursing Needs and Resources of the State (processed). of Maryland. Report of the Subcommittee IOWA STATE NURSES' ASSOCIATION. on Nursing Needs to the Committee on 1956. "Results of Survey Among Office Nurses in Medical Care. Baltimore, Md. 63 pp. Iowa." Bulletin of Iowa State Nurses' Association.10 (1) : 17, 18.Des Moines, MASSACHUSETTS Iowa: The Association. HOWARD, ANNA T., and APPLE, DORRIAN. IONVA STATE NURSES' ASSOCIATION. 1960. Nursing Needs and Resources in Massa- 1956. "INSA Section Committee Complete Per- chusetts. A report of the Survey of Nurs- sonnel Survey." Bulletin of Iowa State ing Needs and Resources in Massachusetts, Nurses' Association.10 (1) : 19, 20.Des a project sponsored by the Massachusetts Moines, Iowa: The Association. League for Nursing, Massachusetts Nurses' Association, and the Board of Registration KANSAS in Nursing. Boston: Massachusetts League for Nursing. 127 pp. KANSAS STATE NURSES' ASSOCIATION, KANSAS LEAGUE FOR NURSING, and KANSAS STATE BOARD OF NURSE MICHIGAN REGISTRATION AND NURSING EDUCATION. 1958. Survey Report of the Nursing Needs and BIXLER, GENEVIEVE K. Resources in Kansas, 1958. Committee To 1996. Nursing Resources and Needs in Michigan. Study Nursing Needs and Resourcesin A Survey Prepared for the Michigan Coun- Kansas.Topeka, Kans. 337 pp. (proc- cilon Community Nursing. Lansing: essed). Michigan State Nurses' Association. 74 PP. LOUISIANA U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WEL- FEDERAL SECURITY AGENCY. PUBLIC HEALTH SERVICE. FARE. PUBLIC HEALTH SERVICE. DIVISION OF NURSING DIVISION OF NURSING RESOURCES. RESOURCES. 1950. Survey of Nursing Resources and Needs in 1953. Planning for Better Nursing in Michigan: Louisiana, 1950. New Orleans: Louisiana A Survey of Resources and Neads. 1953. Nurses' Association. 104 pp. (proc- Lansing: Michigan State Nurses' Associa- essed). tion. 97 pp. (processed).

U.S. DEPARTMENT OF HEALTH, EDUCATION, AND MICHIGAN DEPARTMENT OF HEALTH. WELFARE. PUBLIC HEALTH SERVICE. DIVISIONOF 1954. For Better Nursing in Michigan. A Sur- NURSING RESOURCES. vey. (State version, based on a report 1956. Statewide Nursing Survey: Progress and prepared by the Division of Nursing Re- Action in Louisiana. Resurvey. New sources, Public Health Service, U.S. Depart- Orleans:LouisianaNurses'Association. ment of Health, Education, and Welfare.) 173 pp. (processed). Cunningham Drug Company Foundation. Detroit, Mich. 115 pp. (processed). MAINE FEDERAL SECURITY AGENCY. PUBLIC HEALTH SERVICE. MINNESOTA DIVISION OF NURSING RESOURCES. GOVERNOR'S ADVISORY COMMITTEE ON NURSING. 1953. Maine Nursing Resources: A Survey of the SUBCOMMITTEE ON AID. Mir-se Supply and Needs. 1953. Augusta: 1949. Nursing Resources and Needs in Minne-

104 104 APPENDIX 1

sota. St. Paul, Minn. 141 pp. (proc- NEW JERSEY essed). FEDERAL SECURITY AGENCY. PUBLIC HEALTH SERVICE. MISSISSIPPI DIVISION OF NURSING RESOURCES. 1950. Survey of Nursing Needs, Resources, and MISSISSIPPI COMMISSION ON HOSPITAL CARE. 1948. Report of Nursing Committee. To Develop Supply in New Jersey, 1950. Newark: an Integrated State-Wide Nurse Education New Jersey Nurses' Association. 92 pp. (processed). Program for Mississippi. Ruth I. Gil lan, Secretary,NursingCommittee,Jackson, NEW MEXICO Miss. 31 pp. FEDERAL SECURITY AGENCY. PUBLIC HEALTH SERVICE. UNIVERSITY OF MISSISSIPPI. DIVISION OF NURSING RESOURCES. 1953. TheStatusofNursinginMississippi. 1952. Nursing in New Mexico: A Survey of Needs Facts, Needs, Goals. Committee onNurs- and Resources 1952.Albuquerque: New ing Resources. Jackson, Miss. 56 pp. MexicoNurses'Association. 65pp. (processed). (processed). COORDINATING COUNCIL OF THE MISSISSIPPI STATE NURSES' ASSOCIATION AND THE MISSISSIPPI LEAGUE NE W YORK FOR NURSING. NURSE RESOURCES STUDY GROUP. 1961. Report of Committee for Reappraisal of 1959. Needs and Facilities in Professional Nurs- Mississippi Nursing Needs and Resources. ing Education in New York State.Albany, 1960. Jackson, Miss.: The League. 118 N.Y.: The StateEducationDepartment. pp. 87 pp. MISSOURI COWEN, PHILIP A. UNIVERSITY OF MISSOURI. COLLEGE OF AGRICULTURE. 1961. Needs and Facilities in Professional Nursing 1949. Nursing Needs and Resources in Missouri. Education in New York State. Revised Research Bulletin 437. Series in Rural 1961. Prepared for The Nurse Resources Health No. 3. By Jeannette R. Gruener, Study Group. Albany, N.Y.: The Uni- for the Committee To Study Nursing Needs versity of the State of New York, The State andResources,oftheMissouriState EducationDepartment,DivisionofRe- Nurses' Association and Missouri League of searchinHigher Education. 14pp. Nursing Education, Columbia, Mo. 67 pp. (mimeographed). NEBRASKA NURSE RESOURCES STUDY GROUP. 1961. Needs and Facilities in Practical Nursing NEBRASKA PROFESSIONAL NURSINGORGANIZATIONS; Education in New York State. Albany, NEBRASKA STATE DEPARTMENT OF HEALTH;and N.Y.: University of the State of New York, FEDERAL SECURITY AGENCY, PUBLIC HEALTH SERVICE, State Education Department. DIVISION OF NURSING RESOURCES. 1951.A Report of the Survey To Measure Nursing NORTH CAROLINA Needs and Resources in Nebraska, 1950-51. Omaha:NebraskaNurses'Association. MILLER, JULIA. 122 pp. (processed). 1949. Report of a Survey To Determine Needs for Nursingand Recommendation.,forthe NEVADA Future of Nursing in the State of North Carolina.Raleigh: North Carolina Nurses' U.S.DEPARTMENT OF HEALTH,EDUCATION, AND WELFARE. PUBLIC HEALTH SERVICE. DIVISION OF Association. 199 pp. NURSING RESOURCES. NORTH CAROLINA MEDICAL CARE COMMISSION AND 1954. Nursing in Nevada: A Survey of Needs and UNIVERSITY OF NORTH CAROLINA AT CHAPEL HILL. Resources, 1954. Reno: Nevada Nurses' 1950. Nursing and Nursing Education in North Association. 47 pp. (processed). Carolina. The Report of the North Caro

105 SURVEY AND STUDY REPORTS 105

lina Committee to Study Nursing and Nurs- STATE NURSES' ASSOCIATION, AND SOUTH CAROLINA ing Education. Raleigh, N.C. 100 pp. STATE BOARD OF HEALTH. 1957.Survey of Educational and Professional NORTH DAKOTA Facilities for Collegiate Education in Nurs- UNIVERSITY OF NORTH DAKOTA, DIVISION OF NURSING; ing in South Carolina. Columbia: Uni- and DEACONESS HOSPITAL, SCHOOL OF NURSING versity of South Carolina. 82 pp. COMMITTEE. 1948. Survey of Nursing Facilities and Resources SOUTH DAKOTA For Establishing Basic and Advanced Pro- FEDERAL SECURITY AGENCY. PUBLIC HEALTH SERVICE. f essionalProgramsofNursingatshe DIVISION OF NURSING RESOURCE% University of North Dakota. Grand Forks, 1950. A Report of the Survey To Measure Nursing N.D.The Committee. 55 pp. (proc- Needs and Resources in South Dakota, April essed). 1950. Sioux Falls: South Dakota State OKLAHOMA Nursef,' Association.86 pp.(processed). FEDERAL SECURITY AGENCY. PUBLIC HEALTH SERVICE. TENNESSEE DIVISION OF NURSING RESOURCES. FEDERAL SECURITY AGENCY. PUBLIC HEALTH SERVICE. 1951. Survey of Nursing Needs and Resources in DIVISION OF NURSING RESOURCES. Oklahoma. 1951. Oklahoma City: Okla- 1949. Meeting the Needs lor Nursing Services in homa State Nurses' Association. 70 pp. Tennessee. Nashville:TennesseeState ( p rocessed). Nurses' Association.32 pp.(processed).

OREGON U.S.DEPARTMENT OF HEALTH, EDUCATION, AND FEDERAL SECURITY AGENCY. PUBLIC HEALTH SERVICE. WELFARE. PUBLIC HEALTH SERVICE.DIVISION OF DIVISION OF NURSING RESOURCES. NURSING RESOURCES. 1949. Meeting the Needs lor Nursing Services in 1956. Tennessee: Action and ProgressA State- Oregon: A Study of Nursing Resources, wide Survey of Nursing Needs and Re- Needs, and Educational Facilities. Port- sources.Nashville: Tennessee State Nurses' land:OregonStateNurses' Association. Association. 56 pp. (processed). 27 pp. (processed). TEXAS PENNSYLVANIA FOUNDATION FOR RESEARCH AND DEVELOPMENT IN U.S. DEPARTMENT OF HEALTH, EDUCATION, AND HEALTH ACTIVITIES. WELFARE. PUBLIC HEALTH SERVICE.DIVISIONOF 1951. Texas Nurses in Review. A Survey of NURSING RESOURCES. Nursing Sources and Resources in the State, 1955. Nursing inPennsylvania: A Studyof of Texas. Austin: Texas Nurses Associa- Needs and Resources.1955.Harrisburg: tion. 92 pp. Pennsylvania Nurses' Association.118 pp. (procmed). U.S.DEPARTMENT OF HEALTH,EDUCATION, AND WELFARE. PUBLIC HEALTH SERVICE.DIVISION OF SOUTH CAROLINA NURSING RESOURCES. 1958. Nursing Needs and Resources in Texas. A FEDERAL SECURITY AGENCY. PUBLIC HEALTH SERVICE. The Committee To Study DIVISION OF NURSING RESOURCES. Survey Report. 1949. Survey to Measure Nursing Needs and Nursing Needs and Resources in Texas. Sponsored by the Board of Nurse Examiners Resources in South Carolina. Columbia: for the State of Texas, the Texas Graduate South Carolina Nurses' Association. 80 pp. Nurses' Association, and the Texas League for Nursing, in association with the Texas MEDICAL COLLEGE OF SOUTH CAROLINA, UNIVERSITYOF Commission on Patient Care. San An- SOUTH CAROLINA, WINTHROP COLLEGE, SOUTH tonio: Texas Graduate Nurses' Association. CAROLINA LEAGUE FOR NURSING, SOUTH CAROLINA 144 pp. and appendixes (processed).

6 106 APPENDIX 1

UTAH 1950. A Report of Washington Nursing Study, 1950. Seattle: Washington State Nursing U.S.DEPARTMENT OF HEALTH, EDUCATION, AND Association. 54 pp. (processed). WELFARE. PUBLIC HEALTH SERVICE.DIVISION OF NURSING RESOURCES. WEST VIRGINIA 1954.Nursing in Utah. A Survey of Needs and Resources-1954 and Supplement No. 1. FEDERAL SECURITY AGENCY. PUBLIC HEALTH SERVICE. Salt Lake City: Utah Nurses' Association. DIVISION OF NURSING RESOURCES. 73 pp. (processed). 1951.Nursing in West Virginia. Report of the West Virginia Survey of Nursing Needs and VERMONT Resources, 1951. Charleston: West Vir- FEDERAL SECURITY AGENCY. PUBLIC HEALTH SERVICE. ginia State Nurses' Association. 103 pp. DIVISION OF NURSING RESOURCES. (processed). 1952. Nursing in Vermont: Report of the Vermont Survey of Nursing Needs and Resources, WISCONSIN 1952. Burlington: Vermont State Nurses' COLUMBIA UNIVERSITY. TEACHERS COLLEGE. INSTITUTE Association. 63 pp. (processed). OF RESEARCH AND SERVICE IN NURSING EDUCATION. 1955. Education for Nursing in Wisconsin.(Ad- WASHINGTON dressed to the Wisconsin Commission To FEDERAL SECURITY AGENCY. PUBLIC HEALTH SERVICE. Develop a State-Wide Planfor Nursing DIVISION OF NURSING RESOURCES. Education) New York. 376 pp.

Reports, 1962-71; National, Regional, State and Territorial

National beth V. Cunningham. Code No. 16-1081. New York: The League. 69 pp. WEST, MARGARET D., and CROWTHER, BEATRICE. 1962.Education for Practical Nursing, 1960. A This survey report identifies trends and describes the char- Report of the Committee on the Question- acteristics of diploma nursing education as it existed in the Spring of 1962. The survey focused on educational aspects of naire Study of Praetical Nursing Schools. programs, fiscal practices and policies, deviations from previous New York: National League for Nursing, practices, and major problems. The findings, for the most part, Department of Practical Nursing Programs. were not measured against any standards or criteria but were 63 pp. intendedto be useful for planning and for continuing the sound development of schools. The report reflects a generally Thisisa report ofthefirstnationwide status study of held opinion that the Majority of diploma schools of nursing practical nursing programs directed toward learning facts about were regarded as full-fledged educational institutions, capable these programs for developing evaluative devices and identify- of identifying their own problems, setting goals, and finding ing ways in which they could be improved. The survey report ways for meeting current criteria of educational cxcellence. is based on data from 494 of 662 State-approved schools of practical nursing in the academic year 1959-60. It covers trends U.S. DEPARTMENT OF HEALTH, EDUCATION, AND in the development of programs and assesses the status in WELFARE. PUBLIC HEALTH SERVICE. 1959-60 oftheir organization, control, and size; curriculum 1963. Nurses for Leadership. The Professional patterns; age and educational background of students; costs to students;educational expenditures; program resources; and Nurse Traineeship Program. Report of faculty size and qualification. Recommendations are made for the 1963 Evaluation Conference. PHS improvement in practical nursing programs, and areas requiring Pub. 1098. Washington: U.S. Govern- further study are suggested. ment Printing Office. 53 pp.

NATIONAL LEAGUE FOR NURSING. DEPARTMENTOF This report is an assessment, through 1962, of the results of DIPLOMA AND ASSOCIATE DEGREE PROGRAMS. the Federal government's programto providethrough ad- professionalnursesfor 1963.Today's Diploma Schools of Nursing. vancedtrainingcriticallyneeded Re- teaching, administration, and supervision in hospitals, nursing port of the 1962 Survey of 728 Diploma schools, and health agencies. Recommendations are made for Schools of Nursing. Prepared by Eliza- continuance and extension of this Program. Many of the recom

(-4 SURVEY AND STUDY REPORTS 1.07 mendations support those made bythe Surgeon General's directedto the areas in which Federal assistance can be of Consultant Group on Nursing. Effects of this program on nurs- particular and immediate significance in increasing and improving service and nursing education and future needsare sub- ingnursing personnel and nursing service. They urgently stantiated by program data and a study of future education recommended that the nursing profession immediately conduct plans of professional nurses conducted in 1962 by the Division a study of the present system of nursing education in relation of Nursing, with the assistance of State boards of nursing, to to the responsibilities and skill levels required for high-quality contribute information for the evaluation conference on educa- patient care. They recommended that the Federal Government tional plans and interests of nurses. expand and addtoitspresent programofsupport and assistance in the following areas: (1) recruitment for schools U.S.DEPARTMENT OF HEALTH, EDUCATION, AND of nursing;(2)assistance to schools for expansion and im- WELFARE. PUBLIC HEALTH SERVICE. provement of the quality of educational programs;(3)as- 1963. Toward Quality in Nursing: Needs and sistancetoprofessionalnursesfor advancedtraining;(4) assistance to hospitals and the health agencies for improvement Cods. Report of the Surgeon General's ofutilization and training of nursing personnel; and(5) Consultant Croup on Nursing. PHS Pub. increased support for research in nursing. 922, Washington: U.S. Government Printing (Excerpted from a review by M. Harms in Nursing Research, Office. 73 pp. 12 (3) :202, Summer 1963.) A briefdescription of social, economic, andeducational changes in our society and advances in medical sciencespro- NATIONAL LEAGUE FOR NURSING. DEPARTMENT OF vides the contextfor the analysis of nursing practice and BACCALAUREATE AND HIGHER DEGREE PROGRAMS. nursing educationpast, present, and future. Analysis of goals 1964. Masters Education in Nursing. Report of and needs for nursing services by all types of personnel identified the need, by 1970, for 300,000 auxiliary workers, 350,000 a Study Conducted in Spring 1963, by practical nurses, and 850,000 professional nurses. Of the pro- Jean Campbell, NLN Consultant in Nursing fessional nurses, 200,000 should have baccalaureate degrees and Education. Code No. 15-1157. New 100,000 should have graduate preparation. Those numbers of York: The League. 121 pp. nurses were considered necessary by 1970 if the people of the United States are to be provided therapeutically effective and The nature and scope of education in nursing at the master's efficient nursing service. However, considering potential school level were studiedtoprovide guidelinesforsettinggoals, capacities, potential numbers of students, and the need to safe- developing accreditation criteria, and planning for the future. guard the quality of education, the Consultant Group projected The survey covered 35 institutions offering master's programs a more realistic goal of 680,000 professional nurses by 1970. in 13 fields of specialization during the academic year 1962-63. Of these professional nurses, 120,000 should have baccalaureate The number of faculty members covered in the study was 139; degrees, including 25,000 with graduate preparation. The Con- the number of students, 1,217. The study assessed the characteristics of programs, faculty, and students, including university sultant Group predicted that the estimated goal of350,000 practical nurses by 1970 could be reached. This would provide control, curriculum patterns, clinical practicum, admission re- 38 percent of direct services to patients by professional nurses, quirements, educational preparation of faculty, and faculty and 30 percent by licensed practical nurses, and 32 percent by research activities. auxiliary personnel. To achieve these goals, there must be major expansions NATIONAL LEAGUE FOR NURSING. quantitative and qualitativeof both diploma and collegiate 1964. Study on Cost of Nursing Education. Part programs. Special emphasis must be given to the following: I.Cost of Basic Diploma Programs.Code basic baccalaureate degree programs and the expansion and No. 19-1142. New York: The League. development of new programs providing advanced preparation for leadership and teaching positions; intensification of recruit- 95 pp. ment for all programs; increase in financial aid to students; This is a report of an investigation into the cost of nursing better alignment of personnel policies for graduate nurses with education in 126 diploma programs, using a standard method those of other occupations requiring comparable skills, ability of cost determination for each institution developed by the and preparation; critical study of patterns of education; better National League for Nursing and the Public Health Service in utilizationof existingpersonnel;continuedstaff education, 1956. The study compared income, total costs, and the costs of stimulation, and support for nursing research. educational functions and noneducational functions, by regional To reach these goals of nursing service, a multi-pronged distribution of the programs, type of control, size of enrollment, attack with adequate resources is needed. Cooperative efforts of and accreditation status. The study pointed up the magnitude the nursing profession,alliedprofessions, private and corn- of the cost of maintenance of diploma program students, and munity groups, educational institutes, and health care agencies showed that the costs of both gross and net noneducational will be imperative. Financial support that cannot be provided functions were greater than of educational functions. Profiles by these groups must be provided by government at all levels. of costs are presented in the text, and the appendix includes a The specific recommendations of the Consultant Groupwere schedule of cost analysis for one partkipating agency.

5 108 APPENDIX 1

NATIONAL LEAGUE FOR NURSING. don of the various provisions under the Act, by State and type 1965. Study on Cost of Nursing Education. Part of nursing education program, are included in the appendix. II. Cost of Basic I3accalaureate and As- WALKER, VIRGINIA H. sociate Degree Programs. Code No. 19- 1967. Nursing and RitualisticPractice. New 1174. New York: The League. 95 pp. York: Macmillan Co. 196 pp. This is a report of an investigation into the cost of nursing This book reports the findings of a 3year study, supported education in 19 basic baccalaureate and 10 assooiate degree by the U.S. Public Health Service, in which nursing functions programs offered by institutions of higher learning, using the were examined against the criterion of "ritualistic behavior," National League for Nursing and the Public Health Service defined as operational behavior having some significance to the method developed in1956. The study compared the cost of actor rather than being primarily oriented to the achievement of instructional units in nursing with the cost of those in general organizationalgoals.Traditionalandcontroversialnursing education, and showed the former to be much greater. The functions examined include temperature, pulse, and respiration study demonstrated a negative relationship between the cost of procedures;shift reports;assignment ofnursingactivities; the nursing programs in the study and the percent of cost that nurses'accountabilitytoseveralsupervisors;anddecision- was borne by the students. A profile of costs is given for each making inthe absence of a physician. The studyfindings program, and the schedules used for recording cost analysis clearly indicate that ritualistic behavior related to these func- are included in the appendix. tions accounts for enough difficulty to warrant further investigation. This book can help to prepare nurses to read, eva/uate, NATIONAL LEAGUE FOR NURSING. DEPARTMENT OF and use or reject research findings. Sufficient information and PRACTICAL NURSING PROGRAMS. ideas are presented for beginning efforts in research or evalua- 1966. Practical Nursing Education Today. Re- tion of services. The book is timely, in view of the need to face port of the 1965 Survey of 722 Practical the issues of tbe demand for nurses and the changing role Nursing Programs. Code No. 38-1244. of the professional nurse. (Excerpted from a review by Nancy Kintner, Director of Nursing, Northern State Hospital, Sedro New York: The League. 33 pp. Woolley, Washington. In Nursing Outlook, 15 (12) :21, Decem. This is a report of a survey questionnaire that assessed the her 1967.) characteristics and quality of 722 of 913 existing practical nursing education programs in relationship to acceptable stand- NATIONAL LEAGUE FORNURSING.RESEARCH AND ards and criteria for the evaluation of these programs de- DEVELOPMENT. veloped by the National League for Nursing and published in 1969. A National Survey of Associate Degree 1965.Itevaluatedprogressmade sincethe1960survey, Programs, 1967.By Sylvia Lande.Pub. portrayed the growth and expansion in these programs, and 23-1348. New York: The League. 150 assessedtheeffectsof Federallegislationsupportingthe development of practical nurse programs. It covered such areas PP. as administration, faculty, students, curriculum, facilities, and The characteristicsof associate degree nursing programs, resources, and included a separate analysis of 61 of 150 pro- their administration, students, faculty, curriculum, resources, grams operating under Manpower Development and Training and graduates, are reported in depth. Data were gathered from Act funds. Recommendations are made as a basis for planning replies from 201 of 218 programs to which questionnaires were further improvement in programs. sent in 1967. The history of associate degree nursing programs is traced, and implications are drawn from the survey. U.S.DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE. PUBLIC HEALTHSERVICE. BUREAU OF NATIONAL COMMISSION FOR THE STUDY OF NURSING HEALTH MANPOWER. DIVISION OF NURSING. AND NURSING EDUCATION. 1967.Nurse Training Act of 1964. Program 1970. An Abstract for Action. Vol. I. New Review Report. PHS Pub. 1740. Wash- York: McGraw-Hill, Inc. 167 pp. ington: U.S. Government Printing Office. This independentcommission, establishedjointlyby the American Nurses' Association and the National League for 78 pp. Nursing and supported by foundation funds, carried out the This report, submitted to Congress in January 1968 by the recommendations of the Surgeon General's Consultant Group Committee appointed to review the Nurse Training Act of 1964, on Nursing that nursing education be studied inrelation to documents the accomplishments and shortcomings of the various the responsibilities and skilllevels required for high-quality provisions of the Act and its administration, forecasts future patientcare. The Commission studied trends and changing needs, and redefines goals for nursing inlight of continuing conditions in the Nation's need for nurses, assessed changing social change affecting nursing and the delivery of health rolerequirements and educational practices and the internal services. The Committee recommended continuationofthe and external factors influencing nursing careers. Among the program through 1974 atleast,and expansionofvarious Commission's recommendations, priority is given to the need provisions of the Act. Statistical data on the awards and utiliza. for increased research into the practice of nursing and educa. SURVEY AND STUDY REPORTS 109

tion of nurses, enhanced educational systems and curricula mended. State representatives are advised to stimulate State based on research, and increased financial support for nurses studies and coordinate action on the States' nursing education and nursing to ensure adequate career opportunities. The report problems. also briefly describes the history, organization, and methodology of the investigation. SOUTHERN REGIONAL EDUCATION BOARD. 1967. Agenda Book, Eighth Conference of Council NATIONAL COMMISSION FOR THE STUDY OF NURSING on Collegiate Education for Nursing, April AND NURSING EDUCATION. 19-21, 1967. Project in Nursing Educa- 1971.An Abstract for Action: Appendices. Vol. tion and Research. Atlanta,Ga.: The II. Edited by Jerome P. Lysaught, Direc- Board. 65 pp. tor. New York: McGraw-Hill Book Com- Included inthe proceedings ofthis Conference and the pany. 509 pp. conference agenda book are synopses of various activities and This is a companion publication to volume I which contains progress, up toApril1967, toward statewideplanning for the finalreport and recommendations of the National Com- nursing education in the States of Arkansas, Georgia, Mary- mission. In the eighteen sections which make up the setof land, Mississippi, North Carolina, Oklahoma, Texas, and Vir- appendices, the study methods used are documented, interim ginia. Through these reports, processes in the development of findings and decisions are included, and data relevant to the State planning for nursing can be traced. threeyear study of nursing practice and education are given. SOUTHERN REGIONAL EDUCATION BOARD. 1967. Agetida Book, Ninth Conference. of Council Regional onCollegiateEducationforNursing, PAIR, NONA TILLER. November 8-10, 1967. Project in Nursing 1963. NursingResourcesinIdaho,Montana, Education.Atlanta, Ga.: The Board. 73 Nevada, and Wyoming. A review of nurs- PP. ing resources in theselour States, prepared This agenda book updates previous Conference progress re- for the Mountain States Medical Education ports on statewide planning activities for nursing education for Study. Sponsored by the Western Inter- the States of Arkansas, Georgia, Maryland, Mississippi, and stateCommission forHigher Education, Texas, and adds reports for the States of South Carolina and Tennessee. These reports give information on how the various Boulder, Colo., Sept. 16, 1963. 72 pp. Statessponsor,finance,organize,and carryout planning (processed). activities. Updated statistical data on nursing education in the This report reviews the number of registered nurses by field Southern Regional Education Board region are also included. of practice in the four States in 1962, the number of licensed practical nurses, and the trends in the number of practitioners FLITTER, HESSEL H. being prepared in schools of nursing for registered nurses and 1968. NursingintheSouth. Atlanta,Ga.: practical nurses. A comparison is made of nurse-to-population Southern Regional Education Board. 51 ratios of the country as a whole, of the four States, and of 1313. particular counties within these States. The number of nursing practitioners needed in the future is predicted, based on an This publication concisely analyzes nursing in the 15 States estimate of population growth and present nurse-to.population includedinthe Southern Regional Education Board. It de- ratios. scibes where nurses arc employed, and compares the current and estimated future supply with national goals. It also assesses WESTERN INTERSTATE COMMISSION FOR HIGHER the status of nursing education. The intent of the report is to EDUCATION. encourage each State and local community in the South to plan for meeting its nursing needs in light of its own resources. 1966. Today and Tomorrow in Western Nursing. A WCIIEN Report on the Present, With NATIONAL LEAGUE FOR NURSING. Recommendations for the Future.Boulder, 1968. Operation Decision: Citizen Planning for Colo.: The Commission. 108 pp. Nursing in the South. Report of a con- This publication is a report of a reappraisal of needs and ference sponsored by the Southern Regional resources for nursing educationfor the13 westernStates Assembly of Constituent Leagues for Nurs- regional education compact. It contains an assessment of the ing and the NLN Cour-q of Public Health extentto which the recommendations ofthe 1959 survey, Nursing Services. Puu. 54-1322. New reported in Nurses for the West, were carried out. An action York: The League. 58 pp. program on the regional, State,and institutional levelsfor providing an adequate supply of well-trained nurses is recom- Issuesin nursingservice and nursing education, nursing 110 APPENDIX 1

needs, and required action programs in the 13 southern States mittee Report.Birmingham: The League. all wereidentified inthis Conference intendedto stimulate 53 pp. community planning fornursing. Representatives ofacross section of nursing interests, in addition, assessed data available This is a report of the findings and recommendations of a and needed for planning, and the potential and means for State planning committee appointed to study the current prac- meeting nursing needs. The report describes the Conference ticesofnursesinAlabama andtopropose methodsfor work of each State team and planning for nursing that was in improvementinpatientcare. The Committee conducteda progress in the State. survey of nursing activities in hospitals, nursing homes, and publichealthagencies;determinedthefunctionsofthe FAHS, IVAN J.; BARCHAS, KATHRYN U.; and OLSON, registered nurse; and made recommendations for the improved LINDA G. utilizationofnursingpersonnel. The needforutilization studies,regional demonstration units,continuing education, 1970. Nursing in the Upper Midwest. A Sum- and inservice education was stressed. mary Report. The Upper Midwest Nursing Study, Upper Midwest Research and De- ARIZONA velopmentCouncil. Minneapolis, Minn. A study sponsored by the Louis W. and ARIZONA STATE NURSES' ASSOCIATION. Maud Hill Family Foundation of St. Paul, 1965. "Interim Report of the Joint Committee Minn. 48 pp. (processed). To Study Nursing Needs and Resources in Arizona." Arizona Nurse, 18 (5) :23-38. This is one of several reports on a regional study of nursing November-December 1965. needs and resources in the Upper Midwest. The Upper Midwest region comprises theentire States of Minnesota, Montana, The continuous activities of the Committee on Nurses for North Dakota, and South Dakota, and parts of Michigan and Arizona and the Joint Committee To Study Nursing Needs and Wisconsin. This summary report presents statistics, information, Resources are traced from 1959 through 1965. Progressin and an anulysis of nursing needs and resources in the region carrying out recommendations of the 1950 and 1963 surveys is as they relate to and are influenced by demographic, economic, noted. The report updates to 1964 a statistical summary and social, and health factors and conditions in the region and .analysis of the nurse supply and educational resources. New in the Nation as a whole. Problematic areas related to meeting goals and action programs for meeting Arizona's nursing needs nursing personnel needs are highlighted. are recommended.

State and Territorial ARIZONA STATE NURSES' ASSOCIATION. 1966. "Interim Report No. 2 of the Joint Commit- ALABAMA tee To Study Nursing Needs and Resources in Arizona," Arizona Nurse, 18 (3) :14-22, ALABAMA BOARD OF NURSING. May-June. 1968.Assessment of Nursing Education in Ala- A reassessment of Arizona's nurse supply and educational bama, 1968. Montgomery: The Board. resources, based on an analysis of trend data from 1958 to 58 pp. 1965,is made inthisreport. Changing county needs and additional demands for nursing services are considered. De. This study proposes definitive measures for the development velopment of a statewide plan for education in nursing and of a plan for nursing education in Alabama. The characteristics of the 1967 supply of registered continuing education for practitioners is recommended', to meet nurses, licensedpractical needs for health care and 1970 goals for nursing. nurses, andnursing education resources were analyzed by regions of the State. The characteriatics of facultyand students ARIZONA NURSES' ASSOCIATION. of nursing, recruitment practices, and the applicant experiences 1968. "Interim Report No. 3 of The Joint Commit- of schoolsall were surveyed bya student questionnaire and a structured interview of directors of schools of nursing. General tee To Study Nursing Needs and Resources recommendations are made for the development of nursing in Arizona." Arizona Nurse, 21 (3) : 17-24 educationinthe State,withspecificrecommendations on (May-June). recruitment, nursing faculty development, and the development "Data concerning employed professional nurses licensed in or expansion of specified types of nursing education programs, Arizona for the years 1959 through 1967. Yearly percentage by regions of the State. gain, number and source of new licensed nurses, age distribu. ALABAMA LEAGUE FOR NURSING, ALABAMA STATE tion and total number licensed and employed statistics are NURSES ASSOCIATION, ALABAMA REGIONAL MEDICAL given. Nursing education is reviewed and data includes type of programs, number of admissions and graduations for the PROGRAM. years 1963 to 1968. Results of a questionnaire survey to de- 1969. Nurse Utilization in Alabama, A Com- termine characteristics of inactive nurses, the interest in re SURVEY AND STUDY REPORTS 111

fresher courses and likelihood of returning to active practice vision received; positions or responsibilities refused; adequacy are also reported." (From Abstracts of Hospital Management of preparation for positions held;additional training needed; Studies, V:133, June 1969.) and future plans related to nursing. Biographical data on 516 students entering associate degree nursing programs in 1958 ARKANSAS and 2959 are included. ARKANSAS STATE BOARD OF NURSE EXAMINERS. CALIFORNIA STATE DEPARTMENT OF EDUCATION. 1965. Statistical Report oj the Arkansas State 1966. Associate Degree Nursing Education Pro- Board of Nurse Examiners. January 1, grams in California, 1953-1965. Prepared 1965 to September 1, 1965. Little Rock: by Mrs. Celeste Mercer, Special Consultant, Arkansas State Board of Health. 38 pp. California Associate in Arts Nursing Proj- This report compiles from licensing data the number, location ect, Bureau of Junior College Education, by county, activity status, education, and other characteristics Sacramento. 69 pp. of registered nurses and practicalnursesinthe State of Arkansas in 1965. This report of thehistory and Statewide development of associatedegree nursingeducationprogramsinCalifornia ARKANSAS STATE NURSES' ASSOCIATION. points out some of the critical areas to be observed in planning 1968. Arkansas Health Manpower Project Report, and maintaining a successful program. Included are planning June 26, 1967November 30, 1968.Little the curriculum; providing stuff and facilities; developing plans Rock: The Association. 91 pp. (proc- and policies for the recruitment, selection, and admission of essed). students;and organizing the administrative and supervisory relationships within the college and with other agencies. Evalua- This report of an 18-month project to return inactive health tion processes for the first 6 years of program development have manpower to employment contains data from various surveys yielded special survey and study data on: factors related to of nursing needs and resources. Included are the county distri- admissions, enrollment, attrition, and graduates; attractions of butionofinactiveregisterednurses and licensedpractical the associate degree nursing program; and reasons for the nurses; the intention of inactive registered nurses to return closing of hospital schools. to work; their needs for refresher courses; and the numbers who enrolledin,completed courses, and returned to work. COORDINATING COUNCIL FOR HIGHER EDUCATION. Data on budgeted unfilled vacancies for registered nurses and 1966. Nursing Education in California. A Re- licensedpracticalnurses,by county,inhospitals, nursing port to the Coordinating Council for Higher homes, and Statehealth department services areincluded. Education. No. 1025. Sacramento: The Surveys were made on the number of registered nurses, licensed Council. 51 pp. practical nurses, and non-nurse personnel employed in school and industrial health positions. Unfilled positions for industrial This is a report of a study of nursing education in California nurses, as well as their salary and fringe benefits, were included conducted by the Council to provide a basis for planning. It in the survey. discusses needs for nurses; basic education programs, accreditation of programs, graduate education and articulation of the CALIFORNIA segments;nursing functions, licensure, and economic incentives; and auxiliary nursing personnel. Findings in these areas CALIFORNIA STATEDEPARTMENT OF EDUCATION. are summarized, and the resolutions of the Council based on BUREAU OF JUNIOR COLLEGE EDUCATION. the findings are presented. 1964. Data Regarding the Graduates ol the Cdi- fornia Associate Degree Nursing Program COORDINATING COUNCIL FOR HIGHER EDUCATION. From the Board of Nursing Education and 1968. Progress Report on Nursing Education in NurseRegistration,Six-YearEvaluation California.Pub. 68-13.Sacramento: The Project.Prepared by Mrs. Helen D. Bow- Council. 53 pp. (Processed). man,SpecialConsultant,California As- This report assesses the current status and action taken on sociate in Arts Nursing Project, Bureau of the 1966 resolutions of the Council regarding nursing education JuniorCollegeEducation. Sacramento. in Statejunior and senior colleges and the university. An 54 pp. (mimeographed). assessment is made of educational programs in 1966 for licensed vocational nurses and for registered nurses, including diploma, This report analyzes data collected by questionnaire by the associatedegree,baccalaureate,master's, andpost-master's Board of Nursing Education and Nurse Registration on the programs. Data are presented on faculty and student resources. employment experience of 216 graduates of associate degree admissions, graduates, and percent of graduates passing State nursing programs in 1959 and 1960. The employment evaluation Board examinations; cost factors; and plans for expansion and includes data on: field of nursing; type of position; length of development of programs. Findings and recommendations are time in position; job orientation, inservice training, and super- summarized. 112 APPENDIX 1

DEPARTMENT OF PROFESSIONAL AND VOCATIONAL expansion of education programs. The study includes a regional STANDARDS. BOARD OF NURSING EDUCATION AND NURSE analysis of registered nursus and licensed practical nurses, by type and characteristics of their work places, as well as an REGISTRATION. analysis of educational resources for the years 1955 to 1962. 1969. Profile of Registered Nurses in California. Needs and demands for personnel are estimated. Sacramento: The Board. 51 pp. (processed). COLORADO NURSES' ASSOCIATION. 1968.Inactive Health Personnel Project Final Re- This is astatisticalpresentation without analysis of the port. Denver: The Association. 46 pp. supply and characteristicsofregistered nurseslicensedin California as of December 31, 1968. Data areclassifiedby (processed). county and regions of the State and detailed by sex; age group; This reportisdevotedprincipallytoinactiveregistered marital status; number employed full-time, part-time, and not nurses in 1967 and 1968, their characteristics as to age,marital employed; educational preparation; field of employment; type status, educational preparation, work experience, and intention of position; and area of clinical practice. to return to work. It includes a history of refresher courses for inactive registered nurses, programing procedures, and the HEALTH MANPOWER COUNCIL OF CALIFORNIA. number of nurses who completed courses and returned to work. 1970. 1970 California Health Manpower, Licensed A brief review is given of Colorado's registered nurse supply, VocationalNurses. BasicOccupational from 1962 to 1966 and the nursing education situation by type Information Series. Orinda, Calif.: The of program. Also included are projections of educational re- Council. 49 pp. (processed). sources to 1977 and the State plan for nursingeducation. This reportcompilesavailabledata and information on CONNECTICUT licensed vocational nurses in California. It presents trends in the supply from 1952 to 1968, as well as trends in educational CONNECTICUT COMMISSION ON NURSING. programs. Data from the Board of Vocational Nurses give 1966.Nursing Needs and ResourcesinCon- information on the characteristics of these nurses by age, sex, necticut, A Report oftheConnecticut county distribution, and employment status. Also includedis Commission ort Nursing, 1966. Sponsored information on admissions, enrollments, and graduates from educational programs. The report calls attention to the limited by the Connecticut League for Nursing, source of data on licensed vocational nurses. Connecticut Nurses' Association, and Con- necticut Hospital Association. Hartford: HEALTH MANPOWER COUNCIL OF CALIFORNIA. The Commission. 49 pp. 1970. 1970 California Health Manpower, Regis- The Commission studied nursing personnel resources and tered Nurses.Basic Occupational Informa- needs in hospitals, public health agencies, nursing homes, and tion Series. Orinda, Calif.: The Council. schools of nursing. Action for meeting needs was recommended 65 pp. (processed). inthe areas of planning, recruitment, job satisfaction, and postgraduate education. Priority was given to the need for This report compiles data and information on the registered properly organized and financed continuous planning for nurs- nurse supply from available sources. Data were obtained largely ing as a responsibility of the State Departments of Health, through licensure processes and accreditation procedures for Education, and Labor, and all other public and private agencies nursing education programs. Trends in the nurse supply up to concerned. 1969 and the characteristics of nurses by age, sex, employment status, and distribution by county, are detailed. Trendsin DISTRICT OF COLUMBIA nursing education and the characteristics of students are also traced. The report draws implications on the need for, short- U.S.DEPARTMENT OFHEALTH,EDUCATION, AND ages of, and utilization of nurses for planning purposes. WELFARE. PUBLIC HEALTHSERVICE. BUREAU OF COLORADO HEALTH MANPOWER. DIVISION OF NURSING. 1967.Community Planning for Nursing in the COLORADO LEAGUE FOR NURSING and the WESTERN Districtof Columbia Metropolitan Area. COUNCIL ON HIGHER EDUCATION FOR NURSING. Source Book for Planning. PHS Pub. 1963. Report of the Colorado Committee Toward 1676. Washington:U.S.Government Statewide Planning for the Education of Printing Office. 143 pp. Nursing Practitioners in Colorado. Den- This source book was designed as a tool that can be used ver: The League. 74 pp. by planning groups in other metropolitan areastoidentify Nursing service personnel employed by the health services sources and select data pertinent to their problems, issues, and and educational programs for nursing were assessed as a basis situations. However, itis also a data survey and analysis of for the later development of guidelines and criteria for the nursing needs and resourcesintheDistrictof Columbia

111111 SURVEY AND STUDY REPORTS 113 metropolitan area, and draws implications for planning. Statis- made on employment and career incentives, the utilization of tics and information are presented on the demography of the nursing personnel, or other factors and conditions influencing area; health conditions, expenditures, facilities, and services; nursing practke and education in Hawaii. and socioeconomic factors as they relate to thenurse supply, nursing education resources, and nursing needs. IDAHO GEORGIA UNIVERSITY OF IDAHO. COLLEGE OF EDUCATION. THE STATE OCCUPATIONAL RESEARCH UNIT. GEORGIA EDUCATIONAL IMPROVEMENT COUNCIL. 1967. A Study of the Nursing Profession in Idaho 1969. Nursing Education in Georgia. By Pat Medical Facilities. Moscow: The State Malone. Atlanta: The Council. 103 pp. Occupational Research Unit. 23 pp. In this 18-month statewide study of nursing education, the This is a report of a questionnaire survey of hospitals and educational resources were examined againstthe 1967 nursc nursing homes within thc State of Idaho. The survey was made supply, the needs and demands for nurses, and such influencing to obtain factual data concerned primarily with descriptive factors as carecr and employment incentives, new career pat- information about the facilities and the nursing service person- terns, and changing health services.Quantitativeneeds are nel working therein. projectcd to 1975, and broad recommendations are made for increasing and improving the nurse supply and strengthening WESTERN INTERSTATE COMMISSIONFOR HIGHER the educational program. The involvement inthestudy of EDUCATION. MOUNTAIN STATES REGIONAL MEDICAL selected leaders and professional groups and the wide participa- PROGRAM. IDAHO OFFICE. tion of health and educational institutions and agencies should lay a firm basis for local, regional, or area planning to find 1969. Nursing in Idaho: A Study of Nursing specific solutions for ntirsing problems and to obtain coopera- Needs and Resources. Boulder,Colo.: tion in developing programs for meeting needs. The Commission. 86 pp. Thisfirst statewide survey of Idaho's nursing needs and HAWAII resources was preparedasa guidefor understanding the nursing manpower problems of the State and for planning to KOSAKI, MILDRED D. meet nursing education needs. The 1967-68 supply and charac- 1962. Nursing and Nursing Education in Hawaii. teristics of active and inactive registered nurses are analyzed, Report No. 3. Legislative Reference Bu- including county distribution,ratiotopopulation,attrition, reau, UniversityofHawaii. Honolulu, migration, and source of supply. Nursing education resources Hawaii. 117 pp. in1968 areassessed, and needs forregistered nurses are projected for 1970, 1975, and 1980. Recommendations made This study found the supply of registered nurses andprac- on nursc manpower, utilization, recruitment, and education tical nurses and facilities for basic nursing education tobe include a proposal for the formation of a permanent education adequate in Hawaii in 1961. However, itpredicted definite planning committee under the auspices of the Statewide Co- shortagesforpracticalnurses andprobableshortagesfor ordinating Committee on Nursing Education. The survey in- registered nurses by 1970. Programs in basic nursing education cludes data on the distribution, activity status, and ratio to that were not meeting admission quotas were identified, and population of licensed practical nurses. needs for the advanced educational preparation of nurses in specialty fields, supervision, and administration were pointed ILLINOIS up. Legislative action to promote nursing education was recommended, as well as the collaboration of nursing with other TOMLINSON, R. M.; AsH, C. T-.; T .....ANGDON, LOIS M.; health professions for meeting specified problems in nursing and SUZUKI, W. N. service and nursing education. 1967. Practical Nursing inIllinois: A Profile. Department of Vocational and Technical UNIVERSITY OF HAWAII. LEGISLATIVE REFERENCE Education, College of Education, University BUREAU. of Illinois, in cooperation with the Illinois 1969. Nursing In Hawaii, 1968. Report- No. 4. Board of Vocational Education and Reha- Honolulu: The University. 52 pp. bilitation, and the U.S. Office of Education. This is a report on thc number of registered nurses employed Urbana: University of Illinois. 160 pp. inHawaii in1968, and the needs for nursesprojected by employing agencies for 5 and 12 years.It concluded that, (processed). barring marked changes, thc presently projccted number of The first rcport on a longitudinal study of practical nursing nursing school graduates and nurses coming to Hawaii from in the States of Illinois and Iowa details preliminary findings on other States and countriesis adequate tofillthc near-term practical nursinginIllinois. The development ofpractical needs of thcState. No assessmentor recommendations are nursing in the State is traced and related to thc characteristics 114 APPENDIX 1

of the population of licensed practical nurses, their employment practicalnurses, and aides;their workingconditions; and patterns, and the program through which they are prepared. A their educational preparation. Recommendations developed from 10 percent sample of practical nurses licensed from the incep- the 2.-year stu.ly give directions for improving the quantity and tion of licensure in 1951 through 1965 was used in the study. quality of the supply to meet estimated needs up to 1975, in relation to educational programs, population growth, and health ILLINOIS STUDY COMMISSION ON NURSING. trends. 1968. Nursing in Illinois. An Assessment, 1968, and A Plan, 1980. Chicago: The Commis- HILL, RAYMOND E. sion.64 pp. 1968. A Summation of the Nursing Resources Follow-up Survey. Indianapolis Hospital This is a report of a 2-year, in-depth planning project that has recommended programs of action to meet Illinois' needs Development Association,Inc. Indian- for nursing services by 1980. Assessment of nursing needs and apolis, Ind. 30 pp. resources andthe development ofrecomendationsbythe "The seven nursing education institutions in the metropolitan Commission's representatives of interdisciplinary health groups Indianapolisareaoperativesince1964 each completeda and the public were supported by documentation and analysis questionnaire to update data from the 1964 Booz, Allen and of the nursingsituation from available socioeconomic, health, Hamilton nursing resources survey, assessing the supply of and nursing data, as well as six special studies conducted by nurses currently being educated and collecting pertinent statis- questionnaires, and a research study on nurse utilization in tics regarding the students and the institutions involved. Data hospitals. The report includes a blueprint for nursing education. are tabulated by type of program." (From Abstracts of Hospital Management Studies, V: 127. June 1969.) ILLINOIS STUDY COMMISSION ON NURSING. 1968. Nursing In Illinois. An Assessment, 1968, KANSAS and A Plan, 1980. Vol. II, Committee KANSAS STATE BOARD OF NURSING and KANSAS STATE Reports. Sponsored by the Illinois League for Nursing and Illinois Nurses Association. NURSES' ASSOCIATION. 1963. Reappraisal Study of Nursing Needs and Chicago: The Commission. 136 pp. Resources: A Follow-up of the Survey f "This volume, supplementary to the main report published as NursingNeedsandResources, 1958. volume 1, contains the principal data,forecasts, and recom- Kansas League for Nursing, Implementation mendations ofthe seven-nurse occupational-areacommittees through whom the primary work of the Commission was done." Committee. Topeka, Kans. Reports of special surveys undertaken by the Committees are lii accordance with a recommendation of the initial survey included. of nursing needs and resources, data from the 1958 study were updated, needs, and resources were reappraised, and progress in INDIANA the accomplishment of the 1958 rcicommendations was assessed. Needs and goals for nursingin 1970 were projected, and INDIANAPOLIS HOSPITAL DEVELOPMENT ASSOCIATION. recommendations for action programs were formulated. 1965. Su; vey of Nursing Resources in Indianapoli.s KANSAS HEALTH FACILITIES INFORMATION SERVICE. Metropolitan Area. Indianapolis: The As- INC. sociation. 157 pp. 1965. A Study of Nursing Needs and Goals The goal of this study was to estimate demands and the in Kansas Through 1975. Pub.108. nursing resources required for meeting community .needs from Topeka: The Service. 33 pp. (proc- 1965 to 1975 as part of planning for the expansion of health essed). facilities. Data on hospitals, nursing homes, high school seniors, graduates from nursing schools from 1935 to 1964, and on the This study assessed the lharacteristics of the 1964 supply of cost of nursing educationall were collected by special surveys registered nurses and licenssd practical nurses, nursing educa. and assessed with available data on the nurse supply and its. tion programs, and trends inlursing manpower, as a basis for characteristics. long-range planning for nursing by an interdisciplinary health group. Nursing personnc: Cillsfor 1975 were established, INDIANA COMMITTEE ON NURSING. based on expected need and the abilityto meet that need. 1967.Nurses for Indiana, Present and Future. Recommendations propose a broad attack on the problems of Survey Report of the Nursing Needs and recruitment, preparation, and utilization of nursing personnel. 6 Resources in Indiana, 1967.Indianapolis: KANSAS HEALTH FACILITIES INFORMATION SERVICE, The Committee. 132 pp. INC. This study assessed the statewide demand for, distribution of, 1966. Recommendations and Guidelines for Ac- and characteristics of the supply of registered nurses, licensed tion: Supplement to A Study of Nursing SURVEY AND STUDY REPORTS 115

Needs and Coals in Kansas Through 1975. LOUISIANA STATE NURSES' ASSOCIATION. RECRUITMENT Topeka: The Service.9 pp.(processed). DIVISION. Recommendations from the 1965 study are outlined, with 1968. Fifth Quarterly Report, August 1, 1968 steps and guidelines for accomplishment and designation of a October 31, 1968 (Final Quarterly Report). group or agency having primary responsibility for implementa- Project To Assist in Return of Inactive tion. Health Personnel to Active Employment in KANSAS HEALTH FACILITIES INFORMATION SERVICE, Louisiana. New Orleans: The Associa- INC. tion. 40 pp. (processed). 1968. Recomendations for Development of Nurs- This reportisprimarily a resume and evaluation of the ing Education in Kansas. Pub. 108-A. experience and effect of 15 refresher courses and public rda- Topeka: The Service. 30 pp. (proc- dons activities in returning inactive registered nurses to employment. The appendix includes a work status followup on essed). nurses who took refresher courses from June through November This study is part of a continuing effort to plan for nursing 1968 and on those who had returned to work by October 1968, needs and resources in Kansas. The report revises projections as well as a projection of the number of returnees for the next of nursing needs through1975.Itpresents guidelinesfor 3 months. Data on the county distribution of known inactive program development in nursing education;generalcriteria nurses in September-Omober 1968 and the number interested in for the establishment of new nursing education programs; and taking courses are included. recommendations for immediate program development by type of program, geographic location, and( ducational institution. MAINE Recommendations for development of nursing education plan- HEALTH FACILITIES PLANNING COUNCIL OF MAINE. ning on a regional basis are included. 1966. Nursing Personnel Resources: An Analysis KENTUCKY of the Supply of Registered Professional Nurses in Maine. Augusta: The Council. KENTUCKY NURSES' ASSOCIATION. 31 pp. (processed). 1968. Nursing in Kentucky. Louisville: The As- The 1966 supply of registered nurses with current licenses sociation. 61 pp. was analyzed astoitsdistributionthroughout theState. This is a report of the first statewide survey of the nurse Inactive nurses were surveyed by questionnaire to elicit their supply and nursing education resources in Kentucky, prepared interest in returning to work, in order to determine the po- as a basis for planning for nursing education. It includes a tcntial work force within this pool for meeting nurse manpower statistical analysis of the number of active and inactive regis- requirements. tered nurses and licensed practical nurses in 1967-68, and their characteristics. Trend data on nursing education facilities and MARYLAND student resources from 1957 to 1967 are presented, including PLANNING COUNCIL FOR THE BOARD OF HEALTH AND data on applicant experience, withdrawals, faculty,,and clinical facilities. Numeral goals for the registered nurse supply are MENTAL HYGIENE. proposed for 1972, 1975, and 1980. Implications are drawn from 1966. Survey of Nursing Needs and Resources in the data, and recommendations relative to nursing education Maryland.Report of the Planning Council are made for meeting quantitative and qualitative needs. for the Board of Health and Mental Hy- giene, State of Maryland.Whitehurst Hall, LOUISIANA Universityof Maryland, Baltimore, Md. LOUISIANA STATE NURSES' ASSOCIATION AND LOUISIANA 125 pp. (processed). LEAGUE FOR NURSING. The 1962 Inventory of Registered Professional Nurses, to- 1962. "The Stateof Nursing inthe Stateof gether with State licensing data for practical nurses, was used Louisiana. A Re-Survey of Nursing Needs to assess the supply of registered nurses and licensed practical andResourcesinLonisiana,1950-60." nurses in Maryland, by :Activity qatus, field of employment, county of residence, and level of educational preparation. Needs Pelican News, New Orleans, La., pp. 10-15 for nursing personnel were projected to 1975, including recom- (October). mended levels of educational preparation and ratios for pro- This report briefly presents a picture of the nurse supply, fessional,technical,andauxiliarypersonnel.Measuresfor nursing education resources, and needs for nurses in Louisiana Improving career and employment incentives were proposed. in 1960. It is a reappraisal of Louisiana's nursing needs and MASSACHUSETTS capabilities conducted to determine progress made since the 1955 re-survey. RESEARCH DEPARTMENT. ECONOMIC RESEARCH AND 116 APPENDIX 1

SPECIAL REPORTS. A Skills Inventory of Registered Nurses 1966. Preliminary Report, Survey of Professional Employed by the Commonwealth of Massa- Nurses and Practical Nurses With Active chusetts. Prepared by Barbara Woods, Massachusetts Registrations and Licenses, Employment Training Section, Bureau of JulySeptember, 1966. The Common- PersonnelandStandardization,Boston. wealth of Massachusetts, Division of Em- 66 pp. (processed). ployment Security, Boston, Mass. 22 pp. Thisreport proposes means for meeting the continuing (processed). education needs of registered nurses employed in State services. Active and inactiveregistered nurses and practical nurses It reiterates and supports the 1969 recommendations of the licensed in the State in 1966 were surveyed by questionnaire to Governor's Committee on Nursing for therecruitment and determine the potential work force. Measures for encouraging retention of these nurses. Survey data and other information more of the inactive nurses to return to work were recom- are reported on the following: length of employment of regis- mended. tered nurses in State service; levels of their educational preparation and educational needs; the cost of post-basic education; MALONE, MARY F. and sources and types offinancialassistance available for 1968. Educational Horizons for Nursing in Massa- educational purposes. chusetts. A Report on Nursing Education inthe Commonwealth of Massachusetts, MICHIGAN With Recomendations for the Future. Vol. MICHIGAN LEAGUE FOR NURSING. 3 of the Board of Higher Education Series. 1966. Nursing Needs and Resources in Michigan, Boston: The Board. 113 pp. Today and Tomorrow. A Report to the This study of the nursing education situationhi Massa- People of Michigan from the Michigan chusetts was prepared for the Board of Higher Education as League for Nursing and Michigan Nurses a prerequisite for planning for a system of nursing education to meet the State's service and education needs for nursing Association, 1966. Detroit: The League. personnel. It includes trend data, 1962-67. obtained by ques, 62 pp. tionnaires and interviews on Al types of nursing education The report of the 2-year study for planning for nursing programs, applicanic, admissions, graduations, attritionrates, service and educational needs and resources includea estimates faculty, clinical facibties, and the characteristics of students. of the numbers, kinds, and levels of educational preparation of School enrollments are projected to 1972 and 1980. The report nursing personnel existing and needed for regions within the includes an evaluationof thedata,their implications and State.Guidelines and recommendationsforincreasingthe recommendations. Copies of questionnaires usedin the study supply and the expansion of educational facilities are included. and a list of approved schools of nursing in Massachusetts are in the appendix. ADVISORY COMMITTEE ON NURSING EDUCATION TO THE MASSACHUSETTS NURSES ASSOCIATION. CITIZENS COMMITTEE ON EDUCATION FOR HEALTH 1968.Health Manpower Project. A Study of CARE. STATE BOARD OF EDUCATION. Inactive Profesional Health Personnel in 1969. Nursing Education NeedsinMichigan. Massachusetts. Boston: The Association. Report of the Advisory Committee on Nurs- 113 pp. (processed). ing Education. Pub. Series1,No.3. Education for Health Care Project, School This is a report of a 15-month project to identify and return registered nursos to active employment. It includes findings of ofPublicHealth,TheUniversityof a survey of inactive registered nurses conducted in May and Michigan, Arm Arbor, Mich. 48104. 60 June 1968, their characteristics, work experience, intention to PP. return to work, and interest in refresher programs. A report of a survey of employment opportunities for inactive registered This study reconnnends a mechanism for State planning for nurses is also included, as well as recommendations for further nursing education in Michigai1 within the structure of State study. government. From a review and analysis of existing studies of nursing in Michigan and other studies of nurse staffing, recom- THE COMMONWEALTH OF MASSACHUSETTS. EXECUTIVE mendations rclative tothe development of a State plan for OFFICE FOR ADMINi,iTRATION AND FINANCE. nursiligeducationarealsomade. Theserecommendations concern the following: continued learning for nursing man- 1970. ProfesionalNursingInStateService: power, the effective utilization of nursing manpower, the ex- Needs and Recommendations. Training pansion of nursing educationfacilities,student recruitment, Needs of Massachusetts Nurses in the 70's. and financial support for nursing education. SURVEY AND STUDY REPORTS 117

FAHS, IVAN J., and OLSON, LINDA G. UPPER MIDWEST NURSING STUDY. 1970. Nursing in the Upper Midwest. Focus on 1970. To Meet The Need. Minneapolis, Minn.: the Upper Peninsula of Michigan. The The Study. 18 pp. Upper Midwest Nursing Study, Upper Mid- This brochure presents the recommendations of the Citizens' west Research and Development Council. Committee for Nursing in Minnesota. The recommendations are Minneapolis, Minn. A study sponsornd intended to form the basis for the development of a plan for by the Louis W. and Maud Hill Family nursing service and nursing education in the State. Needs for Foundation of St. Paul, Minn. 35 pp. nurses are projected to 1985, and actions needed in these five areas are emphasized: diploma education, baccalaureate educa- (processed). tion, graduate education, associate degree education, and areer Thisreport, producedincooperationwiththeCitizens' mobility. Committee on the Study of Nursing in the Upper Peninsula, is an analysis of the supply of nursing personnel, nursing educa- MISSOURI tionprograms,theutilizationofnursingpersonnel,and MISSOURI DIVISION OF HEALTH. projected needs for nurses in the Upper Peninsula of Michigan. Nurse manpower supply and needs are related to the demo- 1968. InactiveRegistered Nurses, A Missouri graphic and socioeconomic conditions and to the availability of Study. Jefferson City: The Division. 63 health facilities and health care in the area. 1313- This isa report of a survey conducted intheStateof MINNESOTA Missouri between November 1967 and March 1958 to determine MINNESOTA BOARD OF NURSING. the size of the inactive nurse pool and to assess the potential 1967. Nursing in Minnesota, A Statistical Review, within this resource for reactivation in nursing employment. February 1967. Saint Paul: The Board. The survey included inactive nurses re-registered during the period 1966.67 and some graduates of approved schools for 47 pp. registered nurses who were not registered at the time of the This data source book updates to 1966 the 1961 edition of survey. The age, marital and family status, and educational background statistics and information on Minnesota's nursing preparation of these nurses are delineated. Their reasons for services, nursingpersonnel, and educational resources. Data and period of inactivity are detailed, as well as their interest were compiled from licensing processes, reports to the State in returning to work and in refresher courses. Information on Board of Nursing on educational programs, and health program the incentives or deterrents to re-employment in nursing is also reports. Some data depict trends since 1950. Data are tabulated given. by county and are compared with the national average. Infor- mation on nursing scholarships is included. MISSOURI NURSING FUTURAMA. 1969. Facts about Nursing and Health Care in FAHS, IVAN J., and BARCHAS, KATHRYN. Missouri. Ingeborg G. Mauksch, Ph.D., 1969. Nursing in the Upper Midwest. Focus Project Director, and Sally Anne Chier, on the State of Minnesota. The Upper M.S.H., Associate Project Director.Colum- Midwest Nursing Study, Upper Midwesf bia, Mo. 75 pp. Research and Development Council. Min- Pertinent available data are compiled in this source book neapolis, Minn. A study sponsored by the to describe the nursing situation in Missouri, its socioeconomic Louis W. and Maud Hill Family Founda- background, and factors influencing the practice of nursing. tion of St. Paul, Minn. 125 pp. (proc- Data from a 1969 questionnaire survey of schools of nursing essed). preparing registered nurses and practical nurses are also in- This report is a data source book and analysis of nursing cluded. No evaluation or recommendations are .made. The source book is intended as a basic tool for initiating an assess- needs and resourcesinMinnesota. Itrepresents the study ment and for developing aplan of actionfor nursing in phas e. of planning for nursing education and nursing service in Missouri. Minnesota, initiated by the Citizens Committee for Nursing in Minnesota. Trends in nursing in the State, the supply of nurs NEBRASKA ing personnel, nursing education programs, the utilization of nursing personnel, and projected needs for nurses are described. MARTIN, CORA ANN. Dentographic, economic, and health information bearing on 1967. Nebraska's Nurse Supply, Needs and Re. nursing needs and resources are analyzed within the context sources: 1966. Section of Hospitals and of the Upper Midwest as a region.The recommendations growing out of the study and the plan for nursing are reported Medical Facilities, Nebraska Department of in To Meet the Need, also published by the Upper Midwest Health. Lincoln, Nebr. 57 pp. (proc- Research and Development Council, May 1970. essed). 118 APPENDIX 1

This reappraisal of needs and updating of the 1951 statewide through 1975 is included, as well as a survey of educational study include data on the numbers of registered nurses and resources, their anticipated expansion, and the development of licensed practical nurses and aides, by fields of practice,for new programs. Availableclinicalfacilitiesforstudentex . 1966; the characteristics of educational programs and students; perience, the expected output of nursing schools, and the cost and the numerical needs for nursing personnel expressed by to the State for educational programs required for meeting the hospitals and other institutions. Recommended are acceleration State's nursing needs were delineated. of advanced training for leadership positions, re-design of the educational system, increasedfinancial aid for students, and GOVERNOR'S TASK FORCE ON NURSING. improved salaries znd working conditions for nurses. 1968. Interim Report on Nursing Education of the Governor's Task Force on Nursing. Feb. NEVADA 7, 1968. Trenton, N.J.: The Task Force. 1964. Nursing in Nevada, 1964. A Reappraisal 5 PP. of Needs and Resources. Toward State- This reportbrieflyoutlinesthepurposes, activities,and wide Planning lor the Education of Nursing accomplishments of the Task Force sinceitsinceptionin Practitioners January 1965. It summarizes recommendations for assuring an andQualityNursingin adequate supply of well-prepared nurses for the foreseeable Nevada. Nevada Tuberculosis and Health future, in these areas: pre-service education, continuing educa- Associati cm. Las Vegas, Nev. 77 pp. tion, recruitment, and comprehensive planning. (processed). This study by an interdisciplinary group assessed the charac- NEW MEXICO teristics of the registered nurse and licensed practicalnurse DILLMAN, EVERETT G. supply in 1963, and the health and educational facilities and 1964. resources. The study also projected needs for nursing personnel New Mexico Nursing Needs and Resources: by 1970. It set goals for the future and recommended actions The Situation. &liege of Business Ad- includingactivitiesincontinuingeducation,recruitment, ministration, Univ. of New Mexico, Albu- staffing studies and definition of role, and the establishment of querque. 19 pp. a second school of nursing for the Statean associate degree program. This report updates the 1952 Survey of Nursing Needs and Resources in New Mexico. The characteristics of the 1964 supply of registered nurses and licensed practical nurses, by fields NEW JERSEY of employment, and the number of aides employed in hospitals KENNEDY, JOHANNA; and SOOTKOOS, ALPHONSE. and other institutions, are analyzed. Factors such as economic 1965.An Assessment of Nursing Resources and incentives, turnover, staffing ratios, and the extent of inservice Needs in New Jersey. education programs are examined. Demands for nursing per- Unpublished report sonnel are estimated, and projected needs for 1970 are com- to the Committee To Survey Nursing Needs, puted on three bases:(1)considered as absolute minimum; Resources, and Supply in New Jersey, 1965. (2) reasonable minimum; and (3) lowest adequate levels. The NewJerseyStateNurses'Association, ability of educational programs to meet these needs is assessed. Montclair, N.J. 17 pp. (processed). No recommendations for needed action are included. This study assessed the supply and need for nurses for New NEW YORK Jersey's private and public health agencies,as well as resources for nursing education. UNIVERSITY OF NEW YORK. 1965. CHIMERA, NANCY T. A Survey of Registered Professional Nurses 1966. A Plan for Nursing Education lor New Employed in Hospitals in New York State. The State Education Department, Division Jersey, 1966-1975.Final Report submitted to Dr. Roscoe R. Kandle, Commissioner of of Professional Education,Albany, N.Y. 25 pp. Health, State of New Jersey, and Chairman. Governor's Task Force.on Nursing. Tren- A questionnaire survey was conducted in November 1963 to ton, N.J. 65 pp. (processed). obtain information about full-time and part-time employment, vacancies, and the educa floral preparation of registered nurses The report suggests a plan for nursing education for New inhospitals. Data were compiled by type of hospital and Jersey, based on A Position Paper by the American Nurses' geographic area of the State. Implications for meeting needs Association. As recommended by the Governor's Task Force for registered nurses were drawn from the survey findings. on Nursing, the plan was to become part of the Master Plan for Higher Education in New Jersey. An estimate of the supply HOSPITAL REVIEW AND PLANNING COUNCIL OF SOUTH- and needs for registered nurses and licensed practical nurses ERN NEW YORK, INC. 11 9 SURVEY AND STUDY REPORTS 119

1966. Study of Nurse Education Needs in the 1971. A Project To Determine The Direction and Southern New York Region, 1964-1965. Studies Needed For Areawide Planning In In cooperation with National League for Nursing Education. New York: Genesee Nursing and Divisionof Nursing, U.S. Valley N .irses' Association.62 pp.(proc- Public Health Service. New York: The essed). Council. 93 pp. This report on a project to prepare plans for nursing educa- Needs for increasing the nurse supplyparticularly in relation in a specific region considered its ultimate objective to tion to hospitals and institutionsand educational resourccs, be the improvement of health care. Two major forccs which their capabilities, and potential for expansion, are analyzed for denne the conditions for the realization of this objective were 14 counties in New York State. Recommendations for meeting declared to be: the public's determination to create a universal education requirements are made. system of health care, and the public's changing expectations of education. The task central to this project was to analyze the NEW YORK UNIVERSITY. STATE EDUCATION DEPART- significance of these two forces and to incorporate them into MENT. DWISION OF PROFESSIONAL EDUCATION. BUREAU the recommendations on the future development of nursing OF RESEARCH IN HIGHER AND PROFESSIONAL EDUCA- education for this region. TION. A summary of the Joint Committee's findings and recommendations are included. These recommendations, 16 inall, 1966. Personal and Employment Characteristics of are categorized under the following headings: nursing resources Professional Nurses Registered in New York for expanded health care; increasing opportunity in nursing; State. Albany: The Department. 61 pp. future patterns of nursing education; cooperative planning for This survey to determine the supply of active nurses in New nursing education; maintaining pace with advances in health York describes their personal and employment characteristics science; and increased financial support for nursing education and the personal characteristics of inactive nurses. It identifies and research. the nursing positions for which baccalaureate and graduate education are recommended. The data were collected by a NORTH CAROLINA questionnaire given those registered in New York State from Sept. 1, 1961, to Oct. 31, 1962. BROWN, RAY E. 1964. Report of Survey of Nursing Education in NEW YORK STATE EDUCATION DEPARTMENT. NorthCarolina. Sponsored by North 1966. Facts About Nurses and Nursing in New Carolina Board of Higher Education, North York State. Office of Nurse Education, CarolinaMedical Care Commission, and Division of Professional Education, Albany. North Carolina State Board of Education. N.Y. 40 pp. (processed). Raleigh, N.C. 42 pp. Statistics on the characteristicsofregisterednurses, by The system for educating registered nurses iu the State was geographic area of the State, compiled from licensing and analyzed in this study, which included 5-year trend data on inventory data for the biennium 1961-63, are included in this the input and output of schools and the academic qualifications report. Also included are trend data on the supply of practical of employed nurses. Numerical estimates of needs were not nursesand nursing education programs andresources. In delineated, but higher educationincluding the junior colleges addition, thereare data on budgeted position vacancies in was charged with responsibility for meeting the needs for well- health agencies. prepared nurses at all levels. A continuing joint committee for assuring systematic planning for nursing education on a state- NEW YORK STATE NURSES' ASSOCIATION. wide basis was recommended. 1969. "New York State NursesA Statistical

Survey." New York State Nurse, 41 (2): NORTH CAROLINA BOARD OF HIGHER EDUCATION. 9-10 (March). Albany: The Association. 1967. Nursing Education in North Carolina, To- "Report and analysis of an inventory of registered nurses in day and Tomorrow. Research Report New York for 1968. Survey includes data on age, sex, marital 2-67. Raleigh: The Board. 126 pp. status, education and employment of 110,495 nursesin the Part of the development of a long-range plan for all higher State. These data are compared withfigures from a1964 education in North Carolina was a long-range planning study survey."(From Abstract of Hospital Management Studies, on nursing education on a statewide basis. This study updates June 1970.) Vol. VI: 145. the 1964 survey of nursing education in the State, and analyzes the student potential for each type of nursing program and the REPORT OF THE JOINT COMMITTEE ON COMMUNITY availability of nursing programs to meet these needs. It projects PLANNING FOP NURSING EDUCATION, ROCHESTER AND the number, type, and location of new programs and faculty ELMIRA REGIONS, NEW YORK STATE. needed to meet the future nursing needs of the State.

C .X.- iJ 120 APPENDIX 1

NORTH DAKOTA Ohio. A Report to the Ohio Board of Regents.Columbus: The Association.52 NORTH DAKOTA LEAGUE FOR NURSING. 1968. A Study of Inactive Health Personnel in PP. North Dakota. Bismarck: The League. Guidelines for developing nursing programs as part of the 161 pp. (processed). State's master plan for higher education are presented in this report. An assessment of the characteristics of andfactors This report of the State's project toidentify and recruit affecting programs,facilities,and resourcesforinitialand inactive nursesfor employment covers theperiodJuly1, graduate education for registered nurses and practical nurse 1967 through October 31, 1968. The report contains survey data education was supported by a compilation of trend data from on the number of licensed and unlicensed registered nurses 1956 to 1963. Estimates of the number of nurses needed to be and licensed practical nurses not employed in nursing, their educated by 1975 were related to the State's present supply characteristics, reasons for inactivity in nursing, and desire for and the future needs of service agencies. refresher courses and to returnto work. Refresher course activities are reported, as well as a followup work status survey HERRON, IRENE. of nurses completing courses. The survey questionnaires, re- 1968. Exploratory Study of Nursing Education fresher course curricula outlines, and student evaluation of and Nursing Service in Northwestern Ohio. courses are included. Medical College of Ohio at Toledo. 37 pp. FAIIS, IVAN J., and BARCHAS, KATHRYN. (processed). 1969. Nursing in the Upper Midwest. Focus on This study is astatisticalpresentation on the number of the State of North Dakota. The Upper nursing personnel employed in hospitals, nursing homes, and Midwest Nursing Study, Upper Midwest public health agencies in northwest Ohio in 1968, as well as faculty, student, and program resources and characteristics in Research and Development Council. Min- nursing education. It reports opinions solicited by interview on neapolis, Minn. A study sponsored by the nursing needs and methods or routes for the preparation of Louis W. and Maud Hill Family Foundation personnel for nursing practice. A "model plan" for an orderly of St. Paul, Minn. 65 pp. (processed). transition of nursing education from hospital diploma schools This reportis a data source book produced as part of a to collegiate institutions inthe Northwest Ohio area during study of nursing needs and resources in North Dakota. The the period 1967 through 1976 is detailed. study was conducted to develop a State plan for nursing that would bring about meaningful action. Trends in nursing in the OKLAHOMA State, the supply of nursing personnel, nursing education programs, theutilizationof nursingpersonnel, andprojected WADDLE, FRANCES I. needs for nurses are described. Demographic, economic, and 1965. Planning for Nursing EducationA Study health information bearing on nursing needs and resources are of Current Resources and Future Needs. analyzed within the context of the Upper Midwest as a region. Recommendations growing out ofthe study are reported in Preliminary report; unpublished. Spon- The NeecT To Know, published by the Upper Midwest Re- sored by Oklahoma League for Nursing, search and Development Council, June 1969. Oklahoma State Nurses Association, and Oklahoma Board of Nurse Registration and UPPER MIDWEST NURSING STUDY. Nursing Education. Oklahoma City, Okla. 1969. The Need To Know. Minneapolis: The 100 pp. (processed). Study. 17 pp. The number of active and inactive registered nurses and This is a summary popular report of the North Dakota Joint licensed practical nurses in the State in 1964; characteristics Committee on Nursing Needs and Resources sponsored by the of the supply; needs for nursing service; levels of staffing; North Dakota Nurses' Association, the North Dakota League functions of personnel; and types of inservice education pro- for Nursing, and the North Dakota Hospital Association. The grams in hospitals, nursing homes, and public health agencies study was supported by the research of the Upper Midwest allthese were studiedinrelationtoeducational resources. Nursing Study. The report graphically presents the situation in Needs for 1970 were estimated and feasible goals determined. nursing education, manpower, and utilization in North Dakota. Future needs for nurses are estimated, and steps to be taken OKLAHOMA HEALTH INTELLIGENCE FACILITY. to meet the need are projected. 1968. Analysis of Health Manpower Data Regard- ing Registered Nurses in Oklahoma, 1966. OHIO University of Oklahoma Medical Center and OHIO STATE NURSES ASSOCIATION. The Oklahoma Science Foundation. Okla- 1964. Projected Needs for Nursing Education in homa City, Okla. 35 pp. (processed). SURVEY AND STUDY REPORTS 121

This report is a statistical analysis of registered nurses in by questionnaives and interview. The characteristics of pro- 1966, including their employment status, type of activity, educa- grams and students are detailed, and two levels of need for tional background,personalcharacteristics,specialtraining, registered nurses are projected to 1980. and geographic location in the State. RHODE ISLAND PENNSYLVANIA RHODE ISLAND COUNCIL OF COMMUNITY SERVICES, INC. HOSPITAL EDUCATIONAL AND RESEARCH FOUNDATION 1964. Nursing Needs and Resources in Rhode OF PENNSYLVANIA. Island. A Survey by the Rhode Island 1969. Pennsylvania Nursing Facts. Prepared by Council of Community Services, Inc. In Pennsylvania Nurses Association and Hos- Cooperation with the Rhode Island League pital Educational and Research Foundation. for Nursing. Providence: The League. Camp Hill, Pa.:The Foundation.119 pp. 84 pp. This report is primarily a statistical description of the charac- State Board licensing data and survey questionnaires were teristics of registered nurses licensed in Pennsylvania, their used in this study to secure data for analysis. Included were education, and their utilization. Trend data are presented on the 1963 supply of registered nurses, licensed practical nurses, educational resources from 1958 through 1968, and on the and nursing aides;additional needs for nursing personnel; nurse supply from 1949 through 1966. The characteristics of the employment conditions; and other factors affecting nursing; all 1966 nurse supply is detailed as to age, activity, and marital by field of practice. Data were analyzed and needs were assessed status; educational and position level; and field of employment, by interdisciplinary health groups. To meet increased needs much of which includes a county data base. The reportis for nursing personnel, the following were recommended: im- intended asa source documentforhealthand education proved utilization, economic incentives, upgrading of personnel planners, for educators of health manpower, and for guidance through training, intensified recruitment efforts,financialas- counselors. sistance for nursing education, andstatewide planning for nursing education. PUERTO RICO SOUTH CAROLINA COMMONWEALTH OF PUERTO RICO. DEPARTMENT Or HEALTH. GOVERNOR'S SPECIAL COMMITTEE ON NURSING. 1967. Study of Nursing Resources in Puerto Rico. 1963. Report of the Governor's Special Committee Division of Nursing, Health Bureau. San on Nursing. Columbia, S.C.: The Com- mittee. 8 pp. Juan: The Department. 60 pp. (processed). InFebruary1963,theGovernor appointedaninterdis- ciplinaryconunitteeofrepresentativesfromprofessional This study consists of a compilation and analysis of statistical associations,healthagencies,nursingschools,andhigher data on the registered nurse supply in 1966, and the educa- education,toformulaterecommendations fordevelopinga tional resources for their preparation. Data were obtained by State plan for action for nursing service and nursing education. a questionnaire survey of a 50 percent sample of registered An analysis of available data, previous studies, and the services nurses and from two special studies on staffing ratios. Included of national level consultants were utilized to assess the nursing are the age, educational preparation, activity status,field of situation. The plan recommendedthefollowing:Specified employment, position level, and geographic distribution of these measures for cooperative action between colleges and universi- nurses. Needs for additional nurses are projected, and implica- ties, health agencies, and schools, for improving nursing educa- tions and recommendations are drawn from the data. tion and the competenck s of nursing faculty and personnel; DEPARTMENT OF HEALTH. NURSING DIVISION. OFFICE expansion of baccalaureate programs; development of a graduate nursing program; and provision of nursing consultants in OF SPECIALIZED SUPPORTING SERVICES FOR SUPERVISION service and education in the State Board of Nursing. C,..eation AND CONSULTATION. OFFICE OF THE SECRETARY OF of a nine-member Committee on Nursing to lend support to HEALTH. implementation of the statewide plan was strongly advised. 1969. Nursing Education in Puerto Rico.Report MEDICAL COLLEGE OF SOUTH CAROLINA. of Study in Nursing Education.San Juan: 1963. The Education of Nurses in South Cal olina. The Department. 93 pp. (processed). A Report. Committee on Nursing, Board This is a report of a study of. nursing education in Puerto of Trustees, Medical College of South Caro- Rico conducted to provide a base for program planning and lina,Charleston, S.C. 18 pp. (proc- budgeting by the Department of Health. Recommendations for the expansion, development, and support of nursing education essed). to meet the needs and demands for nursing personnel are This is a report to the Governor of South Carolina on the supported by data secured from all nursing education programs conditions of nursing education in the State, the attitudes of

-14 C;$ !). (.11 122 APPENDIX 1

physicians toward the type and scope of training of nursing in South Carolina. Columbia: The Com- students, and the causes of and recommendations for the abate- mittee. 32 pp. ment of critical shortages of nurses. Itis reactionary to the social forces affecting recruitment, nursing education, and the This is the first report of the permanent Committee appointed practice of n'ursing, and South Carolina's situation. It contains by legislative action in 1964, as recommended by the Governor's many contradictions, but illustrates attitudes and factors that 'Special Committee on Nursing, to support implementation of are encountered and must be coped withinplanning for programs for meeting nursing needs. The Committee designed nursing. a blueprint for nursing educationfor South Carolina. The development of associate and baccalaureate degree programs YATES, WILLIAM L. and a master's level program is designated by area of State and 1963. Nursing in South Carolina, A Statistical college or university and clinical facilities to be utilized. Pro- Study of the Quantity of Nurses and the gram arrangements, curricula, and costs are detailed. The report Quality of Their Training.South Carolina recommends State financial support for diploma programs. It assesses the conditions and social forces affecting systems of Hospital Association, .Columbia, S.C. 57 nursing education related to South Carolina. PP. This study is a concise collection of data pertaining to the SOUTH CAROLINA NURSES' ASSOCIATION. quantity, quality, and economics of nursing service and educa- 1967. Nurses for South Carolina. A Study of tionin South Carolina, and their implications onhospital Nursing Needs and Resources. A Report service in the future. Although the document identifies prob. Prepare.d by Committee on Current and lems, it was not intended to recommend solutions but rather Long-Term Coals for Board of Directors. to be usedasa resource document byorganizations and Columbia: The Association. 23 pp. individuals working toward solving the State's various nursing problems. This is a report of the Committee's continuing work begun in 1964 and first reported in November of that year. The study ALFORD, ELISABETH M. updatedinformation,assessedprogress,refinedideas,and 1964. Nursing in South Carolina, 1964. A Sta- identified priority areas and action programs for meeting South tistical Study of the Quantity of Nurses and Carolina's nursing needs. An in-depth study of nursing needs the Quality of Their Training. South and resources and community planning for nursing education were recommended, as well as mandatory licensure for nursing, Association,Columbia, Carolina Hospital a statewide intensified recruitment program, refresher courses S.C. 55 pp. for inactive nurses, improved economic incentives, better utiliza- This study is an updating of the 1963 statistical source book tion of nursing personnel, and a graduate program in nursing. and data analysis onthe quantity and qualityof hospital nursing services, the economics of nursing, nursing education, SOUTH DAKOTA and factors affecting the demand for nurses in South Carolina. SOUTH DAKOTA STATE UNIVERSITY. 1967. Survey of Inactive Nurses. SOUTH CAROLINA STATE NURSES ASSOCIATION. Department of 1964. Nurses for South Carolina, A Report Pre- Continuing Education, College of Nursing. pared by the Committee on Current and Brookings: The University.3 pp.(proc- Long-Term Goals for Board GI Directors. essed). Columbia:TheAssociation. 15pp. As a basis for the statewide programing of refresher courses, (processed). inactive registered nurses were surveyed by questionnaire to determine their interest in returning to work and their need This is an interim report of the Committee, appointed in for refresher training. A followup report on the number of 1964, which assessed the supply of nursing personnel in 1963, nurses employed following completion of refresher courses is identified the nursing needs of South Carolina, and gave direc- included. tion to and proposed goals for the Association's role in meeting these needs. The report prcjected needs for 1970; endorsed U.S.DEPARTMENT OF HEALTH, EDUCATION, AND statewide planning for nursing education; called for associate WELFARE. PUBLIC HEALTH SERVICE. NATIONAL INSTI- degree nursing programs in tax-supported colleges; reaffirmed TUTES OF HEALTH. BUREAU OF HEALTH PROFESSIONS need for additional baccalaureate programs for nursing; and EDUCATION AND MANPOWER TRAINING. DIVISION OF identified approaches to improved nursing services. NURSING. GOVERNOR'S COMMITTEE To LEND SUPPORT AND 1969. Source Book for Community Planning lor LEADERSHIP TO NURSING IN SOUTH CAROLINA. Nursing in South Dakota. Washington: 1965. Report ol The Governor's Committee To U.S. Government Printing Office. 232 pp. Lend Support and Leadership to Nursing This source boOk was produced as a compilation of existing SURVEY AND STUDY REPORTS 123 statistical data relevant to long.range planning for nursing in a TEXAS State.It, however, is also a report on the data survey and analysis phase of planning for nursing needs and resources in JARRATT, VIRGINIA. South Dakota. It presents statistics and information on the 1966. Report on Nursing Resources in Texas in nurse supply and nursing education resources as they relate to 1966.Prepared for Committee on Nursing demographic, economic, social, and health factors and condi- Needs and Resources.Sponsored by Board tions in South Dakota and neighboring States.Implications of Nurse Examiners for the State of Texas, for planning are drawn from the analysis. Texas Nurses Association, and Texas League SOUTH DAKOTA PLANNING COUNCIL FOR NURSING for Nursing. San Antonio: The Associa- RESOURCES. tion. 76 pp. (processed). 1970. Pulse of the Contmunity. South Dakota This statistical presentation represents the first step in the Board of Nursing, South Dakota Nurses' compilation of available data that can be used in State plan- Association, and South Dakota League for ning. Briefly analyzed are trend data on the supply of registered Nursing. Sioux Falls, S.D.: The Council. nurses and vocational nurses, the number andcharacteristics 15 pp. of registered nurses included inthe 1966 Inventory, as well as educational resources. Data on some of the socioeconomic Recommendations for the recruitment, education, retention, factors related to nursing are included. Gaps in data required and utilization of nurse manpower directed toward improving needs and resources are the delivery of health care are contained in this report of the for an in.depth study of nursing South Dakota Planning Council for Nursing. Representatives puinted up. of nursing, allied health groups, business, education, farming INTERIM SENATE COMMITTEESTUDYING NURSING and State government who studied nursing needs, resources, and utilization in the State propose these recommendations for PROFESSION NEEDS IN TEXAS. implementation by concerned groups. 1967. Report of the Interim Senate Committee Studying NursingProfessionNeedsin TENNESSEE Texas. Presentedtothe60thTexas Legislature, 1967.Austin: The Committee. TENNESSEE MIDSOUTH REGIONAL MEDICAL PROGRAM. 153 pp. (processed). [1968].Study of Nursing Education in Tennessee. Tennessee Mid-South Regional Medical Data and information collected and compiled to support and tothe education, Program. Nashville, Tenn. 38 pp. substantiate the State's needs inrelation practice, and utilization of nurses, as presented in public hear. This is a report of a study which focused on nursing educa- ing, are the substance of this report. tion in Tennessee and includes an analysis of registered nurse data. A numerical shortage of nurses and an insufficient supply of qualifiedfaculty are of prime concern. Recommendations UTAH include: (1) a need for public awareness of both nursing needs and nursing opportunities; and (2) a statewide plan for nurs- COMMISSION To STUDY THE, NURSING NEEDS AND ing education with support by an informed public. The Ten- RESOURCES IN UTAH. nessee Nurses' Association has recommended that the Tennessee 1970. Utah Nursing, Present and Future. Find- Higher Education Commission be recognized as the agency ings,Conclusions and Recommendations. responsiblefor statewide planning for nursing detlucation in Prepared by Dorothy C. Lowman, Chair- the State. man of Commission, and Cora Ilene McKean, TENNESSEE HIGHER EDUCATIONCOMMISSION. ExecutiveDirector,UtahStateNurses' 1969. Survey of Nursing Education in Tennessee. Association, Salt Lake City, Utah. 128 pp. Nashville:TheCommission. 34pp. (processed). (processed). This study report "present facts about nursing service and A time.phased, geographically based plan for the expansion nursing education in the State and offers the best titatements of and development of nursing education in institutions of higher current and projected nursing needs that commission members education in Tennessee is presented in this report. Recom- have been able to formulate. It identifies issuen and makes mendations :aid goals are based on a data survey, on analysis recommendations, but stops short of proposing r. specific pro- and assessment of the 1968 nurse supply and nursing education gram for action because to be effective such an action program resources, and on criteria established by a board of consultants. must be based on broad community participation of consumers Definitivemeasures areproposedforimproving boththe as well as producers of nursing and health care." For the most quantity and quality of nursing in Tennessee, to meet projected part, nursing data are presented through 1968 and needs are needs through 1980. projected to 1975. 124 APPENDIX 1

VERMONT This report was prepared for the Governor's Committee on Nursing. Available statistical data and a special survey ques- VERMONT STATE NURSES' ASSOCIATION, INC. tionnaire of working conditionsof nursing personnel in hos. 1967. Nursing Needs and Resources in Vermont, pitals were usedfor an analysis ofthecharacteristics ,of 1966-1975. A Report to the People of Virginia's supply of registered nurses and licensed practical Vermont. Burlington: The Association. nurses, ofauxiliary nursing personnel inhospitals, andof nursing education resources. Trends in the education and use 196 pp. of allied health professionals and other health personnel are Positive steps to increase the number and improve the quality included, and future needs are estimated. The report makes no of nurses educated in Vermont are recommended in this 2-year recommendations, but is intended as background information study, intended as a basis for statewide planning for nursing. for an in-depth assessment of nursing needs and resources for Study data highlighted the need for utilization studies and the development of a State nursing plan. improving career and employment incentives and recruitment techniques for licensed nursing personnel. Projection of needs GOVERNOR'SCOMMITTEE ON NURSING.COMMON- for 1075 are included. WEALTH OF VIRGINIA. 1969. Nursing In Virginia.Final Report.Rich- VIRGINIA mond: The Committee. 89 pp. GOVERNOR'S COMMITTEE ON NURSING. This is a report of a 2%-year study to assess the State's supply of nurses and nursing education resources; to project 1967. A Report of Progress to His Excellency, quantitative and qualitative needs for a 10.year period; and to Mills E. Godwin, Jr., Governor of the Com- make recommendations for meeting nursing needs andfor monwealth of Virginia. Richmond: The developing educational programs. It discusses the major find. Committee. 21 pp. ings, and the premises and reasoning leading to the recommendations. Recommendations for action concern the following: This is an interim report of Virginia's Governor's Committee measures to stimulate an increase inthe nurse supply and on Nursing, appointed in late 1966 to develop a coordinated improve the work environment;recruitment, selection, educa- State plan for nursing service and nursing education. The tion,andretention of nursingpersonnel;and meansfor report is the work plan and prospectus for the 3.year study to implementing these recommendations. Financial costs for the identify and find means for meeting the State's quantitative and strengthening of nursing education and for further improve. qualitative nursing needs. Nursing issues in the State, areas for ments in nursing services are estimated. study, and the proposed study methodology are fully outlined. GOVERNOR'S COMMITTEE ON NURSING. WEST .VIRGINIA 1968.Future Patterns of Health Care with Em- phasis on Utilization of Nursing Personnel. MCKENNA, FRANCES N. The Report of a Conference held March 1968. Nursing in West Virginia 1968: The Mc- 24-26,1968, at Williamsburg,Virginia. Kenna Report. A Study Sponsored by the Richmond: The Committee. 69 pp. West Virginia State Board of Examiners for Registered Nurses, Charleston, W. Va. 86 This conference, with wide representation from the health professions, civic groups, education, business, and official gov- pp. (processed). ernment, was convened to assist the governor's committee on The distribution, characteristics, supply, and need for regis- nursing in its assessment of Virginia's nursing needs and to tered nurses and licensed practical nurses in 1966 in West suggest means for meeting them. This report is an account Virginia are analyzed in this study report. Also presented are of their consideration of specific questions related to nursing the numbers, kinds, characteristics, and distribution of nursing services,nursingeducation, working conditionsfornurses, education programs in the 1960's, as well as admissions, enroll- recruitment,legalcontrols,financing, and cooperation and ments, and graduations from these programs. Problems in the coordination in planning. The conference emphasized the com- nurse supply and their influencing factors are discussed, and plexityof the issues, and gavethe participants a broader remedial actions are proposed, particularly in regard to the perspective and greater understanding of the contributions following:recruitment of students and staff;migration of which they, individually and collectively, could make in the nurses from the State; and basic, continuing, and graduate improvement and delivery of health care. education for nurses.

THE SCHOOL OF HOSPITAL ADMINISTRATION. FLITTER, HESSEL HOWARD. 1968.Nursing and Health CareinVirginia. 1970. Nursing in the Mountain State of West Vir- Medical College of Virginia, Health Science ginia: An Assessment and a Plan of Action. Divisionofthe Virginia Commonwealth Southern West Virginia Regional Health University, Richmond, Va. 151 pp. Council, Inc. Copies available from: West SURVEY AND STUDY REPORTS 125

Virginia Nurses' Association, 47 Capital WISCONSIN STATE EMPLOYMENT SERVICE. City Building, Charleston, West Virginia 1968. Re-Employment Factors of Inactive Nurses 25301. 104 pp. (processed). in Wisconsin. A Division of the Depart- The Committee To Study Nursing Needs in West Virginia is ment of Industry, Labor, and Human Re- responsible for this report. The Executive Committees of the lations. Incooperation with Wisconsin twonursingorganizationsthe West VirginiaLeaguefor Nurses Association, Inc. Milwaukee: The Nursing and the West Virginia Nurses' Associationjointly Association. 44 pp. (processed). assumed responsibility informing this new committee and carrying out its study activities. Two of its major concerns This survey identified and located the inactive nurses who were the total nursing needs within the State and the compre- had maintained and those who had not maintained an active hensive planning needed to meet these nursing needs. Com- registration, by county, in Wisconsin and in contiguous counties parable data from each of the nine planning regions of the of neighboring States. It estimated the demand for refresher State were collected by committee members. Information per- programs to 1970. The characteristics of inactive nurses and taining to nurse mobility and nursing educationin West their interest in returning to work were related totraining Virginia, compiled by others, was obtained. Conclusions and requirements, such as curricula, time, and location for programs. recommendations based on findings are reported. Recommenda- COMMISSION ON STATEWIDE PLANNING FOR NURSING tions concerning nurse manpower, health care, health facilities, and health services are detailed. EDUCATION. 1970.Nurses for Wisconsin's Future. A Report to the People of Wisconsin by the Com- WISCONSIN mission on Statewide Planning for Nursing COOPER, SIGNE, S. Education. Madison: The Commission. 1962. Wisconsin Registered Nurses. Madison: 22 pp. University of Wisconsin Extension Division. This abbreviated report for wide public distribution recom- 94 pp. mends a plan for the development of nursing education in Wisconsin to assure an adequate supply of nurses. The Com- A 10 percent sample of registered nurses licensed in Wis- mission examined trends in the supply of registered nurses consin in 1960 was used for this descriptive study conducted and licensed practical nurses and in nursing education programs for program planning for the Extension Division's Department from 1956 to1968, assessedtheir adequacy, and projected of Nursing. Itanalyzed the distribution of the nurse supply, needs for nurses and nursing programs to 1978. The plan the nurses' age, marital status, work experience, educational recommends specific measures for the development and distribu- preparation, and needs for further education. Implications for tion of educational programs and their financing, for the in- continuing education in the &Id of nursing are drawn. service and continuing education of nurses, for recruitment, and for continuous planning for nursing education. THE WISCONSIN STATE EMPLOYMENT SERVICE. 1966. A Study of Inactive Nurses in Dane County, COMMISSION ON STATEWIDE PLANNING FOR NURSING Wiscomin. A Division of the Department EDUCATION. of Industry, Labor, and Human Relations. 1970. Resource Document: Nurses for Wisconsin's In cooperation with the Madison League for Future. Commission on Statewide Plan- Nursing. Madison: The League. 34 pp. ning for Nursing Education, 110 East Main (processed). St., Madison, Wis.63 pp. Lists of inactive nurses in the county were obtained from a This reportthe third and final one by this Commission previous survey, from alumnae associations of schools of nurs- is a comprehensive summary of the Commission's work, including, and from phone calls received following extensive publicity. ing recommendations relating to nursing education. Recommen- A survey questionnaire solicited information on the charac- dations were developed following a review and study of current teristics of inactive registered nurses, factors related to their trends, health needs, changes occurringin the health care inactive status, interest in returning to work, and need for system, availability of nursing manpower, types oi practitioners refresher programs. Implications fortheutilizationof the needed, andresources.Relative dataare includedinthe inactive nurse potential are drawn from the data. appendix.

Blueprints for Nursing Education

The term "blueprint for nursing education," as used a design for the transition of nursingeducation into in this publication and in nursing education, designates institutions of higher educatiOn. Many States have 126 APPENDIX I developed such blueprints for nursing education. Most Maryland Nursing News, XXXVII (2) :26 were developed after the American Nurses' Association (Summer). Baltimore: The Association. (ANA) issued its statement, Education Preparation for NEW JERSEY NURSES ASSOCIATION. COMMITTEE ON Nurse Practitioners and Assistants to NursesA Posi- NURSING EDUCATION, 1967-1968. tion Paper. Some blueprints have been prepared as 1968.Nursing Education in Transition. A Plan part of a broad action plan for nursing needs and for Action in New Jersey.Montclair: The resources. Others were designed by committees or Association. 16 pp. groups concerned primarily with planning for nursing NEW YORK STATE NURSES ASSOCIATION. COMMITTEE education and the implementation of ANA's position. ON EDUCATION, 1965-1967. All suggest procedures for planning and initiating 1966. A Blueprint for the Education of Nurses in action. They are intended to give direction for im- New York State.Albany: The Association. proving nursing education systems and the services of 12 pp. nursing practitioners. For reference in this publication, bjueprints are classified as to their content and not as NORTH DAKOTA HOSPITALASSOCIATION,NORTH to the processes through which they were developed, DAKOTA NURSES' ASSOCIATION, and NORTH DAKOTA as explained below. LEAGUE FOR NURSING. THE NORTH DAKOTA JOINT COMMITTEE ON NURSING NEEDS AND RESOURCES. Group 1:Blueprints that state a position and pre- 1969. "To Meet The Need." The Need To scribe guidelines on procedures, actions Know, pp.11-13. Minneapolis, Minn.: required, policies, and a timetable. Upper Midwest Nursing Study. Group 2:Blueprints that, In addition to stating a PENNSYLVANIA LEAGUE FOR NURSING AND PENNSYLVANIA position and general guidelines, consider NURSES ASSOCIATION. COMMITTEE FOR PLANNING FOR each school or program in conjunction EDUCATIONAL TRANSITION. with existing or contemplated institutions 1967. Guidelines for Regional Planning for Nurs- of higher education, clinical facilities, and ing Education Transition in Pennsylvania. the needs for programs ingeographic Harrisburg: The Association. 10 pp. areas of the State. GOVERINOR'S COMMITTEE TO LEND SUPPORT AND Group 1.Prescribing General Guidelines LEADERSHIP TO NURSING IN SOUTH CAROLINA. 1965. Report of The Governor's Committee To ARIZONA STATE NURSES ASSOCIATION. Lend Support and Leadership to Nursing 1967. "Blueprint for Nursing in Arizona."Ari- in South Carolina. Columbia, S.C. 32 zona Nurse, 20: 20-23, May-June. Phoenix: pp. The Association. CONNECTICUT NURSES' ASSOCIATION. NURSING EDUCA- Group 2.Prescribing Time-Phased TION TRANSITION STUDY COMMITTEE. Geographic Plans 1967. "A Plan for the Educational Preparation COLORADO NURSES ASSOCIATION. for Nursing in the State .of Connecticut." 1968. "PlanningforNursinginColorado." Nursing News,Vol.XLI,Nos.10-12. Colorado Nurse, 68(3) :36-40(April). (November). Hartford: The Association. Denver: The Association. MAINE STATE NURSES' ASSOCIATION. NURSING EDUCA- ILLINOIS STUDY COMMISSION ON NURSING. TION NEEDS AND RESOURCES COMMITTEE. 1968. "Illinois Blueprint For Nursing Education 1966. "Future Development of Nursing Educa- 1980."Nursing in Illinois: An Assessment tioninMaine. PreliminaryReport." 1968 and a Plan 1980, pp. 5064.Chicago: Augusta: The Association. 8 pp. (proc- The Commission. essed). MICHIGAN NURSES ASSOCIATION. MARYLAND NURSES ASSOCIATION. AD HOC COMMITTEE 1966. "Action Plan for Future of Nursing Educa- ON NURSING EDUCATION NEEDS IN MARYLAND. tion in Michigan." The Michigan Nurse, 1969. "Report of the Ad Hoc Committee on Nurs- 30: 3-7. Jan.-Feb. Lansing: The Associa- ingEducationNeedsin Maryland." tion. Appendix 2 Background Material and Tools for Planning

Appendix 2 lists references concerning background material relevant to nlanning for nursing. They were selected and annotated to facilitate the work of participants and staff throughout the planning process. These articles, books, and other publications can contribute to understanding of the evolution of nursing and the many factors affecting nursing practice and riursing education. In addition, some of the references describe useful tools important for planners. To expedite selection of information on various planning situations, the.references have been grouped under 12 subjects, as noted in the table of contents on the following page. All references are arranged chronologically under each subject, except the lastIndexes, Journals, Periodicals, and Publications Lists. In that group, since chronological order could not be used, the references are arranged alphabetically according to the title of the publication.

127 Contents

Page Guides to Planning 129

Manuals and Guides for Special Studies 131 Institutional Nursing Services 131 Cost Analysis and Cost Study Methods 133 Criteria and Standards for Nursing Service 134 Criteria and Standards for Nursing Education 136

Planning Theory and Process 137 Tools for Planning 142 Medical and Health Care 147

Health Manpower 151

Nursing Trends, Issues, and Concerns 152

Nursing Education 153 Nursing Service, Nurse Staffing, and Utilization 156 Indexes, Journals, Periodicals, and Publications Lists 162

128

47/ Guidesto Planning

ARNSTEIN, MARGARET G. Guide to Their Planning. World Health 1953. Guide for National Studies of Nursing Re- Organization, Public Health Papers, No. 7, sources. Bulletinof the World Health Geneva, Switzerland. 80 pp. (Available Organization,Supplement7. Geneva, from Columbia University Press, Interna- Switzerland. 36 pp. (Available from tional Document Service, 2960 Broadway, Columbia UniversityPress,International New York, N.Y. 10027.) Documents Service, 2960 Broadway, New Even though basic nursing educationranges from newly York, N.Y. 10027.) developed programs in some countries to well-established pro- This guide, in concise outline form, was designed to help grams in others, nursing leaders and others who may influence nations undertake or continue studies of their supply and need nursing education in any country in the world can find helpful for nurses, point to their urgent nursing problems, and reveal information in this hook. Divided into two parts, this book action that can be taken and areas that require further study. gives direction for general action, not a pattern to be exactly The functional organization, methodology, areas of study and followed. Thefirstpartoutlines the kinds of general and procedures suggested in this guide are basic, still pertinent, and specific information on which planning for nursing education applicable in identifying nursing needs, resources, and problems. should he basedthat is, information about a community and However, depending upon the status of development of services individual school. The second part discusses the general process and technology in.ertain nations where needs and resources of planning and suggests steps for planning and developing a might be studied,itmay be thatstatisticalmethods and nursing education program.(Excerptedfrom a review by techniques newer than those suggested herein would be needed: Loretta E. Heidgerken, Professor of Nursing, Catholic Uni- versity of America,inthe American Journal of Nursing, U.S.DEPARTMENT OF HEALTH, EDUCATION, AND 62 (4) :129. April 1962.) WELFARE. PUBLIC HEALTH SERVICE. 1956. Design for Statewide Nursing Surveys: A LEONE, LUCILE PETRY. Basis for Action. A manual prepared by 1966. Statewide Planning for Nursing Education. the Division of Nursing Resources under Southern Regional Education Board, At- the direction of Margaret Arnstein. PHS lanta, Ga. 42 pp. Pub. 460. Washington: U.S. Government This guide delineates steps for planning nursing education on Printing Office. 88 pp. (Out of print. the State and community level. The firstchapter is devoted May be available on library loan.) to a discussion of five imperatives for planning and action on the State level. The need, advantages, organization, and charac- This guide presents study methodologies and procedures for teristics of a planning body, as well as present systems and group or community action projects to accomplish the follow- trends in nursing education, are discussed. The second chapter ing: Identifythe quantity and characteristics ofaState's encompasses the processes of planning and action for nursing nursesupply and itseducational resources; determine the education. Setting the goals, designing the program, evaluating adequacy of supply and resources; appraise the factors affecting the program, and establishing a continuing plan of actionall needs and demands for nursing personnel; assess the effective- are clearly delineated. A framework for sound planning, think- ness with which nursing resources are utilized; and estimate ing, and decision-making is presented, and questions are raised additionalrequirements.Itsuggestsmeans fordeveloping which must be answered by planners in terms of the needs of recommendations and plans of action to meet needs and de- their specific States. The book should be useful to any corn- mands or to improve service and educational programs, end munity, State, or regional group attempting to form a com- means for carrying out more detailed studies in special areas mittee for statewide planning for nursing education. (Excerpted of concern. from a review by Elda S.Popiel, Associate Professor and For States which have already made a survey, this guide Director, Continuation Education Services, University of Colo- suggests areas for further investigation and ways toupdate rado, School of Nursing, Denver, Colo., in Nursing Outlook, data for reappraisal of needs and resources and for assessing 16(1) :15. Jan. 1968.) progress. Appendixes include suggested guides or ratios for estimating nursing needs byfieldsof nursing, also sample THE AMERICAN PUBLIC HEALTH ASSOCIATION, INC. letters, forms, and tables for collecting data. 1967. A Self-Study Guide for Community Health LYMAN, KATHARINE. Action-Planning. Vol.I. A Report of 1961, Basic Nursing EducationPrograms, 4 the Community ActionStudiesProject. 130 APPENDIX 2

National Commission on Community Health NATIONAL LEAGUE FOR NURSING. Services, Inc.New York: The Association. 1967. Guidelines foi; Assessing the Nursing Educa- 116 pp. tion Needs of a Community.Pub. 11-1245. 11 pp. This guide is an instrument for use by laymen and profes- New York: The League. sionals in efforts to define community health problems, evaluate This guide briefly presents in broad outline form the essential health activities, Project needs, and help definepriorities. It elements of a study for developing a long-range plan for nurs- includes a brief discussion of ways and means of organizing ing education suited to the needs of a local community, State, a self-study, and a series of 52 "index questions" designed to or region. Suggestions for initiating and organizing the study dctect weaknesses in a community's existing health structure are included. Selectedsocioeconomiccharacteristicsofthe andservicesintheareasoforganization,ttdministration population and geographic study area, features of the nurse (medical care and facilities), personal health services, and manpower supply, and health and educational resources are environmental health services. Aspects of personnel and financial outlinedasprincipal areas for data collection,study, and resources are also included. asseument. This study profile is focused on the basic need to improve nursing care for everyone by helping to bring about THE AMERICAN PUBLIC HEALTH ASSOCIATION, INC. sound changes in the educational system that will produce the number of nurses with the quality of preparation needed in 1967. A Self-Study Guide For Community Health the future. Action-Planning.Vol.II.Questionnaires To Aid in Problem-Solving. A Report of U.S.DEPARTMENT OF HEALTH, EDUCATION, AND theCommunity ActionStudiesProject. WELFARE. PUBLIC HEALTHSERVICE. BUREAU OF National Commission on Community Health HEALTH MANPOWER. DIVISION OF NURSING. Services. New York: The Association. 1967. Community Planning for Nursing in the 247 pp. District of Columbia Metropolitan Area. This guide contains a schedule of questionnaires to help Source Book for Planning. PHS Pub. study groups provide for an in-depth examination of priority 1676. Washington:U.S.Government areas of concern in community health planning. Questionnaires Printing Office. 143 pp. are addressedto the following studyareas: A community This source book is a compilation of existing statistical data socioeconomic profile; local health departments; health infor- presentedina socioeconomic framework relevanttolong- mation and referral services; public health education; labora- range planning for nursing in a metropolitan area. The source tory services;home healthcare;extendedcarefacilities; book is designed as a tool that can be used by planning groups hospitals and related services;health manpower resources; in other metropolitan areas for identifying sources and selecting educational system; school health; occupational health; dental data pertinent totheir problems, issues, andsituations. In health; chronic and handicapping conditions;maternal and addition, it contdns a data analysis to demonstrate the uses infantcare;environmentalsanitation;mentalretardation; of data as follows:(1)ininitiating the development of a mental health;drugaddiction;alcoholism;communicable long-range plan for nursing;(2)in shedding light on addi- disease control; and civic and professional organizations and tional data required from special studies to develop the plan; voluntaryhealthagencies. Suggestions usefulindeveloping and (3) in selecting or producing data conclusive enough in action programs to implement study recommendations are in . their implication to point the way to immediate action required cluded in the guide. to meet nursing needs. Data analysis and interpretation are enhanced by information gained by conferences with key people NATIONAL HEALTH COUNCIL andtheAMERICAN concerned with the delivery of health and nursing services and ASSOCIATION OF JUNIOR COLLEGES. the educational resources for producing health manpower in 1967. A Guide for Health Technology Program the metropolitan area. Planning. New York: The Council.51 U.S.DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE. PUBLIC HEALTH SERVICE. NATIONAL INSTI- This guide has as its focus the building of strong programs TUTES OF HEALTH. BUREAU OF HEALTH PROFESSIONS for technical-level health practitioners within 2-year collegiate EDUCATION AND MANPOWER TRAINING. DIVISION OF institutions, through the collaboration of junior colleges with NURSING. health practitioner associations and community health facilities. 1969. Source Book for Community Planning for Interdependent and continuous processes in cooperative program Nursing in South Dakota. Washington: planning are outlinedinsteps foranalyticalpurposes.It suggests a committee structure for planning, outlines criteria U.S. Government Printing Office. 232 pp. to be used in exploring the feasibility of program priorities, This source book is a compilation of existing statistical data and suggests a checklist of the role performance of the various presented in It socioeconomic framework relevant to hnikrange participants in planning. planning for nursing in a State. The source book ih a com- BACKGROUND MATERIAL AND PLANNING TOOLS 131 panion publication to Community Planning lor Nursing in the tional League for Nursing Pub. 19-1355. District of Columbia Metropolitan Area. (PHS Pub. 1676). New York : The League. 49 pp. Both source books were designed as tools for planning groups. The dimensions of planning for nursing are described in this The study methodology employed and source book content, monograph. Defined objectives, sufficient financial background, format, and purpose are essentially the same in both publica- and the involvement of thoughtful persons are emphasized as tions. See the annotation above. requirements for accomplishing goals. Steps and procedures for community planning for nursing are suggested. Included is a digest of information on groups planning for community health PAULSEN, ROBERT F., and TATE, BARBARA L. services and particularlyfor nursing services, submitted by 1969. Community Planning for Nursing. No- 44 States, Puerto Rico, and 37 cities. Manuals and Guides for Special Studies Institutional Nursing Services LEVINE, EUGENE; and WRIGHT, STUART. how a nursing staff can plan and conduct its own study. Steps 1957. "New Ways To Measure Personnel Turnover in designing the study and methods and tools for collecting, in Hospitals." Hospitals, 1.4.11.4., classifying, tabulating, and analyzing data are discussed in detail. The study will yield essentially quantitative information, 31:38-42 (Aug. 1). but will also reveal needed changes in allocation of activities Three methods for conducting studies on turnover among and suggest areas for further study of a qualitative nature. hospital employees are described in this article. The advantages The manual includes a method for judging the appropriateness and limitations of each method are discussed, and the im- of nursing activities, as well as suggestions for using the find- portance ofturnoverstudiestohospitaladministrationis ingstoinitiate change. A followup study methodisalso stressed. described. It should be noted that intensive preliminary planning and U.S.DEPARTMENT OF HEALTH,EDUCATION, AND preparation of the study participants are required for conduct- WELFARE. PUBLIC HEALTH SERVICE. DIVISION OF ing a reliable and valid study. It has been further suggested NURSING. that the time sample of a 2.day survey may not be adequate 1957. How To Study Nursing Service of an Out- and may need to be extended. patientDepartment. PHS Pub.497. (Excerpted from a review by Hannah Walseth, Assistant Washington:U.S.GovernmentPrinting Professor, Univer3ity of Minnesota School of Nursing, Min- neapolis, in the American Journal of Nursing, 62 (6), June Office. 75 pp. 1962.) This manual describes methods for 10 types of studies, to use separately or as part of an overall study, to help hospitals YOUNG, JOHN P. evaluate nursing activities in an outpatient department. 1962. A Method for Allocation of Nursing Per- WRIGHT, STUART. sonnel To MeetInpatientCare Needs. 1957. "Turnover and Job Satisfaction." Hos- Operations Research Division, The Johns pitals, 31:47-52 (Oct. 1). Hopkins Hospital, Baltimore, Md. 32 pp. A study of the relationship between turnover and job satis- A method for the allocation of nursing personnel based on faction in three general hospitals is described. patient care needs rather than on patient census is described. VETERANS ADMINISTRATION. DEPARTMENT OF MEDICINE The method is carried out as an ongoing, day.to.day, administrative procedure and includes the following: Classificationof AND SURGERY. patients into three categories, computation of a direct care 1961. A Guide for Studying the Utilization of index, and considerationof thedisparity between nursing Nursing ServicePersonnelinVeterans load indications and scheduled hours. Administration Hospitals.Program Guide, Nursing Service, G-7, M-2, Part 5. Wash- ABDELLAH, FAYE G., and LEVINE, EUGENE. ington: U.S. Government Printing Office. 1964. Patients and Personnel Speak. U.S. De- 101 pp. partment of Health, Education, and Welfare. Public Health Service. Division of Nursing. This manual presents amodified work-diary method for studying and identifying activities of hospital nursing personne: PHS Pub. 527. Washington :U.S. Gov- from nursing assistant through head nurse. It shows in detail ernment Printing Office. 44 pp. 132 APPENDIX 2

This manual offers a study method for use by hospitals to SERVICE SCHOOL. DEPARTMENT OFNONRESIDENT reveal whether nursing service is adequate, and what specific INSTRUCTION. nursingactivities performed for patients need more nursing 1966. time or attention, from the point of view of the patient and Nursing Service in Army Hospitals. Fort hospital personnel. Checklists are used to record omissions in Sam Houston, Texas. 101 pp. nursing care seen or experienced in 1 day's time in a hospital. Discussed in this publication are staffing guidelines, factors The study can serve to provide criteria for improving patient determining nursing care requirements, and criteria for classify- care. The manual includes sample questionnaires, methodology ing pativnts, based on nursing care needs, Patients are grouped for scoring the checklists, and a bibliography. into four categories: Intensive nursing care; moderate nursing care; minimal nursing care; and patients who can be treated ESTES, M. DIANE. on a clinic appointment basis. Guidelines as to total hours of 1964. "Introducing the Nursing Audit." Ameri- care required by patients in a 24-hour period and the proportion can Journal of Nursing, 64 (4) :91-92 of that time to be delegated to registered nurses and other (Sept. 1964). nursing personnel are stated. Examples of the nursing needs of patients in the four categories are cited. This article is a straightforward description of the rationale for a nursing audit, the way to procure it, and its benefits to GORDON, P. C., et al. patients and staff. 1966. "An ApproachtoPatientCareClassi- U.S.DEPARTMENT OF HEALTH,EDUCATION, AND fication." Canadian Medical Association WELFARE. PUBLIC HEALTH SERVICE.DIVISION OF Journal, 95: 1228-1236 (December 10). NURSING. This classification system uses the principles of progressive 1964. How To Study Nursing Activitiesin a patient care along with data obtained from charts, nurses, and Patient Unit. PHS Pub. 370. Revised. resident physicians. Six levels of care or patient care needs Washington:U.S.GovernmentPrinting are defined. Patients were classified by resident physicians and the method was Office. 142 pp. an outside observer. The repeatability of measured by comparing the classifications of the residents and This manual offers an intermittent sampling method which the outside observer. hospitals can use to plan better staffing by studying the distri- Among thecriteriaused intheclassificationswere the butions of time spent by all nursing service personnel assigned patient'sdiagnoses, length of stay, region of residence, bed to inpatient units. The method has been found to be most useful status, and extent of nursing care and supervision required. It in general hospitals, and will provide reliable information on was concluded that the method was feasible and practical and, the following: (1) kinds of activities performed by each cate- as an ongoing procedure, could be used by the residents and gory of personnel;(2)distribution of types of activities by nursing staff to screen out those most suitable for alternate period of the workday in which they occur; (3) activities that care to the care available in a short-term general hospital. The consumethe mosttime. The revisedmanualincorporates levels of care withinthe short-term general hospital were: simplified coding and statistical procedures and contains sample intensive care, intermediate care, end minimal care. The alter- worktables which the hospital can remove from the book and nate.care classifications were: long-term active treatment hos- duplicate. pital care, nursing care (care of the type available in licensed nursing homes orintheir own home under ahome.care U.S.DEPARTMENT OFHEALTH,EDUCATION, AND program),.and sheltered care. WELFARE. PUBLIC HEALTH SERVICE.DIVISION OF NURSING. PAETZNICK, MARGARET. 1964.How To Study Patient Progress. PHS 1966. A Guide for Staning a Hospital Nursing Pub.1169. Washington: U.S. Govern- Service. World Health Organization, Pub- ment Printing Office. 121 pp. lic Health Papers, No. 31, Geneva, Switzer- "Procedures for reporting changes inthe health status of land. 93 pp. (Available from Columbia patients, presented inthis manual, were developed from an UniversityPress,International Document investigation of practices used by public health nursesin Service, 2960 Broadway, New York, N.Y. recording services rendered. Tested in 1960 byfour public 10029. health agencies, the method was found to be helpful in assessing nursing programs. Appendix contains glossary of terms, and a Although not new or different in theory, methods and pro- summary of the classification of needs assessed and codes for ceduresforestablishingstaffingpatternsusefultonursing carestatus and expected outcome. Report forms arealso service personnelboth in the United States and abroadare shown." (From an abstract in Abstracts of Hospital Manage- clearly outlined. Questions relatingto all facets of hospital ment Studies, Vol. 3, June 1957.) nursing care of patients may be used to establish an evaluation system, or, where staffing patterns already exist, toestablish BROOKE ARMY MEDICAL CENTER. MEDICAL FIELD criteria for patient care. Hospital administration, the use of BACKGROUND MATERIAL, AND PLANNING TO OLS 133 nursingpersonnel,andinscrviceeducationare discussed. Long-Term Care Facilities. Pub. 20-1341. Twelve descriptive guide charts and a list of available public New York: The League. 25 pp. health papers are included. (Excerpted from a review by Irene Pope,DirectorofNurses,DepartmentofPublicHealth, This guide interprets 10 principles of nursing care adapted San Francisco General Hospital, Calif., in Nursing Outlook, from criteria developed by the National League for Nursing. 15(8) : 71. August 1967). Itis in workbook style, with a chart opposite cach principle so that the reader may enter his evaluation and future plans. CALIFORNIA NURSES' ASSOCIATION. (Excerpted from National League for Nursing, NLN News, 1968. EstablishingStaffingPatterns Based on 17 (1) :4. January-February 1969.) Acuity of Patient Needs. Fine' Report of Task Force IV. San Francisco: The As- SHAUGHNESSY, MARY E.; O'BRIEN, GERALDINE ; sociation. 28 pp. (processed). FITZPATRICK, THERESE E.; and GROVES, SARA S. This publication describes a method of patient classification 1969. The Problems of Nursing Home Patients. based upon the patient's need tor nursing care. Patients are Implicationc for Improving Nursing Care. classified according to four categories related to criteria indi- An Approach to Determining the Nursing cating the acuity of need for nursing care. The areas to be Needs of Nursing Home Patients in Order assessed as to degree of need include the following: nursing to Provide a Sound Basis for Planning procedure requirements; physical restrictions; emotional fac- AppropriateEffectiveNursingServices. tors;and instructional needs. A statement of standards for nursing practice which this system implementsisgiven. In Boston College School of Nursing, .Boston, addition, staffing patterns which will implement and maintain Mass. 189 pp. (processed). standards for nursing practice are stated. Two groups of staffing ratios as they relate to the patients' acuity of need for nursing "A study conductedin two Boston area nursing homes care are offered: namely, one optimum and recommended; certified for medicare to assess the nursing problems presented. the other, minimal and not to be reduced in terms of staff Criteria were developed to group patients according to:the assigned. over-all goal for their nursing care; the extent of their nursing Although most patients included in the patient classification requirements; and the level of competence needed to provide study were in short-term general hospitals, a number of them the care. Nurse observers.evaluated 164 patients and reviewed were in outpatient clinics, convalescent hospitals, and at home. their medicalrecordsaccordingtothecriteria.Also121 A brief description of the work ofthe Task Force and its patients were interviewed for their own perceptions of their recommendations on the material presented are included. The nceds. Data given on patient characteristics, length of stay, method used is a modification of the "Classification of Patients medical-physical condition and treatments needed, dietary prob- According to Nursing Care Requirenients," developed by the lems, orientation, attitudes, and group activities. Patient inter- United States Army. view and nursing assessment form included. (LE.W.)" (From NATIONAL LEAGUE FOR NURSING. an abstractinAbstracts ol Hospital Management Studies, 1968. Guide for Assessing Nursing Servicesin 5:33. June 1969.)

Cost Analysis and Cost Study Methods

KNOTT, LESLIE W.; VREELAND, ELLWYNNE M.; and tion, and student and instructional services provided by other units of the university or hospital. GOOCH, MARJORIE. 1956.Cost Analysis for Collegiate Programs in NATIONAL LEAGUE FOR NURSING. DIVISION OF NURSING Nursing.Part I, Analysis of Expenditures. EDUCATION. National League for Nursing, Division of 1957. Cost Analysis for Collegiate Programs in Nursing Education, New York. 166 pp. Nursing. Part II, Current Income and This manual discusses the broad principles involved ina Other ResoOces..A manual to aid uni- study of costs in nursing education, and provides the means for versities, colleges, hospitals, and asscciated analyzingtheexpenditures in eachinstitutionand agency agencies in determining costs of nursing participating in the nursing program. Operating expenses are education. New York: The League. 46 analyzed according to the organization and function of the pp. institutions, and direct and indirect expenses incost centers chargeabletonursing are determined. The computation of This is the second part of a two-part manual for analyzing aggregate costs include appropriate allocations of expenditure the costs of collegiate programs in nursing. Part II provides for administration, plant operation, maintenance and deprecia- the means for an analysis of income and other resources that 134 APPENDIX 2 balance both the educational and non-educational(i.e., student detailed expense figures, as for travel, agency administration, maintenance)expenditures, which together are the aggregate and home visits by specific diagnoses of, patients served. cost of the program. The procedures focus on the financing of the aggregate costsand each of the participating institu- U.S. DEPARTMENT OF HEALTH, EDUCATION, AND tions is considered separately. Income includes the following: WELFARE. PUBLIC HEALTH SERVICE. DIVISION OF Student tuitions and fees; government appropriations, private NURSING. gifts,grants,and endowment incomerestrictedtonursing, 1966. How To Determine Nursing Expenditures education;and generaloperatingfunds oftheinstitution allocated to nursing. Other resources are monetary values that in Small Health Agencies. A procedure representservicescontributed bypersons who receive no using work units. PHS Pub. 902.Wash- personal remuneration. Methods for determining the monetary ington: U.S. Government Printing Office. value of nursing student services are included, although there 54 pp. is considerable difference of opiniorr as to the need for and This guide is for the use of small health agencies or multi- use of such costing data. purpose agencies where amounts and types of financial and statistical data are limited for determining the cost of specific NATIONAL LEAGUE FOR NURSING. units of nursing service. The simplepllocedureoutlinedis 1964. Cost Analysis Pr Public Health Nursing based on the principle of average costs, and includes a propon Services. New York: The League. 133 tionate share of travel and snpportive service expenses in the pp. work unit. The method utilizes an activity time study and a record of annual agency expenditures and charges to nursing This manual presents two methods to determine the cost of service. Sample forms and exhibits of the application of the public health nursing services and the cost per visit for home procedure and their adaptation to various programs are in- health services. It provides means for determining specific and cluded in the manual.

Criteria and Standards for Nursing Service

AMERICAN NURSES' ASSOCIATION. HEAD NURSES Florentine. Code No. 15-1033. New BRANCH. GENERAL DUTY NURSES SECTION. York: The League.29 pp. 1958. Functions, Standards, and Qualifications Pr This monograph suggests guidelines stated as competencies actice for the Head Nurse. New York: and abilities in five major areas that school nurses must have The Association.8 pp. for fulfilling the purposes of a school health program. It can be used to appraise the adequacy of educational programs and The head nurse position is defined. Responsibilities are out- the preparation of nurses for work experience in school health lined in the broad areas of patient care, unit management, and programs. Course offerings and areas of clinicalexperience institutional objectives; also, fnnctions in each area are de- related to required competencies are suggested. tailed. The professional and personal qualifications for a head nurse are specified. AMERICAN NURSES' ASSOCIATION. EDUCATIONAL AD- AMERICAN NURSES' AssoCIATION.OFFICE NURSES MINISTRATORS, CONSULTANTS, AND TEACHERS SECTION. SECTION. 1963.Functions, Standards, and Qualifications Pr 1962. Functions, Standards, and Qualifications Pr Practice Pr Educational Administrators and the Practice ot Office Nursing.New York: Teachers. New York: The Association. The Association. 12 pp. 15 pp. This statement defines the position of office nurse, the major This statement outlines the functions that specifically apply objectives of nursing care, and the basic qualification required to nurse educatorsadministrators and teachersin the broad for practice. It outlines the functions of office nurses. areas of administration,instruction,guidance, and research. Recommended educational and professional requirements and NATIONAL LEAGUE FOR NURSING. DEPARTMENT OF qualifications are briefly outlined. BACCALAUREATE AND HIGHER DEGREE PROGRAMS. 1962. The Preparation and The Role ot Nurses AMERICAN NURSES' ASSOCIATION. in School Health Programs. Guidelines 1964.Statement of Function,s theLicensed for the Use ot Administrators, Educators, Practical Nurse. New York: The Associa- and Students.Prepared by Helen Goodale tion. 5 pp. BACKGROUND MATERIAL AND PLANNING TOOLS 135

This statement describes the role ofthe licensedpractical tu be consideredin determining policy when planningfor nurse, licensure and educational requirements, and legal status. the employment and use of supportive personnel. These ques. It outlines the functions that a licensed practicalnurse can tionsareconcerned with:recruitment,tuining,functions, perform in giving nursing care in simple nursing situations. supervision, program evaluation, and financial support.

AMERICAN NURSES' ASSOCIATION. PUBLIC HEALTH ILLINOIS ASSOCIATION OF SCHOOL NURSES. ILLINOIS NURSES SECTION. EDUCATION ASSOCIATION. 1964.Functions and Qualifications in the Practice 1966. Illinois Study of School Nurse Practice, A of Public Health Nursing. New York: Summary Report. Springfield, Ill. The The Association. 32 pp. Association. 52 pp. Statement of functions and recommended qualifications of This study sampled by questionnaire the opinion of superb'. nurses employed instaff, supervisory, consultant, and educa. tendents, principals, teachers, and school nurses, at both the tional and administrative positions inpublic healthnursing elementary and secondary school levels, regarding the appro- are outlined. A brief discussion of recommended qualifications priate academic preparation and function3 of school nurses. for public health nurses employed byofficial and voluntary Twenty.threefunctionsofschool nurses were ratedasto agencies is included. The supervisory kInctions of public health their importance. Conclusions drawn from the study findings staff nurses as they relate to the licensed practical nurse and were: a need for better informed school personnel and better her functions are also outlined. academically prepared nurses, and a need for teacher nurse consultants and university programs designed to prepare nurses AMERICAN NURSES' ASSOCIATION. for school employment and coordination of working relation- 1965.Standards for Organized Nursing Services ship. (Excerpted from a review by E. G. Lynn in Nur3ing in Hospitals, Public Health Agencies, Nurs- Research, 16 (4): 394. Fall 1967.) ing Homes, Industries, and Clinics. New AMERICANNURSES'ASSOCIATION. COMMITTEE ON York: The Association. 15 pp. NURSING SERVICES. Sixteen formal statements of general standards apPlicable for 1967. Statement on Nursing Stall Requirements nursing service departments are detailed. The purposes, basic New assumptions, and criteria for formulating the standards are for In-Patient Health Ca Te Services. included. Factors for assessing each standard are listed to make York: The Association. 3 pp. them meaningful and to offer guidance in their implementation. This statement outlines criteria for developing staffingpat. These standards are supplemental to those developed for practi. terns for inpatient care services suited to the individual needs tioners in particular fields of nursing. of particular units. It outlines the factors, policies, and pro. cedures to be considered in determining requirements. AMERICAN Num& AssoCIATION. OCCUPATIONAL HEALTH NURSES SECTION. AMERICAN NURSES' AssOCIATION. DIVISION ON 1965.Functions, Standards, and Qualifications for PSYCHIATRIC-MENTAL HEALTH NURSING. Occupational Health Nurses. New York: 1967. Statement on Psychiatric Nursing Practice. The Association. 32 pp. New York: The Association. 41 pp. Occupational health nursing and positions in a one-nurse and Psychiatric patient care is defined in terms of its purpose and multiple-nurse service are defined. The educational preparation, the philosophy and assumptions upon which the care is based. personalcompetencies, andessential knowledge midskills Not only is the specialized areaof practice included in the required of a nurse in a onenurse service, as well as a super- definition of psychiatric nursing, but itsrelationshiptoall and director in an occupational health nursing service, nursing practice is shown. The definitionalso setsrealistic visor.are detailed. Functions arerelated tonursing care,health goals for nursing in psychiatric services. Roles of the various maintenance, safety education, health and welfare benefits, and nursingpractitionersinpsychiatricsettingsareincluded. community health and welfare agencies. These are clinical specialists, registered nurses, licensed practical nurses, and nursing assistants. AMERICAN NURSES' Asso CIATION. COMMITTEE ON PRACTICE. PUBLIC HEALTH NURSES SECTION. FORBES, ORCILIA. 1966. A Guide for the Utilization of Personnel 1967. "The Role and Functions of the School Supportive of Public Health Nursing Serv- Nurse as Perceived by 115 Public School ices. Code No. PH-51. New York: Teachers from Three Selected Counties." The Association. 12 pp. Journal of School Health,37:101-107 This publication outlines guidelines and concepts in utilizing (February). registered nurses, licensed practical nurses, and home health "This article reports a study of 115 elementary and secondary aides for public health nursing services. It poses 35 questions school teachers in 3 Oregon counties carried out to determine 136 APPENDIX 2 their perceptions in 4 areas:1)role and functions of the health center include services for the total population which school nurse; 2) problems encountered with scLool nursing; it represents." Concepts of prevention are primary; neverthe- 3) courses which nurses should take in order to serve better less, care for the mentally disordered persons in the community in the schools; and 4)the importance of 20 selected school is provided. Interrelationships with mental hospitals and ether nursing activities... . The study indicated that many teachers agencies arenecessary. "Partidpationinlocal,State,and have not developed a concept of the professional role of the regional planning is certainly desirable." school nurse." Problems seen by teachers and the activities Psychiatric nurses should prepare themselves to work with given greatest imptxtance by teachers are enumerated. (From groups as well as individuals. The movement is beyond tbe a review by M. L. Pohn in Nursing Research, 16 (4): 394. Fall hospital wall out into the community. Closer working relation- 1967.) ships betweenpublic health nurses and psychiatric nurses should he developed. It bas been suggested that non-profes- STEARLY, SUSAN; NOORDENBOS, ANN; and CROUCH, sionals can be trained and supervised in giving direct services, VOULA. thus freeing the nurse to direct her energies into "such areas 1967. "Pediatric Nurse Practitione7." American as consultation, social action, social advice, liaison with other Journal of Nursing, 67 (10) :2083-2087 groups or agencies, training, and supervision." These duties are (October). reviewed in detail, as well as the implications inherent in them for nursing education. This articledescribes one way in whichthe knowledge, (From a review by Rhetaugh G. Dumas, Nursing Outlook, skills, and role of the pediatric nurse were expanded to deliver 16 (12): 66. December 1968.) more caretochildren. The two phases ofthe program controlled education and practiceare described as they were AMERICAN NURSES' ASSOCIATION.t:OMMISSION ON carried out in a project sponsored by the School of Nursing NURSING SERVICES. and the School of Medicine of the University of Colorado, and 1969. The Position, Role, and Qualifications of supported by a Commonwealth Fund grant. theAdministratorofNursingServices. AMERICAN NURSES' ASSOCIATION. DIVISION OF COM- Pub. N6. New York: The Association. MUNITY HEALTH NURSING PRACTICE. 2 pp. 1968. Functions and Qualifications for an Occu- The statement describes the scope of health services and pationalHealthNurse ina One-Nurse reflects changes in the roleof the administrator of nursing Service. Code No. CH-1. New York: services. Abilities and skills deemed essential are stated. Edu- cational requirements are included. The position is defined in The Association. 10 pp. sufficient breadth to apply to all types, settings, and sizes of This statement details functions of a nurse in a one-nurse nursing services, and is a guide in describing not only the occupational health service in the areas of nursing care, health position of the administrator but also the assodate and assistant evaluation, health education and counseling, and mental hy- arlininistratorsof nursing services. The statement should be giene. It includes administrative and management responsibili- usedwith the ANA publication,Standards for Organized ties and relationships. Recommended education, experience, Nursing Services. and proficiency qualifications are outlined. NATIONAL LEAGUE FOR NURSING. EVANS, FRANCES MONET CARTER. 1969. Extending the Boundaries of Nursing Edu- 1968. The Role of the Nurse in Community cationThe Preparation and Roles of the Mental Health. New York: Macmillan Co. Clinical Specialist. Pub. 15-1367. New 227 pp. York: The League. 82 pp. This publication considers the nurse in a broad perspective Papers and summaries of panel discussions given at the third and draws heavily from theory of social psychiatry as well as conference of the Council of Baccalaureate and Higher Degree from the author's own experiences and research in psychiatric Programs, held in Phoenix, Ariz., in November 1968, are innursing here and abroad. The basic proposition of the book is cluded. The conference was an extension of a 2-year series of that "comprehensive services offered by a community mental programs dealing with graduate education in nursing. Criteria and Standards for Nursing Education

NATIONAL LEAGUE FOR NURSING. DEPARTMENT OF Code No. 16-24. New York: The League. DIPLOMA AND ASSOCIATE DEGREE PROGRAMS. 11 pp. 1962.Criteria for the Evaluation of Educational This statement details the historical development of criteria Programs in Nursing Leading to a Diploma. for diploma education. It outlines criteria intended for use as BACKGROUND MATERIAL AND PLANNING TOOLS 137 a tool in the self-evaluation of programs, as an evaluation tool sociate Degree. Code No. 23-1258. New in accreeltation processes, and as an interpretive device. Criteria York: The League. 12 pp. outlined include objectives,administration and organization, faculty, students, curriculum, facilities,records and reports, Criteriaareoutlinedforthefollowing:philosophy and and program evaluation. purposes, organization, and administration of associate degree programinnursing;studentsandfaculty;resources and facilities; curriculum development and programs of instruction; NATIONAL LEAGUE FOR NURSING. DEPARTMENT OF and program evaluation, These criteria, used for self-evaluation PRACTICAL NURSING PROGRAMS. by schools and for national accreditation, are revised period- 1965. Criteria for the Evaluation of Educational ically by participant., in this type of education through their Programs in Practical Nursing. Code No. membership in the League. 38-1178. New York : The League. 17 PP. NATIONAL LEAGUE FOR NURSING. DEPARTMENT OF Both criteria and guidelines for achievement are outlined for BACCALAUREATE AND HIGHER DEGREE PROGRAMS. use in development of the practical nurse educational program, 1969.Criteria for the Appraisal of Baccalaureate self-evaluation of programs, and national accreditation. Areas and Higher Degree Programs in Nursing. covered include philosophy and objectives of program, organize- CodeNo.15-1251. New York: The tion and administration, curriculum, faculty, students, facilities and resources, records, and program evaluation. These criteria League. 14 pp. areperiodicallyrevisedthrough programactivitiesofthe League. These criteria are intended for use in program self-evaluation and for national accreditation. Criteria are outlined for these NATIONAL LEAGUE FOR NURSING. DEPARTMENT OF levels of nursing programs in the areas of philosophy, purposes, and objectives; organizatioa and administration; faculty corn- DIPLOMA AND ASSOCIATE DEGREE PROGRAMS. position, qualifications, and functions; curriculum and instruc- 1967. Criteria for the Evaluation of Educational tion; resources, facilities, and services; students; and program Programs in Nursing Leading to an As- evaluation.

Planning Theory and Process

PAYNE, STANLEY L. surveys were undertakento determine whether there were 1951. The Art of Asking Questions. Princeton, enough nurses in each field to meet the needs of the State; N.J.:Princeton University Press. 247 pp. whether existing facilities for nursing education could produce enough well-prepared nurses; and whether nurses are prepared This is a highly readable and interesting book. It concerns for the jobs they are performing. The striking similarity of chiefly the wording of questions; yet its usefulness goes beyond recommendations proposed in the various State surveys is noted, that. The problems Payne raises and the illustrations and data and post-survey activity is described. It is concluded that "much he brings to bear on these problems pose questions of theo- more study must be made of how nurses can work with other retical interest for specialists in various areas. For example, groups on relatedresearch, including collectionof original psychologists will see problems relating to frame of reference, data and of how they can assist in development of regional ego involvement, and the attributes of opinion, whereas sociol- and State planning for nursing." A statewide nursing survey ogists will see problems relating to class, status, and social can be a constructive device for getting community action and change. become a pattern for a comprehensive nursing plan. (Excerpted from a review in Nursing Research, 8 (2) :113. Spring 1959.) ABDELLAH, FAYE G. 1952. "State Nursing Surveys and Community ADULT EDUCATION ASSOCIATION OF THE U.S.A. Action." Public Health Reports, 67: 554- 1955. Taking Action in the Community. Leader- 560 (June). ship Pamphlet No. 3. Washington: The Association.48 pp. Major findings are reported from nursing surveys made in 35 States and the Territory of Hawaii,to analyze statewide This pamphlet is concerned with ways to plan and carry out nursing needs and toalleviate nurse shortages. The article a program of social change in a community. It discusses getting summarized organization for and conditions und which the support for and initiating social action, and suggests attitudes surveys were conducted in each State and Territory. The State and methods helpful in beginning and carrying out the job. 138 APPENDIX 2

Community apathy and the forces against taking action are Pamphlet No. 13. Washington: The As- pointed up, as well as methods of handling conflia and con- sociation. 48 pp. troversial issues and problems of public interest. A flow chart showing phases in successful community action through com- This riamphlet is intended to help organizations and agencies in munity groups is included. achievebetterpublicrelations.Approaches andsteps developing a good public relations program are discussed, as well as techniques and media that work in particular situations. ADULT EDUCATION ASSOCIATION OF THE U.S.A. Suggestions are presented for handling criticism and testing 1955. Understanding How Croups Work. Lead- communication effectiveness. A checklist for planning public ership Pamphlet No. 4. Washington: The relations programs is included. Association. 48 pp. ADULT EDUCATION ASSOCIATION OF THE U.S.A. This pamphlet can help group leaders and members increase 1957. Streamlining Parliamentary Procedure. their sensitivity to group processes, organize more effectively', and coordinate their efforts to get things done by group de- Leadership Pamphlet No. 15.Washington: cision and action. It describes group needs and conflicts and The Association. 48 pp. types of behavior that trouble groups; discusses leadership, The contributions that parliamentary procedure can make group codes or customs, structure, and program content; and in meetings and discussions are dealt with, as well asits suggests ways to improve group efficiency. usefulness in finding common factorsof agreement and in reaching decisions. Abuses in the use of parliamentary pro- ADULT EDUCATION ASSOCIATION OF THE U.S.A. cedure in organilational work are outlined, and guidelines are 1956. ConductingWorkshopsandInstituto. given for determining when to and when not to use it. Leadership Pamphlet No. 9. Washington: KNOWLES, MALCOLM S., and KNOWLES, HULDA. The Association.48 pp. 1959. "Understanding Group Behavior." Chap- This pamphlet gives step-by-step help on every phase of the ter 3, pp. 39-62, in Introduction to Group workshop method. It is designed as a practical aid to leaders Dynamics. New York: Association Press. in education, government, welfare, health, agriculture, labor, religion, industry, and the community. Topics discussed are This chapter will help the planner understand group be- pre-planning, getting started, using resource people, learning havior, diagnose its problem, and improve its operation. The through play, back-home application, and evaluation. characteristicsofgroupprocedures,properties,dimensions, membership, and leadership are briefly described. A checklist ADULT EDUCATION ASSOCIATION OF THE U.S.A. of general principles for a group or committee as an effective 1956. Getting and Keeping Members. Leader- instrument for change is given. ship Pamphlet No. 12. Washington: The STRUNK, WILLIAM, JR., and WHITE, E. B. Association. 48 pp. 1959. The Elements of Style. New York: The This pamphlet offers aid in solving the everyday problems MacMillan Company. 71 pp. of group membership. Topics discussedare:finding new Eight rules of English usage and 10 principles of composi- members, keeping old members involved, reducing dropouts, tion most commonly violated are discussed and illustrated in increasing attendance at meetings, working with the member- this concise rule book for writers. In addition, discussion of a ship committee, and relating membership goals to program few matters of form, a list of words and expressions commonly goals. misused, and a suggested approach to style can help planners improve the writing of reports and other documents. ADULT EDUCATION ASSOCIATION OF THE U.S.A. 1957. Better Boards and Committees. Leader- BRADFORD, LELAND P.; GIBB, JACK R.; and BENNE, ship Pamphlet No. 14. Washington: The KENNETH D.; eds. Association. 48 pp. 1964. TCroup Theory and Laboratory Method: Innovation In Re-Education. New York: Some basic featuresof organizations and organizing are discussed in this pamphlet, including the purpose of boards, John Wiley and Sons. 498 pp. suggested ways of improving organizational leadership, and the "Seventeen years of experimental effort went into the content structure and work of committees. Requirements for improving of this book." The idea of the T Group, or Training Group, is the work of committees are discussed in regard to: committee an "innovationin re-education." The T Group member, a size, choosing and orienting members, picking a chairman and participant-observer, "develops new images of potentiality in the chairman's job, and committee agenda and work. A special himself and an understanding of how others might be able to section is presented on the advisory committee. help him convert thesepotentialitiesintoactualities. The difference between the T Group and other groups in our ADULT EDUCATION ASSOCIATION OF THE U.S.A. society is its focuswhich is on group processes, perception, 1957. EffectivePublicRelations. Leadership communication, as well as the job to be done." BACKGROUND MATERIAL AND PLANNING TOOLS 139

This book is written in such a way that it becomes a learn. BUTTER, IRENE. ing experience for the reader. The content in certain chapters 1967. "Health Manpower Research :A Survey." would have special meaning, however, for these three levels of Inquiry, V (4): 5-41 (December). nurses: the student, the teacher, and the administrator. (Based on a review by Eleanor Lefson in Nursing Outlook, This paper focuses on a conceptual framework and analytic 12 (12): 62. December 1964.) tools for future health manpower research that can be adopted from the field of economics. It further purports that operations AHUMADA, JORGE. research offers suitable measurement techniques and quantita- 1965. Health Planning Problems of Concept and tive methods. The research framework presented "draws heavily on the economic concepts of demand for health manpowerand Method. Scientific Publication No. 111. its determining factors; supply of health manpower andits Washington: Pan American Health Organi- determinants; andthe conditions under which demand and zation,Pan American Sanitary Bureau, supply are likelyto reach equilibrium." The interaction of Regional Office of the World Health Organi- changing demands and supplies is discussed, as well as man. zation. 77 pp. power planning and legislation as possible reinforcementsand substitutes forprivate market mechanisms. Problems and re- This publication was intended as a "guide to health planning searchin health manpower ingeneral,forselected health and as a stimulus to a further research and analysis of thc occupations and their interactions, are also discussed. concepts and methods governing it." Social and economic prob. lems as well as health problems are reviewed and are com- NATIONAL COMMISSION ON COMMUNITY HEALTH ponents in assessing needs and requirements. Additional areas SERVICES. covered are: determination of feasible alternatives in the local Community , Health programing area; and preparation of regional plans and the 1967. Action-Plannit,gfor national plan. Services. Report of the Community Action Studies Project. Washington : Public Af- HIESTAND, DALE L. fairs Press.67 pp. 1966. "Research Into Manpower for Health Serv- This report is addressed to civic leaders to help them get ices." Milbank Memorial Fund Quarterly, effective action for health. Three majors areas were explored: 44:146-81 (October). (1) community readiness for action for health;(2)a retro. spective survey of local health studies; and(3)a detailed This paper appraises empirical research into manpower for analysis of a number of successful health efforts by certain the health services.It discusses approaches to manpower re . communities. As a resuh ofthis Commission's work with search, its accomplishments, and priority areas needing research. community leaders, a survey tool, "Self-Study Guide for Com. The availability of research data on health manpower is de. munity Health Action-Planning," was developed. tailed. These principles are stressed: that manpower research can only indicate the nature of manpower situations; and that NATIONAL COMMISSION ON COMMUNITY HEALTH manpower policy, private policy, and public policy must solve manpower problems. For realistic planning, this paper recom- SERVICES. mends that the determinants of demand be clarified. Redirection 1967.Comprehensive Health Care: A Challenge in the orientation of research is urged, as well as study into to American Communities. Report of the the processes of effecting change to determine why goals are TaskForce onComprehensive Personal not reached despite numerous studies. It is believed that solidly Health Services. Washington : Public Af- constructed, finely focused efforts can yieldsignificantcon- fairs Press.94 pp. tributions. The objectives of the report and the recommendationsit AMERICAN HOSPITAL ASSOCIATION. contains are measures to help achieve comprehensive personal health services under present circumstances. The providing of 1967. Principles To Guide Development of State- an adequate number of personal physicians and the organizing wide Comprehensive Health Planning and of health systems around proper modes of access are two of the Protocol for Health Care Planning Within key requirements for comprehensive personal health services. a State. Approved by the American Hos- Still another prime requirement is some degree of association pita] Association. Pub. 846. Chicago: among physicians themselves. Planning by communities must assure that comprehensive personal health services of optimum The Association. 7 pp. quality are available, accessible, and acceptable toalltheir This pamphlet briefly outlines the Association's position on residents. Special areas of need are identified and discussed, the needfor,scope, and relationship between institutional, and suggestions for improvement and study are included. comMunity, State, and areawideplanning. This positionis presented in the form of principles and protocol to guide tbis NATIONAL COMMISSION ON COMMUNITY HEALTH planning. SERVICES. 140 APPENDIX 2

1967. llealth Administration and Organization in 1968. "Agency Problems in Planning for Com- the Decade Ahead. Washington: Public munity HealthNeetls." Medical Care, Affairs Press. 96 pp. VI (6): 454-466 (November-December). This Task Force report examines issues and presents guide- The authors have identified, from interviews with administra- lines for the administration and organization of health services. lors of community health service agencies, a number of con- with the underlyirg purpose of ensuring comprehensive, per- straining influences on coordinative planning for comprehensive sonal, and environmental health services for all Americans. Its healthE e rv ices. These includethe following:differencesin recommendations envision a pivotal role for State government in priority given to the type of community need identified; differ- channeling Federal assistanceto community health services, ences in the way commonly recognized needs were defined in and fostering and coordinating planning at the regional and terms of the agency's own coping responses to the problem; local levels. It suggests replacing the traditional State health current pressures and demands for agency time and manpower; department with a broad.gauged agency with responsibility for lack of clear-eut community norms for allocation of agency the major health functions of the State, yet withdrawn from responsibility for initiation of new activities; and amount of the directprovisionof services and operationoffacilities. organizationalenergy and time requiredforinitiating and Planning by an interdepartmental body working closely with implementing changes in program activities. the Governor's office is seen as the force for integrating diverse Because of the increasing demand for services in all areas of and competing elements of our health system. Creation of new community health and in the absence of a centralized decision policies and programsis mechanisms to coordinateFederal authority and with the relatively weak market situation of the essernialtotheprocess.(Excerpted from areview inthe current organizational system, thereisadiffusion of power American Journal of Public Health and the Nation's Health, and influence;individual agencies seem to have become im- 58 (3): 596.597. March 1968.) 'potent in developing the qualitative changes needed for meeting community health service needs. Arnold and Hink recommend NATIONAL LEAGUE FOR NURSING. the development of competitive planning structures. Equal but 1967. Change, Collaboration, Community Involve- competitive health care systems would provide a choice for the ment. A synthesis of views on nursing as consumer. seen by the Committee on Perspectives. New York: The League. 12 pp. DENISTON, 0. L.; ROSENSTOCK, I. M.; WELCH, W.; This pamphlet summarizes and calls attention to the issues and GETTING, V. A. and changes in society, health care, and nursing, and forecasts 1968. "Evaluation of Program Efficiency." Pub- future trends. It focuses on the knowledge, skills, and attitudes lic Health Reports, 83 (7): 603-610 (July). needed by nursing for improved patient care. The responsibility for nurses at all levels to participate in identifying problems The authors conclude that "the first step in evaluating effec- and devising solutions for needed change is emphasized. In. tiveness and efficiency appears to be to attain conceptual clarity volvement in community planning and action is stressed. about what the program is and what it contains. Then evaluation becomes straightforward." The authors further state that the tools described for evaluating effectiveness and efficiency "are ARNOLD, MARY F. most useful for programs in which (a)theobjectives have 1968. "Useof Management ToolsinHealth been specified qualitatively and quantitatively and have been Planning." Public Health Reports, 83 fixed in time to particular geographic areas and to particular (10): 820-826 (October). target audiences, (b) the programs are described in sufficient "Perhaps the most important function of the health pro- detail to permit reliable observations of performance of planned the resources that are directed toward fessional in community planning is that of finding better ways activity, and (c)all program activity are identified." to measure benefits and delineate health values. If he does not meet this challenge the measures of the technicians will be used, and they may represent a quite narrow value system GUNNING, ROBERT. about health... . 1968. The Technique of Clear Writing. Revised "Therefore,thereallytroublesomeproblemisresolving edition. New York: McGraw-Hill Book conflicting values and clarifying and identifying shifting value Company. 329 pp. premises. . "The knotty problem to be solved in .planning, whether at This guide for writers discusses factors of reading difficulty the organizational or the societal level, is to find a tool that and 10 principles of clear and readable writing. Gunning's will aidin defining the utilitiesto be maximized and the yardsticksfor measuring readability have been helpfulto timcspan that is to be considered. Management tools can help authors and editorsintesting writing. The principles and us plan how to get somewhere and learn where we are going, yardsticks are applied to legal prose, and to technical, business, but they cannot help us decide where it is we want to go." and newspaper writing. In the appendix is a list of short words to substitute for long words. This book can aid planners in ARNOLD, MARY F., and HINK, DOUGLAS L. preparing, revising, and improving 'their reports. BACKGROUND MATERIAL AND PLANNING TOOLS 141

HILLEBOE. H. F., and SCHAEFER, M. Health Reports, 83 (10): 841-848 (Octo- 1968. "ComprehensiveHealthPlanning:Con- ber). ceptual and PoliticalElements." Medical Dr. Storck summarizes his report as follows: "The Public Times, 96: 1072-1080 (November). Health Conference on Records and Statistics, a study program "Four interdependent triads interact in comprehensive health administered by the National Center for Health Statistics, held to consider planning: (1) systematic identification of health problems, and its 12th national biennial meeting in June 1968, determination of goals in light of these problems; (2) rational data 4.ises and needs in comprehensive health planning. The choices in allocating and using resources;(3)consideration conference was organized around discussion group meetings of health and possible modification of the community constraintson on measures of health and health hazards, measures basic demographic. health policies and programs; (4) application of the knowledge service use, statistics on health r.:.ources, and processes of planning so as to integrate the other concepts. data, and data systems. The application of only one of -these elements is not compre- "Among the topics considered were the kinds of stathtics hensive planning." (Quoted from American Journal of Public needed for comprehensive heahh planning, methodologies to Health and the Nation's Health, 59 (1): 198.199. January improve the country's health statistics, ways to organize govern- 1969.) mental healthstatistics operations, and general problems in transforming the country's health needs first into demands and NATIONAL COMMISSION ON COMMUNITY HEALTH then into accomplishments. SERVICES. "The chief organizational prop s.' brought before the con- 1968. The Politics of Community Health.Report ference was that State (inctudingegional) centers for health of the Community Action Studies Project. statistics be established to satisfy needs for health statistics not now being met and to coordinate and give focus to the large by Ralph W. Conant. Washington: Pub- quantities of data already available. lic Affairs Press. 137 pp. "A social action philosophy centering around doing rather This study analyzes five outstanding examples of community than explaining was discernible in the discussions, as in the heulth planning. It found that such planning is essentially a Comprehensive Health Planning Actitself. This philosophy politicalprocess, and that the major obstaclesto successful holds that concrete social activity occurs when ongoing sit- planning are politicalpolitics being defined as the clashof uations are transformed into problems, problems into plans. interests and not party behavior. Five conditions for successful plans into programs, and finally, when programs receive social planning are prescribed:(1)political leadershipskilledin evaluations. Key personsinvolved are statisticians, planners, identifying and resolving conflict among contending groups; programoperators,andpoliticallymotivatedpeople, who (2) legal authority and enforcement sanctions; (3) a reliable mediate between technically motivated groups and the general sourceof money inproportiontoestablishedgoals;(4) or affected public." capacity to combine public andprivate resourceswith the resources of other levelsof government;(5)capacityfor BENNIS, WARREN G.; BENNE, KENNETH D.; and CHIN, skilledanalysis of community healthproblems. The main ROBERT; edS. implication of the study is thatsuccessful planning requires 1969. The Planning of Change. 2d ed. New development of systematic knowledge of health politics and its use by policymakers and planners. (Excerpted from a review in York: Holt, Rinehart and Winston, Inc. the American Journal of PublicHealth and the Nation's 627 pp. Health, 58 (7): 1297. July 1968.) This publication emphasizes "the process of planned changing, on how change is created, implemented, evaluated, main- NEW YORK ACADEMY OF MEDICINE. tained and resisted. Includedalsoare some ofthe major 1968. "Planning For Community Health Services: instruments that have been developed for creating and maintain- Perspectives For Action." Bulletin of the ing change: training, consulting, and applied research." New York Academy of Medicine (Special Issue), 44 (2) : 83-219 (February). U.S. DEPARTMENT OF HEALTH, EDUCATION, AND This entire issue is devoted to reprints of papers read at the WELFARE. PUBLIC HEALTH SERVICE. HEALTH SERVICES 1967 Health Conference of the New York Academy of Medicine. AND MENTAL HEALTH ADMINISTRATION. COMMUNITY Topics covered are: the complexity of health service planning; HEALTH SERVICE. the potentials, goals, and evaluative processes to be considered 1969. The Urban Planner in Health Planning. in the planning process; problems and solutions in health care A report by the American Society of Health planning; and more effective use of resources, manpower, and PlanningOfficials. PHS Pub.1888. facilities. Washington:U.S.GovernmentPrinting STORCK, JOHN. Office. 90 pp, 1968. "Hard Facts for Health Planning." Public The present involvement of urban planning agencies in the

-1:14 142 APPENDIX 2 health problems of their communities isdescribed. Current bibliography of reference materials on the health system and health problems are discussed. Suggestions areprovidedto health planning for the urban planner isincluded. The ap . planning agencies to assist them in making their contribution pendix also contains a selected listing of national and regional toward the solving of health problem6 a more effective one. A health organizatii-ns.

Tools for Planning

MEYER, BURTON. and interprofessional relations; public health nursing; nursing 1957. "Development of a Method for Determining inspecial fields communicable disease, maternal and child Estimates ofProfessional Nurse Needs." health,neurological andpsychiatric nursing; andpractical nurse and auxiliary worker. Nursing Research, 1: 24-28 (June). This paper emphasizes indetail a method for estimating U.S. DEPAlaMF:NT OF LABOR. BUREAU OF LABOR grossquantitative needsforregisterednurses. The method STATISTICS. utilizes a comparative evaluation approachin which nurse- 1963. The Forecastingof Manpower Require- population ratios obtained and considered adequate for good nursing care are applied as a standard to the population for ments. BLS Report 248 (April). Wash- which estimates are being made. Estimates are based on factors ington: The Department. 96 pp. affecting the demand for nursing services and the number of This handbook, prepared for the Agency for International nurses expected to be available. The units of measurement Development (AID), is iutended to serve as a guide for de- utilizedincludepopulationgrowth,nurse-populationratios. termining manpower requirements inrelationtoanticipated attrition rates from the nurse supply, the number of graduates development. The method outlined "relies heavily on economic expected from basic nursing education programs, and expansion analysis and human judgment, and uses whatever statistical needs of education programs to meet desirableratios. The techniques are available and applicable to assist in making a author believesthat withinthe framework of the method common sense evaluation of future needs and resources" in- specified and dependent upon availabledata,theregional. eludingfuture manpower requirements byoccupationand community, and qualitative needs for nurses can be studied future training requirements for high-level occupations. and estimated.

Nursing Research. SIMMONS, LEO W., and HENDERSON, VIRGINIA. 1964.Nursing Research, A Survey and Assess- 1959. "AbstractsofStudiesinPublicHealth Nursing." 8 (2) : 41-144A. ment. New York: Appleton-Century-Crofts. 461 pp. This entire issue of Nursing Research is devoted to an index and compilation of abstracts of studies in public health nursing This guidetonursingstudies reviewsselectedareasof undertaken in the United States from 1924 to 1957, inclusive. research related to occupational interests as well as studies of Abstracts are classified under the following headings: organiza- nursing care. It includes a review of research completed during tion and administration;programs andservices;procedures the past six decades, and an assessment of master's theses and and techniques; personnel policies and practices;time and doctoraldissertations from 1932 to 1955. Also included are cost; occupational orientation and career dynamics; education types of sponsorship of research, the kind of research sponsored forpublic health nursing;interagency and interprofessional hy various organizations, and a report of opinions regarding relations; medical and home care plans; public health nursing the status of nursing research today. Twelve selected surveys of in special fields; and survey and study methods. The compila- nursing needs and resources conducted from 1945 to 1955 are tion includes citations of master's theses, a list of community analyzed. This guide provides historical development and future health surveys that include public health nursing, and a list directions for research in nursing. It should serve as a useful of surveys of nursing needs and resources. resource for those interested in nursing research, including the project staff and others involved in planning. (Excerpted in Nursing Research. part from a review by Shirley Sears Chatter, Associate Pro. fessor, University of California, San Francisco, in American 1960. "Abstracts of Studies in Nursing." Journal of Nursing, 65 (2): 145. February 1965.) 9 (2): 49-106 (Spring). This entireissueof Nursing Researchisdevotedtoa ABDELLAH, FAYEG.,R.N.,Ed.D.;and LEVINE. compilation of 200 abstractsofsignificantresearchinall EUGENE, Ph.D. nursing areas completed between 1955 and 1958. Abstracts are classified under the following headings: nursing and nursing 1965. Better Patient Care Through Nursing Re- services; personnel policies and practices; occupational orienta- search. New York: Macmillan Co. 736 tion and career dynamics; education for nursing; interagency pp. BACKGROUND MATERIAL AND PLANNING TOOLS 143

This is a valuable source book for research investigators. It before Special Session, 94th Annual Meet- establishes the nurse as an essential membcr of the research ing of the American Public Health Associa- team and nursing researchas an essentialfieldof study. tion,SanFrancisco. Statistical analyses and detailed examination of research meth- Baltimore:The odsare presented, with specialattentiontothcthcory of Johns Hopkins University School of Hygiene nursing research,the selectionof researchdesigns,and a and Public Health. 22 pp. (processed). typology for the classification of research to aid researchers in A discussion of how requirements for health personnel arc selecting appropriate theoretical and methodological approaches. measured is included by the author. Two commonly employed There is extensive treatment of the various steps in research approachesnamely, need and demandare reviewed and as- design. sessed. Klarman clarifies thefirst approach, need, belonging The approach is practical, designed to prepare the reader for to public health officials and planners; and the second, demand, direct involvement. Current research activities arc dcscribed, belonghig to the economists. The paper includes specific ap- and what appear to he the activities of the future are outlined. proaches appliedto concretesituationsin which additional The definition and measurement of variables, data collection. personnel are being sought; physicians for primary care, and the role of the nurse in research receive extensive con. registerednursesfor hospitals, public health administrators sideration. Case studies of actual research demonstrate how and planners, and home health aides. the researcher may deal with practical problems likely to arise. POLLIARD, FORBES W. KERLINGER, FRED N. 1966. The Feasibility of a Systematic Study of 1965. "Survey Research." Chapter 22, pp. 392- Manpower Requirementsand Education 408, in Foundations of Behavioral Research. and Training Programs of Selected Health Educational andPsychologicalInquiry. Occupations. Indianapolis Hospital De- New York: Holt, Rhinehart and Winston, velopment Association,Indianapolis,Ind. Inc. 95 pp. This chapter is an overview of survey research insocial. "A four-month investigation,including aliterature survey scientific, and educational research. Survey research is defined and individual and group interviews, fonnd positive response and distinguished from status surveys. Types of surveys are to the proposed study among Indianapolis health profession discussed as interviews and schedules, mailed questionnaires, leaders, specifiedrelated work in progress or planned else- panels, telephone surveys, and controlled observation. Steps or where, and detailed by task and stcp a five year study of health a flow plan for designing and implementing a survey is out- manpower in the Indianapolis metropolitan arca. Included in lined. Examples of application of the method are given. the appendix is the questionnaire used tocollect data on U.S. DEPARTMENT OF LABOR. MANPOWER ADMINISTRA- nursing education in the Indianapolis arca." (From Abstracts TION. of Hospital Management Studies,V: 125. June 1969.) 1965. Health Careers Guidebook. Washington: SLONIM, MORRIS JAMES. U.S. Government Printing Office. 251 pp. 1966. Sampling. A Quick Reliable Guide to Designed tohelp young people in choosing career goals, Practical Statistics.New York: Simon and this guidebook identifies 200 health career opportunities. It Schuster. 144. pp. defines these health professional, technical, and auxiliary occupations; describes educational requirements; gives a broad This guide for the layman, student, or businessman leads the view of work in the health field; and discusses career planning. reader in logical fashion through many phases of sampling as The guide is useful for planners in identifying thc roles, rela- a means of getting information quickly, reliably, and cheaply. tionships, and functional work areas of the numerous categories Sampling theory, its basic principles, practical application, and of health occupations. potential values arc discussed. A wide variety of pertinent case histories of sampling are cited. YETT, DONALD E. 1965. "The Supply of Nurses: An Economist's Fox, DAVID J., and KELLY, RUTH LUNDT. 1967. The Research Process in Nursing. New View." Hospital Progress, 46 (2): 88-102 611 pp. (February). York: Appleton-Century-Crofts. This is a compilation of readings dealing in one way or This paper was based on a larger study pertaining to the another with nursing research. The 62 articles arc carefully economic aspects of the hospital nursing shortage. "Shortage" introduced and organizedtoprovide a review of research based on demand rather than need is discussed. conducted within thc last decade. Trends, too, are exemplified throughout. (Excerpted from a review by Mary Louise Paynich. KLARMAN, HERBERT E. R.N., Associate Professor and Chairman, Public Health Nurs- 1966."Changing Requirements for Health Man- ing, Medical College of Virginia School of Nursing, Richmond, power." Paper presented Nov. 2, 1966, Va.)

'- . 144 APPENDIX 2

MAKI, DENNIS R. QuantitativeInformation. New York: 1967. A Forecasting Model of Manpower Re- Macmillan Co. 550 pp. quirementsintheHealthOccupations. This book is a basic text on statistics designed to help nurses IndustrialRelationsCenter,IowaState become sophisticated users of reports of research in nursing, to University, Ames, Iowa. 147 pp. (proc- provide understanding of the logical and philosophical bases of essed). research methods and statistical techniques, and to acquaint them with a rangeof statisticalprocedures including both This publication presents a model designed to predict, under their rationale and computation. Descriptiveand inferential certain assumptions, the demand, supply, excess demand, and statistics are discussed, as well as bases for making inferences; employment of health personnel applicable for forecasts of 5 for example, using frequency and ranked data. More advanced to 15 years into the future. Manpower requirements are fore- areas such as multiple correlation andcomplex analysisof cast on the basis of the economists' concept of demand, and variance, are touched on. Included are a review of selected are said not to resort to valtie judgments used to forecast mathematicaltopics,illustrativestudiesinnursing research. requirements based on the concept of need for manpower. A practicalexercisesinstatistics, andreferences.(Excerpted cleardistinctionismade betweenprojecting requirements, from a review hy Yvonne A. Ruhens, Statistician, Measurement definedas trend extrapolation, and forecasting requirements, and Evaluation, National League for Nursing, NewYork, in defined as the estimation of the magnitude of some relevant Nursing Outlook, 16 (3): 21. Match 1968.) variables at a future point in time. The model is purported to accommodate numerous techniques for the estimation ofpa- rameters. ALBEE, GEORGE W. 1968. "Conceptual Models and Manpower Re- MYERS, JOHN G., and CREAMER, DANIEL. quirementsinPsychology." American 1967. Aleasuring JobVacancies: A Feasibility Psychologist, 23 (5): 317-320 (May). Study in the Rochester, N.Y. Area. New The author discusses demands for and shortages of mental York: National Industrial Conference health manpower as they are dictated by current concepts of. Board, Inc. 278 pp. models for, and systems of mental health care. He contends that manpower planning must explicitly confront prospective Two general headings divide the contents of this report: (1) chronicshortagesofprofessionals bythedevelopmentof The Survey Plan and Statistical Findings; and (2) Some Gen- alternative models leading to new delivery systems of care, eral Problems and Implications of the Rochester Experience. This study was undertaken to and models requiring manpower that are more easily recruited "determinethefeasibility of is challenged to createits own in- measuring the demand for labor to complement the wealth of and trained. Psychology stitutional structurefor developing methods fordeliveryof material on the supply of manpower." The report is "positive its own structure. The dimensions of such a in its major finding: It is feasible (and meaningful) to measure service within job vacancies on a voluntary basis." model are sketched. The major conclusions can be summarized in a few sentences. CALIFORNIA DEPARTMENT OF HEALTH. Of course, the following points omit such obvious requirements the as care in coding, data processing, and the like: 1968. The Manpower Planning Subsystem, of California Health Information for Planning "(1) Initially, data should be collected by personalinter- view. This serves to clarify definitions, increase the response Service (CHIPS) System.Berkeley, Calif.: rate, and reduce the number of false or perfunctory answers. A The Department. 29 pp. decision should be made for each employer on changing to mail reports. Periodic visits will probably be necessary even "Describes the Personnel-referenced Data File (PDF) which during a continuing mail survey program. is to be operated as a subsystem of California Health Informa- tion for Planning Service (CHIPS). Data on professional and "(2) Enumerators need extensive training and supervision to technical personnel would be input to the PDF from schools ensure accurate reports ininitialinterviews. We, therefore, and training programs, employers, and other sources of infor- suggest that a relatively small sample be interviewed at first. mation. This data on manpower requirements, training and and the size increased later. utilization would be made available to qualified users such as "(3) The list from which the sample is drawn is of utmost schools,hospitaltrainingprograms,planninggroups,and importance to eliminate errors in coverage and classification. various State agencies." (From Abstracts of Hospital Manage- A major effort should be made to obtain and maintain an ment Studies, V: 125. June 1969.) up-to-datelistthat contains new firms,accurate industrial coding, and appropriate grouping of multiestablishment organizations." FOLK, HUGH; and YETT, DONALD E. 1968. "Methods of Estimating Occupational At- PHILLIPS, JEROME S., and THOMPSON, RICHARD F. trition."Western EconomicsJournal, VI 1967.Statistics for Nurses: The Evaluationof (4): 297-302 (September). BACKGROUND MATERIAL AND PLANNING TOOLS 145

This paper analyzes several inethods for taking account of cupations licensed by eacb State and an overview of trends in "non-wage related" factors in predicting occupational supply of occupational licensing, as well as compulsory and voluntary skilled manpower. These methods are based on two important acts. organizational patterns of licensing responsibility, licens. factors influencing supply: The increase in the qualified supply ingboards,renewaloflicenses,qualificationsforinitial measured hy the annual number of graduates; and the rate at licensure, and State policies on special licensure. Twenty.two which qualifiedpersons leave the field because of marriage. chapters. each devoted to a health occupation, detail licensing death, retirement,or transfertoother occupations. Overall practices in the several States. attrition rates are recognized as accounting for wage factors and many non.wage factors influencing occupationalsupply, U.S. CONGRESS. JOI NT COMM MEE PRINT. whereas "age.speeific occupational rates" accountfor demo. 1969. Compilation of Selected Public Health Laws. graphic factors. Prepared for the use of tl:e Senate Com- Various methods of calculating overallattritionrates are mittee on Labor and Public Welfare and illustrated to include the exact method, approximate methods. the House Committee onInterstate and gain-lossratiomethod,straight-root method, and ratioroot method. The method of calculating age-specific occupational ForeignCommerce. Washington:U.S. rates is explained. Results from each method were tested for Government Printing Office. 489 pp. relevance to the fields of nursing and engineering, andwere This compilation includes statutory provisions ineffectin deemedreasonable.Itwas concludedthatmoreaccurate January 1969 of the Public Health Service Act as amended projections will depend upon further research on tbe determi- through the90thCongress, andotherpublichealthlaws nantsofoccupationalparticipation. The gainloss method. relatedtomentalhealth,mentalretardation,food,drugs, simple to calculate, was seen to "yield reliable occupational cosmetics, clean air, waste disposal, and packaging and labeling. attrition rates provided both the base of the calculations and The Reorgnization Plans No. 1 of 1953 and No. 3 of 1966 for the length of the projection are relatively short and frequently the administrative structure and distribution of health functions revised." within the Department of Health, Education, and Welfare are in the appendix. STATE OF CALI FORNIA DEPARTMENT OF PUBLIC AND HEALTH. DIVISION OF PATIENT CARE FACILITIESAND U.S.DEPARTM ENTOF HEALTH,EDUCATION, SERVICES. WELFARE. PUBLIC HEALTH SERVICE. NATIONAL 1968. Summary Report, California llealth Infor- INSTITUTES OF HEALTH. BUREAU OF HEALTH PRO- mation For Planning Service. Supported FESSIONS EDUCATION AND MANPOWER TRAINING. by PHSgrantHM-00446. 1965-1968. DIVISION OF NURSING. Berkeley,Calif.: The Department. 137 . 1969. Research in Nursing, 1955-1968, Research PP. Grants. PHS Pub. 1356. Revised 1969. U.S.GovernmentPrinting This is a report of a demonstration project that tested and Washington: evaluatedaninformationsystemforpossibleapplication Office. 91 pp. throughout California. Procedures, objectives, and mechanisms This is a summary listing of projects supported by the Di. for exchanging health information and data for planning are vision of Nursing's extramural research grants program since described. Included are a case abstract service for hospitals; its inception in1955. Projects are classifiedin three broad an inventory of health facilities; formats for areawide planning areas: (1) organization, distribution, and delivery of nursing reports and establishment ofaclearinghousefor dataon services;(2)recruitment,selection,education, and charac- health facilities, services, manpower, and other relevant data teristics of the nurse supply; and (3)nursing research de. on community planning. velopment. Information provided includes project title, names and addressesofinvestigators,periodof support,abrief U.S.DEPARTMENT OF HEALTH,EDUCATION, AND description of each project, and wherever possible, citations to WELFARE. PUBLIC HEALTH SERVICE. NATIONAL publications that resulted from the research and were provided CENTER FOR HEALTH STATISTICS. hy the investigators. 1968. StateLicensingofHealthOccupations. U.S. DEPARTMENT OF LABOR. BUREAU OF LABOR PHS Pub. 1758. Washington: U.S. Gov- STATISTICS. ernment Printing Office. 171 pp. 1969. Tomorrow's Manpower Needs. National This isa report of a national survey ofState licensing manpower projections and a guide to their practices for 22 health professions and occupations, conducted use as a tool in developing State and area in late 1965 and early 1966 in cooperation with The Council of manpower projections. Vol. 1, Developing State Governments and with State organizaiions that administer licensing statutes. One of the purposes of the survey was to .4rea Manpower Projections.Bulletin 1606 determine the availabilityof statistics on health manpower (February). Washington: U.S. Govern- through licensing processes. Included are a list of health oc ment Printing Office. 100 pp. 146 APPENDIX 2

This rerort presents techniquesforestimatingState and Other Manpower Data. Bulletin1606 area manpower requirements witbin the context of national (February). Washington: U.S. Govern- economic and technological development, taking into account nwnt Printing Office. 247 pp. factors affecting local area industry and occupational employment. Statistics on population and the labor force for 1960 and This volume presents statistics on the national labor force projection for 1970 and 1980 are detailed by age and color for by industry and the distribution of employment by occupation States and regions. Methods for estimating manpower replace- for 1960, and the projected labor force and its occupational ment needs, and approaches for appraising the adequacy of matrix for 1975. The intent is to provide a statistical basis for supply in individual occupations are discussed. making manpowerprojections,using methods describedin volume I, for purposes of planning to meet service, education, U.S. DEPARTMENT OF LABOR. BUREAU OF LABOR and training needs. STATISTI CS. U.S.DEPARTMENT OF HEALTH, EDUCATION, AND 1969. Tomorrow's Manpower Needs. National WELFARE. PUBLIC HEALTH SERVICE. HEALTH SERVICES manpower projections and a guide to their AND MENTAL HEALTH ADMINISTRATION. NATIONAL use as a tool in develoring State and area CENTER FOR HEALTH STATISTICS. manpower projections. Vol. II, National 1969. A State Center for Health Statistics. An Trends and Outlook: ;ndustry Employment Aid in PlanningComprehensiveHealth and Occupational Structure.Bulletin 1606 Statistics. Public Health Conference on (February). Washington: U.S. Govern- Records and Statistics Document No. 626. ment Printing Office. 121 pp. Washington:U.S.GovernnientPrinting "This volume presents a discussion of industry employment Office. 23 pp. trends and occupational structure, and projections of manpower requirements for each major industry in the economy. Also This brochure sets forth the views of the National Center for includedisa discussionofthereasonsforthe expected Health Statistics "regarding the capabilities for data collection changes." Workers in medical and other healthservices arc and analysis of health data that ought to be developed within included in the discussion. For use with Volumes I, III, and IV. a State to meet today's needs and, in general terms, amodel for scope of work, policies and relationships of a State Center U.S. DEPARTMENT OF LABOR. BUREAU OF LABOR for Health Statistics." STATISTICS. WALKER, JAMES W. 1969. Tomorrow's Manpower Needs. National 1969."Forecasting Manpower Needs." Harvard manpower projections and a guide to their Business Review, 47: 152-154+ (March- use as a tool in developing State and area April). manpower projections. Vol. III, National The author discusses views on, the value of, and the reasons Trends and Outlook: Occupational Employ- for interest in, manpower planning by corporate management, ment. Bulletin 1606 (February). Wash- and "describes the first steps that researchers have taken toward ington: U.S. Government Printing Office. improved models for forecasting and planning." Information 50 pp. and statistical data required for forecasting requirements and the factors that influence requirements are pointed out. The "This volume presents information on the national employ- fact that relevant variables will differ from company to comment trends and projected 1975 requirements for workers in pany, by location and over time,is stressed, as well as the nine major occupation groups and 40 selected occupations in- factthat forecasting models suited to organizations' charac- cluding registered nurses. The occupational statements include teristics must be developed for each given situation. adiscussion of past employment trends, the economic and technologkal factorsexpectedtoinfluence occupationalre- WORLD HEALTH ORGANIZATION. REGIONAL OFFICE FOR quirements through the mid-1970's, and ways workers become EUROPE. qualified for the occupation." For use with Volumes I, II, and 1969. Methods of Estimating Health Manpower. IV. Report on a symposium convened by the U.S. DEPARTMENT OF LABOR. BUREAU OF LABOR Regional Office for Europe of the World STATISTICS. Health Organization, Budapest, 15-19 Octo- 1969. Tontorrow's Manpower Needs. National ber 1968. EURO 0289. Distributed by manpower projections and a guide to their tbeRegionalOfficeforEurope, WHO. use as a tool in developing State and area Copenhagen. 141 pp. manpower projections. Vol. IV, The Na- This report records the proceedings of the first meeting on tionalIndustry-Occupational Matrix and health manpower planning and methods of estimating health

7 BACKGROUND MATERIAL AND PLANNING TOOLS 147 manpower requirements convened by WHO for 15 European 1970. A Lis:ing. Revised July 1970. countries. Approaches toprojecting health manpower, their Supplement to PHS Pub. 1154-2. Wash- limitations, and methodological difficultiesare discussed. In- ington: U.S. Government Printing Office. cluded are methods based on economic levels of health activity, manpower-to-populationratiomethods, extrapolating require. 66 pp. ments from analysis of past trends, and methods using pro- Grants awarded from the start of the program through June fessional standards. A widevarietyoffactorsinfluencing 1970to help schools of nursing meet the costs of projects manpower requirements and problems was studied, including designed to improve, strengthen, or expand nursing education health policy, economic, scientific, and technological develop- programs are listed by State, grantee, and title of project. A ment, and types of educational systems. The report includes concise description of each project and its objectives shows data for a survey of 26 countries on methods used for collecting the kinds of projects being undertaken and funded. and analyzing data on the nurse and midwife supply and methods in use for estimating current and future requirements. U.S.DEPARTMENT OF HEALTH, EDUCATION, AM) FOX, DAVID J. WELFARE. PUBLIC HEALTH SERVICE. NATIONAL INSTITUTES OF HEALTH. BUREAU OF HEALTH MAN- 1970. Fundamentals of Research in Nursing. 2d ed. New York: Appleton-Century-Crofts. POWER EDUCATION. DIVISION OF NURSING. 323 pp. 1971. Construction Grants Awarded toSchools of Nursing, December 1965June 1971. This book is addressed to research users who do not have a No.(NIH) 72-89 background in research and statistics. It emphasizes concepts DHEW Publication and approaches that are hasic to understanding research meth- (formerly Supplement to PHS Pub. No. ods in nursing. Half of the book is devoted to statistics and 1154-5). Washington: U.S. Government measurements. It details the development of an actual research Printing Office. 19 pp. (Issued an- study, and gives an overview of the research process. It also nually.) includes a new section on content analysis and a good summary on the effective evaluation and utilization of research findings. This publication updates the list of Federal grants to build This book is considered useful as a basis for formal and guided new educational facilities, or to renovate, extend, and equip instruction in basic research methodology. their nursing educationquarters. The grants were awarded under the Nurse Training Act of 1964, as amended by the OFFICEOF EcoNOMICOppoifruNerv. EXECUTIVE Health Manpower Act of 1968. Grants are listed by State or OFFICE OF THE PRESIDENT. territory and school. The type of nursing education program. 1970. Catalog of Federal Domestic Assistance. type of construction, and amount of the grant are indicated. Washington:U.S.Government Printing U.S.DEPARTMENT OF HEALTH, EDUCATION, AND Office. 1,035 pp. WELFARE. PUBLIC HEALTH SERVICE. NATIONAL This catalog contains a comprehensive listing and description INSTITUTES OF HEALTH. BUREAU OF HEALTH MAN- of the Federal Government's domestic programs and authorizing POWER EDUCATION. DIVISION OF NURSING. legislation to assistthe American people in furthering their 1971. Current Research Project Grants, Division social and economic progress. Designed as a tool to help locate, understand, and utilize Federal assistance programs, it contains of Nursing. PHS Pub. 1762. Revised a master index and includes the agencies that administer the February 1971. Washington: U.S. Gov- programs, with regional and State addresses, program literature, ernment Printing Office. 12 pp. and information contacts. This is a list of ongoing Rursing research projects funded by U.S. DEPARTMENT OF HEALTH, EDUCATION, AND the extramural research grants program of the Division of WELFARE. PUBLIC HEALTH SERVICE. NATIONAL Nursing through February 1971. Information includes title of project, State and institution of grantee, name of investigator, INSTITUTES OF HEALTH. DIVISION OF NURSING. and number of grant. More detailed information about indi- 1970. Special Project Grants Awarded for Im- vidual projects may. be obtained by writing to the principal provement in Nurse Training. June 1965- investigator.

Medical and Health Care

SOMERS, HERMAN M., and SOMERS, ANNE R. Care. Washington: Brookings Institution. 1961. Doctor's, Patient's, and Health Insurance: 563 pp. The Organizing and Financing of Medical *ln their presentation of the historical background and current 148 APPENDIX 2

data on medical care, the authors consider the structure of excdlentbihliography is included. (Excerpted fr(on a medical practice, the hospital, the drug industry, consumer's review hy MiltonJ.Nadworny. Professor of Economics and denumd, the costs, private insurance programs, and the doctor- Business Administration, University of Vermont, inNursing patient relationship. Severaltables are includedinthe ap. Outlook,15 (10) :16-17. October 1967.) !tench. Moss. ARTHUR 13. ; BROEHL. WAYNE G.. JR.; GUEST, AMEmcAN PuBLIC HEALTH AssOCIATIoN, 1Nc. THE ROBERT H.; and HENNESSEY. JOHN W. PROGRAM AREA CoMMITTEE oNMEDICAL CARE 1966. HospitalPolicyDecisions:Processand ADMINISTRATION. Action. New York: G. P. Putnam's Sons. 1965. A Guide to Medical Care Administration. 332 pp. Volume I: Concep,s and Principles. New Various levels of organiz.ational structures in three different York: The Association. 106 pp. community general hospitals were examined and compared in This volume is designed to provide a comprehensive view of this management study. Fundamental organizational problems medical care administration that will serve as a starting point whichfacemodern hospitalpeople responsiblefor making for the discussion of the problems and issues in medical care sound policy decisions were revealed. The trustee, administra- today. tor, and physician play an interlocking role and are subject to internal and external stress, both national and local, in making KLARMAN. HERBERT E. policy decisions. The administrator isusually in a "pivotal" 1965. The Economics of Health. New York: position or one of uncertain authority. Columbia University Press. 200 pp. Accreditations by the National League for Nursing and the Joint Commission on Accreditation of Hospitals are shown as The "economics of health," which is a broader and newer strategic influences in the organizational strata, especially as term than "medical economics," proposesto encompass the they affect nursing service and nursing education. The budget medical care industry and also to extend into such fields as tlw mechanism is seen as one of the strongest factors in linking analysis of the economic costs of diseases and the benefits of together all forces in the decision-making process. control programs, the returns from investment in education and The book is also a study of behavior and beliefs, of values training, and the conditions conducive to medical research. and goals. It should be of interesttotrustees, doctors, and In this monograph, Dr. Klarman reviews the past work done administrators, as wellastonursing servicedirectors and in economics of health and suggests future research opportuni- nursing educators who frequently question their individual force ties. A selected bibliography covers demand and financing: in poliey-making decisions. manpower andfacilities;organizationandplanning;and (Excerpted from a review by Thomas E. Frey inNursing measuring prices and cost-benefits. Oullook, 14 (12): 17 and 18.December 1966.) DAVIS, FRED, ed. AMERICAN PUBLIC HEALTH ASSOCIATION. 1966. The Nursing Profession: Five, Sociological 1967.A Guide to Medical Care Administration, Essays. New Yod:: Jo 1m Wiley and Sons. Vol.II, Medical Care AppraisalQuality 203 pp. andUtilization. PreparedbyAvedis These essays, written by sociologists, are rich in observations, Donabedian, M.D. New York: American analysis, and interpretations of the sociocultural forces which Public Health Association, Inc. 221 pp. have impinged on the preparation of nurses and the practice of nursing. (Excerpted from a review by Pearl Parvin Coulter, This volume is a comprehensive exploration of medkal care Dean, College of Nursing, University of Arizona. Tucson, in appraisalits theory and its operation. The book contains a NursingOutlook,14 (10) :72. October 1966.) carefully developed frame of reference and intensive discussion of appraisal procedures, practical alternatives, and outcomes. FALTA, JEANNETTE 11., and DECK, EDITH S., eds. The testis supplemented by an extensive annotated biblio- 1966. A Sociological Framework for Patient Care. graphy. New York: John Wiley and Sons. 418 pp. CLARK, MARGARET ; and ANDERSON, BARBARA This compilation of articles is designed to help health work- GALLATIN. ers, particularly nurses, understand more fully the values and 1967. CultureandAging. Springfield, concepts of sociological thought for achieving the goal of improved patientcare. Thirty-four articfesone-fourth original Charks C. Thomas, Pub. 478 pp. and the remainder reprints or revisions of articles or speeches Mc authors have used an anthropological approach to aging are divided into seven sections: sociological ccncepts; trends in which 435 elderly people, residents of San Francisco, were and social movements; the professions; the family; health and studied. The subjects included patients and nonpatients. These illness; patient problems; and "toward solutions." Each section anthropologists showed that the following factors are all relevant is preceded by an introduction and followed by an epilogue in the aging process: cultural values, family attitudes, social ,hich are informative and tiethe sections together. An ex- ties and activities, sexual problems, religious beliefs, perception.

u BACKGROUND MATERIAL AND PLANNING TOOLS 149

and both the physical and the psychological problems of aging. nerds are studied. Knowledge is lacking, for example, in sound According tothe rcscarch reported, theauthors maintain measures of direct and indircct costs to the patient, the family, that "the aged in our society are forced to drop earlier primary and the communitl% values in life and select alternative values such as conservation, The authors believe that three kinds of cost studies would be self-acceptance, cooperation, and concern for othcrs as they helpful:"cost-servicestudiestoidentify the exactcostof advance in age." providing each of the various types of services ...(e.g., hos- Further, the aged studied "lack a strong sense of being a pital care versus home care) ;cost-effect studies to determine cohesive social group, and the problems of aging lead the the cost of achieving ccrtain health objectives such as restoring elderly person to deviate from our cultural norms." The authors certainphysicalfunctioningtoapatientsufferingfrom a believe that "the members of our aged population want to stroke; and cost-benefit studies to provide data on the relation- remain involved in life activities, but we need to consider what ships between the cost ofresources used for care and the they can give us and what we need from them. The aged learn money value of the benefits derived from sucb care." to realize that there is more to life than competing with others for self-advancement, making money, and accumulating material REYNOLDS, FRANK W., and BARSARN, PAUL C. items." 1967. Adult Health Services for the Chronically (Based on a review by Madeleine Leininger, Nursing Out- 111 and Aged. New York: Macmillan Co. kok, 16 (2): 14.February 1968.) 242 pp. FEIN, RASH!. This book is a eomprehensive and frank appraisal of chronic 1967. The Doctor Shortage, An Economic Diag- illness as a disease and as a community condition. Chronic nosis. Washington: Brookings Institution. diseases are describcd in relation to prevention, cause, symp- 199 pp. tomatology, clinical courses, prognosis, treatment, rehabilitation. and public and social aspects. Economic issues and a wide range of factors influencing the The qualifications and functions of public health personnel demand for and supply of physicians are exploredinthis and medical specialists are outlined concisely and clearly, and book. In projecting the demand and supply to 1975 and 1980, continuity of patient careis emphasized. Difficultiesinco- a shortage is forecast. Growth in group practice and the greater ordinating community programs and facilities are pointed out. use of auxiliary personnel, including assistant physicians, are Depth information offered can enhance and improve the service .suggested as means of dealing whh this supply problem. Gov- given by health and paramedical personnel. ernment's growing commitmcnt in health and increased ability The bookcontainsanextensivebibliography,excellent to finance services are seen as factors stimulating these de- graphs, pictures, and tables, and a listing of voluntary health velopments. agencies. Federal and State-supported programs for care of the Although traditionaldoctor autonomy isrecognized as a chronically ill, financing of costs, and standards of accreditation problem in reorganizing the practice of medicine, the author of extended care facilities are detailed. believes that doctors' assumption of leadership of the team may (Excerpted from a review by Helen Chestcrman, formerly influence bothrateof acceptanceofthe change and the Director, Public Health Nursing, San Francisco Department of cconoinic framework of the new approach. Itis believed that Public Health, in Nursing Outlook, 15 (12): 21-22. December when doctors' duties are reallocated to semi-professionals, with 1967.) the doctor as teamleader, the doctors and their groups will continue to be reimbursed as before and increased services will SOMERS, HERMAN; and SOMERS, ANNE. bc realized. 1967. Medicare and the Hospitals. Washington: (Excerpted from areview by Charlotte Mullerinthe American Journal, of Public Health and the Nation's Health. Brookings Institution. 303 pp. 58 (9): 1781. September 1968.) The focus of this book is the impact and implications of the Social Security Amendments of 1965 on hospitals. It deals with LENZER, ANTHONY; and DONABEDIAN, AVEDIS. the major issues and basic features of thehospital system 1967. "Needed.. . Research In Home Care." relatingtothe legislationutilization, quality of care, and Nursing Outlook, 15 (10) :42-45(Octo- manpower supply. Itdiscusses the crucial problem areas of ber). reimbursement, planning, and cost control, and makes some recommendations. Future development of current trends are Program planners are coneerned with the allocation of funds predicted. (Excerpted from a review by A. Gerald Renthol in and the outcome of bringing the services to patients versus the American Journal of Public Health, 58(11) :2174-2175. bringing patients to the services. Home care service is only one November 1968.) component in the broad range of instrumentalities for maintaining and restoring health. U.S.DEPARTMENT OF HEALTH, EDUCATION, AND The authors state that more knowledge is needed about the most effective use of home health services, and that the effi- WELFARE. PUBLIC HEALTH SERVICE. ciency and effectiveness of those services can be increased if 1967. Promoting the Group Practice of Medicine. the location, organization, cost, quality of service, and staffing Report of the National Conference on Group

5 150 APPENDIX 2

Practice. PHS Pub. 1750. Washington: development of a national health policy. Health facilities and U.S. Government Printing Office. 70 pp. services, their organization and delivery, the costs of medical care, health manpower, health planning, and the power struc- This report contains detailed recommendations of the phy- ture in health are discussed in this series of papers. sicians, medical school deans, hospital administrators, health insurance industry executives, economists, labor and manage- SELMANOFF, EUGENE D. ment representatives, lawyers, and Federal, State, and local 1968. "Strains in the Nurse-Doctor Relationship." governmentemployees, who met inChicago, October 19-21, 1967, to explore ways to stimulate group practice. The Nursing Clinics of North America, 3 (1) :117-127. Philadelphia: W. B. Saun- DUFF, RAYMOND S., and HOLLINGSHEAD, AUGUST B. ders, Co. (March 1968). 1968. Sickness and Society. New York: Harper This articlebased on research findingsfocuses on some of & Row. 390 pp. the problems and conflicts in the relationship between doctors This report of a 5-year study of the behavior of people and nurses in the hospital. The author makes the point that involved in the care of patients examines hospital care and the many of these difficulties "stem from the organizational struc- impact of illness on patients and their families. It explores the ture of the hospital rather than from the personalities of the patient's relationship tothe doctor, the nurse, ancillary per- individuals involved." sonnel, and his family. It raises critical issues and proposes Three selected aspects of hospital organization that produce vital changes related to the findingsthat the quality of care strain for nurses are cited. (1) Physicians tend to operate as a patient receives is determ'ined by his socioeconomic position "free agents." They, unlike nurses, do not see themselves as as well as his medical disorder, and influences his impression "full-fledged members" of the hospital organization. (2) Two of medical care after his hospital experience. Nurses emerge as lines of authorityexistinthe hospitaladministrative and technical, administrative, task-oriented, and not person-oriented. medical. Nurses are members of the former and physicians Nurses have no communication with medicine, so there is no belong to the latter. Institutional patterns that are mutually collaboration. Nursing care was found to be erratic and usually satisfactory and that meet the needs of the hospital as a whole inadequate. The solution proposed was a new worker in the should be developed. (3) Nurses, in the absence of a function- health field, a medical auxiliary; a person strongly linked to inghealthteam,have assumedresponsibilitywithoutthe patients and physicians rather than to administration.(Ex- requisite authority for the coordination of patient care. cerpted from a reviewin "Book of the Year," American Itis recommended that "nurses participate more actively Journal of Nursing, 69 (3) :555.March 1969. ) and creatively in activities that can alter the existing hospital structures so that health personnel can more effectively bring HILLEBOE, HERMAN E. the benefits of modern medical science and technology to their 1968. "Public Health in the United States in the patients." 1970's." American JournalofPublic Health and The Nation's Health, 58 (9): GINZBERG, ELI; With OSTOW, MIRIAM. 1588-1609 (September). 1969.Men, Money and Medicine. New York: "This paper deals with projections of trends in public health Columbia University Press. 291 pp. over the next decade." The author contends that the Nation is This book analyzes and evaluates trends in the health service ready for all types of planning and that health systems should delivery system and health manpower development and utiliza- be created and coordinated under a national plan in the United tion of the past quarter-century, with emphasis on the changes States. The national effort should respond to the wishes and following the introduction of medicare. It appraises the political needs ofthepeopleandbeadministrativelysoundand economy of health, the critical role of the physician, the roles economically established. of allied health manpower and unmet medical needs as they are KISSICK, WILLIAM L., ed. related to the socioeconomic structure. Prospects for meeting health care requirements and improving the health care system 1968. "Dimensions and Determinants of Health in the years ahead involve a combination of changes in values Policy." The Milbank Memorial Fund and institutions that are essential to restructuring the health Quarterly. Vol. 66, No. 1, Part 2 (Jan- industry. uary). 272 pp. This volume is a collection of papers that focus on the LEININGER, MADELEINE M. identification and review of the complex and diverseheulth 1969. "Community Psychiatric Nursing: Trends, issues and the problems most critically in need of new thought Issues, and Problems." Perspectivesin for fulfillment of our national health purposeto promote and Psychiatric Care. VII (1) :10-20 (Jan- assure the highest level of health attainable for every person. uary-February). The theme in discussing the various components of the health enterprise and the health effort, their characteristics and their .The author describes the change in focus of psychiatric care interrelationships, is the establishment of health goals and the and treatment from the hospital to the community, the emphasis

51 BACKGROUND MATERIAL AND PLANNING TOOLS 151 on and components of primary prevention of mental illness, with and referrals to public health nurses in the community and the purposes and services of a typical community mental are related to the educational needs of public health nurses. It health center. Three viewpoints of role identification and ex- is concluded that psychiatric nursing education content should pectations of nursing and other heahh disciplines in the com- include social science theories and research findings relevant munity mental health center are discussed. Increased contact to the practice of community psychiatric nursing.

Health Manpower

CASSELL, FRANK H., et al. This publication contains the President's Manpower Report 1966. "TheChallengeofHealth Manpower." and a report on manpower requirements, resources, utilization, and training, with the following major subdivisions: The Re. EmploymentServiceReview,November view of Manpower Developments in 1966; Unused Manpower; (entire issue). U.S. Department of Labor, and Occupational Shortages and Training Needs. Supportive Manpower Administration. Washington: statistical data are included in the appendix. U.S. Government Printing Office. 94 pp. "Full issue devoted to health manpower. Includes data and WEISS, JEFFREY H. discussionof wages, hours, working conditions, number of 1967. The Changing JobStructureol Health employees and recruitmentfor bothprofessional andnon- Manpower. HarvardUniversity,Cam- professional personnel. Medical social work and nursing are bridge, Mass. 275 pp. subjects of individual articles, as are needs in nursing homes, structure of career opportunities. Employment Service Surveys "Presents a framework for study of changing health care for Louisiana, Wisconsin, California, North Carolina and South job patterns and for changes in utilization of health manpower Carolina are summarized. Training activities under the Man- over time. Develops a job classification scheme based on [1.] power Development Training Act are described." (From Ab- job families which emphasize health care functions and [2.1 stracts ol Hospital Management Studies, IV: 144.June 1968.) level of job content. Examines changes in health care job structure from 1950 to 1960 and makes projections for such ROSENTHAL, NEAL H.; LEFKOWITZ, ANNIE; and PILOT, changes from 1960. to 1970. Suggests that more emphasis be MICHAEL. placed on improved utilization of existing supplies of health 1967. Health Manpower 1966-1975. Report No. manpower." (From Abstracts ol Hospital Management Studies, 323. Bureau of Labor Statistics, U.S. De- IV: 142. June 1968.) partment of Labor, Washington, D.C. 50 LAMBERTSEN, ELEANOR C. PP. 1968. "TheEmerging Health Occupations." "Discussion of future requirements and supply of health Winter manpower for period of 1966-1975. Part I focuses on medieal Nursing Forum, VII (1): 87-97. and health service industry and includes discussion of 1966 1968. employment shortages. Manpower needs by 1975 are projected. With the provision of nursing services for the spectrum of Part II discusses individual health occupations in terms of health needs and health programs as the focus, the premise is employment, shortages, projected needs, sources of supply and established that present attempts by physicians and nurses to ways of expanding supply. Report concludes demand for health define practice in terms of the knowledge, judgments, and skills services will increase rapidly over next decade, raising employ- required for safe,efficient, and therapeutic services toindi- ment requirements in health industry from 3.7 million to 535 viduals and families constitutes a highly significant trend that million.Individual health occupations are expectedtovary will result in many changing patterns of practice. The author markedly in growth rates with rapidincrease expectedin urges that such efforts be coupled with a determinationof requirements for nursing occupations and small growth in need the levels of training necessary to perform delineated functions. for pharmacists?' (From Abstracts ol :lospital Management She cautions that nurses'must work with emerging specialized Studies, IV: 144. June 1968.) groups in the health manpower fields, yet maintain the administration and supervision of nursing service personnel. The U.S. DEPARTMENT OF LABOR. continuum of specialization within health occupation groups 1967. Manpower Report ol the President: And und nursing and levels of educational preparation are discussed A Reporton Manpower Requirements, against the changing nature of technology and health services. Resources, Utilization, andTraining. Transmitted to the Congress, April 1967. SOMERS, ANNE R. Washington:U.S.GovernmentPrinting 1968. "Meeting Health Manpower Requirements Office. 285 pp. Through Increased Productivity." Hos- 152 APPENDIX 2

pitals, Journal of the American Hospital U.S. DEPARTMENT OF LABOR. MANPOWER ADMINISTRA- Association. 42: 43-48, 116 (March 16). TION. "The United States needs large numbers of additional health 1968. Technology and Manpower in the Health care personnel, the author states, but numbers alone cannot ServiceIndustry,1965-75. Manpower resolve current manpower problems because the present system Research Bulletin 14, May 1967. Wash- channels manpower into inefficient and inappropriate activities. ington: U.S. Government Printing Office. The author maintains that the system must be changed to allow 109 pp. the development of new technology, new jobs and professional categories, and new methods of organizing anddelivering Trends in the structure and characteristics of health service health care." And "the generally pursued approach to produc- employment are presented and analyzed. Major current prob. tivity and to operating efficiency is too narrowly conceived and lems in meeting health manpower needs and job requirements based. A better approach is one that involves all the key ele- are included. Technological developments and their effects on ments inthe productivity equation: manpower, organization, manpower in the decade ahead are examined. Tlwn the cont management, education, motivation, professional mores, even bined effectof expectedtrendsinthe demand for health legislation. This paper isfocused on manpower, but allthe services and the key technological development on the structure factors mentioned above are involved." of health service employment are analyzed.

Nursing Trends, Issues, and Concerns

MEYER, GENEVIEVE ROGGE. a desire for extra money as the most important reason. A small 1960. Tenderness and Technique: Nursing Values proportion gave "finished school" and "offered a job" as the in Transition. Institute of Industrial Rela- major reason. Most women (89 percent) who left the labor force during the study period were married. Pregnancy was by tions, University of California, Los Angeles. far the greatest reason married women under 35 years old left 160 pp. the labor force. Illness was most frequently given as the reason This research report defines four types of nurses in relation- by women 45 to 64 years old and was also frequently given ship to two traditions in nursing"tenderness" and "technique" by women 35 to 44 years old. and the value nurses place on them. The interpretation of Occupations and earnings, work plans, and training are other each type of nurse, made in a time of many changes in the areas of interest discussed in this report. nursing profession, is extended through an examination of the personal background ofnurses andtheirattitudestoward BULLOUGH. BONNIE; and BULLOUGH, VERN. patients, visitors, doctors, practical nurses, and aides. The in- 1966. Issues in Nursing. New York: Springer fluence of education (diploma, associate degree, baccalaureate. Publishing Co. 278 pp. (paperback). and post-basie programs) on the development of attitudes of all types of nurses is examined, as well as their attitudes toward Original source materials on five nursing issueseducation, the process of supervision. The book makes an important con- professional status, role definition, economics, concepts of direct tribution to knowledge of the profession of nursing. (Excerpted nursing careare presented in this volume. Articles and ex . front a review by Gladys Nite, Director of Research in Nurs- eerpts of reports published between 1893 and 1965 are prefaced ing, Community Studies, Kansas City, Mo., in the American with a brief explanation of their relevance and background. Journal of Nursing, 61:44. September 1961.) Critiques which confront rather than avoid controversial issues have been selected. The book gives insight into the present ROSENFELD, CARL; and PERRELLA, VERA C. problems of nursing and how they came about.(Excerpted S. Wald, Dean, Yale University 1965. "Why Women Start and Stop Working: A from a review by Florence SchoolofNursing,inAmerican Journal of Nursing,67 Study in Mobility." Monthly Labor Review. (10): 2174. October 1967.) 88 (9) ;1077-1082 (September). A nationwide sample survey of women who had either taken U.S. DEPARTMENT OF LABOR. MANPOWER ADMINISTRA- jobs or stopped working in 1963 was conducted early in 1964 by TION. the Bureau of the Census. The purpose was to obtain insight 1967. Work Life Expectancy and Training Needs into "the attitudes and motives which influence women's de- of Women. Washington : U.S. Government cisions to participate in or withdraw from the labor force." Printing Office. 10 pp. Among many factors present in the women's decision to go to work, those representing economic necessity were most fre- The work pattern of women, length of working life,the quently reported--about half the women went to work for this dynamics of the female labor force, education, training, re- reason. Approximattly 30 percent gave personal satisfaction or training, and work adjustment are discussed. BACKGROUND MATERIAL AND PLANNING TOOLS 153

BROWN, ESTHER LUCILE. in administration and education. Modifications in the structure 1970. Nursing Reconsidered, A Study of Change. and function of national nursing organizations and the Public PartI, The Professional Role inInstitu- Health Service were reflected in the third printing of the 7th edition in 1968. tional Nursing. Philadelphia: J. B. Lip- At the end of each clmpter, suggested reference listsare pincott Co. 218 pp. given. Also, recommendations are given for additional reading This report describes new or evolving nursing roles and sources for style, library usage, abstracting, indexing, proof- health programs that might provide clues or models .to increase reading, and professional relationships. the effectiveness of nursing practice and nursing service. Tech- Alt lmugh this book is intended as a text for students in basic nical specialization, the expanding role of the clinical nursing nursing, it can contribute a deep understanding of nursing to specialist, and the reorganization of nursing education and lay and non-nursing members of planning groups. nursing services in hospitals and other organizations are discussed. Current nursing practiceinextended-carefacilities, and NOTTER, LUCILLE E. nursing homes, retirement lmmes, and homes for the aged is 1971. Nursing Reconsidered, A Study of Change. explored. Part II, The Professional Role in Com- GLASSER, PAUL H., and GLASSER, Lots N.; eds. munity Nursing. Philadelphia: J. B. Lip- 1970. Families In Crisis. New York: Harper & pincott Co. 285 pp. Row Publishers. 405 pp. (paperback). The authors discuss recent developments in ambulatory and This book offers a broad and nontechnical review of family community nursing, with implications for the expanding role crises. Compiled for students and practitioners in education, ofthe nurse on thetherapeuticteam. Community health welfare, and health professions,itinterpretsthree common centers,lmspital-approvedhome.careservices,neighborhood crisissituations(poverty, disorganization, and physical and family health centers, outpatient services, and psychiatric hos- mental illness) faced by families. It is an important reference, pitalsall these settings are included. particularly for those interested in mental health and public health practice. (Excerpted from a review by Frances Adamson, THE CARNEGIE COMMISSION ON HIGHER EDUCATION. formerly psychiatric nurse, special project, Contra Costa County 1971. Less Time, More Options: Education Be- Medical Ileahli Services, Calif., in American Journal ol Nurs- yond The High School. Hightstown, N.J.: ing, 71 (7): 1441-1442. July 1971.) McGraw-Hill Book Company. 45 pp. SPALDING, EUGENIA KENNEDY; and NOTTER, LUCILLE E. This is a special report by the Commission establishedin 1970. Professional Nursing; Foundation, Perspec- 1967toinvestigateand make recommendations concerning issuesin higher education in the United States as the year tive and Relationships. Philadelphia: J. 2000is approached. The Commission selectedthe following B. Lippincott Co. 677 pp. major concerns of higher education for study and investigation: This text covers the major trends and problems affecting the structure, function, and governance;innovation and change; world of nursinghistorical, political, social, economic, legal, demand, resources, costs, and expenditures; and efficiency in educational, professional, and personal. use of resources. A number of reports will be published. It isinteresting to note that the first edition of this book This report focuses on a topic that is central to every other was published in 1939 under the title Professional Adjustments aspect of higher educationthe general flow of students into in Nursing, and that although it has had four title clmnges and through the formal structure of higher education in the since then, the book has remained basically the same. United States and the key role played by degrees in this flow. A discussion of the leadership necessary forprofessional Recommendations calling for basic changes in the pattern of progress is a distillate of the thinking of outstanding leaders this flow are included.

Nursing Education

MONTAG, MILDRED L. of nurse personnel for faculty for these programs. The study 1951. The Educationof NursingTechnicians. proposed that the education of technical nurses be conducted New York: G. P. Putnam's Sons. 146 pp. in junior colleges, technical institutes, and community colleges. The book describes the education proposed and the general This book is the report of a study to plan a 2-year program nature of such programs and faculty requirements. It recognized for the preparation of nurseswith predominantly technical that the study was limited because no experimental evidence functions consisting of about equal amounts of general educa- was available; no program of this type was in operation. The tion and technical education, and a proposal for the preparation study represents a plan for beginning controlled experimenta. 154 APPENDIX 2 tion in nursing service and nursing education. (Excerpted from TATE, BARBARA L. a review by Helen L. Bunge, Dean, Frances Payne Bolton 1961. "Attrition Rates inSchools of Nursing." Schoolof Nursing, WesternReserveUniversity,Cleveland, Nursing Research, 10 (2) : 91-96 (Spring). Ohio, in the American Journal of Nursing, 51(6): 354. June 1951.) Rates ofattrition of students who entered basicdiploma and baccalaureate programs in nursing in 1954 and 1955 were BRIDGMAN, MARGARET. studied, using data available at the National League for Nurs- 1953. Collegiate Education lor Nursing. New ing. Thc data revealed a significant difference in the attrition York: Russell Sage Foundation. 205 pp. rates in basic nursing programs by type of program, region This book is an exploration into collegiate nursing education of the country, and year in the program. There was no significant difference in the attrition rate by accreditation status focused on basic nursing education anditsrelationshipto higher education. Educational responsibility and policy are dis- of programs. The study raised numerous questions concerning cussed against the background of basic issues in nursing factors that might affect attrition rates. supply and demand for nurses, needs for quality care, enlarged scope of nursing care, deficiency of nursing services, relation- FLANAGAN, JOHN C., et al. ships of nursing service to nursing education, and implications 1964. Project Talent.The Identification Develop- for collegiate nursing education. The intent is to help to clarify ment and Utilization of Human Talents. issues, to bring about a consensus on principles that would The 1960 National Survey. The American lead to long-range planning for collegiate nursing education. High School Student. University of Pitts- The necessity for colleges or universities to have control over education of students in the clinical fields was pointed out and burgh, Pittsburgh, Pa. 493 pp. critical questions were raised as to the best patterns. Thc need This longitudinal research study provides detailed national for regional planning for collegiate nursing education for the inventory data on the achievement, aptitude, interests, person- wisc use of resources was stressed. This book is seen as a ality characteristics, career plans, and aspirations of American guide and aid to the development of collegiato nursing educa- high school studentsin1960. Data are intercorrelated and tion programs. include followup information on occupational choices (includ- (Excerpted from a review by Helen L. Bunge, Dean, Francis ing nursing) and career plans 1 year after graduation. The Payne Bolton School of Nursing, Western Reserve University, study was conducted to provide information on specific patterns Cleveland, Ohio,in Nursing Outlook, 1(2): 72 and 118. of aptitudes,abilities, and interests;on educationalexperi- February 1953.) ences; and on guidance procedures that can provide a basis for assisting students in selecting the career that will assure MONTAG, MILDRED L., and GATKIN, LASSAR G. him the greatest personal satisfaction and success. 1959. Community College Education lor Nursing. New York: Blakiston Division. McGraw- AMERICAN NURSES' ASSOCIATION. Hill Book Co., Inc. 457 pp. 1965. Educational Preparation for Nurse Practi- This is a detailed report on the experimental project con- tioners and Assistants to NursesA Position ducted in seven junior or community colleges and a hospital, Paper. New York: The Association. 16 on technical education for nursing and the systemic evaluation study of the effectiveness of the graduates of these programs. PP. The historical development, purpose of the project, criteria set "This document setsforth theprofessional nursing asso- for participating institutions, project methodology,staff, and ciation's position concerning the education necessary for the advisory services are discussed. practice of nursing." Prepared by the Committee on Education Evaluation included thc development of instruments for de- after a 2-year study of the major trends in nursing and the termining effectiveness of teaching and learning techniques, social forces affecting nursing and patient care, the position andfollowupstudiesfordirecting programimprovements. states that "Education for those who work in nursing should Comparative studies on qualifications for State registered nurse take place in institutions of learning within the general system licensing examination wcre made with graduates from other of education." The paper definesprofessional and technical types of programs. Work performance of graduates in begin- nursing practice. It sets the minimum preparation for profes- ning staff level positions under supervision, given some work sional nursing practice as thebaccalaureate;fortechnical experience and the advantages of inservice training, was com- nursing practice, the associate degree; and for assistants to pared with that of graduates from other types of programs. nurses, the short, intensive, pre-service programs in vocational This book is a record of the successcs of the experimental institutions rather than on-the-job training. Itproposes that phase of technical nursing education for meeting needs for programs for educating practical nurses be systematically re- nursing personnel. placed with programs for beginning technical nurses in junior (Excerpted from a review by Alice E. Imgmire, Associate and community colleges. The need for programs for continuing Professor,University of California Schoolof Nursing, San education, advanced study, and research in nursing, to update Francisco,in Nursing Outlook, 7(9):503-504. September knowledgeandskillsand maintaincompetencies,isalso 1959.) stressed. BACKGROUND MATERIAL AND PLANNING TOOLS 155

TAYLOR, C. W., et al. in-depth nursing education, nursing service, and the role of the 1965. Report of Measurement and Prediction of professional association. It provided an opportunity for an in- depth assessment of the position of tbe professional association Nursing Performance. Part I. Factor for registered nurses on education for nurse practitioners and Analysis of Nursing Student's Application assistants to nurses. As reflected in the report of the proceed- Data, Entrance Test Scores, Achievement ings of the conference, it served to identify and clarify prob. Test Scores, and Grades in Nursing School. lems, sharpen issues, and stimulate group interaction for seeking Salt Lake City: University of Utah.54 pp. solutionstonursing needsand demands.It recommended actions for the Committee on Education, New York State Nurses "This section of a largerstudy isconcerned withinter- Association, to initiate in connection with nursing education. relationships among selection devices and academic and clinical This conference is recognized as the beginning of continuing achievements in nursing;the kinds of qualities or abilities activitytoachieve State and regional planning fornursing that grades in nursing school actually measure; and the degree education in New York. to which selection tests, forms or other devices currently used by nursing schools predict performance on these abilities. A GEITGEY, DORIS A. totalof 814 nursing students' records were studied. Factor 1967. "The Teacher in Associate Degree Nursing analysis was the method selected to study many predictor and Programs." Nursing Outlook, 15(2) : achievementscorevariables. Findings revealed thatclinical and academic performance were not closely related. Typically 30-32 (February). used predictors of intellectual capacity or academic achieve. The author succinctly describes how teaching in an associate ment predict only a narrow spectrum of achievement in nursing degree nursing program differs from teaching in other kinds of education." (From a review by H. E. Dorsch in Nursing Re- nursingeducationprogramsgraduate,baccalaureate,and search, 16 (2): 208. Spring 1967.) diploma. The areas touched upon include the philosophy of the college, heterogeneity of students, purpose of the program, ANDERSON, BERNICE E. curriculum design, and teaching load. 1966. Nursing Education in Community Junior ROBSON, R. A. H. Colleges. Philadelphia: J. B. Lippincott 1967. Sociological Factors Affecting Recruitment Co. 319 pp. Into The Nursing Profession. Royal Com- This is an account of a 5.year project in the States of missiononHealth. Ottawa,Canada: California, Florida, New York, and Texas, supported by the W. K. Kellogg Foundation to further the development of as- Queen's Printer. 244 pp. sociate degree programs in nursing. In accorflance with pre- A model of five factors influencing career choicepersonal established criteria, support was offered in six major areas: values, perception of the degree to which various occupations faculty preparation, continuing education, consultation, program satisfied these values, self.image, social background, and patterns development, demonstration centers and laboratories for future of influence and supportprovide the framework of the study. teachers, and evaluation of developing programs and of grad- Data from questionnaires to over 2,597 persons were amplified uates of programs. by interviews with a subsample of individuals. Cultural and Graduate programs to prepare teachers were estz.blished in attitudinal orientation will assume importance in reconciling four States. One year of program planning preceded the open. divergent points of view. ing of associate degree programs, and funds were allocated for a directorfor1 year and instructorsfor 4 months before TATE, BARBARA L., and KNOPF, LUCILLE. admission of students. Successin the project was attributed 1968. NurseCareer-PatternStudy. PartI: to the teamwork and combined knowledge, experimentation, Practical Nursing Programs. Code No. professional groups and and financial support of educators' 19-1335. New York: National League for private philanthrophy. It further resulted in new methods for recruiting faculty and students, and new teaching methods. Nursing. ResearchandDevelopment. (Excerpted from a review by Ruth S. Swenson, Director, 182 pp. Associate Degree Program in Nursing, Weber State College. This report concerns 3,014 students who entered 117 practical Ogden, Utah, in Nursing Outlook, 14 (7) :17.July 1966.) nurse programs in the fall of 1962. It contains biographical data and statistical presentations and information on reasons NEW YORK STATE NURSES ASSOCIATION. and experiences associated with choice of practical nursing and 1966. Education for Nursing Practice. Report career goals at the time of entrance; biographical data and of the New York State Nurses Association. careergoals at time of graduation; and biographical data, ArdenHouseConference. (Available career information, and related activities1 year after grad. from the Association, 255 Lark St., Albany. uation. Information about non-graduates includes comparisons with graduates. Implications of findings are discussed, and N.Y.) 52 pp. recommendations aremadepertainingtopracticalnursing This conference was held to enable nursing leaders to discuss education and employment. 156 APPENDIX 2

HOWARD, D. ROBERT; and FASSER, C. EMIL. Id Tennessee College of Nursing. The authors believe that the 1970. "DukeUniversity'sPhysician'sAssistant implications of the results of the project fall into four areas: Program." Hospital Progress, 51(2) : (I)use of the theoreticalframework and itsapplication to nursing education;(2) use of the methodology in evaluating 49-55 (February). any content area of a nursing curriculum (with the content This progress report of the physician's assistant program area of occupational health nursing already worked out) ;(3) describes the admission requirements; the current curriculum, continued refinement of the occupational health nursing achieve- with changes that have evolved and proposed changes for the ment test; and (4) exploration of suggested ideas to provide future; program costs; and acceptance of the graduates by additionalmeaningfullearningexperiencesforprofessional physicians and patients. The article includes some thoughts nursing students in the work setting. about the future of this health worker, salary, and questions, particularly in regard to licensure. NATIONAL LEAGUE FOR NURSING. 1970. A Validation Study of the NLN Pre-Nursing KELLER, MAJORIE J., in association with W. THEODORE and Guidance Examination.Pub. 17-1390. MAY. New York: The League. 65 pp. 1970. Occupational Health Content in Baccalaure- ate Nursing Education. Bureau of Occu- The study relates student performance on the pre-nursing pational Safety and Health and Training and guidance examination to survival in the education program, andManpowerDevelopment. Public ratings of classroom and clinical performance, type of educa- graduation,licensingexaminationresults, Health Service. Department of Health, tionalprogram, racial background, and achievement test performance. In addi- Education,andWelfare. Cincinnati, tion, data relating achievement and licensing testresults are Ohio. 126 pp. (Contracts PH-86-64.106 presented, and attrition and graduation statistics are analyzed. and PH-86-66-179.) The samplingcomprisedmore than12,000studentsfrom From 1965 to 1969, a project designed to identify occupa- baccalaureate, diploma, and associate degree programs in 45 tional health nursing content essential in baccalaureate educa- jurisdictions oftheUnited States.(From NL1V News, 18 tion for professional nursing was conducted at the University (3): 11.May-June 1970.) Nursing Service, Nurse Staffing, andUtilization

THE NATIONAL LEAGUE oF NURSING EDUCATION. THE tweenpatientload andbedside workersinthedifferent COMMITTEE ON STUDIES. hospitals. Recommendations based on study findings included the fol- 1937. A Study ol the Nursing Service in Fifty lowing: suggested minimum number of hours of bedside service Selected Hospitals. (Reprinted from the per patient in each 24-hour period, by type of servicestudied; Hospital Survey for New York, Vol.II, the number and kinds of personnel needed and the number of chap. V, pp. 355-429). New York: The hours of employment of those personnel needed for any hospital nursing service. Further study and research about the factors United Hospital Fund of New York. 74 reviewed was strongly recommended. pp. NATIONAL LEAGUE OF NURSING EDUCATION. DEPART- The purpose in making this study of nursing service in 50 MENT OF STUDIES. acute general hospitals was "to findout how well hospital 1948. A Study of Nursing Service. New York: patients are nursed in New York City." Thirty-one voluntary, The League. 63 pp. one county, and 18municipal hospitals were chosen. The number of bedside nursing hours provided patients in the four This was a study of the nursing services in one children's hospital and 21 general hospitals in the New York City area basic servicesmedical, surgical, obstetric, and pediatricin reputed to be well managed and to be providing high quality these institutions was obtained. The hours of care citedin- nursing care. An intensive study was made of the nurse-patient cluded time given by graduate nurses, student nurses, attend- ratiosinthese hospitals and the duties performed by non- ants,orderlies, and ward helpers. The timeprovided was professional nursing personnel trained on the job. In all of the examined in terms of type of hospital, basic service, and shift. hospitals except one, the general hours of nursing care actually Assessment of other factors included: the ratio of supervisors given per patient were fewer than the hours need.Tlu ! and head nurses to patients; the ratio of supervisors and head average ratio was 3.5 hours of nursing care perpatient per day, nurses to bedside workers; the extent to which non-professional of which two-thirds was provided by registerednurses and workers are employed for bedside care; and the balance be- one-third by nursing aides, practical nurses, and others.The

157 BACKGROUND MATERIAL AND PLANNING TOOLS 157 study provided medians to be used as guides in determining both individual and collective accomplishments to all the mem- the nursing needs of medical, surgical, obstetrical, and pediatric ber hospitals for the advantage of each. patients in general hospitals. Measures to improve the training. GARRETT, S. A. G., et al. supervision, and utilization of nursing aides in hospitals were 1966. "The Need for Intensive Nursing Care." also recommended. British Medical Journal, 20: 34-41(Jan. LEVINE, EUGENE; SIEGEL, STANLEY; and DE 1966). LE PUENTE, JOSEPH. Between July 1, 1963 and June 30, 1964, a study was done of 1961. "Diversity of Nurse Staffing Among Gen- patients requiring intensive nursing care in a general teaching eral Hospitals." Hospitals, Journal of The hospital of 486 beds. Of the 486 beds, only 441 were included American Hospital Association, 35: 42-48 inthe study: 203 surgical,196medical, and 42 pediatric. Postoperative patients were excluded from the study. Criteria (May 1). for patients needing intensive nursing care were defined, and This article presents data on the actualratiosof nurses daily evaluations of need for intensive nursing care were made. to patients in short-term general and alliedspecial hospitals it was calculated that,to meet intensive care needs on 95 in the United States in 1957. The data show the great diversity percent of alloccasions, four beds would be required. The that exists among these hospitals in nurse staffing ratios. Many duration of intensive nursing care in patients requiring this factors that may influence the nurse staffing of a hospital are care and the categories and types of patients needing intensive suggested from an analysis of nurse staffing data. nursing care in relationtoallpatients in the hospital are detailed. Methodology and astatistical appendix are given. MULANEY, GERTRUDE S.; CURTIS, JACK; ANTONMATTEI, (From anabstract in Nursing Research, 15(4) :367. Fall JEAN; and WILHELM, MARGARET. 1966.) June 1963.Quantitative Measurement of Nurs- AULD, MARGARET G. ingService inNursingHomes. 1967. "An Investigation into the Recruitment and Milwaukee Health Department, Mil- Integration of Part-time Nursing Staff in waukee, Wisc. 53 pp. (processed). Hospitals." International Journal of Nurs- This is a report of a study by the Milwaukee Health Depart- ing Studies. 4(2) : 119-168 (May). ment that describes the amount of nursing time and the quality of nursing service utilized in the care of 114 patients in 14 This is a report of a survey conducted to ascertain why more nursing homes. Significantfindings,study methodology, ex- trained nurses do not return to work part.time, what induce. ploratory statistics, and a description of assisting personnel are ments are necessary to entice them back to the profession, and reported. Itis believed the data collected in the study can be the best method of bringing new inducements totheir work. useful in estimating the approximate time needed for the care The study revealed that a completely new outlook toward the of patients according to their specific capabilities or disabilities. recruitment and welfare of part.time nurses is needed, including changes in patterns of work, work functions and full inte- EDGECUMBE, ROBERT H. gration of the part-time nurse as part of the nursing team. 1965. "The CASH Approach To Hospital Manage- ment Engineering." Hospitals, 39 (6) : HAWLEY, KAREN SUE. 1967. EconomicsofCollectiveBargaining by 70-74. (March 16, 1965). Nurses. Industrial Relations Center, Iowa This is a report of a project concerned with the improvement State University, Ames, Iowa. 180 pp. of nursing service management. The Commission for Admin. (processed). istrativeServices inHospitals (CASH)is an incorporated, nonprofit organization which provides management engineering This studyexplored the relationship Ldween the use of services for the improvement of hospital service through the collective bargaining by nurses and the nursing shortage. The useof modern management engineering techniquesfora study was supported by a survey of the economic status and monthly subscription fee. At the time this article was written, working conditions of registered nurses in 122 Iowa short.term 80 southern California hospitals were participating. The pro. general non-Federal hospitals in March and April of 1967. A gram includes: traininp of supervisory personnel in scientific labor analysis was made in four main areas:(1) secondary management and industrial engineering techniques, and as- work force characteristics of nurses;(2) determinants of and sistance in applying these techniques in the hospital; intensive relationship between salaries and vacancies for hospital nurs- surveys in the hospital to study departmental operations and ing personnel;(3)influence ofpreparational requirements data standards for job performance and departmental operations upon the supply and quality of nurses; and (4)reaction of in order to establish their own performance standards, person. hospitaladministratorstohigher nursing.ialaries.It was nel, staffing, and departmental organization. The resources of concluded that collective bargaining can have positive effects the member hospitals are used for the devdopment of improved upon the supply of nurses by bothincreasing and making methods and procedures, and information is disseminated on better use of the local supply.

tr r..) c.) 158 APPENDIX 2

MENDELOV, DAVID. PRICE, ELMINA. 1967. A Study of Various Organizational Arrange- 1967. "Data Processing.Present and Potential." ments of the Unit Manager System. The American Journal of Nursing, 674 (12) : George Washington University, Washing- 2258-2264 (December). ton, D.C. 52 pp. This article presents an overview on the potential effects of computerization upon nursing. It explains what is now possible "An investigation of the question of at what level of authority to gain from computers, what is potentially possible, and how Unit Managers function most effectively in hospital nursing nurses will communicate with computers. The difference be- units. Questionnaires were sent to selected hospitals employing tween manual, semi-automated, and fully automated systems is Unit Managers, conferences were held with representatives of explained. The author delineates the place where nurses must active programs, and a pilot program was used for first-hand participate in developing these systems. observation. The author concluded the Unit Manager would be a co.equal of the charge nurse but should be organizationally AYDELOTTE, MYRTLE KITCHELL. placed under administration rather than nursing." (From Ab- 1968.Survey of Hospital Nursing Services.New stracts of Hospital Management Studies, VI: 145. June 1970.) York: National League for Nursing. 58

LEWIS, CHARLES E., and RESNHC, BARBARA A. PP. 1967. "Nurse Clinics and Progressive Ambulatory This is a report of a questionnaire survey of 93 items per- Patient Care." The New England Journal taining to the current status of .nursing serviceactivities in 1,172 short-term general non-Federal, non-psychiatric hospitals of Medicine, 277 (23) :1236-1241 (Dec. of all sizes. The survey, conducted in 1964, was intended to 7) stimulate hospital nursing services to examine their status as thecriteriafor effectivenursing "Report of a projectto evaluatea more active role for abasis for implementing service developed by the National League for Nursing. Survey nurses in ambulatory patient care in a medical clinic. Patients report include: nursing services' were randomly divided into two groups after initial testing and findings highlighted in the evaluation. One group received all their medical care from a continuity for other services; limited inservice education pro- nurse, the other did not. Patient reactions were assessed, and grams; a variety of hospital educational programs; and the characteristics and activities of directors of nursing service. were generally negative toward the nurse. In a retest one year Survey findings point to needed changes in the organization and later, there was no change in control group. In the experimental administration of nursing services and improved leadership for group: the nurse was accepted as primary source of care; there Sits administration. (Excerpted from a review by L. Flynn in was an increased adherence to appointment schedules; a better Nursing Research, 18 (1): 90. January-February 1969.) utilization of time; lower costs; decreased frequency of com- plaints; and 'quality of care and patients' satisfaction with care were higher.'" (From Abstracts of Hospital Management BUEKER, KATHLEEN; and SAINATO, HELEN K. Studies, V: 260. June 1969.) 1968.A Study of Staffing Patterns in Psychiatric Nursing. Washington: Saint Elizabeth's MICKEY, JANICE E. Hospital. 103 pp. 1967. A Methodological Study of Extra-Hospital The purpose of the study was to determine the effects of Nursing Needs. The Johns Hopkins Uni- selected combinations of nursing staff with prescribed functions versity, Baltimore, Md. 562 pp. upon the therapeutic milieu and nursing care of patients. The results of this study showed that a selected combination This study developed and testeda method for estimating of 10 nursing staff, with functions prescribed by a graduate extra-hospital nursing needs of the total population of a county nurse, along with the services of a ward clerk and participation in Pennsylvania. The method employed an interview schedule from the ward physician, increased the effectiveness of the ward soliciting nurse-related health problems in 18 categories, pre- milieu and improved the treatment program for patients. Com- determined criteria of the intensity of need, and judgments for parison with wards that served as controls substantiated the each category.Interviewfindings were testedagainst care findings reported here and elsewhere that traditional staffing actually given by public health nurses. It was concluded that patterns and only remote supervision by professional personnel nurses need considerably more help to be successful in assessing maintain the status quo and custodial patient care. and meeting total public health nursing needs. However, judgments of needs were significantly related to certain demographic DUNLAP, HENRY B. variables such as type and size of familyi and educational and 1968. "Employee Turnover Costs Millions."Hos- occupational status. Replication and refinement in study methods are suggested for development of a mathematical formula to pital Forum, XI (4) :12-13 (July). he applied to census data for generating estimates of service "Report of 1964 and 1966 studies on approximately one-half needs.(Abstracted from Abstracts of Hospital Management of the Southern California hospitals, considering employment Studies, VI: 183-184. June 1970.) costs, efficiency loss, training time and separation costs. Correc. BACKGROUND MATERIAL AND PLANNING TOOLS 159 tive measures are recommended." (From. Abstracts ol Hospital Report on Phase, II, "An Experiment With Management Studies, V:127. July 1969.) A RestructuredSchoolHealthTeam." ESPOSITO, PAULETTE; and LOBOZZO, SANDRA. Sponsored by Medical and Health Research 1968. A Manual for Team Nursing.The Catholic Association of New York City, Inc. In Hospital Association, St. Louis, Mo. 56 cooperation with the Department of Health PP. of the City of New York. 96 pp. "A manual explaining the principles and implementation of Staffing recommendations which resulted from the Phase I team nursing. The roles, responsibilitiesand relationship of part, "A Study of Utilization Patterns: Methodology and Find- the members of the professional health team, and partkularly ings," were used in Phase II of the experiment. A team ap . of the nursing team segment are outlined. Assignment planning, proach to the school health program was undertaken on a very team conferences, and nursing care plans are explained. Criteria large pilot basis in 95 public and parochial elementary schools for team reports are given, as are specimens of report and and 12 junior high schools in New York City. Teams were assignment forms and an example of a nursing team confer. composed of physicians, staff nurses, public health nurses, and ence." (From Abstracts ol Hospital Management Studies, VI: public health assistants. The study showed that the team ap. 141. June 1970.) proadh can reduce the amount of professional time wasted on suhprofessional activities by professional people. It was further MCLAREN, KAZUL K. believed that with longer experience with the team approach, 1968. A Study ofProfessional NursingNon. further reductions are possible. Nursing Tasks in Public Health Nursing in Hawaii. Public Health Nursing Branch. Medical Health Services Division.Hawaii ZIMMERMAN, JAMES P. State Department of Health. Honolulu. 1968. "Initiating A Unit Management System." 34. pp. (mimeographed). Hospital Progress, XLIX (2) :64.66, 72 (February). "A study was conducted in the 4 counties of Hawaii to determine which of the activitiesperformed by publichealth The unit management system is one approach hospitals may nurses required professional nursing knowledge and which did use to improve utilization of unit staff and to expedite nursing not. Tasks were organized into unitsplanning and assessing, care and services to patients. The initiation of a successful unit implementation of nursing care, evaluation, and study and re. management system into a particular hospital depends upon a search. The work units were categorized into service units careful appraisal of the current hospital system and activities visit, clinic, school, nursing and home care, district management, of unit personnel. Successful change and introduction of a new health surveillance, and student and observer activities. Of the system depend upon mutual planning, cooperation, and com- 570 tasks only 63.3% were considered by staff to need pro. munication between hospital administration and nursing service. fessional knowledge. Of the 449 tasks performed during the The author describes:the method usedtoinitiate a unit one.week time study by a random sample of staff public health management system hta 585.bed hospital;the time studies nurses 58% needed professional knowledge.. .." (From a used to identify the activities of unit staff;a description of review hy V. Nelson in Nursing Research. 18 (6): 555. Novem. tbe non.nursing activities which served as the basis for the ber.December 1969.) job description of the unit manager; the pilot unit; and the implementation of the total system. MUSSALLEN, HELEN K. 1968. "No Lack of NursesBut a Shortage of Nursing." International Nursing Review, DUNN, HELEN W., and MOIWAN, ELIZABETH M. 15 (1) : 35.47 (January). 1969. The Nursing Audit. National League for Nursing, New York. 42 pp. (May). The author contends that in Canada there exists a shortage of available nursing hours rather than a nursing shortage. The "A discussion of the nursing audit, an administrative tool causes of this shortage are identified as: poor utilizationof for the evaluation of the quality of nursing care as reflected nursing time, waste of nursing skills, staff turnover, emigration, in the medical records, based on the seven years experience of and non.practicing personnel. Also, if the substandard levels the Department of Nursing at the University of Illinois Re. of salaries and working conditions prevail,the writer states, search and Educational Hospitals. The first section summarizes an actual shortage of nurses will take place in the near future. how the audit functionsas an evaluativetool. The second The causes are discussed in detail, and a number of actions to section presents in detail the steps involved in setting up the improve the situation are proposed. audit and the distinction between the responsibilities of the Department of Nursing and the Medical Records Department. ROSNER, LESTER J.; ROSENBLUTH, LUCILLE; PITKIN, Charting practices and samples of forms aregiven." (From OLIVE; and MCFADDEN, GRACE M. Abstracts olHospital Management Studies, VI: 144. June 1968. School Health Personnel Utilization Project. 1970.)

2 160 APPENDIX 2

HARDNER, SISTER MARGARET ANN. Inespecial!)hdpful to those seekingfederal approvalfor 1969. A Study of Unit Management. Xavier participation in the Medkare program." University, Cincinnati, Ohio. 117 pp. This publication can be used as a reference for daily opera. tional procedures, inservice educational programs, mutual re "Study to detennine the extent of the nutk (g Unit Manage- visions, and employee orientation to special jobs. ment Program (UMP)in 400+ bed, voluntary, short-term It is a useful reference for the new as well as the experienced general hospitals throughout the United States:to collect and administrator. The former will acquire knowledge of the daily analyze data about UMP's in these hospitals;to (kmonstrate amivities her job entails %%hile the latter will be able to compare the development and implementation of the UMP at St. Vincent procedures of operation. Hospital and Medical Center, and to evaluate after one year. The II chapters with appropriate subtitles are complete for A profile of the Unit Manager and the UMP was developed all servkes and departnwntsina good nursing home. The from data collected by questionnaire for 43 UMP hospitals. recipients of carethe patientsare the chief beneficiaries in Thirty-sevenhospitals reported success or partial successin a wellorganized facility. accomplishment of their objectives: mainly better use of nurs- (From a review by Florence L. Blatz in Nursing Outlook. ing personnel and betterpatientcare." (From Abstract ol 18 (4): 24.April 1970.) Hospital Management Studies, VI: 152. June 1970).

JOHNSON, WALTER L. MONTGOMERY, T. A. 1969. Content and Dynamics of Home Visits of 1969. "A Case for Nurse-Midwives." American Public Health Nurses; Part 2. New York: JournalolObbtetricsandGynecology, AmericanNurses' Foundation. 134 pp. 105:309-313 (Oct. 1). (paperback'. "Chronic shortage of physicians in a rural county hospital in This is an empirical study focusing on the "communicative California resulted in many deliveries in the county hospital interactional dimension" of the nurse's therapeuticrole. This being medically unattended. This ledto the developmentin isthe second and final volume of a field study initiated in July,1960, of a demonstration project calling for qualified 1956 tostudy contactsbetweenpatients and public health nurse-midwives to provide maternity case services for all normal nurses. The first section was published in 1962, with the late deliveries. Initially, the physicians were skeptical aboutthe Clara A. Hardin as coauthor. quality of tare that could be provided by nurse-midwives. Their The sample consisted of 289 home visits. The investigator skepticism soon changed and they became staunch supporters describes the observational dimensions of the study and the of the program. Maternity patients also became enthusiastic methods used Ior statistical manipulation, sample comparison, about nurse-midwife services. Although there were only about and analyses. Correlations helped to identify researchable hy- 360 deliveries per year at the county hospital (60% ofall potheses, and the use of case analysis increased the force of deliveries in the county), the neonatal mortality rate fell from some of the findings. 23.9 per 1,000 live births to 10.3 per 1,000 live births. Pre- The findings present "some extremely valuable indicators maturity dropped from 11% of all live births to 6.4%." (From for evaluating the quality of the nurse's home visits and sug- alnabstract in Nursing Research, 19(2):188, March-April gests that the current standard of nursing care is not being met." The author states, "A limiting factorinthe delivery of nursing care which has been documented repeatedly in this O'BRIEN, MARGARET J. report is the variability of patient reactions to services rendered by the nurses." Also, he implies that the nurse needs to rede- 1969."Team Nursing in School Health." IVars- fine "helping the patient" as "finding solutions to his patient's ing Outlook,,17: 28-30 (July). problems as he defines them, even if it takes time." Another "This study of the utilization of school health personnel was implication the data offer for consideration is that "standards carried out in 1964 in 107 of the 1,200 schools in 3 districts of have beendevelopedwithout regardto implementationor New York City. The school health team was reconstructed for effectiveness." this project so that it was headed by a public health nurse as (Based on a review by Beverly H. Brown in Nursing Outlook, team leader" and included two or more staff nurses, two or 18 (4): 24.April 1970.) more public heahh assistants, and the school physician. The MILLER, DULCY B. public health nurse and public health assistantroles were broadened and extended. The Lyear experiment succeeded in 1969. The Extended Care Facility; A Guide, To establishing a team approach in the school health program. It Organization And Operation. New York: is felt that the nature of the team structure and the assignment Blakiston Division, McGraw-Hill Book Co. of duties assured the utilization of each team member at his 480 pp. highest level, and that professional nurses were enabledto "In this book the author shares her years of experience as spend more time on professional duties than under previous directorof an extended carefacility. The proceduresand circumstances. (From a review by J. Vian in Nursing Research. guidelines for organizing all departments and services should. 18 (6) : 558-559. November-December 1969.)

1 61 BACKGROUND MATERIAL AND PLANNING TOOLS 161

SJOBERG, KAY. care and 2.5 for total-care patients and with additional factors 1969. "Unit AssignmentA New Concept."The of about one-fifth for those over 65. Allocation of nursing staff Canadian Nurse, 65 (7) : 29-31 (July). hours among RNs, LPNs, and auxiliary staff is determined by applying the Standard Hours per Patient Day to a Patient A new staffing system on a 47-bed research ward is described. Classification System and applying that totalto a Personnel This ward is organized into six units of care, one 3-bed intensive Guide. Participating units will prepare a Nursing Staff Utiliza- care unit, two 5-bed above-average-care units, and three average. tion Report to compare projected hours with actual nursing care units. staff hours." (From Abstracts of Hospital Management Studies, The definition of a unit is "the number of patients thatcan VI: 152. June 1970.) be effectively cared for by a registered nurse who is given adequate nursing assistance and supply services." EAGEN, SISTER MARY CECILIA. This article discusses unit assignments, the head nurses' role, 1970. "New Staffing Pattern Allows for Total In- st.4ing patterns, service staff, and communication. The unit dividual Quality Care."Hospital Progress, assignment system of staffing will be fully evaluated in the coming months. To date, staff response has been favorable. 51 (2) :62-64, 70 (February). The author defines "total individual quality care" as "the SPERLBAUM, ANDREA. assessment and planned care of each individual patient by a 1969.Bibliography of Service Unit Management. registered nurse." The registered nurse attempts to meet the Ann Arbor: University of Michigan. 55 needs ofthepatienteither throughher own professional PP. capabilities or with the casistance of specialists in various disciplines. Functional care or team nursing careboth are con- "Thisannotatedbibliographycovers fifty-eightjournal sidered by the author to be "traditional care." articles, theses and project reports which deal with experiences The pilotunit was staffedby registerednurses, nursing in nursing unit management." The period covered is 1952 to assistants, and a ward clerk on the morning and afternoon 1968. The following areas are covered in each annotation: (1) shifts. Only registered nurses were employed on the night shift. the job description of the unit manager; (2)the objectives All direct patient care was provided by the registered nurses. to be attained; and (3) the experience each individual hospital The nursing assistants and ward clerks were under the direct lmd in implementing unit management. supervision of the registered nurses. Nursing assistants helped STEWART, DIANE Y. the nurse in all areas not directly associated with patient care. The ward clerk acted as a receptionist and performed selected 1969."Nursing OrganizationCirca 1969". The clericalwork, includingthe copyingofphysicians'ordets, Canadian Nurse, 65 (2) : 59.61 (February). within the nursing unit. To avoid fragmented, depersonalized This article describes an organizational pattern of nursing care, each registered nurse was responsible for total individual service in keeping with current needs to relieve nurses of non- quality care for five or six patients on the unit. nursing functions. Traditional organizationissupplanted by This articledescribesthe planningforthe newstaffing changes in the roles and functions of key persons responsible pattern, the inservice education required, the revision of job for nursing administration in a hospital and by the decentraliza- descriptions, and the plans for transferring and placing person- tion of authority from the director of nursing to other nursing nel; e.g., the head nurse, the licensed practical nurse, and the staff. The plan provides for a nursing administrator on each nursing aide positions were eliminated. floor; a nursing coordinator, who is a clinical specialist, for each 30-bed unit; and floor managers responsible to hospital FREEMAN, RUTH B. administration. 1970. Community Health NursingPractice. UNIVERSITY OF MICHIGAN. Philadelphia: W. B. Saunders Co.414 pp. 1969. SCALENursing Staffing Program, Hos- With a focus on perspectives and prospects of social change pital Systems Improvement Program.Ann and their influence in health care, the author provides a comprehensive and scholarly piece of work on community health Arbor, Mich.: The University. 29 pp. nursing practice. Purposes, roles, goals, and processes in com- "Descriptions of theprocedures and forms used inthe munity health nursing are discussedindepth from sound SCALE (Systems for Control and Analysis of Levels of Effec- philosophic, scientific, and theoretical orientations. tiveness) Nursing Staffing Program. SCALE objectives are to Freeman keenly analyzes nursing care of pertinenttarget establish standards for acc.,rate prediction of staffing require- populations and specific health care problems. Many settings ments and to provide personnel with an objective means of self and conditions are presented in a clear and pertinent manner. evaluation in relation to staff utilization. The CASH (Commis- She emphasizes the concept "nursing the community," using sion for Administrative Services in Hospitals) Program and the family as the focal point of care. The chapter on neighbor- Research at the University of Michigan and Johns Hopkins hood nursing programs willprovidenurses with new and University provided the background data. The SCALE program different ways to conceptualize their practice. The challenge is is based on a stl,dard of four hours per day for an average to interpret this holistic apploach to the public, colleagues, and partial care patient with adjustment multiples of .5 for self the health team. The implementation of this idea should have

6 2 162 APPENDIX 2 a profoundinfluenceon patterns developedfordelivering for her patients as the need arises; e.g., rescheduling outpatient nursing services, the expanding practice of community health appointments, delayinghospitaldischarges,or obtaininga nursing, and research. hospital re-admission. This publication is helpful as atext and as a reference. PALISIN, HELEN E. Chapter references and bibliographies offer direction for self. initiated study, and expand borders of current issues in nursing 1971. "Nursing Care Plans Are a Snare and a with afuturistic view.(Excerpted from areview by Dr. Delusion." American Journal of Nursing, Loretta Ford in American Journal of Nursing, 71 (1): 93.94. 71 (1): 63-66. January 1971.) The value of nursing care plans for patients is questioned LUNT, J. by the author. The limitations of this method of communication 1970. "Bridging the-Gap in Continuity of Care." in the work situation in the hospital setting ere discussed. Nursing Times, 66:12, 372 (March 19). Palisin asserts that nursing care plans may have some value for patients who are acutely ill and cannot communicate, but Improved continuity of care and serviceto patients has proliferation of such a tool for an patients not only complicates resulted since.: a district nursing liaison arrangement was estab. the communication process but interferes with individualized lished betueen a hospital and threelocalauthorities. The care. arrangement enables the nursing liaison officer to: (a) Make hospital ward roundseach morning with the WORLD HEALTH ORGANIZATION. medical and nursing staff of the hospital, thus improving the 1971. Planning and Programming for Nursing understanding between them. Services. Public Health Papers, No. 44. (b) Visit the patient while still in the hospital. This has lessened his anxiety for Hs aftercare and it gives the nurse the Geneva: Office of Publications and Transla- opportunity to assess the patient's requirements for home care. tion. 123 pp. (c) Visit the home on the day of operationto reassure Of particular value and interests are the Annexes tothe relatives and tell them about postoperative care. guide. They describe particular planning techniques such as Since the establishment of this two.way service, the staff the CENDES/PAHO method and the planning methods used public health nurse feels more comiortable about calling the in U.S.S.R. A bibiliography and a glossary of the terms used hospital and obtaining certain services or changes in services in *11guide and in planning are included. Indexes, journals, Periodicals, and Publications Lists

American Education. and advances in the general health field as they applyto U.S. Department of Health, Education, and nursing. Welfare. Office of Education.Patricia L. American Journal of Public Health and the Nation's Cahn, editor. Washington: U.S. Govern- Health. ment Printing Office. Published 10 times Albany, N.Y.: American Public Health As- a year. sociation, Inc. Published monthly. This publication features current information for Federal, The official journal of the Association is devoted to scientific State, and local levels on legislation, research results, and issues knowledge, issues, trends, developments, programs, administra- pertaining to education. Ali levels of education are included. tion, personnel managemeA utilization, training, and educa. This periodical was first issued in 1965. don, in all fields of public health endeavor. It contains articles American Institute of Planners Journal. and reports on surveys, studies, and research in these areas. A Baltimore, Md.: Port City Press.Published book review section and selected annotated references are included, as well as items of association business and news quarterly:February,May, August,and notes of professional interest. November. Public management and planning information for city and ANA 1969-70 Publications List. regional planning are presented in the form of charts, maps, New York: American Nurses' Association. book reviews, bibliographies, and abstracts. Published periodically. American Journal of Nursing. This comprehensive list of available publications and reprints New York: The American Journal of Nursing includes official ANA statements, clinical studies, legislation, Company Monthly publication. guidelines for practice, significant statistical surveys and data, Date of first analysis of key trends in nursing, and general references. It is issue 1900. revised periodically to help nurses and related groups keep up As the official magazine of the American Nurses' Association, to date with important developments in nursing practice, educa. it offers material on clinical and nursing care, nursing service, tion, and research. BACKGROUND MATERIAL AND PLANNING TOOLS 163

Catalog ol Publications 1968-1969. This isan author-subject guide to periodical and selected St. Louis, Mo.: The Catholic Hospital As- literature on all areas of hospital administration; planning; sociation, Publications Department. Pub- financing; and administrative aspects of the medical, paramed- lished periodically. ical, and prepayment fields. It does not include references on clinicalmedicine. Published quarterly, with the fourth issue This catalog lists manuals, guides, books, articles, andreports an annual accumulation. ongeneral hospitaltopics,hospitaladministration, nursing service, and medical technology available from the Association. International Journal ol Nursing Studies. Included are manual guides on team nursing, master staffing Long Island City, N.Y.: Pergamon Press. plan, the audit, inservice education, and ward clerks. Published quarterly. Cumulative Index to Nursing Literature. This journal covers all aspects of nursing and allied profes- Glendale Adventist Hospital, Glendale, Calif. sions throughout the world. Emphasis is on community needs, preparing young people for assuming nursing duties, and en- This cumulative indexto date, asetof four editions couraging nursing research. covers the period 1956.1968. The first edition contains volumes I-V (1956.1960) ;the second edition, volumes VI-VIII (1961- 1963) ;the third edition, volumes IX-XI (19644966) ; and the International Nursing Index. fourth edition, volumes XII.XIII (1967-1968). New York: American Journal of Nursing These editions contain subject matter of interest to nurses, Company, in cooperation with the National compiled from the nursing literature and elsewhere, and ar Library of Medicine. Published quarterly ranged according to subject and author. Since the first edition, since 1966. both format and content have changed. The most recent edition contains greater coverage of nursing and health.related publica. Articles in 160 nursing journals from all over the world and tions, as well as selected articles from popular publications. those in non.nursing journals currently listed in Index Medieus are included. There is a subject section, an author section, and Grant Data Quarterly. an index of nursing publications. Los Angeles: Academia Media Inc. Pub- lished quarterly. NLN Publications Catalog. This reference journal provides a picture of grant support New York: National League for Nursing. available from government, business, professional organizations, Published annually in May. and foundations. A program breakdown includesamong other A list of available publications about nursing service and categorieshealth, medical, and social sciences and the hu- nursingeducation,rangingfromadministrativeguidesto manities. Types of grants available are described, as well as evaluation tools for institutions and individuals to general in eligibility qualifications, financial data, duration of grant, and formation materials about nursing. It includes mimeographed scope of the grant program. books, booklets, manuals, reports, surveys, reprints, and record Health Services Research. forms. Listings are annotated briefly as to content. Chicago: Hospital Research and Educational Nursing Outlook. Trust.Published quarterly. New York: The American Journal of Nursing This journal contains original articles, progress reports, and Company.Published monthly since January news notes on a wide variety of research projects and new 1953. technology concerned with the organization and delivery of health services. The official magazine of the National League for Nursing, for nurses in public health, nursing service administration, and Hospital Abstracts. nursing education, with materials and articles pertinent to these A monthly survey of World Literature pre- fields. pared by the Ministry. of Health. London: Her Majesty's Stationery, Office. Published Nursing Research. monthly since 1960. New York: The American Journal of Nursing Publications and original papers covering the.whole field of Company. Published quarterly since 1952. hospitals and their administration, with the exception of strictly This journal contains articles on scientific studies in nursing, medical and related professional matters, are summarized. reports of nursing research activities, and reviews and abstracts Hospital Literature Index. of existing research literature.Itis designedto make the products of nursing research accessible to research workers, Chicago:AmericanHospitalAssociation. practitioners, educators, and students of nursing and other Published quarterly. health professions, and to stimulate new research in nursing.

/ . :1;) 164 APPENDIX 2

Nursing Studies Index, Volume III, 1950-1956. This complete listing of professional publications developed Prepared under thedirection of Virginia by the American Hospil al Association (AHA) includes man- Henderson. Philadelphia: J. B. Lippincott uals, monographs, reports, reprints, and official statements of the AHA, on all aspects of hospital administration, operations . Co. 653 pp. 1966. services, staffing, personnel, and public relations, as well as This index is an annotated and comprehensive guide to re- clinically related subjects, surveys of the health care field, and ported studies, researchinprogress, research methods, and research project data. historical materials in periodicals, books, and pamphlets, all of which are published in English. Readers Guide to Periodical Literature. Index to Selected U.S. General and Non- Nursing Studies Index, Volume IV, 1957-1959. Technical Periodicals of Reference Value in Prepared under thedirection of Virginia Lthraries. New York: The H. W. Wilson Henderson. Philadelphia: J. B. Lippincott Co. Published twice a month, with cumu- Co. 281 pp. 1963. lative volumes. From 1900 to date. This index is an annotated and comprehensive guideto This is a guide to U.S. periodicals of broad, general, and reported studies, research in progress, research methods, and popular character.ItalsolistsU.S.popular non.technical historical materials in periodicals, books, and pamphlets, all of magazines representing allthe important scientific, technical, which are published in English. and subject fields. Nursing Update. Research in Education. Darien, Conn.: Miller and Fink Publishing U.S. Department of Health, Education, and Corporation.Published monthly since Octo- Welfare. Office of Education, Bureau of ber 1970. Research,DivisionofInformation Tech- This magazine provides the reader with practical, useful, nology and Dissemination, Educational Re- and up-to-date clinical and nursing information. The format sources Information Center. Washington: enables the reader to be selective by the use of "Express U.S. Government Printing Office.Published Stops" (summaries in boldface type in the margins of each mon thly. article), capsule information such as charts and checklists, and This abstract journal announces recently completed research a quiz as a review or memory aid. and research-related reports as well as current research projects Planning Urban Affairs. in the field of education. Each edition is made up of resumes Beverly Hills, Calif.: Sage Publishers, Inc. followed by indexes. The indexes cite the contents by subject, Published annually. author or investigator, institution, and accession number. This annual reference volume, published since 1968, presents ResearchinEducation.Annual Index:January- critical analyses of current interests in urban affairs, prepared December (For each year). by experts in various fields of urban studies. It covers programs, U.S. Department of Health, Education, and policies, and current developments in all areas of concern to Welfare. Office of Education, Bureau of urban specialists. Research,DivisionofInformationTech- Public Health Reports. nology and Dissemination. Washington: U.S. Department of Health, Education, and U.S. Government Printing Office. Welfare. Public Health Service. Wash- Indexes to the research reports that were announced in the ington: U.S. Government PrintingOffice. monthly issues of Research In Education from January through Published monthly. December are provided. The annual publications are intended as This official publication of the U.S. Public Health Service a companion volume to the individual issues. covering items of value and knowledge inhealthfieldsis prepared primarily for distribution to directors and supervisors Social Sciences and Humanities Index. of public health programs and to institutions training public New York: The H. W. Wilson Co. Cumu- health personnel. It contains articles, reports, and items on lative volumes published at regular intervals. the technical, scientific, administrative, service, and educational 1907 to date. aspects of health of potential interest to this audience. This publication is a social science and humanities index of Publications Catalog of the Ameriam Hospital As- 209 journals, in English, that are international in scope and published in the United States, Canada, and Great Britain. sociation. Chicago: The American Hospital Association. Social Security Bulletin. Published January and July. U.S. Department of Health, Education, and BACKGROUND MATERIAL AND PLANNING TOOLS 165

Welfare. Social Security Administration, Ulrich's International Periodical Directory. Office of Research and Statistics. Washing- New York and London: R. R. Bowker Com- ton: U.S. Government Printing Office.Pub- pany. Issued triennially. 1932 to date. lished monthly. Thisis aclassified guidetoa selectedlistofcurrent This publication contains current and trend information and periodicalsforeign and domestic. Over 16,000 periodicals are data on the programs administered by the SocialSecurity classed as follows: scientific, technical, medical, arts, human. Administration. ities, business, and social sciences.

p Appendix 3 Guide to Statistical Data

Appendix 3 is designed to provide guidance in selecting statistical data on health services, health manpower, and educational resources, as well as related social and economic data of potential use in planning for nursing needs and resources. Part 1 of this appendix is an annotated bibliography of selected statistical publica. tions that are issued periodically by the Federal Government, professional associations, and private agencies. The references are grouped under six topics (as shown in the table of contents on the next page) and arranged alphabetically by name of author or department under each topic. Part 2 of this appendix is a guide, in tabular form, to other possible sources of existing statistical data that may be available although not published. The sources are listed under general topics, as shown in the table of contents, next page. The types and amounts of information available will vary from one area and State to another, depending upon the programs and interests of the specific agencies and organizations and their resources for collecting and compiling data. Some agencies may have trend data covering 10 or more years on certain subjects. Contents

Part 1

Page ANNOTATED REFERENCES TO PUBLISHED STATISTICS

Abstracts of Social, Political, and Economic Statistics 169 Education and Educational Resources 170

Health Facilities and Services 172 Health Manpower Statistics 174 Population Statistics 179 Vital and Health Statistics 180

Part 2 GUIDE TO OTHER POSSIBLE SOURCES OF EXISTING DATA Career Incentives 183 Employment Conditions 183 General Education 184 Health and Vital Statistics 184 Health Facilities 184 Health Planning for Geographic Areas 185 Health Services 185 Nurse Supply 186 Nursing Education 188 Other Health Manpower 189 Population 190 Utilization of Health Facilities and Services 190

Utilization of Nursing Personnel 191

168 Part I Annotated References to Published Statistics Abstracts of Social, Political, and Economic Statistics

U.S. DEPARTMENT OF COMMERCE. BUREAU OF THE ernment PrintingOffice. Publishedan- CENSUS. nually from 1960 to 1967. Average 200 pp. 1968. Directory of Federal Statistics for States: Each edition presents current-year national data on program 1967. Pub. 1968 0.268.066. Washing- operations in health, education, and welfare fields; past decade ton : U.S. Government Printing Office.372 annual data;and selentedprojectionstothe next decade. Included are such items as vital statistics,health manpower PP. and facilities, medical care expenditures, income, social insur- This is the first issue of a guide to current statistics for ance and protection, and enrollments in elementary, secondary, States. Itis intended to serve as a comprehensive guide for and higher education. finding availablepublishedsources of Federal statistics on social, political, and economic subjects. The references provided U.S.DEPARTMENT OF HEALTH, EDUCATION, AND consist of the latest data available in print prior to the final preparation of this directory. Sources cited contain data for WELFARE. 1960 or later for each of the 50 States. If a table or series State Data and State Rankings in Health, contains data for fewer than 25 States, the contents are sum- Education, and Welfare. Part 2 of Health, marized when those States represent all or most of the particular Education and Welfare Trends. Washing- phenomenon oractivitydescribed. Availabilityofdatafor ton : U.S. Government Printing Office. Pub- Puerto Rico and outlying areas is separately indicated for each blished annually from 1960 to 1967. Aver- item shown. Style of presentation is described and terms and abbreviations age 65 pp. are defined. A list of complete bibliographic citations, arranged Each edition presents State data and ranking of States for alphabetically by issuing Federal agency, appears as an ap- population; vital statistics; and expenditures and services in pendix to the book. the fields of health, education, and welfare that are presented This publication is a companion document to the Directory ol in Part 1. Federal Statistics lor Local Areas, published by the Bureau of the Census in 1966. U.S. DEPARTMENT OF LABOR. BUREAU OF LABOR STATISTICS. U.S. DEPARTMENT OF COMMERCE. BUREAU OF THE 1964. Industry Wage Survey: Hospitals Mid-1963. CENSUS. Statistical Abstract of the United States. BLS Bulletin1409. Washington:U.S. Government Printing Office. Washington: U.S.GovernmentPrinting Office.Published annually.Average 1,000 Results of a surveyof earnings and supplemental wage benefits are reported for short-term private and State and local PP. government hospitals with 100 employees or more and located This standard summary of statistics on the social, political, in metropolitan areas. Average weekly earnings are reported for and economic organization of the United States is designed to registered nurses in selected positions for the United States serve as a convenient volume for statistical reference and as a and regions of the country. guide to other statistical publications and sources. Major sections of interest include: population; vital statistics; education; U.S. DEPARTMENT OF LABOR. BUREAU OF LABOR income;laborforce;Federal, State,and local government STATISTICS. finance andemployment;agriculture;transportation;construction; and manufacturing. 1966. Industry Wage Survey: Hospitals. BLS Bulletin 1553 (July). Washington: U.S. U.S. DEPARTMENT OFHEALTH,EDUCATION, AND Government Printing Office. 107 pp. WELFARE. A survey of earnings and supplementary wage benefits of Health, Education, and Welfare Trends, Part hospital employees including nursing personnel, in July 1966, 1, National Trends.Washington: U.S. Gov- are reported in this bulletin. The survey coveredallprivate

169

a 170 APPENDIX 3 and State and local government hospitals throughout the Nation and supplementary wage provisions are given for the United (except Alaska and Hawaii). Federal hospitals were excluded. States, by regione and by selected areas. Tables included in Mean, median, and middle-range earnings are given for regions the report give: average hourly earnings by selected charac- of the country and for selected metropolitan areas. teristics, e.g., facilities primarily providing skilled nursing care; occupational averages by type of establishment, e.g., establish- U.S. DEPARTMENT OF LABOR. BUREAU OF LABOR ments not providing skilled nursing care; and occupational STATISTICS. averages in 15 selected areas, e.g., Baltimore, Maryland, and 1969. Industry Wage Survey: Nursing Homes and Cleveland, Ohio. Related Facilities.October 1967 and April U.S. DEPARTMENT OF LABOR. BUREAU OF LABOR 1968. Bulletin 1638. Washington: U.S. STATISTICS. Government Printing Office. 76 pp. (Is- National Survey of Professional, Administra- sued periodically.) tive, Technical, and Clerical Pay. Wash- The information contained in this publication is based on a ington:U.S. Government Printing Office. Bureau of Labor Statistics sample survey of proprietary and Published annually since 1960. Average voluntary (nonprofit)nursing homes and related facilitiesin 75 pp. the United States. The nonsupervisory employee categories, full- This publication summarizes the results of the annual salary time and part-time, surveyed as to earnings and supplementary survey of 81 selected occupations in private industry through- benefits were: registered professional nurses; practical nurses, out the United States except Alaska and Hawaii. National, licensedandunlicensed;nursingaides;kitchenhelpers; annual, and monthly mean, median, and middle-range salaries laundry workers; maids and porters; and other nonsupervisory are presented by occupation, and job descriptions are included. employees. This report is useful as a guide for salary administration pur- Data were collected by personal visits to the establishments poses, for general economic analysis, and for comparison among included in the sample. Tabulations of establishment practices occupations. Education and Educational Resources NATIONAL LEAGUE FOR NURSING. DEPARTMENT OF Education for Nursing The Diploma Way. BACCALAUREATE AND HIGHER DEGREE PROGRAMS. Code No. 16-1314.New York: The League. College Education: Key to a Professional Published periodically. Average 40 pp. Career in Nursing. New York: The League. This publication gives general information on requirements, Published annually. Average 15 pp. goals, and features of diploma programs. It contains a State listing of NLN-accredited programs by name, location, and This pamphlet givesgeneral information about collegiate control. For each school listed, it describes admission require- education for nursing. A State listing of senior colleges and ments, educational prerequisites, length of program, affiliations universities that offer baccalaureate programs accredited by the with colleges,living arrangements, and cost to students for National League for Nursing details educational and other tuition and fees. requirements for admission, length of program, living arrangements, clinical experience arrangements, possibility of part-time NATIONAL LEAGUE FOR NURSING. RESEARCH AND study, and the cost of required tuition and fees. DEVELOPMENT. State Approved SchoolsLPN, LVN. New NATIONAL LEAGUE FOR NURSING. DEPARTMENTOF York: The League. Average 75 pp. BACCALAUREATE AND HIGHER DEGREE PROGRAMS. Pub- Master's Education, Route to Opportunities lished annually since 1961. in Modern Nursing. New York: The This yearly list, by State and territories and by name and address of adult education and high school programs fdr League. Published annually. Average 15 licensed practical nurses, gives statistical information on the PP. characteristics of these programs. Included are NLN accredita- This pamphlet gives information about master's degree pro- tion status, administrative control, principal source of financial grams in nursing, with a list of NLN-accredited college and support, age and educational admission requirements, length of university master's programs in nursing. The type of control program, enrollments, admissions, and graduations. State and of each program, admission requirements, curriculum offered, regional summary tables are included. clinical practicum, length of program, tuition and fees, and NATIONAL LEAGUE FOR NURSING.RESEARCH AND living arrangements are described. DEVELOPMENT. NATIONAL LEAGUE FOR NURSING. DEPARTMENT OF State-Approved Schoolsof NursingR.N. DIPLOMA PROGRAMS. New York: The League. Average 100 pp.

17 0 GUIDE TO STATISTICAL DATA 171

Published annually since 1955. Average 1962 were compared with those in 1954 and 1955, the rate of attri- 100 pp. tion appeared to have increased in the baccalaureate programs, and was higher in associate degree (1962 data only) than in This yearly list, by State and territories and by name and diploma programs. Study findings seemed to indicate that as address of baccalaureate, associate degree, and diploma pro- nursing education tends to move toward these two types of grams, givesstatistical information on the characteristics of programs, it will be necessary to have a considerablylarger programs. Included are NLN accreditation status, administrative number of students admitted in order torealize the same control, financial support, admission policies, and the number proportion of graduates as would have come from diploma of enrollments, admissions, and graduations. State and regional programs. summary tables are included. U.S. DEPARTMENT OF HEALTH, EDUCATION, AND NATIONAL LEAGUEFOR NURSING.RESEARCH AND WELFARE. OFFICE OF EDUCATION. DEVELOPMENT. Digest of Educational Statistics. Washing- 1968. The Nurse Career-Pattern Study. Bio- ton :U.S.GovernmentPrintingOffice. graphical Data Reported by Entering Stu- Published annually 1962-67. Average 130 dents, Fall 1965. Pub. 19-1321. New York: The League. 6 pp. PP. This yearly abstract of national and State statistical informa- Statistics are presented in tabular form on the family and tion covers elementary and secondary education, higher educa- environmental backgrounds of students entering a sample of tion, Federal programs of education, and miscellaneous statistics nursing programs, by type of program. Included aresuch related to American education. It contains trend and current items as religion, ethnicity, place of birth, educational attain- data on enrollments, graduations, earned degrees, teachers and ment of parents, occupation of father, and family income. instructional staff, schools and school districts, facilities, reten- NATIONAL LEAGUE FOR NURSING. RESEARCH AND tion rates and educational attainment, income, expenditures, facilities, job opportunities, and research and development. DEVELOPMENT. 1969. The Nurse Career-Pattern Study. Bio- U.S. DEPARTMENT OF HEALTH, EDUCATION, AND graphical Data Reported by Entering Stu- WELFARE. OFFICE OF EDUCATION. dents. Fall 1969. Pub. 19-1364. New Opening Fall Enrollments in Higher Educa- York: The League. 4 pp. tion: Part BInstitutional Data. Wash- Statistical tables give the ethnic background, religion,age, ington: U.S. Government Printing Office. estimated family income, and other biographical data of students Published annually. Average 130 pp. who entered a sample of associate degree, baccalaureate, and diploma programs. This publication, a supplement to Part A, details for the previous yearactualenrollmentsoffirst-timestudentsin NATIONAL LEAGUE FOR NURSING.RESEARCH AND degree credit programs and in occupational programs, by State and institution. Data are also presented by sex of student and STATISTICS SERVICE. full-time or part-time attendance. Nurse-Faculty Census. New York: The League. Published periodically. Average U.S. DEPARTMENT OF HEALTH, EDUCATION, AND 10 pp. WELFARE. OFFICE OF EDUCATION. These census reports contain national data on numbers and Projections of Educational Statistics. Wash- qualifications of nurse faculty members in all nursing education ington: U.S. Gbvernment Printing Office. programs,including number ofunfilled budgeted positions. Published annually since 1964. Average State breakdowns arenot given. Reports are availablefor 68 pp. 1964, Code No. 19-1146, and for 1966, Code No. 19-1231. National statistical projections are made for a 10-year period TATE, BARBARA L. on enrollments, graduates, teachers, and expenditures for ele- 1968. "Rate of Graduation in Schools of Nursing." mentary and secondaryschoolsandinstitutionsof higher International Nursing Review, 15 (4) : 339- education. Projections are based on trends over the preceding 346. 10-year period, and are extrapolated for 10 years into the future.

This report concerns the rate of graduation of students who U.S. DEPARTMENT OF HEALTH, EDUCATION, AND entered a sample of schools of nursing in the fall of 1962. The WELFARE. OFFICE OF EDUCATION. sample included each type of basic nursing education program 1964. Residence and Migration of College Stu- representativeof schools in the Nation, interms of their regionallocation, religiousaffiliation,administrativecontrol, dents, Fall 1963, State and Regional Data. and financial support. When admissions to nursing programs in Higher Education Studies Branch. Di. 172 APPENDIX 3

vision of Statistical Analysis.Washington: uation. Resurvey of Women Graduates U.S. Government Printing Office. 100 pp. Class of 1957. Bulletin 292. Washing- This circular presents summary State and regional data on ton: U.S. Government Printing Office. 54 the residence and migration of college students in the fall of PP. 1963, by level of enrollments and by level and control of in- The findings of a 1964 survey of women graduates of the stitution.Statistical analysisis made for undergraduate and June 1957 graduatingclass of 153 colleges and universities graduate students, for men and women, and for publicly and revealed rising interest of college women in paid employment privately controlled institutions. and continuing education. This report presents statistical data and information on their family status and employment, salaries. U.S. DEPARTMENT OF LABOR. WOMEN'S BUREAU. future employment plans, work history, and occup99onal pat- 1966. College Women Seven Years After Grad- terns. Nurses were included and reported in the survey.

Health Facilities and Services

AMERICAN HOSPITAL ASSOCIATION. between hospitals in amount of care for under and over 65 age Hospitals, Journal of the American Hospital groups. (i) There were wide variations between regions in pay rates for like staff and wide variation in policies regarding Association, Guide Issue, Part 2.Chicago: payment of shift differentials. 7) Data from 40 of the hospitals The Association. Published annually since wereextrapolatedto1,776hospitals of likecharacteristics 1945. Average 650 pp. which indicate annual additional cost for providing care to This controlled data source contains a State list of hospital elderly was $30 mion and $10 million." (From Abstracts ol association members by name, control,type of service, and Hospital Management Studiqs, VI:146-147. June 1970.) number of beds.Itdetailsdata on admissions, occupancy, average daily patient census, expenses, revenue, andassets. NATIONAL COUNCIL FOR HOMEMAKER SERVICES, INC. Accredited extended carefacilities arelisted by name and 1967. Directory of Homemaker-Home Health Aide location, as are professional schools for health personnel and Services. 1966-67. New York: The organizations and agencies in the health field. Council. 181 pp. (Supplemental publi- JACOBS, STANLEY E.; PATCHIN, NAOMI; and ANDER- cations planned.) SON, GLENN L. All known agencies providing homemaker-home health aide 1969. A.H.A. Nursing Activity Study: Project services (direct service only) in the United States are listed. Report. Chicago: American Hospital As- Agencies are arranged alphabetically, by State and city. The sociation. 503 pp. person designated in charge and groups served by each ageno are noted. Sponsoring organizations and members of the N. "Report details a nationwide study of nursing activities in tional Cour-il for Homemaker Services are identified. Three adult medical and/or surgical units in 55 of the nation's short homemalytr registries, members of NCHS, are also included. term general hospitals, conducted by AHA. Work-sampling was conducted on a round the clock basis for 7-12 days in each hospital. Additional data gathered include hospital, patient and U.S.DEPARTMENT OF HEALTH,EDUCATION, AND unit characteristics, staff hours, by category of staff for each WELFARE. PUBLIC HEALTH SERVICE.BUREAU OF unit/day/shift and hourly salary data. All data are converted HEALTH PROFESSIONS EDUCATION AND MANPOWER to magnetic tape and are available to nursing research person- TRAINING. DIVISION OF NURSING. nel. Charts of these data are also included in appendices. Major Services Available for Nursing Care of the findings are: 1) There was an average of 4.39 hours of care tA Sick at Home. PHS. Pub. 1265. Wash- per patient per day. 2) There were no significant differences in hours of care per patient among hospitals grouped by certain ington: U.S. Government Printing Office. characteristics of size, university affiliation and specialization. Published periodically-1959, 1961, 1964. 3)After age 55, hours per care per patient increased sig- 1966. Average 75 pp. nificantly with age. 4) Head nurses and ward clerks provided same amount of care for all age groups, but care per patient This is a report on the distribution of the population by provided by othernuruing personnelincreasedsignificantly State, county, and territory, with available services for nursing from under age 65 group to 65-74 and 75 and over group. care of the sick at home. It also provides information on agency There were no differences in care hours by sex group. 5) Same costs and fees for services, number and types of contracts for amount of nursing care per age group was rendered in both care, size of nursing staff, services provided by paranursing medical and surgical units. There was, however, wide variation personnel, and agencies and personnel providing services. GUIDE TO STATISTICAL DATA 173

U.S.DEPARTMENT OF HEALTH, EDUCATION, AND 1971. Health Care Facilities: Existing and Needed. WELFARE. PUBLIC HEALTH SERVICE. HEALTH SERVICES Hill-13u.rton State Plan Data as of January AND MENTAL HEALTH ADMINISTRATION. 1, 1969. HealthFacilities Series.HSM 1970. Hospitals: A County and Metropolitan Area Pub. 72-4004 (Revised 1971). Washing- Data Book. Data compiled from the 1967 ton: U.S. Government Printing Office. 90 Master Facility Inventory. Reported by PP. the National Center for Health Statistics. This report, which is revised annually, summarizes national PHS Pub. 2043,Sec.1. Washington: and State data on civilian health facilities available and needed U.S. Government Printing Office. 234 pp. in the United States. Statistics are taken from inventory data generated in the development of State plans for hospital and This report contains hospital data at the State, SMSA, and related health.facility construction. Data for the preceding year county levels. The data for the-United States include type of are classified by type of facility,hospital beds per 100,000 ownership, number of beds, occupancy, and admissions. This population, conforming and nonconforming beds in accordance volume is section 1 of a 3.section series containing State and with minimum Federal standards, beds needed, bedstobe county information on health facilities and health professions. added, and beds to be modernized. Trend data are presented U.S.DEPARTMENT OF HEALTH, EDUCATION, AND for some types offacilities.Previous editions (PHS Pub, 930-F.2) have annual summaries, 1948-68, and trend data since WELFARE. PUBLIC HEALTH SERVICE. HEALTH SERVICES 1948. AND MENTAL HEALTH ADMINISTRATION. 1970, Nursing Homes: A County and Metropolitan U.S. DEPAWFMENT OF HEALTH, EDUCATION, AND Area Data Book. Data compiled from the WELFARE. PUBLIC HEALTH SERVICE. HEALTH SERVICES 1967 Master Facility Inventory. Reported AND MENTAL HEALTH ADMINISTRATION. DIVISION OF by the National Center for Health Statistics. INDIAN HEALTH. PHS Pub. 2043,Sec.2. Washington: Indian Health Highlights. Washington : U.S. Government Printing Office, 234 pp, U.S. Government Printing Office. Pub- This report contains nursing home data at the State, SMSA, lished annually since 1960. Average 65 and county levels. The data for the United States include type PP. of ownership, number of beds, number of residents, and number Population, vital statistics, and health service data for the of full-time personnel. 23 Federal Indian Reservation States and Alaska Natives in- U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WEL- elude trends from 1950. Population distribution by age and FARE. PUBLIC HEALTH SERVICE. HEALTH SERVICES sex, family income, and educational levels are analyzed. Birth rates, morbidity for selected causes,mortality, and data on AND MENTAL HEALTH ADMINISTRATION. HEALTH CARE hospital use, health center visits, and home visits are recorded. FACILITIES SERVICE. OFFICE OF PROGRAM PLANMNG AND ANALYSIS. U.S. DEPARTMENT OF HEALTH, EDUCATION, AND 1971 Hill-Burton Prograin Progress Report, July WELFARE. SOCIAL SECURITY ADMINISTRATION. BUREAU 1, 1947June 30, 1970. Health Facilities OF HEALTH INSURANCE. Series. HSM Pub. 72-4005 (Revised 1970). 1968. Directory of Medicare Providers of Services: Washington:U.S.GovernmentPrinting Extended Care Facilities. Title XVIII. Office. 83 pp. Health Insurance for the Aged. Washing- This report, which is revised each year, presents nafional ton: U.S. Government Printing Office.210 and State statistics on the projects that have been approved for pp. (To be reissued as required.) the construction, modernization, and replacement of voluntary nonprofit and other heahh facilities throughout the Nation "This directory is a compilation of the names and addresses of extended care facilities which are participating as providers under the Hill.Burton program. Data cover fiscal years since of services in the Health Insnrance for the Aged Program." the beginning of the program in 1947 and are classified by type And "To facilitate reference, the directory is arrangedin of facility, type of construction, size of community, bed capacity, alphabetical sequence by State; by city within State; and by total cost, and Federal funding. the name of the extended care facility." UNITED STATES DEPARTMENT OF HEALTH, EDUCATION, This directory was prepared to furnish "identifying info', AND WELFARE. PUBLIC HEALTH SERVICE. HEALTH maim regarding theavailability of extendedcareset vicz, covered under Title XVIII of the Social Security Act." By SERVICES AND MENTAL HEALTH ADMINISTRATION. definition, "a provider of services is an extended care facility HEALTH CARE FACILITIES SERVICE. OFFICE OF PRO- which (1) meets certain requirements under the Health Insur- GRAM PLANNING AND ANALYSIS. ance for the Aged Act and (2) has entered into an agreement

i 174 APPENDIX 3 with the Secretary of Health, Education, and Welfare to provide "This directory is a compilation of the names and addresses services to Health Insurance beneficiaries." of hospitals which are participating as providers of services in Similar directories are available for hospitals, home health the Health Insurance for the Aged Program. It was prepared agencies, and independent laboratoriesparticipatingit.the to furnish identifying information regarding the availability of Health Insurance for the Aged Program. hospital services covered underTitle XVIII ofthe Social Security Act." U.S.DEPARTMENT OF HEALTH, EDUCATION, AND The directory is arranged in alphabetical sequence by State; WELFARE. SOCIAL SECURITY ADMINISTRATION. BUREAU by city within the State; and by name of the hospital. OF HEALTH INSURANCE. By definition, a provider of service is "a hospital which (1) 1968.Directory of Medicare Providers of Serv- meets certain requirements under theHealth Insurancefor ices: Home Health Agencies. Title XVIII. the Aged Act and (2) has entered into an agreement with the Secretary of the Department of Health, Education, and Welfare Health Insurance for the Aged. Washing- to provide services to Health Insurance beneficiaries." ton: U.S. Government Printing Office.152 pp. (To be reissued as required.) U.S.DEPARTMENT OF HEALTH, EDUCATION, AND "This directory is a compilation of the names and addresses WELFARE. SOCIAL SECURITY ADMINISTRATION. BUREAU of home health agencies which are participating as prnviders of OF HEALTH INSURANCE. services in the Health Insurance for th: Aged Program. It was 1968. Directory of Medicare Suppliers of Serv- preparedtofurnishidentifyinginformationregardingthe availability of home health agencies covered under Title XVIII ices:IndependentLaboratories. Title of the Social Security Act." XVIII. Health Insurance for the Aged. The agencies are listed in alphabetical order by State; by Washington:U.S.GovernmentPrinting city within the State; and by the name of the home health Office. 146 pp. (To be reissued as re- agency. quired.) A provider of service is defined as "a home health agency which(1)meetscertainrequirements undertheHealth "This directory is a conipilation of the names and addresses Insurance for the Aged Act and(2)has entered into an of independent laboratories which are participating as suppliers agreement with the Secretary of the Department of Health, of services in the Health Insurance for the Aged Program." Education, and Welfare to provide services to Health Insurance Identifying information regarding the availability of independ- beneficiaries." ent laboratory services covered under Title XVIII of the Social Security Act is furnished. U.S.DEPARTMENT OF HEALTH, EDUCATION, AND The directory is arranged "in alphabetical sequence by State; WELFARE. SOCIAL SECURITY ADMINISTRATION. BUREAU by city within State; and by the name of the independent OF HEALTH INSURANCE. laboratory." 1968. Directory of Medicare Providers of Serv- By definition, "a supplier of service is an independent labora- ices: Hospitals. Title XVIII. Health In- tory which (1) meets certain requirements under the Health Insurance for the Aged Act and (2) has received an approval surance for the, Aged. Washington: U.S. from the Secretary of the Department of Health, Education, Government Printing Office.290 pp.(To and Welfare to permit reimbursement for specified laboratory he reissued as required.) tests performed for Health Insurance beneficiaries."

Health Manpower Statistics

AMERICAN COLLEGE OF NURFE-MIDWIFERY. SL:mmary Report of a Survey Conducted by Descriptive Data, Nurse Midwives, U.S.A. the Bureau of Health Manpower, Public New York: The College. Issued period- HealthService,DepartmentofHealth, ically. Average 6 pp. (mimeographed). Education, and Welfare, and the American 1963 and 1968 editions. Hospital Association. Chicago: The As- The distribution of the supply of nurse-midwives, their type sociation. 75 pp. ofpractice,andpositionandeducationalpreparationare This report gives U.S., regional, and State data on the num- briefly described. ber of health personnel in 33 categories employed full-time and part-time in hospitals in April 1966, and the current and most AMERICAN HOSPITAL ASSOCIATION. urgent needs for additional personnel. Utilization characteristics 1967. Manpower Resources in Hospitals-1966. of the responding hospitals are summarized. GUIDE TO STATISTICAL DATA 175

AMERICAN MEDICAL ASSOCIATION. DEPARTMENT OF about nursing education programs are included by type, State SURVEY RESEARCH. distribution, and student admissions, enrollments, and grad. Distribution of Physicians and Hospital Beds nations. Other data pertain to economic security, population, hospital utilization, insurance coverage, and medical expenses. in the United States. Chicago: The As- sociation. Published annually 1963 through AMERICAN NURSES' ASSOCIATION. RESEARCH AND 1965. Average 300 pp. STATISTICS DEPARTMENT. The distribution ofnon-Federalphysicianspracticingin 1969. RN's 1966...An Inventory of Registered regions,States,counties,StandardMetropolitanStatistical Nurses. Prepared by Eleanor D. Marshall Areas(SMSA's) andpotentialSMSA's arcdetailedby and Evelyn B. Moses. New York: The specialty and major professional activity for the United States Association. 50 pp. and its possessions. Summary tables are provided. The State distribution of the Nation's registered nurse supply AMERICAN MEDICAL ASSOCIATION. DEPARTMENT OF as identified in the 1966 Inventory is described, by age, marital SURVEY RESEARCH. status, employment status, highest educational preparation, area Distribution of Physicians, Hospitals,and ofclinical practice, and type ofpositions in hospitals and public health work. Hospital Beds in the United States.Chicago: The Association.Published annually 1966 KNOPF, LUCILLE ; TATE, BARBARA L.; and PATRYLOW, through 1969.Average 200 pp. SARMI. The location, specialty, and functional category or profes- 1970. Fhe Y ears After Graduation. New York: sional activity of doctors of medicine are detailed by regions, National League for Nursing. 76 pp. divisions, States, and counties for the United States and its This is the report of a study that traced the careers of 3,014 possessions. Included also are the number of hospitals and students who entered 117 practical nursing schools in1962. hospital beds,the residentpopulation, and certaingeneral Mailed questionnaires were used to collect data describing the economic characteristics, hy county. The distribution of non- work life of this sample of practical nurses for the first5 Federal physicians practicing in Standard MetropolitanSta- years following graduation front the practical nursing programs. tistical Areas (SMSA's) and potential SMSA's are detailed by Factorsinfluencingworkforceparticipationage,marital specialty and major professional activity for the United States status, personal satisfaction, salary, working conditions, avail- and its possessions. Summary tables are provided. able employment, and interrupted employmentare presented. (NOTE: Previous publications have been less detailed. How. Study findings have resultedin recommendations relating to ever, the American Medical Association has been a source of practical nursing education, employment, and suggested areas information on the location, spedalty, and professional activities for further study. of doctors uf medicine since 1906.) MARSHALL, ELEANOR D., and MOSES, EVELYN B. AMERICAN MEDICAL ASSOCIATION. CENTER FOR 1965. The Nation's Nurses. Inventory of Pro- HEALTH SERVICES RESEARCH AND DEVELOPMENT. fessional Registered Nurses. New York: DEPARTMENT OF SURVEY RESEARCH. AmericanNurses'Association,Research 1971. Distribution of Physicians in the United and Statistics Program. 39 pp. States,1970.Regional,State,County, Metropolitan Areas. Chicago: The As- The State distribution of the Nation's registered nurse supply asidentified inthe 1962 Inventory isdescribed as toage, sociation. 329 pp. marital status, employment status, fields of practice, and types This publication updates data on the distribution of phy- of positions in hospitals and public health work. Data on a sicians in the United States and its possessions for 1970. The special substudy of the educational preparation of nurses in 15 types of data and information contained in this publication are States is included. essentially the same as those formerlyincluded inthe two AMA citations listed above. MARSHALL, ELEANOR D., and MOSES, EVELYN B. 1971. LPN's, 1967, An Inventory of Licensed AMERICAN NURSES' ASSOCIATION. Practical Nurses. Research and Statistics Facts About Nursing. A Statisfical Sum- Department, American Nurses' Association. mary. New York: The Association.Pub- Washington:U.S.GovernmentPrinting lished annually since 1939. Average 250 Office. 105 pp. PP. This 1967 survey by the American Nurses' Association is the Comprehensive statistical information is compiled concerning first one conducted to obtain baseline data on licensed practical nursing personnel inthe United States,itsdistribution by nurses. The methodology used was the same as for the registered kinds, educational background, and employment fields. Data nurse inventories. The data collected from the State Boards of 176 APPENDIX 3

Nursing covered practical nurses with active registrations, those been revised where necessary to discuss new definitions and employed, and those inactive in nursingalso their age, sex, new trends, similarities, differences, and limitations of nurse marital status, field of employment, employment status, basis of manpower surveys, and preliminary effects of legislation on original licenses, and nurse.populationratios. In addition to nurse education and supply. Although the focus of the publica- State data, distributions of i;censed practical nurses were given tion is on the registered nurse, the growth of practical nursing by county and metropolitan areas. County identification was and all nursing personnel who serve patients in hospitals is also made from the mailing address rather than the employment discussed. Projections of registered nurse need and supply, with address. emphasis on the varying factors that affect these determinations, and a discussion of methodology for estimating both are found U.S. DEPARTMENT OF HEALTH, EDUCATION, AND in this edition. Previous editions were published in 1953 and WELFARE. PUI3LIC HEALTH SERVICE. 1966. 1953. Health Manpower Source Book. Section 2. Nursing Personnel. PHS Pub. 263. U.S. DEPARTMENT OF HEALTH,EDUCATION, AND Washington:U.S.GovernmentPrinting WELFARE. PUBLIC HEALTH SERVICE. NATIONAL INSTI- Office. 81 pp. TUTES OF HEALTH. BUREAU OF HEALTH PROFESSIONS EDUCATION AND MANPOWER TRAINING. This source book is a compilation and systematic organization of data from various sources on nursing personnel, prin- 1969. Health Manpower Source Book. Section cipally graduate or registered nurses and practical nurses. Data 20, Manpower Supply and Educational Sta- are presented for States and four geographic regions. Included tisticsforSelectedHealth Occupations: are trends in supply, 1910-1952, their distribution, population 1968. PHS Pub. 263, Sec. 20, Washing- ratio, age, sex, and marital status. Comparative data are given ton: U.S. Government Printing Office.164 for nurses in six fields. The number of schools of nursing, studentadmissions,enrollments,graduationsandstudent- PP. instructorratiosarealsoincluded. For 1951,nurse.patient This publication updates data in Health Manpower Perspec- ratios in hospitals are detailed. tive: 1967 and supplements data in Health Resources Statistics 1968. Statistics on the supply and education of health man- U.S. DEPARTMENT OF HEALTH, EDUCATMN, AND power are presented for the following fields: medicine, oste- WELFARE. PUBLIC HEALTH SERVICE. DIVISION OF opathy,dentistry, optometry, pharmacy, podiatry,veterinary NURSING. medicine, nursing-R.N., dental assisting, dental hygiene, labora- 1966. Health Manpower Source Book. Section tory technology,medical record librarianship, medical technology,occupationaltherapy,physicaltherapy,radiologic 2, Nursing Personnel. PHS Pub. 263, technology, and public health. Trends in supply, their geo- Revised January 1966. Washington: U.S. graphic distribution, ratio of supply to population, and educa- Government Printing Office. 113 pp. tional resources are detailed by States. Projections of supply The second revision of this source book presents trend data are included. by States on registered nurses and practical nurses, including numbers, general distribution, licensure, training, and field of U.S. DEPARTMENT OF HEALTH,EDUCATION, AND practice. Biennial estimates of the registered nurse supply are WELFARE. PUBLIC HEALTH SERVICE. NATIONAL INSTI- included. Each set of tables is preceded by a discussion of TUTES OF HEALTH. BUREAU OF HEALTH PROFESSIONS methods used in making estimates and an evaluation of sources EDUCATION AND MANPOWER TRAINING. and backg/ mind material needed for accurate interpretation of 1970. Health Manpower Source Book. Section the data. 21,AlliedHealthManpower.1950-80. U.S. DEPARTMENT OF HEALTH,EDUCATION, AND PHS Pub. 263, Sec. 21. Washington: U.S. WELFARE. PUI3LIC HEALTH SERVICE. NATIONAL INSTI- Government Printing Office. 107 pp. TUTES OF HEALTH. DIVISION OF NURSING. This report is concerned chiefly with professional, technical, 1969. Health Manpower Source Book.Section 2, and supportive workers in the fields of patient care, public Nursing Personnel. PHS Pub. 263, Re- health, and health research, who engage inactivities that vised 1969. Washington: U.S. Govern- support, complement, or supplement the professional functions of physicians, dentists, registered nurses, and personnel engaged ment Printing Office. 144 pp. in environmental health activities. Allied health manpower and The third revision of this source book contains the most resources are classified by categories for which basic prepara- recent data available in early 1969 for the States and the Nation tion is at least a baccalaureate and those for which it is less on the number, distribution, and characteristicsofnursing than baccalaureate. Data are presented on estimated employ- personnel. Data arealso compiledfor thefour geographic ment in selected fields in 1967, and on personnel requirements legions. In addition to an updating of information contained and projected supply for 1975 and 1980. Trend data as available inprevious editions(e.g., nursing education), the text has on educational programs, students, and graduates cover the

176 GUIDE TO STATISTICAL DATA 177 period 1949.69. The appendix includes an inventory of Federal and biennially beginning in 1960. Aver- programs that support health occupations training, and a dis- age 60 pp. cussion of methods of estimating requirements. This census reports the number of agencies and the number U.S. DEPARTMENT OF HEALTH,EDUCATION, AND of registered nurses and licensed practical nurses employed WELFARE. PUBLIC HEALTH SERVICE. full-time and part-time by official and nonofficial local, State, and national health agencies and boards of education. Data 1966. Occupational Health Nurses. An Initial on the educational preparation of registered nurses and type Survey. Division of Occupational Health. of position are included. PHS Pub. 1470. Washington: U.S. Gov- ernment Printing Office. 146 pp. U.S. DEPARTMENT OF HEALTH,EDUCATION, AND This report presents data from a 1964 questionnaire survey WELFARE. PUBLIC HEALTH SERVICE.DIVISION OF of occupational health nurses identified during the 1962 Inven- PUBLIC HEALTH METHODS and the NATIONAL CENTER tory of Professional Registered Nurses. It provides descriptive FOR HEALTH STATISTICS. data on their characteristics, such as age, marital status, educa- 1965. Location of Manpower in Eight Health Oc- tionalpreparation,previous work experience, and placeof cupations, 1962. Section 19 of Health employment byregions. Characteristics of work places are detailed by type of industry and number of employees, and Manpower Source Book. PHS Pub. 263. include the size of nursing staff, salaries, and type of medical Washington:U.S.GovernmentPrinting and nursing supervision. Statetablesareincludedinthe Office. 167 pp. appendix on the structure of health units in which occupational This source book details the quantitative distribution of the health nurses were employed. 1962 supply by region, State, county, metropolitan areas, Rand- McNally trading areas, and State economic areas. It includes U.S. DEPARTMENT OF HEALTH,EDUCATION, AND data on population distribution, effective buying income, and WELFARE. PUBLIC HEALTHSERVICE.BUREAU OF number of general hospital beds. The eight occupations are: HEALTH MANPOWER. physicians (M.D. and D.O.), dentists, registered nurses, phar- 1967.Health Manpower, Perspective: 1967. PHS macists, sanitarians, sanitary engineers, and veterinarians. Pub. 1667. Washington: U.S. Government Printing Office. 81 pp. U.S. DEPARTMENT OF HEALTH,EDUCATION, AND WELFARE. PUBLIC HEALTH SERVICE.DIVISION OF This report presents a review of present supply, needs, and shortages in health occupations, education, and health services. PUBLIC HEALTH METHODSincooperationwith It details Federal aid now available for educational programs in DIVISION OF DENTAL PUBLIC HEALTH AND RESOURCES the health field, and suggests possible methods of improving and DIVISION OF NURSING. the quantity and quality of health manpower. Statistical tables 1964. Manpower in the 1960's. Section 18 of and graphs, plus a bibliography and other references, support Health Manpower Source Book.P115 Pub. the text. 263.Washington: U.S. Government Print- U.S. DEPARTMENT OF HEALTH,EDUCATION, AND ing Office. 67 pp. WELFARE. PUBLIC HEALTH SERVICE.DIVISION OF This report presents statistical data on the characteristics COMMUNITY HEALTH SERVICES. of health manpower, with particular emphasis on physicians 1967. Local Health Officers: Statistics and Charac- (M.D. and D.O.), dentists, and registered nurses. It includes data on the U.S. civilian labor force by major occupational teristics. PHS Pub. 1636. Washington: groups and their characteristics, 1950 and 1960, andhealth U.S. Government Printing Office. 20 pp. service employees by occupational groups, 1950 and 1960. For Characteristics of medical and nonmedical administrators of physicians, dentists, and registered nurses, itdetails the 1963 localhealth departments in the United States in 1966 are supply and ratio to population by States, educational institu- presented in this publication. State breakdowns are given for tions, trendsin school enrollments and graduates, and the age, educational preparation, tenure, type of health units in projected 1975 supply. which employed, full- and part-time employment and vacancies. U.S. DEPARTMENT OF HEALTH,EDUCATION, AND U.S. DEPARTMENT OF HEALTH,EDUCATION, AND WELFARE. PUBLIC HEALTH SERVICE. HEALTH SERVICES WELFARE, PUBLIC HEALTH SERVICE.DIVISIONOF AND MENTAL HEALTH ADMINISTRATION. NURSING. 1968. Health Resources Statistics Reported From Nurses in PublicHealth. Washington: the National Center for Health Statistics. U.S. Government Printing Office. Annual Health Manpower and Health Facilities, reports 1937 through 1953, report for 1957 1968. PHS Pub.1509, 1968 edition. 178 APPENDIX 3

Washington:U.S.GovernmentPrinting the National Center for Health Statistics, Office. 260 pp. 1970. PHS Pub. 1509,1970 Edition This edition updates to 1968 the 1965 statistical information (Feb.) Washington:U.S. Government in the previous edition and adds statistics on inpatient facilities Printing Office.362 pp.To be published including hospitals, nursing homes, and other inpatient health annually. facilities. This edition updates to 1970 the statistical informationin U.S. DEPARTMENT OF HEALTH, EDUCATION, AND the previous edition(1969)including statistics on inpatient WELFARE. PUBLIC HEALTH SERVICE. HEALTH SERVICES facilitieshospitals, nursing homes, and other inpatient heahh facilities. The first edition, published in 1965, contained heahh AND MENTAL HEALTH ADMINISTRATION. manpower data only. The latest edition includes statistics on 1969. Inventory ofState SurveyorsofHealth outpatient and nonpatient health services. Facilities for Licensure and Certification. Submitted by The Ad Hoc Committee on U.S.DEI'ARTMENT OF HEALTH, EDUCATION, AND Training and Composition of State Agency WELFARE. PUBLIC HEALTH SERVICE. HEALTH SERVICES Personnel. Prepared by Subcommittee on AND MENTAL HEALTH ADMINISTRATION. COMMUNITY Definition and Identification of Surveyors, HEALTH SERVICE. COMMUNITY PROFILE DATA CENTER. QualificationsandFunctions. 37pp. 1969. An Analysis of the Current Status of Se- Available from Community Health Service, lected Health Manpower intheUnited Divisionof Health Resources,Park lawn State and Projections of Additional Re- Building,5600FishersLane,Rockville, quirements.Washington: The Center.72 Md. 20852. pp. (processed). This committee report compiles information obtained bysur- This study presentsstatisticaldata drawn fromexisting vey questionnaire from 49 States and the District of Columbia sources on the distribution by State and region of seven selected onthe functionalprocesses and staffing patterns forState categories of health manpower. Ratios per 100,000 population surveyors for certification and licensing of healthfacilities. are also presented. The manpower categories enumerated in- Data are detailed on the number of surveyors by discipline, cludephysiciansbyspecialty,registerednurses,licensed age, marital status, full- and part-time employment, work ex- practical nurses, laboratory technicians, radiological technicians, perience, supervisory responsibility, and specific survey func- physical therapists, and pharmacists. Most data are for 1966 tions. Data are also included on the salary and educational or later. Data on physician distribution by population size of preparation of surveyors and on inservice training and education metropolitan areas are also included. These data are also found for survey staff. The survey revealed that one-halfof the in a different form in Health Resources Statistics, 1968. surveyors were registered nurses. U.S.DEPARTMENT OF HEALTH,EDUCATION, AND U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE. PUBLIC HEALTH SERVICE. NATIONAL CENTER WELFARE. PUBLIC HEALTH SERVICE. HEALTH SERVICES FOR HEALTH STATISTICS. AND MENTAL HEALTH ADMINISTRATION. 1967. Health Resources Statistics: Health Man- 1971. Health Manpower, A County and Metro- power, 1965. PHS Pub. 1509. Wash- politan Area Data Book. Reported by the ington: U.S. Government Printing Office. National Center For Health Statistics, Di- 182 pp. vision of Health Resources Statistics.PHS Pub. 2044.Washington: U.S. Government This report encompasses 140 health occupations requiring some special education or training to function in the health Printing Office. 164 pp. field. Information and statistics are presented on occupational This report contains data for tbe United States on the dis- duties,currentlaborforce,Statedistribution,employment tribution of pharmacists and registerednurses in1966, phy- trends since 1950, type of practice, educational and licensing re- sicians and dentists in 1967, and podiatrists and veterinarians in quirements, and trends in the number of schools and graduates. 1968, by State, standard metropolitan statistical area (SMSA), county group within State, and county. Data also include the U.S. DEPARTMENT OF HEALTH, EDUCATION, AND distribution of population in 1966, and effective buying income WELFARE. PUBLIC HEALTH SERVICE. NATIONAL INSTI- in 1966 and 1967. TUTE OF MENTAL HEALTH. U.S. DEPARTMENT OF HEALTH,EDUCATION, AND 1965. Mental Health Manpower Current Statistical WELFARE. PUBLIC HEALTH SERVICE. HEALTH SERVICES and Activities Report. No. 7. Selected AND MENTAL HEALTH ADMINISTRATION. CharacteristicsofNursesEmployedin 1971. Health Resources Statistics Reported From Mental Health Establishments, 1963. GUIDE TO STATISTICAL DATA 179

Training and Manpower Resources Branch, U.S. DEPARTMENT OF HEALTH, EDUCATION, AND MentalHealth ManpowerStudiesUnit. WELFARE. PUBLIC HEALTH SERVICE. NATIONAL INSTI- Washington:U.S.GovernmentPrinting TUTE OF MENTAL HEALTH. Office. 8 pp. 1966. Mental Health Manpower Current Statistical This report details data obtained by special questionnaire and Activities Report. No. 10. Profes- on 18,010 nurses reported in the 1962 Inventory of Professional sional Mental Health Personnel Employed in Registered Nurses who were employed in mental health estab. States.Training and Manpower Resources lishments during the period December 1962 through May 1963. Branch, Mental Health Manpower Studies Data are analyzed nationally for age, professional experience Unit. Washington:U.S.Government and affiliation, activities in a typical week, type of employing Printing Office. establishment, and staffing patterns by educational levels. State 27 pp. tables are presented for data on the distribution ofnurses, This report presents a detailed statisticalanalysis of data their sex, and level of educational preparation. onthecharacteristicsofpsychiatrists,psychologists,social workers, and nurses employed in mental health establishments and classified by States. Data on general distribution, age and U.S. DEPARTMENT OF HEALTH, EDUCATION, AND sex, educational attainment, citizenship, andtotal hours em- WELFARE. PUBLIC HEALTH SERVICE. NATIONAL INSTI- ployed was obtained in a nationwide survey conducted in 1963. TUTE OF MENTAL HEALTH. U.S. DEPARTMENT OF HEALTH,EDUCATION, AND 1965. Mental Health Manpower Current Statistical WELFARE. PUBLIC HEALTH SERVICE. NATIONAL INSTI- and Activities Report. No. 8.Survey of TUTES OF HEALTH. BUREAU OF HEALTH PROFESSIONS Mental Health EstablishmentsStaffing Pat- EDUCATION AND MANPOWER TRAINING. DIVISION OF terns and Survey Methodology. Training NURSING. and Manpower Resources Branch, Mental 1970. NursingPersonnelinHospitals,1968. Health Manpower Studies Unit. Washing- Washington:U.S.GovernmentPrinting ton: U.S. Government Printing Office. 12 Office. 372 pp. PP. .This is a report of a survey of nursing manpower inall This report presents findings on staffing patterns bytype hospitals in the United States in May of 1968. Statistical data of employment settingfor personnel employedinthe core without analysis are detailed for 50 States and the District of disciplines of psychiatry, psychology, psychiatric social work, Columbia, and are summarized for the United Statesas a and psychiatric nursing. Data collected in a nationwidesurvey whole. Staffing patterns for registered nurses, practical nurses, conducted in 1963 are analyzed for outpatient clinics and for nursing aides, orderlies, attendants, and clerical personnel are private and public hospitals forthementallyillridthe categorized by full-time and part-time employment, by type of mentally retarded. The report coversthecharacteristicsof position, type and size of hospital, and type of nursing unit or personnel as to age, sex, citizenship, and education, as wellas service. Data on the number of nursing personnel employed in selected work activities and hours employed. non-nursing positions are included.

Population Statistics

U.S. DEPARTMENT OF COMMERCE. BUREAU OF THE U.S. DEPARTMENT OF COMMERCE. BUREAU OF THE CENSUS. CENSUS. Current Population Reports. Series P-25. 1962. U.S. Census of Population: 1960. Census Washington:U.S.GovernmentPrinting Tract Reports. Series PHC (1). Wash- Office. Published periodically. Average ington: U.S. Government Printing Office. 100 pp. Population and housing data from the decennial census are Periodic issues in this series are devoted to:(1)monthly given for 175 tracted areas in the United States and Puerto estimates of the total population of the United States;(2) an- Rico. The reports contain population data classified as to age, nual midyear estimates of thepopulation of the States by race, marital status, ethnic origin, education, school enrollment, broad age groups, and of the United States by age, color, and migration, occupation, income, and certain characteristics of sex;(3)annual estimates of the components of population the nonwhite population. Housing data are classified by tenure. change; and (4) projections of future population of the United color of head of household, number of rooms, bathrooms, units, States. year built, heating, plumbing, number of persons inunit per

t")0 1:1 180 APPENDIX 3 room, and certain characteristics of housing units with nonwhite This report contains selected characteristics of the population household head for selected tracts. from the decennial census according to State economic areas and social and economic data by size of urbanized area and U.S. DEPARTMENT OF COMMERCE. BUREAU OF THE urban place. CENSUS. 1962. U.S. Census of Population: 1960.Charac- U.S. DEPARTMENT OF COMMERCE. BUREAU OF THE teristicsofthe Population. Volume I, CENSUS. Series PC (1). Washington: U.S. Gov- 1966. Americans at Mid-Decade. Series P-23, ernment Printing Office. (Also see 1970 No. 16, Revised. Washington: U.S. Gov- Census when available.) ernment Printing Office. 30 pp. The volume contains population, social, and economic charac- Broad aspects of population change and growth since the teristics from the decennial census. There is a separate report 1960 Census, the geographic distribution of the population, and for 57 areas: one for the United States; each of the 50 States their social and economic characteristics are reported. Included and the District of Columbia, Puerto Rico, Guam, Virgin is information on mobility, the labor force,unemployment, Islands, American Samoa, and the Canal Zone. Population counts family income, educational attainment, and age structure. forStates, counties, and theirurban and rural parts and urbanized areas are given in chapter A. Chapter B gives statistics on age, sex, marital status, color or race, and relationship U.S. DEPARTMENT OF COMMERCE. BUREAU OF THE to head of household. Ethnic origin, migration, income, and CENSUS. employment characteristicsaredetailedinchapter C and 1966. Current Population Reports. Population are cross-classified in chapter D. Estimates. Illustrative Projections of the U.S. DEPARTMENT OF COMMERCE. BUREAU OF THE Population of States: 1970-1985. Series CENSUS. P-25, No. 326, Feb. 7. Washington: U.S. 1962. U.S. Census of Population: 1960. Subject Government Printing Office. 106 pp. Reports. VolumeII,Series PC(2). Washington:U.S.GovernmentPrinting This reportpresentsalternativeseriesofprojectionsof total population of States from 1970 to 1985, taking into account Office. (Also see 1970 Census when avail- data on interstate migration from the 1960 Census as well as able.) the estimated changes in State population that have occurred This volume consists of approximately 40 reports on the since 1960. Projections are given by regions, divisions, and decennial census devoted essentially to detailed cross-classifica- States, and data are shown for broad age groups, sex, and tions for the United States and regions, for such subjects as color, and by quinquennial dates. nationaloriginandrace,fertility,families, maritalstatus, migration, education, employment, unemployment, occupation, U.S.DEPARTMENT OF HEALTH, EDUCATION, AND industry, and income. On some subjects(e.g.,migration), WELFARE. PUBLIC HEALTH SERVICE. HEALTH SERVICES statistics for standard metropolitan statistical areas or States AND MENTAL HEALTH ADMINISTRATION. NATIONAL are given. In addition, there are reports on veterans. The U.S. population overseas and the geographic distribution and charac- CENTER FOR HEALTH STATISTICS. teristics of the institutional population are included. Data f rom the Institutional Population Sur- veys. PHS Pub. 1000, Series 12. Wash- U.S. DEPARTMENT OF COMMERCE. BUREAU OF THE ington: U.S. Government Printing Office. CENSUS. Published periodically. Average 50 pp. 1962. U.S. Census of Population: 1960. Selected Area Reports. Volume III, Series pc (3). This publicationreportsstatistics onthehealth characteristics of persons in institutions and on medical, nursing, and Washington: U.S.GovernmentPrinting personal care received. The data are based on national samples Office. (Also see 1970 Census when avail- of establishments providing medical, nursing, and personal care, able.) and samples of the residents or patients.

Vital and Health Statistics

GROVE, ROBERT D., and HETZEL, ALICE M. Service. National Center for Health Sta- 1968. Vital Statistics Rates in the United States, tistics. PHS Pub. 1677. Washington: 1940-1960. U.S. Department of Health, U.S. Government Printing Office. 881 pp. Education, and Welfare. Public Health Data are brought forward to 1960 and basic mortality and GUIDE TO STATISTICAL DATA 181 natality data found in an earlier report are included, as are Data from the Health Examination Survey. areas not previously covered, such as statistics onlifeex- PHS Pub. 1000, Series 11. Washington: pectancy, marriages, and divorces.Several basic series show U.S. Government Printing Office. Pub- data from its first year of availability. Charts provide graphic descriptions of the trends of selected vital statistics through lished periodically. Average 50 pp. 1960. This publication reports data from direct examination, testing, and measurement of national samples of the population. LINDER, FORREST E., and GROVE, ROBERT D. Two types of reports include: (1) estimates of the medically 1943. Vital Statistics Rates in the United States, defined prevalence of specific diseases in the United States and 1900-1940. U.S. Department of Com- the distribution of the population with respect to physical, andpsychologicalcharacteristics;and (2) Washing- physiological, merce. Bureau of the Census. analysis of relationship among the various measurements with- ton:U.S.GovernmentPrintingOffice. out reference to an explicit finite universe of persons. 1051 pp. U.S. DEPARTMENT OF HEALTH,EDUCATION, AND This volume brings together and summarizes past time trends, WELFARE. PUBLIC HEALTH SERVICE. HEALTH SERVICES 1900.1940, and the1940 statusof important mortality and natality rates. The authors hoped that the vital statistics for AND MENTAL HEALTH ADMINISTRATION. NATIONAL the 40.year period would be an essential aid and guide for CENTER FOR HEALTH STATISTICS. health administrators and social analysts in the decades ahead. Data from the Hospital Discharge Survey. PHS Pub. 1000, Series 13. Wr.shington: U.S.DEPARTMENT OF HEALTH, EDUCATION, AND U.S. Government Printing Office. Period- WELFARE. PUBLIC HEALTH SERVICE. HEALTH SERVICES ically. Average 50 pp. AND MENTAL HEALTH ADMINISTRATION. Vital and Health Statistics. Data from Thispublicationreportsstatisticsrelatingtodischarged the National Health Survey. National patients in short-stay hospitals. Data are based on a sample of Center for Health Statistics. PHS Pub. patient records in a national sample of hospitals. 1000, Series 10. Washington: U.S. Gov- U.S. DEPARTMENT OF HEALTH,EDUCATION, AND ernment Printing Office.Published period- WELFARE. PUBLIC HEALTH SERVICE. HEALTH SERVICES ically. Average 50 pp. AND MENTAL HEALTH ADMINISTRATION. NATIONAL This series reports statistics on illness; accidental injuries; CENTER FOR HEALTH STATISTICS. disability; use of hospital, medical, dental, and other services; Data on Mortality.PHS Pub. 1000, Series and other health-related topics based on data collectedina 20. Washington: U.S. Government Print- continuing national household interview survey. ing Office.Published periodically.Aver- U.S. DEPARTMENT OF HEALTH,EDUCATION, AND age 50 pp. WELFARE. PUBLIC HEALTH SERVICE. HEALTH SERVICES This publication series presents various statistics on mor- AND MENTAL HEALTH ADMINISTRATION. DIVISION OF tality other than as included in monthly and annual reports. INDIAN HEALTH. It includes special analyses by cause of death, age, and other Illness Among Indians. Washington: U.S. demographic variables, as well as geographic and time series analyses. Government Printing Office. Published annually since 1960. Average 20 pp. U.S. DEPARTMENT OF HEALTH,EDUCATION, AND Data on the incidence of communicable diseases, new cases WELFARE. PUBLIC HEALTH SERVICE. HEALTH SERVICES of "notifiable" diseases, and other selected diseases among the AND MENTAL HEALTH ADMINISTRATION. NATIONAL beneficiary population of the Division of Indian Health are CENTER FOR HEALTH STATISTICS. summarized and published each calendar year. Trends over a Data on Natality, Marriage, and Divorce. period of years are analyzed for a number of diseases that are PHS. Pub. 1000, Series 21, Washington: of particular importance among Indians and Alaska Natives. Comparisons are made with data for the general population, U.S. Government Printing Office. Pub- wherever possible. Some ofthe diseases are not reportable lished periodically. Average 50 pp. nationally, however, because of their minor significance in the This series presents various statistics on natality, marriage, population at large. and divorce other than as included in annual or monthly reports. It includes special analyses by demographic variables, U.S.DEPARTMENT OF HEALTH, EDUCATION, AND also geographic and time series analyses and studies of fertility. WELFARE. PUBLIC HEALTH SERVICE. HEALTH SERVICES AND MENTAL HEALTH ADMINISTRATION. NATIONAL U.S. DEPARTMENT OF HEALTH,EDUCATION, AND CENTER FOR HEALTH STATISTICS. WELFARE. PUBLIC HEALTH SERVICE. HEALTH SERVICES 182 APPENDIX 3

AND MENTAL HEALTH ADMINISTRATION. NATIONAL U.S. DEPARTMENTOF HEALTH, EDUCATION, AND CENTER FOR HEALTH STATISTICS. WELFARE. PUBLIC HEALTH SERVICE. HEALTH SERVICES Data from the National Natality and Mor- AND MENTAL HEALTH ADMINISTRATION. CENTER FOR tality Survey. PHS Pub. 1000, Series 22. DISEASE CONTROL. Washington:U.S.GovernmentPrinting Morbidity and Mortality Annual Supplement Office. Published periodically. Average Summary. Atlanta,Ga.:The Center. 50 pp. Published annually. Average 60 pp. This publication series preselas statistics on characteristics The Annual Supplement carries final figures on the reported of births and deaths not available from vital records based on incidence of "notifiable" diseases.Informationis based on sample surveys stemming from these records. Included are such summaries submitted to the Center for Disease Control by the topics as mortality by socioeconomic class, medical experience individualStates through the National Morbidity Reporting in the last year of life, characteristics of pregnancy. System and data collected by the Tuberculosis Program, the Venereal Disease Program, and two surveillance units of the Epidemiology Programthe Neurotropic Viral Disease Unit U.S.DEPARTMENT OF HEALTH, EDUCATION, AND and the Rabies Control Unit. WELFARE. PUBLIC HEALTH SERVICE. NATIONAL CENTER FOR HEALTH STATISTICS. U.S. DEPARTMENTOF HEALTH, EDUCATION, AND VitalStatisticsoftheUnitedStates: WELFARE. SOCIAL SECURITY ADMINISTRATION. OFFICE (Year). Vol. I, Natality. Vol. II, Mor- OF RESEARCH AND STATISTICS. tality, Part A, and Vol. II, Mortality, Part Research and Statistics Health Insurance B. Washington: U.S. Government Print- Statistics. Publication Staff, Washington, ing Office. Published annually. D.C. Published periodically. Average 20 pp. Natalitydatain Volume I concern thebirth ratesand characteristics, localareastatistics, and technical appendix. This brochure highlights data on the recipients, covered Mortality, Part A, in Volume II, has six sections on mortality services, and costs of the health insurance programs admin. asfollows: general,infant,fetal, accident,lifetables, and istered by the Social Security Administration. It includes re- technicalappendix.Mortality,Part B, in Volume II,has ports on special surveys and studies on various aspects of the geographic detail for mortality and mortality data for Puerto programs, and may include State and regional breakdowns in Rico and Virgin Islands (U.S.). data. NI" V' Part 2 - CAREER INCENTIVES : Category Guide to Other Possible Sources of Existing Data Possible source Type of data Comments Recruitment into nursing. councils,Statenursing, boardnurses' student hospital of association, nursing, nurses' association, health association, league career med- for "Candyprograms,formationWritten Stripers," or onand verbal recruitment processes career reports days, and speak- in- activities,such as compilestructuredMay require comprehensive interview survey questionnaire instrument data. toor individualsionalical society and schools. healthauxiliaries, associations, other profes- and educationalactivitiescareerersof bureaus, nursing. counseling, between institutions recruitment healthand coordinatedand literature, schools agencies, SalariesEMPLOYMENT and fringe benefits. CONDITIONS : State hospital association. Data from periodic surveys of mem- Some associations may have trend dry,tirementholidays,berpro hospitalsmeals, grams. and vacations, and insurance may in-service include sick plans, leave,education data laun- re-on data for 5, 10, or more years. districtCommittees nurses' on associations. practice of State and Datafields as fromabove special for various surveys. practice innursingWhen gram,throughbrief groups,are act their usuallyas dataeconomicbargaining andheld information securityas agents confi- pro- for State nurses' associations, State health department. operatedin Datapublic as institutions healthabove for health and agencies; manpower fields or State- dentiaL employees.Commissionfromsurveysmay befiscal statewideor employment division for official data or fromQvil informationgovernment Servicespecial RecruitmentGENERAL pool EDUCATION: for nursing. CategorY State department of education. Possible source Number of male and female high Type of data Tabulations by counties Comments and for publishedgraduatesschoolsectionable graduatesfrom offorreports the future researchdepartment. and or years. mayprojections and be May statisticsavail- beof listedwhenareas byinformationof school.a State may is available be possible and expansion.Resources and plans for school or program licState instruction,tion. department or vocational of education, educa- pub- nical,Master and plans higher for education. secondary, tech- healthelor'snurse,Maycation include programs manpowerassociate programs. firm in degree, planstrainingnursing for and and andpractical bach- otheredu- l3irths,STATISTICS:HEALTH deaths, AND and reportable VITAL illnesses. State health department. countyIncidence or healthand rates regions for State of the and State by specialUsually reportpublished or aseach part year of inthe a form.studies,fromby age, vitalspecial sex,and records. ortabulationsrace. periodic May May be collections, have inclassified data report annual report of the department. Diagnostic,HEALTH treatment, FACILITIES: and rehabilitation centers. State health department. forInventorymedical construction usually and health and part renovationfacilities. of State plan of Hospitals. State hospitalhealth department. association. Division or Numberandlocation,Listings number ownership,of licensedmemberof beds. type hospitals, of service, by hospitals, by sectionmedicaltheandfacilities, responsible facilities. or with licensingfor State authorityplan for construction for hospital and medical of hospital and ofownership, countybeds,for expansion.geographic or typeplanning of savice, distribution areas, number and plansby Category Possible source Type of data Comments Nursing homes and homes for the aged. pitalsState above.) health department. (See Hos- tribution,ofclassificationNumber beds, ownership,of and licensed forplans licensure, homes,forgeographic expansion. bynumber State dis- HEALTH PLANNING FOR State nursing home association. numbertion,Listing ownership, ofof memberbeds, andState homes, type classification, of by service. loca- HealthGEOGRAPHIC information and AREAS: data for health planning. centersHealthdeveloped information for health on State centers or regional or State basis. statistics being gatementDepending dataof the on center,upon population; stage may ofhave vitaldevelop- aggre- and partmentStatisticalSponsorship units of State Health De- or of State centers Comprehensive will vary. HEALTH SERVICES: economicservices,healthhealth manpower;data.financing and and utilization;related socio- statistics; health facilities, knowHealthand whenthe location. centers Planning Agencies are developed should Coverage, duplication, and gaps in services. welfarePlanning councils, groups as stated and above. health and orofPlanning dataservice from documents, agencies, special surveys. annual reports special reports communityformationwelfarePlanningsemble councils fromgroups and groups, servicecompile may and prepare routinelyagencies data special and and as- in- litzltl! and Mental health services. healthorState division departiaentdepartment. of mental of mentalhealth of health State InventoryState plan data for usuallymental health retardation.part of and the the reports, and conduct special studies. Needs and demands for health care and services. Stateconductingcommunitycils,agency, comprehensive health private and projectsaction healthwelfare health program under planning councils, planning Office groups coun- and of healthandneeds,Dataable planned on planningand target needed for, populations, anddocuments, from resources comprehensive mentalhealth avail- facilities, services provided planning.andMay studies have data from special surveys conducted as part of Economic Opportunity. Burton)hospital0E0surveyshealth projects. and and and medical mental planning retardationfacilities documents (Hill- plans, for planning documents. And CategorY 'Sy HospitalNURSE nurses. SUPPLY: State board Possibleof nursing. source Type of data Comments State hospital association. PeriodicasOn to licensure type survey data of hospital. recordsnot on categories classified mayMay notbe be collected tabulated. yearly, and may or medicalbureau,State health or section department. for hospital Division, Y earlypositions,ployedof nursing full- counts as noted and budgeted personnel,and part-time, vacancies.number type of em- Inactive nurses. facilities. and licensurecheckingtained for codes for planningcompliance nurses. purposes or for withabove, Statemain- State board of nursing. latedOn or belicensure in report records; form. may be tabu- Includes data on characteristics State inactive nurse projects. forandSurvey data inactivity,characteristics or reports desire of nurses, on number reasons Availablequestionnairenurses for from years whenis used. agency holding inventory man- of Licensure examinations. State board of nursing. Numberlengthwork, of of need inactivity. first-timefor refresher to return courses, to versity,StateMaypower health he reactivation etc. (1967 State department, nursesthrough project association,State1971). uni- contract. Migration of supply. State board of nursing. ing.nurses,registeredand reexaminations scores, failures, nurses for licensureand State examinationsstand- practical of Mobility of supply. countriesto andorLicensure for in from report data on the Stateslicensureform, for records,on endorsements or from other tabolated maintainYields data licensure. only on nurses who State hospital association. hospitals.stabilitySpecialnurses of and survey data practical personnel on turnove;nurses. in member registered and Possible source Type of data Comments NursesNurses in physicians'in nursing educationoffices. programs. StateState board board of ofnursing. nursing. OnnotOn belicensure licensuretabulated. records; records; may may or or maymay Nurses in private practice. State board of nursing. nurseslectedOnnot licensure yearly.be and tabulated. practical Mayrecords; include nurses. may registered be col- nurses'andHospital registries associations. registries, private registries, approved by State practicalnursingofNumber "sitter" nurse personnel registrants. registrants. Number of registrants registered or auxiliarynurse and Occupational health nurses. department,StateState board division, of nursing. bureau, or sec- health department or State dateMayasOn to licensure placemaintaina list and records; andtype periodically of notemployment. classified up- of occupational health Maymay be not collected be tabulated. yearly and may or tiontional of industrial health. health, or occupa- typepersonnel,numberMaynurses of industrialhave by employed place more establishment.of detailed employment. by category full- and part-time and data on of Practical or vocational nurses. State board of nursing. andnursesorLicensure place in licensed, report of residence.data form,employment on records, on number tabulatedstatus, of Public health nurses. State health department. countyinlicensedInventory public practicalhealth of registered work. nurses Available nurses employed and by and State. May include nuallyMayCensusCompiled be in compiled some States. and tabulated an- of Public Health Nurses.biennially for National healthtechnicians,cludesclinicauxiliary programs. aides, nurses nursing home hearing employed health personnel and aides. screening such In- as in school NURSE SUPPLYContinued Category Possible source Type of data Comments Registered nurses. State boards of nursing. residence.licensed,orLicensure in report employment data form; on records,number of status, place of tabulated nurses tionalfieldANAMay preparation, inventoryinclude dataquestionnaire for from an of practice, position, educa- standardon age, ContinuingNURSING education. EDUCATION: State or constituent league for nurs- 1956-58,National 1962,Inventory 1966, and years 1949, 1951, 1972. years or Stateing. department of education, ex- Schools,inferences, ExtentState location, or specialand types of area, and needs. courses,courses cost. conducted workshops, con- sociation,associations,Nonprofittension division. suchhealth and heart association,as hospital professional and as- needs.Courses offered, attendance, and Financial need and support. Medicaltuberculosis society association. auxniaries. needawards;Number, for financial number of kinds, and amounts requests and of IndividualService clubsschools and of civic nursing. organizations. Same asas above. above, including assistance. scholar- Nurse faculty. State board of nursing. Numbergramships employed sourcesand loans distributed full- from by schools. Federal pro- Scholarships and loans for nursing education. ingState and or Stateconstituent nurses' league for nurs- Sourcesnumberleveltime, ofby ofand educationalbudgetedschool availability, and preparation,type of program,vacancies. and andeligibility part- toSurvey obtain of these schools data. may be required Ilea lth career councils. association. Samefinancialmand,requirements, as above. assistance. and obligations; utilization, and needs forde- Categori State board of nursing. Possible source employmentavailability,State-sponsored andeligibility, nursing payment scholarships,awards, records. and Type of data Comments education.Schools of nursing and programs of nursing State board of nursing. typeNameproved and and levelor location accredited of educational of schoolsby the Board,pro- ap- sitionalprogramsShould have information' on new arrangemems in and schools and planning tran- ing.State or constituent leagues for nurs- quirementsName,facilities.gram, length location, of programs,and admission clinical of schools; type and re- cruitmentMaintainsgramsstage; andalso program and reasons closed updates purposes. forschools closing. list forand repro- Students in nursing education programs. State board of nursing. Admissions,status.fees;length enrollments, and grad- and of programs;national accreditationtuition and andVarious students aspects and of nursing nursing education education needs. programs State or constituent league for nurs- Specialreasons.tritionuations, survey by typeand study of program; data, such of students, number, and at- ing. incentivestion;visors;administrators,as educationalstudent and characteristics; satisfactions. preparationteachers, and careerof super- nurse patterns of nursing educa- DemandOTHER for. HEALT111 MANPOWER : boardsmentState of of employmentemployment education, vocationalservice security, or Statedepart-edu- programs,ningSurveys service, onconducted training,number asof or basishealth education for per- plan- professionalStatecation, hospital or public organizations. association instruction, and or other healthandvacancies,time,sonnel turnover fields. by employed occupational needs for full one title,time or budgeted andmore part replacement, expansion, inTechnical educationalall health and agencies services. professional and institutions personnel employedand their Regional Medical Programs. numberventoriesdataMay from haveemployed for specialprojects the full-timeprogram surveys, for compiling and area including part- or in- Category Possible source Type of data Comments MANPOWERContinuedOTHER HEALTH time, and other charac- inTechnical all health and fields. professional personnel employed medicalProfessional society, dental society, phys- associations such as haveMembersteristics. survey of associationdata on number by State. licensed May position, inTechnical hospitals. and professional personnel employed sociation,iotherapyState hospital pharmacyassociation, association. association. podiatric as- timesonnel,Mayistics,or registered andhave place typepart-time data and of by type byposition, employment,State, category of employment. and of full-fromper- character- needsMay include for additional data on personnel. demands and inTechnical nursing andhomes. professional personnel employed State health department. employedMaypitals.periodic maintain inventory of number surveys full- and of member hos- part-time, by medicaidparticipationforemploymentcategory compliance programs. of personnelas with conditions and place of under medicare part of procedures and Technicalin State-operated and professional institutions personnel and agencies. employed State health department. timetypeNumbervacancies. of position, and category full-time of personnel, and part- employment, and budgeted Estimates.POPULATION: State health department. yearsStatewide between and the countycensus. estimates for eachUsually year. estimated as of July 1 of _UTLIZATION OF HEALTH ernmentsresearchandBureaus departmentsor or State departments universities. of State of business gov- economic development. Also race,includeEstimatesand and counties data of on for mobility. future years. May classification by age, population for State sex, Hospitals,State-operatedFACILITIES nursing institutions homes, AND outpatient and SERVICES agencies. clinics, and : andresponsibledivisionState medical health with for facilities department. planninglicensing and for authority specialty Sectionhospital and or census,missions,reportingMay require length and maintainof stay, clinic data attend-on ad- average or request voluntary daily patient Category departments such as mental health, Possible source ance, etc. Also available from annual Type of data Comments mental retardation, tuberculosis. mandsorspecialdepartments.statistical special for tabulations andhealthstudies Mayservice care of ofhave needs services. reportsservice data and of from de-the data anceOld-age, beneficiaries survivors, and disability, benelit payments. and health insur- SecurityState programs. agency administering Social needsonmayAnnual have for statistical healthdata from services,and special service and surveys reports utili- various aspects of programs, disease,crippledPublic health maternalchildren, and and tuberculosispreventive child health, programs control, school venereal such health. as State health department. charges,service,Casezation rates by admissions typeclinic by oftype and service. of tohome program visits and or service, dis- tabulationsofdepartmenttisticalservice the department. and orand service survey divisions May data.reports have or bureaus specialof the contacts from annual sta- Hospitals.PERSONNEL:UTILIZATION OF NURSING tion,Individual or professional hospitals, hospitalnursing associa-organi- Informationnursing activity regarding studies, and datapatient from clas- Statezations. hospital association. Periodicpitals.studiessification survey conducted in individual hos- studies, or other special data for member May be raw data on questionnaire nursingprofessionalpersonnelpatienthospitals personnel per perday, to technical100 number beds, toof ratiosauxiliary nursing of on nursing hours per eachContentforms period or beof conducted.tabulated.survey may differ for UTILIZATION OF NURSING Category Possible source Type of data Comments PrivatePERSONNELContinued pracgce. nurses'andHospital registries associations. registries, approved private registries,by State categoryandorOn special servicedisposition of reports records, nurse on registrant. service calls received reports, May of calls for each practice.trendsquested,calls,include in the use of nurses in private type of nursing serviceinformationneeds on source of for service, and re- Index

193 Index

[This index covers chapters 1 through 7 only]

Abdellah, Faye G., 68 Bartow, Josephine A., 29 Abstracting data, 65 Benne, Kenneth D., 45, 56 Accreditation Bennis, Warren G., 56 national, 55 Berger, Anne G., 77 program, 3 Better Boards and Committees, 29, 45 Action initiation and planning, 6, 55 Better Patient Care Through Nursing Research, 68 Action-Planning for Community Health Services, Blue Cross Associations, 61 7, 12, 69 Board of Nursing Education and Nurse Registration, 69 Actions, are they achieving purpose?, 55 Brown, Ray E., 12 Administrative codes, modification of, 54 Budgetary requirements estimations, 15 Administrative procedures, important, 44 Budgeted positions and needs assessments, 74 Administrators and planning, 35 Budgets, planning, 39 Adult Education Association of the U.S.A., Building the organizational structure, 13-31 12, 29, 45, 56 Bulletin of the New York Academy of Medicine, Adult Leadership, 29, 30, 45, 46 7, 12, 56 Advisory committee, the, 21 Bullough, Bonnie, 45 Albee, George W., 77 Bullough, Vern, 45 Alternatives to planning, 12 Business administration consultants, 29 American Hospital Association, 7 American Journal of Nursing, 46 American Nurses' Association, 18, 29, 51, 68 California Department of Health, 69 American Psychologist, 77 Career choice and nursing needs, iii Anderson, Betty Jane, 29 Career incentive improvement, 54, 55 Appraisal of nurse supply, 5 Career satisfaction, 66 Area of planning, 40-42 Certification procedures, 41 Areas, emerging, needing study, 56 Change, Collaboration, Community I nvolvement, listing, 16 Changing Job Structure of Health Manpower, The, Arnold, Mary F., 56 46, 78 Assessing needs and resources, 7 Charge of a planning group, example of a, 50 Assessment Chin, Robert, 45, 56 constant, required in many areas, vii Civic groups listed, 36 framework for, 49 Collection of data, importance of adequacy of, 66 how tasks are accomplished, 52 Commercial growth patterns, 6 indices for, 49-50 Committee rules for decision-making, 52 steps in, logical, 49 Committee, single top-level, illustrated, 26 tools of, 51.52 Committee structure in planning, 15, 21 Associations, health professions, list of, 36 variations in, 23 TZ,7 195

4 196 INDEX

Committees systems development, 6 designations of, 22-23 confidential, designated, 68 guidelines for organizing, 35 existing, 63.64, 67 size of, the, 35 accuracy of, 67 Communication definitions used in, 67 see also, Public relations refinement of, 67 organizational structure, and the, 15 timeliness of, 67 planning groups, between, 21 use of, 64 Community groups listed, 36 gaps in, 68 Community Planning for Nursing in the District of information systems in planning, 62 Columbia Metropolitan Area, 64, 69 limitations of, 65, 66, 67 Competition for employment of professionals, 41 original, methods of collecting, 65 Comprehensive Health Care, A Challenge to American predetermining, 62 Communities, 46 procedures for collection of, 68 Comprehensive Health Planning (CHP) program, 64 processing, 39, 62 Concepts in assessing manpower requirements, 73-74 re-evaluating the requirements, 68 Concepts of nursing problems, data and, 51 review of preparatory to planning, 16 Conde-Thillet, Mario L., 45 source books, 43 Conducting Workshops and Institutes, 29 sources in study outline, 18, 19, 20 Confidential data, 68 sources of, 63-66 Conflict of interests, 44 systems for continuous planning, 68 Consultants and resource persons, 29 types required, 62-63 Consultants, use of, 52 Davis, R. C. W., 29 Contracts, employment, for planning staff, 37 Decentralized planning, 41 Cooperative arrangements in factfinding, 62 Decision-making on nursing needs, 49 Coordination with other groups, planning and, 5-6 Decision-making, rules for, 52 Cost data in planning, 54 Demand Cost of planning current, for manpower, 74 see Funding measuring, methods for, 74 Council. illustrated, 27 need in manpower requirement measurements, and. Creamer, Daniel, 77 73 Criteria and standards. assessment tools, 51 projection, methods for measuring, 74 Crude ratios in manpower assessments, 73 ratios, refined, 73, 74 Deniston, 0. L., 56 Design for Statewide Nursing Surveys, iii Data Designations of committees, 22.23 abstracting, 65 Difficulties impeding progress, 44 analysis of, 61, 65 Director of project assessing adequacy of, 66-67 qualifications of, 37 assessment, 65 responsibilities of, 37 assessment tool, an, 51 Discrimination, vi base for planning, a, 51 Discussions, panel, 23 collection, 7, 61, 64 Dissipation of interest of participants, 40 adequacy of, 66.67 Diversity of needs, 53 ad hoc committees and, 61 Division or Nursing, U.S. Public Health Service, iii, 64 methods and the data, 67 Doughman. Gordon 0., 45 observer error in, 67 Duties of project director, 37 planning and, 6 sampling error in, 67 source book in, 61 Economic demand and nursing need, 76

195 INDEX 197

Economic realities of area, 15 Factors affecting nursing, 49 Economics of Health, The, 46 Facts About Nursing, 18, 20, 68 Education Faculty, qualifications of, 55 accreditation, national, 55 Federal financial aid, 54 criteria and standards of, 50 Financial resources and planning, 6 educational materials, use of, 61 Financial support in planning, 12 educators and planning, 35 Financing goals of, 54-55 see Cost data ;. and Funding nursing, iii, 5 Flaws in data collection, the importance of, 66 costs of, 66 Folk, Hugh, 77 effective patterns of, 3 Forecasting Model of Manpower Requirements in the planning for, 3 Health Occupations, A, 77 problems of, 4 Forecasting of Manpower Requirements, The, 78 programs, continuing, 41 Format of reports listed, 43 programs criteria, 51 Formulation of recommendations in planning, 50 programs, establishment of, 11 Fox, David J., 69 programs listed, 55 Functions, Standards and Qualifications, 19 resources, vii, 18 Fundamentals of Research in Nursing, 69 perspective on, necessary, 73 Funding service areas and planning, 40 expenditures for a 2-year planning activity, 39 systems and planning, 6 fund-raising activities, 38 Educational preparation of nurses, 11 project grant, by, 38 Educational Preparation for Nurse Practitioners and planning, and, 21 Assistants to Nurses: A Position Paper, 29 planning project, of, 38-39 Effective Public Relations, 45 prospectus preliminary to, 38 Effective utilization of nursing personnel, 41 sources of, list of, 38 Effective Writing: For Engineers, Managers, Scienasts, Future manpower demand, assessment of, 74 46 Future population projections, 63 Elements of Style, The, 46 Employment conditions, 4 Gaps in data requirements, 68 contracts for planning staff, 37 Geographic planning, 15, 40 opportunities and planning, 6 Georgia Educational Improvement Council, 12 Evaluation of ongoing planning, 21 Gessner Quentin H., 30 Example of a charge given a planning group, 50 Getting and Keeping Members, 45 Executive committee Getting, V. A., 56 composition of, 21 Ginzberg, Eli, 46 functions of, 21-22 Goodell, Frank C., 30 Existing data, 63-64 see also, Data, existing Greenberg, Bernard C., 56 Existing staffing ratios, standards based on, 75 Guidelines for organizing-planning committees., 35 Expenditures for a 2-year planning activity, 39 Gunning, Robert, 46 Expenses, operating, planning, 39 Experience, aggregate, reviewed, 16 Experimentation, planning endorses, 6 Hampton, Leonard A., 30 Harvard Business Review, 78 Health agencies and factfinding, 62 Factfinding, 59-69 Health associations, list of, 36 cooperative arrangements for, 62 Health facilities, staffing, 3 providing for, 61 Health. Manpower 1966-1975, 46 198 INDEX

Health manpower planning J see Planning Job satisfaction improvement, 54 Health Manpower Source Book, 20, 69, 75, 77, 78 Judgment, expert, standards based on, 75 Health needs and nursing, 50 Judgments and decisions Health planning assessment tools, 51 comprehensive, 6 bases for, the, 51.52 in 1970's, vii Health professions, interdependence of, 3 Health programs Keneally, Henry J., Jr., 46 existing, 63 Kissick, William L., 46 shift in emphasis of, 6 Klarman, Herbert E., 46 Health service Knowles, Hulda F., 46 areas and planning, 40 Knowles, Malcolm S., 46 demand for, 63 Health services, deprived areas and, 53 progressive expansion of, 3 Leaders, identification of, 15, 16 Health status of population, 63 Leadership, planning and, 6, 16 Hearings, 15 Lefkowitz, Annie, 46 see also, Public hearings Legislative authorizations, modification of, 54 planning, in, 23 Levine, Eugene, 68 Hilleboe, Herman E., 7, 56 Liaison with other organizations, planning group and, 5 Hink, Douglas L., 56 Licensing codes at State level, 41 Hospital Progress, 78 Licensing of nurses, a data source, 64 Hospitals, 78 Limitations of data in planning, 65, 66, 67.68 Lippitt, Gordon L., 30 Local area planning, 41 Illinois Study Commission on Nursing, 69 Long Range Planning for Higher Education, 30 Implementation of plan, 55-56 Implementation phase, the, 55 Industrial growth patterns, 6 Maki, Dennis R., 77 Information Manpower and transportation, 65 dissemination, planning and, 6-7 assessing requirements for, 71-78 needs assessment, 18, 19, 20 challenges, planning to meet, 3 public, and planning, 39 pool for training, 77 required iplanning, 62-63 requirements, levels of, examples of, 73 Informational materials, use of, 61 requirements, planning and, 6 Initial planning objectives, 4 Manpower Planning Subsystem of the California Health Initiating planning, 9-12 Information for Planning Service (CHIPS) Initiat;on of planning, not automatic, 11 System, The, 69 Innovation in meeting needs, 3 Mass media Instruments for data collection, 67 planning, in, 35 Interest groups and planning, 12 public relations and the, 42 Interests, conflict of, 44 use in planning, 6-7 Interregional planning, 41 Mass transportation andmanpower availability, 65 Interstate mobility of nursing manpower,66 Mayhew, Lewis B., 30 Interviews in planning, 65 Measurement of nursingneeds, 73 Introduction to Group Dynamics, 46 Measuring I ob Vacancies: A Feasibility Study in the I ssues in Nursing, 45 Rochester, N.Y.Area, 77 INDEX 199

Measuring Nursing Resources, iii demand, methods of projecting, 77 Medical Care, 56 Division of, The, iii Medicai College of Virginia, 69 education costs, 66 Medical Times, 56 education goals. 54-55 Medicare and Medicaid influence noted in study out- education resources, iii line. 20 educational attainment of practitioners, 51 Men, Money and Medicine, 46 every area should have plan for, 49 Mental health, 6 factors influencing, 6, 49 Mental health and mental retardation, 40 Nation's health cate system and, iii Mental retardation, 6 needs, planning for see Planning Method, selecting an estimating, 76 nurse supply trends, 53 Methodology conditions affecting, 4 for assessing nursing needs, 76 measurement of, 73 planning activity, of, 22 patient care patterns and, iii planning, 15 program innovation and, iii developing, 15 standards for determining, 76 Methods of Estimating Health Manpower, 78 statistical surveys of, iii Meyer, Burton, 77 wide variations in, 50 Mico, Paul R., 30 personnel Milbank Memorial Fund Quarterly, The, 46 improved utilization of, 19 Minnesota Board of Nursing, 69 quantity and quality of, 54 Morbidity trends, 6 turnover of, 66 Motivation and interest of planning participants and utilization of, 66 long-term assessment, 40 plan for, the, 54 Motivation of participants, 44 planning for, iii Mortality rates in planning, 63 "plans may be no more than hopes," 55 Mountin, Joseph W., 77 practices, appraisal of, 51 Myers, John G., 77 and educationdiscrepancies between. 66 research, 54 schools improvement of, 55 National Commission on Community Health Services. 7, 12, 46, 56, 69 services development highly specialized, 41 National League for Nursing, 7, 69, 75, 78 Nature of planning, the, 1-7 croals 54 Need for planning, recognizing the, 11 improvement grant, 54 Needs, assessing, 47-57 requirements and need measuring, 76 Neighborhood health center programs, 52 socioeconomic environment of, 50 New York Academy of Medicine, 7 specific needs for, 54 Notter, Lucille E., 46 staffing ratios, 51 Nurses, differing types required, 73 supply. estimating future, 77 Nurses for a Growing Nation, 78 various fields of, 50 Nurses in Public Health, 20 Nursing and Health Care in Virginia, 69 Nursing Nursing Clinics of North America, 29 care measurement, 66 Nursing Education in Georgia, 12 career choice and, iii Nursing in Illinois, 69

I. concern, 18, 19, 20 Nursing in Minnesota, 69 concerns, perimeters of, 15 Nursing in Virginia, 12 delineation of the role of. 51 Nursing Research, 77

p 200 INDEX

0 Planners Objectives familiarity with areas of concern, 50 see also, Planning mixture of talent, a, 61 initial, 4 Planning of Change, The, 45, 46, 56 planning, of, 4 Planning refined, 4 acceptance of, 16 Objectivity of recommendations in planning, 21 accommodation of participants, 6 Obstacles in planning, 22 alternatives to, 12 Onthe-job training, 54 appointment of a body for, 11 Operational direction over planning tasks, 22 appreciation of, 16 Organizational forms used in planning, 16 approach to, the, 16 Organizational structuie, building the, 13-31 area differences in, 5 Organizational structure for areawide planning, area of, 40-42 illustrated, 28 assessing needs and developing the plan of action. Organizations, cooperation of, vii 47-57 Organizing assessing requirements for nurse manpower, 71-78 building organizational structure, 17, 13-31 assessment phase, the, 49-50 facets of, many, 15 assessment tasks accomplishment, 52 for planning, 13-31 associated events leading to, 11 framework for, 15 benefits of involvement in, vii strengthening the organizational structure, 33-46 budgetary requirements in, 15, 38 Orientation of participants, 45 budgets examples, 39 Original data and collection, 65 cannot be done in isolation, 5 Ostow, Miriam, 46 change and, vii Outlines, study, 16, 17, 18-20 charge of planning group, examples of a, 50 commitment to inidate, 11 committee organizing guidelines, 35 cornmittee structure in, 15, 21 Panels, 15 committees, establishment of, 16 planning, in. 23 common purposes and goals, 51 Participants concepts in, 3 in planning, 35-37 contracts for staff, 37 information, adequate, for, 45 consultants in, 29 listed, 36 continuity of functions in, 6 orientation of, 45 continuous, 55-56 selection of, the, 35 continuous, data information systems for, 68 Participation in planning, 5 coordination with other groUps essential, 5 Past trends in nurse-manpower supply, 62 cost data in, 54 Patient care patterns affecting nursing needs, iii cost of the, 38-39 council structure in small areas, 23 Patient requirements and manpower need, 76 data. a base for, 51 Patterns of planning areas summarized, 42 data collection and use, 6, 61 Pennell, Elliott H., 77 data processing in, 62 Personnel, nursing data review and, 16 roles of, 3 data types required in, 62-63 interdependence of, 3 decentralized, 41 utilization of, efficient, 5 defined, 3 Phillips, Jeanne S., 69 deliberate process, a, 3 Pilot, Michael, 46 demand and need in assessing requirements, 73 Plan of action, developing the, 47-57 development of plan, 53 INDEX 201

PlanningContinued refined, 4 difficulties, resolution of, 44 short-term, 6 director of project, the, 37 observations in, 65-66 education, programs of, 54-55 organization for, 13.31 essentials of, the, vii organizational mechanisms, 54 evaluation of progress in, 53 organizing planning, 33-46 experience assessment in, 15 panels in, 23 experimentation endorsed in, 6 participants in, 35.37 factfinding, 59-69 list of potential, 36 factfinding phase of, 62 participation in, basic, 5 financial support in, 12 phases of planning process, 7 financing of planners a mixture of talent, 61 see Funding planning groups reports, 76 five-year periods of, 56 previous, 5 funding and, 21 principles and requirements of, 5-7 funding of, 38-39 process of, tabulated, 7 future estimates in, 56 promotional activities and, 11 general purpose of, 4 provisions of groups, 61 goals of action in, 4 public relations in, 42 group, composition of, 5 readiness for, 11-12 health care requirements aid, 3 recommendations in, 52-53 hearings in, 23 reports implementation of, 55-56 planning, 43 influencing factors, 18, 19, 20 popular, 44 information, availability of, 5 special, 44 information dissemination and, 6-7 summary, 43-44 information for planning, 63.66 research and processes for change in nursing, 66 initiation of, 9-12 research as part of, 66 initiative in, the, 3 research in, 66 interregional, 41 salaries of staff, 38 involvement of community leaders in, 12 sanctions and sponsors for, 11 leaders in, identifying, 15, 16 scope and patterns of, 4 leadership and, 6, 16 scope and structure of plan, 53-54 local area, 41 scope of, 4-5 manpower requirements and, 6 selecting a method to estimate requirements, 76 mass media and, 6.7, 55 social activities and, 29 measuring manpower demand, 74 social and health goals and, 3 methodologies, 6 socioeconomic environment, and the, 5 migration rates in and out of planning area,77 socioeconomic framework and, 62 modifications in, 55 sources of data in, 63-66 mortality rates in, 63 special committees in, 22 nature of, the, 1-7 special studies in, 6, 15, 66 need for, recognizing the, 11 staff to administer activities, 36 non-nurse representatives in, 63 staffing patterns, 36-37 no one phase more important, 7 statewide, 40-41 nursing education, for, 3 statisticians in, 61 nursing, for, iii strategy of, 5 objectives, 4 studies with, costs of, 39 initial, 4 study areas listed, 50 long-range, 6 study outlines in, 16, 18, 19, 20 'alto

202 INDEX

PlanningContinued Public relations, 42 success dependence, 35 ;group meetings in, 42 success of, the, 55 policy statements in, 42 summary of planning area patterns, 42 progress reports in, 42 supervision over planning tasks, 21 promotion, 21 support, adequate, 35 public forums in, 4.2 supportive measures, 55 State Governor, visits to, and, 42 techniques, other, 23-29 reports on surveys in, 42 "thinking phase" of, 15 special materials in, 42 timetable determination in, 15 timetable for, 40 variations in, 4-5 Questionnaires in planning, 65 work plan for, 15 workshops in, 29 Policy-making committee, the, 21 Ratio projections, crude and refined, 73 functions of, 21 Readiness for planning, 11-12 Political action often required, 40 Recommendations Politics of Community Health, The, 46, 56 development of, the, 52, 53 Popular reports, 44 nature of, the, 52-53 Population characteristics, 63 priorities of, 53 Population growth, 6 realistic, must be, 52 Power structure in planning area, 15 Recruitment, nursing, 4, 66 Predetermining the data necessary, 62 Recruitment potential, student, 55 Price, Elmina, 46 Reference materials, 45 Principles and requirements of planning process, 5-7 Refined planning objectives, 4 Principles To Guide Development of Statewide Com- Regional Medical Programs, 6 prehensive Health Planning and Protocol for Reliability of data, 67 Health Care Planning Within a State, 7 Report, analytical, preparation of, 50 Priorities for action programs, 21 Reports, 4.3, 44 Priorities in study outlines, 16 Reports of study findings, preparation of, 22 Priorities of recommendations suggested, 53 Resources, deployment to meet changing conditions. vii Proceedings of workshops, 44 Resources Processes for change in nursing programs, 66 exploring the. 49 Professional associations, 41 re-examination of, 56 Professional Nursing: Foundations, Perspectives and wise allocation of, 5 Relationships, 46 Responsibilities, assignment of, 45 Profile of Registered Nurses in California, 69 Research findings application, 54 Program accreditation, 3 Research, nursing, 54 Program-planning techniques, 51 Research in planning, 66 Progress, assessment of, 55 Research, standards based on, 76 Progress in planning, evaluation of, 53 Review of past studies as planning approach, 16 Project cooperation, 5 Rosenthal, Neal H., 46 Project endorsement, 5 Rosenstock, 1. M., 56 Projecting nurse supply, methods of, 77 Promotional activities and planning, 11 Public Health Bulletin No. 305,77 Salaries and fringe benofits, 54, 66 Public Health Reports, 56 Sampling, A Quick, Reliable Guide to Practical Public hearings, 52 Statistics, 69 planning, 23 Sanctions and sponsors for planning, 11 proceedings compilation, 44 Sargent, Edward H., Jr., 30 INDEX 203

Schaefer, Morris, 7, 56 Statewide planning, 40-41 Schools of nursing a data source, 64 Statistical Abstract oj the United States, 69 Scope and patterns of planning, 4 Statistical approach to nursing needs surveys, iii Selection of planning participants, 35 Statisticians and planning studies, 61 Sensitivity of data, 67 Statistics consultants, 29 Service, nursing service programs, 54 Statistics for Nurses: The Evaluation of Quantitative Simultaneous planning for sub-areas or regions, 28 Information, 69 Site visits by committee members, 45 Statistics, potential distortions in, 66 Situations considerations listed, 50 Steering committee, illustrated, 25 Slonim, Morris James, 69 Steps in assessment, 49 Social activities and planning, 29 Streamlining Parliamentary Procedure, 56 Social and health goals, planning related to, 3 Strength of organizational structure and success in Socioeconomic data to be collected continuously, 68 planning, 35 Socioeconomic environment of nursing, 50 Sociocconomic environment, planning and the, 5 Strengthening factors, 44-45 Socioeconomic framework and planning, 62 Strengthening the organizational structure, 15, 33-46 Somers, Anne R., 78 Structure, organizational, building the, 13-31 Source Book for Community Planning for Nursing in Strunk, William, Jr., 46 South Dakota, 64, 69, 74, 77, 78 Student enrollment capabilities, 55 Source book, use of, 61 Student-faculty ratios, 55 Sources of data, identification of, 64-65 Student scholarships, 54 Sources of data in planning, 63-66 Studies Spalding, Eugenia Kennedy, 46 defined, 3 Special committees, planning, in, 22 nursing needs, iii Special reports, 44 special, 66 Special studies in planning, 6, 15 Study areas listed, 50 Special surveys required in study outline, 18. 19, 20 Study of Nursing Service, A, 78 Specialized nursing units listed in study outline, 19 Study outlines Staff for planning, sources of, 37 determination of scope through, 16 Staff to administer planning activities, 36 examples of, 18, 19, 20 Staffing patterns, studies on, 75 Medicare and Medicaid noted in, 20 Staffing standards and manpower needs, 75 preparation, 50 Standards specialized nursing units listed in, 19 comparison of, 51 Summarizing data, 0 criteria, and measuring need on, 74-76 Summary Report, California Health Information for determination of, 51 Planning Service, 69 nursing education, for, 3 Summary reports, 43 State agencies listed, 36 format outlined, 43 State and Regional Medical Program areas, 40 Supplies and equipment in planning, 39 State-Approved Schools of NursingLPN 1 LVN, 18 State-Approved Schools of NursingRIV, 18 Supply, future, estimating, 77 State-Approved Schools of NursingRN, 1971, 69 Surgeon General's Consultant Group on Nursing, 75, 78 State associations, the role of,' 56 Surveys State boards of nursing, 11, 75 defined, 3 a data source, 64 nursing needs, and the community group, 12 State Center for Health Statistics, A, 46, 69 studies and planning, definitions of, 3 State league for nursing, 11 State nurses' associations, 11 State of California Department of Public Health, 69 Takinq Action in the Community, 12, 56 State planning groups, iv Task f,.rce, illustrated, 24

2 204 INDEX

Team nursing, 19 U.S. Department of Health, Education, and Welfare. Technical committees 46, 69, 78 data surveys and, 61 U.S. Department of Labor, 78 planning, in, 22 Utilization of nursing personnel in hospitals, 19 technical staff, and, 23 V Technique of Clear Writing, 46 Thompson, Richard F., 69 Vacancies on nursing staffs, 11 Tichy, H. J., 46 Validity of data, 67 Timetable for planning, 40 \Teri, Clive C., 30 Timetable, preparation of essential, 40 Virginia Governor's Committee on Nursing, 12 Tomorrow's Manpower Needs, 78 Tools of assessment, 51-52 Toward Quality in Nursing, 75, 78 Walker, James W., 78 Traineeships, 54 Watson, Goodwin, 46 Weiss, Jeffrey H., 46, 78 Training courses, short-term, 52 Welch, W., 56 Training facilities and future nurse supply, 77 Welfare organizations, planning and, 5 Transportation and manpower, 65 Western Economics Journal, 77 Travel expenses in planning, 39 White, E. B., 46 Trends in nursing, interpretation of, 55 World Health Organization, 78 Work plan and the project director, 37 Work sheets, details of, 16, 17 Understanding How Groups Work, 45, 56 Workshops, 15, 29 Urban planning, 6 U.S. Department of Commerce, Bureau of the Census. 69 Yett, Donald E., 77, 78

* U.S. GOVERNMENT PRINTING OFFICEt 1972 0-444-999

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