DOCUMENT RESUME ED 246 720 HE-017 298 TITLE \ Nursing and Nursing Education: Public Policies and Private Actions. INSTITUTION Institute of Medicine (NAS), Washington, D.C. REPORT NO \, ISBN-0-309-03346-2 PUB DATE \ 83 NOTE \ 335p. AVAILABLE FROM \National Academy Press, 2101 Constitution Avenue, 14i W Washington DC 20418 ($12.50). ,., r PUB TYPE Reports - Evaluative/Feasibility (142) \, EDRS PRTCE MF01 Plus Postage. PC Not Available from EDRS. DESCRIPTORS *Employment Opportunities.; Employment Projections; Federal Aid; Financial Support; Higher-Education; Labor Needs; *Labor Supply;. Needs Assessment; *Nurses; *Nursing Education; Occupational Surveys; Personnel Policy; *Public Policy ABSTRACT Results are presented of a study of nursing and nursing education that focused on the need for continued federal support of nursing education, ways to attract nurses to medically .underserved areas,-and approaches to encourage nurses to stay in the profession. Findings are presented on whether the aggregate supply of generalist nurses will be sufficient to meet future demand, and how changes that could occur in the health care system' might-affect demand. Attention is also directed to: how the current and future supply/of nurses may be influenced by the costs of nursing education and the sources of education financing; and education for generalist .* --x'positions7in nursing. In addition, the supply and demand situation for nurses educationally prepared for advanced professional positions in nursing is examined'. The influence of employer policies and practices in utilization of nursing resources on demand and supply is also addressed. Finally, areas in which further date and studies are needed to better monitor nursing supply and demand are identified. In addition' to 21 recommendations, appendices include information on. Nursing Training Act appropriations, stete reports on nursing issues, certificates for specialist registered nurses, projections of registered nurse supply and requirements, and doctoral programs in nursing. (SW) *********************************************************************** Reproductions supplied by EDRS are the best that can be made ,from the original document. ********************************************************************** U.S. DEPARTMENTorEDUCATION "PERMISSION TO REPRODUCE NATIONAL INSTITUTE, OF EDUCATION THIS . INFORMATION MATERIAL. IN MICROFICHE ONLY IAEDU TIONAL RESOURCES CENTER (EM) HAS' BEEN GRANTED'SY',' This document has beenreproduced as received from the person ororganization originating it. ri Minor changes have beenmade to...improVo reproductiOn quality. Points of view or opiniansstated in this clocu TO THE EDUCATIONAL RESOURCES' I represent official NIE !..:"; INFORMATION:CENTER (ERIC) ment do not necessarily I position or policy. Nursing and Nursing Education: Public Policies and Private Actions Division of Health Care Services Institute of Medicine. NATIONAL ACADEMY PRESS Washington, D.C.1983 NOTICE: The project that is the subject ofthis report was approved by the Governing Board of the.National Research Council, whose members are drawn from thecouncils of the National Academy of Sciences,the National'Academy of Engineering, and the Instituteof Medicine. The members of the committee responsible for the report werechosen for their special competences and with regardfor appropriate balance. This report has been reviewed by a. groupother than the authors according to procedures approved by a'ReportReview Committee consisting of members of the National Academyof Sciences, the National Academy of Engineeritig, and theInstitute of Medickne. The Institute of Medicinewas chartered0.1970 by the National Academy of Sciences to enlist distinguishedmembers of the appropriate professions in the examination of policy matterspertaining' to.the health of the public. In,this, the Institute acts under boththe Academyte,1863 congressional charter responsibilityto'be an 'adviser to the federal goVernment and its owninitiative, in identifying issues of medical care, research, and education. This study wes,supported by U.S. Departmentof Health and Human Services Contract No. 282-80-0043, T.O.7. Library of Congress Catalog Card Number83-60053 International Standard Book Number 0-309-03346-2 Available from NATIONAL ACADEMY PRESS 2101 Constitution, Avenue, N.W. Washington, D.C. 20418 Printed in the United States or America OOMMITTEE ON NURSING. AND NURSING EDUCATION Arthur E. Hess, Chairman Scholar-in-Residence, Institute of Medicine Washington, D.C. Ira Trail Adams, Dean and Professor, University of Tulsa, College of Nursing, Tulsa, Oklahoma Linda H. Aiken, Vice President for Research, The Robert Wood Johnson Foundation, Princeton, New Jersey Stuart. H. Altman, Dean, The Florence Heller Graduate School for Advanced Studies in Social Welfare, Brandeis University, Waltham, Massachusetts Karen W. Beaver, Director=Professor, Practical Nursing Program, Weber State College, Ogden, Utah Harry J. Bolwell, Chairman and Chief Executive Officer, Midland-Ross Corporation, Cleveland, Ohio Otis R. Bowen, Professor and Director, Undergraduate Family Practice Education, Indiana University Schoolof Medicine, Indianapolis, Indiana Roger J. Bulger, President University of Texas Health Science Center at Houston, Houston, Texas Saul J. Farber Professor and Chairman, Department of Medicine, New York University, New York, New York William C. Fetch, Practicing Internist, Rye, New York Charles D. Flagle, Professor and Head, Division of. Operations Research, Department of Health Services Administration, Johns Hopkins University School of Hygiene and PubliesHealth, Baltiniore, Maryland iii David H. Jeppson, Executive Vice President,Intermountain Health Care, Inc., Salt Lake City, Utah Carol Lockhart, Director, Division of HealthResources, Arizora State Department of Health Services, Phoenix,Arizona Gabrielle D. Martel, Vice President of Nursing, NorthwesternMemorial Hospital, Chicago, Illinois Dorothy J. Novello, Vice President forAcademic Affairs and Dean, 'Le Institute for Nursing, Villa Maria College,ETie, Pennsylvania Virginia L. Olesen, Professor of Sociology, Departmentof Social and Behavioral Sciences, University of California, SanFrancisco, California Edward B. Perrin, Director, Health andPopulation Study Center, Battelle Human Affairs Research Centers, Seattle,Washington Elliott C. Roberts, Sr., Director, Cook CountyHospital, Chicago, Illinois Isabel V. Sawhill, Senior Fellow, Employmentand Lebo,: Policy, The Urban Institute, Washington, D.C. Edyth H. Schoenrich, Associate Dean, JohnsHopkins University School. of Hygiene and Public Health,Baltimore, Maryland Stephen M. Shortell, A.C. BuehlerDistinguished Professor of Hospital and Health Services Management, J.L. KelloggGraduate School of Management, Northwestern University, Evanston,Illindis Judy Solkovits, President, United Teachers--LosAngeles, Los Angeles, California John"D. Thompson, Professor of Public Health andChief, Division of Health Services Administration, YaleUniversity School of Medicine, New Haven, Connecticut Frances D. Tompkins, Director of Nursing,Union Memorial Hospital, Baltimore, Maryland Robert A. Wallhaus,* Deputy Director for Academic and Health Affairs,-Illinois Board of Higher Education,Springfield, Illinois *From April 1981 to January 1982. v Ruby L. Wilson, Dean and Professor, School of Nursing, Duke University, Durham, North Carolina Robert C. Wood,* Director of Urban Studies, Professor of Political Science, University of Massachusetts, Boston, Massachusetts From .Thnuary 1982. INSTITUTE OF MEDICINE Frederick C. Robbins President Study Staff Katharine G. Bauer Study Director and Senior Professional Associate Michael Millman, senior Staff Officer Barbara Smith, Senior Research Associate Julia Bauder, Staff Officer Sunny Yoder, Staff Officer Ilissa Light,,4esearch Associate Deborah Parham,Research Associate Jeisica Townsend, PrOressionalAssociate SandiaM,:Matthews Administrative Assistant Virginia Ingram, Administrative Secretary Patricia King, Administrative Secretary Talitha Shipp, Word Processing Specialist Principal Consultants Eugene Levine Judith Ottoson Margaret D. West Daniel I. Zwick vi Contents PREFACE xv ACKNOWLEDGMENTS xxi SUMMARY AND RECOMMENDATIONS 1 CHAPTER INURSING SERVICES AND NURSING EDUCATION: AN OVERVIEW 24 The Diversity of Registered Nurses'Responsibilities, 24 Variety of Nursing Service Personnel, 26 Variations in Nursing Service Staff Mix, 29 Educati9n for Registered and Practical Nurses, 35 Relation of. Type of Generalist Nurse Education to Licensure and Practice,37,E Debate Over Appropriate Generalist Nurse Education,41 Responsibilities of Advanced Level Nurses, 43 Education for Advanced Level Positions, 44 Federal, State, and. Private Financing of Nurse 'Education, 46 CHAPTER IIMEETING CURRENT AND FUTURE NEEDS FOR NURSES 51 Current Supply and Demand, 52 Future Supply and Demand, 63 Supply of Registered Nurses Educated in the Three Types of Generalist Programs, 77 State and Local Planning for Generalist Nurse Education, 80 CHAPTER IIITHE EFFECTS OF EDUCATION FINANCING ON GENERALIST NURSE SUPPLY 89 Student Decision Making, 90 State and Institutional Decision Making,104 CHAPTER IVEDUCATION FOR GENERAL,:', POSITIONS IN NURSING 116 Attracting New Kinds of Students, 116 Opportunities for Educational Advancement, 119 Collaboration Between Education and Servide, 126 viii CHAPTER VEDUCATION FOR ADVANCED POSITIONS IN NURSING 133 Advanced Education for Nursing.Administration, 133 Advanced Education for Teaching and Research, 135