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Foerst, Helen V.; Gareau, Florence E.Planning for Nu:rsing Needs and Resources.Public Health Service (DHFW), Washington, D.C. Div.of Nursing.DHEW-Pub-NIH-72-87Apr 72204p.Superintendent of Documents, U.S. Government PrintingOffice, Washington, D.C. 20402 (Stock Number1741-0026, $2.00)

EDRS PRICE MF-$0.65 HC-$9.87DESCRIPTORS *Administrative Organization; Diagrams; *Educational

Planning; *Educational Resources; *Manpower Needs;*Nursing; Reference Materials; Reports

ABSTRACTTo aid state and local manpower planning for nursing

needs and resources, this guide presents basic principles andprocedures essential to identifying needs and exanining resourceseffectively. A wide range of resource and annotated reference listspresent survey and study reports, background material, tools forplanning, and a guide to statiatical data. The general nature of theplanning process, initiation of planning, building and strengtheningthe organizational structure, and assessing needs are discussed.Developing a plan of action, data collection, and assessingrequirements for nursing manpower are covered. Diagrams present fiveorganizational structures for planning. This guide was written by twonursing consultants and their director in manpower evaluation andplanning. (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 & WELFAREOFFICE OF EDUCATION

THIS DOCUMENT HAS BEEN REPRO-DUCED EXACTLY AS RECEIVED FROMTHE PERSON OR ORGANIZATION ORIG-INATING IT. POINTS OF VIEW OR OPIN-IONS STATED DO NOT NECESSARILYREPRESENT OFFICIAL OFFICE OF EDU-CATION POSITION OR POLICY.

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This guide to planning for nursing needs andresources has been prepared in the ManpowerEvaluation and Planning Branch of the Division ofNursing by HELEN V. FOERST and FLORENCE E.

GAREAU, Nursing Consultants, principal authors,and Dr. EUGENE LEVINE, Branch Chid, contributingauthor.

Issued April 1972 Washington, D.C.

For sale by the Superintendent of Documents, U.S. GovernmentPrinting Office, Washington, D.C. 20402 Price $2

Stock Number 1741-0028

)

ForewordThis 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 tohelp 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 educationalresources of those States have indeed improved.

The nature of surveys and studies of nursing needs and resources has changedsignificantly from the stereotyped statistical approach of the 1940's and 1950's. Since1960, the objectives, depth, and scope of the studies have become more diversified.The patterns of initiation, the organizational structure, and the methodology havevaried according to locale. These changes reflect growth and development in planningtechniques. They also demonstrate response to the constantly changing nature ofsociety and its profound, yet diverse, effects on the Nation's health care system andthe nature of nursing.

Today, studies of nursing needs and resources are more concerned with thedevelopment of programs of action for meeting needs. Much more information onthe characteristics of the nurse supply and nursing practice has become availablethrough routine inventories, periodic studies, and research findings. Growth in healthfacilities and health manpower as well as changes in patterns of patient care haveraised concern for the utilization of personnel, staffing, quality of nursing service,and the social and economic needs of nurses. Educational opportunities, career choicesfor youth, and changing concepts in education have called attention to the evaluationof nursing education resources. Thus, emphasis in planning has shifted from simplefactfinding and analysis to compiling and interpreting available data, developingmethods 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 ofNursing and its predecessor, Division of Nursing Resources, has been that of aidingStates and local communities in studying nurse manpower needs and resources. TheDivision has assisted not only in conducting initial studies but also in reappraisingnursing needs and resources in a number of States.

In 1949, the U.S. Public Health Service issued a manual entitled MeasuringNursing Resources, to guide State groups in conducting nursing surveys. In 1956,the Public Health Service, through the Division of Nursing Resources, issued Designfor Statewide Nursing Surveys, a guide for States conducting initial surveys orreappraisals of nursing needs and resources. Today, another guide is called forbecause of the urgency for continuous and coordinated planning suited to the vastdifferences in nurse manpower needs among the various regions, States, and localareas, according to their populations and resources.

This new book, Planning lor Nursing Nceds and Resources, prepared in theDivision of Nursing, presents basic guidelines and the elements essential to effectiveplanning for nursing. It is not a blueprint. It does not offer a detailed description ofa 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 changingconditions. Although addressed primarily to the conduct of broad, in-depth planningfor all fields of nursing service, nursing education, and all types of nursing personnelwithin designated geographic areas, the basic guidelines can be applied also to

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 needfor such information. State planning groups and those of other jurisdictions with whomDivision personnel have been issociated have contributed significantly. Their experi-ences in planning efforts have provided the background for the formulation and de-velopment of these guidelines.

JESSIE M. SCOTT

Assistant Surgeon GeneralDirectorDivision of Nursing

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Contents

oreword

Page

hi

List of Figures vi

Introduction vii

Chapter 1. The Nature of Planning 1

Concepts in Planning 3

General Purpose of Planning 4Objectives of Planning 4Scope and Patterns of Planning 4Principles and Requirements of the Planning Process 5

Various Phases of the Planning ProcessReferences

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 40Planning Area 40Public Relations 42Planning Reports 43

Other Strengthening Factors 44References 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

Implementing the Plan 55

References 56

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Page

Chapter 6. Faetfinding 59

Providing for Factfinding 61Determining Data Needed 62Types of Data and Information Required 62Sources of Data and Information for Planning 63Assessing Adequacy of Data and Data-Collection Methods 66Data Information Systems for Continuous Planning 68References 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-makingresponsibili ty 24

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

3 Organizational structure in which a single top-level committee orcommission 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 planningfor sub-areas or regions 28

DISCRIMINATION PROHIBITEDTitle VI of the Civil Rights Act of 1964 states: "Noperson in the United States shall, on the ground of race, color, or national origin, beexcluded from participation in, be denied the benefits of, or he subjected to discriminationunder any program or activity receiving Federal financial assistance." Therefore, planningfor nursing needs and resources, like every program or activity receiving Federal assistancefrom the Department of Health, Education, and Welfare, must be operated in compliancewith this law.

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IntroductionOne 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 urgentproblems of the day and keep pace with changing health care requirements. It attemptsto provide and sustain coordinated health services within the planning area. Thisapproach 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 mostpart, outside of nursing. But it is within nursing that the means for meeting theserequirements must be devised.

It is nursing's responsibility to keep its programs abreast of the expanding fieldsof knowledge. Nursing must provide diversified services and educational programsthat reflect the changing needs of patients for care as well as the educational needs ofpractitioners for rendering patient care. That is why there is a continuous urgencyfor studying nursing needs and finding practical ways to meet those needs. Constant,searching assessment is required in many areasincluding supply and distributionof nurse manpower, educational resources, services, organization, administration,financing, and special problems, as well as the potential of nursing. Equally urgent isthe need, after assessment, to carry out the recommendationsto apply the measuresand develop the programs and resources recommended.

The cooperation of lay, community, and professional organizations is needed inplanning for nursing. The wisdom and knowledge they contribute help greatly indeveloping adequate nursing services, nursing education programs, and personalresources.

Planning for nursing also benefits those who participate in the planning. It pro-vides them an opportunity to share in shaping the course of nursing. Their interestsand resources are brought to bear to develop goals and strategies for nursing serviceand nursing education, to set priorities, to allocate and marshal resources towardobjectives, and to evaluate accomplishments. Their involvement in the planning processalso motivates the participants to influence change and to take action regarding thequestions under study and the planning decisions they helped to make.

In nursing, change comes slowly. The nursing profession needs to develop a fullerappreciation of the benefits of planning. In many cases, hesitancy to plan stems fromthe fact that planning involves change and change disturbs the status quo. Otherobstacles to planning are varying concepts of the planning process and the lack of aspecific pattern that can be applied to all situations and guarantee desired results.

The planning task is large and complex. It requires strong leadership and theunited 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 tothe challenge of developing and implementing new designs for improved nursing care,services, and education.

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Chapmr 1

The Nature of Planning

Chapter 1

The Nature of PlanningPlanning is essentially a deliberate and calculated

process aimed at achieving goals. Health manpowerplanning has as its purpose the achievement of po-tentials in manpower and the maintenance of a balancein recruiting, developing, and utilizing manpower re-sources to meet health care requirements. It is aimedalso at uniting health workers with other professional,lay, and political leadership in developing and promot-ing measures to meet health care requirements inparticular situations and areas.

Planning for nursing, as described in this guide,is specifically related to broad social and health goals,and considers all nursing in prescribed geographicareas as opposed to operational or institutional plan-ning. Implicit in this planning is the need for effectivepatterns of nursing education and nursing service thatwill ensure the progressive expansion and strengthen-ing of health services. Planning for nursing also seeksto develop continuing communication and cooperationbetween the various agencies involved in health andnursing service and educational resources.

For the purpose of this publication, it is advisableto distinguish between the terms "surveys," "studies,"and "planning." The meaning and character of plan-

ning may thus be made more definite. Surveys provideonly for factfinding or a description of the problem.Studies describe and investigate problems and findand recommend solutions. Planning embraces all ofthe characteristics of surveys and studies and, in addi-tion, provides for the application of solutions and theactual resolution of problems.

Planning for nursing is a process in which overallor particular nursing needs are identified and resourcesare examined. First, the nature and scope of needs andresources are defined, related to their influencing fac-tors, and considered as a whole. Then' the meansavailable for meeting needs and augmenting resourcesare interposed, and courses of action are developed toachieve the goals.

When based on experience, knowledge. study, andresearch findings, planning for nursing and otherhealth manpower can reshape health and educationalsystems to meet present and future manpower chal-lenges. Planning's greatest value for nursing, as for allother fields, lies in the opportunity it provides forcontinuing change, experimentation, and innovationin meeting needs.

Concepts in Planning

Significant concepts to he considered in planningfor nursing service, nursing education, and nursemanpower include the following.

The responsibility for taking the initiative inplanning for nursing needs and resources rests withnursing leaders. This includes spearheading and co-ordinating planning at the institutional, local, State,and regional levels.

Planning for nursing needs snd resources is ajoint responsibility of nursing service and nursingeducation. Both have a common goalto determinehow the highest quality of patient care and nursingpractice can be achieved. Each must focus on its ownresponsibility and role.

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The foundation of planning for nursing educationand nursing service is a clear definition of the rolesand functions of nursing personnel.

Planning should be oriented to meet or exceed thegenerally accepted minimal requirements that mayalready exist for program accreditation, eligibility forlicensure, or staffing of health facilities. Standards fornursing practice and nursing education should besupported or, if lacking or inadequate, should bedeveloped.

Planning for nursing recognizes the interdepend-ence of all types of nursing personnel and nursing'srelationships to other health professions and healthmanpower.

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4 CHAPTER 1

General Purpose of Planning

The general purpose of planning for nursing is toeffect areawide, coordinated improvement, expansion,and development in health programs, services, andresources. In addition, planningwhich is future-orientedshould attempt to ensure adaptation to socialchange as requirements dictate.

Planning groups may be established for purposessucix as these:

To develop and implement a long-range plan formeeting the nursing needs of a metropolitan area.

To develop a program of action to improve theutilization of nursing personnel for meeting qualitativeand quantitative needs for health care.

To plan and initiate a State, regional, or area-wide recruitment program in nursing education, tomeet requirements for nursing service.

To develop a State plan for nursing educationthat will identify courses of action and schedules ofactivities for expanding and developing programs tomeet nursing needs.

Objectives of Planning

Objectives are the subsidiary aims of planning orthe intermediate steps, all directed toward achievingthe general purpose or ultimate goal. They are con-sistent and closely interrelated with the particularcircumstances and prevailing conditions in the plan-ning situation. There are initial and refined objectives.Initial objectives help the planning group to under-stand the needs and the factors contribriting to thoseneeds. They are described in terms of the questionsthat planning can be expected to answer and the typeof actions it can hope to accomplish. As planningproceeds, the objectives are refined. They propose indetail how needs can be met and what measures canbe put into effect to accomplish the purpose of plan-ning. In other words, refined objectives are translatedinto recommendations and become the goals of action.

For example, the purpose of one planning groupwas to ensure adequate numbers of nursing personnelto meet health care requirements. The starting pointwas to identify how many nursing personnel wereavailable, how many more were needed, and how theycould be obtained. These were clearly and brieflystated as the initial objectives of the planning group.As study progressed, it was found that poor employ-ment conditions, mobility of p arses, and lack of stu-

;

dent resources in the area were deterrents to acquiringand maintaining an adequate nurse supply. Thus, to

effectively realize the purpose of planning in thisinstance, the finding of feasible answers and the de-veloping of workable programs to overcome thesedeterrents became the refined objectives of planning.

Another example, a planning activity whose purposewas to develop a State plan for nursing education hadthese initial objectives:

To determine the number, kinds, and qualifica-tions of nursing personnel needed for expanding popu-lation and changing health services in the decadeahead.

To identify and assess the problems of nursingeducation as they relate to nursing service and thecontinuing education of nurse practitioners.

To devise means to educate the number andquality of personnel required, whether by establishingnew programs or expanding existing ones, public orprivate.

To formulate a timetable and designate specificinstitutions for expansion and appropriate sites forihe development of new programs.

To improve methods of recruiting and educatingthe most desirable students for nursing in requisitenumbers.

Still other examples of objectives of planning fornursing are. contained in the reports referenced inappendix 1.

Scope and Patterns of Planning

As a continuous process and a many-sided procedure,planning will vary in purpose, subject matter, depth,time, geographic area, and size and characteristics of

organizational structure. The scope of planning de-pends upon whether the planning is to be on a local,State, or regional basis, and whether it is directed to

THE NATURE OF PLANNING 5

special concerns of nursing or to the entire field ofnursing. This determination is usually made in relationto the following:

The dimensions of identified nursing concernsand problems.

The extent and recency of previous planning.The availability of information and data identify-

ing all aspects of nursing concerns and problems.The need for special surveys and studies.The amount of participation and involvement of

interrelated groups required to develop and carry outprojects and programs for meeting needs.

Planning may be primarily concerned with certainaspects of nursing, such as the utilization of nursingpersonnel, nursing education resources, or quantitativeneeds. Specific problems, however, need to be viewedin relation to the total situation. For example, a com-plete appraisal or reappraisal of the nurse supply,

nursing services, and educational resources of a localarea, State, or region may be necessary for the wiseallocation of resources or the develoment of a Stateplan for nursing education. Or special studies in con-junction with a complete reappraisal of nursing needsand resources might best be carried out to determinethe most efficient utilization of nursing personnel.

No single or common pattern is applicable for allplanning. Regional, State, and local areas differ intheir needs, resources, leadership, traditions, socialvalues, and readiness for planning. The strategy ofplanning varies also with the socioeconomic environ-ment in which planning takes place. The best approachand formalized organizational structure for planningare developed in relation to the objectives of the plan-ning activity and are tailored to the resources of theplanning area. Various organizational structures aresuggested in chapter 3.

Principles and Requirements of the Planning Process

The planning process is based on certain funda-mental principles and specific requirements that areknown to be effective. They hold to these generalcriteria: Planning cannot be done in isolation; par-ticipation in planning and involvement in decisions arebasic to obtaining action; and planning builds im-plementation into the process. Planning for nursingincorporates into the process the following basic prin.ciples and requirements.

The planning group includes representatives of theentire spectrum of health interests. Maximum use ismade of talents from all units of government, educa-tion, business, voluntary groups, organized professions,and lay leadership. Participation of agencies or groupsthat relate to nursing and have a potential for con-tributing to the planning process are necessary for:

Objectively identifying and assessing needs.Setting common goals and objectives.Coordinating efforts for developing recommenda-

tions and adequate programs for meeting needs.Influencing action.

The planning group establishes liaison with otherorganizations to obtain endorsement, solicit support,and seek cooperation for the project. A broad spectrumof relationships and liaison needs to be initiated, de-veloped, and maintained with professional societies,

health associations, health care facilities and services,health and welfare organizations, and agencies orinstitutions concerned with nursing education. Theserelationships lead to a mutual awareness and under-standing of current nursing issues and concomitantimplications. They pave the way for direct activitieswith appropriate agencies in required program de-velopment.

Planning must be coordinated with other planningprograms and groups. Planning for the developmentand improvement of nursing service and nursing edu-cation will affect and be affected by the activities ofother planning bodies in the fields of health, education,and welfare. To avoid contradictory planning, effectiveliaison and working relationships must be establishedwith State-designated planning agencies and otherofficial, nonofficial, or ad hoc planning groupsin-cluding areawide, regional, State, or local groups.Coordination of planning with these groups is essential,particularly in respect to the availability and use ofmanpower for staffing planned programs and servicesand for developing coordinated programs for the edu-cation of nurse manpower. Unless goals for nursingare interrelated in the network of other planning forhealth manpower, health facilities, services, and educa-tion, the recommendations may be meaningless andplans of action unattainable. Such groups include:

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6 CHAPTER 1

Hospital and health facility planning.Regional Medical Programs.Mental health.Mental retardation.Health manpower planning in fields other than

nursing.Comprehensive health planning.Vocational and higher education facilities and

resources planning.Urban planning.Other health-rdated programs in social planning

as they emerge and are developed.

Planning has both short-term and long-range ob-jectives and develops recommendations and courses ofaction directed toward steady progress in meetingneeds. Short-term objectives involve urgent needs andthose for which immediate action is necessary andfeasible. Long-range objectives are related to overallneeds toward which action is directed; they encompassthe entire field of nursing and its resources. Long-range goals reflect persistent activity toward findingnew and more effective means for meeting needs,adapting to changing requirements, and applying newknowledge.

Planning relates needs and resources to social andeconomic trends. Practical and realistic planning re-quires an understanding of all the .factors influencingnursing. The demands for and the availability, utiliza-tion, and development of nursing service, nursingeducation facilities, and nurse manpower resources willbe affected by the following:

Trends in population growth, age composition,and mobility patterns.

Patterns of commercial and industrial growth.Employment opportunities.Family and personal income and financial re-

sources.Educational systems, opportunities, and attain-

ment.Morbidity trends and needs for health care.Health care systems and availability of facilities

and services.Resources for financing health care and health

and educational services.Shift in content or emphasis of health, education,

and welfare programs.

Planning requires the collection of adequate dataand the development ol data-collection systems. To

provide a base for analyzing and assessing the charac-teristics of nursing and the extent of its needs andresources, data are required. The development of data-collection systems is essential for continuous evaluation,measurement of change, and projection of future needsand resources.

Planning balances conflicting objectives and securesreasonable consensus among service and educationalagencies as to means for meeting manpower require-ments. Planning requires, stimulates, and developsmutual understanding among various agencies regard-ing their respective roles, responsibilities, and relation-ships to nursing. It fosters readiness to adapt goals andinterests and adjust program operations to attain ob-jectives in conformity with needs for nurse manpowerand an adequate level of health and nursing care. Thisrequires negotiation, compromise, and accommodationamong the participants in planning.

Planning is organized to facilitate the implementingof recommendations in active programs and projectslor meeting objectives. Planning methodologies shouldstrengthen communications and relationships betweenthe broadly representative nursing interests. Involve-ment stimulates cooperative arrangements for develop-ing programs to meet needs. It commits responsibleleadership to find mechanisms for initiating action, andto support and encourage such action.

Planning stresses, stimulates, and endorses experi-mentation, special studies, and research. Research isneeded to test and re-test conceptual models for nursingservice and nursing education and for new understand-ing in the production and use of health manpower.Also, research methodology is required for assemblingand analyzing data, for designing and developingstudies, and for translating research findings intoapplicable skills.

Planning is organized to provide for continuity ofplanning functions. Mechanisms for a continuing eval-uation of progress in implementing recommendationsand plans of action should be provided for in planning.In addition, plans require periodic revision in responseto changes in health and educational services or tochanges in the characteristics and needs of the popula-tion for health and nursing services.

Planning continually disseminates informationthrough mass media to a variety of targets. This pro-vides maximum understanding, participation, and sup-

THE NATURE OF PLANNING

port for nursing among cooperating organizations andindividuals as well as among the lay public, for whomnursing is established. Planning purposes and activities

Various Phases

should be interpreted through personal contacts, pre-sentations before association or group meetings, news-paper articles, and other mass media.

of the Planning Process

The different phases of the planning process areinterdependent and continuous; they frequently over-lap in time and are often not discrete. But for thepurposes of this guide these phases have beenseparated and are discussed as though a plan is totallydeveloped and then implemented. This is not meant toconvey the idea that planning always takes place inrigid and sequential steps. Viewed in phases, the plan-ning process constitutes the following:

Initiating.Organizing: building and strengthening the organi-

zational structure.

Collecting and analyzing data.

Assessing needs and resources.

Developing recommendations.

Developing the plan of action.

Implementing the plan of action.

Evaluating and reviewing progress in implementingand in continuous planning.

No one phase of planning is more important thananother. Each has significance for bringing about theactions needed to solve nursing problems.

References

AMERICAN HOSPITAL ASSOCIATION.

1967. Principles To Guide Development of State-wide Comprehensive Health Planning andProtocol for Health Care Planning Withina State. Leaflet No. S 46. Chicago: TheAssociation. 7 pp.

HILLEBOE, HERMAN E., and SCHAEFER, MORRIS.

1968. "Evaluation in Community Health: RelatingResults to Goals." Bulletin of the NewYork Academy of Medicine, 44 (2) : 140-158 (February).

NATIONAL COMMISSION ON COMMUNITY HEALTHSERVICES.

1967. Action-Planning for Community HealthServices. Report of the Community ActionStudies Project, pp. 17-29. Washington:Public Affairs Press.

1968. The Politics of Community Health. Reportof the Community Action Studies Project.By Ralph W. Conant. Washington: PublicAffairs Press. 136 pp. (See "Conclusions,"pp. 97-105, for definition and essential in-gredients of community health planning.)

NATIONAL LEAGUE FOR NURSING.

1967. Change, Collaboration, Community Involve-ment. A synthesis of views on nursing asseen by the Committee on Perspectives.New York: The League. 12 pp.

NEW YORK ACADEMY OF MEDICINE.

1968. "Planning for Community Health Services:Perspectives for Action." Bulletin of theNew York Academy of Medicine (specialissue), 44 (2) : 83-219 (February).

Chapter 2

Initiating Planning

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10

Chapter 2

Initiating PlanningInitiation of planning for nursing is not an auto-

matic response to a recognized need. Concerns for thesupply of nurses, needs and demands for nurses, theireducational preparation, and the quality of services

they deliverall lead to planning. But various indi-vidual and group contacts and interactions are requiredto cement shared concerns and to bring about a com-mitment to initiate planning.

Recognizing Need for Planning

The need for planning may first be recognized whenconcerns for nursing are highlighted by individuals,agencies, and organizations that contribute to and areaffected by the nurse supply. For example, planningmay be initiated in response to a hospital association'sconcern about an increasing number of vacancies onhospital nursing staffs, or a health department's recog-nition of the unavailability of nursing services inspecific areas, or the need for various health agenciesto provide and ensure nursing services for emerging

programs. Another example, numerous requests to adepartment of higher education to establish additionalnursing education programs may provide the stimulusfor planning for nursing. Or it can be associated withor be an integral part of the development of a masterplan for higher education. Frequently, the need forplanning for nursing is recognized and recommendedby all these groups, and planning is initiated becauseof a series of associated events.

Getting Sanctions and Sponsors

Sanction, sponsors, participants, and means for con-ducting planning must be actively sought. This respon-sibility is often referred to, accepted by, or assumedby a committee of a State nurses' association, a Stateleague for nursing, or both. Or the State board ofnursing or other nursing agencies may be initiallyinvolved. Sometimes an ad hoc committee of variednursing interest groups is established to solicit supportfor planning.

The primary promoters of planningwhoever theyaremay call a meeting with representatives fromcommunity, health, education, and social welfareagencies, to stimulate interest in planning, interpretthe need for planning, and explore possible ways toinitiate planning. These meetings often result in com-

mitted sponsors and the establishment of a core com-mittee to initiate planning.

Or a single organization or agency may spearheador sponsor planning and actively seek co-sponsors.When concerns related to official government and itsdepartments or agencies are highlighted, the backingand support of official groups are sought. Promotionalactivities often result in the appointment of a planningbody or commission by an official agency or branch ofgovernment.

Sponsors and co-sponsors work tofzether to organizefor planning, to get it financed, and i ') see it through.They may work as a core committee or a steeringcommittee. This group is often designated later as theexecutive committee of the fully organized planningactivity.

Assuring Readiness for Planning

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

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12 CHAPTER 2

for planning can he joined into a cohesive organizationto work for a common purpose. Sponsors can build upa readiness for planning by interpreting the needwidely and persuading leaders in political, health, edu-cational, and other professional fields to become in-volved. They begin to formally organize when the needfor planning is recognizedgauged by having com-manded the attention of such a wide base of interestgroups to the point that they want to participate.Readiness coincides with the development of supportand cooperation in various forms.

In other words, planning is ready to begin when:Major health agencies and professional groups

approve the planning by action of their governingboards.

Relationships between interest groups and in-fluential leaders are such that they are willing tocommunicate and cooperate with one another to findand apply solutions for meeting nursing needs andimproving health services.

Groups and individuals are interested and com-mitted to the task.

Responsibility is accepted for securing financialand other types of support and that support is forth-coming.

Alternatives to Planning

When readiness for planning is not evident, surveysor studies of nursing needs and resources should beconsidered as alternatives to planning. Although sur-veys and studies are limited activities in terms oftheir potential for attaining areawide nursing goals,they can develop awareness of the needs of nursingand also help develop readiness for planning.

A data survey and analysis can identify nursing

needs. Survey findings and their implications can bepresented to other community groups and organizationsas a means of achieving a better understanding ofneeds.

A study may be conducted to thoroughly investigatea problem area and discover the particular means formeeting a need. Interpretation of study findings andrecommendations can help win support, and can in-fluence action toward meeting specified nursing needs.

References

ADULT EDUCATION ASSOCIATION OF THE U.S.A.

1955. "Community Apathy" and "From Ideas toAction." Taking Action in the Com-munity. Leadership Pamphlet No. 3, pp.22-31. Washington: The Association.

BROWN, RAY E.

1968. "Problems of tl'az Planning Process." Bul-letin of the New York Academy of Medicine,94 (2) : 107-111 (February).

GEORGIA EDUCATIONAL IMPROVEMENT COUNCIL.

1969. Nursing Education in Georgia, p. 3. By

Pat Malone. Atlanta: The Council.

GOVERNOR'S COMMITTEE ON NURSING. COMMON-

WEALTH OF VIRGINIA.

1969. Nursing in Virginia. Final Report, p. 1.Richmond: The Committee.


1967. Action-Planning lor Community HealthServices. Report of the Community ActionStudies Project, pp. 12, 13, 20-23, and 58.Washington: Public Affairs Press.

Chapter 3

Organizing for Planning: Building the

Orgmizational Structure

PLANNING ACTIVITYCHECKLIST

Seek commonpurposes andobjectives.

CI Identify issuesand concerns.

0 Identify dataand informationneeds and sources.

0 Determineorganizationalstructure.

0 Selectparticipants.

LI Hire or obtainstaff.

111 Assemble and

analyze data.

El Assess needsand resources.

El Develop

recommendations.

El Outline programsand coursesof action.

El Coordinate efforts.

El Take action

El Review andevaluate progress

in meeting needs.

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14

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Chapter 3

Organizing for Planning: Building theOrganizational Structure

Because of the many facets to organizing and theiznportance of describing them in detail, the discussionof this phase of planning has been divided into twochapters. The present chapteron building the or-ganizational structuredeals with the first steps informally organizing for planning. It explains how todetermine planning objectives and the scope of plan-ning, and describes planning methodology includingstudy outlines, and various organizational structuresof committees and councils. It also mentions other

techniques, such as panels, workshops, and hearings.Chapter 4on strengthening the organizational struc-turedeals with staff, other participants to be involved,funding, public relations, and other means for ensuringa sound organization.

The methodology and structural organization to beused in each case are determined largely in relation tothe objectives of planning. They must be tailored tothe unique economic, social, and political realities ofthe area.

Developing Planning Methodology including Study Outlines

First, a stage of reflective and collective thinking bythe group organizing the planning is essential. Duringthe "thinking phase" the group crystallizes the purposeand objectives of planning and decides who is to beinvolved. They also determine what procedures to usefor studying, analyzing, and acting on findings. Asthis work proceeds, it is best to write out insa detailedwork plan the methodology that has been developed.

Work PlanThe work plan gives direction in structuring of plan-

ning and later guides its operation. It provides for astep-by-step determination of: (1) the best approachto planning; (2) the scope of the activity; and (3)the relative emphasis to be placed on the separatephases of factfinding, study, and program develop-ment. Suitable committee structure and membership,staff requirements, and budgetary needs are detailed.

Framework for OrganizingThe development of planning methodology can be

fit into a broad framework from which precise methodsand procedures to be used for a particular planningactivity can be determined. To design and create a

planning mechanism adapted to area conditions andneeds, one must:

Assess planning experience and readiness forplanning.

Outline the perimeters of nursing concerns andrequired actions and set the objectives of planning.

Pinpoint the data and information needs andavailability.

Determine what special studies or surveys may berequired.

Consider and understand the so-called powerstructure in the planning area.

Decide what tasks must be undertaken to assessneeds and resources and to reach planning objectives;decide what procedures are feasible and possible forthe assessment phase, such as committee structure.

Identify leaders and select participants for func-tional tasks.

Determine staff requirements.Determine the geographic planning area.Set a tentative timetable.Estimate budgetary requirements.

This point must be stressed: The organizationalstructure and operation as developed should serve as(1) a channel of communication, (2) a negotiation

15

16 CHAPTER 3

forum, (3) a means of setting common goals to meetneeds, and (4) a springboard for leadership in in-fluencing and stimulating action and developing appro-priate programs to meet needs.

Approach

Early in the organization process, it is necessary toreview and explore current and past surveys, studies,and planning activities for the particular area, thushelping to develop an appropriate approach to plan-ning. Such a review can give initial clues to the area'sstatus, experience, and readiness for planning. It canalso help identify groups and individuals who recognizeresponsibility and assume kadership in planning. Andit can reveal strengths and weaknesses in planningmethodologies as well as initial indications of thescope of required planning activities. This reviewshould assess:

The general appreciation and acceptance of plan-ning.

The organizational forms used for previous plan-ing and the effects on attaining objectives.

The development and aggregate experience ofindividuals and agencies in planning for health serv-ices, facilities, manpower, and educational resources.

The accomplishments in implementing the recom-mendations of previous surveys and appraisals ofnursing needs and resources and special studies.

The recency and relevancy of such surveys andstudies.

The recommendations of surveys or studies stillrelevant but not yet attained.

The scope and sponsorship of current activities inad hoc or continuous planning for nursing.

The trend data, special study data, and back-ground information available through completed andongoing surveys and studies.

Determining Scope and Objectives ThroughUse of Study Outlines

To determine the scope and content of planning, astudy outiine should be set up, including headings todetail: (1) nursing concerns and problems to bestudied; (2) influencing factors that warrant study;(3) data and information needed; (4) existing andpossible sources of data; and (5) special surveys orstudies required. Work sheets with headings arranged

horizontally, as shown on the following page, can behelpful.

It is helpful to identify and list, in the form ofquestions or simple, clear statements, areas that needstudy. The focus should be on major problems relatedto the purpose of planning. Related information anddata needs should be pinpointed. The aggregate knowl-edge of the group should be drawn upon to identifydata sources and indicate where special studies orsurveys may well be required.

The completed outline should be thoroughly screenedto determine those areas that merit study and to ex-clude those that are not essential. Some items, althoughinteresting, may not be strictly relevant to the purposeand objectives of planning. They should be deletedbecause every additional item not actually requiredadds to planning tasks, makes planning more cumber-some and time-consuming, and increases the work ofdata and information collection, analysis, and report-ing. Also, irrelevant items obstruct primary concerns.

When the pressing problems, factors, and situationsrequiring examination have been isolated, they shouldbe grouped into subject categories. Each category is amajor area for study. At this time, study areas shouldalso be scaled and given priorities as to their signifi-cance as short-term or long-range goals. A patternshould develop that will indicate major and minorobjectives.

The completed study outline provides a basis fordetermining planning procedures and the course to befollowed. The number and kinds of study areas identi-fied influence the techniques to be used, such as publichearings and panels; the number and kinds of com-mittees to be established; and the selection of par-ticipants and committee members. Normally, publichearings, panels, or technical committees are developedaround each of the principal subject areas identified.The planning techniques, data requirements, and needsfor special surveys and studies will, in turn, influencestaff and budgetary requirements.

Three examples of study outlines follow. These ex-ampks are not complete outlines; each example detailsonly one item that could be a nursing concern of aplanning group. In a complete study outline, however,all items of nursing concern should be presented. Asitems are added, there will necessarily be some duplica-tion in data requirements, influencing factors, andareas to be assessed.

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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


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 determination

of nursing personnel in the hospital.Appropriate roles of allied health personnel and relationshipEffectiveness of patient care and nursing services.Job descriptions, standards, and staffing patterns.Assigned roles and functions of nursing personnel, by type of

by committees of appropriate roles and functions of each level

to nursing.

personnel and level of position.Number and use of auxiliary and allied health personnel and the effect onExtent of use of ward clerks, ward secretaries, unit managers, messengers,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.

utilization of nurses.et cetera.

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 stud-

ies: 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


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 extendedcare 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 HealthService 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-ning. They are created for specific purposes and aregiven definite assignments relative to the objectives ofthe planning activity. Whatever the objectives, com-mittees are basically organized for advisory, policy-making, executive, and technical functions. Variouscombinations of these functions are often assigned to asingle committee. Committees may be established onan ad hoc or a permanent basis. Fundamentally, theircomposition and responsibilities are as described below.

The Advisory Committee

The advisory committee ensures that planning isdeveloped and carried out to accomplish its basic ob-jectives. Members are chosen to provide a broad back-ground of knowledge, attitudes, and experience. Theyusually represent health, education, nursing, labor,industry, and other vital community interests. Theyalso represent geographic areas and social groups. Theadvisory committee usually exists only to advise anddoes not make policy. Its functions are to:

Provide overall advice and guidance in the plan-ning activity and its development.

Review and evaluate ongoing planning and op-erating functions in relation to the objectives ofplanning.

Assist in setting the purposes of planning and inpinpointing the objectives.

Promote public relations and liaison for carryingout planning and later implementing recommendationsinto action programs.

Promote communication, collaboration, coopera-tion, and coordination among representative groupsrelated to and involved in meeting nursing needs andresources.

Contribute to the understanding and interpreta-tion of findings and the assessment of needs and re-sources, to reflect the total spectrum of health andnursing interests and resources.

Advise on the objectivity, soundness, and feasi-bility of proposed recommendations and programs ofaction.

Advise on setting priorities for action programsand their relative importance in meeting immediateand long-range goals.

The Policy-Making Committee

The policy-making committee is responsible for thetotal planning activity and makes the ultimate decisions.The membership of this group is chosen to include:(1) representatives of the sponsors of planning; (2)individuals responsible for establishing broad healthpolicy; and (3) administrators of total programs inhealth, education, or related fields. The members ofthis committee, by virtue of their positions, can laterimplement and coordinate those plans that are de-veloped. The policy-making committee has the follow-ing functions:

Set the purposes of the study and planningactivity.

Approve policies and organizational structure.Delegate authority for carrying out planning

tasks.

Exercise general supervision over planning tasksand advise on crucial questions inherent in planning.

Promote public relations and liaison as requiredthroughout the study and later in implementing recom-mendations.

Seek means for funding and supporting planningactivities.

Approve all findings, recommendations, and pro-posals for operational activities or action program formeeting needs and resources.

Urge, stimulate, support, and facilitate the imple-menting of recommendations in action programs.

Periodically evaluate the effectiveness of actionand operational programs.

The Executive Committee

The executive committee is responsible for thegeneral operation and coordination of the planningactivity. It may be the original core committee desig-nated to initiate and organize planning, or it may beappointed when the core committee goes out of ex-istence. Members include persons drawn from thesponsoring and cooperating agencies and leaders innursing, medicine, health, education, and civic fields.The chairman of each technical committee is usuallyincluded. Executive committee members often serve onall upper echelon committees. The executive committeehas these functions:

22 CHAPTER 3

Pinpoint and detail the objectives of the studyand planning activity.

Develop the structure, methodology, and workplan for carrying out the planning activity.

Develop the functions of all committees and sub-committees.

Appoint or recommend for appointment membersand chairmen of advisory, policy-making, and technicalcommittees.

Provide general operational direction and super-vision over planning tasks, as follows:

(1) Facilitate the work of committees by:(a) Receiving regular reports from

committees.Considering and advising uponproblems encountered by commit-tees.Coordinating and reconciling inter-committee problems and activities.

(2) Receive, correlate, and reconcile data,projections, and recommendations fromtechnical or ad hoc committees.Recognize gaps in study and planning ac-tivities and make provision for filling thegaps.

(4) Formulate for consideration of the ad-visory and/or policy-making committees:

(a) Issues requiring general policy con-sideration and advisement.

(b) Drafts of recommendations.(c) Proposed plans of action.

(5) Oversee the preparation and distributionof reports of the study findings, recommen-dations, and plans for action.

Stimu!ate and support the implementation of ac-tion programs for meeting needs and resources.

(b)

(c)

(3)

Technical Committees

The major or central task in planning is usuallydelegated to technical committees. These committeesone or severalexamine and analyze specific segmentsof the critical questions under study to which they areassigned, develop recommendations, and propose plansof action. The focus of such committee appointmentsand assignments may be by employment fields, byareas of demonstrated need, by resources, or by otherdesignated areas that support the attainment of overallstudy objectives. The membership of technical com-mittees is chosen to reflect the expertise required for

the particular area of assessment and to effect involve-ment later in terms of implementation. Activated atthe same time or at different times, technical commit-tees are either ad hoc or standing. Subcommittees areoften utilized for particular tasks that contribute tooverall analysis and review. Specifically, technical com-mittees have these functions:

Examine and review trends, the present situation,and conditions in their specific area of study.

Assess all resources in their area of study and theadequacy of resources; also identify gaps and needs.

Determine the criteria and standards in use andrequired for meeting needs in their area of study.

Assess and project current and future quantitativeand qualitative requirements.

Identify obstacles to be overcome in meetingneeds, and suggest ways and means to overcome them.

Formulate initial recommendations for meetingquantitative and qualitative needs for review and ap-proval by upper echelon committees, as directed.

Specify courses of action to be taken to implementthe recommendations.

Make concrete proposals for initiating action pro-grams.

Outline relevant information not available -forwhich investigation may be necessary.

Identify areas needing research for long-rangeplanning.

Prepare an analytic report on their special areaof study, including findings, supporting data and in-formation, recommendations, and courses of actionproposed.

Special Committees

Special committees or subcommittees appointedfor administrative tasks and executive functions areworthy of mention. Their vital assignments are con-cerned with finance, publicity, publications and edit-ing, the recruiting of staff, and the seeking out andnominating of participants in planning. Such arrange-ments ensure essential administrative support, andprovide for more adequate efforts in these spheres ofendeavor.

Committee DesignationsCommittees' names may not literally designate their

functions or echelon of organization. The term "task


force" may be used for the policy-making body forone planning group; for another such group "taskforces" may be the technical committees. (See figures1 and 2.) A "steering committee" may be establishedas an ad hoc body to initiate planning and organizethe activity. Other "steering committees" may haveexecutive functions or policy-making functions or beestablished for coordinating the work of several tech-nical committees.

Variations in Committee StructureAs mentioned, committees may be organized in

various patterns and with various combinations offunctions to facilitate planning. For example, the com-mittee structure of one planning group may providefor: a single top-level committee having combinedadvisory and policy.making functions; an executivecommittee; and three technical committees: (See figure3.) In this instance, the top-level committee advisesand also has the right of ultimate decision. The finalapproval of all recommendations would rest with thisbody. Another example, the .committee structure of aplanning group may provide for: an advisory com-mittee; a top-level committee having both policy.making and executive functions; and two -technicalcommittees with subcommittees or ad hoc committeesin special areas of interest. (See figure 2.) In that

instance, the advisory committee counsels on whatrecommendations are feasible but does not have au-thority to approve them. Recommendations are finallyapproved by the top-level committee having policy.mak;ng and executive functions. Such arrangementsestdolish the planning mechanism that best fits a plan-ning area's leadership resources and yet considersincumbent positions for influencing action.

In planning for small geographic or sparsely popu-lated areas, the combining of advisory, policy-making,and executive functions into one top-level committee(often called a council) provides effective administra-tion, cooperation, and participation for pknning. (Seefigure 4.) When it is possible to hire a large technicalor professional staff, skilled and experienced in specificareas under study, technical committees may not benecessary. Their functions are then vested in tech-nical staff and the advisory committee. Since involve-ment is more limited, this organizational form tendsto be more suitable for conducting surveys and studiesthan for overall planning. (A comparison of surveys,studies, and planning is found on page 3.)

An example of an organizational structure for area-wide planning and planning for sub.areas or regionssimultaneously is shown in figure 5.

Various patterns in which committees may bestructured have been shown in figures 1 to 5. Otherequally effective patterns are possible.

Other Planning Techniques

Various other techniques are used to complementcommittee activities and to examine and appraise sig-nificant areas that need study.

Panels

Panels are usually designed to stimulate as muchopen discussion as possible. Experts on selected panelsubjects are asked to present their varying points ofview on basic issues. In addition, technical staff mayprepare statistical data and a bibliography pertainingto the subject. Panel discussions may extend over a1- or 2-day period. The information presented is oftensummarized and circulated to panel participants forfurther comment and criticism, and then to membersof the planning group for further study and comment.From consideration of panel work, data collected andanalyzed, and deliberations in committee sessions, the

findings and recommendations on critical issuesemerge.

HearingsSome planning groups conduct hearings to solicit

wide participation and broad support in analyzingquestions under study, determining needs, and develop-ing recommendations. Public hearings are usuallyscheduled in different locations in the geographicplanning area. Attendance may be open or restrictedby invitation; the agenda may be prescribed or es .sentially unstructured except for the introduction ofbroad topics. From the comments, advice, and criticismof citizens, of the business community, and of publicagencies, valuable insights and direction are obtained.Public reaction thus guides decision.making and thedevelopment 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


SPONSORING ORGANIZATION(S)

STAFF 1111.01mm STEERING COMMITTEE

Figure 2.Organizational structure in which a steering committee has policy-making and executive re-sponsibilities.

26 CHAPTER 3

RESOURCE PERSONS

PANELS

WORKSHOPS

HEARINGS

PROJECT DIRECTOR

AND OTHER STAIT

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

?3


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 respon-sibilities.

28 CHAPTER 3

SPONSORING ORGANIZATION(S)

CORE COMMITTEE

EXECUTIVE COMMITTEE

, ADVISORY COMMITTEE

SURVEY DIRECTOR

TECHNICAL OR STANDING COMMITTEES

4

COMMITTEES FOR REGIONAL PLANNING

Figure 5.Organizational structure for areawide planning and simultaneous planning for sub-areas orregions.


Workshops

The workshop is another effective procedure forplanning. This metho3 can be used during differentphases of planning to bring together interested partiesto work on particular tasks with the assistance of astaff of experts. For example, workshops have beenheid to: explore specific problems in nursing service,such as the utilization of nursing personnel; developrecommendations and set priorities for action; developguidelines for action in implementing specific recom-mendations.

Standard workshop techniques are used for planningwith: (I) large, general group sessions for presenta-tions by special authorities and for sharing the prod-ucts of work groups; (2) small work groups organizedaround the common interest of a number of partici-pants for a cooperative attack on some aspect of theoverall workshop theme; and (3) social activities andinterchange to encourage thinking together in formaland informal situations.

Workshop attendance depends upon the theme andthe number of people who should be assembled formutual consideration of the overall theme and relatedsubtopics. As attendance and the number of workgroups increase, more pre.planning is required. In a2- or 3-day retreat, ideas can be exchanged, new ideasgenerated, problems explored under skillful leadership,and consensus reached concerning steps that need tobe taken to solve particular problems. Intensive workon the solution of problems, however, requires longerperiods of time.

The greatest values of the workshop are these: theinsights gained on the issues and concerns under dis-cussion that assist in making decisions and recommen.dations; the changes in attitudes on the part ofparticipants; and the encouragement afforded par-ticipants to accept responsibility for implementingsome of the ideas growing out of the workshop ex-perience.

Consultants and Resource PersonsPlanning groups make various arrangements for the

use of consultants and resource persons to supplementtheir aggregat: talents and capabilities. Frequentlystaff or committees may require consultation servicesfrom professionals or specialists not represented in thetotal planning group. For example, consultants instatistics, research methodology, business administra.tion, or the social sciences may be required in de.veloping planning processess, work techniques, andprocedures or special studies. Also, committees findthat resource persons or experts from the varioushealth, education, and social welfare fields are helpfulin obtaining additional insight in clarifying issues andimplications of trends. Or specialists may contribute tounderstanding in particular areas under study whereprecise data, information, or experience are lacking.

Consultation may be arranged with resources in theplanning area such as universities, departments ofState government, private practitioners, and profes-sional associations. Or formal arrangements with aregional, State, or national level agency may be inorder.

References

ADULT EDUCATION ASSOCIATION OF THE U.S.A.1956. Conducting Workshops and institutes.

Leadership Pamphlet No. 9. Washington:The Association. 48 pp.

1957. Better Boards and Committees. Leader-ship Pamphlet ,No. 14, pp. 21.48. Wash-ington: The Association.

AMERICAN NURSES' ASSOCIATION.

1965. Educational Preparation for Nurse Prac-titioners and Assistants to Nurses: APosition Paper. New York: The Associa-tion. 16 pp.

ANDERSON, BETTY JANE.

1970. "Orderly Transfer of Procedural Responsi-bilities from Medical to Nursing Practice."Nursing Clinics of North America, 5 (2) :311.319 (June).

BARTOW, JOSEPHINE A.

1965. "What Is a Leader?" Adult Leadership, 13(8) : 245.246, 264-265 (February).

DAVIS, R. C. W.1966. "How To Prepare a Press Release." Adult

Leadership, 15 (6): 209-210 (December).

30 CHAPTER 3

GESSNER, QUENTIN H.

1969. "Planning Educational Conferences." AdultLeadership, 18 (2) : 45-46, 65-66 (June).

GOODELL, FRANK C.

1969. "A Program Planning Checklist for theMeeting Planner." Adult Leadership, 18(6) : 180 (December).

HAMPTON, LEONARD A.

1967. "Democratic Leadership: A PhilosophicalApproach." Adult Leadership, 16 (3) :95-98 (September).

LIPPITT, GORDON L.

1968. "Multiple Roles of the Meeting Planner."Adult Leadership, 17 (4) : 158-160, 187-189(October).

MAYHEW, LEWIS B.1969. Long Range Planning for Higher Educa-

tion. Washington: The Academy for Edu-cational Development, Inc. 221 pp.

MICO, PAUL R.1965. "Community Self-Study: Is There a Method

to the Madness?" Adult Leadership, 13(9) : 288-292 (March).

SARGENT, EDWARD H., JR.

1966, "Ground Rules for Group Process." AdultLeadership, 15 (4) : 122 and 145 (Octo-ber).

VERI, CLIVE C.1968. "How To Write a Proposal and Get It

Funded." Adult Leadership, 16 (9) :318-20, 343 (March).

i

1

ORGANIZING: BUILDING ORGANIZATIONAL STRUCTURE

Planning techniques

Technique Pattern ofparticipation Use

Committees

Consultants andresource persons

Hearings

Lectures,films,slides

Panels

High degree ofparticipation

among membersfor pooling of ideasand knowledge inorder to arrive atgroup decisions.

Participation withstaff, committees,

in panels,workshops, orother capacityas required .

Citizen

participation

To administer andoperate the

planning activityand assess needs

and resources in

specified areas.

To contribute under-standing, insight, &knowledge in areaswhere data, infor-mation or exper-ience is lacking .

To solicit public

reaction for

guiding decision-making and toobtain public

support .

Systematic

presentation ofknowledge

followed byquestion-and-

answer periodfor clarification .

41To inform public,

lay, andprofessional

groups of needfor, purposes of,

and activitiesof planning.

Stimulating opend iscussion,

soliciting differentpoints of view,and stimulating

analysis .

To analyze andassess critical

issues by selected

participants .

WorkshopsFull participation

of large groupsthrough small

clusters of

participants .

To explore andinvestigate

special problemsand issues with

experts andstimulate actionand leadership

on part ofparticipants .

31

Chapter 4

Organizing for Planning: Strengthening theOrganizational Structure

I

(0)

cv,

Chapter 4

Organizing for Planning: Strengthening the

Organizational Structure

The success of planning depends primarily on thestrength of the organizational structure; that is, on:(1) the participants chosen for the planning group;(2) the staff who guides planning activities; (3) ade-quate support; (4) a geographic base appropriate to

the magnitude of the planning problem; (5) clearlydefined roles, functions, and responsibilities of par-ticipants and staff to allow for teamwork; and (6) theuse of mass media to interpret and publicize theactivities and findings of the planning group.

Participants in Planning

There is no specific pattern for the composition ofa planning group nor an exact formula for selectingcommittee members, staff, consultants, and resourcepersons. The main consideration is that persons whocan be helpful in attaining the objectives should beinvolved. Also representatives of major opposing in-terest groups should be included even though they,through position or influence, could impede progressin planning. Only by including such opposition candifferences regarding the concerns of planning beresolved.

Members of the planning group should have knowl-edge in the areas under study, skills related to plan-ning processes, and talents in planning procedures.The mix of members should include:

Representatives of agencies and groups who havea major interest in nursing and in the specific problemunder study.

Leaders in health, education, and related fieldswho have comprehensive knowledge of services, pro-grams, and requirements.

Persons who are in positions to influence actionsand who can work for change in administration, serv-ices, programs, or legislation, as may be required.

Persons who can contribute considerable insight,judgment, and creativity to assessing needs and provid-ing the means for meeting those needs.

Persons who can interpret planning purposes,findings, and recommendations, and disseminate suchinformation to the community.

Selecting ParticipantsPersons to serve in specific capacities and on par-ticular.committees for planning should be carefully

selected. For example, to effect change in nursingservice administration, persons in hospital administra-tion should be selected. To identify educational trendsand philosophies and help design a plan for nursingeducation, educators can help. To obtain funds andmodify and develop legislative programs, legislatorsshould be selected.

Broad guidelines often proposed for organizingcommittees and advisory groups and selecting mem-bers specify that: (1) all participants be officiallyappointed by the planning body; (2) membership berequested and confirmed in writing; (3) official rep-resentatives of organizations be nominated by theorganizations concerned; and (4) the size of commit-tees be restricted. The number of members consideredreasonable for technical and executive committees isfrom five to 10, with a maximum of 12; for policy-making and advisory committees, 15 to 30. Experiencehas shown that as the size of the committees increases,group effectiveness decreases. The scheduling of meet-ings becomes more difficult and discussion more com-plicated.

Potential Participants in PlanningThe following list may be helpful in deciding upon

the representation or mix needed:

35

36 CHAPTER 3

Health profession organizations:Nursing organizations:

State nurses' association.State league for nursing.State board of nursing.Occupational health nurse groups.Practical nurses' association.School nurses' associatinn.Other State organizations for professional,

technical, and other nursing personnel.Medical society.Dental society.

Official State agencies:Agency administering planning, construction, and

licensing of hospitals and nursing homes.Comprehensive health planning agency.Department of education (vocational, secondary,

and higher education).State health department.State department or office of rehabilitation.State department of mental health or mental

health planning council or agency.State legislature.State department of welfare.State department of labor.

Other health, welfare, and social organizations:Hospital association.Mental health association.Cancer Society.Heart association.Tuberculosis and respiratory disease association.Red Cross.Health insurance agencies.Health careers council.

Civic groups:Rotary, Lions, Kiwanis, and similar clubs.Urban kagues.Health councils.Councils of social agencies.Veterans' groups and auxiliaries.Federated women's clubs.Parentteacher associations.Women's medical auxiliaries.

General community groups:Industry (management and labor).Farm groups or bureau.Press, radio, and television.Religious institutions and auxiliary groups.Leading influential citizens who represent con-

sumers of health and nursing services.

h 9'I- I..)

Minority groups.Citizens at large.

Organizations and projects for coordinated health,welfare, social planning, and related programs:

Areawide planning councils.Regional Medical Programs.Hospital planning councils.Special health, education, and community action

programs spnnsored under Office of EconomicOpportunity and Area Redevelopment.

Housing and Urban Development (HUD).Metropolitan area planning councils.

Representatives chosen by health discipline, servicefield, or type of health and educational facilities:

Director of nursing service.Director of school of nursing.Director of inservice education or continuing edu-

cation program.Inactive nurse.Counselor.Representatives of fields of nursing, such as hos-

pital, nursing home, public health, mentalhealth, occupational health, school health,private duty, physician's office, nursing educa-tion, clinical specialty, and research.

Physician.Anesthetist.Representative of general education.Social scientist or psychologist.Social worker.Other allied health workers.Representatives of other special study groups on

health services or health manpower.

Staff To Administer Planning ActivitiesThe importance of an adequate and skilled staff to

administer and guide planning activities cannot beoverestimated. Usually, the staff consists of a projectdirector, professional or technical assistants, clerks,and typists. The size and requirements of the staffdepend, of course, upon the depth and scope of plan-ning, and vary during the different phases of planning.

Staffing Patterns

The demanding work of coordinating the variousplanning tasks and directing and supporting committeeactivities requires, as the minimum, a full-time projectdirector and a secretary. For most areawide planningas, for example, statewide and metropolitan area

ORGANIZING: STRENGTHENING ORGANIZATIONAL STRUCTURE 37

planningan assistant project director, research as-sociate, or administrative assistant is also employed.If multiple committees are appointed, part-time staffassistants are usually provided. They are responsiblefor administering the work of single committees, andrender technical assistance to the committee chairmenand members. During peak workloads, as when sur-veys or special studies are conducted and reports areprepared, additional typing and clerical assistance is

often needed.

The staff may include also personnel of cooperatingorganizations and agencies, and consultants and re-source persons as required.

All personnel, regardless of the particular staffingarrangements, should have written employment con-tracts.

Sources of Staff

Staff members are usually recruited from withintheplanning area. Nurses, nursing organizations, sponsors,and participating agencies often know and can recom-mend qualified persons for staff positions. This type ofrecruitingthrough personal and agency contactsis most often successful.

Cooperating agencies may contribute the full- orpart-time services of professional or technical staff forvarious tasks. A wide range of competencies is foundamong staff members of university faculties, healthdepartments, other departments of State government,health and welfare agencies and councils, other plan-ning bodies, and health and professional associations.These agencies often lend staff members to serve asfull-time project directors or as technical assistants,consultants, and resource persons. They can makesizable contributions in collecting and analyzing nurs-ing information and supporting data and in conductingspecial studies. En addition, they can help to establishidentity and provide a stable base for continuingplanning activities.

Qualifications of Project Director

The project director should have executive ability,administrative skill, ability to work with groups andcommittees, knowledge of community resources andneeds, and experience in community organization. It isdesirablealthough less importantthat the project

director have a background in research and experiencein conducting surveys, studies, and planning.

A question frequently asked is whether the projectdirector should be a nurse. Often a person havingexperience in social research methods in a relatedhealth and welfare field is chosen. In such cases, theft non-nurse" project director should be given the op-portunity to acquire background knowledge aboutnursing and to understand fully all aspects of theproposed planning activity. In addition, guidance fromnursing should be made readily available to the projectdirector in interpreting nursing matters and drawingimplications for nursing from data collected.

Duties and Responsibilities of Project Directorand Staff

The project director is charged with the overallmanagement of planning, and is most often directlyresponsible to the executive committee and the chair-man of the planning body. The duties and responsibili-ties of this crucial position, whether totally assumedby one individual or partially delegated to associatesand assistants, include the following:

Prepare, in cooperation with the executive com-mittee, the work plan for conducting the planningactivity.

Obtain and provide data and information re-quired as a basis for assessing needs and resourcesand developing plans of action.

Direct and supervise office management andplanning staff.

Guide, counsel, and assist in coordinating theactivities of standing, technical, and ad hoc com-mittees.

Prepare minutes of committee meetings; also re-ports of surveys, studies, findings, recommendations,and publications on planning activities.

Follow through on the suggestions and recom-mendations of the planning body for conducting thestudy as so delegated.

Perform assignments related to continuous plan-ning and the implementing of action programs tomeet needs.

Tbe assumption of these functions is necessarilyinfluenced by the point in time of hire of the projectdirector and other staff. Often the project director ishired after the work plan has already been developed.

38 CHAPTER 4

Funding

Every planning group faces the problem of securingfunds for its project, and most of the financing has tobe found within the planning area itself. The abilityof planning groups to attract capital depends largelyon the soundness of the endeavor. Planning projectsmust compete with other investment needs within thearea and with those of potential donors.

Various sources can be tapped to support healthplanning, surveys, studies, and research that cannotbe financed adequately under existing public andprivate health programs.

Where To Look for FundsFunding for planning activities for nursing needs

and resources may come from many private and publicsources and various combinations of these sources.Financial support emanates from and through thoseinterested in or intrinsically involved in the planningactivity, such as:

Professional associations.Voluntary health agencies and associations.Government agencies and departments in health,

education, and related fields at all levels of functioning.State legislative appropriations from general,

emergency, or special funds.Project, contract, and grant funds under Federal

and State legislative programs.Industrial, business, and labor establishments,

groups, and organizations.Private citizens.Private foundations.

Fund-Raising ActivitiesRaising funds is a challenging task. All representa-

tives of the planning group can assist in creatingsponsor interest. However, it is often wise to designateresponsibility for fund-raising to a single committeewhose members are experienced and skilled in obtain-ing financial support. Fund-raising activities alsopublicize the planning and win interest and support.

All economic possibilities of the area should beexplored and the development of promotional materialsand methods for fund-raising should be considered.

Experienced planning groups report that personalcontacts are most significant in soliciting support. Aprospectus is also a good information medium and a

convincing promotional tool. It can be prepared fromthe work plan for the project. Designed to arouseinterest and win support, the prospectus concisely:

2 Explains the purpose of the project.Portrays the situation to which planning is di-

rected.Justifies the need.Anticipates the expected potential and outcome

of the activity.Outlines the budget to show how funds will be

utilized.Suggests amounts and methods of contributing

fun ds.

Sometimes funds are obtained through a projectgrant from public or private sources, in which caseit is necessary to prepare a project proposal. Suchproposals must be more detailed than a prospectus, andshould include, in addition, a description of: represen-tation and cooperating agencies; scope of project;duration of activity and a timetable; organizationalstructure; plan of operation; and methods of evaluat-ing the accomplishment of project goals.

The lack of funds need not retard planning or limitthe scope. Planning activities can be carried out withlittle cash expenditure if individual participants andagencies represented will contribute staff, materials, orother needed resources. In such a case, financial re-sponsibility for various activities of the planningproject is cooperatively arranged and guaranteedaccordingly.

In projects that are substantially funded, cooperativearrangements are often made between participatingagencies for the loan of not only staff and equipmentbut also office and meeting space, and statistical dataprocessing, or other supporting services. Businessgroups and others also contribute services, thus lower-ing the total cost of planning.

Cost of PlanningThe cost of planning will depend upon the scope of

the activity, its organization, and local economic con-ditions. A budget should be drawn up, showing esti-mated expenses. It should detail all activities for whichfinancial or other assistance is required.

Major items include:Staff salaries, full or part time as required, for:

Project director.

ORGANIZING: STRENGTHENING ORGANIZATIONAL STRUCTURE

Assistant director or research associate.Administrative assistant.Secretary, clerks, and typists.

Travel and per diem for:Project director and other staff within planning

area.Committee members to attend meetings.

Data processing of:Inventories.Special studies.

Mimeographing and duplicating of:Minutes of meetings.Special reports.Background data and informational materials.

Supplies and equipment:Stationery.Office equipment.Stamps and postage.

Operating expenses:Office space.Telephone.Meeting rooms.

Production and publication of reports:Writer and/or editor.Printing.

Public information materials.

Consultation services.Cash expenditures for statewide planning for nurs-

ing conducted in recent years have varied widely. Forprojects requiring 2 to 21/2 years to complete the studyphase and develop recommendations, cash expenditurevn nged from $10,000 to $96,000, averaging over$50,000. These studies had a variety of contributionsin kind and no common pattern of funding. If thecontributions had been given a cash value, costs mighthave reached $160,000.

The costs of planning rise, of course, with the num-ber of special studies or research conducted, staffrequirements, and the patterns of travel and supportprovided for committee members.

Examples of Budgets

For the first 2 years of an in-depth statewide plan-ning activity in a western agricultural State, yearlycash expenditures averaged $20,000. Travel expensesof committee members to monthly meetings were paidby the agencies they represented. Tabulation of specialstudies was contributed by the State university and

39

health department. The staff was employed full time.

Salaries:Project Director $12,000Secretary 3,600

Office rent 1,200

Supplies and equipment 1,100Travel of director 1,500

Printing of reports 900

Total $20,300

Another example, the budget for a 2-year planningactivity in a metropolitan area that did not requiretravel of committee members was $63,373. Expendi-tures were as follows:

First Y ear Second Y ear

Salary of project dircctor $11,000 $11,650Salary of secretary 5,500 5,750

Fringe benefits 1,320 1,730

Travel for consultants and resourcepersons 500 500

Office space and utilities 1,500 1,500

Supplies and office equipment rental 5,353 1,770

Rental of meeting spare 1,000 1,000

Postage 450 650

Telephone 400 400

Data tabulation and analysis 3,000 0

Editorial expenses 0 2,000

Publication costs 0 4,500

Special publication and promotionalcosts 1,000 1,000

Total $31,023 $32,350

A third example: For a 2-year planning project thatincluded six special studies, the total cost was $95,442.Most data-processing was contributed by cooperatingagencies. In the second year, technical committees hadpart-time staff members. Extra statistical and clericalstaff was required for processing the special studies.All travel expenses of committee members were paidfrom project funds. Office and meeting space wasdonated. Expenditures included:

First Y ear Second Y ear

Salary and fthige benefits $17,416 $38,780

Supplies 4,773 4,094

Utilities 280 296

Telephone 500 862

Travel of committee members,consultants, and resource persons 689 4,794

Posta ge 1,915 1,485

Data-processing and tabulation 0 8,386

Writing and editorial expenses 0 6,076

Publication of reports 0 6,096

Total $25,573 $70,869

40 CHAPTER 4

Timetable

The length of time needed for planning will vary indifferent situations and with the scope of thc planning.Considerable time is often required just to developrecognition of the need, assure readiness, and gainsupport for planning. That phase may take months ora year or more. Thc average time required to formallyorganize, carry out an in-depth assessment, and de-velop a plan is 2 years. However, with adequate staff,the capability to gather and analyze data quickly, andthe ready commitment of time by all participants, thetime span can he reduced. But even in ideal situations,1 year is considered a minimum amount of time.

Preparation of a timetable for planning is es-sential. A schedule that correlates the timing, order,and sequence of planning tasks helps to assure thatplanning is progressing. The time requirements of eachphase of planning will affect the budget, the relevanceof data, and the ability to make commitments for

staff, services, and participants. Although there maybe overlap in the timing and sequence of the phasesof planning as described in this guide, the aveiagetime required for some designated tasks is as follows:

MonthsFormal!y organizing 3

Collecting and analyzing available data 6

Assessing needs and resources; preparingrecommendations and committee repork 12

Writing the summary report 3

As planning proceeds, the timetable may have tobe modified. For example, special surveys and studiesmay be needed. many of which require 1 or 2 yearsfor completion, thus prolonging the assessment phaseof planning. It must be borne in mind, however, thatwhen the assessment phase of planning does extendbeyond several years, the motivation and interest ofthe participants tend to dissipate..

Planning Area

The current trend is to establish the boundaries ofa planning arca on the basis of a geographic areawithin which planning concerns can be defined, solu-tions found, and programs developed for meetingneeds. The geographic planning area is economically,socially, and functionally cohesive. Its political orjurisdictional boundaries do not ignore patterns in theuse of health, education, and other social services. Nordo geographic boundaries ignore existing relationshipsamong health and educational institutions.

The planning area may be large or small, geo-raphically. It may encompass a metropolitan area, aState, several States, parts of a State, parts of severalStates, a county, several counties, or one or more localcommunities. The given area is often referred to as acommunity or region within which community orregional planning takes place.

A planning area can best be defined by reviewingthe ftmctional relationships that exist within a givenarea. Mannin,: areas for nursing arc necessarily re-lated to b..iltli and educational service areas. Andhealth service areas usually follow traditional tradinga rea pa tterns.

The patterns of geographic coverage already es-tablished by health, education. and welfare agenciesmay ic 'wed to determine the feasibility of desig-

nating nursing areas in the same pattern. In mostStates, regions for tho delivery of services or forplanning already exist for: (1) the State Health De-partment; (2) mental health and mental retardation;(3) hospital and medical facilities (Hill-Burton) ; (4)trade and economics; and (5) State Department ofEducation school districts. The professional organiza-tions for registered nurses have districts for programpurposes. Areawide and State Comprehensive HealthPlanning agencies have designated planning areas.Regional Medical Program planning ineas disregardState boundaries and are designated in terms of theexisting and anticipated geographic needs for healthservices and the usage of these services. Metropolitanarea planning and service areas may cover parts ofseveral counties and States that are essentially andeconomically dependent.

Statewide Planning

A State is a logical study area because of significantpolitical considerations. Our social organization is, inmany respects, functionally structured in State units.The implementing of programs often require3 policy-making and achievement of political action at theState level.

ORGANIZING: STRENGTHENING ORGANIZATIONAL STRUCTURE

Public educational programs and health services areorganized in statewide systems. Licensing codes areenacted at the State level. State boards of education,heahh, and nursing establish certification proceduresand enforce minimum standards of practice. Profes-sional associations tend to organize programs andservices in State constituencies. The services of volun-tary and private agencies generally conform to Statepatterns.

Areas within a State, however, have dissimilarcharacteristics and particular problems that requiresolutions tailored to the needs, resources, and aspira-tions of each locality. Yet, as different as rural andurban areas may be, they have dependent relation-ships. Therefore, it is often advisable to organize theplanning effort for coherent statewide planning thatconsiders regional nceds. Simultaneous statewide andintrastate regional planning also properly integratesand balances issues and problems that require state-wide solutions and those that must be resolved on alocal or regional basis.

Increasingly, planning for nursing is being or-ganized and conducted for regions of a State and forthe State as a whole. The development of nursingeducation resources in junior and senior colleges, forexample, requires coherent statewide and regionalplanning. This calls for an organized planning effortwith a framework for appraising and responding tostatewide, regional, and local needs.

Interregional PlanningAs mentioned, a trend toward regionalization and

concerted planning for nursing for areas that com-prise several States or parts of States is now emerging.In many States there are areas that are dependentupon other States for medical care, health manpower,and educational services. Consequently, such areasrequire health planning and manpower study acrossState lines. For high-level professionals, manpowersupply is often a national and regional as well as aState concern. Specialized professional personnel areeducated in only a limited number of States, and thereis competition between States for the employment ofsuch professionals.

Interregional planning, whether it be interstate orintrastate, draws and builds upon planning withinregional boundaries, and requires careful scrutiny ofregional relationships. This includes identification ofproblems associated with interregional planning and

41

amenable to resolution on an interregional or areawidebasis.

Some examples where interstate and intrastateregional planning is beneficial for cooperative arrange-ments in meeting nursing needs and providing re-sources for education and service are:

Development of highly specialized nursing servicesassociated with scientific and medical advances anddiagnosis and treatment services in specialized fieldsnot feasible for all areas.

Continuing education programs drawing on theresources of more than one State or region.

Educational resources for developing leadershippersonnel.

Research and demonstration projects for moreeffective distribution and utilization of all types ofnursing personnel.

Local Area PlanningUltimately, the implementing of recommendations

and the initiating of actions that assure adequate nursemanpower, educational facilities, and resources takeplace at a local level. Local areas must identify factorsoperating in theit own setting that influence the supplyof, demand for, and utilization of nursing personnel.Inter-institutional cooperation in local areas is requiredto develop community-wide nursing programs andresources.

In the newer concepts of planning, emphasis isbeing placed on decentralized planning. Local areasare potential local planning regions. Townships, towns,villages, and municipalities are amalgameted to makeup a reasonable planning area. Local citizens are en-couraged to help improve the community's healththrough their own efforts and participation in plan-ning.

Approaches to planning at the local level vary.Responsibility for planning may be initiated andcarried out at the local level, or a State or regionalentity may initiate and guide planning for a local area.In the first approach, the local area carries out its ownplanning. Needs of the area are defined and coopera-tive efforts are maintained with adjacent, related, ordependent areas to develop programs and to allocateresources. In the second approach, where planning isdirected from the State or regional level, local areaneeds and resources are considered in relationship tothe State or region as a whole.

42 CHAPTER 4

Summary of Planning Area PatternsIn summary, the patterns for planning on the basis

of geographic needs include the following:Local unit planning.Coordination of multiple local unit planning in a

regional context and planning on a regional basis forservices, programs, and manpower transcending localcontrol.

Statelevel coordination of regional and/or local

planning and concurrent planning on the State levelfor study and action required at the State level.

State-level planning for overall State needs withstatewide representation and consideration of regionaland local needs.

Interstate regional planning for cooperative effortsand coordination in program devdopment and re-source allocation not feasible for individual Stateregions.

Public Relations

Essential to effective planning are good public rela-tions and the development of a communication systemfor winning support. An intrinsic part of organizingfor planning is establishment of a strong informationprogram that will stimulate interest in and acceptanceof the objectives of planning. Publicity efforts shouldbe aimed at all segments of the population but par-ticularly toward those who must support and engagein the actions that evolve as part of planning.

Initially, the understanding of professional groupsmust be sought. The primary sponsor should elicit theendorsement and cooperation of vital interest groupsfirst, before informing other groups. If this is not done,there may be difficulty in gaining necessary support.The so-called power structure of the planning areashould be carefully studied to search out those indi-viduals and groups whose approval and participationare essential. Personal contact and individual approachare considered best for key individuals and groups.

After those closely concerned are adequately in-formed, the entire planning area must be made awareof the planning activity, why it is needed, and whatit can accomplish. Once communication is begun, itmust be maintained. All types of mass medianews-papers, radio, television, group meetingscan be used.Good public relations and publicity stimulate individ-uals and groups to become involved and to give supportin a number of ways, such as by contributing money,pledging and providing services and work, developingconcern for achievement of the goals of planning.deepening the understanding of the capabilities whichcan be brought to bear to provide for meeting nursing

needs, and finally, accepting responsibility for theactions that are necessary to meet nursing needs.

Special materials and information programs mustbe developed at various stages and at appropriateintervals of planning, directed to particular groups. Afew techniques that have been successfully used arelisted here:

Periodic written progress reports on planningactivities are sent to sponsors, participating agencies,and contributors to planning.

Health organizations and professional and laygroups are informed of the needs of nursing throughindividual and personal contacts and conferences withkey representatives.

Group meetings are arranged with the member-ship of professional organizations, such as the hospitalassociation, medical society, and nursing organizations,to discuss planning for nursing in its various phases.

Public forums and hearings are conducted tosolicit response and support for the needs of nursing.

Progress reports of planning activities are sub-mitted to professional journals, newsletters of healthassociations or agencies, and other publicity organs,for publication.

Protocol visits are made to the State Governor, de-partments of government, boards of various kinds, aswell as interested institutions, to interpret the needfin' and objectives of planning.

Policy statements on controversial matters areissued and circulated widely.

Summary reports on surveys, special studies, andplanning activities are published.


Planning Reports

Planning groups issue a variety of formal reports;most are printed publications. Planning reports serveas educational documents and instruments for solicit-ing professional and public support. They are toolsfor interpreting needs, findings, recommendations, andgoals. In addition, they provide the basic guidelines foraction and a baseline for evaluating progress in im-plementing recommendations. Four types of reports aremost commonly used:

Data-compilation or source books, with or withoutan analysis.

Summary or overall reports on planning activi-ties, study findings, recommendations, and plans ofaction.

Popular, abbreviated reports on findings, formal-ized recommendations, and plans of action.

Reports on special studies, selected phases, orparticular concerns of planning to which it is.desirableto draw special attention.

Data Source BooksData collection and analysis constitute an important

aspect of planning and are discussed in detail inchapter 6. Background and reference data and- infor-mation assembled for the study of nursing concernsby those actively engaged in planning are frequentlycompiled in source book or report form. These ma-terials are usually presented as a perspective on theproblems and concerns under study or to be studied.Such source books may be widely distributed to health,educational, and related institutions and agencies, toarouse interest in improving nursing and to secure awide realization of needs.

Examples of reports of data surveys and analyses aregiven in appendix 1. It should be noted that somedata surveys are not part of broad planning for nursingbut are independent activities produced as a basis forplanning by other groups.

Summary ReportsThe most common type of report prepared by plan-

ning groups is the summary report. Although oftenreferred to as the final report, the summary report isnot the end product of planning. The summary reportdoes give an account of the origin, purpose, methodof operation, and guiding principles of planning

groups. It highlights major findings and recommenda-tions, as well as the premises and reasoning which ledto the recommendations. Such a report is issued togive detailed information to professional, health-related, and other interested individuals and groupswho can help to carry out recommendations.

It is possible to give general but not specific direc-tions for preparing a summary report. The format andstyle must be adapted to the audience and use forwhich each report is intended. The findings and recom-mendations are sometimes placed at the beginning.This is convenient; the reader need not read the wholereport before he can focus on the significance of thefindings and recommendations, and pinpoint thoserecommendations most relevant to his interests. Whatis to go into the main body of the report and thelength of the report are often difficult to judge.Emphasis is usually given to a discussion of thosedetails that have to be interpreted and that can in-fluence the reader in desired directions.

Most summary reports follow this format:Title page.Acknowledgments and preface or foreword.Table of contents.List of tables.List of figures.Text, or body of report:

Introductory chapter.Report of planning divided into logical chapters

that represent important divisions of theproblems studied.

Summary chapter on findings, conclusions, andrecommendations.

Appendix:Reference and source materials.

Although they vary in content, summary reportsgenerally include the following:

Organizational structure and study methodology.Lists of participants, committee members, re-

source persons, and consultants.Summary of primary findings, conclusions, and

recommendations.Plans of action, or suggested measures for initiat-

ing action on recommendations.References to source materials, or a bibliography.Selected statistical data to highlight points of

importance.

44 CHAPTER 4

Discussion of the nursing situation (s) to whichplanning is addressed and the relationship to:

Trends in the nurse supply, nursing practice,and nursing education.

Characteristics of the nurse supply and thepresent practice of nursing.

Characteristics of nursing education programsand student resources.

Assumptions, standards, and criteria for nurs-ing service and nursing education.

Effectiveness of nursing service, facilities, andresources.

Factors affecting the needs and demands fornursing.

Projection of future needs and demands andpotentials.

Goals, recommended courses of action, andplans.

Popular Reports

Popular reports, which are brief versions of overallreports, are commonly prepared for wide distributionto the general public, or to individuals representingdiverse interests but sharing a common concern innursing. In popular reports, attention is given to thepotential reader who may not be thoroughly familiar

with nursing and the changes and factors influencingnursing practice and education. Main points of surveysand stulies are often graphically portrayed, and majorrecommendations are enumerated and discussed to giveinformation quickly and highlight findings and neededactions.

Special Reports

Planning groups routinely document their proceed-ings and assemble and compile extensive informationand statistical data on nursing. These materials maybe reproduced in a variety of special reports. Under-lying the preparation and issuance of special reportsis the need to give a broader perspective and to pro-vide greater understanding of particular aspects ofnursing than can be given in summary or popularreports.

Special reports may detail findings from specialstudies, surveys, or research conducted as a part ofplanning. Records of the deliberations of committeesor their assessment of particular areas of nursing maybe abridged and published as a separate report. Theproceedings of workshops and public hearings or sum-maries of other supporting materials may be compiledin report form.

Other Strengthening Factors

Traditional difficulties that can impede progress areinherent in planning. Most often they arise fromconflicts of interests and philosophies; fear of loss ofstatus or autonomy of the agency, profession, or indi-vidual; failure to realize the importance of planning;and administrative patterns of particular planninggroups. Insofar as possible, the organizers of planningshould consider methods of weakening or eliminatingthe negative forces and strengthening positive ones.Barriers to effective planning are evidenced in:

Refusal of some individuals or groups to partici-pate in or endorse planning; the blocking of othersupport.

Undue influence by special interest groups, andpower struggles between vested interest groups.

Poor relationships between agencies that shouldbe represented for integrated planning.

Apathy on the part of participants, and com-placency with the status quo.

Resistance to the introduction of new concepts.Refusal of committee members to compromise,

thus blocking action.

Reluctance to share data and otherwise cooperate.

To confront conflicting forces, there must be strongleadership and support, administrative skill, personalpersuasion, good information, and, again, good humanrelations. Other suggestions that help to avoid pitfallsare included below.

Important Administrative ProceduresConsideration should he given to factors that dis-

sipate personal interest of the participants, strengthenmotivation, increase involvement, and enhance thecontributions they can make. This requires attentionto fundamental administrative procedures, such as

orienting participants, assigning responsibilities, andsupplying needed information.


OrientationParticipants in planning must first clearly under-

stand the goals of planning, the importance of thejob to be done, and how they can help. All who serveshould be oriented to:

The overall situation to which planning is ad-dressed.

The puz pose and objectives of planning.How planning is organized and will function.The roles and responsibilities of sponsors, com-

mittees, and their particular assignment.Anticipated and expected commitments of time.

Assigning ResponsibilitiesTo guide their work and assure its completion, staff

and those who serve on planning committees shouldoperate under clearly defined responsibilities and es-tablished procedures. Their time should be used wiselyin meaningful activity. Requirements are that:

Organizational structure for the planning, lines ofauthority, and functions and responsibilities of staffand committees be put in writing.

The specific charge be developed and made toeach committee or group to which members are as-signed.

Meetings be scheduled well in advance to assure

maximum participation of already busy committeemembers.

Agenda be prepared to utilize the time of par-ticipants in directed activities.

Minutes of meetings be kept and circulated togive continuity to planning activities.

Supplying Adevthte Information forParticipants

In terms of their background, knowledge, and ex-perience, individual participants and committees will,throughout planning, need information on varioussubjects relative to their assigned tasks. Such informa-tion may be necessary for understanding brOad orspecific aspects of social, education, health, welfare,and nursing conditions, as well as programs, trends,and developments. Staff support and other means forproviding adequate information are essential to intelli-gent judgments, decisions, and actions. Measuresutilized to provide background information include:

Distribution of selected reference materials.Reports to committees on special subjects.Use of resource persons.Speakers on selected subjects.Site visits by staff or committee members to ob-

serve in particular areas of interests and to solicitinformation.

References


1955. Understanding How Groups Work. Lead-ership Pamphlet No. 4, pp. 5-14 and 33-48.Washington: The Association.

1956. Getting and Keeping Members. Leader-ship Pamphlet No. 12. Washington: TheAssociation. 48 pp.

1957. Better Boards and Committees. Leader-ship Pamphlet No. 14. Washington: TheAssociation. 48 pp.

1957. Effective Public Relations. LeadershipPamphlet No. 13. Washington: The As-sociation. 48 pp.

BULLOUGH, BONNIE; and BULLOUGH, VERN; eds.

1966. Issues in Nursing. New York: SpringerPublishing Co. 278 pp.

CHIN, ROBERT; and BENNE, KENNETH D.

1969. "General Strategies for Effecting Changesin Human Systems." The Planning ofChange, 2d ed., pp. 32-59. Edited byWarren G. Bennis, Kenneth D. Benne, andRobert Chin. New York: Holt, Rinehartand Winston, Inc.

CONDE-THILLET, MARIO L.

1965. "Dealing With Controversial Issues."Adult Leadership, 13 (7) : 207 and 236(January).

DOUGHMAN, GORDON 0.

1965. "Towards an Evaluation of Committees."Adult Leadership, 13 (9): 287, 302-304(March).

46 CHAPTER 4

GINZBERG, ELI; with ()STOW, MMIAM.1969. Men, Money and Medicine. New York:

Columbia UniVersity Press. 291 pp.

GUNNING, ROBERT.

1968. The Technique of Clear Writing. Revisededition. New York: McGrawHill BookCompany. 329 pp.

KENEALLY, HENRY J., JR.

1966. "The Inter and Intra Agency Communica-tion Process Used in a Community Develop-ment Program." Adult Leadership, 14(9) : 294-296, 317 (March).

KISSICK, WILLIAM L., ed.1968. "Dimensions and Determinants of Health

Policy." The Milbank Memorial FundQuarterly, 66 (1) : Part 2 (January).

KLARMAN, HERBERT E.

1965. The Economics of Health. New York:Columbia University Press. 200 pp.

KNOWLES, MALCOLM S., and KNOWLES, HULDA F.1959. "Understanding Group Behavior." Intro-

duction to Group Dynamics, pp. 39-62.New York: Association Press.


1967. "Regional Organization in Integration ofServices." Comprehensive Health Care,A Challenge to American Communities, pp.63.67. Washington: Public Affairs Press.

1968. The Politics of Community Health. Re-port of the Community Action StudiesProject, p. 101. By Ralph W. Conant.Washington: Public Affairs Press.

PRICE, ELMINA.

1967. "Data Processing, Present and Potential."American Journal of Nursing, 67 (12) :2558-2564 (December).

ROSENTHAL, NEAL H.; LEFKOWITZ, ANNIE; and PILOT,

MICHAEL.

1967. Health Manpower 1966-1975. A Study ofRequirements and Supply. Bureau of La-bor Statistics Report No. 323. U.S. De-partment of Labor. Washington: U.S.Government Printing Office. 50 pp.(Available from U.S. Department of Com-merce, National Technical InformationService, Springfield, Va. 22151.)

SPALDING, EUGENIA KENNEDY ; and NOTTER, LUCILLE E.

1970. Professional Nursing: Foundations, Per-spectives and Relationships. 8th ed. Phila.delphia: J. B. Lippincott Co. 677 pp.

STRUNK, WILLIAM, JR., and WHITE, E. B.

1959. The Elements of Style,. New York: TheMacmillan Company. 71 pp.

TICHY, H. J.1966. Effective Writing: For Engineers, Man-

agers, Scientists. New York: John Wiley& Sons, Inc. 337 pp.

U.S. DEPARTMENT OF HEALTH, EDUCATION, and WEL-

FARE. PUBLIC HEALTH SERVICE. HEALTH SERVICES

and MENTAL HEALTH ADMINISTRATION. NATIONALCENTER FOR HEALTH STATISTICS.

1969. A State Center Pr Health Statistics: An Aidin Planning Comprehensive Health Statis-tics. Public Health Conference on Recordsand Statistics Document No. 626. RevisedOctober 1969. Washington: U.S. Govern-ment Printing Office. 23 pp. (Availablefrom National Center for Health Statistics,5600 Fishers Lane, Rockville, Md. 20852.)

WATSON, GOODWIN.

1969. "Resistance to Change." The Planning ofChange, 2d ed., pp. 488-498. Edited byWarren G. Bennis, Kenneth D. Benne, andRobert Chin. New York: Holt, Rinehartand Winston, Inc.

WEISS, JEFFREY H.1967. The Changing Job Structure of Health

Manpower. Cambridge, Mass.: HarvardUniversity. 267 pp.

Chapter 5

Assessing Needs and Developingthe Plan of Action

Chapter .5

Assessing Needs and Developing the Plan of Action

At the very core of planning for nursing is theassessment of needs and resources. The assessmentphaseessentially a survey and study processlaysthe foundation for developing a specific plan withrecommendations for the expansion, development, andimprovement in nursing programs and the translationof these recommendations into action.

Every area of the country should have a plan fornursinga plan that sets common goals and prioritiesand guides action in the entire spectrum of nursing

facilities, services, and resources. Moreover, the planshould be periodically updated. There should be acontinuing critical analysis and evaluation of majornursing concerns.

A comprehensive nursing plan cannot provideanswers to all questions. It can, however, give perspec-tive to nursing needs; set the perimeters for opera-tional, institutional, and program planning; and guidecoordinated action within the planning areas. Thusthe plan offers the greatest potential for meeting needs.

Assessment Phase

Assessment is the phase of planning concerned withinvestigating, pinpointing, and making specific recom-mendations on the needs of nursing. In this phase, afactfinding periodduring which data and informa-tion are collected, analyzed, and synthesized--is fol-lowed by a period of decision-making on the needs ofnursing.

Framework for Assessment

A basic framework for assessing overall health needsand resources has been developed which can be ap-plied to nursing. The framework sets the requirementsfor factfinding and furnishes guidelines for reasoning,judgments, and decisions. Assessment of the nursingneeds and resources of any planning area must becarried out within a framework that includes the fol-lowing:

Defining the nature and scope of nursing concernsas manifest in the planning area.

Identifying and evaluating the political, demo-graphic, cultural, and economic factors, conditions,and changes affecting nursing in general and thespecific areas of nursing under study; also recognizingthe problems they pose in the development of positiveprograms for meeting needs.

Weighting the relative importance of all factors

related to the concerns and the needs of nursing.Becoming aware of and exploring the resources

available to deal with specific concerns and problems.

Steps in Assessment

Although complex, the assessment phase can be car-ried out in definite steps in a logical sequence, asfollows:

Collecting available data and descriptive informa-tion.

Conducting special surveys or studies as requiredfor factfinding.

Statistically analyzing data; summarizing descrip-tive information; and integrating and interpretinginformation, data, and findings.

Synthesizing findings, knowledge, and under-standings, and forming concepts of the situation.

Drawing implications and conclusions and mak-ing judgments on needs in terms of adequacy, effective-ness, and efficiency of nurse manpower resources andservices.

Making decisions on approaches, methods, andmeasures for meeting needs.

Indices of Assessment

The preceding framework and steps in assessment

49

50 CHAPTER 5

suggest a summary index of factors to be assessed indetermining nursing needs. Whatever the nursingproblems in need of solution, assessment would bebased on understanding, review, detailed knowledge,or study of the following:

Socioeconomic environment of and associatedwith nursing.

Health needs and resources and their relationshipto nursing.

Trends, concepts, practices, and patterns in thedelivery of health services, in nursing service, and innursing education.

Standards, criteria, and controls on which nursingpractice and nursing education are based.

It is impossible in this publication to outline indetail all the potential indices of assessment becausenursing conditions and needs vary widely among plan-ning areas and are changing constantly. Nursing con-cerns requiring assessment by particular planninggroups are initially identified when the study outlineis prepared. (See page 16.). Other concerns or aspectsof issues and problems requiring analysis and studywill emerge as planners begin to seek solutions toparticular nursing problems. The time spent in assess-ing particular items and the depth of assessment arecontingent upon the availability of data and study find-ings and the familiarity of planners with particularareas of concern.

Indices and the process of assessment may be ex-plained more clearly by the following example of acharge given to the technical committees of one plan-ning group that had as its purpose the developmentof a statewide plan for nursing service and nursingeducation. Committees were structured by fields ofnursing, such as institutional nursing, public healthnursing, office nursing, and occupational health nurs-ing. The charge, with a few adaptations, could applyto committees that were structured, for example, interms of nursing needs, nursing resources, and theutilization of nursing personnel, as shown in the or-ganization charts on pages 24 and 26 (figs. 1 and 3).The charge was as follows:

Assess the social, cultural, economic, and admin-istrative factors effective in the delivery of health andnursing services and nursing education, and relativeto the specific area of study assigned to the committee.

Examine and review the present situation andconditions in the specific area of study assigned to thecommittee in light of the following:

Data on hand.

Past and current trends.

Published reports and positions.

Expert judgment and experience of members ofthe committee.

Counsel of experts or resource persons asneeded and required.

Broadly consider the situations and conditions inthe specific area of study as they relate to the follow-ing:

Patient care requirements.

Utilization, staffing, and available resources.

Employment incentives.

Career incentives.

Educational preparation of personnel.

Organizational patterns of services.

Nursing responsibilities.

Assess patient and service needs in the specificfield, current and future.

Assess the current quantitative and qualitativedirection of nursing, and project future directions,including new responsibilities for health care and fornursing.

Determine the criteria and standards in use andrequired for projection of needs and resources in thearea of study.

Assess and estimate current and future nursingpersonnel requirements, quantitative and qualitative.

Assess and estimate all resources for nursing, alsothe adequacy of recruitment programs and of existingeducational facilities for producing the required num-ber of nursing personnel in the specific field.

Outline relevant information needed but notavailable and for which special investigation may benecessary.

Identify areas needing research for long-rangeplanning.

Formulate initial recommendations for meetingquantitative and qualitative needs for review and ap-proval by the Executive Committee and Task Force.

Specify courses of action to be taken to implementthe recommendations.

Make concrete proposals for initiating action pro-grams.

Prepare an analytical report on the special areasof study.

ASSESSING NEEDS AND DEVELOPING PLAN 51

Tools of Assessment

The principal tools of assessment are a combinationof both tangible and intangible instruments. They areintegral devices. Three tools(1) data; (2) criteriaand standards; and (3) judgments and decisionsrequire special mention.

DataData provide the context for forming concepts of

the nursing situations, the scope of problems, thecharacteristics of nursing needs and the shape anddirection of measures and programs needed to meetneeds. Because of the fundamental importance of anadequate data base for planning, data as an integralpart of factfinding are discussed fully in chapter 6.

Standards and CriteriaProgram-planning techniques and evaluation meth-

ods frequently employed in health and education fieldsare essential to a critical appraisal of nursing practices,programs, and personnel resources. Quality, effective-ness, and efficiency are inferred, judged, and measuredfrom established quantitative and qualitative standardsand criteria that, in addition, provide a base for im-provement. Their application in the assessment processis focused on the following:

* A comparison of recommended standards andcriteria with those in practice as revealed by datasurvey and analysis and study finding<

An appraisal of acceptable standards and criteriaapplicable to the conditions and changing require-ments of the planning area.

A determination of standards and criteria to beused as a base for setting goals and formulating recom-mendations.

When recommendations have been formulated andthe nursing plan has been prepared, the standards andcriteria set by the planners provide a frame of refer-ence for future goals, a guide to action, and yardsticksagainst which progress and achievement can bemeasured.

An assessment of nursing needs and resources mustbe founded on a clear conception or delineation of therole of nursing, to which standards and criteria arethen applied. The standards and criteria most fre-quently used and formulated in assessing nursingneeds and resources are these:

Classification of nursing functions by each levelof proficiency of the practitioner.

Staffing ratios.Ratios for levels of educational attainment of

practitioners.Standards of performance of practitioners.Criteria for educational programs.

The commissions on practice, of the AmericanNurses' Association (ANA), establish and publishfunctions, standards, and qualifications for practice inthe various fields of nursing. The commission oneducation sets criteria for the various types of nursingeducation programs. These ANA standards and cri-teria can be used by planners as guidelines. SpecificANA publications are referenced in appendix 2. Theuse of criteria and standards in assessing quantitativeand qualitative manpower needs is discussed furtherin chapter 6.

Judgments and Decisions

Data, standards, and criteria form the base forjudgments and decisions on the needs of nursing andthe means for meeting those needs. The making ofjudgments and decisions in planning are, however, in-fluenced by a number of subjective factors and implicitconditions. Planning judgments and decisions reflectthe participants' understanding and knowledge gainedthrough the planning effort They are influenced bythe effectiveness of the plutining process in resolvingplanners' conflicts and controversies in reaching com-mon understandings. Planning judgments and de-cisions also reflect the values, attitudes, and motivationsof the planners and participants in planning, whorepresent various social, economic, and political seg-ments of the planning area. Judgments and decisionsare also influenced by the degree to which the planningprocess enables planners to set common purposes andgoals.

The organizational structure, operation, and ongoingactivities of the planning effort should provide theframework for making appropriate decisions on meansfor meeting nursing needs. In other words, when thetime for decision-making has arrived, these steps musthave been accomplished:

Concerted concern for the needs of nursing hasdeveloped.

.5 7~41

52 CHAPTER 5

O The various agencies and groups have agreedupon the need to cooperate to correct deficiencies.

Willingness to accept the majority rule on whatthe needs are and how they can be met have beenevidenced.

Committees may deal with highly controversial sub-jects and represent many divergent points of view.One well-known national study developed a climatefavorable to reaching consensus on needed actions byestablishing these commitite rules for decision-making:

Lay aside any preconceived bias, and approachthe assigned task with an open mind.

Reach no conclusions until you have heard allthe evidence that can he assembled from basic data,unearthed from studies, and supplied by experts.

Recognize and utilize the respective knowledgeand contribution which each committee member canmake.

Listen ,to all points of view on any question.

How Assessment Tasks Are Accomplished

The main work of assessment is usually donethrough one or more technical committees. (See p. 22.)Not all committees work in the same way. Someemphasize critical thinking and the clarification ofproblems in the total group. Others pay greater atten-tion to work in subgroups. The technical job of arriv-ing at the roles and functions of nursing personneland standards for educatiun and practice is oftenassigned to an ad hoc or special committee of experts,commanding the best talent within the planning area.

As previously mentioned, public hearings, work-shops, panels, and the use of consultants and resourcepersons are actually in3truments of assessment andmake various contributions to the process.

The planning staff usually obtains the basic back-ground data and conducts special surveys and studiesconcerning pertinent needs and resources to supporttechnical committees in their assessment. This fact-finding process is discussed in chapter 6.

Developing Recommendations

The search for the measures that will best meet theneeds of the planning area culminates in recommenda-tions. The recommendations state the goals and ob-jectives of the plan of action and suggest measures formeetincr them. Recommendations represent the collec-tive thinking of the membership of the planninggroup. In controversial issues, alternate recommenda-tions for reaching objectives are sometimes made.

Nature of RecommendationsStatements of recommendations should indicate the

probkms toward which each recommendation is di-rected; should specify objectives in terms of theimpact on nursing practice and nursing education andthe improvements anticipated; and should describe, ingeneral, the measures designed to reach the objective.

Recommendations may (1) extend activities alreadypresent in the planning area; (2) specify approachesand activities developed elsewhere which might beapplied in the planning area; or (3) specify new meansand activities for meeting needs. Recommendations, at

their best, are devoid of preconceived ideas; theyspecify new ways of meeting needs instead of follow-ing traditional patterns. New patterns reflect the needto keep up with changing society.

To be meaningful, recommendations must be realis-tic in terms of the needs, capacities, and limitatiuns ofthe planning area. At first, goals may have to belimited in depth to provide essential elements. Forexample, short-term training courses may need to beprovided while fully qualified personnel are beingtrained. Or periods of trial and pilot projects in a fewrepresentative agenciesfor instance, a hospital, anoutpatient department, or a health centermay benecessary to test realistic schemes. Immediate aimswould be to improve nursing service and care; sec-ondary aims would be to strengthen and demonstratemethods that could be applied in implementing theoverall plan for meeting long-range objectives. Indeveloping neighborhood health center programs inurban areas, for example, one or more of these prin-ciples have been applied for providing care while the


most appropriate means for extending health servicesto socially and ,..conomically deprived areas are beingsought.

Priorities of Recommendations

As each recommendation is developed, it should begiven a priority for action. Priorities must be based onconsiderations that reflect particular conditions andcapabilities of the planning area, such as the follow-ing:

Magnitude of the problem.Relative need.Allocation of scarce manpower resources.Available financial resources.

The survey, analysis, and assessment of existingneeds and resources should demonstrate areas requir-

ing particular attention. Specific priority factors canbe selected oy relating these needs to the objective ofthe planning activity and the resources available formeeting needs. The designation of priority recommen-dations provides a starting point for developing theplan of action.

For example, the priority recommendation of onf.planning group vb as directed to measures for securingadvanced educational preparation for nurses in lead-ership positions, including both nurse faculty andnursing service administrators. Expansion in nursingeducation resources and improvement in the qualityof nursing education was related toin fact, dependeduponthe availability and qualifications of the faculty.The improved utilization of nursing personnel inhealth care settings was directly related to the skillsand preparation of nursing administrators.

The Plan of Aciion

The plan of action for nursing grows out of thein-depth study of nursing needs and resources andbroad planning for nursing. The comprehensive planprovides guidelines for a rational system of nursingfacilities, services, and manpower that embrace allaspects of nursing, including the service and educa-tional components. A thorough plan details a co-

ordinated and comprehensive overall program of actionwitbin a specified geographic area and designatedsub-areas. It is addressed to both quantitative andqualitative needs. Patterns and methods of action inthe improvement, expansion, and development of pro-grams, facilities, and resources are prescribed.

Developing the PlanWhen recommendations have been formulated and

priorities have been determined, they are then in-corporated into a definitive plan for meeting nursingneeds. In developing the plan, attention is given tothe following:

Specifying goals, objectives and policies forcarrying out recommendations and suggested pro-grams.

Phasing activities so that resolution of problemsrequiring immediate action, on the short-term goals,leads to actions and measures for attaining long-rangegoals.

Indicating the geographic location, agencies, in-

stitutions, organizations,each recommendation.

Specifying a timeobjectives or steps in the

Providing methodsmeeting objectives.

The plan of action builds upon existing institutions,services, and manpower resources. The diversity ofneeds, resources., and existing patterns o: educationand service must be dealt with; yet innovative ap-proaches should be tried. Efforts in several directionsat once may be required. In developing the plan,problems to be encountered in its phasing must beconsideredas, for example, resistance to the intro-duction of new concepts. Measures to surmount po-tential obstacles must be worked out in advance andintegrated into the plan.

or individuals to carry out

span for achieving spc.cificplan.for evaluating progress in

Structure and Scope of PlanThe plan of action for nursing should begin with a

statement of the purposes and the objectives, policies,or principles on which it is based. It should also con-tain the planners' objective assessment of the strengthsand weaknesses of nursing service and education pro-grams. From such an assessment, the needs are in-terpreted and substantiated. The plan should containspecifically the planners' assessment of the following:

Trends in the nurse supply, nursing services,

(7.4

54 CHAPTER 5

nursing practice, and nursing education; and factorsinfluencing the supply, preparation, and utilization ofnurse practitioners.

The specific needs related to nursing and its re-sources, based on study findings.

The quantity and quality of nursing personnelrequired to meet current needs and future projectedneeds for nursing services; also the ratio or proportionof nursing personnel required to be prepared at eachlevel.

The criteria and standards for sound service andeducational programs; and capabilities for the gradualimprovement in these criteria and standards.

The plan for nursing should also specify the essentialelements, mechanisms, and support required for im-plementing the specific measures that are directedtoward program improvement and development. Toinsure meaningful progress toward established goals,the leadership, coordination, and cooperative relation-ships required among major health and educationalresources for carrying out the plan should also bespecified. The basic aspects of any plan of action fornursing should define or specify the following:

The modifications necessary in legislative authori-zations and administrative codes for improved healthand nursing service and educational programs for thebest use of manpower and facilities.

The financial and budgetary support requiredfrom appropriating bodies for carrying out the plan.Cost items for each recommended area of improve-ment, development, and expansion are calculated andjustified when possible; cost data are required, par-ticularly when requests are to be submitted to thelegislature for support.

All sources of financial assistance and the per-centage of support to be reasonably expected fromfeasible sources. This may include Federal or otherassistance available for:

Construction of finilities.Grant funds for the development and improve-

ment of nursing service and nursing educa-tion programs.

Student loans and scholarships.Payments toward operating costs.Short-term and long-term traineeships.Nursing research.

Organizational mechanisms through which nurs-ing may maintain active, appropriate, and effectivecommunication with institutional managements and

other allied health professions with respect to matterswhich affect the practice of nursing and the educationof nursing practitioners.

Mechanisms for involving nursing representationin the planning and coordination of health care sys-tems, nursing services, and nursing education pro-grams.

Methods for applying research findings to theappropriate health care systems, nursing services, andnursing education programs.

Investigations, studies, and research into nursingpractice, the effective utilization of nursing personnel,and the education of nursing practitioners needed forattaining long-term goals.

Nursing Service GoalsRelating specifically to nursing service, the plan

shoul dDesignate the type and kinds of new or existing

nursing service programs to be involved in the plan.Set priorities for the expansion, improvement, or

development of nursing service programs.Prescribe administrative reorganization or new

organizational mechanisms required so that the avail-able manpower can be utilized with the greatest effi-ciency and economy.

Prescribe utilization patterns for each type ofnurse in varying work situations.

Establish the boundaries of nursing responsibili-ties in relation to other health disciplines and overallhealth effort and health needs.

Define new roles for nursing personnel and pat,terns of service for meeting health care requirements.

Recommend changes in legislation relative tolicensing laws to reflect the type of practice a nurse isprepared to carry out.

Recommend measures to improve job satisfactionand employment and career incentives that contributeto the quality of nursing service, such as the following:

Personnel policies, practices, and procedures.Working conditions.In-service and continuing education.On-the-job training.Salaries and fringe benefits.

Nursing Education GoalsRelating specifically to nursing education, the plan

should


Set priorities for the expansion and developmentof nursing education programs by type of program, tomeet the specitic demands of the area; also prescribetarget dates for achievement of specific aspects of theplan.

Designate geographically and by type of programthe proper balance in the development of programs toinclude the following:

Number of additional nursing education pro-grams needed, from the practical nursing pro-gram to the masters' and advanced degreeprograms.

Merging, transition, or closing of programs.

Potential foi developing new and expandingexisting education programs, including suchresources as: (1) academic fields and institu-tional capabilities available to support eachtype of nursing program; (2) physical facili-ties; (3) clinical facilities; (4) student enroll-

ment capabilitiesminimum and maaimumsize of program; (5) studelit recruitmentpotential and demand to support program.

Prescribe improvements needed in schools ofnursing on the basis of criteria for sound educationprograms directed toward achievement of quality care,such as the following:

Qualifications of faculty.Reasonable student-faculty ratios.Clinical facilities, libraries, classrooms.Curriculums, curriculum enrichment, and in-

novations.Attainment of national accreditation.

Recommend broad measures to support the planand its goals, such as the following:

Utilization of resources from educat;onal pro-grams.

Recruitment activities and programs.Measures contributing to improvement in career

incentives.

Implementing the Plan

Plans for nursing may be no more than hopes unlesspractical means of implementing plans are found.Ultimately, implementation is done at the communitylevel and requires creativity and leadership. To imple-ment a plan, organization is still essential. Either theorganizational structure used to develop the plan mustbe sustained or another structure identified or es-

tablished to provide for coordination and follow-

through on prescribed actions.

The implementation phase of planning provides theguidelines for action and directs the development ofthe overall plan. This requires adequate support and amechanism for the following:

Interpreting nursing trends and needs and pro-viding information for local levels and autonomousunits for cooperative efforts in implementing the plan.

Stimulating the appropriate individuals and Or-ganizations to accept responsibility for action.

Allocating the recomended actions to the differentregional, local, or individual health organizations orinstitutions in the planning area who can initiateaction programs.

Designing the detailed programs for carrying outeach specific recomendation needed to fulfill the ob-jectives of the plan.

Continuous PlanningUltimately, the success of planning is judged by the

extent to which recomendations have actually beenimplemented and progress is being made toward meet-ing goals. There must be sustained communication,involvement, and evaluation to attain the goals of aplan of action for nursing. In addition, nursing needsand resources must be reassessed periodically to meetchanging needs for nursing services and to balancenurse supply and demand.

The results of planning must be fed back into re-planning to effect a continuous process for maintainingand improving the nurse supply and nursing resources.Some type of mechanism must be established forcontinuous planning for nursing to accomplish thefollowing:

Ascertain progress in implementing recommenda-tions and developing action programs.

Determine whether the implemented activities oractions are achieving their intended purpose.

Evaluate whether the activities or actions shouldbe continued.

Suggest modifications that would better meetgoals.

56 CHAPTER 5

Periodically re-examine the resources available inorder to assess the degree and direction of change.

Identify areas still needing continuing action andadditional or expanded effort.

Project estimates of the planning area's nursingneeds farther into the future.

Determine the emerging areas that need intensivestudy.

Planning groups should assume responsibility forstimulating the development or establishment of somemechanism for continuous planning for nursing. Someplanners assign responsibility for continuous planningto a specific agency or institution. Other plannersappoint a committee composed of members of theorganizations sponsoring planning to assume this re-sponsibility. A number of States have continuing joint

planning committees of, for example, the State nurses'association and the State league for nursing. Thesecommittees function to implement the recommenda-tions of study groups, to continue to aid in planning,and to stimulate planning and development.

An existing mechanism for continuous planning actsas a vehicle for recognizing the needs and demands ofnursing as they develop, and precludes having a staticplan. Nursing needs and resources and long-rangegoals must be extensively evaluated in 5-year periodsso that adjustments can be made and future stepsdetermined in terms of emerging trends in healthservices, nursing services, and nursing education. Atsuch times the continuing committees, for example,may function to establish the mechanism for anotherin-depth study of nursing needs and resources.

References


1955. Taking Action in the Community. Leader-ship Pamphlet No. 3, pp. 27-48. Washing-ton: The Association.

1955. Understanding How Groups Work. Lead-ership Pamphlet No. 4, pp. 15-32. Wash-ington: The Association.

1957. Streamlining Parliamentary Procedure.Leadership Pamphlet No. 15. Washing-

ton: The Association. 48 pp.

ARNOLD, MARY F.

1968. "Use of Management Tools in Health Plan-ning." Public Health Reports, 83 (10) :

820-826 (October).

and HINK, DOUGLAS L.1968. "Agency Problems in Planning for Com-

munity Health Needs." Medical Care, VI(6) : 454-466 (November-December).

BENNIS, WARREN G.; BENNE, KENNETH D.; and CHIN,ROBERT; eds.

1969. The Planning of Change. 2d ed. NewYork: Holt, Rinehart and Winston, Inc.627 pp.

DENISTON, 0. L.; ROSENSTOCK, I. M.; WELCH, W.;and GETTING, V. A.

1968. "Evaluation of Program Efficiency." Pub.lic Health Reports, 83 (7) : 603-610 (July).

GREENBERG, BERNARD C.

1968. "Goal Setting and Evaluation: Some BasicPrinciples." Bulletin of the New YorkAcademy of Medicine, 44 (2) : 131-139(February).

HILLEBOE, H. E., and SCHAEFER, M.1968. "Comprehensive Health Planning: Con-

ceptual and Political Elements." MedicalTimes, 96: 1072-1080 (November).

HILLEBOE, HERMAN E., and SCHAEFER, MORRIS.1968. "Evaluation in Community Health: Relating

Results to Goals." Bulletin of the NewYork Academy of Medicine, 44 (2): 140-158 (February).


1968. The Politics of Community Health. Reportof the Community Action Studies Project,pp. 14-18 and 97-105. By Ralph W. Conant.Washington: Public Affairs Press.

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Chapter 6

Factfinding

Planners develop a plan for nursing on the basis oftheir knowledge and linderstanding of the resourcesand needs of nursing in the planning area. Becauseplanners represent a mix of leadership talentfromeducation, business, industry, health fields, and thegeneral communitythey need a wide range of statis-tics, data, and background material. Such informationmust be developed and disseminated to provide factsabout nursing, about the diverse factors bearing on

needs, and about the feasibility of meeting those

needs. This is called the factfinding phase of planning.ft incorporates these procedures: (1) collecting andanalyzing data; (2) conducting special surveys, stud-ies, and research; (3) using educational and informa-tional materials and devices; and (4) soliciting factsand information from persons knowledgeable in par-ticular areas of endeavor.

Providing for Factfinding

For the factfinding phase of their work, planninggroups make various provisions, depending upon theavailability and competence of staff or other resources.Data collection is a technical operation that requiresa good understanding of the subject to which it is

applied; therefore, a knowledgeable group is neededto assist in collecting and interpreting the data. Oftenstatisticians or specialists from other health and relatedfields must be called in.

To guide data collection and analysis, ad hoc orspecial committees are often appointed. If statisticiansor a technical staff are provided, the members of thead hoc or special committee specify the data require-ments, supervise data collection, and assist as necessaryin compiling, validating, and analyzing the data. Orsometimes this function is assumed by the membersof the advisory or executive committee, who act asconsultants to the planning project staff as required.

Some planning groups collect and assemble dataas needed by particular planning committees. Othergroupsearly in the planning processbring together,in a written report called a source book, data andinformation on the overall areas of inquiry consideredessential for investigation. This source book is madeavailable to all participants in planning. It serves toorient committee members, giving them essential

background information for beginning their assess-

ment of nursing needs and resources. The source bookcan have other useful purposes, as previously noted inchapter 4, page 43.

Data source Looks and reports, when made availableto technical committees before they meet, stimulateinterest and active participation of committee membersand reduce the time required for asSessraent. In addi-tion, such source books compile releVant data and factsabout nursing in an orderly fashion for current andfuture use.

As technical committees begin their assessment, theyoften identify subject areas for which data surveysmay be necessary. The need for such special surveysand studies should be identified early in the planningor assessment processes, so that data and findings canbe made available in time to contribute to the under-standing, judgment, and decisions required for makingrecommendations. When the planning group or par-ticular.committees decide they need to undertakespecial studies, they should seek appropriate technicalassistance from statistically trained people. If specialstudies are to be extensive, a full-time statisticianshould be hired. Part-time statistical assistance andconsultation are often available from State or localhealth departments, universities, and health organiza-tions, such as hospital associations, health planningcouncils, Blue Cross Associations, and health careercouncils.

61

62 CHAPTER 6

Cooperative Arrangements for FactfindingFactual and statistical information for planning

groups has also been produced through various co-operative arrangements among segments of the healthmre industry, the professions providing health services,and the State agencies which share responsibility forplanning and for the health care of its citizens. Thefactfinding phase of planning has been utilized, forexample, as practical educational experience for uni-versity and graduate students who must learn how toidentify problems and search out, collect, and analyzedata for planning. Universities, health departments,and private industry have made sizabk contributionsto planning groups in data-processing services also.

Health agencies and institutions or professionalgroupsfor example, the hospital association or de-partment of mental healthoften agree to carry outspecial surveys or studies pertinent to their fields ofinterest. Such arrangements indicate the cooperationand involvement required for developing a coordinatedlong-range plan for nursing.

Determining

The first step in the factfinding phase of the plan-ning process is to determine the basic and special dataneeded to meet the particular objectives of the plan-ning activity. Data and information that will reflect ascompletely and reliably as possible the situation forwhich planning has been undertaken must be compiledand analyzed. Only on the basis of such informationcan a realistic evaluation be made and the indices ofneed be developed.

The purposes for which data are collected, thequestions the data are expected to answer, and theguidance the data are intended to give to the planninggroup are specified wben the study outline is prepared.(See page 16.) When the data are analyzed, con-clusions are drawn in terms of the questions that have

Data Processing

With the advent of the computer and other mechan-ical means for transforming data from their raw stateto a finished product, mostif not allof the datacollected in a planning activity will be processed bymechanical or electronic equipment. Oi course, in verysmall data collections that involve answers to only afew questions from a small number of respondents.hand-processing may he preferable. In all other in-

stances, however, machine-processing should be used;it is more precise, can be done more quickly andeasily, and can yield a greater amount of informationper dollar than can hand-processing. Moreover, ma-chine-processed data can be permanently stored oncards or magnetic tape for reuse in the future. Thisis a particularly desirable feature because an initialplanning study would, hopefully, lay the groundworkfor the establishment of data information system forcontinuous planning. Such a system depends on anadequate information base consisting of data fromprevious years which could be periodically updated toestablish trends and projections into the future.

Data Needed

been posed and the planning goals that have 'been set.The development of a meaningful long-range plan forninsing requires data that will:

Show past trends in nurse-manpower supply andthe various resources that contribute to the supply,thus shedding light on what future trends might be.

Reveal the dimensions of nurse manpower needs--past, present, and futureand provide clues to thevarious ways of meeting those needs.

Describe the present nurse-manpower situation,including the supply and needs and the resourcesaffecting supply and needs.

Describe the socioeconomic framework withinwhich nurse-manpower planning will be done.

Types of Data and Information Required

In planning for nursing, an adequate data baseincludes facts about the supply and distribution ofnursing personnel; resources for producing the sup-ply; and projections of future resources, supply, and

needs. It also includes data on the socioeconomiccharacteristics of the area in which planning is beingdone, and the patterns and availability of total healthservices and facilities.

FACI FINDING 63

Although planning studies differ in their scope andobjectives, a basic core of data will be common to allsuch studies. These data can be grouped into sevencategories, as follows:

(I) Characteristics of the population, including itssize, distribution, density, mobility, economic status.degree of urbanization, educational attainment, lifeexpectancies, births, and deaths.

(2) Health status of the population, includingmorbidity and mortality rates and major health prob-lems and needs.

(3) Existing health programs, facilities, and serv-ices, including hospitals, nursing homes, clinics, homehealth agencies, and other out-of-hospital facilities andservices; their geographic distribution, ownership andcontrol, methods of financing, and functional organiza-tion; and the identification of gaps in services.

(4) Indicators of the utilization and demand forhealth services as related to the financial resources forobtaining and providing these services and to the needfor health manpower.

(5) Inventories of nurse manpower, including pro-fessional, technical, and auxiliary personnel; theircharacteristics, employment status, fields of practice,and geographic location. Inventories of other healthpersonnel, their fields of practice, and their relation-ship to nurse manpower needs and utilization.

(6) Inventories of nursing education programs bytype of program, control, geographic location, and thecharacteristics of these programs in relation to theirstudents.

(7) Projections of future population, estimates offuture needs for and plaimed expansion of healthfacilities, services, and edoca:ional resources.

The planning group will haw to determine specificdata requirements in these suggested areas relevant tothe nature, scope, and specific objectives of theirproject. In addition to the requirements for basicquantified data, the needs of the participants in plan-ning for information and other background materialsin these areas should be considered. For example,non-nurse representatives or those not engaged inhealth fields may need to become acquainted with orknowledgeable about nursing, the structure of healthand nursing services and their operation, trends in thedevelopment of heahh services and resources, andsocioeconomic influences and th:ir relationship to pre-vailing nursing conditions and needs.

Likewise, representatives of nursing and health fieldsmay need to be made aware of trends and develop-ments in the educational sphere or in other aspects ofsociety affecting nursing. All members may need back-ground information in special fields or about specialsituations.

Sources of Data and Information for Planning

Much, if not all, of the data needed to provide ameaningful framework for planning for nurse man-power will be available from existing sources (referredto in this guide as existing data). If, however,specific data to meet particular objectives of the plan-ning activity are not likely to be available from exist-ing sources, special surveys and studies may need tobe undertaken to obtain such data (referred to in thisguide as original data). For insight into some specialnursing problems, research may also be essential.

Generally, a planning activity can be conductedwithout collecting extensive original data. The recom-mendations for action that stem from planning canusually be derived from existing data and a few un-complicated surveys. Planning decisions seldom requirethe degree of precision and validity of supporting dataacquired through research. Research conducted as a

part of Warming is usually directed to the accomplish-ment of long-term planning goals and is concernedwith the development and improvement of tools fornursing administration, service, and education.

Existing DataExisting data required for planning for nursing

relate particularly to the socioeconomic characteristicsof the area, the health services and facilities available,and the nursing and related health manpower supplyand distribution.

Basic data on population, general morbidity andmortality patterns, health facilities, health services,and health manpower are collected, coordinated, andsynthesized from periodically conducted inventories,surveys, or reports on the routine service functions of

64 CHAPTER 6

health facilities and agencies. For example, in mostStates, hea:th departments regularly collect and some-times publish data on population, births, deaths, mor-tality and morbidity statistics, as well as services

provided by health agencies.Also, existing data useful in planning for nursing

can sometimes be found in the reports and studies ofother planning organizations. Health facilities planninghas been conducted by hospital councils and similaragencies for many years. Planning activities underthe Comprehensive Health Planning (CHP) program,although of recent origin, should soon make availabledata that are pertinent not only to planning for nursingbut also to planning for total health, into which plan-ning for health manpower should be fitted.

In addition to data that exist in published form, aconsiderable amount of data exists in raw, unpublishedform. These data can often provide a wealth of infor-mation if brought together by the planning group intabulated form. For example, many State boards ofnursing have considerable information derived fromthe licensure process for registered nurses and prac-tical nurses and from accrediting or approval pro-cedures for schools of nursing. Tabulation of statisticalinformation gathered in connection with licensure caninclude considerable data on the characteristics andworking situation of nurses. Some States collect thisinformation on licenses routinely. Information fromschools of nursing pertinent to the work of planninggroups may include the following: physical condi-tion of schools, their capacity for expansion, clinicalfacilities, faculty, and the delineation of problemsconcerning recruitment and retention of students.

Special surveys and studies sponsored by govern-mental agencies, universities, health agencies, researchinstitutes, and community organizations can providepertinent data and clues to present health and nursingconditions and change over the years. Further infor-mation to facilitate planning can be found in thefindings of research in nursing and other fields relatedto questions under study. Since 1960, studies of healthmanpower covering a wide variety of subjects havebeen undertaken in many areas. Indexes to researchare included in appendix 2.

In addition, information contributing to the analysisand interpretation of data and to understanding andassessment of the nursing situation can be obtainedby observation, consultation, and through the use ofresource persons with knowledge in special areas orfields related to planning for nursing.

6 9

Publications in health and other social welfare fieldsover the years have also provided valuabk guidance inthe sttidy of subjects significant to the improvement ofnursing service and nursing education. This literaturecovers a wide range of activities concerning nursing.Selected articles, reports, books, and other publicationsare listed in appendix 2. Planners may find them ofvalue in understanding and evaluating the nursingsituation, in identifying trends, in projecting futuredirections and needs, and in formulating recommenda-tions and developing action programs.

Two publications of the Division of Nursing, U.S.Public Health Service, ale essentially compilations ofdata from existing sources that can provide a usefulframework for planning for nursing. The two publica-tions, Community Planning for Nursing in the Districtof Columbia Metropolitan Area and Source Book forCommunity Planning for Nursing in South Dakota,consolidate a large amount of statistical data in theseven areas discussed previously. (See page 63.)Available from the Superintendent of Documents, U.S.Government Printing Office, these publications can bevery helpful in pointing out to a planning group thekinds of existing data that are useful in planning, andthe sources of such data.

Also helpful in identifying existing sources of datais the material contained in appendix 3, which liststhe major data areas and sources useful to planning.

Using Existing DataThe use of data from existing sources presents few

problems and precludes elaborate, time-consumingdata collection. Use of these data involves the follow-ing: (1) identifying their sources; (2) assessing theirrelevance, timeliness, and accuracy; (3) abstractingthe data from the original sources for use in the plan-ning documents in a way that would be most meaning-ful to the planning group; and (4) analyzing themeaning and implicaiions of the data in terms of theplanning objectives.

Identifying SourcesAli of the agencies, organizations, or private indi-

viduals participating in planning can identify sourcesof data. At the beginning of the data-collection activity,it is important that all other sources of existing databe identified, and that agencies and planning bodiesbe located and queried as to the availability of datauseful to planning for nursing. These agencies andplanning bodies would include not only those in the

FACTFINDING 65

field of health but also those in related areas, such aswelfare, education, and urban redevelopment, as wellas manpower planning for other industries. Planningactivities in areas seemingly unrelated to health man-power planning can sometimes shed useful insight andprovide valuable data for nurse manpower planning.For example, inadequate transportation links cancreate difficulties in manpower recruitment, partic-ularly for health institutions that are located in subur-ban areas and are dependent on the central city forsources of supply. References to mass transportationplans may be essential for improved planning for thelocation of health services and to make meaningfulprojections as to the availability of manpower.

Assessing, Analyzing, and AbstractingExisting data should be carefully selected, analyzed,

and studied. Some data from existing sources may notlend themselves to a definition and description ofparticular planning situations. Measures for assessingdata and the limitations of data for planning purposesare briefly described in the next section, pages 66.68.

As data are collected, relevant information not avail-able but deemed essential should be noted as areas forspecial surveys or studies or for which special con-sultants and resource people knowledgeable in par-ticular areas relevant to planning may be utilized orrequired.

Existing data must not only be analyzed but alsoabstracted or summarized in a form readily usable byplanning committees. Planning staff or those responsi-ble for factfinding usually produce some type of reporton designated subjects and particular areas of concernto the planning group.

Descriptive information, interpretation, and analysisof the data are usually presented in narrative form,interspersed with quantified data in statistical tablesthat clarify and highlight the findings or conclusionsdrawn from the data, and the implications. The de-tailed tabulations of statistical materials may be com-piled in statistical tables for further analysis and forreference to particular items as may be necessary. APof these materials may be used later in the wrinendocuments and publications of the planning body.

It should be emphasized that some recommendationsand implications for planning action programs mayhe suggested by the analysis of data, without need forfurther detailed assessment or !'.udy. The statisticalsurveys and analyses, however, are only a stage in the

development of the plan, and should not be thoughtof as the end product of planning.

Original Data

Although, as mentioned, much of the data neededfor planning will be available from existing sources,special problems may arise for which no existing dataare available to provide appropriate guidance to theirsolution. Existing data may be too refined, of question-able validity, or out of date. Therefore, special surveysand studies may have to be undertaken to collectoriginal data that will yield the information needed.Because these studies can be time-consuming and ex-pensive, and require technical expertise, the value ofthe data to be gained from such studies should becarefully assessed before the studies are launched.

Aletlwds of Collecting Original DataQuestionnaires, interviews, and observation are

used to collect original data. Any one or all of thesemethods may be employed to gather data on the samesubject.

Ouestionnaire.The questionnaire, perhaps the mostwidely used method for original data collection, is thesimplest type of data-collecting method to administer.It is also less expensive and time-consuming than othermethods. The questionnaire is used to elicit data onthe following: (1) objective facts, such as the numberof facilities and services available and the number ofpersonnel employed; (2) behavioral variables that maybe of interest to planning groups, such as kinds ofnursing activities performed; (3) evaluations, such asfeelings about the quality of patient care; and (4)specified events, such as the time spent by nurses onclerical activities.

lnierview.The interview method is used wherequestionnaires cannot provide the depth of responserequired. The unstructured interview permits probinginto the responses solicited to verify meaning and toobtain data in depth. The highly structured interviewallows for the collection of standardized data and in-formation and for probing to clarify and broadenresponses.

Observations.The observation method is used forstudies in which evaluation is the primary objective orwhere data required are complex, are difficult to ob-tain, and need considerable interpretation. Suchstudies would include, for example, evaluating the

66 CHAPTER 6

activities of personnel or the quality of their perform-ance. Data are recorded in the form of an evaluativerating of what is being observed, a narrative descrip-tion of what was seen, or as entries on a checklist. Theuse of this method requires considerable control overthe observation to ensure reliability.

The various methods available for collecting originaldata cannot be described in detail here. Statisticallytrained persons who are recruited for the planningactivity have knowledge of these methods. Also, manyexcellent books are available on data-collection anddata-processing.

Special StudiesIt is difficult to anticipate the kinds of special studies

that may have to be undertaken for a specific planningactivity. This will depend upon the nature of the prob-lems encountered in the planning process, as well asthe status of available data.

To mention but a few, special studies have beenconducted in planning activities for nursing concerningthe following:

Utilization of nursing personnel.Nurse staffing.Patient's needs for services.Turnover of nursing personnel in employing in-

stitutions.Interstate mobility among nurse manpower.Job and career satisfaction and incentives.Salaries and fringe benefits.Processes of recruitment for nursing.Nature of nursing school applicants and applicant

experience.Costs of nursing education to schools and students.Costs of nursing services.Inactive nurses.

Study techniques and methodologies developed forconducting special studies of particular aspects ofnursing are referenced in appendix 2.

Research as Part of PlanningThe identification of nursing situations and problems

requiring research is a natural outgrowth of an in .depth assessment of nursing needs and resources.Planners recognize that methods of augmenting exist-ing personnel resources must be developed both byexploring creative ways to utilize personnel and hydeveloping pi.ocedures for education and training ofpersonnel. Although the particular approach in eachplanning area must be guided by existing conditions.the development of nursing programs may depend...won study and research to determine the nature of thebasic problem to be solved, the means for solving theproblem, or the means for applying a solution alreadyfound.

Problems requiring formalized research are cited inthe reports of many planning groups. Among these, forexample, are the following:

Discrepancies between current nursing practiceand basic nursing education.

Measures of the quality of nursing care andservices.

Effective information on recruitment and counsel-ing programs and techniques.

Career choices and motivation.Effectiveness of various financial and other incen-

tives as a means of increasing nurse manpower.Evaluation measures and techniques for effec-

tiveness of nursing service and nursing educationprograms.

Processes for effecting change in personnel utiliza-tion and nursing programs.

Stimulating, promoting, or sponsoring nursingresearch geared to the particular needs of the planningarea is an essential part of continuous planning. Re-search is required for attaining long-term goals con-cerned with the improvement of nursing care, nursingservices, and personnel resources. References to Fed-eral assistance programs in health research fields arelisted in appendix 2.

Assessing Adequacy of Data and Data-Collection Methods

In the data-collecting process, the adequacy of themethods used, the quality of the data, and the rele-vance of the data to the planning activity should beassessed. Flaws in collection methods and inadequacies

in statistics can indeed modify the findings and theconclusions to be drawn from data. Therefore, plan-ners should be aware of potential distortions in statis-tics and error factors in collection methods.

FACTFINDING 67

The following four criteria should be applied to anymethod of data collection to evaluate its quality:

Validity: The degree to which the data-collectingmethod yields data that are relevant to the problemsbeing investigated.

Reliability: The extent to wbich the method yieldsaccurate or consistent data.

Sensitivity: The degree to which the data discrim-inate.

Meaningfulness: The degree to which the datapossess practical significance.

Attention should be given to these major sources oferror in data collection:

Sampling error: Technically used to denote thedifference between the value of a parameter of auniverse and the value of the statistics derived fromthe sample of the universe.

Observer error: Psychological bias or mistakes inrating on the part of observers.

Response error: Failure of the respondents in astudy to participate or to give accurate or completeresponses.

Data-processing error: Errors in collecting data,and inadequate editing or errors in coding, card-punching, tabulating, and programing data.

The extent of error in collecting data can be mini-mized and precise data can be obtained and skillfullyinterpreted if planners are critical about their data-collecting processes and provide for appropriate as-sistance as required for the following:

Assessing existing sources of data.Determining the effect uf the data-collecting

methods on the data.Designing original data-collection instruments.

' Limitations of DataPlanners also need to be alert to the potential

limitations of data which tend to impede effectivenessin assessing needs and resources. One of the greatestproblems in assembling available data for health man-power planning is lack of a coordinated statisticaleffort for the collection of data focused on planning.In addition, many gaps exist in data required forhealth planning. Some of the gaps are related to theneed to develop study mcthods and statistical reportingsystems, which are costly and difficult to produce.Until means for overcoming these deficiencies arefound, planners must rely on their own knowledge,

experience, and best judgment for making some oftheir planning decisions.

Existing DataExisting data are secondary sources of data, and as

such have certain limitations. For adequately definingparticular planning situations and making relevantplanning decisions, it is important that existing databe evaluated in terms of these possible limitations:(I) definition, (2) refinement, (31 accuracy, and (4)timeliness.

Definitions.Definitions used in existing data maynot correspond to the definitions of the planningproject. An example of this is the term "manpowershortage." In some studies, "manpower shortage" maybe defined as the number of vacant budgeted positionsfor health manpower. In other studies, "manpowershortage" might be defined as the difference betweensome optimal desired number of health manpower(based on criteria of what constitutes good healthcare) and the number actually employed in providinghealth care.

Refinement.Existing data may be either too re-fined (detailed) or not refined enough to be of use forplanning. Groupings of data in terms of one or moreof its variables may not coincide with descriptiverequirements of planning groups. Categories of datamay be too broad, or data may be grouped into toomany categories for defining a particular situation.For example, data on turnover of hospital personnelsometimes are not refined enough; they do not dif-ferentiate between the various categories of nursingpersonnel, as registered nurses, licensed practicalnurses, and nursing aides. An overall turnover ratemay disguise the fact that for nursing aides the turn-over rates are very high, whereas for practical nursesthe turnover rates are very low. On the other hand,census data on the age distribution of the populationare too refined; they are broken down into 5-yeargroups. Broader age groupings may be more meaning-ful for health manpower planning.

Accuracy.lt is difficult to evaluate the accuracyof existing data. They may be incomplete or may havebeen inaccurate when originally collected. Such de-ficiencies may be undetected by the user of the data,particularly if the limitations are not made known.

Timeliness.Data may be too old to be of value formaking relevant planning decisions. There is often a2- to 3-year lag between the time of collection of data

68 CHAPTER 6

and the time of publication. The stability of data.however, should be assessed against the degree andrate of change in the factors which the data portray.When current data are not available, estimates ofcurrent data can be made by extrapolation and projec-tion techniques that use a series of data from a numberof previous years.

Gaps in Data.As a basis for planning, data andstatistics should reflect all components of the healthcare services and health manpower educational systemand their relationship to one another. Measurementsof the amount and quality of care and services pro-vided are needed, as well as measurements of futureneeds. The major gaps in these data requirements forplanning concern the following:

Data Information Systems

To improve the availability and reliability of statis-tics, increasing recognition is being given to the needto develop cooperative arrangements and systems forthe centralized collection, analysis, and retrieval ofdata and information required for continuous healthplanning. An area's nursing supply and needs and theresources for meeting needs could be appraised quicklyand systematically if the necessary facts were gathered,tabulated, and analyzed on a continuous basis. More-over, an information system for continuous planningwould provide source data and other information forassessing progress in meeting planning goals and forshedding light on any needed revisions in the basicplan, in terms of new developments that had occurred.

The major kinds of data that should be collected ona continuing basis are as follows:

Supply and distribution of nursing personnel.Nursing school admissions, enrollments, and

graduations.Basic socioeconomic data relevant to providing a

framework for analyzing musing supply and resources.

Precise measuring techniques for evaluating theimpact of demographic cultural and economic influ-enres and change.

Precise data and means for measuring supplyneeds.

Uniform standards for programing and staffing.

Incomplete reporting of data due to varyingrequirements for reporting data among health andeducational agencies and political jurisdictions.

Designation of data as confidential by the collect-ing agencies for reasons which they consider judiciousfor carrying out their programs.

for Continuous Planning

Projections of nursing supply and needs.Planning groups should assume leadership and

responsibility for stimulating and rendering activesupport in the development of a statistical health in-formation system for continuous planning. In coopera-tion with other planning groups and with health andrelated agencies, nurse planning groups can guide andassist in the following:

Determining the types and kinds of data neededfor assessing nurse manpower needs and resources.

Establishing procedures for collecting and analyz-ing nursing data.

Securing the cooperation and collaboration ofprograms of nursing service and nursing education inthe statistical information program.

Achieving the accurate and complete reporting ofrequired data by nursing agencies and institutions.

Re-evaluating at regular intervals the data re-quirements; the availability of new data; and theprocedures adopted for data collection, analysis, andretrieval.

References

ABDELLAH, FAYE G., and LEVINE, EUGENE.

1965. Better Patient Care Through Nursing Re-search, pp. 311-333 and 548-558. NewYork: Macmillan Co.


1969. Facts About Nursing, 1969 Edition. NewYork: The Association. 250 pp.

FACTFINDING

CALIFORNIA DEPARTMENT OF HEALTH.

1968. The Manpower Planning Subsystem of theCalifornia Health Information for PlanningService (CHIPS) System. Berkeley, Calif.:The Department. 29 pp.

DEPARTMENT OF PROFESSIONAL and VOCATIONAL

STANDARDS. BOARD OF NURSING EDUCATION and NURSE

REGISTRATION.

1969. Profile of Registered Nurses in California.Sacramento: The Board. 51 pp.

Fox, DAVID J.1966. "Data Gathering Methods and Techniques."

Fundamentals of Research in Nursing, pp.199-226. New York: Appleton-Century-Crofts, Inc.

ILLINOIS STUDY COMMISSION ON NURSING.

1968. Nursing in Illinois: An Assessment 1968and a Plan 1980, XIV, p. 23. Chicago:The Commission.

MINNESOTA BOARD OF NURSING.

1967. Nursing in Minnesota, A Statistical Review,February 1967. St. Paul, Minn.: TheBoard. 47 pp.


1967. Action-Planning for Community HealthServices. Report of the Community ActionStudies Project, pp. 36-40. Washington:Public Affairs Press.

NATIONAL LEAGUE FOR NURSING. DIVISION OF

RESEARCH.

1971. State-Approved Schools of NursingR.N.,1971. New York: The League. 112 pp.

PHILLIPS, JEANNE S., and THOMPSON, RICHARD F.1967. Statistics for Nurses: The Evaluation of

Quantitative Information. New York: Mac-millan Co. 550 pp.

SCHOOL OF HOSPITAL ADMINISTRATION. MEDICAL

COLLEGE OF VIRGINIA.

1968. Nursing and Health Care in Virginia, p.Health Science Division of the VirginiaCommonwealth University, Richmond, Va.

SLONIM, MORRIS JAMES.

1966. Sampling. A Quick, Reliable Guide toPractical Statistics. New York: Simon &Schuster, Inc. 144 pp.

69

STATE OF CALIFORNIA DEPARTMENT OF PUBLIC

HEALTH. DIVISION OF PATIENT CARE FACILITIES ANDSERVICES.

1968. Summary Report, California Health Infor-mation for Planning Service. Berkeley,Calif.: The Department. 137 pp.

U.S. DEPARTMENT OF COMMERCE. BUREAU OF THECENSUS.

1970. Statistical Abstract of the United States,1970. National Data Book and Guide toSources. 91st Arnual Edition. Washing-ton: U.S. Government Printing Office.

1,018 pp.

U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WEL-

FARE. PUBLIC HEALTH SERVICE. BUREAU OF HEALTH

MANPOWER. DIVISION OF NURSING.

1967. Community Planning for Nursing in theDistrict of Columbia Metropolitan Area.Source Book for Planning. PHS Pub.1676. Washington: U.S. GovernmentPrinting Office. 143 pp.

PUBLIC HEALTH SERVICE. HEALTH

SERVICES AND MENTAL HEALTH ADMINISTRATION.NATIONAL CENTER FOR HEALTH STATISTICS.

1969. A State Center for Health Statistics. AnAid in Planning Comprehensive HealthStatistics. Public Health Conference onRecords and Statistics Document No. 626.Revised October 1969. Washington: U.S.Government Printing Office. 23 pp.(Available from National Center for HealthStatistics, 5600 Fishers Lane, Rockville,Md. 20852.)

PUBLIC HEALTH SERVICE. NATIONAL

INSTITUTES OF HEALTH.

1969. Health Manpower Source Book. Section2, Nursing Personnel,. Revised 1969.

PHS Pub. 263. Washington: U.S. Gov-ernment Printing Office. 144 pp.


INSTITUTES OF HEALTH. BUREAU OF HEALTH PRO-

FESSIONS EDUCATION AND MANPOWER TRAINING.

DIVISION OF NURSING.

1969. Source Book for Community Planning lorNursing in South Dakota. Washington:U.S. Government Printing Office. 232 pp.

Chapter 7

Assessing Requirements forNurse Manpower

FACTORS IN ESTIMATINGNURSE MANPOWER REQUIREMENTS

EE IIIIIO 1 OM

Migration

Recruitmentpool

Utilizationof facilitiesand nurse

supply

EPI1,

.........

Facilities,criteriay.andstandards for

care andservices..... .......

Type of

educationalprogram

Distributionof facilitiesand nurse

supplyInactive

72

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

Chapter 7

Assessing Requirements for Nurse Manpower

Manpower planning in any field cannot proceedlogically without a careful assessment of manpowerrequirements, both qualitative and quantitative, andboth current and future. Nurse manpower require-ments must he measured in all nurse manpower plan-ning projects, to provide a framework for assessingthe adequacy of the supply of nurses. Furthermore,supply requirements must be determined for broadgeographic areas as well as for particular fields ofnursing and for the various types of institutions andagencies where nursing services are rendered or nurs-ing programs are carried out. Such measurement isessential for setting goals, for developing meaningful

recommendations, and for establishing guidelines tomeet requi rcments.

Intelligent planning relates requirements for nursemanpower to available resources. Projections of futurerequirements should be supported by determinationsthat attainment is reasonably Possible, and should indi-cate measures required for that attainment. Estimatesof future supply provide a framework for assessingthe likelihood of meeting requirements. In addition,perspective on educational resources necessary formeeting manpower needs and demands can be obtainedby a careful examination of projected manpower re-quirements against projected manpower supply.

Concepts in Assessing Manpower Requirements

Measurement of manpower requirements falls intotwo broad classes: demand and need. Health inanpower demand defines requirements.primarily on thebasis of economic factors. In other words, demand canbe assessed by determining how many dollars areavailable from employers to pay for salaries as meas-ured by the. number of budgeted positions. Healthmanpower need, on the other hand, defines require-ments by considering the standards, expectations, andvalues as determined by health professionals. Need canhe assessed by applying criteria considered to produceoptimal levels of nursing care or service. For clarity,throughout the remainder of this chapter, the words"demand" and "need" are used only in the contextof these concepts of demand and need for measuringmanpower rcqui rements.

Demand for health manpower is derived from &-mild for health care; need for health manpower.from need for health cam. To measure and projectboth demand and need for nurse manpower, ratios forcurrent and future supply are usually derived. Forexample, both demand and need estimates of man-power requirements frequently use manpower-popula-

tion ratios or nurse-patient ratios to express currentrequirements. Future requirements are then projectedin terms of supply based on some aspect of the man-power-population ratio or nurse-patient ratio.

Ratios may be either a single aggregate ratio of allnurses to total population or a set of demand or needratios for different areas of nursing. Ratios that usea single gross factor affecting manpower in determin-ing requirements are termed "crude ratios." Ratiosthat consider more than one factor are termed "re-fined ratios."

Crude ratio projections, for example, assume thatthe only factor that will affect the future demand andneed for nurse manpower is population growth. Re-filled ratio projections, however, go beyond the popula-tion factor; they embrace a set of ratios for differentareas of nursing to determine overall needs. For ex-am*, such sets of ratios might consider the numberof sAool nurses required based on the number ofschools in the future; of office nurses required basedon the number of physicians' offices in the future; andof hospital nurses required based on the number ofpatients in hospitals in the future. Detailed examplesof 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 atmethods, 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 measurebecause of the variety of health services and nursingpersonnel from which demand is derived. The mostpopular method utilizes crude demand ratios, and eventhese may be imprecise measurements because of dif-ferences in the definition and perception of the singlefactor of measurement used. For example, differencesin fiscal resources, in perception of need for personnel.in utilization patterns, and in availability of personnelresources lead to inconsistencies in the demand esti-mates of budgeted positions from one institution to

another.Other methods utilize refined demand ratios. To be

precise, refined demand ratios need to be constructedwith respect to the many interrelated demand variablessuch as philosophies toward care, institutional patternsrelating to staffing patterns, and the volumes of health'care rendered by the various health services in theplanning area.

Measuring Current DemandThe usual approach to computing demand ratios is

to measure demand by determining the total number ofbudgeted positions for nursing personnel. Staffing re-quirements are the total number of budgeted positions

in each nursing service agency and institution in thegeographic area for which planning is being done. Thedifference between the total demand (budgeted posi-tions) and the actual supply represents manpowershortages (the budgeted vacancies).

Ratios of current demand for nursing personnel arecomputed by relating total budgeted positions (supplyplus budgeted vacancies) to some population base. Thepopulation base could he total population or someselected segment. such as the number of people inhospitals, or the number of people 65 years of ageand older.

Projecting Future DemandThe most widely used method for projecting future

demand for nurse manpower is to apply ratios ofcurrent demand for nursing personnel to populationprojections at some future date. This method ofestimating future demand assumes that current demandfor nursing personnel will remain constant into thefuture and yields a projection of the status quo. How-ever, changes in patterns of the delivery of health carein the future might result in significant shifts in thedemand level for nursing personnel, which would notbe reflected in the projection.

Methods for Measuring and Projecting Need

The most frequently used methods for assessingnurse manpower need are based on the applicationof a set of standards or criteria that quantitativelyexpress desirable ratios of nursing personnel to thepopulation served. Other methods focus on the needof consumers for nursing care as being the primarydeterminant of manpower requirements. Those meth-ods, however, are extremely difficult to apply, aretime-consuming, require an enormous research effort.and, in their present stage of methodological develop-ment, are impractical for determining overall need forplanning purposes.

Measuring Need Based on Standards andCriteria

The application of standards and criteria in theassessment process was discussed in chapter 5. Methodsof assessing nurse manpower need based on a set ofstandards and criteria require the derivation of staffingstandards for determining the quantity and mix ofnursing personnel needed to attain some optimumgoal. Staffing ratios are determined and are appliedas standards to the institutions and agencies in theplanning area. Projections of need are then based onestimates of the number of persons seeking health

ASSESSING MANPOWER REQUIREMENTS 75

care at some particular point in time. Ideally, toadequately estimate nurse manpower need for a totalplanning area, different staffing ratios for the manydifferent staffing patterns in the various fields of nurs-ing are required. Approaches to the derivation andapplication of 'standards for estimating need includethe following:

Using existing staffing standards and ratios de-rived from previously conducted studies and researchor determined as part of planning.

Constructing desirable staffing ratios based onthe knowledge, experience, and expert judgment ofplanners.

Undertaking research programs to determinestaffing patterns to be. used as standards.

Standards Based on Ex&ting Staffing Ratios

Standards based on existing good practice can beused as models for making projections. Previous sur-veys, studies, research or other planning activities mayhave derived staffing ratios that can be applied forprojecting need. Or the planning group itself mayderive staffing ratios through its own stuidy or studiesof existing staffing ratios.

A set of model institutions in which "good" nursingcare is reported to be provided can be selected. Theexisting staffing ratios in these institutions can be de-termined and applied to all institutions in the popula-tion in which the assessment of nursing need is beingmade. For example, in 1948 the National League forNursing Education selected 22 hospitals in the NewYork City arca that were reputed to be well-managedand were providing high-quality nursing care. Anintensive study was made of the nurse-patient ratiosin these hospitals. (See reference at end of chapter).It was determined that the average ratio was 3.5hours of nursing care per patient per day, of whichtwo-thirds was provided by registered nurses and one-third by nursing aides, practical nurses, and others.

Similar studies could be made by the planning groupin other fields of nursing. For example, "good" homehealth agencies could be studied and their staffingpatterns determined; their patterns could serve asstandards for projecting needs in all home healthagencies.

Nursepopulation ratios of geographic areas withhigh ratios can be used as standards. Registerednurse-population ratios existing in the individualStates are estimated periodically from data obtainedfrom the registered nurse inventories. Nurse-population

ratios are also periodically estimated for counties andmetropolitan areas, or can be derived from licensuredata available from State boards of nursing. The ratiosof the States that rank highest in their nurse populationdistribution or the ratio of any selected State or otherarea can be used as a standard. Need is thus projectedon the basis of a selected optimum ratio that bas beenattained in another area.

Standards Based on Expert JudgmentInstead of current ratio projections, a set of de-

sirable ratios based on assessment of future patternsof nursing care and their impact on nursing need canbe developed. In this approach, planners and expertsselected for this purpose construct a model of thefuture organization and delivery of nursing services.Criteria arc developed based on value judgments forstaffing and for the educational preparation thatshould be required for the various nursing positionsin cach field of nursing employment. By applyingthese criteria and staffing patterns to the appropriatehospital population expected, the projeeted number ofnursing homes, the general population, and the num-ber of students, it is possible to estimate the numberof nursing personnel required for each field.

An example of the determination of national nurs-ing need through the use of an expert panel was theSurgeon General's Consultant Group on Nursing, whoreported their findings in Toward Quality in Nursing.(See reference at the end of this chapter.) In develop-ing its estimates of nursing requirements for hospitals,for example, the consultants believed that the numer-ical ratio of nursing personnel to patients in generalhospitals in 1963 would probably be adequate for1970. The consultants also believed that distributionof nursing personnel giving bedside care should be50 percent registered nurses, 30 percent licensedpractical nurses, and 20 percent other nursing per-sonnel, 50-30-20 mix instead of the then existing30-20-50 mix.

A fuller description of the methodology is con-tained in Part VIII of Health Manpower Source Book,Section 2, Revised 1969. (See reference at end ofchapter.) It is recognized that many of the criteriaused, the judgments about the future status of nursing,and the predictions about the need for nursing carein the future, all represent the values and philosophiesof the particular group of experts involved. However,a projection of nursing needs by this method attemptsto free itself from the status quo and considers changes

76 CHAPTER 7

that are likely to occur in health care, efficient staffingpatterns in response to these changes, and the appro-priate amount and mix of care. Such projections needto be re-examined from time to time. to assess theircontinued relevance and meaningfulness.

Standards Based on Research

Numerous research projects can be undertaken toestablish standards for determining nursing needs.Such studies would be aimed at determining staffingpatterns that would optimize economy, efficiency, andquality.

Research conducted to develop optimum staffingpatterns suggests that no single staffing pattern wouldbe applicable to large groups of employing institutions.Factors affecting nursing requirements include, for

example, the form of nursing organization, the effi-ciency of the organization, and the levels of educa-tional preparation and experience of nursing personnelproviding care. Attempts to yield methods that wouldincorporate the significant variables related to man-power requirements have not been definitive. Much ofthe research that could be conducted in the improve-ment of nursing practice and utilization could help inproviding criteria for assessing nursing requirements.

Measuring Need Based on Requirements forNursing Service

Methods of determining manpower need by assessingpeople's requirements for nursing service may be ofinterest to planning groups who have resources forhaving research conducted or who must determinerequirements in particular areas. Nursing requirementscan be aggregated from the assessment of the needs ofconsumers, which would include not only people whoare ill but also those who are well, since everyoneneeds preventive care.

Some methodology is available for assessing patientrequirements for nursing services. (See appendix 2.)These methods, however, are concerned only withpeople who are ill and whose needs for health carehave already been identified; the objectives of themethodology are to classify the needs according to ascale of intensity of illness for purposes of allocatingpatients to different facilities or assigning staff. Amongsuch methods are the various tools that have beendeveloped to classify patients for hospital, nursinghome, and home care, according to the intensity oftheir illness, and to translate these classifications toneed for nursing personnel. A broader approach wouldassess comprehensive health care needs for all persons,regardless of whether they are patients. Althoughexisting methodology is confined largely to determin-ing medical needs, it is also possible to conceive ofmethodology that would determine nursing needs.

Selecting a Method

All of the methods that have been used to estimatenurse manpower requirements for the purposes .ofplanning have limitations. All can be criticized. Thereis serious lack of precision in projection techniques.Much research is needed to improve methodologies.However, since estimates of current and future man-power requirements are essential to formulate rationalgoals and to provide guidelines for achieving thesegoals, planners must select some method or methodsfor measuring current and future manpower require-ments. Such a selection will be conditioned by thefollowing:

The resources and capability of the planninggroup to compile and quantify relevant data.

The method offering the best analytic framework

for esta bushing requirements of the various institu-tions and agencies in the planning area.

The areas or fields of nursing that may requirean in-depth assessment of requirements for developingmeaningful recommendations.

The simplest approach is to base future estimates onthe concept of economic demand. This method usuallygives the most conservative estimate. Many planninggroups find the most satisfactory approach is to usestandards based on expert judgment. Planning groupsmight find it useful to examine what other planninggroups have done in estimating future manpower re-quirements. A list of reports of planning groups iscontained in Appendix 1.


Estimating Future Supply

The capability of planning areas to meet nursemanpower requirements, whether set by need or de-mand measurements, should be assessed. Althoughinadequacies are implicit in all methods for estimatingthe future nurse supply, the use of these methods cangive indications of whether goals will be unmet, met,or exceeded. In addition, these methods can be usedto determine requirements for reaching desirable goals.

The most frequently used methods for projectingnurse supply are as follows: (1) straight-line projec-tion methods, which predict supply by applying trendsof recent years to the projection date and whichassume that increases in the supply will continue atthe same rate as in past years; (2) "age-specificoccupational employment rate methods," which consider the number of persons employed in the occupa-tion by age and the number of persons qualified forthe occupation or educational output.

The most accurate projections of future nurse supplyare made by using a variation of the "age-specificoccupational employment rate method" provided theprojections are made for short periods and are fre-quently revised. Projections of the nurse supply aremade by adding the expected output from educationand training programs in the planning area to thecurrent employed nurse supply after deducting attri-tion. Included are estimates for the number of nurseswho leave the occupation through marriage, death,retirement, inactivity, or transfer out of the planningarea.

Variations in the use of this gain.loss ratio methodfor projecting supply also permit determination of thenumber of graduations needed, supply replacements,and growth required to attain specified goals in thenurse supply. Such compilations can, for example, berelated to and guide educational efforts in the follow-ing:

The adequacy of existing and projected trainingfacility capacities.

The required number of admissions to educa-tional programs.

The required size of the future manpower poolfor training.

A full discussion of the method of computation iscontained in Source Book for Community Planningfor Nursing in South Dakota, referenced at the endof this chapter. The use of the method as applied tonational nurse supply projections is further discussedand illustrated on pages 125-144 of Health ManpowerSource Book, Section 2, Nursing Personnel, also refer-enced at the end of this chapter.

Much research is needed to improve techniques forprojecting supply. For more refined projections forplanning areas, variables such as the following wouldneed to be considered:

Migration rates in and out of the planning area.The nature and size of the manpower pool for

training.Changed conditions in the future affecting de-

mand and need for nursing personnel

References

ALBEE, GEORGE W.

1968. "Conceptual Models and Manpower Re-quirements in Psychology," AmericanPsychologist, 23 (5) : 317-320 (May).

FOLK, HUGH ; and YETT, DONALD E.1968. "Methods of Estimating Occupational At-

trition." Western Economics Journal, VI(4) : 297-302 (September).

MAKI, DENNIS R.1967. A Forecasting Model of Manpower Require-

ments in the Health Occupations. In-dustrial Relations Center, Iowa StateUniversity, Ames, Iowa. 147 pp.

MEYER, BURTON.

1957. "Development of a Method for DeterminingEstimates of Professional Nurse Needs."Nursing Research, 6 (1) : 24-28 (June).

MOUNTIN, JOSEPH W.; PENNELL, ELLIOTT H.; andBERGER, ANNE G.

1949. "Health Service Areas: Estimates of FuturePhysician Requirements." Public Health&Hain No. 305. Washington: U.S. Gov-ernment Printing Office. 89 pp.

MYERS, JOHN G., and CREAMER, DANIEL.

1967. Measuring lob Vacancies: A FeasibilityStudy in the Rochester, N.Y. Area. New

78 CHAPTER 7

York: National Industrial ConferenceBoard, Inc. 278 pp.

NATIONAL LEAGUE FOR NURSING. COMMITTEE ON THE

FUTURE.

1957. Nurses for a Growing Nation. New York:The Association. 31 pp.

NATIONAL LEAGUE FOR NURSING EDUCATION. DEPART-

MENT OF STUDIES.

1948. A Study of Nursing Service. New York:The League. 63 pp.

SOMERS, ANNE R.

1968. "Meeting Health Manpower RequirementsThrough Increased Productivity." Hos-pitals, Journal of the American HospitalAssociation, 42: 43-48 (Mar. 16).

U.S. DEPARTMENT OF HEALTH, EDUCATION, AND

WELFARE. PUBLIC HEALTH SERVICE.1963. Toward Quality in Nursing: Needs and

Goals. Report of the Surgeon General'sConsultant Group on Nursing. PHS Pub.992, pp. 15-23. Washington: U.S. Gov-ernment Printing Office.


INSTITUTES OF HEALTH.

1969. Health Manpower Source Book. Section2, Nursing Personnel. Revised 1969.PHS Pub. 263, pp. 125.144. Washington:U.S. Government Printing Office.


INSTITUTES OF HEALTH. BUREAU OF HEALTH PRO-FESSIONS EDUCATION AND MANPOWER TRAINING.


1969. Source Book for Community Planning forNursing in South Dakota, pp. 87-90.Washington: U.S. Government PrintingOffice.

U.S. DEPARTMENT OF LABOR. BUREAU OF LABORSTATISTICS.

1963. The Forecasting of Manpower Require-ments. BLS Report 248. Washington:The Department. 96 pp. (processed).

BUREAU OF LABOR STATISTICS.

1969. Tomorrow's Manpower Needs. Nationalmanpower projections and a guide to theiruse as a tool in developing State and areamanpower projections. Vol.1, DevelopingArea Manpower Projections. Bulletin 1606(February). Washington: U.S. Govern-ment Printing Office. 100 pp.

WALKER, JAMES W.

1969. "Forecasting Manpower Needs." HarvardBusiness Review, 47: 152-154 (March.April).

WEISS, JEFFREY H.1967. The Changing Job Structure of Health

Manpower. Cambridge, Mass.: HarvardUniversity. 267 pp.

WORLD HEALTH ORGANIZATION. REGIONAL OFFICE FOR

EUROPE.

1969. Methods of Estimating Health Manpower.Report on a symposium convened by theRegional Office for Europe of the WorldHealth Organization, Budapest, 15-19 Octo-ber 1968. EUR00289. Distributed bythe Regional Office for Europe, WHO,Copenhagen. 141 pp.

YETT, DONALD E.

1965. "The Supply of Nurses: An Economist'sView." Hospital Progress, 46 (2) : 88-102(February).

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

0 4

Appendix 1

Survey and Study Reports

This appendix lists references to reports of major or typical surveys and studieson planning for health manpower needs and resources that have been carried out inthe United States. No attempt has been made to include all such reports; additionalones may be found for individual jurisdictions. The reports listed here document themany changes and advances since the 1920's in health and nursing services, healthmanpower resources, and nursing education. They also depict the progress made inmeeting needs and demands for health and nursing services. In addition, they providea way to evaluate the various measures taken to meet the needs and demands. Andfinally, they point to the many old and unsolved problems in nursing, as well as thenew, emerging ones.

Appendix 1 is divided into two parts. Part 1 pertains to overall health manpowerneeds and resources; part 2, to nursing manpower needs and resources. Within eachpart, the oldest referenceslisted in the first sectionare of historical interest. Thereferences are arranged, within each section or group, in chronological order. Mostare annotated. In the last section of part 2, blueprints for nursing education aredefined and a few examples of State blueprints are referenced.

I,

84

Contents

Part 1

NEEDS AND RESOURCES IN OVERALL HEALTH DISCIPLINES ANDMANPOWER

Page

Historical Reports, 1925-38, National 85

Reports, 1948-60, National 86

Reports, 1962-70; National, Regional, State and Territorial 88National 88Regieual 91State 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 100National 100Regional 101State and Territorial 102

Reports, 1962-71; National, Regional, State and Territorial 106National 106Regional 109State and Territorial 110

Blueprints for Nursing Education 125Group 1. Prescribing General Guidelines 126Group 2. Prescribing Time-Phased Geographic Plans 126

Part 1

Needs and Resources in Overall Health Disciplinesand Manpower

Historical Reports, 1925-38; National

FLEXNER, ABRAHAM.

1925. Medical Education: A Comparative Study.New York: Macmillan Co. 334 pp.

Flexner attempted to make a comparative study of medicaleducation in certain European countries and in America,against the background afforded by the general educationaland social systems of the respective countries. The theme ofthis book, on the clinical side, is that internal medicine is tilecontrolling factor. The other branches of medicine are notconsidered unimportant, but Flexner believed that if a soundorganization is perfected and if support can be obtained andthe medical clinic is properly carried on, the requisite adjust-ments in other clinics will come about. Discussion of post-graduate education is not included because it presents otherproblems. Examinations for lieensure are omitted from thediscussion, although Flexner believed that if the general trend-of his presentation was sound, the examinations for licensurewould in time be adjusted. Flexner's book did much to showthe way for a sounder and more scientifically motivated form ofmedical education in the United States. It was timely andforward looking in 1925, and even today is considered to bea distinguished report.

LEE, ROGER I., and JONES, LEWIS W.1933. The Fundamentals of Good Medical Care.

Chicago: University of Chicago Press.302 pp. (Known as the Lee-Jones study.)

On behalf of the Committee on the Costs of Medical Care,Drs. Lee and Jones estimated heahh manpower requirementsof the Nation on the basis of expert opinions on the amountof care needed to provide adequate preventive, diagnostic, andcurative services. By computing treatment requirements forspecific diseases and conditions, the authors found a totalneed for 134.7 doctors per 100,000 population, or 165,424 forthe United States (a shortage of 13,000). Nurse needs wereestimated at about 220 per 100,000 people, below the nationalsupply hut well over the ratio in many parts of the country.

Needs for dentists were estimated at 99-179 per 100,000, com-pared with the existing ratio of 56. Lee and Jones doubted,however, that the Nation was economically able to support anincreased supply of professional health personnel at that time.The authors concluded that the provision of adequate medicalcare depended more upon revision of organization and economicarrangements than upon increases in the number of personnel.(Excerpted from Report of the National Advisory Commissionon Health Manpower, Vol. H, p. 265. Washington: U.S. Gov-ernment Printing Office. November 1967.)

TECHMCAL COMMITTEE ON MEDICAL CARE OF THEINTERDEPARTMENTAL COMMITTEE To COORDINATE

HEALTH AND WELFARE ACTIVITIES.

1938. The Need for a National Health Program.Report of the Technical Committee onMedical Care. Washington, D.C. 36 pp.(multilithed).

"Reviewing health numpower requirements for effectivemodern health service, this Committee found that many areasof the country lacked an adequate supply of physicians,dentists, and nurses; and that even in better supplied areas,inability to pay for care frequently prevented full use ofavailable personnel. The supply of physicians and private.dutynurses, if adequately distributed, appeared to be approximatelysufficient to meet the current effective demand for service.Public health nursing suffered from an under-supply of person-nel, especially in rural areas. The number of dentists wasgrossly inadequate to meet true need, although it sufficed tosatisfy demand under current methods of payment. The com-mittee called for development of a national health programto improve the attractiveness of practice in under-privilegedareas and to lower economic barriers to the receipt of care."(Quoted from Report of the National Advisory Commission onHealth Manpower, Vol. II, p. 265. Washington: U.S. Govern-ment Printing Office. November 1967.)

85

86 APPENDIX 1

Reports, 1948-60; National

EWING, OSCAR R.

1948. The Nation's Health: A Ten-Year Program;A Report to the President. Washington:U.S. Government Printing Office.. 186 pp.

"On the hasis of the National Health Assembly's deliberationsand of consultations with many persons in and out of Govern-ment, Federal Security Administrator Ewing reported to thePresident that it was not enough to meet present effective de-mand; we must assure people services for all their needs. Asa standard of adequacy based on actual experience, Ewing pro-posed the level of supply already attained by the top 12 States.1 physician for every 667 persons (150/100,000), 1 dentistfor every 1,400 persons (72/100,000), and 1 nurse (professionalor practical) .for every 280 persons (357/100,000). He citedspecific shortages of psychiatrists, pediatricians, public healthworkers, and certain categories of supporting personnel.

"Simply to staff expanded health facilities planned under theHospital Survey and Construction Act of 1946, to meet militaryand other Federal requirements, and to provide basic minimumservices throughout the nation under an adequate system ofprepayment for health services, we would have needed by 1960a 40 percent increase in medkal school graduates, a 50 percentincrease in dental school graduates, and a 50 percent increasein the output of all types of nurses. Mr. Ewing recommendedaiming first toward meeting the nation's minimum demand and,beyond that, pushing toward achieving the 12-state goal.

"As a means of promoting the needed expansion of trainingcapacity for the health professions, Ewing proposed Federalaid of at least $40 million a year at the outset (more in sub.sequent years) for the construction of new or expanded schools,the operation of teaching programs, and a scholarship andfellowship program for students. At the same time, he recom .mended the Federal Government should encourage greaterefficiency in the use of professional personnel through thefurther development of group practice, the wider use of sup.porting workers, the extension of refresher and postgraduatetraining courses, and other ways."

(Quoted from Report of the National Advisory Commissionon Health Manpower, Vol. II, pp. 267.268. Washington: U.S.Government Printing Office. 1967.)

MOUNTIN, JOSEPH W.; PENNELL, ELLIOTT H.; andBERGER, ANNE G.

1949. "Health Service Areas: Estimates of FuturePhysician Requirements." Public HealthBulletin No. 305. Washington: U.S. Gov-ernment Printing Office. 89 pp.

"In this study, Dr. Mountin of the U.S. Public HealthService and his staff estimated requirements for physicians in1960 on the basis of three possible measures of adequacy: Tobring the total active physician ratitis up to those of the topone.quarter of the inhabitants of the United States (146 per100,000 civilians), tlm top third (136 per 100,000) or the tophalf (118 per 100,000). At 1949 rates of production, the ex-

ci C.)(..;;

pected supply of physicians in 1960 would have been 227,119.To meet the three standards, the nation would have required anadditional 45,000, 34,000 and 17,000 physicians, respectively.

"For purposes of computing present physician supply, Dr.Mountin and his staff used health service areas outlined bythem in the course of prior studies of the distribution of hos-pitals and the adequacy of available beds. These areas includedhealth service districts (generally a nucleus county with its

hospital center, surrounded by several adjacent counties whosehospital facilities were less advanced), and health service

regions (several districts falling into a more or less broadtrade area). Projections of future physician requirements werebased on regional data.

"Because of the length of time required to expand medicalschool output, the authors noted, it would be a practicalpossibility to meet even the smalkst deficit projected (17,000ad(litional physkians) in the time available between 1949 and1960. Allowing another decade for taking care of expecteddeficits, present medical training facilities would still have tobe expanded considerably.

"The analyses presented by Mountin et al., were intended toillustrate methods of preparing physician estimates for somefuture date, if different assumptions were made, and to indicatepossible location patterns for physicians. The authors notedthat many forces now limiting effective demand for physiciansin sonic areas would have to be removed or modified before

the distribution of physicians would parallel more nearly the

distribution of population."(Quoted from Report of the National Advisory Commission

(n Health Manpower, Vol. II, pp. 268.269. Washington: U.S.Government Printing Office. November 1967.)

HEALTH RESOURCES ADVISORY COMMITTEE (RUSK

COMMITTEE).

1951. "Medicine, Mobilization and Manpower."By Howard A. Rusk, Chairman. Wash-

ington, D.C.: The Committee. 6 pp.

"Created at the outbreak of the Korean War to advise the

National Security Resources Board on health resources essential

during the period of national emergency, the Health Resources

Advisory Committee in 1950.51 made a serk. of studiesanalyzing overall national needs for medical and health man.

power. These included studies of requirements for physicians,dentists, and nurses for the period 1949.54.

"Thc Committee made three basic assumptions as to health

needs. First, we should maintain 1949 staff-population ratios

and services. Second, we should meet additional requirements

of civil ddense, industry, public health, rehabilitation, and

teaching in medical, dental, and nursing schools. Third, we

must meet the needs of the Armed Forces. The Committee also

assumed that for the next 10 years the nation might be in a

state of partial or complete mobilization."At existing levels of production, substantial deficits in

supply of physicians and dentists were foreseen. Because of

the time required to train these personnel, a straight increase

SURVEY AND STUDY REPORTS 87

in school enrollments would meet only part of the need antici-pated over the following few years. A larger increase couldbe effected by acceleration of classes ahead of the usual andcurrent schedule. i.e., eliminating summer vacations. Even withboth expansion and acceleration, however, supply was expectedto fall behind need. The extent of the deficit by 1954 would beabout 22,000 physicians and 9,200 dentists."

(Quoted from Report of the National Advisory Commissionon Health Manpower, Vol. II, pp. 269-270. Washington: U.S.Government Printing Office. November 1967.)

HEALTH RESOURCES ADVISORY COMMITTEE (RUSKCOMMITTEE).

1951. "Dentistry, Mobilization and Manpower."By Leo J. Schoeny, Member. Washington,D.C.: The Committee. 10 pp.

See annotation above.

THE PRESIDENT'S COMMISSION ON THE HEALTH NEEDS

OF THE NATION.

1952. Building America's Health. A Report tothe President by the President's Commissionon the Health Needs of the Nation. Vol-

ume I, Findings and Recommendations.Washington: U.S. Government PrintingOffice. 80 pp.

The Magnuson Commission, as it is commonly known, wascharged with making a critical study of the total health re-quirements of the Nation and recommending action requiredto assure an adequate supply of personnel, services, and educa-tional resources to meet these needs in this time of mobilizationand for the future. This summary volume discusses the majorfindings of the Commission, as well as an account of thepremises and reasoning which led to the recommendations. Sixdifferent estimates of the total requirements for physicians,dentists, and nurses were projected to 1960. Federal aid toschools of medicine, dentistry, nursing, and public health formodernizing and expanding their physical facilities and forhelping meet operating costs was recommended. The need forbetter utilization of professional personnel and the delegationof tasks to auxiliary workers is stressed. Shortages in certainparamedical fields were citcd.

TIIE PRESIDENT'S COMMISSION ON THE HEALTH NEEDSOF THE NATION.

1953. Building America's Health. A report tothe President by the President's Commissionon the Health. Needs of the Nation. Vol-ume 2, America's Health Status, Needs andResources. Washington : U.S. GovernmentPrinting Office. 319 pp.

This volume gives attention to the varied and extensive dataon which the Commission based the conclusions and recom-mendations reported in volume 1. Much of the material comesfrom the discussants at 25 panel meetings and seven joint

panels in which experts on various phases of the health needsof the Nation presented views and evidence. Included also arethe information and reference materials collected by the tech-nical staff to the Commission. This volume outlines the diversi-lied picture of health needs, facilities, and resources presentedto the Commission, including important health needs relatedto special health problems and population groups.

THE PRESIDENT'S COMMISSION ON THE HEALTH NEEDS

OF THE NATION.

1953. .Building America's Health. A report tothe President by the President's Commissionon the Health Needs of the Nation. Vol-

ume 3, America's Health Status, Needsand Resources. A Statistical Appendix.Washington : U.S. Government PrintingOffice. 299 pp.

This volume presents the statistical materials drawn frommany sources on the health status of the American people, onhealth personnel and facilities, and on utilization of healthservices. It is a statistical appendix to volume 2. Included aredata on nursing personnel and supply and nursing educationfor 1951 and 1952. This volume is a good example of the variedkinds of statistical evidence available and required to supportan in-depth study.

HEALTH RESOURCES ADVISORY COMMITTEE.

1955. "Mobilization and Health Manpower."Report to the Director of the Office of De-fense Mobilization by the Health ResourcesAdvisory Committee. 50 pp.

"This report sumtnarized some of the more important find-ings of the Health Resources Advisory Committee of the Officeof Defense Mobilization on health resources and potentials inthe United States, and the effects of military mobilization onspecific sections of the whole. The Committee foresaw a declin-ing ratio of physicians and dentists to population by 1960, andmany unmet demands for nurses. Despite improved utilizationof health personnel by the Armed Forces, military requirementscontinued to be high in relation to those of the civilian popula-tion. . . . Among the areas of greatest need, would be medicaland dental school staffings, hospital staffing, public healthactivities. and civil defense programs." (Quoted from Reportof the National Advisory Commission on Health Manpower,Vol. II, p. 271. Washington: U.S. Government Printing Office.November 1967.)

HEALTH RESOURCES AI;VISORY COMMITTEE.

1956. Mobilization and Health Manpower: II.A report of the Subcommittee on Para-medical Personnel in Rehabilitation andCare of the Chronically Ill. Report to theDirector of the Office of Defense Mobiliza-tion by the Health Resources AdvisoryCommittee. Washington: U.S. Govern-ment Printing Office. 87 pp.

. ei

88 APPENDIX 1

The primary findings of the subcommittee, which compiledextensive data on supply and resources of paramedical person-nel, were, in part, as follows: (ll "An undetermined numberof Americans suffering from physical disabilities and chronicillness were in need of services provided by physical therapists,tecupational therapists, social workers, clinical and counseling

psychologists, speech and hearing therapists, rehabilitationcounselors, and nurses. Identifiable trends indicated that thisnumber would increase. (2) There were not enough paramed-ical personnel of the types indicated to meet existing needsor expected future needs. (3) The supply of personnel andthe level of their training did not constitute an adequatemobilization base."

It was thought that the program for the training of paramed-ical personnel being carried out mainly by thc Office of Voca-tional Rehabilitation and the Public Health Service weresound and well administered. No new Federal legislation fortraining paramedical personnel was needed at that time tomeet national needs, and a mobilization hasc could he achievedthrough continuing and increased support of existing Federalprograms. In case of a national disaster, Federal aid could besubstantially increased within the framework of ongoing pro-grams.

(Excerpted from Report of the Notional Advisory Commis-sion on Health Manpower, Vol. II, pp. 271-272. Washington:U.S. Government Printing Office. November 1967.)

U.S. DEPARTMENT OF HEALTH, EDUCATION. AND WE L-

FARE. OFFICE OF THE SECRETARY.

1958. The Advancement of Medical Research andEducation Throagh the Department ofHealth, Education., and Welfare. FinalReport of the Secretary's Consultants onMedical Research and Education. Wash-ington: U.S. Government Printing Office.82 pp.

Commonly called the Bayne-Jones report, this document con-tains a set of principles and expresses a philosophy that wasto provide important guides to the development of the medicaleducation and research matters of the Department of Health,Education, and Welfare. Included arc some broad conclusionsrelating to the future of medical researchconclusions thatwould provide useful guidelines for the development of publicpolicy in these fields during the next sm.veral years.

DEPARTM ENT OF HEAvrn, EDUCATION, AND WEL-

FA RE. PUMA C HEALTH SERVICE.

1959. Physicians for a Growing Natim. Reportof the Surgeon General's Consultant Groupon Medical Education. PHS Pub. 709.Washington: U.S. Government PrintingOffice. 95 pp.

This report of the Consultant Group is commonly known asthe Bane report. The group assessed the quantitative andqualitative needs for and the supply of physicians against thcbackdrop of socioeconomic change, technological advances, andtrends in health care and services. They projected the numberof physicians required by 1975, and made specific recommenda-tions regarding the quality of medical education, the develop-ment and expansion of educational facilities, and the recruit-ment of students. The report set future goals for medicaleducation, and defined the supporting role of the Federal gov-ernment in aid for construction of facilities, operating expenses,and student educational grants.

THE COMM ITTEE OF CONSULTANTS ON MEDICAL

ESEARCH .

1960. Federal Support of Medical Research. Re-

port of the Committee of Consultants onMedical Research to the Subcommittee onDepartments of Labor and Health, Educa-tion, and Welfare, of the Committee onAppropriations, United States Senate.

Washington: U.S. Government PrintingOffice. 133 pp.

This committee was asked "to determine whether the fundsprovided by the Government for research in dread diseasesare sufficient and efficiently spent in the best interests of theresearch for which they arc designated." The consultants onthe committee concluded that Federal funds provided formedical research, w hilc substantial and efficiently used, are notsufficient for full utilization of the country's medical researchpotential in the national effort to attain solutions to the prob-lems of serious disease. Thc report is .commonly referred to asthe Jones report.

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

NationalTHE PRESIDENT'S COMMISSION ON HEART DISEASE,

CANCER AND STROKE.

1964. Report to The President: A National Pro-gram To Conquer Heart Disease, Cancerand Stroke. Vol. 1. Washington: U.S.Government Printing Office. 114 pp.(Known as the DeBakey Report.)

Manpower needs for the prevention and control of heartdisease, cancer, and stroke were viewed by thc Commission asinseparable from manpower needs for medical care, generally.A full-scale attack on these threc diseases would require ex-pansion of the entire work force in health services. Althoughshortages existed across the entire range of health occupations,the physician supply was deemed the most critical element.

90


Because needs for trained health manpower were so great asto he unattainable during the decade, the Commission recom-mended a twofold program. First, the greatest efforts shouldhe made to utilize present manpower resources in the mosteffective way possible. Secondly, the Nation should imo .3iatelybegin a massive program for the training of additional physi-cians, dentists, nurses, and other health personnel as rapidlyas possible.

Among the Commission's specific suggestions for streng:hen-ing manpower resources were increased Federal appropriationstinder the Health Professions Educational Assistance Act, a

new program of support for the creation of 2year medicalschools, project grant support for health careers education andrecruitment activities, and Federal scholarships for medicaland dental students. Tbe Commission also recommended ex-pansion of Federal support for undergraduate and advancedclinical training in heart disease, cancer, and stroke; moreinvestment in the recruitment and training of health tech-nicians and other paramedical personnel; and development ofa Public Health Service health manpower unit for continuousassessment of manpower requirements for health services.

(Excerpted from Report of the N,,:ional Advisory Commis-sion on Health Manpower, Vol. II, pp. 274-275. Washington:U.S. Government Printing Office. 1967.)

COGGESHALL, LOWELL T.

1965. Planning for Medical Progress ThroughEducation. A report submitted to theExecutive Council of the Association ofAmerican Medical Colleges. Evanston,III.: The Association. 107 pp.

"This report briefly outlines the perspective within whichAmerican medical education has developed, the major trendsrelated to health care that are now emerging, and their impli-cations for medical education and the work of the Association.The report gives specific attention to the past and present rolesof the Association, and the steps the Association should taketo channel its future development along the lines that will en-able it to provide the positive and effective leadership thatthe field of medical education will inevitably require in theyears and decades immediately ahead." A bibliography is in-cluded.

AMERICAN MEDICAL ASSOCIATION.

1966. The Graduate Education of Physicians.The Report of the Citizen's Commission onGraduate Medical Education, Commissionedby the American Medical Association.John S. Millis, Chairman. Chicago: TheAssociation. 114 pp.

In this report of an external examination and thoughtful,extensive study of problems in graduate medical education to-day, this phase of medical educationa process of specializa-tionis recognized as the larger portion of the formal educationof the physician. Recommendations for improvement in thiseducation and mechanisms for their implementation are pointed

at the core problems of the need for (1) emphasis on trainingphysicians for cooperative effort for optimum, continuous,comprehensive health services and patient care; and (2) betteradaptation of education and practice to the specializationmade necessary by greater knowledge and skill.

Creation of a "primary physician" for first contact practicingin a group arrangement is recommended, and a program forhis educalion is suggested. The report recommends that generalmedical education terminate at graduation from medical schooland that :nternship, residency training, and graduate educationbe a 'tidied sequential program of progressive education. ACommisFion on Graduate Medical Education is recommendedto design educational programs, establish standards, supervisegraduate training, and assess the quality of graduates.

Other areas requiring further deliberation for solution arepointed up. The report is a valuable tool for reshaping thecourse of medical education for the future to insure increasedexcellence.

(Excerpted from a review by William A. Sodeman, M.D.,Dean, Jefferson Medical College, in the Journal of MedicalEducation, 42:88-89. January 1967.)

HARVARD UNIVERSITY PRESS.

1966. Health is a Community Affair. Report ofthe National Commission on CommunityHealth Services. Cambridge, Mass. 252

PP.

This is a report of a 4,year study sponsored by the AmericanPublic Health Association and the National Health Council onthe provision and delivery of community health services. Com-prehensive analysis and assessment of resources, needs, anddemands for services were carried out by six national taskforces, 21 community health studies, and four regional healthforums attended by 1,000 community leaders. Critical issuesare raised, positions taken, and recommendations made, butmethods of implementation are not specified.

The study covered many facets of hospitals, health and wel-fare agencies, the preparation of health and welfare personnel,health services and jurisdictional areas, accident prevention,family planning, urban design, and control of man's environ-ment. The Commission called for support of diploma schoolsof nursing as a proven source of supply, and stressed the needfor more registered nurses with degrees, two-year collegegraduates, and vocational or practical nurses. Prepaid grouppractice plans and the development of personal physicians whowould emphasize health care were advocated. The report is a

call to action.(Excerpted from a review by Suzanne H. Freedman, formerly

associate editor, Nursing Outlook. In Nursing Outlook, 15(7) :70-76, July 1967.)

NATIONAL ADVISORY COMMISSION ON HEALTH MAN-POWER.

1967. Report of the National Advisory Commis-.sion on Health Manpower. Vol. I. Wash-ington: U.S. Government Printing Office.93 pp.

91

90 APPENDIX 1

Established by President Join:son in the summer of 1966,this Commission was charged with developing appropriaterecommendations for action by government and the privatesector for improving the availability and utilization of healthmanpower. Recommendations deal primarily with present-dayactions required to assure availability and quality of healthcare at a reasonable cost and as basis for the wise formulationof future plans. Key recommendations include widespread re-shaping of American health care, the periodic relicensing ofhealth workers, university supervision of the education of allhealth professionals, and mechanisms to force the inefficientinstitution or worker to improve or go out of husiness. It wasre:kmmended that nursing should be made a more attractiveprofession by such measures as appropriate utilization of nurs-ing skills, increased levels of professional responsibilities,improved salaries, more flexible hours for married women, andbetter retirement provisions.

NATIONAL ADVISORY COMMISSION ON HEALTH MAN-

POWER.

1967. Report of the National Advisory Commis-sion on Health Manpower. Vol. II.Washington: U.S. Government PrintingOffice. 595 pp.

This volume contains the key materials, data, and analyticalreports which are the foundation of the Commission's study.This includes the original reports of the Commission's sevenpanels: Consumer; Education and Supply; Federal Use ofHealth Manpower; Foreign Medical Graduates; Hospital Care;New Technology; and Organization of Health Services.

NATIONAL COMMISSION ON COMMUNITY HEALTH

SERVICES.

1967. Health Care Facilities, The CommunityBridge to Effective Health Services. Re-port of the Task Force on Health CareFacilities. Washington : Public AffairsPress. 67 pp.

This Task Force examined all types of health care facilitiesfor personal health care, their relationship to each other andto other community services, the factors influencing the healthcare facilities systems, its patterns of organization, and itsshortcomings. It assessed the changing role and function ofhealth care facilities, projected future availability, use, and

demands for care.

NATIONAL COMMISSION ON COMMUNITY HEALTII

SERVICES.

1967. Health Mani,3wer. Action To Meet Corn-mum:1y Needs. Report of the Task Forceon Health Manpower. Washington: Pub-lic Affairs Press. 167 pp.

This Task Force foresaw a vast increase in coming years inthe need:for gm qfied health personnel at all levels of skill. Itrecommended act.ons at the local, State, regional, and par-

tieularly the Federal level. Effective planning for recruitment,education, and tbe use of personnel was urged, as well as im-proved health manpower statistics and information. Of particularconcern was the need to assure adequatt numbers of competentallied and auxiliary personnel. The use of non-physician healthservice administrators educated in schools of public health wasstressed, and the establishment by the Federal Government ofminimum requirements for licensure of personnel in all healthprofessions was recommended. The Task Force concluded thatnursing education should be carried out primarily in institu-tions of higher learning, and hospital schools should continuetraining nurses until sufficient associate degree and baccalaur-eate programs are developed. For producing adequate numbersof high quality health personnel, government support at alllevels is required and Federal funds are of greatest importance.(Excerpted from a review in Report 01 the National AdvisoryCommission on Health Manpower, Vol. II, pp. 276-277. Wash-ington: U.S. Government Printing Office.)

U.S. DEPARTMENT OF HEALTH, EDUCATION, ANDWELFARE. PUBLIC HEALTH SERVICE. BUREAU OF

HEALTH MANPOWER.

1967. Education for the Allied Health Professionsand Services. Report of the Allied HealthProfessions Education Subcommittee of theNational Advisory Health Council. PHSPub. 1600. Washington: U.S. Govern-ment Printing Office. 61 pp.

This report is primarily concerned with the problems ofmeeting needs for health manpower through education, Lv trecognizes closely related needs for the effective use of person-nel, the development of new categories of workers, and im-provements in the organizational setting in which health servi-ces are provided. Trends and gaps traced in the supply ofhealth manpower and educational program output points to agrossly inadequate supply. Need is noted for greater attentionto the analysis of dutieo and qualifications required for thedelivery of health services. Recommendations are made re-garding the development of career ladders to reduce dead-endjobs in health occupations, improvement in methods to identifyand recruit individuals into the allied health occupations,areawide planning, and the significance of licensing andaccreditation. The appendix includes a list of State reports onallied health manpower, schools of allied health professions,and a State listing of the number of baccalaureate programs inselected allied health professions. (Excerpted from a reviewin "Credit Lines," American Journal ol Public Health and theNation's Health, 58(1): 204.205, January 1968.)

U.S. DEPARTMENT OF HEALTH, EDUCATION, ANDWELFARE.

1968. Report of the Secretary's Advisory Commit-tee on Hospital Effectiveness. Washington:U.S. Government Printing Office. 37 pp.

Charged with advising on action required to improve theperformance of hospitals as a functioning mechanism and corn-

n 9

41


munity health service, this Committee made a few specificrecommendations but pointed up priority areas for creatingpublic pressures for action. Improvement of hospital effective-ness was seen to lie in better planning for health facilities andservices; in a licensing or franchisement system with authorityto effect needed improvements by controlling the flow of publicfunds to health facilities and services; in improving the internalmanagement of health care institutions, inlcuding participationin management by physicians; in broader benefits and strongerregulations of carriers; and in capital financing and reimburse-ment methods that will provide incentives for efficient manage-ment of the health care system. (Excerpted from "Credit Lines,"American Journal of NI) lic Health and the Nation's Health,58(7): 1311-1312. July J968.)

THE CARNEGIE COMMISSION ON HIGHER EDUCATION.

1970. Higher Education and the Nation's Health:Policies for Medical and Dental Education.New York: McGraw-Hill Book Co. 130 pp.

This publicationa special report with recommendations bythe Carnegie Commission on Higher Educationis concernedwith more and better health manpower, particularly at thelevel of physicians and dentists. The areas covered include thecrises in health care delivery and health manpower, medicaleducation today, financial support, the future of health caredelivery, and the future of health manpower education. Goalsto be achieved by 1980 are outlined.

Regional

HEALTH MANPOWER STUDY COMMISSION.

1966. If e al t h Manpower for the Upper Midwest.A Study of the Needs for Physicians andDentists in Minnesota, North Dakota, SouthDakota, and Montana. Sponsored by theLouis W. and Maud Hill Family Founda-tion, St. Paul, Minn. 135 pp.

Long-range planning for meeting the regional needs foreducating physicians and related health manpower promptedthis in-depth study and assessment of the characteristics anddistribution of physicians and dentists, their services, andeducational resources in the fuur-State area. Needs and de-mands for physicians are projected to 1975. A brief analysis ofgrowth in the number of nurses in the four States is included.

State and Territorial

ALABAMADUNBAR, JOHN.

1965. "Expanding Needs in the ParamedicalProfessions." University of Alabama Ex-tension News Bulletin, No. 23, pp. 1-3(August).

This is a report on estimated needs and job openings forhealth professionals and assistants to professionals obtainedthrough interviews conducted by the Health Careers Council.The greatest need for professional personnel was for nurses.Needs for all types of sub-professional personnel were twiceas great as those for professionals.

ALASKA

CLARK, DEAN A., M.D., and associates.1965. Health Service Resources, a Profile of the

State of Alaska. Prepared for the WesternInterstate Commission for Higher Educa-tion. Graduate School of Public Health,University of Pittsburgh, Pittsburgh, Pa.53 pp.

This is a report of a survey of the numbers and ratio topopulation of professional, technical, and other categories ofhealth workers in the State of Alaska. Comparisons with theU.S. average reveal considerably lower ratios to population inAlaska than in other States for practical nurses, midwives,pharmacists, dietitians, dentists, and optometrists.

ARIZONA

ARIZONA HEALTH SERVICES EDUCATION ASSOCIATION.

1966. Arizona Health Services Education for aNew Era of Health Care. Phoenix: TheAssociation. 55 pp.

In 1965, as part of the Association's planning program forthe expansion and development of health service education, acomprehensive health manpower survey was conducted byquestionnaires, telephone calls, and personal interviews. Itcovered health institutions, schools, major industries, andprivate practitioners. Manpower needs and educational gapswere identified and recommendations made for meeting re-quirements. Among 24 professional, technical, and auxiliaryheahh occupations surveyed were those in the fields of nurs-ing, medical records, dentistry, X-ray, laboratory, physicaltherapy, occupational therapy, social work, and dietetics. Itincluded medical and surgical technicians and assistants.

ARIZONA STATE EMPLOYMENT SERVICE. MANPOWER

RESEARCH AND ANALYSIS SECTION.

1968. Arizona Medical Manpower. Research andInformation Series No. OCC-1-68. Phoenix :The Service. 28 pp.

National as well as local trends are examined in an attemptto identify some of the factors contributing to the currentshortage of trained medical health manpower, to determine theextent of present needs and future needs to 1975, and tosuggest possible ameliorative resources.

ARKANSAS

THE COMMISSION ON COORDINATION OF HIGHER EDU-

CATIONAL FINANCE.

92 APPENDIX 1

1968. Personnel Needs in the Health and AdaptiveBehavioral Problem Service Areas in Ark-ansas. Report of Phase I: Manpower

Project: Health and Related Services.

Little Rock, Ark. 124 pp.

This report was prepared for use by institutions of highereducation in program planning and devdopment for meetingState requirements for health and related personnel. Thisphase of a 3-part study presents State needs for professionaland semi-professional personnd requiring education above thehigh school level for services in health care and adaptive be-havioral probkms. Quantitative regional service needs for

optimum care by this type of manpower were identified for1967 and projected to 1972 and 1977.

CALIFORNIA

CALIFORNIA DEPARTMENT OF EMPLOYMENT.

1964. Medical Service Job Opportunities, SanFrancisco, Bay Area, 1964-66. San Fran-cisco: The Department. 82 pp.

Job shortages and future training needs were identified for107 health occupations through a skill survey conducted in

January 1964. The survey covered 1,100 health establishments,the numbers employed in each occupation, and needs for thenext 2 years. It revealed previously unidentified demand in thecentral cities in a wide range of medical occupations. Thelargest occupational category was nursing.

CALIFORMA DEPARTMENT OF EMPLOYMENT RESEARCH

AND STATISTICS SECTION.

1965. Manpower for California Hospitals, 1964-1975. Prepared for the Commission onManpower, Automation, and Technology(COMMAT). COMMAT Report No. 65-6.Sacramento: Department of Employment.61 pp. (processed).

The health facilities studied included hospitals, nursinghomes, and convalescent homes. Data on the number of bedsand empolyment in these facilities were collected from variousagencies and combined into an approximate model of theindustry in 1964. Projections for 1965, 1967, 1970, and 1975were based on this model. Occupations studied include theregistered nurse, licensed vocational nurse, and nurse aid. Theassessment of the occupation contained a definition of therole, the job preparation, and future prospects.

STATE OF CALIFORNIA. DEPARTMENT OF PUBLIC

HEALTH.

1967. Health Manpower Needs In California: ASource Book ol Available Information onSelected Health Occupations. Sacramento:State Department of Public Health. 25pp. (processed).

The information presented in this report should he con-sidered only as gross estimates of health manpower needs.Much of the data was assembled from already publishedsources and the balance compiled or calculated from un-published reports of the California State Department of PublicHealth and other agencies.

THE CALIFORNIA STATE COLLEGES AND THE CALI-FORNIA STATE DEPARTMENT OF PUBLIC HEALTH.

1968. Conference on Health Sciences at the Bac-calaureate and Beginning Graduate Level.California State College at Hayward. 151

131).

This report contains the presentations and related materials,as well as the findings of a Conference on Health Sciences hehlin January 1967. The purpose of the meeting was to explorethe national and regional needs for licahh science personnel,and to delineate the important policy issues relating to state-wide needs for heahh manpower at the baccalaureate andbeginning graduate levels. The supply and need of nursemanpower was included.

CONNECTICUTSTATE DEPARTMENT OF EDUCATION. DIVISION OFVOCATIONAL EDUCATION. LABOR EDUCATION CENTER.

THE UNIVERSITY OF CONNECTICUT.

1967. Health Service OccupationsOccupationalNeedsEducational Requirements. Storrs,Conn.: The University. 117 pp. and app.

This statewide questionnaire survey, conducted in June 1967,covered personnel employed in 49 health occupations in hos-pitals, convalescent homes, physicians' and dentists' offices,

dental laboratories, employee health clinics, and public licahh.Personnel surveyed were those directly involved in renderinghealth services and supporting personnel. The survey includednurses but not doctors, dentists, or other occupations requiringa college degree. It assessed personnel vacancies, expectedwithdrawals, and expansion needs for 1971 and 1976, and re-lated these data to the courses and content given in secondaryand post-secondary schools for training these types of personnel.

GEORGIA

FINCHER, CAMERON.

1962. Nursing and Paramedical Personnel in

Georgia: A Survey of Supply and Demand.Atlanta: Georgia State College. 118 pp.

This questionnaire survey, conducted from October 1961 toOctober 1962, covered the supply of health manpower in nurs-ing and 11 paramedical occupations. It estimated demand fora 5- to 10-year period, and the adequacy of training andeducational programs. Recommendations were made for theexpansion of educational programs, for the development ofbaccalaureate and master's programs in specific fields, and foradditional study of the needs and resources for instructors and

9'

SURVEY AND STUDY REPORTS

teachers. Occupations surveyed included registered nurses,licensed practical nurses, dietitians, hospital administrators,laboratory and x-ray technicians, medical technologists, medicalrecord librarians, medical social workers, occupational andphysical therapists, and medical assistants.

HAWAIIU.S. EMPLOYMENT SERVICE, U.S. DEPARTMENT OFLABOR, and HAWAII LABOR DEPARTMENT.

1967. Honolulu's Manpower Outlook: A Surveyof Demand and Supply for 78 Occupations.Honolulu, State of Hawaii. Department ofLabor and Industrial Relations, Employ-ment Service Division, Research and Statis-tics Office. 88 pp.

This report is based on the Manpower Skill Survey of theHonolulu area in 1966. Seventy-eight occupations were included.The period 1965-1970 is assessed in terms of the extent ofmanpower demands, replacement needs, and implications ofthe survey concerning manpower training. The occupations areranked according to demand for the years 1967 and 1970. Thecategory, registered nurse, ranked I1th and 7th respectively.Shortage occupations were also ranked according to supply.When this was done, the registered nurse category ranked34th for both years 1967 and 1970. A summary of the findingspertaining to each occupation and an explanation of themethodology employed are included.

IDAHOWESTERN INTERSTATE COMMISSION FOR HIGHEREDUCATION.

1969. Idaho Health Profile. Boulder, Colo.: TheCommission. 387 pp.

"Contains data concerning health manpower, health facilities,health vital statistics and certain socio-economic information forthe state of Idaho." (From Abstracts of Hospital ManagementStudies, VI:26. June 1970.)

ILLINOIS

STATE OF ILLINOIS BOARD OF HIGHER EDUCATION.1968. Education in the Health Fields for State o/

Illinois. Prepared by James A. Campbell,M.D.; W. Randolph Tucker, M.D.; andIrene R. Turner, M.T. Presbyterian-St.Luke's Hospital, Chicago. Vol. I, 161 pp.;Vol. II, 866 pp.

Manpower and educational needs and resources for all of themajor health service occupations were surveyed in this study todetermine requirements for additional facilities and educationalprograms in teaching of the health sciences in Illinois. Thereport includes the recomendations on nursing education ofthe Illinois Study Commission on Nursing.

93

INDIA.NA

INDIANAPOLIS HOSPITAL DEVELOPMENT ASSOCIATION.

1968. Health Manpower Requirements and Re-sources in Metropolitan Indianapolis, 1966-1971. Indianapolis, Ind.: The Association.71 pp.

"Seventy-five agencies employing and training health workerswere sent a questionnaire covering current and future man-power strengths, needs difficult to fill, and education andtraining outputs. The educational system and private prac-titioners, as users of health personnel, were not contacted.Additional investigation estimated the net loss in manpowerby either out-migration or abandonment of the health field.Data are presented and discussed. Conclusions include notingnot only a general need for rapid acquisition of health workers,but a need to revise licensing requirements, wage scales, andopportunities for advancement." (From Abstracts of HospitalManagement Studies, V: 126, June 1969).

IOWASMITH, JERRY L.

1967. Public Health Manpower Analysis: AnEstimate of the Potential Need for PublicHealth Personnel in the State of Iowa.Prepared for the Education and TrainingCommittee. Des Moines, Iowa : State De-partment of Health. 68 pp.

This report presents an estimate of the current and potentialneed for public health manpower in the State for the years1970-1985. Conclusions and recommendations with respect tomeeting the health needs of the residents of Iowa are based onthe information and data presented in the report.

MARYLANDHOSPITAL COUNCIL OF MARYLAND.

1966. Manpower in Maryland's Hospitals: Reportand Recoriimendations on a Growing Crisis.Baltimore: The Council. 43 pp.

Manpower resources and needs in Maryland hospitals inJanuary 1966 were delineated and related to educational re-sources and to factors influencing demand for health personneland limiting the quality and quantity of the supply. Hospitalrequirements for nursing personnel and laboratory technicianswere most critical. Regional planning for nursing educationwas recommended; also nurse utilization studies. Immediateand long-range programs were proposed in the areas of recruit-ment, education, health career development, and employmentand career incentives.

MARYLAND COUNCIL FOR HIGHER EDUCATION.

1969. A Projection of Maryland's Health Man-power Needs Through the 1980's. Balti-more: The Council. 194 pp.

94 APPENDIX 1

This study was directed toward the need for health manpowereducation facilities, and makes recommendations, for action tomeet manpower needs projected for 1980 and 1990. The supply,needs and demands, and educational programs for physicians,dentists, and nurses were extensively studied. Data on otherprofessional, technical, and auxiliary health fields are morelimited. The study gives directions for the State's public andprivate health and educational agencies and the legislature tobegin to plan without delay to meet current and future needs.

MASSACHUSETTS

AMMER, DEAN S.; CALLAGHAN, JOH' JR.; and others.1967. Institutional Employment and Shortages of

Paramedical Personnel. Bureau of Busi-ness and Economic Research, NortheasternUniversity, Boston, Mass. 41 pp.

This is a report of a detailed study of staffing patterns andshortages in hospitals, nursing homes, and various other institu-tions in the greater Boston area.

MICHIGANMICHIGAN OFFICE OF PLANNING COORDINATION. Bu-

REAU OF PLANNING AND PROGRAM DEVELOPMENT.EXECUTIVE OFFICE OF THE GOVERNOR.

1967. Michigan Technician Need Study. Tech-nical Report No. 13. November 1967.Lansing, Mich. 191 pp. (processed).

This study estimated needs for new or expanded techniciantraining programs in Michigan to help assure industry andhospitals an adequate supply of appropriately trained man-power. It defined technician categories; set preliminary criteriafor persons in various fields in these categories; assessed thepresent supply, the educational and training opportunities, theadequacy of training, and the number of technicians needed forthe future. The study included technician occupations withinthe health-related fields, including registered nurses andlicensed practical nurses.

MISSOURIZIMMERMAN, T. F., and CRNIC, CAROL A.

1968. Master Facilities Inventory: A Study ofHealth Manpower Training Resources,Jackson and Clay Counties, Missouri 1967.Institute for Community Studies, KansasCity, Mo. 37 pp.

This survey identified the number and kinds of manpowertraining resources for allied medical professions in two countiesof Missouri. It assessed their capacity and the level of capacityat which they were operating, and identified training needs andpriorities for development of programs. Resources for registerednurses and licensed practical nurses were included. The reportalso includes a directory of personnel involved with each typeof health manpower training program studied.

MONTANADEPARTMENT OF PUBLIC INSTRUCTION. RESEARCH

COORDINATING UNIT.

1968. Paramedical and Allied Health ServiceOccupations in Montana. A Survey of theOccupations, Manpower Requirements, andTraining Needs Essential to the Support ofGeneral Health Services in the State ofMontana. Helena, Mont. 39 pp. (proc-essed).

Total full- and part-time positions, vacancies, and projectedneeds for 1973 are detailed for 52 basic paramedical and alliedmedical service occupations requiring less than 2 years post-high school training. The survey covered hospitals, nursinghomes, medical clinics, and a 10 per cent sample of physiciansand dentists. Job descriptions for the 52 occupations and entrylevel salary ranges are included. The survey was intended toprovide information for educational and health facilities plan-ning. It includes licensed practical nurses and nursing aides.

WESTERN INTERSTATE COMMISSION FOR HIGHEREDUCATION.

1969. Montana Health Profile. Boulder, Colo.:The Commission. 443 pp.

"Contains data on health manpower, health facilities, healthvital statistics and certain socio-economic information for thestate of Montana." (From Abstracts of Hospital ManagementStudies, VI:26, June 1970.)

NEVADAWESTERN INTERSTATE COMMISSION FOR HIGHER

EDUCATION.

1969. Nevada Health Profile. Boulder, Colo.:The Commission. 220 pp.

"An assessment of health resources in Nevada: health man-power, health facilities, health vital statistics and certain socio-economic information." (From Abstracts of Hospital Manage-ment Studies, VI:26, June 1970.)

NEW HAMPSHIRENEW HAMPSHIRE HEALTH CAREERS COUNCIL.

1968. New Hampshire Health Manpower Study,1968. Concord: The Council. 77 pp.

This statistical survey of health manpower supply and needson a statewide, regional, and county basis covered 40 categoriesof health manpower including registered nurses, licensed prac-tical nurses, and nursing aides. Included is a breakdown onfull-time and part-time employment and total supply by typesof health facilities and services. Thirteen major causes of healthmanpower shortages are ranked by vocation and type of healthservice, and needs are projected for 1970 and 1975. Data arereported on hospital admissions, outpatient visits, and planned

SURVEY AND STUDY REPORTS

expansion in the number of hospital and nursing home beds.The questionnaire, definition of occupational titles, and list ofhealth facilities surveyed are included in the report.

NEW YORKTHE BOARD OF REGENTS. NEW YORK STATE EDUCA-TION DEPARTMENT.

1963. Education for the Health Professions, AComprehensive Plan for ComprehensiveCare To Meet New York's Needs in an Ageof Change. A Report to the Governor andthe Board of Regents from the New YorkCommittee on Medical Education. Al-bany, N.Y. 114 pp.

This in-depth study of needs and resources for health pro-fessionals and health-related professions and vocations includedan assessment of the nursing situation in the State, and thefactors affecting it. Needs for nursing personnel and the ex-pansion required in educational programs to meet needs wereprojected to 1970. The development of baccalaureate programsin nursing was given top priority. Other recommendations forstrengthening nursing education to meet nursing needs weremade.

STATE UNIVERSITY OF NEW YORK AT BUFFALO.DEPARTMENT OF PREVENTIVE MEDICINE. COMMUNITY

SERVICES RESEARCH AND DEVELOPMENT PROGRAM.

1967. Health Care Manpower Survey. Buffalo,N.Y.: The University. 209 pp.

This survey, conducted by the Regional Medical Program ofWestern New York in 1967, determined the current resourcesand distribution of 22 professional categories of health carepersonnel which required formal training and were thereforesignificant in terms of future educational needs. Data wereobtained from licensure records of the State Education Depart-ment, commercial listings of health professionals, and question-naires to 664 health facilities and agencies. (Excerpted froma review in Medical Care Review, Oct. 1969.)

NORTH CAROLINABUREAU OF EMPLOYMENT SECURITY RESEARCH.

1963. North Carolina Study of Manpower andTraining Needs for Medical and HealthService Occupations. Employment SecurityCommission of North Carolina. Raleigh,N.C. 63 pp.

This survey was conducted as a basis for planning and ex-panding vocational educational facilities and curricula to meetthe State's needs for health care and associated personnelrequirements. It covered 43 selected key occupations thatwere generally known to be in short supply for 5/6, or 417,of the medical and health service esteblibhments. Data wereobtained regarding current job vacaucies and replacement andexpansion needs by the end of 19$3 and 1966. Trainee output

95

for thc same periods as a result of on-the-job training in theinstitutions and affiliated schools was estimated. The majorityof training requirements for workers needed by the end of1966 were found to be concentrated in 11 health occupations.

BUREAU OF EMPLOYMENT SECURITY RESEARCH.

1967. Health Manpower Needs in North Carolina,1967-1973. Employment Security Com-mission of North Carolina. Raleigh, N.C.64 pp.

This survey was conducted to determine growth patterns inthe employment of health manpower, to evaluate the output ofexisting programs, and to, plan for future program requirements.The supply of personnel employed in 48 health occupations in1,500 medical and health service facilities was surveyed in thespring of 1967. Turnover rates and manpower needs by 1973were estimated, as compared with anticipated trainee outputin medical and health service occupations in 1970 and 1973.Supply and demand data are broken down for seven areas ofthe State.

OREGONOREGON STATE BOARD OF CONTROL. MENTAL HEALTH.

1965. Report of Committee on Manpower andTraining (1963-1965). Salem: The StateBoard of Control. 20 pp. (processed).

A questionnaire survey of current available manpower in thetraditional mental health professionspsychiatrists, psycholo-gists, social workers, and psychiatric nurseswas undertakento obtain information on their personal characteristics, presentposition, employment setting, competence, experience, training,sources of professional and personal satisfaction, and salaryrequirements. These data were collected also to develop acomprehensive, long-range plan for utilization of current pro-fessional manpower for the community mental health programs,and to appraise what a variety of non-traditionally trainedprofessional personnel could contribute to social care, in theevent that the current numbers of traditional mental healthpersonnel were inadequate.

PUERTO RICOTRUSSELL, RAY E., and ARBANA, GUILLERMO.

1962. Medical and Hospital Care in Puerto Rico.A Report Submitted to the Governor andThe Legislature of the Commonwealth ofPuerto Rico by The School of Public Healthand Administrative M2dicine, ColumbiaUniversity, and the Department of Healthof Puerto Rico. New York: ColumbiaUniversity Press. 427 pp.

This report of a joint study by the University and the Depart-ment of Health appraised the quality of medical care, itsorganization and administration, and its expenditures andfinancing. It included hospital care, the distribution of hospitals

96 APPENDIX 1

and other facilities, their utilization, and the maintenance offacilities and equipment. Health personnel were not overlooked;however, study was limited to physicians, dentists, nurses, socialworkers, and technicians. Data were obtained from the re-cipients of health care services. A representative sample ofisland families-2,951 in numberwere interviewed, and infor-mation was recorded pertaining to patterns of utilization ofmedical services, aspects of care received, costs, and opinionsand attitudes about care.

COMMONWEALTH OF PUERTO RICO. OFFICE OF THEGOVERNOR. PLANNING BOARD. BUREAU OF ECONOMICS

AND SOCIAL ANALYSIS.

1967. Manpower Report to the Governor: A Re-port on a Society in Transition. San Juan:The Planning Board. 130 pp.

This report concerns many aspects of human resources andmanpower development in the Commonwealth. Industrial andoccupational trends in the economy are assessed, with someconsideration of the effect on future trends in the educationalsystem. The main objective of the report is to provide man-power and educational information to officials and plannerswho need to concern themselves with the manpower and humanresources implications of their economic decisions. A summaryof findings and conclusions is presented.

SOUTH CAROLINASOUTH CAROLINA HOSPITAL ASSOCIATION.

1964. Crisis in Health Care in South Carolina.Preliminary Report on Professional, Para-medical, and Technical Personnel, Novem-ber 9, 1964. Columbia: The Association.9 PP.

The supply and needs for all categories of personnel weresurveyed in 70 non-Federal South Carolina hospitals in August1964. Growth in hospital facilities and their use were described.Reported shortages of 1,381 hospital personnel in all categoriesapproximated a 10 percent unmet need for personnel. Shortagesof professional and paramedical personnel approximated 20percent; for nonprofessional categories, about 6 percent.

SOUTH CAROLINA EMPLOYMENT COMMISSION.

1966. Manpower Requirements for Health Facili-ties in South Carolina. South CarolinaHospital Association and South CarolinaEmployment Security Commission. Colum-bia: The Commission. 54 pp.

The need for workers in health service occupations wassurveyed to provide data for planning regional health trainingcenters. Shortages were detailed for registered nurses, practicalnurses, aides, ward clerks, anesthetists, diet clerks, medicalrecord clerks, and medical supply clerks. The formation of aHealth Manpower Council was recommended, as well as con-certed recruitment, educational, and career and employmentincentive efforts.

TEXAS

TEXAS HOSPITAL EDUCATION AND RESEARCH FOUNDA-

TION.

1969. Allied Health Manpower in T exas 1969: AStatus Report on Employment. Texas Hos-pital Education and Research Foundation,Austin, Tex. 56 pp.

A mail questionnaire survey of all major allied health per-sonnel employers was undertaken during a week of averageactivities, March 10 through 14, 1968, to collect informationon a statewide basis on allied health personnel. Information wasobtained on each personnel classification as to the number offull.time and part-time personnel employed, the number ofhours worked by part-thne personnel, and the number ofbudgeted vacancies that existed. Data in this report can beconsidered as a statistical base from which to project needs.

TEXAS HEALTH CAREERS PROGRAM AND THE GOVER-

NOR'S OFFICE OF COMPREHENSIVE HEALTH PLANNING.

1970. Allied Health Manpower in Texas, 1970.Executive Department Office of Compre-hensive Health Planning. Dallas, Tex.259 pp.

The report contains baseline information on allied healthmanpower and education in Texas. Fifty-four careers in theallied health field were included in the survey. The mailquestionnaire was the primary method for data collection.Questionnaires were sent to all major allied health personnelemployers, requesting information on the number of full-timeand part-time personnel employed in each classification, hoursworked by part-time personnel, number of budgeted vacancies,and number of additional vacancies anticipated for 1971. Asurvey of the allied health educational programs was conductedin a similar manner. The questions pertained to approvedstudent capacity, current enrollment, student body composition,number of graduates in 1970, and average attrition percentageover the last 3 years.

Supply and demand, according to present evidence, will notsoon be in balance. The task ahead is not only to increase thesupply of well-qualified workers but also to make the best useof the resources that are available.

WASHINGTONSTATE OF WASHINGTON DEPARTMENT OF EMPLOYMENT

SECURITY and STATE BOARD FOR VOCATIONAL EDUCA-

TION.

1965. Occupational Trends in Health Care Indus-tries, King County, 1965-1970. Preparedby Virginia 0. Hannig. Seattle: TheDepartment. 111 pp.

This is a pilot study of manpower problems in medical in-dustries of King County. The study tried out a procedure foranalyzing occupational shortages and training requirements on

Cq"?


a continuing basis for a wide range of occupations and in-dustries. Industrial and occupational characteristics were iden-tified. Registered nurses, licensed practical nurses, nurse aides,and orderlies were included among the 26 occupations describedas "demand occupations."

WEST VIRGINIATHE GOVERNOR'S TASK FORCE ON HEALTH.

1967. Adequate Health Services for West Virginia.A Program To Meet the Total Health Needsof the People of West Virginia. The FinalReport for Governor Hulett C. Smith.Charleston, W.Va. 107 pp.

Health facilities and services, health manpower needs andresources, and the influencing socioeconomic factors were as-sessed to determine overall health needs in the State and the

capabilities for meeting these needs. Study recommendationsincluded regionalization for health services, long.term planning,and specific charges to institutions and agencies in the State.The study assessed the 1967 supply of registered nurses andlicensed practical nurses and needs for 1971, 1976, and 1986.

WYOMINGWESTERN INTERSTATE COMMISSION FOR HIGHER

EDUCATION.

1969. Wyoming Health Profile. Boulder, Colo.:The Commission. 215 pp.

"Data on health manpower, health facilities, health vital sta.tistics and certain socioeconomic information for the state ofWyoming." (From Abstracts of Hospital Management Studies,VI:26, June 1970.)

Part 2

Needs and Resources in Nursing

Historical Reports,

COMMITTEE ON THE STUDY OF NURSING.

1923. Nursing and Nursing Education in theUnited States. New York: Macmillan Co.584 pp.

Commonly known as the Goldmark Report, from the nameof its chief investigator, Josephine Goldmark, this report raisedquestions about financing and control of nursing education byhospitals and set goals for the educational preparation ofnurses in administrative, supervisory, and instructor positionsand for public health nurses. The report is recognized asaccelerating the development of both basic and post-basiccollegiate nursing education.

Initiated to study the status of public health nursing andpropose a course of training for their preparation, the Com-mittee, financed by the Rockefeller Foundation, surveyed andassessed the entire fields of nursing education and nursingservice. Their work is recognized as the first broad-scale studybased on actual observations of nursing practices and for whichrecommendations are supported by data.

Now over 40 years old, the study recommended licensure ofa subsidiary grade of nursing personnel working under thesupervision of doctors or trained nurses, and courses of trainingfor their preparation for service. It pointed out the lack ofsufficiently attractive avenues of entrance to the field of nursing,and recommended financial support and administration ofnursing education under separate boards of education. Thestudy also proposed elimination of the service functions ofstudents, and shortening of hospital training to 28 months.Special additional training beyond the basic nursing coursewas recommended for nurses in administrative, supervisory, andinstructor positions and for public health nurses, as well asstrengthening of university schools of nursing for the trainingof nurse leaders, and endowments for university schools ofnursing.

(Excerpted from The Historical Development of Nursing,pp. 308-311. By Sister Charles Marie Frank. Philadelphia: W.B. Saunders Co. 1953. Also excerpted from Nursing Research:A Survey and Assessment, pp. 20-21. By Leo W. Simmons andVirginia Henderson. New York: Appleton-Century-Crofts.1964.)

BURGESS, MAY AYRES.

1928. Nurses, Patients, and Pocketbooks. NewYork: Committee on the Grading of NursingSchools. 618 pp.

1923-34; National

This was the first report of an interprofessional body, or-ganized in 1926, on its socioeconomic investigation of the supplyand demand of nursing services. Completed during the de-pressionthe only time when an oversupply of nurses hasexistedthe study revealed vacancies for better preparednurses. Economic conflicts between nurses and their employersand between student service and school of nursing objectiveswere highlighted. It was concluded that hospitals operatedtraining schools because it cost less to run a poor school thanit did to employ graduate nurses, and because it was easierto handle the nursing service with students, who would acceptwithout complaintconditions that were becoming increas-ingly objectionable to graduates. Personnel policies for graduatenurses were deplorable. They asked for reasonable hours ofwork, a living wage, constructive leadership, sound administra-tive policies, and opportunities for further growth.

The Committee set forth two principles: (1) that the educa-tion of nurses is as much a public responsibility as is theeducation of physicians, teachers, or others to be engaged inpublic professional service, and the cost of such educationshould be supported by private and public funds and not bythe hospital budget; (2) that a hospital school of nursingshould be conducted solely on the basis of the kind and amountof educational experience that can be offered and not uponthe need for cheap labor. The Committee recommended theemployment of private duty nursesmany of whom were with-out workas graduate staff to give bedside care in hospitalsand to free students from excessive service demands.

(Excerpted from The Historical Development of Nursing, p.312. By Sister Charles Marie Frank. Philadelphia: W. B.Siunders Co. 400 pp. 1953.)

COMMITTEE ON THE GRADING OF NURSING SCHOOLS.

1934. Nursing Schools Today and Tomorrow.Final Report. New York: National Leaguefor Nursing Education. 247 pp.

This report of the Committee's educational survey showedthat there were some good schools of nursing; many mediocreschools, whose principal aim was to provide cheap service forthe hospital; and some poor schools. Less than half of theschools had one full-time instructor, and only one-fourth of theinstructors had college degrees. In 88 percent of the schools,students worked more than 48 hours, exclusive of classwork.Clinical facilities were inadequate and clinical assignments

haphazard.

10099

100 APPENDIX 1

The report recommended the following for every professionalschool of nursing: An interdisciplinary representative board;a separate budget, drawn in part from tuition, endowment,gifts, or subsidies; and a director who was an educator andcapable administrator. The report also recommended otheressential conditions which schools should meet, as follows:That the majority of the faculty be registered nurses who arecollege graduates with special training in a particular fieldand experience in several fields of nursing; that students meetentrance requirements of a good college; that work be of suchcharacter as to receive credit toward a degree; and thatclinical assignments be made only in light of what studentsneed to know.

This and the other reports of the Committee stimulated theclosing of more than 500 of the poorest schools of nursing,and later showed that the remaining schools could train manymore students than had been trained formerly in the largernumber of schools.

(Excerpted from The,Historical Development of Nursing,

pp. 318-319. By Sister Charles Marie Frank. Philadelphia: W.B. Saunders Co. 1953.)

COMMITTEE ON THE GRADING OF NURSING SCHOOLS.

1934. An Activity Analysis of Nursing. NewYork: National League for Nursing Educa-tion. 214 pp.

This study and analysis of nursing functions helped to definenursing and its unique position in the health professions. Along list of nursing activities was compiled from reports ofactual situations previously studied by various organizationsand agencies. The list distinguished nursing functions fromnon-nursing duties that were commonly considered part of thenurses' work. Conclusions on what every nurse should knowand do became criteria for judging a competent nurse. (Ex-cerpted from The Historical Development of Nursing, pp. 316-318. By Sister Charles Marie Frank. Philadelphia: W. B.Saunders Co. 1953.)


NationalBROWN, ESTHER LUCILE.

1948. Nursing for the Future. A report preparedfor the National Health Council. NewYork: Russell Sage Foundation. 198 pp.

This study was concerned with the education needed for theresponsibilities to be carried by nurses to meet communityneeds for health services, and the actions required for reachinggoals defined for this purpose. It considered the probable natureof nursing in the latter half of the 20th centry, and set thestage for research in nursing itself and in nursing as a part ofoverall health programs. The findings and recommendationsfrom the study have value and are applicable today. The studyand its report are recognized as stirring up controversies onmany nursing issues that contributed immeasurably to motivat-ing thinking and action and resulted in extensive improvementsin nursing service and nursing education.

The report pointed out the following needs: Study of nursingfunctions; building of integrated nursing service teams; use ofnonprofessional assistants; mandatory licensure of practicalnurses; greatly expanded and improved in-service training;establishment of procedures and standards for State accredita-tion of nursing schools; and establishment of a syitem forrecognizing excellence in nursing practice at various positionlevels to raise the status of nursing.

The future role of the professional nurse, her education, andthe education of nonprofessional personnel were discussedextensively. The study recommended experimentation intomeasures for reorganizing and increasing the social contribu-tions of hospitals to nursing education as well as directingefforts to building basic schools of nursing in universities andcolleges as autonomous units "that are sound in organizationand financial structure, adequate in facilities and faculty, and

well distributed to serve the needs of the entire country."Statewide planning for basic nursing education as well as

regional and national planning for higher forms of nursingeducation was urged.

(Excerpted from The Historical Development of Nursing,pp. 339-347. By Sister Charles Marie Frank. Philadelphia: W.B. Saunders Co. 1953.)


1948. The Economic Status of Registered Profes-sional Nurses, 1946-1947. Bulletin No.931. Washington: U.S. Government Print-ing Office. 69 pp.

This study related the problems of nurse shortages andattrition from nursing to nurses' working hours, salaries, andother working conditions. It compared nursing to other fieldsand their socioeconomic and working conditions. Findings weredetailed and remedial measures suggested. (Excerpted fromThe Historical Development of Nursing, p. 339. By SisterCharles Marie Frank. Philadelphia: W. B. Saunders Co. 1953.)

WEST, MARGARET; and HAWKINS, CHRISTY.

1950. Nursing Schools at the Mid-Century. A

report prepared under the auspices of theSubcommittee on School Data Analysis forthe National Committee for the Improve-ment of Nursing Services. (This commit-

tee is no longer in existence. Nursingschool libraries may be able to providecopies.) 88 pp.

101


This survey report presents a detailed record of the educa-tional practices in 1,156 of the 1,193 basic schools of nursing inexistence in 1949, including those offering hospital and col-legiate programs. It compares findings to specific standards setin 1937 and 1942 for a good school of nursingsuch as instruc-tional hours, student clinical experience, library resources.and appointment of faculty. The two overall impressions drawnfrom the survey are as follows: (1) In 1949, the basic schoolof nursing was not regarded as enough of an educationalinstitution to define its own goals and to decide how thesegoals could be best met; (2) the major share of the nursingschool program was not being predominately focused on educa-tion, and in nrost schools of nursing the service to hospitalswas as important an objective as was the education of students.

HEALTII RESOURCES ADVISORY COMMITTEE (RUSKCOMMITTEE) , 1950-51.

1951. "Nurse Power in Mobilization." By RuthP. Kuehn, Member. Washington: TheCommittee. 4 pp.

"As nearly as the Committee could estimate, 49,000 nursesover and above those in sight for 1954 would be needed to meetrequirements for this category of personnel. The Committeenoted that the shortage of nurses could be reduced slightly byan increase in nursing school enrollment; more nurses shouldbe trained for administrative, teaching, and supervisory posi-tions; the supply of trained practical nurses should be in-creased as rapidly as possible; and hospitals should expandand improve their inservice training programs for nurses' aidesand other auxiliary nursing personnel below the practical nurselevel." (Quoted from Report of the National Advisory Com-mission on IIealth Manpower, Vol. II, p. 270. Washington: U.S.Government Printing Office. November 1967.)

NATIONAL LEAGUE FOR NURSING. COMMITTEE ON THE

FUTURE.

1957. Nurses for a Crowing Nation. New York:The Association. 31 pp.

The purpose of this study was to forecast changing needsin nursing service and nursing education, based on examinationof social and health trends in the foreseeable future. An attemptwas made to estimate overall existing needs and additionalneeds for nurses. Needs were forecast on the premise thatreasonable predictions for the future can be proposed by study-ing past trends, by examining present supply, and by relatingthe findings to future demands and goals.

Two goals were projected for the future: (1) A higher goalof 350 nurses per 100,000 population, already reached or ex-ceeded in six States; and (2) a more conservative objectivegoal of 300 nurses per 100,000 population, to bring gradualimprovement in the supply. For reaching the higher goal by1970, an annual average increase of 6 nurses per 100,000 popula-tion would be required; for the lower goal, an annual averageincrease of 3 nurses per 100,000 population. Considering anannual attrition rate of 5 percent from the nurse supply.700,000 nurses would be needed by 1970 to meet the highergoal and 600,000 to reach the lower goal.

(Excerpted from Nursing Research: A Survey and Assess-ment, pp. 144.145. By Leo W. Simmons and Virginia Herder-son. New York: Appleton-Century-Crofts. 1964.)

HUGHES, EVERETT C.; HUGHES, HELEN MACGILL; andDEUTSCHER, IRWIN.

1958. Twenty Thousand Nurses Tdl Their Story.A Report on the American Nurses' Associa-tion Studies of Nursing Functions. Phila-delphia: J. B. Lippincott. 280 pp.

This book is a synthesis of data from more than 30 functionstudies. The findings have implications for the nurse as a

practitioner, her relationship to others in the work situation,and the future of nursing. The present status of nursing andwhere it has to go are vividly portrayed.

These studies were focused primarily on the following: whonurses are, what they do, where they come from, where theywork and why, how they prepare themselves for this work,what their relationships are with co-workers and patients, howthey feel about nursing, and how others feel about them. Tnemajor contribution of this book is the challenge it presentsand the questions ol vital importance it raises concerning theimprovement of nursing service and nursing education.

(Excerpted from a review by Gwendoline MacDonald, form-erly Instructor in Medical-Surgical Nasing, Vassar HospitalSchool of Nursing, Poughkeepsie, N.Y., in Nursinp Outlook,7 (1) :9. January 1954.)

NATIONAL LEAGUE FOR NURSING. DEPARTMENT OFDIPLOMA AND ASSOCIATE DEGREE PROGRAMS.

1959. Report on Hospital Schools of Nursing,1957. New York: The League. 44 pp.

This survey updated information in Nursing Schools at Mid-Century and gave bases for measuring progress in the improve-ment of resources and practices in schools of nursing. Thesurvey focuses primarily cm a comparison of 247 accredited and551 nonaccredited programs, and common educational methods.Deviation from traditional and rigid criteria and standards tomore flexible guidelinet as marks of excellence is reflected inthe report,.which gives the impression that in 1957 the hospitalschools were regarded as educational institutions in the making.

RegionalWESTERN INTERSTATE COMMISSION FOR HIGHER

EDUCATION.

1959. Nurses for the West. Western Council onHigher Education for Nursing. Boulder,Colo. 112 pp.

This report of the first regional survey of nursing needs andresources in the 13 States comprising the western educationalcompact presents facts on the registered nurse supply and theresources for the education of registered nurses. Projectionsare made for the number of nurses by levels of educationalpreparation needed in each of the States by 1970. Recommenda-tions are made for the development and improvement of nursing

102 APPENDIX 1

education in the West, and criteria are specified for new juniorcollege and baccalaureate programs.

State and TerritorialThe following list, by States in alphabetical order,

includes those surveys that assessed statewide nursingneeds and resources, and that for the most part em-braced all fields of nursing. Many of these studyreports are out of print and are available only fromthe sponsoring organizations or by library loan. Thereports are not annotated. They are listed here merelyfor historical considerations and for comparabilitywith future reports and surveys. These reports canprovide trend data, information regarding planningactivities and processes used in particular States, andindications of progress and action in meeting recom-mended goals.

ARIZONA

FEDERAL SECURITY AGENCY. PUBLIC HEALTH SERVICE.

DIVISION OF NURSING RESOURCES.

1950. Survey of Nursing Needs, Resources, andSupply in Arizona. Phoenix: ArizonaNurses' Association. 57 pp. (processed).

ARKANSAS

COMMITTEE ON NEEDS AND RESOURCES. ARKANSAS

STATE NURSES ASSOCIATION and ARKANSAS LEAGUE

FOR NURSING.

1958. Blue Print For Action. Arkansas Survey.Nursing Needs and Resources. Report pre-pared by Committee on Needs and Re-sources, Arkansas; and Division of NursingResources, Public Health Service, U.S. De-partment of Health, Education, and Welfare.Little Rock, Ark.: The Association. 177pp. (processed).

COLORADO


WELFARE. PUBLIC HEALTH SERVICE. DIVISION OF

NURSING RESOURCES.

1953. Colorado Nursing Resources: A Survey ofthe Nurse Supply and Needs, 1953. Den-ver: Colorado Nurses' Association. 46 pp.(processed).

CONNECTICUTU.S. DEPARTMENT OF HEALTH, EDUCATION, AND

WELFARE. PUBLIC HEALTH SERVICE.

1958. A Survey. Nursing Needs and Resourcesin Connecticut. The Connecticut JointCommission for Improvement of Care ofthe Patient. The Committee on FutureNeeds for Nurses. Hartford, Conn. 89pp. (processed).

DISTRICT OF COLUMBIAFEDERAL SECURITY AGENCY. PUBLIC HEALTH SERVICE.


1952. Nursing in the Nation's Capitol: A Surveyof Needs and Resources in the District ofColumbia, 1952. Washington: District ofColumbia Nurses' Association. 127 pp.(processed).

HAWAIIFEDERAL SECURITY AGENCY. PUBLIC HEALTH SERVICE.


1951. A Survey of Nursing Needs and Resourcesin Hawaii. Honolulu: Hawaii Nurses'Association. 73 pp. (processed).

TERRITORIAL COMMISSION ON NURSING EDUCATION AND

NURSING SERVICES.

1952. The Nurse of Tomorrow: A Report onNursing in Hawaii. Honolulu: HawaiiNurses' Association. 20 pp. (processed).

ILLINOIS



1950. A Report of Current Supply, Present andFuture Needs of the People of Illinois forNursing Service. May 1950. Chicago:Illinois League for Nursing. 73 pp.(processed).

INDIANABIXLER, GENEVIEVE K.; FADDIS, MARGENE 0.; andBIXLER, ROY W.

1952. Indiana Nursing Survey. Indianapolis:Indiana Nurses' Association. 70 pp.

IOWAMILLER, J. ROBERT.

1951. "Report of the 1950 Survey for the IowaState Nurses' Association." Bulletin ofIowa State Nurses' Association. 5 (2) :4-7. Des Moines, Iowa: The Association.

to 3


IOWA STATE NURSES' ASSOCIATION, IOWA STATELEAGUE OF NURSING EDUCATION, IOWA STATE ORGANI-

ZATION FOR PUBLIC HEALTH NURSING, et al.1952. Iowa Survey: Nursing Needs; Resources.

Des Moines, Iowa: Executive Committee forthe Iowa State Nursing Survey. 45 pp.(processed).

IOWA STATE NURSES' ASSOCIATION.

1956. "Results of Survey Among Office Nurses inIowa." Bulletin of Iowa State Nurses'Association. 10 (1) : 17, 18. Des Moines,Iowa: The Association.

IONVA STATE NURSES' ASSOCIATION.

1956. "INSA Section Committee Complete Per-sonnel Survey." Bulletin of Iowa StateNurses' Association. 10 (1) : 19, 20. DesMoines, Iowa: The Association.

KANSAS

KANSAS STATE NURSES' ASSOCIATION, KANSAS LEAGUE

FOR NURSING, and KANSAS STATE BOARD OF NURSEREGISTRATION AND NURSING EDUCATION.

1958. Survey Report of the Nursing Needs andResources in Kansas, 1958. Committee ToStudy Nursing Needs and Resources inKansas. Topeka, Kans. 337 pp. (proc-essed).

LOUISIANA

FEDERAL SECURITY AGENCY. PUBLIC HEALTH SERVICE.DIVISION OF NURSING RESOURCES.

1950. Survey of Nursing Resources and Needs inLouisiana, 1950. New Orleans: LouisianaNurses' Association. 104 pp. (proc-essed).


WELFARE. PUBLIC HEALTH SERVICE. DIVISION OFNURSING RESOURCES.

1956. Statewide Nursing Survey: Progress andAction in Louisiana. Resurvey. NewOrleans: Louisiana Nurses' Association.173 pp. (processed).

MAINE



1953. Maine Nursing Resources: A Survey of theMir-se Supply and Needs. 1953. Augusta:

Maine Nurses' Association. 87 pp. (proc-essed).

MARYLANDMARYLAND STATE PLANNING COMMISSION.

1953. Nursing Needs and Resources of the Stateof Maryland. Report of the Subcommitteeon Nursing Needs to the Committee onMedical Care. Baltimore, Md. 63 pp.

MASSACHUSETTS

HOWARD, ANNA T., and APPLE, DORRIAN.1960. Nursing Needs and Resources in Massa-

chusetts. A report of the Survey of Nurs-ing Needs and Resources in Massachusetts,a project sponsored by the MassachusettsLeague for Nursing, Massachusetts Nurses'Association, and the Board of Registrationin Nursing. Boston: Massachusetts Leaguefor Nursing. 127 pp.

MICHIGANBIXLER, GENEVIEVE K.

1996. Nursing Resources and Needs in Michigan.A Survey Prepared for the Michigan Coun-cil on Community Nursing. Lansing:Michigan State Nurses' Association. 74

PP.


FARE. PUBLIC HEALTH SERVICE. DIVISION OF NURSING

RESOURCES.

1953. Planning for Better Nursing in Michigan:A Survey of Resources and Neads. 1953.Lansing: Michigan State Nurses' Associa-tion. 97 pp. (processed).

MICHIGAN DEPARTMENT OF HEALTH.

1954. For Better Nursing in Michigan. A Sur-vey. (State version, based on a reportprepared by the Division of Nursing Re-sources, Public Health Service, U.S. Depart-ment of Health, Education, and Welfare.)Cunningham Drug Company Foundation.Detroit, Mich. 115 pp. (processed).

MINNESOTAGOVERNOR'S ADVISORY COMMITTEE ON NURSING.

SUBCOMMITTEE ON AID.

1949. Nursing Resources and Needs in Minne-

104

104 APPENDIX 1

sota. St. Paul, Minn. 141 pp. (proc-essed).

MISSISSIPPI

MISSISSIPPI COMMISSION ON HOSPITAL CARE.

1948. Report of Nursing Committee. To Developan Integrated State-Wide Nurse EducationProgram for Mississippi. Ruth I. Gil lan,Secretary, Nursing Committee, Jackson,Miss. 31 pp.

UNIVERSITY OF MISSISSIPPI.

1953. The Status of Nursing in Mississippi.Facts, Needs, Goals. Committee onNurs-ing Resources. Jackson, Miss. 56 pp.(processed).

COORDINATING COUNCIL OF THE MISSISSIPPI STATE

NURSES' ASSOCIATION AND THE MISSISSIPPI LEAGUEFOR NURSING.

1961. Report of Committee for Reappraisal ofMississippi Nursing Needs and Resources.1960. Jackson, Miss.: The League. 118pp.

MISSOURIUNIVERSITY OF MISSOURI. COLLEGE OF AGRICULTURE.

1949. Nursing Needs and Resources in Missouri.Research Bulletin 437. Series in RuralHealth No. 3. By Jeannette R. Gruener,for the Committee To Study Nursing Needsand Resources, of the Missouri StateNurses' Association and Missouri League ofNursing Education, Columbia, Mo. 67 pp.

NEBRASKANEBRASKA PROFESSIONAL NURSING ORGANIZATIONS;

NEBRASKA STATE DEPARTMENT OF HEALTH; andFEDERAL SECURITY AGENCY, PUBLIC HEALTH SERVICE,


1951. A Report of the Survey To Measure NursingNeeds and Resources in Nebraska, 1950-51.Omaha: Nebraska Nurses' Association.122 pp. (processed).

NEVADAU.S. DEPARTMENT OF HEALTH, EDUCATION, AND


1954. Nursing in Nevada: A Survey of Needs andResources, 1954. Reno: Nevada Nurses'Association. 47 pp. (processed).

NEW JERSEY



1950. Survey of Nursing Needs, Resources, andSupply in New Jersey, 1950. Newark:New Jersey Nurses' Association. 92 pp.(processed).

NEW MEXICOFEDERAL SECURITY AGENCY. PUBLIC HEALTH SERVICE.


1952. Nursing in New Mexico: A Survey of Needsand Resources 1952. Albuquerque: NewMexico Nurses' Association. 65 pp.(processed).

NE W YORK

NURSE RESOURCES STUDY GROUP.

1959. Needs and Facilities in Professional Nurs-ing Education in New York State. Albany,N.Y.: The State Education Department.87 pp.

COWEN, PHILIP A.1961. Needs and Facilities in Professional Nursing

Education in New York State. Revised1961. Prepared for The Nurse ResourcesStudy Group. Albany, N.Y.: The Uni-versity of the State of New York, The StateEducation Department, Division of Re-

search in Higher Education. 14 pp.(mimeographed).

NURSE RESOURCES STUDY GROUP.

1961. Needs and Facilities in Practical NursingEducation in New York State. Albany,N.Y.: University of the State of New York,State Education Department.

NORTH CAROLINAMILLER, JULIA.

1949. Report of a Survey To Determine Needs forNursing and Recommendation., for theFuture of Nursing in the State of NorthCarolina. Raleigh: North Carolina Nurses'Association. 199 pp.

NORTH CAROLINA MEDICAL CARE COMMISSION AND

UNIVERSITY OF NORTH CAROLINA AT CHAPEL HILL.

1950. Nursing and Nursing Education in NorthCarolina. The Report of the North Caro

105


lina Committee to Study Nursing and Nurs-ing Education. Raleigh, N.C. 100 pp.

NORTH DAKOTAUNIVERSITY OF NORTH DAKOTA, DIVISION OF NURSING;

and DEACONESS HOSPITAL, SCHOOL OF NURSINGCOMMITTEE.

1948. Survey of Nursing Facilities and ResourcesFor Establishing Basic and Advanced Pro-f essional Programs of Nursing at she

University of North Dakota. Grand Forks,N.D. The Committee. 55 pp. (proc-essed).

OKLAHOMAFEDERAL SECURITY AGENCY. PUBLIC HEALTH SERVICE.


1951. Survey of Nursing Needs and Resources inOklahoma. 1951. Oklahoma City: Okla-homa State Nurses' Association. 70 pp.( p rocessed) .

OREGONFEDERAL SECURITY AGENCY. PUBLIC HEALTH SERVICE.


1949. Meeting the Needs lor Nursing Services inOregon: A Study of Nursing Resources,Needs, and Educational Facilities. Port-land: Oregon State Nurses' Association.27 pp. (processed).

PENNSYLVANIAU.S. DEPARTMENT OF HEALTH, EDUCATION, AND


NURSING RESOURCES.

1955. Nursing in Pennsylvania: A Study ofNeeds and Resources. 1955. Harrisburg:Pennsylvania Nurses' Association. 118 pp.(procmed).

SOUTH CAROLINAFEDERAL SECURITY AGENCY. PUBLIC HEALTH SERVICE.


1949. Survey to Measure Nursing Needs andResources in South Carolina. Columbia:South Carolina Nurses' Association. 80pp.

MEDICAL COLLEGE OF SOUTH CAROLINA, UNIVERSITY OFSOUTH CAROLINA, WINTHROP COLLEGE, SOUTH

CAROLINA LEAGUE FOR NURSING, SOUTH CAROLINA

STATE NURSES' ASSOCIATION, AND SOUTH CAROLINA

STATE BOARD OF HEALTH.

1957. Survey of Educational and ProfessionalFacilities for Collegiate Education in Nurs-ing in South Carolina. Columbia: Uni-versity of South Carolina. 82 pp.

SOUTH DAKOTAFEDERAL SECURITY AGENCY. PUBLIC HEALTH SERVICE.

DIVISION OF NURSING RESOURCE%

1950. A Report of the Survey To Measure NursingNeeds and Resources in South Dakota, April1950. Sioux Falls: South Dakota StateNursef,' Association. 86 pp. (processed).

TENNESSEE



1949. Meeting the Needs lor Nursing Services inTennessee. Nashville: Tennessee StateNurses' Association. 32 pp. (processed).



NURSING RESOURCES.

1956. Tennessee: Action and ProgressA State-wide Survey of Nursing Needs and Re-sources. Nashville: Tennessee State Nurses'Association. 56 pp. (processed).

TEXAS

FOUNDATION FOR RESEARCH AND DEVELOPMENT IN

HEALTH ACTIVITIES.

1951. Texas Nurses in Review. A Survey ofNursing Sources and Resources in the State,of Texas. Austin: Texas Nurses Associa-tion. 92 pp.



NURSING RESOURCES.

1958. Nursing Needs and Resources in Texas. A

Survey Report. The Committee To StudyNursing Needs and Resources in Texas.Sponsored by the Board of Nurse Examinersfor the State of Texas, the Texas GraduateNurses' Association, and the Texas Leaguefor Nursing, in association with the TexasCommission on Patient Care. San An-tonio: Texas Graduate Nurses' Association.144 pp. and appendixes (processed).

6

106 APPENDIX 1

UTAHU.S. DEPARTMENT OF HEALTH, EDUCATION, AND


1954. Nursing in Utah. A Survey of Needs andResources-1954 and Supplement No. 1.Salt Lake City: Utah Nurses' Association.73 pp. (processed).

VERMONT



1952. Nursing in Vermont: Report of the VermontSurvey of Nursing Needs and Resources,1952. Burlington: Vermont State Nurses'Association. 63 pp. (processed).

WASHINGTONFEDERAL SECURITY AGENCY. PUBLIC HEALTH SERVICE.


1950. A Report of Washington Nursing Study,1950. Seattle: Washington State NursingAssociation. 54 pp. (processed).

WEST VIRGINIAFEDERAL SECURITY AGENCY. PUBLIC HEALTH SERVICE.


1951. Nursing in West Virginia. Report of theWest Virginia Survey of Nursing Needs andResources, 1951. Charleston: West Vir-ginia State Nurses' Association. 103 pp.(processed).

WISCONSINCOLUMBIA UNIVERSITY. TEACHERS COLLEGE. INSTITUTE

OF RESEARCH AND SERVICE IN NURSING EDUCATION.

1955. Education for Nursing in Wisconsin. (Ad-dressed to the Wisconsin Commission ToDevelop a State-Wide Plan for NursingEducation) New York. 376 pp.


NationalWEST, MARGARET D., and CROWTHER, BEATRICE.

1962. Education for Practical Nursing, 1960. A

Report of the Committee on the Question-naire Study of Praetical Nursing Schools.New York: National League for Nursing,Department of Practical Nursing Programs.63 pp.

This is a report of the first nationwide status study ofpractical nursing programs directed toward learning facts aboutthese programs for developing evaluative devices and identify-ing ways in which they could be improved. The survey reportis based on data from 494 of 662 State-approved schools ofpractical nursing in the academic year 1959-60. It covers trendsin the development of programs and assesses the status in1959-60 of their organization, control, and size; curriculumpatterns; age and educational background of students; costs tostudents; educational expenditures; program resources; andfaculty size and qualification. Recommendations are made forimprovement in practical nursing programs, and areas requiringfurther study are suggested.

NATIONAL LEAGUE FOR NURSING. DEPARTMENT OF

DIPLOMA AND ASSOCIATE DEGREE PROGRAMS.

1963. Today's Diploma Schools of Nursing. Re-port of the 1962 Survey of 728 DiplomaSchools of Nursing. Prepared by Eliza-

(-4

beth V. Cunningham. Code No. 16-1081.New York: The League. 69 pp.

This survey report identifies trends and describes the char-acteristics of diploma nursing education as it existed in theSpring of 1962. The survey focused on educational aspects ofprograms, fiscal practices and policies, deviations from previouspractices, and major problems. The findings, for the most part,were not measured against any standards or criteria but wereintended to be useful for planning and for continuing thesound development of schools. The report reflects a generallyheld opinion that the Majority of diploma schools of nursingwere regarded as full-fledged educational institutions, capableof identifying their own problems, setting goals, and findingways for meeting current criteria of educational cxcellence.



1963. Nurses for Leadership. The ProfessionalNurse Traineeship Program. Report ofthe 1963 Evaluation Conference. PHSPub. 1098. Washington: U.S. Govern-ment Printing Office. 53 pp.

This report is an assessment, through 1962, of the results ofthe Federal government's program to providethrough ad-vanced trainingcritically needed professional nurses forteaching, administration, and supervision in hospitals, nursingschools, and health agencies. Recommendations are made forcontinuance and extension of this Program. Many of the recom

SURVEY AND STUDY REPORTS 1.07

mendations support those made by the Surgeon General'sConsultant Group on Nursing. Effects of this program on nurs-ing service and nursing education and future needs are sub-stantiated by program data and a study of future educationplans of professional nurses conducted in 1962 by the Divisionof Nursing, with the assistance of State boards of nursing, tocontribute information for the evaluation conference on educa-tional plans and interests of nurses.



1963. Toward Quality in Nursing: Needs andCods. Report of the Surgeon General'sConsultant Croup on Nursing. PHS Pub.922, Washington: U.S. Government PrintingOffice. 73 pp.

A brief description of social, economic, and educationalchanges in our society and advances in medical sciences pro-vides the context for the analysis of nursing practice andnursing educationpast, present, and future. Analysis of goalsand needs for nursing services by all types of personnel identi-fied the need, by 1970, for 300,000 auxiliary workers, 350,000practical nurses, and 850,000 professional nurses. Of the pro-fessional nurses, 200,000 should have baccalaureate degrees and100,000 should have graduate preparation. Those numbers ofnurses were considered necessary by 1970 if the people of theUnited States are to be provided therapeutically effective andefficient nursing service. However, considering potential schoolcapacities, potential numbers of students, and the need to safe-guard the quality of education, the Consultant Group projecteda more realistic goal of 680,000 professional nurses by 1970.Of these professional nurses, 120,000 should have baccalaureatedegrees, including 25,000 with graduate preparation. The Con-sultant Group predicted that the estimated goal of 350,000practical nurses by 1970 could be reached. This would provide38 percent of direct services to patients by professional nurses,30 percent by licensed practical nurses, and 32 percent byauxiliary personnel.

To achieve these goals, there must be major expansionsquantitative and qualitativeof both diploma and collegiateprograms. Special emphasis must be given to the following:basic baccalaureate degree programs and the expansion anddevelopment of new programs providing advanced preparationfor leadership and teaching positions; intensification of recruit-ment for all programs; increase in financial aid to students;better alignment of personnel policies for graduate nurses withthose of other occupations requiring comparable skills, abilityand preparation; critical study of patterns of education; betterutilization of existing personnel; continued staff education,stimulation, and support for nursing research.

To reach these goals of nursing service, a multi-prongedattack with adequate resources is needed. Cooperative efforts ofthe nursing profession, allied professions, private and corn-munity groups, educational institutes, and health care agencieswill be imperative. Financial support that cannot be providedby these groups must be provided by government at all levels.The specific recommendations of the Consultant Group were

directed to the areas in which Federal assistance can be ofparticular and immediate significance in increasing and improv-ing nursing personnel and nursing service. They urgentlyrecommended that the nursing profession immediately conducta study of the present system of nursing education in relationto the responsibilities and skill levels required for high-qualitypatient care. They recommended that the Federal Governmentexpand and add to its present program of support andassistance in the following areas: (1) recruitment for schoolsof nursing; (2) assistance to schools for expansion and im-provement of the quality of educational programs; (3) as-sistance to professional nurses for advanced training; (4)assistance to hospitals and the health agencies for improvementof utilization and training of nursing personnel; and (5)increased support for research in nursing.

(Excerpted from a review by M. Harms in Nursing Research,12 (3) :202, Summer 1963.)

NATIONAL LEAGUE FOR NURSING. DEPARTMENT OFBACCALAUREATE AND HIGHER DEGREE PROGRAMS.

1964. Masters Education in Nursing. Report ofa Study Conducted in Spring 1963, byJean Campbell, NLN Consultant in NursingEducation. Code No. 15-1157. NewYork: The League. 121 pp.

The nature and scope of education in nursing at the master'slevel were studied to provide guidelines for setting goals,developing accreditation criteria, and planning for the future.The survey covered 35 institutions offering master's programsin 13 fields of specialization during the academic year 1962-63.The number of faculty members covered in the study was 139;the number of students, 1,217. The study assessed the charac-teristics of programs, faculty, and students, including universitycontrol, curriculum patterns, clinical practicum, admission re-quirements, educational preparation of faculty, and faculty andresearch activities.


1964. Study on Cost of Nursing Education. PartI. Cost of Basic Diploma Programs. CodeNo. 19-1142. New York: The League.95 pp.

This is a report of an investigation into the cost of nursingeducation in 126 diploma programs, using a standard methodof cost determination for each institution developed by theNational League for Nursing and the Public Health Service in1956. The study compared income, total costs, and the costs ofeducational functions and noneducational functions, by regionaldistribution of the programs, type of control, size of enrollment,and accreditation status. The study pointed up the magnitudeof the cost of maintenance of diploma program students, andshowed that the costs of both gross and net noneducationalfunctions were greater than of educational functions. Profilesof costs are presented in the text, and the appendix includes aschedule of cost analysis for one partkipating agency.

5

108 APPENDIX 1


1965. Study on Cost of Nursing Education. PartII. Cost of Basic I3accalaureate and As-sociate Degree Programs. Code No. 19-1174. New York: The League. 95 pp.

This is a report of an investigation into the cost of nursingeducation in 19 basic baccalaureate and 10 assooiate degreeprograms offered by institutions of higher learning, using theNational League for Nursing and the Public Health Servicemethod developed in 1956. The study compared the cost ofinstructional units in nursing with the cost of those in generaleducation, and showed the former to be much greater. Thestudy demonstrated a negative relationship between the cost ofthe nursing programs in the study and the percent of cost thatwas borne by the students. A profile of costs is given for eachprogram, and the schedules used for recording cost analysisare included in the appendix.

NATIONAL LEAGUE FOR NURSING. DEPARTMENT OFPRACTICAL NURSING PROGRAMS.

1966. Practical Nursing Education Today. Re-port of the 1965 Survey of 722 PracticalNursing Programs. Code No. 38-1244.New York: The League. 33 pp.

This is a report of a survey questionnaire that assessed thecharacteristics and quality of 722 of 913 existing practicalnursing education programs in relationship to acceptable stand-ards and criteria for the evaluation of these programs de-veloped by the National League for Nursing and published in1965. It evaluated progress made since the 1960 survey,portrayed the growth and expansion in these programs, andassessed the effects of Federal legislation supporting thedevelopment of practical nurse programs. It covered such areasas administration, faculty, students, curriculum, facilities, andresources, and included a separate analysis of 61 of 150 pro-grams operating under Manpower Development and TrainingAct funds. Recommendations are made as a basis for planningfurther improvement in programs.

U.S. DEPARTMENT OF HEALTH, EDUCATION, ANDWELFARE. PUBLIC HEALTH SERVICE. BUREAU OFHEALTH MANPOWER. DIVISION OF NURSING.

1967. Nurse Training Act of 1964. ProgramReview Report. PHS Pub. 1740. Wash-ington: U.S. Government Printing Office.78 pp.

This report, submitted to Congress in January 1968 by theCommittee appointed to review the Nurse Training Act of 1964,documents the accomplishments and shortcomings of the variousprovisions of the Act and its administration, forecasts futureneeds, and redefines goals for nursing in light of continuingsocial change affecting nursing and the delivery of healthservices. The Committee recommended continuation of theprogram through 1974 at least, and expansion of variousprovisions of the Act. Statistical data on the awards and utiliza.

don of the various provisions under the Act, by State and typeof nursing education program, are included in the appendix.

WALKER, VIRGINIA H.

1967. Nursing and Ritualistic Practice. New

York: Macmillan Co. 196 pp.

This book reports the findings of a 3year study, supportedby the U.S. Public Health Service, in which nursing functionswere examined against the criterion of "ritualistic behavior,"defined as operational behavior having some significance to theactor rather than being primarily oriented to the achievement oforganizational goals. Traditional and controversial nursingfunctions examined include temperature, pulse, and respirationprocedures; shift reports; assignment of nursing activities;nurses' accountability to several supervisors; and decision-

making in the absence of a physician. The study findings

clearly indicate that ritualistic behavior related to these func-tions accounts for enough difficulty to warrant further investiga-tion. This book can help to prepare nurses to read, eva/uate,and use or reject research findings. Sufficient information andideas are presented for beginning efforts in research or evalua-tion of services. The book is timely, in view of the need to facethe issues of tbe demand for nurses and the changing roleof the professional nurse. (Excerpted from a review by NancyKintner, Director of Nursing, Northern State Hospital, SedroWoolley, Washington. In Nursing Outlook, 15 (12) :21, Decem.her 1967.)

NATIONAL LEAGUE FOR NURSING. RESEARCH AND

DEVELOPMENT.

1969. A National Survey of Associate DegreePrograms, 1967. By Sylvia Lande. Pub.23-1348. New York: The League. 150

PP.

The characteristics of associate degree nursing programs,their administration, students, faculty, curriculum, resources,and graduates, are reported in depth. Data were gathered fromreplies from 201 of 218 programs to which questionnaires weresent in 1967. The history of associate degree nursing programsis traced, and implications are drawn from the survey.

NATIONAL COMMISSION FOR THE STUDY OF NURSING

AND NURSING EDUCATION.

1970. An Abstract for Action. Vol. I. NewYork: McGraw-Hill, Inc. 167 pp.

This independent commission, established jointly by theAmerican Nurses' Association and the National League forNursing and supported by foundation funds, carried out therecommendations of the Surgeon General's Consultant Groupon Nursing that nursing education be studied in relation tothe responsibilities and skill levels required for high-qualitypatient care. The Commission studied trends and changingconditions in the Nation's need for nurses, assessed changingrole requirements and educational practices and the internaland external factors influencing nursing careers. Among theCommission's recommendations, priority is given to the needfor increased research into the practice of nursing and educa.


tion of nurses, enhanced educational systems and curriculabased on research, and increased financial support for nursesand nursing to ensure adequate career opportunities. The reportalso briefly describes the history, organization, and methodologyof the investigation.

NATIONAL COMMISSION FOR THE STUDY OF NURSING

AND NURSING EDUCATION.

1971. An Abstract for Action: Appendices. Vol.II. Edited by Jerome P. Lysaught, Direc-tor. New York: McGraw-Hill Book Com-pany. 509 pp.

This is a companion publication to volume I which containsthe final report and recommendations of the National Com-mission. In the eighteen sections which make up the set ofappendices, the study methods used are documented, interimfindings and decisions are included, and data relevant to thethreeyear study of nursing practice and education are given.

Regional

PAIR, NONA TILLER.

1963. Nursing Resources in Idaho, Montana,Nevada, and Wyoming.ing resources in theselour States, preparedfor the Mountain States Medical EducationStudy. Sponsored by the Western Inter-state Commission for Higher Education,Boulder, Colo., Sept. 16, 1963. 72 pp.(processed).

This report reviews the number of registered nurses by fieldof practice in the four States in 1962, the number of licensedpractical nurses, and the trends in the number of practitionersbeing prepared in schools of nursing for registered nurses andpractical nurses. A comparison is made of nurse-to-populationratios of the country as a whole, of the four States, and ofparticular counties within these States. The number of nursingpractitioners needed in the future is predicted, based on anestimate of population growth and present nurse-to.populationratios.

A review of nurs-

WESTERN INTERSTATE COMMISSION FOR HIGHEREDUCATION.

1966. Today and Tomorrow in Western Nursing.A WCIIEN Report on the Present, WithRecommendations for the Future. Boulder,Colo.: The Commission. 108 pp.

This publication is a report of a reappraisal of needs andresources for nursing education for the 13 western Statesregional education compact. It contains an assessment of theextent to which the recommendations of the 1959 survey,reported in Nurses for the West, were carried out. An actionprogram on the regional, State, and institutional levels forproviding an adequate supply of well-trained nurses is recom-

mended. State representatives are advised to stimulate Statestudies and coordinate action on the States' nursing educationproblems.

SOUTHERN REGIONAL EDUCATION BOARD.

1967. Agenda Book, Eighth Conference of Councilon Collegiate Education for Nursing, April19-21, 1967. Project in Nursing Educa-tion and Research. Atlanta, Ga.: TheBoard. 65 pp.

Included in the proceedings of this Conference and theconference agenda book are synopses of various activities andprogress, up to April 1967, toward statewide planning fornursing education in the States of Arkansas, Georgia, Mary-land, Mississippi, North Carolina, Oklahoma, Texas, and Vir-ginia. Through these reports, processes in the development ofState planning for nursing can be traced.

SOUTHERN REGIONAL EDUCATION BOARD.

1967. Agetida Book, Ninth Conference. of Councilon Collegiate Education for Nursing,November 8-10, 1967. Project in NursingEducation. Atlanta, Ga.: The Board. 73

PP.

This agenda book updates previous Conference progress re-ports on statewide planning activities for nursing education forthe States of Arkansas, Georgia, Maryland, Mississippi, andTexas, and adds reports for the States of South Carolina andTennessee. These reports give information on how the variousStates sponsor, finance, organize, and carry out planningactivities. Updated statistical data on nursing education in theSouthern Regional Education Board region are also included.

FLITTER, HESSEL H.

1968. Nursing in the South. Atlanta, Ga.:Southern Regional Education Board. 51

1313.

This publication concisely analyzes nursing in the 15 Statesincluded in the Southern Regional Education Board. It de-scibes where nurses arc employed, and compares the currentand estimated future supply with national goals. It also assessesthe status of nursing education. The intent of the report is toencourage each State and local community in the South to planfor meeting its nursing needs in light of its own resources.


1968. Operation Decision: Citizen Planning forNursing in the South. Report of a con-ference sponsored by the Southern RegionalAssembly of Constituent Leagues for Nurs-ing and the NLN Cour-q of Public HealthNursing Services. Puu. 54-1322. NewYork: The League. 58 pp.

Issues in nursing service and nursing education, nursing

110 APPENDIX 1

needs, and required action programs in the 13 southern Statesall were identified in this Conference intended to stimulatecommunity planning for nursing. Representatives of a crosssection of nursing interests, in addition, assessed data availableand needed for planning, and the potential and means formeeting nursing needs. The report describes the Conferencework of each State team and planning for nursing that was inprogress in the State.

FAHS, IVAN J.; BARCHAS, KATHRYN U.; and OLSON,LINDA G.

1970. Nursing in the Upper Midwest. A Sum-mary Report. The Upper Midwest NursingStudy, Upper Midwest Research and De-velopment Council. Minneapolis, Minn.A study sponsored by the Louis W. andMaud Hill Family Foundation of St. Paul,Minn. 48 pp. (processed).

This is one of several reports on a regional study of nursingneeds and resources in the Upper Midwest. The Upper Midwestregion comprises the entire States of Minnesota, Montana,North Dakota, and South Dakota, and parts of Michigan andWisconsin. This summary report presents statistics, information,and an anulysis of nursing needs and resources in the regionas they relate to and are influenced by demographic, economic,social, and health factors and conditions in the region andin the Nation as a whole. Problematic areas related to meetingnursing personnel needs are highlighted.

State and Territorial

ALABAMA

ALABAMA BOARD OF NURSING.

1968. Assessment of Nursing Education in Ala-bama, 1968. Montgomery: The Board.58 pp.

This study proposes definitive measures for the developmentof a plan for nursing education in Alabama. The characteristicsof the 1967 supply of registered nurses, licensed practicalnurses, and nursing education resources were analyzed byregions of the State. The characteriatics of faculty and studentsof nursing, recruitment practices, and the applicant experiencesof schoolsall were surveyed by a student questionnaire and astructured interview of directors of schools of nursing. Generalrecommendations are made for the development of nursingeducation in the State, with specific recommendations onrecruitment, nursing faculty development, and the developmentor expansion of specified types of nursing education programs,by regions of the State.

ALABAMA LEAGUE FOR NURSING, ALABAMA STATE

NURSES ASSOCIATION, ALABAMA REGIONAL MEDICALPROGRAM.

1969. Nurse Utilization in Alabama, A Com-

mittee Report. Birmingham: The League.53 pp.

This is a report of the findings and recommendations of aState planning committee appointed to study the current prac-tices of nurses in Alabama and to propose methods forimprovement in patient care. The Committee conducted a

survey of nursing activities in hospitals, nursing homes, andpublic health agencies; determined the functions of theregistered nurse; and made recommendations for the improvedutilization of nursing personnel. The need for utilizationstudies, regional demonstration units, continuing education,and inservice education was stressed.

ARIZONA

ARIZONA STATE NURSES' ASSOCIATION.

1965. "Interim Report of the Joint CommitteeTo Study Nursing Needs and Resources inArizona." Arizona Nurse, 18 (5) :23-38.November-December 1965.

The continuous activities of the Committee on Nurses forArizona and the Joint Committee To Study Nursing Needs andResources are traced from 1959 through 1965. Progress in

carrying out recommendations of the 1950 and 1963 surveys isnoted. The report updates to 1964 a statistical summary and

.analysis of the nurse supply and educational resources. Newgoals and action programs for meeting Arizona's nursing needsare recommended.

ARIZONA STATE NURSES' ASSOCIATION.

1966. "Interim Report No. 2 of the Joint Commit-tee To Study Nursing Needs and Resourcesin Arizona," Arizona Nurse, 18 (3) :14-22,May-June.

A reassessment of Arizona's nurse supply and educationalresources, based on an analysis of trend data from 1958 to1965, is made in this report. Changing county needs andadditional demands for nursing services are considered. De.velopment of a statewide plan for education in nursing andcontinuing education for practitioners is recommended', to meetneeds for health care and 1970 goals for nursing.

ARIZONA NURSES' ASSOCIATION.

1968. "Interim Report No. 3 of The Joint Commit-tee To Study Nursing Needs and Resourcesin Arizona." Arizona Nurse, 21 (3) : 17-24(May-June).

"Data concerning employed professional nurses licensed inArizona for the years 1959 through 1967. Yearly percentagegain, number and source of new licensed nurses, age distribu.tion and total number licensed and employed statistics aregiven. Nursing education is reviewed and data includes typeof programs, number of admissions and graduations for theyears 1963 to 1968. Results of a questionnaire survey to de-termine characteristics of inactive nurses, the interest in re


fresher courses and likelihood of returning to active practiceare also reported." (From Abstracts of Hospital ManagementStudies, V:133, June 1969.)

ARKANSASARKANSAS STATE BOARD OF NURSE EXAMINERS.

1965. Statistical Report oj the Arkansas StateBoard of Nurse Examiners. January 1,1965 to September 1, 1965. Little Rock:Arkansas State Board of Health. 38 pp.

This report compiles from licensing data the number, locationby county, activity status, education, and other characteristicsof registered nurses and practical nurses in the State ofArkansas in 1965.

ARKANSAS STATE NURSES' ASSOCIATION.

1968. Arkansas Health Manpower Project Report,June 26, 1967November 30, 1968. LittleRock: The Association. 91 pp. (proc-essed).

This report of an 18-month project to return inactive healthmanpower to employment contains data from various surveysof nursing needs and resources. Included are the county distri-bution of inactive registered nurses and licensed practicalnurses; the intention of inactive registered nurses to returnto work; their needs for refresher courses; and the numberswho enrolled in, completed courses, and returned to work.Data on budgeted unfilled vacancies for registered nurses andlicensed practical nurses, by county, in hospitals, nursinghomes, and State health department services are included.Surveys were made on the number of registered nurses, licensedpractical nurses, and non-nurse personnel employed in schooland industrial health positions. Unfilled positions for industrialnurses, as well as their salary and fringe benefits, were includedin the survey.

CALIFORNIACALIFORNIA STATE DEPARTMENT OF EDUCATION.

BUREAU OF JUNIOR COLLEGE EDUCATION.

1964. Data Regarding the Graduates ol the Cdi-fornia Associate Degree Nursing ProgramFrom the Board of Nursing Education andNurse Registration, Six-Year EvaluationProject. Prepared by Mrs. Helen D. Bow-man, Special Consultant, California As-sociate in Arts Nursing Project, Bureau ofJunior College Education. Sacramento.54 pp. (mimeographed).

This report analyzes data collected by questionnaire by theBoard of Nursing Education and Nurse Registration on theemployment experience of 216 graduates of associate degreenursing programs in 1959 and 1960. The employment evaluationincludes data on: field of nursing; type of position; length oftime in position; job orientation, inservice training, and super-

vision received; positions or responsibilities refused; adequacyof preparation for positions held; additional training needed;and future plans related to nursing. Biographical data on 516students entering associate degree nursing programs in 1958and 2959 are included.

CALIFORNIA STATE DEPARTMENT OF EDUCATION.

1966. Associate Degree Nursing Education Pro-grams in California, 1953-1965. Preparedby Mrs. Celeste Mercer, Special Consultant,California Associate in Arts Nursing Proj-ect, Bureau of Junior College Education,Sacramento. 69 pp.

This report of the history and Statewide development ofassociate degree nursing education programs in Californiapoints out some of the critical areas to be observed in planningand maintaining a successful program. Included are planningthe curriculum; providing stuff and facilities; developing plansand policies for the recruitment, selection, and admission ofstudents; and organizing the administrative and supervisoryrelationships within the college and with other agencies. Evalua-tion processes for the first 6 years of program development haveyielded special survey and study data on: factors related toadmissions, enrollment, attrition, and graduates; attractions ofthe associate degree nursing program; and reasons for theclosing of hospital schools.

COORDINATING COUNCIL FOR HIGHER EDUCATION.

1966. Nursing Education in California. A Re-port to the Coordinating Council for HigherEducation. No. 1025. Sacramento: TheCouncil. 51 pp.

This is a report of a study of nursing education in Californiaconducted by the Council to provide a basis for planning. Itdiscusses needs for nurses; basic education programs, accredita-tion of programs, graduate education and articulation of thesegments; nursing functions, licensure, and economic incen-tives; and auxiliary nursing personnel. Findings in these areasare summarized, and the resolutions of the Council based onthe findings are presented.

COORDINATING COUNCIL FOR HIGHER EDUCATION.

1968. Progress Report on Nursing Education inCalifornia. Pub. 68-13. Sacramento: TheCouncil. 53 pp. (Processed).

This report assesses the current status and action taken onthe 1966 resolutions of the Council regarding nursing educationin State junior and senior colleges and the university. Anassessment is made of educational programs in 1966 for licensedvocational nurses and for registered nurses, including diploma,associate degree, baccalaureate, master's, and post-master'sprograms. Data are presented on faculty and student resources.admissions, graduates, and percent of graduates passing StateBoard examinations; cost factors; and plans for expansion anddevelopment of programs. Findings and recommendations aresummarized.

112 APPENDIX 1

DEPARTMENT OF PROFESSIONAL AND VOCATIONAL

STANDARDS. BOARD OF NURSING EDUCATION AND NURSE

REGISTRATION.

1969. Profile of Registered Nurses in California.Sacramento: The Board. 51 pp. (proc-essed).

This is a statistical presentation without analysis of thesupply and characteristics of registered nurses licensed inCalifornia as of December 31, 1968. Data are classified bycounty and regions of the State and detailed by sex; age group;marital status; number employed full-time, part-time, and notemployed; educational preparation; field of employment; typeof position; and area of clinical practice.

HEALTH MANPOWER COUNCIL OF CALIFORNIA.

1970. 1970 California Health Manpower, LicensedVocational Nurses. Basic OccupationalInformation Series. Orinda, Calif.: TheCouncil. 49 pp. (processed).

This report compiles available data and information onlicensed vocational nurses in California. It presents trends inthe supply from 1952 to 1968, as well as trends in educationalprograms. Data from the Board of Vocational Nurses giveinformation on the characteristics of these nurses by age, sex,county distribution, and employment status. Also included is

information on admissions, enrollments, and graduates fromeducational programs. The report calls attention to the limitedsource of data on licensed vocational nurses.

HEALTH MANPOWER COUNCIL OF CALIFORNIA.

1970. 1970 California Health Manpower, Regis-tered Nurses. Basic Occupational Informa-tion Series. Orinda, Calif.: The Council.65 pp. (processed).

This report compiles data and information on the registerednurse supply from available sources. Data were obtained largelythrough licensure processes and accreditation procedures fornursing education programs. Trends in the nurse supply up to1969 and the characteristics of nurses by age, sex, employmentstatus, and distribution by county, are detailed. Trends innursing education and the characteristics of students are alsotraced. The report draws implications on the need for, short-ages of, and utilization of nurses for planning purposes.

COLORADO

COLORADO LEAGUE FOR NURSING and the WESTERNCOUNCIL ON HIGHER EDUCATION FOR NURSING.

1963. Report of the Colorado Committee TowardStatewide Planning for the Education ofNursing Practitioners in Colorado. Den-ver: The League. 74 pp.

Nursing service personnel employed by the health servicesand educational programs for nursing were assessed as a basisfor the later development of guidelines and criteria for the

expansion of education programs. The study includes a regionalanalysis of registered nursus and licensed practical nurses, bytype and characteristics of their work places, as well as ananalysis of educational resources for the years 1955 to 1962.Needs and demands for personnel are estimated.

COLORADO NURSES' ASSOCIATION.

1968. Inactive Health Personnel Project Final Re-port. Denver: The Association. 46 pp.(processed).

This report is devoted principally to inactive registered

nurses in 1967 and 1968, their characteristics as to age, maritalstatus, educational preparation, work experience, and intentionto return to work. It includes a history of refresher coursesfor inactive registered nurses, programing procedures, and thenumber of nurses who completed courses and returned to work.A brief review is given of Colorado's registered nurse supply,from 1962 to 1966 and the nursing education situation by typeof program. Also included are projections of educational re-sources to 1977 and the State plan for nursing education.

CONNECTICUTCONNECTICUT COMMISSION ON NURSING.

1966. Nursing Needs and Resources in Con-

necticut, A Report of the ConnecticutCommission ort Nursing, 1966. Sponsoredby the Connecticut League for Nursing,Connecticut Nurses' Association, and Con-necticut Hospital Association. Hartford:The Commission. 49 pp.

The Commission studied nursing personnel resources andneeds in hospitals, public health agencies, nursing homes, andschools of nursing. Action for meeting needs was recommendedin the areas of planning, recruitment, job satisfaction, andpostgraduate education. Priority was given to the need forproperly organized and financed continuous planning for nurs-ing as a responsibility of the State Departments of Health,Education, and Labor, and all other public and private agenciesconcerned.

DISTRICT OF COLUMBIA


WELFARE. PUBLIC HEALTH SERVICE. BUREAU OFHEALTH MANPOWER. DIVISION OF NURSING.


This source book was designed as a tool that can be usedby planning groups in other metropolitan areas to identifysources and select data pertinent to their problems, issues, andsituations. However, it is also a data survey and analysis ofnursing needs and resources in the District of Columbia

0

111111


metropolitan area, and draws implications for planning. Statis-tics and information are presented on the demography of thearea; health conditions, expenditures, facilities, and services;and socioeconomic factors as they relate to the nurse supply,nursing education resources, and nursing needs.

GEORGIAGEORGIA EDUCATIONAL IMPROVEMENT COUNCIL.

1969. Nursing Education in Georgia. By PatMalone. Atlanta: The Council. 103 pp.

In this 18-month statewide study of nursing education, theeducational resources were examined against the 1967 nurscsupply, the needs and demands for nurses, and such influencingfactors as carecr and employment incentives, new career pat-terns, and changing health services. Quantitative needs areprojectcd to 1975, and broad recommendations are made forincreasing and improving the nurse supply and strengtheningthe educational program. The involvement in the study ofselected leaders and professional groups and the wide participa-tion of health and educational institutions and agencies shouldlay a firm basis for local, regional, or area planning to findspecific solutions for ntirsing problems and to obtain coopera-tion in developing programs for meeting needs.

HAWAIIKOSAKI, MILDRED D.

1962. Nursing and Nursing Education in Hawaii.Report No. 3. Legislative Reference Bu-reau, University of Hawaii. Honolulu,Hawaii. 117 pp.

This study found the supply of registered nurses and prac-tical nurses and facilities for basic nursing education to beadequate in Hawaii in 1961. However, it predicted definiteshortages for practical nurses and probable shortages forregistered nurses by 1970. Programs in basic nursing educationthat were not meeting admission quotas were identified, andneeds for the advanced educational preparation of nurses inspecialty fields, supervision, and administration were pointedup. Legislative action to promote nursing education was recom-mended, as well as the collaboration of nursing with otherhealth professions for meeting specified problems in nursingservice and nursing education.

UNIVERSITY OF HAWAII. LEGISLATIVE REFERENCE

BUREAU.

1969. Nursing In Hawaii, 1968. Report- No. 4.Honolulu: The University. 52 pp.

This is a report on thc number of registered nurses employedin Hawaii in 1968, and the needs for nurses projected byemploying agencies for 5 and 12 years. It concluded that,barring marked changes, thc presently projccted number ofnursing school graduates and nurses coming to Hawaii fromother States and countries is adequate to fill thc near-termneeds of thc State. No assessment or recommendations are

made on employment and career incentives, the utilization ofnursing personnel, or other factors and conditions influencingnursing practke and education in Hawaii.

IDAHOUNIVERSITY OF IDAHO. COLLEGE OF EDUCATION. THE

STATE OCCUPATIONAL RESEARCH UNIT.

1967. A Study of the Nursing Profession in IdahoMedical Facilities. Moscow: The StateOccupational Research Unit. 23 pp.

This is a report of a questionnaire survey of hospitals andnursing homes within thc State of Idaho. The survey was madeto obtain factual data concerned primarily with descriptiveinformation about the facilities and the nursing service person-nel working therein.

WESTERN INTERSTATE COMMISSION FOR HIGHER

EDUCATION. MOUNTAIN STATES REGIONAL MEDICAL

PROGRAM. IDAHO OFFICE.

1969. Nursing in Idaho: A Study of NursingNeeds and Resources. Boulder, Colo.:The Commission. 86 pp.

This first statewide survey of Idaho's nursing needs andresources was prepared as a guide for understanding thenursing manpower problems of the State and for planning tomeet nursing education needs. The 1967-68 supply and charac-teristics of active and inactive registered nurses are analyzed,including county distribution, ratio to population, attrition,migration, and source of supply. Nursing education resourcesin 1968 are assessed, and needs for registered nurses areprojected for 1970, 1975, and 1980. Recommendations madeon nursc manpower, utilization, recruitment, and educationinclude a proposal for the formation of a permanent educationplanning committee under the auspices of the Statewide Co-ordinating Committee on Nursing Education. The survey in-cludes data on the distribution, activity status, and ratio topopulation of licensed practical nurses.

ILLINOIS

TOMLINSON, R. M.; AsH, C. T-.; T .....ANGDON, LOIS M.;

and SUZUKI, W. N.1967. Practical Nursing in Illinois: A Profile.

Department of Vocational and TechnicalEducation, College of Education, Universityof Illinois, in cooperation with the IllinoisBoard of Vocational Education and Reha-bilitation, and the U.S. Office of Education.Urbana: University of Illinois. 160 pp.(processed).

The first rcport on a longitudinal study of practical nursingin the States of Illinois and Iowa details preliminary findings onpractical nursing in Illinois. The development of practicalnursing in the State is traced and related to thc characteristics

6

114 APPENDIX 1

of the population of licensed practical nurses, their employmentpatterns, and the program through which they are prepared. A10 percent sample of practical nurses licensed from the incep-tion of licensure in 1951 through 1965 was used in the study.


1968. Nursing in Illinois. An Assessment, 1968,and A Plan, 1980. Chicago: The Commis-sion. 64 pp.

This is a report of a 2-year, in-depth planning project thathas recommended programs of action to meet Illinois' needsfor nursing services by 1980. Assessment of nursing needs andresources and the development of recomendations by theCommission's representatives of interdisciplinary health groupsand the public were supported by documentation and analysisof the nursing situation from available socioeconomic, health,and nursing data, as well as six special studies conducted byquestionnaires, and a research study on nurse utilization inhospitals. The report includes a blueprint for nursing education.


1968. Nursing In Illinois. An Assessment, 1968,and A Plan, 1980. Vol. II, CommitteeReports. Sponsored by the Illinois Leaguefor Nursing and Illinois Nurses Association.Chicago: The Commission. 136 pp.

"This volume, supplementary to the main report published asvolume 1, contains the principal data, forecasts, and recom-mendations of the seven-nurse occupational-area committeesthrough whom the primary work of the Commission was done."Reports of special surveys undertaken by the Committees areincluded.

INDIANAINDIANAPOLIS HOSPITAL DEVELOPMENT ASSOCIATION.

1965. Su; vey of Nursing Resources in Indianapoli.sMetropolitan Area. Indianapolis: The As-sociation. 157 pp.

The goal of this study was to estimate demands and thenursing resources required for meeting community .needs from1965 to 1975 as part of planning for the expansion of healthfacilities. Data on hospitals, nursing homes, high school seniors,graduates from nursing schools from 1935 to 1964, and on thecost of nursing educationall were collected by special surveysand assessed with available data on the nurse supply and its.characteristics.

INDIANA COMMITTEE ON NURSING.

1967. Nurses for Indiana, Present and Future.Survey Report of the Nursing Needs andResources in Indiana, 1967. Indianapolis:The Committee. 132 pp.

This study assessed the statewide demand for, distribution of,and characteristics of the supply of registered nurses, licensed

practical nurses, and aides; their working conditions; andtheir educational preparation. Recommendations developed fromthe 2.-year stu.ly give directions for improving the quantity andquality of the supply to meet estimated needs up to 1975, inrelation to educational programs, population growth, and healthtrends.

HILL, RAYMOND E.

1968. A Summation of the Nursing ResourcesFollow-up Survey. Indianapolis HospitalDevelopment Association, Inc. Indian-apolis, Ind. 30 pp.

"The seven nursing education institutions in the metropolitanIndianapolis area operative since 1964 each completed a

questionnaire to update data from the 1964 Booz, Allen andHamilton nursing resources survey, assessing the supply ofnurses currently being educated and collecting pertinent statis-tics regarding the students and the institutions involved. Dataare tabulated by type of program." (From Abstracts of HospitalManagement Studies, V: 127. June 1969.)

KANSAS

KANSAS STATE BOARD OF NURSING and KANSAS STATE

NURSES' ASSOCIATION.

1963. Reappraisal Study of Nursing Needs andResources: A Follow-up of the Survey fNursing Needs and Resources, 1958.

Kansas League for Nursing, ImplementationCommittee. Topeka, Kans.

lii accordance with a recommendation of the initial surveyof nursing needs and resources, data from the 1958 study wereupdated, needs, and resources were reappraised, and progress inthe accomplishment of the 1958 rcicommendations was assessed.Needs and goals for nursing in 1970 were projected, andrecommendations for action programs were formulated.

KANSAS HEALTH FACILITIES INFORMATION SERVICE.INC.

1965. A Study of Nursing Needs and Goalsin Kansas Through 1975. Pub. 108.Topeka: The Service. 33 pp. (proc-essed).

This study assessed the lharacteristics of the 1964 supply ofregistered nurses and licenssd practical nurses, nursing educa.tion programs, and trends in lursing manpower, as a basis forlong-range planning for nursing by an interdisciplinary healthgroup. Nursing personnc: Cills for 1975 were established,based on expected need and the ability to meet that need.Recommendations propose a broad attack on the problems ofrecruitment, preparation, and utilization of nursing personnel.

KANSAS HEALTH FACILITIES INFORMATION SERVICE,INC.

1966. Recommendations and Guidelines for Ac-tion: Supplement to A Study of Nursing


Needs and Coals in Kansas Through 1975.Topeka: The Service. 9 pp. (processed).

Recommendations from the 1965 study are outlined, withsteps and guidelines for accomplishment and designation of agroup or agency having primary responsibility for implementa-tion.

KANSAS HEALTH FACILITIES INFORMATION SERVICE,INC.

1968. Recomendations for Development of Nurs-ing Education in Kansas. Pub. 108-A.Topeka: The Service. 30 pp. (proc-essed).

This study is part of a continuing effort to plan for nursingneeds and resources in Kansas. The report revises projectionsof nursing needs through 1975. It presents guidelines forprogram development in nursing education; general criteriafor the establishment of new nursing education programs; andrecommendations for immediate program development by typeof program, geographic location, and ( ducational institution.Recommendations for development of nursing education plan-ning on a regional basis are included.

KENTUCKYKENTUCKY NURSES' ASSOCIATION.

1968. Nursing in Kentucky. Louisville: The As-sociation. 61 pp.

This is a report of the first statewide survey of the nursesupply and nursing education resources in Kentucky, preparedas a basis for planning for nursing education. It includes astatistical analysis of the number of active and inactive regis-tered nurses and licensed practical nurses in 1967-68, and theircharacteristics. Trend data on nursing education facilities andstudent resources from 1957 to 1967 are presented, includingdata on applicant experience, withdrawals, faculty,,and clinicalfacilities. Numeral goals for the registered nurse supply areproposed for 1972, 1975, and 1980. Implications are drawn fromthe data, and recommendations relative to nursing educationare made for meeting quantitative and qualitative needs.

LOUISIANA

LOUISIANA STATE NURSES' ASSOCIATION AND LOUISIANA

LEAGUE FOR NURSING.

1962. "The State of Nursing in the State ofLouisiana. A Re-Survey of Nursing Needsand Resources in Lonisiana, 1950-60."

Pelican News, New Orleans, La., pp. 10-15(October).

This report briefly presents a picture of the nurse supply,nursing education resources, and needs for nurses in Louisianain 1960. It is a reappraisal of Louisiana's nursing needs andcapabilities conducted to determine progress made since the1955 re-survey.

LOUISIANA STATE NURSES' ASSOCIATION. RECRUITMENT

DIVISION.

1968. Fifth Quarterly Report, August 1, 1968October 31, 1968 (Final Quarterly Report).Project To Assist in Return of InactiveHealth Personnel to Active Employment inLouisiana. New Orleans: The Associa-tion. 40 pp. (processed).

This report is primarily a resume and evaluation of theexperience and effect of 15 refresher courses and public rda-dons activities in returning inactive registered nurses to em-ployment. The appendix includes a work status followup onnurses who took refresher courses from June through November1968 and on those who had returned to work by October 1968,as well as a projection of the number of returnees for the next3 months. Data on the county distribution of known inactivenurses in September-Omober 1968 and the number interested intaking courses are included.

MAINE

HEALTH FACILITIES PLANNING COUNCIL OF MAINE.

1966. Nursing Personnel Resources: An Analysisof the Supply of Registered ProfessionalNurses in Maine. Augusta: The Council.31 pp. (processed).

The 1966 supply of registered nurses with current licenseswas analyzed as to its distribution throughout the State.Inactive nurses were surveyed by questionnaire to elicit theirinterest in returning to work, in order to determine the po-tcntial work force within this pool for meeting nurse manpowerrequirements.

MARYLANDPLANNING COUNCIL FOR THE BOARD OF HEALTH AND

MENTAL HYGIENE.

1966. Survey of Nursing Needs and Resources inMaryland. Report of the Planning Councilfor the Board of Health and Mental Hy-giene, State of Maryland. Whitehurst Hall,University of Maryland, Baltimore, Md.125 pp. (processed).

The 1962 Inventory of Registered Professional Nurses, to-gether with State licensing data for practical nurses, was usedto assess the supply of registered nurses and licensed practicalnurses in Maryland, by :Activity qatus, field of employment,county of residence, and level of educational preparation. Needsfor nursing personnel were projected to 1975, including recom-mended levels of educational preparation and ratios for pro-fessional, technical, and auxiliary personnel. Measures for

Improving career and employment incentives were proposed.

MASSACHUSETTSRESEARCH DEPARTMENT. ECONOMIC RESEARCH AND

116 APPENDIX 1

SPECIAL REPORTS.

1966. Preliminary Report, Survey of ProfessionalNurses and Practical Nurses With ActiveMassachusetts Registrations and Licenses,JulySeptember, 1966. The Common-wealth of Massachusetts, Division of Em-ployment Security, Boston, Mass. 22 pp.(processed).

Active and inactive registered nurses and practical nurseslicensed in the State in 1966 were surveyed by questionnaire todetermine the potential work force. Measures for encouragingmore of the inactive nurses to return to work were recom-mended.

MALONE, MARY F.

1968. Educational Horizons for Nursing in Massa-chusetts. A Report on Nursing Educationin the Commonwealth of Massachusetts,With Recomendations for the Future. Vol.3 of the Board of Higher Education Series.Boston: The Board. 113 pp.

This study of the nursing education situation hi Massa-chusetts was prepared for the Board of Higher Education asa prerequisite for planning for a system of nursing educationto meet the State's service and education needs for nursingpersonnel. It includes trend data, 1962-67. obtained by ques,tionnaires and interviews on Al types of nursing educationprograms, applicanic, admissions, graduations, attrition rates,faculty, clinical facibties, and the characteristics of students.School enrollments are projected to 1972 and 1980. The reportincludes an evaluation of the data, their implications andrecommendations. Copies of questionnaires used in the studyand a list of approved schools of nursing in Massachusetts arein the appendix.

MASSACHUSETTS NURSES ASSOCIATION.

1968. Health Manpower Project. A Study ofInactive Profesional Health Personnel inMassachusetts. Boston: The Association.113 pp. (processed).

This is a report of a 15-month project to identify and returnregistered nursos to active employment. It includes findings ofa survey of inactive registered nurses conducted in May andJune 1968, their characteristics, work experience, intention toreturn to work, and interest in refresher programs. A report ofa survey of employment opportunities for inactive registerednurses is also included, as well as recommendations for furtherstudy.

THE COMMONWEALTH OF MASSACHUSETTS. EXECUTIVE

OFFICE FOR ADMINi,iTRATION AND FINANCE.

1970. Profesional Nursing In State Service:Needs and Recommendations. TrainingNeeds of Massachusetts Nurses in the 70's.

A Skills Inventory of Registered NursesEmployed by the Commonwealth of Massa-chusetts. Prepared by Barbara Woods,Employment Training Section, Bureau ofPersonnel and Standardization, Boston.66 pp. (processed).

This report proposes means for meeting the continuingeducation needs of registered nurses employed in State services.It reiterates and supports the 1969 recommendations of theGovernor's Committee on Nursing for the recruitment andretention of these nurses. Survey data and other informationare reported on the following: length of employment of regis-tered nurses in State service; levels of their educational prepara-tion and educational needs; the cost of post-basic education;and sources and types of financial assistance available foreducational purposes.

MICHIGANMICHIGAN LEAGUE FOR NURSING.

1966. Nursing Needs and Resources in Michigan,Today and Tomorrow. A Report to thePeople of Michigan from the MichiganLeague for Nursing and Michigan NursesAssociation, 1966. Detroit: The League.62 pp.

The report of the 2-year study for planning for nursingservice and educational needs and resources includea estimatesof the numbers, kinds, and levels of educational preparation ofnursing personnel existing and needed for regions within theState. Guidelines and recommendations for increasing thesupply and the expansion of educational facilities are included.

ADVISORY COMMITTEE ON NURSING EDUCATION TO THE

CITIZENS COMMITTEE ON EDUCATION FOR HEALTH

CARE. STATE BOARD OF EDUCATION.

1969. Nursing Education Needs in Michigan.Report of the Advisory Committee on Nurs-ing Education. Pub. Series 1, No. 3.

Education for Health Care Project, Schoolof Public Health, The University ofMichigan, Arm Arbor, Mich. 48104. 60

PP.

This study reconnnends a mechanism for State planning fornursing education in Michigai1 within the structure of Stategovernment. From a review and analysis of existing studies ofnursing in Michigan and other studies of nurse staffing, recom-mendations rclative to the development of a State plan fornursilig education are also made. These recommendationsconcern the following: continued learning for nursing man-power, the effective utilization of nursing manpower, the ex-pansion of nursing education facilities, student recruitment,and financial support for nursing education.


FAHS, IVAN J., and OLSON, LINDA G.1970. Nursing in the Upper Midwest. Focus on

the Upper Peninsula of Michigan. TheUpper Midwest Nursing Study, Upper Mid-west Research and Development Council.Minneapolis, Minn. A study sponsorndby the Louis W. and Maud Hill FamilyFoundation of St. Paul, Minn. 35 pp.(processed).

This report, produced in cooperation with the Citizens'Committee on the Study of Nursing in the Upper Peninsula, isan analysis of the supply of nursing personnel, nursing educa-tion programs, the utilization of nursing personnel, andprojected needs for nurses in the Upper Peninsula of Michigan.Nurse manpower supply and needs are related to the demo-graphic and socioeconomic conditions and to the availability ofhealth facilities and health care in the area.

MINNESOTAMINNESOTA BOARD OF NURSING.

1967. Nursing in Minnesota, A Statistical Review,February 1967. Saint Paul: The Board.47 pp.

This data source book updates to 1966 the 1961 edition ofbackground statistics and information on Minnesota's nursingservices, nursing personnel, and educational resources. Datawere compiled from licensing processes, reports to the StateBoard of Nursing on educational programs, and health programreports. Some data depict trends since 1950. Data are tabulatedby county and are compared with the national average. Infor-mation on nursing scholarships is included.

FAHS, IVAN J., and BARCHAS, KATHRYN.

1969. Nursing in the Upper Midwest. Focuson the State of Minnesota. The UpperMidwest Nursing Study, Upper MidwesfResearch and Development Council. Min-neapolis, Minn. A study sponsored by theLouis W. and Maud Hill Family Founda-tion of St. Paul, Minn. 125 pp. (proc-essed).

This report is a data source book and analysis of nursingneeds and resources in Minnesota. It represents the studyphas e. of planning for nursing education and nursing service inMinnesota, initiated by the Citizens Committee for Nursing inMinnesota. Trends in nursing in the State, the supply of nursing personnel, nursing education programs, the utilization ofnursing personnel, and projected needs for nurses are described.Dentographic, economic, and health information bearing onnursing needs and resources are analyzed within the contextof the Upper Midwest as a region. The recommendationsgrowing out of the study and the plan for nursing are reportedin To Meet the Need, also published by the Upper MidwestResearch and Development Council, May 1970.

UPPER MIDWEST NURSING STUDY.

1970. To Meet The Need. Minneapolis, Minn.:The Study. 18 pp.

This brochure presents the recommendations of the Citizens'Committee for Nursing in Minnesota. The recommendations areintended to form the basis for the development of a plan fornursing service and nursing education in the State. Needs fornurses are projected to 1985, and actions needed in these fiveareas are emphasized: diploma education, baccalaureate educa-tion, graduate education, associate degree education, and areermobility.

MISSOURI

MISSOURI DIVISION OF HEALTH.

1968. Inactive Registered Nurses, A MissouriStudy. Jefferson City: The Division. 63

1313-

This is a report of a survey conducted in the State ofMissouri between November 1967 and March 1958 to determinethe size of the inactive nurse pool and to assess the potentialwithin this resource for reactivation in nursing employment.The survey included inactive nurses re-registered during theperiod 1966.67 and some graduates of approved schools forregistered nurses who were not registered at the time of thesurvey. The age, marital and family status, and educationalpreparation of these nurses are delineated. Their reasons forand period of inactivity are detailed, as well as their interestin returning to work and in refresher courses. Information onthe incentives or deterrents to re-employment in nursing is alsogiven.

MISSOURI NURSING FUTURAMA.

1969. Facts about Nursing and Health Care inMissouri. Ingeborg G. Mauksch, Ph.D.,Project Director, and Sally Anne Chier,M.S.H., Associate Project Director. Colum-bia, Mo. 75 pp.

Pertinent available data are compiled in this source bookto describe the nursing situation in Missouri, its socioeconomicbackground, and factors influencing the practice of nursing.Data from a 1969 questionnaire survey of schools of nursingpreparing registered nurses and practical nurses are also in-cluded. No evaluation or recommendations are .made. Thesource book is intended as a basic tool for initiating an assess-ment and for developing a plan of action for nursing inMissouri.

NEBRASKA

MARTIN, CORA ANN.

1967. Nebraska's Nurse Supply, Needs and Re.sources: 1966. Section of Hospitals andMedical Facilities, Nebraska Department ofHealth. Lincoln, Nebr. 57 pp. (proc-essed).

118 APPENDIX 1

This reappraisal of needs and updating of the 1951 statewidestudy include data on the numbers of registered nurses andlicensed practical nurses and aides, by fields of practice, for1966; the characteristics of educational programs and students;and the numerical needs for nursing personnel expressed byhospitals and other institutions. Recommended are accelerationof advanced training for leadership positions, re-design of theeducational system, increased financial aid for students, andimproved salaries znd working conditions for nurses.

NEVADA1964. Nursing in Nevada, 1964. A Reappraisal

of Needs and Resources. Toward State-wide Planning lor the Education of NursingPractitioners and Quality Nursing inNevada. Nevada Tuberculosis and HealthAssociati cm. Las Vegas, Nev. 77 pp.(processed).

This study by an interdisciplinary group assessed the charac-teristics of the registered nurse and licensed practical nursesupply in 1963, and the health and educational facilities andresources. The study also projected needs for nursing personnelby 1970. It set goals for the future and recommended actionsincluding activities in continuing education, recruitment,staffing studies and definition of role, and the establishment ofa second school of nursing for the Statean associate degreeprogram.

NEW JERSEYKENNEDY, JOHANNA; and SOOTKOOS, ALPHONSE.

1965. An Assessment of Nursing Resources andNeeds in New Jersey. Unpublished reportto the Committee To Survey Nursing Needs,Resources, and Supply in New Jersey, 1965.New Jersey State Nurses' Association,Montclair, N.J. 17 pp. (processed).

This study assessed the supply and need for nurses for NewJersey's private and public health agencies, as well as resourcesfor nursing education.

CHIMERA, NANCY T.

1966. A Plan for Nursing Education lor NewJersey, 1966-1975. Final Report submittedto Dr. Roscoe R. Kandle, Commissioner ofHealth, State of New Jersey, and Chairman.Governor's Task Force.on Nursing. Tren-ton, N.J. 65 pp. (processed).

The report suggests a plan for nursing education for NewJersey, based on A Position Paper by the American Nurses'Association. As recommended by the Governor's Task Forceon Nursing, the plan was to become part of the Master Planfor Higher Education in New Jersey. An estimate of the supplyand needs for registered nurses and licensed practical nurses

through 1975 is included, as well as a survey of educationalresources, their anticipated expansion, and the development ofnew programs. Available clinical facilities for student ex .

perience, the expected output of nursing schools, and the costto the State for educational programs required for meeting theState's nursing needs were delineated.

GOVERNOR'S TASK FORCE ON NURSING.

1968. Interim Report on Nursing Education of theGovernor's Task Force on Nursing. Feb.7, 1968. Trenton, N.J.: The Task Force.5 PP.

This report briefly outlines the purposes, activities, andaccomplishments of the Task Force since its inception inJanuary 1965. It summarizes recommendations for assuring anadequate supply of well-prepared nurses for the foreseeablefuture, in these areas: pre-service education, continuing educa-tion, recruitment, and comprehensive planning.

NEW MEXICODILLMAN, EVERETT G.

1964. New Mexico Nursing Needs and Resources:The Situation. &liege of Business Ad-ministration, Univ. of New Mexico, Albu-querque. 19 pp.

This report updates the 1952 Survey of Nursing Needs andResources in New Mexico. The characteristics of the 1964 sup-ply of registered nurses and licensed practical nurses, by fieldsof employment, and the number of aides employed in hospitalsand other institutions, are analyzed. Factors such as economicincentives, turnover, staffing ratios, and the extent of inserviceeducation programs are examined. Demands for nursing per-sonnel are estimated, and projected needs for 1970 are com-puted on three bases: (1) considered as absolute minimum;(2) reasonable minimum; and (3) lowest adequate levels. Theability of educational programs to meet these needs is assessed.No recommendations for needed action are included.

NEW YORKUNIVERSITY OF NEW YORK.

1965. A Survey of Registered Professional NursesEmployed in Hospitals in New York State.The State Education Department, Divisionof Professional Education, Albany, N.Y.25 pp.

A questionnaire survey was conducted in November 1963 toobtain information about full-time and part-time employment,vacancies, and the educa floral preparation of registered nursesin hospitals. Data were compiled by type of hospital andgeographic area of the State. Implications for meeting needsfor registered nurses were drawn from the survey findings.

HOSPITAL REVIEW AND PLANNING COUNCIL OF SOUTH-

ERN NEW YORK, INC.

11 9


1966. Study of Nurse Education Needs in theSouthern New York Region, 1964-1965.In cooperation with National League forNursing and Division of Nursing, U.S.Public Health Service. New York: TheCouncil. 93 pp.

Needs for increasing the nurse supplyparticularly in rela-tion to hospitals and institutionsand educational resourccs,their capabilities, and potential for expansion, are analyzed for14 counties in New York State. Recommendations for meetingeducation requirements are made.

NEW YORK UNIVERSITY. STATE EDUCATION DEPART-

MENT. DWISION OF PROFESSIONAL EDUCATION. BUREAU

OF RESEARCH IN HIGHER AND PROFESSIONAL EDUCA-TION.

1966. Personal and Employment Characteristics ofProfessional Nurses Registered in New YorkState. Albany: The Department. 61 pp.

This survey to determine the supply of active nurses in NewYork describes their personal and employment characteristicsand the personal characteristics of inactive nurses. It identifiesthe nursing positions for which baccalaureate and graduateeducation are recommended. The data were collected by aquestionnaire given those registered in New York State fromSept. 1, 1961, to Oct. 31, 1962.

NEW YORK STATE EDUCATION DEPARTMENT.

1966. Facts About Nurses and Nursing in NewYork State. Office of Nurse Education,Division of Professional Education, Albany.N.Y. 40 pp. (processed).

Statistics on the characteristics of registered nurses, bygeographic area of the State, compiled from licensing andinventory data for the biennium 1961-63, are included in thisreport. Also included are trend data on the supply of practicalnurses and nursing education programs and resources. Inaddition, there are data on budgeted position vacancies inhealth agencies.

NEW YORK STATE NURSES' ASSOCIATION.

1969. "New York State NursesA StatisticalSurvey." New York State Nurse, 41 (2) :

9-10 (March). Albany: The Association.

"Report and analysis of an inventory of registered nurses inNew York for 1968. Survey includes data on age, sex, maritalstatus, education and employment of 110,495 nurses in theState. These data are compared with figures from a 1964survey." (From Abstract of Hospital Management Studies,Vol. VI: 145. June 1970.)

REPORT OF THE JOINT COMMITTEE ON COMMUNITYPLANNING FOP NURSING EDUCATION, ROCHESTER AND

ELMIRA REGIONS, NEW YORK STATE.

C

.X.- iJ

1971. A Project To Determine The Direction andStudies Needed For Areawide Planning InNursing Education. New York: GeneseeValley N .irses' Association. 62 pp. (proc-essed).

This report on a project to prepare plans for nursing educa-tion in a specific region considered its ultimate objective tobe the improvement of health care. Two major forccs whichdenne the conditions for the realization of this objective weredeclared to be: the public's determination to create a universalsystem of health care, and the public's changing expectations ofeducation. The task central to this project was to analyze thesignificance of these two forces and to incorporate them intothe recommendations on the future development of nursingeducation for this region.

A summary of the Joint Committee's findings and recom-mendations are included. These recommendations, 16 in all,are categorized under the following headings: nursing resourcesfor expanded health care; increasing opportunity in nursing;future patterns of nursing education; cooperative planning fornursing education; maintaining pace with advances in healthscience; and increased financial support for nursing educationand research.

NORTH CAROLINABROWN, RAY E.

1964. Report of Survey of Nursing Education inNorth Carolina. Sponsored by NorthCarolina Board of Higher Education, NorthCarolina Medical Care Commission, andNorth Carolina State Board of Education.Raleigh, N.C. 42 pp.

The system for educating registered nurses iu the State wasanalyzed in this study, which included 5-year trend data onthe input and output of schools and the academic qualificationsof employed nurses. Numerical estimates of needs were notdelineated, but higher educationincluding the junior collegeswas charged with responsibility for meeting the needs for well-prepared nurses at all levels. A continuing joint committee forassuring systematic planning for nursing education on a state-wide basis was recommended.

NORTH CAROLINA BOARD OF HIGHER EDUCATION.

1967. Nursing Education in North Carolina, To-day and Tomorrow. Research Report2-67. Raleigh: The Board. 126 pp.

Part of the development of a long-range plan for all highereducation in North Carolina was a long-range planning studyon nursing education on a statewide basis. This study updatesthe 1964 survey of nursing education in the State, and analyzesthe student potential for each type of nursing program and theavailability of nursing programs to meet these needs. It projectsthe number, type, and location of new programs and facultyneeded to meet the future nursing needs of the State.

120 APPENDIX 1

NORTH DAKOTANORTH DAKOTA LEAGUE FOR NURSING.

1968. A Study of Inactive Health Personnel inNorth Dakota. Bismarck: The League.161 pp. (processed).

This report of the State's project to identify and recruitinactive nurses for employment covers the period July 1,1967 through October 31, 1968. The report contains survey dataon the number of licensed and unlicensed registered nursesand licensed practical nurses not employed in nursing, theircharacteristics, reasons for inactivity in nursing, and desire forrefresher courses and to return to work. Refresher courseactivities are reported, as well as a followup work status surveyof nurses completing courses. The survey questionnaires, re-fresher course curricula outlines, and student evaluation ofcourses are included.

FAIIS, IVAN J., and BARCHAS, KATHRYN.

1969. Nursing in the Upper Midwest. Focus onthe State of North Dakota. The UpperMidwest Nursing Study, Upper MidwestResearch and Development Council. Min-neapolis, Minn. A study sponsored by theLouis W. and Maud Hill Family Foundationof St. Paul, Minn. 65 pp. (processed).

This report is a data source book produced as part of astudy of nursing needs and resources in North Dakota. Thestudy was conducted to develop a State plan for nursing thatwould bring about meaningful action. Trends in nursing in theState, the supply of nursing personnel, nursing education pro-grams, the utilization of nursing personnel, and projectedneeds for nurses are described. Demographic, economic, andhealth information bearing on nursing needs and resources areanalyzed within the context of the Upper Midwest as a region.Recommendations growing out of the study are reported inThe NeecT To Know, published by the Upper Midwest Re-search and Development Council, June 1969.

UPPER MIDWEST NURSING STUDY.

1969. The Need To Know. Minneapolis: TheStudy. 17 pp.

This is a summary popular report of the North Dakota JointCommittee on Nursing Needs and Resources sponsored by theNorth Dakota Nurses' Association, the North Dakota Leaguefor Nursing, and the North Dakota Hospital Association. Thestudy was supported by the research of the Upper MidwestNursing Study. The report graphically presents the situation innursing education, manpower, and utilization in North Dakota.Future needs for nurses are estimated, and steps to be takento meet the need are projected.

OHIOOHIO STATE NURSES ASSOCIATION.

1964. Projected Needs for Nursing Education in

Ohio. A Report to the Ohio Board ofRegents. Columbus: The Association. 52

PP.

Guidelines for developing nursing programs as part of theState's master plan for higher education are presented in thisreport. An assessment of the characteristics of and factorsaffecting programs, facilities, and resources for initial andgraduate education for registered nurses and practical nurseeducation was supported by a compilation of trend data from1956 to 1963. Estimates of the number of nurses needed to beeducated by 1975 were related to the State's present supplyand the future needs of service agencies.

HERRON, IRENE.

1968. Exploratory Study of Nursing Educationand Nursing Service in Northwestern Ohio.Medical College of Ohio at Toledo. 37 pp.(processed).

This study is a statistical presentation on the number ofnursing personnel employed in hospitals, nursing homes, andpublic health agencies in northwest Ohio in 1968, as well asfaculty, student, and program resources and characteristics innursing education. It reports opinions solicited by interview onnursing needs and methods or routes for the preparation ofpersonnel for nursing practice. A "model plan" for an orderlytransition of nursing education from hospital diploma schoolsto collegiate institutions in the Northwest Ohio area duringthe period 1967 through 1976 is detailed.

OKLAHOMA

WADDLE, FRANCES I.

1965. Planning for Nursing EducationA Studyof Current Resources and Future Needs.Preliminary report; unpublished. Spon-sored by Oklahoma League for Nursing,Oklahoma State Nurses Association, andOklahoma Board of Nurse Registration andNursing Education. Oklahoma City, Okla.100 pp. (processed).

The number of active and inactive registered nurses andlicensed practical nurses in the State in 1964; characteristicsof the supply; needs for nursing service; levels of staffing;functions of personnel; and types of inservice education pro-grams in hospitals, nursing homes, and public health agenciesall these were studied in relation to educational resources.Needs for 1970 were estimated and feasible goals determined.

OKLAHOMA HEALTH INTELLIGENCE FACILITY.

1968. Analysis of Health Manpower Data Regard-ing Registered Nurses in Oklahoma, 1966.University of Oklahoma Medical Center andThe Oklahoma Science Foundation. Okla-homa City, Okla. 35 pp. (processed).


This report is a statistical analysis of registered nurses in1966, including their employment status, type of activity, educa-tional background, personal characteristics, special training,and geographic location in the State.

PENNSYLVANIA

HOSPITAL EDUCATIONAL AND RESEARCH FOUNDATION

OF PENNSYLVANIA.

1969. Pennsylvania Nursing Facts. Prepared byPennsylvania Nurses Association and Hos-pital Educational and Research Foundation.Camp Hill, Pa.: The Foundation. 119 pp.

This report is primarily a statistical description of the charac-teristics of registered nurses licensed in Pennsylvania, theireducation, and their utilization. Trend data are presented oneducational resources from 1958 through 1968, and on thenurse supply from 1949 through 1966. The characteristics of the1966 nurse supply is detailed as to age, activity, and maritalstatus; educational and position level; and field of employment,much of which includes a county data base. The report is

intended as a source document for health and educationplanners, for educators of health manpower, and for guidancecounselors.

PUERTO RICOCOMMONWEALTH OF PUERTO RICO. DEPARTMENT OrHEALTH.

1967. Study of Nursing Resources in Puerto Rico.Division of Nursing, Health Bureau. SanJuan: The Department. 60 pp. (proc-essed).

This study consists of a compilation and analysis of statisticaldata on the registered nurse supply in 1966, and the educa-tional resources for their preparation. Data were obtained bya questionnaire survey of a 50 percent sample of registerednurses and from two special studies on staffing ratios. Includedare the age, educational preparation, activity status, field ofemployment, position level, and geographic distribution of thesenurses. Needs for additional nurses are projected, and implica-tions and recommendations are drawn from the data.

DEPARTMENT OF HEALTH. NURSING DIVISION. OFFICE

OF SPECIALIZED SUPPORTING SERVICES FOR SUPERVISION

AND CONSULTATION. OFFICE OF THE SECRETARY OFHEALTH.

1969. Nursing Education in Puerto Rico. Reportof Study in Nursing Education. San Juan:The Department. 93 pp. (processed).

This is a report of a study of. nursing education in PuertoRico conducted to provide a base for program planning andbudgeting by the Department of Health. Recommendations forthe expansion, development, and support of nursing educationto meet the needs and demands for nursing personnel aresupported by data secured from all nursing education programs

by questionnaives and interview. The characteristics of pro-grams and students are detailed, and two levels of need forregistered nurses are projected to 1980.

RHODE ISLANDRHODE ISLAND COUNCIL OF COMMUNITY SERVICES, INC.

1964. Nursing Needs and Resources in RhodeIsland. A Survey by the Rhode IslandCouncil of Community Services, Inc. InCooperation with the Rhode Island Leaguefor Nursing. Providence: The League.84 pp.

State Board licensing data and survey questionnaires wereused in this study to secure data for analysis. Included werethe 1963 supply of registered nurses, licensed practical nurses,and nursing aides; additional needs for nursing personnel;employment conditions; and other factors affecting nursing; allby field of practice. Data were analyzed and needs were assessedby interdisciplinary health groups. To meet increased needsfor nursing personnel, the following were recommended: im-proved utilization, economic incentives, upgrading of personnelthrough training, intensified recruitment efforts, financial as-

sistance for nursing education, and statewide planning fornursing education.

SOUTH CAROLINAGOVERNOR'S SPECIAL COMMITTEE ON NURSING.

1963. Report of the Governor's Special Committeeon Nursing. Columbia, S.C.: The Com-mittee. 8 pp.

In February 1963, the Governor appointed an interdis-ciplinary conunittee of representatives from professionalassociations, health agencies, nursing schools, and highereducation, to formulate recommendations for developing a

State plan for action for nursing service and nursing education.An analysis of available data, previous studies, and the servicesof national level consultants were utilized to assess the nursingsituation. The plan recommended the following: Specifiedmeasures for cooperative action between colleges and universi-ties, health agencies, and schools, for improving nursing educa-tion and the competenck s of nursing faculty and personnel;expansion of baccalaureate programs; development of a grad-uate nursing program; and provision of nursing consultants inservice and education in the State Board of Nursing. C,..eationof a nine-member Committee on Nursing to lend support toimplementation of the statewide plan was strongly advised.

MEDICAL COLLEGE OF SOUTH CAROLINA.

1963. The Education of Nurses in South Cal olina.A Report. Committee on Nursing, Boardof Trustees, Medical College of South Caro-lina, Charleston, S.C. 18 pp. (proc-essed).

This is a report to the Governor of South Carolina on theconditions of nursing education in the State, the attitudes of

-14 C;$ !).(.11

122 APPENDIX 1

physicians toward the type and scope of training of nursingstudents, and the causes of and recommendations for the abate-ment of critical shortages of nurses. It is reactionary to thesocial forces affecting recruitment, nursing education, and thepractice of n'ursing, and South Carolina's situation. It containsmany contradictions, but illustrates attitudes and factors thatare encountered and must be coped with in planning fornursing.

YATES, WILLIAM L.

1963. Nursing in South Carolina, A StatisticalStudy of the Quantity of Nurses and theQuality of Their Training. South CarolinaHospital Association, .Columbia, S.C. 57

PP.

This study is a concise collection of data pertaining to thequantity, quality, and economics of nursing service and educa-tion in South Carolina, and their implications on hospitalservice in the future. Although the document identifies prob.lems, it was not intended to recommend solutions but ratherto be used as a resource document by organizations andindividuals working toward solving the State's various nursingproblems.

ALFORD, ELISABETH M.

1964. Nursing in South Carolina, 1964. A Sta-tistical Study of the Quantity of Nurses andthe Quality of Their Training. SouthCarolina Hospital Association, Columbia,S.C. 55 pp.

This study is an updating of the 1963 statistical source bookand data analysis on the quantity and quality of hospitalnursing services, the economics of nursing, nursing education,and factors affecting the demand for nurses in South Carolina.

SOUTH CAROLINA STATE NURSES ASSOCIATION.

1964. Nurses for South Carolina, A Report Pre-pared by the Committee on Current andLong-Term Goals for Board GI Directors.Columbia: The Association. 15 pp.(processed).

This is an interim report of the Committee, appointed in1964, which assessed the supply of nursing personnel in 1963,identified the nursing needs of South Carolina, and gave direc-tion to and proposed goals for the Association's role in meetingthese needs. The report prcjected needs for 1970; endorsedstatewide planning for nursing education; called for associatedegree nursing programs in tax-supported colleges; reaffirmedneed for additional baccalaureate programs for nursing; andidentified approaches to improved nursing services.

GOVERNOR'S COMMITTEE To LEND SUPPORT AND

LEADERSHIP TO NURSING IN SOUTH CAROLINA.

1965. Report ol The Governor's Committee ToLend Support and Leadership to Nursing

in South Carolina. Columbia: The Com-mittee. 32 pp.

This is the first report of the permanent Committee appointedby legislative action in 1964, as recommended by the Governor's

'Special Committee on Nursing, to support implementation ofprograms for meeting nursing needs. The Committee designeda blueprint for nursing education for South Carolina. Thedevelopment of associate and baccalaureate degree programsand a master's level program is designated by area of State andcollege or university and clinical facilities to be utilized. Pro-gram arrangements, curricula, and costs are detailed. The reportrecommends State financial support for diploma programs. Itassesses the conditions and social forces affecting systems ofnursing education related to South Carolina.

SOUTH CAROLINA NURSES' ASSOCIATION.

1967. Nurses for South Carolina. A Study ofNursing Needs and Resources. A ReportPrepare.d by Committee on Current andLong-Term Coals for Board of Directors.Columbia: The Association. 23 pp.

This is a report of the Committee's continuing work begunin 1964 and first reported in November of that year. The studyupdated information, assessed progress, refined ideas, andidentified priority areas and action programs for meeting SouthCarolina's nursing needs. An in-depth study of nursing needsand resources and community planning for nursing educationwere recommended, as well as mandatory licensure for nursing,a statewide intensified recruitment program, refresher coursesfor inactive nurses, improved economic incentives, better utiliza-tion of nursing personnel, and a graduate program in nursing.

SOUTH DAKOTASOUTH DAKOTA STATE UNIVERSITY.

1967. Survey of Inactive Nurses. Department ofContinuing Education, College of Nursing.Brookings: The University. 3 pp. (proc-essed).

As a basis for the statewide programing of refresher courses,inactive registered nurses were surveyed by questionnaire todetermine their interest in returning to work and their needfor refresher training. A followup report on the number ofnurses employed following completion of refresher courses isincluded.


WELFARE. PUBLIC HEALTH SERVICE. NATIONAL INSTI-

TUTES OF HEALTH. BUREAU OF HEALTH PROFESSIONS

EDUCATION AND MANPOWER TRAINING. DIVISION OFNURSING.

1969. Source Book for Community Planning lorNursing in South Dakota. Washington:U.S. Government Printing Office. 232 pp.

This source boOk was produced as a compilation of existing


statistical data relevant to long.range planning for nursing in aState. It, however, is also a report on the data survey andanalysis phase of planning for nursing needs and resources inSouth Dakota. It presents statistics and information on thenurse supply and nursing education resources as they relate todemographic, economic, social, and health factors and condi-tions in South Dakota and neighboring States. Implicationsfor planning are drawn from the analysis.

SOUTH DAKOTA PLANNING COUNCIL FOR NURSINGRESOURCES.

1970. Pulse of the Contmunity. South DakotaBoard of Nursing, South Dakota Nurses'Association, and South Dakota League forNursing. Sioux Falls, S.D.: The Council.15 pp.

Recommendations for the recruitment, education, retention,and utilization of nurse manpower directed toward improvingthe delivery of health care are contained in this report of theSouth Dakota Planning Council for Nursing. Representativesof nursing, allied health groups, business, education, farmingand State government who studied nursing needs, resources,and utilization in the State propose these recommendations forimplementation by concerned groups.

TENNESSEE

TENNESSEE MIDSOUTH REGIONAL MEDICAL PROGRAM.

[1968]. Study of Nursing Education in Tennessee.Tennessee Mid-South Regional MedicalProgram. Nashville, Tenn. 38 pp.

This is a report of a study which focused on nursing educa-tion in Tennessee and includes an analysis of registered nursedata. A numerical shortage of nurses and an insufficient supplyof qualified faculty are of prime concern. Recommendationsinclude: (1) a need for public awareness of both nursing needsand nursing opportunities; and (2) a statewide plan for nurs-ing education with support by an informed public. The Ten-nessee Nurses' Association has recommended that the TennesseeHigher Education Commission be recognized as the agencyresponsible for statewide planning for nursing detlucation inthe State.

TENNESSEE HIGHER EDUCATIONCOMMISSION.

1969. Survey of Nursing Education in Tennessee.Nashville: The Commission. 34 pp.(processed).

A time.phased, geographically based plan for the expansionand development of nursing education in institutions of highereducation in Tennessee is presented in this report. Recom-mendations :aid goals are based on a data survey, on analysisand assessment of the 1968 nurse supply and nursing educationresources, and on criteria established by a board of consultants.Definitive measures are proposed for improving both thequantity and quality of nursing in Tennessee, to meet projectedneeds through 1980.

TEXAS

JARRATT, VIRGINIA.

1966. Report on Nursing Resources in Texas in1966. Prepared for Committee on NursingNeeds and Resources. Sponsored by Boardof Nurse Examiners for the State of Texas,Texas Nurses Association, and Texas Leaguefor Nursing. San Antonio: The Associa-tion. 76 pp. (processed).

This statistical presentation represents the first step in thecompilation of available data that can be used in State plan-ning. Briefly analyzed are trend data on the supply of registerednurses and vocational nurses, the number and characteristicsof registered nurses included in the 1966 Inventory, as wellas educational resources. Data on some of the socioeconomicfactors related to nursing are included. Gaps in data requiredfor an in.depth study of nursing needs and resources arepuinted up.

INTERIM SENATE COMMITTEE STUDYING NURSING

PROFESSION NEEDS IN TEXAS.

1967. Report of the Interim Senate CommitteeStudying Nursing Profession Needs inTexas. Presented to the 60th TexasLegislature, 1967. Austin: The Committee.153 pp. (processed).

Data and information collected and compiled to support andsubstantiate the State's needs in relation to the education,practice, and utilization of nurses, as presented in public hear.ing, are the substance of this report.

UTAHCOMMISSION To STUDY THE, NURSING NEEDS ANDRESOURCES IN UTAH.

1970. Utah Nursing, Present and Future. Find-ings, Conclusions and Recommendations.Prepared by Dorothy C. Lowman, Chair-man of Commission, and Cora Ilene McKean,Executive Director, Utah State Nurses'Association, Salt Lake City, Utah. 128 pp.(processed).

This study report "present facts about nursing service andnursing education in the State and offers the best titatements ofcurrent and projected nursing needs that commission membershave been able to formulate. It identifies issuen and makesrecommendations, but stops short of proposing r. specific pro-gram for action because to be effective such an action programmust be based on broad community participation of consumersas well as producers of nursing and health care." For the mostpart, nursing data are presented through 1968 and needs areprojected to 1975.

124 APPENDIX 1

VERMONTVERMONT STATE NURSES' ASSOCIATION, INC.

1967. Nursing Needs and Resources in Vermont,1966-1975. A Report to the People ofVermont. Burlington: The Association.196 pp.

Positive steps to increase the number and improve the qualityof nurses educated in Vermont are recommended in this 2-yearstudy, intended as a basis for statewide planning for nursing.Study data highlighted the need for utilization studies andimproving career and employment incentives and recruitmenttechniques for licensed nursing personnel. Projection of needsfor 1075 are included.

VIRGINIAGOVERNOR'S COMMITTEE ON NURSING.

1967. A Report of Progress to His Excellency,Mills E. Godwin, Jr., Governor of the Com-monwealth of Virginia. Richmond: TheCommittee. 21 pp.

This is an interim report of Virginia's Governor's Committeeon Nursing, appointed in late 1966 to develop a coordinatedState plan for nursing service and nursing education. Thereport is the work plan and prospectus for the 3.year study toidentify and find means for meeting the State's quantitative andqualitative nursing needs. Nursing issues in the State, areas forstudy, and the proposed study methodology are fully outlined.

GOVERNOR'S COMMITTEE ON NURSING.

1968. Future Patterns of Health Care with Em-phasis on Utilization of Nursing Personnel.The Report of a Conference held March24-26, 1968, at Williamsburg, Virginia.Richmond: The Committee. 69 pp.

This conference, with wide representation from the healthprofessions, civic groups, education, business, and official gov-ernment, was convened to assist the governor's committee onnursing in its assessment of Virginia's nursing needs and tosuggest means for meeting them. This report is an accountof their consideration of specific questions related to nursingservices, nursing education, working conditions for nurses,recruitment, legal controls, financing, and cooperation andcoordination in planning. The conference emphasized the com-plexity of the issues, and gave the participants a broaderperspective and greater understanding of the contributionswhich they, individually and collectively, could make in theimprovement and delivery of health care.

THE SCHOOL OF HOSPITAL ADMINISTRATION.

1968. Nursing and Health Care in Virginia.Medical College of Virginia, Health ScienceDivision of the Virginia CommonwealthUniversity, Richmond, Va. 151 pp.

This report was prepared for the Governor's Committee onNursing. Available statistical data and a special survey ques-tionnaire of working conditions of nursing personnel in hos.pitals were used for an analysis of the characteristics ,ofVirginia's supply of registered nurses and licensed practicalnurses, of auxiliary nursing personnel in hospitals, and ofnursing education resources. Trends in the education and useof allied health professionals and other health personnel areincluded, and future needs are estimated. The report makes norecommendations, but is intended as background informationfor an in-depth assessment of nursing needs and resources forthe development of a State nursing plan.

GOVERNOR'S COMMITTEE ON NURSING. COMMON-

WEALTH OF VIRGINIA.

1969. Nursing In Virginia. Final Report. Rich-mond: The Committee. 89 pp.

This is a report of a 2%-year study to assess the State'ssupply of nurses and nursing education resources; to projectquantitative and qualitative needs for a 10.year period; and tomake recommendations for meeting nursing needs and fordeveloping educational programs. It discusses the major find.ings, and the premises and reasoning leading to the recommen-dations. Recommendations for action concern the following:measures to stimulate an increase in the nurse supply andimprove the work environment; recruitment, selection, educa-tion, and retention of nursing personnel; and means forimplementing these recommendations. Financial costs for thestrengthening of nursing education and for further improve.ments in nursing services are estimated.

WEST .VIRGINIAMCKENNA, FRANCES N.

1968. Nursing in West Virginia 1968: The Mc-Kenna Report. A Study Sponsored by theWest Virginia State Board of Examiners forRegistered Nurses, Charleston, W. Va. 86pp. (processed).

The distribution, characteristics, supply, and need for regis-tered nurses and licensed practical nurses in 1966 in WestVirginia are analyzed in this study report. Also presented arethe numbers, kinds, characteristics, and distribution of nursingeducation programs in the 1960's, as well as admissions, enroll-ments, and graduations from these programs. Problems in thenurse supply and their influencing factors are discussed, andremedial actions are proposed, particularly in regard to thefollowing: recruitment of students and staff; migration ofnurses from the State; and basic, continuing, and graduateeducation for nurses.

FLITTER, HESSEL HOWARD.

1970. Nursing in the Mountain State of West Vir-ginia: An Assessment and a Plan of Action.Southern West Virginia Regional HealthCouncil, Inc. Copies available from: West


Virginia Nurses' Association, 47 CapitalCity Building, Charleston, West Virginia25301. 104 pp. (processed).

The Committee To Study Nursing Needs in West Virginia isresponsible for this report. The Executive Committees of thetwo nursing organizationsthe West Virginia League forNursing and the West Virginia Nurses' Associationjointlyassumed responsibility in forming this new committee andcarrying out its study activities. Two of its major concernswere the total nursing needs within the State and the compre-hensive planning needed to meet these nursing needs. Com-parable data from each of the nine planning regions of theState were collected by committee members. Information per-taining to nurse mobility and nursing education in WestVirginia, compiled by others, was obtained. Conclusions andrecommendations based on findings are reported. Recommenda-tions concerning nurse manpower, health care, health facilities,and health services are detailed.

WISCONSINCOOPER, SIGNE, S.

1962. Wisconsin Registered Nurses. Madison:University of Wisconsin Extension Division.94 pp.

A 10 percent sample of registered nurses licensed in Wis-consin in 1960 was used for this descriptive study conductedfor program planning for the Extension Division's Departmentof Nursing. It analyzed the distribution of the nurse supply,the nurses' age, marital status, work experience, educationalpreparation, and needs for further education. Implications forcontinuing education in the &Id of nursing are drawn.

THE WISCONSIN STATE EMPLOYMENT SERVICE.

1966. A Study of Inactive Nurses in Dane County,Wiscomin. A Division of the Departmentof Industry, Labor, and Human Relations.In cooperation with the Madison League forNursing. Madison: The League. 34 pp.(processed).

Lists of inactive nurses in the county were obtained from aprevious survey, from alumnae associations of schools of nurs-ing, and from phone calls received following extensive publicity.A survey questionnaire solicited information on the charac-teristics of inactive registered nurses, factors related to theirinactive status, interest in returning to work, and need forrefresher programs. Implications for the utilization of theinactive nurse potential are drawn from the data.

WISCONSIN STATE EMPLOYMENT SERVICE.

1968. Re-Employment Factors of Inactive Nursesin Wisconsin. A Division of the Depart-ment of Industry, Labor, and Human Re-lations. In cooperation with WisconsinNurses Association, Inc. Milwaukee: TheAssociation. 44 pp. (processed).

This survey identified and located the inactive nurses whohad maintained and those who had not maintained an activeregistration, by county, in Wisconsin and in contiguous countiesof neighboring States. It estimated the demand for refresherprograms to 1970. The characteristics of inactive nurses andtheir interest in returning to work were related to trainingrequirements, such as curricula, time, and location for programs.

COMMISSION ON STATEWIDE PLANNING FOR NURSING

EDUCATION.

1970. Nurses for Wisconsin's Future. A Reportto the People of Wisconsin by the Com-mission on Statewide Planning for NursingEducation. Madison: The Commission.22 pp.

This abbreviated report for wide public distribution recom-mends a plan for the development of nursing education inWisconsin to assure an adequate supply of nurses. The Com-mission examined trends in the supply of registered nursesand licensed practical nurses and in nursing education programsfrom 1956 to 1968, assessed their adequacy, and projectedneeds for nurses and nursing programs to 1978. The planrecommends specific measures for the development and distribu-tion of educational programs and their financing, for the in-service and continuing education of nurses, for recruitment,and for continuous planning for nursing education.

COMMISSION ON STATEWIDE PLANNING FOR NURSING

EDUCATION.

1970. Resource Document: Nurses for Wisconsin'sFuture. Commission on Statewide Plan-ning for Nursing Education, 110 East MainSt., Madison, Wis. 63 pp.

This reportthe third and final one by this Commissionis a comprehensive summary of the Commission's work, includ-ing recommendations relating to nursing education. Recommen-dations were developed following a review and study of currenttrends, health needs, changes occurring in the health caresystem, availability of nursing manpower, types oi practitionersneeded, and resources. Relative data are included in the

appendix.

Blueprints for Nursing Education

The term "blueprint for nursing education," as used a design for the transition of nursing education 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. Mostwere developed after the American Nurses' Association(ANA) issued its statement, Education Preparation forNurse Practitioners and Assistants to NursesA Posi-tion Paper. Some blueprints have been prepared aspart of a broad action plan for nursing needs andresources. Others were designed by committees orgroups concerned primarily with planning for nursingeducation and the implementation of ANA's position.All suggest procedures for planning and initiatingaction. They are intended to give direction for im-proving nursing education systems and the services ofnursing practitioners. For reference in this publication,bjueprints are classified as to their content and not asto the processes through which they were developed,as explained below.

Group 1:

Group 2:

Blueprints that state a position and pre-scribe guidelines on procedures, actionsrequired, policies, and a timetable.Blueprints that, In addition to stating aposition and general guidelines, considereach school or program in conjunctionwith existing or contemplated institutionsof higher education, clinical facilities, andthe needs for programs in geographicareas of the State.

Group 1. Prescribing General GuidelinesARIZONA STATE NURSES ASSOCIATION.

1967. "Blueprint for Nursing in Arizona." Ari-zona Nurse, 20: 20-23, May-June. Phoenix:The Association.

CONNECTICUT NURSES' ASSOCIATION. NURSING EDUCA-

TION TRANSITION STUDY COMMITTEE.

1967. "A Plan for the Educational Preparationfor Nursing in the State .of Connecticut."Nursing News, Vol. XLI, Nos. 10-12.(November). Hartford: The Association.

MAINE STATE NURSES' ASSOCIATION. NURSING EDUCA-

TION NEEDS AND RESOURCES COMMITTEE.

1966. "Future Development of Nursing Educa-tion in Maine. Preliminary Report."Augusta: The Association. 8 pp. (proc-essed).

MARYLAND NURSES ASSOCIATION. AD HOC COMMITTEE

ON NURSING EDUCATION NEEDS IN MARYLAND.

1969. "Report of the Ad Hoc Committee on Nurs-ing Education Needs in Maryland."

Maryland Nursing News, XXXVII (2) :26(Summer). Baltimore: The Association.

NEW JERSEY NURSES ASSOCIATION. COMMITTEE ON

NURSING EDUCATION, 1967-1968.

1968. Nursing Education in Transition. A Planfor Action in New Jersey. Montclair: TheAssociation. 16 pp.

NEW YORK STATE NURSES ASSOCIATION. COMMITTEE

ON EDUCATION, 1965-1967.

1966. A Blueprint for the Education of Nurses inNew York State. Albany: The Association.12 pp.

NORTH DAKOTA HOSPITAL ASSOCIATION, NORTH

DAKOTA NURSES' ASSOCIATION, and NORTH DAKOTA

LEAGUE FOR NURSING. THE NORTH DAKOTA JOINTCOMMITTEE ON NURSING NEEDS AND RESOURCES.

1969. "To Meet The Need." The Need ToKnow, pp. 11-13. Minneapolis, Minn.:Upper Midwest Nursing Study.

PENNSYLVANIA LEAGUE FOR NURSING AND PENNSYLVANIA

NURSES ASSOCIATION. COMMITTEE FOR PLANNING FOR

EDUCATIONAL TRANSITION.

1967. Guidelines for Regional Planning for Nurs-ing Education Transition in Pennsylvania.Harrisburg: The Association. 10 pp.

GOVERINOR'S COMMITTEE TO LEND SUPPORT ANDLEADERSHIP TO NURSING IN SOUTH CAROLINA.

1965. Report of The Governor's Committee ToLend Support and Leadership to Nursingin South Carolina. Columbia, S.C. 32

pp.

Group 2. Prescribing Time-PhasedGeographic Plans

COLORADO NURSES ASSOCIATION.

1968. "Planning for Nursing in Colorado."Colorado Nurse, 68 (3) :36-40 (April).Denver: The Association.


1968. "Illinois Blueprint For Nursing Education1980." Nursing in Illinois: An Assessment1968 and a Plan 1980, pp. 5064. Chicago:The Commission.

MICHIGAN NURSES ASSOCIATION.

1966. "Action Plan for Future of Nursing Educa-tion in Michigan." The Michigan Nurse,30: 3-7. Jan.-Feb. Lansing: The Associa-tion.

Appendix 2

Background Material and Tools for Planning

Appendix 2 lists references concerning background material relevant to nlanningfor nursing. They were selected and annotated to facilitate the work of participantsand staff throughout the planning process. These articles, books, and other publicationscan contribute to understanding of the evolution of nursing and the many factorsaffecting nursing practice and riursing education. In addition, some of the referencesdescribe useful tools important for planners.

To expedite selection of information on various planning situations, the.refer-ences have been grouped under 12 subjects, as noted in the table of contents on thefollowing page. All references are arranged chronologically under each subject, exceptthe lastIndexes, Journals, Periodicals, and Publications Lists. In that group, sincechronological order could not be used, the references are arranged alphabeticallyaccording to the title of the publication.

127

ContentsPage

Guides to Planning 129

Manuals and Guides for Special Studies 131Institutional Nursing Services 131Cost 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

47/

128

Guides to Planning

ARNSTEIN, MARGARET G.

1953. Guide for National Studies of Nursing Re-sources. Bulletin of the World HealthOrganization, Supplement 7. Geneva,Switzerland. 36 pp. (Available fromColumbia University Press, InternationalDocuments Service, 2960 Broadway, NewYork, N.Y. 10027.)

This guide, in concise outline form, was designed to helpnations undertake or continue studies of their supply and needfor nurses, point to their urgent nursing problems, and revealaction that can be taken and areas that require further study.The functional organization, methodology, areas of study andprocedures suggested in this guide are basic, still pertinent, andapplicable in identifying nursing needs, resources, and problems.However, depending upon the status of development of servicesand technology in .ertain nations where needs and resourcesmight be studied, it may be that statistical methods andtechniques newer than those suggested herein would be needed:



1956. Design for Statewide Nursing Surveys: ABasis for Action. A manual prepared bythe Division of Nursing Resources underthe direction of Margaret Arnstein. PHSPub. 460. Washington: U.S. GovernmentPrinting Office. 88 pp. (Out of print.May be available on library loan.)

This guide presents study methodologies and procedures forgroup or community action projects to accomplish the follow-ing: Identify the quantity and characteristics of a State'snurse supply and its educational resources; determine theadequacy of supply and resources; appraise the factors affectingneeds and demands for nursing personnel; assess the effective-ness with which nursing resources are utilized; and estimateadditional requirements. It suggests means for developingrecommendations and plans of action to meet needs and de-mands or to improve service and educational programs, endmeans for carrying out more detailed studies in special areasof concern.

For States which have already made a survey, this guidesuggests areas for further investigation and ways to updatedata for reappraisal of needs and resources and for assessingprogress. Appendixes include suggested guides or ratios forestimating nursing needs by fields of nursing, also sampleletters, forms, and tables for collecting data.

LYMAN, KATHARINE.

1961, Basic Nursing Education Programs, 4

Guide to Their Planning. World HealthOrganization, Public Health Papers, No. 7,Geneva, Switzerland. 80 pp. (Availablefrom Columbia University Press, Interna-tional Document Service, 2960 Broadway,New York, N.Y. 10027.)

Even though basic nursing education ranges from newlydeveloped programs in some countries to well-established pro-grams in others, nursing leaders and others who may influencenursing education in any country in the world can find helpfulinformation in this hook. Divided into two parts, this bookgives direction for general action, not a pattern to be exactlyfollowed. The first part outlines the kinds of general andspecific information on which planning for nursing educationshould he basedthat is, information about a community andindividual school. The second part discusses the general processof planning and suggests steps for planning and developing anursing education program. (Excerpted from a review byLoretta E. Heidgerken, Professor of Nursing, Catholic Uni-versity of America, in the American Journal of Nursing,62 (4) :129. April 1962.)

LEONE, LUCILE PETRY.

1966. Statewide Planning for Nursing Education.Southern Regional Education Board, At-lanta, Ga. 42 pp.

This guide delineates steps for planning nursing education onthe State and community level. The first chapter is devotedto a discussion of five imperatives for planning and action onthe State level. The need, advantages, organization, and charac-teristics of a planning body, as well as present systems andtrends in nursing education, are discussed. The second chapterencompasses the processes of planning and action for nursingeducation. Setting the goals, designing the program, evaluatingthe program, and establishing a continuing plan of actionallare clearly delineated. A framework for sound planning, think-ing, and decision-making is presented, and questions are raisedwhich must be answered by planners in terms of the needs oftheir specific States. The book should be useful to any corn-munity, State, or regional group attempting to form a com-mittee for statewide planning for nursing education. (Excerptedfrom a review by Elda S. Popiel, Associate Professor andDirector, Continuation Education Services, University of Colo-rado, School of Nursing, Denver, Colo., in Nursing Outlook,16(1) :15. Jan. 1968.)

THE AMERICAN PUBLIC HEALTH ASSOCIATION, INC.1967. A Self-Study Guide for Community Health

Action-Planning. Vol. I. A Report ofthe Community Action Studies Project.

130 APPENDIX 2

National Commission on Community HealthServices, Inc. New York: The Association.116 pp.

This guide is an instrument for use by laymen and profes-sionals in efforts to define community health problems, evaluatehealth activities, Project needs, and help define priorities. Itincludes a brief discussion of ways and means of organizinga self-study, and a series of 52 "index questions" designed todctect weaknesses in a community's existing health structureand services in the areas of organization, ttdministration(medical care and facilities), personal health services, andenvironmental health services. Aspects of personnel and financialresources are also included.

THE AMERICAN PUBLIC HEALTH ASSOCIATION, INC.

1967. A Self-Study Guide For Community HealthAction-Planning. Vol. II. QuestionnairesTo Aid in Problem-Solving. A Report ofthe Community Action Studies Project.National Commission on Community HealthServices. New York: The Association.247 pp.

This guide contains a schedule of questionnaires to helpstudy groups provide for an in-depth examination of priorityareas of concern in community health planning. Questionnairesare addressed to the following study areas: A communitysocioeconomic profile; local health departments; health infor-mation and referral services; public health education; labora-tory services; home health care; extended care facilities;hospitals and related services; health manpower resources;educational system; school health; occupational health; dentalhealth; chronic and handicapping conditions; maternal andinfant care; environmental sanitation; mental retardation;mental health; drug addiction; alcoholism; communicabledisease control; and civic and professional organizations andvoluntary health agencies. Suggestions useful in developingaction programs to implement study recommendations are in .cluded in the guide.

NATIONAL HEALTH COUNCIL and the AMERICAN

ASSOCIATION OF JUNIOR COLLEGES.

1967. A Guide for Health Technology ProgramPlanning. New York: The Council. 51

This guide has as its focus the building of strong programsfor technical-level health practitioners within 2-year collegiateinstitutions, through the collaboration of junior colleges withhealth practitioner associations and community health facilities.Interdependent and continuous processes in cooperative programplanning are outlined in steps for analytical purposes. Itsuggests a committee structure for planning, outlines criteriato be used in exploring the feasibility of program priorities,and suggests a checklist of the role performance of the variousparticipants in planning.


1967. Guidelines foi; Assessing the Nursing Educa-tion Needs of a Community. Pub. 11-1245.New York: The League. 11 pp.

This guide briefly presents in broad outline form the essentialelements of a study for developing a long-range plan for nurs-ing education suited to the needs of a local community, State,or region. Suggestions for initiating and organizing the studyare included. Selected socioeconomic characteristics of thepopulation and geographic study area, features of the nursemanpower supply, and health and educational resources areoutlined as principal areas for data collection, study, andasseument. This study profile is focused on the basic need toimprove nursing care for everyone by helping to bring aboutsound changes in the educational system that will produce thenumber of nurses with the quality of preparation needed inthe future.


WELFARE. PUBLIC HEALTH SERVICE. BUREAU OFHEALTH MANPOWER. DIVISION OF NURSING.


This source book is a compilation of existing statistical datapresented in a socioeconomic framework relevant to long-range planning for nursing in a metropolitan area. The sourcebook is designed as a tool that can be used by planning groupsin other metropolitan areas for identifying sources and selectingdata pertinent to their problems, issues, and situations. Inaddition, it contdns a data analysis to demonstrate the usesof data as follows: (1) in initiating the development of along-range plan for nursing; (2) in shedding light on addi-tional data required from special studies to develop the plan;and (3) in selecting or producing data conclusive enough intheir implication to point the way to immediate action requiredto meet nursing needs. Data analysis and interpretation areenhanced by information gained by conferences with key peopleconcerned with the delivery of health and nursing services andthe educational resources for producing health manpower inthe metropolitan area.




EDUCATION AND MANPOWER TRAINING. DIVISION OF

NURSING.

1969. Source Book for Community Planning forNursing in South Dakota. Washington:U.S. Government Printing Office. 232 pp.

This source book is a compilation of existing statistical datapresented in It socioeconomic framework relevant to hnikrangeplanning for nursing in a State. The source book ih a com-

BACKGROUND MATERIAL AND PLANNING TOOLS

panion publication to Community Planning lor Nursing in theDistrict of Columbia Metropolitan Area. (PHS Pub. 1676).Both source books were designed as tools for planning groups.The study methodology employed and source book content,format, and purpose are essentially the same in both publica-tions. See the annotation above.

PAULSEN, ROBERT F., and TATE, BARBARA L.

1969. Community Planning for Nursing. No-

131

tional League for Nursing Pub. 19-1355.New York : The League. 49 pp.

The dimensions of planning for nursing are described in thismonograph. Defined objectives, sufficient financial background,and the involvement of thoughtful persons are emphasized asrequirements for accomplishing goals. Steps and procedures forcommunity planning for nursing are suggested. Included is adigest of information on groups planning for community healthservices and particularly for nursing services, submitted by44 States, Puerto Rico, and 37 cities.

Manuals and Guides for Special StudiesInstitutional Nursing Services

LEVINE, EUGENE; and WRIGHT, STUART.

1957. "New Ways To Measure Personnel Turnoverin Hospitals." Hospitals, 1.4.11.4.,31:38-42 (Aug. 1).

Three methods for conducting studies on turnover amonghospital employees are described in this article. The advantagesand limitations of each method are discussed, and the im-portance of turnover studies to hospital administration isstressed.


WELFARE. PUBLIC HEALTH SERVICE. DIVISION OFNURSING.

1957. How To Study Nursing Service of an Out-patient Department. PHS Pub. 497.Washington: U.S. Government Printing

Office. 75 pp.

This manual describes methods for 10 types of studies, touse separately or as part of an overall study, to help hospitalsevaluate nursing activities in an outpatient department.

WRIGHT, STUART.

1957. "Turnover and Job Satisfaction." Hos-pitals, 31:47-52 (Oct. 1).

A study of the relationship between turnover and job satis-faction in three general hospitals is described.

VETERANS ADMINISTRATION. DEPARTMENT OF MEDICINE

AND SURGERY.

1961. A Guide for Studying the Utilization ofNursing Service Personnel in VeteransAdministration Hospitals. Program Guide,Nursing Service, G-7, M-2, Part 5. Wash-ington: U.S. Government Printing Office.101 pp.

This manual presents a modified work-diary method forstudying and identifying activities of hospital nursing personne:from nursing assistant through head nurse. It shows in detail

how a nursing staff can plan and conduct its own study. Stepsin designing the study and methods and tools for collecting,classifying, tabulating, and analyzing data are discussed indetail. The study will yield essentially quantitative information,but will also reveal needed changes in allocation of activitiesand suggest areas for further study of a qualitative nature.The manual includes a method for judging the appropriatenessof nursing activities, as well as suggestions for using the find-ings to initiate change. A followup study method is also

described.

It should be noted that intensive preliminary planning andpreparation of the study participants are required for conduct-ing a reliable and valid study. It has been further suggestedthat the time sample of a 2.day survey may not be adequateand may need to be extended.

(Excerpted from a review by Hannah Walseth, AssistantProfessor, Univer3ity of Minnesota School of Nursing, Min-neapolis, in the American Journal of Nursing, 62 (6), June1962.)

YOUNG, JOHN P.

1962. A Method for Allocation of Nursing Per-sonnel To Meet Inpatient Care Needs.Operations Research Division, The JohnsHopkins Hospital, Baltimore, Md. 32 pp.

A method for the allocation of nursing personnel based onpatient care needs rather than on patient census is described.The method is carried out as an ongoing, day.to.day, administra-tive procedure and includes the following: Classification of

patients into three categories, computation of a direct careindex, and consideration of the disparity between nursingload indications and scheduled hours.

ABDELLAH, FAYE G., and LEVINE, EUGENE.

1964. Patients and Personnel Speak. U.S. De-partment of Health, Education, and Welfare.Public Health Service. Division of Nursing.PHS Pub. 527. Washington : U.S. Gov-ernment Printing Office. 44 pp.

132 APPENDIX 2

This manual offers a study method for use by hospitals toreveal whether nursing service is adequate, and what specificnursing activities performed for patients need more nursingtime or attention, from the point of view of the patient andhospital personnel. Checklists are used to record omissions innursing care seen or experienced in 1 day's time in a hospital.The study can serve to provide criteria for improving patientcare. The manual includes sample questionnaires, methodologyfor scoring the checklists, and a bibliography.

ESTES, M. DIANE.

1964. "Introducing the Nursing Audit." Ameri-can Journal of Nursing, 64 (4) : 91-92(Sept. 1964).

This article is a straightforward description of the rationalefor a nursing audit, the way to procure it, and its benefits topatients and staff.



1964. How To Study Nursing Activities in aPatient Unit. PHS Pub. 370. Revised.Washington: U.S. Government PrintingOffice. 142 pp.

This manual offers an intermittent sampling method whichhospitals can use to plan better staffing by studying the distri-butions of time spent by all nursing service personnel assignedto inpatient units. The method has been found to be most usefulin general hospitals, and will provide reliable information onthe following: (1) kinds of activities performed by each cate-gory of personnel; (2) distribution of types of activities byperiod of the workday in which they occur; (3) activities thatconsume the most time. The revised manual incorporatessimplified coding and statistical procedures and contains sampleworktables which the hospital can remove from the book andduplicate.



1964. How To Study Patient Progress. PHSPub. 1169. Washington: U.S. Govern-ment Printing Office. 121 pp.

"Procedures for reporting changes in the health status ofpatients, presented in this manual, were developed from aninvestigation of practices used by public health nurses inrecording services rendered. Tested in 1960 by four publichealth agencies, the method was found to be helpful in assessingnursing programs. Appendix contains glossary of terms, and asummary of the classification of needs assessed and codes forcare status and expected outcome. Report forms are alsoshown." (From an abstract in Abstracts of Hospital Manage-ment Studies, Vol. 3, June 1957.)

BROOKE ARMY MEDICAL CENTER. MEDICAL FIELD

SERVICE SCHOOL. DEPARTMENT OF NONRESIDENT

INSTRUCTION.

1966. Nursing Service in Army Hospitals. FortSam Houston, Texas. 101 pp.

Discussed in this publication are staffing guidelines, factorsdetermining nursing care requirements, and criteria for classify-ing pativnts, based on nursing care needs, Patients are groupedinto four categories: Intensive nursing care; moderate nursingcare; minimal nursing care; and patients who can be treatedon a clinic appointment basis. Guidelines as to total hours ofcare required by patients in a 24-hour period and the proportionof that time to be delegated to registered nurses and othernursing personnel are stated. Examples of the nursing needs ofpatients in the four categories are cited.

GORDON, P. C., et al.1966. "An Approach to Patient Care Classi-

fication." Canadian Medical AssociationJournal, 95: 1228-1236 (December 10).

This classification system uses the principles of progressivepatient care along with data obtained from charts, nurses, andresident physicians. Six levels of care or patient care needsare defined. Patients were classified by resident physicians andan outside observer. The repeatability of the method wasmeasured by comparing the classifications of the residents andthe outside observer.

Among the criteria used in the classifications were thepatient's diagnoses, length of stay, region of residence, bedstatus, and extent of nursing care and supervision required. Itwas concluded that the method was feasible and practical and,as an ongoing procedure, could be used by the residents andnursing staff to screen out those most suitable for alternatecare to the care available in a short-term general hospital. Thelevels of care within the short-term general hospital were:intensive care, intermediate care, end minimal care. The alter-nate.care classifications were: long-term active treatment hos-pital care, nursing care (care of the type available in licensednursing homes or in their own home under a home.careprogram),.and sheltered care.

PAETZNICK, MARGARET.

1966. A Guide for Staning a Hospital NursingService. World Health Organization, Pub-lic Health Papers, No. 31, Geneva, Switzer-land. 93 pp. (Available from ColumbiaUniversity Press, International DocumentService, 2960 Broadway, New York, N.Y.10029.

Although not new or different in theory, methods and pro-cedures for establishing staffing patterns useful to nursingservice personnelboth in the United States and abroadareclearly outlined. Questions relating to all facets of hospitalnursing care of patients may be used to establish an evaluationsystem, or, where staffing patterns already exist, to establishcriteria for patient care. Hospital administration, the use of

BACKGROUND MATERIAL, AND PLANNING TO OLS 133

nursing personnel, and inscrvice education are discussed.Twelve descriptive guide charts and a list of available publichealth papers are included. (Excerpted from a review by IrenePope, Director of Nurses, Department of Public Health,San Francisco General Hospital, Calif., in Nursing Outlook,15(8) : 71. August 1967).

CALIFORNIA NURSES' ASSOCIATION.

1968. Establishing Staffing Patterns Based onAcuity of Patient Needs. Fine' Report ofTask Force IV. San Francisco: The As-sociation. 28 pp. (processed).

This publication describes a method of patient classificationbased upon the patient's need tor nursing care. Patients areclassified according to four categories related to criteria indi-cating the acuity of need for nursing care. The areas to beassessed as to degree of need include the following: nursingprocedure requirements; physical restrictions; emotional fac-tors; and instructional needs. A statement of standards fornursing practice which this system implements is given. Inaddition, staffing patterns which will implement and maintainstandards for nursing practice are stated. Two groups of staffingratios as they relate to the patients' acuity of need for nursingcare are offered: namely, one optimum and recommended;the other, minimal and not to be reduced in terms of staffassigned.

Although most patients included in the patient classificationstudy were in short-term general hospitals, a number of themwere in outpatient clinics, convalescent hospitals, and at home.A brief description of the work of the Task Force and itsrecommendations on the material presented are included. Themethod used is a modification of the "Classification of PatientsAccording to Nursing Care Requirenients," developed by theUnited States Army.


1968. Guide for Assessing Nursing Services in

Long-Term Care Facilities. Pub. 20-1341.New York: The League. 25 pp.

This guide interprets 10 principles of nursing care adaptedfrom criteria developed by the National League for Nursing.It is in workbook style, with a chart opposite cach principleso that the reader may enter his evaluation and future plans.(Excerpted from National League for Nursing, NLN News,17 (1) :4. January-February 1969.)

SHAUGHNESSY, MARY E.; O'BRIEN, GERALDINE ;

FITZPATRICK, THERESE E.; and GROVES, SARA S.

1969. The Problems of Nursing Home Patients.Implicationc for Improving Nursing Care.An Approach to Determining the NursingNeeds of Nursing Home Patients in Orderto Provide a Sound Basis for PlanningAppropriate Effective Nursing Services.Boston College School of Nursing, .Boston,Mass. 189 pp. (processed).

"A study conducted in two Boston area nursing homescertified for medicare to assess the nursing problems presented.Criteria were developed to group patients according to: the

over-all goal for their nursing care; the extent of their nursingrequirements; and the level of competence needed to providethe care. Nurse observers.evaluated 164 patients and reviewedtheir medical records according to the criteria. Also 121

patients were interviewed for their own perceptions of theirnceds. Data given on patient characteristics, length of stay,medical-physical condition and treatments needed, dietary prob-lems, orientation, attitudes, and group activities. Patient inter-view and nursing assessment form included. (LE.W.)" (Froman abstract in Abstracts ol Hospital Management Studies,5:33. June 1969.)

Cost Analysis and Cost Study Methods

KNOTT, LESLIE W.; VREELAND, ELLWYNNE M.; andGOOCH, MARJORIE.

1956. Cost Analysis for Collegiate Programs inNursing. Part I, Analysis of Expenditures.National League for Nursing, Division ofNursing Education, New York. 166 pp.

This manual discusses the broad principles involved in a

study of costs in nursing education, and provides the means foranalyzing the expenditures in each institution and agencyparticipating in the nursing program. Operating expenses areanalyzed according to the organization and function of theinstitutions, and direct and indirect expenses in cost centerschargeable to nursing are determined. The computation ofaggregate costs include appropriate allocations of expenditurefor administration, plant operation, maintenance and deprecia-

tion, and student and instructional services provided by otherunits of the university or hospital.

NATIONAL LEAGUE FOR NURSING. DIVISION OF NURSING

EDUCATION.

1957. Cost Analysis for Collegiate Programs inNursing. Part II, Current Income andOther ResoOces.. A manual to aid uni-versities, colleges, hospitals, and asscciatedagencies in determining costs of nursingeducation. New York: The League. 46

pp.

This is the second part of a two-part manual for analyzingthe costs of collegiate programs in nursing. Part II providesthe means for an analysis of income and other resources that

134 APPENDIX 2

balance both the educational and non-educational (i.e., studentmaintenance) expenditures, which together are the aggregatecost of the program. The procedures focus on the financingof the aggregate costs and each of the participating institu-tions is considered separately. Income includes the following:Student tuitions and fees; government appropriations, privategifts, grants, and endowment income restricted to nursing,education; and general operating funds of the institutionallocated to nursing. Other resources are monetary values thatrepresent services contributed by persons who receive nopersonal remuneration. Methods for determining the monetaryvalue of nursing student services are included, although thereis considerable difference of opiniorr as to the need for anduse of such costing data.


1964. Cost Analysis Pr Public Health NursingServices. New York: The League. 133

pp.

This manual presents two methods to determine the cost ofpublic health nursing services and the cost per visit for homehealth services. It provides means for determining specific and

detailed expense figures, as for travel, agency administration,and home visits by specific diagnoses of, patients served.



1966. How To Determine Nursing Expendituresin Small Health Agencies. A procedureusing work units. PHS Pub. 902. Wash-ington: U.S. Government Printing Office.54 pp.

This guide is for the use of small health agencies or multi-purpose agencies where amounts and types of financial andstatistical data are limited for determining the cost of specificunits of nursing service. The simple pllocedure outlined isbased on the principle of average costs, and includes a propontionate share of travel and snpportive service expenses in thework unit. The method utilizes an activity time study and arecord of annual agency expenditures and charges to nursingservice. Sample forms and exhibits of the application of theprocedure and their adaptation to various programs are in-cluded in the manual.

Criteria and Standards for Nursing ServiceAMERICAN NURSES' ASSOCIATION. HEAD NURSES

BRANCH. GENERAL DUTY NURSES SECTION.

1958. Functions, Standards, and Qualifications Practice for the Head Nurse. New York:

The Association. 8 pp.

The head nurse position is defined. Responsibilities are out-lined in the broad areas of patient care, unit management, andinstitutional objectives; also, fnnctions in each area are de-tailed. The professional and personal qualifications for a headnurse are specified.

AMERICAN NURSES' AssoCIATION. OFFICE NURSESSECTION.

1962. Functions, Standards, and Qualifications Prthe Practice ot Office Nursing. New York:The Association. 12 pp.

This statement defines the position of office nurse, the majorobjectives of nursing care, and the basic qualification requiredfor practice. It outlines the functions of office nurses.


1962. The Preparation and The Role ot Nursesin School Health Programs. Guidelinesfor the Use ot Administrators, Educators,and Students. Prepared by Helen Goodale

Florentine. Code No. 15-1033. New

York: The League. 29 pp.

This monograph suggests guidelines stated as competenciesand abilities in five major areas that school nurses must havefor fulfilling the purposes of a school health program. It canbe used to appraise the adequacy of educational programs andthe preparation of nurses for work experience in school healthprograms. Course offerings and areas of clinical experience

related to required competencies are suggested.

AMERICAN NURSES' ASSOCIATION. EDUCATIONAL AD-

MINISTRATORS, CONSULTANTS, AND TEACHERS SECTION.

1963. Functions, Standards, and Qualifications PrPractice Pr Educational Administrators andTeachers. New York: The Association.15 pp.

This statement outlines the functions that specifically applyto nurse educatorsadministrators and teachersin the broadareas of administration, instruction, guidance, and research.Recommended educational and professional requirements andqualifications are briefly outlined.


1964. Statement of Function,s the LicensedPractical Nurse. New York: The Associa-tion. 5 pp.

BACKGROUND MATERIAL AND PLANNING TOOLS 135

This statement describes the role of the licensed practicalnurse, licensure and educational requirements, and legal status.It outlines the functions that a licensed practical nurse canperform in giving nursing care in simple nursing situations.

AMERICAN NURSES' ASSOCIATION. PUBLIC HEALTHNURSES SECTION.

1964. Functions and Qualifications in the Practiceof Public Health Nursing. New York:The Association. 32 pp.

Statement of functions and recommended qualifications ofnurses employed in staff, supervisory, consultant, and educa.tional and administrative positions in public health nursingare outlined. A brief discussion of recommended qualificationsfor public health nurses employed by official and voluntaryagencies is included. The supervisory kInctions of public healthstaff nurses as they relate to the licensed practical nurse andher functions are also outlined.


1965. Standards for Organized Nursing Servicesin Hospitals, Public Health Agencies, Nurs-ing Homes, Industries, and Clinics. NewYork: The Association. 15 pp.

Sixteen formal statements of general standards apPlicable fornursing service departments are detailed. The purposes, basicassumptions, and criteria for formulating the standards areincluded. Factors for assessing each standard are listed to makethem meaningful and to offer guidance in their implementation.These standards are supplemental to those developed for practi.tioners in particular fields of nursing.

AMERICAN Num& AssoCIATION. OCCUPATIONAL

HEALTH NURSES SECTION.

1965. Functions, Standards, and Qualifications forOccupational Health Nurses. New York:The Association. 32 pp.

Occupational health nursing and positions in a one-nurse andmultiple-nurse service are defined. The educational preparation,personal competencies, and essential knowledge mid skillsrequired of a nurse in a onenurse service, as well as a super-visor.and director in an occupational health nursing service,are detailed. Functions are related to nursing care, healthmaintenance, safety education, health and welfare benefits, andcommunity health and welfare agencies.

AMERICAN NURSES' Asso CIATION. COMMITTEE ON

PRACTICE. PUBLIC HEALTH NURSES SECTION.

1966. A Guide for the Utilization of PersonnelSupportive of Public Health Nursing Serv-ices. Code No. PH-51. New York:The Association. 12 pp.

This publication outlines guidelines and concepts in utilizingregistered nurses, licensed practical nurses, and home healthaides for public health nursing services. It poses 35 questions

tu be considered in determining policy when planning forthe employment and use of supportive personnel. These ques.tions are concerned with: recruitment, tuining, functions,supervision, program evaluation, and financial support.

ILLINOIS ASSOCIATION OF SCHOOL NURSES. ILLINOIS

EDUCATION ASSOCIATION.

1966. Illinois Study of School Nurse Practice, ASummary Report. Springfield, Ill. TheAssociation. 52 pp.

This study sampled by questionnaire the opinion of superb'.tendents, principals, teachers, and school nurses, at both theelementary and secondary school levels, regarding the appro-priate academic preparation and function3 of school nurses.Twenty.three functions of school nurses were rated as to

their importance. Conclusions drawn from the study findingswere: a need for better informed school personnel and betteracademically prepared nurses, and a need for teacher nurseconsultants and university programs designed to prepare nursesfor school employment and coordination of working relation-ship. (Excerpted from a review by E. G. Lynn in Nur3ingResearch, 16 (4): 394. Fall 1967.)

AMERICAN NURSES' ASSOCIATION. COMMITTEE ON

NURSING SERVICES.

1967. Statement on Nursing Stall Requirementsfor In-Patient Health Ca Te Services. NewYork: The Association. 3 pp.

This statement outlines criteria for developing staffing pat.terns for inpatient care services suited to the individual needsof particular units. It outlines the factors, policies, and pro.cedures to be considered in determining requirements.

AMERICAN NURSES' AssOCIATION. DIVISION ON

PSYCHIATRIC-MENTAL HEALTH NURSING.

1967. Statement on Psychiatric Nursing Practice.New York: The Association. 41 pp.

Psychiatric patient care is defined in terms of its purpose andthe philosophy and assumptions upon which the care is based.Not only is the specialized area of practice included in thedefinition of psychiatric nursing, but its relationship to allnursing practice is shown. The definition also sets realisticgoals for nursing in psychiatric services. Roles of the variousnursing practitioners in psychiatric settings are included.These are clinical specialists, registered nurses, licensed prac-tical nurses, and nursing assistants.

FORBES, ORCILIA.

1967. "The Role and Functions of the SchoolNurse as Perceived by 115 Public SchoolTeachers from Three Selected Counties."Journal of School Health, 37: 101-107(February).

"This article reports a study of 115 elementary and secondaryschool teachers in 3 Oregon counties carried out to determine

136 APPENDIX 2

their perceptions in 4 areas: 1) role and functions of theschool nurse; 2) problems encountered with scLool nursing;3) courses which nurses should take in order to serve betterin the schools; and 4) the importance of 20 selected schoolnursing activities. .. . The study indicated that many teachershave not developed a concept of the professional role of theschool nurse." Problems seen by teachers and the activitiesgiven greatest imptxtance by teachers are enumerated. (Froma review by M. L. Pohn in Nursing Research, 16 (4): 394. Fall1967.)

STEARLY, SUSAN; NOORDENBOS, ANN; and CROUCH,VOULA.

1967. "Pediatric Nurse Practitione7." AmericanJournal of Nursing, 67 (10) : 2083-2087(October).

This article describes one way in which the knowledge,skills, and role of the pediatric nurse were expanded to delivermore care to children. The two phases of the programcontrolled education and practiceare described as they werecarried out in a project sponsored by the School of Nursingand the School of Medicine of the University of Colorado, andsupported by a Commonwealth Fund grant.

AMERICAN NURSES' ASSOCIATION. DIVISION OF COM-MUNITY HEALTH NURSING PRACTICE.

1968. Functions and Qualifications for an Occu-pational Health Nurse in a One-NurseService. Code No. CH-1. New York:The Association. 10 pp.

This statement details functions of a nurse in a one-nurseoccupational health service in the areas of nursing care, healthevaluation, health education and counseling, and mental hy-giene. It includes administrative and management responsibili-ties and relationships. Recommended education, experience,and proficiency qualifications are outlined.

EVANS, FRANCES MONET CARTER.

1968. The Role of the Nurse in CommunityMental Health. New York: Macmillan Co.227 pp.

This publication considers the nurse in a broad perspectiveand draws heavily from theory of social psychiatry as well asfrom the author's own experiences and research in psychiatricnursing here and abroad. The basic proposition of the book isthat "comprehensive services offered by a community mental

health center include services for the total population whichit represents." Concepts of prevention are primary; neverthe-less, care for the mentally disordered persons in the communityis provided. Interrelationships with mental hospitals and etheragencies are necessary. "Partidpation in local, State, andregional planning is certainly desirable."

Psychiatric nurses should prepare themselves to work withgroups as well as individuals. The movement is beyond tbehospital wall out into the community. Closer working relation-ships between public health nurses and psychiatric nursesshould he developed. It bas been suggested that non-profes-sionals can be trained and supervised in giving direct services,thus freeing the nurse to direct her energies into "such areasas consultation, social action, social advice, liaison with othergroups or agencies, training, and supervision." These duties arereviewed in detail, as well as the implications inherent in themfor nursing education.

(From a review by Rhetaugh G. Dumas, Nursing Outlook,16 (12): 66. December 1968.)

AMERICAN NURSES' ASSOCIATION. t:OMMISSION ON

NURSING SERVICES.

1969. The Position, Role, and Qualifications ofthe Administrator of Nursing Services.Pub. N6. New York: The Association.2 pp.

The statement describes the scope of health services andreflects changes in the role of the administrator of nursingservices. Abilities and skills deemed essential are stated. Edu-cational requirements are included. The position is defined insufficient breadth to apply to all types, settings, and sizes ofnursing services, and is a guide in describing not only theposition of the administrator but also the assodate and assistantarlininistrators of nursing services. The statement should beused with the ANA publication, Standards for OrganizedNursing Services.


1969. Extending the Boundaries of Nursing Edu-cationThe Preparation and Roles of theClinical Specialist. Pub. 15-1367. NewYork: The League. 82 pp.

Papers and summaries of panel discussions given at the thirdconference of the Council of Baccalaureate and Higher DegreePrograms, held in Phoenix, Ariz., in November 1968, are in-cluded. The conference was an extension of a 2-year series ofprograms dealing with graduate education in nursing.

Criteria and Standards for Nursing EducationNATIONAL LEAGUE FOR NURSING. DEPARTMENT OFDIPLOMA AND ASSOCIATE DEGREE PROGRAMS.

1962. Criteria for the Evaluation of EducationalPrograms in Nursing Leading to a Diploma.

Code No. 16-24. New York: The League.11 pp.

This statement details the historical development of criteriafor diploma education. It outlines criteria intended for use as


a tool in the self-evaluation of programs, as an evaluation toolin accreeltation processes, and as an interpretive device. Criteriaoutlined include objectives, administration and organization,faculty, students, curriculum, facilities, records and reports,and program evaluation.

NATIONAL LEAGUE FOR NURSING. DEPARTMENT OFPRACTICAL NURSING PROGRAMS.

1965. Criteria for the Evaluation of EducationalPrograms in Practical Nursing. Code No.38-1178. New York : The League. 17

PP.

Both criteria and guidelines for achievement are outlined foruse in development of the practical nurse educational program,self-evaluation of programs, and national accreditation. Areascovered include philosophy and objectives of program, organize-tion and administration, curriculum, faculty, students, facilitiesand resources, records, and program evaluation. These criteriaare periodically revised through program activities of theLeague.

NATIONAL LEAGUE FOR NURSING. DEPARTMENT OFDIPLOMA AND ASSOCIATE DEGREE PROGRAMS.

1967. Criteria for the Evaluation of EducationalPrograms in Nursing Leading to an As-

sociate Degree. Code No. 23-1258. NewYork: The League. 12 pp.

Criteria are outlined for the following: philosophy andpurposes, organization, and administration of associate degreeprogram in nursing; students and faculty; resources andfacilities; curriculum development and programs of instruction;and program evaluation, These criteria, used for self-evaluationby schools and for national accreditation, are revised period-ically by participant., in this type of education through theirmembership in the League.


1969. Criteria for the Appraisal of Baccalaureateand Higher Degree Programs in Nursing.Code No. 15-1251. New York: TheLeague. 14 pp.

These criteria are intended for use in program self-evaluationand for national accreditation. Criteria are outlined for theselevels of nursing programs in the areas of philosophy, purposes,and objectives; organizatioa and administration; faculty corn-position, qualifications, and functions; curriculum and instruc-tion; resources, facilities, and services; students; and programevaluation.

Planning Theory and ProcessPAYNE, STANLEY L.

1951. The Art of Asking Questions. Princeton,N.J.: Princeton University Press. 247 pp.

This is a highly readable and interesting book. It concernschiefly the wording of questions; yet its usefulness goes beyondthat. The problems Payne raises and the illustrations and datahe brings to bear on these problems pose questions of theo-retical interest for specialists in various areas. For example,psychologists will see problems relating to frame of reference,ego involvement, and the attributes of opinion, whereas sociol-ogists will see problems relating to class, status, and socialchange.

ABDELLAH, FAYE G.

1952. "State Nursing Surveys and CommunityAction." Public Health Reports, 67: 554-560 (June).

Major findings are reported from nursing surveys made in35 States and the Territory of Hawaii, to analyze statewidenursing needs and to alleviate nurse shortages. The articlesummarized organization for and conditions und which thesurveys were conducted in each State and Territory. The State

surveys were undertaken to determine whether there wereenough nurses in each field to meet the needs of the State;whether existing facilities for nursing education could produceenough well-prepared nurses; and whether nurses are preparedfor the jobs they are performing. The striking similarity ofrecommendations proposed in the various State surveys is noted,and post-survey activity is described. It is concluded that "muchmore study must be made of how nurses can work with othergroups on related research, including collection of originaldata and of how they can assist in development of regionaland State planning for nursing." A statewide nursing surveycan be a constructive device for getting community action andbecome a pattern for a comprehensive nursing plan. (Excerptedfrom a review in Nursing Research, 8 (2) :113. Spring 1959.)


1955. Taking Action in the Community. Leader-ship Pamphlet No. 3. Washington: TheAssociation. 48 pp.

This pamphlet is concerned with ways to plan and carry outa program of social change in a community. It discusses gettingsupport for and initiating social action, and suggests attitudesand methods helpful in beginning and carrying out the job.

138 APPENDIX 2

Community apathy and the forces against taking action arepointed up, as well as methods of handling conflia and con-troversial issues and problems of public interest. A flow chartshowing phases in successful community action through com-munity groups is included.


1955. Understanding How Croups Work. Lead-ership Pamphlet No. 4. Washington: TheAssociation. 48 pp.

This pamphlet can help group leaders and members increasetheir sensitivity to group processes, organize more effectively',and coordinate their efforts to get things done by group de-cision and action. It describes group needs and conflicts andtypes of behavior that trouble groups; discusses leadership,group codes or customs, structure, and program content; andsuggests ways to improve group efficiency.


1956. Conducting Workshops and Instituto.Leadership Pamphlet No. 9. Washington:The Association. 48 pp.

This pamphlet gives step-by-step help on every phase of theworkshop method. It is designed as a practical aid to leadersin education, government, welfare, health, agriculture, labor,religion, industry, and the community. Topics discussed arepre-planning, getting started, using resource people, learningthrough play, back-home application, and evaluation.


1956. Getting and Keeping Members. Leader-ship Pamphlet No. 12. Washington: TheAssociation. 48 pp.

This pamphlet offers aid in solving the everyday problemsof group membership. Topics discussed are: finding newmembers, keeping old members involved, reducing dropouts,increasing attendance at meetings, working with the member-ship committee, and relating membership goals to programgoals.


1957. Better Boards and Committees. Leader-ship Pamphlet No. 14. Washington: TheAssociation. 48 pp.

Some basic features of organizations and organizing arediscussed in this pamphlet, including the purpose of boards,suggested ways of improving organizational leadership, and thestructure and work of committees. Requirements for improvingthe work of committees are discussed in regard to: committeesize, choosing and orienting members, picking a chairman andthe chairman's job, and committee agenda and work. A specialsection is presented on the advisory committee.


1957. Effective Public Relations. Leadership

Pamphlet No. 13. Washington: The As-sociation. 48 pp.

This riamphlet is intended to help organizations and agenciesachieve better public relations. Approaches and steps in

developing a good public relations program are discussed, aswell as techniques and media that work in particular situations.Suggestions are presented for handling criticism and testingcommunication effectiveness. A checklist for planning publicrelations programs is included.


1957. Streamlining Parliamentary Procedure.Leadership Pamphlet No. 15. Washington:The Association. 48 pp.

The contributions that parliamentary procedure can makein meetings and discussions are dealt with, as well as its

usefulness in finding common factors of agreement and inreaching decisions. Abuses in the use of parliamentary pro-cedure in organilational work are outlined, and guidelines aregiven for determining when to and when not to use it.

KNOWLES, MALCOLM S., and KNOWLES, HULDA.

1959. "Understanding Group Behavior." Chap-ter 3, pp. 39-62, in Introduction to GroupDynamics. New York: Association Press.

This chapter will help the planner understand group be-havior, diagnose its problem, and improve its operation. Thecharacteristics of group procedures, properties, dimensions,membership, and leadership are briefly described. A checklistof general principles for a group or committee as an effectiveinstrument for change is given.

STRUNK, WILLIAM, JR., and WHITE, E. B.1959. The Elements of Style. New York: The

MacMillan Company. 71 pp.Eight rules of English usage and 10 principles of composi-

tion most commonly violated are discussed and illustrated inthis concise rule book for writers. In addition, discussion of afew matters of form, a list of words and expressions commonlymisused, and a suggested approach to style can help plannersimprove the writing of reports and other documents.

BRADFORD, LELAND P.; GIBB, JACK R.; and BENNE,KENNETH D.; eds.

1964. TCroup Theory and Laboratory Method:Innovation In Re-Education. New York:John Wiley and Sons. 498 pp.

"Seventeen years of experimental effort went into the contentof this book." The idea of the T Group, or Training Group, isan "innovation in re-education." The T Group member, aparticipant-observer, "develops new images of potentiality inhimself and an understanding of how others might be able tohelp him convert these potentialities into actualities. Thedifference between the T Group and other groups in oursociety is its focuswhich is on group processes, perception,communication, as well as the job to be done."


This book is written in such a way that it becomes a learn.ing experience for the reader. The content in certain chapterswould have special meaning, however, for these three levels ofnurses: the student, the teacher, and the administrator.

(Based on a review by Eleanor Lefson in Nursing Outlook,12 (12): 62. December 1964.)

AHUMADA, JORGE.

1965. Health Planning Problems of Concept andMethod. Scientific Publication No. 111.Washington: Pan American Health Organi-zation, Pan American Sanitary Bureau,Regional Office of the World Health Organi-zation. 77 pp.

This publication was intended as a "guide to health planningand as a stimulus to a further research and analysis of thcconcepts and methods governing it." Social and economic prob.lems as well as health problems are reviewed and are com-ponents in assessing needs and requirements. Additional areascovered are: determination of feasible alternatives in the localprograming area; and preparation of regional plans and thenational plan.

HIESTAND, DALE L.

1966. "Research Into Manpower for Health Serv-ices." Milbank Memorial Fund Quarterly,44:146-81 (October).

This paper appraises empirical research into manpower forthe health services. It discusses approaches to manpower re .search, its accomplishments, and priority areas needing research.The availability of research data on health manpower is de.tailed. These principles are stressed: that manpower researchcan only indicate the nature of manpower situations; and thatmanpower policy, private policy, and public policy must solvemanpower problems. For realistic planning, this paper recom-mends that the determinants of demand be clarified. Redirectionin the orientation of research is urged, as well as study intothe processes of effecting change to determine why goals arenot reached despite numerous studies. It is believed that solidlyconstructed, finely focused efforts can yield significant con-tributions.


1967. Principles To Guide Development of State-wide Comprehensive Health Planning andProtocol for Health Care Planning Withina State. Approved by the American Hos-pita] Association. Pub. 846. Chicago:The Association. 7 pp.

This pamphlet briefly outlines the Association's position onthe need for, scope, and relationship between institutional,comMunity, State, and areawide planning. This position ispresented in the form of principles and protocol to guide tbisplanning.

BUTTER, IRENE.

1967. "Health Manpower Research : A Survey."Inquiry, V (4): 5-41 (December).

This paper focuses on a conceptual framework and analytictools for future health manpower research that can be adoptedfrom the field of economics. It further purports that operationsresearch offers suitable measurement techniques and quantita-tive methods. The research framework presented "draws heavilyon the economic concepts of demand for health manpower and

its determining factors; supply of health manpower and its

determinants; and the conditions under which demand andsupply are likely to reach equilibrium." The interaction ofchanging demands and supplies is discussed, as well as man.power planning and legislation as possible reinforcements and

substitutes for private market mechanisms. Problems and re-search in health manpower in general, for selected healthoccupations and their interactions, are also discussed.


SERVICES.

1967. Action-Plannit,g for Community , HealthServices. Report of the Community ActionStudies Project. Washington : Public Af-fairs Press. 67 pp.

This report is addressed to civic leaders to help them geteffective action for health. Three majors areas were explored:(1) community readiness for action for health; (2) a retro.spective survey of local health studies; and (3) a detailedanalysis of a number of successful health efforts by certaincommunities. As a resuh of this Commission's work withcommunity leaders, a survey tool, "Self-Study Guide for Com.munity Health Action-Planning," was developed.


SERVICES.

1967. Comprehensive Health Care: A Challengeto American Communities. Report of theTask Force on Comprehensive PersonalHealth Services. Washington : Public Af-fairs Press. 94 pp.

The objectives of the report and the recommendations itcontains are measures to help achieve comprehensive personalhealth services under present circumstances. The providing ofan adequate number of personal physicians and the organizingof health systems around proper modes of access are two of thekey requirements for comprehensive personal health services.Still another prime requirement is some degree of associationamong physicians themselves. Planning by communities mustassure that comprehensive personal health services of optimumquality are available, accessible, and acceptable to all theirresidents. Special areas of need are identified and discussed,and suggestions for improvement and study are included.


140 APPENDIX 2

1967. llealth Administration and Organization inthe Decade Ahead. Washington: PublicAffairs Press. 96 pp.

This Task Force report examines issues and presents guide-lines for the administration and organization of health services.with the underlyirg purpose of ensuring comprehensive, per-sonal, and environmental health services for all Americans. Itsrecommendations envision a pivotal role for State government inchanneling Federal assistance to community health services,and fostering and coordinating planning at the regional andlocal levels. It suggests replacing the traditional State healthdepartment with a broad.gauged agency with responsibility forthe major health functions of the State, yet withdrawn fromthe direct provision of services and operation of facilities.Planning by an interdepartmental body working closely withthe Governor's office is seen as the force for integrating diverseand competing elements of our health system. Creation of newmechanisms to coordinate Federal policies and programs is

essernial to the process. (Excerpted from a review in theAmerican Journal of Public Health and the Nation's Health,58 (3): 596.597. March 1968.)


1967. Change, Collaboration, Community Involve-ment. A synthesis of views on nursing asseen by the Committee on Perspectives.New York: The League. 12 pp.

This pamphlet summarizes and calls attention to the issuesand changes in society, health care, and nursing, and forecastsfuture trends. It focuses on the knowledge, skills, and attitudesneeded by nursing for improved patient care. The responsibilityfor nurses at all levels to participate in identifying problemsand devising solutions for needed change is emphasized. In.volvement in community planning and action is stressed.

ARNOLD, MARY F.

1968. "Use of Management Tools in HealthPlanning." Public Health Reports, 83(10): 820-826 (October).

"Perhaps the most important function of the health pro-fessional in community planning is that of finding better waysto measure benefits and delineate health values. If he does notmeet this challenge the measures of the technicians will beused, and they may represent a quite narrow value systemabout health... .

"Therefore, the really troublesome problem is resolvingconflicting values and clarifying and identifying shifting valuepremises. .

"The knotty problem to be solved in .planning, whether atthe organizational or the societal level, is to find a tool thatwill aid in defining the utilities to be maximized and thetimcspan that is to be considered. Management tools can helpus plan how to get somewhere and learn where we are going,but they cannot help us decide where it is we want to go."

ARNOLD, MARY F., and HINK, DOUGLAS L.

1968. "Agency Problems in Planning for Com-munity Health Neetls." Medical Care,VI (6): 454-466 (November-December).

The authors have identified, from interviews with administra-lors of community health service agencies, a number of con-straining influences on coordinative planning for comprehensivehealth E e rv ices. These include the following: differences in

priority given to the type of community need identified; differ-ences in the way commonly recognized needs were defined interms of the agency's own coping responses to the problem;current pressures and demands for agency time and manpower;lack of clear-eut community norms for allocation of agencyresponsibility for initiation of new activities; and amount oforganizational energy and time required for initiating andimplementing changes in program activities.

Because of the increasing demand for services in all areas ofcommunity health and in the absence of a centralized decisionauthority and with the relatively weak market situation of thecurrent organizational system, there is a diffusion of powerand influence; individual agencies seem to have become im-'potent in developing the qualitative changes needed for meetingcommunity health service needs. Arnold and Hink recommendthe development of competitive planning structures. Equal butcompetitive health care systems would provide a choice for theconsumer.

DENISTON, 0. L.; ROSENSTOCK, I. M.; WELCH, W.;and GETTING, V. A.

1968. "Evaluation of Program Efficiency." Pub-lic Health Reports, 83 (7): 603-610 (July).

The authors conclude that "the first step in evaluating effec-tiveness and efficiency appears to be to attain conceptual clarityabout what the program is and what it contains. Then evaluationbecomes straightforward." The authors further state that thetools described for evaluating effectiveness and efficiency "aremost useful for programs in which (a) the objectives havebeen specified qualitatively and quantitatively and have beenfixed in time to particular geographic areas and to particulartarget audiences, (b) the programs are described in sufficientdetail to permit reliable observations of performance of plannedactivity, and (c) all the resources that are directed towardprogram activity are identified."

GUNNING, ROBERT.

1968. The Technique of Clear Writing. Revisededition. New York: McGraw-Hill BookCompany. 329 pp.

This guide for writers discusses factors of reading difficultyand 10 principles of clear and readable writing. Gunning'syardsticks for measuring readability have been helpful to

authors and editors in testing writing. The principles andyardsticks are applied to legal prose, and to technical, business,and newspaper writing. In the appendix is a list of short wordsto substitute for long words. This book can aid planners inpreparing, revising, and improving 'their reports.


HILLEBOE. H. F., and SCHAEFER, M.1968. "Comprehensive Health Planning: Con-

ceptual and Political Elements." MedicalTimes, 96: 1072-1080 (November).

"Four interdependent triads interact in comprehensive healthplanning: (1) systematic identification of health problems, anddetermination of goals in light of these problems; (2) rationalchoices in allocating and using resources; (3) considerationand possible modification of the community constraints on

health policies and programs; (4) application of the knowledgeand processes of planning so as to integrate the other concepts.The application of only one of -these elements is not compre-hensive planning." (Quoted from American Journal of PublicHealth and the Nation's Health, 59 (1): 198.199. January1969.)


SERVICES.

1968. The Politics of Community Health. Reportof the Community Action Studies Project.by Ralph W. Conant. Washington: Pub-lic Affairs Press. 137 pp.

This study analyzes five outstanding examples of communityheulth planning. It found that such planning is essentially apolitical process, and that the major obstacles to successfulplanning are politicalpolitics being defined as the clash ofinterests and not party behavior. Five conditions for successfulplanning are prescribed: (1) political leadership skilled inidentifying and resolving conflict among contending groups;(2) legal authority and enforcement sanctions; (3) a reliablesource of money in proportion to established goals; (4)capacity to combine public and private resources with theresources of other levels of government; (5) capacity forskilled analysis of community health problems. The mainimplication of the study is that successful planning requiresdevelopment of systematic knowledge of health politics and itsuse by policymakers and planners. (Excerpted from a review inthe American Journal of Public Health and the Nation'sHealth, 58 (7): 1297. July 1968.)

NEW YORK ACADEMY OF MEDICINE.

1968. "Planning For Community Health Services:Perspectives For Action." Bulletin of theNew York Academy of Medicine (SpecialIssue), 44 (2) : 83-219 (February).

This entire issue is devoted to reprints of papers read at the1967 Health Conference of the New York Academy of Medicine.Topics covered are: the complexity of health service planning;the potentials, goals, and evaluative processes to be consideredin the planning process; problems and solutions in health careplanning; and more effective use of resources, manpower, andfacilities.

STORCK, JOHN.

1968. "Hard Facts for Health Planning." Public

Health Reports, 83 (10): 841-848 (Octo-ber).

Dr. Storck summarizes his report as follows: "The PublicHealth Conference on Records and Statistics, a study programadministered by the National Center for Health Statistics, heldits 12th national biennial meeting in June 1968, to considerdata 4.ises and needs in comprehensive health planning. Theconference was organized around discussion group meetingson measures of health and health hazards, measures of healthservice use, statistics on health r.:.ources, basic demographic.

data, and data systems."Among the topics considered were the kinds of stathtics

needed for comprehensive heahh planning, methodologies toimprove the country's health statistics, ways to organize govern-mental health statistics operations, and general problems intransforming the country's health needs first into demands andthen into accomplishments.

"The chief organizational prop s.' brought before the con-ference was that State (inctuding egional) centers for healthstatistics be established to satisfy needs for health statistics notnow being met and to coordinate and give focus to the largequantities of data already available.

"A social action philosophy centering around doing ratherthan explaining was discernible in the discussions, as in theComprehensive Health Planning Act itself. This philosophyholds that concrete social activity occurs when ongoing sit-uations are transformed into problems, problems into plans.plans into programs, and finally, when programs receive socialevaluations. Key persons involved are statisticians, planners,program operators, and politically motivated people, whomediate between technically motivated groups and the generalor affected public."

BENNIS, WARREN G.; BENNE, KENNETH D.; and CHIN,

ROBERT; edS.1969. The Planning of Change. 2d ed. New

York: Holt, Rinehart and Winston, Inc.627 pp.

This publication emphasizes "the process of planned chang-ing, on how change is created, implemented, evaluated, main-tained and resisted. Included also are some of the majorinstruments that have been developed for creating and maintain-ing change: training, consulting, and applied research."


WELFARE. PUBLIC HEALTH SERVICE. HEALTH SERVICES

AND MENTAL HEALTH ADMINISTRATION. COMMUNITY

HEALTH SERVICE.

1969. The Urban Planner in Health Planning.A report by the American Society of HealthPlanning Officials. PHS Pub. 1888.Washington: U.S. Government PrintingOffice. 90 pp,

The present involvement of urban planning agencies in the

-1:14

142 APPENDIX 2

health problems of their communities is described. Currenthealth problems are discussed. Suggestions are provided to

planning agencies to assist them in making their contributiontoward the solving of health problem6 a more effective one. A

bibliography of reference materials on the health system andhealth planning for the urban planner is included. The ap .pendix also contains a selected listing of national and regionalhealth organizatii-ns.

Tools for PlanningMEYER, BURTON.

1957. "Development of a Method for DeterminingEstimates of Professional Nurse Needs."Nursing Research, 1: 24-28 (June).

This paper emphasizes in detail a method for estimatinggross quantitative needs for registered nurses. The methodutilizes a comparative evaluation approach in which nurse-population ratios obtained and considered adequate for goodnursing care are applied as a standard to the population forwhich estimates are being made. Estimates are based on factorsaffecting the demand for nursing services and the number ofnurses expected to be available. The units of measurementutilized include population growth, nurse-population ratios.attrition rates from the nurse supply, the number of graduatesexpected from basic nursing education programs, and expansionneeds of education programs to meet desirable ratios. Theauthor believes that within the framework of the methodspecified and dependent upon available data, the regional.community, and qualitative needs for nurses can be studiedand estimated.

Nursing Research.1959. "Abstracts of Studies in Public Health

Nursing." 8 (2) : 41-144A.

This entire issue of Nursing Research is devoted to an indexand compilation of abstracts of studies in public health nursingundertaken in the United States from 1924 to 1957, inclusive.Abstracts are classified under the following headings: organiza-tion and administration; programs and services; proceduresand techniques; personnel policies and practices; time andcost; occupational orientation and career dynamics; educationfor public health nursing; interagency and interprofessionalrelations; medical and home care plans; public health nursingin special fields; and survey and study methods. The compila-tion includes citations of master's theses, a list of communityhealth surveys that include public health nursing, and a listof surveys of nursing needs and resources.

Nursing Research.1960. "Abstracts of Studies in Nursing."

9 (2): 49-106 (Spring).

This entire issue of Nursing Research is devoted to acompilation of 200 abstracts of significant research in allnursing areas completed between 1955 and 1958. Abstracts areclassified under the following headings: nursing and nursingservices; personnel policies and practices; occupational orienta-tion and career dynamics; education for nursing; interagency

and interprofessional relations; public health nursing; nursingin special fields communicable disease, maternal and childhealth, neurological and psychiatric nursing; and practicalnurse and auxiliary worker.

U.S. DEPAlaMF:NT OF LABOR. BUREAU OF LABORSTATISTICS.

1963. The Forecasting of Manpower Require-ments. BLS Report 248 (April). Wash-ington: The Department. 96 pp.

This handbook, prepared for the Agency for InternationalDevelopment (AID), is iutended to serve as a guide for de-termining manpower requirements in relation to anticipateddevelopment. The method outlined "relies heavily on economicanalysis and human judgment, and uses whatever statisticaltechniques are available and applicable to assist in making acommon sense evaluation of future needs and resources" in-eluding future manpower requirements by occupation andfuture training requirements for high-level occupations.

SIMMONS, LEO W., and HENDERSON, VIRGINIA.

1964. Nursing Research, A Survey and Assess-ment. New York: Appleton-Century-Crofts.461 pp.

This guide to nursing studies reviews selected areas ofresearch related to occupational interests as well as studies ofnursing care. It includes a review of research completed duringthe past six decades, and an assessment of master's theses anddoctoral dissertations from 1932 to 1955. Also included aretypes of sponsorship of research, the kind of research sponsoredhy various organizations, and a report of opinions regardingthe status of nursing research today. Twelve selected surveys ofnursing needs and resources conducted from 1945 to 1955 areanalyzed. This guide provides historical development and futuredirections for research in nursing. It should serve as a usefulresource for those interested in nursing research, including theproject staff and others involved in planning. (Excerpted inpart from a review by Shirley Sears Chatter, Associate Pro.fessor, University of California, San Francisco, in AmericanJournal of Nursing, 65 (2): 145. February 1965.)

ABDELLAH, FAYE G., R.N., Ed.D.; and LEVINE.EUGENE, Ph.D.

1965. Better Patient Care Through Nursing Re-search. New York: Macmillan Co. 736pp.


This is a valuable source book for research investigators. Itestablishes the nurse as an essential membcr of the researchteam and nursing research as an essential field of study.Statistical analyses and detailed examination of research meth-ods are presented, with special attention to thc thcory ofnursing research, the selection of research designs, and atypology for the classification of research to aid researchers inselecting appropriate theoretical and methodological approaches.There is extensive treatment of the various steps in researchdesign.

The approach is practical, designed to prepare the reader fordirect involvement. Current research activities arc dcscribed,and what appear to he the activities of the future are outlined.The definition and measurement of variables, data collection.and the role of the nurse in research receive extensive con.sideration. Case studies of actual research demonstrate howthe researcher may deal with practical problems likely to arise.

KERLINGER, FRED N.

1965. "Survey Research." Chapter 22, pp. 392-408, in Foundations of Behavioral Research.Educational and Psychological Inquiry.New York: Holt, Rhinehart and Winston,Inc.

This chapter is an overview of survey research in social.scientific, and educational research. Survey research is definedand distinguished from status surveys. Types of surveys arediscussed as interviews and schedules, mailed questionnaires,panels, telephone surveys, and controlled observation. Steps ora flow plan for designing and implementing a survey is out-lined. Examples of application of the method are given.

U.S. DEPARTMENT OF LABOR. MANPOWER ADMINISTRA-

TION.

1965. Health Careers Guidebook. Washington:U.S. Government Printing Office. 251 pp.

Designed to help young people in choosing career goals,this guidebook identifies 200 health career opportunities. Itdefines these health professional, technical, and auxiliary oc-cupations; describes educational requirements; gives a broadview of work in the health field; and discusses career planning.The guide is useful for planners in identifying thc roles, rela-tionships, and functional work areas of the numerous categoriesof health occupations.

YETT, DONALD E.

1965. "The Supply of Nurses: An Economist'sView." Hospital Progress, 46 (2): 88-102(February).

This paper was based on a larger study pertaining to theeconomic aspects of the hospital nursing shortage. "Shortage"based on demand rather than need is discussed.

KLARMAN, HERBERT E.

1966. "Changing Requirements for Health Man-power." Paper presented Nov. 2, 1966,

'- .

before Special Session, 94th Annual Meet-ing of the American Public Health Associa-tion, San Francisco. Baltimore: TheJohns Hopkins University School of Hygieneand Public Health. 22 pp. (processed).

A discussion of how requirements for health personnel arcmeasured is included by the author. Two commonly employedapproachesnamely, need and demandare reviewed and as-sessed. Klarman clarifies the first approach, need, belongingto public health officials and planners; and the second, demand,belonghig to the economists. The paper includes specific ap-proaches applied to concrete situations in which additionalpersonnel are being sought; physicians for primary care,registered nurses for hospitals, public health administratorsand planners, and home health aides.

POLLIARD, FORBES W.

1966. The Feasibility of a Systematic Study ofManpower Requirements and Educationand Training Programs of Selected HealthOccupations. Indianapolis Hospital De-velopment Association, Indianapolis, Ind.95 pp.

"A four-month investigation, including a literature surveyand individual and group interviews, fonnd positive responseto the proposed study among Indianapolis health professionleaders, specified related work in progress or planned else-where, and detailed by task and stcp a five year study of healthmanpower in the Indianapolis metropolitan arca. Included inthe appendix is the questionnaire used to collect data onnursing education in the Indianapolis arca." (From Abstractsof Hospital Management Studies, V: 125. June 1969.)

SLONIM, MORRIS JAMES.

1966. Sampling. A Quick Reliable Guide toPractical Statistics. New York: Simon andSchuster. 144. pp.

This guide for the layman, student, or businessman leads thereader in logical fashion through many phases of sampling asa means of getting information quickly, reliably, and cheaply.Sampling theory, its basic principles, practical application, andpotential values arc discussed. A wide variety of pertinent casehistories of sampling are cited.

Fox, DAVID J., and KELLY, RUTH LUNDT.1967. The Research Process in Nursing. New

York: Appleton-Century-Crofts. 611 pp.

This is a compilation of readings dealing in one way oranother with nursing research. The 62 articles arc carefullyintroduced and organized to provide a review of researchconducted within thc last decade. Trends, too, are exemplifiedthroughout. (Excerpted from a review by Mary Louise Paynich.R.N., Associate Professor and Chairman, Public Health Nurs-ing, Medical College of Virginia School of Nursing, Richmond,Va.)

144 APPENDIX 2

MAKI, DENNIS R.

1967. A Forecasting Model of Manpower Re-quirements in the Health Occupations.Industrial Relations Center, Iowa StateUniversity, Ames, Iowa. 147 pp. (proc-essed).

This publication presents a model designed to predict, undercertain assumptions, the demand, supply, excess demand, andemployment of health personnel applicable for forecasts of 5to 15 years into the future. Manpower requirements are fore-cast on the basis of the economists' concept of demand, andare said not to resort to valtie judgments used to forecastrequirements based on the concept of need for manpower. Aclear distinction is made between projecting requirements,defined as trend extrapolation, and forecasting requirements,defined as the estimation of the magnitude of some relevantvariables at a future point in time. The model is purported toaccommodate numerous techniques for the estimation of pa-rameters.

MYERS, JOHN G., and CREAMER, DANIEL.1967. Aleasuring Job Vacancies: A Feasibility

Study in the Rochester, N.Y. Area. NewYork: National Industrial ConferenceBoard, Inc. 278 pp.

Two general headings divide the contents of this report: (1)The Survey Plan and Statistical Findings; and (2) Some Gen-eral Problems and Implications of the Rochester Experience.This study was undertaken to "determine the feasibility ofmeasuring the demand for labor to complement the wealth ofmaterial on the supply of manpower." The report is "positivein its major finding: It is feasible (and meaningful) to measurejob vacancies on a voluntary basis."

The major conclusions can be summarized in a few sentences.Of course, the following points omit such obvious requirementsas care in coding, data processing, and the like:

"(1) Initially, data should be collected by personal inter-view. This serves to clarify definitions, increase the responserate, and reduce the number of false or perfunctory answers. Adecision should be made for each employer on changing tomail reports. Periodic visits will probably be necessary evenduring a continuing mail survey program.

"(2) Enumerators need extensive training and supervision toensure accurate reports in initial interviews. We, therefore,suggest that a relatively small sample be interviewed at first.and the size increased later.

"(3) The list from which the sample is drawn is of utmostimportance to eliminate errors in coverage and classification.A major effort should be made to obtain and maintain anup-to-date list that contains new firms, accurate industrialcoding, and appropriate grouping of multiestablishment organi-zations."

PHILLIPS, JEROME S., and THOMPSON, RICHARD F.

1967. Statistics for Nurses: The Evaluation of

Quantitative Information. New York:Macmillan Co. 550 pp.

This book is a basic text on statistics designed to help nursesbecome sophisticated users of reports of research in nursing, toprovide understanding of the logical and philosophical bases ofresearch methods and statistical techniques, and to acquaintthem with a range of statistical procedures including boththeir rationale and computation. Descriptive and inferentialstatistics are discussed, as well as bases for making inferences;for example, using frequency and ranked data. More advancedareas such as multiple correlation and complex analysis of

variance, are touched on. Included are a review of selectedmathematical topics, illustrative studies in nursing research.practical exercises in statistics, and references. (Excerpted

from a review hy Yvonne A. Ruhens, Statistician, Measurementand Evaluation, National League for Nursing, New York, in

Nursing Outlook, 16 (3): 21. Match 1968.)

ALBEE, GEORGE W.

1968. "Conceptual Models and Manpower Re-quirements in Psychology." AmericanPsychologist, 23 (5): 317-320 (May).

The author discusses demands for and shortages of mentalhealth manpower as they are dictated by current concepts of.models for, and systems of mental health care. He contendsthat manpower planning must explicitly confront prospectivechronic shortages of professionals by the development of

alternative models leading to new delivery systems of care,and models requiring manpower that are more easily recruitedand trained. Psychology is challenged to create its own in-stitutional structure for developing methods for delivery of

service within its own structure. The dimensions of such amodel are sketched.

CALIFORNIA DEPARTMENT OF HEALTH.

1968. The Manpower Planning Subsystem, of the

California Health Information for PlanningService (CHIPS) System. Berkeley, Calif.:

The Department. 29 pp.

"Describes the Personnel-referenced Data File (PDF) whichis to be operated as a subsystem of California Health Informa-tion for Planning Service (CHIPS). Data on professional andtechnical personnel would be input to the PDF from schoolsand training programs, employers, and other sources of infor-mation. This data on manpower requirements, training andutilization would be made available to qualified users such asschools, hospital training programs, planning groups, and

various State agencies." (From Abstracts of Hospital Manage-ment Studies, V: 125. June 1969.)

FOLK, HUGH; and YETT, DONALD E.1968. "Methods of Estimating Occupational At-

trition." Western Economics Journal, VI(4): 297-302 (September).


This paper analyzes several inethods for taking account of"non-wage related" factors in predicting occupational supply ofskilled manpower. These methods are based on two importantfactors influencing supply: The increase in the qualified supplymeasured hy the annual number of graduates; and the rate atwhich qualified persons leave the field because of marriage.death, retirement, or transfer to other occupations. Overallattrition rates are recognized as accounting for wage factorsand many non.wage factors influencing occupational supply,whereas "age.speeific occupational rates" account for demo.graphic factors.

Various methods of calculating overall attrition rates areillustrated to include the exact method, approximate methods.gain-loss ratio method, straight-root method, and ratiorootmethod. The method of calculating age-specific occupationalrates is explained. Results from each method were tested forrelevance to the fields of nursing and engineering, and weredeemed reasonable. It was concluded that more accurateprojections will depend upon further research on tbe determi-nants of occupational participation. The gainloss method.simple to calculate, was seen to "yield reliable occupationalattrition rates provided both the base of the calculations andthe length of the projection are relatively short and frequentlyrevised."

STATE OF CALI FORNIA DEPARTMENT OF PUBLIC

HEALTH. DIVISION OF PATIENT CARE FACILITIES AND

SERVICES.

1968. Summary Report, California llealth Infor-mation For Planning Service. Supportedby PHS grant HM-00446. 1965-1968.Berkeley, Calif.: The Department. 137

PP.

This is a report of a demonstration project that tested andevaluated an information system for possible applicationthroughout California. Procedures, objectives, and mechanismsfor exchanging health information and data for planning aredescribed. Included are a case abstract service for hospitals;an inventory of health facilities; formats for areawide planningreports and establishment of a clearinghouse for data onhealth facilities, services, manpower, and other relevant dataon community planning.


WELFARE. PUBLIC HEALTH SERVICE. NATIONAL

CENTER FOR HEALTH STATISTICS.

1968. State Licensing of Health Occupations.PHS Pub. 1758. Washington: U.S. Gov-ernment Printing Office. 171 pp.

This is a report of a national survey of State licensingpractices for 22 health professions and occupations, conductedin late 1965 and early 1966 in cooperation with The Council ofState Governments and with State organizaiions that administerlicensing statutes. One of the purposes of the survey was todetermine the availability of statistics on health manpowerthrough licensing processes. Included are a list of health oc

cupations licensed by eacb State and an overview of trends inoccupational licensing, as well as compulsory and voluntaryacts. organizational patterns of licensing responsibility, licens.ing boards, renewal of licenses, qualifications for initiallicensure, and State policies on special licensure. Twenty.twochapters. each devoted to a health occupation, detail licensingpractices in the several States.

U.S. CONGRESS. JOI NT COMM MEE PRINT.

1969. Compilation of Selected Public Health Laws.Prepared for the use of tl:e Senate Com-mittee on Labor and Public Welfare andthe House Committee on Interstate andForeign Commerce. Washington: U.S.Government Printing Office. 489 pp.

This compilation includes statutory provisions in effect in

January 1969 of the Public Health Service Act as amendedthrough the 90th Congress, and other public health lawsrelated to mental health, mental retardation, food, drugs,cosmetics, clean air, waste disposal, and packaging and labeling.The Reorgnization Plans No. 1 of 1953 and No. 3 of 1966 forthe administrative structure and distribution of health functionswithin the Department of Health, Education, and Welfare arein the appendix.

U.S. DEPARTM ENT OF HEALTH, EDUCATION, AND


INSTITUTES OF HEALTH. BUREAU OF HEALTH PRO-FESSIONS EDUCATION AND MANPOWER TRAINING.


. 1969. Research in Nursing, 1955-1968, ResearchGrants. PHS Pub. 1356. Revised 1969.Washington: U.S. Government PrintingOffice. 91 pp.

This is a summary listing of projects supported by the Di.vision of Nursing's extramural research grants program sinceits inception in 1955. Projects are classified in three broadareas: (1) organization, distribution, and delivery of nursingservices; (2) recruitment, selection, education, and charac-teristics of the nurse supply; and (3) nursing research de.velopment. Information provided includes project title, namesand addresses of investigators, period of support, a briefdescription of each project, and wherever possible, citations topublications that resulted from the research and were providedhy the investigators.


1969. Tomorrow's Manpower Needs. Nationalmanpower projections and a guide to theiruse as a tool in developing State and areamanpower projections. Vol. 1, Developing.4rea Manpower Projections. Bulletin 1606(February). Washington: U.S. Govern-ment Printing Office. 100 pp.

146 APPENDIX 2

This rerort presents techniques for estimating State andarea manpower requirements witbin the context of nationaleconomic and technological development, taking into accountfactors affecting local area industry and occupational employ-ment. Statistics on population and the labor force for 1960 andprojection for 1970 and 1980 are detailed by age and color forStates and regions. Methods for estimating manpower replace-ment needs, and approaches for appraising the adequacy ofsupply in individual occupations are discussed.

U.S. DEPARTMENT OF LABOR. BUREAU OF LABORSTATISTI CS.

1969. Tomorrow's Manpower Needs. Nationalmanpower projections and a guide to theiruse as a tool in develoring State and areamanpower projections. Vol. II, NationalTrends and Outlook: ;ndustry Employmentand Occupational Structure. Bulletin 1606(February). Washington: U.S. Govern-ment Printing Office. 121 pp.

"This volume presents a discussion of industry employmenttrends and occupational structure, and projections of manpowerrequirements for each major industry in the economy. Alsoincluded is a discussion of the reasons for the expectedchanges." Workers in medical and other health services arcincluded in the discussion. For use with Volumes I, III, and IV.


1969. Tomorrow's Manpower Needs. Nationalmanpower projections and a guide to theiruse as a tool in developing State and areamanpower projections. Vol. III, NationalTrends and Outlook: Occupational Employ-ment. Bulletin 1606 (February). Wash-ington: U.S. Government Printing Office.50 pp.

"This volume presents information on the national employ-ment trends and projected 1975 requirements for workers innine major occupation groups and 40 selected occupations in-cluding registered nurses. The occupational statements includea discussion of past employment trends, the economic andtechnologkal factors expected to influence occupational re-quirements through the mid-1970's, and ways workers becomequalified for the occupation." For use with Volumes I, II, andIV.


1969. Tontorrow's Manpower Needs. Nationalmanpower projections and a guide to theiruse as a tool in developing State and areamanpower projections. Vol. IV, The Na-tional Industry-Occupational Matrix and

Other Manpower Data. Bulletin 1606(February). Washington: U.S. Govern-nwnt Printing Office. 247 pp.

This volume presents statistics on the national labor forceby industry and the distribution of employment by occupationfor 1960, and the projected labor force and its occupationalmatrix for 1975. The intent is to provide a statistical basis formaking manpower projections, using methods described in

volume I, for purposes of planning to meet service, education,and training needs.



AND MENTAL HEALTH ADMINISTRATION. NATIONALCENTER FOR HEALTH STATISTICS.

1969. A State Center for Health Statistics. An

Aid in Planning Comprehensive HealthStatistics. Public Health Conference onRecords and Statistics Document No. 626.Washington: U.S. Governnient PrintingOffice. 23 pp.

This brochure sets forth the views of the National Center forHealth Statistics "regarding the capabilities for data collectionand analysis of health data that ought to be developed withina State to meet today's needs and, in general terms, a model

for scope of work, policies and relationships of a State Centerfor Health Statistics."

WALKER, JAMES W.

1969. "Forecasting Manpower Needs." HarvardBusiness Review, 47: 152-154+ (March-April) .

The author discusses views on, the value of, and the reasonsfor interest in, manpower planning by corporate management,and "describes the first steps that researchers have taken towardimproved models for forecasting and planning." Informationand statistical data required for forecasting requirements andthe factors that influence requirements are pointed out. Thefact that relevant variables will differ from company to com-pany, by location and over time, is stressed, as well as thefact that forecasting models suited to organizations' charac-teristics must be developed for each given situation.

WORLD HEALTH ORGANIZATION. REGIONAL OFFICE FOR

EUROPE.

1969. Methods of Estimating Health Manpower.Report on a symposium convened by theRegional Office for Europe of the WorldHealth Organization, Budapest, 15-19 Octo-ber 1968. EURO 0289. Distributed bytbe Regional Office for Europe, WHO.Copenhagen. 141 pp.

This report records the proceedings of the first meeting onhealth manpower planning and methods of estimating health

7


manpower requirements convened by WHO for 15 Europeancountries. Approaches to projecting health manpower, theirlimitations, and methodological difficulties are discussed. In-cluded are methods based on economic levels of health activity,manpower-to-population ratio methods, extrapolating require.ments from analysis of past trends, and methods using pro-fessional standards. A wide variety of factors influencingmanpower requirements and problems was studied, includinghealth policy, economic, scientific, and technological develop-ment, and types of educational systems. The report includesdata for a survey of 26 countries on methods used for collectingand analyzing data on the nurse and midwife supply andmethods in use for estimating current and future requirements.

FOX, DAVID J.

1970. Fundamentals of Research in Nursing. 2ded. New York: Appleton-Century-Crofts.323 pp.

This book is addressed to research users who do not have abackground in research and statistics. It emphasizes conceptsand approaches that are hasic to understanding research meth-ods in nursing. Half of the book is devoted to statistics andmeasurements. It details the development of an actual researchstudy, and gives an overview of the research process. It alsoincludes a new section on content analysis and a good summaryon the effective evaluation and utilization of research findings.This book is considered useful as a basis for formal and guidedinstruction in basic research methodology.

OFFICE OF EcoNOMIC OppoifruNerv. EXECUTIVE

OFFICE OF THE PRESIDENT.

1970. Catalog of Federal Domestic Assistance.Washington: U.S. Government PrintingOffice. 1,035 pp.

This catalog contains a comprehensive listing and descriptionof the Federal Government's domestic programs and authorizinglegislation to assist the American people in furthering theirsocial and economic progress. Designed as a tool to help locate,understand, and utilize Federal assistance programs, it containsa master index and includes the agencies that administer theprograms, with regional and State addresses, program literature,and information contacts.



INSTITUTES OF HEALTH. DIVISION OF NURSING.

1970. Special Project Grants Awarded for Im-provement in Nurse Training. June 1965-

147

1970. A Lis:ing. Revised July 1970.Supplement to PHS Pub. 1154-2. Wash-ington: U.S. Government Printing Office.66 pp.

Grants awarded from the start of the program through June1970 to help schools of nursing meet the costs of projectsdesigned to improve, strengthen, or expand nursing educationprograms are listed by State, grantee, and title of project. Aconcise description of each project and its objectives showsthe kinds of projects being undertaken and funded.

U.S. DEPARTMENT OF HEALTH, EDUCATION, AM)


INSTITUTES OF HEALTH. BUREAU OF HEALTH MAN-POWER EDUCATION. DIVISION OF NURSING.

1971. Construction Grants Awarded to Schoolsof Nursing, December 1965June 1971.DHEW Publication No. (NIH) 72-89(formerly Supplement to PHS Pub. No.1154-5). Washington: U.S. GovernmentPrinting Office. 19 pp. (Issued an-nually.)

This publication updates the list of Federal grants to buildnew educational facilities, or to renovate, extend, and equiptheir nursing education quarters. The grants were awardedunder the Nurse Training Act of 1964, as amended by theHealth Manpower Act of 1968. Grants are listed by State orterritory and school. The type of nursing education program.type of construction, and amount of the grant are indicated.



INSTITUTES OF HEALTH. BUREAU OF HEALTH MAN-POWER EDUCATION. DIVISION OF NURSING.

1971. Current Research Project Grants, Divisionof Nursing. PHS Pub. 1762. RevisedFebruary 1971. Washington: U.S. Gov-ernment Printing Office. 12 pp.

This is a list of ongoing Rursing research projects funded bythe extramural research grants program of the Division ofNursing through February 1971. Information includes title ofproject, State and institution of grantee, name of investigator,and number of grant. More detailed information about indi-vidual projects may. be obtained by writing to the principalinvestigator.

Medical and Health CareSOMERS, HERMAN M., and SOMERS, ANNE R.

1961. Doctor's, Patient's, and Health Insurance:The Organizing and Financing of Medical

Care. Washington: Brookings Institution.563 pp.

*ln their presentation of the historical background and current

148 APPENDIX 2

data on medical care, the authors consider the structure ofmedical practice, the hospital, the drug industry, consumer'sdenumd, the costs, private insurance programs, and the doctor-patient relationship. Several tables are included in the ap.!tench.

AMEmcAN PuBLIC HEALTH AssOCIATIoN, 1Nc. THEPROGRAM AREA CoMMITTEE oN MEDICAL CAREADMINISTRATION.

1965. A Guide to Medical Care Administration.Volume I: Concep,s and Principles. NewYork: The Association. 106 pp.

This volume is designed to provide a comprehensive view ofmedical care administration that will serve as a starting pointfor the discussion of the problems and issues in medical caretoday.

KLARMAN. HERBERT E.

1965. The Economics of Health. New York:Columbia University Press. 200 pp.

The "economics of health," which is a broader and newerterm than "medical economics," proposes to encompass themedical care industry and also to extend into such fields as tlwanalysis of the economic costs of diseases and the benefits ofcontrol programs, the returns from investment in education andtraining, and the conditions conducive to medical research.

In this monograph, Dr. Klarman reviews the past work donein economics of health and suggests future research opportuni-ties. A selected bibliography covers demand and financing:manpower and facilities; organization and planning; andmeasuring prices and cost-benefits.

DAVIS, FRED, ed.

1966. The Nursing Profession: Five, SociologicalEssays. New Yod:: Jo 1m Wiley and Sons.203 pp.

These essays, written by sociologists, are rich in observations,analysis, and interpretations of the sociocultural forces whichhave impinged on the preparation of nurses and the practice ofnursing. (Excerpted from a review by Pearl Parvin Coulter,Dean, College of Nursing, University of Arizona. Tucson, inNursing Outlook, 14 (10) :72. October 1966.)

FALTA, JEANNETTE 11., and DECK, EDITH S., eds.1966. A Sociological Framework for Patient Care.

New York: John Wiley and Sons. 418 pp.

This compilation of articles is designed to help health work-ers, particularly nurses, understand more fully the values andconcepts of sociological thought for achieving the goal of im-proved patient care. Thirty-four articfesone-fourth originaland the remainder reprints or revisions of articles or speechesare divided into seven sections: sociological ccncepts; trendsand social movements; the professions; the family; health andillness; patient problems; and "toward solutions." Each sectionis preceded by an introduction and followed by an epilogue,hich are informative and tie the sections together. An ex-

excdlent bihliography is included. (Excerpted fr(on areview hy Milton J. Nadworny. Professor of Economics andBusiness Administration, University of Vermont, in NursingOutlook, 15 (10) :16-17. October 1967.)

Moss. ARTHUR 13. ; BROEHL. WAYNE G.. JR.; GUEST,ROBERT H.; and HENNESSEY. JOHN W.

1966. Hospital Policy Decisions: Process andAction. New York: G. P. Putnam's Sons.332 pp.

Various levels of organiz.ational structures in three differentcommunity general hospitals were examined and compared inthis management study. Fundamental organizational problemswhich face modern hospital people responsible for makingsound policy decisions were revealed. The trustee, administra-tor, and physician play an interlocking role and are subject tointernal and external stress, both national and local, in makingpolicy decisions. The administrator is usually in a "pivotal"position or one of uncertain authority.

Accreditations by the National League for Nursing and theJoint Commission on Accreditation of Hospitals are shown asstrategic influences in the organizational strata, especially asthey affect nursing service and nursing education. The budgetmechanism is seen as one of the strongest factors in linkingtogether all forces in the decision-making process.

The book is also a study of behavior and beliefs, of valuesand goals. It should be of interest to trustees, doctors, andadministrators, as well as to nursing service directors andnursing educators who frequently question their individual forcein poliey-making decisions.

(Excerpted from a review by Thomas E. Frey in NursingOullook, 14 (12): 17 and 18. December 1966.)

AMERICAN PUBLIC HEALTH ASSOCIATION.

1967. A Guide to Medical Care Administration,Vol. II, Medical Care AppraisalQualityand Utilization. Prepared by AvedisDonabedian, M.D. New York: AmericanPublic Health Association, Inc. 221 pp.

This volume is a comprehensive exploration of medkal careappraisalits theory and its operation. The book contains acarefully developed frame of reference and intensive discussionof appraisal procedures, practical alternatives, and outcomes.The test is supplemented by an extensive annotated biblio-graphy.

CLARK, MARGARET ; and ANDERSON, BARBARA

GALLATIN.

1967. Culture and Aging. Springfield,Charks C. Thomas, Pub. 478 pp.

Mc authors have used an anthropological approach to agingin which 435 elderly people, residents of San Francisco, werestudied. The subjects included patients and nonpatients. Theseanthropologists showed that the following factors are all relevantin the aging process: cultural values, family attitudes, socialties and activities, sexual problems, religious beliefs, perception.

u


and both the physical and the psychological problems of aging.According to the rcscarch reported, the authors maintain

that "the aged in our society are forced to drop earlier primaryvalues in life and select alternative values such as conservation,self-acceptance, cooperation, and concern for othcrs as theyadvance in age."

Further, the aged studied "lack a strong sense of being acohesive social group, and the problems of aging lead theelderly person to deviate from our cultural norms." The authorsbelieve that "the members of our aged population want toremain involved in life activities, but we need to consider whatthey can give us and what we need from them. The aged learnto realize that there is more to life than competing with othersfor self-advancement, making money, and accumulating materialitems."

(Based on a review by Madeleine Leininger, Nursing Out-kok, 16 (2): 14. February 1968.)

FEIN, RASH!.

1967. The Doctor Shortage, An Economic Diag-nosis. Washington: Brookings Institution.199 pp.

Economic issues and a wide range of factors influencing thedemand for and supply of physicians are explored in thisbook. In projecting the demand and supply to 1975 and 1980,a shortage is forecast. Growth in group practice and the greateruse of auxiliary personnel, including assistant physicians, are.suggested as means of dealing whh this supply problem. Gov-ernment's growing commitmcnt in health and increased abilityto finance services are seen as factors stimulating these de-velopments.

Although traditional doctor autonomy is recognized as aproblem in reorganizing the practice of medicine, the authorbelieves that doctors' assumption of leadership of the team mayinfluence both rate of acceptance of the change and thecconoinic framework of the new approach. It is believed thatwhen doctors' duties are reallocated to semi-professionals, withthe doctor as teamleader, the doctors and their groups willcontinue to be reimbursed as before and increased services willbc realized.

(Excerpted from a review by Charlotte Muller in theAmerican Journal, of Public Health and the Nation's Health.58 (9): 1781. September 1968.)

LENZER, ANTHONY; and DONABEDIAN, AVEDIS.

1967. "Needed . . . Research In Home Care."Nursing Outlook, 15 (10) : 42-45 (Octo-ber).

Program planners are coneerned with the allocation of fundsand the outcome of bringing the services to patients versusbringing patients to the services. Home care service is only onecomponent in the broad range of instrumentalities for main-taining and restoring health.

The authors state that more knowledge is needed about themost effective use of home health services, and that the effi-ciency and effectiveness of those services can be increased ifthe location, organization, cost, quality of service, and staffing

nerds are studied. Knowledge is lacking, for example, in soundmeasures of direct and indircct costs to the patient, the family,and the communitl%

The authors believe that three kinds of cost studies would behelpful: "cost-service studies to identify the exact cost of

providing each of the various types of services . . . (e.g., hos-pital care versus home care) ; cost-effect studies to determinethe cost of achieving ccrtain health objectives such as restoringcertain physical functioning to a patient suffering from astroke; and cost-benefit studies to provide data on the relation-ships between the cost of resources used for care and themoney value of the benefits derived from sucb care."

REYNOLDS, FRANK W., and BARSARN, PAUL C.

1967. Adult Health Services for the Chronically111 and Aged. New York: Macmillan Co.242 pp.

This book is a eomprehensive and frank appraisal of chronicillness as a disease and as a community condition. Chronicdiseases are describcd in relation to prevention, cause, symp-tomatology, clinical courses, prognosis, treatment, rehabilitation.and public and social aspects.

The qualifications and functions of public health personneland medical specialists are outlined concisely and clearly, andcontinuity of patient care is emphasized. Difficulties in co-

ordinating community programs and facilities are pointed out.Depth information offered can enhance and improve the servicegiven by health and paramedical personnel.

The book contains an extensive bibliography, excellentgraphs, pictures, and tables, and a listing of voluntary healthagencies. Federal and State-supported programs for care of thechronically ill, financing of costs, and standards of accreditationof extended care facilities are detailed.

(Excerpted from a review by Helen Chestcrman, formerlyDirector, Public Health Nursing, San Francisco Department ofPublic Health, in Nursing Outlook, 15 (12): 21-22. December1967.)

SOMERS, HERMAN; and SOMERS, ANNE.

1967. Medicare and the Hospitals. Washington:Brookings Institution. 303 pp.

The focus of this book is the impact and implications of theSocial Security Amendments of 1965 on hospitals. It deals withthe major issues and basic features of the hospital systemrelating to the legislationutilization, quality of care, andmanpower supply. It discusses the crucial problem areas ofreimbursement, planning, and cost control, and makes somerecommendations. Future development of current trends arepredicted. (Excerpted from a review by A. Gerald Renthol inthe American Journal of Public Health, 58 (11) :2174-2175.November 1968.)



1967. Promoting the Group Practice of Medicine.Report of the National Conference on Group

5

150 APPENDIX 2

Practice. PHS Pub. 1750. Washington:U.S. Government Printing Office. 70 pp.

This report contains detailed recommendations of the phy-sicians, medical school deans, hospital administrators, healthinsurance industry executives, economists, labor and manage-ment representatives, lawyers, and Federal, State, and localgovernment employees, who met in Chicago, October 19-21,1967, to explore ways to stimulate group practice.

DUFF, RAYMOND S., and HOLLINGSHEAD, AUGUST B.

1968. Sickness and Society. New York: Harper& Row. 390 pp.

This report of a 5-year study of the behavior of peopleinvolved in the care of patients examines hospital care and theimpact of illness on patients and their families. It explores thepatient's relationship to the doctor, the nurse, ancillary per-sonnel, and his family. It raises critical issues and proposesvital changes related to the findingsthat the quality of carea patient receives is determ'ined by his socioeconomic positionas well as his medical disorder, and influences his impressionof medical care after his hospital experience. Nurses emerge astechnical, administrative, task-oriented, and not person-oriented.Nurses have no communication with medicine, so there is nocollaboration. Nursing care was found to be erratic and usuallyinadequate. The solution proposed was a new worker in thehealth field, a medical auxiliary; a person strongly linked topatients and physicians rather than to administration. (Ex-

cerpted from a review in "Book of the Year," AmericanJournal of Nursing, 69 (3) :555. March 1969. )

HILLEBOE, HERMAN E.

1968. "Public Health in the United States in the1970's." American Journal of PublicHealth and The Nation's Health, 58 (9):1588-1609 (September).

"This paper deals with projections of trends in public healthover the next decade." The author contends that the Nation isready for all types of planning and that health systems shouldbe created and coordinated under a national plan in the UnitedStates. The national effort should respond to the wishes andneeds of the people and be administratively sound and

economically established.

KISSICK, WILLIAM L., ed.1968. "Dimensions and Determinants of Health

Policy." The Milbank Memorial FundQuarterly. Vol. 66, No. 1, Part 2 (Jan-uary). 272 pp.

This volume is a collection of papers that focus on theidentification and review of the complex and diverse heulthissues and the problems most critically in need of new thoughtfor fulfillment of our national health purposeto promote andassure the highest level of health attainable for every person.The theme in discussing the various components of the healthenterprise and the health effort, their characteristics and theirinterrelationships, is the establishment of health goals and the

development of a national health policy. Health facilities andservices, their organization and delivery, the costs of medicalcare, health manpower, health planning, and the power struc-ture in health are discussed in this series of papers.

SELMANOFF, EUGENE D.

1968. "Strains in the Nurse-Doctor Relationship."The Nursing Clinics of North America, 3(1) : 117-127. Philadelphia: W. B. Saun-ders, Co. (March 1968).

This articlebased on research findingsfocuses on some ofthe problems and conflicts in the relationship between doctorsand nurses in the hospital. The author makes the point thatmany of these difficulties "stem from the organizational struc-ture of the hospital rather than from the personalities of theindividuals involved."

Three selected aspects of hospital organization that producestrain for nurses are cited. (1) Physicians tend to operate as"free agents." They, unlike nurses, do not see themselves as"full-fledged members" of the hospital organization. (2) Twolines of authority exist in the hospitaladministrative andmedical. Nurses are members of the former and physiciansbelong to the latter. Institutional patterns that are mutuallysatisfactory and that meet the needs of the hospital as a wholeshould be developed. (3) Nurses, in the absence of a function-ing health team, have assumed responsibility without therequisite authority for the coordination of patient care.

It is recommended that "nurses participate more activelyand creatively in activities that can alter the existing hospitalstructures so that health personnel can more effectively bringthe benefits of modern medical science and technology to theirpatients."

GINZBERG, ELI; With OSTOW, MIRIAM.

1969. Men, Money and Medicine. New York:Columbia University Press. 291 pp.

This book analyzes and evaluates trends in the health servicedelivery system and health manpower development and utiliza-tion of the past quarter-century, with emphasis on the changesfollowing the introduction of medicare. It appraises the politicaleconomy of health, the critical role of the physician, the rolesof allied health manpower and unmet medical needs as they arerelated to the socioeconomic structure. Prospects for meetinghealth care requirements and improving the health care systemin the years ahead involve a combination of changes in valuesand institutions that are essential to restructuring the healthindustry.

LEININGER, MADELEINE M.

1969. "Community Psychiatric Nursing: Trends,Issues, and Problems." Perspectives inPsychiatric Care. VII (1) : 10-20 (Jan-uary-February).

. The author describes the change in focus of psychiatric careand treatment from the hospital to the community, the emphasis

51


on and components of primary prevention of mental illness,and the purposes and services of a typical community mentalhealth center. Three viewpoints of role identification and ex-pectations of nursing and other heahh disciplines in the com-munity mental health center are discussed. Increased contact

with and referrals to public health nurses in the communityare related to the educational needs of public health nurses. Itis concluded that psychiatric nursing education content shouldinclude social science theories and research findings relevantto the practice of community psychiatric nursing.

Health ManpowerCASSELL, FRANK H., et al.

1966. "The Challenge of Health Manpower."Employment Service Review, November(entire issue). U.S. Department of Labor,Manpower Administration. Washington:U.S. Government Printing Office. 94 pp.

"Full issue devoted to health manpower. Includes data anddiscussion of wages, hours, working conditions, number ofemployees and recruitment for both professional and non-

professional personnel. Medical social work and nursing aresubjects of individual articles, as are needs in nursing homes,structure of career opportunities. Employment Service Surveysfor Louisiana, Wisconsin, California, North Carolina and SouthCarolina are summarized. Training activities under the Man-power Development Training Act are described." (From Ab-stracts ol Hospital Management Studies, IV: 144. June 1968.)

ROSENTHAL, NEAL H.; LEFKOWITZ, ANNIE; and PILOT,

MICHAEL.

1967. Health Manpower 1966-1975. Report No.323. Bureau of Labor Statistics, U.S. De-partment of Labor, Washington, D.C. 50

PP.

"Discussion of future requirements and supply of healthmanpower for period of 1966-1975. Part I focuses on mediealand health service industry and includes discussion of 1966employment shortages. Manpower needs by 1975 are projected.Part II discusses individual health occupations in terms ofemployment, shortages, projected needs, sources of supply andways of expanding supply. Report concludes demand for healthservices will increase rapidly over next decade, raising employ-ment requirements in health industry from 3.7 million to 535million. Individual health occupations are expected to varymarkedly in growth rates with rapid increase expected inrequirements for nursing occupations and small growth in needfor pharmacists?' (From Abstracts ol :lospital ManagementStudies, IV: 144. June 1968.)

U.S. DEPARTMENT OF LABOR.

1967. Manpower Report ol the President: AndA Report on Manpower Requirements,Resources, Utilization, and Training.Transmitted to the Congress, April 1967.Washington: U.S. Government PrintingOffice. 285 pp.

This publication contains the President's Manpower Reportand a report on manpower requirements, resources, utilization,and training, with the following major subdivisions: The Re.view of Manpower Developments in 1966; Unused Manpower;and Occupational Shortages and Training Needs. Supportivestatistical data are included in the appendix.

WEISS, JEFFREY H.

1967. The Changing Job Structure ol HealthManpower. Harvard University, Cam-bridge, Mass. 275 pp.

"Presents a framework for study of changing health carejob patterns and for changes in utilization of health manpowerover time. Develops a job classification scheme based on [1.]job families which emphasize health care functions and [2.1level of job content. Examines changes in health care jobstructure from 1950 to 1960 and makes projections for suchchanges from 1960. to 1970. Suggests that more emphasis beplaced on improved utilization of existing supplies of healthmanpower." (From Abstracts ol Hospital Management Studies,IV: 142. June 1968.)

LAMBERTSEN, ELEANOR C.

1968. "The Emerging Health Occupations."Nursing Forum, VII (1): 87-97. Winter1968.

With the provision of nursing services for the spectrum ofhealth needs and health programs as the focus, the premise isestablished that present attempts by physicians and nurses todefine practice in terms of the knowledge, judgments, and skillsrequired for safe, efficient, and therapeutic services to indi-viduals and families constitutes a highly significant trend thatwill result in many changing patterns of practice. The authorurges that such efforts be coupled with a determination ofthe levels of training necessary to perform delineated functions.She cautions that nurses'must work with emerging specializedgroups in the health manpower fields, yet maintain the ad-ministration and supervision of nursing service personnel. Thecontinuum of specialization within health occupation groupsund nursing and levels of educational preparation are discussedagainst the changing nature of technology and health services.

SOMERS, ANNE R.

1968. "Meeting Health Manpower RequirementsThrough Increased Productivity." Hos-

152 APPENDIX 2

pitals, Journal of the American HospitalAssociation. 42: 43-48, 116 (March 16).

"The United States needs large numbers of additional healthcare personnel, the author states, but numbers alone cannotresolve current manpower problems because the present systemchannels manpower into inefficient and inappropriate activities.The author maintains that the system must be changed to allowthe development of new technology, new jobs and professionalcategories, and new methods of organizing and deliveringhealth care." And "the generally pursued approach to produc-tivity and to operating efficiency is too narrowly conceived andbased. A better approach is one that involves all the key ele-ments in the productivity equation: manpower, organization,management, education, motivation, professional mores, evenlegislation. This paper is focused on manpower, but all thefactors mentioned above are involved."


TION.

1968. Technology and Manpower in the HealthService Industry, 1965-75. ManpowerResearch Bulletin 14, May 1967. Wash-ington: U.S. Government Printing Office.109 pp.

Trends in the structure and characteristics of health serviceemployment are presented and analyzed. Major current prob.lems in meeting health manpower needs and job requirementsare included. Technological developments and their effects onmanpower in the decade ahead are examined. Tlwn the contbined effect of expected trends in the demand for healthservices and the key technological development on the structureof health service employment are analyzed.

Nursing Trends, Issues, and ConcernsMEYER, GENEVIEVE ROGGE.

1960. Tenderness and Technique: Nursing Valuesin Transition. Institute of Industrial Rela-tions, University of California, Los Angeles.160 pp.

This research report defines four types of nurses in relation-ship to two traditions in nursing"tenderness" and "technique"and the value nurses place on them. The interpretation ofeach type of nurse, made in a time of many changes in thenursing profession, is extended through an examination of thepersonal background of nurses and their attitudes towardpatients, visitors, doctors, practical nurses, and aides. The in-fluence of education (diploma, associate degree, baccalaureate.and post-basie programs) on the development of attitudes ofall types of nurses is examined, as well as their attitudes towardthe process of supervision. The book makes an important con-tribution to knowledge of the profession of nursing. (Excerptedfront a review by Gladys Nite, Director of Research in Nurs-ing, Community Studies, Kansas City, Mo., in the AmericanJournal of Nursing, 61:44. September 1961.)

ROSENFELD, CARL; and PERRELLA, VERA C.1965. "Why Women Start and Stop Working: A

Study in Mobility." Monthly Labor Review.88 (9) ; 1077-1082 (September).

A nationwide sample survey of women who had either takenjobs or stopped working in 1963 was conducted early in 1964 bythe Bureau of the Census. The purpose was to obtain insightinto "the attitudes and motives which influence women's de-cisions to participate in or withdraw from the labor force."

Among many factors present in the women's decision to goto work, those representing economic necessity were most fre-quently reported--about half the women went to work for thisreason. Approximattly 30 percent gave personal satisfaction or

a desire for extra money as the most important reason. A smallproportion gave "finished school" and "offered a job" as themajor reason. Most women (89 percent) who left the laborforce during the study period were married. Pregnancy was byfar the greatest reason married women under 35 years old leftthe labor force. Illness was most frequently given as the reasonby women 45 to 64 years old and was also frequently givenby women 35 to 44 years old.

Occupations and earnings, work plans, and training are otherareas of interest discussed in this report.

BULLOUGH. BONNIE; and BULLOUGH, VERN.

1966. Issues in Nursing. New York: SpringerPublishing Co. 278 pp. (paperback).

Original source materials on five nursing issueseducation,professional status, role definition, economics, concepts of directnursing careare presented in this volume. Articles and ex .eerpts of reports published between 1893 and 1965 are prefacedwith a brief explanation of their relevance and background.Critiques which confront rather than avoid controversial issueshave been selected. The book gives insight into the presentproblems of nursing and how they came about. (Excerptedfrom a review by Florence S. Wald, Dean, Yale UniversitySchool of Nursing, in American Journal of Nursing, 67

(10): 2174. October 1967.)


TION.

1967. Work Life Expectancy and Training Needsof Women. Washington : U.S. GovernmentPrinting Office. 10 pp.

The work pattern of women, length of working life, thedynamics of the female labor force, education, training, re-training, and work adjustment are discussed.


BROWN, ESTHER LUCILE.

1970. Nursing Reconsidered, A Study of Change.Part I, The Professional Role in Institu-tional Nursing. Philadelphia: J. B. Lip-pincott Co. 218 pp.

This report describes new or evolving nursing roles andhealth programs that might provide clues or models .to increasethe effectiveness of nursing practice and nursing service. Tech-nical specialization, the expanding role of the clinical nursingspecialist, and the reorganization of nursing education andnursing services in hospitals and other organizations are dis-cussed. Current nursing practice in extended-care facilities,nursing homes, retirement lmmes, and homes for the aged isexplored.

GLASSER, PAUL H., and GLASSER, Lots N.; eds.1970. Families In Crisis. New York: Harper &

Row Publishers. 405 pp. (paperback).This book offers a broad and nontechnical review of family

crises. Compiled for students and practitioners in education,welfare, and health professions, it interprets three commoncrisis situations (poverty, disorganization, and physical andmental illness) faced by families. It is an important reference,particularly for those interested in mental health and publichealth practice. (Excerpted from a review by Frances Adamson,formerly psychiatric nurse, special project, Contra Costa CountyMedical Ileahli Services, Calif., in American Journal ol Nurs-ing, 71 (7): 1441-1442. July 1971.)

SPALDING, EUGENIA KENNEDY; and NOTTER, LUCILLE E.1970. Professional Nursing; Foundation, Perspec-

tive and Relationships. Philadelphia: J.B. Lippincott Co. 677 pp.

This text covers the major trends and problems affecting theworld of nursinghistorical, political, social, economic, legal,educational, professional, and personal.

It is interesting to note that the first edition of this bookwas published in 1939 under the title Professional Adjustmentsin Nursing, and that although it has had four title clmngessince then, the book has remained basically the same.

A discussion of the leadership necessary for professionalprogress is a distillate of the thinking of outstanding leaders

in administration and education. Modifications in the structureand function of national nursing organizations and the PublicHealth Service were reflected in the third printing of the 7thedition in 1968.

At the end of each clmpter, suggested reference lists aregiven. Also, recommendations are given for additional readingsources for style, library usage, abstracting, indexing, proof-reading, and professional relationships.

Alt lmugh this book is intended as a text for students in basicnursing, it can contribute a deep understanding of nursing tolay and non-nursing members of planning groups.

and NOTTER, LUCILLE E.1971. Nursing Reconsidered, A Study of Change.

Part II, The Professional Role in Com-munity Nursing. Philadelphia: J. B. Lip-pincott Co. 285 pp.

The authors discuss recent developments in ambulatory andcommunity nursing, with implications for the expanding roleof the nurse on the therapeutic team. Community healthcenters, lmspital-approved home.care services, neighborhoodfamily health centers, outpatient services, and psychiatric hos-pitalsall these settings are included.

THE CARNEGIE COMMISSION ON HIGHER EDUCATION.

1971. Less Time, More Options: Education Be-yond The High School. Hightstown, N.J.:McGraw-Hill Book Company. 45 pp.

This is a special report by the Commission established in1967 to investigate and make recommendations concerningissues in higher education in the United States as the year2000 is approached. The Commission selected the followingmajor concerns of higher education for study and investigation:structure, function, and governance; innovation and change;demand, resources, costs, and expenditures; and efficiency inuse of resources. A number of reports will be published.

This report focuses on a topic that is central to every otheraspect of higher educationthe general flow of students intoand through the formal structure of higher education in theUnited States and the key role played by degrees in this flow.Recommendations calling for basic changes in the pattern ofthis flow are included.

Nursing EducationMONTAG, MILDRED L.

1951. The Education of Nursing Technicians.New York: G. P. Putnam's Sons. 146 pp.

This book is the report of a study to plan a 2-year programfor the preparation of nurses with predominantly technicalfunctions consisting of about equal amounts of general educa-tion and technical education, and a proposal for the preparation

of nurse personnel for faculty for these programs. The studyproposed that the education of technical nurses be conductedin junior colleges, technical institutes, and community colleges.The book describes the education proposed and the generalnature of such programs and faculty requirements. It recognizedthat the study was limited because no experimental evidencewas available; no program of this type was in operation. Thestudy represents a plan for beginning controlled experimenta.

154 APPENDIX 2

tion in nursing service and nursing education. (Excerpted froma review by Helen L. Bunge, Dean, Frances Payne BoltonSchool of Nursing, Western Reserve University, Cleveland,Ohio, in the American Journal of Nursing, 51 (6): 354. June1951.)

BRIDGMAN, MARGARET.

1953. Collegiate Education lor Nursing. NewYork: Russell Sage Foundation. 205 pp.

This book is an exploration into collegiate nursing educationfocused on basic nursing education and its relationship tohigher education. Educational responsibility and policy are dis-cussed against the background of basic issues in nursingsupply and demand for nurses, needs for quality care, enlargedscope of nursing care, deficiency of nursing services, relation-ships of nursing service to nursing education, and implicationsfor collegiate nursing education. The intent is to help to clarifyissues, to bring about a consensus on principles that wouldlead to long-range planning for collegiate nursing education.

The necessity for colleges or universities to have control overeducation of students in the clinical fields was pointed out andcritical questions were raised as to the best patterns. Thc needfor regional planning for collegiate nursing education for thewisc use of resources was stressed. This book is seen as aguide and aid to the development of collegiato nursing educa-tion programs.

(Excerpted from a review by Helen L. Bunge, Dean, FrancisPayne Bolton School of Nursing, Western Reserve University,Cleveland, Ohio, in Nursing Outlook, 1 (2): 72 and 118.February 1953.)

MONTAG, MILDRED L., and GATKIN, LASSAR G.

1959. Community College Education lor Nursing.New York: Blakiston Division. McGraw-Hill Book Co., Inc. 457 pp.

This is a detailed report on the experimental project con-ducted in seven junior or community colleges and a hospital,on technical education for nursing and the systemic evaluationstudy of the effectiveness of the graduates of these programs.The historical development, purpose of the project, criteria setfor participating institutions, project methodology, staff, andadvisory services are discussed.

Evaluation included thc development of instruments for de-termining effectiveness of teaching and learning techniques,and followup studies for directing program improvements.Comparative studies on qualifications for State registered nurselicensing examination wcre made with graduates from othertypes of programs. Work performance of graduates in begin-ning staff level positions under supervision, given some workexperience and the advantages of inservice training, was com-pared with that of graduates from other types of programs.This book is a record of the successcs of the experimentalphase of technical nursing education for meeting needs fornursing personnel.

(Excerpted from a review by Alice E. Imgmire, AssociateProfessor, University of California School of Nursing, SanFrancisco, in Nursing Outlook, 7 (9): 503-504. September1959.)

TATE, BARBARA L.

1961. "Attrition Rates in Schools of Nursing."Nursing Research, 10 (2) : 91-96 (Spring).

Rates of attrition of students who entered basic diplomaand baccalaureate programs in nursing in 1954 and 1955 werestudied, using data available at the National League for Nurs-ing. Thc data revealed a significant difference in the attritionrates in basic nursing programs by type of program, regionof the country, and year in the program. There was no sig-nificant difference in the attrition rate by accreditation statusof programs. The study raised numerous questions concerningfactors that might affect attrition rates.

FLANAGAN, JOHN C., et al.

1964. Project Talent. The Identification Develop-ment and Utilization of Human Talents.The 1960 National Survey. The AmericanHigh School Student. University of Pitts-burgh, Pittsburgh, Pa. 493 pp.

This longitudinal research study provides detailed nationalinventory data on the achievement, aptitude, interests, person-ality characteristics, career plans, and aspirations of Americanhigh school students in 1960. Data are intercorrelated andinclude followup information on occupational choices (includ-ing nursing) and career plans 1 year after graduation. Thestudy was conducted to provide information on specific patternsof aptitudes, abilities, and interests; on educational experi-ences; and on guidance procedures that can provide a basisfor assisting students in selecting the career that will assurehim the greatest personal satisfaction and success.


1965. Educational Preparation for Nurse Practi-tioners and Assistants to NursesA PositionPaper. New York: The Association. 16

PP.

"This document sets forth the professional nursing asso-ciation's position concerning the education necessary for thepractice of nursing." Prepared by the Committee on Educationafter a 2-year study of the major trends in nursing and thesocial forces affecting nursing and patient care, the positionstates that "Education for those who work in nursing shouldtake place in institutions of learning within the general systemof education." The paper defines professional and technicalnursing practice. It sets the minimum preparation for profes-sional nursing practice as the baccalaureate; for technicalnursing practice, the associate degree; and for assistants tonurses, the short, intensive, pre-service programs in vocationalinstitutions rather than on-the-job training. It proposes thatprograms for educating practical nurses be systematically re-placed with programs for beginning technical nurses in juniorand community colleges. The need for programs for continuingeducation, advanced study, and research in nursing, to updateknowledge and skills and maintain competencies, is also

stressed.


TAYLOR, C. W., et al.1965. Report of Measurement and Prediction of

Nursing Performance. Part I. FactorAnalysis of Nursing Student's ApplicationData, Entrance Test Scores, AchievementTest Scores, and Grades in Nursing School.Salt Lake City: University of Utah. 54 pp.

"This section of a larger study is concerned with inter-relationships among selection devices and academic and clinicalachievements in nursing; the kinds of qualities or abilitiesthat grades in nursing school actually measure; and the degreeto which selection tests, forms or other devices currently usedby nursing schools predict performance on these abilities. Atotal of 814 nursing students' records were studied. Factoranalysis was the method selected to study many predictor andachievement score variables. Findings revealed that clinicaland academic performance were not closely related. Typicallyused predictors of intellectual capacity or academic achieve.ment predict only a narrow spectrum of achievement in nursingeducation." (From a review by H. E. Dorsch in Nursing Re-search, 16 (2): 208. Spring 1967.)

ANDERSON, BERNICE E.

1966. Nursing Education in Community JuniorColleges. Philadelphia: J. B. LippincottCo. 319 pp.

This is an account of a 5.year project in the States ofCalifornia, Florida, New York, and Texas, supported by theW. K. Kellogg Foundation to further the development of as-sociate degree programs in nursing. In accorflance with pre-established criteria, support was offered in six major areas:faculty preparation, continuing education, consultation, programdevelopment, demonstration centers and laboratories for futureteachers, and evaluation of developing programs and of grad-uates of programs.

Graduate programs to prepare teachers were estz.blished infour States. One year of program planning preceded the open.ing of associate degree programs, and funds were allocated fora director for 1 year and instructors for 4 months beforeadmission of students. Success in the project was attributedto the teamwork and combined knowledge, experimentation,and financial support of educators' professional groups andprivate philanthrophy. It further resulted in new methods forrecruiting faculty and students, and new teaching methods.

(Excerpted from a review by Ruth S. Swenson, Director,Associate Degree Program in Nursing, Weber State College.Ogden, Utah, in Nursing Outlook, 14 (7) :17. July 1966.)

NEW YORK STATE NURSES ASSOCIATION.

1966. Education for Nursing Practice. Reportof the New York State Nurses Association.Arden House Conference. (Availablefrom the Association, 255 Lark St., Albany.N.Y.) 52 pp.

This conference was held to enable nursing leaders to discuss

in-depth nursing education, nursing service, and the role of theprofessional association. It provided an opportunity for an in-depth assessment of the position of tbe professional associationfor registered nurses on education for nurse practitioners andassistants to nurses. As reflected in the report of the proceed-ings of the conference, it served to identify and clarify prob.lems, sharpen issues, and stimulate group interaction for seekingsolutions to nursing needs and demands. It recommendedactions for the Committee on Education, New York State NursesAssociation, to initiate in connection with nursing education.This conference is recognized as the beginning of continuingactivity to achieve State and regional planning for nursing

education in New York.

GEITGEY, DORIS A.

1967. "The Teacher in Associate Degree NursingPrograms." Nursing Outlook, 15 (2) :30-32 (February).

The author succinctly describes how teaching in an associatedegree nursing program differs from teaching in other kinds ofnursing education programsgraduate, baccalaureate, and

diploma. The areas touched upon include the philosophy of thecollege, heterogeneity of students, purpose of the program,curriculum design, and teaching load.

ROBSON, R. A. H.1967. Sociological Factors Affecting Recruitment

Into The Nursing Profession. Royal Com-

mission on Health. Ottawa, Canada:Queen's Printer. 244 pp.

A model of five factors influencing career choicepersonalvalues, perception of the degree to which various occupationssatisfied these values, self.image, social background, and patternsof influence and supportprovide the framework of the study.Data from questionnaires to over 2,597 persons were amplifiedby interviews with a subsample of individuals. Cultural andattitudinal orientation will assume importance in reconcilingdivergent points of view.

TATE, BARBARA L., and KNOPF, LUCILLE.

1968. Nurse Career-Pattern Study. Part I:Practical Nursing Programs. Code No.19-1335. New York: National League forNursing. Research and Development.182 pp.

This report concerns 3,014 students who entered 117 practicalnurse programs in the fall of 1962. It contains biographicaldata and statistical presentations and information on reasonsand experiences associated with choice of practical nursing andcareer goals at the time of entrance; biographical data andcareer goals at time of graduation; and biographical data,career information, and related activities 1 year after grad.uation. Information about non-graduates includes comparisonswith graduates. Implications of findings are discussed, andrecommendations are made pertaining to practical nursingeducation and employment.

156 APPENDIX 2

HOWARD, D. ROBERT; and FASSER, C. EMIL.1970. "Duke University's Physician's Assistant

Program." Hospital Progress, 51 (2) :49-55 (February).

This progress report of the physician's assistant programdescribes the admission requirements; the current curriculum,with changes that have evolved and proposed changes for thefuture; program costs; and acceptance of the graduates byphysicians and patients. The article includes some thoughtsabout the future of this health worker, salary, and questions,particularly in regard to licensure.

KELLER, MAJORIE J., in association with W. THEODOREMAY.

1970. Occupational Health Content in Baccalaure-ate Nursing Education. Bureau of Occu-pational Safety and Health and Trainingand Manpower Development. PublicHealth Service. Department of Health,Education, and Welfare. Cincinnati,Ohio. 126 pp. (Contracts PH-86-64.106and PH-86-66-179.)

From 1965 to 1969, a project designed to identify occupa-tional health nursing content essential in baccalaureate educa-tion for professional nursing was conducted at the University

Id Tennessee College of Nursing. The authors believe that theimplications of the results of the project fall into four areas:(I) use of the theoretical framework and its application tonursing education; (2) use of the methodology in evaluatingany content area of a nursing curriculum (with the contentarea of occupational health nursing already worked out) ; (3)continued refinement of the occupational health nursing achieve-ment test; and (4) exploration of suggested ideas to provideadditional meaningful learning experiences for professionalnursing students in the work setting.


1970. A Validation Study of the NLN Pre-Nursingand Guidance Examination. Pub. 17-1390.New York: The League. 65 pp.

The study relates student performance on the pre-nursingand guidance examination to survival in the education program,ratings of classroom and clinical performance, type of educa-tional program, graduation, licensing examination results,

racial background, and achievement test performance. In addi-tion, data relating achievement and licensing test results arepresented, and attrition and graduation statistics are analyzed.The sampling comprised more than 12,000 students from

baccalaureate, diploma, and associate degree programs in 45jurisdictions of the United States. (From NL1V News, 18(3): 11. May-June 1970.)

Nursing Service, Nurse Staffing, and UtilizationTHE NATIONAL LEAGUE oF NURSING EDUCATION. THE

COMMITTEE ON STUDIES.

1937. A Study ol the Nursing Service in FiftySelected Hospitals. (Reprinted from theHospital Survey for New York, Vol. II,chap. V, pp. 355-429). New York: TheUnited Hospital Fund of New York. 74pp.

The purpose in making this study of nursing service in 50acute general hospitals was "to find out how well hospitalpatients are nursed in New York City." Thirty-one voluntary,one county, and 18 municipal hospitals were chosen. Thenumber of bedside nursing hours provided patients in the fourbasic servicesmedical, surgical, obstetric, and pediatricinthese institutions was obtained. The hours of care cited in-cluded time given by graduate nurses, student nurses, attend-ants, orderlies, and ward helpers. The time provided wasexamined in terms of type of hospital, basic service, and shift.Assessment of other factors included: the ratio of supervisorsand head nurses to patients; the ratio of supervisors and headnurses to bedside workers; the extent to which non-professionalworkers are employed for bedside care; and the balance be-

tween patient load and bedside workers in the different

hospitals.Recommendations based on study findings included the fol-

lowing: suggested minimum number of hours of bedside serviceper patient in each 24-hour period, by type of service studied;

the number and kinds of personnel needed and the number ofhours of employment of those personnel needed for any hospitalnursing service. Further study and research about the factorsreviewed was strongly recommended.

NATIONAL LEAGUE OF NURSING EDUCATION. DEPART-

MENT OF STUDIES.

1948. A Study of Nursing Service. New York:

The League. 63 pp.

This was a study of the nursing services in one children'shospital and 21 general hospitals in the New York City areareputed to be well managed and to be providing high qualitynursing care. An intensive study was made of the nurse-patientratios in these hospitals and the duties performed by non-professional nursing personnel trained on the job. In all of thehospitals except one, the general hours of nursing care actuallygiven per patient were fewer than the hours need. Tlu !

average ratio was 3.5 hours of nursing care per patient per day,

of which two-thirds was provided by registered nurses andone-third by nursing aides, practical nurses, and others. The

157


study provided medians to be used as guides in determiningthe nursing needs of medical, surgical, obstetrical, and pediatricpatients in general hospitals. Measures to improve the training.supervision, and utilization of nursing aides in hospitals werealso recommended.

LEVINE, EUGENE; SIEGEL, STANLEY; and DELE PUENTE, JOSEPH.

1961. "Diversity of Nurse Staffing Among Gen-eral Hospitals." Hospitals, Journal of TheAmerican Hospital Association, 35: 42-48(May 1).

This article presents data on the actual ratios of nursesto patients in short-term general and allied special hospitalsin the United States in 1957. The data show the great diversitythat exists among these hospitals in nurse staffing ratios. Manyfactors that may influence the nurse staffing of a hospital aresuggested from an analysis of nurse staffing data.

MULANEY, GERTRUDE S.; CURTIS, JACK; ANTONMATTEI,

JEAN; and WILHELM, MARGARET.June 1963. Quantitative Measurement of Nurs-

ing Service in Nursing Homes.Milwaukee Health Department, Mil-waukee, Wisc. 53 pp. (processed).

This is a report of a study by the Milwaukee Health Depart-ment that describes the amount of nursing time and the qualityof nursing service utilized in the care of 114 patients in 14nursing homes. Significant findings, study methodology, ex-ploratory statistics, and a description of assisting personnel arereported. It is believed the data collected in the study can beuseful in estimating the approximate time needed for the careof patients according to their specific capabilities or disabilities.

EDGECUMBE, ROBERT H.

1965. "The CASH Approach To Hospital Manage-ment Engineering." Hospitals, 39 (6) :70-74. (March 16, 1965).

This is a report of a project concerned with the improvementof nursing service management. The Commission for Admin.istrative Services in Hospitals (CASH) is an incorporated,nonprofit organization which provides management engineeringservices for the improvement of hospital service through theuse of modern management engineering techniques for a

monthly subscription fee. At the time this article was written,80 southern California hospitals were participating. The pro.gram includes: traininp of supervisory personnel in scientificmanagement and industrial engineering techniques, and as-sistance in applying these techniques in the hospital; intensivesurveys in the hospital to study departmental operations anddata standards for job performance and departmental operationsin order to establish their own performance standards, person.nel, staffing, and departmental organization. The resources ofthe member hospitals are used for the devdopment of improvedmethods and procedures, and information is disseminated on

both individual and collective accomplishments to all the mem-ber hospitals for the advantage of each.GARRETT, S. A. G., et al.

1966. "The Need for Intensive Nursing Care."British Medical Journal, 20: 34-41 (Jan.1966).

Between July 1, 1963 and June 30, 1964, a study was done ofpatients requiring intensive nursing care in a general teachinghospital of 486 beds. Of the 486 beds, only 441 were includedin the study: 203 surgical, 196 medical, and 42 pediatric.Postoperative patients were excluded from the study. Criteriafor patients needing intensive nursing care were defined, anddaily evaluations of need for intensive nursing care were made.it was calculated that, to meet intensive care needs on 95percent of all occasions, four beds would be required. Theduration of intensive nursing care in patients requiring thiscare and the categories and types of patients needing intensivenursing care in relation to all patients in the hospital aredetailed. Methodology and a statistical appendix are given.(From an abstract in Nursing Research, 15 (4) : 367. Fall1966.)

AULD, MARGARET G.

1967. "An Investigation into the Recruitment andIntegration of Part-time Nursing Staff inHospitals." International Journal of Nurs-ing Studies. 4(2) : 119-168 (May).

This is a report of a survey conducted to ascertain why moretrained nurses do not return to work part.time, what induce.ments are necessary to entice them back to the profession, andthe best method of bringing new inducements to their work.The study revealed that a completely new outlook toward therecruitment and welfare of part.time nurses is needed, includ-ing changes in patterns of work, work functions and full inte-gration of the part-time nurse as part of the nursing team.

HAWLEY, KAREN SUE.

1967. Economics of Collective Bargaining byNurses. Industrial Relations Center, IowaState University, Ames, Iowa. 180 pp.(processed).

This study explored the relationship Ldween the use ofcollective bargaining by nurses and the nursing shortage. Thestudy was supported by a survey of the economic status andworking conditions of registered nurses in 122 Iowa short.termgeneral non-Federal hospitals in March and April of 1967. Alabor analysis was made in four main areas: (1) secondarywork force characteristics of nurses; (2) determinants of andrelationship between salaries and vacancies for hospital nurs-ing personnel; (3) influence of preparational requirementsupon the supply and quality of nurses; and (4) reaction ofhospital administrators to higher nursing .ialaries. It wasconcluded that collective bargaining can have positive effectsupon the supply of nurses by both increasing and makingbetter use of the local supply.

tr r..)c.)

158 APPENDIX 2

MENDELOV, DAVID.

1967. A Study of Various Organizational Arrange-ments of the Unit Manager System. TheGeorge Washington University, Washing-ton, D.C. 52 pp.

"An investigation of the question of at what level of authorityUnit Managers function most effectively in hospital nursingunits. Questionnaires were sent to selected hospitals employingUnit Managers, conferences were held with representatives ofactive programs, and a pilot program was used for first-handobservation. The author concluded the Unit Manager would bea co.equal of the charge nurse but should be organizationallyplaced under administration rather than nursing." (From Ab-stracts of Hospital Management Studies, VI: 145. June 1970.)

LEWIS, CHARLES E., and RESNHC, BARBARA A.

1967. "Nurse Clinics and Progressive AmbulatoryPatient Care." The New England Journalof Medicine, 277 (23) : 1236-1241 (Dec.7)

"Report of a project to evaluate a more active role fornurses in ambulatory patient care in a medical clinic. Patientswere randomly divided into two groups after initial testing andevaluation. One group received all their medical care from anurse, the other did not. Patient reactions were assessed, andwere generally negative toward the nurse. In a retest one yearlater, there was no change in control group. In the experimentalgroup: the nurse was accepted as primary source of care; therewas an increased adherence to appointment schedules; a betterutilization of time; lower costs; decreased frequency of com-plaints; and 'quality of care and patients' satisfaction withcare were higher.'" (From Abstracts of Hospital ManagementStudies, V: 260. June 1969.)

MICKEY, JANICE E.

1967. A Methodological Study of Extra-HospitalNursing Needs. The Johns Hopkins Uni-versity, Baltimore, Md. 562 pp.

This study developed and tested a method for estimatingextra-hospital nursing needs of the total population of a countyin Pennsylvania. The method employed an interview schedulesoliciting nurse-related health problems in 18 categories, pre-determined criteria of the intensity of need, and judgments foreach category. Interview findings were tested against careactually given by public health nurses. It was concluded thatnurses need considerably more help to be successful in assessingand meeting total public health nursing needs. However, judg-ments of needs were significantly related to certain demographicvariables such as type and size of familyi and educational andoccupational status. Replication and refinement in study meth-ods are suggested for development of a mathematical formula tohe applied to census data for generating estimates of serviceneeds. (Abstracted from Abstracts of Hospital ManagementStudies, VI: 183-184. June 1970.)

PRICE, ELMINA.

1967. "Data Processing. Present and Potential."American Journal of Nursing, 674 (12) :2258-2264 (December).

This article presents an overview on the potential effects ofcomputerization upon nursing. It explains what is now possibleto gain from computers, what is potentially possible, and hownurses will communicate with computers. The difference be-tween manual, semi-automated, and fully automated systems isexplained. The author delineates the place where nurses mustparticipate in developing these systems.

AYDELOTTE, MYRTLE KITCHELL.

1968. Survey of Hospital Nursing Services. New

York: National League for Nursing. 58

PP.

This is a report of a questionnaire survey of 93 items per-taining to the current status of .nursing service activities in1,172 short-term general non-Federal, non-psychiatric hospitalsof all sizes. The survey, conducted in 1964, was intended tostimulate hospital nursing services to examine their status asa basis for implementing the criteria for effective nursing

service developed by the National League for Nursing. Surveyfindings highlighted in the report include: nursing services'continuity for other services; limited inservice education pro-grams; a variety of hospital educational programs; and thecharacteristics and activities of directors of nursing service.Survey findings point to needed changes in the organization andadministration of nursing services and improved leadership forSits administration. (Excerpted from a review by L. Flynn inNursing Research, 18 (1): 90. January-February 1969.)

BUEKER, KATHLEEN; and SAINATO, HELEN K.

1968. A Study of Staffing Patterns in PsychiatricNursing. Washington: Saint Elizabeth'sHospital. 103 pp.

The purpose of the study was to determine the effects ofselected combinations of nursing staff with prescribed functionsupon the therapeutic milieu and nursing care of patients.

The results of this study showed that a selected combinationof 10 nursing staff, with functions prescribed by a graduatenurse, along with the services of a ward clerk and participationfrom the ward physician, increased the effectiveness of the wardmilieu and improved the treatment program for patients. Com-parison with wards that served as controls substantiated thefindings reported here and elsewhere that traditional staffingpatterns and only remote supervision by professional personnelmaintain the status quo and custodial patient care.

DUNLAP, HENRY B.

1968. "Employee Turnover Costs Millions." Hos-

pital Forum, XI (4) :12-13 (July).

"Report of 1964 and 1966 studies on approximately one-halfof the Southern California hospitals, considering employmentcosts, efficiency loss, training time and separation costs. Correc.


tive measures are recommended." (From. Abstracts ol HospitalManagement Studies, V:127. July 1969.)

ESPOSITO, PAULETTE; and LOBOZZO, SANDRA.

1968. A Manual for Team Nursing. The CatholicHospital Association, St. Louis, Mo. 56

PP.

"A manual explaining the principles and implementation ofteam nursing. The roles, responsibilities and relationship ofthe members of the professional health team, and partkularlyof the nursing team segment are outlined. Assignment planning,team conferences, and nursing care plans are explained. Criteriafor team reports are given, as are specimens of report andassignment forms and an example of a nursing team confer.ence." (From Abstracts ol Hospital Management Studies, VI:141. June 1970.)

MCLAREN, KAZUL K.

1968. A Study of Professional NursingNon.Nursing Tasks in Public Health Nursing inHawaii. Public Health Nursing Branch.Medical Health Services Division. HawaiiState Department of Health. Honolulu.34. pp. (mimeographed).

"A study was conducted in the 4 counties of Hawaii to de-termine which of the activities performed by public healthnurses required professional nursing knowledge and which didnot. Tasks were organized into unitsplanning and assessing,implementation of nursing care, evaluation, and study and re.search. The work units were categorized into service unitsvisit, clinic, school, nursing and home care, district management,health surveillance, and student and observer activities. Of the570 tasks only 63.3% were considered by staff to need pro.fessional knowledge. Of the 449 tasks performed during theone.week time study by a random sample of staff public healthnurses 58% needed professional knowledge. . . ." (From areview hy V. Nelson in Nursing Research. 18 (6): 555. Novem.ber.December 1969.)

MUSSALLEN, HELEN K.

1968. "No Lack of NursesBut a Shortage ofNursing." International Nursing Review,15 (1) : 35.47 (January).

The author contends that in Canada there exists a shortageof available nursing hours rather than a nursing shortage. Thecauses of this shortage are identified as: poor utilization of

nursing time, waste of nursing skills, staff turnover, emigration,and non.practicing personnel. Also, if the substandard levelsof salaries and working conditions prevail, the writer states,an actual shortage of nurses will take place in the near future.The causes are discussed in detail, and a number of actions toimprove the situation are proposed.

ROSNER, LESTER J.; ROSENBLUTH, LUCILLE; PITKIN,OLIVE; and MCFADDEN, GRACE M.

1968. School Health Personnel Utilization Project.

Report on Phase, II, "An Experiment WithA Restructured School Health Team."Sponsored by Medical and Health ResearchAssociation of New York City, Inc. Incooperation with the Department of Healthof the City of New York. 96 pp.

Staffing recommendations which resulted from the Phase Ipart, "A Study of Utilization Patterns: Methodology and Find-ings," were used in Phase II of the experiment. A team ap .proach to the school health program was undertaken on a verylarge pilot basis in 95 public and parochial elementary schoolsand 12 junior high schools in New York City. Teams werecomposed of physicians, staff nurses, public health nurses, andpublic health assistants. The study showed that the team ap.proadh can reduce the amount of professional time wasted onsuhprofessional activities by professional people. It was furtherbelieved that with longer experience with the team approach,further reductions are possible.

ZIMMERMAN, JAMES P.

1968. "Initiating A Unit Management System."Hospital Progress, XLIX (2) : 64.66, 72(February).

The unit management system is one approach hospitals mayuse to improve utilization of unit staff and to expedite nursingcare and services to patients. The initiation of a successful unitmanagement system into a particular hospital depends upon acareful appraisal of the current hospital system and activitiesof unit personnel. Successful change and introduction of a newsystem depend upon mutual planning, cooperation, and com-munication between hospital administration and nursing service.

The author describes: the method used to initiate a unitmanagement system ht a 585.bed hospital; the time studiesused to identify the activities of unit staff; a description oftbe non.nursing activities which served as the basis for thejob description of the unit manager; the pilot unit; and theimplementation of the total system.

DUNN, HELEN W., and MOIWAN, ELIZABETH M.1969. The Nursing Audit. National League for

Nursing, New York. 42 pp. (May).

"A discussion of the nursing audit, an administrative toolfor the evaluation of the quality of nursing care as reflectedin the medical records, based on the seven years experience ofthe Department of Nursing at the University of Illinois Re.search and Educational Hospitals. The first section summarizeshow the audit functions as an evaluative tool. The secondsection presents in detail the steps involved in setting up theaudit and the distinction between the responsibilities of theDepartment of Nursing and the Medical Records Department.Charting practices and samples of forms are given." (FromAbstracts ol Hospital Management Studies, VI: 144. June1970.)

2

160 APPENDIX 2

HARDNER, SISTER MARGARET ANN.

1969. A Study of Unit Management. XavierUniversity, Cincinnati, Ohio. 117 pp.

"Study to detennine the extent of the nut k (g Unit Manage-ment Program (UMP) in 400+ bed, voluntary, short-termgeneral hospitals throughout the United States: to collect andanalyze data about UMP's in these hospitals; to (kmonstratethe development and implementation of the UMP at St. VincentHospital and Medical Center, and to evaluate after one year.A profile of the Unit Manager and the UMP was developedfrom data collected by questionnaire for 43 UMP hospitals.Thirty-seven hospitals reported success or partial success inaccomplishment of their objectives: mainly better use of nurs-ing personnel and better patient care." (From Abstract olHospital Management Studies, VI: 152. June 1970).

JOHNSON, WALTER L.

1969. Content and Dynamics of Home Visits ofPublic Health Nurses; Part 2. New York:American Nurses' Foundation. 134 pp.(paperback' .

This is an empirical study focusing on the "communicativeinteractional dimension" of the nurse's therapeutic role. Thisis the second and final volume of a field study initiated in1956 to study contacts between patients and public healthnurses. The first section was published in 1962, with the lateClara A. Hardin as coauthor.

The sample consisted of 289 home visits. The investigatordescribes the observational dimensions of the study and themethods used Ior statistical manipulation, sample comparison,and analyses. Correlations helped to identify researchable hy-potheses, and the use of case analysis increased the force ofsome of the findings.

The findings present "some extremely valuable indicatorsfor evaluating the quality of the nurse's home visits and sug-gests that the current standard of nursing care is not beingmet." The author states, "A limiting factor in the deliveryof nursing care which has been documented repeatedly in thisreport is the variability of patient reactions to services renderedby the nurses." Also, he implies that the nurse needs to rede-fine "helping the patient" as "finding solutions to his patient'sproblems as he defines them, even if it takes time." Anotherimplication the data offer for consideration is that "standardshave been developed without regard to implementation oreffectiveness."

(Based on a review by Beverly H. Brown in Nursing Outlook,18 (4): 24. April 1970.)

MILLER, DULCY B.

1969. The Extended Care Facility; A Guide, ToOrganization And Operation. New York:Blakiston Division, McGraw-Hill Book Co.480 pp.

"In this book the author shares her years of experience asdirector of an extended care facility. The procedures andguidelines for organizing all departments and services should.

1 61

In especial!) hdpful to those seeking federal approval forparticipation in the Medkare program."

This publication can be used as a reference for daily opera.tional procedures, inservice educational programs, mutual revisions, and employee orientation to special jobs.

It is a useful reference for the new as well as the experiencedadministrator. The former will acquire knowledge of the dailyamivities her job entails %%hile the latter will be able to compareprocedures of operation.

The II chapters with appropriate subtitles are complete forall servkes and departnwnts in a good nursing home. Therecipients of carethe patientsare the chief beneficiaries ina wellorganized facility.

(From a review by Florence L. Blatz in Nursing Outlook.18 (4): 24. April 1970.)

MONTGOMERY, T. A.1969. "A Case for Nurse-Midwives." American

Journal ol Obbtetrics and Gynecology,105:309-313 (Oct. 1).

"Chronic shortage of physicians in a rural county hospital inCalifornia resulted in many deliveries in the county hospitalbeing medically unattended. This led to the development in

July, 1960, of a demonstration project calling for qualifiednurse-midwives to provide maternity case services for all normaldeliveries. Initially, the physicians were skeptical about thequality of tare that could be provided by nurse-midwives. Theirskepticism soon changed and they became staunch supportersof the program. Maternity patients also became enthusiasticabout nurse-midwife services. Although there were only about360 deliveries per year at the county hospital (60% of all

deliveries in the county), the neonatal mortality rate fell from23.9 per 1,000 live births to 10.3 per 1,000 live births. Pre-maturity dropped from 11% of all live births to 6.4%." (Fromalnabstract in Nursing Research, 19 (2): 188, March-April

O'BRIEN, MARGARET J.

1969. "Team Nursing in School Health." IVars-ing Outlook,,17: 28-30 (July).

"This study of the utilization of school health personnel wascarried out in 1964 in 107 of the 1,200 schools in 3 districts ofNew York City. The school health team was reconstructed forthis project so that it was headed by a public health nurse asteam leader" and included two or more staff nurses, two ormore public heahh assistants, and the school physician. Thepublic health nurse and public health assistant roles werebroadened and extended. The Lyear experiment succeeded inestablishing a team approach in the school health program. Itis felt that the nature of the team structure and the assignmentof duties assured the utilization of each team member at hishighest level, and that professional nurses were enabled to

spend more time on professional duties than under previouscircumstances. (From a review by J. Vian in Nursing Research.18 (6) : 558-559. November-December 1969.)


SJOBERG, KAY.

1969. "Unit AssignmentA New Concept." TheCanadian Nurse, 65 (7) : 29-31 (July).

A new staffing system on a 47-bed research ward is described.This ward is organized into six units of care, one 3-bed intensivecare unit, two 5-bed above-average-care units, and three average.care units.

The definition of a unit is "the number of patients that canbe effectively cared for by a registered nurse who is givenadequate nursing assistance and supply services."

This article discusses unit assignments, the head nurses' role,st.4ing patterns, service staff, and communication. The unitassignment system of staffing will be fully evaluated in thecoming months. To date, staff response has been favorable.

SPERLBAUM, ANDREA.

1969. Bibliography of Service Unit Management.Ann Arbor: University of Michigan. 55

PP.

"This annotated bibliography covers fifty-eight journalarticles, theses and project reports which deal with experiencesin nursing unit management." The period covered is 1952 to1968. The following areas are covered in each annotation: (1)the job description of the unit manager; (2) the objectivesto be attained; and (3) the experience each individual hospitallmd in implementing unit management.

STEWART, DIANE Y.

1969. "Nursing OrganizationCirca 1969". TheCanadian Nurse, 65 (2) : 59.61 (February).

This article describes an organizational pattern of nursingservice in keeping with current needs to relieve nurses of non-nursing functions. Traditional organization is supplanted bychanges in the roles and functions of key persons responsiblefor nursing administration in a hospital and by the decentraliza-tion of authority from the director of nursing to other nursingstaff. The plan provides for a nursing administrator on eachfloor; a nursing coordinator, who is a clinical specialist, foreach 30-bed unit; and floor managers responsible to hospitaladministration.

UNIVERSITY OF MICHIGAN.

1969. SCALENursing Staffing Program, Hos-pital Systems Improvement Program. AnnArbor, Mich.: The University. 29 pp.

"Descriptions of the procedures and forms used in theSCALE (Systems for Control and Analysis of Levels of Effec-tiveness) Nursing Staffing Program. SCALE objectives are toestablish standards for acc.,rate prediction of staffing require-ments and to provide personnel with an objective means of selfevaluation in relation to staff utilization. The CASH (Commis-sion for Administrative Services in Hospitals) Program andResearch at the University of Michigan and Johns HopkinsUniversity provided the background data. The SCALE programis based on a stl, dard of four hours per day for an averagepartial care patient with adjustment multiples of .5 for self

161

care and 2.5 for total-care patients and with additional factorsof about one-fifth for those over 65. Allocation of nursing staffhours among RNs, LPNs, and auxiliary staff is determined byapplying the Standard Hours per Patient Day to a PatientClassification System and applying that total to a PersonnelGuide. Participating units will prepare a Nursing Staff Utiliza-tion Report to compare projected hours with actual nursingstaff hours." (From Abstracts of Hospital Management Studies,VI: 152. June 1970.)

EAGEN, SISTER MARY CECILIA.

1970. "New Staffing Pattern Allows for Total In-dividual Quality Care." Hospital Progress,51 (2) : 62-64, 70 (February).

The author defines "total individual quality care" as "theassessment and planned care of each individual patient by aregistered nurse." The registered nurse attempts to meet theneeds of the patient either through her own professionalcapabilities or with the casistance of specialists in various dis-ciplines. Functional care or team nursing careboth are con-sidered by the author to be "traditional care."

The pilot unit was staffed by registered nurses, nursingassistants, and a ward clerk on the morning and afternoonshifts. Only registered nurses were employed on the night shift.All direct patient care was provided by the registered nurses.The nursing assistants and ward clerks were under the directsupervision of the registered nurses. Nursing assistants helpedthe nurse in all areas not directly associated with patient care.The ward clerk acted as a receptionist and performed selectedclerical work, including the copying of physicians' ordets,within the nursing unit. To avoid fragmented, depersonalizedcare, each registered nurse was responsible for total individualquality care for five or six patients on the unit.

This article describes the planning for the new staffingpattern, the inservice education required, the revision of jobdescriptions, and the plans for transferring and placing person-nel; e.g., the head nurse, the licensed practical nurse, and thenursing aide positions were eliminated.

FREEMAN, RUTH B.

1970. Community Health Nursing Practice.Philadelphia: W. B. Saunders Co. 414 pp.

With a focus on perspectives and prospects of social changeand their influence in health care, the author provides a com-prehensive and scholarly piece of work on community healthnursing practice. Purposes, roles, goals, and processes in com-munity health nursing are discussed in depth from soundphilosophic, scientific, and theoretical orientations.

Freeman keenly analyzes nursing care of pertinent targetpopulations and specific health care problems. Many settingsand conditions are presented in a clear and pertinent manner.She emphasizes the concept "nursing the community," usingthe family as the focal point of care. The chapter on neighbor-hood nursing programs will provide nurses with new anddifferent ways to conceptualize their practice. The challenge isto interpret this holistic apploach to the public, colleagues, andthe health team. The implementation of this idea should have

6 2

162 APPENDIX 2

a profound influence on patterns developed for deliveringnursing services, the expanding practice of community healthnursing, and research.

This publication is helpful as a text and as a reference.Chapter references and bibliographies offer direction for self.initiated study, and expand borders of current issues in nursingwith a futuristic view. (Excerpted from a review by Dr.Loretta Ford in American Journal of Nursing, 71 (1): 93.94.January 1971.)

LUNT, J.

1970. "Bridging the-Gap in Continuity of Care."Nursing Times, 66:12, 372 (March 19).

Improved continuity of care and service to patients hasresulted since.: a district nursing liaison arrangement was estab.lished betueen a hospital and three local authorities. Thearrangement enables the nursing liaison officer to:

(a) Make hospital ward rounds each morning with themedical and nursing staff of the hospital, thus improving theunderstanding between them.

(b) Visit the patient while still in the hospital. This haslessened his anxiety for Hs aftercare and it gives the nurse theopportunity to assess the patient's requirements for home care.

(c) Visit the home on the day of operationto reassurerelatives and tell them about postoperative care.

Since the establishment of this two.way service, the staffpublic health nurse feels more comiortable about calling thehospital and obtaining certain services or changes in services

for her patients as the need arises; e.g., rescheduling outpatientappointments, delaying hospital discharges, or obtaining ahospital re-admission.

PALISIN, HELEN E.1971. "Nursing Care Plans Are a Snare and a

Delusion." American Journal of Nursing,71 (1): 63-66.

The value of nursing care plans for patients is questionedby the author. The limitations of this method of communicationin the work situation in the hospital setting ere discussed.Palisin asserts that nursing care plans may have some valuefor patients who are acutely ill and cannot communicate, butproliferation of such a tool for an patients not only complicatesthe communication process but interferes with individualizedcare.

WORLD HEALTH ORGANIZATION.

1971. Planning and Programming for NursingServices. Public Health Papers, No. 44.Geneva: Office of Publications and Transla-tion. 123 pp.

Of particular value and interests are the Annexes to theguide. They describe particular planning techniques such asthe CENDES/PAHO method and the planning methods usedin U.S.S.R. A bibiliography and a glossary of the terms usedin *11 guide and in planning are included.

Indexes, journals, Periodicals, and Publications ListsAmerican Education.

U.S. Department of Health, Education, andWelfare. Office of Education. Patricia L.Cahn, editor. Washington: U.S. Govern-ment Printing Office. Published 10 timesa year.

This publication features current information for Federal,State, and local levels on legislation, research results, and issuespertaining to education. Ali levels of education are included.This periodical was first issued in 1965.

American Institute of Planners Journal.Baltimore, Md.: Port City Press. Publishedquarterly: February, May, August, andNovember.

Public management and planning information for city andregional planning are presented in the form of charts, maps,book reviews, bibliographies, and abstracts.

American Journal of Nursing.New York: The American Journal of NursingCompany Monthly publication. Date of firstissue 1900.

As the official magazine of the American Nurses' Association,it offers material on clinical and nursing care, nursing service,

and advances in the general health field as they apply tonursing.

American Journal of Public Health and the Nation'sHealth.

Albany, N.Y.: American Public Health As-sociation, Inc. Published monthly.

The official journal of the Association is devoted to scientificknowledge, issues, trends, developments, programs, administra-tion, personnel managemeA utilization, training, and educa.don, in all fields of public health endeavor. It contains articlesand reports on surveys, studies, and research in these areas. Abook review section and selected annotated references areincluded, as well as items of association business and newsnotes of professional interest.

ANA 1969-70 Publications List.New York: American Nurses' Association.Published periodically.

This comprehensive list of available publications and reprintsincludes official ANA statements, clinical studies, legislation,guidelines for practice, significant statistical surveys and data,analysis of key trends in nursing, and general references. It isrevised periodically to help nurses and related groups keep upto date with important developments in nursing practice, educa.tion, and research.


Catalog ol Publications 1968-1969.St. Louis, Mo.: The Catholic Hospital As-sociation, Publications Department. Pub-lished periodically.

This catalog lists manuals, guides, books, articles, and reportson general hospital topics, hospital administration, nursingservice, and medical technology available from the Association.Included are manual guides on team nursing, master staffingplan, the audit, inservice education, and ward clerks.

Cumulative Index to Nursing Literature.Glendale Adventist Hospital, Glendale, Calif.

This cumulative indexto date, a set of four editionscovers the period 1956.1968. The first edition contains volumesI-V (1956.1960) ; the second edition, volumes VI-VIII (1961-1963) ; the third edition, volumes IX-XI (19644966) ; and thefourth edition, volumes XII.XIII (1967-1968).

These editions contain subject matter of interest to nurses,compiled from the nursing literature and elsewhere, and arranged according to subject and author. Since the first edition,both format and content have changed. The most recent editioncontains greater coverage of nursing and health.related publica.tions, as well as selected articles from popular publications.

Grant Data Quarterly.Los Angeles: Academia Media Inc. Pub-lished quarterly.

This reference journal provides a picture of grant supportavailable from government, business, professional organizations,and foundations. A program breakdown includesamong othercategorieshealth, medical, and social sciences and the hu-manities. Types of grants available are described, as well aseligibility qualifications, financial data, duration of grant, andscope of the grant program.

Health Services Research.Chicago: Hospital Research and EducationalTrust. Published quarterly.

This journal contains original articles, progress reports, andnews notes on a wide variety of research projects and newtechnology concerned with the organization and delivery ofhealth services.

Hospital Abstracts.A monthly survey of World Literature pre-pared by the Ministry. of Health. London:Her Majesty's Stationery, Office. Publishedmonthly since 1960.

Publications and original papers covering the.whole field ofhospitals and their administration, with the exception of strictlymedical and related professional matters, are summarized.

Hospital Literature Index.Chicago: American Hospital Association.Published quarterly.

This is an author-subject guide to periodical and selectedliterature on all areas of hospital administration; planning;financing; and administrative aspects of the medical, paramed-ical, and prepayment fields. It does not include references onclinical medicine. Published quarterly, with the fourth issuean annual accumulation.

International Journal ol Nursing Studies.Long Island City, N.Y.: Pergamon Press.Published quarterly.

This journal covers all aspects of nursing and allied profes-sions throughout the world. Emphasis is on community needs,preparing young people for assuming nursing duties, and en-couraging nursing research.

International Nursing Index.New York: American Journal of NursingCompany, in cooperation with the NationalLibrary of Medicine. Published quarterlysince 1966.

Articles in 160 nursing journals from all over the world andthose in non.nursing journals currently listed in Index Medieusare included. There is a subject section, an author section, andan index of nursing publications.

NLN Publications Catalog.New York: National League for Nursing.Published annually in May.

A list of available publications about nursing service andnursing education, ranging from administrative guides to

evaluation tools for institutions and individuals to general information materials about nursing. It includes mimeographedbooks, booklets, manuals, reports, surveys, reprints, and recordforms. Listings are annotated briefly as to content.

Nursing Outlook.New York: The American Journal of NursingCompany. Published monthly since January1953.

The official magazine of the National League for Nursing,for nurses in public health, nursing service administration, andnursing education, with materials and articles pertinent to thesefields.

Nursing Research.New York: The American Journal of NursingCompany. Published quarterly since 1952.

This journal contains articles on scientific studies in nursing,reports of nursing research activities, and reviews and abstractsof existing research literature. It is designed to make theproducts of nursing research accessible to research workers,practitioners, educators, and students of nursing and otherhealth professions, and to stimulate new research in nursing.

/. :1;)

164 APPENDIX 2

Nursing Studies Index, Volume III, 1950-1956.Prepared under the direction of VirginiaHenderson. Philadelphia: J. B. LippincottCo. 653 pp. 1966.

This index is an annotated and comprehensive guide to re-ported studies, research in progress, research methods, andhistorical materials in periodicals, books, and pamphlets, allof which are published in English.

Nursing Studies Index, Volume IV, 1957-1959.Prepared under the direction of VirginiaHenderson. Philadelphia: J. B. LippincottCo. 281 pp. 1963.

This index is an annotated and comprehensive guide to

reported studies, research in progress, research methods, andhistorical materials in periodicals, books, and pamphlets, all ofwhich are published in English.

Nursing Update.Darien, Conn.: Miller and Fink PublishingCorporation. Published monthly since Octo-ber 1970.

This magazine provides the reader with practical, useful,and up-to-date clinical and nursing information. The formatenables the reader to be selective by the use of "ExpressStops" (summaries in boldface type in the margins of eacharticle), capsule information such as charts and checklists, anda quiz as a review or memory aid.

Planning Urban Affairs.Beverly Hills, Calif.: Sage Publishers, Inc.Published annually.

This annual reference volume, published since 1968, presentscritical analyses of current interests in urban affairs, preparedby experts in various fields of urban studies. It covers programs,policies, and current developments in all areas of concern tourban specialists.

Public Health Reports.U.S. Department of Health, Education, andWelfare. Public Health Service. Wash-ington: U.S. Government Printing Office.

Published monthly.This official publication of the U.S. Public Health Service

covering items of value and knowledge in health fields is

prepared primarily for distribution to directors and supervisorsof public health programs and to institutions training publichealth personnel. It contains articles, reports, and items onthe technical, scientific, administrative, service, and educationalaspects of health of potential interest to this audience.

Publications Catalog of the Ameriam Hospital As-sociation.

Chicago: The American Hospital Association.Published January and July.

This complete listing of professional publications developedby the American Hospil al Association (AHA) includes man-uals, monographs, reports, reprints, and official statements ofthe AHA, on all aspects of hospital administration, operations .services, staffing, personnel, and public relations, as well asclinically related subjects, surveys of the health care field, andresearch project data.

Readers Guide to Periodical Literature.Index to Selected U.S. General and Non-Technical Periodicals of Reference Value inLthraries. New York: The H. W. WilsonCo. Published twice a month, with cumu-lative volumes. From 1900 to date.

This is a guide to U.S. periodicals of broad, general, andpopular character. It also lists U.S. popular non.technicalmagazines representing all the important scientific, technical,and subject fields.

Research in Education.U.S. Department of Health, Education, andWelfare. Office of Education, Bureau ofResearch, Division of Information Tech-nology and Dissemination, Educational Re-sources Information Center. Washington:U.S. Government Printing Office. Publishedmon thly.

This abstract journal announces recently completed researchand research-related reports as well as current research projectsin the field of education. Each edition is made up of resumesfollowed by indexes. The indexes cite the contents by subject,author or investigator, institution, and accession number.

Research in Education. Annual Index: January-December (For each year).

U.S. Department of Health, Education, andWelfare. Office of Education, Bureau ofResearch, Division of Information Tech-nology and Dissemination. Washington:U.S. Government Printing Office.

Indexes to the research reports that were announced in themonthly issues of Research In Education from January throughDecember are provided. The annual publications are intended asa companion volume to the individual issues.

Social Sciences and Humanities Index.New York: The H. W. Wilson Co. Cumu-lative volumes published at regular intervals.1907 to date.

This publication is a social science and humanities index of209 journals, in English, that are international in scope andpublished in the United States, Canada, and Great Britain.

Social Security Bulletin.U.S. Department of Health, Education, and


Welfare. Social Security Administration,Office of Research and Statistics. Washing-ton: U.S. Government Printing Office. Pub-lished monthly.

This publication contains current and trend information anddata on the programs administered by the Social SecurityAdministration.

Ulrich's International Periodical Directory.New York and London: R. R. Bowker Com-pany. Issued triennially. 1932 to date.

This is a classified guide to a selected list of currentperiodicalsforeign and domestic. Over 16,000 periodicals areclassed as follows: scientific, technical, medical, arts, human.ities, business, and social sciences.

p

Appendix 3

Guide to Statistical Data

Appendix 3 is designed to provide guidance in selecting statistical data on healthservices, health manpower, and educational resources, as well as related social andeconomic 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 thetable of contents on the next page) and arranged alphabetically by name of authoror department under each topic.

Part 2 of this appendix is a guide, in tabular form, to other possible sources ofexisting statistical data that may be available although not published. The sources arelisted 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 Stateto another, depending upon the programs and interests of the specific agencies andorganizations and their resources for collecting and compiling data. Some agenciesmay 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


1968. Directory of Federal Statistics for States:1967. Pub. 1968 0.268.066. Washing-ton : U.S. Government Printing Office. 372

PP.

This is the first issue of a guide to current statistics forStates. It is intended to serve as a comprehensive guide forfinding available published sources of Federal statistics onsocial, political, and economic subjects. The references providedconsist of the latest data available in print prior to the finalpreparation of this directory. Sources cited contain data for1960 or later for each of the 50 States. If a table or seriescontains data for fewer than 25 States, the contents are sum-marized when those States represent all or most of the particularphenomenon or activity described. Availability of data forPuerto Rico and outlying areas is separately indicated for eachitem shown.

Style of presentation is described and terms and abbreviationsare defined. A list of complete bibliographic citations, arrangedalphabetically by issuing Federal agency, appears as an ap-pendix to the book.

This publication is a companion document to the Directory olFederal Statistics lor Local Areas, published by the Bureau ofthe Census in 1966.


Statistical Abstract of the United States.Washington: U.S. Government PrintingOffice. Published annually. Average 1,000PP.

This standard summary of statistics on the social, political,and economic organization of the United States is designed toserve as a convenient volume for statistical reference and as aguide to other statistical publications and sources. Major sec-tions of interest include: population; vital statistics; education;income; labor force; Federal, State, and local governmentfinance and employment; agriculture; transportation; con-struction; and manufacturing.


WELFARE.

Health, Education, and Welfare Trends, Part1, National Trends. Washington: U.S. Gov-

ernment Printing Office. Published an-

nually from 1960 to 1967. Average 200 pp.

Each edition presents current-year national data on programoperations in health, education, and welfare fields; past decadeannual data; and selented projections to the next decade.Included are such items as vital statistics, health manpowerand facilities, medical care expenditures, income, social insur-ance and protection, and enrollments in elementary, secondary,and higher education.


WELFARE.

State Data and State Rankings in Health,Education, and Welfare. Part 2 of Health,Education and Welfare Trends. Washing-ton : U.S. Government Printing Office. Pub-blished annually from 1960 to 1967. Aver-age 65 pp.

Each edition presents State data and ranking of States forpopulation; vital statistics; and expenditures and services inthe fields of health, education, and welfare that are presentedin Part 1.


1964. Industry Wage Survey: Hospitals Mid-1963.BLS Bulletin 1409. Washington: U.S.Government Printing Office.

Results of a survey of earnings and supplemental wagebenefits are reported for short-term private and State and localgovernment hospitals with 100 employees or more and locatedin metropolitan areas. Average weekly earnings are reported forregistered nurses in selected positions for the United Statesand regions of the country.


1966. Industry Wage Survey: Hospitals. BLS

Bulletin 1553 (July). Washington: U.S.Government Printing Office. 107 pp.

A survey of earnings and supplementary wage benefits ofhospital employees including nursing personnel, in July 1966,are reported in this bulletin. The survey covered all private

a

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170 APPENDIX 3

and State and local government hospitals throughout the Nation(except Alaska and Hawaii). Federal hospitals were excluded.Mean, median, and middle-range earnings are given for regionsof the country and for selected metropolitan areas.


1969. Industry Wage Survey: Nursing Homes andRelated Facilities. October 1967 and April1968. Bulletin 1638. Washington: U.S.Government Printing Office. 76 pp. (Is-sued periodically.)

The information contained in this publication is based on aBureau of Labor Statistics sample survey of proprietary andvoluntary (nonprofit) nursing homes and related facilities inthe United States. The nonsupervisory employee categories, full-time and part-time, surveyed as to earnings and supplementarybenefits were: registered professional nurses; practical nurses,licensed and unlicensed; nursing aides; kitchen helpers;laundry workers; maids and porters; and other nonsupervisoryemployees.

Data were collected by personal visits to the establishmentsincluded in the sample. Tabulations of establishment practices

and supplementary wage provisions are given for the UnitedStates, by regione and by selected areas. Tables included inthe report give: average hourly earnings by selected charac-teristics, e.g., facilities primarily providing skilled nursing care;occupational averages by type of establishment, e.g., establish-ments not providing skilled nursing care; and occupationalaverages in 15 selected areas, e.g., Baltimore, Maryland, andCleveland, Ohio.


National Survey of Professional, Administra-tive, Technical, and Clerical Pay. Wash-ington: U.S. Government Printing Office.Published annually since 1960. Average75 pp.

This publication summarizes the results of the annual salarysurvey of 81 selected occupations in private industry through-out the United States except Alaska and Hawaii. National,annual, and monthly mean, median, and middle-range salariesare presented by occupation, and job descriptions are included.This report is useful as a guide for salary administration pur-poses, for general economic analysis, and for comparison amongoccupations.

Education and Educational Resources


College Education: Key to a ProfessionalCareer in Nursing. New York: The League.Published annually. Average 15 pp.

This pamphlet gives general information about collegiateeducation for nursing. A State listing of senior colleges anduniversities that offer baccalaureate programs accredited by theNational League for Nursing details educational and otherrequirements for admission, length of program, living arrange-ments, clinical experience arrangements, possibility of part-timestudy, and the cost of required tuition and fees.

NATIONAL LEAGUE FOR NURSING. DEPARTMENT OF

BACCALAUREATE AND HIGHER DEGREE PROGRAMS.

Master's Education, Route to Opportunitiesin Modern Nursing. New York: TheLeague. Published annually. Average 15PP.

This pamphlet gives information about master's degree pro-grams in nursing, with a list of NLN-accredited college anduniversity master's programs in nursing. The type of controlof each program, admission requirements, curriculum offered,clinical practicum, length of program, tuition and fees, andliving arrangements are described.

NATIONAL LEAGUE FOR NURSING. DEPARTMENT OFDIPLOMA PROGRAMS.

Education for Nursing The Diploma Way.Code No. 16-1314. New York: The League.Published periodically. Average 40 pp.

This publication gives general information on requirements,goals, and features of diploma programs. It contains a Statelisting of NLN-accredited programs by name, location, andcontrol. For each school listed, it describes admission require-ments, educational prerequisites, length of program, affiliationswith colleges, living arrangements, and cost to students fortuition and fees.

NATIONAL LEAGUE FOR NURSING. RESEARCH ANDDEVELOPMENT.

State Approved SchoolsLPN, LVN. NewYork: The League. Average 75 pp. Pub-lished annually since 1961.

This yearly list, by State and territories and by name andaddress of adult education and high school programs fdrlicensed practical nurses, gives statistical information on thecharacteristics of these programs. Included are NLN accredita-tion status, administrative control, principal source of financialsupport, age and educational admission requirements, length ofprogram, enrollments, admissions, and graduations. State andregional summary tables are included.


DEVELOPMENT.

State-Approved Schools of NursingR.N.New York: The League. Average 100 pp.

17 0

GUIDE TO STATISTICAL DATA 171

Published annually since 1955. Average100 pp.

This yearly list, by State and territories and by name andaddress of baccalaureate, associate degree, and diploma pro-grams, gives statistical information on the characteristics ofprograms. Included are NLN accreditation status, administrativecontrol, financial support, admission policies, and the numberof enrollments, admissions, and graduations. State and regionalsummary tables are included.


DEVELOPMENT.

1968. The Nurse Career-Pattern Study. Bio-

graphical Data Reported by Entering Stu-dents, Fall 1965. Pub. 19-1321. NewYork: The League. 6 pp.

Statistics are presented in tabular form on the family andenvironmental backgrounds of students entering a sample ofnursing programs, by type of program. Included are suchitems as religion, ethnicity, place of birth, educational attain-ment of parents, occupation of father, and family income.


DEVELOPMENT.

1969. The Nurse Career-Pattern Study. Bio-

graphical Data Reported by Entering Stu-dents. Fall 1969. Pub. 19-1364. NewYork: The League. 4 pp.

Statistical tables give the ethnic background, religion, age,estimated family income, and other biographical data of studentswho entered a sample of associate degree, baccalaureate, anddiploma programs.


STATISTICS SERVICE.

Nurse-Faculty Census. New York: TheLeague. Published periodically. Average10 pp.

These census reports contain national data on numbers andqualifications of nurse faculty members in all nursing educationprograms, including number of unfilled budgeted positions.State breakdowns are not given. Reports are available for1964, Code No. 19-1146, and for 1966, Code No. 19-1231.

TATE, BARBARA L.

1968. "Rate of Graduation in Schools of Nursing."International Nursing Review, 15 (4) : 339-346.

This report concerns the rate of graduation of students whoentered a sample of schools of nursing in the fall of 1962. Thesample included each type of basic nursing education programrepresentative of schools in the Nation, in terms of theirregional location, religious affiliation, administrative control,and financial support. When admissions to nursing programs in

1962 were compared with those in 1954 and 1955, the rate of attri-tion appeared to have increased in the baccalaureate programs,and was higher in associate degree (1962 data only) than indiploma programs. Study findings seemed to indicate that asnursing education tends to move toward these two types ofprograms, it will be necessary to have a considerably largernumber of students admitted in order to realize the sameproportion of graduates as would have come from diplomaprograms.


WELFARE. OFFICE OF EDUCATION.

Digest of Educational Statistics. Washing-ton : U.S. Government Printing Office.

Published annually 1962-67. Average 130

PP.This yearly abstract of national and State statistical informa-

tion covers elementary and secondary education, higher educa-tion, Federal programs of education, and miscellaneous statisticsrelated to American education. It contains trend and currentdata on enrollments, graduations, earned degrees, teachers andinstructional staff, schools and school districts, facilities, reten-tion rates and educational attainment, income, expenditures,facilities, job opportunities, and research and development.



Opening Fall Enrollments in Higher Educa-tion: Part BInstitutional Data. Wash-ington: U.S. Government Printing Office.Published annually. Average 130 pp.

This publication, a supplement to Part A, details for theprevious year actual enrollments of first-time students indegree credit programs and in occupational programs, by Stateand institution. Data are also presented by sex of student andfull-time or part-time attendance.



Projections of Educational Statistics. Wash-ington: U.S. Gbvernment Printing Office.Published annually since 1964. Average68 pp.

National statistical projections are made for a 10-year periodon enrollments, graduates, teachers, and expenditures for ele-mentary and secondary schools and institutions of highereducation. Projections are based on trends over the preceding10-year period, and are extrapolated for 10 years into the future.



1964. Residence and Migration of College Stu-dents, Fall 1963, State and Regional Data.Higher Education Studies Branch. Di.

tA

172 APPENDIX 3

vision of Statistical Analysis. Washington:U.S. Government Printing Office. 100 pp.

This circular presents summary State and regional data onthe residence and migration of college students in the fall of1963, by level of enrollments and by level and control of in-stitution. Statistical analysis is made for undergraduate andgraduate students, for men and women, and for publicly andprivately controlled institutions.

U.S. DEPARTMENT OF LABOR. WOMEN'S BUREAU.

1966. College Women Seven Years After Grad-

uation. Resurvey of Women GraduatesClass of 1957. Bulletin 292. Washing-ton: U.S. Government Printing Office. 54

PP.

The findings of a 1964 survey of women graduates of theJune 1957 graduating class of 153 colleges and universitiesrevealed rising interest of college women in paid employmentand continuing education. This report presents statistical dataand information on their family status and employment, salaries.future employment plans, work history, and occup99onal pat-terns. Nurses were included and reported in the survey.

Health Facilities and Services


Hospitals, Journal of the American HospitalAssociation, Guide Issue, Part 2. Chicago:The Association. Published annually since1945. Average 650 pp.

This controlled data source contains a State list of hospitalassociation members by name, control, type of service, andnumber of beds. It details data on admissions, occupancy,average daily patient census, expenses, revenue, and assets.Accredited extended care facilities are listed by name andlocation, as are professional schools for health personnel andorganizations and agencies in the health field.

JACOBS, STANLEY E.; PATCHIN, NAOMI; and ANDER-SON, GLENN L.

1969. A.H.A. Nursing Activity Study: ProjectReport. Chicago: American Hospital As-sociation. 503 pp.

"Report details a nationwide study of nursing activities inadult medical and/or surgical units in 55 of the nation's shortterm general hospitals, conducted by AHA. Work-samplingwas conducted on a round the clock basis for 7-12 days in eachhospital. Additional data gathered include hospital, patient andunit characteristics, staff hours, by category of staff for eachunit/day/shift and hourly salary data. All data are convertedto magnetic tape and are available to nursing research person-nel. Charts of these data are also included in appendices. Majorfindings are: 1) There was an average of 4.39 hours of careper patient per day. 2) There were no significant differences inhours of care per patient among hospitals grouped by certaincharacteristics of size, university affiliation and specialization.3) After age 55, hours per care per patient increased sig-nificantly with age. 4) Head nurses and ward clerks providedsame amount of care for all age groups, but care per patientprovided by other nuruing personnel increased significantlyfrom under age 65 group to 65-74 and 75 and over group.There were no differences in care hours by sex group. 5) Sameamount of nursing care per age group was rendered in bothmedical and surgical units. There was, however, wide variation

between hospitals in amount of care for under and over 65 agegroups. (i) There were wide variations between regions in payrates for like staff and wide variation in policies regardingpayment of shift differentials. 7) Data from 40 of the hospitalswere extrapolated to 1,776 hospitals of like characteristicswhich indicate annual additional cost for providing care toelderly was $30 mion and $10 million." (From Abstracts olHospital Management Studiqs, VI:146-147. June 1970.)

NATIONAL COUNCIL FOR HOMEMAKER SERVICES, INC.

1967. Directory of Homemaker-Home Health AideServices. 1966-67. New York: TheCouncil. 181 pp. (Supplemental publi-cations planned.)

All known agencies providing homemaker-home health aideservices (direct service only) in the United States are listed.Agencies are arranged alphabetically, by State and city. Theperson designated in charge and groups served by each agenoare noted. Sponsoring organizations and members of the N.tional Cour-il for Homemaker Services are identified. Threehomemalytr registries, members of NCHS, are also included.


WELFARE. PUBLIC HEALTH SERVICE. BUREAU OF

HEALTH PROFESSIONS EDUCATION AND MANPOWER

TRAINING. DIVISION OF NURSING.

Services Available for Nursing Care of theSick at Home. PHS. Pub. 1265. Wash-ington: U.S. Government Printing Office.Published periodically-1959, 1961, 1964.1966. Average 75 pp.

This is a report on the distribution of the population byState, county, and territory, with available services for nursingcare of the sick at home. It also provides information on agencycosts and fees for services, number and types of contracts forcare, size of nursing staff, services provided by paranursingpersonnel, and agencies and personnel providing services.




AND MENTAL HEALTH ADMINISTRATION.

1970. Hospitals: A County and Metropolitan AreaData Book. Data compiled from the 1967Master Facility Inventory. Reported bythe National Center for Health Statistics.PHS Pub. 2043, Sec. 1. Washington:U.S. Government Printing Office. 234 pp.

This report contains hospital data at the State, SMSA, andcounty levels. The data for the-United States include type ofownership, number of beds, occupancy, and admissions. Thisvolume is section 1 of a 3.section series containing State andcounty information on health facilities and health professions.




1970, Nursing Homes: A County and MetropolitanArea Data Book. Data compiled from the1967 Master Facility Inventory. Reportedby the National Center for Health Statistics.PHS Pub. 2043, Sec. 2. Washington:U.S. Government Printing Office, 234 pp,

This report contains nursing home data at the State, SMSA,and county levels. The data for the United States include typeof ownership, number of beds, number of residents, and numberof full-time personnel.


FARE. PUBLIC HEALTH SERVICE. HEALTH SERVICESAND MENTAL HEALTH ADMINISTRATION. HEALTH CARE

FACILITIES SERVICE. OFFICE OF PROGRAM PLANMNGAND ANALYSIS.

1971 Hill-Burton Prograin Progress Report, July1, 1947June 30, 1970. Health FacilitiesSeries. HSM Pub. 72-4005 (Revised 1970).Washington: U.S. Government PrintingOffice. 83 pp.

This report, which is revised each year, presents nafionaland State statistics on the projects that have been approved forthe construction, modernization, and replacement of voluntarynonprofit and other heahh facilities throughout the Nationunder the Hill.Burton program. Data cover fiscal years sincethe beginning of the program in 1947 and are classified by typeof facility, type of construction, size of community, bed capacity,total cost, and Federal funding.

UNITED STATES DEPARTMENT OF HEALTH, EDUCATION,

AND WELFARE. PUBLIC HEALTH SERVICE. HEALTHSERVICES AND MENTAL HEALTH ADMINISTRATION.HEALTH CARE FACILITIES SERVICE. OFFICE OF PRO-GRAM PLANNING AND ANALYSIS.

1971. Health Care Facilities: Existing and Needed.Hill-13u.rton State Plan Data as of January1, 1969. Health Facilities Series. HSMPub. 72-4004 (Revised 1971). Washing-ton: U.S. Government Printing Office. 90

PP.

This report, which is revised annually, summarizes nationaland State data on civilian health facilities available and neededin the United States. Statistics are taken from inventory datagenerated in the development of State plans for hospital andrelated health.facility construction. Data for the preceding yearare classified by type of facility, hospital beds per 100,000population, conforming and nonconforming beds in accordancewith minimum Federal standards, beds needed, beds to beadded, and beds to be modernized. Trend data are presentedfor some types of facilities. Previous editions (PHS Pub,930-F.2) have annual summaries, 1948-68, and trend data since1948.

U.S. DEPAWFMENT OF HEALTH, EDUCATION, AND


AND MENTAL HEALTH ADMINISTRATION. DIVISION OF

INDIAN HEALTH.

Indian Health Highlights. Washington :U.S. Government Printing Office. Pub-lished annually since 1960. Average 65

PP.Population, vital statistics, and health service data for the

23 Federal Indian Reservation States and Alaska Natives in-elude trends from 1950. Population distribution by age andsex, family income, and educational levels are analyzed. Birthrates, morbidity for selected causes, mortality, and data onhospital use, health center visits, and home visits are recorded.

U.S. DEPARTMENT OF HEALTH, EDUCATION, ANDWELFARE. SOCIAL SECURITY ADMINISTRATION. BUREAU

OF HEALTH INSURANCE.

1968. Directory of Medicare Providers of Services:Extended Care Facilities. Title XVIII.Health Insurance for the Aged. Washing-ton: U.S. Government Printing Office. 210pp. (To be reissued as required.)

"This directory is a compilation of the names and addressesof extended care facilities which are participating as providersof services in the Health Insnrance for the Aged Program."

And "To facilitate reference, the directory is arranged inalphabetical sequence by State; by city within State; and bythe name of the extended care facility."

This directory was prepared to furnish "identifying info',maim regarding the availability of extended care set vicz,covered under Title XVIII of the Social Security Act." Bydefinition, "a provider of services is an extended care facilitywhich (1) meets certain requirements under the Health Insur-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 provideservices to Health Insurance beneficiaries."

Similar directories are available for hospitals, home healthagencies, and independent laboratories participating it. theHealth Insurance for the Aged Program.


WELFARE. SOCIAL SECURITY ADMINISTRATION. BUREAU


1968. Directory of Medicare Providers of Serv-ices: Home Health Agencies. Title XVIII.Health Insurance for the Aged. Washing-ton: U.S. Government Printing Office. 152pp. (To be reissued as required.)

"This directory is a compilation of the names and addressesof home health agencies which are participating as prnviders ofservices in the Health Insurance for th: Aged Program. It wasprepared to furnish identifying information regarding theavailability of home health agencies covered under Title XVIIIof the Social Security Act."

The agencies are listed in alphabetical order by State; bycity within the State; and by the name of the home healthagency.

A provider of service is defined as "a home health agencywhich (1) meets certain requirements under the HealthInsurance for the Aged Act and (2) has entered into anagreement with the Secretary of the Department of Health,Education, and Welfare to provide services to Health Insurancebeneficiaries."




1968. Directory of Medicare Providers of Serv-ices: Hospitals. Title XVIII. Health In-surance for the, Aged. Washington: U.S.Government Printing Office. 290 pp. (Tohe reissued as required.)

"This directory is a compilation of the names and addressesof hospitals which are participating as providers of services inthe Health Insurance for the Aged Program. It was preparedto furnish identifying information regarding the availability ofhospital services covered under Title XVIII of the SocialSecurity Act."

The directory is arranged in alphabetical sequence by State;by city within the State; and by name of the hospital.

By definition, a provider of service is "a hospital which (1)meets certain requirements under the Health Insurance forthe Aged Act and (2) has entered into an agreement with theSecretary of the Department of Health, Education, and Welfareto provide services to Health Insurance beneficiaries."




1968. Directory of Medicare Suppliers of Serv-ices: Independent Laboratories. TitleXVIII. Health Insurance for the Aged.Washington: U.S. Government PrintingOffice. 146 pp. (To be reissued as re-quired.)

"This directory is a conipilation of the names and addressesof independent laboratories which are participating as suppliersof services in the Health Insurance for the Aged Program."Identifying information regarding the availability of independ-ent laboratory services covered under Title XVIII of the SocialSecurity Act is furnished.

The directory is arranged "in alphabetical sequence by State;by city within State; and by the name of the independentlaboratory."

By definition, "a supplier of service is an independent labora-tory which (1) meets certain requirements under the HealthInsurance for the Aged Act and (2) has received an approvalfrom the Secretary of the Department of Health, Education,and Welfare to permit reimbursement for specified laboratorytests performed for Health Insurance beneficiaries."

Health Manpower Statistics

AMERICAN COLLEGE OF NURFE-MIDWIFERY.

Descriptive Data, Nurse Midwives, U.S.A.New York: The College. Issued period-ically. Average 6 pp. (mimeographed).1963 and 1968 editions.

The distribution of the supply of nurse-midwives, their typeof practice, and position and educational preparation arebriefly described.


1967. Manpower Resources in Hospitals-1966.

SL:mmary Report of a Survey Conducted bythe Bureau of Health Manpower, PublicHealth Service, Department of Health,Education, and Welfare, and the AmericanHospital Association. Chicago: The As-sociation. 75 pp.

This report gives U.S., regional, and State data on the num-ber of health personnel in 33 categories employed full-time andpart-time in hospitals in April 1966, and the current and mosturgent needs for additional personnel. Utilization characteristicsof the responding hospitals are summarized.

GUIDE TO STATISTICAL DATA

AMERICAN MEDICAL ASSOCIATION. DEPARTMENT OFSURVEY RESEARCH.

Distribution of Physicians and Hospital Bedsin the United States. Chicago: The As-sociation. Published annually 1963 through1965. Average 300 pp.

The distribution of non-Federal physicians practicing inregions, States, counties, Standard Metropolitan StatisticalAreas (SMSA's) and potential SMSA's arc detailed byspecialty and major professional activity for the United Statesand its possessions. Summary tables are provided.

AMERICAN MEDICAL ASSOCIATION. DEPARTMENT OFSURVEY RESEARCH.

Distribution of Physicians, Hospitals, andHospital Beds in the United States. Chicago:The Association. Published annually 1966through 1969. Average 200 pp.

The location, specialty, and functional category or profes-sional activity of doctors of medicine are detailed by regions,divisions, States, and counties for the United States and itspossessions. Included also are the number of hospitals andhospital beds, the resident population, and certain generaleconomic characteristics, hy county. The distribution of non-Federal physicians practicing in Standard Metropolitan Sta-tistical Areas (SMSA's) and potential SMSA's are detailed byspecialty and major professional activity for the United Statesand its possessions. Summary tables are provided.

(NOTE: Previous publications have been less detailed. How .

ever, the American Medical Association has been a source ofinformation on the location, spedalty, and professional activitiesof doctors uf medicine since 1906.)

AMERICAN MEDICAL ASSOCIATION. CENTER FOR

HEALTH SERVICES RESEARCH AND DEVELOPMENT.

DEPARTMENT OF SURVEY RESEARCH.

1971. Distribution of Physicians in the UnitedStates, 1970. Regional, State, County,Metropolitan Areas. Chicago: The As-sociation. 329 pp.

This publication updates data on the distribution of phy-sicians in the United States and its possessions for 1970. Thetypes of data and information contained in this publication areessentially the same as those formerly included in the twoAMA citations listed above.


Facts About Nursing. A Statisfical Sum-mary. New York: The Association. Pub-lished annually since 1939. Average 250PP.

Comprehensive statistical information is compiled concerningnursing personnel in the United States, its distribution bykinds, educational background, and employment fields. Data

175

about nursing education programs are included by type, Statedistribution, and student admissions, enrollments, and grad.nations. Other data pertain to economic security, population,hospital utilization, insurance coverage, and medical expenses.

AMERICAN NURSES' ASSOCIATION. RESEARCH AND

STATISTICS DEPARTMENT.

1969. RN's 1966 . . . An Inventory of RegisteredNurses. Prepared by Eleanor D. Marshalland Evelyn B. Moses. New York: TheAssociation. 50 pp.

The State distribution of the Nation's registered nurse supplyas identified in the 1966 Inventory is described, by age, maritalstatus, employment status, highest educational preparation, areaof clinical practice, and type of positions in hospitals andpublic health work.

KNOPF, LUCILLE ; TATE, BARBARA L.; and PATRYLOW,SARMI.

1970. Fhe Y ears After Graduation. New York:National League for Nursing. 76 pp.

This is the report of a study that traced the careers of 3,014students who entered 117 practical nursing schools in 1962.

Mailed questionnaires were used to collect data describing thework life of this sample of practical nurses for the first 5

years following graduation front the practical nursing programs.Factors influencing work force participationage, maritalstatus, personal satisfaction, salary, working conditions, avail-able employment, and interrupted employmentare presented.Study findings have resulted in recommendations relating topractical nursing education, employment, and suggested areasfor further study.

MARSHALL, ELEANOR D., and MOSES, EVELYN B.1965. The Nation's Nurses. Inventory of Pro-

fessional Registered Nurses. New York:American Nurses' Association, Researchand Statistics Program. 39 pp.

The State distribution of the Nation's registered nurse supplyas identified in the 1962 Inventory is described as to age,marital status, employment status, fields of practice, and typesof positions in hospitals and public health work. Data on aspecial substudy of the educational preparation of nurses in 15States is included.

MARSHALL, ELEANOR D., and MOSES, EVELYN B.1971. LPN's, 1967, An Inventory of Licensed

Practical Nurses. Research and StatisticsDepartment, American Nurses' Association.Washington: U.S. Government PrintingOffice. 105 pp.

This 1967 survey by the American Nurses' Association is thefirst one conducted to obtain baseline data on licensed practicalnurses. The methodology used was the same as for the registerednurse inventories. The data collected from the State Boards of

176 APPENDIX 3

Nursing covered practical nurses with active registrations, thoseemployed, and those inactive in nursingalso their age, sex,marital status, field of employment, employment status, basis oforiginal licenses, and nurse.population ratios. In addition toState data, distributions of i;censed practical nurses were givenby county and metropolitan areas. County identification wasmade from the mailing address rather than the employmentaddress.


WELFARE. PUI3LIC HEALTH SERVICE.

1953. Health Manpower Source Book. Section2. Nursing Personnel. PHS Pub. 263.Washington: U.S. Government PrintingOffice. 81 pp.

This source book is a compilation and systematic organiza-tion of data from various sources on nursing personnel, prin-cipally graduate or registered nurses and practical nurses. Dataare presented for States and four geographic regions. Includedare trends in supply, 1910-1952, their distribution, populationratio, age, sex, and marital status. Comparative data are givenfor nurses in six fields. The number of schools of nursing,student admissions, enrollments, graduations and student-instructor ratios are also included. For 1951, nurse.patientratios in hospitals are detailed.

U.S. DEPARTMENT OF HEALTH, EDUCATMN, ANDWELFARE. PUBLIC HEALTH SERVICE. DIVISION OFNURSING.

1966. Health Manpower Source Book. Section2, Nursing Personnel. PHS Pub. 263,Revised January 1966. Washington: U.S.Government Printing Office. 113 pp.

The second revision of this source book presents trend databy States on registered nurses and practical nurses, includingnumbers, general distribution, licensure, training, and field ofpractice. Biennial estimates of the registered nurse supply areincluded. Each set of tables is preceded by a discussion ofmethods used in making estimates and an evaluation of sourcesand backg/ mind material needed for accurate interpretation ofthe data.


WELFARE. PUI3LIC HEALTH SERVICE. NATIONAL INSTI-

TUTES OF HEALTH. DIVISION OF NURSING.

1969. Health Manpower Source Book. Section 2,Nursing Personnel. PHS Pub. 263, Re-vised 1969. Washington: U.S. Govern-ment Printing Office. 144 pp.

The third revision of this source book contains the mostrecent data available in early 1969 for the States and the Nationon the number, distribution, and characteristics of nursingpersonnel. Data are also compiled for the four geographiclegions. In addition to an updating of information containedin previous editions (e.g., nursing education), the text has

been revised where necessary to discuss new definitions andnew trends, similarities, differences, and limitations of nursemanpower surveys, and preliminary effects of legislation onnurse education and supply. Although the focus of the publica-tion is on the registered nurse, the growth of practical nursingand all nursing personnel who serve patients in hospitals is alsodiscussed. Projections of registered nurse need and supply, withemphasis on the varying factors that affect these determinations,and a discussion of methodology for estimating both are foundin this edition. Previous editions were published in 1953 and1966.




EDUCATION AND MANPOWER TRAINING.

1969. Health Manpower Source Book. Section20, Manpower Supply and Educational Sta-tistics for Selected Health Occupations:1968. PHS Pub. 263, Sec. 20, Washing-ton: U.S. Government Printing Office. 164

PP.

This publication updates data in Health Manpower Perspec-tive: 1967 and supplements data in Health Resources Statistics1968. Statistics on the supply and education of health man-power are presented for the following fields: medicine, oste-opathy, dentistry, optometry, pharmacy, podiatry, veterinarymedicine, nursing-R.N., dental assisting, dental hygiene, labora-tory technology, medical record librarianship, medical tech-nology, occupational therapy, physical therapy, radiologictechnology, and public health. Trends in supply, their geo-graphic distribution, ratio of supply to population, and educa-tional resources are detailed by States. Projections of supplyare included.




EDUCATION AND MANPOWER TRAINING.

1970. Health Manpower Source Book. Section21, Allied Health Manpower. 1950-80.PHS Pub. 263, Sec. 21. Washington: U.S.Government Printing Office. 107 pp.

This report is concerned chiefly with professional, technical,and supportive workers in the fields of patient care, publichealth, and health research, who engage in activities thatsupport, complement, or supplement the professional functionsof physicians, dentists, registered nurses, and personnel engagedin environmental health activities. Allied health manpower andresources are classified by categories for which basic prepara-tion is at least a baccalaureate and those for which it is lessthan baccalaureate. Data are presented on estimated employ-ment in selected fields in 1967, and on personnel requirementsand projected supply for 1975 and 1980. Trend data as availableon educational programs, students, and graduates cover the

176


period 1949.69. The appendix includes an inventory of Federalprograms that support health occupations training, and a dis-cussion of methods of estimating requirements.



1966. Occupational Health Nurses. An InitialSurvey. Division of Occupational Health.PHS Pub. 1470. Washington: U.S. Gov-ernment Printing Office. 146 pp.

This report presents data from a 1964 questionnaire surveyof occupational health nurses identified during the 1962 Inven-tory of Professional Registered Nurses. It provides descriptivedata on their characteristics, such as age, marital status, educa-tional preparation, previous work experience, and place ofemployment by regions. Characteristics of work places aredetailed by type of industry and number of employees, andinclude the size of nursing staff, salaries, and type of medicaland nursing supervision. State tables are included in theappendix on the structure of health units in which occupationalhealth nurses were employed.


WELFARE. PUBLIC HEALTH SERVICE. BUREAU OFHEALTH MANPOWER.

1967. Health Manpower, Perspective: 1967. PHSPub. 1667. Washington: U.S. GovernmentPrinting Office. 81 pp.

This report presents a review of present supply, needs, andshortages in health occupations, education, and health services.It details Federal aid now available for educational programs inthe health field, and suggests possible methods of improvingthe quantity and quality of health manpower. Statistical tablesand graphs, plus a bibliography and other references, supportthe text.


WELFARE. PUBLIC HEALTH SERVICE. DIVISION OFCOMMUNITY HEALTH SERVICES.

1967. Local Health Officers: Statistics and Charac-teristics. PHS Pub. 1636. Washington:U.S. Government Printing Office. 20 pp.

Characteristics of medical and nonmedical administrators oflocal health departments in the United States in 1966 arepresented in this publication. State breakdowns are given forage, educational preparation, tenure, type of health units inwhich employed, full- and part-time employment and vacancies.


WELFARE, PUBLIC HEALTH SERVICE. DIVISION OF

NURSING.

Nurses in Public Health. Washington:U.S. Government Printing Office. Annualreports 1937 through 1953, report for 1957

and biennially beginning in 1960. Aver-age 60 pp.

This census reports the number of agencies and the numberof registered nurses and licensed practical nurses employedfull-time and part-time by official and nonofficial local, State,and national health agencies and boards of education. Dataon the educational preparation of registered nurses and typeof position are included.



PUBLIC HEALTH METHODS and the NATIONAL CENTER

FOR HEALTH STATISTICS.

1965. Location of Manpower in Eight Health Oc-cupations, 1962. Section 19 of HealthManpower Source Book. PHS Pub. 263.Washington: U.S. Government PrintingOffice. 167 pp.

This source book details the quantitative distribution of the1962 supply by region, State, county, metropolitan areas, Rand-McNally trading areas, and State economic areas. It includesdata on population distribution, effective buying income, andnumber of general hospital beds. The eight occupations are:physicians (M.D. and D.O.), dentists, registered nurses, phar-macists, sanitarians, sanitary engineers, and veterinarians.



PUBLIC HEALTH METHODS in cooperation withDIVISION OF DENTAL PUBLIC HEALTH AND RESOURCES

and DIVISION OF NURSING.

1964. Manpower in the 1960's. Section 18 ofHealth Manpower Source Book. P115 Pub.263. Washington: U.S. Government Print-ing Office. 67 pp.

This report presents statistical data on the characteristicsof health manpower, with particular emphasis on physicians(M.D. and D.O.), dentists, and registered nurses. It includesdata on the U.S. civilian labor force by major occupationalgroups and their characteristics, 1950 and 1960, and healthservice employees by occupational groups, 1950 and 1960. Forphysicians, dentists, and registered nurses, it details the 1963supply and ratio to population by States, educational institu-tions, trends in school enrollments and graduates, and theprojected 1975 supply.




1968. Health Resources Statistics Reported Fromthe National Center for Health Statistics.Health Manpower and Health Facilities,1968. PHS Pub. 1509, 1968 edition.

178 APPENDIX 3

Washington: U.S. Government PrintingOffice. 260 pp.

This edition updates to 1968 the 1965 statistical informationin the previous edition and adds statistics on inpatient facilitiesincluding hospitals, nursing homes, and other inpatient healthfacilities.




1969. Inventory of State Surveyors of HealthFacilities for Licensure and Certification.Submitted by The Ad Hoc Committee onTraining and Composition of State AgencyPersonnel. Prepared by Subcommittee onDefinition and Identification of Surveyors,Qualifications and Functions. 37 pp.Available from Community Health Service,Division of Health Resources, Park lawnBuilding , 5600 Fishers Lane, Rockville,Md. 20852.

This committee report compiles information obtained by sur-vey questionnaire from 49 States and the District of Columbiaon the functional processes and staffing patterns for Statesurveyors for certification and licensing of health facilities.Data are detailed on the number of surveyors by discipline,age, marital status, full- and part-time employment, work ex-perience, supervisory responsibility, and specific survey func-tions. Data are also included on the salary and educationalpreparation of surveyors and on inservice training and educationfor survey staff. The survey revealed that one-half of thesurveyors were registered nurses.




1971. Health Manpower, A County and Metro-politan Area Data Book. Reported by theNational Center For Health Statistics, Di-vision of Health Resources Statistics. PHSPub. 2044. Washington: U.S. GovernmentPrinting Office. 164 pp.

This report contains data for tbe United States on the dis-tribution of pharmacists and registered nurses in 1966, phy-sicians and dentists in 1967, and podiatrists and veterinarians in1968, by State, standard metropolitan statistical area (SMSA),county group within State, and county. Data also include thedistribution of population in 1966, and effective buying incomein 1966 and 1967.




1971. Health Resources Statistics Reported From

the National Center for Health Statistics,1970. PHS Pub. 1509, 1970 Edition(Feb.) Washington: U.S. GovernmentPrinting Office. 362 pp. To be publishedannually.

This edition updates to 1970 the statistical information in

the previous edition (1969) including statistics on inpatientfacilitieshospitals, nursing homes, and other inpatient heahhfacilities. The first edition, published in 1965, contained heahhmanpower data only. The latest edition includes statistics onoutpatient and nonpatient health services.

U.S. DEI'ARTMENT OF HEALTH, EDUCATION, AND


AND MENTAL HEALTH ADMINISTRATION. COMMUNITY

HEALTH SERVICE. COMMUNITY PROFILE DATA CENTER.

1969. An Analysis of the Current Status of Se-lected Health Manpower in the UnitedState and Projections of Additional Re-quirements. Washington: The Center. 72pp. (processed).

This study presents statistical data drawn from existingsources on the distribution by State and region of seven selectedcategories of health manpower. Ratios per 100,000 populationare also presented. The manpower categories enumerated in-clude physicians by specialty, registered nurses, licensedpractical nurses, laboratory technicians, radiological technicians,physical therapists, and pharmacists. Most data are for 1966or later. Data on physician distribution by population size ofmetropolitan areas are also included. These data are also foundin a different form in Health Resources Statistics, 1968.


WELFARE. PUBLIC HEALTH SERVICE. NATIONAL CENTER


1967. Health Resources Statistics: Health Man-power, 1965. PHS Pub. 1509. Wash-ington: U.S. Government Printing Office.182 pp.

This report encompasses 140 health occupations requiringsome special education or training to function in the healthfield. Information and statistics are presented on occupationalduties, current labor force, State distribution, employmenttrends since 1950, type of practice, educational and licensing re-quirements, and trends in the number of schools and graduates.



TUTE OF MENTAL HEALTH.

1965. Mental Health Manpower Current Statisticaland Activities Report. No. 7. SelectedCharacteristics of Nurses Employed inMental Health Establishments, 1963.


Training and Manpower Resources Branch,Mental Health Manpower Studies Unit.Washington: U.S. Government PrintingOffice. 8 pp.

This report details data obtained by special questionnaireon 18,010 nurses reported in the 1962 Inventory of ProfessionalRegistered Nurses who were employed in mental health estab.lishments during the period December 1962 through May 1963.Data are analyzed nationally for age, professional experienceand affiliation, activities in a typical week, type of employingestablishment, and staffing patterns by educational levels. Statetables are presented for data on the distribution of nurses,their sex, and level of educational preparation.


WELFARE. PUBLIC HEALTH SERVICE. NATIONAL INSTI-TUTE OF MENTAL HEALTH.

1965. Mental Health Manpower Current Statisticaland Activities Report. No. 8. Survey ofMental Health EstablishmentsStaffing Pat-terns and Survey Methodology. Trainingand Manpower Resources Branch, MentalHealth Manpower Studies Unit. Washing-ton: U.S. Government Printing Office. 12

PP.

This report presents findings on staffing patterns by typeof employment setting for personnel employed in the coredisciplines of psychiatry, psychology, psychiatric social work,and psychiatric nursing. Data collected in a nationwide surveyconducted in 1963 are analyzed for outpatient clinics and forprivate and public hospitals for the mentally ill rid thementally retarded. The report covers the characteristics ofpersonnel as to age, sex, citizenship, and education, as well asselected work activities and hours employed.



TUTE OF MENTAL HEALTH.

1966. Mental Health Manpower Current Statisticaland Activities Report. No. 10. Profes-sional Mental Health Personnel Employed inStates. Training and Manpower ResourcesBranch, Mental Health Manpower StudiesUnit. Washington: U.S. GovernmentPrinting Office. 27 pp.

This report presents a detailed statistical analysis of dataon the characteristics of psychiatrists, psychologists, socialworkers, and nurses employed in mental health establishmentsand classified by States. Data on general distribution, age andsex, educational attainment, citizenship, and total hours em-ployed was obtained in a nationwide survey conducted in 1963.




EDUCATION AND MANPOWER TRAINING. DIVISION OF

NURSING.

1970. Nursing Personnel in Hospitals, 1968.Washington: U.S. Government PrintingOffice. 372 pp.

.This is a report of a survey of nursing manpower in allhospitals in the United States in May of 1968. Statistical datawithout analysis are detailed for 50 States and the District ofColumbia, and are summarized for the United States as awhole. Staffing patterns for registered nurses, practical nurses,nursing aides, orderlies, attendants, and clerical personnel arecategorized by full-time and part-time employment, by type ofposition, type and size of hospital, and type of nursing unit orservice. Data on the number of nursing personnel employed innon-nursing positions are included.

Population Statistics


Current Population Reports. Series P-25.Washington: U.S. Government PrintingOffice. Published periodically. Average100 pp.

Periodic issues in this series are devoted to: (1) monthlyestimates of the total population of the United States; (2) an-nual midyear estimates of the population of the States bybroad age groups, and of the United States by age, color, andsex; (3) annual estimates of the components of populationchange; and (4) projections of future population of the UnitedStates.


1962. U.S. Census of Population: 1960. CensusTract Reports. Series PHC (1). Wash-ington: U.S. Government Printing Office.

Population and housing data from the decennial census aregiven for 175 tracted areas in the United States and PuertoRico. The reports contain population data classified as to age,race, marital status, ethnic origin, education, school enrollment,migration, occupation, income, and certain characteristics ofthe nonwhite population. Housing data are classified by tenure.color of head of household, number of rooms, bathrooms, units,year built, heating, plumbing, number of persons in unit per

t") 01:1

180 APPENDIX 3

room, and certain characteristics of housing units with nonwhitehousehold head for selected tracts.


1962. U.S. Census of Population: 1960. Charac-teristics of the Population. Volume I,Series PC (1). Washington: U.S. Gov-ernment Printing Office. (Also see 1970Census when available.)

The volume contains population, social, and economic charac-teristics from the decennial census. There is a separate reportfor 57 areas: one for the United States; each of the 50 Statesand the District of Columbia, Puerto Rico, Guam, VirginIslands, American Samoa, and the Canal Zone. Population countsfor States, counties, and their urban and rural parts andurbanized areas are given in chapter A. Chapter B gives sta-tistics on age, sex, marital status, color or race, and relationshipto head of household. Ethnic origin, migration, income, andemployment characteristics are detailed in chapter C andare cross-classified in chapter D.U.S. DEPARTMENT OF COMMERCE. BUREAU OF THECENSUS.

1962. U.S. Census of Population: 1960. SubjectReports. Volume II, Series PC (2).Washington: U.S. Government PrintingOffice. (Also see 1970 Census when avail-able.)

This volume consists of approximately 40 reports on thedecennial census devoted essentially to detailed cross-classifica-tions for the United States and regions, for such subjects asnational origin and race, fertility, families, marital status,migration, education, employment, unemployment, occupation,industry, and income. On some subjects (e.g., migration),statistics for standard metropolitan statistical areas or Statesare given. In addition, there are reports on veterans. The U.S.population overseas and the geographic distribution and charac-teristics of the institutional population are included.


1962. U.S. Census of Population: 1960. SelectedArea Reports. Volume III, Series pc (3).Washington: U.S. Government PrintingOffice. (Also see 1970 Census when avail-able.)

This report contains selected characteristics of the populationfrom the decennial census according to State economic areasand social and economic data by size of urbanized area andurban place.


1966. Americans at Mid-Decade. Series P-23,No. 16, Revised. Washington: U.S. Gov-ernment Printing Office. 30 pp.

Broad aspects of population change and growth since the1960 Census, the geographic distribution of the population, andtheir social and economic characteristics are reported. Includedis information on mobility, the labor force, unemployment,family income, educational attainment, and age structure.


1966. Current Population Reports. PopulationEstimates. Illustrative Projections of thePopulation of States: 1970-1985. SeriesP-25, No. 326, Feb. 7. Washington: U.S.Government Printing Office. 106 pp.

This report presents alternative series of projections of

total population of States from 1970 to 1985, taking into accountdata on interstate migration from the 1960 Census as well asthe estimated changes in State population that have occurredsince 1960. Projections are given by regions, divisions, andStates, and data are shown for broad age groups, sex, andcolor, and by quinquennial dates.



AND MENTAL HEALTH ADMINISTRATION. NATIONAL


Data f rom the Institutional Population Sur-veys. PHS Pub. 1000, Series 12. Wash-ington: U.S. Government Printing Office.Published periodically. Average 50 pp.

This publication reports statistics on the health charac-teristics of persons in institutions and on medical, nursing, andpersonal care received. The data are based on national samplesof establishments providing medical, nursing, and personal care,and samples of the residents or patients.

Vital and Health Statistics

GROVE, ROBERT D., and HETZEL, ALICE M.

1968. Vital Statistics Rates in the United States,1940-1960. U.S. Department of Health,Education, and Welfare. Public Health

Service. National Center for Health Sta-tistics. PHS Pub. 1677. Washington:U.S. Government Printing Office. 881 pp.

Data are brought forward to 1960 and basic mortality and


natality data found in an earlier report are included, as areareas not previously covered, such as statistics on life ex-pectancy, marriages, and divorces. Several basic series showdata from its first year of availability. Charts provide graphicdescriptions of the trends of selected vital statistics through1960.

LINDER, FORREST E., and GROVE, ROBERT D.1943. Vital Statistics Rates in the United States,

1900-1940. U.S. Department of Com-merce. Bureau of the Census. Washing-ton: U.S. Government Printing Office.

1051 pp.

This volume brings together and summarizes past time trends,1900.1940, and the 1940 status of important mortality andnatality rates. The authors hoped that the vital statistics forthe 40.year period would be an essential aid and guide forhealth administrators and social analysts in the decades ahead.




Vital and Health Statistics. Data fromthe National Health Survey. NationalCenter for Health Statistics. PHS Pub.1000, Series 10. Washington: U.S. Gov-ernment Printing Office. Published period-ically. Average 50 pp.

This series reports statistics on illness; accidental injuries;disability; use of hospital, medical, dental, and other services;and other health-related topics based on data collected in a

continuing national household interview survey.



AND MENTAL HEALTH ADMINISTRATION. DIVISION OF

INDIAN HEALTH.

Illness Among Indians. Washington: U.S.Government Printing Office. Publishedannually since 1960. Average 20 pp.

Data on the incidence of communicable diseases, new casesof "notifiable" diseases, and other selected diseases among thebeneficiary population of the Division of Indian Health aresummarized and published each calendar year. Trends over aperiod of years are analyzed for a number of diseases that areof particular importance among Indians and Alaska Natives.Comparisons are made with data for the general population,wherever possible. Some of the diseases are not reportablenationally, however, because of their minor significance in thepopulation at large.





Data from the Health Examination Survey.PHS Pub. 1000, Series 11. Washington:U.S. Government Printing Office. Pub-lished periodically. Average 50 pp.

This publication reports data from direct examination, test-ing, and measurement of national samples of the population.Two types of reports include: (1) estimates of the medicallydefined prevalence of specific diseases in the United States andthe distribution of the population with respect to physical,physiological, and psychological characteristics; and (2)analysis of relationship among the various measurements with-out reference to an explicit finite universe of persons.





Data from the Hospital Discharge Survey.PHS Pub. 1000, Series 13. Wr.shington:U.S. Government Printing Office. Period-ically. Average 50 pp.

This publication reports statistics relating to dischargedpatients in short-stay hospitals. Data are based on a sample ofpatient records in a national sample of hospitals.





Data on Mortality. PHS Pub. 1000, Series20. Washington: U.S. Government Print-ing Office. Published periodically. Aver-age 50 pp.

This publication series presents various statistics on mor-tality other than as included in monthly and annual reports.It includes special analyses by cause of death, age, and otherdemographic variables, as well as geographic and time seriesanalyses.





Data on Natality, Marriage, and Divorce.PHS. Pub. 1000, Series 21, Washington:U.S. Government Printing Office. Pub-lished periodically. Average 50 pp.

This series presents various statistics on natality, marriage,and divorce other than as included in annual or monthly re-ports. It includes special analyses by demographic variables,also geographic and time series analyses and studies of fertility.



182 APPENDIX 3



Data from the National Natality and Mor-tality Survey. PHS Pub. 1000, Series 22.Washington: U.S. Government PrintingOffice. Published periodically. Average50 pp.

This publication series preselas statistics on characteristicsof births and deaths not available from vital records based onsample surveys stemming from these records. Included are suchtopics as mortality by socioeconomic class, medical experiencein the last year of life, characteristics of pregnancy.


WELFARE. PUBLIC HEALTH SERVICE. NATIONAL CENTER


Vital Statistics of the United States:(Year). Vol. I, Natality. Vol. II, Mor-tality, Part A, and Vol. II, Mortality, PartB. Washington: U.S. Government Print-ing Office. Published annually.

Natality data in Volume I concern the birth rates andcharacteristics, local area statistics, and technical appendix.Mortality, Part A, in Volume II, has six sections on mortalityas follows: general, infant, fetal, accident, life tables, andtechnical appendix. Mortality, Part B, in Volume II, hasgeographic detail for mortality and mortality data for PuertoRico and Virgin Islands (U.S.).



AND MENTAL HEALTH ADMINISTRATION. CENTER FOR

DISEASE CONTROL.

Morbidity and Mortality Annual SupplementSummary. Atlanta, Ga.: The Center.Published annually. Average 60 pp.

The Annual Supplement carries final figures on the reportedincidence of "notifiable" diseases. Information is based onsummaries submitted to the Center for Disease Control by theindividual States through the National Morbidity ReportingSystem and data collected by the Tuberculosis Program, theVenereal Disease Program, and two surveillance units of theEpidemiology Programthe Neurotropic Viral Disease Unitand the Rabies Control Unit.


WELFARE. SOCIAL SECURITY ADMINISTRATION. OFFICE

OF RESEARCH AND STATISTICS.

Research and Statistics Health InsuranceStatistics. Publication Staff, Washington,D.C. Published periodically. Average20 pp.

This brochure highlights data on the recipients, coveredservices, and costs of the health insurance programs admin.istered by the Social Security Administration. It includes re-ports on special surveys and studies on various aspects of theprograms, and may include State and regional breakdowns indata.

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ex, r

ace.

May

hav

e da

tafr

om s

peci

al o

r pe

riod

ic c

olle

ctio

ns,

stud

ies,

and

tabu

latio

ns in

repo

rtfo

rm.

Inve

ntor

y us

ually

par

t of

Stat

e pl

anfo

r co

nstr

uctio

n an

d re

nova

tion

ofm

edic

al a

nd h

ealth

fac

ilitie

s.

Lis

tings

of

mem

ber

hosp

itals

, by

loca

tion,

ow

ners

hip,

type

of

serv

ice,

and

num

ber

of b

eds.

Num

ber

of li

cens

edho

spita

ls, b

yow

ners

hip,

type

of

savi

ce, n

umbe

rof

bed

s, g

eogr

aphi

c di

stri

butio

n by

coun

ty o

r pl

anni

ng a

reas

, and

pla

nsfo

r ex

pans

ion.

Tab

ulat

ions

by

coun

ties

and

for

area

s of

a S

tate

may

be

poss

ible

whe

n in

form

atio

n is

ava

ilabl

e an

dlis

ted

by s

choo

l.

May

incl

ude

firm

pla

ns f

or p

ract

ical

nurs

e, a

ssoc

iate

deg

ree,

and

bac

h-el

or's

pro

gram

s in

nur

sing

and

oth

erhe

alth

man

pow

er tr

aini

ng a

nd e

du-

catio

n pr

ogra

ms.

Usu

ally

pub

lishe

d ea

ch y

ear

in a

spec

ial r

epor

t or

as p

art o

f th

ean

nual

rep

ort o

f th

e de

part

men

t.

Cat

egor

yPo

ssib

le s

ourc

eT

ype

of d

ata

Com

men

ts

Nur

sing

hom

es a

nd h

omes

for

the

aged

.St

ate

heal

th d

epar

tmen

t. (S

ee H

os-

pita

ls a

bove

.)

Stat

e nu

rsin

g ho

me

asso

ciat

ion.

Num

ber

of li

cens

ed h

omes

, by

Stat

ecl

assi

fica

tion

for

licen

sure

, num

ber

of b

eds,

ow

ners

hip,

geo

grap

hic

dis-

trib

utio

n, a

nd p

lans

for

exp

ansi

on.

Lis

ting

of m

embe

r ho

mes

, by

loca

-tio

n, o

wne

rshi

p, S

tate

cla

ssif

icat

ion,

num

ber

of b

eds,

and

type

of

serv

ice.

HE

AL

TH

PL

AN

NIN

G F

OR

GE

OG

RA

PHIC

AR

EA

S:

Hea

lth in

form

atio

n an

d da

ta f

or h

ealth

pla

nnin

g.H

ealth

info

rmat

ion

cent

ers

or S

tate

Dep

endi

ng u

pon

stag

e of

dev

elop

-Sp

onso

rshi

pof

cent

ers

will

vary

.ce

nter

s fo

r he

alth

stat

istic

s be

ing

men

t of

the

cent

er, m

ay h

ave

aggr

e-St

atis

tical

uni

ts o

f St

ate

Hea

lth D

e-de

velo

ped

on S

tate

or

regi

onal

bas

is.

gate

dat

a on

pop

ulat

ion;

vita

l and

heal

thst

atis

tics;

heal

thfa

cilit

ies,

serv

ices

, fin

anci

ng a

nd u

tiliz

atio

n;

part

men

tor

Stat

eC

ompr

ehen

sive

Hea

lthPl

anni

ng A

genc

ies

shou

ldkn

ow w

hen

cent

ers

are

deve

lope

d

HE

AL

TH

SE

RV

ICE

S:

Cov

erag

e, d

uplic

atio

n, a

nd g

aps

in s

ervi

ces.

Men

tal h

ealth

ser

vice

s.

Nee

ds a

nd d

eman

ds f

or h

ealth

car

e an

d se

rvic

es.

Plan

ning

gro

ups

and

heal

than

dw

elfa

re c

ounc

ils, a

s st

ated

abo

ve.

Stat

e de

part

iaen

t of

men

tal h

ealth

or d

ivis

ion

of m

enta

l hea

lth o

f St

ate

heal

th d

epar

tmen

t.

Stat

e co

mpr

ehen

sive

hea

lth p

lann

ing

agen

cy, p

riva

te h

ealth

pla

nnin

g co

un-

cils

, hea

lth a

nd w

elfa

re c

ounc

ils, a

ndco

mm

unity

act

ion

prog

ram

gro

ups

cond

uctin

g pr

ojec

ts u

nder

Off

ice

ofE

cono

mic

Opp

ortu

nity

.

heal

th m

anpo

wer

; and

rel

ated

soc

io-

econ

omic

dat

a.

Plan

ning

doc

umen

ts, a

nnua

l rep

orts

of s

ervi

ce a

genc

ies,

spec

ial r

epor

tsor

dat

a fr

om s

peci

al s

urve

ys.

Inve

ntor

y da

ta u

sual

ly p

art o

f th

eSt

ate

plan

for

men

tal h

ealth

and

the

Stat

e pl

an f

or m

enta

l ret

arda

tion.

Dat

a on

targ

et p

opul

atio

ns, h

ealth

need

s,fa

cilit

ies,

serv

ices

prov

ided

and

plan

ned

for,

and

res

ourc

es a

vail-

able

and

nee

ded

from

com

preh

ensi

vehe

alth

pla

nnin

g do

cum

ents

, men

tal

heal

th a

nd m

enta

l ret

arda

tion

plan

s,ho

spita

l and

med

ical

fac

ilitie

s (H

ill-

Bur

ton)

plan

ning

doc

umen

ts. A

ndsu

rvey

s an

d pl

anni

ng d

ocum

ents

for

0E0

proj

ects

.

and

the

loca

tion.

Plan

ning

gro

ups

and

litzl

tl!an

dw

elfa

re c

ounc

ils m

ay r

outin

ely

as-

sem

ble

and

com

pile

dat

a an

d in

-fo

rmat

ion

from

ser

vice

age

ncie

s an

dco

mm

unity

gro

ups,

pre

pare

spe

cial

repo

rts,

and

con

duct

spe

cial

stu

dies

.

May

hav

e da

ta f

rom

spe

cial

sur

veys

and

stud

ies

cond

ucte

d as

par

t of

plan

ning

.

'Sy

Cat

egor

Y

Poss

ible

sour

ceT

ype

ofda

ta

Com

men

ts

NU

RSE

SUPP

LY

:H

ospi

tal n

urse

s.

Inac

tive

nurs

es.

Lic

ensu

reex

amin

atio

ns.

Mig

ratio

n of

supp

ly.

Mob

ility

of

supp

ly.

Stat

e bo

ard

of n

ursi

ng.

Stat

e ho

spita

l asso

ciat

ion.

Stat

ehe

alth

depa

rtm

ent.

Div

isio

n,bu

reau

,or

sec

tion

for

hosp

ital

and

med

ical

faci

litie

s.

Stat

e bo

ard

of n

ursi

ng.

Stat

ein

activ

enu

rse

proj

ects

.

Stat

e bo

ard

of n

ursi

ng.

Stat

e bo

ard

of n

ursi

ng.

Stat

e ho

spita

las

soci

atio

n.

On

licen

sure

reco

rdsn

otcl

assi

fied

as to

type

of h

ospi

tal.

Peri

odic

surv

ey d

ata

on c

ateg

orie

sof

nur

sing

pers

onne

l,nu

mbe

rem

-pl

oyed

ful

l-an

dpa

rt-t

ime,

type

of

posi

tions

,an

d bu

dget

edva

canc

ies.

Y e

arly

coun

ts a

s no

ted

abov

e,m

ain-

tain

ed f

orpl

anni

ngpu

rpos

es o

r fo

rch

ecki

ngco

mpl

ianc

ew

ithSt

ate

licen

sure

code

s fo

rnu

rses

.

On

licen

sure

reco

rds;

may

be

tabu

-la

ted

or b

ein

rep

ort

form

.

Surv

ey d

ata

or r

epor

tson

num

ber

and

char

acte

rist

ics

ofnu

rses

,re

ason

sfo

rin

activ

ity,

desi

reto

ret

urn

tow

ork,

nee

dfo

rre

fres

her

cour

ses,

leng

th o

fin

activ

ity.

Num

ber

offi

rst-

time

exam

inat

ions

and

reex

amin

atio

nsfo

r lic

ensu

reof

regi

ster

ednu

rses

and

prac

tical

nurs

es,

scor

es, f

ailu

res,

Stat

e st

and-

ing.

Lic

ensu

reda

ta o

nre

cord

s,ta

bola

ted

or in

rep

ort

form

,on

end

orse

men

tsto

and

fro

mth

e St

ates

or f

rom

oth

erco

untr

ies

for

licen

sure

for

regi

ster

ednu

rses

and

prac

tical

nurs

es.

Spec

ial

surv

ey d

ata

on tu

rnov

e;an

dst

abili

ty o

fpe

rson

nel

in m

embe

rho

spita

ls.

May

be

colle

cted

year

ly, a

ndm

ay o

rm

ay n

ot b

eta

bula

ted.

Incl

udes

data

on c

hara

cter

istic

sof

nurs

es f

orye

ars

whe

nin

vent

ory

ques

tionn

aire

is u

sed.

Ava

ilabl

efr

omag

ency

hol

ding

man

-po

wer

rea

ctiv

atio

npr

ojec

tco

ntra

ct.

May

he

Stat

enu

rses

asso

ciat

ion,

Stat

e he

alth

depa

rtm

ent,

Stat

e un

i-ve

rsity

,et

c. (

1967

thro

ugh

1971

).

Yie

lds

data

only

on n

urse

sw

hom

aint

ain

licen

sure

.

Poss

ible

sou

rce

Typ

e of

dat

aC

omm

ents

Nur

ses

in n

ursi

ng e

duca

tion

prog

ram

s.

Nur

ses

in p

hysi

cian

s' o

ffic

es.

Nur

ses

in p

riva

te p

ract

ice.

Occ

upat

iona

l hea

lth n

urse

s.

Prac

tical

or

voca

tiona

l nur

ses.

Publ

ic h

ealth

nur

ses.

Stat

e bo

ard

of n

ursi

ng.

Stat

e bo

ard

of n

ursi

ng.

Stat

e bo

ard

of n

ursi

ng.

Hos

pita

l reg

istr

ies,

pri

vate

reg

istr

ies,

and

regi

stri

esap

prov

ed b

y St

ate

nurs

es' a

ssoc

iatio

ns.

Stat

e bo

ard

of n

ursi

ng.

Stat

ehe

alth

depa

rtm

ent o

r St

ate

depa

rtm

ent,

divi

sion

, bur

eau,

or

sec-

tion

of in

dust

rial

hea

lth, o

roc

cupa

-tio

nal h

ealth

.

Stat

e bo

ard

of n

ursi

ng.

Stat

e he

alth

dep

artm

ent.

On

licen

sure

rec

ords

; may

or

may

not b

e ta

bula

ted.

On

licen

sure

rec

ords

; may

or

may

not b

e ta

bula

ted.

On

licen

sure

rec

ords

; may

be

col-

lect

ed y

earl

y. M

ay in

clud

e re

gist

ered

nurs

es a

nd p

ract

ical

nur

ses.

Num

ber

ofre

gist

ered

nurs

ean

dpr

actic

al n

urse

reg

istr

ants

. Num

ber

of "

sitte

r"re

gist

rant

sor

aux

iliar

ynu

rsin

g pe

rson

nel r

egis

tran

ts.

On

licen

sure

rec

ords

; not

cla

ssif

ied

as to

pla

ce a

nd ty

pe o

f em

ploy

men

t.

May

mai

ntai

n an

d pe

riod

ical

ly u

p-da

te a

list

of o

ccup

atio

nal h

ealth

nurs

es b

y pl

ace

of e

mpl

oym

ent.

May

hav

e m

ore

deta

iled

data

on

num

ber

empl

oyed

by

cate

gory

ofpe

rson

nel,

full-

and

par

t-tim

e an

dty

pe o

f in

dust

rial

est

ablis

hmen

t.

Lic

ensu

re d

ata

on r

ecor

ds, t

abul

ated

or in

rep

ort f

orm

, on

num

ber

ofnu

rses

lice

nsed

, em

ploy

men

t sta

tus,

and

plac

e of

res

iden

ce.

Inve

ntor

y of

reg

iste

red

nurs

es a

ndlic

ense

d pr

actic

al n

urse

s em

ploy

edin

pub

lic h

ealth

wor

k. A

vaila

ble

byco

unty

and

Stat

e.M

ay in

clud

eau

xilia

ry n

ursi

ng p

erso

nnel

suc

h as

clin

ic a

ides

, hea

ring

and

scr

eeni

ngte

chni

cian

s, h

ome

heal

th a

ides

. In-

clud

es n

urse

s em

ploy

edin

scho

olhe

alth

pro

gram

s.

May

be

colle

cted

yea

rly

and

may

or

may

not

be

tabu

late

d.

Com

pile

dbi

enni

ally

for

Nat

iona

lC

ensu

sof

Pub

lic H

ealth

Nur

ses.

May

be

com

pile

d an

d ta

bula

ted

an-

nual

ly in

som

e St

ates

.

Cat

egor

yPo

ssib

le s

ourc

eT

ype

of d

ata

Com

men

tsN

UR

SE S

UPP

LY

Con

tinue

dR

egis

tere

d nu

rses

.

NU

RSI

NG

ED

UC

AT

ION

:

Con

tinui

ng e

duca

tion.

Fina

ncia

l nee

d an

dsu

ppor

t.

Nur

se f

acul

ty.

Scho

lars

hips

and

loan

sfo

r nu

rsin

g ed

ucat

ion.

Stat

e bo

ards

of

nurs

ing.

Stat

e or

con

stitu

ent

leag

ue f

or n

urs-

ing.

Stat

e de

part

men

t of

educ

atio

n, e

x-te

nsio

n di

visi

on.

Non

prof

it he

alth

and

prof

essi

onal

asso

ciat

ions

, suc

has

hos

pita

las

-so

ciat

ion,

hear

tas

soci

atio

n,an

dtu

berc

ulos

is a

ssoc

iatio

n.

Med

ical

soc

iety

aux

niar

ies.

Lic

ensu

re d

ata

on r

ecor

ds,

tabu

late

dor

in r

epor

t for

m; n

umbe

r of

nurs

eslic

ense

d, e

mpl

oym

ent

stat

us, p

lace

of

resi

denc

e.

Ext

ent a

nd ty

pes

ofw

orks

hops

, con

-fe

renc

es, s

peci

alco

urse

s co

nduc

ted

in S

tate

or

area

, and

nee

ds.

Scho

ols,

loca

tion,

cour

ses,

cos

t.

Cou

rses

offe

red,

atte

ndan

ce,

and

need

s.

Num

ber,

kind

s,an

d am

ount

sof

awar

ds; n

umbe

r of

requ

ests

and

need

for

fin

anci

alas

sist

ance

.

Serv

ice

club

s an

d ci

vic

orga

niza

tions

.Sa

me

as a

bove

.

Indi

vidu

al s

choo

ls o

fnu

rsin

g.

Stat

e bo

ard

of n

ursi

ng.

Stat

e or

con

stitu

ent

leag

ue f

or n

urs-

ing

and

Stat

e nu

rses

' ass

ocia

tion.

Ilea

lth

care

er c

ounc

ils.

Sam

e as

abo

ve, i

nclu

ding

scho

lar-

ship

s an

d lo

ans

from

Fede

ral p

ro-

gram

sou

rces

dis

trib

uted

by

scho

ols.

Num

ber

empl

oyed

ful

l-an

d pa

rt-

time,

by

scho

ol a

ndty

pe o

f pr

ogra

m,

leve

l of

educ

atio

nal

prep

arat

ion,

and

num

ber

of b

udge

ted

vaca

ncie

s.So

urce

s an

d av

aila

bilit

y,el

igib

ility

requ

irem

ents

, and

obl

igat

ions

;de

-m

and,

utili

zatio

n, a

nd n

eeds

for

fina

ncia

l ass

ista

nce.

Sam

e as

abo

ve.

May

incl

ude

data

fro

mst

anda

rdA

NA

inve

ntor

y qu

estio

nnai

reon

age

,fi

eld

ofpr

actic

e,po

sitio

n, e

duca

-tio

nal p

repa

ratio

n, f

or a

nye

ars

orN

atio

nal I

nven

tory

year

s 19

49, 1

951,

1956

-58,

196

2, 1

966,

and

1972

.

Surv

ey o

f sc

hool

s m

ay b

e re

quir

edto

obt

ain

thes

e da

ta.

Cat

egor

iPo

ssib

le s

ourc

eT

ype

of d

ata

Com

men

ts

Scho

ols

of n

ursi

ng a

nd p

rogr

ams

of n

ursi

nged

ucat

ion.

Stud

ents

in n

ursi

ng e

duca

tion

prog

ram

s.

Var

ious

asp

ects

of

nurs

ing

educ

atio

npr

ogra

ms

and

stud

ents

and

nur

sing

edu

catio

n ne

eds.

OT

HE

R H

EA

LT

111

MA

NPO

WE

R:

Dem

and

for.

Tec

hnic

al a

nd p

rofe

ssio

nal p

erso

nnel

em

ploy

edin

all

heal

th a

genc

ies

and

inst

itutio

ns a

ndth

eir

educ

atio

nal s

ervi

ces.

Stat

e bo

ard

of n

ursi

ng.

Stat

e bo

ard

of n

ursi

ng.

Stat

e or

con

stitu

ent l

eagu

es f

ornu

rs-

ing.

Stat

e bo

ard

of n

ursi

ng.

Stat

e or

con

stitu

ent l

eagu

e fo

r nu

rs-

ing.

Stat

e em

ploy

men

t ser

vice

or

depa

rt-

men

t of

empl

oym

ent s

ecur

ity, S

tate

boar

ds o

f ed

ucat

ion,

voc

atio

nal e

du-

catio

n, o

r pu

blic

inst

ruct

ion,

and

Stat

e ho

spita

l ass

ocia

tion

or o

ther

prof

essi

onal

org

aniz

atio

ns.

Reg

iona

l Med

ical

Pro

gram

s.

Stat

e-sp

onso

red

nurs

ing

scho

lars

hips

,av

aila

bilit

y, e

ligib

ility

, aw

ards

, and

empl

oym

ent a

nd p

aym

ent r

ecor

ds.

Nam

e an

d lo

catio

n of

sch

ools

ap-

prov

ed o

r ac

cred

ited

by th

e B

oard

,ty

pe a

nd le

vel o

f ed

ucat

iona

l pro

-gr

am, l

engt

h of

pro

gram

s, c

linic

alfa

cilit

ies.

Nam

e, lo

catio

n, a

nd a

dmis

sion

re-

quir

emen

tsof

scho

ols;

type

and

leng

thof

prog

ram

s;tu

ition

and

fees

;an

dna

tiona

lac

cred

itatio

nst

atus

.

Adm

issi

ons,

enr

ollm

ents

, and

gra

d-ua

tions

, by

type

of

prog

ram

;at

-tr

ition

ofst

uden

ts,

num

ber,

and

reas

ons.

Spec

ial s

urve

y an

d st

udy

data

, suc

has

edu

catio

nal p

repa

ratio

n of

nur

sead

min

istr

ator

s, te

ache

rs, a

nd s

uper

-vi

sors

;pa

ttern

s of

nur

sing

edu

ca-

tion;

stu

dent

cha

ract

eris

tics;

car

eer

ince

ntiv

es a

nd s

atis

fact

ions

.

Surv

eys

cond

ucte

d as

bas

is f

or p

lan-

ning

ser

vice

, tra

inin

g, o

r ed

ucat

ion

prog

ram

s, o

n nu

mbe

r of

hea

lth p

er-

sonn

el e

mpl

oyed

ful

l tim

e an

d pa

rttim

e, b

y oc

cupa

tiona

l titl

e, b

udge

ted

vaca

ncie

s,re

plac

emen

t,ex

pans

ion,

and

turn

over

nee

ds f

or o

ne o

r m

ore

heal

th f

ield

s.

May

hav

e pr

ojec

ts f

or c

ompi

ling

in-

vent

orie

s fo

r th

e pr

ogra

m a

rea

orda

ta f

rom

spe

cial

sur

veys

, inc

ludi

ngnu

mbe

r em

ploy

ed f

ull-

time

and

part

-

Shou

ld h

ave

info

rmat

ion'

on

new

prog

ram

san

dsc

hool

san

dtr

an-

sitio

nal

arra

ngem

ems

inpl

anni

ngst

age;

als

o cl

osed

sch

ools

and

pro

-gr

ams

and

reas

ons

for

clos

ing.

Mai

ntai

ns a

nd u

pdat

es li

st f

or r

e-cr

uitm

ent p

rogr

am p

urpo

ses.

Cat

egor

yPo

ssib

le s

ourc

eT

ype

of d

ata

Com

men

ts

OT

HE

R H

EA

LTH

MA

NP

OW

ER

Con

tinue

d

Tec

hnic

al a

nd p

rofe

ssio

nal p

erso

nnel

em

ploy

edin

all

heal

th f

ield

s.

Tec

hnic

al a

nd p

rofe

ssio

nal p

erso

nnel

em

ploy

edin

hos

pita

ls.

Tec

hnic

al a

nd p

rofe

ssio

nal p

erso

nnel

em

ploy

edin

nur

sing

hom

es.

Tec

hnic

al a

nd p

rofe

ssio

nal p

erso

nnel

em

ploy

edin

Sta

te-o

pera

ted

inst

itutio

ns a

nd a

genc

ies.

POPU

LA

TIO

N:

Est

imat

es.

_UT

LIZ

AT

ION

OF

HE

AL

TH

FAC

ILIT

IES

AN

D S

ER

VIC

ES

:H

ospi

tals

, nur

sing

hom

es, o

utpa

tient

clin

ics,

and

Stat

e-op

erat

ed in

stitu

tions

and

age

ncie

s.

Prof

essi

onal

asso

ciat

ions

such

asm

edic

al s

ocie

ty, d

enta

l soc

iety

, phy

s-io

ther

apy

asso

ciat

ion,

pod

iatr

icas

-

soci

atio

n, p

harm

acy

asso

ciat

ion.

Stat

e ho

spita

l ass

ocia

tion.

Stat

e he

alth

dep

artm

ent.

Stat

e he

alth

dep

artm

ent.

Stat

e he

alth

dep

artm

ent.

Bur

eaus

or

depa

rtm

ents

of

busi

ness

and

econ

omic

deve

lopm

ent.

Als

ore

sear

ch d

epar

tmen

ts o

f St

ate

gov-

ernm

ents

or

Stat

e un

iver

sitie

s.

Stat

e he

alth

dep

artm

ent.

Sect

ion

ordi

visi

on w

ith li

cens

ing

auth

ority

and

resp

onsi

ble

for

plan

ning

for

hos

pita

lan

d m

edic

al f

acili

ties

and

spec

ialty

time,

posi

tion,

and

othe

rch

arac

-te

rist

ics.

Mem

bers

of

asso

ciat

ion

by S

tate

. May

have

sur

vey

data

on

num

ber

licen

sed

or r

egis

tere

d by

Sta

te,

char

acte

r-is

tics,

pla

ce a

nd ty

pe o

f em

ploy

men

t.

May

hav

e da

ta b

y ca

tego

ry o

f pe

r-M

ay in

clud

e da

ta o

n de

man

ds a

ndso

nnel

, typ

e of

pos

ition

, and

ful

l-ne

eds

for

addi

tiona

l per

sonn

el.

time

and

part

-tim

e em

ploy

men

t, fr

ompe

riod

icsu

rvey

sof

mem

ber

hos-

pita

ls.

May

mai

ntai

n in

vent

ory

of n

umbe

rem

ploy

edfu

ll-an

dpa

rt-t

ime,

byca

tego

ry o

f pe

rson

nel a

nd p

lace

of

empl

oym

ent a

spa

rt o

f pr

oced

ures

for

com

plia

nce

with

con

ditio

ns o

fpa

rtic

ipat

ion

unde

r m

edic

are

and

med

icai

d pr

ogra

ms.

Num

ber

and

cate

gory

of

pers

onne

l,ty

pe o

f po

sitio

n, f

ull-

time

and

part

-tim

eem

ploy

men

t,an

dbu

dget

edva

canc

ies.

Stat

ewid

e an

d co

unty

est

imat

es f

orU

sual

ly e

stim

ated

as

of J

uly

1 of

year

s be

twee

n th

e ce

nsus

.

Est

imat

es o

fpo

pula

tion

for

Stat

ean

d co

untie

s fo

r fu

ture

yea

rs. M

ayin

clud

ecl

assi

fica

tion

by a

ge,

sex,

race

, and

dat

a on

mob

ility

.

May

req

uire

or r

eque

st v

olun

tary

repo

rtin

g an

d m

aint

ain

data

on

ad-

mis

sion

s,av

erag

eda

ilypa

tient

cens

us, l

engt

h of

sta

y, c

linic

atte

nd-

each

yea

r.

Cat

egor

yPo

ssib

le s

ourc

eT

ype

of d

ata

Com

men

ts

Old

-age

, sur

vivo

rs, d

isab

ility

, and

hea

lth in

sur-

ance

ben

efic

iari

es a

nd b

enel

it pa

ymen

ts.

Publ

ic h

ealth

and

pre

vent

ive

prog

ram

s su

ch a

scr

ippl

ed c

hild

ren,

tube

rcul

osis

con

trol

, ven

erea

ldi

seas

e, m

ater

nal a

nd c

hild

hea

lth, s

choo

l hea

lth.

UT

ILIZ

AT

ION

OF

NU

RSI

NG

PER

SON

NE

L:

Hos

pita

ls.

depa

rtm

ents

suc

h as

men

tal h

ealth

,an

ce, e

tc. A

lso

avai

labl

e fr

om a

nnua

lm

enta

l ret

arda

tion,

tube

rcul

osis

.st

atis

tical

and

ser

vice

rep

orts

of

the

depa

rtm

ents

. May

hav

e da

ta f

rom

spec

ial t

abul

atio

ns o

f se

rvic

eda

taor

spe

cial

stu

dies

of

need

s an

d de

-m

ands

for

hea

lth c

are

serv

ices

.

Stat

eag

ency

adm

inis

teri

ngSo

cial

Ann

ual s

tatis

tical

and

ser

vice

rep

orts

Secu

rity

pro

gram

s.m

ay h

ave

data

fro

m s

peci

al s

urve

yson

vari

ous

aspe

cts

ofpr

ogra

ms,

need

s fo

r he

alth

ser

vice

s, a

nd u

tili-

zatio

n by

type

of

serv

ice.

Stat

e he

alth

dep

artm

ent.

Indi

vidu

al h

ospi

tals

, hos

pita

l ass

ocia

-tio

n, o

r pr

ofes

sion

al n

ursi

ng o

rgan

i-za

tions

.

Stat

e ho

spita

l ass

ocia

tion.

Cas

e ra

tes

by ty

pe o

f pr

ogra

m a

ndse

rvic

e, a

dmis

sion

s to

serv

ice,

dis

-ch

arge

s, c

linic

and

hom

e vi

sits

or

serv

ice

cont

acts

from

ann

ual

sta-

tistic

al a

nd s

ervi

ce r

epor

ts o

f th

ede

part

men

t and

div

isio

ns o

r bu

reau

sof

the

depa

rtm

ent.

May

hav

e sp

ecia

lta

bula

tions

or

surv

ey d

ata.

Info

rmat

ion

rega

rdin

g an

d da

ta f

rom

nurs

ing

activ

ity s

tudi

es, p

atie

nt c

las-

sifi

catio

nst

udie

s, o

r ot

her

spec

ial

stud

ies

cond

ucte

d in

indi

vidu

al h

os-

pita

ls.

Peri

odic

sur

vey

data

for

mem

ber

hosp

itals

onnu

rsin

gho

urs

per

patie

nt p

er d

ay, n

umbe

r of

nur

sing

pers

onne

l per

100

bed

s, r

atio

s of

prof

essi

onal

to te

chni

cal t

o au

xilia

rynu

rsin

g pe

rson

nel

May

be

raw

dat

a on

que

stio

nnai

refo

rms

or b

e ta

bula

ted.

Con

tent

of

surv

ey m

ay d

iffe

r fo

rea

ch p

erio

d co

nduc

ted.

Cat

egor

yPo

ssib

le s

ourc

eT

ype

of d

ata

Com

men

ts

UT

ILIZ

AT

ION

OF

NU

RSI

NG

PER

SON

NE

LC

ontin

ued

Priv

ate

prac

gce.

Hos

pita

l reg

istr

ies,

pri

vate

reg

istr

ies,

and

regi

stri

es a

ppro

ved

by S

tate

nurs

es' a

ssoc

iatio

ns.

On

serv

ice

reco

rds,

ser

vice

rep

orts

,or

spe

cial

rep

orts

on

calls

rec

eive

dan

d di

spos

ition

ofca

llsfo

r ea

chca

tego

ry o

f nu

rse

regi

stra

nt. M

ayin

clud

ein

form

atio

n on

sou

rce

ofca

lls,

type

of

nurs

ing

serv

ice

re-

ques

ted,

need

sfo

rse

rvic

e,an

dtr

ends

in th

e us

e of

nur

ses

in p

riva

tepr

actic

e.

Index

193

Index

[This index covers chapters 1 through 7 only]

A

Abdellah, Faye G., 68Abstracting data, 65Accreditation

national, 55program, 3

Action initiation and planning, 6, 55Action-Planning for Community Health Services,

7, 12, 69Actions, are they achieving purpose?, 55Administrative codes, modification of, 54Administrative procedures, important, 44Administrators and planning, 35Adult Education Association of the U.S.A.,

12, 29, 45, 56Adult Leadership, 29, 30, 45, 46Advisory committee, the, 21Albee, George W., 77Alternatives to planning, 12American Hospital Association, 7American Journal of Nursing, 46American Nurses' Association, 18, 29, 51, 68American Psychologist, 77Anderson, Betty Jane, 29Appraisal of nurse supply, 5Area of planning, 40-42Areas, emerging, needing study, 56

listing, 16Arnold, Mary F., 56Assessing needs and resources, 7Assessment

constant, required in many areas, viiframework for, 49how tasks are accomplished, 52indices for, 49-50steps in, logical, 49tools of, 51.52

Associations, health professions, list of, 36

Bartow, Josephine A., 29Benne, Kenneth D., 45, 56Bennis, Warren G., 56Berger, Anne G., 77Better Boards and Committees, 29, 45Better Patient Care Through Nursing Research, 68Blue Cross Associations, 61

Board of Nursing Education and Nurse Registration, 69Brown, Ray E., 12Budgetary requirements estimations, 15Budgeted positions and needs assessments, 74Budgets, planning, 39Building the organizational structure, 13-31Bulletin of the New York Academy of Medicine,

7, 12, 56Bullough, Bonnie, 45Bullough, Vern, 45Business administration consultants, 29

California Department of Health, 69Career choice and nursing needs, iiiCareer incentive improvement, 54, 55Career satisfaction, 66Certification procedures, 41Change, Collaboration, Community I nvolvement,Changing Job Structure of Health Manpower, The,

46, 78Charge of a planning group, example of a, 50Chin, Robert, 45, 56Civic groups listed, 36Collection of data, importance of adequacy of, 66Commercial growth patterns, 6Committee rules for decision-making, 52Committee, single top-level, illustrated, 26Committee structure in planning, 15, 21

variations in, 23

4

TZ,7

195

196 INDEX

Committeesdesignations of, 22-23guidelines for organizing, 35size of, the, 35

Communicationsee also, Public relationsorganizational structure, and the, 15planning groups, between, 21

Community groups listed, 36Community Planning for Nursing in the District of

Columbia Metropolitan Area, 64, 69Competition for employment of professionals, 41Comprehensive Health Care, A Challenge to American

Communities, 46Comprehensive Health Planning (CHP) program, 64Concepts in assessing manpower requirements, 73-74Concepts of nursing problems, data and, 51Conde-Thillet, Mario L., 45Conducting Workshops and Institutes, 29Confidential data, 68Conflict of interests, 44Consultants and resource persons, 29Consultants, use of, 52Contracts, employment, for planning staff, 37Cooperative arrangements in factfinding, 62Coordination with other groups, planning and, 5-6Cost data in planning, 54Cost of planning

see FundingCouncil. illustrated, 27Creamer, Daniel, 77Criteria and standards. assessment tools, 51Crude ratios in manpower assessments, 73

Dataabstracting, 65analysis of, 61, 65assessing adequacy of, 66-67assessment, 65assessment tool, an, 51base for planning, a, 51collection, 7, 61, 64

adequacy of, 66.67ad hoc committees and, 61methods and the data, 67observer error in, 67planning and, 6sampling error in, 67source book in, 61

195

systems development, 6confidential, designated, 68existing, 63.64, 67

accuracy of, 67definitions used in, 67refinement of, 67timeliness of, 67use of, 64

gaps in, 68information systems in planning, 62limitations of, 65, 66, 67original, methods of collecting, 65predetermining, 62procedures for collection of, 68processing, 39, 62re-evaluating the requirements, 68review of preparatory to planning, 16source books, 43sources in study outline, 18, 19, 20sources of, 63-66systems for continuous planning, 68types required, 62-63

Davis, R. C. W., 29Decentralized planning, 41Decision-making on nursing needs, 49Decision-making, rules for, 52Demand

current, for manpower, 74measuring, methods for, 74need in manpower requirement measurements, and.

73projection, methods for measuring, 74ratios, refined, 73, 74

Deniston, 0. L., 56Design for Statewide Nursing Surveys, iiiDesignations of committees, 22.23Difficulties impeding progress, 44Director of project

qualifications of, 37responsibilities of, 37

Discrimination, viDiscussions, panel, 23Dissipation of interest of participants, 40Diversity of needs, 53Division or Nursing, U.S. Public Health Service, iii, 64Doughman. Gordon 0., 45Duties of project director, 37

Economic demand and nursing need, 76

INDEX 197

Economic realities of area, 15Economics of Health, The, 46Education

accreditation, national, 55criteria and standards of, 50educational materials, use of, 61educators and planning, 35goals of, 54-55nursing, iii, 5

costs of, 66effective patterns of, 3planning for, 3

problems of, 4programs, continuing, 41programs criteria, 51programs, establishment of, 11programs listed, 55resources, vii, 18

perspective on, necessary, 73service areas and planning, 40systems and planning, 6

Educational preparation of nurses, 11Educational Preparation for Nurse Practitioners and

Assistants to Nurses: A Position Paper, 29Effective Public Relations, 45Effective utilization of nursing personnel, 41Effective Writing: For Engineers, Managers, Scienasts,

46Elements of Style, The, 46Employment

conditions, 4contracts for planning staff, 37opportunities and planning, 6

Evaluation of ongoing planning, 21Example of a charge given a planning group, 50Executive committee

composition of, 21functions of, 21-22

Existing data, 63-64see also, Data, existing

Existing staffing ratios, standards based on, 75Expenditures for a 2-year planning activity, 39Expenses, operating, planning, 39Experience, aggregate, reviewed, 16Experimentation, planning endorses, 6

Factfinding, 59-69cooperative arrangements for, 62providing for, 61

Factors affecting nursing, 49Facts About Nursing, 18, 20, 68Faculty, qualifications of, 55Federal financial aid, 54Financial resources and planning, 6Financial support in planning, 12Financing

see Cost data ;. and FundingFlaws in data collection, the importance of, 66Folk, Hugh, 77Forecasting Model of Manpower Requirements in the

Health Occupations, A, 77Forecasting of Manpower Requirements, The, 78Format of reports listed, 43Formulation of recommendations in planning, 50Fox, David J., 69Functions, Standards and Qualifications, 19Fundamentals of Research in Nursing, 69Funding

expenditures for a 2-year planning activity, 39fund-raising activities, 38project grant, by, 38planning, and, 21planning project, of, 38-39prospectus preliminary to, 38sources of, list of, 38

Future manpower demand, assessment of, 74Future population projections, 63

Gaps in data requirements, 68Geographic planning, 15, 40Georgia Educational Improvement Council, 12Gessner Quentin H., 30Getting and Keeping Members, 45Getting, V. A., 56Ginzberg, Eli, 46Goodell, Frank C., 30Greenberg, Bernard C., 56Guidelines for organizing-planning committees., 35Gunning, Robert, 46

Hampton, Leonard A., 30Harvard Business Review, 78Health agencies and factfinding, 62Health associations, list of, 36Health facilities, staffing, 3Health. Manpower 1966-1975, 46

198

Health manpower planningsee Planning

Health Manpower Source Book, 20, 69, 75, 77, 78Health needs and nursing, 50Health planning

comprehensive, 6in 1970's, vii

Health professions, interdependence of, 3Health programs

existing, 63shift in emphasis of, 6

Health serviceareas and planning, 40demand for, 63

Health services, deprived areas and, 53progressive expansion of, 3

Health status of population, 63Hearings, 15

see also, Public hearingsplanning, in, 23

Hilleboe, Herman E., 7, 56Hink, Douglas L., 56Hospital Progress, 78Hospitals, 78

Illinois Study Commission on Nursing, 69Implementation of plan, 55-56Implementation phase, the, 55Industrial growth patterns, 6Information

dissemination, planning and, 6-7needs assessment, 18, 19, 20public, and planning, 39required i planning, 62-63

Informational materials, use of, 61Initial planning objectives, 4Initiating planning, 9-12Initiat;on of planning, not automatic, 11Innovation in meeting needs, 3Instruments for data collection, 67Interest groups and planning, 12Interests, conflict of, 44Interregional planning, 41Interstate mobility of nursing manpower,Interviews in planning, 65Introduction to Group Dynamics, 46I ssues in Nursing, 45

INDEX

JJob satisfaction improvement, 54Judgment, expert, standards based on, 75Judgments and decisions

assessment tools, 51bases for, the, 51.52

Keneally, Henry J., Jr., 46Kissick, William L., 46Klarman, Herbert E., 46Knowles, Hulda F., 46Knowles, Malcolm S., 46

Leaders, identification of, 15, 16Leadership, planning and, 6, 16Lefkowitz, Annie, 46Legislative authorizations, modification of, 54Levine, Eugene, 68Liaison with other organizations, planning group and, 5Licensing codes at State level, 41Licensing of nurses, a data source, 64Limitations of data in planning, 65, 66, 67.68Lippitt, Gordon L., 30Local area planning, 41Long Range Planning for Higher Education, 30

Maki, Dennis R., 77Manpower

and transportation, 65assessing requirements for, 71-78challenges, planning to meet, 3pool for training, 77requirements, levels of, examples of, 73requirements, planning and, 6

Manpower Planning Subsystem of the California HealthInformation for Planning Service (CHIPS)System, The, 69

Mass mediaplanning, in, 35public relations and the, 42use in planning, 6-7

Mass transportation and66 Mayhew, Lewis B., 30

Measurement of nursingMeasuring I ob Vacancies: A Feasibility Study in the

Rochester, N.Y . Area, 77

manpower availability, 65

needs, 73

I.

INDEX 199

Measuring Nursing Resources, iiiMedical Care, 56Medicai College of Virginia, 69Medical Times, 56

Medicare and Medicaid influence noted in study out-line. 20

Men, Money and Medicine, 46Mental health, 6Mental health and mental retardation, 40Mental retardation, 6Method, selecting an estimating, 76Methodology

for assessing nursing needs, 76planning activity, of, 22planning, 15

developing, 15Methods of Estimating Health Manpower, 78Meyer, Burton, 77Mico, Paul R., 30Milbank Memorial Fund Quarterly, The, 46Minnesota Board of Nursing, 69Morbidity trends, 6Motivation and interest of planning participants and

long-term assessment, 40Motivation of participants, 44Mortality rates in planning, 63Mountin, Joseph W., 77Myers, John G., 77

National Commission on Community Health Services.7, 12, 46, 56, 69

National League for Nursing, 7, 69, 75, 78Nature of planning, the, 1-7Need for planning, recognizing the, 11Needs, assessing, 47-57Neighborhood health center programs, 52New York Academy of Medicine, 7Notter, Lucille E., 46Nurses, differing types required, 73Nurses for a Growing Nation, 78Nurses in Public Health, 20Nursing

care measurement, 66career choice and, iiiconcern, 18, 19, 20concerns, perimeters of, 15delineation of the role of. 51

demand, methods of projecting, 77Division of, The, iiieducation costs, 66education goals. 54-55education resources, iiieducational attainment of practitioners, 51every area should have plan for, 49factors influencing, 6, 49Nation's health cate system and, iiineeds, planning for

see Planningnurse supply trends, 53

conditions affecting, 4measurement of, 73patient care patterns and, iiiprogram innovation and, iiistandards for determining, 76statistical surveys of, iiiwide variations in, 50

personnelimproved utilization of, 19quantity and quality of, 54turnover of, 66utilization of, 66

plan for, the, 54planning for, iii"plans may be no more than hopes," 55practices, appraisal of, 51

and educationdiscrepancies between. 66research, 54schools

improvement of, 55services

development highly specialized, 41croals 54improvement grant, 54requirements and need measuring, 76

socioeconomic environment of, 50specific needs for, 54staffing ratios, 51supply. estimating future, 77various fields of, 50

Nursing and Health Care in Virginia, 69Nursing Clinics of North America, 29Nursing Education in Georgia, 12Nursing in Illinois, 69Nursing in Minnesota, 69Nursing in Virginia, 12Nursing Research, 77

p

200 INDEX

0Objectives

see also, Planninginitial, 4planning, of, 4refined, 4

Objectivity of recommendations in planning, 21Obstacles in planning, 22Onthe-job training, 54Operational direction over planning tasks, 22Organizational forms used in planning, 16Organizational structuie, building the, 13-31Organizational structure for areawide planning,

illustrated, 28Organizations, cooperation of, viiOrganizing

building organizational structure, 17, 13-31facets of, many, 15for planning, 13-31framework for, 15strengthening the organizational structure, 33-46

Orientation of participants, 45Original data and collection, 65Ostow, Miriam, 46Outlines, study, 16, 17, 18-20

Panels, 15planning, in. 23

Participantsin planning, 35-37information, adequate, for, 45listed, 36orientation of, 45selection of, the, 35

Participation in planning, 5Past trends in nurse-manpower supply, 62Patient care patterns affecting nursing needs, iiiPatient requirements and manpower need, 76Patterns of planning areas summarized, 42Pennell, Elliott H., 77Personnel, nursing

roles of, 3

interdependence of, 3utilization of, efficient, 5

Phillips, Jeanne S., 69Pilot, Michael, 46Plan of action, developing the, 47-57

Plannersfamiliarity with areas of concern, 50mixture of talent, a, 61

Planning of Change, The, 45, 46, 56Planning

acceptance of, 16accommodation of participants, 6alternatives to, 12appointment of a body for, 11appreciation of, 16approach to, the, 16area differences in, 5area of, 40-42assessing needs and developing the plan of action.

47-57assessing requirements for nurse manpower, 71-78assessment phase, the, 49-50assessment tasks accomplishment, 52associated events leading to, 11benefits of involvement in, viibudgetary requirements in, 15, 38budgets examples, 39cannot be done in isolation, 5change and, viicharge of planning group, examples of a, 50commitment to inidate, 11committee organizing guidelines, 35cornmittee structure in, 15, 21committees, establishment of, 16common purposes and goals, 51concepts in, 3contracts for staff, 37consultants in, 29continuity of functions in, 6continuous, 55-56continuous, data information systems for, 68coordination with other groUps essential, 5cost data in, 54cost of the, 38-39council structure in small areas, 23data. a base for, 51data collection and use, 6, 61data processing in, 62data review and, 16data types required in, 62-63decentralized, 41defined, 3deliberate process, a, 3demand and need in assessing requirements, 73development of plan, 53

PlanningContinueddifficulties, resolution of, 44director of project, the, 37education, programs of, 54-55essentials of, the, viievaluation of progress in, 53experience assessment in, 15experimentation endorsed in, 6factfinding, 59-69factfinding phase of, 62financial support in, 12financing of

see Fundingfive-year periods of, 56funding and, 21funding of, 38-39future estimates in, 56general purpose of, 4goals of action in, 4group, composition of, 5health care requirements aid, 3hearings in, 23implementation of, 55-56influencing factors, 18, 19, 20information, availability of, 5information dissemination and, 6-7information for planning, 63.66initiation of, 9-12initiative in, the, 3interregional, 41involvement of community leaders in, 12leaders in, identifying, 15, 16leadership and, 6, 16local area, 41manpower requirements and, 6mass media and, 6.7, 55measuring manpower demand, 74methodologies, 6migration rates in and out of planning area,modifications in, 55mortality rates in, 63nature of, the, 1-7need for, recognizing the, 11non-nurse representatives in, 63no one phase more important, 7nursing education, for, 3nursing, for, iiiobjectives, 4

initial, 4long-range, 6

INDEX 201

refined, 4short-term, 6

observations in, 65-66organization for, 13.31organizational mechanisms, 54organizing planning, 33-46panels in, 23participants in, 35.37

list of potential, 36participation in, basic, 5phases of planning process, 7planners a mixture of talent, 61planning groups reports, 76previous, 5principles and requirements of, 5-7process of, tabulated, 7promotional activities and, 11provisions of groups, 61public relations in, 42readiness for, 11-12recommendations in, 52-53reports

planning, 43popular, 44special, 44summary, 43-44

research and processes for change in nursing, 66research as part of, 66research in, 66salaries of staff, 38sanctions and sponsors for, 11scope and patterns of, 4scope and structure of plan, 53-54scope of, 4-5selecting a method to estimate requirements, 76social activities and, 29social and health goals and, 3socioeconomic environment, and the, 5

77 socioeconomic framework and, 62sources of data in, 63-66special committees in, 22special studies in, 6, 15, 66staff to administer activities, 36staffing patterns, 36-37statewide, 40-41statisticians in, 61strategy of, 5studies with, costs of, 39study areas listed, 50study outlines in, 16, 18, 19, 20

'alto

202 INDEX

PlanningContinuedsuccess dependence, 35success of, the, 55summary of planning area patterns, 42supervision over planning tasks, 21support, adequate, 35supportive measures, 55techniques, other, 23-29"thinking phase" of, 15timetable determination in, 15timetable for, 40variations in, 4-5work plan for, 15workshops in, 29

Policy-making committee, the, 21functions of, 21

Political action often required, 40Politics of Community Health, The, 46, 56Popular reports, 44Population characteristics, 63Population growth, 6Power structure in planning area, 15Predetermining the data necessary, 62Price, Elmina, 46Principles and requirements of planning process, 5-7Principles To Guide Development of Statewide Com-

prehensive Health Planning and Protocol forHealth Care Planning Within a State, 7

Priorities for action programs, 21Priorities in study outlines, 16Priorities of recommendations suggested, 53Proceedings of workshops, 44Processes for change in nursing programs, 66Professional associations, 41Professional Nursing: Foundations, Perspectives and

Relationships, 46Profile of Registered Nurses in California, 69Program accreditation, 3Program-planning techniques, 51Progress, assessment of, 55Progress in planning, evaluation of, 53Project cooperation, 5Project endorsement, 5Projecting nurse supply, methods of, 77Promotional activities and planning, 11Public Health Bulletin No. 305,77Public Health Reports, 56Public hearings, 52

planning, 23proceedings compilation, 44

Public relations, 42;group meetings in, 42policy statements in, 42progress reports in, 42promotion, 21public forums in, 4.2State Governor, visits to, and, 42reports on surveys in, 42special materials in, 42

Questionnaires in planning, 65

Ratio projections, crude and refined, 73Readiness for planning, 11-12Recommendations

development of, the, 52, 53nature of, the, 52-53priorities of, 53realistic, must be, 52

Recruitment, nursing, 4, 66Recruitment potential, student, 55Reference materials, 45Refined planning objectives, 4Regional Medical Programs, 6Reliability of data, 67Report, analytical, preparation of, 50Reports, 4.3, 44Reports of study findings, preparation of, 22Resources, deployment to meet changing conditions. viiResources

exploring the. 49re-examination of, 56wise allocation of, 5

Responsibilities, assignment of, 45Research findings application, 54Research, nursing, 54Research in planning, 66Research, standards based on, 76Review of past studies as planning approach, 16Rosenthal, Neal H., 46Rosenstock, 1. M., 56

Salaries and fringe benofits, 54, 66Sampling, A Quick, Reliable Guide to Practical

Statistics, 69Sanctions and sponsors for planning, 11Sargent, Edward H., Jr., 30

INDEX 203

Schaefer, Morris, 7, 56Schools of nursing a data source, 64Scope and patterns of planning, 4Selection of planning participants, 35Sensitivity of data, 67Service, nursing service programs, 54Simultaneous planning for sub-areas or regions, 28Site visits by committee members, 45Situations considerations listed, 50Slonim, Morris James, 69Social activities and planning, 29Social and health goals, planning related to, 3Socioeconomic data to be collected continuously, 68Socioeconomic environment of nursing, 50Sociocconomic environment, planning and the, 5Socioeconomic framework and planning, 62Somers, Anne R., 78Source Book for Community Planning for Nursing in

South Dakota, 64, 69, 74, 77, 78Source book, use of, 61Sources of data, identification of, 64-65Sources of data in planning, 63-66Spalding, Eugenia Kennedy, 46Special committees, planning, in, 22Special reports, 44Special studies in planning, 6, 15Special surveys required in study outline, 18. 19, 20Specialized nursing units listed in study outline, 19Staff for planning, sources of, 37Staff to administer planning activities, 36Staffing patterns, studies on, 75Staffing standards and manpower needs, 75Standards

comparison of, 51criteria, and measuring need on, 74-76determination of, 51nursing education, for, 3

State agencies listed, 36State and Regional Medical Program areas, 40State-Approved Schools of NursingLPN 1 LVN, 18State-Approved Schools of NursingRIV, 18State-Approved Schools of NursingRN, 1971, 69State associations, the role of,' 56State boards of nursing, 11, 75

a data source, 64State Center for Health Statistics, A, 46, 69State league for nursing, 11State nurses' associations, 11State of California Department of Public Health, 69State planning groups, iv

Statewide planning, 40-41Statistical Abstract oj the United States, 69Statistical approach to nursing needs surveys, iiiStatisticians and planning studies, 61Statistics consultants, 29Statistics for Nurses: The Evaluation of Quantitative

Information, 69Statistics, potential distortions in, 66Steering committee, illustrated, 25Steps in assessment, 49Streamlining Parliamentary Procedure, 56Strength of organizational structure and success in

planning, 35Strengthening factors, 44-45Strengthening the organizational structure, 15, 33-46Structure, organizational, building the, 13-31Strunk, William, Jr., 46Student enrollment capabilities, 55Student-faculty ratios, 55Student scholarships, 54Studies

defined, 3nursing needs, iiispecial, 66

Study areas listed, 50Study of Nursing Service, A, 78Study outlines

determination of scope through, 16examples of, 18, 19, 20Medicare and Medicaid noted in, 20preparation, 50specialized nursing units listed in, 19

Summarizing data, 0Summary Report, California Health Information for

Planning Service, 69Summary reports, 43

format outlined, 43Supplies and equipment in planning, 39Supply, future, estimating, 77Surgeon General's Consultant Group on Nursing, 75, 78

Surveys

defined, 3nursing needs, and the community group, 12studies and planning, definitions of, 3

Takinq Action in the Community, 12, 56Task f,.rce, illustrated, 24

2

204 INDEX

Team nursing, 19Technical committees

data surveys and, 61planning, in, 22technical staff, and, 23

Technique of Clear Writing, 46Thompson, Richard F., 69Tichy, H. J., 46Timetable for planning, 40Timetable, preparation of essential, 40Tomorrow's Manpower Needs, 78Tools of assessment, 51-52Toward Quality in Nursing, 75, 78Traineeships, 54Training courses, short-term, 52Training facilities and future nurse supply, 77Transportation and manpower, 65Travel expenses in planning, 39Trends in nursing, interpretation of, 55

Understanding How Groups Work, 45, 56Urban planning, 6U.S. Department of Commerce, Bureau of the Census.

69

U.S. Department of Health, Education, and Welfare.46, 69, 78

U.S. Department of Labor, 78Utilization of nursing personnel in hospitals, 19

VVacancies on nursing staffs, 11Validity of data, 67\Teri, Clive C., 30Virginia Governor's Committee on Nursing, 12

Walker, James W., 78Watson, Goodwin, 46Weiss, Jeffrey H., 46, 78Welch, W., 56Welfare organizations, planning and, 5Western Economics Journal, 77White, E. B., 46World Health Organization, 78Work plan and the project director, 37Work sheets, details of, 16, 17Workshops, 15, 29

Yett, Donald E., 77, 78

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

2.13

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