The bill also contains a provision, not included in the administration bill (which you introduced as S. 2529), which would authorize a 5-year program of grants totaling $41 million to public and nonprofit private, accredited diploma schools of nursing to defray a portion of the cost of training students of nursing whose enrollment in such schools can be reasonably attributable to this legislation, in order to prevent further attrition of such schools and reduce the deficit incurred by the hospital schools (which deficit is borne by the patients in those hospitals). These grants would be paid to public and nonprofit private diploma schools of nursing on a formula basis. For each fiscal year of the program each school would be entitled to an amount equal to the product of $250 times the sum of (1) the number of students enrolled in the school on a full-time basis who received a loan for that year of $100 or more under this legislation and (2) the number by which the full-time enrollment in such school during the year exceeds the average enrollment in such school during a 3-year base period established by the legislation. In no case could a school for any year receive more than the product of $100 and the full-time enrollment in the school for that year.

The administration bill would authorize project grants to diploma schools as well as to collegiate and associate degree schools to strengthen, expand, or improve programs of nurse training; and it would authorize project grants to these schools and to other agencies, organizations, and institutions for the development of new or improved methods of (1) recruiting persons into the nursing profession, (2) training nurses, and (3) utilizing nursing personnel. The authorization for these purposes over a 5-year period would total $58.8 million.

Although the provisions and the purposes stated in the Housepassed bill with respect to Federal assistance to diploma schools differ from those of the administration bill, both bills would provide assistance to diploma schools to help them meet the costs of training nurses. Consequently, while we feel the approach of the administration bill is preferable, we think the Federal financial assistance authorized by the House-passed bill will result in strengthened and enlarged programs for training of nurses in the diploma schools, and we therefore would have no objection to its enactment.

H.R. 11241 would extend for 5 years the program for advanced training of professional nurses for teaching, supervision, and administration, and would expand the program to include other professional nursing specialties determined by the Surgeon General to require advanced training. The bill would authorize appropriations totaling $50 million for this program over the next 5 years.

The professional nurse traineeship program was established in 1956. It expired June 30, 1964. Continuation and expansion of this program has been recommended by the Surgeon General's Consultant Group on Nursing and by the 1963 conference called to evaluate the program. Both recommended that enrollment in long-term training be at least doubled by 1970, and that funds for short-term training be doubled within 5 years. The $50 million authorized in H.R. 11241, although $22,525,000 less than the estimates submitted by this Department as a reasonable basis for reaching these goals, will assist greatly in the expansion of the program.

I should like to say parenthetically at this point, gentlemen, that the nurse traineeships authority that is to be extended by this bill was originally enacted as part of the Health Amendments Act of 1956 which originated in your committee. A parallel provision in that 1956 legislation authorized a traineeship program for public health specialists, including public health nurses. Both of these programs have been highly successful and have clearly demonstrated the need for further extension. As you know, the legislation extending the public health traineeship authority was also recently passed by the House. We consider the extension of that authority to be essential.

We are, therefore, submitting to your committee a report endorsing the House-passed bill and urging its enactment. I shall be pleased to comment further about that subsequently.

The CHAIRMAN. All right, Doctor.

Dr. PRICE. Going back to the Department's report and turning to the provisions dealing with loans to students: To help remove the financial barrier to attendance at schools of nursing, the bill would authorize a loan program, with a forgiveness clause, for students in all types of professional nursing schools. This program would be patterned generally after that for medical and dental students contained in Public Law 88-129, the Health Professions Educational Assistance Act of 1963.

Students in need of financial assistance who are pursuing a full-time course of study in collegiate, associate degree, or diploma schools of nursing would be eligible for loans, with preference given to students entering as first-year students after enactment of the bill. The maximum amount of a loan could not exceed $1,000 a year, with interest computed only for periods during which the loan is repayable at 3 percent per year or the "going Federal rate," whichever is the higher. Under the administration bill, the maximum amount of s loan could not exceed $1,000 a year for collegiate students, and $500 a year for associate degree or diploma school students. We have no objection to the $1,000 maximum for all students.

The loans would be repayable over a 10-year period beginning after the first year after graduation; and up to 50 percent of the amount of the loan would be canceled at the rate of 10 percent for each complete year of full-time employment as a professional nurse in any public or nonprofit private institution or agency. The administration bill would allow up to 60 percent of the loan to be "forgiven." Although we prefer 60-percent forgiveness, particularly as an incentive for continuing the practice of nursing, we would not object to the 50-percent provision.

Loan funds would be established in schools of nursing wishing to participate in the program under agreement with the Secretary of Health, Education, and Welfare. The school would be required to provide $1 for every $9 of Federal contribution to the loan fund. Loans would be administered by the schools, and students would make applications to the schools.

The total cost of this program over a 5-year period is ee at $85 million, a substantial portion of which would h

to the United States.

H.R. 11241 omits one program of assistance which is included in the administration bill

mpetitive scholarship program. The purpose of this program is to imulate interest among a greater number of highly qualified seconary school graduates in attending collegiate schools of nursing, and >attract public attention to the urgency of this need. The scholarips would be allocated among the States in proportion to the umber of high school graduates, but with a minimum allocation of ve per State. One thousand scholarships would be made available ach year to entering students, and the students would continue to eceive scholarships until the completion of their nursing course. The amount of an individual scholarship would be based on need for inancial assistance, with a maximum of $1,000 a year. The cost of this program is estimated at $750,000 the first year, rising to $3 million in the fourth year. Although we believe this program would contribute greatly to developing a national awareness of the urgent need for nurses and in attracting outstanding high school graduates into the field, we would not object to enactment of H.R. 11241 without this program.

H.R. 11241 has no provision for planning grants. The administration bill would authorize $4.4 million for 2 years for matching grants to State, interstate, regional or local planning area agencies to assist them in surveying their present and future needs for nurses and in planning for the development of and improvement of nurse training facilities, personnel, and programs required to meet their needs. These planning groups would also play a major role in encouraging training and service agencies and institutions to undertake appropriate action to increase school capacity and enrollment, improve training programs and faculty, and improve the effectiveness of nursing services through the most efficient utilization of nursing personnel.

Although the administration proposal, embodied in S. 2529, would provide for a more comprehensive and intensive attack on the nursing shortgage, we believe that the difference between the bills is largely one of degree, and we would therefore recommend that H.R. 11241, with the technical amendments suggested above, be enacted.

The Bureau of the Budget advises that if H.R. 11241 is amended as recommended above, its enactment would be in accord with the program of the President.

The CHAIRMAN. Doctor, how many hospital schools of nursing have been closed over the past 10 years? Can you tell us?

Dr. PRICE. Mr. Chairman, during the past 3 years, which is the span of the data that we have available here this morning, 51 diploma schools of nursing have been closed. Thirteen new diploma schools opened during that period.

The CHAIRMAN. That would be 38 less, then.

Dr. PRICE. Thirty-eight less, then.

The CHAIRMAN. That is the last 3 years?

Dr. PRICE. Yes; during the past 3 years.

The CHAIRMAN. To what do you attribute these closing of schools, Doctor?

Dr. PRICE. The reasons for their closing, Senator Hill, are complicated. The principal reason is a lack of qualified faculty. Associated with this is a shortage of funds to maintain the schools. I think that one would have to indicate that it is a combination of the two which comprise the principal reasons for the closing.

The CHAIRMAN. We have had our graduate training program for professional nurses, I believe, since 1956. Has that been very helpful in providing faculty members?

Dr. PRICE. This has been a very productive program, Mr. Chairman. There have been 11,000 nurses who have received long-term training during the life of this program and 14,000 nurses receiving short-term training.

The CHAIRMAN. Well then, the program has been well worthwhile.
Dr. PRICE. We consider it has been an extremely valuable program.
The CHAIRMAN. Of course, this bill carries on the program.
Dr. PRICE. Yes, sir.

The CHAIRMAN. Doctor, in my State of Alabama we have 13 schools or nursing and only 2 of them have not been accredited by the National League for Nursing. For the country as a whole, however, I understand that 441 of the 1,148 schools of nursing have not been accredited. Many of them are hospital schools of nursing and would not be eligible for the formula grants that would be authorized by the bill to improve the program of instruction.

I am wondering how much it costs a school of nursing to be examined for accreditation purposes and how much time it would take the National League for Nursing to inspect the 441 schools that are not accredited, assuming these schools wish to be accredited. Would it be a year, 2 years or perhaps longer?

Dr. PRICE. As you know, sir, the accreditation program is carried out by the National League for Nursing.

The CHAIRMAN. Yes.

Dr. PRICE. And I believe that there is a representative of the league here to speak to your committee this morning.

The CHAIRMAN. You would rather have her give that answer? Dr. PRICE. I would like very much to defer an answer to this question to a greater authority.

The CHAIRMAN. All right, sir. I can understand your reason for that, sir.

Is there anything you would like to add, or Dr. Peterson, or Miss Scott?

Well, we very much appreciate your appearance. You brought a very clear, definite presentation, and we certainly want to thank you for it, Doctor. Thank you very much.

Dr. PRICE. Thank you very much, sir.

The CHAIRMAN. Now, Dr. Ann M. Douglas, American Nurses Association.

Doctor, we are glad to have you here with us and your associates. I believe you are dean of the School of Nursing at Georgetown, is that correct?

STATEMENT OF DR. ANN M. DOUGLAS, DEAN, SCHOOL OF NURSING, GEORGETOWN UNIVERSITY, APPEARING IN BEHALF OF THE AMERICAN NURSES' ASSOCIATION; ACCOMPANIED BY HELEN CONNORS, DIRECTOR OF THE LEGISLATIVE PROGRAM OF ANA; AND MISS JULIA THOMPSON, DIRECTor of ana, WASHINGTON OFFICE

Dr. DOUGLAS. Thank you, sir. I am Ann M. Douglas, dean of the School of Nursing, Georgetown University, Washington, D.C. I am accompanied by Helen Connors, director of legislative program of the ANA, and Miss Julia Thompson, director of ANA, Washington office. I appear here today on behalf of the American Nurses Association, the national professional association of registered nurses.

I have a prepared statement, portions of which I will read, and request that the entire statement be inserted in the record, sir.

The CHAIRMAN. All right, we will be very happy to have the entire statement inserted at this point in the record, and you may make such supplementary statement as you see fit.

Dr. DOUGLAS. Thank you, sir.

(The prepared statement of Dr. Douglas follows:)

PREPARED STATEMENT OF DR. ANN M. DOUGLAS, AMERICAN NURSES ASSOCIATION,

ON H.R. 11241

I am Ann M. Douglas, dean of the School of Nursing, Georgetown University, Washington, D.C. I appear here today on behalf of the American Nurses Association, the national professional organization of registered nurses. Our ultimate purpose is to secure for the people of this country the best possible nursing care, and one commitment of the association is to elevate the standards of nursing education to insure effective nursing practice. I welcome the opportunity to appear here today on behalf of ANA to speak to H.R. 11241, the proposed Nurse Training Act of 1964, and to urge you to give provisions of the bill your immediate and favorable consideration.

The legislation you are considering would authorize construction grants for schools of nursing; extension of the professional nurse traineeship program; a loan program for nursing students; project grants to develop new and improved methods of training and enable collegiate schools of nursing to strengthen, improve, and expand programs of nursing education; and a direct subsidy program to diploma schools of nursing.

There are over half a million registered nurses practicing today. However, an acute shortage exists that is both qualitative and quantitative. This has been caused in part by the rapid population increase, the growth and expansion of health facilities and advances in medical science. It has been intensified by the delegation to registered nurses of many functions once performed only by physicians.

For example, since the enactment of the Hospital Survey and Construction Act in 1946, 9,810 projects have been approved, representing a total of 290,000 general, mental, tuberculosis, and chronic disease hospital and nursing home beds. In addition, 1,992 rehabilitation facilities, public health centers, diagnostic and treatment centers, and State public health laboratories have been constructed. With the exception of laboratories, nursing personnel are needed in all these facilities. The American Nurses Association has always supported the intent and purposes of the Hospital Survey and Construction Act, but we are concerned that there are continuing appropriations for construction without an associated plan for staffing the facilities to insure effective and safe care. The Congress has passed a bill for hospital construction with over $1 billion allotted. We must have properly prepared persons to staff these new institutions.

There is a growing imbalance between professional nurses on the one hand and practical nurses and nurses' aids on the other. Federal support of practical 1 "Facts About Nursing", 1962-63 edition, American Nurses Association.