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IiPPE N DrX Congressional Charge Excerpts From Public Law 96-76 Sec. 113.(a)~1) The Secretary of Health, Education, and Welfare (hereinafter in this section referred to as the "Secretary") shall arrange, in accordance with subsection (b), for the conduct of a study- (A) to determine the need to continue a specific program of Federal financial support for nursing education, (B) to determine the reasons nurses do not practice in medically underserved areas and to develop recommendations for actions which could be taken to encourage nurses to practice in such areas, and (C) to determine the rate at which and the reasons for which nurses leave the nursing profession and to develop recommendations for actions which could be taken to encourage nurses to remain or re-enter the nursing profession, including actions involving practice settings conducive to the retention of nurses. (2)The part of the study described in paragraph (1~(A), shall include considerations of the following: (A) The need for nurses under the present health care delivery system and under such system as it may be modified by increased use of ambulatory care facilities or as it may be changed by the enactment of legislation for national health insurance. Determination of such need shall include determination of the need for nurses trained in each type of school of nursing (as defined in section 853~2) of the Public Health Service Act), for nurses with graduate training in the varying nurse practitioner clinical specialties, and for nurse administrators and nurse educators. (~) The cost of nursing education and a comparison of the cost of education at each type of school of nursing (as so defined) and comparison of the cost of each of the graduate programs of nursing. (C) The availability of other sources of support for nursing education, including support under general programs of Federal financial support for postsecondary education, under State and other public programs, and from private sources. 228

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229 (b)(l) The Secretary shall first request the National Academy of Sciences (hereinafter in this section referred to as the "Academy"), acting through the Institute of Medicine, to conduct the study, required by subsection (a), under an arrangement whereby the actual expenses incurred by the Academy directly related to the conduct of such study will be paid by the Secretary. If the Academy agrees to such request, the Secretary shall enter into such an agreement with the Academy. (2) If the Academy declines the Secretary's request to conduct such study under such an arrangement, then the Secretary, after consulting with the Committee on Labor and Human Resources of the Senate and the Committee on Interstate and Foreign Commerce of the House of Representatives, shall enter into a similar arrangement with another appropriate public or nonprofit private entity to conduct such study. (3) Any arrangement entered into under paragraph (1) or (2) of this subsection for the conduct of a study shall require that such study be completed and reports thereon be submitted within such period as the Secretary may require to meet the requirements of subsection (c). (4) The Secretary shall undertake such preliminary activities as may be necessary to enable the Secretary to enter into an arrangement for the conduct of the study at the earliest possible date. (c) Not later than six months after the date the arrangement for the conduct of the study is entered into under subsection (b), the Secretary and the entity conducting the study shall each report to the Committee on Human Resources of the Senate and the Committee on Interstate and Foreign Commerce of the House of Representatives their respective preliminary recommendations respecting the matters described in subparagraphs (A), (B), and (C) of subsection (a)(l) and, if a need for continued Federal financial support for nursing is found, the form in which the support should be provided. Not later than two years after such date, the Secretary and the entity which conducted the study shall each report to such Committees recommendations respecting such matters (including the form of Federal financial support for nursing) and the basis for such recommendations. as

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liPPE N DrX 2 Appropriations Under the Nurse liaising Act Appropriations under the Nurse Training Act (NTA) of 1964 and subsequent amendments are listed in Table 1. The listing provides information through Fiscal Year (FY) 1982. The latest amendments, which were part of the Omnibus Budget Reconciliation Act of 1981, extended nurse training provisions of the Public Health Service Act through FY 1984. The NTA and subsequent amendments authorized funds for a number of programs of institutional support and student support. In addition, support for research activities has been provided under other provisions of the Public Health Service Act. The data in this appendix were secured from various sources in the Department of Health and Human Services (DHHS) and Health Resources and Services Administration (HKSA). Formula and Capitation Grants Capitation grants provided support to basic nursing education programs from FY 1972 through FY 1981. About 1,000 schools received assistance annually. In 1980, 1,075 schools participated, including 386 baccalaureate programs, 554 associate degree (AD) programs, and 135 diploma programs. About 190,000 students were enrolled in these schools. The amount of capitation support varied among schools according to the type of program and number of full-time students. In 1980, the average level of support per student counted for capitation purposes was 3221 for students in baccalaureate programs, $152 for students in AD programs, and $138 for students in diploma programs. Participating schools were required to increase enrollment of first-year students or to strengthen program activities in at least two specified programs. The program options were (1) training of nurse practitioners, (2) encouraging enrollment and retention of students from disadvantaged backgrounds, (3) providing clinical training at sites geographically remote from the school, and (4) extending continuing education opportunities. 230

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231 of 1 En C) em 00 So o So C) _1 C~ S~ E~ cn z S~ o U) o o S~ P~ 'm ~ O O S~ ~ O O tn ~rl ~ O ~rl e~ <; a~ E~ _' o S 0 Pt o JJ u31 o ce C U' C ~a tn - S U) L Ct o' o S ~rl ~ s cn e a) , - =, Ct - s~ s ~1 cn c ca o . - a eq C) o ~ ~. - Z ~ ~ o ~ oo. - C) 5 Z S~ U] ~ ~ O O ~ C.) JJ o~ O - O O U~ P~ ,/ O ~.- o ~ ~ ca - ct o E~ o o ~ ~ ~ . ~ c~ ~ ~ ~ - - ~ O C~ C~ ~ ~ ~ ~ ~ ~O O O O O ~ . . . . . . . . ~ C~ C~ C~4 C~ ~ C~ ~ ~ C~ _~ ~ U~ ~ U~ ~ c ~l u) z o u~ o u~ c~ o ~ ~ ~ o o ~ o o o . . . . . . O u~ _ cr~ ~ ~ ~ o~ - - c~ ~ - O O O O u~ ~ u~ ~ u~ O O O O O O O O sD . . . . . ~ ~ ~ o o o o o ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ - - ~ ~ - ~ - ~ - - - O O d" ~ U~ U~ O ~ . . . . ~ oo ~ ~ a~ ~ ~ _ ~ ~ ~ ~ ~ ~ ~ ~ ;t ,_ ~ - - ~ cN c~ ~ c~ ~ c~ cN - - - o o o o o o ~ ..- ~ ~ ~ ~ ~ ~ -u~ - .- o o o o o o ~ ..~ c~l =\ ~ ~ c~ ~ -o ~ _ _ _ _r_ o o o o o ~ ~ o o o o u~ - ~ ~ ~ ~ oo ~ ~ ~ o o - ~ ~ ~ ~ - c~ ~ ~ o o o o o ~ ~ o o o o o o o o o o ~q . . . . . . ;t - ~ - ~ - - - - - - o ~ o o o - ~ c~ ~ ~ ~ ~ Lr, ~ ~ o o o o o o . . . ~ ;t ~ ~ o o ~ ~ o ~ ~ ~ ~ ~ ~ ~ ~ c~ - oo ~ r~ 00 u~ ~ ~ ~ C~ ~D ~ ~ O ~ ~ ~ ~ oO ~ . ~ ~ ax _ U~ ~ U~ ~ o~ oo O ~ c~ r- ~ ~ ~ ~ 0 0 ;t ~ ~ ~ ~ ~ ~ ~ ~ ~ c~ c~ cN - - - - - - - - - oo o~ 0 _ c~ ~ ;' ~ ~ ~ ~ a~ 0 _ c~ ~D ~ r~ ~ ~ ~ r~ ~ ~ ~ ~ ~ oo oO oO o~ ~ ~ ~ o~ o~ ~ o~ ~ ~ o~ ~ ~ a~ ~ o~ - ~ - - - - - - - - - - - - - - - - o v s~ u) .,1 e .,, cn c ca U) o U' - x ~o C .,, ~C r ~O O 0 - ~C) u, a _ ~_ _ C) O . ~C) _ ~ C cn Ct 0 c :^ a _ ~ ~ 0 ~ :^ 0- U) U' ~ .,, ~ C 0 _ ~ Ct ~ 0 _ ~D O - ~. r=, E ~E~ 0 0 ~Z CO 00 _ C) ~ C Cd | D | U) C) ,1 U, X S - ~a o e . . r~ o CD

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232 Special Project Grants and Contracts Special projects to improve the availability and quality of nursing education are assisted under this funding program. There are currently five specified purposes: 1. 2. 3. 4. 5. to increase educational opportunities for individuals from disadvantaged backgrounds; to provide continuing education; to provide retraining opportunities for nurses reentering active practice; to increase the supply or improve the distribution of nurses by geographic area and speciality field; and to upgrade the skills of licensed vocational and practical nurses and other paraprofessional personnel. At least 20 percent of available funds must be used for item 1, 20 percent for item 4, and 10 percent for item 5. Three other purposes were specified for support prior to 1982. They were the following: 6. to assist mergers and other cooperative agreements among hospitals and academic institutions; 7. to develop new or modify existing training programs, develop research in nursing education, and improve curricula; and 8. to assist short-term training fin' Ale ~ A; ~_A ^ -1~ -1 '__ ~ @ In nursing homes. ~^o _~. & ~e ~;7~= c&~;> O.ll ~ULUt:~1 BUS In recent years, about 100 projects received assistance annually In 1981, assistance was awarded to 98 projects at 84 nursing schools and 14 other agencies. About 40 percent of the projects related to item 7, 30 percent to item 2, 20 percent to item 4, and 10 percent to item 1. Construction Assistance Grants Program--Nursing Funds were appropriated under NTA as extended and amended, to aid the construction and equipping of nursing education facilities over a 12-year period beginning in 1966. Altogether, assistance was provided to 301 programs, of which 52 were diploma programs, 90 AD programs, 105 baccalaureate programs, 43 graduate degree programs, and 11 continuing education programs. About 70 percent of the projects were for the expansion or renovation of existing schools and 30 percent for the construction of new schools. Schools expanding facilities were required to expand first-year enrollment by at least 5 percent or 5 students, whichever was greater. Local funds financed at least 25 percent of the construction costs. Over 50,000 student places benefited from this activity, of which over 12,000 were increased f irst-year student places. Of the total,

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233 about 16 percent were in diploma programs, 23 in AD programs, 54 percent in baccalaureate programs, and 7 percent in graduate degree programs. Advanced Nurse Training Grants and Contracts Assistance is made available to collegiate schools of nursing to (1) plan, develop, and operate, (2) significantly expand, or (3) maintain programs to prepare nurses at the graduate level. Educational programs offering master's and doctoral degrees are supported to help develop clinical nurse specialists, teachers, administrators, and supervisors. Special emphasis is now given to three clinical specialties: maternal and child health, geriatrics, and community health nursing. In recent years, about 90 projects have been supported annually. Between 1979 and 1981, about 80 percent of the areas of concentration in these programs were focused on clinical specialties and about 10 percent each on education and administration. Among the clinical areas, maternal and child health and medical/surgical care were the most frequent, followed by geriatric and community health nursing. About 90 percent of the programs were at the master's level and 10 percent at the doctoral level. In academic year 1981, about 2,500 full-time equivalent students were enrolled in assisted programs, of which approximately 1,500 were full tome. During that period, there were about 700 graduations, approximately 14 percent of the estimated national total. Nurse Practitioner Grants and Contracts Support is provided to (1) plan, develop and, operate, (2) significantly expand, or (3) maintain programs to train nurse practitioners. Emphasis is given to training to improve care to geriatric and nursing home patients and to strengthen primary health care in homes, ambulatory care facilities, long-term care facilities, and other settings. In recent years, about 70 projects have been funded annually. In 1981, 75 projects were assisted, involving 103 training programs; 33 focused on family care, 21 on pediatrics, 15 on adult care, 14 on geriatrics, and 11 on midwifery. About 1,900 students were enrolled in these projects, of which 41 awaided master's degrees and 34 awarded certificates. About 80 percent of the projects were at nursing schools, 8 percent at medical schools, 6 percent at hospitals, and 5 percent at other participating institutions. Traineeships have also been provided to selected nurse practitioner students who agree to serve after graduation in designated primary medical care shortage areas. Eligibility was limited to students from health manpower shortage areas through 1981; thereafter, the legislation, although not limited to residents of these areas, provided that special consideration be given to them.

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234 Payback commitments equal the months of educational support. Traineeships were made through participating schools; 36 schools received support initially in 1978, and same of them have received subsequent continuation awards. A total of 361 eligible trainees were appointed between FY 1978 and FY 1981. Student Loans Low-interest loans up to $2,500 a year--to a total of $10,000--are made to assist students in basic registered nursing education programs (including diploma, AD, and baccalaureate programs) and in graduate programs. Students may be on a full-time or half-time basis. Funds are awarded to participating schools on a formula based on the relative number of full-time nursing students. The schools make and monitor the loans and must contribute at least 10 percent of the total federal dollars awarded. Participating schools may retain the amounts repaid by students and make new loans from a revolving fund made up of collections. Loans are repayable over 10 years following completion of training; repayment may be deferred during advanced professional education in nursing, study as a nurse anesthetist, or service in the uniformed services or Peace Corps. About 1,150 schools have participated in this program annually. In 1982, about 24,000 students received loans--about 8,200 from newly appropriated funds and 15,600 through the revolving funds. The average loan was approximately $800. Loans incurred under this program prior to September 29, 1979, may be canceled in part for service of more than one year as a nurse in a public or nonprofit hospital, health center, or other health care agency for more than one year. Since 1971, cancellations may be up to 85 percent for 5 years of service; previously, cancellations were up to 50 percent or 100 percent, depending on the location and length of work as a nurse. Through 1979, a portion of about 150,000 loans had been canceled; the number of individual nurses benefiting is not known because many students received multiple loans from these funds. Funds have also been available to repay portions of loans of nurses who serve in designated shortage areas. For those completing years of such service, 60 percent is repaid; for 3 years, 85 percent. Between 1973 and 1982, about 130 nurses had benefited from this loan repayment option. Professional Nurse Traineeships Grants are made to graduate schools of nursing and to schools of public health, which in turn provide traineeships for up to 36 months to students working toward a master's or doctoral degree. Nurses are prepared to serve as teachers, administrators and supervisors, nurse practitioners, and in other professional specialities determined by DUNS to require advanced training. These are the same clinical 1 2

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235 specialties that have been supported by the Advanced Nurse Training Program: maternal and child health, geriatric nursing, community health, acute care, adult care, and medical/surgical nursing. Priority in the award of traineeships to nurse practitioner trainees Is given to nurse midwife trainees. In recent years, between 2,000 and 3,000 trainees have received support annually. In 1981, awards made to 126 schools supported about 2,000 trainees at approximately $6,400 each. Scholarships Scholarships up to $2,000 a year were made available to selected students with exceptional financial need in basic and graduate nursing education programs during a 14-year period beginning in 1967. Funds were allocated to participating schools on a formula based on the relative number of full-time nursing students. The schools selected the scholarship recipients. About 1,300 schools participated in this program annually. In 1981, 1,328 schools received funds, including 603 AD programs, 418 baccalaureate programs, 213 diploma programs, and 94 graduate programs. That year, over 8,900 students received benefits, about 4 percent of the total student body. During the program's operation, over 200,000 scholarships were made available. It is estimated that in excess of 67,000 students benefited. The average annual scholarship was about $1,000. Research Fellowships Fellowships are awarded for full-time predoctoral and postdoctoral education in nursing and related behavioral and biological sciences under the authority of the Section 472 of the Public Health Service Act. Support is aimed at preparing nurses to conduct and direct research, collaborate in interdisciplinary research, and strengthen faculties in nursing schools. Support may be provided up to 5 years for predoctoral programs and up to 3 years for postdoctoral programs. Payback agreements require participation in research or teaching activities for periods commensurate with the educational support received. In recent years, an average of about 115 predoctoral and 3 postdoctoral fellowships have been supported each year. In 1981, 47 new fellowships were awarded, of which 22 were in nursing, 11 in behavioral sciences, 3 in biomedical sciences, and 11 in other fields. Fellowships are sometimes referred to as National Research Service Awards.

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236 Research Grants Grants are made to schools of nursing and other public and private institutions to support high-quality research projects, under the authority of Section 301 of the Public Health Service Act. Basic and clinical research related to patient care and clinical therapy, as well as to nursing education, manpower, and administration, is emphasized. In recent years, about 50 awards have been made annually. At the end of lY 1981, 58 projects were ongoing, of which 23 were focused on nursing practice and 11 on fundamental issues on which nursing practice research is based; 13 were institutional projects designed to enhance the research capabilities of schools of nursing with doctoral programs; 6 were concerned with such issues as stress, parenting, and health promotion; and 5 dealt with the delivery of nursing services and professional issues, such as nursing staff turnover. Other Between 1972 and 1975, funds were available for specific other programs. These included aid to nursing schools experiencing financial distress, start-up grants to initiate new nursing programs and funds to encourage recruitment of groups underrepresented in nursing, including minorities. Authority for financial distress grants was reinstated in 1981, but no funds have been appropriated under the new provision.

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AiPPE N DrX 3 Summary of ~formabon on State Reports of Nursing Issues Nursing issues have been studied in almost every state of the nation during the past few years. Reports of recent studies have been identified from 45 states. More than 75 such studies were completed between 1977 and 1982. As indicated in Table 1, many agencies--both public and private-- have sponsored and published studies of nursing issues in recent years. In many states, more than one agency undertook such reviews. In same cases, the multiple state studies were complementary, focusing on different aspects of the subject; in others, they present different perspectives and conclusions. A majority of the recent state nursing studies have been sponsored by public agencies. Altogether about two-thirds were by official bodies. State higher education agencies were the most frequent sponsors. Other public agencies that were active along these lines in many states were nursing or other schools at a state university, state health planning agencies, and governors' commissions and legislative committees. In other cases, health departments, education departments, and nursing boards took the lead. Private agencies assumed responsibilities for reviews of nursing issues in about one-third of the states. State hospital associations often conducted studies of nursing problems being experienced by their member hospitals. State nurses' associations carried out such studies directly in many states and participated actively in others. There has been broad participation in many of these efforts. Committees composed of representatives of the many parties concerned with nursing matters were reported to have been involved in about one-half of the studies. In some cases, they were responsible for directing the work, and in others they had advisory roles. In many cases, public hearings provided opportunities for other concerned parties to participate. In about one-half of the states, the studies involved detailed analyses. In the past 2 years, for example, reports of extensive studies were issued in Alaska, Arizona, Arkansas, Georgia, Indiana, Maryland, Michigan, Ohio, South Carolina, and Wyoming. About 40 of the studies addressed educational issues and a similar number focused on employment aspects. Approximately 25 studies presented projections of future requirements and resources and about 237

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238 of 1 ax on on cn on So :~ o on o u In o Ed 4J o a: o a) a; .,' o U' o cn a) :^ Cal . - ~ ~ V ~ do o ~ o . - o nil us us L, O U) C~ ~ o . - a) ~ ~q o ~ ~ oo U cn Z . - ~ C) ~ o ~ s" o ~ S~ JJ o ~ ~ tn a~ - o V ~ .- ~ :^ CQ ~ P~ ~ :^ 4~ . - U) . - ~ C U. o . - C) C~ oc ~ ~ JJ ~ ~ ~ tD cn ~ L~ <: - o or ~: ~ ~ ~_ oo oo oo oO a u ~ ~ ~cr~ 0 0 ~ oo 00 t- o~ ~0 ~ oo 00 I_ o ~ a) ~oo _I _. , C ~C~ ~ oo oo ~ oo ~o ~ ~ r ~ _ C~ o~ oo 0 0 ~0 0 oo oo oo a: oo a' ~o~ _ c s~ 0 ~4~ ~.,, 00 U, e ~ ~ CO ~ e ~ S"~- ~ z ~ ~ ~ O O ~ ~ ~ ~ ~ ~ 0 ~a ~ ~ ~ ~ ~3 E ~u ~=~- ~ 3 3 3 ~ o Cd o C. Z ~1 ~ ~ :~ ~ :Z Z ~ p! o C. CO ~ ~ ~ . - ,, ~ o o ~ c: <. ~ ~ o =: o ,,.,, C~ CO - ~ ~ 3 ~ v ~ m. - ~ ~ ~ ~ o ~ ~ ~ ~ ~ o ~ t~ ~-1 i~ ~ ;~: ~ ~ O cn 3

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300 teenagers, services designed to enhance self-care in the chronically i 11 and the very old ~ . Enhance the care of clients culturally different from the majority (e.g. Black Americans, Mexican-A,nericans, Nat ive Americans ~ and c lients with spec ial problems (e . g. teenagers, prisoners, and the mentally ill), and the underserved ~ the elderly, the poor, and the rural) ~ Design and assessment, in terms of effectiveness and cost, of models for delivering nursing care strategies found to be effective in clinical studies. . All of the foregoing are directly related to the priority of developing the knowledge and information needed for improvement of the pract ice of nursing. While priority should be given to this form of clinical research, there is no intent to discourage other forms of nursing research. These would include such investigations as those utilizing historical and philosophical modes of inquiry, and studies of manpower for nursing education, practice, and research, as well as studies of quality assurance for nursing and those for e stabl ishment of criterion measures f or prac Lice and educat ion.

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AiPPE N DrX 9 Parbapants in Me Study's Workshops and Advisory Panels The committee was privileged to draw on the knowledge of many distinguished people during the course of the study; they are listed in this appendix. Many leaders in the nursing profession gave generously of their time. Their contributions to consideration of issues in nursing education, in nursing research, and in nursing services were invaluable. In addition, as the listings illustrate, the study's advisory panels and workshops drew on participants representing a broad range of other professional backgrounds and experience. Their assistance, also, was invaluable in consideration of issues related to identification of data required for the study, trends, and projection methodologies; the cost and financing of nursing education; and the economics of nurse supply and demand. Members of each of the five advisory panels usually met together twice. The advice of individual members was solicited more frequently, on an informal basis. The Economics Workshop was a day-long meeting; sessions of the Workshop on Advanced Nurse Education covered 2 days. Advisory Panel on Nursing Education Costs and Financing to the TOM Study of Nursing and Nursing Education * Roger J. Bulger, chair President, University of Texas Health Science Center at Houston Eileen Alessandro Executive Director, Association of Diploma Schools of Professional Nursing Steven D. Campbell Director, Financial Management Center, National Association of College and University Business Officers * Member--IOM Study Committee on Nursing and Nursing Education. 301

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302 Joseph Paul Case Director of Program Administration, College Scholarship Service, College Board Salvatore B. Corrallo Director, Student and Institutional Financing Division, Office of Program Budgeting and Evaluation, Department of Education Joseph C. Czerwinski President, The Czerwinski Group, Inc., Milwaukee, Wisconsin Ruth S. Hanft Consultant Gladys Chang Hardy Program Officer in Charge, Education and Culture Program, The Ford Foundation Rose Muscatine Hauer Director of Nursing Service, Dean, School of Nursing, Beth Israel Medical Center, New York City Robert Kinsinger Vice President, W.K. Kellogg Foundation Wayne R. Kirschling Deputy Commissioner, Indiana Commission for Higher Education Lucille Knopf Division of Research, National League for Nursing Mary Nell Lehnhard Executive Washington Representative, Federal Financing and Tax Legislation, Blue Cross and Blue Shield Association Lawrence S. Lewin President, Lewin and Associates, Washington, D.C. * Robert A. Wallhaus Deputy Director for Academic and Health Affairs, Illinois Board of Higher Education * Ruby L. Wilson Dean and Professor, School of Nursing, Duke University

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303 Advisory Panel on Data Needs for the TOM Study of Nursing and Nursing Education * Edward B. Perrin, chair Director, Health and Population Study Center, Battelle Human Af f airs Re search Centers Myrtle Aydelotte Executive Director, American Nurses' Association (retired December 1981), Consultant (January 1982) Walter Johnson Director of Research, National League for Nursing Wayne R. Kirschling Deputy Commissioner, Indiana Commission for Higher Education Evelyn B. Moses Acting Chief, Data Development and Evaluation Section, Division of Health Professions Analysis, Health Resources Administration, Department of Health and Human Services Now with Division of Nursing, Bureau of Health Professions Analys i s, HRSA, DHHS Carol S. Weisman Assoc late Professor, School of Hygiene and Public Health, Johns Hopkins Univers ity Advisory Panel on Intervention Strateg ies to the TOM Study of Nursing and Nursing Education * Robert C. Wood, chair (November 1981-January 1982) Direct or of Urban Stud ies, Prof e s sor of P o l it ical Sc ienc e, Univers ity of Massachusetts Harbor Campus * Arthur E. Hess, chair (February 1982-April 1982) Scholar-in-Residence, Institute of Medicine, National Academy of Sciences * Otis R. Bowen Professor and Director, Undergraduate Family Practice Education, Indiana University School of Med icine Shirley S. Chater Vice Chancellor, Academic Af fairs, University of California, San F ranc i sc o Robert A. Derzon Vice President, Lewin and Associates, Inc., Washington, D . C .

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304 Vernice D. Ferguson Director, Nursing Service, Veterans Administration Central Off ice Wayne R. Kirschling Deputy Commissioner, Indiana Commission for Higher Education Nan S. Robinson Vice President for Administrat ion, Rockef eller Foundat ion F rank A. S loan Professor of Ec onomics, Vanderbilt University Nathan J. Stark Senior Vice Chancellor, Health Sc fences, University of Pittsburgh Advisory Panel on Nursing Education/Nursing Service to the ION Study of Nursing and Nursing Education * Edyth H. Schoenrich, chair Assoc late Dean, Johns Hopkins University School of Hygiene and Pub 1 ic Hea 1 th Virginia Allen Director of Accreditation, National League for Nursing Myrtle Aydelotte Executive Director, American Nurses' Association (retired December 1981), Consultant (January 1982) Madeline A. Bohman Executive Director, Bellevue Hospital Center, New York City Rose Marie Chioni Dean, School of Nursing, University of Virginia Barbara A. Donaho Corporate Director of Nursing, Sisters of Mercy Health Corporation Sister Rosemary Donley Dean, School of Nursing, Catholic University of America * David H. J eppson Executive Vice President, Intermountain Health Care, Inc., Salt Lake C ity, Utah Patric ia Perry Dean, Bishop Clarkson Memorial Hospital College of Nursing, Omaha, Nebraska

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305 Doris L. Wagner Chief Nurse, Bureau of Public Health Nursing, Division of Public Health, The Health and Hospital Corporation of Marion County, Indianapolis, Indiana Advisory Panel on Trends and Projections to the IOM Study of Nursing and Nursing Education Charles D. Flagle, Chair Professor and Head, Division of Operations Research, Department of Health Services Administration, Johns Hopkins University School of Hygiene and Public Health John Drabek Chief of Supply and Requirements, Forecasting Branch, Health Resources Administration, U.S. Department of Health and Human Services Hesook Susie Kim College of Nursing, University of Rhode Island * * Carol Lockhart Director, Division of Health Resources, Arizona Department of Health Services, Phoenix William Lo saw Statistician, Health Resources Administration, Department of Health and Human Services Scott A. Mason President, National Health Advisors, Ltd., McLean, Virginia Edward B. Perrin Director, Health and Population Study Center, Battelle Human Affairs Research Centers -- John D. Thompson Professor of Public Health and Chief, Division of Health Services Administration, Yale University School of Medicine Richard F. Tompkins Deputy Director, Study of the Costs and Financing of Graduate Medical Education, Arthur Young and Company Donald E. Yett Professor of Economics and Director, Human Resources Research Center, University of Southern California

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306 Economics Workshop of the IOM Study of Nursing and Nursing Education October 16, 1981 Part ic ipant s * Isabel V. Sawhill, chair Senior Fellow, The Urban Inst itute -- Linda H. Aiken Vice President for Research, The Robert Wood Johnson Foundation -- Stuart H. Altman Dean, The Florence Helter Graduate School for Advanced Studies in Social Welfare, Brandeis University Myrtle Aydelotte Ex ecut ive Direc tar, American Nurse s ' As sac fat ion (ret ired De cember 1981), Consultant (January 1982) Haro Id Cohen Executive Director, Maryland Health Services Cost Review Commission * Charles D. Flagle Professor and Head, Division of Operations Research, Department of Health Services Administration, Johns Hopkins University School of Hygiene and Public Health Lois Friss Assistant Professor, Graduate Program in Health Services Admini s trat ion, S chool of Pub 1 ic Admini s trat ion, Univers ity of Southern Calif ornia He id i I. Hartmann Assoc late Executive Director, Commission on Behavioral and Social Sciences, and Education, National Academy of Sciences Jesse S. Hixson Chief, Modeling and Research Branch, Division of Health Professions Analysis, Hea 1th Resources Adminis trat ion : David H. Jeppson Executive Vice President, Intermountain Health Care, Inc., Salt Lake C ity, Utah Charles R. Link Professor, Department of Ec onomics, University of De [aware Russell F. Sett le Assoc late Professor, Department of Economics, University of Delaware

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307 Frank A. Sloan Prof es sor of Ec anomie s, Vanderb i It Univers ity Gary S. . Syke s NIE Assoc late, National Institute of Education * John D. Thompson Professor of Public Health and Chief, Division of Health Services Admi ni s t rat ion, Yale Univers ity S choo 1 of Med ic ine William White Associate Professor, Department of Economics, University of Illinois at Chic ago Donald E. Yett Professor of Ec anomies and Director, Human Resources Research Center, University of Southern California Advanced Nurse Education Workshop of the ION Study of Nursing and Nursing Educ at ion March 9-10, 1982 * Edyth H. Schoenrich, chair Assoc late Dean, School of Hygiene and Public Health, Johns Hopkins Univers ity Faye G. Abdellah Deputy Surgeon General and Chief Nurse Officer, U.S. Public Health Service * Ira Trail Adans Dean and Professor, College of Nursing, University of Tulsa Kathleen C. Andreoli Executive Director of Academic Services, Office of the President, School of Nursing, The University of Texas Health Science Center Myrtle Aydelotte Executive Director, American Nurses' Association (retired December 1981), Consultant (January 1982) Madeline A. Bohman Ex ec ut ive Di rec t or, Be 1 revue Ho sp it al Center, New York C i ty Pauline F. grimmer Director, Research and Policy Analysis Department, American Nurses' As s oc i at ion

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308 Joan E. Caserta Assistant Commissioner of Health for Personal Health Services, Westchester County Department of Health Rose Marie Chioni Dean, School of Nursing, University of Virginia Luther Christman The John L. and Helen Kellogg Dean, College of Nursing, Rush University Anna B. Coles Dean and Professor, College of Nursing, Howard University Verla Collins Director of Nursing Education and Education Information, Intenmountain Health Care, Inc. Peter Dans Associate Professor and Director, Office of Medical Evaluation, Johns Hopkins University School of Hygiene and Public Health Robert A. Derzon Vice President, Lewin and Associates, Inc. Donna Diers Dean, School of Nursing, Yale University Barbara A. Donaho Corporate Director of Nursing, Sisters of Mercy Health Corporation Sister Rosemary Donley Dean, School of Nursing, Catholic University of America Jo Eleanor Elliott Director, Division of Nursing, Bureau of Health Professions Analysis, Health Resources and Services Administration, Department of Health and Human Services Eunice K. M. Ernst Director, Cooperative Birth Center Network--Maternity Center Association, Perkiomenville, Pennsylvania Geraldene Felton Dean, College of Nursing, University of Iowa Vernice D e Ferguson Director, Nursing Service, Veterans Administration Central Office

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30-9 Cynthia Freund Director, Nursing Administration Program, School of Nursing, Univers ity of Pennsylvania He ten Grac e Dean, College of Nursing, University of Illinois Medical Center John R. Hogness President, As sac fat ion of Ac ademic Health Centers Ada K. Jacox Prof essor of Nurs ing and Direc tar, Center f or Re search, School of Nursing, University of Maryland Jean E. Johnson Professor in Nursing and Associate Director of Oncology Nursing in Cancer Center, University of Rochester Medical Center Jean A. Kelley Assistant Dean, Graduate Program, School of Nursing, University of Alabama at Birmingham Jerri Laube Dean and Professor, School of Nursing, University of Southern Mis sis sippi Barbara J. Lee Program Director, W. K. Kellogg Foundation (retired October 1982) * Carol Lockhart Director, Division of Health Resources, Arizona Department of Health Services, Phoenix Barbara tiertman Lowery Associate Professor, School of Nursing, University of Pennsylvania Jannetta MacPhail Dean and Professor, School of Nursing, University of Alberta Kathleen McCormick Assistant for Research to the Chief, Nursing Department, National Inst itutes of Health Maurice I. May Chief Executive Officer, Hebrew Rehabilitation Center for the Aged Clarion I. Murphy Executive Director, American Association of Colleges of Nursing

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310 Patricia Perry Dean, College of Nursing, Bishop Clarkson Memorial Hospital, College of Nursing, Omaha, Nebraska Jessie M. Scott Associate Professor, School of Nursing, University of Maryland F rank A. Shaf f er Director, Continuing Education Service and Director, National Forum of Administrators of Nursing Services, National League for Nursing Barbara J. Stevens Director, Division of Health Services, Sciences, and Education, Teachers College, Columbia University Frances D. Tompkins Director of Nursing, Union Memorial Hospital, Baltimore, Maryland Rheba de Tornyay Dean and Professor, School of Nursing, University of Washington Debbie Turner Professional Staff Member, Committee on Labor and Human Resources, United States Senate Patric ia L. Valoon Director of Nursing, University Hospital, New York University Medical Center Doris L. Wagner Chief Nurse, Bureau of Public Health Nursing, Division of Public Health, The Health and Hospital Corporation of Marion County, Ind ianapo l i s, Ind iana The lma We 11 s As s oc fat e Prof e ssor, Schoo 1 of Nurs ing, Univers ity of Michigan Carolyn Wil limes Assoc late Professor of Nurs ing and Ep idemiology, School of Public Health, University of North Carolina Ruby L. Wi lson Dean and Professor, School of Nursing, Duke University