Nursing and Nursing Education Public Policies and Private Actions (1983) / Chapter Skim
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APPENDIXES
APPENDIXES
Pages 228-310
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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)
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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.
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. Formula and Capitation Grants Capitation grants provided support to basic nursing education programs from FY 1972 through FY 1981.
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231 of 1 En C)
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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.
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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.
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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)
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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.
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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.
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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.
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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)
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239 C~ a~ C~ oo o~ o CC o o o ~ o ~ o ~ oo oo oo oo oo oo ~oo oo oo o ~crs ~ o ~o - a) oo oo a ~a~ o CC o~ o ~C ~o~ oooo oo r ~oo ~ 1- r~ C ~o ~o~ C ~o C ~o oo oo oo oo s o cn C' ,, C' C~ o o U' ,' s JJ C)
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The "target" year varied considerably among the studies, ranging from 1982 to 1995. In most reports, the projections indicated desired changes in the mix of nurses that would result in estimated shortages of registered nurses (RNs)
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Other topics that were often discussed were the roles and responsibilities of nurse practitioners, the number of minority nurses, the effect of migration, and the impact of changes in health care financing. The state studies tend to concentrate on local and state actions to address identified problems.
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242 1 1 en a' en on ·rl GO o Jo o Jo u U]
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243 en a)
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246 furl En C)
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247 earl a)
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248 u o Cal _ Cal En a' Girl En ¢ ·rl o 0 of In a)
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249 ~4 i_ ~In er' 1 se 3 :^ ~ ~ o O In ..
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251 :^ V o ~ .,' to .- 3 co O In ~ ~ c.
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252 · a Cal a_ Cal En 1 ~o ~ Cal - a)
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Tables 2 and 3 contain information on two organizations that certify RNs in specialty areas. In all tables, certification for nurse practitioners/ nurse midwives is underlined.
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nursing -60 contact hours of con tinuing education within last 5 years -currently employed full time in occupational health nursing American Board of 1972 ~500; -RN or LPN or physician's Urologic Allied "a few" -assistant kc ensure Health Profes- LPNs employed in urology for signals at least 1 year prior to examination
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Pediatric Nurse Practitioners and Associates 1979 608 1977 ~ 4,000 2,800 -RN licensure -graduate of a 6 to 8-week enterostomal therapy course -practice as an RN for at least 2 years prior to attending enterostomal course -RN licensure -currently employed in -1 year of clinical experience in field -RN licensure -graduation from a formal pediatric nurse practitioner program ADoes not include those jointly certified with NAACOG, but does include nurse practitioners. bThe AAOHN began certifying occupational health nurses in 1972.
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66 P sychiatr ic 633 and mental health nurs ing Medical-surgical 437 nurs 1ng Medical-surg ice 1 154 clinical spec tall sts MAN in psychiatric and mental health nursing -currently employed in direct patient care at least 4 hours each week -post-MSN practice in field at least 8 hours per week for 2- years or 4 hours per week for 4 years -experience in at least 2 different treatment modalities -100 hours post-MSN supervision -access to clinical supervision or consulation -as above -currently practicing in field giving direct patient care at least 4 hours per week -have practiced 24 of the last 48 months in the field -have access to supervision or consultation -currently practicing in field giving direct patient care at least 16 hours per week -have practiced 24 of last 36 months in field an average of at least 16 hours per week -MSN -currently practicing in field giving direct patient care an average of at least 4 hours per week -have practiced 12 of last 24 months as clinical specialist (post MSN) giving direct patient care an average of at least 16 hours per week
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-have 30 contact hours of continuing field within last 3 years education in
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nursing Pediatric nurse 450 practitioner School nurse 272 practitioner oa Adult nurse 2,468 practitioner Family nurse 2,630 practitioner -2,100 hours of direct patient care in MCH nursing -30 contact hours of continuing education in field within last 3 years -completed program of study that meets criteria identified by ANA and American Academy of Pediatrics "Guidelines on Short-Term Continuing Education Programs for Pediatric Nurse Associates" or "Guidelines for Nurse Practitioner Training Programs" -completed formal education program affiliated with an institution of higher learning of at least 9 months or 1 academic year of full-time study including didactic and clinical components as outlined in the "Certification Guidelines for Educational Preparation of School Nurse Practitioners" -completed formal educational program affiliated with institution of higher learning of at least 9 months or 1 academic year of full-time study including didactic and clinical components as outlined in the "Certification Guidelines for Educational Preparation of Adult Nurse Practitioners" -completed formal educational program affiliated with an institution of higher learning of at least 9 months or 1 academic year of full-time study including didactic and clinical components as outlined in "Certification Guidelines for Educational Preparation of Family Nurse Practitioners"
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259 TABLE 2 ~ cant inued ~ Title of Total Number Eligibility Requirements Specialt Area Certif fed for Certif ication Y Gerontolog ical 91 nurse practitioner -completed formal program of study that prepares nurses to function as adult, f amity, or gerontolog ical nurse practitioners as out lined in "Guide line s f or Nurse Pract it loner Training Programs" NOTE: Taken from American Nurse s ' As soc fat ion. 198 3 cert if ic at ion catalog.
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414 -2 years of experience in field -employment in field within last 2 years -2 years of experience in field -employment in field within last 2 years . -2 years of experience in field or certification as an NICU nurse -graduation from neonatal nurse clinician/practitioner program that is at least 12 weeks long and ace eptable to NAACOG, or 4 years of RN employment in NICU with at least 2 years as a neonatal nurse practitioner or clinician -completion of formal nurse practitioner progam that has at lest 3 months of OB/GYN content, is at least 12 weeks in length, and is found acceptable to N
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From the National Sample Survey of Registered Nurses, .
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The projections were initiated from a data set based on the 1977 National Sample Survey of Registered Nurses amplified by data from the 1972 Inventory of Registered Nurses.8~9 (The Third Report to Congress noted that data from the National Sample Survey of Registered Nurse, November 1980 survey would be used to update the data base, when it became available.) For "current estimates," graduation data were taken from the annual surveys made by the National League for Nursing (NLN)
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This estimate was based on 1976 licensing data. The age distribution of both the United States and foreign new licensees was based primarily on data from 1977 National Sample Survey of Registered Nurses.l3 · Activity rates (employed KNs/all RNs currently licensed)
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The proportion graduating from Norm wait 1 d her ~m" fi ~ 1 through baccalaureate programs would become 65 percent, the estimate for the latest data, while the rates for the other programs would remain the same as those in Series A In addition to these higher levels of basic nursing graduates, it was assumed that the number of master's degree programs would increase to 328 by the end of the projection period.
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. The Study's Projections These projections were developed both to utilize the new data on the supply of RNs, which became available with the National Sample Survey of Registered Nurses, November 1980, and to explore the effect of alternative assumptions as to graduations and activity rates.
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This base population was updated to 1990, using appropriate age-specific death rates based on 1978 life tables for white females. Activity rates for November 1980 were computed by calculating the ratio of the number of employed RNs in each age group, as reported in the National Sample Survey of Registered Nurses, November 1980, to the number of living nurses in that age group.14 Alternative assumptions as to future activity rates were the following: 1.
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TABLE 5 Number of Graduates of Basic Registered Nurse Programs, Study's High Projections, 1990 and 1981-1990 Program Type 1990 1981-1990 Associate 42,600 406,400 Diploma 8,500 111,300 Baccalaureate 25,800 250,800 TOTAL 76,900 768,500 SOURCE: West, M.D. Projected supply of nurses, 1990: methodology, Tables 6, citation)
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Total Projected Supply The total number of active As under each of these three study projections, together with the corresponding f igures for FTE RNs, are shown in Table 6. TABLE 6 Study' s Pro jections of the Supply of Employed Registered Nurses and Full-Time Equivalents, December 31, 1990 Registered Nurses Study Group Proj ec t ion Emp toyed High Intermed i ate Low Ful 1-Time Equivalenta 1, 728, 000 1 ,451 ,000 1,710,000 1,436,000 1, 643, 000 1, 379, 000 lithe number of full-t ime equivalent (FTE)
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From page 269... ...
The reasons for these differences are found primarily in the differing bases used for the two sets of projections-that of DHHS being the 1977 National Sample Survey of Registered Nurses and that of this study group being the 1980 RN Sample Survey. The effect of the use of the newer base is to raise the study projections by 109,100 over those of the DHHS.
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From national sample survey of registered nurses, November, 1980, Table 3, p. 11 (see Reference 2 for complete citation)
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Third report to the Congress, February 17, 1982, Table 24, p. 155 (see Reference 1 for complete citation)
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Requirements for nurse educators, community health nurses, private duty nurses, and RNs in other settings were calculated on the basis of historical time trends rather than specific utilization rate projections. The major data source was the 1977 National Sample Survey of Registered Nurses.20 Independent data for hospitals, nursing homes, and public health services were also used.
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In 1980 a new workshop was held to augment, review, and revise existing criteria for hospitals, nursing homes, and community health services. An adjusted 1990 lower bound was proposed as a level that all states could meet by that year, while an upper bound represented a goal to be met by states exceeding the lower bound.
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These differences reflect the view of the WICHE national panel that present RN staffing patterns in nursing homes and community health settings are grossly inadequate.23 TABLE 13 DHHS Projections of Full-Time Equivalent Registered Nurses Required Under Two Sets of Staffing Assumptions, January 1990 Trend-Based Judgment-of-Need Area of Practice Demand Model Model, Lower Bound Difference Hospital899, 900 935, 70035, 800 Nursing home93, 300 469, 900376, 600 Community health101,100 240,500139,400 Physician's office71,900 66, 700- 5, 200 Nurs ing educat ion47, 100 37, 000-10, 100 Other32, 000 34, 6002, 600 TOTAL1, 245, 400 1, 7 84, 400538, 6 00 SOURCE: Secretary, DHHS. 1982, Table 37, p.
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Rather, the study group believed it could provide insight into the future by three relatively simple illustrations that would test how much the demand for RNs might be altered by the assumed effects of certain changes in the financing climate, which, in turn, would tend to produce changes in how patients use health care and how programs and institutions utilize RNs. In making illustrative projections using the historical trend-based demand model, time, resource, and technical limitations permitted only surrogate adjustments compatible with the model structure.
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National Health Insurance Updates RN utilization data and HMO enroll- 1,471,600 ment projections; assumes continued upward health service utilization trends as in the projections for the Third Report to Congress.
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In the original model, because HMO enrollment was not a major influence, inpatient per capita savings attributable to TABLE 15 Comparison of Per Capita Health Service Rates, Historical Trend-Based Demand Model and Study's Illustrative Projections, December 1990 Practice Setting DHHS Projections Per Capita Service Historical Model Study Group Illustrative ProjectionsC ICU bed day 0.134271 0.129987 0.104286 0.104286 Non-ICU inpatient day 1.224304 1.224305 1.224305 1.001157 Hospital out patient visit 1.065468 1.065468 1.005471 0.745550 Physician' s office visit 5.029299 5.029302 5.029302 3.529225 HMO clinic visit (per enrolled member)
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TABLE 16 Comparision of Selected Registered Nurse Per Service Ratios, Historical Trend-Based Demand Model and Study's Illustrative Projections, December 1990 Practice DHHS Projec Setting Lions Histori Ratio of RNs Cal Model Study Group Illus trat ive Proj ec Lions I II III ICU bed day 2.45471 2.45471 2.43832 2.43832 Non-ICU in patient day 0.63026553 0.74969667 0.65011829 0.74969667 Hosp ital out pat lent visit 0.00039008 0.00042960 0.00042675 0.00042960 Phy s ic fan ' s office visit 0.2785 0.2693 0.2693 0.098~ HMO visit 0.000099 0.000099 0.000099 0.000099 Nurs ing home resident dayb Type 1 0.05766 0.06035 0.06027 0.06035 Type 2 0.02457 0.02801 0.02802 0.02801 Home visit 0.0005335 0.0008259 0.0008259 0.0008259 Was noted in Chapter II, the deep drop in nurse per service ratio and in resulting nurse requirements in physicians' offices under Illustration III can be discounted; it appears to be only partially attributable to a shift in patient utilization by HMO services. It may also be due, in part, to the fact that the existing model was not designed to accommodate such large increases in assumed HMO enrollments, which cause correspondingly large decreases in non-HMO physicians' offices.
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As a result FTE RN requirements rose from 116,600 in 1980 to 212,700 in 1990 -- a 92-percent increase. Comparison of Historical Trend-Based Model and Illustrative Projections The study's December 1990 demand projection totals were moderately higher in the aggregate than the historical trend-based demand model's projection, as is shown in Table 18.
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-type organizations 6,900 10,300 10,30032,400 Nursing education 48,000 56,500 51,70049,800 Private duty and other 32, 600 63, 000 63, 00063, 000 TOTAL 1,271,600 1,471,600 1,348,1001,297,600 NOTE: Detail may not add to totals because of rounding.
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and Schmittling, G 1977 national sample survey of registered nurses: A report on the nurse population and factors affecting their supply (NTIS Publication No.
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Health Resources Administration, , _ , is, _ _ Methodologies for projecting the nation's future nurse requirements. Background paper of the Institute of Medicine Study of Nursing and Nursing Education.
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They are also the major faculty resource for doctoral programs in nursing, where they are expected to prepare students who are committed to becoming productive researchers, educators, and clinicians. Growth in the numbers of doctorally prepared nurses may meet the need for research-qualified faculty with ongoing research and for faculty who are actively engaged in practice.
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The Center houses a research planning conference roam and a large data analysis laboratory equipped with a CRT Terminal, Deswriter, keypunch and calculators. Faculty research interests include cognitive development, nursing diagnoses, adjustment to widowhood, pain, cultural aspects of health, sleep, history of nursing education in Alabama, benefits and attitudes toward exercise, curriculum issues, parent-infant relationships, energy expenditure and moral development of nurses.
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From page 285... ...
Nursing, with its emphasis on a big-psycho-social model of care, has great potential for enhancing the distribution and quality of patient care, encouraging health protection and promotion, and creating cost effective improvements in the organization and delivery of health services. To pursue excellence in research and theory development in clinical nursing, graduates must be clinically proficient and have extensive preparation in the biophysical and/or behavorial sciences and in research methods and data analysis.
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The overall purpose of the program is to prepare nurses competent in research design, data analysis, and inferential processes, and thus capable of pursuing research related to the delivery of patient care by nurses, and of developing theory oriented toward applications of nursing practice. University of Maryland The purpose of the Ph.D.
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. Those who successfully complete the program are fully prepared to answer the national need for doctorally prepared nursing school faculty.
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Work Status To ascertain the simultaneous effects of a number of independent variables thought to influence nurses' work status -- full time, part time, or inactive -- data from the National Sample Survey of Registered Nurses, November 1980,* were analyzed using multivariate regression techniques.
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TABLE 1 Regression Estimates of Determinants of Full-Time Work Status for Licensed Registered Nurses Regression Coefficient Independent Variable (t Statistic) _ Age less than 25 Age 25-34 Age 35-44 Level of Significance Omitted -.1406 (-11.83)
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Non-SMSA .0057 .3810 (.88) Northeastern region Omitted -~ Western region -.0190 .0182 (-2.36)
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Experience 26 years and more .1191 .0001 (8.57) Diploma Omitted Associate degree -.0056 .4541 (-.75)
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Non-SMSA -.0199 .0013 (-3.22) Northeastern region Omitted Western region .0221 .0036 (2.91)
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000 1 .0001 Associate degree -.1223 .0001 (-19.48) Baccalaureate degree -.
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Non-SMSA -.0019 .7133 (-.37) Northeastern region Omitted Western region .0011 .8625 ~ .
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TABLE 4 Regression Estimates of Determinants of Monthly Wage Rates for Full-Time Licensed Registered Nurses Regression Coefficient Level of Independent Variable (t Statistic) Significance Diploma Omitted Associate degree85.04 .0451 (2.00)
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Southern region84.44 .0274 ~ 2.21) Western region282.90 .
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The priorities identified below were developed by the Commission on Nursing Research of the American Nurses' Association, a nine member group of nurses actively engaged in research whose backgrounds represent considerable diversity in preparation and experience. The priorities represent the consensus of the commissioners, developed through a process of thoughtful discussion and careful deliberation with colleagues.
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From page 298... ...
Nursing research directed to clinical needs can contribute in a significant way to development of those solutions. Definition of Nursing Research Nursing research develops knowledge about health and the promotion of health over the full lifespan, care of persons with health problems and disabilities, and nursing actions to enhance the ability of individuals to respond effectively to actual or potential health problems.
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From page 299... ...
· Identification of phenomena that negatively influence the course of recovery and that may be alleviated by nursing practice, such as, for example, anorexia, diarrhea, sleep deprivation, deficiencies in nutrients, electrolyte imbalances, and infections. o Development and testing of care strategies to do the following: Facilitate individuals' ability to adopt and maintain health enhancing behaviors (e.g.
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From page 300... ...
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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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.
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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.
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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 *
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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 *
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* 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
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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
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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.
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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.
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* 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
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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
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