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the future of medical education and the future health of the American people would be served by breaking down a single nationwide uniform approval program of such schools and substituting several possible approval authorities with the likelihood of widely differing standards and quality being the result.

We sincerely urge that the Senate committee not accept the amendment to section 843 and pertaining particularly to the term "accrediting," but that you retain the language presently in this section of the act. When the Congress passed the nurse education bill, it was quite specific in its intention to require the assurance which accreditation would provide to students in nursing education. There is every indication that a strong uniform accreditation program is needed and one which can exert its influence upon all schools of nurse education. It is important to realize that for the year 1963-64, of the graduates of baccalaureate programs which were not accredited, 19 percent failed to pass their State board examinations and 25 percent of the graduates of associate degree (2year junior college) programs which were not accredited failed to pass their examinations. This would certainly seem to indicate the desirability of refraining from any weakening of accreditation requirements which must be met by all schools of nursing in order to be eligible to receive Federal funds. Sincerely yours,


Associate Director,

American Hospital Association.

Hon. ALAN BIBLE, U.S. Senate, Washington, D.C.

AUGUST 26, 1965.

DEAR SENATOR BIBLE: Congressman PAUL ROGERS, Democrat, of Florida, recently introduced an amendment to the Health Professions Educational Assistance Amendments of 1965 (H.R. 3141) which stated that a school in receipt of Nursing Training Funds will not be forced to be accredited by the National League for Nursing. The accreditation required would then only be regional or State approval of the educational institution.

On August 6, 1964, favorable testimony was given (at hearings on H.R. 11241) concerning accredited over nonaccredited nursing programs. Dr. Ann Douglas, dean of the

Georgetown University School of Nursing, and I are prepared to testify on latest figures that not only reconfirm, but make even more impressive, the record of the accredited

programs and reemphasize the need for public concern regarding the educational programs that are not accredited by the National League for Nursing.

The nursing school dean and myself are further prepared to show facts that National League for Nursing accredited programs, admit, retain, and graduate the largest number of students, have the lowest proportion of failures on State board examinations, and attract better prepared faculties.

In our opinion, such an amendment as introduced by Congressman ROGERS, is a step backward in nursing education as well as evidence of lack of knowledge of the responsibilities nursing has, not only to the medical profession, but to the community as a whole.

Sincerely yours,

JOHN F. GILLESPIE, M.D., Assistant Professor of Surgery, Georgetown University.

Washington, D.C.

House of Representatives,
Washington, D.C.

DEAR MR. CUNNINGHAM: Thank you for offering me the opportunity to comment on

the position of the Office of Education with reference to the designation of an accrediting agency for associate degree programs in nursing for purposes of the Nurse Training Act of 1964. We are enclosing a summary statement of issues and developments involved in an attempt to reconcile conflicting views.

Let us know if we may be of further service.

Sincerely yours,

PETER P. MUIRHEAD, Associate Commissioner for Higher Education.

DESIGNATION OF THE NATIONAL LEAGUE FOR NURSING AS THE APPROPRIATE ACCREDITING AGENCY FOR THE PURPOSES OF PUBLIC LAW 88-581, THE NURSE TRAINING ACT OF 1964 The U.S. Commissioner of Education, pursuant to legislative authorization and on the basis of criteria established and published in October 1952, designated the National League for Nursing as the nationally recognized accrediting agency for the field of nurse education. When, in 1957, the league extended its accreditation to include evaluation of associate degree programs in nursing, the Commissioner of Education recognized this as a logical assumption of responsibility by the nationally recognized accrediting agency in the field of nurse education.

Parallel situations appear in several other professional and specialized fields, e.g., accreditation of engineering technology programs by the Engineers' Council for Professional Development; accreditation of dental hygiene, dental technology, and dental assistant programs by the American Dental Association; accreditation of allied medical

sciences such as medical technology, physical therapy, occupational therapy, and X-ray technology by the Council on Medical Education of the American Medical Associa

tion; and accreditation of programs in music at the junior college level by the National

Association of Schools of Music.

The associate degree program in nursing is of fairly recent development, and many of the junior colleges offering the program had not, prior to the passage of Public Law 88581, sought National League for Nursing accreditation. At the close of fiscal 1965, of

the more than 100 associate degree programs in nursing, 3 had been accredited by the League and 37 had attained the status of "reasonable assurance" provided in section 843 (f) of the act.

professional accrediting agencies accrediting programs in those colleges, representatives of State education departments, and the Federation of Regional Accrediting Commissions of Higher Education the factors involved and the problems in need of resolution. The results of the several conferences held have led to the conclusion that accreditation for general purposes by regional accrediting or State agencies will not guarantee the achievement of the goals of the act-to increase the quantity of nurses available for the care of patients and to improve the quality of training of nurses. Pertinent to this conclusion are the following facts:

The present policy of the Federation of Regional Accrediting Commissions of Higher Education regarding accreditation of specialized programs within an institution is as


"The general accreditation of the institution as a whole is not and should not be interpreted as being equivalent to specialized accreditation of each of the separate parts or programs of the institution."

Thus, while regional association accreditation implies attainment of minimum standards for the institution as a whole, it does not attempt to provide evaluation appropriate to a determination of satisfactory preparation in a professional field. This has been the long standing, institutionally accepted practice in the accreditation of baccalaureate programs, and there seems to be no defensible reason for inaugurating a different practice at the junior college level. Furthermore, the development of the associate degree program in nurse education is so recent that many of the institutions offering such programs have not had their regional accreditation reaffirmed since the

institution of such program.

The procedures and standards for licensing of nurses and approval of programs of nurse education in the several States vary so widely that it does not seem feasible to identify State licensing or approval agencies for the purposes of the act. The States are concerned primarily with identifying individuals who are competent to perform professional duties. Licensure or certification by the State complements but affords no substitute for identifying well qualified institutions and helping to raise and maintain

institutional standards.

The professional leadership in the field of nursing as represented by the California Nurses' Association, the American Nurses' Association, and the State and Territorial

The institutions not qualifying for participation in the provisions of the act have Directors of Nursing has indicated support voiced objection to the requirement of "specialized" accreditation for the associate de

gree program in nursing, suggesting that "general" accreditation by nationally recognized regional agencies or by State agencies should be considered adequate for specialized programs at the junior or community college level.

In November 1964, when the U.S. Commissioner reaffirmed his designation of the National League for Nursing as the appropriate agency for the accreditation of programs of nurse education at the baccalaureate and higher degree, associate degree, and diploma (hospital school) levels, it was with the reservation that it may be necessary to designate additional accrediting bodies for programs at the associate degree level at a later date. This reservation recognized the fact that there were honest differences of opinion between the junior colleges on the one hand and the professional leadership, practitioners and educators, on the other.

With the cooperation of the National Commission on Accrediting (the nongovernmental agency assuming responsibility for recognizing accrediting agencies in the interest of institutions of higher education), the Office of Education has explored with representatives of the junior colleges, the

of the Commissioner of Education's designation of the National League for Nursing for purposes of the Nursing Training Act of 1964 and expressed the conviction that it is the role of government to protect the safety of the public through State licensure of individual practitioners but that standards for educational preparation should be established by peer groups in the appropriate field and carried out through voluntary nationwide participation.

The Office of Education concurs in this point of view and supports the deletion of the proposed amendment to H.R. 3141 which would substitute "general" for "specialized" accreditation as establishing institutional eligibility for participation in the provisions of Public Law 88-581.


The American Nurses' Association recognizes and supports the National League for Nursing as the national accrediting agency for all basic nursing education programs. National League for Nursing accreditation is directed toward strengthening and maintaining quality of nursing education for the protection of both the student and the public. Such accreditation, we believe, is most

essential at the present time for the effective development of associate degree programs which are providing rapidly increasing numbers of candidates for licensure as registered nurses.

We support the designation of the National League for Nursing as the accrediting agency for the purposes of awarding Federal funds for nursing education, and urge that be maintained as a requirement for Federal

assistance to associate degree and baccalaureate programs, as well as for diploma


Columbia, S.C., August 25, 1965.
House Office Building,
Washington, D.C.

DEAR CONGRESSMAN ASHMORE: The South Carolina State Nurses' Association is very much concerned about and opposed to the technical amendment to H.R. 3141, the Health Professions Educational Assistance Amendments of 1965.

This technical amendment calls for changes in the Nurse Training Act of 1964 to

provide that funds be available to collegiate programs on the basis of regional or State approval rather than approval by the Na

tional League for Nursing as named by the Commissioner of Education.

You will understand that this matter is of the greatest concern to nurses in South Carolina. We have, together with State government and other citizens, sought to improve the preparation of nursing practitioners so that our people might have better nursing care. And we believe that definite stand

ards must be adhered to if we are to insure sound education for nursing.

While regional accreditation is important, it testifies to general excellence of the educational institution rather than excellence of specific programs within the institution. Since nurses are so vitally concerned with health and often with matters of life and death, we believe that the nursing programs and clinical facilities used must be exam

ined by those qualified to judge ability to prepare sound practioners of nursing.

Our experience in this State has shown that nationally accredited programs can attract faculty and students and that graduates of these programs make better, safer, practitioners of nursing. Since the National League for Nursing is the recognized accrediting body for basic nursing education programs, we believe that NLN accreditation (or reasonable assurance as provided) should be a requirement for schools to receive funds under the Nurse Training Act of 1964.

This association, therefore, urges you to oppose the technical amendment to H.R. 3141 when it comes up for debate in the


Very sincerely yours,


LANSING, MICH., August 26, 1965.
House Office Building,
Washington, D.C.:

The Michigan Hospital Association opposes those portions of H.R. 3141 which would remove collegiate and associate degree nurse training programs from present national accreditation requirements. Nurse training is vital to the health of our citizens and should meet uniform standards of quality as presently established through the National League for Nursing.

We endorse the position of the American Hospital Association on this subject and trust that your support of our opposition to this measure will be forthcoming.


The CHAIRMAN. The Chair recognizes the gentleman from Arkansas [Mr. HARRIS].

Mr. HARRIS. Madam Chairman, I yield 10 minutes to the gentleman from yield 10 minutes to the gentleman from Utah [Mr. KING).

Mr. KING of Utah. Madam Chairman, I rise in support of H.R. 3141, but vigorously oppose that portion of the committee amendment which modifies the language of section 843 (f) of the Public Health Service Act. Under the present law, assistance is given to schools of nursing which are properly accredited by a recognized body approved for such purpose by the Commissioner of Education. The proposed modification would make eligible for assistance any school of nursing offering collegiate or associate degree programs, if the school is part of an educational institution approved or accredited by either a regional accreditation agency, or a State approval agency.

This modification was approved in subcommittee without hearing, and after little or no notice, notwithstanding the fact that it vitally affects the operation of our nurses training schools, and the profession generally. The American Nursing Association and the American Hospital Association are unqualifiedly opposed to this change in the present law.

It is because of their inherent limitations that almost all of our professional schools have established their own professional accreditation associations for the purpose of establishing a higher standard of excellence than it is possible to maintain by the regional accreditation associations.

Thus, the nursing profession has organized the National League for Nursing for the purpose of establishing national and uniform standards of excellence. This league has been designated by the Commissioner of Education to establish accreditation for schools of nursing. It has done an excellent job, and succeeded in raising the standards of nursing throughout the Nation, so that to be a registered nurse, today, is to be accepted everywhere as a person of quality and competence.

If the above language remains in the bill, the vast progress made in raising standards of nursing will be compromised, and the hands of time will be set back many years.

Today's little lady with the lamp has come a long way since the Crimean War, over a hundred years ago, when Florence Nightingale brought care and comfort to the battered British soldiers. Today she still brings care and comfort, but on a plane of scientific enlightenment and skill which would have confounded the founder of modern nursing. Today's registered nurse, acting under doctor's instructions, but nevertheless relying entirely on her own skill, is licensed to administer any one of hundreds of drugs and narcotics, medications, blood transfusions, intravenous feedings, and oxygen. She is required to exercise skill, and judgment in the most professional sense of the word. It is probably not an exag

If this amendatory language remains in the bill as finally approved, it will, in effect, make it no longer necessary for a school of nursing to meet the high standards prescribed by its officially designated accreditation organization, in order to qualify for assistance. It will weaken those professional nursing standards which have been carefully erected as citadels for the safety of the American people. It will expose those stand-geration to state that today's registered ards to erosion, resulting in projecting the nursing profession along a downward, rather than an upward, road.

By way of background, may I say that the junior colleges and senior colleges the junior colleges and senior colleges and universities in this country have organized themselves into six regional accreditation associations whose purpose it is to extend accreditation to member organizations. These regional associations, although performing a very useful function, are strictly limited. Their function is to accredit schools or universities, as a unit, rather than to pass on the merits of any constituent professional school. It is very possible, for example, that a regional accreditation association might approve a university, on its overall performance, even though its school of nursing might be conspicuously weak. The Federation of Regional Accrediting Commissions of Higher Education has admitted this itself, when, on October 14, 1964, it adopted a policy statement which reads in part as follows:

The general accreditation of the institution as a whole is not and should not be interpreted as being equivalent to specialized accreditation of each of the several parts or programs of the institution.

It is these regional associations which the above-referred to amendment enthrones as the final authority on matters Executive Director, Michigan Hospital of accreditation and eligibility for FedAssociation.


eral funds.

nurse literally holds life and death power over more people than does any other professional person.

With each new advance in technology, there come new demands upon her knowledge and skill. Every year there are scores of new antibiotics, new serums, new narcotics, new medications, new machines and gadgets with which she must become thoroughly familiar.

It seems to me that we should move in the direction of raising standards, rather than lowering them. To leave in the present bill the language in question would without any question move us in the wrong direction. It would remove from hundreds of institutions the incentive to achieve accreditation. It would squander millions of dollars on programs foredoomed to turn out unduly large numbers of failures: that is, nursing candidates who fail to pass the State board examinations. The records show, for example, that last year 10 percent of those receiving an associate degree from accredited schools failed their State boards, but that 25 percent of those receiving the same degree from nonaccredited schools failed their examination.

Because of the incredible complexity of modern medicine, it is apparent to me that the least the public should expect is that those nurses who care for them in their illness should meet, not just the minimum standards prescribed by the

regional accreditation associations, but the much higher standards of competence and excellence prescribed by the National League for Nursing. A dying man should not be required to gamble on whether or not he will receive good nursing care.

Let me make it abundantly clear that the issue here is not one of whether or not the junior colleges should be allowed to participate in the nursing program. The answer is clear that they should, and are. They are not on trial. The National League for Nursing has already accredited 3 junior colleges, and has given 32 others reasonable assurance of receiving accreditation, which has made them eligible for Federal funds. Twentythree more are in the process of review. All of this has been accomplished, in a year's time.

Nothing which I have said is intended to disparage the program of the junior colleges. The position which I take is merely that junior colleges should ex

pect no preferential treatment where standards of professional excellence are concerned. If their courses meet the accreditation standards of the National League for Nursing, then they should become accredited; if they do not, they should not.

I cannot understand why the noble nursing profession has been singled out for this type of discriminatory treatment by the committee bill. On page 18 reference is made to the professions of medicine, dentistry, osteopathy, and optometry. As to them, financial assistance shall be made conditional upon accreditation by a nationally recognized association approved by the Commissioner of Education. Why has an exception been carved out from the general rule, for nurses? Is it because a lower standard of excellence is required of them? This cannot be. Or is it because this is the opening salvo of a legislative barrage that will eventually batter down the standards for all the healing art profes

sions? I believe that the Nation deserves answers to these questions.

No amendment is being offered to the committee bill at this time, frankly because the matter was so handled that insufficient time was allowed to publicize our point of view. I am confident that had committee hearings been allowed on this provision, it would never have survived.

I feel however that it is absolutely imperative that a record of opposition be established during the debate on this bill. I will say frankly that although I approve the general purposes of this bill, and will support it on final roll call vote, I shall think a long time before approving the conference report if it shall still contain language which in my opinion is so repugnant to the public good.

The following material was prepared by the National League for Nursing, showing importance of maintaining National Accreditation standards for schools of nursing, dated August 6, 1965.

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The cost of nursing education programs varies inversely with the size of student enrollment. A study of costs of nursing education conducted by the Research and Studies Service of the National League for Nursing and published in 1964 provided dramatic evidence relating to cost, size of enrollment, and accreditation status of the 126 diploma schools that participated in the study. The larger the program, the lower the annual cost per student and the greater the likelihood that the program is accredited.



No additional data collected in 1965.

No additional data collected in 1965.

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5. A HIGHER PROPORTION OF GRADUATES FROM ACCREDITED PROGRAMS ENTER NURSING PRACTICE A higher proportion of the graduates from accredited programs than from not-accredited programs pass State board examinations and are licensed to practice as registered nurses. It is only the graduates who are licensed and practice as registered nurses who swell the ranks of nurses to provide nursing service. 1964





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Mr. KING of Utah. I yield to the gentleman from Pennsylvania.

Mr. MOORHEAD. Is it the position of the gentleman in the well that the same standards of accreditation should be in existence for all of the health professions, including the nursing profession?

Mr. KING of Utah. That is essentially true. It is my position that there should be national professional standards for all of the professions pertaining to the healing arts, as a requisite for receiving Federal aid.

Mr. MOORHEAD. I say it seems to me the gentleman's position is eminently sound.

Mr. KING of Utah. I thank the gentleman for his contribution.

While I support the overall objectives of the Health Professions Educational Assistance Act, I believe deletion of the Rogers amendment would assist the cause of quality nursing care.

Mr. KING of Utah. I thank the

gentleman from North Dakota for his

excellent contribution.

Mr. SPRINGER. Madam Chairman, I yield 8 minutes to the gentleman from I yield 8 minutes to the gentleman from Kentucky [Mr. CARTER].

Mr. CARTER. Madam Chairman, I rise in support of H.R. 3141. However, I believe we should have a national accrediting agency for schools of nursing. It is quite evident that unless there is It is quite evident that unless there is a significant increase in the number of medical school graduates and also an increase of medical personnel, technicians, and nurses, our Nation will face a critical shortage. Recent enactment of medicare will result in a greater demand for medical services. These needs must be met and H.R. 3141 will help toward that end. The student loan program, which will be extended for 3 years, is Mr. KING of Utah. I yield to the sound. Of 152 schools of medicine,

The CHAIRMAN. The time of the The time of the gentleman from Utah has expired.

Mr. HARRIS. Madam Chairman, I yield to the gentleman 2 additional minutes.

Mr. MACHEN. Madam Chairman, will the gentleman yield to me?

gentleman from Maryland.

Mr. MACHEN. I would like to congratulate the distinguished gentleman in the well for his statement in support of this bill and in opposition to the socalled Rogers amendment. I do want to associate myself with the gentleman from Utah's remarks in opposition to the Rogers amendment and in support of the bill.

Mr. KING of Utah. I thank the gentleman from Maryland.

Mr. REDLIN. Madam Chairman, will the gentleman yield?

Mr. KING of Utah. I yield to the distinguished gentleman from North Dakota.

Mr. REDLIN. Madam Chairman, the distinguished gentleman from Utah has made an excellent presentation of the concern many of us have for protecting the high standards of the nursing profession. I wish to associate myself with his remarks.

Madam Chairman, an evaluation of the standards of a profession is most meaningful coming from the experts in that particular profession.

In the Health Professions Educational Assistance Act, this principle is applied to medicine, dentistry, osteopathy, and optometry. For each of these professions, the bill provides for the accreditation of schools and training programs by appropriate professional associations in determining eligibility for Federal assist


A technical amendment, the Rogers amendment, makes one exception-for the nursing profession. Its adoption would mean that accreditation by the National League for Nursing would no longer be a requirement for receiving Federal assistance under the Nurse the Nurse Training Act of 1964.

Madam Chairman, the National League for Nursing has an excellent record in maintaining high standards in nursing education. Graduates from training programs accredited by the League have

dentistry, osteopathy, and optometry, 147 have established student loan funds and there have been more than 10,000 student borrowers. The present cost of medical schooling is prohibitive to lower income groups. This cost averages over $3,700 per year. $3,700 per year. I see nothing wrong and much that is commendable in allotting scholarships up to $2,500 per year for those gifted individuals who have the ability but not the funds to attend medical schools. Four-fifths of graduate students in life sciences in 1962-63 received nonrefundable grants averaging $2,700. Less than one-third of our medical students received such grants and the average grant was only $760. Because of the impending great need for increased medical personnel, I urge my colleagues to support H.R. 3141. Otherwise we will be unable to supply the Otherwise we will be unable to supply the physicians and other personnel needed.

Mr. HARRIS. Madam Chairman, will the gentleman yield?

Mr. CARTER. I yield to my distinguished chairman.

Mr. HARRIS. Madam Chairman, I want to compliment the gentleman for his very constructive statement just made to the committee. The gentleman made to the committee. The gentleman has been an active practicing doctor in the medical profession over the years and is familiar with the problems as one who has been schooled and trained and has had experience in the field of medicine. As such he has performed a great service. His work on the committee has been outstanding. I want not only the medical profession and the Members of this Conprofession and the Members of this Congress but the people of the Nation to know that he has contributed tremendously to the work of the committee in these fields out of the abundance of knowledge and experience that he has brought with him to this Congress.

I congratulate him not only on the outstanding service he has rendered as a standing service he has rendered as a Member of Congress in these fields, but Member of Congress in these fields, but for the very thorough enunciation he has for the very thorough enunciation he has made here today in connection with this

program and the recognized need of our people as we try to meet future demands. Mr. CARTER. I thank the distinguished chairman for his very kind remarks.

Mr. SPRINGER. Madam Chairman, will the gentleman yield?

Mr. CARTER. I yield to the distinguished gentleman from Illinois.

Mr. SPRINGER. Madam Chairman, I have felt for a number of years that we ought to have a practicing physician on

this committee. We have been fortunate

this year to have one on our side of the aisle. When these complicated questions come before the committee we usually have to get outside advice, but now we are able to get an immediate answer. I congratulate the gentleman not only on his excellent service in connection with this particular bill but also for his service on the committee in connection with the heart, stroke and cancer program which the committee is now considering and on which he has done an equally good job.

Madam Chairman, the gentleman should be commended for coming to the Congress in the capacity in which he did come and for the kind of service he has rendered.

Mr. CARTER. Madam Chairman, I thank the distinguished ranking member of the committee for his kind re


Mr. HARRIS. Madam Chairman, I yield 3 minutes to the gentleman from California [Mr. VAN DEERLIN], a member of the committee.

Mr. VAN DEERLIN. Madam Chairman, as a member of this great committee I, too, am proud to appear on behalf of this legislation immediately following my esteemed colleague, Dr. CARTER. I am sure no one would suggest that there is a conflict of interest in a licensed physician addressing himself to the topics of this legislation. And no one would, other than facetiously, suggest that those few Members of the House who are married to registered nurses suffer from any conflict of interest in rising to speak to that portion of the bill which appears to have curtailed the eligibility of nursing organizations to maintain a high standard in the field of nurses' training.

I am one of those Members of the House who cheerfully accepted, 25 years ago this October, the conflict of interest that was imposed upon me by marriage to a registered nurse, and I must say that I recommend this conflict of interest to any of my bachelor colleagues who may now contemplate marriage.

Madam Chairman, I am also in receipt of a letter from the California Nurses Association which cites the long record of service performed by the National Nursing League in maintaining the standards of patient care at the nursing level through the accreditation of nurses training schools.

Madam Chairman, this letter makes the point that "the National League for Nursing has long and honorably carried out a national accreditation of nursing programs. It has proved its ability and its recognition of the responsibilities in

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