OFFICE OF THE SURGEON GENERAL 1. Chief Medical Officer, United States Coast Guard. 2. Division of Commissioned Officers. 3. Division of Public Health Methods. 4. Division of Nurse Education. 5. Dental Division. 6. Sanitary Engineering Division: (a) Stream pollution investigations. (c) Milk and food. (d) General sanitation. (e) Vessel sanitation. 7. International health relations. EXHIBIT G.-Postwar budget and personnel requirements of the Office of the Surgeon General, fiscal year 1946, and first, sixth, and tenth postwar fiscal years 1 Includes laboratory facilities provided for States Relations Division project. 2 Assume that by the sixth postwar year all nursing functions will be in 1 division. 3 Transferred from States Relations. Includes commissioned officers assigned to Coast Guard, Prison Service, Army, Foreign Economic Administration, etc.; also death gratuity and burial benefits, additional pay for foreign service, etc., not allocated to the several bureaus. To be computed when all other figures have been compiled. PUBLIC HEALTH NURSING AND NURSE EDUCATION POSTWAR NEEDS FOR MORE PUBLIC HEALTH NURSES More than 20,000 public health nurses are employed in the United States and Territories by Federal, State, and local governmental agencies, by insurance companies and industrial plants, and by voluntary organizations such as the visiting nurse associations. This number should be increased nearly fourfold by 1955 if the goal of 1 public health nurse per 2,000 population and 1 supervisor (including special consultants) per 9 staff nurses is to be attained. No State has yet reached the ratio of 1 nurse to 2,000 population which for many years has been recommended by the National Organization for Public Health Nursing. Some of the New England States, which have ratios of 1 to 3,000 or 4,000, come the nearest to this ratio. Although the public health committee of the procurement and assignment service and the administrative practice committee of the American Public Health Association have recommended that there be at least 1 public health staff nurse to each 5,000 of the population, 39 States have more than 5,000 persons per staff nurse. It is clear that there will need to be a marked expansion after the war in the number of staff nurses and accompanying supervisors if we are to have what competent authorities recommend as a desirable ratio of nurses to population. POSTWAR GOALS By 1955, we shall need 74,000 staff public health nurses, of whom about 25,000 should be qualified public health nurses, and 8,200 supervisors. This means that about 3,000 public health nurses per year will need to be trained, allowing for withdrawal from the profession at the rate of about 6 percent per year. NEED FOR FEDERAL AID There is reason to believe local governments may not be able to pay for the much larger number of public health nurses that will be needed to carry out the postwar health programs. Furthermore, since 1939 the number of such nurses employed by nonofficial health agencies has been gradually declining. The Annual Census of Public Health Nursing in 1944 showed that less than 5,000 of the 20,000 nurses in this field were employed by voluntary (nonofficial) agencies. It is assumed that, if the public health nursing strength of the country reaches 82,200 (74,000 staff plus 8,200 supervisors), at least 75,000 of them will be paid from tax funds, either local, State, or Federal. At present, State and local health departments and boards of education are paying for about 15,000 nurses. If these agencies cannot secure appropriations to pay for any material increases in the number of nurses, it would appear that Federal funds will be needed to supply salaries, traveling expenses, and equipment for some 60,000 additional nurses (54,000 staff and 6,000 supervisors) by 1955 and for smaller numbers in intermediate years. Furthermore, it seems likely that Federal aid will be required for the education of 3,000 nurses a year to fill the public health nursing positions that will develop after the war. Federal support should be given in the form of grants-in-aid to State health departments. This BEDSIDE NURSING CARE A PROPER FUNCTION OF PUBLIC HEALTH NURSING SERVICE For the past 3 years the Public Health Service has been urging State and local health departments to include in their programs more bedside nursing care for the sick in their homes. Two years ago, the State and Territorial health officers passed a resolution stating that bedside nursing care is a proper function of a generalized public health nursing service and that it should supplement, not replace, the services usually rendered by public-health nurses. While there has been this official endorsement of nursing care of the sick as a legitimate health department activity, only a few State health officers have encouraged local health departments to develop this type of service. Among the cities which have included the nursing care of the sick as a regular function of the health department nurses are Savannah and Augusta, Ga.; New Orleans, La. and Montclair, N. J. Seattle, Wash., has combined all its public health nursing services under the health department and is including bedside nursing care as one of its major functions. INABILITY OF RURAL HEALTH DEPARTMENTS TO OFFER BEDSIDE NURSING CARE Few rural health departments have offered this type of service because practically no rural health department has had a sufficent number of nurses to attempt such a service. Kitsap County Health Department in Washington (Bremerton Navy Yard area) began such a service a year ago. This service was made possible by the Red Cross which furnished several additional nurses. However, even with the additional nurses furnished by the Red Cross, the population per nurse in this area is 15,000 whereas the ratio should be 1 nurse to 2,000 population if the bedside nursing program is to be carried in addition to the usual preventive nursing activities. POSTWAR UTILIZATION OF GRADUATE NURSES NOW IN WAR SERVICE When the war is over, there will be available an unprecedented number of graduate nurses in this country. There will not be too many nurses in terms of the need for nursing care, but unless there is a carefully laid plan for the utilization of the services of these nurses as they are released from war duty there will be widespread nurse unemployment. On the other hand, inelusion of bedside care as a regular activity of every local health department would utilize the services of at least 45,000 additional nurses. It is important to realize now that returning veteran nurses who have not had public-health training and senior student nurses (cadets) will be able to find a place in this program even though they are not specially trained for this type of work. Not all staff nurses need to be fully qualified public-health nurses; it is sufficient if 1 in 3 is so qualified. NEED FOR DEMONSTRATIONS Nursing care for the sick is one of the services recognized by appropriating bodies as a commodity worth buying. When such a service has been demonstrated effectively, it will have unlimited community support. However, a demonstration is essential, first to convince the health administrators that good nursing care in illness reduces morbidity and mortality rates, and second, to teach the citizens that they may expect such service from a tax-supported agency. NATION-WIDE POSTWAR NURSING PROGRAM The subcommittee on local health units of the committee on administrative practice of the American Public Health Association, has proposed a scheme for health service coverage for the entire Nation. This plan is based upon units of not less than 50,000 population for each health district. Under this proposal, 1 nurse per 5,000 population is recommended (exclusive of supervisory personnel) for the usual health department nursing services exclusive of bedside nursing services. (The ratio is 1 nurse per 2,000 population if bedside nursing service is included.) PROPOSED POSTWAR DEMONSTRATIONS In order to demonstrate the value of including nursing services in a generalized health service program and to ascertain the costs of such an expanded service as well as the most economical methods for its provision, the recommendation is made: 1. That four rural health departments in different sections of the country be selected where the present organizational set-up and staff are in accordance with American Public Health Association standards. 2. That a sufficient number of nurses be added to maintain a ratio of 1 nurse to 2,000 population. Senior cadet nurses and returning veteran nurses who have not had special public health preparation could be used for this purpose as "assistant nurses" in the ratio of two assistants to one qualified public health nurse. 3. A team of nursing service analysts consisting of one full-grade public health nursing consultant, one associate statistician and two clerk-stenographers should be provided to help plan the demonstration, evaluate the service given, study the disease incidence, hospitalization facilities, and need for home nursing care in each community. Some of the questions to which the nursing service analysts should find answers would include: (a) At what point does home nursing care of the sick cease to bring public health returns and become a “luxury service" for the mere convenience of the citizens? |