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REPORT RESUMESED 020 320 VT 002 902NURSING EDUCATION FACILITIES, PROGRAMING CONSIDERATIONS ANDARCHITECTURAL GUIDE, REPORT OF THE JOINT COMMITTEE ONEDUCATIONAL FACILITIES FOR NURSING OF THE NATIONAL LEAGUE FORNURSING AND THE PUBLIC HEALTH SERVICE.PUBLIC HEALTH SERVICE (CHEW), WASHINGTON, D.C.REPORT NUMBER PHS-PUB-1180-F-18 PUB DATE JUN 64EDRS PRICE MF-$Q.50 HC NOT AVAILABLE FROM EDRS. 96P.

DESCRIPTORS- *HEALTH OCCUPATIONS EDUCATION, *EDUCATIONALFACILITIES, CONSTRUCTION COSTS, CONSTRUCTION NEEDS SCHOOLARCHITECTURE, *NURSING, NURSES, PRACTICAL NURSES,*PROFESSIONAL EDUCATION, PROGRAM DEVELOPMENT, SPACEUTILIZATION, GRADUATE STUDY, TECHNICAL EDUCATION, *FACILITYGUIDELINES, BUILDING DESIGN,

THE JOINT COMMITTEE ON EDUCATIONAL FACILITIES FORNURSING OF THE NATIONAL LEAGUEFOR NURSING AND FOUR GROUPS OFCONSULTANTS REPRESENTING RESPECTIVELY BACCALAUREATE, DIPLOMA,ASSOCIATE DEGREE, AND PRACTICAL NURSING PROGRAMS ADVISED THEPUBLIC HEALTH SERVICE STAFF IN DEVELOPING THIS GUIDE TO THECONSTRUCTION OF NEW SCHOOLS AND THE EXPANSION OF EXISTINGPROGRAMS. THE COMMITTEE REVIEWED THE LITERATURE, VISITEDNURSING EDUCATION FACILITIES IN VARIOUS PARTS OF THE NATION,AND HELD DISCUSSIONS WITH THE CONSULTANT GROUPS. ANINTRODUCTORY OVERVIEW OF NURSING EDUCATION DESCRIBES EACH OFTHE ABOVE TYPES OF NURSING EDUCATION PROGRAMS AS WELL ASGRADUATE EDUCATION, RELATIONSHIPS WITH COOPERATING HEALTHAGENCIES, CLINICAL FACELITIES NEEDED FOR NURSING RESOURCES,AND TRENDS IN ADMISSION AND GRADUATION. EACH TYPE OF PROGRAMIS TREATED IN TERMS OF PROGRAM CHARACTERISTICS, NEEDS ANDGOALS', PROGRAMING AND SPACE REQUIREMENTS, AND OPERATINGBUDGET. THE CHAPTER "ARCHITECTURAL CONSIDERATIONS" TREATSTEACHING, RESEARCH, FACULTY, ADMINISTRATIVE, STUDENT,SUPPORTING, CONTINUING EDUCATION, AND MECHANICAL FACILITIESAS WELL AS FIRE SAFETY AND ACOUSTICS. CONSTRUCTION COSTS AREDISCUSSED AND DIAGRAMS SUGGEST METHODS OF ARRANGING VARIOUSFACILITIES. THISZOCUMENT IS AVAILABLE AS FS2.74 /4- -FIB FOR65 CENTS FROM SUPERINTENDENT OF DOCUMENTS, U.S. GOVERNMENTPRINTING OFFICE, WASHINGTON, D.C. 20402. (JK)

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HOSPITAL AND MEDICAL FACILITIES SERIES Mg 2NURSING

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NURSINGEDUCATIONFACILITIES

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programing considerations

and architectui-al guideC

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U.S. DEPARTMENT OF HEALTH, EDUCATION, AND 'WELFARE

Public Health Service

THIS SPECIAL STUDY brings together in one document a comprehen-sive picture of facility needs as related to four types of nursingeducation programs. These are the diploma and practical nursingprograms, the associate degree program, and collegiate programs atthe baccalaureate and graduate levels.

While primarily a guide for those involved in establishingnew nursing education facilities or expanding existing programs, infor-mation of interest is also presented for faculty, community planners,and the staff of various types of health facilities which providelearning experiences for the student nurse.

In light of accelerated building programs resulting fromrecently enacted legislation which provides grants to baccalaureateprograms, this report should prove particularly helpful at this time.

HARALD M. GRANINGAssistant SurgeonChief, Division of o

and Medical Facilities

U.S. DEPARTMENT OF HEALTH, EDUCATION & WELFARE

OFFICE OF EDUCATION

THIS DOCUMENT HAS BEEN REPRODUCED EXACTLY AS RECEIVED FROM THE

PERSON OR ORGANIZATION ORIGINATING IT. POINTS OF VIEW OR OPINIONS

STATED DO NOT NECESSARILY REPRESENT OFFICIAL OFFICE OF EDUCATION

POSITION OR POLICY.

NURSINGEDUCATIONFACILITIES

programing considerations

and architectural guide

Report of the Joint Committeeon Educational Facilities for Nursingof the National League for Nursingand the Public Health Service

U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE

Public Health ServiceWashington, D.C. 20201

PUBLIC HEALTH SERVICE PUBLICATION NO. 1180-F-11)

June 1964

For sale by the Superintendent of Documents, U.S. Government Printing Office, Washington, D.C., 20402 - Price 85 cents

UM=

FOREWORD

ANY Alit, at resolving the Nation's critical nursing shortage will involvethe construction of new facilities or additions to these which already exist.This report, the result of intensive, thoughtful work by the members andspecial consultants to the Joint Committee on Educational Facilities for Nurs-ing of the National League for Nursing and the Public Health Service, should Iserve as a useful guide for those who are taking steps to fill this crucial need.!

The committee which advised the Public Health Service staff in thedevelopment of this document held its first meeting in February 1963. Later,four groups of consultants were appointed, each group representing a dif-ferent type of nursing education program. The value judgments of the expertscomprising both the committee and the special groups are incorporated inthe material presented. Special recognition is also due to the faculties andadministrators of the various facilities visited during the course of the project.

The sponsors are indeed grateful for the important contribution madeby those who aided in the development of this important document. Theguidelines presented should be most helpful in the ultimate establishment ofadequately planned nursing education facilities wherever needed in the Nation.

tiIrrEz isms, R.N., B.S. IITHER L. TERRYGeneral Director urgeon GeneralNational League for Nursing Public Health Servi e

iii

Joint Committee on Educational Facilities for Nursing of the National League for Nursingand the Public Health Service

JACK C. HALDEMAN, M.D., ChairmanPresident

Hospital Review and Planning Council of Southern New YorkNew York, N.Y.

FAYE G. ABDELLAH, R.N., ED. D.Chief, Research Grants BranchDivision of NursingPublic Health ServiceWashington, D.C.

RENA BOYLE, R.N., PH. D.Director, Department of Baccalaureate

and Higher Degree ProgramsNational League for NursingNew York, N.Y.

ROBERT R. CAMIUS, M.D.Consulting DirectorNorth Carolina Memorial HospitalProfessor and Chairman of Department

of Hospital AdministrationSchool of MedicineUniversity of North CarolinaChapel Hill, N.C.

MAXINE COPE, R.N., M.S.Director, Practical Nurse ProgramSalt Lake Trade Technical InstituteSalt Lake City, Utah

EIARALD M. GRANING, M.D.Chief, Division of Hospital

and Medical FacilitiesPublic Health ServiceWashington, D.C.

THE REVEREND R. J. HENLE, S.J., PH. D.Acting Academic Vice President and DeanGraduate School, St. Louis UniversitySt Louis, Mo.

JAMES T. HOWELL, M.D.Education DirectorHenry Ford HospitalDetroit, Mich.

RUTH V. MATHENEY, R N., ED. D.Chairman, Department of NursingNassau Community CollegeGarden City, N.Y.

Donis I. MILLER, R.N., M. ED.A88i8tant Professor of NursingUniversity of CaliforniaSan Francisco, Calif.

PAYE PANNELL, R.N., M.A.Dean, College of NursingTexas Woman's UniversityDenton, Tex.

ROZELLA SCHLOTFELDT, R.N., PH. D.Dean, School of NursingWestern Reserve UniversityCleveland, Ohio

JOHN D. THOMPSON, R.N., B.B.A., M.S.A880Ciate ProfessorDepartment of Epidemiology and

Public HealthYale UniversityNew Haven, Conn.

SISTER ALOYSWS WILLIAMS, R.N., M.S.Director of Nursing EducationHotel Dieu School of NursingEl Paso, Tex.

CONTRIBUTING STAFF

PUBLIC HEALTH SERVICE

Division of Hospital and Medical Facilities

RUTH G. YANKAUER, R.N., M.S.Project Director

AUGUST P. HOENACK, B. ARCH., A.I.A. JOHN R. MCGIBONY, M.D.

GRUINE ROBINSON, B.S., M.P.H.RICHARD LOPACKI, DIP. ARCH.

RENA BOYLE, R.N., PH.D.

iv

THE NATIONAL LEAGUE FOR NURSING

ELIZABETH GATES, R.N., M.S. FRANCES PETERSON, R.N., M.S.

ELLA DAVIS

HAROLD R. ROWE, M.S.

SPECIAL CONSULTANTS

Associate Degree Programs

RUTH V. MATHENEY, R.N., ED. D.Chairman, Department of NursingNassau Community CollegeGarden City, N.Y.

FRANCES PETERSON, R.N., M.S.Director, Lepartrnent of Diploma c.nd

Associate Degree ProgramsNational League for NursingNew York., N.Y.

MILDRED S. SCHMIDT, R.N., M.A.Predoctoral FellowTeachers CollegeColumbia UniversityNew York, N.Y.

WALTER SINDLINGER, PH. D.Professor, Higher EducationTeachers CollegeColumbia UniversityNew York, N.Y.

ELEANOR A. TOURT1LLOTT, R.N., M. ED.Coordinator of Education for NursingHenry Ford Community CollegeDearborn, Mich.

Baccalaureate and Higher Degree Programs

RZNA BOYLE, PH. D.Director, Department of Baccalaureate

and Higher Degree ProgramsNational League for NursingNew York, N.Y.

DORIS I. MILLER, R.N., M. ED.Assistant Professor of NursingUniversity of CaliforniaSan Francisco, Calif.

FAYE PANNELL, R.N., M.A.Dean, College of NursingTexas Woman's UniversityDenton, Tex.

ROZELLA SCHL(YTFELDT, R.N., PH. D.Dean, School of NursingWestern Reserve UniversityCleveland, Ohio

Diploma Programs

SISTER ALOYSIUS WILLIAMS, R.N., M.S.Director of Nursing EducationHotel Dieu School of NursingEl Paso, Tex.

JUSTINE MAUER, R.N., M.A.Instructor., Obstetrical NursingHartford HospitalSchool of NursingHartford, Conn.

FRANCES PETERSON, R.N., M.S.Director, Department of Diploma and

Associate Degree ProgramsNational League for NursingNew York, N.Y.

Maw FADEN REYNOLDS, R.N., M4.Director, School of NursingMobile InfirmaryMobile, Ala.

V

Vi

SPECIAL CONSULTANTSContinued

Practical Nurse Programs

MAXINE COPE, R.N., M.S.Director, Practical Nurse ProgramSalt Lake Trade Technical InstituteSalt Lake City, Utah

EDNA FREEMAN, R.N., M.S.Assistant PrincipalShapero School of NursingDetroit, Mich.

ELIZABETH GATES, R.N., M.S.Assistant DirectorDepartment of Practical Nursing ProgramsNational League for NursingNew York, N.Y.

NELLIE KU.TALA, R.N.Director, Practical Nursing DepartmentUtah Trade Technical InstituteProvo, Utah

SISTER COLETTE VAN HEEK, R.N., B.S.Acting DirectorSchool of Practical NursingSt. Marys' HospitalPierre, S. Dak.

Coot Study

HAROLD R. ROWE, M.S.Director, Study on Costs of Nursing EducationNational League for NursingNew York, N.Y.

INEZ HAYNES, R.N.General DirectorNational League for Nursing

andLIITHER L. TERRY, M.D.Surgeon GeneralPublic Health Service

DEAR MISS HAYNES AND DR. TERRY :

AFTER MORE than a year and a half of study and careful deliberation, theJoint Committee on Educational Facilities for Nursing herewith submits itsreport intended as a guide to those contemplating the construction of newschools or the expansion of existing programs.

The methodology used in developing this study consisted of a .-eviewof the literature, visits to nursing education facilities in various parts of theNation, discussions with special consultant groups, and meetings of both thefull committee as well as subsections of the committee. Every effort was madeto pool the judgment of experts in the four programs so that the guidelineswhich ultimately evolved would represent the most desirable approach to thedesign of nursing education facilities.

While the material presented might serve numerous purposes, the pri-mary objectives were (1) to call attention to essential factors in developinga nursing education facility program, and (2) to present design considerationswhich night be adapted to meet a program's particular needs. In addition,it is hoped that many will find particularly useful the profile developed tomore clearly delineate the characteristics and needs of each type of program.

The pros and cons of presenting material pertaining to the four nursingschools in separate documents were discussed; and the committee decided thatone publication which included all four programs would be the most advan-tageous. With such a document, planners will have an opportunity to revieweach program before deciding which would be the most desirable. In addition,institutions may find it useful to have information readily available pertainingto another program.

As a further aid to the reader, each chapter relating to a particularnursing program is complete in itself. Because of this, however, a certainamount of repetition was found to be necessary in describing program objec-tives, needs, and goals.

Particular thanks are due to the staff members of the National Leaguefor Nursing who reviewed school catalogs and compiled information onfaculty-student ratios and costs of operating nursing programs. The majorpart of the writing and editing of the report, including the development ofarchitectural designs, is the work of the staff of the Division of Hospital andMedical Facilities of the Public Health Service. We owe a special debt ofgratitude to Mrs. Ruth Yankauer far her coordinative efforts and leadershipin the development of this study.

CJACK C. HALDEMAN, M.D.Chairmav,

vii

CONTENTS

Foreword.

Committee Members and Staff

Transmittal Lett ©r

Introduction

Page

iv

vii

xv

Chapter I. Overview of Nursing Education 1

Nurse Education Programs 1

Registered Nurse Programs 1

Practical Nurse Programs 2

Hospital and Health Agency Requirements and Responsibilities 2

--Clinical Facilities Needed for Nursing Research 3

Trends in Admissions and Graduations 3

Nursing Needs 5

Planning To Meet the Needs 5Programing for Construction 5

Chapter II. Diploma Nursing Programs 7

Program Characteristics 7

Approval and Accreditation 7Number of Programs and Graduates 7Curriculum 8Resources for Patient Care Experience 3Faculty 8

Needs and Goals 9Meeting the Needs 9New Schools 9

Programing and Space Requirements 9Teaching Space 9Faculty Space 11Administrative Space 11Supporting Space 12Continuing Education Space 12Student Housing. 12Resources for Patient Care Experience 12

ix

x

Page

PROFILE OF A DIPLOMA PROGRAM ORGANIZED IN A HOSPITAL 13

Space Requirements 13

Patient Care Experience Area 13Continuing Education 13

Annual Operating Budget 14

Program Character tics 14Budget Components 16

SELECTED BIBLIOGRAPHY 17

Chapter IlL The Associate Degree Nursing Program 18


Approval and Accreditation 18Number of Programs and Students 19

19192020

Nee w and Goals 20

Propuming and Space Requirements 21

Teaching Space 21Faculty Space 22Administrative Space 23Supporting Space 23Patient Care Experience Areas 23Continuing Education Space 23

PROFILE OF A DEPARTMENT OF NURSING IN A COMMUNITY COLLEGE._ _ _ 23


Teaching Space 23Faculty Space 24Administrative Space 24Supporting Space 24Collapsing Education Space 25


Program Characteristics 25Budget Components 26


CurriculumResources for Patient Care ExperienceFacultyContinuing Education

Chapter IV. Baccalaureate and Graduate Nursing Programs 28

Characteristics of Programs 28

Approval and Accreditation 28Types of Programs 28Number of Programs and Students 29

THE BACCALAUREATE PROGRAM 30

Prewam Characteristics 30

Curriculum 30Resources for Patient Care Experience 30Faculty 31

Page

Needs and Goals 32

Meeting the Needs 32Responsibilities of Universities 33

Planning Considerations_ 34

New Schools 35

Programing and Space Requirements 35

Teaching Space 36

Faculty Space 37

Administrative Space 37

Supporting Space 38

Continuing Education Space 38

Resources for Patient Care Experience 38

PROFILE OF A BACCALAUREATM PROGRAM 38


Teaching Space 39

Faculty Space 39

Administrative Space 39

Supporting Space 39

Patient Care Experience Area 39

Continuing Education Space 40



Components of Operating Budget 41

GRADUATE NURSING PROGRAMS 43


Curriculum 43

Faculty 43

Needs and Goals 44

Programing and Space Requirements 44

Teaching Space 44Research Space 45Faculty Space 45Administrative Space 45

PROFILE OF A GRADUATE PROGRAM 46


Teaching Space 46Research Space 46

Faculty Space 46Administrative Space 46

Operating Costs 47


xi

xii

Chapter V. Practical Nursing ProgramPage

49

Program Characteristics 49Approval 49Number of Programs and Students 49Curriculum 49Resources for Patient Care Experience 50Faculty 50

Needs and Goals 50

Programing and Space Requirements 51Teaching Space 51Faculty Space 52Administrative Space 52Supporting Space 52Student Housing 52Patient Care Experience Areas 53

PROFILE OF PRACTICAL NURSING PROGRAMS 53

Space Requirements 53Operating Budget 53


Chapter VI. Architectural Considerations 58

SPACE REQUIREMENTS 58

Teaching Spaces 59

Lecture-Demonstration Rooms 59Classrooms_ 59Students' Conference Rooms (Teaching) 60Multipurpose Room 62Science Laboratories 64Library 64

Research Facilities 66

Biological Science Laboratories 66Behavioral Science Laboratory 66Data Analysis Room 69

Faculty Offices 69

Administrative Unit 69

Offices and Ancillary Supporting Area 69

Administrative Stag Lounge 70

Students' Facilities 70

Supporting Areas 70

Continuing Education 71

Assembly Room 71

Conference Rooms 71

Reception and Registration Area 71

LIGHTING 71

Page

MECHANICAL FACILITIES 73Laboratories 74Electronic Equipment and Data Processing Room 74Projection Booths 74Plumbing and Utilities 74

OTHER DESIGN CONSIDERATIONS 74

Fire Safety 74Acoustics in Learning Spaces 75

CONSTRUCTION COST FACTORS 75


Appendix A. Operating Budgets for Nursing Programs 78

Appendix B. Programing for a Nursing Education Facility 86

RELATED AD HOC COMMITTEE REPORTS 88

TABLESNumber

1. Admissions to initial programs which prepare for beginning practicein nursing, 1956-57 through 1962-63 4

2. Gradhations from initial programs which prepare for beginningpractice in nursing, 1956-57 through 1962-63 4

3. Admissions and graduations from diploma programs in nursing,1955-1962 8

4. Space requirements for a 3-year diploma program with a total enter-ing class of 64 and a total enrollment of 148 15

5. Proposed annual operating budget for educational and noneduca-tional functions for a diploma program, with an entering class of 64 anda total enrollment of 148 16

6. Space requirements for a 2-year associate degree program in com-munity college with an entering class of 64 and a total enrollment of104 25

7. Nursing program operating budget for the community college 26

8. Enrollments and accreditation of baccalaureate and master's degreein nursing programs, fall 1963 30

9. Number of professional nurses in practice, educational level, in 1962and the goals for 1970 33

10. Space requirements for 4-year basic baccalaureate nursing programwith an entering class of 96 and a total enrollment of 240 40

11. Proposed annual operating budget for a baccalaureate nursing pro-gram with an entering class of 96 and a total enrollment of 240.. _ _ _ _ 43

12. Space requirements for a 2-year graduate nursing program in con-junction with basic baccalaureate program with a total entering class of30 and a total enrollment of 60 47

xni

Number

13. Number of approved programs, and the admissions and graduationsin schools of practical nursing, 1955-56 through 1961-62

14. Space requirements for a 1-year practical nursing program in avocational school with an entering class and enrollment of 64

15. Space requirements for a 1-year practical nursing program in ahospital with an entering class and total enrollment of 64

FIGURES

49

54

55

Number

1. Space relationships in the diploma program 14

2. Admissions to and graduations from associate degree programs innursing, academic years 1956-57 through 1961-62 19

3. Space relationships in an associate degree nursing program 24

4. A nursing program in a college 31

5. A nursing program located in a university 31

6. A nursing program in a university with a detached medical centercampus 32

7. A nursing program conducted by a university 33

8. A program in nursing located at a university medical center 34

9. Space relationships in baccalaureate, graduate, and continuing educa-tion programs 42

10. Enrollments and graduations from master's program in nursing,1956-62 44

11. Space relationships of a practical nursing program in a vocationalschool 56

12. Space relationships of a practical nursing program in a hospital___ _ 56

13. Lecture-demonstration room (example a)

14. Lecture-demonstration room (example b) 61

15. Lecture-demonstration room at Texas Woman's University Collegeof Nursing, Houston, Tex.

16. Student-faculty areas

17. Multipurpose room

18. Library facilities for a diploma nursing program 65

19. Typical research laboratory arrangements 67

20. Behavioral science laboratory for a nursing graduate program 68

60

62

63

64

xiv

INTRODUCTION

THE NEED for a greatly increased supply of nurses has been documented bymany studies in recent years. The latest of these, "Toward Quality in Nurs-ing,"1 sets feasible goals by 1970. This study recognizes that if realistic goalsare to be met, additional educational facilities must be provided to accommo-date expanded enrollments and faculties necessary to carry out educationalprograms.

With growing public demands for nursing services and with increasesin nursing research as a reflection of public policy, even more nurses and nursescientists must be trained. This training will require a substantial investmentin educational facilities for all types of nursing programs.

The establishment of a new program in nursing or planning for facili-ties for rapidly expanding enrollments has been such an infrequent occurrencethat it is rare for any nurse educator or architect to have participated in thedesign of more than one school. The lack of published reports on planningand construction of nursing educational facilities and the sizable costs ofconstruction led the Surgeon General's Consultant Group on Nursing to rec-ommend that "Steps should be taken by the Public Health Service and thenursing profession to prepare prototypes of school facilities most conduciveto efficient and effective teaching of nursing."

The Public Health Service and the National League for Nursing jointlyappointed a committee composed of hospital administrators and educatorsfrom general, medical, and nursing education. This committee was to advisethe Public Health Service in the development of a guide to be used by col-leges, universities, hospitals, communities, and regional groups in planningeducational facilities for nursing.

The committee recommended that consultants for each type of educationprogram be appointed to describe the educational practices which influence

space requirements and to determine the facilities necessary to carry out thespecific type of educational program. The staff and each consultant groupreviewed pertinent literature, made site visits, and examined architecturalplans for the particular program being described.

The schools visited were organized in hospitals, vocational educationalsystems, junior colleges, and colleges and universities. Some were in smallcommunities, some in metropolitan areas. Each school had either recentlybuilt or was planning to build a new educational facility. Valuable informa-tion obtained from these visits has been incorporated in this report.

1 U.S. Department of Health, Education, and Welfare, Public Health Service, TowardQuality in Naming. (Item 6, Selected Bibliography, Ch. II, p. 17. )

OUTLINE OF REPORT

Six chapters and two appendices comprise this report. The first andfinal chapters, as well as the appendices, are overall in scope and have appli-cation for all programs. The remainder of the report (chs. IIV) relates tospecific types of nursing education facilities.

Chapter I, "Overview of Nursing Education," contains a brief descrip-tion of each program for nursing, where it is organized, and the purpose ofthe program. It also includes information on admissions, graduations, andthe goals for expansion to meet needs projected to 1970.

Chapters II, III, IV, and V relate to the following nursing programs,respectively : the diploma, associate degree, baccalaureate and graduate degrees,and practical nursing. In each chapter, a description is presented of specialaspects of each program from the standpoint of their effect on space planningfor teaching, faculty, and administration.

In each chapter relating to individual nurse education programs, ahypothetical school has been described, an annual operating budget projected,and space requirements determined. No attempt was made to compare theoperating cost or space requirements of one program with another, since eachhas its special needs precluding a common basis for comparative purposes.For example, each program differs in purpose, curriculum, and graduationrequirements. The determination of the kind of program to be establishedshould be based on the type of nurses for which there is the greatest need.

Chapter VI sets forth planning considerations which will affect thearchitectural design of a facility. No attempt is made to outline finishedplans since this should be the decision of the individual school, after a carefulevaluation of various alternatives. Moreover, before the architect begins todevelop his plans, the school must first establish its educational program.

A selected bibliography is presented at the conclusion of each chapter,with the exception of the first.

Appendix A presents a review of faculty-student ratios and costs ofoperating nursing programs. A profile of costs for each of the nursing pro-grams is offered as a guide for administrators to consider.

Appendix B, "Programing for a Nursing Education Facility," lists inoutline form the important planning factors which must be considered priorto the development of a building program.

xvi

Chapter I

Overview of Nursing Education

THE PRIMARY FUNCTION of nursing education is to

provide qualified nurse practitioners to meet thediversified nursing needs of persons requiringhealth services. To carry out this function, con-sideration must be given to the preparation of be-ginning practitioners, the supervisors required inbeginning practice, and the faculty necessary forall types of educational programs. Of equal im-portance is the need to prepare administrators andpersons qualified for research in nursing serviceand nursing education.

Two distinctive levels of preparation areneeded : (1) basic preparation and (2) advancededucation for specialization. The basic prepara-tion aims at developing individuals Who may, withorientation, supervision, inservice, and continuingeducation, carry out the nursing services for whichthey are prepared with increasing competencywherever employed. These programs representinitial education for the practice of nursing. Pro-grams for specialization are on a postbaccalaureatelevel and are primarily for clinical practitioners,administrators, teachers, and researchers in nurs-ing service and nursing education.

Basic educational programs for nursingprepare students for examination for licensure asa registered professional nurse or us a practicalnurse. The programs have marked differencesfrom the standpoint of entrance requirements,curriculum, length of course, job opportunities,and opportunities for advanced study.

732-486 0-01--2

Nurse Education Programs

REGISTERED NURSE PROGRAMS

Students preparing to become registerednurses may enroll in a diploma program or in pro-grams at the associate and baccalaureate degreelevels. Only the recipient of a baccalaureate de-gree is eligible to apply for graduate study innursing.

The Diploma ProgramThe diploma pro-gram in nursing is conducted by a single-purposeschool of nursing under the auspices of a hospital,or the school is independently incorporated. Thisprogram, usually 3 years or less in length, is forthe qualified high school graduates who want : (1)an education centered in a hospital, and (2) anearly and continuing opportunity to be with pa-tients and with personnel who provide healthservices.

The Associate Degree ProgramThe asso-ciate degree nursing program is generally estab-lished as a division or department of a communityjunior college, although some are in 4-year colleges

or universities. This program is usually 2 yearsin length, designed to fulfill the educational needs

of qualified high school graduates who want (1)to prepare to practice nursing as a registered nurse,and (2) to study in a college where they share theresponsibilities, privileges, and intellectual and so-cial experiences with all the other students.

1

77"

The Baeealawreate Degree Program.Anursing program leading to a baccalaureate degreeis conducted by an educational unit in nursing(department, division, school, or college) that isan integral part of a college or university and isorganized and controlled in the same way as sim-ilar units in the institution.

The baccalaureate degree program is de-signed to serve the needs and purposes of qualifiedhigh school graduates who want : (1) to learn andhave practice in caring for patients on a human-istic and scientific basis, (2) to prepare on a bac-calaureate level for nursing, (3) to share withstudents preparing for other occupations all thegeneral advantages of college or university prepa-ration, and (4) to acquire baccalaureate educationas a prerequisite to preparation for specializedpractice, teaching, administration, or research.

Some graduates of associate degree and di-ploma programs in nursing may wish to fulfillrequirements for a baccalaureate degree. Eachcollege or university establishes its own entrancerequirements.

Graduate Education.Graduate nursingprograms provide an opportunity to prepare forteaching and administration in all types of edu-cational programs and for supervisory and admin-istrative positions in nursing service. Consultants,clinical specialists, and research workers also re-quire graduate study.

PRACTICAL NURSE PROGRAMS

A program leading to a certificate or di-ploma in practical nursing 1 may be organized andoperated under public vocational education, hos-pitals, or other community agencies.

This type of program, usually 1 year inlength, is self-contained, complete, and satisfac-tory for its own purpose, providing preparationexclusively for practical nursing. It is not a partof, nor the beginning of, any other type of edu-cational program in nursing. Its objective is toprepare a worker who will share in giving directcare to patients.

1 Some States license the graduates of 1-year programsunder the title, "licensed vocational nurse." The term"practical nurse" in this study includes the licensed voca-tional nurse.

2

Hospital and Health AgencyRequirements and Responsibilities

The nature of nursing makes it mandatoryfor the student to have learning opportunitiesunder faculty supervision in several kinds of com-munity agencies in which patients are seen andtreated. These may be general or special, acuteor long-term care hospitals. The use of outpatientdepartments of hospitals and of nursery schools,day care centers for adults, and related communityhealth agencies gives students an opportunity todbserve persons in all age groups and in variousdegrees of health. Students need to have experi-ence in the preventive and rehabilitative aspects ofnursing in addition to the care of the acutely illpatient. Public health or related communityhealth service agency experiences are required bystudents enrolled in baccalaureate degree pro-grams.

Most programs use more than one hospitalor health agency to obtain sufficient nursing careexperiences for the students. On the other hand,many hospitals will be offering nursing care ex-perience to students from more than one type ofprogram and more than one school. Special hos-pitals, such as children's hospitals and hospitalsfor the mentally ill, offer affiliations to studentsfrom a number of schools. In affiliation with di-ploma and many practical nurse programs, thespecial hospital may provide the faculty for stu-dent teaching. Associate and baccalaureate de-gree programs provide the faculty instruction fortheir students in each hospital or health agency.

Teaching hospitals in medical centers mayhave students from practical nursing, diploma, as-sociate, and baccalaureate degree programs as-signed for patient care experience on the same day.In some instances where there are sufficient patientcare units, students from each program may be as-signed to different patient care areas. In others,coordinating committees schedule students to usealternate days for patient care experience andclassroom instruction. Under the latter plan somepatient care experiences may not be availableand/or some medical care conferences may not bescheduled on the day that students from one groupare in the hospital.

Although the hospital and other communityhealth agencies are primarily organized for patientcare, they are also essential in the planning of

educational programs for student nurses. Theaddition of educational programs to patient carerequirements imposes responsibilities upon boththe educational and service agencies. The boardsof trustees of both the service and the educationalagencies must understand the requirements foreducational programs in service agencies and themutual responsibilities of each group.

Written administrative agreements cover-ing the educational control of the nursing programand the service control of the hospital and healthagency define the mutual responsibility of each.These agreements are developed jointly and aresubject to periodic review.

The agreements usually specify that theschool will (1) have control of the students' ex-perience, (2) appoint the faculty to teach the stu-dents, and (3) select the patients for the stut" ants'experience. The hospital or health agency pro-vides (1) facilities such as conference rooms andspace for reference materials, (2) time for the in-structor and nursing service personnel to plan forthe students' experience, and (3) a quality of nurs-ing and medical care that makes it possible forstudents to learn good nursing care where it isbeing practiced.

Cooperation between a school of nursingand a nursing service agency is based on a mutualinterest in good nursing, both as to education andservice as well as a willingness to share what eachhas to offer. The contributions of the faculty-student group and those of the personnel of thehospital or health agency are thought to balanceeach other fairly equally.

Hospitals and health agencies which acceptnursing students for patient care experience willhave space requirements for educational progyamsthat are not usually required in a hospital or anagency not used for teaching. These will includeconference rooms, locker and lounge space, andfood service for students and faculty when as-signed to the hospital.

Each patient care unit used for student ex-perience should provide a conference room to seatat least 12 persons. This room may also be usedfor the current periodical and reference materialsneeded by the students. Where nursing serviceconference rooms are available on patient careunits, these may be shared by nursing education.

Students are usually in the hospital orhealth agency for one or more meals when receiv-ing patient care experience. They will utilize the

same food service provided for agency personnel.The addition of a group of students may requireenlargement of the food service area or the exten-sion of time for food service. Locker and loungespace must also be provided in the hospital andhealth agency.

Clinical Facilities Neededfor Nursing Research

Graduate programs in nursing leading tothe master's and/or doctoral degree are placinggreater emphasis on the preparation of nurses whohave depth of content in a highly specializedclinical nursing area. Other programs within thegraduate school of the university provide trainingfor nurses in the behavioral and natural sciences.These programs are also preparing nurses to carryout research projects independently or collabora-tively with other members of the research team.Nursing research in the clinical area aims at pro-viding new knowledge through scientific inquiryabout the specific effects of nursing practice onpatient care.

Clinical nursing research requires access topatient care facilities. Nursing care research mustbe coordinated both with the total medical researchprogram and with the patient's physician. Morethan one patient care area may be needed to studydifferent types of nursing problems. For ex-ample, outpatient departments have been used tostudy how well patients understand and carry outthe instructions given them for medications andtreatments to be taken at home. The adult medi-cal units have been used to study nursing practiceswhich would prevent decubitus ulcers and promotewound healing. Among surgical patients it hasbeen possible to identify nursing measures thatwill relieve such conditions as Vomiting to reducepostoperative distress.

Trends in Admissionsand Graduations

Tables 1 and 2 present a 7-year trend inadmissions to and graduations from basic nursingprograms. Increases are shown both in the num-ber of practical nurse and associate degree pro-

3

Table 1. Admissions to initial programs which prepare for beginning practice in nursing, 195(i-57through 1962-63

Practical or vocations! Associate degree Diploma BaccalaureateAcademic Year

Programs Admissions Programs Admissions Programs Admissions Programs Admissions

1956-57 432 16, 843 20 578 944 37, 571 167 7, 0941957-58 520 20, 531 28 953 935 36, 402 172 6, 8661958-59 607 23, 116 38 1, 266 918 37, 722 171 7, 2751959-60 661 23, 060 48 1, 598 908 40, 013 172 7, 5551960-61 693 24, 955 57 2, 141 883 38, 702 174 8, 7001961-62 739 26, 660 69 2, 504 875 38, 257 176 9, 04419C1-63 (*) (4) 84 (*) 874 (4) 178 (*)

Table 2. Graduations from initial programs which prepare for beginning practice in nursing,1956-57 through 1962-63

Practical or vocational Associate degree Diploma BaccalaureateAcademic Year

Programs Graduations Programs Graduations Programs Graduations Programs Graduations

1956-57 432 10, 652 14 276 944 26, 141 167 3, 4781957-58 520 12, 407 20 425 935 26, 314 172 3, 6501958-59 607 14, 573 2i 462 916 25, 907 171 3, 9431959-60 661 16, 491 38 789 908 25, 288 172 4, 1361960-61 693 16, 635 48 949 883 25, 311 174 4, 0391051-62 739 18, 106 57 1, 159 875 25, 727 176 4, 3001962-63 (*) (*) (*) (4) 874 (4) 178 (4)

*Data not available for specified academic year.Source: National League for Nursing. April 1963.

grams being offered and in the number ofgraduates each year. Although the total numberof diploma programs is decreasing, admissionsand graduations have not dropped appreciably,indicating growth for individual schools. Theenrollments and graduations from baccalaureateprograms are also increasing.

The difference between the number of stu-dents admitted to nursing each year and the num-ber who complete the program is a problem as itis in other fields of education. In the Nation asa whole, the completion rate from admissions toprofessional nursing programs ranges from anaverage of approximately 70 percent in diplomaprograms to 59 percent in baccalaureate programs.2

The loss to the profession from degree pro-grams is misleading since it includes the dropoutswithin the first 2 years of college before the stu-dent begins, her upper division study in nursing,her major field. This includes students who leavecollege as well as those who change careers but

2 Unpublished study of "Attrition Rates in Schools ofNursing," Department of Studies, National League forNursing, 1962.

4

may complete college. Those who may transf ©rto another college are also included in this figure.

Determining the completion rates from as-sociate decree programs on a national basis hasbeen difficult for many reasons. These programsare fairly new and experience indicates that it re-quires approximately 3 years for a new programto achieve stabilization of its enrollment. Drop-outs are usually high in the first year of the school'soperation. Thr number of new programs eachyear adds to the difficulty in determining, on, anational basis, the completion rate from schoolsthat may have stabilized their enrollments.

The various factors which complicate theinterpretation of the completion rates of theaforementioned nursing programs do not applyto the practical nursing programs. The statisticsprovided by these programs show a more favorablecompletion rate. Practical nursing programs re-port that three out of every four students admittedcomplete the program.2

Education for Practical Nursing, National League forNursing. (Item 1, Selected Bibliography, ch. V, p. 57.)

Nursing Needs

The Surgeon General's Consultant Groupon Nursing in its publication, "Toward Quality inNursing," discusses present and future needs andrecommends feasible goals which might be attainedby 1970. The Group recommended increases inall types of programs, with a triple increase in thenumber of nurses receiving master's and doctoraldegrees. The recommended increases are shownin the following tabulation.

Type of program

Goal forNumber of number ofgraduates graduates

1001 1070Percentinereace

Master's or higher degree_ _ _ _ 1, 020 3, 000 194Post-R.N. baccalaureate___ _ -

Total basic programs.._

2, 456 5, 000 104

30, 267 53, 000 75

Basic baccalaureate 4, 039 8, 000 98Diploma 25, 311 40, 000 58Associate degree 917 5, 000 445

Source: Toward Quality in Nursing, p.ch. a 11 17.)

22. (Item 6, Selected Bibliography,

In addition to the goals shown in the abovetable, the report noted that by 1970, some 350,000licensed practical nurses are expected to be needed.

PLANNING TO MEET THE NEEDS

The most rapid increase in graduations fromall types of nursing programs will probably takeplace in well-established, nationally accreditedprograms. Nevertheless, some new programs mayalso need to be developed.

Expansion of health services, health facil-ities, and preparation of health personnel must becoordinated if new and expanded nursing educa-tion programs are to be established whereverneeded. Educational and financial support mustbe available to assure continuing growth and de-velopment.

Intelligent planning for expansion of nurs-ing programs or the development of new programswill require the cooperation of official and volun-tary groups concerned with meeting the educa-tional and health needs of the area involved.

The area to be considered in planning mayvary with different programs. Community jun-ior colleges and some vocational schools underboards of education usually serve a fairly well-defined geographic area. Although there are in-terstate enrollments in hospital-controlled schools,liberal arts colleges and universities, it may be

possible to define a geographic area from whichthe majority of their students are recruited. Thearea served by graduate programs, on the otherhand, may consist of interstate regions, the Na-tion, and may have large international enrollments.

Groups interested in planning for nursingeducation will be composed of interested andknowledgeable persons from the area involved.They may wish to have specialized consultantservice for some phases of the planning. Fact-finding surveys to determine the nursing man-power needs and resources have been conducted bymany States. The statistics in relation to serviceand educational needs must be kept current andcorrelated with demands created by the construc-tion of new health facilities or the establishmentof new health programs. Planning groups maywish to use consultants iL order to arrive at sounddecisions. Consultants, however, cannot assumethe responsibility for making the decisions whichmust be made by the local planning group.

The State agency which approves schoolsfor registered or practical nurses must he con-sulted to assure that graduates from any programwill be eligible for examination for licensure.The National League for Nursing should be con-sulted concerning requirements for nationalaccreditation.

PROGRAMING FOR CONSTRUCTION

Construction to expand an existing schoolor to establish a new school will be costly. Suchdecisions will have long-range effects. It is there-fore important that planning incorporate a highdegree of flexibility which will permit futuregrowth or change at a reasonable cost. The pro-gram will consist of two parts, the functional pro-gram and the building program.

The functional program to be developed bythe dean or director will be used by the architectfor the building program. Functional program-ing describes the educational requirement of thecourses of instruction in such a way that the archi-tect can determine the teaching, faculty, adminis-trative, and supporting spaces required as well asthe equipment and supplies needed to carry outthe purposes of the school.

Functional programing will include the set-ting and control of the program and the relation-ships of proposed facilities to other usable spacessuch as libraries and auditoriums. The number ofpersons to be accommodated in administrative and

5

faculty space must be determined. Teaching spacerequirements will be based on the number ofstudento to be taught, the teaching methods to beused, and the projection of class schedules.

6

Functional planning will require approxi-mately six months. In addition, architecturalplanning and construction of the building may re-quire from 1 year to 18 months.

Chapter II

Diploma Nursing Programs

THE DIPLOMA NURSING PROGRAM 15 conducted by asingle-purpose school and may be either hospital-sponsored or independently incorporated. Thisprogram serves the interests and needs of quali-fied high school graduates who want (1) an edu-r'stion centered in a hospital, and (2) an early andcontinuing opportunity to be with patients andwith personnel who provide health services.

Program Characteristics

Diploma programs emphasize the basic sci-entific principles of nursing care and of recogniz-ing indications of diseases, disabilities, and patientneeds. The curriculum is planned to equip grad-uates with the skills necessary to organize andimplement a nursing plan that will meet the im-mediate needs of one or more patients, to be re-sponsible for the direction of other members of thenursing team, and, to the degree possible, promotethe restoration of the patient's health.

Some graduates of diploma programs maywish to fulfill requirements for a baccalaureatedegree in nursing. Admission is granted in accord-ance with the admission policies of the particularcollege or university they wish to attend.

APPROVAL AND ACCREDITATION

The appropriate State licensing authoritymust approve diploma nursing programs. Di-ploma graduates are eligible for admission to State

examinations for licensure as registered nurses.After licensure, they are qualified for beginninggeneral-duty nursing positions in hospitals and re-lated agencies.

The National League for Nursing, Depart-ment of Diploma and Associate Degree Programs,upon request from the administrative board of con-trol, will evaluate the school of nursing for na-tional accreditation. Accreditation of the hos-pital by the Joint Commission on Accreditation ofHospitals is a prerequisite for evaluation of thenursing education program.

NUMBER OF PROGRAMSAND GRADUATES

In 1962 there were 883 diploma programs,a decrease of 79 programs since 1e9. (See table3.) However, 60 percent of the hospitals that dis-continued their programs during this period arestill involved in nursing education. Some arenow conducting a practical nurse program. Othershave administrative agreements for student prac-tice with nursing programs under the control ofvocational schools, community colleges, or collegesand universities.

During the same period the number of grad-uations each year has remained at approximately25,000.2 This indicates that the size of the individ-ual school is increasing.

1 Cunningham, Elizabeth V., Today's Diploma Schoolsof Nursing, p. 66. (Item 4 in Selected Bibliography, p.17.)

Ibid., p. 5.

7

Table 3. Admissions and graduations fromdiploma programs in nursing, 1955-62

Academic year Programs Admissions Graduations

1955-56 962 37,763 26,8281956-57 956 37,571 26,1411957-58 944 36,402 26,3141958-59 935 37,722 25,9071959-60 918 40,013 25,1881960-61 908 38,702 25,3111961-62 883 38,257 25,727

Source: National League for Nursing.

CURRICULUM

The diploma program curriculum includes,in addition to nursing subjects, certain coursesfrom general education and from physizal,biolog-ical, and social sciences that are supportive tonursing. Among the general education coursesoffered are religion and ethics, literature, history,and English. The supportive sciences includepsychology, sociology, anatomy and physiology,microbiology, nutrition, and chemistry. Thenursing courses include lectures, demonstrations,laboratory work, and patient care experience in thefundamentals of medical, surgical, pediatric, ob-

stetric, and psychiatric nursing.Traditionally, diploma programs covered

a 3-year thnespan and required 141 to 144 weeksof instruction and patient care experience. Allgeneral and supporting instruction was providedwithin the parent institution. In recent years,however, new practices in curriculum organizationhave resulted in changes affecting the time re-quired for the completion of the program and theway in which instruction in general and support-ive educational courses are provided.

In the 1962 study of diploma schools ofnursing, twos curriculum patterns were identified :

1. Schools that arrange for at least someof the instruction in general education to be givenby a college or colleges, and

2. Schools that have their own faculty pro-vide all the instruction in general education.

RESOURCES FOR PATIENTCARE EXPERIENCE

Diploma programs use the patient care fa-cilities of the responsible hospital as the labora-

°Cunningham, Elizabeth V., Today's Diploma Schoolsof Nursing, p. 29. (Item 4, Selected Bibliography, p. 17.)

8

tory for the major share of the instruction innursing. When the hospital's clinical resourcesare not considered adequate for all the clinicallearning experience planned for the educationalprogram, the facilities of other institutions oragencies are used. Agencies other than the re-sponsible hospital are most frequently used forexperience in psychiatric nursing and in the nurs-ing of children. In the majority of instances, notonly patient care facilities but also instruction per-sonnel are provided by the cooperating oraffiliatingagency. The majority of schools utilize at leadtwo such agencies. In 1962, all but 20 of 728 di-ploma schools reported that they use more thanone hospital for student experience. Psychiatricexperience is obtained in another institution by682 of the diploma schools.4

Faculty members plan the patient care ex-perience and cooperate with nursing service instudent assignments. The cooperation of hos-pital and nursing service administration in help-ing to carry out the educational aim of the nursingprogram is a crucial element in the development ofnursing education. Therefore, the relationshipbetween nursing service and nursing educationmust be clearly defined and understood.

FACULTY

In diploma programs, the administrativeand instructional personnel may be on a full- orpart-time basis. For example, personnel fromcolleges or universities may teach general educa-tional and science courses; social workers, dieti-tians, chaplains, and others may have part-timeteaching responsibilities. The nurse faculty mem-bers who teach the nursing courses are usually ona full-time basis.

The basic full-time nurse faculty for a di-ploma program consists of an administrator andone instructor in each of the nursing courses. Asa guide for planning, a ratio of 1 instructor to 10students may be used. This does not mean that1 instructor will necessarily supervise 10 studentsin patient care practice. An instructor may dem-onstrate and supervise patient care for one studentwith one patient, or she may have two groups offour or five students within the patient care area.Factors affecting the number of faculty neededinclude the teaching methods used and the numberof agencies and patient care units required for

4Ibid., p. 15.

student experience. The annual admissions andthe total enrollment will indicate the number offaculty needed. Programs that provide instruc-tion for some or all of the sciences from the schoolof nursing will require additional faculty.

Needs and Goals

The Surgeon General's Consultant Groupon Nursing in its publication "Toward Quality inNursing" recommends that diploma schools shouldgraduate 40,000 students a year by 1970. Thiswould be a 58-percent increase over the numbergraduated in 1961.5 If this goal is met, the ex-pansion of existing schools must exceed that of thepast 5 years and some new programs may need tobe developed.

MEETING THE NEEDS

, greatest increase in diploma graduateswill probably occur as a result of expansion ofwell-established nationally accredited schools.Many factors must be considered in determiningwhether to expand enrollments in existing pro-grams or to plan for a new school. State or re-gional plans for the establishment of associatedegree or baccalaureate programs may require areevaluation of the sources of applicants to di-ploma programs.

Evaluation of available patient care ex-perience for student learning may indicate the needto establish affiliation agreements with other hos-pitals for some student experience.

Cost studies should be reviewed to deter-mine the expense of the educational program perstudent per year. In some instances boards oftrustees have established the annual admission andtotal enrollment for a program on the basis of theamount that can be allocated from the budget tothe educational program.

NEW SCHOOLS

A new school should be considered onlywhere regional or State surveys have indicatedthe need for more diploma nurses than can be pre-

5 Toward Quality in Nursing, p. 22. (Item 6, SelectedBibliography, p. 17.)

pared by expanding enrollments in existing pro-grams. Before establishing a new program, con-sideration should be given the recommendationsof a nurse consultant 6 who will survey and evalu-ate the availability of patient care and other com-munity health agency resources for studentlearning. The consultant will also advise as tothe nursing program requirements to meetState and National criteria for approval andaccreditation.

After a decision has been reached to estab-lish a nursing program, the next step is the ap-pointment of the basic faculty. At a minimum,the faculty should include the program directorand instructors in the major nursing areas. Thesepersons should be appointed at least 1 year beforestudents are admitted. This time is necessary toallow functional and building programing to becarried out. The architect will use the functionalplan as the basis for developing the buildingprogram.

Programing and SpaceRequirements

The sponsors and the architect should usethe curriculum, housing needs, patterns of affili-ations, and the total educational program todevelop a written functional program. The func-tional program is the basis for the developmentof the building program and the preparation ofarchitectural drawings. The building programwill include space requirements for teaching,faculty administration, housing, and supportingservices.

TEACHING SPACE

Programing for teaching space will be basedon the size of the student group and the teachingmethods to be used. In diploma programs thetotal student enrollment consists of the first-yearadmissions, plus the second- and third-yearenrollments.

Lists of persons qualified for educational consulta-tion may be obtained from the National League for Nurs-ing, State boards of nurse examiners, and the Division ofNursing of the U.S. Public Health Service.

9

Programing for teaching space will be basedon the size of the group that can be accommodatedfor different teaching methods. For example, thesize of the group for such methods as lecture orlecture with demonstration and student participa-tion will indicate the number of sections of a cursethat will need to be scheduled. A projection of theclass schedule for the maximum enrollment isnecessary to determine the type and number ofclassrooms needed. The architect should be ad-vised of the teaching methods and educationalmedia to be used so that the design and equipmentrecommended will reflect the school's specialneeds.

Other factors that affect the number andtypes of teaching spaces are the decision to teachthe sciences in the home school or to purchasescience instruction outside the school, the need toprovide space for observers such as practice teach-ers, and the availability of classrooms for -,hed-

uling at the optimum time for teaching.Clinical nursing classes must be scheduled

on the basis of the most suitable hours for patientcare practice. In many situations, the morninghours may be the best for student practice in med-ical-surgical, pediatric, psychiatric, and obstetricnursing. It will then be necessary to schedulelectures in the afternoon. In these instances, thetotal number of classrooms to be provided may begreater for nursing than for programs that sched-ule classes both in the morning and afternoon.

To provide flexibility for future expansion,it is recommended that : (1) lecture rooms beplanned to accommodate the maximum enrollmentprojected; (2) schools which may be used as prac-tice teaching centers by graduate nursing programsprovide seating for observers; (3) the number ofsmaller classrooms be sufficient to permit sched-uling additional sections as enrollments and facultymembers increase; and (4) architectural designand engineering incorporate features which, whennecessary, can be modified to accommodate futurechanges in program and teaching methods.

Teaching methods commonly used that af-fect architectural planning include demonstrationsof patient care, and the projection and/or moni-toring of demonstrations by television. The archi-tect should be informed of the planned projectionfor films, slides, tape recordings, and other audio-visual aids.

The teaching space to be planned will in-

10

dude lecture, class, multipurpose, and conferencerooms; library; and science laboratories.

Lecture-Demonstration, R o o m. Lecture-demonstration rooms may be needed to seat thetotal number of students to be admitted in any oneclass. If space for demonstration is included,these rooms may be used for the lecture portion ofnursing courses. Where the instructor impartsinformation by lecture, larger groups can be ac-commodated in a single room which provides fixed

seating.

Classrooms. Teaching methods that in-clude student participation require classrooms forsmall groups with movable seating. This type ofroom is used to accommodate sections of the classfor courses such as medical, surgical, maternal andchild health, and psychiatric nursing. The fa-culty should determine the size of each group.

Multipurpose Room.Nursing care of pa-tients requires that the student develop skills incaring for the patient and handling certain equip-ment for patient care. For this type of teachingthe room should stimulate the patient care area ofthe hospital. After demonstration by the, instruc-tor and supervised laboratory practice, the studentmay need independent practice to improve her skillin such things as positioning a patient and main-taining asepsis by the use of gowns, gloves, andsterile instruments. The faculty may also wish todevelop new equipment, test modifications thatmay be made in techniques and/or procedures, orexperiment with modified arrangements of servicefacilities for patient care.

Conference Rooms.Rooms for small groupconferences are required within the educationalunit for teaching groups of students. These maybe used for students assigned to one patient carearea or for students assigned to more than onearea.

Science Laboratory. The diploma pro-gram curriculum requires instruction in anatomy,physiology, microbiology, chemistry, and otherscience courses. The present trend is for diplomaprograms to purchase instruction and/or labora-tory space in these courses from educational insti-tutions within the community. This method mayeliminate the need to provide expensive space with

limited utilization. The inability to provide qual-ified faculty to teach these courses for a nursing

program has stimulated this trend. The schoolwill need to determine the way in which scienceinstruction wIlesprovided in order to determinethe need for science 'laboratories.

Nutrition Laboratory.Current practice inaccredited diploma programs integrates the prin-ciples of nutrition into courses relating to the nurs-ing care of patients. Laboratory practice incooking is usually not included. Therefore, manyschools are not planning nutrition laboratories.Some are converting existing nutrition labora-tories to classrooms, office space, and other uses.

Library.Diploma programs use one oftwo methods to provide library facilities for stu-dents. The majority of programs provide a sep-arate facility within the educational unit. Anincreasing number combine nursing reference ma-terial with the medical library for the hospital.In either instance, the library should provide studyspace for approximately one-third of the studentpopulation. The schedule for the library mustrecognize that students will require access to thelibrary in the late afternoon and evening. Ittherefore should have an entrance that can be usedwhen the remainder of the educational unit maybe closed.

Educational Media Storage Area.Manyschools are planning for the library to become thecenter for distributing and storing educationalmedia such as tape recordings, films, teachingmachines, and anatomical models. If this methodof storing educational media is not used, otherstorage areas will be needed.

FACULTY SPACE

Space requirements for the faculty includeconference rooms, offices, lounge, lockers or lockerrooms, and toilets. Conference rooms are neededfor faculty meetings and meetings with representa-tives from cooperating institutions and agenciesfor program planning.

Each faculty office Should be designed toaccommodate only one faculty member, sinceprivacy is a fundamental requirement. The num-ber of offices should be based on a 10-year antici-pated expansion in enrollments. A ratio of 1 nursefaculty member to 10 students should be used as aplanning factor. This refers to the faculty mem-bers who teach nursing courses and supervise

patient care experience. If the school employsfull- or part-time instructors for the physical, bio-logical, and social sciences, or nutrition, additionaloffice space will be needed. Faculty lounges andtoilets are also essential.

ADMINISTRATIVE SPACE

The diploma program is organized as a"self- contained" school. Many of the nonacademicfunctions, such as student health, recreation, andstudent counseling carried out by central adminis-tration of other types of educational institutions,become the responsibility of the administration ofthe diploma school.

The administrative spaces will include alobby reception room for visitors, general offices,space for a receptionist and clerk-typists, generalstorage area, and offices for the program directorand her assistants.

Lobby Reception Area.This space may bea control point for guests and may be under thegeneral supervision of a receptionist who is also aclerk-typist. Toilets for visitors should be pro-vided.

General office space may provide for clerk-typists and the control of incoming and outgoingmessages. Space for the duplication of educa-tional materials may be adjacent to the generaloffice.

Director's OfIke.The director of the pro-gram will require a private office with a space forsmall group conferences with families of students,potential applicants, and faculty committees.

Assistant Director's Office.Office spacefor one or more assistant directors will be required.The school's total enrollment will determine thenumber of assistants needed.

Secretary's Office.The program directorwill require a full-time secretary in addition to theclerk-typists provided for general faculty use.

Other Offices.Offices for the persons carry-ing out the functions of registration, admissions,student counseling, and student health service willbe required by diploma programs. The size of thetotal enrollment will determine whether certainfunctions can be combined or whether each func-tion requires a full-time person.

11

SUPPORTING SPACE

Supporting areas will include janitors'closets, corridors, mechanical equipment, and stor-age rooms.

Lockers.A lounge and locker space will beneeded for day students who live within a commut-ing area. In addition, space is essential for thosewho must change from street clothes to uniform.

CONTINUING EDUCATION SPACE

Diploma programs cooperate with profes-sional nursing organizations and hospital nursingservice in sharing classrooms and faculty for re-fresher courses for nurses reentering active prac-tice. Workshops are also provided to introducenew nursing practices.

Assembly Rooms. Diploma programs haveinfrequent, but recurring, requirements for a largeassembly or auditorium-type room. This facilitymay be used for meetings of the total student body,graduation exercises, and social or recreationaltypes of programs. Although the percent utiliza-tion of such space by nursing does not warrantbuilding an auditorium exclusively for the use ofnurses, the total requirements for such space by thehospital, medical staff, and others may indicate theneed for an auditorium. It is frequently placedadjacent to a nursing education unit.

STUDENT HOUSING

Diploma programs provide housing for stu-dents in dormitories which also provide for thesocial and recreational life of the student. Themajority of diploma programs permit studentswithin commuting distance to live at home. How-ever, many students prefer to live in the residence.Day students seldom comprise more than 20 per-cent of the total enrollment. The cost of maintain-ing the students accounts for approximately 40percent of the noneducational costs in diplomaprograms.

The type of residence to' e provided shouldbe similar to that required in any program for

12

students beyond high school. Requirements forcollege housing have been developed by collegehousing specialists 7 and these will be of assistanceto groups planning students' residences.


Conference space will be needed in the pa-tient care areas of cooperating hospitals and healthagencies and in the educational unit.

Students enrolled in clinical nursing courseswill be assigned in small groups for patient careexperience in medical, surgical, pediatric, psychi-atric, and other patient care areas. Precare andpostcare planning conferences are an integral partof this experience. These conferences are sched-uled while the student is assigned to the patientcare areaprobably during the morning or earlyafternoon hours. The number of conferencerooms needed will depend upon the number of sec-tions for each class. For example, if there are 6groups of students in medical-surgical nursing, 2groups in psychiatric nursing, 2 in maternity nurs-ing, and 2 in pediatric nursing, there might be 24conferences to be scheduled in any one day. Wherenursing service conference rooms are available onpatient units, there are certain hours of the daywhen they might be available for conferences withnursing students.

These conference rooms should provide forflexible seating arrangement. If taping of confer-ence is anticipated, acoustical treatment may benecessary in the room. Where televised demon-stration of patient care is planned, monitoring setswill be needed.

Lockers and Lounges. If the nurses' resi-dence is closely connected to the hospital, lockerspace may not be needed within the hospital.However, if students must wear coats or capes overtheir uniforms, space for their storage will be re-quired.

Food Service. This is usually provided inthe general employee dining room of the hospital.

College Students Live Here. (Item 2, Selected Bibli-ography, p. 17.)

PROFILE OF A DIPLOMA PROGRAM ORGANIZED IN A HOSPITAL

THE REMAINDER of this chapter presents a profileof a typical diploma, program organized in a hos-pital, based on a composite picture of such facili-ties. This profile, offered as a guide, should beadapted in accordance with the individual needsof the school.

Size of School. Space requirements havebeen planned for a diploma program admitting 64students each year. The total enrollment is 148students.

The personnel to be accommodated are :1 director1 assistant director

15 nurse faculty members1 admissions clerk and registrar com-

bined1 secretary5 clerk-typists

Space Requirements

The student health program is included inthe hospital employee's health service. The officesfor residence director and social and recreationaldirectors are in the residence. One secretary is as-signed to the director of the program and fiveclerk-typists provide clerical services for the fac-ulty and the admissions-registrar's office.

The teaching methods used are (1) lecture-demonstration for the total number of students ad-mitted in any one year, and (2) lecture, demon-stration, and discussion with groups composed ofeither one-half or one-quarter of the annual ad-missions. All teaching space has been planned toaccommodate the student group, plus additionalspace for visitors, practice teachers, or expandedenrollments.

Space requirements have been developedshowing both the inclusion or exclusion of sciencelaboratories.

The library is a part of the educational unit.It provides space for 3,000 volumes and 1,000

bound periodicals. Study space for one-third ofthe students is planned.

PATIENT CAREEXPERIENCE AREA

Each patient care area used for studentteaching in the hospital has a nursing service con-ference room which is shared by nursing education.This conference space accommodates reference ma-terials and other teaching aids such as film pro-jection or tape recorders.

Lockers are not provided in the hospital.Students obtain their meals in the employee din-ing room.

CONTINUING EDUCATION

The school cooperates with local nursingorganizations and hospital nursing service in mak-ing available classrooms, multipurpose room, andthe assembly hall for refresher courses for inactivenurses.

As shown in table 4, the total net usablespace for this program, when science laboratoriesare not in the home school and no assembly roomis provided, is estimated as follows :

Space Square feetTeaching 9, 330Faculty 2, 277Administration 1, 660Supporting area 1, 580

Total 14, 847

When laboratory facilities are in the homeschool and no assembly room is provided, the ad-ditional net usable space to be added is estimatedas follows:

Space Square feetTeaching 4, 368Faculty 500

Total 19, 215

The addition of an assembly room will add3,000 square feet, making the total net usable space22,215 square feet.

Space relationships for a diploma program areshown in figure 1.

13

2

3 1

LIBRARY

TEACHING SPACES

1. LIBRARY2. LIBRARIAN'S OFFICE3. LIBRARIAN'S WORKROOM4. MULTIPURPOSE DEMON-

STRATION ROOM5. CORRIDOR6. LECTURE DEMO. ROOM7. CORRIDOR8-10. STUD. CONF. RM.

11-12. CLASSROOMS

SUPPORTING SPACES 12

11

TEACHING SPACES10

8

SUPPORTING SPACES !SINEW2413. STORAGE ROOM

14. UTILITY ROOM15. A. & V. STORAGE RM.16. STUDENTS' LOUNGE17. W. TOILETS18. M. TOILETS19. W. LOCKER ROOM20. JANITOR'S CLOSET21. MECH. EQUIP. RM.

22

23

28

2529

ADMINISTRATION SPACES 26

22-23. VISITORS' TOILET'S30 31

24. GENERAL OFFICE25. FILES 7 ADMINISTRATION SPACES

26. DUPLICATING 35

27. ASST. DIRECTOR'S OFF. 50

28. ADMISSIONS OFFICE 3629. WAITING AREA 32 33 34 37 49

30. CORRIDOR31. STUD. COUNSELOR'S OFF.32. STAFF & FACULTY LOUNGE33. STAFF'S LOCKER ROOM

10' 5

34. DIR. SECRETARY'S OFF.35. TOILET36. CLOSETS37. DIRECTOR'S OFFICE

FACULTY SPACES

38-48. FACULTY OFFICES49. COFFEE PREP. AREA50. JANITOR'S CLOSET51. FACULTY CONF. ROOM

30

39

43

44

45

46

47

48

FACULTY SPACES

51

40

41

42

0

Figure 1. Space relationships in thediploma program.

Annual Operating Budget

PROGRAM CHARACTERISTICS

The program has been in operation at least3 years. This year, 64 students entered the pro-

14

10 30'

gram; the total enrollment is 148. Second- andthird-year students each take one 12-week coursein an outside cooperating agency. During theyear, the 148 students have a total of 6,096 student-weeks of instruction in the school of nursing. Thenatural sciences courses are taken outside of theschool of nursing. The nursing education staff

Table 4. Space requirements for a &year diploma program with a total entering class of 64 anda total enrollment of 148

Spaces

Nursing education area

Numberof

rooms

Groupsize,eachMOM

Totalnetarea

(sq. ft.)

Remarks

Teaching 9, 330

Lecturt,-demonstration room I 75 1, 940Classrooms 2 38 1, 370Conference rooms 3 16 900 Additional required in hospital.Multipurpose room with storage and utility

room_ 1 2, 000 8 beds.Science laboratories Optional.Storage--teaching aids 1 120Library 1 3, 000 3,000 books; 1,000 bound periodical volumes.

Faculty 2, 277

Offices 15 1 1, 500Conference room 1 20 377Lounge 1 300 Shared with administrative staff.Washrooms, toilets 1 100 1 watercloset and 2 lavatories.

Lockers

Administration 1, 660

Lobby--reception area_ 1 100General office 1 5 400

Secretary-receptionist.Clerk-typists.

Storage area 1 120Duplicating area 1 100Director's office 1 340 With coat closet and toilet.Director's secretary office_ 1 1 100Assistant director's office 1 1 120Registrar's office and admissions office 1 140 Combined function.Students' counselor's office 1 1 160Students' health service Shared with hospital employees' health

service.Staff lounge Shared with faculty.Visitors' toilets:

Men 1 40 1 watercloset, 1 lavatory.Women 1 40 1 watercloset, 1 lavatory.

Supporting 1, 580

Students' toilets:Men 1 120 1 watercloset, 1 lavatory, including 10 full-

size lockers.Women 1 280 7 waterclosets, 7 lavatories.

Students' lounge 300Lockers 240 30 full-size lockers.

Janitors' closets 1 40 Or as required.Coat alcoves As required.Vending machines As required.Telephone booths As required.Drinking fountains Minimum of 4recessed or as required.General storage 1 11.1 600

14, 847 Net area.9, 898 For walls, partitions, corridors, stairs, and

mechanical space.

24, 745 Total gross area.

167. 2 Area per enrolled student.

15

Table 4. Space requirements for a 3-year diploma program with a total entering class of 64 anda total enrollment of 148Continued

Spaces


Numberof

MOMS

Group Totalsize, neteach areaMOM (sq. ft.)

Remarks

Teaching

ClassroomsScience laboratoriesStorage and preparation room

Faculty

Offices

Assembly room

121

38

5 1

4, 368

6483, 600

120

500

500

19, 21512, 810

32, 025

216. 4

200 3, 000

22, 21514, 810

37, 025

250. 2

These should be added if the sciences areare taught in the home school.

Total net area.For walls, partitions, corridors,

mechanieal space.

Total gross area.

Area per enrolled student.

Flat floor.

stairs, and

Total net area.For walls, partitions, corridors, stairs, and

mechanical space.

Total gross area.


consists of an educational director, an assistanteducational director, 15 nurse faculty members,a librarian, a coun6elor, a residence director, a sec-retary, and 5 clerk-typists.

BUDGET COMPONENTS

The projected operating budget, as shownin table 5, is based upon an analysis of 31 diplomaprograms where the total enrollment was closestto that described. Certain items, such as salariesand fringe benefits, are based upon past studiesand, therefore, may not reflect current rates.

The costs of this type of nursing programare presented here under two headings : the costof the educational functions and the cost of thenoneducational functions. Educational functionsrefer to the activities and services that are involvedin instruction, per se. Noneducational functionsrefer to board, room, laundry, and recreation.The costs of these items are not considered in thecollegiate programs because the student presum-ably provides or purchases these items.

16

T able 5. Proposed annual operating budget foreducational and noneducational junctions fora diploma program, with an entering class of64 and a total enrollment of 148

ItemEduca-tional

functionscosts

Noneduca-tional

functionscosts

Total $194, 540 $192, 390

Direct costs 136, 340 17, 816

Salaries 1 116, 000 12, 602Supplies 20, 340 , 214

Indirect costs 58, 200 174, 574

Staff benefits 3, 956 577Operation of plant 35, 038Administration 11, 630 2, 097Library 7, 576 -Health services - 6, 233Laundry 5, 195Dietary 79, 707Residence 80, 765

1Salaries provide for the following personnel: 1 director,1 assistant director, 15 nurse faculty members, 1 librarian,1 counselor, 1 residence director, 1 secretary, and 5 ciork-typists.

SELECTED BIBLIOGRAPHY

1. Characteristics of Educations' Programs iin Noncollegiate InstihttionsLeading to a Diploma in Nursing. New York. The National League for Nurs-ing. 1960. 1 p.

2. College Students Live Here. Educational Facilities Laboratory, Inc. NewYork. 1961. 151 pp.

3. Criteria for the Evaluation of Educational Programs in Nursing Leadingto a Diploma. New York. The National League for Nursing. 1962. 11 pp.

4. Cunningham, Elizabeth V., Today's Diploma Schools of Nursing. NewYork. The National League for Nursing. 1963. 69 pp.

5. National League for Nursing. Study on Costs of Nu/rm./rigInterim Report.(Unpublished.)

6. U.S. Department of Health, Education, and Welfare, Public Health Serv-ice. Toward Quality in Nursing : Report of the Surgeon General's ConsultantGroup on Nursing. PHS Publication No. 992. Washington, D.C., U.S. Gov-ernment Printing Office. February 1963. 73 pp. Price 50 cents.

17782-486 0--64-8

Chapter III

The Associate Degree Nursing Program.

MB ASSOCIATE DEGREE nursing program is gener-ally established ar, a division or department of acommunity junior college, although some are in4-year colleges or ukversities. This program isdesigned to fulfill the educational needs of quali-fied high school graduates who want (1) to prepareto practice nursing as a registered nurse, and (2)to study in a college where they may share respon-sibilities and privileges as well as intellectual andsocial experience; with students in other educa-tional programs.


The following characteristics identify asso-ciate degree nursing programs:

1. The college controls, finances, and ad-ministers the program.

2. The program conforms with the overallstandards and policies of the college and operateswithin the framework of its organization, admin-istration, interdisciplinary curriculum committees,and the student personnel program.

3. The policies and procedures promulgatedfor faculty in other college departments also applyto the nursing faculty.

4. Members of the nursing faculty plan,organize, implement, and teach the nursingcourses. They select, guide, and evaluate all learn-ing experiences including those in the patient careareas.

5. The college, by means of written agree-ments with hospitals and other agencies in the

18

community, provides clinical facilities essential tonursing education.

6. Students meet the requirements of thecollege and its nursing department for admission,continuation of study, and graduation.

7. The nursing program is organized withinthe framework of the community junior collegecurriculum pattern leading to an associate degree.

Graduates of the associate degree nursingprogram are prepared to give patient-centerednursing care in beginning general duty nurse posi-tions. They are prepared to draw upon a back-ground from the physical, biological, and socialsciences in administering nursing care to patients.They relate well with people and are self-directivein learning from experience as practicing nurses.They are prepared to cooperate and share respon-sibility for the patients' welfare with othergeneral-duty nurses, head nurses, supervisors, at-tending physicians, and others. As all otherbeginning practitioners, these graduates need tobe oriented to new work situations and given timeand opportunity to become increasingly effectivein the practice of nursing.

The program is complete for its purpose.Some graduates from associate degree programsmay later wish to fulfill requirements for a bac-calaureate degree in nursing.


The appropriate State licensing authoritymust approve the associate degree program, thismaking graduates eligible for admission to ex-amination for licensure as registered nurses.

Community junior colleges that are ac-credited or approved by the appropriate State andregional accrediting agencies may request reviewfor accreditation of the nursing program by theNational League for Nursing.

NUMBER OF PROGRAMSAND STUDENTS

The associate degree nursing program hasbeen in existence since the early 1950's. In 1952it was offered in four or five institutions. By 1963there were 84 such programs. Figure 2 shows therar'd growth of admission to associate degree pro-grams between 1956 and 1961. The total admis-sions to these programs in 1961 was 2,504.

CURRICULUM

The curriculum for the nursing program isthe basis for developing the functional program toguide the architect in designing educationalfacilities. The curriculum should be planned forapproximately 2 academic years. It should in-clude courses in nursing anu. general educationrelating to the humanities; the social, physical,and biological sciences; and crAmmunic,ations. Atypical associate degree program requires the stu-dent to complete 62-64 semester credits. Anapproximate equal balance is maintained betweenthe general education and nursing credits.

The distribution of credits does not reflectthe distribution of the scheduled time of the stu-dent. For example, the hours required for nursingcare experience may account for approximatelytwo-thirds of the student's scheduled time.

Nursing care experience in a variety ofhealth agencies is a vital part of nursing educa-tion and is therefore planned as an integral partof nursing courses which are broad in scope.Credit is granted for the patient care experienceportion of the course within policies set by thecollege. The nursing courses include lecture andlaboratory instruction, and patient care experiencein medical, surgical, maternal and child, and psy-chiatric setting:, although these nursing coursesmay be organized under other titles.


The community college assesses the totalresources of the community for its students' edu-

2,500

2,000

1,500

1,000

0

ADMISSIONS

GRADUATIONS

State. 1956-57 1957.48 1958-59 1959-60 1960 -81 1961-62

ApprovedPrograms.. 20 28 38 48 57 60

No. ofAdmissions-578 953 1,266 1, 598 2,141 2, 504

ProgramsGraduattngStudents... 14 20 26 38 48 57

No. ofGraduates-270 425 462 789 949 1,150

Souncm: National League for Nursing, Department of Diploma andAssociate Degree Programs, 1962.

Figure 2. Admissions to and graduationsfrom associate degree programs in nursing,academic years 1956 -S7 through 1961-62.

cations/ experiences. The college enters into ad-ministrative agreements with community healthagencies that will permit the faculty to selectpatient care experiences for students under super-vision of their instructors. At present, more thanhalf of the programs utilize the facilities of fouror five agencies which may include three or. morehospitals, nursery schools, clinics, facilities forrehabilitation, convalescent homes, and others.

The responsibilities of the college, the hos-pitals, and the health agencies should be set forthin written agreements. The college will appointthe faculty members responsible for selecting andguiding the student's experience. The hospital orhealth agency provides conference rooms, lockers,and lounges; in addition, the agency provides timefor the nursing staff to serve as resource personsfor faculty planning of students' experience.

In all patient care areas, the faculty is re-sponsible for selecting and using the best learning

19

experiences tor the student. The assignment ofthe student to the patient care unit should be forthe student's education.

The nursing curriculum provides that nurs-ing students attend general education and sciencecourses with other students in the college. Thenumber to be enrolled may require the establish-ment of additional lecture and laboratory sectionsfor the courses. Where new programs are beingplanned, courses such as human anatomy andphysiology and microbiology may need to bedeveloped.

FACULTY

The faculty for the department or divisionof nursing consists of the instructors who teachnursing courses. Faculty members from other de-partments or divisions of the college will teachsuch courses as science, general education, andother related areas.

The basic nurse faculty includes instruc-tors in each of the clinical nursing courses and aprogram director. Faculty members should beprepared at least at the master's level as expertpractitioners and teachers. As enrollments in-crease, additional faculty at the ratio of 1 nursefaculty to each 10 students will be required. Thisdoes not mean that 1 instructor will necessarilysupervise 10 students in patient care practice. Aninstructor may demonstrate and supervise patientcare for one student with one patient, or she mayhave two groups of four or five students within apatient care area. Factors affecting the numberof faculty members needed include the teachingmethods used and the number of agencies and pa-tient care units used for student experience in aparticular clinical area. The annual admissionsand total enrollment will indicate the projectednumber of faculty members needed.

CONTINUING EDUCATION

The associate degree program faculty maycooperate with nursing organizations and the nurs-ing service staff of community health agencies inprograms to improve nursing care. These mayconsist of refresher courses for nurses returning topractice, or noncredit workshops to introduce newmethods for patient care. Some courses may re-quire only lecture space; others may require super-

20

vised practice in the multipurpose room and thecare of patients in patient care units.

Needs and Goals

The Surgeon General's Consultant Groupon Nursing, in its report on the Nation's nursingneeds, recommended that associate degree pro-grams should g: actuate 4,000 students annually by1970. This is a 445-percent increase over gradu-ations in 1961.1 To meet this goal, existing pro-grams will need to increase enrollments and newprograms will need to be organized.

The steady increase of associate degreenursing programs in community colleges over thepast decade can be expected to continue as com-munity colleges continue to be established. Ex-pansion of existing programs and development ofnew programs should be based on a clearly definedneed for more graduates and a clearly demon-strated probability of success in achieving thequality that will meet national criteria for accred-itation and State standards for approval.

Associate degree nursing programs and allother educational programs in nursing as well asservice agencies recruit faculty from the limitednumber of persons completing graduate study eachyear. Student recruitment for the program maybe affected by the presence of diploma and bacca-laureate nursing programs in the area. The com-munity and future employers of the graduatesmust understand and accept the purposes of theassociate degree in nursing.

Adequate finances must be assured if theprogram is to be a success. Special considerationshould be given to the cost of employing facultyfor planning the curriculum and physical facili-ties, and to the initial cost for library materialsand other equipment.

A new program should 'be considered onlywhere regional or State planning has indicated theneed for additional nurses with this preparation.Before determining whether a new program shouldbe established, a survey should be conducted whichwould evaluate the availability of patient care andother community health agency resources for stu-dent learning.

1 Toward Quality in Nursing. (Item 6, Selected Bibli-ography, ch. II, p. 17.)

If the requirements for a sound programcan be met, the next step is to appoint the basicfaculty. At a minimum, this faculty should in-clude the program director and instructors in themajor nursing areas. The director should be ap-pointed at least 2 years and the faculty 6 monthsbefore the first students are admitted. This timeinterval is necessary to permit the establishmentof community and college relationships and agree-ments. It is also essential that time be allowedfor the director and the faculty to plan concur-rently for educational and building programs.

The college must provide space for the de-partment of nursing as for all other departments,both in the initial and the expansion phase of aprogram. Some of the facilities planned for nurs-ing will be unique to nursing. In many instances,however, certain facilities such as classrooms maybe available for overall scheduling by the college.


Before an adequate building program canbe developed to provide the physical facilitiesneeded to accommodate the curriculum, the archi-tect should be given such information as : (1) thestudent enrollment; (2) the courses to be taughtand the teaching methods used; and (3) space re-quirements for instruction, faculty and adminis-trative offices, and supporting areas. This infor-mation Should be set forth in a functional programdeveloped by the building committee, assisted bythe program director and the nursing faculty.

Space relationships for teaching, adminis-tration, supporting areas, and faculty are given infigure 3, p. 24.

The number of students to be admitted ini-tially and anticipated expansion in enrollment willaffect space planning. In associate degree pro-grams, total student enrollment is based on annualincrements of new admissions plus the number ofsecond-year students registered.

TEACHING SPACE

Programing for teaching space will requirea projection of the curriculum and the schedule of

classes to be taught each anticipated increase inadmissions.

Clinical nursing courses should' e scheduledso there will be no conflict with what has been de-termined as the most suitable hours for nursingpractice. In many situations the morning hoursmay prove best for student practice in medical-surgical, pediatric, psychiatric, and obstetric nurs-ing. In these instances, more classrooms may beneeded for clinical nursing'coursoN than for a gen-eral education class. These rooms may be avail-able for scheduling for use by other groups in thecollege when not needed for nursing courses.

To provide flexibility for future expansion,it is recommended that : (1) lecture rooms beplanned to accommodate the maximum enrollmentprojected; (2) schools which may be used as prac-tice teaching centers by graduate programs innursing provide seating for observers; (3) thenumber of smaller classrooms be sufficient to per-mit scheduling additional sections of a class as en-rollments and faculty increase; and (4) the archi-tectural design incorporate features which, whennecessary, can be modified to accommodate futurechanges in the program and in teaching methods.

Teaching methods commonly used that willinfluence architectural planning include demon-stration within the classroom and monitoring ofdemonstrations by clued-circuit television. Thearchitect should be informed of plans for projec-tion of films, video tapes and slides, and the useof tape recordings and other audiovisual aids.

The space requirements for various types ofteaching space will be determined by the maximumsize of the group that can be accommodated inusing a specific teaching method.

The teaching methods and the educationalmedia to be used will guide the architect in design-ing and providing for equipment in classrooms.Other factors to be considered in determining thenumber, size, and location of classrooms include :(1) the purpose for which the room is to be used;(2) the maximum number of students in any oneclass (possible dropouts are not considered in thiscomputation) ; (3) the number and size of the sec-tions into which 'classes in nursing may be divided;and (4) the availability of rooms at the optimumtime for teaching.

Planning for teaching spaces must incor-porate requirements for lecture-demonstrationrooms, classrooms, multipurpose rooms, conferencerooms, science laboratories, and libraries.

21

Lecture-Demonstration Room. --A largelecture-demonstration room, with fixed seating toaccommodate at least the total class, will be needed.Demonstration space should be included.

Classrooms.Teaching methods which in-clude student participation require movable chairsso that seating arrangements can be improvisedfor small groups. Examples of such courses arethe nursing cares of medical, surgical, obstetrical,and pediatric patients.

Multipwrpose Room.Nursing care of pa-tients requires that the student develop skill incaring for the patients and handling the equipmentused for patient care. After demonstration bythe instructor, the student may need independentpractice of techniques to improve her skill in suchthings as positioning a patient and in maintainingasepsis by the use of gowns, gloves, and sterile in-struments. The faculty may also wish to developnew equipment and test possible modifications innursing procedures. This type of practice re-quires a room with hospital beds, a medicine prep-aration area, and utility and storage space.

Many associate degree programs are offeredin localities where hospital beds, needed for studentlearning, may be rented for a short time ( approxi-mately 6 to 8 weeks) . Other programs requirespace for storing beds and bedside tables when notin use. When large equipment is not required,this room may then be used for lectures or con-ferences.

If students are to change from street clothesto uniforms, dressing rooms and lockers should beprovided.

Conference Rooms. Conference space willbe needed in the patient care areas of cooperatinghospitals and health agencies and in the educa-tional unit.

Students enrolled in clinical nursing courseswill be assigned in small groups for patient careexperience in medical, surgical, pediatric, psychia-tric, and other care areas. Precare and postcareplanning conferences are an integral part of thisexperience. These conferences are scheduled whilethe student is assigned to the patient care areaprobably during the morning or early afternoonhours. The number of conference rooms neededwill depend upon the number of small sections ofeach class assigned to the patient care area. Forexample, if there are 6 groups of students in medi-cal-surgical nursing, 2 groups in psychiatric nurs-

22

ing, and 2 in maternity nursing, there might be 24conferences scheduled in any one day. Whereconference rooms are available for nursing servicepersonnel, they may be used by nursing studentsduring certain hours of the day. Or, if joint post-conferences of several groups of students areplanned, a larger conference room may be needed.

If the college is close to the hospital orhealth agency, conference rooms in both the schooland health facility should be available. If clinicalfacilities are a great distance from the school, theconferences will have to be scheduled in the patientcare facility.

These conference rooms should provide formovable seating. Tape recording of conferencesmay require acoustical treatment. Televised dem-onstration of patient care will require monitoringsets.

Science Laboratories.Nursing studentsattend courses in the physical, biological, and socialsciences with other students enrolled in the college.Space for these courses will not be required in thenursing education unit. College administrationwill need to determine whether the present utiliza-tion of science laboratories will allow for expandedenrollments in nursing.

Library.Professional nursing referencesand periodicals are added to the general libraryof the college. Library stacks and study spacemust be available to accommodate the anticipatedenrollment in the nursing course.

FACULTY SPACE

Conference Room. --A room for facultymeetings, conferences, and work groups is neededin the educational unit. The frequency of use willdetermine whether or not this space may be sharedwith other faculty groups.

Offices.Privacy is a fundamental require-ment for faculty offices. Each office should accom-modate only one faculty member. If provision ismade in each office for hanging coats and hats aswell as for changing from street clothes to uni-form, locker space in faculty lounges can be

omitted.Graduate students from colleges and univer-

sities who are preparing to teach in communitycollege programs frequently obtain field practicein associate degree programs. Space will be re-

quired to accommodate from four to six practice ment, vending machines, telephone booths, andteachers, each of whom should be provided desks. drinking fountains also have space requirements.


Administrative space includes offices for thedirector and her secretary. It also provides alobby reception area for visitors and space forclerk-typists as well as for storing supplies. Pro-vision for duplicating educational materials maybe needed if this function is not centrilized in thecollege.

Registration, admissions, student counsel-ing, and student health services are provided bythe general administration of the college. Spacefor these functions is not needed in the educationalunit for nursing.

SUPPORTING SPACE

Lounges for the faculty as well as for maleand female students and visitors are required.Lockers for students may be placed in a centralarea or recessed in the corridor.

Space is essential for storage files and edu-cational aids. Janitors' closets, mechanical equip-

PATIENT CAREEXPERIENCE AREAS

A high proportion of the education fornursing takes place in patient care practice areasof hospitals and related health agencies. Super-imposing an educational aim on the service aim ofthese agencies requires some space not usuallyfound in hospitals without teaching programs.Space will be needed for conferences, referencematerials, and teaching aids. Students and fa-culty require locker space. Provision for foodservice must be made if students and faculty arein the agency at mealtime.


Faculty members from associate degree pro-grams cooperate with nursing organizations, localhospitals, and health agencies in developing andcarrying out continuing education projects.Courses are offered for nurses returning to prac-tice, and instruction is also given relating to newmethods of patient care.

PROFILE OF A DEPARTMENT OF NURSING

IN A COMMUNITY COLLEGE

THE REMAINDER of this chapter presents a profileof a typical department of nursing in a commu-nity college, based on a composite picture of suchfacilities. This profile, offered as a guide, shouldbe adapted to comply with each school's individualneeds. Space relationships as developed for thisprogram are shown in figure 3.

Size of School.Space requirements havebeen prepared for a department of nursing in acommunity college admitting 64 students eachyear. Forty students remain at the end of the firstyear. The total enrollment is 104 students.

The faculty consists of a director and 10full-time nurse instructors. There is one secretaryfor the director and three clerk-stenographers whoserve the entire faculty.

Space Requirements

TEACHING SPACE

Lecture-Demonstration Rooms.This pro-gram would require one lecture-demonstrationroom with fixed seating for the total student bodyof 104 students. This room is designed for filmand slide projection. The schedule of classesplaces the nursing utilization of this room at ap-proximately 10 perasnt. The room is thereforeavailable for scheduling classes other than nursing.

Classrooms.The students admitted eachyear will be divided into two sections for lectureand discussion of patient care. One classroom

23

TEACHING SPACES

4

i 89

SUPPORTING SPACES

110 111 112 13

ADMINISTRATION

115 114 116

18 19

17

20

21

22

23

24

25

26

27

28

29

31 30

10' 5 0 10 30'

TEACHING SPACES ADMINISTRATION SPACES

1. CLASSROOM 14. LOBBY2. MULTIPURPOSE 15. GENERAL OFFICE

DEMONSTRATION ROOM 16. DIRECTOR'S OFFICE3. PROJECTION ROOM 17. TOILET4. LECTURE DEMO. ROOM 18. CLOSET5-7. STUDEN'TS' CONF.

SUPPORTING SPACES

8. UTILITY ROOM9. STORAGE ROOM

10. MEN'S ROOM11. WOMEN'S TOILETS12. MECH. EQUIP. ROOM13. A. is V. STORAGE ROOM

19. JANITOR'S CLOSET

FACULTY SPACES

20-29. FACULTY OFFICES30. FACULTY CONF. ROOM31. COFFEE PREP. AREA

Figure 3 3. Space relationships in anassociate degree nursing program.

with movable seats for 44 will accommodate N stu-dents in addition to observers such as practiceteachers. This room will be in use approximately50 percent of the schoolday.

Multipurpose R o o m .A multipurposeroom with space for eight adult beds will allow thefirst-year class to be divided into four sections forsupervised laboratory practice. When the bedsare not in use, the room will seat 64 students whomay also use this room independently to practice

24

techniques in caring for patients. Its availabilityfor scheduling classes other than nursing islimited.

Conference Rooms.Assignments to patientcare practice in the hospitals and health agenciesare made in groups of 8 to 10. Students from oneor more similar patient care areas may be broughttogether for pre- and post-assignment conferences.The cooperating agencies should provide confer-ence rooms for 16 people on each clinical service.Three conference rooms, each to accommodate 16people either around a table or with movable seats,will be required in the educational unit.

Library. This space is shared with the en-tire college and not required in the nursingeducational unit.

Science Laboratories.Science laboratoriesare shared with the entire college. They are notrequired in the nursing educational unit.

FACULTY SPACE

Individual faculty offices for 10 nurse in-structors will be required. A faculty conferenceroom may be shared with other faculty groups.The conference room may include provision forcoffee or tea service.


The administrative area provides space forthe director's office and a lobby reception room forstudents and visitors. Space to accommodate thedirector's secretary and three clerk-typists is in-cluded in the administrative area.

The administrative functions of admission,registration, student health, student counseling,recreation, and other student activities are sharedwith the total college and do not require space inthe nursing educational unit.

SUPPORTING SPACE

Supporting space includes provisions forstorage of educational media such as anatomicalmodels, films, and tape recorders; general officestorage for files and supplies 521s well as for house-keeping and maintenance materials.

Lounges, lockers, toilets, and washrooms forfaculty, students, and visitors also require space.


It is assumed that the multipurpose roomin the associate degree program will be availablefor scheduling the lecture, demonstration, andpmctice required for short-term, noncreditcourses.

As shown in table 6, the total net usablespace for this program is estimated as follows:

Space Square feet

Teaching 6,120Faculty 1, 580Administration 840Supporting areas 1, 300

TotaL 9, 840


The projected annual operating budget fora 2-year associate degree nursing program 2 isbased upon an analysis of nine existing associatedegree programs projected to the program char-acteristics described below. Certain items, suchas salaries and fringe benefits, are based upon paststudies and may not reflect current rates for theseitems.


The program has been in operation for atleast 2 years. In the year considered, 64 studentsentered the program; the total enrollment was 104.

a See app. A, p. 78.

Table 6. Space requirements for a 2-year associate degree program in community college with anentering class of 64 and a total enrollment of 104

Spaces


Groupsize,eachroom

Totalnetarea

(sq. ft.)

Teaching

Lecture-demonstration roomClassroomsConference roomsMultipurpose room with storage and utility

MOMSStorageteaching aidsScience laboratoriesLibrary

Faculty

OfficesConference roomLoungeWashroom and toilets

Administration

Lobby-receptionGeneral office

Secretary-receptionistClerk-typists

Storage areaDuplicating areaDirector's office

Registrar's officeAdmissions officeStudent counselor's officeStudents' health serviceStaff loungewashroom and toiletVisitors' toilets:

MenWomen

Remarks

6, 120

2, 300800900 Additional required in hospital.

2, 000 8 beds.120

In the college.In the college.

1, 580

1, 000400

180

840

100320

80

340

In the college.

In the college.With coat closet and toilet.In the college.In the college.In the college.In the college.In the college.

In the college.In the college.

25

Table 6. Space requirements for a 2-year associate degree program in community college with anentering class of 64 and a total enrollment of 104-Continued

Spaces


RemarksNumberof

TOMB

Groupsize,eachroom

Totalnetarea

(sq. ft.)

Supporting 1,300

Students' toilets 420Men's toilet 1 watercloset, 1 lavatory, 1 urinal.Women's toilets 5 waterelosets, 5 lavatories.

Students' lounge Located in college.Lockers 240 104 full-size lockers. (Additional may be

needed in the hospital.)Janitors' closets 1 40 Or as required.Coat alcoves As required.Vending machines As required.Telephone booths As required.Drinking fountains Minimum of 3-recessed or as required.General storage 1 600

9,840 Net area.6,560 For walls, partitions, corridors, stairs, and

mechanical space.

16,400 Total gross area.

157.7 Area per enrolled student.

The nursing department staff included the direc-tor, 10 faculty members, 1 secretary, and 3 clerk-typists.

The required credits were evenly dividedbetween general education courses taught in thearts and sciences (or corresponding) departmentsof the junior college and nursing education sub-jects offered in the nursing department.

The probable annual operating costs to thecommunity college for establishing the nursingprogram are shown in table 7.

BUDGET COMPONENTS

Arts and Sciences.-Introduction of a nurs-ing program into the junior college setting wouldextend the cost of general education (arts andsciences) credits as would increasing the numberof students in any program that had half of therequired credits in the area of general education.

Nursing Department. -In forecasting thenursing department's budget, necessary facultyand facilities were given primary considerations.

26

The subcommittee's recommendations relating tothe number of faculty needed and space require-ments were used.

Table 7. Nursing program operating budgetfor the community college

Item TotalGeneraleduca-

tion costs

Nursingeduca-

Um costs

Total $165,801 $33,197 $132,604

Direct costs 110,452 18,740 91,712

Salaries 1 104,821 16,821 88,000Supplies 5,631 1,919 3,712

Indirect costs 55,349 14,457 40,892

staff benefits 6,037 1,285 4,752Plant operation 18,106 3,705 14,401General institutional

administrative ex-pense 11,395 2,609 8,786

Library 8,407 2,835 5,572Student services 11,404 4,023 7,381

1 Salaries provide for nonnurse faculty and the followingnursing department personnel: 1 director, 10 facultymembers, 1 secretary, and 3 clerk-typists.


P

1. Montag, Mildred L., and Gotkin, Lasser G., Cormnianity College Educationfor Nursing. New York. McGraw-Hill Book Co., Inc. 1959. 146 pp.

2. National League for Nursing. Characteristics of College-Controlled Pro-grams in Nursing Education Leading to an Associate Degree. The League.New York. 1960. 1 p.

3. National League for Nursing. Criteria for the Evaluation of EducationalProgram it Nursing Leading to an Associate Degree. New York. TheLeague. 1962. 12 pp.

4. National League for Nursing. Guiding Principles for Junior College Par-ticipation in Education for Nursing. New York. The League. 1961. 9 pp.

5. National League for Nursing. Report on Associate Degree Programs inNursing. New York. The League. 1961. 43 pp.

Chapter IV

Baccalaureate and Graduate Nursing Programs

IN 1962, some 178 private and tax-supported col-leges and universities offered undergraduate pro-grams in nursing leading to a baccalaureate de-gree. Master's degree programs in nursing wereoffered in 48 institutions. The majority of gradu-ate students in nursing terminate their study atthe master's level. However, an increasing num-ber are electing to fulfill the requirements for thedoctorate degree. More and more educational pro-grams are recognizing their growing responsibilityfor continuing education.

CharacterlAics of Programs


The appropriate State licensing authoritymust approve baccalaureate programs in nursing.This approval admits students to examination forlicensure as registered nurses.

Programs organized within colleges or uni-versities approved by the appropriate regional ac-crediting agency may request review for accredita-tion by the National League for Nursing of anundergraduate or graduate nursing program orboth. National accreditation signifies fulfillmentof criteria of excellence established by the profes-sion.

TYPES OF PROGRAMS

Undergraduate Programs

A nursing program leading to a baccalau-reate degree is conducted by an educational unit in

28

nursing (department, division, school, or college)that is an integral part of a college or universityand is organized and controlled in fih^ same way asother units in the institution.

The baccalaureate degree program is de-signed to serve the needs and purposes of personswho want (1) to learn and practice the humanisticand scientific bases for care of patients, (2) to pre-pare for nursing at the baccalaureate level, (3) toShare with students preparing for other occupa-tions all the general advantages of a college oruniversity preparation, and (4) to acquire a bac-calaureate education as a prerequisite for graduatestudy to prepare to practice in such specialties asteaching, administration, or research.

Graduates of baccalaureate programs areprepared for nursing positions in communityhealth services and may advance without furtherformal education to positions, such as head nurseand team leader, which require administrativeskills. Graduates also have a foundation for con-tinuing personal and professional developmentand for graduate study in nursing.

Some graduates of associate degree and di-ploma programs in nursing may wish to fulfill re-quirements for a baccalaureate degree in nursing.Admission requirements vary with different col-leges and universities.

Graduate Programs

Graduate programs in nursing providepreparation for clinical specialization, teaching,and administration in all types of educational pro-grams. They also prepare for supervision and ad-ministration in nursing services, for consultation,and for research in nursing.

Graduate students in nursing must meet theuniversity's requirements for admission to grad-uate study. In all such programs the faculty andstudents ace engaged in research which is increas-ingly being supported by institutes and founda-tions. Some of the research is directed by facultymembers who also have teaching responsibilities.Other research is conducted by personnel with full-time research responsibility but who may havegraduate students as assistants.

To assure adequacy of nursing services, alarger number of nurses must be prepared for.leadership roles, including positions on facultiesof schools for professional and practical nursing,as supervisors and administrators of nursing serv-ices in hospitals and other health agencies, and inresearch.

Baccalaureate nursing education is the bestbasic preparation for nurses with leadership po-tential. Preparation for supervision, administra-tion, teaching, clinical specialization, consultation,and research requires postbaccalaureate educationin nursing as in other professional disciplines. Ex-perience has demonstrated the importance of pro-viding strong formal education in key areas ofspecialization. The challenging educational andscientific problems of nursing require rigorousacademic training. The administration of nursingservices within the framework of medical care pro-grams requires graduate preparation for adminis-tration.

The need for advanced professional trainingfor the teacher has become so well established ateven the elementary school level that there wouldseem to be no question with respect to its impor-tance for nursing educators.

Many public health nursing agencies needstaff qualified in public health to provide commu-nity health services. They also need leadershippersonnel prepared at the graduate level to super-vise and administer public health nursing pro-grams. As of January 1964, programs accreditedby the National League of Nursing include prep-aration for public health nursing.

Faculty in baccalaureate and graduate pro-grams should meet the same academic requirementsas other faculties in the college and universities.This would require a master's degree for juniorfaculty members and the doctoral degree forseniorfaculty, department heads, and deans.

Continuing Education

Colleges and universities are looked upon ascenters for continuing education for practitionersin nursing service and nursing education. Thetype of program offered may vary from those ar-ranged for foreign or local visitors who come tothe center for observation to short-term noncreditcourses planned to meet the needs of a group ofnurses in the area. Continuing education courseshave been developed to improve skills in nursingcare, to introduce new nursing techniques, to pro-vide refresher courses for nurses returning to prac-tice, and to improve teaching and administrationin nursing schools and nursing service.


In 1962, some 23,000 full-time students wereregistered in the Nation's 178 baccalaureate de-gree programs. In addition, 129 programs ad-mitted registered nurses from diploma and asso-ciate degree programs as candidates for thebachelor's degree.

In the same year, 48 programs, of which 33are accredited by the National League for Nursing,offered master's degree programs in nursing. (Seetable 8.) The number of nurses receiving master'sdegrees each year is only about one-third of the3,000 per year that the Surgeon General's Consult-ant Group estimated is needed.

As shown in table 8, approximately three-fifths of the registered nurse candidates for thebaccalaureate degree and almost one-third of thecandidates for the master's degree are enrolled forpart-time study.

29

Table a Enrollments and accreditation oi baccakasreate and master's degree in nursing programs,fall 1963

STATUS

BACCALAUREATE DEGREE

Basic student Registered nurse student

MASTER'S DEGREE

Num-ber ofpro-

gram

Enroll- Per-ment cent

Total

Other

178

11959

23, 656 1100

19, 493 82 44,163 17.6

Num- Enrollmenther ofpro-

grams Full Part I Totaltime time

Per-cent

Num-ber ofpro-

grams

Enrollment

Fulltime

Parttime Total

Per-cent

129 3, 670

69 3, 08860 582

5,262

4,2131, 049

8, 932

7,3011, 631

100 48 1, 717 757 2, 474 100

81. 718. 3

33 1, 503 677 2,180 88.615 214 80 294 11.4

Source: National League for Nursing.

THE BL,XALAUREATE PROGRAM


CURRICULUM

The curriculum and instruction in baccalau-reate degree programs are planned to preparegraduates for practice as professional mines.Without fursher preparation they may accept posi-tions requiring beginning administrative skills.Baccalaureate programs lay the foundation forcontinuing professional and personal developmentand for graduate study in nursing.

Baccalaureate programs in nursing includeliberal education from broad fields of knowledge;professionally related courses in the physical,biological, and behavioral sciences; and prepara-tion for the professional practice of nursing. Theliberal education and professionally related coursesare taught by faculty from other departments ofthe college and university. In some colleges it

will be necessary to introduce such courses as hu-man anatomy, physiology, biochemistry, and mi-crobiology if a new program is to be started. Theenrollment of nursing students may affect spacerequirements in other departments of the collegeor university. The pressure of new programs fornursing or of increased enrollments is particularlyfelt in the sciences and related courses required fornursing as well as in library.

The curriculum is so organized that the

30

courses from general education which are prereq-uisites to nursing practice, especially the suiencso,precede the nursing courses or are offered concur-rently. The major in nursing is usually concen-trated in the last 2 years of the program.

Some schools admit students directly fromhigh school to the nursing program; others re-quire 1 or 2 years of prescribed college coursesbefore the student is accepted into the nursing ma-jor. The admission requirements for the programand the location of the clinical facilities for patientcare practice may influence the sequence of coursesand the relationship between the general educationand nursing courses in the curriculum. This is il-lustrated in figures 4 through 8.


The nature of nursing makes it mandatoryfor students to have learning opportunities in sev-eral kinds of community agencies in which patientsare seen and treated, in institutions where adultsand children meek in groups, and in the homes offamilies where nursing care is being provided.All of these experiences require faculty super-vision.

In some instances the nursing experiencearea may be at a great distance from the campus.

AcademicYear Calendar Years

Type of Unie:

Nursing

Geural Education

Total

Number ofUniS:

40

88

128

Includcs proferianally related sabjects such as sciences.

Figure 4. A nursing program in a college.The division uses patient care facilities infive hospitals, day care centers, a children'shome, and other health agencies.

It is often necessary to use more than one hospitalor health agency to obtain sufficient nursing carepractice for the number of students to La admitted.Where facilities of another agency or institutionare used, written agreements establishing mutualrEsponsibilities are developed jointly and are sub-ject to periodic review. These agreements specifythe responsibility of the college to teach and super-vise the students, select their learning opportuni-ties, and be responsible for the quality of care thestudents give.

The hospital and health agency's responsi-bility includes time for nursing service personnelto plan with the faculty for student experience.Conference rooms, faculty space, lockers, lounges,and provision for food service requirements areincluded.1

National League for Nursing. Arrangements Betweenan Institution of Higher Education and a Hospital Con-cerning the Provision of Hospital Faeilities for CollegeEducation in Nursing. (Item 6, Selected Bibliography,p. 48.)

Academic Years

1st yr. 2nd yr. 8rd yr. 4th yr.

82%28 units

7 ,e4. g"g is% .e:/,,

.-- -/ 6 units .,.4 0:

,

61%22 units

,/' - ,..39% *.,,,

14 units ;-..,-

...).-./ '//0..q."/ ... 0.' /

.t. //Fie 4

6% 2 units' ,trAft 4..

,, 94% W:.30 units'

I..., ,..

7, .

7 , .

.4. /efe.,/ /

, ./ ,// /. / .,,.:,p,,','1/ /.`" _/;/ ,.. r

/1//' /e . 0 's..,... /,1./..

..5, . -.' 94 4

59 %©

20 units

r,s,' ,-/ ;A.4

41E7oi 1 1 units'..,.,.,Ae. ' /

e,

,0,M,-...f!, 4.,,,/,

.. /4' . fm.4-,. 40, -..../.. Acr

Type of Unit:

Nursing

General Education'

Total

Number ofUnits:

64

72

130

Ir.cludes professionally related subjects srch as sconces.

Figure 5. A nursing program located in auniversity. The first 2 years may be takenat either the university or at one of two Statecolleges located 200 and 450 miles from theuniversity campus. Nurse faculty membersfrom the university are assigned to each Statecollege to teach the nursing courses. All stu-dents transfer to the university at the end ofthe sophomore year. This school uses threegeneral hospitals, two Federal hospitals thepublic schools, doctors' offices, and State andcity health departments for student experi-ence.

FACULTY

The faculty for a nursing unit in a collegeor university consists of those whose full responsi-bility is for teaching in the nursing major. Thenature of nursing practice and education is suchthat the faculty-student ratio is much lower thanin curricula where the safety and well-being ofpeople are not considerations.

The location of the patient care areas, theneed to utilize community resources to obtain stn-dent experience, and the need for close supervi-sion of the student in patient care experience are

31

Academic Years


94%29 units

6%

90%36 units

24%8 units

11%3 units

..:.

:.

24 unite i:::::::::

::::: 76%26 units

:::::::::::::?:x.:.:.x.:,

.:::

:::.

::.?

-

Niii 10% ,-iiiii.::

a: 4 units ;:".gii :::::::

...::.:.:..,:.

.*.a:: 2 units

Type of Unit:

Nursing

General Education

Total

Number ofUnits:

56

76

132

*Includes prdessionally related subjects such as sciences.

Figure 6. A nursing program in a universitywith a detached medical center campus. Thefirst 2 years of the program are taken at theuniversity campus for general studies. Atthe end of the sophomore year studentstransfer to the medical center campus. Inaddition to the medical center hospital, thisschool uses the resomrces of two State hos-pitalt and one municipal tuberculosis center.

some of the factors which influence the faculty-student ratio.

Additional faculty will be needed wheremembers of the faculty are involved in curricularexperimentation, community health projects, orresearch.

Needs and Goals

To meet the Nation's growing health needs,the number of graduates from baccalaureate pro-gren.s should be doubled by 1970, according to theSurgeon General's Consultant Group on Nursing.2

U.S. Department of Health, IIucation, and Welfare,Public Health Service. Toward Quality in Nursing, p.22. (Item 6, Selected Bibliography, ch. II, p. 17.)

32

This includes initial admissions as well as thosegraduates from diploma and associate degree pro-grams who are eligible to complete requirementsfor the baccalaureate degree. From this pool willcome the candidates for graduate study who mayprepare for specialized practice, teaching, nursingservice, and research. The number of nurses re-ceiving master's and doctoral degrees must triple,the Group notes. If these goals are to be met, exist-ing programs will need lo increase enrollments andnew schools may need to be established.

The specific goals for graduates from eachtype of program 'are shown in table 9.

MEETING THE NEEDS 3

The Report of the Surgeon General's Con-sultant Group on Nursing and increasing pressurefrom communities will call to the attention of col-lege administrators the need for extending facili-ties and enrollments of existing programs and, insome instances, for establishing new baccalaureateprograms in nursing. College presidents, who arenow administratively re,sponisble for nursing pro-grams, know the need to attract qualified nursefaculty, to secure adequate clinical experience forstudents in hospitals 'and public health agencies,and of the costs of such programs. These sameneeds are not as will blown to administrativegroups which for the first time are concerned withdetermining -whether it is advisable to establish acollegiate nursing program. It seems timely torecapitulate certain information regarding the ed-ucational picture in nursing which may be usefulto groups that are contemplating the establishmentof baccalaureate programs in nursing.

During the 6-year period, 1956-62, the num-ber of baccalaureate nursing programs increasedfrom 161 to 178, and the average enrollment inthese programs increased from 116 to 132. On thesurface, this increase in number of programs wouldappear most encouraging, since it comes at a timewhen more students, both men and women, are en-tering college than ever before. However, despitethe increase in number and size of 'baccalaureateprograms, there has not been a sufficient increasein the number of graduates from master's pro-grams who are preparing for college teaching.

3 This portion of the text through "Planning Considera-tions," p. 34, was prepared by the staff of the Departmentof Baccalaureate and Higher Degree Programs, NationalLeague for Nursing, New York.

Table 9. Number of professional nurses inpractice, educational level, in 1962 and thegoals for 1970

Educational level

1962 actual

Num-ber

Per-cent

1970 goals

Num- Per-ber cent

Total

Master's or higherdegree 11,500

Baccalaureate degree 43,500Diploma or associate

degree 495,000

2.17.9

90.0

680,000 100.0

25,00095,000

560,000

3.714.0

82.3

Source : Toward Quality in Nursing, p. 22. (Item 6,Selected Binliography, ch. II, p. 17.)

In the fall of 1962, enrollments in master'sprograms in nursing (both full-time and part-timestudents) totaled 2,472, while graduations fromthese programs totaled 1,098 for the academic year,1961-62.4 The dearth of candidates qualified forcollege teaching is reflected in statistics reportedin January 1962 that Showed only 4 percent of the

nurse faculty members teaching in baccalaureateand higher degree programs held doctoral degrees,76 percent held master's degrees, and 20 percentheld baccalaureate degrees. These same programsreported 202 budgeted vacancies.5

In addition to the 192 baccalaureate andhigher degree programs that were seeking to at-tract the graduates of master's programs in 1962,there were 886 diploma, 53 associate degree, and693 practical nursing pre ms which were alsobidding for these potential candidates. In thesame year the budgeted vacancies in these other 3types of programs totaled 1,202. Add to the needsof the schools, the demands for administrative andsupervisory personnel of some 6,000 hospitals and7,800 health agencies and boards of education andit can be readily seen that the college admin-istrator must compete with a highly competitivemarket for a well-qualified faculty.

4 Some Statistics on Nursing Education -1962, p. 2 (un-

published) . The statistics presented in this report werecollected by the Research and Studies Service o the NLNand supplement published annually in Nurewg Outlook.

'From statistics collected by the NLN Research andStudies Service based on questionnaire responses from180 of 192 (94 percent) baccalaureate and higher degreeprograms.

732486 0 84

Academic Years Calendar Years

1st yr. 2nd yr.

------

3rd yr. 4th yr.

100%30 units

100%30 units

.

27%9 units

..v.::..v....:.,

100%f 4 38 units

-....,. A

..r.. f. .:/>:::::%e

,:.. 73%..:;i;g: 24 units

:.........;6., .0

::..: .::::4:,.0. ,:.:4::::xip .i.:.;fir>.::.,

,-- :: ...::'x ..:. ,..4:

. k,

...:.

..,

., :

.::, .p ,..,..

....,

.---

P..f4:::,-:: ...§.

4.* v..-4,:y .:...... §iZ.: Ar Yrs, ,

's .e...:- ''''. :.:-x::::::: , '...

A.: ../..

5a4v:rb

,. .,4,...,

.3.

,,.: :

::5 i:.

. ff4.5.g...*: .

Type of Unit:

Nursing

General Education

Total

Number ofUnits:

02

131

'Includes professionally related subjects such as sciences.

Figure 7. A nursing program conducted by auniversity. This school requires four semes-ters of academic study for admission to thenursing program. General academic creditmay be transferred from a junior or liberalarts college or another university. The nurs-ing program is placed at the school of medi-cine campus and requires 2 calendar yearsfor the nursing major.

RESPONSIBILITIES OF UNIVERSITIES

What are some of the responsibilities whichshould be assumed by a university offering a pro-gram in nursing education ? The following ex-cerpt from a paper by Margaret Bridgman 6 pre-sents an apt description of some of these responsi-bilities :

Some institutions in planning a new program havenot been aware of certain essential conditions and havebeen quite naturally influenced by patterns in neighboringinstitutions. Hospital administrators, doctors, and di-rectors of nursing also have been uninformed in manycases, and some of them have been prejudiced in favorof the "traditional" affiliation pattern. Yet college pro-

°Bridgman, Margaret. The Development of CollegiateEducation in Nursing in the Mated States, p. 2. (Item3, Selected Bibliography, p. 48.)

33

Academic Years

let yr. 2nd yr. 3rd yr. 4th yh,. 5th yr.

100%30 units

200 %30 units 36%

10 units

' . W;:';;:0:§ / -0..*:::A:":" 'e. , ...?4,5

:5, .%,;,..-,- --:.4,22.0,,,..§. /.,,o,

18 :-.18 unitsw/,,/.5../-Af.,:.5./ei://4? 7...::, /

- AZxAriP (, , /.-1,43..49,-; 4,409

ee/ .4.:;4:5,- >e...-:g.-

j".""f:: .PW';".Y.;::;?49

( i:,KI4'/erFL.

23%6 units

e--:;$ AF/f)

.:".'(/ AV/, '" nL. ..".'

77 %i Is:, 20 um:: ...-§70,,,4:-.;:....t&j...:22...w..-

1:1*.0:*;47-...: ./.13::; ..,././.0- 013-p ,%-z z,"Vy, ./.7 ,.;*-.5,.../e,:.*;4:.,,, ,I/...,-/,-2:5,/

-:::3kzSz. /,':. :--v.--:*/*9- /7..-WW, 9 'J. /If14*' ZW 1,

,.. ,e,

1..,.;4 .".0../

,,).4 ".0 p2.:*-7.,z, /

100%

.,..," ,/V

.."(W &IX.'05.-

:,-

P" /7 F.."Fil ././.:,-.,0.40/ /,:--.1

f7"/ /-/-0- , ,e...//.-'

.:;W(/ /.0/0/7 4,-7414 .7/F'z' 44f.... g?'"e F.,...X,./

ielg.O. :

.

','A 0fr

Type of Unit:

Nursing

General Education

Total

Number ofUnits:

64

76

140


Figure 8. A program in nursing located at auniversity medical center. This school ofnesrang requires 60 semester hours of gen-era! education for admission to the nursingmajor. The nursing major requires six aca-demie semesters for completion.

grams, concentrated upon education, do not provide ex-tensive student service, though the faculty-student groupmakes 'Minable contributions to the hospital. Studentsdo not earn their way because they receive more value ineducation than they give in service, and faculty guidancehas played a very large part in their contribution. It islogical, therefere, that students in these programs shouldpay the same tuition as other students in the educationalinstitution and meet their own living expenses, and alsothat they should share in all the benefits of college serv-ices and college life and associations.

The essential conditions an institution of highereducation should he aarcel of meeting before it under-takes the responsibility of! offering this type of profes-sional education may be bri °fly outlined as follows :

Recognition of nursing as a subject comparable toothers that are established as college majors and realiza-tion that it must be developed in the same way to justifya degree and give students the benefits they have a rightto expect from college education for their chosen profes-sion.

Recognition of the need to produce graduates reallycompetent for the functions for which college-eduattednurses are so urgently needed.

Establishment of an educational unit in nursing

34

in the institution on a completely equal basis with otherunits of the institution, with a faculty adequate in numberand well qualified in the various special types of nursingto teach all the courses in nursing including faculty-guidedclinical practice. A le um number of faculty mem-

is six, with specialists, respectively, in medical, sur-gical, obstetric, pediatT2e, psychiatric, and public healthnursing.

Provision for the necessary facilities for education:classrooms, faculty offices, and library.

Provision of housing and all other student personnelservices required for college students.

Provision of available and accessible hospital andother agency facilities for the practice of nursing, sinceit is here that faculty help students to develop profes-sional skills and to use pertinent knowledge from all pre-ceding academic and professional sources.

In other words, a university needs to accept thesame responsibility for this type of education as for anyother in which it undertakes to provide the kind, level,and quality of prei73Tation characteristic of the institu-tion and represented by its degree.

PLANNING CONSIDERATIONS

In surveying resources and estimating thecosts of establishing a nursing program, the col-lege adminktrator might well ask the followingquestions with respect to student yatential, facultypersonnel, and physical facilities:

1. What is the student potential of womenand men who are intellectually able and interestedin professional education for nursing?

2. What new preprofessional courses mustbe offered? (Human physiology, anatomy, etc.)

8. What additional faculty and facilities(both classroom and laboratories) will be neededto accommodate x number of students in theliberal arts and pmprofessional courses (history,humanities, mathematics, psychology, chemistry,nutrition, etc.) ?

4. What 0,affing will be required to providepersonnel services such as counseling, admission,health, housing, food, and recreation?

5. What additional library facilities andstaffing will be needed to accommodate numberof students and faculty?

6. What additions or changes in the physi-cal plant will be needed to provide the nursingprogram with an administrative unit, faculty of-fices, conference or seminar rooms, special class-rooms, laboratories, or demonstration units inaccordance with the educational specifications ofthe program ?

7. How many faculty members will beneeded initially to develop the curriculum and im-

plement the program ? How many Additional fac-ulty members will be needed to provide adequateinstruction for the increased enrollments antici-pated after the first 2 or 3 years'?

8. What are potential resources for candi-dates for the deanship and other nurse facultypositions?

9. What financed resources will be neededto support a qualified faculty with salaries com-parable to those in other schools?

10. How are special, yet recurring Widgetitems, such as cost of accreditation, periodic re-quirement for the faculty to travel to professionalmeetiags, and student transportation to the clinicalarea; to be met?

11. What clinical resources are availablewithin the community? What types of studentexperience must be cibtained elsewhere and howwill this affect the scheduling of classes?

Valuable assistance can be obtained fromother administrators and from nursing consultantsin answering the above questions.

NEW SCHOOLS

A new school should be considered when re-gional educational or State nursing surveys indi-cate the need for additional baccalaureate degreeprograms. Forgraduate study, regional planningshould indicate the desirability of coordinatedaction on a broad geographic basis toestablish oneor more centers within a region. Universitieswith medical center provide the major require-ments for graduate study in the health sciencesincluding nursing.

A qualified nurse consultant may be em-ployed to survey and evaluate the availability ofclinical and other community health agency re-sources for student learning? The State boardsof nursing can advise as to the requirements theprogram must fulfill to qualify for State approval.The National League for Nursing administers theprogram for national accreditation of nursingprograms.

Where coordinated planning results in therecommendation for the establishment of a nurs-ing program in a college or university, the next

Lists of qualified consultants are available from theNational League for Nursing, the U.S. Public Fiealth Serv-ice, the western Interstate Commission for Higher Edu-cation (WICHE), and the Southern Regional EducationalBoard (SREB).

step is to obtain administrative approval and sup-port and to appoint the basic faculty. The basicminimum faculty for the program will be the deanand the professors in the major nursing areas.The dean should be appointed at least 2 years be-foe° the first students are admitted to the nurs-ing courses. This time interval will permit theestablishment of interagency relationships andagreements, and allow curriculum and functionalplanning for the building program to proceeL con-

currently.The curriculum for the nursing program is

the basis for the development of functional plan-ning to guide the architect in develoring the build-ing program. Architectural planning will requireat least 6 months, and 1 year should be allowedfor construction of the proposed educationalfacilities.


Before the architect will be able to developa building program which provides adequatephysical facilities, he must be provided with suchessential information as: (1) the enrollment; (2)educational program; and (3) space requirementsfor instruction, research, faculty and administra-tive offices, and supporting areas. This informa-tion should be set forth in a written program.

Many colleges and universities have estab-lished building committees within the central ad-ministrative office. A committee for planningnursing education facilities must be established ifno overall committee has been formed.

Subcommittees from major departments ofthe school submit recommendations to the planningcommittee for space air equipment requirementsto meet their particular needs:. Consultation withrepresentatives of °thee educational units withwhom they may share space is essential. Thiswould include auditoriums and facilities for con-tinuing education.

The dean and the faculty will develop animmediate and long-range program for nursingwithin the college or university. This will includean estimate of the immediate enrollment and acareful consideration of the projected eerollmentin each existing program within a specified time

35

period (20 years with periodic revision every 5years). Curricular space requirements are af-fected by organization, the size of classes for dif-ferent teaching methods, and the use of educationalaids such as films, televised projection and moni-toring, and the number and availability of confer-ence rooms in the inpatient areas.

To provide for future expansion, it isrecommended that : (1) lecture rooms be plannedto accommodate the maximum enrollments pro-jected; (2) seating for observers of the teachingprocess be planned (these may be graduate stu-dents or visitors) ; (3) the architectural designand engineering incorporate features which, whennecessary, can be modified to accommodate futurechanges in the program and in teaching methods.

In most instances, at least 2 or 3 years willelapse lastween the time planning for construc-tion begins and a new building may be ready foroccupancy. If in a new school students are to beenrolled in nursing courses as freshmen, availableclassrooms on campus will need to be modified topermit patient care demonstration by the facultyand practice by the student. Otherwise the ad-mission of students will have to be delayed untilthe new facility is ready.

The building committee should visit otherschools as a team rather than individually to eval-uate new educational facilities and practice.Other health disciplines using new educationalmedia that are adaptable to nursing instructionshould also be visited. JEn this way facilities willbe observed and evaluated from different points ofview. New programs which may not have ap-pointed the basic faculty may need consultationfrom nurse faculty in other programs.

The functional program developed by thebuilding committee will contain the specificationsfor teaching, research, faculty, administrative andsupporting space necessary to carry out the edu-cational program.

TEACHING SPACE

The types of teaching space to be providedinclude lecture, class and conference rooms, mul-tipurpose rooms, laboratories, and libraries.

The number and size of different typas ofclassrooms for nursing courses are determined bya projection of class schedules to ascertain the fre-quency of room use.- This projection should bebased on the lingest anticipated enrollment. It

36

is necessary to determine the size of the group thatcan be taught by various teaching methods.

The scheduling of classes for clinical nurs-ing courses will be determined by the most suit-able hours for clinical nursing practice. In manysituations the morning hours may prove to be thebest hours for student experiences. It would thenbe necessary to schedule lectures in the afternoon.In these instances, the total number of classroomsrequired may be greater for clinical nursingcourses &g in for courses which can be scheduledthroughout the day. With effective schedulingprocedures, these rooms may be made availablefor other college classes, thereby increasing theirutilization.

Lecture-Demonstration Room,.One ormore rooms with fixed seats for students and withspace for patient care demonstration to accommo-date the maximum annual admission should beplanned. In programs where graduate studentsmay be having practice teaching experience, whereforeign and local visitors for observation are ex-pected, or where observation for evaluation of cur-riculum experimentation is anticipated, it will benecessary to provide a lecture-demonstration roomadequate to seat the total class, plus an additional20 percent.

Cla,8srooms.Where student participationis expected as a part of the teaching method,smaller classrooms with movable seating will beneeded. The faculty should determine the maxi-mum number of students who can participateeffectively.

Multipurpose Laboratory (Teaehing-Learrtirtg Laboratory) .Nursing care that re-quires manipulative skills is learned through prac-tice in teaching and learning laboratories thatsimulate the patient care areas of hospitals. Theselaboratories are also used to acquire greater un-derstanding of the nurse-patient relationship.

Conference Roonta.Conference space willbe needed in the patient care areas of cooperatinghospitals and health agencies and in the educa-tional unit.

Students enrolled in clinical nursingcourses will be assigned in small groups for nurs-ing practice in the agency. Precare and postc,areplanning conferences are an integral part of thisexperience. These conferences are scheduledwhile the student is assigned to the patient care

areaprobably during the morning or early after-noon hours. The number of conference roomsneeded will depend upon the number of sectionsfor each class. For example, if there are 6 groupsof students in medical-surgical nursing, 2 groupsin psychiatric nursing, 2 in maternity nursing, and2 in pediatric nursing, there might be 24 confer-ences to be scheduled in any one day. Wherenursing service conference rooms are available onpatient units, there are certain hours of the daywhen th y might be available for conferences withnursing students.

In addition to conference space in the pa-tient care areas, students and faculty will havescheduled and unscheduled conferences in theeducational unit.

ASEcience Laboratories.Since science re-quirements for the nursing program are taken withother college or university students, such space isnot required in the nursing education unit. Theuniversity administration will need to determinewhether science classrooms and laboratories willneed to be expanded to accommodate the projectedincrease in enrollments.

Libraries.Library materials for nursingwill be added to the central library complex of thecollege and university. Nursing students requireaccess to reference materials from the humanities,the physical, biological, and social sciences as wellas professional materials.

Library resources must be available to thestudent at the site of the educational unit and atthe site of patient care practice. If patient careis obtained at centers remote from the campus, itwill be necessary to duplicate library materialsand provide for their transportation.

Teaching Aids.Programed educationalaids, either textbooks or materials for machine useand the machines for programed learning, may bestored with other library materials where theymay be accessible to the total student body. Insome instances, separate storage for movable teach-ing aids will be needed adjacent to the areas wherethey are to be used.

FACULTY SPACE

The faculty space will include offices, con-fei-Qace rooms, research space, lounges, toilets, andlocker rooms.

Ofleg.Office space for the total antici-pated faculty should be planned and constructedas a part of new educational units. If such plan-ning is not done when the program and facultyexpands, it may be necessary to convert costlyclassroom or laboratory space to offices.

Patient care planning and professionalcounseling of students requires frequent privateconferences between the student and her instruc-tor. For this reason, an office should be plannedfor each faculty member. Staff shouldhave readyaccessibility to secretarial services.

As a planning factor for undergraduateprograms, it is recommended that at least a ratioof 1 faculty to 9 students be used. This ratio isnot intended to indicate that within the patientcare practice area 1 faculty member will supervise9 students at a given time in pationt care experi-ence. She may demonstrate n l;ing care to onestudent or a group of students as she may have twoor more groups of students needing supervHon.

When there are greduate assistants or fieldpractice students, office space will be required.

Con,ference Rowns.A conference room isneeded for faculty meetings, group projects, andmeetings with representatives from communityagencies. This room should have provision forserving refreshments.

Research 8pace.-11 faculty members areexpected to engage in research, appropriate spaceand laboratories must be provided for experimen-taton in nursing practices, teaching method-ologies, administr-tive processes, and biologicaland/or sociological research.

Lounge and Locker Space.Facultylounges may be shared with other faculty groupsin a multiple-use building. In other instances, alonmge for the nursing school faculty will beneeded. Lockers and space for changing fromstreet clothes to uniform will be required.

ADMINISTRAIIVE SPACE

The educational unit in nursing in a collegeor university is directed by a nurse responsible forthe academic administration of the program. Anadministrative assistant is frequently responsiblefor fiscal matters and such nonacademic adminis-trative functions as supervisionion of clerical staff,and supply and equipment control.

The administrative area, in addition to the

37

office for the dean and her assistants, includes thelobby-reception area, general offices for secretariesand clerk-typists (including those for faculty andadministrative personnel), files, and office supplystorage space. Adequate secretarial space shouldbe provided. Secretaries for the faculty shouldbe in the ratio of 1 secretary to 3 to 6 faculty mem-bers (1 : 3-6). The number of secretaries requiredwill depend upon the nature of the instructionalresearch loads and publications by the faculty.

Student affairs administration, which in-cludes admissions, registrations, counseling, andstudent health, are functions shared by other de-partments of the college and university. Spacefor such activities needed only by the nursingschool should be provided.

Administrative staff will require lounge,locker, and toilet space. Mai la and female visitors'washrooms and toilets are usually in the admin-istrative area.

SUPPORTING SPACE

Supporting space will include studentlobkers, lounges, and toilets. In addition, work-space will be needed for duplicating, housekeeping,maintenance, and mechanical equipment. Vendingmachines, telephone booths, and drinking foun-tains may be recessed in corridors.


Noncredit workshops and refresher coursesmay be scheduled for 1 or more days or may be for1 or more weeks. They usually require space forthe total day. It is difficult to schedule such pro-

grams in the rooms regularly used by full-timestudents.

This type of program needs space where thetotal group can be brought together for lecture aswell as rooms where the group can be divided intosmall work or discussion groups. An aczemably-type room with lounge space for on-the-spot reg-istration of participants is desirable. To accom-modate small conference groups, the assembly roommay be divided with folding partitions of sound-retardant construction or separata conferencerooms may be provided.

This type of space is frequently shared withother groups in the college or university. If alarge-scale program of continuing education isplanned, an office for the director will be needed.


Hospitals and health agencies which acceptnurse students for patient care experience need toprovide space for educational fun:itions that arenot required in the nonteaching agencies.

Conference rooms in patient care areas ofhospitals and health agencies should provide spacefor patient care demonstration and patient teach-ing. Some of these units should be equipped fortelevision projection and for monitoring with one-way viewing screens. Faculty office space, lockers,and space in which faculty and students can changefrom their street clothes will be needed if the hos-pital is at a distance from the educational unit.

Students and faculty may utilize the food serv-ice of the hospital when assigned for patient carepractice.

PROFILE OF A BACCALAUREATE PROGRAM

THE REMAINDER of this chapter presents a profileof a typical nursing program in a libeisl arts col-lege, based on a composite picture of such facilities.This profile, offered as a guide, should be adaptedin accordance with a school's individual needs.

Size of SehookSpace requirements andan operating budget have been prepared for a de-partment of nursing in a college admitting 96 stu-

38

dents each year. The total enrollment is 2tOstudents, based on a 37.5-percent attrition rate.

The faculty consists of a dean and 27 full-time nurse instructors. There are nine clerk-typ-ists who serve the faculty and one secretary to thedean. If the faculty is engaged in research or ifcontinuing education is contemplated, additionalfaculty and stenographers will be needed.

TEACHING SPACE

SPACE REQUIREMENTS

Lecture - Demonstration Rooms.The pro-gram planned for this school requires two lecture-demonstration rooms, each seating the total enter-ing class. An additional 25 percent space allot-ment should be made for visitors or expandingenrollments.

Classrooms.The students admitted eachyear will be divided into 2 sections of 48 each forlecture with demonstration of patient care. Theserooms have also been planned for a 25- percent ad-ditional seating capacity.

Multipwrpose Room. One multipurposeroom with 8 beds has been planned for a section of16 students. Storage and utility space is provided.

Observation Room. Where graduate stu-dents from higher degree programs obtain experi-ence in practice teaching, an observation roomadjacent to the multipurpose room facilitates ob-servation of the teaching process.

Conference Rooms.Six conference roomswith movable chairs to accommodate 20-25 stu-dents are planned in the nursing education unit.Oversizing of these rooms permits their use forsmall groups in informal seating arrangements orlarger groups where less student participation isexpected.

Science Laboratories.The total require-ments for the nursing degree consist of nursingcourses, liberal education, and professionallyrelated sciences; e.g., physical, biological, and so-cial sciences. Since science courses are shared withthe total college, laboratory facilities are not re-quired in the nursing education unit.

Library.The college library has sufficientspace to add the professional books and journalsfor nursing as well as the study space for the ad-ditional students who will be enrolled in nursing.

Reference-Reading Room,.A reference-reading room for current periodicals and pam-phlets has been provided to accommodate 16 per-sons within the nursing educational unit.

FACULTY SPACE

Individual offices for 27 full-time facultymembers and 1 office with desks for 4 graduate as-sistants are provided. Also included are a facultyconference room and a lounge. Research space isplanned in accordance with the faculty zesearchactivities.


The administrative space includes a lobbyreception room, general office for nine clerk-typ-ists, one of whom acts as general receptionist. Italso includes general storage and duplicating spaceand toilets for men and women visitors.

A private office for the dean with adjacentspace for her secretary is included.

SUPPORTING SPACE

The supporting area includes space for stu-dent lounges and lockers, toilets, janitors' closets,and storage rooms.


The college has administratkcD agreementswith three general and two special hospitals, andtwo public health agencies for student experiencein patient care. The hospitals and health agen-cies are geographically close to the college.

Each patient care area used for teachingstudents in the hospitals has a nursing service con-ference room which is shared by nursing educa-tion. One general hospital and one specializedhospital have demonstration units equipped withtelevision cameras and one-way viewing screens.The conference space accommodates reference ma-terials and other teaching aids.

Within the agencies providing patient careexperience, lockers and provision for food serviceare available for the use of students and facultywhen they are in the agency.

39


The school of nursing conducts three non-credit courses, each of 3 weeks' duration, for fac-ulty of other schools in the area to improve teach-ing methods. Two courses of 2 weeks each aregiven to nursing service personnel from hospitalsto improve supervisory techniques. These coursesrequire a lecture room for the total group andspace for group conference. At least three coursesof 1 week each are given either as refreshercourses in patient care or to teach new methods ofpatient care. The latter requires lecture, a demon-stration, and practice in the multipurpose demon-stration room and in the patient care units of thecooperating hospitals.

Table 10 indicates the number of rooms,the size of group accommodated, and the space re-quirements of the facilities planned for the pro,gram admitting N students each year. Figure 9shows space relationship for this program and in-cludes space for a graduate program.

As shown in table 10, the total net usablespace for this program it estimated as follows :

Space Square feetTeaching 14, 064Faculty (including research) 3, 980Administration 1, 500Supporting area 1, 940Continuing education 2, 560

Total 24, 044

Table 10. Space requirements for a 4-year basic baccalaureate nursing program with an enteringclass 0196 and a total enrollment of 240

Spaces


Numberof

rooms

Group I Totalsize, neteach arearoom (sq. ft.)

Remarks

Teaching

Lecture-demonstration roomsClassroomsConference roomsMultipurpose room with storage, utility, and

observation rooms_Science laboratoriesStorage-teaching aidsReference reading roomLibrary

Faculty

OfficesResearch space addedGraduate assistants' officeConference roomLounge_

Administration

Lobby-receptionGeneral office


Storage areaDuplicating areaDean's officeDean's secretary's officeRegistrar's officeAdmissions officeStudent counselor's officeStudents' health centerVisitors' toilets:

MenWomen

40

226

1

11

1206025

16

14, 064

4, 6082, 2003, 696

3, 000

160400

27

111

3, 980

440

2, 700

722400320

1, 500

11

1111

9

1

100720

8080

340100

4040

Additional required in the hospital.

8 beds.In the college.

In the college.

Depending on the program.

Shared with administrative staffwith 5lockers.

With coat closet and tctilet.

In the college. .00In the college.In the college.lin the college.

IL watercloset, 1 lavatory.IL watercloset, 1 lavatory.

;7..4 're -NY

Graduate students in nursing must meet theuniversity's requirements for admission to grad-uate study. In all such programs the faculty andstudents are engaged in research which is increas-ingly being supported by institutes and founda-tions. Some of the research is directed by facultymembers who also have teaching responsibilities.Other research is conducted by personnel with full-time research responsibility but who may havegraduate students as assistants.

To assure adequacy of nursing services, alarger number of nurses must be prepared forleadership roles, including positions on facultiesof schools for professional and practical nursing,as supervisors and administrators of nursing serv-ices in hovpitals and other health agencies, and inresearch.

Baccalaureate nursing education is the bestbasic preparation for nurses with leadership po-tential. Preparation for supervision, administra-tion, teaching, clinical specialization, consultation,and research requires postbaccalaureate educationin nursing as in other professional disciplines. Ex-perience has demonstrated the importance of pro-viding strong formal education in key areas ofspecialization. The challenging educational andscientific problems of nursing require rigorousacademic training. The administration of nursingservices within the framework ui medical care pro-grams requires graduate preparation for adminis-tration.

The need for advanced professional trainingfor the teacher has become so well established ateven the elementary school level that there wouldseem to be no question with respect to its impor-tance for nursing educators.

Many public health nursing agencies needstaff qualified in public health to provide commu-nity health services. They also need leadershippersonnel prepared at the graduate level to super-vise and administer public health nursing pro-grams. As of January 1964, programs accreditedby the National League of Nursing include prep-aration for public health nursing.

4.; ,atr- ,W.r.'471177#4

Faculty in baccalaureate and graduate pro-grams should meet the same academic requirementsas other faculties in the college and universities.This would require a master's degree for juniorfaculty members and the doctoral degree for-seniorfaculty, department heads, and deans.


Colleges and universities are looked upon ascenters for continuing education for practitionersin nursing service and nursing education. Thetype of program offered may vary from those ar-ranged for foreign or local visitors mho come tothe center for observation to short-term noncreditcourses planned to meet the needs of a group ofnurses in the area. Continuing education courseshave been developed to improve skills in nursingcare, to introduce new nursing techniques, to pro-vide refresher courses for nurses returning to prac-tice, and to improve teaching and administrationin nursing schools and nursing service.


In 1962, some 23,000 full-time students wereregistered in the Nation's 178 baccalaureate de-gree programs. In addition, 129 programs ad-mitted registered nurses from diploma and asso-ciate degree programs as candidates for thebachelor's degree.

In the same year, 48 programs, of which 33are accredited by the National League for Nursing,offered master's degree programs in nursing. (Seetable 8.) The number of nurses receiving master'sdegrees each year is only about one-third of the3,000 per year that the Surgeon General's Consult-ant Group estimated is needed.

As shown, in table 8, approximately three-fifths of the registered nurse candidates for thebaccalaureate degree and almost one-third of thecandidates for the master's degree are enrolled forpart-time study.

29

Table 8. Enrollments and accreditadon of baccalaureate and master's degree In nursing programs,fail 1963

STATUS

BACCALAUREATE DEGREE MASTER'S DEGREE

Basic student Registered nurse student

Num-ber of Enroll-pro- went

gram

Per-cent

Num-ber ofpro-

grams

Enrollment

Full Parttime time

Total

Per-cent

Enrollment

Num-ber ofpro- Full

yams timeParttime Total

Per-cent

Total 178 23, 656

Accredited- 119 19, 493Other 59 4, 1,63

100 129 3, 670 5,262,g,,,...,,,.-...,/82. 4 69 3, 088 4, 21317.6 60 582 1, 049

8, 932T--7,3011,631

100 48 1, 717 757 2, 474 100

81.718.3

33 1, 50315 214

677 2,180 83.680 294 11.4

Source: National League for Nursik,.-

THE BACCALAUREATE PROGRAM


CURRICULUM

The curriculum and instruction in baccalau-reate degree programs are planned to preparegraduates for practice as professional nurses.Without further preparation they may accept posi-tions requiring beginning administrative skills.Baccalaureate programs lay the foundation forcontinuing professional and personal developmentand for graduate study in nursing.

Baccalaureate programs in nursing includeliberal education from broad fields of knowledge;professionally related courses in the physical,biological, and behavioral sciences; and prepara-tion for the professional practice of nursing. Theliberal education and professionally related coursesare taught by faculty from other departments ofthe college and university. In some colleges itwill be necessary to introduce such courses as hu-man anatomy, physiology, biochemistry, and mi-crobiology if a new program is to be started. Theenrollment of nursing students may affect spacerequirements in other departments of the collegeor university. The pressure of new programs fornursing or of increased enrollments is particularlyfelt in the sciences and related courses required fornursing as well as in the library.

The curriculum is so organized that the

30

courses from general education which are prereq-uisites to nursing practice, especially the sciences,precede the nursing courses or are offered concur-rently. The major in nursing is usually concen-trated in the last 2 years of the program.

Some schools admit students directly fromhigh school to the nursing program; others re-quire 1 or 2 years of prescribed college coursesbefore the student is accepted into the nursing ma-jor. The admission requirements for the programand the location of the clinical facilities for patientcare practice may influence the sequence of coursesand the relationship between the general educationand nursing courses in the curriculum. This is il-lustrated in figures 4 through 8.


The nature of nursing makes it mandatoryfor students to have learning opportunities in sev-eral kinds of community agencies in which patientsare seen and treated, in institutions where adultsand children meet in groups, and in the homes offamilies where nursing care is being provided.All of these experiences require faculty super-vision.

In some instances the nursing experiencearea may be at a great distance from the campus.

AcademicYear Calendar Years

4th yr.

Academic Years

let, yr. 2nd yr. 3rd yr. 4th yr.

82%28 unite

76%13 units

Typo ol Unit: Number ofUnits:

Type of Unit: Number ofUnits:

Nusiug 40 Nursing di

General Education' se General Education'

Total us Total 1$

'Include profrosionally related subjects such as sciences.

Figure 4. A nursing program in a college.The division uses patient care facilities infive hospitals, day care centers, a children'shome, and other health agencies.

It is often necessary to use more than one hospitalor health agency to obtain sufficient nursing carepractice for the number of students to be admitted.Where facilities of another agency or institutionare used, written agreements establishing mutualresponsibilities are developed jointly and are sub-ject to periodic review. These agreements specifythe responsibility of the college to teach and super-vise the students, select their learning opportuni-ties, and be responsible for the quality of care thestudents give.

The hospital and health agency's responsi-bility includes time for nursing service personnelto plan with the faculty for student experience.Conference rooms, faculty space, lockers, lounges,and provision for food service requirements areincluded?

National League for Nursing. Arrangements Betweenan Institution of Higher Education and a Hospital Con-cerning the Provision of Hospital Facilities for CollegeEducation in Nursing. (Item 8, Selected Bibliography,m48.)

'Includes professionally related subjects such as Kismet.

Figure 5. A nursing program. located In auniversity. The first 2 years may be takenat either the university or at one of two Statecolleges located 200 and 450 miles from theuniversity campus. Nurse faculty membersfrom the university are assigned, to each Statecollege to teach the nursing courses. AU stu.dents cransfer to the university at the end ofthe sophomore year. This school uses threegeneral hospitals, two Federal hospitals, thepublic schools, doctors' offices, and State ,andcity health departments for student expert..ence.

FACULTY

The faculty for a nursing unit in a collegeor university consists of those whose full responsi-bility is for teaching in the nursing major. Thenature of nursing practice and education is suchthat the faculty- student ratio is much lower thanin curricula where the safety and well-being ofpeople are not considerations.

The location of the patient care areas, theneed to utilize community resources to obtain stu-dent experience, and the need for close supervi-sion of the student in patient care experience are

31

Academic Years


94%29 Units

6%

90%36 units

s 24%8 units

11%3 units

Ay -*;:::.:.is777..,,,s.::::::.:.:40,ssi.,44,..:::/:-.1-0:*4.>,..s.::::-.D-t:sz

f tiff 89% ..,:-.:.*

'.>::, .4.6iii:.:::43.:2

/::: 26 umts4 ,f .4..

,......:::-/-.(.1,/,. c. -°' .:4.

.:,..-...,

-:(//:, .

.:. "::f; A / s:..ge. ..6:

/>>107/.41:;9e.4,0"04, /,')If' / /

4%4. X., ..5 '..} *'..A 5., /

VAX.e.::::.:,: :::.,..:47/

, .9. : 4:::441.c.s.:* 41:;:.:, (/

01#, / fil 2;...Z.VV

4-zo:kg&.:,:. ....e.:.:

24 umisg::1.-....:4--. ::,..

..

.....

,.:,..--6:

:.;;;,. ).6;.0

A..4. I:: $.f::::::*

V:.'

:4 v:

::."' A, V ::.:4,..,...:

.... ....:

, 4,..-: ;.:-),/....,,. :,. 10% /.

IssW"q''°*/4 um ..,.:::::WA..4,..4" 2 umts$:4j..,"

Type of Unit: Number ofUnits:

Nursing aa

General Education 76

Total 132

*Includes professionally related subjects such as sciences.

Figure 6. A nursing program in a universityWith a detached medical center campus. Thefirst 2 years of the program are-taken at theuniversity campus for general studies. Atthe end Of the sophomore year studentstransfer to the medical center campus. Inaddition to the medical center hospital, thisschool uses the resources of two State hos-pitals and one municipal tuberculosis center.

some of the factors which influence the faculty-student ratio.

Additional faculty will be needed wheremembers of the faculty are involved in curricularexperimentation, community health projects, orresearch.

Needs and Goals

To meet the Nation's growing health needs,the number of graduates from baccalaureate pro-grrms should be doubled by 1970, according to theSurgeon General's Consultant Group on Nursing.2

U.S. Department of Health, Education, and Welfare,Public Health Service. Toward Quality in Nursing, p.22. (Item 6, Selected Bibliography, ch. II, p. 17.)

32

This includes initial admissions as well as thosegraduates from diploma and associate degree pro-grams who are eligible to complete 'requireinentsfor the baccalaureate degree. From this pool willcome the candidates for graduate study who mayprepare for specialized practice, teaching, nursingservice, and research. The number of nurses re-ceiving master's and doctoral degree's must triple,the Group notes. If these goals are to be met, exist-ing programs will need to increase enrollments andnew schools may need to be established.

The specific goals for graduates from eachtype of program are shown in table 9.

MEETING THE NEEDS 3

The Report of the Surgeon General's Con-sultant Group on Nursing and increasing pressurefrom communities will call to the attention of col-lege administrators the need for extending facili-ties and enrollments of existing programs and, insome instances, for establishing new baccalaureateprograms in nursing. College presidents, who arenow administratively responisble for nursing pro-grams, know the need to attract qualified nursefaculty, to secure adequate clinical' experience forstudents in hospitals .and public health agencies,and of the COSIS of such programs. These sameneeds are not as well known to administrativegroups which for the first time are concerned withdetermining whether it is advisable to establish acollegiate nursing program. It seems timely torecapitulate certain information regarding the ed-ucational picture in nursing which may be usefulto groups that are contemplating theestablishmentof baccalaureate programs in nursing.

During the 6-year period, 1956-62, the num-ber of baccalaureate nursing programs increasedfrom 161 to 178, and the average enrollment inthese programs increased from 116 to 132. On thesurface, this increase in number of programs wouldappear most encouraging, since it comes at a timewhen more students, both men and women, are en-tering college than ever before. However, despitethe increase in number and size of baccalaureateprograms, there has not been a sufficient increasein the number of graduates from master's pro-grams who tare preparing for college teaching.

s This portion of the text 'through "Planning Considera-tions," p. 44, was prepared by the Staff of the Departmentof Baccalaureate and Higher Degree Programs,, NationalLeague for Nursing, New York.

jtilUiielAAltelg,614;,Q.,,,S041:46,.4034:2;444X.76445.4i09.44..s1AL5:144=:4 .,-..,

Table 9. Number of professional nurses Inpractice, educational level, in 1962 and thegoals for 1970

Educational level

?41.32 actual 1970 goals

Num-ber

Total

Master's or higherdegree

Baccalaureate degreeDiploma or associate

degree

Per-cent

100.0

3.714.0

82.3

Source: Toward Quality in Nursing, p. 22. (Item 6,Selected Bibliography, ch. II, p. 17.)

In the fall of 1962, enrollments in master's

programs in nursing (both full-time and part-timestudents) totaled 2,472, while graduations fromthese programs totaled 1,098 for the academic year,1961-62.4 The dearth of candidates qualified forcollege teaching is reflected in statistics reportedin January 1962 that showed only 4 percent of the

nurse faculty members teaching in baccalaureateand higher degree programs held doctoral degrees,76 percent held master's degrees, and 20 percentheld' accalaureate degrees. These same programsreported 202 budgeted vacancies.5

In addition to the 192 baccalaureate andhigher degree programs that were seeking to at-tract the graduates of master's programs in 1962,there were 88E diploma, 53 associate degree, and

693 practical nursing programs which were alsobidding for these potential candidates. In thesame year the budgeted vacancies in these other 3types of programs totaled 1,202. Add to the needs

of the schools, the demands for administrative andsupervisory personnel of some 6,000 hospitals and7,800 health agencies and boards of education andit can be readily seen that the college admin-istrator must compete with a highly competitivemarket for a well-qualified faculty.

6 Some Statistics on Nursing Education-1962, p. 2 (un-published). The statistics presented in this report werecollected by the Research and Studies Service of the MNand supplement published annually in Nursing Outlook.

`From statistics collected by the NLN Research andStudies Service based on questionnaire responses from

180 of 192 (94 percent) baccalaureate and higher degree

Programs.

782-486 0 64 4

Academic Years CCalendar Years

1st yr. 2nd yr. 3rd yr. 4th yr. ,

100%30 units

100%30 units

9ousts

1;;;;,..;0-§2 24;

tiff,: 73% -'24 units :.:

f,.5.4.2A-mo,;:(ys,*.-.x.,,,,oe,.0...

..,

,,,,..4...,/m; -/;,

ff::37.. fe?' : X ' f; a:,-.0 4-, / ,pe ,4>. Ad-,,,,,./4 /<4' fA..,,.ii:-: ..,,,,,zi:

tg-* // ,WA," 4.?-7;,., -7/,

::>4..0,0s.s.VrAft.z.2..Mzv,t..e;'. 100% .

.2.5.(x21P,8iW,-..ilnii77{1,z..'

?7V t i./ i

..".:.7,'

%-f f? -454,71.4 ,,fs:'z.,. 4 < ;.-.,,t. - ,

i, ,,,y , ....,. ...,,,..4.4p.A.,,,,, .-1,704,...,

s.o.",;::.,,:,. ..e ."e,

4 .0Y.:-.,. fte4 '9:(44.-....,::,%.,,,ge

,Jams

/ 41.e/4 ;;;/ /0 v: .;.i.

..,..

:A. -:. .-:' #

WS%

Type of Unit:

Nursing

General Education'

Total

Number ofUnits:

62

CO

131


Figure 7. A nursing program conducted by aur..7versity. This school requires four semes-ters of academic study for admission to thenursing program. General academic creditmay be transferred, from a junior or liberalarts college or another university. The nurs-ing program is placed at the school of medi-cine campus and requires 2 calendar yearsfor the nursing major.

PuclwINsTRILITIES OF UNIVERSITIES

:What are some of the responsibilities whichshould be assumed by a university offering a pro-gram in nursing education ? The following ex-cerpt from a paper by Margaret Bridgmc.r_ a prz-sents an apt description of some of these responsi-bilities:

Some institutions) in planning a new program havenot been awl_re of certain essential conditions and havebeen quite naturally influenced by patterns in neighboringinstitutions. Hospital administrators, doctors, and di-rectors of nursing also have been uninformed in man,*cases, and some of them have been prejudiced in favorof the "traditional" affiliation pattern. Yet College pro-

°Bridgman, Margaret. The Development of CollegiateEducation in Nursing in the United States, p. 2. (Item3, Selected Bibliography, p. 48.)

33

Academic Years

Type of Unit:

Nursing

Genera Education

Total

Number ofUnits:

64

76

140


Figure lk A program In nursing located at aUniversity medical center. This school ofnursing requires 60 semester hours of gen-eral 'education for admission to the nursingmajor. The r.isrsing major requires six aca-demic semesters for completion.

grams, concentrated upon education, do not provide ex-tensive student service, though the faculty - student groupmakes valuable contributions to the hospital Studentsdo not earn their way because they receive more value ineducation than they give in service, and faculty guidancehas played a very large part in their contribution. It islogical, therefore, that students in these programs shouldpay the same tuition as other students in the educationalinstitution and meet their own living expenses, and alsothat they Should share in all the benefits of college serv-ices and college life and associations.

The essential conditions an institution of highereducation should be assured of meeting before it under-takes the responsibility of offering this type of profes-sional education may be briefly outlined as follows:

Recognition of nursing as a subject comparable toothers that are established as college nrijors and realisa-tion that it must be developed in the same way to justifya degree and give students the benefits they have a rightto expect from college education for their chosen profes-sion.

Recognition of the need to produce graduates reallycompetent for the functions for which collegeeducatednumb are so urgently needed.

Establishment of an educational unit in nursing

34

in the institution on a completely equal buds with otherunits of the institution, with a faculty adequate in numberand well qualified in the =rims special types of nursingto tench all the courses in nursing including faculty-guidedclinical practice. A minimum number of faculty mem-bers is six, with medalists, respectively, in medical, sur-gical, obstetric, pediatric, psychiatric, and public healthnursing.

Provision for the necessary facilities for education:classrooms, faculty offices, and library.

Provision of housing and all other student personnelservices required for college students.

Provision of available and accessible hospital andother agency facilities for the practice of nursing, sinceit is here that faculty help students to develop profes-sional skills and to use pertinent knowledge from all pre-ceding academic and professional sources.

In other words, a university needs to accept thesame responsibility for this type of education as for anyother in which it undertakes to provide the kind, level,and quality of preparation characteristic of the institu-tion and represented by its degree.

PLANNING CONSIDERATIONS

In surveying resources and estimating thecosts of establishing a nursing program, the col-lege administrator might well ask the followingquestions with respect to student potential, facultypersonnel, and physical facilities:

1. What is the student potential of womenand men who are intellectually able and interested'in professional education for nursing?

2. What new preprofessional courses mustbe offered? (Human physiology, anatomy, etc.)

8. What additional faculty and facilities(both classroom and laboratories) will be neededto accommodate x number of students in theliberal arts and preprofessional courses (history,humanities, mathematics, psychology, chemistry,nutrition, etc.) I

4. What staffing will be required to providepersonnel services such as counseling, admission,health, housing, food, and recreation?

5. What additional library facilities andstaffing will be needed to accommodate x numberof students and faculty?

6. What additions or changes in the physi-cal plant will be needed to provide the nursingprogram with an administrative unit, faculty of-qces, conference or seminar rooms, special class-rooms, laboratories, or demonstration units inaccordance with the educational specifications ofthe prcgram I

7. How many faculty members will beneeded initially to develop the curriculum and im-

plement the program I How many additional fac-ulty members will be needed to provide adequateinstruction for the increased enrollments antici-pated after the first 2 or 3 years I

8. What are potential resources for candi-dates for the deanship and other nurse facultypositions?

9. What financial resources will be neededto support a qualified faculty with salaries com-parable to those in other schools?

10. How are special, yet recurring budgetitems, such as cost of accreditation, periodic re-quirement for the faculty to travel to professionalmeetirigst and student transportation to the clinicalareas, to be met?

11. What clinical resources are availablewithin the community? What types of studentexperience must be obtained elsewhere and howwill this affect the scheduling of classes/

Valuable assistance can be obtained fromother administrators and from nursing consultantsin answering the above questions.

NEW SCHOOLS

A new school should be considered when re-gional educational or State nursing surveys indi-cate the need for additional baccalaureate degreeprograms. For graduatestudy, regional planningshould indicate the desirability of coordinatedaction on a broad geographic basis to establish oneor more centers within a region. Universitieswith medical centers provide the major require-ments for graduate study in the health sciencesincluding nursing.

A qualified nurse consultant may be em-ployed to survey and evaluate the availability ofclinical and other community health agency re-sources for student learning: The State boardsof nursing can advise as to the requirements theprogram must fulfill to qualify for State approval.The National League for Nursing administers theprogram for national accreditation of nursingprograms.

Where coordinated planning results in therecommendation for the establishment of a nurs-ing program in a college or university, the next

Lists of qualified consultants are available from theNational League for Nursing, the U.S. Public Health Serv-ice, the western Interstate Commission for Higher Edu-cation (WICHE), and the Southern Regional EducationalBoard (SREB).

step is to obtain administrative approval and sup-port and to appoint the basic faculty. The basicminimum faculty for the program will be the deanand the professors in the major nursing areas.The dean should be appointed at leant 2 years be-fore the first students are admitted to the nurs-ing courses. This time interval will permit theestablishment of interagency relationships andagreements, and allow curriculum and functionalplanning for the building program to proceed con-

currently.The curriculum for the nursing program is

the basis for the development of functional plan-ning to guide the architect in developing the build-

ing program. Architecturalplanning will requireat least 6 months, and 1 year should be allowedfor construction of the proposed educationalfacilities.


Before the architect will be able to developa building program which provides adequatephysical facilities, he must be provided with Suchessential information as: (1) the enrollment; (2)educational program; and (8) space requirementsfor instruction, research, faculty and administra-tive offices, and supporting areas. This informa-tion should be set forth in a written program.

Many colleges and universities have estab-lished building committees within the central ad-ministrative office. A committee for planningnursing education facilities must be established ifno overall committee has been formed.

Subcommittees from major departments ofthe school submit recommendations to theplanningcommittee space and equipment requirementsto meet their particular needs. Consultation withrepresentatives of other educational units withwhom they may share space is essential. Thiswould include auditoriums and facilities for con-tinuing education.

The dean and the faculty will develop animmediate and long-range program for nursingwithin the college or university. This will includean estimate of the immediate enrollment and acareful consideration of the projected enrollmentin each existing program within a specified time

36

period (20 years with periodic revision every 5years). Curricular space requirements are af-fected by organization, the size of classes for dif-ferent teaching methods, and the use of educationalaids such as films, televised projection and moni-toring, and the number and availability of confer-ence rooms in the inpatient areas.

To provide for future expansion, it isrecomm ended that : (1) lecture rooms be plannedto accommodate the maximum enrollments pro-jected; (2) seating for observers of the teachingprocess be planned (these may be graduate stu-dents or visitors) (3) the architectural design&nd engineering incorporate features which, whennecessary, can be modified to accommodate futurechanges in the program and in teaching methods.

In most instances, at least 2 or 3 years willelapse between the time planning for construc-tion begins and a new building may be ready foroccupancy. If in a new school students are to beenrolled in nursing courses as freshmen, availableclassrooms on campus will need to be modified topermit patient care demonstration by the facultyand practice by the student. Otherwise the ad-mission of students will have to be delayed untilthe new facility is ready.

The building committee should visit otherschools as a team rather than individually to eval-uate new educational facilities and practice.Other health disciplines using new educationalmedia that are adaptable to nursing instructionshould also be visited. In this way facilities willbe observed and evaluated, from different points ofview. New programs which may not have ap-pointed the basic faculty may need consultationfrom nurse faculty in other programs.

The functional program developed by thebuilding committee will contain the specificationsfor teaching, research, faculty, administrative andsupporting space necessary to carry out the edu-cational program.

TEACHING SPACE

The types of teachizg space to be providedinclude lecture, class and conference rooms, mul-tipurpose rooms, laboratories, and libraries.

The number and size of different types ofclassrooms for nursing courses are determined bya projection of class schedules to ascertain the fre-quency of room UN:- This projection should bebased on the largest anticipaLid enrollment. It

36

is necessary to determine the size of the group thatcan be taught by various teaching methods.

The scheduling of classes for clinical nurs-ing courses will be determined by the most suit-able hours for clinical nursing practice. In manysituations the morning hours may prove to be thebest hours for student experiences. It would thenbe necessary to schedule lectures in the afternoon.In these instances, the total number of classroomsrequired may be greater for clinical nursingcourses than for courses which can be scheduledthroughout the day. With effective schedulingprocedures, these rooms may be made availablefor other college classes, thereby increasing theirutilization.

Lecture-Demonstration Room. One ormore rooms with fixed seats for students and withspace for patient care demonstration to accommo-date the maximum annual admission should beplanned. In programs where graduate studentsmay be having practice teaching experience, whereforeign and local visitors for observation are es-pected, or where observation for evaluation of cur-riculum experimentation is anticipate?, it will benecessary to provide a lecture-demonstration roomadequate to seat the total class, plus an additional20 percent.

Claw ooms.Where student participationis expected as a part of the teaching method,smaller classrooms with movable seating will beneeded. The faculty should determine the maxi-mum number of students who can partipateeffectively.

Multipurpose Laboratory (T arching -Learning Laboratory).Nursing care that re-quires manipulative skills is learned through prac-tice in teaching and learning laboratories thatsimulate the patient care areas of hospitals. Theselaboratories are also used to acquire greater un-derstanding of the nurse-patient relationship.

Conference Rooma.Conference space willbe needed in the patient care areas of cooperatinghospitals and health agencies and in the educi-tional unit.

Students enrolled in clinical nursingcourses will be assigned in small groups for nurs-ing practice ;11 the agency. Precare and postcareplanning conferences are an integral part of thisexperience. These conferences are seheduledwhile the student is assigned to the patient care

areaprobably during the morning or earlyafter-noon hours. The number of conference roomsneeded will depend upon the number of sectionsfor each class. For example, if there are 6 groupsof students in medical-surgical nursing, 2 groupsin psychiatric nursing, 2 in maternity nursing, and2 in pediatric nursing, there might be 24 confer-ends to be scheduled in any one day. Wherenursing service conference rooms are available onpatient units, there are certain hours of the daywhen they might be available for conferences withnursing students.

In addition to conference space in the pa-tient care areas, students and faculty will havescheduled and unscheduled conferences in theeducational unit.

Science Laboratories.Since science re-quirements for the nursing program are taken withother college or university students, such space isnot required in the nursing education unit. Theuniversity administration will need to determinewhether science classrooms and laboratories willneed to be expanded to accommodate the projectedincrease in enrollments.

Libraries.Library materials for nursingwill be added to the central library complex of thecollege and university. Nursing students requireaccess to reference materials from the humanities,the physical, biological, and social sciences as well

as professional materials.Library resources must be available to the

student at the site of the educational unit and atthe site of patient care practice. If patient careis obtained at centers remote from the campus, itwill be necessary to duplicate library materialsand provide for their transportation.

Teaching Aida.Programed educationalaids, either textbooks or materials for machine useand the machines for programed learning, may bestored with other library materials where theymay be accessible to the total student body. Insome instances, separate storage for movable teach-ing aids will be needed adjacent to the areas wherethey are to be used.

FACULTY SPACE

The faculty space will include offices, con-ference rooms, research space, lounges, toilets, andlocker rooms.

Of/temOffice space for the total antici-pated faculty should be planned and constructed

s part of new educational units. If such plan-ning is not done when the program and facultyexpands, it may be necessary to convert costlyclassroom or laboratory space to offices.

Patient care planning and professionalcounseling of students requires frequent privateconferences between the student and her instruc-tor. For this reason, an office should be plannedfor each faculty member. Staff should have readyaccessibility to secretarial services.

As a planning factor for undergraduateprograms, it is recommended that at least a ratioof 1 faculty to 9 students be used. This ratio isnot intended to indicate that within the patientcare practice area 1 faculty member Will supervise9 students at a given time in patient care experi-ence. She may demonstrate nursing care to onestudent or a group of students as she mayhave twoor more groups of students needing supervision.

When there are graduate assistants or fieldpractice students, office space will be required.

Conference Rooms.-4. conforente'reoa isneeded for faculty meetings, group irojects,, indmeetings with representatives frain communityagencies. This room should have provision forserving refreshments.

Research Space.If faculty members areexpected to engage in research, appropriate spaceand laboratories must be provided for experinka-tation in nursing practices, teaching method-ologies, administrative processes, and biologicaland/or sociological esearch.

Lounge and Locker SpamFacultylounges may be shared with other faculty groupsin a multiple-use building. In other instances, alounge for the nursing school faculty will beneeded. Lockers and space for changing fromstreet clothes to uniform will be required.

ADMINISTRATIVE SPACE,

The educational unit in nursing in a college

or university is directed by a nurse responsible forthe academic administration of the program. Anadministrative assistant is frequently responsiblefor fiscal matters and such nonacademic adminis-trative functions as supervision of clerical staff,and supply and equipment control.

The administrative area, in addition to the

37

"MST;r177

0,4

office for the dean and her assistants, includes thelobby-reception area, general offices for secretariesand clerk-typists (including those for faculty andadministrative personnel), files, and office supplystorage space. Adequate secretarial space shouldbe provided. Secretaries for the faculty shouldbe in the ratio of 1 secretary to 3 to 6 faculty mem-bers (1: 3-6). The number of secretaries requiredwill depend upon the nature of the instructionalresearch loads and publications by the faculty.

Student affairs administration, which in-cludes admissions, registrations, counseling, andstudent health, are fumtions shared by other de-partments of the college and university. Spacefor such activities needed only by the nursingschool should be provided.

Administrative staff will require lounge,locker, and toilet space. Male and female visitors'washrooms and toilets are usually in the admin-istrative area.

SUPPORTING SPACE

Supporting space will include studentlobkers, lounges, and toilets. In addition, work-space will be needed for duplicating, housekeeping,maintenance, and mechanical equipment. Vendingmachines, telephone booths, and drinking foun-tains may be recessed in corridors.


Noncredit workshops and refresher coursesmay be scheduled for 1 or more days or may be for1 or more weeks. They usually require space forthe total day. It is difficult to schedule such pro-

grams in the rooms regularly used by full-timestudents.

This type of program needs space where thetotal group can be brought together for lecture aswell as rooms where the group can be divided intosmall work or discussion groups. An assembly-type room with lounge space for on-the-spot reg-istration of participants is desirable. To accom-modate small conference groups, the assembly roommay be divided with folding partitions of sound-retardant construction or separate conferencerooms may be provided.

This type of space is frequently shared withother groups in the college or university. If alarge-scale program of continuing education isplanned, an office for the director will be needed.


Hospitals and health agencies which acceptnurse students for patient care experience need toprovide space for educational fu '*ions that arenot required in the nonteaching agencies.

Conference rooms in patient care areas ofhospitals and health agencies should provide spacefor patient care demonstration and patient teach-ing. Some of these units should be equipped fortelevision projection and for monitoring with, one-way viewing screens. Faculty office space, lockers,and space in which faculty and students can changefrom their street clothes will be needed if the hos-pital is at a distance from the educational unit.

Students and faculty may utilize the food serv-ice of the hospital when assigned for patient carepractice.

PROFILE OF A BACCALAUREATE PROGRAM

Tax EZICAINDER of this chapter presents a profileof a typical nursing program in a libeisl arts col-lege, based on a composite picture of such facilities.This profile, offered as a guide, should be adaptedin accordance with a school's individual needs.

Sze of &hookSpace requirements andan operating budget have been prepared for a de-partment of nursing in a college admitting 96 stu-

38

dents each year. The total enrollment is 20students, based on a 37.5-percent attrition rata

The faculty consists of a dean and 27 fnll-time nurse instructors. There are nine clerk-typ-ists who serve the faculty and one secretary to thedean. If the faculty is engaged in research Cr ifcontinuing education is contemplated, additionalfaculty and stenographers will be needed..

TEACHING SPACE

SPACE REQUIREMENTS

Lecture-Demonstration Rooms.The pro-gram planned for this school requires two lecture-demonstration rooms, each seating the total enter-ing class. An additional 25 percent space allot-ment should be made for visitors or expandingenrollments.

Classrooms.The students admitted eachyear will be divided into 2 sections of 48 each forlecture with demonstration of patient care. Theserooms have also been planned for a 25-percent ad-ditional seating capacity.

Multipurpose Room. One multipurposeroom with 8 beds has been planned for a section of16 students. Storage and utility space is provided.

Observation Room.Where graduate stu-dents from higher degree programs obtain experi-ence in practice teaching, an observation roomadjacent to the multipurpose room facilitates ob-servation of the teaching process.

Conference Rooms.Six conference roomswith movable chairs to accommodate 20-25 stu-dents are planned in the nursing education unit.Oversizing of these rooms permits their use forsmall groups in informal seating arrangements orlarger groups where less student participation isexpected.

Science Laboratories.The total require-ments for the nursing degree consist of nursingcourses, liberal education, and professionallyrelated sciences; e.g., physical, biological, and so-cial sciences. Since science courses are shared withthe total college, laboratory facilities are not re-quired in the nursing education unit.

Library.The college library has sufficientspace to add the professional books and journalsfor nursing as well as the study space for the ad-ditional students who will be enrolled in nursing.

Reference-Reading Room.A reference-reading room for current periodicals and pam-phlets has been provided to accommodate 16 per-sons within the nursing educational unit.

FACULTY SPACE

Individual offices for 27 full-time facultymembers and 1 office with desks for 4 graduate as-sistants are provided. Also included are a facultyconference room and a lounge. Research space isplanned in accordance with the faculty researchactivities.


The administrative space includes a lobbyreception room, general office for nine clerk-typ-ists, one of whom acts as general receptionist. Italso includes general storage and duplicating spaceand toilets for men and women visitors.

A private office for the dean with adjacentspace for her secretary is included.

SUPPORTING SPACE

The supporting area includes space for stu-dent lounges and lockers, toilets, janitors' closets,and storage rooms.


The college has administrative agreementswith three general and two special hospitals, andtwo public health agencies for student experiencein patient care. The hospitals and health agen-cies are geographically close to the college.

Each patient care area used for teachingstudents in the hospitals has a nursing service"con-ference room which is shared by nursing educa-tion. One general hospital and one specializedhospital have demonstration units equipped withtelevision cameras and one-way viewing screens.The conference space accommodates reference ma-terials and other teaching aids.

Within the agencies providing patient careexperience, lockers and provision for food serviceare available for the use of students and facultywhen they are in the agency.


The school of nursing conducts three non-credit courses, e,a,lh of 3 weeks' duration, for fac-ulty of other schools in the area to improve teach-ing methods. Two courses of 2 weeks each aregiven to nursing service personnel from hospitalsto improve supervisory techniques. These coursesrequire a lecture room for the total group andspace for group conference. At least three coursesof 1 week each are given either as refreshercourses in patient care or to teach new methods ofpatient care. The latter requires lecture, a demon-stration, and practice in the multipurpose demon-strat:on room and in the patient care units of thecooperating hospitals.

Table 10 indicates the number of rooms,the size of group accommodated, and the space re-quirements of the facilities planned for the pro-gram admitting 96 students each year. Figure 9shows space relationship for this program and in-cludes space for a graduate program.

As shown in table 10, the total net usablespat* for this program is estimated as follows:

SpaceTeaching

Square feet14,064

Faculty (including research) .8, 980Administration 1, 500SupPortimi area 1,940Continuing education

.Total

2,

24,

560

044

Table 10. Space requirements for a 4-year basic baicalaureate nursing program with an enteringclass of 96 and a total enrollmOnt of 240

Spaces


RemarksNumberof

rooms

Groupsize,eachroom

Totalnetarea

(sq. ft.)

Teaching

Lecture-demonstration roomsClassroomsConference roomsMultipurpose room with storage, utility, and

observation roomsScience laboratoriesStorage-teaching aidsReference reading roomLibrary

Faculty

OfficesResearch space addedGraduate assistants' officeConference roomLounge

.Administration

Lobby-receptionGeneral dike


Storige areaDuplicating areaDean's officeDean's secretary's officeRegistrar's officeAdmissions officeStudent counselor's officeStudents' health centerVisitors' toilets:

MenWomen

14, 064

Additional required in the hospital.

8 beds.In the college.

In the college.

Depending on the program..

Shared with administrative staffwith 5lockers.

With coat closet and toilet.

In the iollege.In the college.In the college.In the.00llege.

1 watercloset, 1 lavatory.1 watercloset, 1 lavatory.

226

1WNW

11

1206025

WNW

16

4,6082, 2003, 696-

3, 000

*160400

3, 980

27

111

1

440

2,100

'240720320

1, 500

11

1

11

000

WNW

9

1

WNW

1E10

100720

8080

340_100

4040

Table 10. Space requirements for a 4-year basic baccalaureate nursing program with em ewsringclass o 96 and a total enrollment of 240Continued

Spaces


Numberof

rooms

Group Totalsize, nel;each areaMom (sq. ft.)

Remarks

Supporting

Students' toiletsMenWomen _

Stude ts' loungeLockers

Janitors' closetsCoat alcovesVending machinesTelephone bootDrinking founts'General storage

Continuing education

Assembly room

Conference roomLounge and reception areaToilets:

MenWomen

Drinking fountains

1,940

12

2

1

1

11

100

660

60080

600

2,560

1,600

700

130130

24,04416,029

40,073

166.97

1 lavatory.1 watercloset; 1 urinal.13 waterclosets; 13 lavatories.In the college.250 full-size lockers or as required.As required.As required.As required.As required.Minimum of 7recessed or as required.

Folding partitions to divide the room into 4spaces (optional).

Optional.

1 watercloset; 1 urinal; 1 lavatory.1 watercloset; 2 lavatories.

T.:.tal net area.For walls, partitions, corridors, stairs, and

mechanical space.

Total gross area.

Area per enrolled student, approximately167 sq. ft.



The program has been in operation for atleast 4 years. This year 96 students entered theprogram; the total enrollment was240. The nurs-ing department staff consisted of the dean, 27 fac-ulty members, 1 secretary, and 9 clerk-typists.The number of credits required were equally di-vided between general education and professionaleducation; therefore the arts and sciences depart-

See app. A, p. 78.

ment of the college or university and the nursingdepartment offered the same number of credits.

COMPONENTS OF OPERATING BUDGET

Arts and Seienees.Introduoing a nursingprogram into the college setting would increase thecost of arts and sciences instruction, since the stu-dent would be required to have credits in this areaalso. The cost of the nursing department shouldbe considered in light of the particular require-ments of 4-year baccalaureate programs in nurs-ing. Because of these considerations, the proposedarts and sciences portion of the nursing program

41

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budget is based upon the additional credit how s ofarts and sciences.

Mining Department.--In forecaseing thisbudget, primary consideration was given to thenecessary faculty and facilities that would be ade-quate for such a program. For instance, the nurs-ing faculty includes professors who accompanyand instruct the students in all areas. A combina-tion of all of these factors indicates the probableannual increase in operating costs to the institutionfor all areas of instruction for the students in thenursing program.

This budget, shown in table 11, is basedupon an analysis of existing baccalaureate degreeprograms projected to the program characteristicsdescribed. Sufficient salaries were budgeted tocover the recommended number of faculty mem-bers. Certain items, such as salaries and fringebenefits, are based on studies conducted from 1958-62. For a more precise estimate, current ratesshould be substituted for these items.

Table 11. Proposed annual operating budgetfor a baccalaureate nursing program, with anentering class of 96 and a total enrclionent of240

Item TotalArts andsciences

costs

Nursingdepart-mentcosts

Total $413, 691 $106, 852 $306, 339

Direct costs 290, 102 72, 549 217, 553

Salaries 1 274, 178 67, 778 206, 400Supplies 15, 924 4, 771 11, 153

Indirect costs 123, 589 34, 303 89, 286

Staff benefits 11, 161 3, 807 7, 354Plant operation 39, 407 7, 304 32, 103General institutional

administrative ex-pense 22, 594 6, 546 16, 048Library 25, 736 9, 182 16, 554Student services 24, 691 7, 464 17, 227

Salaries provide for nonnursing faculty and thefollowing nursing department personnel: I dean, 27faculty members, 1 secretary, and 9 clerk-typists.

GRADUATE NURSING PROGRAMS

Graduate study in miming is aimed at thepreparation of teachers, clinical specialists, admin-istrators, consultants, and researchers in nursingeducation and nursing service.


A graduate nursing program is organizedsimilar to other graduate programs within theuniversity. With only few exceptions, these areoffered in conjunction with a baccalaureate nursingprogram.

The graduate program is designed to pre-pare nurses for leadership positions in teachingaa..a administration in all types of educational pro-grams. Such a program also provides an oppor-tunity to study for supervisory and administrativepositions in nursing service. Consultants, clinicalspecialists, and research workers also require grad-uate study.

CURRICULUM

The curriculum for each school will be de-termined by the area or areas of specialization in-cluded in the master's degree program. Thecontent for a particular area of specialization willinclude courses from related sciences, nursing, andan introduction to research methods. Programswhich include specialization in an area of nursingpractice, such as medicine and/or surgery, mater-nal and child health, or public health, will requireaccess to patient care areas for student experienceand research.

FACULTY

The faculty for graduate programs requirespreparation which will qualify for teaching at thegraduate level, for independent research, and forinstruction in research. Some faculty membersmay have combined teaching and research respon-sibilities. Qthers may have full-time researchpositions and may supervise graduate students asassistants.

43

Needs and Goals

In 1962, enrollments in 48 master's programsin nursing (both full-time and part-time students)totaled 2,472, while graduations from these pro-grams totaled 19098 for the academic year, 1961-62.0

As shown in figure 10, except for the aca-demic years of 1959-60 and 1960-61, in the last 10years total enrollment and the percentage of stu-dents enrolled full time have increased.

The dearth of candidates qualified for col-lege teaching is reflected in statistics reported inJanuary 1962. Only 4 percent of the nurse facultymembers teaching in baccalaureate and higher de-gree programs held doctoral degrees, while 76 per-cent had master's degrees. These same programsreported 202 budgeted faculty vacancies.1°

In addition to the 192 baccalaureate andhigher degree programs that were seeking to em-ploy graduates of master's programs in 1962, therewere 886 diploma, 53 associate degree, and 693practical nursing programs that were also biddingfor these potential candidates. In the same year,the budgeted faculty vacancies in these other 3types of programs totaled 1,202.

Leadership personnel prepared at the grad-uate level are also needed for hospital and publichealth nursing services. In 1962, only 31.6 percentof administrative and supervisory personnel inpublic health agencies held graduate degrees.11


Nursing programs that admit candidatesfor the master's and doctorate degrees will requirespace for teaching, research, faculty, administra-tion, and supporting services.

D Some Statistics on Nursing Education-1962, p. 2.(Unpublished.) See footnote 4.

10 From statistics collected by the NLN Research andStudies Service based on questionnaire responses from180 of 192 (94 percent) baccalaureate and higher degreeprograms.

11 U.S. Department of Health, Education, and Welfare,Public Health Service. Nurses for Leadership. (Item 11,Selected Bibliography, p. 48.)

44

2,500

TOTAL ENROLLMENTS

GRADUATIONS

2,000

Part-time enrollments

1,50

1,000

500

01956-57 1957-58 1958-59 1959-60

Academic YearFigure 10. Enrollments and graduations from

master's program in rtarsing, 1956-62.

Full-time enrollments

1960- 1 1961-62

TEACHING SPACE

Lecture and Classrooms. The teachingmethods used in graduate education require lim-ited access to large lecture rooms, since there isa high concentration of teaching in small groups.Nevertheless, both lecture and classrooms areneeded. In addition, seminar rooms for not morethan 20 students should be provided. To deter-mine the number of classrooms and seminar rooms,the same type of projection of schedules used forundergraduate programs should be made.

Library.Research programs orientedtoward the behavioral sciences require a universitylibrary adequate for graduate work in sociologyand psychology or the equivalent. Programsoriented toward research in the biological scienceswill require a university or medical center libraryadequate for graduate work in the basic medicalsciences or its equivalent. Periodicals in the fieldof nursing and research tools in nursing must beavailable.

Study space will require individual carrels ortheir equivalent in the library.

RESEARCH SPACE

Nurse faculty and graduate students may beengaged in research in curriculum, in clinical nurs-ing, and in the behavioral, biological, or naturalsciences. Research institutes and foundations areincreasing their contributions for nursing projects.Some of these grants are under the direction offaculty who also have teaching responsibilities.Others are for personnel with full-time researchresponsibility who may have graduate studentsas assistants.

To fulfill the research requirement for agraduate degree and to allow the faculty to pursueindependent research, adequate space must be madeavailable. The space may be in the school ofnursing or in a basic science building accommodat-ing research personnel employed by schools ofnursing, medicine, and others. Nursing researchrequires an environment with appropriate facili-ties, personnel, and ongoing research studies inthe basic sciences which may be oriented towardthe behavioral sciences and/or toward the physicaland biological sciences.

Research in curricula, clinical nursing, andnursing service administration may use the multi-purpose demonstration rooms for projects relatingto methods of providing nursing care, for practiceteaching, and for study of nurse-patient relation-ships. Clinical nursing studies may require accessto the patient care areas of hospitals and healthagencies.

Behavioral science laboratories are used toobserve human and/or animal subjectsally or in groups. The laboratory should providea section for the experimenter (s) and sufficientspace to accommodate a human subject in bed.It should also provide space for electronic physi-ological monitoring and other bulky equipment.The room for the subject should have controls forhumidity, temperature, and a dimmer switch tocontrol illumination. The room should be sound-proof and should allow for television monitoringand for a microphone and speaker system betweenthe subject area and the observation room.

The human subject portion of the laboratoryis separated from the observation room by a one-way viewing glass. The observation room providesspace for equipment to record from the monitor-ing systems. Space for additional observers maybe desirable. The two areas of the laboratoryshould not have connecting doors. The entrance

door from the corridor to the subject portion ofthe laboratory should be sufficiently wide to permitmoving a hospital bed in and out of the room.

Study of the human subject, either individ-ually or in groups, will require the same type ofobservation room. Rooms used for studyinggroups should accommodate 25 people seatedaround a table. Such research (on human sub-jects) requires space for a patient waiting room.If children are used as subjects, a playroom ornursery is necessary. Sound-resistant interview-ing rooms, some with one-way viewing screens,tape recorders, and television projection or moni-toring facilities, will be needed.

Behavioral science research requires spacefor concealed tape-recording apparatus, a kitchen-ette, bathroom facilities, and a data analysis room.

Although it is assumed that the universityhas a central computer service, ongoing researchrequires space for preliminary data analysis andstorage of records, IBM cards, and tapes.

Biological science research and some be-havioral research may require animals. Labora-tories should be of the multidiscipline type to al-low for either high or low laboratory workbenchspace and storage cabinets around the sides andend of rooms. A center island should provide fora laboratory sink, hot and cold water, and electricand gas outlets. Ventilated hoods and a refrigera-tor are necessary. The laboratory should provideindividual desks and laboratory work areas forresearch assistants. Each area require:, storagespace, gas, and electrical outlets. The laboratoryshould be adjacent to the research director's office.

Additional areas will provide space fordrying ovens for glassware, storage, and the instal-lation of specialized equipment required for par-ticular projects.

FACULTY SPACE

Office space provided for the faculty ingraduate programs should be similar or identicaltc that described for baccalaureate faculty. Inaddition, space will be needed for graduate as-sistants either in research or teaching. Graduateassistants usually share office space.


Programs which enroll a large number ofstudents in a variety of major areas of study may

45

require the establishment of a department forgraduate study administered by an administrativeassistant. The size of the student enrollment andof the faculty will determine whether secretarial

and other administrative personnel will be sharedwith other programs or assigned to the graduateprogram. For faculty engaged in research, a ratioof 1 secretary to 3 faculty members is necessary.

PROFILE OF A GRADUATE PROGRAM

THE REMAINDER of this section presents a profileof a typical graduate program in nursing in auniversity based on a composite picture of suchfacilities. The profile, offered as a guide, shouldbe adapted in accordance with the needs of theindividual school.

Description and Size of the Program.Theprogram offers only one major in a clinical nursingspecialty with no more than one functional orien-tation; i.e., teaching, supervision, or administra-tion. A research thesis is required. There are 15faculty memben: a ratio of 1 faculty member toeach 4 students. The faculty members are quali-fied to teach and direct a graduate program and areengaged in independent research. Thirty studentsare admitted each year. The program requires 2academic years for completion. The total enroll-ment is 60.

Space Requirements

TEACHING SPACE

It is assumed that a few courses will betaught to the whole group, but the majority ofteaching will be in groups of eight.

Lecture Room. The total group will havea limited number of lectures each week. Thiswould require a room to accommodate 80 people(60 students and 20 observers). The use would belimited; therefore this room could be shared, orother space in the educational unit may be avail-able.

Classrooms.Assuming there are two 3-hour courses each semester, there will be 12 hoursof course work per week for 2 groups of 30 stu-

48

dents. Classrooms in the undergraduate programmay be available for scheduling.

Conference Rooms.Nine hours of seminarper week for 10 groups of 6 students would require90 class hours per week for conference rooms.This schedule would require three or four confer-ence rooms.

Reference-Reading RoomA reference-reading room for current periodicals and studyspace should be provided in the graduate programarea.

RESEARCH SPACE

The number and type of research labora-tories to be provided will be determined by theresearch effort carried out by the graduate andresearch faculty of the school. A higher degreeprogram probably requires a multipurpose labora-tory for curriculum research, a human subjectexperimental laboratory, and a biochemistrylaboratory.

FACULTY SPACE

Private offices are provided for each facultymember. In addition, it is assumed that eightgraduate students will have appointments as grad-uate assistants. One room with desks for eightpersons is provided.


It is assumed that a graduate program withonly one clinical major and one functional orienta-tion will be in conjunction with and administered

I

by the dean who also administers the undergradu-ate program. The graduate program will shareadministrative services. However, adequate spaceshould be provided for secretarial staff. A ratioof 1 secretary to 3 faculty members will berequired.

As shown in table 12, the total net usablespace for this program is assumed to be :

Space Square feet

Teaching 1, 280Research 7, 735Faculty

Total

2, 726

11, 741

Operating Costs

A study of the costs of graduate nursingprograms was made in 1959. The method useddoes not permit the projection of an annual operat-ing budget. The report states that "$2,500 is areasonable estimate of the average cost in theUnited States per full-time master's degree studentof nursing in 1957-58." 11 It is further estimatedthat "tuition meets well under half and little morethan a third of the costs to the institution of grad-uate education for nursing."

11 See item 4, Selected Bibliography, p. 48.

Table 12. Space requirements for a 2-year graduate nursing program in conjunction with bidebaccalaureate program with a total entering class of 30 and a total enrollment of 60


Spaces

Teaching

Lecture-demonstration roomClassroomsSeminar roomsReference-reading roomLibrary

Research laboratories

Behavioral scienceWaiting areaNurseryObservation roomsInterview roomsConference roomData analysis roomMultipurpose projects room

Faculty

OfficesResearch space addedGraduate assistant's officeSecretaries' officeToilets:

MenWomen

Supporting

Numberof

rooms

Groupsize,eachroom

Totalnetarea

(sq. ft.)

Remarks

1, 280

Shared with undergraduate pgogram.Shared with undeguaduate program.

Shared with college.

Depending on program.

1 water closet, 1 urinal, 1 lavatory.3 waterclosets, 3 lavatories.

Shared with undergraduate program.

Total net area.For walls, partitions, corridors, stairs, and

mechanical space.

Total gross area.


ow.

IMO

80401216 490

7, 735

ORO

2, 726

15

11

1

1

85

. .

1, 500

576400

100 I150

11, 7417, 827

19, 568

326. 1

47


1. Boyle, Rena E. "Critical Issues in Collegiate Education for Nursing."Nursing Outlook, 10 : 165) March 1962.

2. Bridgman, Margaret. Collegiate Education for Nursing. Russell Founda-tion. New York. 1953. 205 pp.

3. Bridgman, Margaret. The Development of Collegiate Education in Nurs-ing in the United States. From material prepared for the Department ofBaccalaureate and Higher Degree Programs. 1961.

4. MacManus, R. Louise. "Cost Estimates for Graduate Nurse Programs."Nursing Outlook, 8 : 198, April 1960.

5. Nagele, Margaret F. "Faculty Student Ratio in Nursing" : Part INurs-ing Outlook, 10: 9-3, September 1962. Part IINursiv Outlook, 10: 10-5,October 1962.

6. National League for Nursing. Arrangements Between an Institution ofHigher Education and a Hospital Concerning the Provision of HospitalFacilitts for College Education in Nursing. The League. New York. 1959.

5 PP.

7. National League for Nursing. Characteristics of Baccalaureate Educa-tion in Nursing. The League. New York. 1961. 3 pp.

8. National League for Nursing. Characteristics of Graduate Education inNursing. The League. New York. 1959. 1 p.

9., National League for Nursing. Criteria for the Evaluation of Programs inNursing That Lead to Baccalaureate or Master's Degrees. The League. NewYork. 1960. 17 pp.

10. National League for Nursing. Problems in Student Faculty Ratio. TheLeague. New York. 1962.

1L. U.S. Department of Health, Education, and Welfare, Public Health Serv-ice. Nurses for Leadership: The Professional Nurse Traineeship Program.Report of the 1963 Evaluation Conference. PHS Publication No. 1098.Washington, D.C., U.S. Government Printing Office. 1963. 53 pp. Price 40cents.

Chapter V

Practical Nursing Programs

SEVENTY-FIVE percent of the State-approved nurs-ing programs leading to a practical nurse certifi-cate are controlled by educational institutions oragencies. The majority are under State and localboards of education. The remainder are mostlyunder the control of hospitals, with the exceptionof about six which are under other communityagencies.


The practical nursing program which leadsto a certificate or diploma is usually 1 year inlength, self-contained, complete, and satisfactoryfor its own purpose, providing preparation ex-clusively for practical nursing. (California andTexas call these programs "Vocational Nurse Pro-grams" and license the graduates as Licensed Vo-cational Nurses.) This program's objective is toprepare a needed worker in nursing service whowill share in giving direct care to patients. Grad-uates of practical nursing programs perform twomajor functions :

1. Under the direction of a registered nurseor physician, they administer nursing care in situ-ations relatively free of scientific complexity.

2. In a close working relationship, they as-sist registered nurses in providing nursing care inmore complex situations.1

'National League for Nursing. Nursing Edvidation Pre-gram; Today. p. 9. (Item 2, Selected Bibliography,p. 57.)

182-486 0-64-5

Table 13. Number of approved programs, andthe admissions and graduations in schools ofpractical nursing, 1955-56 through 1961-62

Academic year Approvedprograms

Admissions I Graduations

1961-62

1959-601958-591957-581956-57195556

739692

606617520489396

26,66024,95523,06023,11620,53116,84315,526

18,10616,63516,49114,57312,40710,66610,641

Source: National League for Nursing, 1963.

APPROVAL

The appropriate State licensing authoritymust approve practical nursing ixograms. Thisapproval admits graduates to examination forlicensure as a practical nurse.


Table 13 shows the extent to which admis-sions to and graduations from practical nursingprograms ar increasing. Three-fourths of allstudents admitted complete the course. Th ma-jority of programs admit t -o classes annually.

CURRICULUM

The practical nursing curriculum includesinstruction in classrooms, in laboratories, in the

49

patient care areas of hospitals, and in other com-munity agencies. Included are related courseswhich provide a foundation for the nursing por-tion of the curriculum and nursing courses whichprepare the student for nursing practice.

The related courses cover the physical, bio-logical, behavioral, and social sciences. Theprinciples of science which apply to pra-fical nurs-ing are correlated and integrated into the nursingcurriculum.

The nursing courses are planned so thatstudents will receive instruction and experience inthe nursing care of medical, surgical, pediatric,obstetric, and psychiatric patients. The studentsare prepared to become proficient in caring for thepatient whose needs are relatively free from scien-tific complexity as well as in assisting the profes-sional nurse in a highly complex nursing situation.

The teaching methods used consist of aminimum of lectures, a high concentration of timein small group conferences, demonstration by theinstructor of nursing care to patients, and labora-tory practice by the student in administering pa-tient care. In the patient care areas in addition topatient care experience by the student, the instruc-tor will hold prenursing and postnursing careplanning conferences with the students. The in-structor also demonstrates care to the group andsupervises the care given by one or more students.The total class may be divided into groups androtated within the areas of nursing for instructionand patient care experience.

RESOUR;ES FOR PATIENTCARE EXPEDIENCE

Supervised experience in administeringnursing care to patients is an essential and vitalelement in nursing education. In addition to in-patient care areas in general hospitals, many pro-grams use other community health facilities suchas long-term care units, ambulatory outpatientfacilities, and nursery schools.

Practical nursing programs under the con-trol of hospitals have access to inpatient care areaswithin the hospital in which they are organized.All other programs must establish administrativeagreement with hospitals and other health agenciesfor the nursing experience the students will re-quire. Some hospital-controlled schools, lacking

50

certain facilities) will need to seek patient carefacilities in other agenciesusually communityrelated. The types of patients for whom thesefacKities may be needed are maternity, pediatric,aria psychiatric.

Programs organized under vocational edu-cation may use four or more agencies to arrangefor the patient care experience the student requires.Written administrative agreements between theeducational control of the program and the servicecontrol of the hospital and health agency definethe mutual responsibilities of each. These agree-ments are developed jointly and are subject toperiodic review.

Agreements usually specify that the schoolwill have control of the students' experience, ap-point the faculty to teach and supervise the stu-dents, and select the patients for the students' ex-perience. The hospital or health agency provides(1) facilities such as conference rooms and spacefor reference materials, (2) time for the instruc-tors and nursing service personnel to plan for thestudents' experience, and (3) a quality of nursingand medical care which makes it possible for stu-dents to learn good nursing care where it is beingpracticed,

FACULTY

The faculty consists of those whose fullresponsibility is to teach in the practical nursingprogram. The school may use resource personsfrom related professional groups including physi-cians, nutritionists, and social workers.

Needs and Goals

The Surgeon General's Consultant Groupon Nursing 2 estimates that in 1962 licensed prac-tical nurses totaled 225,000 and that by 1970 theneed will reach 350,000. To meet this goal, someexisting schools will and to expand and, in someinstances, new schools will need to be established.

2 U.S Department of Health, Education, and Welfare,Public Health Service. Toward Quality is Nursing.(Item 6, Selected Biblio:;kaphy, ch. II, p. 17.)


Before the architect will be able to developan adequate building program in keeping withcurriculum requirements, he should be providedsuch information as : (1) the student enrollment;(2) educational program; (3) space requirementsfor instruction, faculty and administrative offices,

and supporting areas. This information should beset forth in a written program developed by abuilding committee, assisted by the program direc-tor and the nursing faculty.

Historical and current trends indicate in-evitable expansion of facilities to meet increasingdemands for graduates from practical nursingprograms. Failure to consider the requirementsfor long-range as well as immediate needs willresult in increased construction costs and poorfunctional arrangements when expansion occurs.

The decision to expand an existing schoolor build a new facility should be made only aftercareful consideration of such factors as the em-ployment demand for practical nurses and theprobability of recruiting sufficient qualified ap-plicants to make the establishment of the programworth while. Of equal importance is the need toassure continuing financial support, and the avail-ability of qualified faculty and adequate patientcare facilities. State boards for practical nurseeducation and licensure as well as State and localboards of education should be consulted to assurethat curriculum planning will meet legal and regu-latory requirements.

The curriculum is the basis for the develop-ment of the functional and building program. Atleast 1 year will be required for this programing.

In practical nu, sing programs admittingonly one class per year, the maximum total enroll-ment will be the new admissions at the beginningof the academic year. If two or more classes areadmitted in 1 year, the increase in enrollments mayrequire additional classroom space.

To provide flexibility for future expansion,it is recommended that (1) lecture rooms beplanned to accommodate the maximum enrollmentprojected, (2) the number of small classrooms besufficient to permit scheduling additional sectionsas enrollments and faculty increase, and (3)architectural design and engineering incorporate

features which, when necessary, can be modified toaccommodate future changes in the program andin teaching methods.

TEACHING SPACE

Teaching methods commonly used that re-quire architectural planning include lecture, stu-dent conferences, demonstration, and films. Theuse of slides and other audiovisual aids must beconsidered. The teaching space to be planned willinclude lecture, class, multipurpose and conferencerooms, and libraries.

Lecture-Demonstration Roont.--A largelecture room to seat the total admissions may beneeded for some courses. If space for patient caredemonstration is included, this room may be usedfor nursing courses. Where only lecture anddemonstration are to be used as teaching methods,fixed seating for large groups can be accommo-dated in a single classroom.

Classroonw. C our s e s requiring studentparticipation should be held in small rooms havingmovable seats. The school should determine theoptimum size of such groups, so that the numberof rooms needed can be established.

Multipurpose Room. Students must de-velop skills in caring for patients and in handlingequipment used for patient care. After demon-stration by the instructor, students in practicalnursing programs have supervised practice inlaboratories that simulate the patient care areas ofhospitals.

Conference Rooms Conferences with asmall group of students assigned for a specific typeof patient care experience are frequently scheduledin the educational unit.

Science Laboratory.While students in thepractical nursing curricula have instruction inbody structure and functions as well as principlesof chemistry and biology, these are not organizedas are the science courses in other nursing pro-grams. The required science content is integratedinto the nursing courses. Science laboratories aretherefore not required for practical nursingprograms.

Nutrition Laboratory.The principles ofnutrition for patient care are included in the nurs-ing courses. Laboratory practice for food prepa-

51

ration is seldom included. Many schools planningnew facilities are omitting nutrition laboratories;other schools are converting nutrition laboratoriesinto classroom or office space.

Library.Practical nursing programs re-quire library resources available to students whenthey are in the educational unit and within thepatient care practice areas. Programs organizedin hospitals may include the practical nurse refer-ence material in the hospital library. Programsin vocational schools use the school library forhousing practical nurse reference materials.

In addition to the central library, all pro-grams require a limited number of current refer-ence books in the patient care areas. These maybe placed at the head nurse's station or in the nurs-ing conference room. Where multiple patient carefacilities are used for nursing practice, duplicationof this type of reference material will be necessaryand methods for its transportation provided.

Storage space for educational aids that arespecific to nursing such as anatomical models andcharts is needed in the nursing educational area.

FACULTY SPACE

Conference Room. A room for facultymeetings, conferences, and work groups is neededin the educational unit. The size of the group andthe frequency of meetings will determine whetherother space may be used or whether a specifiedroom is required.

Oflice8.Since privacy is a fundamental re-quirement for faculty offices, each office should bebuilt to accommodate only one faculty member.To determine office requirements as enrollments in-crease, it is recommended that for teaching in thepatient care areas in relation to such clinical nurs-ing courses as medicine, surgery, obstetrics, andpediatrics, a ratio of 1 instructor to 10 studentsmay be used as a planning factor.

This does not mean that 1 instructor willnecessarily supervise 10 students in patient carepractice. An instructor may demonstrate andsupervise patient care for one student with onepatient or she may have two groups of four or fivestudents within the patient care area. Factorsaffecting the number of faculty needed include theteaching methods and the number of agencies andpatient care units used for student experience.

52

The annual admissions and the total enrollmentswill indicate the number of faculty needed.


The administrative space includes offices forthe program director and her secretary; a lobbyreception area for visitors; space for clerk-typists,and areas for storage. Also needed is space forduplicating educational materials, registering andadmitting students, providing student health serv-ices, and controlling communications.

Practical nursing programs in vocationalschools are organized under the control of boardsof education; hospital programs are controlled bythe hospital. Each program will require the com-plete range of administrative functions. How-ever, the extent to which any one program providesfacilities for the total administrative functionswithin the educational unit will be determined bythe control of the program.

Programs organized in vocational schoolswill centralize the administrative functions com-mon to all programs in the school. Examples ofthese functions are student health, registrar ac-tivities, public relations, publications, fiscal man-agement, maintenance, and housekeeping. Person-nel functions for faculty and supporting personnelare also centralized in educational institutions.

Practical nursing programs organized in ahospital will need to assure that space for all ad-ministrative functions is provided.

SUPPORTING SPACE

Lounges and lockers are necessary in theeducational unit if students and faculty mustchange from street clothes to uniforms. Space isalso needed for janitors' closets, toilets for visitorsand students, mechanical equipment, corridors,vending machines, and public telephones.

STUDENT HOUSING

Practical nursing programs under hospitalcontrol frequently admit both resident and daystudents. If a student residence is provided ad-jacent to the educational unit, the lobby receptionarea might possibly be shared. Locker space forstudents in residence may be omitted, but suffi-

cient locker and lounge space to accommodate theday students must be planned.

PATIENT CAREEXPERIENCE AREAS

Conference Rooms. Students enrolled inclinical nursing courses will be assigned in smallgroups for patient care experience in medicine,surgery, pediatrics, psychiatry, and other areas.Patient care planning conferences are an integralpart of this experience. These conferences arescheduled while the student is assigned to the pa-tient care area. If the nursing educational facilityis close to the hospital or health agency, conferencerooms in both areas are available for scheduling.

If conference rooms on patient units in hos-pitals are assigned to nursing service, they may be

made available for conferences with nursing stu-dents during certain hours of the day. These con-ference rooms should provide for flexible seatingarrangement, reference materials, and the use ofaudiovisual teaching aids.

Lockers.Students and faculty will requirelocker space in the hospital. Programs organizedunder hospital control may omit lockers in the hos-pital if there is direct access from the residence tothe hospital.

Food Service. Students and faculty fromvocational school programs will use the food serv-ice of the hospital when they are in the hospitalfor patient care experience. Resident students inprograms organized within the hospital obtaintheir meals in the employee dining room.

PROFILE OF PRACTICAL NURSING PROGRAMS

THE REMAINDER of this chapter presents a profileof a typical practical nursing program organizedeither in a vocational school or in a hospital.These profiles, offered as a guide, should beadapted to comply with each school's needs.

Size of School. Each school admits 48 stu-dents once a year. A nurse director administerseach program which has five full-time nursefaculty members, one secretary, and one clerk-typist. In the hospital program the secretary andclerk-typist also carry out the functions of theadmissions' clerk and the registrar. These func-tions are shared by all programs organized in thevocational school.

Space Requirements

As shown in table 14, the total net usablespace for the program in a vocational school isestimated as follows:

Space Square feet

Teaching 5, 368Faculty 500Administrative 580Supporting area 1, 825

Total 8, 273

As shown in table 15, the total usable spacefor a program organized under the control of aHospital is estimated as follows :

Spade Square feetTeaching 5,368Faculty 500Administrative 780Supporting area 1, 265

Total 7, 913

Operating Budget

Cost data that could be used to project an-nual operating budgets for practical nursing pro-grams are not available at this time. Althoughrecent studies 8 have reported expenditures byprograms under educational or hospital control,many items necessary for an operating budget arenot included. For this reason, no attempt wasmade to project annual operating costs.

a National League for Nursing. Education for PracticalNursing. p. 47. (Item I, Selected Bibliography, p. 57.)

53

Table 14. Space requirements for a 1-year practical nursing program in a vocational school withan entering class and enrollment of 64

Spaces


Numberof

TOMS

Group Totalsize, neteach arearoom (sq. ft.)

Remarks

Teaching


MOMSStorage-teaching aidsReference-reading roomLibrary

Faculty

OfficesLoungeToilets and lockers

Administration

5, 368

112

111

64 1, 60036 64S16 600 Additional required in hospital.

2, 000 8 beds.120

18 400Shared.

500

5 1 500School faculty lounge.Shared.

Reception and general office 1

Storage area 1

Duplicating areaDirector's office_ 1

Registrar's officeAdmissions officeStudent counselor's officeStudents' health serviceStaff lounge_Washroom, toilets, and lockersVisitors toilets:

MenWomen

Supporting

2

1

=NO

NM.

580

16080

340Shared.With coat closet and toilet.Shared.Shared.Shared.Shared.Shared.Shared.

Shared.Shared.

MMI 1, 825

Students' toilets:Men 1

Women 1

Students' lounge 1

Lockers

Janitors' closets I 1

Coat alcovesVending machinesTelephone boothsDrinking fountainsGeneral storage 1

NM.

180 2 waterclosets, 2 urinals, 2 lavatories.180 4 waterclosets, 4 lavatories.400400 1 full-size locker for each new student and

each staff member.40 Or as required.25 Or as required.

As required.As required.Minimum of 2 recessed or as required.

600

8, 273 Total net area.5, 515 For walls, partitions, corridors, stairs, and

mechanical space.

13, 788 I Total gross area.

215. 4 Area per enrolled student.

54

Table 15. Space requirements for a 1-year practical nursing program in a hospital with Gn enteringclass and total enrollment of 64

Spaces


Numberof

rooms

Group Totalsize, neteach arearoom (sq. ft.)

Remarks

Teaching


MOMSStorage-teaching aidsReference-reading roomLibrary

Faculty

Offices

Administration

112

111

643616

16

5, 368

1, 600648600

2, 000120400

Lobby-reception area 1

Storage area 1

Duplicating areaDirector's office 1Staff lounge and washroom 1

Toilets and lockers

Supporting..

2

1

500

500

780

16080

340200

1, 265

Students' toilets:Men 1Women 1

Student? lounge 1Lockers

Janitors' closets I 1Coat alcovesVending machinesTelephone boothsDrinking fountainsGeneral storage 1

1801840101004025

600

7, 9135, 275

13, 188

206. 06

Additional required in hospital.

8 beds.

Shared with a hospital.

Shared with hospital.With coat closet and toilet.

2 waterclosets, 2 urinals, 2 lavatories.4 waterclosets, 4 lavatories.

Or as required.Or as required.As required.As required.Minimum of 2 recessed or as required.

Total net area.For walls, corridors, partitions, stairs, and

mechanical space.

Total gross area.


55

TEACHING SPACES

TEACHING SPACES

10' 5 0 10 30'

SUPPORTING SPACES

TEACHING SPACES

26

ADMINISTRATION27

25 24

TEACHING SPACES

15

16

7

17 f 18119

20

10' 5 0 10 30'leO!!

SUPPORTING SPACES

I. CLASSROOM 15. STUDENTS' LOCKER ROOM I. CLASSROOM 15. STUDENTS' LOCKER ROOM2. MULTIPIIRPOSE ROOM 16. STUDENTS' LOUNGE 2. MULTIPURPOSE ROOM 16. STUDENTS' LOUNGE3. LECTUIX DEMONSTRATION ROOM 17. JANITOR'S CLOSET 3. LECTURE DEMONSTRATION ROOM 17. JANITOR'S CLOSET4-5. STUDENTS' CONFERENCE ROOM 18. VENDING MACHINES 4-5. STUDENTS' CONFERENCE ROOM 18. VENDING MACHINES6. REFERENCE READING ROOM 19. TELEPHONE BOOTHS 6. REFERENCE READING ROOM 19. TELEPHONE BOOTH7. STORE ROOM - TEACHING AIDS 20. M. TOILETS & WASHROOM 7. STORE ROOM - TEACHING AIDS 20. M. TOILETS & WASHROOM8. UTILITY ROOM 21. W. TOILETS & WASHROOM 8. UTILITY ROOM 21. W. TOILETS & WASHROOM9. STORE ROOM 9. STORE ROOM 22. MECHANICAL EQUIPMENT ROOM

FACULTY SPACES

10-14. FACULTY OFFICES

ADMINISTRATION SPACES

22. DIRECTOR'S OFFICE23. LOBBY-RECEPTION AREA

Figure 11. Space relationships of a practicalnursing progran in a vocational school.

56

FACULTY SPACES

10-14. FACULTY OFFICES

ADMINISTRATION SPACES

23. STAFF LOUNGE24. ADMISSION & REGISTRAR'S OFF.25. FILES & STATIONERY STORE ROOM26. DIRECTOR'S OFFICE27. LOBBY-RECEPTION AREA

Figure .12. Space relationships of a practicalnursing program in a hospital.


1. National League for Nursing. Education for Practical Nursing-1960.New York. The League. 1962. 63 pp.

2. National League for Nursing. Nursing Education Programs Today. NewYork. The League. 1961. 15 pp.

3. National League for Nursing. Statements Regarding Practical Nursingand Practical Nursing Education. New York. The League. 1962. 18 pp.

4. Orem, Dorothea. Guides for Developing Curricula for Education of Prac-tical Nurses. Washington, D.C. U.S. Government Printing Office. 1959.

165 pp.

5. U.S. Department of Health, Education, and Welfare, Office of Education.Curriculum, Development in Practical Nurse EducationA Report of Sevenintraregional Conferences. Washington, D.C. U.S. Government PrintingOffice. 1961. 100 pp.

57

Chapter VI

Architectural Considerations

A CAREFUL analysis of the needs and objectives ofthe proposed facility for nursing education is anessential prerequisite to the development of anadequate architectural design. This analysisshould be expressed in a functional program andshould contain such information as the relation-ship of the proposed facility to other similar andrelated facilities in the area, special characteris-tics of the curriculum, a listing of the specific sub-jects to be taught and some of the special require-ments necessary to teach them, schedule of classes,and information about the staff and the proposedstudent body. This usually is the responsibility ofthe sponsors, consultants, and the staff.

After the functional program has been de-termined, a building program should be developed.The building program will contain more specificinformation regarding the kinds and number ofclassrooms; student enrollment by classes; thenumber of offices, locker spaces, and service areas;the kinds of equipment; and other relevant infor-mation covering such considerations as lightingrequirements, sound control, and audiovisual aids.

If the architect is engaged from the outsetof planning, he will be able to contribute greatlyto the program's development. He can suggest

many aspects to be considered by the sponsors sothat adequate provisions may be made in. planning.He can also advise in regard to site problems whichmay occur.

An important planning consideration isthat the facility express its own identity as a co-hesive unit, whether as a separate building, a wingof a building, or a floor in a large building.

The physical essentials of the various spacesrequired for any type of program of nursing edu-cation are briefly described in this chapter. Allthe spaces noted, however, are not necessarily re-quired for all programs. Moreover, many of thespaces may be used in conjunction with other de-partments of a community college, a university,or institution to which the nursing education pro-gram is related. Where possible, variations arenoted.

The diagrams of teaching spaces are onlysuggestive of one method of arranging thesespaces. The final scheme used by a nursing edu-cation program will depend on its particular needsexpressed in the written program. The degree towhich the architect can effectively design a facilitydepends largely on how thoroughly the functionalprogram of the proposed facility was prepared.

SPACE REQUIREMENTS

ALTHOUGH EACH nursing education facility willfind it necessary to determine its own space re-quirements in light of its own needs, the spacesrequired by most schools might be grouped under

58

seven categories. These categories include : teach-ing spaces, research facilities, faculty offices, ad-ministrative unit, students' facilities, supportingareas, and continuing education.

I.

Teaching Spaces

LECTURE-DEMONSTRATION ROOMS

The lecture-demonstration room (figs. 13,14, and 15) is used for the purpose implied in itsname. Factors to be considered in determiningphysical dimensions are requirements for the fol-lowing : (1) teaching station, (2) demonstrationarea, (3) seating area, (4) projection space orroom, and (5) storage closets. A brief descriptionof each follows :

Teaching Station.The teaching stationshould be equipped with chalkboards, tackboards,projection screens, and map rails above to supportdiagrams and charts. Recent technological de-velopments in coated plastic-adhesive-back mate-rials for chalkboards should be investigated sincetheir use may reduce costs.

Demon8tration Area.The demonstrationarea in front of the teaching station should belarge enough to permit the use of equipment suchas an adult-size bed or movable sectional counterunits which have locking wheels. These units,which have storage space underneath,, providegreater flexibility than fixed counters, since theycan be assembled into any arrangement or lengthand can be stored elsewhere when not in use.

A lavatory will be needed in the lecture-demonstration area for use whenever a patient caredemonstration is presented. The doors into thisroom should be a minimum of 3 feet 8 inches wideto provide an adequate passageway for a bed andother equipment used during a demonstration.

Seating Area.Since good visibility of theinstruction and demonstration area should be as-sured from all seats, a stepped floor should be con-sidered. Steps should be so designed that eachsight line misses the row ahead by 4 inches. Fixedseats equipped with hinged or removable tabletsupport for writing are recommended. Ten per-cent of the seats should be for left-handed students.

Projection Room.A projection room sepa-rated from the classroom is desirable because iteliminates such disturbing factors as noise andlight. However, certain disadvantages of a sepa-rate projection room such as the need for an opera-tor and for communication facilities between theoperator and the instructor should be considered.

In lieu of a projection room, a console forprojection equipment is a good compromise. This

console will contain all lighting and projectioncontrols and will have locked storage space forequipment when not in use.

If such a room is provided, it may also beused for editing and storing material to be pro-jected. Provision, therefore, should be made forcounters with storage space underneath. One ofthe counters should have a sink. Open shelves orwall cabinets with glazed doors may be providedabove the counters.

The projection wall should have two smallwindows so that two projectors can show twoimages on the screens simultaneously. The widthof the screen should be approximately equal toone-sixth of the distance to the last row of seats.Projection screens can be the rollup type, eithermanually or mechanically operated, or the fixedtype. Mechanical operation, although noisy, pre-vents accidental damage to the screen.

Storage Closets, Storage closets withstandard height doors may be provided. Amongother things, skeletons and full-scale models of thehuman body may be stored here if there is no cen-tralized storage.

CLASSROOMS

The classroom (see fig. 16) should providean optimum setting for communication betweenthe instructor and the students.

The room's shape and size should permiteasy visibility of written material on the chalk-board as well as the projected image on the screen.The need to maintain as close a verbal distance aspossible between students and the instructorshould also be considered.

Acoustical treatment to support verbal com-munication and sound insulation to prevent thepenetration of outside noises must be consideredin selecting structural and finish materials.

In addition to the floor area required forseating, space should be allocated for teaching anddemonstration and for mounting a projector.(Advantages and disadvantages of a separate pro-jection room were noted in the section entitled"Projection Room.")

If central storage of such teaching aids asskeletons and full-scale models of the human bodyis not provided, storage closets will be required inclassrooms.

A lavatory should be provided in the roomnear the teaching station so that it will be easily

59

4' 0' 4' 12'

Figure 13. Lecture-demonstration room (example a).

accessible for use whenever patient care is beingdemonstrated.

The classroom door should be a minimum of 3feet 8 inches wide to permit easy transportationof an adult-size bed which may be required fordemonstration.

Equipment which will be needed for class-rooms includes chalkboards, tackboards, and pro-jection screens. X-ray film illuminators, eitherportable or wall mounted, may also be used.

60

STUDENTS' CONFERENCEROOMS (TEACHING)

Student conference rooms will be requiredin all programs. (See fig. 16.) The number ofsuch rooms will depend on the anticipated enroll-ment. Major planning considerations include:

Seating arrangement at tables for groupdiscussions or lectures.

UPiiMECH.DUCT

°INEZ'S

4'-0"

Coat rod=Shelf above

COATS

3'-7 1/4"

3'-2 1/2"2'-10 1/4"

2'-6"

1 ' - 10 1/4"

S

WALL CABINETS ABOVE

COUNTER

Storage cabinets below

PROJECTION ROOM

MaCM

0 GO

Coat rod

Shelf above

COATS.

CEE

COUNTERStorage cabinets

below

II

' /

// 'C'HALICB°

MOVABLECOUNTER

ECTIONALTS

ROLL-UP PROJECTIONS SCREEN 'YE

ODDEDD

:

1_

ARDS

II

MECH.DUCT

Louvers

LAV.BED, IFREQ'ED.

COUNTER s(Storage cabinetsbelow

r SPEAKERS

4' 0' 4' 12'

Figure .14. Lecture-demonstration room (example b).

61

1

1

1

CORRIDOR

1

CORRIDOR

CORRIDOR

4' 0' 4'

r

12'

Figure 15. Lecture-demonstration, Toom at Texas Woman's University College of Nursing, Houston,Tex. (Freeman and Van Ness, Architects).

Placement of chalkboards and tack -boirds.Adequate sound isolation from one roomspace to another.

62

MULTIPURPOSE ROOM

The multipurpose room (see fig. 17) may beused for student practice of patient care as well

Figu

re 1

6.St

uden

qacu

lty a

reas

.

a

LEGEND

C.D. = CHALKBOARD

T.B. = TACKBOARD

as for classroom functions. Thus, the room shouldaccommodate the following :

1. Adult-size beds which may be separatedby curtains suspended from ceiling curtain tracks.

2. A medicine preparation area includingmovable sectional counter units (see fig. 17) andfixed counters located at the wall with sink andstorage cabinets underneath and wall cabinets withglazed doors above.

3. A handwashing demonstration unit anda minimum of three lavatory basins, with foot,wrist, or knee control.

4. Dressing cubicles. One method for pro-viding privacy is through the use of curtains sus-pended from ceiling curtain tracks.

5. Storage closets for small equipment,linen, charts, and diagrams. These closets shouldhave a full-size door and should be large enoughto store skeletons and full-size models of the hu-man body, if necessary.

6. Chalkboards, tackboards, projectionscreens.

7. Seating around tables for seminar-typelectures for 16 students.

8. Space for projector mounting.X-ray film illuminators may be used in all

teaching areas. They can be either wall mountedor portable. If portable, storage space should beallocated for them when not in use.

Utility Room.The utility room can eitherbe a part of the multipurpose demonstration roomor may be separated by a solid partition.

Although each facility must determine itsown specific equipment needs, the following built-in features are recommended :

(1) A counter with sink and storage under-neath with wall cabinets above, and

(2) Roughed-in plumbing to accommodatefuture fixtures.

SCIENCE LABORATORIES

Students enrolled in associate and baccalau-reate degree programs in nursing attend sciencecourses with other undergraduates. The trend indiploma programs is to purchase instruction in thesciences from a local junior college, a college, or auniversity. To avoid the unnecessary duplicationof expensive facilities, diploma programs shouldplan science laboratories only if such facilities arenot available from other institutions.

64

STORAGEROOM

F-11, I

L_J

a

E-1

Descriptionsame as Utility Room

MEDICINEPREPARATION AREA

Movable sectionalcomer units withstorage underneath

ICJ DI I

DJ 3I-0I

DI CD

0 DI g

<> El1=1

t

F-0"

IL- -jI _ =

MULTIPURPOSEI ROOM

L__JI

L.

4' 0' 4' 12'

C.B. = CHALKBOARDT.B. = TACKBOARD _

cs

Figure 17. Multipurpose room.

LIBRARY

Library facilities are required in all nurseeducation programs. Wherever feasible, a library

may be shared with other types of programs; how-

ever, the diploma school will usually have its ownlibrary. An example of library facilities for adiploma program is shown in figure 18.

The information presented in the remainderof this section is considered minimum for the needs

of a nurse education facility whether it is part ofa larger library or an independent library. Inany event, future expansion should be a majorplanning consideration.

Principal elements to be considered in de-signing a library include: (1) the library room;(2) the librarian's office; (3) the librarian's work-room; and (4) the storage area for audiovisualequipment and models.

Library Room

Reference and Study Area.Study spaceshould accommodate a minimum of one-third ofthe total student body. Reference tables may beprovided for one-half of these students and car-rels for the other half. Teaching machines maybe used in carrels.

The reference and study area should occupy

55 to 60 percent of the total floorspace of the li-

brary room.Service Area.Card catalog and circula-

tion activities should be located near the libraryentrance and reading area.

Storage Area.All nursing programsshould have an adequate amount of space forstacks to accommodate necessary titles and boundvolumes of periodicals. Appropriate filing ar-

11

gial

DISPLAY

LIBRARIAN'SCabinets

Workroom

RECEIVING c011

DESK

LMRA'N.

FilesLIBRARIAN'

OFFICE

Shelves

rangements should be provided for reports, pam-phlets, bulletins, microfilms, microcards, and pro-gramed material for teaching machines. For thediploma program, stacks should be provided fora. minimum of 3,000 titles and 1,000 boundperiodical volumes.

Librarian's Office

The librarian's office should be separatedfrom the library room by a glazed wall partitionor a view window to enable the librarian to over-see activity in the library. The office should besufficiently large to accommodate several peoplefor an informal conference and should be equippedwith necessary furniture including bookshelves,desk, and typewriter stand.

Librarian's Workroom

The workroom should be adjacent to thelibrary room and to the librarian's office. Directaccess should be provided into the corridor to per-mit easy deliveries by either a 3-foot 8-inch clearopening or double doors.

The room should include :Counter worktop with sink and storage

cabinets underneath; part of the counter shouldhave knee space underneath.

Storage shelves or wall cabinets above.Adequate number of electrical outlets.Space allocation for desk, worktables,

movable book carts.

Reference Reading Room

Nurse education programs which use adja-cent library facilities may need only a small

1/

Ell 1:11 01=7/1f -=.11' .-.=1./...-//0

BOUNDPERIODICALS

CATALOGS

1ID

01 El 01 01

DI 01 01

01 El DI ID

El DI 11: 13

REFERENCE TABFAS

11I

STUDY CARRELS

is

4' 0' 4' 12'

Figure 18. Library facilities for a diploma nursing program.

782-486 0 61 465

reference-reading room in the nursing educationfacility. Standard references and professionalperiodicals should be kept in this room wherestudy space should also be provided.

Equipment such as shelves, storage cabinets,reference tables, and seats around tables for 16people should be provided.

Storage Area

Some nurse education programs may wishto centralize all teaching aids under the librarian'ssupervision. Such a center is sometimes referredto as the Instructional Materials Center (IMC).If provisions for storing skeletons and full-scalemodels of the human body are not made elsewhere(i.e., lecture-demonstration room, classrooms, ormultipurpose demonstration room), a central stor-age facility should be provided. This room shouldbe placed close to the library and should beequipped with sturdy open shelving to hold heavyequipment In planning the space to be providedfor storing charts and diagrams, considerationshould be given the need for easy identificationand accessibility.

Full-scale skeletons and models of thehuman body, preferably mounted on a small cartfor easy transportation, should be stored in full-size closets. Small models of parts of the humanbody may be stored in wall cabinets with glazeddoors for easy identification. It may be prefer-able to store certain audiovisual items within theroom in which they are used. In addition, a gen-eral storage area or room is required, and pro-vision for storing teaching machines should bemade.

A building with more than one story willneed at least one service elevator for transportingheavy equipment.

Research Facilities

Research facilities will be required only bythe baccalaureate and graduate nursing educationprograms. Typical laboratory arrangements areshown in figure 19.

In some instances, nurse education pro-grams will need to develop research facilitieseither for graduate students or faculty members.The amount of laboratory space required dependsupon the type of research program offered.

66

Therefore, before architectural plans are devel-oped, the needs should be carefully evaluated anddefined by the faculty members airl others whowill use the laboratory facilities. The NationalInstitutes of Health study, Planning and Design ofMedical Research, Facilities, gives detailed labora-tory space requirements. (See item 13, SelectedBibliography, p. 77.)

The building program for research facili-ties will vary among schools since it must be basedon each school's individual requirements. Re-search facilities may include :

Biological science laboratories.Behavioral science laboratories.The data analysis room including officesand conference room.Multipurpose project room ( s) .

BIOLOGICAL SCIENCE LABORATORIES

Biological science laboratories will need thefollowing spaces :

Separate offices for each researcher.Storage or supply preparation room to

serve several laboratories, for equipment, glass-ware, and supplies.

Deluge shower and eye bath for emer-gencies.

Design factors to be considered for theselaboratories are :

Counters of different heights with kneespace underneath and reagent shelf. These maybe located along the walls or, if the space permits,an island-type counter similar to others should beprovided.

Chemical-resistant sinks with hot andcold water.

Gas, air, and electrical outlets.Fume hoods with adequate exhaust sys-

tem and sprinkler heads.A refrigerator or freezer may be needed

for these laboratories.It is assumed that the animals needed for

research will be supplied from a central location,since it would not be economically feasible toconstruct special animal housing facilities withinthe nursing education unit.

BEHAVIORAL SCIENCE LABORATORY

The primary requirement in the behavioralscience laboratory is that the human subject be

2 Mod. @ 4' -8"

Desk

si I

g"FUMES

HOOD

I

I

Ammis pomi2-person laboratory

4 Mod. 4'-8"

2 Mod. @ 4' -8"

Description as above

I

1

4

41

Locker(rY13)

TiDesk(TSP.)

lCSherY1)ves.)

4 study cubicles

3- or 4-person laboratory

r

4 Mod. 4' -8"

2 Mod. V -8"

Desk

I sink I

L

4

1

1

Sink FUME,/HOOD


4 Mod. 4' -8"

Desk

FileCab.

Description as above


HOOD.

4' 4' 8'

Figure 19. Typical research laboratory arrangements.67

observed unobtrusively by the students. (See fig.20.) Thus, the following design factors shouldbe considered :

1. The laboratory should be large enoughto accommodate a bed and various patient care ac-tivities. Space is also needed for research person-nel and equipment.

2. An adjacent observation room with aone-way viewing glass partition will provide anoverall view of the laboratory. The one-wayviewing glass partition should 'be double glazedwith sealed airspace between the glass to insuresound isolation between the two rooms. The view-ing screen should be unobtrusive floor-to-ceilingpanels rather than a view window which in itselfmay suggest its purpose. Not all panels need betwo-way glassonly those necessary for viewing.

3. The observation room should accommo-date 16 students. A stepped seating platform,either permanent or temporary, might be con-sidered to assure all the participants a good over-all view of activities within the laboratory. Sincethe subject should not be disturbed while beingobserved, observation rooms should be carpetedand should have sound-absorbing materials onwalls and ceilings.

4. Provision should be made for communi-cation facilities between the two rooms as well asfor concealed recording and audio and physio-logical factor monitoring equipment.

5. Both the behavioral science laboratoryroom and the observation room should be equippedwith a dimmer switch to control the illuminationlevel. Temperature and humidity controls arealso important.

6. Facilities which should be directly acces-sible from the behavioral science laboratoryinclude :

Toilet room with lavatory for hand-washing.Kitchenette or alcove with kitchen ac-commodations.Storage room for storing equipment suchas children's toys.

In conjunction with behavioral science lab-oratories, the following should be considered :

1. Waiting room or area, suitably furnishedfor adults or adults with children.

2. Play nursery for children with provisionto oversee the activities from the waiting room.

68

Rau I-TT13"

I 1 1 1 1 l I I I

MONITORINGEQUIPMENT

OBSERVATION ROOM

One-way viewing glass partition - double glazingacoustic insulation above ceiling

BEHAVIORAL SCIENCE LABORATORY

U

OBSBRV. RM.

One-way viewingglass partitions

INTERVIEWROOM

ornoc=noEn

0 Duppou<>CONFERENCE ROOM

4' 0' 4' 12'

C.B. = CHALKBOARDT.B. = TACKBOARD

Figure 20. Behavioral science laboratory fora nursing graduate program.

Special attention should be paid to acousticaltreatment of this room and its decor.

3. Interviewing rooms, with adjacent ob-servation room, separated by one-way glass view-ing partition. (Items 2-5 cited above also applyhere.)

DATA ANALYSIS ROOM

The data analysis room will require spacefor calculating machines, tables, and office-typefurniture. Area allocation should be made forstoring data. Other requirements include indi-vidual offices and a conference room that can beused by research personnel.

Faculty Offices

Faculty offices may be grouped together toform the faculty offices suite. In programshaving a small faculty, administrative and busi-ness offices may be grouped together with facultyoffices forming a unit that is separate in characterfrom the teaching spaces. (See fig. 16.) Inaddition to offices for each faculty member, oneor more offices might be provided for guest lec-turers or visiting faculty.

The faculty offices suite should include :

Individual offices for each faculty mem-ber. Each office should have ample space forfurniture, bookcases or shelves, and files.

Conference room or rooms. The size ofthe conference room depends on the number ofpeople to be accommodated. Chalkboards andtackboards are necessary in these rooms.

Faculty lounge. An alcove or smallroom off the lounge may be provided to accommo-date a kitchenette unit and a counter with sink andstorage cabinets underneath.

Toilet facilities including a washroomand locker room or lockers, located in proximityto the lounge or adjoining it. An alcove offthe washroom or small room accommodating asofa, cot, or other suitable furniture might beconsidered.

Graduate assistants' office. This roomshould be furnished with desks for use of teach-ing assistants or graduate assistants.

In addition to the teaching machines lo-cated elsewhere in the school for students' use,some teaching machines may be needed in thefaculty office suite for use by members of the fac-ulty who may be engaged in developing pro-gramed materials.

Administrative Unit

The administration needs of a nursing edu-cation program may range from nominal to totalservices, depending upon its relationship to a col-lege or university that permits the use of existingadministrative services.

The administrative unit should preferabL,be separate from teaching space in order to sepa-rate the two different kinds of traffic. Moteover,the space in this unit should lend itself to possiblefuture rearrangement, with minimum of disturb-ance and cost.

OFFICES AND ANCILLARYSUPPORTING AREAS

Requirements for office space and for sup-porting areas and services will vary from schoolto school. Each program, therefore, should de-termine its particular needs. Some of the spacesto be considered include :

1. A lobby and reception area with an in-formation desk as a point of control. The in-formation desk or counter may be incorporatedin the general office. In small schools the lobbyor reception area may also be the secretary's of-fice and the secretary may also be the receptionist.Toilet facilities for visitors should be convenientlylocated.

2. General office including space for secre-tarial staff. The amount of space needed will bebased on the ratio of secretaries to faculty mem-bers established by the school's policy.

3. Space for filing cabinets for the stu-dents' active records. This may be either a partof the general office or a small room directly ac-cessible from the general office. A storage areashould be provided for inactive files. Programsorganized under hospital control must providespace for permanent storage of student and schoolrecords.

69

4. Space for duplicating equipment includ-ing a counter with sink and storage cabinets under-neath. This space may be either an alcove in thegeneral office or a small room directly accessiblefrom the general office.

5. Storage room for stationery directly ac-cessible from the general office.

6. Small room for receiving, dispatching,and distributing mail and packages. This roomalso may serve as a message center for facultymembers.

7. An intercommunication control system(switchboard) within the general office. Inter-communication between the rooms within thefacility for nursing education is highly desirable.Outside calls should be handled by one personwho would transfer them to the party concernedor, when necessary, take messages.

8. Wall space should be allocated for of-ficial bulletin boards either in the lobby waitingarea or outside the general office.

9. Storage room for miscellaneous officeequipment or furniture.

10. An office for the dean or director. Theoffice should be large enough to accommodate sev-eral people for small conferences. A privatetoilet room with handwashing facilities and a coatcloset adjacent to this office is highly desirable.(See fig. 16.)

11. An office for a secretary adjoining oraccessible to the office of the dean or director.

12. Office or offices for assistants or asso-ciates of the dean or director. These offices shouldeither be adjacent or in proximity to the office ofthe dean or director.

13. Office for registrar with ample spacefor filing cabinets.

14. O =we for admissions officer with amplespace for filing cabinets.

15. Students' health service and observationarea.

16. Office for students' counselor, incor-porating waiting area.

17. Office for graduate assistants and fel-lows, each of whom should have a desk.

18. Janitors' closets and storage space ofhousekeeping supplies.

ADMINISTRATIVE STAFF LOUNGE

The physical size of the lounge will dependon the number of personnel to be accommodated.

70

In a relatively small school, one lounge shouldserve both the administrative personnel andfaculty.

An alcove or a small room off the loungemay be provided to accommodate a kitchenette unitand a counter with a sink and storage cabinetsunderneath.

A toilet room, washroom, and locker roomshould be provided in proximity to the lounge oradjoining it. An alcove off the washroom or asmall room having a sofa or cot or other suitablefurniture might be considered.

Students' Facilities

Provision of student facilities should begoverned by such factors as enrollment and theschool's physical setting. Whether the facility isa self- contained unit or is a part of a larger educa-tion complex is an important consideration. Theneeds should be evaluated and established individ-ually for each program.

Spaces for the following should be con-sidered :

Toilet room and washroom for womenstudents with adjoining room or alcove to accom-modate a sofa or cot.

Toilet room and washroom for male stu-dents, if any.

Locker rooms or lockers in corridors.A student lounge may be found desirable,

particularly if no other lounges in the facility areavailable to nursing students. A lounge may beprovided in the students' residence which may bephysically connected with the nursing educationfacility. In some facilities, students' lounge orlounges are provided, either in the student unionbuilding or elsewhere on the college or universitycampus.

Supporting Areas

Listed below are planning considerationsfor supporting areas :

The provision of coat alcoves in corridorsmay be desirable.

The need for general storage roomsshould be determined by each program.

Housekeeping and maintenance rooms,including janitors' closets and storage areas forhousekeeping supplies and equipment, will beneeded.

Space should be allocated for vendingmachines either in alcoves of corridor or central-ized in one room assigned for this purpose.

An adequate number of public pay tele-phone booths should be located in strategic loca-tions in alcoves off corridors so that traffic will notbe obstructed.

An adequate number of drinking foun-tains or water coolers should be placed in alcovesoff corridors or recessed in the wall so that trafficflow will not be obstructed.


Continuing education is usually a part ofthe overall school facility. However, for the pur-poses of nursing education it would have the fol-lowing elements :

Assembly room to seat a large group.Conference rooms.Lounge room and space for coffee service.Reception and registration area.Men's and women's toilets.If warranted, offices for the continuing

education director and staff.

ASSEMBLY ROOM

The number of people to be accommodatedin the assembly room will depend upon the indi-vidual facility. In general, provision should be

made for 100 or more persons, seated along rowsof tables or groups of sectional tables. A movableplatform to elevate the speaker should be con-sidered.

If found desirable, this room may be sub-divided into from two to four conference spaces bymeans of folding partitions which should prefer-ably stack up in a wall alcove designed for thispurpose. They should be selected for maximumsound-retardant properties to limit the passage ofsound from one space to the other. Sound reduc-tion of at least 25 to 30 decibels is consideredminimum. These conference spaces should havechalkboards and tackboards.

CONFERENCE ROOMS

In some institutions it may be desirable notto subdivide the assembly room, in which case fouror five small conference-type rooms should be pro-vided, each to accommodate from 20 to 25 persons.These rooms should have separate entrances,should be equipped with chalkboards and tack-boards, and should be arranged with seats aroundtables for face-to-face conferences.

RECEPTION AND REGISTRATION AREA

Definite allocation for the reception andregistration area should be made. Coat room oralcove for depositing the outer garments shouldbe incorporated.

Lounge Roont.A lounge room should beprovided large enough to accommodate the antici-pated number of participants in the ContinuingEducation Program. An alcove accommodating akitchenette unit, counter for coffee service, andvending machines may be considered desirable.

An adequate number of toilets should beconvenient to this area.

LIGHTING

Lighting should be considered as one of thetools of architectural design through which thefollowing functional characteristics may beachieved :

1. Visibility (influenced by the amount,color, distribution, and control of light).

2. Comfort (elimination of glare andstrain).

3. Composition (layout of light fixturesarchitectural esthetics).

4. Atmosphere (psychological effects).Illumination requirements in teaching and

study areas include :

71

1. Local illumination of the instructor'sstation, chalkboards, and display areas.

2. Lighting of the table surface for takingnotes.

3. General background lighting on wallsand ceiling.

The objective in any educational facilitylighting program is to produce a visual environ-ment in which seeing may be accomplished effi-ciently and without hindrance or distraction fromany part of the luminous elements of that environ-ment. Adequate levels of illumination with prop-erly balanced brightnesses help the educationalprocess by improving visibility, by reducing visualfatigue, and by helping create a cheerful andand pleasant atmosphere.

The multipurpose demonstration and lec-ture rooms should have a comfortable generallighting system which provides a moderately highillumination level for general use and a subduedlevel for use during projection or special demon-strations. This can be accomplished with dimmercontrols. If a demonstration table is used, spot-lights should be aimed down on the table and thelecturer. These spotlights should be located with-in. a 45° to 60° angle above the horizontal line ofvision measured from the probable location of aspeaker's head when he stands behind the table.This arrangement assures minimum glare andgood lighting on the speaker's face. A low light-ing level confined to the audience area for use infinding seats and taking notes is also necessary.This lighting may be provided from direct light-ing unitsi well shielded from the audience andcontrolled so that light does not strike the pro-jection screen when it is in use. Dimmer opera-tion on the various circuits is desirable. If thisarea is to be used as a study hall, the level of il-lumination recommended for the task should beprovided.

Chalkboard lighting should meet twobrightness criteria. Chalkboards should be lightenough to blend in well with their background anddark enough so that chalk writing has sufficientcontrast to assure good visibility. A chalkboardshould be measured for reflectance with a typicalamount of chalk film on its surface. Coloredboards should not exceed 20-percent reflectanceand blackboards 10-percent reflectance under typi-cal use conditions.

The writing on the chalkboard used by theinstructor as a visual teaching aid should have a

72

high degree of visibility. In the college field, itis not uncommon for a student to be seated beyond50 feet from the instructor's chalkboard. For thisreason, the instructor's board should be providedwith supplementary lighting in the range of 150foot-candles on the task.

Beeeptaeles.In general, receptacles shouldbe of the type and current rating required and in-stalled at a location convenient for use at all loca-tions where plug-in service is required. In thedemonstration area the receptacle outlets shouldbe spaced for convenient use at any place alongthe walls as directed or along the risers in lecture-demonstration rooms. Grounding-type recepta-cles are recommended for use in all locations.

Concluits.Provision should bemade for such items as raceways, communicationconductors (between teaching station and projec-tion room), and television coaxial cables, even ifthere is no immediate need. If provisions are notmade for these items during the initial planningstage, any future installation may prove costly.

Levels of Illumination Currently Recommendedfor Specific School Areas

(Minimum on the task at any time) 1

Foot-aandle8Area on ta8k8

Auditorium :Assembly only 15Exhibitions 30Social activities 5

Classrooms :Laboratories 100Lecture rooms :

Audience area 70Demonstration area 150

Study halls 70Typing 70

Corridors and stairways 20Library :

Reading room :Study and notesOrdinary reading

StacksBook repair and bindingCatalogingCard filesCheck-in and checkout desks

Lounges:General 10Reading books, magazines, newspapers 30

70303050707070

See footnote at end of table.

AreaOffices :

Accounting, auditing, tabulating bookkeeping,business machine operation, and reading poorreproduction 150

Regular officework, reading good reproductions,reading or transcribing handwriting in hardpencil or on poor paper, active filing, indexreferences, mail sorting 100

Reading or transcribing handwriting in ink ormedium pencil on good-quality paper, inter-mittent filing 70

Reading high contrast or well-printed material,tasks and areas not involving critical or pro-longed seeing such as conferring, interview-ing, and inactive files 30

Parking areas 1

Storerooms :Inactive 5

Active :Rough bulky 10

Medium 20

Fine 50

Foot-oandleson twice"

See items 1 and 2, Selected Bibliography, p. 76.

Occasionally, locaLl lighting is needed tosupplement the general illumination. This isgenerally the case when it is economically un-feasible to produce the recommended foot-candlelevels from a general lighting system. If theseeing task is on oblique rather than horizontalsurfaces, the illumination is reduced, resulting ina loss in task brightness. Also, some of the seeingtasks are more difficult because the contrast be-tween the paper and the printing may be low. Inboth of the foregoing cases, supplementary illumi-nation is sometimes required or indicated. Careshould be used in the choice of supplementarylighting units, so that they will not direct ob-jectionable glare into the eyes of any student.The distribution of the light across the workingsurface should be as uniform as possible.2

2 Idtuminating Engineering Society Lighting Handbook,pp. 11-21. ( See item 6, Selected Bibliography, p. 76. )

MECHANICAL FACILITIES

THE DESIGN standards for mechanical facilities formost areas of the school are well established andpresent no particular problem. However, not sowidely understood are the designs for the environ-ment, safety requirements, and utility services forsuch areas as the laboratories.

Since air conditioning is an accepted in-stallation in modern buildings, nursing schoolsshould not be an exception. The school environ-ment is important in achieving student and staffcomfort, efficiency, and health, and a good environ-ment will assist in attracting teaching personneland students. With the exception of the northern-most part of the United States, heating, ventila-tion, and humidity control can beprovided with anair system. The combining of ventilation, heat-ing, and cooling into one air system is not onlyeconomical in cost but also provides more work-space within the building. Sufficient room shouldbe provided in mechanical spaces to properly serv-ice and maintain the equipment.

Heating, ventilation, and air-conditioningsystems in the school should be controlled inde-pendent of those systems in the hospital becauseof the short hours the school will be in use. Tern-

perature and humidity within the comfort zonewith a well-defined pattern of air movement isnecessary to provide an acceptable environmentwithin the school and especially in the science

laboratories.The mechanical facilities must be designed

to accommodate the changes in teaching contentand methods, and the rapid and continuing de-velopments of new types of equipment that serveboth teaching and research. The changing condi-tions will require ingenuity in design to providea flexibility and capacity in service systems whichwill permit frequent changes in the services with aminimum of disturbance and expense and a po-tential for future expansion of the facilities.

The design standards relative to tempera-ture, humidity, and ventilation for some areas ofthe school such as amphitheater, lecture rooms,and offices are well established and in most in-stances will be governed by local, State, and na-tional codes. Not so widely understood are thedesigns for utility services and environmental andsafety requirements for such areas as teachinglaboratories, research laboratories, and their

73

auxiliaries and facilities for highly specializedsubjects.

Of utmost importance in the design 432 the

systems are four basic considerations, namely : lo-cation of the systems to provide easy accessibility ;provision of sufficient space to accommodate thesystems without crowding; sizing and arrangementto facilitate expansion and modification as re-quired; and quality of materials used in fabrica-tion of the systems. The chases serviig the vari-ous utility piping systems, ventilation ducts, andelectrical raceways should be shafts of sufficientsize to permit modifications to the systems and theinstallation of additional services as required.

The nursing school in most instances willbe an adjunct of a hospital or of a group of medicalor educational facilities. Normally all these build-ings will be served by a central boiler and mechani-cal plant so that only under unusual circumstanceswill such plants be required in the school building.However, space will be required for certain me-chanical equipment rooms throughout the build-ing. Steam distribution and water heatingequipment will normally be located in the base-ment, while fan rooms should be located on thevarious floors depending upon the design.

LABORATORIES

Particular attention should be given to thetypes and size of equipment used in the variouslaboratories. The heat gain from ovens, dryingcabinets, kettles, sterilizers, electronic equipment,and heating elements can negate the usefulness ofan otherwise well-designed ventilation or air-con-ditioning system if neglected in the originaldesign.

To insure safety of students and personneland to provide a suitable environment, the byprod-

ucts of many of the activities must be contained inand exhausted from fume hoods. These byprod-ucts may be odorous, toxic, radioactive, infective,explosive, or corrcsive. The ventilation systemmust provide sufficient air to insure good ventila-tion of the hoods in addition to that required toprovide a suitable environment.

ELECTRONIC EQUIPMENT ANDDATA PROCESSING ROOM

To insure proper and accurate performanceof the equipment of these rooms, particular atten-tion must be directed toward careful control ofhumidity, temperature, and ventilation.

PROJECTION BOOTIB

Where enclosed rooms are used for motionpicture or slide projection, care must be exercisedto insure proper temperature and ventilation.

PLUMBING AND UTILITIES

Plumbing fixtures, including trim and pip-ing materials, must be selected with care to suitthe function they servo, Acid-resisting pipingmaterials should be used for the drainage systemof all laboratory and fume hood sinks.

It is important that hazardous systems suchas gas piping have an emergency shutoff valve lo-cated at some distance from the point of use.Deluge showers and eye baths should be installedin each laboratory in which hazardous materialsare used. Controls for the operation of utilityservices to fume hoods should be mounted on theexterior of the hood.

OTHER DESIGN CONSIDERATIONS

FIRE SAFETY

Circulation spaces such as corridors andstairways should be wide enough to minimize con-gestion and comply with requirements of local andnational codes.

A corridor cutoff to isolate the library fromthe remainder of the facility is desirable. This

74

would permit use of the library during off-schoolhours. The type of barrier selected should complywith exit requirements of local and national codes.

Adequate exit illumination, appropriatesigns designating the location of exits or the pathof travel to reach them, and approved manuallyoperated fire alarm facilities must be provided.

Standard-typ fire extinguishersprovided in hazardouo areas.

ACOUSTICS INLEARNING SPACES

must be

Since acoustical design is a complex subject,it will not be discussed in detail here. Attention

is canal, however, to the following objectives re-lating to acoustics in learning spaces :

1. The provision of a satisfactory acousticalenvironment which prevents sound waves frompassing through materials or open spaces.

2. The provision of good hearing condi-tions, by controlling the direction, impact, dura-tion, absorption, and reflection of sound waveswithin the space itself.

CONSTRUCTION COST FACTORS

Tiii. AVERAGE cost of construction for schools ofnursing will follow closely the cost of constructionfor colleges or university buildings if all compo-nents of the facility are included. The incorpora-tion of research facilities would tend to increasethe average cost somewhat due to the additionalplumbing and ventilation requirements. Thety pes of finishes provided and the kinds of class-room and laboratory furniture used can make aconsiderable difference in the total cost. In plan-ning for additions to existing schools of nursing,if only classrooms are being added, a lower rangeof unit costs may be satisfactory; on the otherhand, if the proposed addition contains mostlylaboratories, a higher range of unit costs shouldbe used. National unit construction costs forschools of nursing for 1963 range from $19 to $25per square foot. Construction costs will vary tosome extent with the section of the country. It isalso 'mportant to consider that construction costs

have been rising approximately 4-6 percent an-nually. Therefore, the unit cost selected for esti-mating a project in the programing and schematicstage should reflect the costs as they probably willbe 1 or 2 years hence when bids are requested.

Th3 F.etual cost of building a nursing educa-tion facility involves costs in addition to theconstruction contracts. In preparing a total esti-mated budget during the programing and sche-matic stages, the following items of cost must beprovided for:

Construction contracts.Built-in equipment not included in con-

struction contracts such as laboratory furniture.Movable furniture and equipment.Site costs including clearing of site.Site survey and soil investigation.Architect and consultant fees.Owner's administrative costs.


1. American Standard Guide for School Lighting (A23.1) . American Stand-ards Association, 10 East 40th St., New York 16, N.Y. 1962. 40 pp.

2. Applying the Guide (A23.1). Journal of The Illuminating EngineeringSociety, 1860 Broadway, New York 23, N.Y. April 1962. 12 pp.

3. Dearborn Board of Education. Dearborn, Pkns the New Henry FordCommunity College Campus. Dearborn, Mich. 1959. 223 pp.

4. Educational Facilities Laboratories, Inc., 477 Madison Ave., New York22, N.Y.

Bricks and Mortarboards. A report on college planning and building.1964. 168 pp. (Library of Congress Catalog Card No. 64-14232.)Riker, Harold, and Lopez, Frank. College Students Lice Here. 1961.152 pp. (Library of Congress Catalog Card No. 61-18584.)A College Health Center. Case Studies of Educational Facilities No. 6.17 pp. (Library of Congress Catalog Card No. 63-15980.)Design or Educational TV . 1960. 96 pp. (Library of CongressCatalog Card No. 60-10689.)

Horizontal and Vertical Circulation in University Instructional and Re-search, Buildings. 20 pp. (Library of Congress Catalog Card No. 61-18841.)

New Spaces for Learning. 1961. 71 pp. (Library of Congress CatalogCard No. 61-17937.)

Plumbing Fixture Requirements in University Instructional and Research,Buildings. 19 pp. (Library of Congress Catalog Card No. 61-18843.)Planning Schools for New Media. Prepared in cooperation with U.S.Department of Health, Education, and Welfare, Office of Education.Copies may be obtained from : Division of Education, Portland StateCollege, Portland, Oreg. 1962. 72 pp. 50 cents.

Ten Designs-Community Colleges. Department of Architecture, RiceUniversity, Houston, Tex. 1962. 100 pp. (Library of Congress CatalogCard No. 62-217M.)

5. Finn, James D., and Perrin, Donald G. Teaching .Machines and ProgramedLearning. U.S. Department of Health, Education, and Welfare, O.E. 340 19.1962. 85 pp.

6. Illuminating Engineering Society Lighting Handbook-Third edition. TheSociety, 1860 Broadway, New York 23, N.Y. 1959. 634 pp.

7. Eastman Kodak Co. Image Viewing. Rochester, N.Y. 1962.

8. Newman, Robert B. "Design for Hearing." Progressive Architecture,40 : 191-196. May 1959.

9. National Audio-Visual Association, Inc. The Audio-Visual Equipment Di-rectory, 9th edition. The Association, Fairfax, Va. 1963. 346 pp. (Libraryof Congress Catalog Card No. 54-35264.)

76

10. Palmer, R. Ronald, and Rice, William Maxwell. Modern Physics Build-ings, Design and Function. New York, Reinhold Publishing Corp. 1961.

324 pp. (Library of Congress Catalog Card No. 61-8456.)

11. Salvadori, Mario, and Heller, Robert. Structure in Architecture. Engle-wood Cliffs, N.J., Prentice-Hall, Inc. 250 pp. (Library of Congress CatalogCard No. 63-7992.)

12. Simonds, John Ormsbee. Landscape Architecture. New York, F. W.Dodge Corp. 244 pp. (Library of Congress Catalog Card No. 60-53454.)

13. U.S. Department of Health, Education, and Welfare. Planning and De-sign of Medical Research Facilities. Public Health Service, National Insti-tutes of Health, Bethesda, Md. 1962. 29 pp. (Unpublished.)

14. United States Gypsum. Sound Control in Design. Publication X183.1959. 93 pp.

15. Waagen, Louise 0., "Basic Steps in Planning the Nurses' Residence andEducational Facility." The Modern Hospital, 81: 68; 140-147, October 1953;81: 77; 132-140, November 1953; 81: 70, 140-147, December 1953; 82: 90, 140-148, January 1954.

77

Appendix A

Operating Budgets for Nursing Programs'

GENERAL CONSIDERATIONS

COST ANALYSIS METHOD

THE PROPOSED BUDGETS presented in this appendixare based on the cost analyses of a sampling ofnursing programs. The method used was thesame as that employed in "The Study on Cost ofNursing Education" I conducted by the NationalLeague for Nursing from 1958-64. Other methodsof cost analysis could result in differences in theportion of the total cost assigned to any particularitem and could reflect a different total cost for theeducational program. While depreciation ofbuildings has been computed in this analysis, itis not allocated to any cost center or department.

EFFECTS OF VARIABLESON COSTS

The data used as bases for the proposedbudgets apply to various kinds of nursing pro-grams throughout the country. In the case ofdiploma nursing programs, the Study on Cost ofNursing Education found significant relationshipsbetween certain costs of the program and thevariables, type of control, enrollment size, and geo-graphic location. While the study extended overa 5-year period, there was no significant evidencethat the cost of the educational program varied

78

from year to year. When applicable, the dataused as a basis for the projected budget were limi-ted to those cases where the enrollment size wasclose to that of the projected program. The dataused represent an average of programs in variousgeographic regions, both accredited and non-accredited by the National League for Nursing,under private or public control.

COMPARABILITY OF COSTS AMONGTYPES OF NURSING PROGRAMS

In analyzing each nursing program, the costof each was studied in relation to and as a part ofthe total operating cost of the institution offeringthe course. Comparing the result of an analysisof a baccalaureate program with that of a diplomaprogram would involve comparing total costs thatresulted from computing different items of cost.The dollar values given are not intended to beused to determine whether or not one type ofprogram is more expensive than the other. Rather,they are intended to indicate to the particular in-stitution how a nursing program could affect itscosts.

1 Harold R. Rowe, Director. "Study on Costs ofNursing Education." National League for Nursing.(Unpublished.)

PROJECTED OPERATING BUDGET FOR A 3 YEAR

INITIAL DIPLOMA NURSING PROGRAM

FOR ILLUSTRATIVE PURPOSES, the following casestudy is presented of a projected operating budgetfor a 3-year initial diploma nursing program.


The program has been in operation for atleast 3 years. In the year considered, 64 studentsentered the program; the total enrollment was 148.Second- and third-year students each take one 12-week course in an outside cooperating agency.During the year the 148 students have a total of6,096 student-weeks of instruction in the school ofnursing. The science courses are taken outside ofthe school of nursing. The nursing educationstaff consists of an educational director, an assist-ant educational director, 15 nurse faculty mem-bers, a librarian, a counselor, a residence director,a secretary, and 3 c, k-typists.

OPERATING BUDGET COMPONENTS

The costs of this type of nursing programare presented under two headings : the cost of theeducational functions of the program and thecost of the noneducational functions of the pro-gram. Under educational functions are listed thecosts of activities and services involved in instruc-tion, pei se. Noneducational function costs referto the cost of board, room, laundry, and recreation.These items are not considered in the cost of col-legiate programs, since they presumably are pro-vided or purchased by the student.

DETERMINING COSTS OF THEEDUCATIONAL FUNCTIONS

Data Sources. --Data used as bases for thisbudget are limited to those 31 cases in "The Studyon Cost of Nursing Education" where the totalenrollment was closest to that of the proposedenrollment. Because faculty-student ratios andsquare footage used for the nursing programsvaried from that of the proposed program, themanner of deriving each item of educational func-tion costs is described separately.

The cost items included here are :

SALARIES : Salaries of those whose activi-ties are directed toward the educational functionsof the program.

SUPPLIES : Money spent for supplies usedin instruction.

DIRECT EXPENSES ( SUBTOTAL) : The sum ofthe two previous items.

STAFF BENEFITS : The cost of insurance,retirement contract premiums, retirement allow-ances, social security, workmen's compensation,and similar expenses prorated on the basis ofsalaries paid in each department.

PLANT OPERATION : The cost of heat, light,power maintenance, and housekeeping, plus anyallocations, prorated on the basis of square footage.

ADMINISTRATION : Direct expenses of ad-ministration, plus any allocations prorated on thebasis of direct expenditures.

LIBRARY : Direct expenses of the libraryand any allocations. (Prorated on the basis ofusage when the nurses' library was part of a hos-pital medical library.)

PropoBed Operating Budget for Educa-tional Fuinction8.The derivation of cost centersor items in the proposed budget are shown in ap-pendix table 1.

DETERMINING COSTS OF THENONEDUCATIONAL FUNCTIONS

DATA SOURCES.Data used as basesfor the budget for noneducational functions wereobtained from the 31 previously mentioned pro-grams. The total cost was computed on the basisof average cost per student week in these 31 casesapplied to the number of student-weeks in theproposed program. The cost of separate itemswas derived on the basis of average percent foreach in the 31 cases.

The cost items included here are :SALARIES: Salary of those whose activi-

79

Appendix Table 1. Derivation of items of costfor educational functions in the diplomanursing program

Item

Salaries

Supplies

Direct expenses(subtotal).

Staff benefits....

Plant operation_ _ _

Administration.._

Library

Total

Cost

$116, 000

20, 340

Derivation

136, 340

3, 956

35, 038

11, 630

7, 576

194, 540

Salary rates based onfindings in 30 diplomaprograms, applied tothe recommended num-ber of nursing educa-tion staff.

Average cost of suppliesper student week in 31similar cases, appliedto the student-weeksof the proposedprogram.

Sum of above.

Average percent ofsalaries in 31 similarcases, applied to theproposed salaries.

Average cost per squarefoot in 31 similar cases,applied to the recom-mended square footage.

Average percent of directexpenses in 31 similarcases, applied to thesum of the first 2items.

Library costs per student-week in 31 similarcases, applied to thestudent-weeks of theproposed program.

ties are directed toward the noneducational func-tions of the program.

SUPPLIES : Money spent for supplies fornoneducational functions.

DIRECT EXPENSES ( SUBTOTAL ) : The sum ofthe two previous items.

STAFF BENEFITS : The cost of insurance, re-tirement contract premiums, retirement allow-ances, social security, workmen's compensation,and similar expenses, prorated on the basis ofsalaries paid in each department.

HEALTH SERVICES : Direct expenses of thehealth service, plus any allocations prorated onthe basis of usage in each department.

ADMINISTRATION : Direct expenses of admin-istration, plus any allocations prorated on thebasis of direct expenditures.

LAUNDRY : Direct expenses of laundry, plusany allocations prorated on the basis of poundageand piecework per department.

DIETARY : Direct expenses of dietary de-partment, plus any allocations prorated on the

80

basis of number of meals served to eachdepartment.

RESIDENCE : Direct expenses of the resi-dence and any allocation, prorated on the basisof occupancy, plus, when applicable, the cost ofplant operation of other areas used for noneduca-tional functions.

Proposed Operating Budget for Nonediaca-tional Funetions.-Appendix table 2 presents anitemization of the proposed operating budget fornoneducational functions.

Appendix Table 2. Proposed annual operatingbudget for noneducational functions in adiploma program with an entering class of 64and a total enrollment of 148

Item Cost

Total $192, 390

Direct costs 17, 816

Salaries 12, 602Supplies 5, 214

174, 574Indirect costs

577Staff benefitsHealth services 6, 233Administration 2, 097Laundry 5, 195Dietary 79, 707Residence 80, 765

Appendix Table 3. Proposed annual operatingbudget for educational and noneducationalfunctions for a diploma program with an en-tering class of 64 and a total enrollment of148

ItemEduca-tional

functioncosts

Noneduca-tional

functioncosts

Total $194, 540 $192, 390

Direct costs 136, 340 17, 816

Salaries 1 116, 000 12, 602Supplies 20, 340 5, 214

Indirect costs 58, 200 174, 574

Staff benefits.. 3, 956 577Plant operation 35, 038Administration 11, 630 2, 097Library 7,576Health services 6, 233Laundry 5, 195Dietary 79, 707Residence 80, 765

1 Salaries provide for the following personnel: 1 director, 1 assistant direc-tor, 15 nurse faculty members, 1 librarian, 1 counselor, 1 residence director,1 secretary, and 5 c/erktypists.

PROJECTED OPERATING BUDGET FOR A 2YEAR

ASSOCIATE DEGREE PROGRAM IN NURSING

FOR ILLUSTRATIVE PURPOSES, the following casestudy is presented of an operating budget for a 2-year associate degree program in nursing.


The program has been in operation for atleast 2 years. In the year considered, 64 studentsentered the program; the total enrollment was 104.The nursing department staff consisted of thedirector, 10 faculty members, 1 secretary, and 3clerk-typists.

The number of required credits was equallydivided between general education courses takenin the arts and sciences, or corresponding depart-ments of the junior college and nursing educationwhich was given in the Nursing Department.

COMPONENTS OF THEOPERATING BUDGET

Introduction of a nursing program into thejunior college setting increases the cost of generaleducation (arts and science) credits for the school,since additional credit hours must be planned. Inaddition, the cost of the nursing department needsto be considered in light of the particular require-ments of a 2-year initial associate degree programin nursing.

BASES FOR PROJECTING BUDGETS

Of the three types of nursing programs re-viewed in "The Study on Cost of Nursing Educa-tion," the least amount of data was collected on the2-year associate degree nursing program. Thesedata were limited to analyses of nine such pro-grams. Several existed for a relatively short timeand had smaller enrollments than the 104 studentsfor which this budget was projected. In one in-stance, a cost analysis was done for 2 consecutiveyears during which the enrollment increased from27 to 48 students. Changes occurred in cost per

732-486

student enrolled as well as in the percent of totalcost contributed by certain cost items. Thesechanges were most marked in the cost items relat-ing to the nursing department.

The cost of arts and sciences per credit used inthe proposed budget is based on the analyzed costof 242,393 credits.

GENERAL EDUCATIONINSTRUCTION BUDGET

To estimate the increase in general educa-tion (arts and sciences) instruction costs, the aver-age cost per credit in nine junior colleges was com-puted. All credits combined were estimated tocost $4,836,608. The average cost per credit was$19.95.

Assuming an enrollment of 104 students,each of whom would take 16 credits of generaleducation per year, the credits would total 1,664at a cost of $33,197.

This cost was distributed among the variouscast centers or cost items on the basis of averagepercentage of total cost per item. The itemsconsidered were :

SALARIES : The salaries of all professionaland nonprofessional employees employed in thedepartment.

SUPPLIES : Money spent for supplies usedin instruction and in departmental research.(When depreciation of equipment was computedas a direct expense, it was placed under "supplies."Institutions doing so would probably have a higherportion of costs under this heading.)

DIRECT EXPENSES ( SUBTOTAL ) : The sum of

the two previous items.STAFF BENEFITS : The cost of insurance, re-

tirement contract premiums, retirement allow-ances, social security, workmen's compensation,and similar expenses prorated on the basis of sal-aries paid in each department.

81

PLANT OPERATION : The cost of heat, light,power maintenance, and similar expenses, plusany allocations, prorated on the basis of squarefootage in each department.

GENERAL LiSTITUTIONAL AND ADMINISTRA-nvE ExpErrsEs : General expenses of the juniorcollege as a whole other than staff benefits. Ex-amples of items included an alumni office, catalogs,commencement, publications, campaigns andtravel, salaries and supplies for the general andbusiness administrative staff, and any allocationsprorated on the basis of direct expenditures ineach department. (Basis for computing items inthis category was a combination of cost items intwo nursing programs.)

GENERAL LIBRARY : Salaries and suppliesfor the general library, plus any allocation pro-rated on the basis of usage by each department.

STUDENT SERVICES : The expenditures forservices available to all students, including sal-aries and supplies for the registrar, the dean ofstudents, the guidance program, the health serv-ice, and student activities, plus any allocationsprorated on the basis of the number of studentsin each department.

Proposed Operating Budget.The cost ofgeneral education credits taken by nursing stu-dents was distributed among eight categories,using average percentages, as shown in appendixtable 4.

Appendix Table 4. Proposed annual operatingbudget for general education credits in an as-sociate degree program with an entering classof 64 and a total enrollment of 104 students

ItemGeneral

educationexpense orallocation

Averagepercentage

Total

Direct costs

SalariesSupplies

Indirect costs

Staff benefitsPlant operationGeneral institutional admin-

istrative expenseGeneral libraryStudent services

$33, 197 100. 00

18, 740 56. 45

16, 821 50. 671, 919 5. 78

14, 457 43. 55

1, 285 3. 873, 705 11. 16

2, 609 7. 862, 835 8. 544, 023 12. 12

82

,4475:.;11

DETERMINING AN OPERATING BUDGETFOR NURSING INSTRUCTION

Data Sources.In forecasting an operatingbudget for nursing instruction, primary considera-tion was given to the necessary faculty and facili-ties needed for such a program. The costs ofcertain items such as faculty salaries and plantoperation were projected and were based on therecommended number of faculty members andspace requirements. Excepting for the data per-taining to direct expenses for supplies, combineddata from cost analyses of nine programs wereused. Data pertaining to supplies were limited tothose from programs having a total enrollment of50 students or more.

Special Budget Considerations.All theclinical nursing courses entail laboratory experi-

Appendix Table 5. Derivation of items of costfor nursing education in the associate degreeprogram

Item I Cost Derivation

Salaries_

Supplies

Staff benefits

Plant operation.. _ _

General institu-tional adminis-trative expense.

$88 , 000

3,712

4,752

14,401

8,786

Library 5,572

Student services__ _ 7,381

Total 132,604

Salary rate based on find-ings reported in "Studyon Cost of Nursing Edu-cation." Applicationwas made to the recom-mended number offaculty and other staffmembers.

Average cost of suppliesper student in costanalyses of associatedegree programs with anenrollment greater than50 students was appliedto the recommendedenrollment.

Average percent of salariesin cost analyses of 9associate degree pro-grams was applied to thesalaries proposed.

Average cost per squarefoot in the 9 programswas applied to therecommended squarefootage.

Average percent of directexpenses used for thisfunction in the 9 pro-grams applied to thesum of the first 2 items.

Average cost per studentin the 9 programs wasapplied to the recom-mended enrollment.

Average cost per studentin the 9 programs wasapplied to the recom-mended enrollment.

ence. The number of hours of such experience isusually greater in the nursing courses (3 or 4 hoursper credit) than in general education (2 hours percredit). The nature of the nursing laboratory,which includes learning experiences in the care ofill patients, greatly limits the number of studentsthat the nursing faculty member can instruct inthe clinical area at one time.

Proposed Operating Budget.The costcenters or items in the proposed budget are identi-cal to those used in the general education budget.The derivation of the items of cost vary, as shownin appendix table 5.

ADDITIONAL COSTS TO THE JUNIORCOLLEGE FOR THE NURSING PROGRAM

A combination of the budgets presented in-dicated the probable increase in operating coststo the college for instruction in the nursing pro-gram. (See appendix table 6.)

Appendix Table 6. Proposed annual operatingbudget for a nursing program in acommunitycollege with an entering class of 64 and a totalenrollment of 104 students

Item TotalGeneraleduca-

tion costs

Nursingeduca-

tion costs

Total $165, 801 $33, 197 $132, 604

Direct costs 110, 452 18, 740 91, 712


Indirect costs 55, 349 14, 457 40, 892


administrativeexpense 11, 395 2, 609 8, 786

Library 8, 407 2, 835 5, 572Student services_ 11, 404 4, 023 7, 381

I Salaries provide for nonnurse faculty and the following nursing depart-ment faculty personnel: 1 director, 10 faculty members, 1 secretary, and 3clerk-typists,

PROJECTED OPERATING BUDGET FOR A 4 YEAR

BACCALAUREATE NURSING PROGRAM

FOR ruLTISTPArrivE purposes the following projectedoperating budget is presented for a 4-year bac-calaureate nursing program.


The program has been in operation for atleast 4 years. In the year considered, 96 studentsentered the program; the total enrollment was240. The nursing department staff consisted ofthe dean, 27 faculty members, 1 secretary, and 9clerk-typists. The required credits were evenlydivided between general education courses taughtin the arts and sciences department of the college

or university and courses in professional educa-tion offeredin the nursing department.

COMPONENTS OF OPERATING BUDGET

Introducing a nursing program into the col-lege setting would add to the cost of arts and sci-ence instruction, since the student nurses wouldbe required to have credits in this area also. The

cost of the nursing department should be con-sidered in light of the particular requirements of4-year initial baccalaureate programs in nursing.The proposed arts and science portion of the nurs-ing program budget is based upon the additionalcredit-hours of arts and science, and the nursingdepartment portion of the budget is constructedfrom various bases that reflect the needs of sucha department.

DETERMINING THE OPERATING BUDGETFOR ARTS AND SCIENCE INSTRUCTION

In the "Study on Cost of Nursing Educa-tion," the typical basic nursing program accountedfor 4.5 percent of all arts and sciences creditsgivento all students in the institution during the yearof the study. The cost of these credits for nursingstudents was determined by computing the creditcost for all credits given and by prorating this costto the various departments or schools on the basisof number of credits taken. To estimate the costincrease for arts and sciences instruction resulting

83

from the introduction of a basic nursing program,the average cost per arts and science credit wascomputed.

The basic data were limited to 15 cost ana-lyses with comparable credit units and with a totalcollege or university enrollment of 1,000 or more.In these 15 cases, some 1,186,442 credits were takenduring the year of study. The total analyzed costof these credits was $33,013,840. The average costper credit was $27.83.

Assuming an enrollment of 240 basic stu-dents and that each student took 16 arts and sci-ences credits per year, the 240 students would take3,840 total credits at a cost of $106,852.

This cost was distributed among the variouscost centers or cost items on the basis of the aver-age percentage of total cost per item.

The items considered were as follows :

SALARIES : The salaries of all professionaland nonprofessional personnel in the department.

SUTPLIES : Expenditures for supplies usedin instruction and in departmental research.(When depreciation of equipment was computedas a direct expense, it was listed under "supplies."Institutions doing so would probably have ahigher portion of costs under this heading.)

DIRECT EXPENSES (SUBTOTAL) : The sum of

the two previous items.STAFF BENEFITS : The cost of insurance, re-

tirement contract premiums, retirement allow-ances, social security, workmen's compensation,and similar expenses prorated on the basis of sal-aries paid in each department.

PLANT OPERATION : The cost of heat, light,power maintenance, and similar items, plusany allocations prorated on the basis of squarefootage in each department.

GENERAL INSTITUTIONAL AND ADMINISTRA-

TIVE EXPENSES : General expenses of the universityas a whole other than staff benefits. Examples ofitems include alumni office, catalogs, commence-ment, publications, campaigns and travel, salariesand supplies for the general and business admin-istrative staff, and any allocations prorated onthe basis of direct expenditures in each depart-ment. (Basis for computing items in this cate-gory was an analysis of a combination of costcenters in two nursing programs.)

84

GENERAL LIBRARY : Salaries and suppliesfor the general library, plus any allocations pro-rated on the basis of usage by each department.

STUDENT SERVICES : The expenditures forservices available to all students, including sal-aries and supplies for the registrar, the deanof students, the guidance program, the healthservice, and student activities, plus any allocationsprorated on the basis of the number of students ineach department.

Proposed Operating Budget.The cost ofarts and science credits taken by the initial nursingstudents was distributed among the various cate-gories as shown in appendix table 7.

Appendix Table 7. Proposed annual budgetfor arts and sciences credits in the bacca-laureate nursing program with an enteringclass of 96 and a total enrollment of 240students

Item

Additionalarts andsciences

expense orallocation

Averagepercentage

Total $106,852 100.00

Direct costs 72,549 67.90

Salaries 67,778 63.43Supplies 4,771 4.47

indirect costs 34,303 32.10

Staff benefits 3,807 3.56Plant operation 7,304 6.84General institutional adminis-

trative expense 6,546 6.13General library 9,182 8.59Student services 7,464 6.98

DETERMINING THE OPERATING BUDGETFOR NURSING INSTRUCTION

Special Budget Considerations.The na-ture of the laboratory (clinical) experience in thenursing department requires a relatively greaterfaculty-student ratio than does laboratory experi-ence in arts and sciences. A relatively larger por-tion of the nursing courses entail laboratory ex-perience. The number of hours of laboratory percredit is greater in nursing courses (usually 4 to6 hours per credit) than in general education(usually 2 hours per credit) . The nature of thenursing laboratory, which includes responsibilityfor the care of ill patients, greatly limits the num-

her of students that the nursing faculty membercan instruct in the clinical area at one time.

Source of Data for Budget Forecast.Inforecasting this budget, primary considerationwas given to the necessary faculty and facilitiesthat would be adequate for such a program. Forinstance, the faculty includes nursing program in-structors who accompany and instruct the stu-dents who are having public health nursing fieldexperience. The nursing plant includes sufficient

Appendix Table 8. Deriva®n of items of costfor nursing instruction in baccalaureateprogram

Item Cost Derivation

Salaries

Supplies

Staff benefits

Plant operation__ __

General institu-tional adminis-trative expense.._

Library

Student services__ _

Total.._

$206,400

11,153

7,354

32,103

16,048

16,554

17,227

306,839

Salary rate based onfindings reported in"Study on Cost ofNursing Education."Application was madeto the recommendednumber of facultyand other staffmembers.

Average cost of suppliesper student in 6 simi-lar programs, appliedto the recommendedenrollment.

Average percent ofsalaries in 6 similarprograms, applied tothe salaries proposed.

Average cost per sqaurefoot in 14 1 of theinstitutions studied todetermine arts andsciences costs, appliedto the recommendedsquare footage.

Average percent of directexpenses used for thisfunction in costanalyses of similarprograms, applied tothe sum of the first2 items.

Average cost per studentin the 15 institutionsstudied to determinearts and sciencescosts, applied to therecommended enroll-ment.

Average cost per studentin the same 15 insti-tutions, applied tothe recommendedenrollment.

1 1 case deleted because of an atypical arrangement foroperation of plant.

space for individual conferences between facultymembers and students.

The data used as a basis for cost items weredistributed to all students in the college or uni-versity. The use of the library or of student serv-ices are examples of such items. However, inforecasting cost items that were determined by thenature of the nursing programs, the data used werelimited to six schools in which the enrollment andother characteristics resembled the characteristicsof the proposed program.

Proposed Operating Budget.The cost cen-ters in the proposed operating budget are identicalto those described for the arts and sciences instruc-tion budget. The derivation of the items of costvary, as shown in appendix table 8.

ADDITIONAL COSTS TO THECOLLEGE OR UNIVERSITY

The foregoing budgets were combined todetermine the probable increase in operating coststo the institution for all areas of instruction forthe students in the nursing program. (See ap-pendix table 9.)

Appendix Table 9. Proposed annual operatingbudget for a baccalaureate degree nursingprogram with an entering class of 96 and atotal enrollment of 240 students

Item TotalArts andsciences

costs

Nursingdepart-mentcosts

Total $413, 691 $106, 852 $306, 839

Direct costs 290, 102 72, 549 217, 553


Indirect costs 123, 589 34, 303 89, 286


administrative ex-pense 22, 594 6, 546 16, 048

Library 25, 736 9, 182 16, 554Student services 24, 691 7, 464 17, 227

1 Salaries provide for nonnursing faculty and the follow-ing nursing department personnel: 1 dean, 27 facultymembers, 1 secretary, and 9 clerk-typists.

85

Appendix B

Programing for a Nursing Education Facility

IN THE DEVELOPMENT of nurse education programs,special attention should be given to functional andbuilding considerations. The following outlinehas been prepared as a guide to planning suchfacilities.

A. FUNCTIONAL PROGRAM

86

1. Setting :a. Physical planning of facility.b. Identification as a cohesive unit, whether

as a separate building, a wing of abuild-ing, or a floor in a large building.

2. Control:a. Administrative control of facility for

nursing education.b. Type of program.c. Initial enrollment.d. AnticipatPd expansion of the student

body.3. Personnel:

a. Administrative.b. Faculty.c. Maintenance.

4. Curriculum :a. Subjects.b. Size of classes.c. Types and number of classes (lecture,

seminar, and discussion).

5. Educational requirements and resources :a. Lecture.b. Demonstration.c. Laboratories.d. Library.

e. Teaching machines.f. Television monitor viewing.

6. Schedule of classes (utilization study ofproposed facility) .

7. Administrative policies (utilization of ex-isting educational facilities in the vicinityor community to avoid costly duplication) .

8. Students residence :a. Relationship to facility for nursing edu-

cation, distance.b. HI commuters, evaluation of distance,

time, and availability of transportation.9. Availability of dining and recreation facil-

ities for students and faculty members.10. Relationship of nurse education facility to

other educational institutions as well as tosuch planning considerations in the com-munity and region as transportation facil-ities and general community development.

11. Continuing education :a. The role of a new facility for nursing

education in a particular locality.b. Areawide planning.

12. Long-range and short-range goals. (Itmight be helpful to formulate a master plancovering a number of years and amend it onthe yearly basis as the needs will arise thusassuring an orderly growth.)

B. BUILDING PROGRAM

1. Detailed information regarding each of thespaces for teaching, research, faculty, ad-ministrative, and service areas :a. Desirable number of persons to be ac-

commodated, utilization rate, seasonaland daily load.

b. Purpose of the room or area, and the ac-tivities that take place in that space.

c. Special features required.d. Interdependence and necessary physical

relationship with other units, traffic flow.e. Auxiliary supportive spaces.

2. The equipment and supplies required whichwill affect the size and arrangement of therooms.

3. Site, orientation, and utilities.4. Relation to existing buildings, if any.5. Structure, building materials, finishes, ex-

terior, interior.

6. Fire protection and safety.7. Mechanical, electrical, air-conditioning

equipment. Heat may be supplied fromboiler room within a new facility or fromexisting adjacent facilities.

8. Acoustics.9. Illumination.

100 Audiovisual equipment.11. Communications.12. Color and decor.

There are usually many possible solutionsfor each architectural problem, and it is the ar-chitect's role to find the best compromise 'betweenfunctional, structural, mechanical, esthetic, andeconomic considerations.

87

88

RELATED AD HOC COMMITTEE REPORTSPREVIOUS Ad Hoc Committee reports which are paEt of the series of pub-lications concerned with hospital and related health facility planning are:

"Planning of Facilities for Mental Health Services," Report ofthe Surgeon General's Ad Hoc Committee on Planning for Mental HealthFacilities. Public Health Service Publication No. 808. January 1961.55 pp. 40 cents.

"Areawide Planning for Hospitals and Related Health Facilities,"Report of the Joint Committee of the American Hospital Association andPublic Health Service. Public Health Service Publication No. 855. July1961. 56 pp. 35 cents.

"Medical Education FacilitiesPlanning Considerations and Ar-chitectural Guide," Prepared by the Public Health Service in cooperationwith ad hoc committees on Medical School Architecture and Design ofUniversity Teaching Hospitals. Public Health Service Publication No.1180-A-lb. 1964. 185 pp. $1.00.

"Areawide qnning of Facilities for Long-Term Treatment andCare," Report of the Joint Committee of the American Hospital Asso-ciation and the Public Health Service. Public Health Service Publica-tion No. 930-B-1. February 1963. 81 pp. 55 cents.

"Areawide Planning of Facilities for Rehabilitation Services,"Report of the Joint Committee of the Public Health Service and theVocational Rehabilitation AdministrationParticipating Agency : As-sociation of Rehabilitation Centers, Inc. Public Health Service Publi-cation No. 930-B-2. 1963. 88 pp. 55 cents.

"Areawide Planning of Facilities for Tuberculosis Services," Re-port of the Joint Committee of the National Tuberculosis Associationand the Public Health Service. Public Health Service Publication No.930-B-4. 1963. 46 pp. 40 cents.

Free single copies of the above publications are available fromDivision of Hospital and Medical FacilitiesPublic Health ServiceU.S. Department of Health, Education, and WelfareWashington, D.C. 20201.

The publications may be purchased at the above-cited prices fromThe Superintendent of DocumentsU.S. Government Printing OfficeWashington, D.C. 20402.

U.S. GOVERNMENT FEINTING OFFICE. 1984 0-732-486