NBSIR 73-285

Structure Analysis and Program

Planning Study of the Army Nurse

Corps (ANC)

Part il

John W. Rowen, Ralph B. Swisher, Patsy B. Saunders

Technical Analysis Division

Institute for Applied Technology

National Bureau of Standards

Washington, D. C. 20234

October 1, 1973

Final Report: Project No. 431 4487

(The findings in this repoit are not to be construed

as an official Depaiioient of the Army position.)

Prepared for The Department of the Army

Office of The Surgeon General

Washington. D. C. 20314

NBSIR 73-285

STRUCTURE ANALYSIS AND PROGRAM

PLANNING STUDY OF THE ARMY NURSE

CORPS (ANC)

Part li

John W. Rowen, Ralph B. Swisher, Patsy B. Saunders

Technical Analysis Division

Institute for Applied Technology

National Bureau of Standards

Washington, D. C. 20234

October 1,1973

Final Report: Project No. 431 4487

(The findings in this report are not to be construed

as an official Department of the Army position.)

Prepared for The Department of the Army

Office of The Surgeon General

Washington, D. C. 20314

U. S. DEPARTMENT OF COMMERCE, Frederick B. Dent, Secretary

NATIOMAL BUREAU OF STAMDARDS, Richard W. Roberts, Director
PART II

ANNEXES TO FINAL REPORT

• TABLE OF CONTENTS

Annex

Number Title

II-l Promotion, Separation, and Retirement System

of the Army

.11-2 Quantitative Description of Force Structure

Changes in Terms of Transition Probabilities

II-3 MEDDAC Analysis

11-4 Actual Computer Output Material for Reference

II-5 Data Matrix Set 2

II-6 Data Matrix Set 2a

II-7 The ANC Officer Worldwide Questionnaire and

Survey of Nursing Personnel Sections A, B, C,

and D

II-S Simulation of a Preferred Configuration of the

A-PTny Nnrse Corps Force Structure

II-9 MEDDOC MOS Requirements Compared with Available

Nurses (Under Two Specific, Policies)

11-10 Additional Figures for Section if. 5. 2, Graphical

Relationships

11-11 Identification and Statistics of MEDDAC Variables,

Additions to Table k-k in Section 4.5.3? Geo - graphical Distribution
ANNEX .11-1

PROMOTION, SEPARATION AND RETIREMENT SYSTEM OF THE ARMY

Introduction

The Army Nurse Corps (ANC) structure is an important component in

the quality of Army patient care. This structure is markedly affected

by the individual nurse officers' numerous career transitions, promotions,

career modifications, separations and retirements. These career factors

are both deterministic and stochastic in nature; they profoundly impact

i;5)on the ANC leadership and nursing skills thus directly influencing

the quality of patient care. This paper describes in nontechnical terms

the effects of the statutory, regulatory, recruitment, and training

factors iqDon the ANC and its efforts in providing for the ever- changing

needs of the service. This Appendix has been prepared as part of the

Office of the Surgeon General (OTSC) stndy eni-nti^-ri "Awr Structure ^r.clyzzz

and Program Planning Studies." It thus contains a description of the

recruitment, promotion, separation, and retirement processes for the U.S.

Army. Much of the material has been gleaned by tlie staff at the National

Bureau of Standards from the UNITED STATES CODE ANNOTATED -- Title 10

"Armed Forces" Sections 3001 - 5000 - Subtitle B (Army)

Promotion

The U.S. Army operates the following three separate promotion systems:

the Regular Army system, the reserve system and finally the AUS (temporary)

system. These systems have some elements in commion but there are

differences and each system applies to a quite different constituency.

There follows a general discussion first and a more detailed description

of each system aftewards.

(II-l)-l
The Secretary of the Army, through his designated representative,

annually appoints promotion boards for the grades of 1st Lt. (02),

Captain (03), Major (04), Lt. Col. (05), Col. (06), and General (07). -

Since the ANC has only one General this report will concentrate on grades

of 1st Lt. to Col. and not delve into the details of promotion to General.

The promotion boards are instructed on the maximum number of officers they

are to recommend from the list presented to them. This list is developed

in the following manner: A date is selected by the Secretary of the Amiy

for each grade level. All the officers in that grade with date of rank

on or before the specified date are in the zone of consideration . Officers

in the zone of consideration are ordered by time in grade (TIG) and then

by active Federal commissioned service time (AFCS) among those having the

same time in grade. No officer may be considered for promotion unless

all those above him are ^Iso considered.

Except for the grade of Col. the ratio of the number allowed to be

promoted to the number in the zone of consideration (an officer's

"opportunity" for promotion) must be no less than 0.8^. The officers

not recommended are considered passed over.

Regular Army

We shall consider the Regular Army system first. The Regular Army

is the standing Army of the Nation and its size is fixed by law.

Tlie officer complement of the Regular Army is fixed^ by law at 49,500

(II-l)-2
(exclusive officers of the ANC, the Army Medical Specialist Corps

and the permanent professors of the U. S. Military Academy). Currently,

there is no statutory maximum number of officers in the ANC. However,

the Secretary of the Array has placed an administrative maximum of 1200

for the Regular Army conponent of the Nurse Corps. Regular Army officers

have the folloidng statutory maximum time in commissioned service

limitations for Regular Army promotions.

1) 2nd Lt. to 1st Lt. .3 years

2) 1st Lt. to Capt. 7 years

3) Capt. to Major 14 years

4) Major to Lt. Col. 21 years

Each officer must be considered by a promotion board far enough in advance

to meet the time limitations shown above. If an officer is passed over,

his length of service (for promotion purposes only) is reduced"* by one

year.

Reserve Army System

The Reserve Army Promotion System operates in a similar manner to

the Regular Army System except that the time limitations are different

than those shorn above. For the Reserve officers the maximum statutory

time in service limitations are:

1) 2nd Lt. to 1st Lt. 3 years

2) 1st Lt. to Capt. 6 years

3) Capt. to Major 12 years

4) Major to Lt. Col. 17 years

If an officer is passed over for promotion these statutory time limitations

are increased by one year for that officer. Any Reserve officer on active

(II-l)-3
duty who is serving in a ten^orary grade higher than his permanent grade

need not be considered by the promotion board but is automatically

considered to have been recommended and is promoted when he reaches the

appropriate time in service limitation^ specified above.

AUS System

The third promotion system relates to all officers (both Regular and

Reserve) who are on active duty and it is referred to as the Army of the

United States (AUS) This third system is the temporary promotion system

and it operates independently of the other two. Promotions usually occur

more rapidly under this system and officers are considered together

disregarding their status as Regular or Reserve Array officers. The

temporary system (AUS) allows the Army in time of increased military

commitments to fill positions of responsibility.

There are two major differences in the AUS proTnntion^: ?.s ccinpared

with the Regular and Reserve position systems. The first difference is

that an officer passed over tvdce is not separated by statutory requirements. However, experience indicates that few officers below the grade

of Lt. Col. \\rho are passed over remain on active duty, and in the Regular

and Reserve systems and officer below the grade of Lt. Col. passed over

twice for promotion is separated. The exception to this practice is

the officer with 18 or 19 years of service at the time of his second

pass over is allowed to continue until he accrues the specified 20 years

of service. Tlie second difference in AUS promotions is that the Army

may at its discretion when forming the promotion lists make up a secondary

(II-l)-4

!."
zone of consideration. The officers in the secondary zone are in effect

all those not in the primary zone. Instructions may be given to select

a small number of officers from this group to promote. Naturally this

reduces the number of officers recommended from the primary zone. This

"procedure" allows the Army to promote promising officers ahead of their

contenporaries . Officers are promoted as vacancies occur while in the

other two systems they are promoted on the anniversary of their previous

promotions.

Separation, Retention, and Retirement from the Army

To completely describe flow through the system knowledge is

necessary about various ways in which officers leave the service.

This process is complex and will be discussed in terms of retirement and

separation. These terms shall be understood to be mutually exclusive.

Within each of these t^vo wavs of leaving tJie service we shall

consider both voluntary and involuntary means. First let us concentrate

on retirement. With rare exception all Reserve officers with 20 years

of service are retired. Regular Army officers ha\^e guaranteed tenure

of 28 years of service at the grade of Lt. Col. or the maximum of 30

years service or 5 years in grade at the permanent grade of Col. Regular

Army officers may elect to retire at any time after 20 years of service.

Regular Army officers below the grade of Lt. Col. must retire after 21

years unless they have been selected for promotion to Lt. Col. Lt. Cols,

must retire after 28 -years^unless they have been selected for promotion

to Col.

The only involuntary means of separation other than for cause is as a result

of (for an officer below the grade of Lt. Col.) having been passed over

Cn-i)-5 .
tvd.ce for permanent promotion. Officers twice passed over are released

from active duty within a year unless they have 18 or 19 years active

Federal commissioned service. In that case they are allowed to remain

on active duty until they have accrued 20 years service and are then

retired.

Any officer may resign from the Army upon completion of his

obligated tour of duty.

(II-l)-6
ANNEX II - 2

Quantitative Description of Force Structure

Changes In Terms of Transition Probabilities

As mentioned in Section 6.1 the total number of transitions possible

by officers in a cohort group is six transitions denoted by six subscripts.

These subscripts include all temporary and permanent promotions related

to service component, years of service, time in temporary/permanent

grades,, differences in the temporary/pemanent grades and MDS. The

six component cohort vector (a, ^y, A, p^e) are of two types: those involving

promotion and those which do not. The functions of importance are two

compount transition probabilities for promotion and transfer respectively.

The promotion system, as seen in Figure i , encompasses both regular

and reserve officers, temporary and permanent promotion and these complete

expressions and detailed balance equations are complex. The following

provide a complete description. In these equations:

N^(t} = number of officers of grade i at time t

p„, „ . = probability that an officer of grade i and NDS 3' switches

to Mos e

CII-2)-l
r-r T
8

for all grades and conponents. The model first extracts from the Nurse

Officer Master File the present conposition of the Corps in terms of

conponent, permanent and tenporary grade, time in permanent grade, time

in tenporary grade, and P^^OS. Using the rules and rates discussed above,

forecasts of the structure of the Corps are made in terms of these

variables and factors.

This description illustrates both the power and the limitations of

the model. The effects of varying recruitment and promotion policy are

readily coirputed. Attrition rates can be easily altered to determine

their inpact on the forecasted configuration. Changes in ^DS mixes may be

brought about by factors mentioned above and other stochastic elements and

specific policy changes. It leaves the definition of the desired or

preferred structure in the hands of the planner and gives him a flexible

tool to determine the consequences, in advance, of budget, retirement, \

training and incentive policies , and other means he deems appropriate for

attaining the desired or preferred structure.

The promotion system enconpassing both regular and reserve officers

tenporary and permanent promotions, as described under Introduction is

necessarily quite conplex. The follOTvang equations give a conplete

description of that system. In these equations

N^(t) - number of officers of grade i at time t

Po, o

. - probability of officer of grade i and ^DS 6' switching to

MOS 3

(II-2)-3
- attrition rate for officers of grade i, component a,

- , years of active federal service y

?^ - the probability of receiving a permanent promotion for

eligible officers in grade i

- the probability of receiving a temporary promotion for

eligible officers in grade i

fO - regular army

(1 - reserve

3 = MOS code

Y = years of active federal service

A = time in temporary grade

0 = time in nprmflnfiTit a-rc>r1o

1 = ten5)orary grade

6 = difference between permanent and temporary grade.

Equations that describe transitions encountered by Colonels.

1) No promotion

^'^^"^^ (a,3,Y,A,p,e) = j,^' (a, 3' ,Y-1,A-1, 6)^(3' ,3,6) <^l-\a,Y,6)^

2) Temporary promotion to Colonel, no permanent promotion.

N=(t"15(a,B.Y,o,p,en) = (6,,i,z^3^=^*^(a g' ,Y-l,A-l,p-l,e) 'P^-PCB' ,3.5)

3) Permanent promotion to Colonel, no temporary promotion.

(II-2)-4
4) Temporary and permanent promotion to Colonel.

(a,6,Y,o,o,o) =

^^.z^,''^^"^ (a ,S' ,Y-l,A,p,o) -P'-PCB' ,6,5)

5) Tenporary promotion to Colonel, permanent promotion to Lt. Col.

Ne(W)

(^,3,^,0,0,1)

= ^^3,^^^^,^3N^^^)(a,3,Y-l,A,3,l)-^3',6,5)-P^-P^

Equations that describe transitions encountered by grades 1st Lt. - Lt. Col.

1) No promotion.

^i^^""^^ (a,3,Y,A,P,e) ^

^^3, ,A-l£Z.)^^^^^ »Y-l,A-l,p-l,e) '^(3' ,3,i)

~-^^-\a,y,i)>Cl-V

NaCt)^^, o. A.T Q^'Prot o ^^(i-^r..

2) Temporary promotion, no permanent promotion.

^i^^'"^^(a,3,Y,o,p,e+l) =

(gr^^^^O^'-"^^^'^^'''^'''^"^*^''''^'^^^'-^^^''^''-^^

p<_ statutory

no. of years

3) Permanent promotion, no temporary promotion.

^i^^^) (a,B,Y,A.o.e-l) =

^(g,

^..^^..^^'iM Ca,B' ,T-l,A-l,p,e3 • (l-PP

p>^ Statutory

number of years

•P(3^3,i)'^^"^(a,Y,i)^'^3,^^_^^2.)^''^^^^''>^''^"^'^"^'P e)*Pi'PC3',3,i)

Ca,Y,i)

p>_ statutory

no. of years

(II-2)-5
4) Ten^orary and permanent promotion.

^i^^'^^(a,3,Y,o,o,o) = ^3,^^^2.-l)^i-l^^'^<^">^^Y-l,A,p,o)'P(B,e,i)'Vl'^ip> statutory- no. o£ years

5) Permanent and temporary promotions to different grades.

^i^^'"^^(a,p,Y,o,o,l) =

^^^^^^2. p^i-l^^''Ca.3>Y-l,A,P,l)*^i-lVl'P(3',3,i)

p> statutory

no. of years

Note: Some of these equations may be modified by adding the tem R. _

representing recruitment at the appropriate grade and MOS.

Equation for 1st Lt.

' (a,ti,Y,A,p,yj g,--^^"^ Ca,3,Y-l,A-l,p-l,e)

Although these equations are quite complex, the actual sequence of

steps needed to model flow through the Corps is not insurmountably complex.

The flow diagram for the ANC promotion system is shown in Figure 1. The

following sequential steps are applied to single nurse officers and the

changes in status during the year are determined. These steps together with

the processing of records, promotion points, ^DS, and other variables

and factors described in the Appendix represent the components of the

Flow Computer Model.

(I I- 2) -6
ANNEX II-3

MEDDAC ANALYSIS

The purpose of this Annex is to provide supplementary and

reference material to that presented in the text (Section 4 of

Part I) dealing with MEDDAC.

1 The MEDDAC Regression Model (MRM)

1.1 Examples of Additional Regression Results

1.1.1. Many Variables

Several further examples of results will be presented,

followed by a relatively brief description of a key idea, how well the

regressions "fit." As mentioned in the text, one measure of fit is

the quantity (explained below) which can take values between 0 and

1. Values near 1 are considered to represent very good fits and values

near 0, poor fits.

(1) One of the best fits that the study has obtained has

the following form:

R2 = .986; y = 21.067 + .01699x + .2644x + .3592x10"^ x

1 30 1

- . 1752x10" ^x + . 9779x10" ^\

13 1 it

+ .5784xl0"'*x + 2.9177X - 17.7573x

1 5 9

+ .01662X + 15.563X , 2 it2

The complete computer printout pertaining to each of the regressions

discussed here is given in 7\iiiiex 1

1 -4 for reference purposes. Only

the one-page plots appearing at the end of each regression outputs are presented and discussed here.

(n-3)-l
where the variables are as follws:

y

= no. o£ (ANC + DAC-RN) nurses

X

1 = no. of Beds Staffed

X

30 = no. of M.D. 's

X

17 = no. of Bed Occupied Days FY 72

X

13 = Total Admissions FY 72

X

Ik = Total Births FY 72

X

15 = Total Visits FY 72

X

9 = Normal no. of Operating Rooms

X

60

M.D./ANC staff ratio

X

2 Average Daily Patient Census - all units

X

^2

Professional/Nonprofessional staff ratio

This equation means that if values of the indicated variables are Substituted

on the right-hand side, the equation will give an estimate of the number of

professional nurses, y . = (ANC + DAC-RN), in a MEDDAC.

An inpression of the goodness of fit can be obtained from Figure 3-1

which plots the actual ("Observed") values of y against the calculated ("Fitted")

estimates obtained by substituting the values of the variables for each MGDDAC in

the above equation. Nfost of the values are seen to lie close to a

straight line. Tliey would all actually lie on a line if the fit were

perfect (R^ = 1), i.e., if each calculated estimate were equal to the

actual number of (ANC + DAC-RN) nurses.

(2) In contrast to this , a simpler equation was obtained with far

fewer variables and with a closeness of fit that may be regarded as

almost equally good. This equation and accompanying plot were given in

the text (Part I, Section 4) but are included here for convenience:

(II-3)-2

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(II-3)-3
= .957; y = 8.927 + . 7707x10" + .4238xl0''*x

17 15 + .6493xl0"^x

where the variables are as follov/s:

y = no. o£ (ANC + DAC-RN) nurses

x^^ = no. of Bed Occi^Died Days FY 72

X = Total Visits FY 72

15

X = Total Births FY 72

'

i** The corresponding plot of actual vs_. conputed y is sho\m in Figure 3-2

and the eye can hardly detect. from the two plots that the fit is less

close. For this equation, additional calculation showed that the estimates

of y differed from the actual values by 10 percent or less in as many

as half the cases. This sha^/s that it need not be necessary to have

many variables in order to obtain a reasonably good fit.

(3) An example of an intermediate case is as follows, with

7 variables:

= .979; y = 5.524 .30 + .2109x + . 3666x10" ^x - .1539xl0'^x

17 13 + .8278xl0"2x + .6082xl0"'*x + 2.500x

Ih 15 9 + .04319X , 2 where the variables are as follows:

y

= no. of (ANC + DAC-RN) nurses

X = no. of M.D. 's

30

X = no. BOD

1 7 X = Total Admissions FY 72

1 3 X = Total Births FY 72 ^ lit

(II-3)-4
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Cn-3)-5
X = Total Visits FY 72

15

x^ = Normal no. o£ Operating Rooms

X = Average Daily Patient Census - all units

2 The corresponding plot of actual vs. computed y is shown in Figure 3-3, and

again there is little difference in fit coirpared to the other equations.

The percentage residuals calculation showed that the estimates of y

differed from the actual values by 10 percent or less in nearly 2/3

of the cases (29 out of 47) , and by 5 percent or less in about 1/3 of

the cases (16 out of 47)

1.1.2. One Variable

It also seemed worthwhile to look at, so to speak, the other end

of the scale, where only 1 variable was fitted to the same variable y as

above, and see to what extent that variable "explained" the actual

nuiiiut;!- of professional nurses (.ANC + DAC-RN) in the MEDDAC. Of the various

variables tried one at a time, it is instructive to see how closely each

of the three that are combined in the three-variable fitted equation above

(and, in addition, the remaining variable in the ICCU definition,^ namely.

Admissions) can fit the observ^^ed staff variable y when used separately.

(1) = .939; (ANC + DAC-RN) = 20.721 + .9248 x 10" ^ (BOD)

Plot of actual vs. computed y is shown in Figure 3-4.

(2) r2 = .718; (MC + DAC-RN) = 11.007 + .2114 x 10" ^ (Visits)

Plot of actual vs. confuted y is shovm in Figure 3-5.

(3) r2 = .231; TaNC + DAC-RN) = 48.410 + .0486 (Births)

Plot of actual vs. conputed y is shown in Figure 3-6.

(4) R^ = .597; (ANC + DAC-RN) = 17.345 + .923 x lO'^ (Acbnissions)

Plot of actual vs. coiiputed y is shown in Figure 3-7.

(II-3)-6
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(II-3)-ll
Of the three variables in the 3- variable equation. Bed Occupied

Days, Visits, Births, it is not surprising that BOD gives the closest fit,

as being the most relevant determinant of total professional nursing

staff, and that Births gives the poorest fit, as determining a workload '

mainly for only part of this staff, namely, those connected with newborn

units. The variables. Visits, Admissions, while perhaps representing a

workload that concerns the staff in general—thus giving better fit than

Births—apparently are not as intimately related to the staff variable as

' actually occupied beds represented by the variable, BOD. Thus, apparently

Bed Occupied Days explains the lion's share of size of staff, and there

is relatively little to be gained by 2, 6, or even 9 more variables as

in the equations of Section 1.1.1.

1.2 Goodness of Fit-Nontechnical Explanation

1.2.1. The Quantity

The idea is to use a single number to express how closely the

actual values of the dependent variable, y, the number of professional

nurses, say, are reproducible from the fitted equation. The equation

yields a calculated value of y, denoted y^ to avoid ambiguity, by substituting into the equation the values of tlie variables associated with

the actual, or observed, value of y. If we denote values for a particular

MEDDAC by the subscript i_, then we are conparing y^ with y^^ for all

values of i, say i 1,2,...,N if there are N fCDDAC . Our comparison

is by means of the differences:

^i " ^i ^Ci' ^ " 1,2,...,N.

Tlie explanation is simplified by considering the ideal case, where the

fit is "perfect" and all differences or "residuals", d. , are zero, i.e.:

d^ = 0, i = 1,2,. ..,N. .
These n relations may be replaced by the single relation:

N

S = E d.^ = 0,

1=1 ^ when it is realized that this sum o£ positive numbers (or zero) can be

0 only when each term is 0. S is thus a number that expresses the

"variation" of the actual about the calculated values of y, and we see

that in the ideal case this variation is 0. In actual

cases we may expect some variation, and S will, in general, not be 0,

but the closer it is to 0 the better the fit". The closeness of S to 0

cannot be judged independently of the characteristics of the data. The

data themselves (the y values) have an overall variability of their

own, expressed by a quantity Sy^, whose foimulation is given in Section 3.2

A fitted regression "removes" or "explains" some of this variation in

the sense that the quantity S described above, calculated by means of the

TCgrcssiori and J&iiOtcd "GGLl" xVl tlic dji.5cu^5j.uii ueluw, is less LhanSy^.

The quantity which measures the goodness of fit essentially compares

the explained variation with the original "variation Sy^ and when. the

two are close so that almost all of the variation is "explained", then

takes values very close to 1. Details are presented in Section 3

below.

1.2.2. Percentage Residuals

Another means of measuring closeness of fit is to conpare each

residual, d^, with the corresponding actual value of the dependent value,

y^, through their ratio, and so tell whetlier the regression has fit the

actual value

y^^^ to within some small amount such as 5 percent, or 10

percent, etc. This further calculation has been made in the 3- and 7-

variable equations in Subsection 1.1.1, paragraplis (2) and (3) above,

V — ~ ^
respectively. The result is expressed as the proportion of MEDDAC that

have been fitted to within a certain percentage. This measure is ntuch

more stringent tiian R^, since it depends more directly on individual

values of the d^'s, rather than on an aggregate or average basis. It

has the advantage of being more single and direct to interpret.

1.3 Some Features of Regression Equations

One of the things to notice about these regression equations is the

presence of a constant term. This means that if the regression is a

true model in the sense that its variables explain the values of the

dependent variable, here, Number of Professional Nurses (ANC + DAC-RN) , then

there would theoretically be a certain amount of nurses indicated even

i if all values of the other variables were zero. This may be interpreted

as a kind of basic "overhead" which would be present irrespective of

workload, etc. It should be noted that this constant tenn is not

fixed, but depends upon which variables are used in the regression model,

as do the coefficients in the equation.

Another feature that may require explanation is the presence of

negative coefficients in the equation. It will be apparent that the

meaning of a coefficient, such as .01699, the coefficient of x-j^ (No. of

Beds Staffed) in 1.1.1 equation (1) above, is, roughly, that if the

number of beds increased by, say 100 , then the value of y (number of

professional nurses) would increase by about 2, according to the data,

provided that no dianges were made in any other variables . Where this

latter assunption cannot be made because it is contrary to the data—^for

exanple, MEDDAC that differ in size by 100 beds do not have the same

(II-3)-14
number of M.D.'s, Admissions, Births, etc. —one cannot make an

interpretation of an individual coefficient. Thus, even if a coefficient is

negative—apparently indicating, for example, a decrease in the number

of nurses with increase in Admissions, contrary to common sense—one

cannot interpret such a coefficient by itself alone. Because of this

interdependency among the variables, a regression equation model must be

considered in its entirety—it cannot be "taken apart".

*A negative coefficient means a corresponding partial correlation

coefficient that is also negative, through the relation which is a generalization of r^-j^ = b-j^ (s^/s^) whidi holds for the two-variable

case y = bp + b^ x. s^, are standard deviations (and positive). '.

(For derivation of the raJuStionship see, e.g. , Yule and Kendall, An

Introduction to the Theory of Statistics , Griffin 5 Co., Ltd., London (1949),

p. 266, eq. (14.;83). Discussion o± a negative partial correlation

coefficient (and therefore regression coefficient) will be found in

J. M. Lucas, "Large Differences Between Partial Correlation Coefficients,"

The American Statistician , April 1973, pp. 77-78.

(II-3)-15
2 Testing of Certain Hypotheses on MEDDAC

Si^pose it is desired to test a hypothesis that two grou^DS o£ MEDDAC

are alike with respect to a certain variable, x. For this purpose it

is necessary to know several statistics for each group: the number in

the group, n; the average for the group, x; and the amount of scatter or

dispersion of the values of x in the groLp, represented by the variance ,

V. These quantities are given subscripts "1" or "2" according to which

group they pertain. It may be apparent that just knowing the means for

each groi^ would not be sufficient for judging their difference, and that a

more precise approach is necessary.

From the above statistics,* two other quantities are calculated, one

of which, V, is conpared with a criterion value in a table, this table

being entered by means of the other quantity, c, and the parameter v =

"i * '2 "2

V /n

1 1

. ^

" V1122 /n + V /n

For example, if the two groups are the Class II and Class I MEDDAC , then

we find the following from the conputer output with respect to the variable. No. of MC nurses:

*These statistics are given directly by a single instruction STATIS

(Statistical i'Vnalysis) in the NBS 0?NITAB conputer program system. For

a brief explanation, see section 3.5 below.

(II-3)-16
Class II Class I

n = 10 n = 54

1 2 X = 106.3 X2 = 36.3

V = 3345.6 V = 927.8

1 2 From these the above formula gives:

V = 3.73, c = 0.9511

A special table for this statistical test (a modified t-test) is given

in Biometrika Tables for Statisticians , Vol. I, edited by Pearson and

Hartley, 1954, pp. 136-137. The table is in two parts, depending on the

probability level involved. Thus, if the right-hand part is used (p. 137)

then the table is entered at the quantities = 10-1 = 9, = 54-1 = 53,

and c (column heading) = 0.95. Because of the very slo\\r variation of the

tabled value, the value for v is given by the value for v = <»; single

2 2 interpolation is used for v^. tHtq gives the values for c = 0.9 a^iJ 1.0,

which are v(table) = 2.74 and 2.80, respectively. Interpolating midway

between these corresponding to c = 0.95 gives as the tabular value to use

as a criterion v = 2. 77 . The value of v, above, of 3.73 is coupared with

it, and since v is greater, we conclude that the hypothesis that Class II

and Class I MEDDAC are alike with regard to No. of ANC nurses must be

rejected.

A more precise statement can be made.. 'In<.rejecting the hypothesis,

we may be in error, due to chance. The chance, or probability, hopefully

small, arises because even if the two groups of MEDDAC are alike, then

chance could produce variation in the data which would result in calculated

values of v, above, leading to rejection of the hypothesis. The larger

CIt-3)-17
the calculated value, v, the less willing one should be to believe that the

two MEDDAC groups are alike. The part of the table we looked at gives this

chance as P = .02, called the level of significance . This means that,

'

technically stated, the given data lead to a rejection of the hypothesis

that Class II and Class I MEDDAC are alike with regard to number of ANC

nurses at the .02 significance level. In other words, the probability that

this large a value of v or larger could result from chance alone is only

2 in 100, if the MEDDAC groups are alike, and this is the chance of

being in error in rejecting the hypothesis.

Of course, in this case, the difference in means of the two groups

is so large that a statistical test was not necessary. This work only

served as an illustration of the calculations involved in less obvious

cases

Other il lustratiorio of intexe^L, wjiidi ijidicate me range of

possibilities, Biay be summarized as follows (numbers in parenthesis are

degrees of freedom, which are 1 less than sample size)

Variable, x Statistic Class II Class I

No. of M.D. 's No. of MEDDACs n 10(9) 54(53)

average x 174.2 48.04

variance V 1,565 1,562

Values to enter table^^:

V 12=9, V = °°, c = .98

Conputed test value: v = 3.16**

Table comparison value: 1.83 (P = .10); 2.79 (P = .02)

a/ — Because of slow change, results for v = °° are the same as for v = 20 or 30

" 2 2 Simple interpolation is generally adequate with regard to v^.

**Signifleant at the 2 percent level.

(II-3)-18
Variable, x Statistic Class II Class I

Average length of

stay—^all

patients

No. beds staffed

No. of MEDDAO n 10(9)

average x 15.58

variance V 120.4

a/ Values to enter table— : V = 9, V =00, c = .99

Confuted test value: v = 2.35*

Table conparison value: 1.84 (P = .10)

No. of MEDDAC .n average x

variance V

8(7)

666.6

52(51)

7.38

7.14

; 2.79 (P = .02)

53(52)

201.7

9.63619x10"* 4.57077x10'*

Values to enter table —a/.

v^ = 7. V = OOj 2 c = 93

Coirputed test value:

Table conparison value

(approx.)

V = 4.09**

1.87 (P = .10) , 2.84 (P = ,02)

a/ — Because of slow change, results for v = are the same as for v = 20 or 30.

2 2 Simple interpolation is generally adequate with regard to v . * Significant at tlie 10 percent level. ^ **Significant at the 2 percent level.

CII-3)-19
3 TECHNICAL NOTES ON REGRESSION ANALYSIS AND HYPOTHESIS TESTING*

3.1 Fitting a Regression Model

A general form of regression model is:

(1) y=a+ax+ax+...+ a_x„

^ ^01122 n n*

where, for exanple, the "independent" variables, x , x ,. .

. , and the

1 2 "dependent" variable, y, take values that all belong to the same MEDDAC.

To clarify this sippose x^ denotes size of. MEDDAC (number of beds) , x^

denotes number of patient visits, and x denotes number of M.D.'s; and

3 y denotes number of professional nurses. The structure of the data then

assumes that for a particular MEDDAC there is available data on each of

X , X , X , and y. These four values constitute a group of data for that 12 3 MEDDAC, so that here n = 3, and there are as many groips of data as there

are MEDDAC to be d.ncluded in the model.

FiLliiig uitj abuve model or equation means finding suitable a's

(the "coefficients," to distinguish them from the "variables" x^ such

that when an observed set of values of the x's for a MEDDAC are substituted,

then the right-hand side of the above equation takes a value (denoted

y^) "close" to the observed value of y for the same MEDDAC, and this is

true for many of the MEDDAC . Closeness of such a calculated value to

an observed y, for the ith MEDDAC, is measured by the residual (or

"error" of fi^O ~ 7^ ' Yci' overall closeness of the calculated

Although this subject is treated in many statistics books, e.g.,

Tlie Statistical Aiialysis of Experimental Data , by John Mandel,

National Bureau of Standards , who is a \\'orld authority in this

field (see Chapter 12, "The Fitting of Straight Lines", especially

Sections 12.1 and 12.2.), the essential material is presented here

for the convenience of the teclinically-minded reader.

(II-5)-20
to observed values of y is measured by the sum of squares of the

differences for all (say N) MEDDAC : N

(2) SSE = E (y. - y^.)^ = QCa , a , . .

. , aJ ,

where SSE denotes "sum of squares due to error," and Q is a quadratic

function of the a's when the right-hand side of (1), with the observed

values of the x's, is substituted for y. To have the best measure of

fit, it is evidently desirable to choose the a's so as. to minimize the

measure of closeness, Q, or SSE.

The procedure for this is a minimization problem of calculus ; it

is not necessary to go into detail here because the results are readily

obtainable by standard computer programs (see Section 3.3 below).

These yield among other quantities, the minimi,zing values of the a^,

which will be termed regression coefficients , together with the minimized

value of Q. For evident reason, this method has been, called the "method

of least squares," and has been well established by a wide variety of

theoretical arguments, as well as the above heuristic one.

These regression coefficients determine the model for the n

assumed variables x , x ,

. . . , x : 12 n

C^^ y=a+ax+ax+...+ax, ^01122 n n'

where now the a's have the least squares values determined above.

5.2 Goodness of Fit —

As stated above, goodness of fit is measured by the sum of squares

due to error:

(II-3)-21
(4) SSE = Z (y . - y^ - ) ^

where the sum is over all MEDDAC and y^^ is calculated using the regression

coefficients a^ determined above. For furtlier development, it is

necessary to analyze the sum of squares in (4) Through properties of

the regression coefficients, it may be shown that this sum of squares may

be broken into:

(5) SSE = 2 (y^ - y)2 - SSR,

where the sum of squares on the right is the total sum of squares (of

the dependent variable) about the mean, y = (Y.y^)/N, and where SSR, an

essentially positive quantity, is the "reduction (in total sum of squares) due

to regression," or the "sum of s_quares due to (or "explained by") the j;egression.'

relation (5) states is as follows. Initially, there is a sum of

squares inherent in the data represented by sum of squares of the

deviations of the dependent variable values about their mean y. This

is the "total" sum of squares and is represented by:

N

(6) Sy2 = Z (y. - y)^

i=l ^

It may be shown that:

(7) SSR = R^ (Sy^),or, R^ = SSR/Sy^

where R is the multiple correlation coefficient between y and all the

variables x , x , . . . , x , and R takes values between 0 and 1 . 1 2 n

Equation (7) shows that R^ may be regarded as the fraction of

total variation Sy^ that is "explained" (SSR) . After a regression is

obtained, the replacement of y by the calculated value, y^^, in the above

(II-3)-22
sum o£ squares (6) produces a smaller sum of squares, SSE (equation CA4)),

and the amount of reduction due to that regression is SSR. The better

the fit, the smaller the sum of squares SSE (if the fit is perfect then

each calculated value y^^ equals its corresponding observed value y^, and

SSE = 0) and hence from (5) since the first term on the right depends

only on the data and not on a regression, the greater is the reduction,

2

SSR. Therefore, from (7) the greater is R .

If a regression is enlarged by adding k variables, and the entire

reduction in sum of squares due to the whole enlarged regression is

denoted SSR, and the reduction attributable to the first n variables

alone is denoted SSR^, then the part of the reduction attributable to

the added k variables is the difference, SSR - SSR^^.

To test whether the addition of the last k variables improves the

xxsgieiiluii "bignificaiiciy" il is then necessary lo res"c whexher "che added

reduction in sum of squares due to these k variables, namely, SSR - SSR^

is "sufficiently small," according to statistical criteria, so that it

could have resulted from pure chance alone. This test is carried out

conveniently by setting up an "analysis of variance" table as follows,

where the concept of "A/"ariance" is essentially "sum of squares":

CII-3)-23

n
Line Source of Variation

No.

Degrees of

Freedom

Sum of

Squares

Mean Square

(1) Reduction of sum

of squares due to

first (n+1) vectors (n

variables + constant t (2) Entire reduction due

to enlarged regression

(3) Added reduction due

to k added variables

(=lihe(2)-line(l))

(4) Sum of squares due

to error, for en- larged regression

n+1

erm)

(n+l+k)

k

N- (n+l+k)

SSR

SSR - SSR„^.

n+.

SSE

(SSR - SSRj^^^i/k

SSE/[N- (n+l+k)]

"Degrees of freedom" basically measures the amount of data that goes into

the calculation of sums of squares, and makes possible their conparison

by expressing them on a per unit data basis as indicated in the "Mean

Squares" column. The added reduction due to the additional k variables

calculated in line (3) is tested by forming the ratio of the two mean

squares in the last column:

(SSR - SSR^)/ k

F = with (k, N-(n+k)-l) degrees of freedom

SSE/[N-(n+k)-lJ

This quantity is looked up in an "F- table" and if it exceeds the tabulated

value in the column and row corresponding to the above respective degrees

of freedom, then we conclude that the additional k variables have

improved the regression "significantly"—significance at the probability

level P indicated in the table used, usually P = .05 or .01. That is,

the odds against the indicated improvement being due to chance alone

are about 20 or 100 to 1, respectively.

(II-3)-24
If k = 1, then the preceding procedure provides a method for

testing whether bringing the last variable into the regression

made a significant inprovement . If so, then the fit is inproved by

using it, and if not, then it can be dropped without impairing the fit,

3. 3 Estimation From tlie Model

IVhen a regression model deemed satisfactory has been obtained, then

it may be used for estimation. This is done by inserting new desired

values of the variables into the equation such as (1) and calculating

the left-hand side. For exanple, the effect of changes in size of

MEDDAC, and/or the number of M.D. 's or number of professional nurses can

be estimated by using the new specified values of these quantities. The

new value for number of professional nurses can be compared with the old

to see what change may be expected and this nrncediire r.nnlri he repeater!

for other choices of values of the independent variables.

CII-3)-25
Use of atNITAB in Computer-aideH Regression An.lv.^.

The regression calculations were carried out with the aid of the

ms WITAB system of computer programs on the on-site Univac 1108

computer. MITAB is an interpretive computing system developed and

maintained by the National Bureau of Standards to enable scientists

to perfom extensive numerical, statistical, and data analysis without

extensive programming training. CMNITAB contains numerous instructions

that automatically provide many of the quantities needed in a wide

variety of analyses. For example, the single command "FIT" produces

almost all of the quantities needed in a regression analysis, such

as:

o actual and estimated y- values;

o residuals;

o analysis of variance;

o estimates of coefficients from least squares fit; and

o fit omitting last variable.

For the convenience of the reader, these quantities are described

in detail for the output (Exhibit I) corresponding to the 3- variable

equation presented in Section 1.1.1 above. Further details may be found

in the CMNITAB Manual [1]

In this regression analysis, the variable, Professional Nursing

Staff, consisting of (ANC + DAC-RN) , is fitted by the 3 variables

Total Bed Occi^ied Days FY 72 (BOD), Total Visits FY 72, and Total Births

FY 72. In the output, the variables are designated by Column Members,

as follows:

(II-3)-26
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(II-3)-27
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(II-3)-30
Col. 70 CANC +DAC-RN)

17 BOD

15 Visits

14 Births

In addition.

Col. 64 all I's

provides for the constant term in the regression equation. Thus the

equation has 4 terms, which are designated "4 predictor variables" in

the output page headings. The input data to the analysis run appears

on PAGE 1 , with one line for each MEDDAC, for a total of 47 MEDDACs and consists

of data for the variables headed "Col. 17, 15, 14, 70", which are the

variables identified above. The next column, "Predicted Values", furnishes

what has been called in the text "estimated", or "calculated" values,

conputed for each MEDDAC from the regression equation. The next iirportant

items on this Page are the columns headed "Residuals" and "Std. Res."

(Standardized Residuals) . Residuals are the quantities

d. = y. - y^. , i = 1, 2, ... , 47

that were ± x /discussed in the text. These are standardized, or normalized, by subtracting their mean and dividing by their standard deviation. Thus the

column "Std. Res." is to be thought of as representing the number of

standard deviations by which the actual value y differs from the

corresponding estimated value from the equation. From this viewpoint,

any value far in excess of 3 (the "3-sigma" limit) provides grounds for

suspecting the corresponding observation as being grossly in error or

having other difficulty associated with it.

(II- 3) -31
PAGE 2 contains four plots of the standardized residuals. The

standardized residuals are used instead of the residuals to (i) have

a common vertical scale for all plots going from -3.75 to +3.75 in steps

of 0.3, and (ii) to avoid distortion, in some cases, due to differences

in the standard deviations of the residuals. Item (i) avoids using a

different scale for each set of measurements and makes it possible to

present the results in a more contact fonii. Only residuals associated

with non-zero weig^its are used in the plots. An examination of these

plots can be very helpful in assessing the adequacy of the statistical

model used. Non- random patterns and/or very large (small) values are

evidence of one kind or another of failure of the model to represent

the data.

(1) Upper Left . The standardized residuals are plotted against

the order in which the measurements are entered into the worksheet (row

number). If this order corresponds to the order in which the measurements

were taken, patterns of non- randomness indicate that time has an effect

on the measurements.

(2) Upper Right . The standardized residuals are plotted against

the predicted values. Non -randomness may indicate non-constant variance

or that some important variable (s) has been excluded from the model.

The former case may indicate the need to use weights , the weights used

are improper or a transformation of the measurements is required.

(3) Lmer Left . The standardized residuals are plotted against

the predictor (independent) variable. In a FIT, this plot may or may

not have much meaning, depending i^on the order cind character of the

predictor variables. The predictor variable used for the plot is the

first one whicli is not identically equal to one (unless the number of

vectors is one)

riI-3)-32
(4) Lower Right . This is a probability plot of the standardized

residuals against the expected value of the standardized residuals,

assuming that the measurement errors are normally and independently

distributed. The ordered standardized residuals are plotted against:

X. = Gau-Hp) = 4.91(p-^'* - Cl-P)*''),

where

p = (i - 7r/8)/(N + 1 - 7T/4) , for i > 2 or N > 10

= C3i - 1)/C3N + 1) , for i = 1 and N < 10

and i=l,2,...,N = the total number of points; x is the inverse (percentage

point) of the normal probability integral and the Tukey approximation

on the right is used to conpute x. If the statistical model adequately

represents the data, the points should lie approximately on a straight

line. ~

PAGE 5 shows the "analysis of variance" for the regression. This is

not the most common analysis of variance, but rather several analyses

combined into one, so that the notation taken from the CMNITAB Manual does

not always conform to that given in Sec. 3.2 above. The results depend,

in general, on the order in which the variables are entered. The ten

columns of the printing under "Analysis of Variance" are described under

(1) through (10) below, keyed to these identification numbers entered on the

output

(1) ShCT^^s the column numbers of the variables used in the instruction

FIT. . . ^

(2) The second column, shov/s a separation of the total sum of squares

2 ^ 2

Sy' = Z w y^,

n=l ^

^

into (n+1) parts

V - — \ \
(where it will be recalled that the regression equation has n variables

and (n+1) terms or vectors) with one degree of freedom for each of the

(n+1) vectors fitted and N -(n+1) degrees of freedom for the residual.

The second sum of squares is the sum of squares due to fitting the second

vector after having fit the first. The third (if n exceeds 1) sum of

squares is the reduction due to fitting the third vector after having

fitted both the first and second vectors, and so on.

(3) For the rth line of printing the cumulative mean square

reduction equals:

r

E S-/r,

i=l ^

where is the ith sum of squares shown in the second column. On PAGE 3,

for exanple, 230980.84 = (486339,59 + 203277.87 + 3325. 0583) /3.)

(4) The cumulative degrees of freedom 1 , 2 , . .

. , n+1 are printed

and followed by the degrees of freedom for the residual, N - (n+1) , and

for the total, N. The number in the rth line, r, is the number in the

denominator of the expression used to compute the cumulative mean

square reduction above.

(5) The cumulative residual mean square on the rth line is:

n+1

E S./(N-r)

i=r+l ^

The last number in the column is the residual mean square, which equals

the residual sum of squares divided by the residual degrees of freedom.

On PAGE 3, 214.89668 = 9240.5573/43. The square root of the residual

mean square (214.89668) equals the residual standard deviation (14.659355)

shoim on PAGE 4.

(II- 3) -34 >
(bj Gives tne aegrees ot treedom for the cumulative residual mean

square, which equals (N-r) on the rth line.

(7) The F-ratio printed is the sum of squares (due to coefficient)

divided by the residual mean square with 1 and N- (n+1) degrees of freedom.

On PAGE 3, 9437.18= 99404.994/10.5333333. The F-values are printed with

3 decimal places.

(8) Gives the significance level of the F-ratio on the same line

in (7) , under the hypothesis that the corresponding parameter (coefficient)

in the model equals zero. These significance levels should be interpreted

carefully. Three decimal places are shown. The value .000 is the

(rounded) probability value that a F-ratio will exceed 15.473 if the

model does not include the Col. 15 variable, namely. Total Visits, FY 72.

(9) The F-ratio on the rth line is used to test the hypothesis,

that all the parameters r, r+1, n+1 equal zero.

(10) Gives the significance level of the F-ratio on the same line

of (9)

PAGE 4 is divided into three parts: (a) estimates, (b) accuracy,

and (c) estimates from refit omitting last tem.

(al) to (a4) . Least squares estimates of the unknown parameters

are printed on the left. On the extreme left (al) the usual column

heading appears. This is followed by a listing of the estimates

(coefficients), standard deviations of the . estimates, and the ratios of

the estimates to their standard deviations, (a2) to (a4) , respectively.

The residual standard deviation and the associated degrees of

freedom are printed at the bottom. The degrees of freedom equals the

number of non-zero weights minus the nun±)er. of vectors fitted, n+1, which

is the third argument in a FIT -instruction. Tlie smaller the residual

standard deviation, the better the fit, since it means that the estimated

values var\^ less about the fitted regression.
The ratio (a4) can be used to perform t- tests and construct confidence

intervals for the parameters in the model.

(b) Next, a column headed *ACC. DIGITS is printed.. The algorithm

used in FIT is generally accurate, but no least squares fitting algorithm

is fully accurate in all cases. (See Longley [2], Wampler [3] or. [4],)

Computational accuracy, is affected by several factors;

in particular (i) the nuiriber of measurements and vectors, (ii) the scaling

of measurements and vectors, (iii) how closely the vectors are related

(correlated) , and (iv) the number of digits in the ras,-! data. The

values under *ACC DIGITS provide an indication of how well the results

have been computed. Loosely speaking, values between 6. and 8. indicate

that the confutations are accurate. Values less than 4.0 indicate some

source of computing difficulty. Negative values cry out for an

investigation.

Mathematically, singular matrices cannot be inverted. However,

in a computer, an algorithm sometimes fails to distinguish between a

singular matrix and a non-singular matrix. This can happen here. Users

will sometimes use a set of vectors which is not of full rank. For exanple,

one of the columns (variables) may inadvertently be a sum (or other linear

combination) of other columns. Any of the folla.ving may indicate trouble:

(i) a coefficient exactly equal to zero, (ii) extremely large or small

coefficients or standard deviations of coefficients , and (iii) small

values under *ACC. DIGITS.

(II-3)-36
The values under *ACC. DIGITS are estimates based upon a refit of

the predicted values. If the calculations are accurate, the two

calculations of the coefficients should agree. (Mathematically, they

are exactly equal.) The estimates of accuracy are reasonably reliable.

The smallest and largest possible values are -8.0 and +8.0. If B is

the coefficient and 3 is a coefficient confuted from the refit, the

accuracy of the conputations is given by:

-iog^Q|(3 - 3) /a].

Negative answers indicate the first digit iil the coefficient is incorrect.

For example, the last coefficient in column (a2) is accurate to at

least 6 (non-zero) digits.

The results here apply to the coefficients and provide a general

assessment of computational accuracy. They cannot be generalized to

all other conputations. For example, if a measurement equals 15923.648

may have only 3 or 4 correct digits.

(cl) to (c3) . On the right, the coefficients, their standard

deAaations and the ratio of the coefficients to the standard deviations,

(cl) to (c3) , respectively, are printed from a refit omitting the last

term (vector). Again, the residual standard deviation and degrees of

freedom are printed at the bottom. These results can be usefully compared with the results on the left. In a FIT, these results may or

may not be useful, depending upon the order in which the vectors appear

in the instruction and the inportance of the last term. If only one

vector is fitted, only the residual standard deviation and degrees of

freedom are printed.

(II-3)-37
The squared multiple correlation coefficient is (if weights are used)

2 ^ - 2

R = 1 - Residual Sum of Squares/ Z w.(y.-y ) , where v = TM.y./lM

• _T 1 1 W W XI 1*1

The denominator in the fraction is the "corrected" Total Sum of Squares

(SSE) , i.e., sum of squares about the mean. If the first vector is a

vector of I's, the corrected Total Sum of Squares is the uncorrected

Total Sum of Squares minus the sum of squares due to fitting the mean

(constant term) , i.e. , the last number minus the first number under SS =

RED. DUE TO COEFF. on PAGE 3. If the first vector is not identically

2

equal to 1, then R has no meaning.

3.5 Use of OMNITAB in Computer-aided Hypothesis Testing

As with regression analysis, a single instruction, "STATIS", in

the OMITAB programming system, can be used to produce essentially all

the quantities for a regres'sion analysis. Tliis will be described in

detail for the output fExhibit II) corresnonrjina to the ex?JT!ple for

the variable. No. of ANC nurses, discussed in the text (Part I, Sec. 4).

For a more detailed description of the use of the STATIS instruction, see

reference [5]

To use this programming, the total data is first separated into

the two groups which are to be conpared through hypothesis testing.

For this work, the available data were in the form of pundied cards,

one set of 12 or so cards for each of 71 MEDDAC, with data for up to

70 variables for each MEDDAC. Because of missing data, etc. , the number

of MEDDAC with complete data varied for the different variables, and

only these could be included in the analysis. The groiq^s considered were

the Class II and Class I MEDDAC , and it was singlest to separate

(II-3)-38
manually the punch cards into two sets each consisting of the MEDDAC

of the appropriate group. Thus, the Class II set consisted of the

cards for those 10 MEDDAC , and the Class I set consisted of the remaining cards , for the other 61 MEDDAC , even though some data were incomplete

This difficulty was taken care of through conputer processing, as will

be described.

Exhibit II shows the conputer results' for the Class I MEDDAC •

The corresponding results for the Class II MEDDAC were precisely similar.

The preparatory part of the confuter run took the 61 values of

each variable, corresponding to the 61 NEDDAC , deleted missing results,

etc. eliminating the corresponding ^EDDAC , and closed up the remaining

values of each variable, so that, in effect, there are a different

number of MEDDAC corresponding to each variable. Thus, in the exanple,

there are (second line of PAGE 161 in Exhibit II) N = 54 Class I MEDDAC

for which there are usable data and for which the statistical analysis

calculations were made. The second line also shows the name of the

command and indicates the identification of the variable by means of

Column number. The reference to NBS Handbook 91 is [6]. For further

reference see p. 119 in the OMNITAB manual [1],

'

In order to cover as many different situations as possible, the

STATIS command produces 53 statistics of many different kinds, spread

over several pages of output. For the purposes of this report,

actually only two of them are needed, and consideration will essentially

be limited to these.

The statistics are preceded by a FREQUENCY DISTRIBUTION, on PAGE 161

which showTs the number of data points that fall in each of 10 equal

intei-vals of the range of all the data, listed in ascending sequence

of intervals. Items in parentheses refer to page number in NBS

Handbook 91 [6]
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1^ « 9 tH «
(1) looking at the shape o£ distribution, e.g., skewness, peakedness,

etc. , and in

(2) detecting outliers at one or both ends.

Usually if an end point is separated by one or more zeroes from

the main part of the data in the frequency distribution, it is suspected

as an outlier. If it can be verified that the outlier is present because

of a mistake in recording or typing, or because of violation of experimental conditions, obviously the point should be deleted. Other than

that the course of action is not clear. We suggest as a first reference

the three -page article, "Some Remarks on Wild Observations" by William H.

Kruskal {7].'

MEASURES OF LOCATION. The only value needed is the Unweighted Mean,

which is designated x (with subscript 2 for the Class I group in the

hypothesis testing calculation)

MEASURES OF DISPERSION. The one used is the Variance, designated

COEFFICIENT OF VARIATION (in percent, designated C.V.) . Although

not used, this is useful in indicating an overall impression of the spread

of the data. If the C.V. for a variable is much over 100 percent, then

one can expect more difficulty in the analysis of that variable because

of the extremely wide spread than for a variable that is relatively

concentrated, about a central value, with a C.V. of say, less than 50

or even 25 percent.

.(II-3)-44
RANKED OBSERVATIONS, ORDERED OBSERVATIONS, PAGES 162-5 . Two blocks

of information are presented, with essentially these titles, in sets of

columns at the left, and right, of the page, respectively. The first

column "I" indexes the observations in tlie sequence they are read into

the program. Since the printout is automatic, no other identification

can be provided. Thus, if incomplete MEDDAC data are eliminated and

the column "closed up", then it wall not be possible from this printout

alone to identify a particular value with its MEDDAC without looking

for that value in the original data input, before elimination, which

should therefore be programmed to show in the output. The second

column "X(I)" lists the value of observations in floating point

format. The third column lists the ranks of the values when ranked

from smallest to largest. If two or more values are the same, these

are given in the same rank number, calculated as the average of the

ranks if these numbers are slightly different. The fourth column lists

the differences X(I) - MEAN in floating point format.

The column X(J} orders the observations in an ascending sequence.

Under the heading "NO." the index number "I" associated with the

observations are listed so that specific ones can be identified in terms

of those listed in the left block of columns. The last column X(J + 1)

- X(J) gives the successive differences between adjacent ordered

observations. The last column is useful because large differences,

especially associated with large observations at the bottom of the

column X(J) , indicate gaps that may represent "outliers" that really

do not belong with the body of the data, tliat may be due to error or

other cause.

ai-3)-45

h

^
The last page, PAGE 164, showing HISTOGRAM, is provided by a few

instructions that produce a frequency distribution in graphical form.

This shows at a glance the character of the data being analyzed. VVhen

the STATIS instruction is run on a large succession of variables, then

flipping the pages with HISTOGRAM output makes it possible to very

rapidly screen the variables, and enable preliminary attention to be

focused on segments of the total data that are more amendable to analysis.

(II-3)-46
REFERENCES

[1] Q^NITAB II: User's Reference Manual , Hogben, Peavy, and Vamer,

NBS Tech. Note 552, Oct. 1971.

[2] Longley, J. W. (1967) . An appraisal of least squares programs for the

electronic coiiputer from the point of view of the user. J. Amer.

Statist. Assoc., 62_, 819-841.

[3] Warrrpler, R. H. (1969) . An evaluation of linear least squares

conputer programs. J. of Res., B, NBS, 73B, 59-90.

[4] Wampler R. H. (1970) . A report on the accuracy of some widely used

least squares computer programs. J. Amer. Statist. Assoc., 65_,

549-565.

[5] Ku, H. H. (1973). A Users 's Guide to the OMNITAB Command "STATISTICAL

ANALYSIS," N'BS Tech. Note 756, issued March 1973.

[6] Natrella, Mary G. , Experimental Statistics . National Bureau of

Standards Handbook 91, 1965, 2nd edition, 1966.

[7] Kruskal, William H. , Some remarks on wild observations. Techometries , 2, No. 1, 1-3 (1960). Reprinted as a paper in 5.5 in

Reference [8] below.

[G] Ku, fldixy n. , Ed., Precision Measurem.enr and Lalibration - concepts

and Procedures . National Bureau of Standards Special Publication

300, Vol. 1, 1969.

(II-3)-47

\1>

ANNEX n-4

ACTUAL COMPUTER OUTPUT MATERIAL FOR REFERENCE

Tliis annex presents 9 sets of computer outputs of five pages

each. Each set corresponds to a regression equation discussed in

Annex II- 3 and is identified by the corresponding section and equation

numbers. Column numbers in the outputs correspond to the subscripts of,

and identify, variables in the list below.

For further explanation of these regression analysis outputs, see

discussion of OMITAB in Annex II-3, Section 3.4.

Col. 70 = y = no. of (ANC + DAC RN) nurses

x^ = no. of Beds Staffed

x^Q = no. of M.D. '

x^j = no. of Bed Occupied Days FY 72

Xt^ = Total Admissions FY 72

x^^ = Total Births FY 72

x^^ = Total Visits FY 72

Xg = Nonnal no. of Operating Rooms

x^Q = M.D. /ANC staff ratio

X2 = Average Daily Patient Census - all units

x^2 ~ Professional/Nonprofessional staff ratio

^16 ~ ^^^^^^^'^ ^^^^ Composite Units (TCCU)

The regression outputs are followed by the relevant portions of

the correlation analysis output for SO variables witli 47 observations indicated

in Part I, Sec. 4.1, and there identified as Set 3 (also so identified

in Annex 11-11)

(II-4)-l t

Computer Output for ANNEX II- 3, Sec. 1.1.1 (1)

(II-4) -3
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(II-4)'-7 r o c

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(11-4) -9
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TABLE OF COI^rENTS FOR COLUNNS

1 No. Beds Staffed on 9-30-72

2 No. Beds Can Staff With Present Nurse Personnel

3 No. Units - Normal FY 72 All Units

4 No. Units - Peak FY 72 All Units

5 Av. Daily Patient Census FY 72 - All Units

6 Av. No. Beds Occ./Day - All Units FY 72

7 Sept. 72 Daily Pat. Cens. - All Units

8 Sept. 72 Av. Daily Beds Occ. - All Units (ColCF))

9 No. Units - Normal FY 72 - Intens. Care

10 No. Units - Peak FY 72 - Intens. Care

11 Av. Daily Pat. Cens. FY 72 - Intens. Care U.

12 Av. No. Beds Occ./Day - Intens. Care U. FY 72

13 Sept. 72 Av. Daily P. Cens. - Intens. Care U. (Col(E])

14 Sept. 72 Av. Daily Beds Occ. - Intens. Care U.

15 No. Units - Normal FY 72 - Min./Intermed. Care

16 No. Units - Peak FY 72 - Min./Intermed. Care

17 Av. Daily Pat. Cens. FY 72 - Min./Intermed. Care U.

18 Sept. 72 Av. Daily Pat. Cens. - Min./Intermed. Care U.

19 Sept. 72 Av. Daily Beds Occ. - Min./Intermed. Care U.

20 Normal No. Operating Rooms FY 72

21 Normal No. Delivy. Rms. FY 72

22 Max. No. Operating Rooms FY 72

23 Max. No. Delivery Rooms FY 72

24 Total Admiss. JrY 72

25 Total Births FY 72

26 Total Visits FY 72

27 Total MCCU FY 72

28 Total Bed Occ. Days FY 72

29 Certified Hospital Infections FY 72

30 Certif. Hosp. Infection Rate FY 72

31 Av. Length of Stay - All Patients FY 72

32 Total No. Dispos. - All Patients FY 72

33 Av. Length of Stay - All Gen. Surgy Patients FY 72

34 Total No. Dispos. - All Gen. Surgy. FY 72

35 Av. Length of Stay - Append. FY 72

36 Tot. No. Dispos. - Append. FY 72

37 Av. Length of Stay - Hernia FY 72

38 Tot. No. Dispos. FY 72 - Hernia

39 Av. Length of Stay - FY 72 - Cholelithiasis

40 Tot. No. Dispos. FY 72 - Cholelithiasis

41 Tot. No. Bed Occ. Days - Intens. Care U. Sept. 72

42 No. Bed Occ. Days - Min. Care U. Sept. 72

43 No, Bed Occ. Days - All Otlier Pat. Sept. 72

44 No. Rations in Wards on 9-27-72

45 No. Rations in Dining Rms. on 9-27-72

46 Tot. Rations Category CI? 2, or 3)

47 Tot. Patient Complaints - 10 Mos. In FY 72

48 Tot. Pat. Coiiplaints Re. Care - 10 Mos. in 71-72

49 No. Unusual Occurrences - Sept. 72

(11-5)^15
50 No. ofM.D.'s (Physicians - Form DA 3604, 9-30-72)

51 ANC Strength 9-30-72

52 Civil Reg'd. Nurses 9-30-72

53 Enlisted Men in Nursg. Service 9-30-72

54 Civilian Non-Pro£l. Nursg. Staff 9-30-72

55 ANC Assigned 6-30-72 (Turnover)

56 Dept. Army Civ. R.N. Assigned as of 6-30-72 (T.O.)

57 ANC on PCS (Perm. Change Station) FY 72 (T.O.)

58 ANC Transf. During FY 72 (T.O.)

59 ANC Separated During FY 72 (T.O.)

60 Civ. R.N. Joined During FY 72 (T.O.)

61 Civ. R. N. Resigned or Discharged During FY 72

62 Tot. Nursg. Staff 4-30-72 (Sum of 4 Compnts.)

63 Fraction of Patient Complaints Re. Quality

64 Ratio Max. /Normal for C^erating Rooms FY 72

65 Ratio Max. /Normal for Delivy. Rms. FY 72

66 Ratio Tot. Nursg. Staff 9-30-72/Tot. MCCU FY 72

67 Ratio Beds Can Staff/Beds Staffed

68 Ratio Rations in Wards/No. in Dining Rms. 9-27-72

69 Mil. /Civ. Staff Ratio 9-30-72

70 Officers/Enlisted Staff Ratio 9-30-72

71 Profl./Non- Prof1. Staff Ratio 9-30-72

72 Military Turnover P.C. Rate FY 72

73 Civ. Turnover P.C. Rate FY 72

74 Tot. Mil. + Civ. Turnover P.C. Rate FY 72

75 Percent Bed Ccc. Days - liiL. Caxtj/Tui:. B.O.D. 9/72

76 Percent Bed Occ. Days - Min. Care/Tot. B.O.D. 9/72

77 Percent Bed Occ. Days - All Other/Tot. B.O.D. 9/72

78 Check Sum of Percents B.O.D. (To Add To 100 P.C.)

79 Total Admiss. Sept. 72

80 Total Births Sept. 72

81 Total Visits Sept. 72

82 Total MCCU Sept. 72

83 Total Bed Occ. Days Sept. 72

84 Av. Daily Beds Occ. - 10 Mos. 71-72

85 No. ANC (From OTSG Fom DA 3604, 9-30-72)

86 Ratio ANC Str. 9-30-72/Daily Pat. Cens. FY 72

87 Ratio ANC Str. 9-30-72/Intens. Pat. Cens. FY 72

88 Ratio Tot. Nursg. Staff 9-30-72/Int. Pat. Cens. FY 72

89 Ratio Tot. Nur.sg. Staff 9-30-72/Av. Dly. Beds Occ. FY 72

90 Ratio ANC 9-30-72 (Fom DA 3604)/Beds Staffed 9-30

91 Ratio No. M.D./ANC 9-30-72 (Form DA 3604)

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TABLE OF CONmYTS POR COLUMNS

1 No, Beds Staffed on 9-30-72

2 No. Beds Can Staff With Present Nurse Personnel

3 No. Units - Normal FY 72 All Units

4 No. Units - Peak FY 72 All Units

5 Av. Daily Patient Census FY 72 - All Units

6 Av. No. Beds Occ./Day - All Units FY 72

7 Sept. 72 Daily Pat. Cens. - All Units

8 Sept. 72 Av. Daily Beds Occ. - All Units CCol(F))

9 No. Units - Normal FY 72 - Intens. Care

10 No. Units - Peak FY 72 - Intens. Care

11 Av. Daily Pat. Cens. FY 72 - Intens. Care U.

12 Av. No. Beds Occ./Day - Intens. Care U. FY 72

13 Sept. 72 Av. Daily P. Cens. - Intens. Care U. CCol(E))

14 Sept. 72 Av. Daily Beds Occ. - Intens. Care U.

15 No. Units - Normal FY 72 - Min./Intermed. Care

16 No. Units - Peak FY 72 - Min./Inteimed. Care

17 Av. Daily Pat. Cens. FY 72 - Min./Intermed. Care U.

18 Sept. 72 Av. Daily Pat. Cens. - Min./Intermed. Care U.

19 Sept. 72 Av. Daily Beds Occ. - Min. /Interned. Care U.

20 _Normal No. Operating Rooms FY 72

21 Nomal No. Delivy. Rms. FY 72

22 Max. No, Operating Rooms FY 72

23 Max. No. Delivery Rooms FY 72

24 Totpi Admi5£. FY 72

25 Total Births FY 72

26 Total Visits FY 72

27 Total MCCU FY 72

28 Total Bed Occ. Days FY 72

29 Certified Hospital Infections FY 72

30 Certif. Hosp. Infection Rate FY 72 • - 31 Av. Length of Stay - All Patients FY 72

32 Total No. Dispos. - All Patients FY 72

33 Av. Length of Stay - All Gen. Surgy Patients FY 72

34 Total No. Dispos. - All Gen. Surgy. FY 72

35 Av. Length of Stay - Append. FY 72

36 Tot. No. Dispos. - Append. FY 72

37 Av. Length of Stay - Hernia FY 72

38 Tot. No. Dispos. FY 72 - Hernia

39 Av. Lengtli of Stay - FY 72 - Cholelithiasis

40 Tot. No. Dispos. FY 72 - Cholelithiasis

41 Tot. No. Bed Occ. Days - Intens. Care U. Sept. 72

42 No. Bed Occ. Days - Mn. Care U. Sept. 72

43 No, Bed Occ. Days - All Other Pat. Sept. 72

44 No. Rations in Wards on 9-27-72

45 No. Rations in Dining Rms. on 9-27-72

46 Tot. Rations Category Cl> 2, or 3)

47 Tot, Patient Complaints - 10 Mos. In FY 72

48 Tot, Pat. Complaints Re. Care - 10 Mos. in 71-72

49 No. Uiiusual Occurrences - Sept. 72

CII-6)^15 .
50 No. of M.D. 's (Physicians - Form DA 3604, 9-30-72)

51 ANC Strength 9-30-72

52 Civil Reg'd. Nurses 9-30-72

53 Enlisted Men in Nursg. Service 9-30-72

54 Civilian Non-Profl. Nursg. Staff 9-30-72

55 ANC Assigned 6-30-72 (Turnover)

56 Dept. Army Civ. R.N. Assigned as of 6-30-72 (T.O.)

57 ANC on PCS (Perm. Change Station) FY 72 (T.O.)

58 ANC Transf. During FY 72 (T.O.)

59 ANC Separated During FY 72 (T.O.)

60 Civ. R.N. Joined During FY 72 (T.O.)

61 Civ. R. N. Resigned or Discharged During FY 72

62 Tot. Nursg. Staff 4-30-72 (Sum of 4 Compnts.)

63 Fraction of Patient Complaints' Re. Quality

64 Ratio Max. /Normal for Operating Rooms FY 72

65 Ratio Max. /Normal for Delivy. Rms. FY 72

66 Ratio Tot. Nursg. Staff 9-30-72/Tot. MCCU FY 72

67 Ratio Beds Can Staff/Beds Staffed

68 Ratio Rations in Wards/No. in Dining Rms. 9-27-72

69 Mil. /Civ. Staff Ratio 9-30-72 . 70 .Officers/Enlisted Staff Ratio 9-30-72

71 Prof1. /Non-Profl. Staff Ratio 9-50-72

72 Military Turnover P.C. Rate FY 72

73 Civ. Turnover P.C. Rate FY 72

74 Tot. Mil. + Civ. Turnover P.C. Rate FY 72

75 Percent Bed Occ. Days - Int. Care/Tot. B.O.D. 9/72

76 Percent Bed Ccc. Days Min. Care/Tot. B.O.D. 9/72

77 Percent Bed Occ. Days - All Other/Tot. B.O.D. 9/72

78 Check Sum of Percents B.O.D. (To Add To 100 P.C.)

79 Total Admiss. Sept. 72

80 Total Births Sept. 72

81 Total Visits Sept. 72

82 Total MCCU Sept. 72

83 Total Bed Occ. Days Sept. 72

84 Av. Daily Beds Occ. - 10 Mos. 71-72

85 No. ANC (From OTSG Fom DA 3604, 9-30-72)

86 Ratio ANC Str. 9-30-72/Daily Pat. Cens. FY 72

87 Ratio ANC Str. 9-30-72/Intens. Pat. Cens. FY 72

88 Ratio Tot. Nursg. Staff 9- 30- 7 2/ Int. Pat. Cens. FY 72

89 Ratio Tot. Nursg. Staff 9-30-72/Av. Dly. Beds Occ. FY 72

90 Ratio ANC 9-30-72 (Form DA 3604) /Beds Staffed 9-30

91 Ratio No. M.D. /ANC 9-30-72 (Fom DA 3604)

Cl.I-6)-16

\ ! - -
Annex II-7

Instruments Used to Obtain Survey Data:

Army Nurse Corps Worldwide

Questionnaire (ANCWWQ)

Survey of Nursing Personnel:

Sections A, B, C, D

Reports Control Symbol

MEI>- (OT) -295

Army Nurse Corps Officer

World-wide Questionnaire

Conducted by

Technical Analysis Division

Washington, D.C. 20234

For

Office of The Surgeon General

Department of the Army

Washington, D.C. 20314

05650

THIS IS A QUESTIOJNAIRE - NOT A TEST 9/72

1 )7

DEPARTMENT OF THE ARMY

OFFICE OF THE SURGEON GENERAL

WASHINGTON. D.C. 20314

Dear Nurse Corps Officer:

In the spring issue of the U.S. Army Medical Department Newsletter, I spoke briefly about the importance of the Army Nurse Corps Structure

Analysis and Program Planning Studies which have been developed over

the past few years. Data obtained from various portions of this

project will serve as a foundation for future planning and proposed

change relative to the Corps.

The Army Nurse Corps Officers World-Wide Questionnaire which follows

offers the opportunity for your individual contribution to this

effort. Thoughtful and accurate answers will assure that your views

and opinions are reflected in the data summarips th»t wp rprp-fvp.

All information in the survey instrument will be handled by the

National Bureau of Standards to maintain the anonymity of each individual officer. This important feature of the study is to permit you

to answer all questions freely and honestly. This questionnaire is

your opportunity to make your views known and in doing this each of

you will be taking an active part in assisting the Army Nurse Corps in

its future planning.

LILLIAN DUNLAP \j Brigadier General, ANC

Chief, Army Nurse Corps
FOREWORD

The Office of The Surgeon General needs the benefit of your

experience, professional judgment, and your fresh and up-to-date opinions

in its efforts to improve Army health care. You and all other Army nurses

are being asked to complete this questionnaire because the Surgeon General

cannot get this kind of information from regular reports.

Answer freely, saying whatever you think. To protect your identity

and insure that your answers will be treated confidentially, the Surgeon

General has asked the National Bureau of Standards to conduct this survey.

The National Bureau of Standards will report only on the accxomulated data

and will not release to the Army or any other government agency either your

individual questionnaire or the computer tapes from which individual answers

could be retrieved.

Your answers will help us to determine —

(1) What characterizes you — your background, training, experience,

and personal and family responsibilities which help form the perspectives

you and other nurses have;

(2) The range and kinds of tasks that you actually perform; whether or

not you think nurses should be doing them; and how best to provide training

for the kinds of duties and nursing positions that are realistically needed

for the future;

(3) How you feel about housing, pay and allowances, fringe benefits,

benefits for dependents, career planning, and how often you would like

to be reassigned;

ii

\ •«.
(4) How you feel eibout some proposals concerning married nurses,

dependents, education, and other aspects of Army life that may affect

your personal life; and

(5) What changes are necessary in laws, regulations, organization,

programs, education, and other training concepts in order to provide the

best nursing care today and In the future

You will find that not all questions apply to you because the

questionnaire was designed for the entire Army Nurse Corps — from

the newest officer to the most senior. If you feel that a question does

not apply to you, please put "9^"s in the spaces provided for your

answer.

Two Important Points

(1) You will be teiking an active part in defining the role of the

Army Nurse Corps Officer; in determining the structure of the Corps;

and in developing programs that will benefit ANC Officers, Army nursing

personnel, and patients entrusted to your care. Your opinion is important .

(2) The answers you give are for OFFICIAL RESEARCH PURPOSES ONLY. Your

individual questionnaire is to be mailed directly by you to the National

Bureau of Standards and will be seen only by National Bureau of Standards

researchers. The questionnaires will remain at the National Bureau of Standards

until they are destroyed: THESE QUESTIONNAIRES — AS WELL AS COMPUTER TAPES

FROM WHICH INDIVIDUAL WISWERS COULD BE RETRIEVED — WILL NOT BE RELEASED TO THE

DEPARTMENT OF THE ARMY OR ANY OTHER GOVERNMENT AGENCY.

u — >

Thank you, in advance, for your time, effort, and the inconvenience

of filling out this very important questionnaire.

iii
1 SOME THINGS TO REMEMBER AS YOU

ANSWER THIS QUESTIONNAIRE

ANSWER about only your own military and personal background, duties, j

and opinions as an Army Nurse Corps officer. Mostly the items in the

questionnaire ask you to write in a particular space the number of the

answer that most closely applies to you or your ideas. If none of the

^

answers provided is exactly right for you, then pick one that best

describes what you do or how you feel.

TELL US HOW YOU FEEL . Do not choose an answer because you think

the Army might want you to say that. On YOUR questionnaire, we are

interested in YOUR answers, opinions, comments and judgments.

DO YOU HAVE YOUR DA FORM 66? Before you begin to fill out this

questionnaire, you should have in hand your official DA Form 66. Please

Uac iL Lo Iv^ok diiowvci-o cts> ywa may iieeu help in remembering. xf i'C isn't;

up to date, then answer with the best infoimation you can recall. A staff

assistant will be in the room to help when you are filling in the questionnaire.

Ask him to help you interpret questions that may be lanclear. j IF YOU ARE IN A NEW DUTY STATION and have been in yoxir present

assignment less than 30 days ythen you receive this questionnaire, use your

immediate past assignment as the reference for questions that ask about your

"present" unit or assignment. However, use your present assignment if your

last assignment was basic training.

If you are on TDY from your home unit , answer the questions about your

"present" \init in terms of your home unit. If you are in a staff position,

answer only those questions about patient care and the hospital setting that

you can answer from your experience; do not answer questions pertaining specifically

to a present assignment in a hospital or treatment facility.

iv
COMMENTS please ! We invite your comments or questions about the questionnaire,

but because your answers to individual questions will be machine processed,

anything else you might write on the form itself would be lost. Use

the tearout blank pages in the back of the questionnaire (pages 51 and 52)

for your comments. Keep these psges alongside your booklet and write

on them any comments you may wish to make as you go through the questionnaire.

Ask for additional pages if you want them. Please be certain to show the

number of the question you are commenting about.

DO NOT WRITE IN THE LEFT-HAND MARGINS OF THE QUESTIONNAIRE ITSELF : You

will confuse the key pvinch operators if you do so. If there are any terms that

cure mclear, please ask the staff member who has been assigned to help you.

Examples

Multiple Choice Questions ;

A majority of the questions ask you to choose the "best fit" answer from

a list of possibilities and then to write the number of your choice in an answer

space. The following example assumes you are now serving in the grade of Captain.

1/11 What is your current active duty grade?

1 = Second Lieutenant

2 = First Lieutenant

3 = Captain

4 = Major

5 = Lieutenant Colonel

6 = Colonel

7 = Brigadier General

Unless you are specifically asked to do otherwise, as in the next

example , please write the number of the answer you choose in the space

given.

V
Direct Answer Questions : Some questions ask you to put your

information directly in the answer space; for example, the number of

years you have been in active military service. If there are more blank

spaces than your answer will fill, always put your answers as far to the

right as possible and fill the other blank spaces with zeros. For example,

if your answer to the following questions were " 2 years and 10 months ",

and you roxmded it to the nearest year, you would fill in:

1/23

years How many years of active military service

do you have for pay purposes? (Include enlisted,

officer and creditable reserve time. Comt actual

completed years , not your present longevity increment.

DA Form 66, item 12.)

The numbering system appearing alongside the blanks is adapted to IBM

data cards for the convenience of key punchers. The first number is for the

card on which your answers will be punched, and the number to the right of the

slash (/) gives the correct coliamn that will be used on the 80-col\imn card.

PLEASE

PRINT IN BLOCK STYLE AND PUT ONLY ONE DIGIT IN EACH SPACE. When

your responses are machine processed they must be clear and legible for the

key punch operator.

ENTER "9_"s IN THE SPACES PROVIDED IF THE QUESTION DOES NOT

APPLY TO YOU

REMEMBER: THIS IS A QUESTIONNAIRE—NOT A TEST.

We want your answers, so please do not discuss the questions with other

Army nurses \intil you have all completed the questionnaires and mailed them.

vi
PERSCNAL HISTORY

1/08 In what year were you bom (last 2 digits)?

year (Last

2 digits)

1/10 What sex are you?

1 = Male

2 = Female

1/11 What is your current active duty grade?

1 = Second Lieutenant

2 = First Lieutenant

3 = Captain

4 = Major

5 = Lieutenant Colonel

6 = Colonel

7 = Brigadier General

1/12 Are you a Regular Army (RA) Officer or a Reserve

(USAR) Officer?

1 = Regular Army

2 = Reserv*^

1-
THE FOLLOWING DATA CAN USUALLY BE FOUND ON DA FORM 66. NUMBERS OF

ITEMS cm THE DA 66 ARE SHOWN IN PARENTHESES AFTER EACH QUESTION

TO HELP YOU FIND THE INFORMATION WE NEED. IF YOU NEED FURTHER HELP,

BE SURE TO ASK STAFF MEMBER ADMINISTERING THIS QUESTIONNAIRE.

Please give the date (month and year) for the following:

1/13

month year

(last 2

digits)

What is your RA or USAR Date of Rank (often

called Permanent Date of Rank)? (On your

DA Form 66, item 12, this will be the last

entry preceded by RA or USAR.)

1/17

montii year

(last 2

digits)

What is your AUS Date of Rank (often called

Temporary Date of Rank)? (On your DA Form 66,

item 12, this will be the last entry with an AUS prefix.)

1/21

years

How many years of active federal military service

do you have? (Include enlisted officer time.

Count service 6 months or longer as a full year.

DA Form 66, item 12.)

1/23

years

How many years of active military service

do you have for pay purposes? (Include enlisted,

officer and creditable reserve time. Count actual

completed years , not your present longevity increment.

DA Form 66, item 12.)

1/25

years

How many years of active federal military service do

you have as a commissioned officer? (Count service

6 months or longer as a full year. DA Form 66, item 12.)

2
IF YOU ARE A PEGULAR ARMY OFFICER ANSWER THESE 5 QUESTIONS. IF YOU

ARE NOT AND HAVE NEVER BEEN A REGULAR ARMY OFFICER, ENTER "99_" or

IN THE NEXT 5 QUESTION SPACES AND GO TO THE NEXT PAGE.

1/27 How many years of actual service do you have as a years Regular Army Officer? Count service 6 months or longer as a full year; exclude constructive credit.

1/29 What is your Basic Date of Appointment as a Regular

year (Last Army Officer? Enter the last 2 digits of the year.

2 digits) (DA Form 66, item 12)

, 1/31 What is your Regular Army grade?

1 Second Lieutenant

2 First Lieutenant

3 Captain

4 Major

5 Lieutenant Colonel

6 Colonel

9 Does not apply now because I am not

now a member of the Regular Army.

1/32 If you became a Regular Army officer after entering

the ANC, what was your USAR grade (ycur pGnr.anent

TS-de) zt the tiir.^?

1 = Second Lieutenant

2 = First Lieutenant

3 = Captain

4 = Major

5 = Lieutenant Colonel

6 = Colonel

If you became a Regular Army officer, how many years of

active duty commissioned service had you completed at the

time? Put the number of years in the spaces.

1/33

years

3
IF YOU ARE A RESERVE OFFICER ANSWER THESE TWO QUESTIONS. IF

YOU ARE A REGULAR ARMY OFFICER, ENTER "£"s IN THE NEXT TWO QUESTION

SPACES AND GO ON TO QUESTION 1/37.

1/35 What is yoxir USAR (permanent) grade?

1 = Second Lieutenant

2 = First Lieutenant

3 = Captain

4 = Major

5 = Lieutenant Colonel

6 = Colonel

9 = Does not apply

1/36 If you are not a Regular Army officer, are you

qualified to become a Regular Army officer in

the Army Nurse Corps?

1 = Yes

2 = No

8 = Don't know

9 = Does not apply

EVERYBODY ANSI'ffiR

1/37 Have vou been nominated to become a member of the regular

Army? (the select ANC opportunity)

1=1 was offered the opportunity and I became

a member of the Regular Army,

2=1 was offered the opportunity but did not accept.

3=1 have not been offered the opportvmity , but I would accept if it were offered to me. 4=1 have not been offered the opportunity, and I would not accept if it were offered to me.

5 = 1 have not been offered the opportxinity but I am

a member of the Regular Tkrmy.

4 \
1/38 Have you ever applied for a commission as an officer in the

Regular Army?

1=1 applied and I am a member of the Regular Army.

2=1 have applied; my application is pending.

3=1 applied but was not accepted because of age.

4=1 applied, but was not accepted because of a physical

limitation.

5=1 applied, but was not accepted for other reasons.

6=1 have not applied although I might be eligible.

7=1 have not applied; I am ineligible because of age.

8=1 have not applied; I am ineligible because of a physical limitation.

9 = None of the above applies to me.

When does your current service agreement terminate

(DA Form 66, item 13)? If you are Regular Army or

on indefinite extension, enter "9 9 9 9".

1/39

month year

(last 2

digits)

1/43 If you are now serving a tour of duty as an Army

Nurse Corps officer that extends beyond your initial

obligated tour, for how long did you agree to extend

your services? (DA Form 66, item 13)

1 = Regular Army, indefinite extension

2 = Reserve, indefinite extension

3 = 1 to 6 mos.

4 = 7 to 12 mos. 9=1 have ne>t extended beyond my initial

obligated tour

1/44 If you have a service obligation as a result

year of military or civilian schooling, when will

(last 2 you complete this obligation? Write the year

digits) in the answer space. (DA Form 66, items 13 and

16) . If this question does not apply to you,

enter "99".

5
1

1/46 Since you were commissioned and completed basic training,

have you ever incurred a service obligation as a result

of Army sponsored Long Term Civilian Education? (assignment or courses lasting 20 weeks or more at civilian

schools) (DA Form 66, item 16)

1/47

1 = Yes

2 = No

month year If you, as a commissioned officer in the ANC, have

departure ever left the service and returned, please write in

the month and year of your departure and return.

If this kind of separation appeared more than once,

1/51 answer for the most recent time. Obtain dates from

month year DA-66 (item 18) . Enter "9,"s in all the spaces if

return the question does not apply to you.

1/55 How did you obtain your original commission?

1 = Army Student Nurse Program (ASNP)

Diploma Program

2 = Army Student Nurse Program (ASNP)

Degree Program

3 = Walter Reed Army Institute of Nursing

(WRAIN)

4 = Reaistered Nurs^a StiirlAnt- pvorrraTn

(RNSP) : Degree Program

5 = Direct Appointment from civilian status

6 - Interservice transfer

7 = Other

1/56 How many different jobs (ANC duty assignments) have

you had during the last 12 months? Include changes

from one duty station to anotJier, from ward to ward,

service to service, or jobs within a ward or service,

but not shift changes. Exclude student status and

basic training, (DA Form 66, item 18)

0 = none

1 = one

2 = two

3 = three

4 = four

5 = five or more
How many Permanent Changes of Station (PCS moves)

have you made since September 1967 or since you

reported to your first duty station if that was after September 1967? Do not include the move

from basic training to your first duty station (DA

Form 66, item 18)

0 = none

1 = one

2 = two

3 = three

4 = four

5 = five or more

How many temporary duty assignments (TDY) , excluding

basic training and conferences, have you had since

September 1967 (DA Form 66, item 18)?

0 = none

1 = one

2 = two

3 = three

4 = four

5 = five or more

How many months have you been assigned to your

prCCCnt Cr^^^j-i^itiGii? 1£ ^v->u liavc been ctssJ-yiieu

to your present organization for less than one month,

disregard the earlier instruction to answer on the

'basis of your last assignment and put "0^ 0^ 0_" in the

spaces provided (DA Form 56, item 18)

If you have been assigned tp your present organization

less than one month and you are using your last

assignment as. the basis for answers about your assignment,

what was the geographic area of your last assignment?

If you just completed basic training or long term civilian

schooling within the last month put "9_" in the answer space.

1 First Army Area

2 Third Army Area

3 Fifth Army Area

4 Sixth Army Area

5 Military District of Washington

6 Asia/Pacific

7 Europe

8 Middle East/Africa

9 Does not apply

Including your present assignment, have you ever

served in a Class II hospital?

1 = Yes

2 = No

3 DOxi ' t know
IF YOU ARE ASSIGNED TO A HOSPITAL OR CLINIC COMPLETE NEXT

PAGE. IF YOU ARE NOT ASSIQJED TO A HOSPITAL OR CLINIC ENTER " 999 " IN ALL THE BLANK SPACES ON THE NEXT PAGE.

ACTUALLY SPENT

Read all eight types of duties listed on the next page.

Decide which ones you have done in your present assignment.

From the choices given in the box on the next page, estimate

about how many hours and minutes were actually spent on each kind of work in an average day.

Enter the estimated time in the column headed, "Actually

Spent" for each type of duty. The total time for all

eight items should not exceed 8 hours.

If you wish to comment or explain, use your comment sheets.

THAT SHOULD BE SPENT

Tell us about how much of your time you think you should be

spending on each kind of duty in an average day.

Enter the time in hours and minutes in the column headed

"That Should Be Spent" for each type of duty. The total time

for all eight items should not exceed 8 hours.

Use your comment sheets if you wish to comment or explain your

choices.
Actually That Should

Spent Be Spent

Hrs. Min. Hrs. Min.

1/64 teaching duties related to inservice education

programs and on-the-job training for nursing

personnel

1/70 direct patient care that requires my skills

' " and knowledge, includij-g patient education

and counselina

1/76 9 9 9 9 9

2/08 duties related to patient care, including

_^ . . . _ »_ _ supervision and record keeping, that require

my skills and knowledge

2/14 patient care and related duties that could more

" appropriately have been performed by a doctor or other Army Medical Department officer

2/20 patient care and related duties that could more ~~" — ~ appropriately have been performed by MOS 91C

enlisted clinical nursing specialists or licensed

2/26 patient care and related duties that could — _ . more appropriately have been performed by enlisted

or civilian non-professional nursing personnel

other than MOS 91C or licensed practical nurses

2/32 administrative or management duties that could

. „ _ ^ _ have been performed by officers other than

ANC, wardmasters and/or ward clerks

2/38 all other duties that could have been performed — - =^ - non-nursing personnel (escort service pick-up

& delivery, housecleaning , etc.)

9
Oa this and the next page you are asked four questions about each of 29 tasks that are or might sometimes be performed by nurses - either as normal duties, under emergency conditions, special programs, or new

proposals. For questions A, B, C and D on 'this page write your answer in

Column A, B, C, axid D for each task. For questions C and D assume that laws and regulations permit you to perform any task listed. These

questions concern proposals on which we need to have your professional

opinion. The cinswers to all four questions are either "Yes" or "No". A "Yes" answer is always "1" and a "No" is always "2".

A Have you ever performed or assisted in this task?

B Are you competent to perform this task?

C Would you object to carrying out this task as a normal part of

your duties, assuming you ware trained for it?

D Do you feel this task is one that a nurse should do?

1 = Yes

2 = No

2/44 In aavance or aoctor's ini-ciaj. visir inaepenaentLj-y oraer

and sign requests for diagnostic procedures, e.g.. X-rays,

blood tests, etc. for patients

2/48 Start I.V. infusion of blood or blood derivatives.

2/52 Do venipuncture for infusion of solutions other

than blood or blood derivatives.

2/56 Do venipuncture for diagnostic blood studies or therapeutic procedures.

2/60 Do arterial punctures for diagnostic blood studies or therapeutic procedures.

2/64 Start hypodermoclysis.

2/68 Do nasogastric intubations.

2/72 Do obstetrical vaginal examinations.

2/76 Perform gynecological vaginal examinations

2/80 9_ —

3/08 Prepare and administer fractional doses of

medication, including narcotics.

3/12 Perform bone marrow biopsies.

10
: , A Kive you ever performed or assisted in this task?

Are you competent to perform this task?-

Would you object to carrying out this task as a normal part

of your duties, assuming you were trained for it?

D Do you feel this task is one that a nurse should do?

1 = Yes

2 = No

A B C D

3/15 Perform emergency tracheotomy.

3/20 Perform minor acts of surgery, such as: I&D, suture lacerations, etc.

3/24 Start closed cardiopulmonary resuscitation.

3/28 Establish oral airway using mechanical

devices (excluding procedures performed by

anesthesia services)

3/32 '

. Apply orthopedic traction (other than skeletal)

3/36 Start defibrillation by external electric countershock.

/4C Perform basic metabolic rate (BMR) procedures.

3/44 Apply simple orthopedic casts.

3/48 ___ Remove simple orthopedic casts.

3/52 Screen sick call to include diagnosing, prescribing,

and administering treatment for common/chronic illnesses

or minor injuries.

3/56 Do (not interpret) electrocardiography (EKG) procedures.

3/60 ___ Do simple physical examinations using basic examining

instnmients.

3/64 ^ Take and record medical histories.

3/68 Obtain vaginal Pap smears.

3/72 ___ __ Do (not interpret) electroencephalography (EEG) procedures.

3/76 __ Perform simple X-ray procedures.

3/80 9_

4/08 Do Audiometer testing.

4/12 visuad testing.

^ r 11 ^
SOME PROPOSALS AND POSSIBILITIES

The items on the next four pages are proposals that have been

identified in previous studies as having at least some significance to

many officers. We would like to know how you feel about them. Because

all ANC officers are answering this questionnaire, all will have the

opportianity to speak for themselves.

If you were presently trying to make up your mind whether to

choose a career in the Army Nurse Corps , how important would each

of the following proposals be to you in making that decision?

Give serious thought to each proposal and to its implications.

Rate each propose.1 by determining the number of

that statement which best expresses how important

that proposal would be to you if you were in the

middle of making a decision about a military career. Write the nuinber in the space given. Be sure

to tell us how you think it v;ould affect you, not

L

1 o
To me, this proposal would be : 1 = A major advantage.

2 = A minor advantage.

3 = Not important.

4 = A minor disadvantage.

5 = A major disadvantage.

Rating Proposal

1-5

4/16 Adjust off-post housing allowance to conform to local prices

in high cost living areas.

4/17 Adjust subsistance allowance to conform to cost-of-living

index in high cost living areas.

4/18 Pay the cost of commercial transportation to and from work

vrtien government transportation is not available.

4/19 Make dislocation allowance more consistent with the actual

expenses you have on Permanent Change of Station.

4/20 Authorize government housing to include civilian husbands of

female members of the military regardless of whether or not the

husband is classified as a dependent.

4/21 Aurnorize eacn military member a housing allowance if husband

and wife are both members of the military and occupy the same government quarters.

4/22 Authorize, when applicable, accompanied tours for civilian husbands

of female members of the military regardless of whether or not the

husband is classified as a dependent.

4/23 Accord to guests of single officers the same privileges for post

welfare and recreation activities as those given to dependents

of married officers.

4/24 ^ Qoatinue policy of appointing Baccalaureate graduates at a higher

rank than graduates of other basic nursing programs.

4/25 Liberalize maternity regulations for women in the military,

subject to specific personnel management conditions.

13
To me, this proposal would be ; 1 = A major advantage.

2 = A minor advantage.

3 = Not important.

4 = A minor disadvantage.

5 = A major disadvantage.

Rating Proposal

1-5

4/26 Give husbands and dependents of female members of the military

the same survivor's benefits and relief that the wives and

dependents of male members have. .

4/27 Offer an annual retention bonus for ANC officers who extend

their service tours or who volunteer for an indefinite category

(bonus payable at the completion of each extended year)

4/28. Give the same special professional pay to military nurses as to physicians, dentists and veterinarians.

4/29 Pro-rate professional pay to officers in all AMEDD corps based on education and experience.

4/30 Have enough government housing, either on-post or leased, to give

all officers the option of occupying such quarters regardless of

marital status or number of dependents.

4/31 Give medical and dental services for civilian husbands of female

members of the military regardless of the dependency status of the

husband.

4/32 Give transportation allowance .on accompanied tours for civilian

husbands of women in the military regardless of dependency status

of the husband.

4/33 Give the husbands of female members of the ni-ilitary (both active

and retired) the same benefits and privileges the v;ives of male

members have.

4/34 Give extra pay to those members of the military whose marital

status or dependent relationships do not limit their geographic

assignments

4/35 Provide regulatory restrictions, subject to specific personnel

management conditions, for those members of the military whose

marital status or dependent relationships do limit their

geographic assignments to the disadvantage of single officers.

4/36 Give bachelor male officers the same provisions now regulating

the length of an "unaccompanied tour" for single female officers.

14 V
To me., this proposal would be ; 1 = A major advantage.

2 = A minor advantage.

3 = Not important.

4 = A minor disadvantage.

5 = A major disadvantage.

Rating Proposal

1-5

4/37 Offer differential pay for military persons required to work

routinely at times normally free for others (holidays, weekends,

evenings, nights, or on-call basis)

4/38. See that military persons really get compensatory time if they

have to work routinely at times when others are normally free

(holidays, weekends, evenings, nights, on-call)

4/39 Give incentive pay, or other pay above yoxir rank and longevity,

for critical Military Occupational Specialities which are based upon training and experience in the specialty.

4/40 Pay military nurses at a level more nearly like that of nurses

in civilian life who have similar qualifications and experience.

4/41 Suppose all fringe benefits and tax-free allowances (medical and

dental services, allowances and services for dependents, commissary,

post exchange, and retirement provisions) were simply included in your

base pay, how much influence would this have on your decision to

stay in the Army?

4/42 What kind of influence would your present fringe benefits have

on your decision to stay in the Army?

4/43 What kind of influence would your present military base pay and the

tax-free allowances for quarters and subsistence have on your

decision to stay in the Army?

4/44 How important would it be to you if the Army changed its retirement

policy so that early retirement resulted in reduced retirement

pay?

4/45 9

15
To me, this proposal would be : 1 = A major advantage.

2 = A minor advantage.

3 = Not important.

4 = A minor disadvantage.

5 = A major disadvantage.

Rating

1-5

Proposal

4/46

4/47

4/48

4/49

4/50

4/51

4/52

Require that all ANC officers who receive direct commissions be

currently licensed registered nurses with a baccalaureate degree.

ANC officers would then have the same criteria for commission

as all other corps of the Army Medical Department.

Let those ANC officers who do not have a baccalaureate degree

remain in the Army, but require all incoming nurse officers

to have a baccalaureate degree cut-off date.

If ANC commissioned officers wished to continue on active duty

longer than 5 years they would be required either to obtain a baccalaureate degree or to show satisfactory attendance in

classes while working towards such a degree.

Permit ANC officers to be assigned to those medical activities

from which they could attend civilian educational institutions

on a "part-time-work. part:-tiTD(a-c<"hrif-\T b?.5i2" until they cither

attained a desired degree or qualified for long-term civilian

schooling.

Try to procure nurses by direct appointment rather than relying

on the present subsidized education programs.

Allow ANC career officers in grade of Captain and above to have

excess leave (leave without pay) to attend school or pursue other

interests related to the field of nursing.

Extend the authority of the Selective Service Act to permit

drafting any group of persons whose skills are essential

to the national health, safety, and interest.

16
HOW YOU FEEL ABOUT

SOME FACTORS THAT MAY AFFECT YOUR MORALE

In this section we ask you to give your feelings about a number

of factors that may affect your morale as a member of the Army Nurse

Corps. The items listed range from America's role in other areas of

the world to aspects of military service and your particular

medical activity—circumstances that you may find satisfying or

tro\ablesome.

Be completely frank in giving your answers . Your individual

identity is not known to us in the National Bureau of Standards and

thus can never be revealed to the Army. If you wish to add special comments

about any issue, please do so on the comment sheets. Be sure to label

your comment with the question number so the two can be put together later.

INSTRUCTIONS FOR PAGES 18 TO 21

Whether you are already committed to a career in the Army or not,

would you please tell us how you feel about each statement on the next

4 pages . By each statement write the n\amber of the choice below that

most closely expresses how you feel about that sxabject:

strongly agree with the statement,

tend to agree with the statement,

have no opinion or am uncertain , tend to disagree with the statement.

strongly disagree with the statement.

I don't care. Does not apply.

Use your last assignment as the basis for your answers if you have

been in your present assignment less than a month* have bean

out of basic training for less than a moment use your present assignment .)

17
Scale: 1

2

3

4

5

I strongly agree with the statement.

I tend to agree with the statement.

I have no opinion or am uncertain . I tend to disagree with the statement.

I strongly disagree with the statement.

4/53

4/54

4/55

4/56

4/57

4/58

4/59

4/60

4/61

4/62

4/63

6=1 don't care.

9 = Does not apply.

I like the variety of jobs (work assignments) in the Army.

I would prefer to be assigned directly to the doctors of an organizational element (OB/GYN, Medicine, Pediatrics/ etc.) rather

than the nursing department or services.

I am frustrated by the lack of responsiveness of the hospital's

administration to the needs of the patients when these conflict

with administrative requirements.

The attitudes of some of my close friends and immediate family

may influence me to leave the Army.

In my experience, the more rank Army nurses attain, the more they

are concerned with their next promotion instead of patient care.

Compulsory attendance at social activities is an irritating part

of military life.

Retirement, policies of the Army, as they affect me, are generous

and adequate.

The authority I have is too little in proportion to my responsibility.

In my present assignment, I usually receive the compensatory

time that I have earned.

Married Army nurses who have children are not able to handle all

duty and station assignments in either peace time or mobilization.

I like the geographical location of my present station.

18
Scale : 1 I strongly agree with the statement.

2 — I tend to agree with the statement.

3 I have no opinion or am uncertain.

4 _ I tend to disagree with the statement.

.5 = I strongly disagree with the statement.

6 I don't care.

9 Does not apply.

4/64 I have been well prepared for the job I'm doing.

4/65 I came into the Army to take care of the military and not

civilians or dependents.

4/66 The lines of authority in my present organization work effectively.

4/67 ^ Army medical facilities are often obsolete.

4/68 Most of my close friends approve of my being an Army nurse.

4/69 It bothers me that professional nursing questions are settled

on the basis of rank, not professional knowledge.

4/70 My immediate family approves of my being an Army Nurse.

4/71 I would 1 1 Vp i-r, bo aKTe. +^/-. ^j^rr-n rr.r, cffLZ-CT.Zj' TCpcrt to prC/Va

that I have read it.

4/72 The professional responsibilities I have are superior

to those of civilian nurses in my present duty station.

4/73 I find working conditions in Army medical facilities mattractive

4/74 The dependency and benefit differences between married and single

officers are fair and equitable.

.4/75 Working overseas, away from family, friends, and familiar surroundings,

would be or is a very difficult experience for m.e.

4/76 Nursing in'-service education programs available at my present duty

station are limited.

39

>

•
Scale: 1 I strongly agree with the statement.

2 I tend to agree with the statement.

3 I have no opinion or am uncertain.

4 I tend to disagree with the statement.

5 I strongly disagree with the statement.

6 I don ' t care

9 Does not apply.

4/77 The direct support I am able to give my patients is important to me.

4/78 Because they cannot be commanding officers. Army nurses cannot really

assume the responsibility and leadership role that they should.

4/79 The quality of Army medical equipment helps to make Army nursing

professionally satisfying.

4/80 Civilian attitudes that are critical of the Army are usually lanjustified.

5/08 In my experience the esprit de corps of the Army health team is excellent.

5/09 The upper echelons of the Army are generally responsive to the

needs of the individual officer.

5/10 Cn-pcst social activities are unimportant to me.

5/11 _ The Army's promotion system is the best way to meet the need for

competent officers in higher grades.

5/12 I have had few or no opportunities to attend professional conventions

or meetings.

5/13 ___ Work schedules (tours of duty, weekends, holidays, etc.) work out as fairly as is practical.

5/14 ___ Dependency and benefit differences between men and women officers

are a source of dissatisfaction with me.

5/15 I prefer working in the size medical facility to which I am presently

assigned.

5/16 I like the idea of assuming responsibility for medical procedures

previously perfomed only by a doctor.

5/17 The degree of professional accomplishment I have attained in the Army

as a nurse has been too limited.

5/18 The difference between what I was trained to do as a nurse and what

I actually do frustrates me.

20
Scale: 1 - I strongly agree with the statement.

2 — I tend to agree with the statement.

3 X have no opinion, am uncertain.

4 = I tend to disagree with the statement.

5 I strongly disagree with the statement.

6 I don • t care

9 Does not apply.

5/19 Army nurses don't have enough opportunities to practice direct

patient care.

5/20 The quality of patient care in my present organization is very

good.

5/21 Enlisted nursing personnel do many things in patient care that should

be done only by registered nurses.

5/22 Serving in the ANC is important to me as a way of serving my country.

5/23 The military doesn't give enough recognition to human dignity.

5/24 The manner in which Army Nurse Corps officers wear their military

uniforms is often below the standards officers should maintain.

\ 5/25 I would rather have my efficiency reports made out by doctors with

5/26 Fringe benefits for an Army nurse compare favorably with those of

nurses in the civilian sector.

5/27 You get ahead faster in your job in the military than you would in

civilian nursing.

5/28 The hours 1 work are disagreeable in comparison with those of the ~~ civilian nurses who work in my present duty station,

5/29 Differences in benefits and dependency allowances for men and women

' officers usually reflect fairly the differences in their family

;cesponsibilities.

5/30 I think I can assume the responsibilities of a military officer

in the next higher grade.

5/31 I prefer working in the type of medical facility to which I am presently

assigned.

5/32 I am much more competent as a nurse than my immediate supervisor.

.21
The next 5 questions concern matters of current interest to Army nurses.

You are asked to give your opinion on them.

Select from the scale below the item that best represents your

opinion on each question.

1 = Strongly approve

2 = Approve

3 = Don ' t care

4 = Disapprove

5 = Strongly disapprove

5/33 The appointment of 2 year junior college associate degree

graduate nurses as warrant officers in the Army Nurse Corps.

5/34 The appointment of 2 year junior college associate degree

graduate nurses as second lieutenants in the Army Nurse Corps,

5/35 The appointment of hospital diploma school graduate nurses

as warrant officers in the Army Nurse Corps.

5/36 Training enlisted personnel to become physician's assistants

in the Army.

5/37 Commissionina phvsician's asQi st-^nt-c wa-rr-an-h officer? ir. the Army.

Rank the seven iteras below based on how important they are to you ^ that is how you really feel about them. Put "1" by the item that

matters most to you, "2" by the item that is second most important

down through "7" — the one that matters least. Remember:

1 = most important.

5/38 What other people think of me as a person

5/39 ___ Pride in being a member of the Army

5/40 The appreciation of patients for the care I give them

5/41 How my immediate family and close friends feel about my being in

the Army

5/42 Being able to remain in the Army Nurse Corps until I can get full

retirement benefits

5/43 Performance that is recognized by others as professionally excellent

5/44 Recognition for the work I do in my present organization
PMOS HISTORY

Tell us how many and which Primary ( not Duty) Military Occupational Specialities

(PMOS) you have been awarded, beginning with your first (initial) Primary MOS

v^en you entered the Army Nurse Corps.

Consider the addition of a prefix or a change in the prefix as a new Primary MOS

XPMOS) , and put the 4-digit MOS and the new prefix on the next line.

Put numbers in the answer spaces \inder each column. Use I.D. numbers for answers to Column B and Column D. Put "9^"s in all spaces that do not apply to

you.

ANC MOSs are listed in the box on the top of the next page. Your Primary

MOS is the Military Occupational Specialty awarded on the basis of training and

and qualification. Your Duty MOS refers to the MOS appropriate for the job

you actually hold. Your initial MOS is the first PMOS you were awarded.

These may or may not be the same. If you are imcertain about any other aspect

of this page, ask the project officer to explain it.

COLUMN A COLUMN B COLUMN C COLUMN D

4-Digit PMOS PREFIX YEAR Awarded Rank at Time

Enter each PMOS I.D. No. Prefix Last two PMOS was you have been digits of awarded

awarded. Put 1 D year that

yo\ir first PMOS 2 C PMOS was I.D. No. Rank

in the top space 3 B awcirded. 1 2nd Lt.

•* A 2 = Isc Lt. listing your 5 4 3 Captain

present PMOS 6 8 4 Major

last. 9 None or 5 Lt. Col.

other 6 Colonel

5/45 1st ?MOS

5/53 2nd PMOS

5/61 3rd PMOS

5/69 _ __ 4th PMOS

6/08 _ 5th PMOS

6/16 ^ 6th PMOS

5/77 9999

23
KOS AND DUTIES

Cn this page you are asked about your Primary Military Occupational

Specialty (PMOS) , Secondary Military Occupational Specialty (SMOS)

and your duty positions. Use the lists provided below and your

DA Form 66 for reference.

Column A Column B

I.D. I.D. Number Prefixes Nimiber MOS

1 = A 02 3430: Nurse Administrator

2 = B 03 3431: Army Health Service Niirse

3 = C 04 3437: Neuropsychiatric Service Nurse

4 = D 05 3442: Pediatric Nurse

5 = 4 06 3443: Operation Room Nurse

6 = 8 07 3445: Anesthetist

9 = Other or None 08 3446: Obstetric Nurse

09 3448: Medical-Surgical Nurse

10 3449: General Duty Nurse

11 Research MOS

12 Teaching MOS

99 None

6/24 Does your present PMOS satisfy your current interests? If it does , write "01" in the answer spaces. If it does not , what other MOS

do you feel would give (or would have given) you greater satisfaction?

Find this preferred MOS in Column B and write the ID number in the answer soaces.

6/26

6/27

6/28

Is your principal interest in:

. 1 = Practice

2 = Research

3 = Teaching

PMOS prefix Locate the alphabetical or numerical prefixes of

your Primary and Secondary MOS's in column A- SMOS prefix Write their ID nimbers in the spaces to the left

(DA Form 66, item 9)

6/29

6/31

PMOS

SMOS

Locate your PMOS in Column B. Write the identification

nicnber for this PMOS into spaces to the left (DA

Form 66, item 9)

Locate your SMOS in

number for this SMOS

Form 66, item 91,-

Column B, Write the identification

in the spaces to the left (DA

24
The next t±iree questions concern duty positions (jobs) . Use the list provided with the questions on each page.

01 = Chief, Army Nurse Corps

02 m Chief, Nursing Division, Headquarters

03 Chief, Nursing Department or Service

04 Assistant Chief Nurse

05 — Supervisor of Service or Section

06 — Clinical Head Nurse

07 — Clinical Staff Nurse (Less than 1 year of experience)

08 — Clinical Staff Nurse (More than 1 year's experience)

09 — Army Health Nurse (Community Health. Nurse)

10 = Nurse Clinician in a recognized specialty field

11 Nursing Methods Analyst

12 Educational Coordinator

13 Consultant (designated by the Surgeon General)

14 = Researcher

15 — Historian

16 = Technical Writer

17 Recruiting Coiinselor or Coordinator

18 Staff Officer (HQs, Command, OTSG, DA level)

19 Professor (Full, Assoc., Ass't.)

20 = Instructor

21 Student (exclude basic training and basic nursing program)

22 — Other

Dr^ n +" ^CT^ 99 = Do not have one (Do not use for Q. 6/33; may only be used for 6/35.)

6/33 What is your present assigned primary duty position?

Get number from list of titles above.

6/35 What is your presently assigned secondary duty position?

Get number from list of titles above.

.25
what duty position (job) assignments ( not MOS)have you had

since your graduation from basic nurses training?

Put a "1" in the space to the left of each position you have

held, either once or more than once.

Put a "0" to the left of each position you have NOT held.

0 = Not held

1 = Have held

6/37 C!hief, Airmy Nurse Corps, Nursing Division or Iiea<iquarters

6/38 Chief, Nursing Department or Service

6/39 Assistant Chief, Nursing Department or Service

6/40 Supervisor of Service or Section

6/41 Clinical Head Nurse

6/42 Clinical Staff Nurse (Less than 1 year of experience)

6/43 Clinical Staff Nurse (More than 1 year's experience)

6/44 Army Health Nurse (Community Health Nurse)

C/43 Wurae Clinician m a recognizea specialty field

6/46 Administrator (Chief or Director)

6/47 Administrator (Assistant Chief or Deputy Director)

6/48 Nursing Methods Analyst

6/49 Educational Coordinator

6/50 Consultant (designated by The Surgeon General)

6/51 Researcher

6/52 Historian

6/53 Technical Writer

6/54 Recruiting Counselor or Coordinator

6/55 Staff Officer (HQs, Command, OTSG, DA level)

6/56 Professor (Full, Assoc., Ass't.

6/57 Instructor

6/58 Student (exclude basic training and basic nursing program)

6/51 _ Other

26 \^
DUTIES AND TASKS

The next nine questions ask your opinion on the grade and MOS

qualifications for anyone assigned to your present duty position

(job)

6/60 Under normal circumstances in your present assignment, would it

be more important for your replacement to have the Grade or the

Primary MOS normally assigned to your position?

1 = Grade

2 = Primary MOS

6/61 How important is it for another ANC officer who may sometime occupy

the job you now hold, to have a Primary MOS which is the same as the Duty MOS?

1 = Essential

2 = Very important

3 = Important

4 = Of little importance

5 = No importance whatsoever

USE THE FOLLOWING SCALE FOR THE NEXT 7 QUESTIONS:

1 = Would probably perform very well.

2 = Would probably perfoirm competently.

3 = Would probably have minor difficulty.

4 = Would probably have serious difficulty.

5 = Probably could not handle the position.

6/62 If for any reason it were necessary for someone to replace you

who held the grade but not the MOS normally assigned to your

position, how well would you expect such an officer to be able

to perform the required tasks and duties? (Select an answer

from the list above.)

6/63 What if your replacement had the appropriate MOS but was one

grade below that-jaormally assigned to your position?

6/64 What if your replacement had the MOS but was two grades below

that normally assigned? (Enter "9" if the normal grade for your

position is below captain)

6/65 And what if yctir replacement were three grades below, still

assuming the same MOS? (Enter "9" if the normal grade for your

position is below major)
Would probably perform very well.

Would probably perform competently.

Would probably have minor difficulty.

Would probably have serious difficulty.

Probably could not handle the position.

How well do you think your present position could be filled by

an ANC officer with a Primary MOS (PMOS) different than your

own?

How adequately do you think your present position could be filled

by an ANC officer with a Secondary MOS (SMOS) different than your

own? (Enter "9" if you do not have a Secondary MOS)

How adequately could an ANC officer fill- your present position

if the officer's Secondary MOS (SMOS) were the same as the MOS

normally assigned to your position?

ASSIGNMENT PREFERENCE — —.

.

Was the geographic location of your present duty assignment your —

1 = first choice?

2 = second choice?

3 = third or lesser choice?

Were you given an opportunity to discuss or express your preference

of duty assignments (jobs) in your present assignment?

1 = Yes

2 = No

Is your present duty position (job) your —

1 = first choice?

2 = second choice?

3 = third or lesser choice?

9 = does not apply

Is your present duty station (hospital, school, etc.) a result of —

1 = needs of the service?

2 = your personal or compassionate choice?

3 = both the needs ox the service and your personal or

compassionate choice?

1 =

2 =

3 =

4 =

5 =

28
Rank the 7 items below in the order of their importance to you - how you

really feel about them. Enter "_1^' by the item that matters most to you,

"_2" by the item that is next in importance, down through "_7", the one that matters least. Remember - "1" = most important.

RANK ORDER

6/73 My image of myself and the value of the work I do as a nurse

6/74 Fulfilling my role in the Army

6/75 My own knowledge that I am giving good nursing care to my patients

6/76 Public attitudes toward the Army

6/77 Advancing my career in the Army Nurse Corps

6/78 Personal standards of performance that I set for the work I do

6/79 Contributing to the work of my organization

Please tell us what you think of the V7orking

relationships among ANC officers and betv;een ?2:IC officers

and other AIIEDD pcL&uniiel . i or each question Dexow

select the answer to the left that, from your experience^

best reflects the working relations in your facility .

6/80 Among ANC officers

. 7/08 Between Army nurses and Department of Army Civilian nurses

7/09 Between Army nurses and physicians

7/10 _ Between Army nurses and other AMEDD officers (exclude physicians)

7/11 between nursing services and other departments or services

of your organization

7/12 Between Army nurses and enlisted nursing service personnel

Excellent

• J :3^-'~^ Good

Poor

Very poor

29
MORE QUESTIONS ABOUT

FACTORS THAT MAY AFFECT YOUR MORALE

In this section we again ask you to give your feelings about a number

of factors that may affect your morale as a member of the Army Nurse Corps.

Be completely frank in giving your answers. If you wish to add

special comments about any issue, please do so on the comment sheets

provided. Be sure to label your comment with the question number so the two can be put together later.

Whether you are already committed to a career in the Army or not,

would you please tell us how you feel about each statement. By each

statement write the number of the choice below that most closely expresses

how you feel about that subject:

INSTRUCTIONS FOR PAGES 30 TO 33

1

2

3

4

5

I strongly agree with the statement.

I tend to agree with the statement.

•I have no opinion or am uncertain . I tend to disagree with the statement.

I strongly disagree with the statement.

6

9

I don ' t care

Does not apply.

7/13 I like the degree of challenge in my work.

7/14 The opportunity for responsibility in the ANC is

professionally satisfying.

7/15 In my experience the quality of Army nursing care has been excellent.

7/16 The number of Army nurses in my present organization is adequate.

7/17 As a way of fulfilling my sense of duty to society. Army nursing is

less satisfying to me than civilian nursing v;ould be.

7/18 I like the opportunities for travel that being in the Army gives me.

30
Scale: 1 = I strongly agree with the statement.

2 = I tend to agree with the statement.

3 = I have no opinion or am uncertain.

5 = I strongly disagree with the statement.

6 T don ' t care

9 Does not apply.

7/19 Military life allows me more personal privacy than civilian life.

7/20 Regimentation (military ritual, saluting, etc.) seems out of place

in today's Army.

7/21 The rating officers have usually been in a position to make a fair

and accurate judgment of my performance and ability.

"^/^^ Educational opportunities for my family are poor in my present area. 7/23 The orientation to my present duty station was not good.

7/24 As an Army nurse, my opportunities for further education are too limited

7/25 Promotion in the ANC does not depend enough on professional

competence.

7/26 My present assignment does not utilize r.y skills, knowledge or

7/27 I do not like my present job (duty assignment)

7/28 ^ Orders given by physician assistants for patient treatment

would not be acceptable to me.

7/29 The reputation of the nursing services in my own organization is not

very good.

7/30 Army hospitals should be staffed with more military nurses than

civilian nurses.

7/31 I do not like so much U.S. military involvement in other countries - it makes an Army Nursing career less attractive to me than it would

be otherwise.

31
Scale: 1 — I strongly agree with the statement.

2 — I tend to agree with the statement.

3 I have no opinion or am uncertain.

4 :

I tend to disagree with the statement.

5 I strongly disagree with the statement.

6 I don't care.

9 Does not apply.

7/32 Military discipline is necessary to maintain the highest standards of care in an Army hospital.

7/33 The white cap should always be worn with the white hospital uniform

by female nurses.

7/34 The Army's promotion system is usually fair to the individual.

7/35 PX and Commissary fringe benefits are an important advantage to me.

7/36 The orientation I received for my present duty position was good.

7/37 The opportunities I have had to further my formal education in the

Army are better than they would have been in civilian life.

7/38 I am able to v;ork as a responsible professional in the Army.

7/39 I have had an excellent opportunity to gain experience in my specialty

in tne Army.

7/40 I find satisfaction in the opportunities to use my own initiative in

my job.

7/41 Knowing what is expected of me in my present assignment makes my job

more satisfying.

7/42 There is an adequate niamber of enlisted nursing personnel in iny present

organization.

7/43 It is important that the U.S., as a great power, remain committed to the

defense of the free world.

7/44 I find military discipline out of place in a professional environment.

7/45 Military headgear should be required only in military formations.

7/46 The degree of job satisfaction I have experienced as a nurse in the

Army has been high. ^

7/47 The Army's system of efficiency reports doesn't include adequate

safeguards against personality conflicts with superiors.

7/48 Too frequently the benefits and advantages that are promised in

the Army are not delivered.

32
Scale: 1 I strongly agree with the statement.

7/49

7/50

7/51

7/52

7/53

7/54

7/55

7/55

7/57

7/58

7/59

7/60

7/61

7/62

7/63

7/64

2=1 tend to agree with the statement.

3=1 have no opinion or am uncertain . 4=1 tend to disagree with the statement.

5=1 strongly disagree with the statement.

6=1 don't care.

9 = Does not apply.

More stability ±n assignments would make the WIC more attractive.

The irregularity of working hours is a source of dissatisfaction for me.

The prestige of the Army Medical Department is low.

Advancement in the Army Nurse Corps depends too much on formal educational

achievement.

I do not like the idea of assigning to physician's assistants some medical procedures which were previously performed

only by doctors.

The kind of assignments I have had since becoming an MIC officer have

been disappointing.

I am impressed by the competence of my peers (ANC Officers)

The adTiinistrati&n of Army hospitals is usually quite competent.

I am impressed by the competence of my subordinates (subordinate

ANC officers)

The military system of rank, seniority and command is the best way of

insuring that those with the best professional experience and competence

will be given responsibility.

Mandatory social activities are an attractive aspect of

military life.

Army retirement benefits are not an important factor in deciding to

make a career of the Army Nurse Corps.

I am given the opportunity to do my work in my own way.

The introduction of the expanded role of the Army Nurse gives me

an opportunity to prepare myself to practice nursing as I would prefer.

I object to being expected to move from ward to ward without being

consulted or being prepared to work with the particular kind of patient.

Shift schedules have made it difficult for me to obtain additional

education.

33
For each of the seven pairs of statements below, select the one statement

that best reflects how you really feel, that is, the statement in each pair

that is more important to you. Put the number of your choice, either

a "JJ' or a "_2_" , in the answer space to the left of each pair of statements.

Please choose one statement from each pair even though neither expresses

exactly how you feel.

7/65 1 = My image of myself and the value of the work I do as a nurse.

2 = What other people think of me as a person.

7/66 1 = Performance that is recognized by others as professionally excellent,

2 = Personal standards of performance that I set for the work I do.

7/67 1 = The appreciation of patients for the care I give them.

2 = My own knowledge that I am giving good, nursing care to my patients.

7/68 1 = Contribution to the work of my organization.

2 = Recognition for the work I do in my present organization.

7/69 1 = Advancing my career in the Army Nurse Corps.

2 = Being able to remain in the Army Nurse Corps \antil I can get full retirement benefits.

7/70 1 = Pride in being a member of the Army.

2 = Fulfilling my role in the Army.

7/71 1 = Public attitudes toward the Army.

9 = Hnw my iTrmipdiate family and close friends feel about my

being in the Army.

7/72 How do you feel at the present time about making a career in the

Army—that is, staying for twenty or more years of active duty?

Your answer will not commit you to the course of action you choose

here

1 = Definitely intend to leave active duty as soon as possible.

2 = Strong possibility that I will not make a career in ANC.

3 = Undecided as to whether I will stay or leave.

4 = Strong possibility that I will remain on active duty.

5 - Definitely intend to make a career in the Army.

7/73 9
EDUCATION

7/74 Are you now assigned to a student detachment as a candidate

for a degree?

1 = Yes

2 = No

Wfiat formal academic programs have you completed? Write the last two digits

of the year in' which you completed the program by the program name in the

list below.

What fomal academic programs are you now enrolled in? If you are now

assigned, to a student detachment as a candidate for a degree, write the

last two digits of the year in which you expect to complete the program by

that program name in the list below.

Write "9"s in the spaces that do not apply to you.

Year in which com- pleted or of ex- pected completion

(Last 2 digits) ACADEMIC PROGRAM

V75 __ Diploma Program — No Degree

7/77 AR<=o(->iat-.(^ Arts Dpare<=

V79 Baccalaureate in Nursing

Baccalaureate in Other Field

8/10 Master's in Nursing

8/12 _ Master's in Other Field

8/14 ^ Doctorate

8/16 _ When did you last take a college course for credit

towards a Bachelor's or higher degree? Enter the last

two digits of the year the class ended.

How many semester hour credits have you earned toward the

attainment of an academic degree beyond the degree (s) or program(s) which you have already completed? Choose from

the list below even if you do not know the exact number.

0 = None

1 = 1 to 5 semester hour credits

2 = 6 - 30

3 = 31 - 60

4 = 61 - 90

5 - 91 - 105

6 = More than 105 semester hour credits

35
If you are working on a degree tell us your major and minor fields, or

if you have a degree tell us about your highest one. If you are considexing

a degree but are undecided about fields of study tell us your most probable

choice in space 8/27. Use nxmbers frcan list below. Use "S9"s where it

doesn't apply to you.

8/19 Major Field

8/21 Second Major

8/23 Minor Field

I^w . 40 Civil Law

41 Medical Jurisprudence

42 Military Legislation

43 Other

Health Care

01 Nursing: General (Basic) EU3 iness and Social Sciences

02 Nursing

Administration 50 Anthropology

03 Nursing: Anesthesia 51 Audio-Visual Aids

04 Niarsing; Education 52 Business

05 Nursing: Maternal & Child 53 Economics

06 Nursing: Medical/Surgical 54 Education

07 Nursing: Mental Health 55 Government

08 Nursing: Operating Room 56 History

09 Nursing: Pediatrics 57 Labor/Management Relations

10 Nursing: Nurse Clinician 53 Personnel Management

CUI-!^ U<^a^^-'^ cc

12 Nursing: Research Methods 60 Psychology

13 Dentistry 61 Public Relations

14 Environmental Hygiene 62 Sociology

15 Gerontology 63 Other

16 Hospital Administration

17 Medicine: General Practice

18 Nutrition

19 Occupational Therapy

20 Optometry

21 Pharmacology

22 Physical Therapy

23 Podiatry

24 Veterinary Medicine

25 Midwifery

26 Psychiatry Physical and Biological Sciences

27 Obstetrics to Anatomy

28 Ambulatory Keal A Care 81 Bacteriology

82 Biochemistry

Humanities 83 Biology

30 Art 84 Biophysics

31 Journalism, Writing, Editing 85 Chemistry

32 Languages 86 Physics

33 Motion Pictiare Production 87 Physiology

34 Philosophy 88 Mathematics

35 Other 89 Microbiology

90 Statistics

. 91 Other

8/25 Second Minor

8/27 Undecided

Engineering S Architecture

70 Architectural Design

71 Automatic Data Processing Systems

72 Construction Engineering

73 Operations Research

74 systems Analysis

75 Systems Engineering

76 Other
8/29 If you had but one choice

,

which of the following clinical

nursing courses offered by the military would you most

like to attend?

01 Anesthesiology for ANC Officers

02 Army Health Nursing Orientation

03 Intensive Care Nursing

04 Operating Room (Advanced)

05 Operating Room (Basic)

06 Nurse Clinician^ Psychiatry/Mental Health

07 Nurse Clinician, Ambulatory Care

08 Nurse Clinician, Obstetrics and Gynecology

09 Nurse Clinician, Pediatrics

10 Nurse Midwifery (projected for Fy-74)

11 Other

12 Not interested in any

99 Don • t know

Year Completed

or Projected

Completion

(Last 2 Digits)

8/31

8/33

8/35

8/37

8/39

8/41

8/43

8/45

What military service schools or courses have you attended or

are currently attending? Enter the last two digits of the

year you completed each school or course or expect to com- plete each school or course. Exclude short courses. Enter

"99" for those that do not apply.

U.S. Army War College

U.S. Army Command and General Staff College

U.S. Army-Baylor Univ. Program in Health Care Administration

Army Medical Department Advanced Course (Nurses and other

AMEDD officers in same course)

Army Medical Department Basic Course (Nurses and other

AMEDD officers in same course)

Army Nurse Corps Officer Advanced Course (Nurses only)

Army Nurse Corps Officer Basic Course (N\irses only)

Other (Do not include short courses, MOS producing courses

or functional courses.)

37
8/47 If you had but one choice ^ which of the following military

service schools or courses would you like to go to?

1 = U.S. Army War College

2 = U.S. Army Command and General Staff College

3 = U.S. Army - Baylor Univ. Program in Health

Care Administration

4 = Army Medical Department Advanced Course

5' = Other

6 = Not interested in any

9 = Don't loiow

Belong Indicate which of the following organizations, if

A*W I— ' " U ^ " — — " • — ** ^

belong space by those of which you are a member and

"9^" by those you do not belong to.

8/48 American Nurses Association

8/49 National League for Nursing

8/50 American Pxablic Health Association

8/51 Association of Operating Room Nurses

8/52 American Association of Nxirse Anesthetists

8/53 Other:

Write the name here, please.
In which of the following organizations or types of organizations have

you served or are you now serving in other than a student capacity?

G = Place zero "0" in front of those types of organizations in which

you have NOT served.

1 = Put a "1^" in front of the type of organization in which you

are now serving

2 = Put a "2_" in front of those types of organizations in which

you served in the past.

(If you have been in your present assignment less than 30 days, consider

your last assignment as if it were your present one. Use your present

assignment if your last assignment was Basic Training.) If your medical

activity has been redesignated, include both types. Include TDY

assignments of 30 days or more. If you are now serving in a type of

medical activity in which you have also served in the past, put a "1_"

in the space. (DA Form 66, item 18)

8/54 — HQ Dept. of the Army, Office of The Surgeon General

8/55 —

HQ Medical or Hospital Center

8/56 U.S. Army Recruiting Command

8/57 U.S. Army Medical Research and Development Command

8/58 U.S. Army Medical Training Center

8/59 Walter Reed Army Institute of Research

8/60 Walter Reed Army Institute of Nursing

8/61 Medical Field Service School

8/62 Detoxification Center or Unit

8/63 MUST Hospital: Combat or Training Unit

8/64 Surgical Hospital: Combat or Training Unit

8/65 Evacuation Hospital: Combat or Training Unit

8/66 Field or Station Hospital: Combat or Training Unit

8/67 Hospital with less than 150 beds: Non-Combat or Training

8/68 Hospital with between 150 and 499 beds: Non-Combat or Training

8/69 Hospital with 500 or more beds: Non-Combat or Training

8/70 Troop Medical Clinic Dispensary or Health Clinic, physically

separated from any hospital^

8/71 Other

39 T^-'^
IF YOU ARE ASSIGNED TO A MEDICAL TREATMENT FACILITY, ANSWER THE QUESTIONS BELOW.

IF YOU ARE NOT ASSIGNED TO A MEDICAL TREATMENT FACILITY PUT 99s IN ALL OF THE

SPACES BELOW AND GO TO THE NEXT PAGE.

8/72

8/74

6/76

8/78

8/80

To what area of your medical treatment facility are you now assigned? Find the name of the area to

which you are now assigned and write its identification

number in the top answer space (8/72).

If you are assigned to more than one area, or your

hospital combines some of the working areas listed below,

write down all of the appropriate identification numbers

in the extra spaces provided (8/74 - 8/78)

Fill any imneeded spaces with 99s .

COMMUNITY HEALTH CARE NURSING

01=0ffice of Service/Section Chief

Clinics Nursing

02=0ffice of Section Chief

04=Hospital Emergency Room

Troop Medical or Health Clinics

05=0ffice of Section Chief

06=Separate Clinics and Dispensaries on or off Post

07=Army Health Nursing

CLINICAL NURSING

08=0ffice of Service/Section Chief

Psychiatry and Neurology Nursing

09=0ffice of Section Chief

10=Psychiatric Wards

ll=Neurology Wards

Maternal and Child Health Care Nursing

12=0ffice of Section Chief

13=0bstetric Wards

14=Newbom Nurseries

15=Premature Nurseries

16=Pediatric Wards

Medical Nursing

17=0ffice of Section Chief

18=Medical Wards

Svirgical Nursing

19=0ffice of Section Chief

20=Surgical Wards (Excluding Ortho.)

21=0rthopedic Wards (ONLY)

23=Anesthesiology Nursing

24=Intensive Care Units

25=Other

NURSING EDUCATION AND TRAINING

26=0ffice of Service/Section Chief

27=Nursing In-Service Education and

Training

Nursing Specialty Education and

Training

28=0ffice of Section Chief

29=Army Health Nursing Orient Course

30=Clinical Specialty Course

31=Nurse Clin, Psych/Men Health Course

32=Anes. for ANC Officer Course

33=Intensive Care Nursing Course

34=OR Advanced Course

35=OR Basic Course

36=Nurse Clin, Ambulatory Care Course

37=Nurse Clin, OB & GYN Course

38=Nurse Clin, Pediatrics Course

39=Other

40

'J
SOME MORE QUESTIONS

9/08 Which of the following sources of information do you feel

influenced you most when you decided to apply for an appointment

in the ANC? (You may name two if they were equally influential;

9/10 Put "99" in the second space if you name only one.)

01=Radio

02=Television

03=Nursing Journals

04=Magazihes (Good Housekeeping, Seventeen, etc.)

05=High school teachers

06=High school advisors

07=College counselors

08=Talk or visit by Army Nurse Corps

recruiting counselor

09=Army Nurse Corps recruiting mail/brochures

10=Navy or Air Force recruiting officers

ll=Nurse with previous military service

12=0ther civilian nurses

13=0thers (such as parents, friends, family physician,

ministers, etc.) j

9/12 Apart from the above sources of information, what was the principal |' reason you decided to join the Army Nurse Coarps? If more than ' 9/14 one reason was important, you may indicate as many as two

5/16 additional reasons from the list below. Enter the numbers of the

items in their order of importance and enter "99" in the \anused

spaces.

01=Professional opportunity

02=Better pay, allowance and benefits

03=To serve my comtry

04=Because the Army was involved in a conflict and nurses

were needed

05=1 thought I would like the Army as a place to practice nxirsing

06=Because I thought I would be drafted

07=Because the Army programs gave me the best opportunity to obtair

a nursing education

08=1 came from a military family

j 09=World travel appealed to me 10=It seemed to me the best way to live my own life

at the time

ll=To get. away from home

12=Because my spouse or fiance (e) was in the service

13=0ther

9/18 If you have elected to stay in the Army,

9/20 why have you decided to stay? Using the same ' 9/22 list (above) put the most important reason by 9/18.

If more than one reason is important, you may indicate

as many as two additional reasons by 9/20 and 9/22.

0

'
Has the DOLLAR VALUE of your total military pay ever been cleeirly

explained to you? Include in your consideration your base pay,

tax-free allowances (quarters and subsistence) and fringe benefits

(medical and dental services, allowances and services for dependents

commissary, post exchange, and retirement provisions).

Do you now have a good understanding of your total military

pay as described above?

1 = Yes

2 = No

Have you filled in your Officer Preference Statement

again since your first assignment?

1 = Yes

When did you last complete your Officer Preference Statement?

1-= Within the last year

2 = More than one year ago but less than twj years ago

3 = More than two years ago but less than five years ago

4 = More than five years ago

Do you believe your Officer Preference Statement was taken

into account when you were assigned to your present duty station?

1 =

2 = YesNo

2 = No

1

2

3

= Yes

= No

= Don ' t know
CAREER COUNSELING

9/29 How many individual or small group career counseling interviews

or sessions (exclude group orientations) do you remember having

had with ANC officers senior to yoir-in grade or position?

0 = None

1=1

2 = 2 3=3

4 = 4 or more

9//30 Do your superiors discuss your work with you on a regular basis

(other than when doing your efficiency report)

1 = Yes

•

. 2 = No

IF YOU HAVE ANSWERED "NONE" TO 9/2 9 ABOVE , ENTER IN THE SPACES BY THE

NEXT FOUR QUESTIOJS AND GO W TO THE NEXT PAGE.

9/31 What were the attitudes of these senior ANC officers, generally

speaking, towards you and yoiir career during these counseling

sessions?

1 = Thpv wArft Tint interested

2 = They were moderats ly interested

3 = They were very interested and most helpful

9 = Does not apply

9/32 In yo\ar opinion, how well informed about careers in the Army

were these senior officers?

1 = Fully informed

2 = Moderately well informed

S = Not very well informed

4 = Very poorly informed

9 = Does not apply

9/33 Overall, what effect did career counseling by these senior

ANC officers have on your decision to stay in the Army Nurse

Corps?

1 = Strong influence to leave active duty

2 = Moderate influence to leave active duty

3 = No influence on my staying or leaving

4 = Moderate influence to stay in the Army Nurse Corps

5 = Strong influence to stay in the Army Nurse Corps as a

career officer

9 = Does not apply

9/34 Did career counseling influence you to apply for the Regular Army?

1 " Yes

2 = No

9 = Does not apply r\ \^

43
CHANGE OF DUTY STATION

In the next seven questions we ask you about your experience and

preferences concerning Permanent changes of station (PCS)

9/35 On the average, about how long in advance have you received

your orders prior to departing on your Permanent Changes of

Station (PCS moves)?

0 = Never made a PCS move

1 = Less than 1 month

2 = About 2 months in advance

3 = About 3 months in advance

4 = About 4 months in advance

5 = About 5 months in advance

6 = Six (6) or more months in advance

.9/36 What do you consider an adequate amount of time between receipt of

orders and departure on Permanent Change of Station (PCS moves)?

1 = Less than 1 month

2 = About 2 months in advance

3 = About 3 jnonths in advance

4 = About 4 months in advance

5 = About 5 months in advance

6 = Six (6) or more months in advance

9 = No opinion

9/37 What was the length, in months, of your one longest PCS

months assignment in any one location since becoming an Army Nurse

Ccrps officer (exclude basic training) . Enter "99" if you have

had only one PCS assignment. (Calculate from DA Form 66, item

18, if you are not certain.)

9/39 How many months did your shortest PCS assignment last? (exclude

months basic training). Enter "99" if you have had only one PCS assignment.

9/41 If you were given your own choice, how often would you

prefer to make a PCS move?

1 = Every year

2 = Every 2 years

3 = Every 3 years

4 = Every 4 years

5 = Every 5 years

6 = Never

7 = Only on my own request

44
If given your choice of assignments which one of these factors

woiald be most important to you?

1 = The professional experience to be gained

2 = The geographic area

3 = Specific duty station

4 = Educational opportunity available

5 = Closeness to family

9 = None of the above

Which one of the following do you. consider to be the most

desirable geographical assignment for you? Consider

all factors important to you. . . both on and off duty.

01 East Coast, Continental United States : First Army Area

02 South East, Continental United States : Third Army Area

03 Mid-West, Continental United States: Fifth Army Area

04 West Coast, Continental United States : Sixth Army Area

05 Alaska

06 Hawaii

07 Vietnam

08 Korea

09 Japan

10 Okinawa

11 Thailand

12 Germany

13 Italy

14 Belgium

15 Ethiopia

16 Iran

17 Canal Zone

99 No preference

45
PERSONAL

9/45 Do you presently live on, or off post?

1 a On Post

2 =« Off Post

9/46 Do you prefer to live on, or off post?

1 = On Post

2 = Off Post

3 = No Preference

9/47 Should options of living off post be offered to all ranks?

1 = Yes

2 = No

3 = No Preference

9/48 What is your marital status?

1 = Married

2 = Divorced

3 = Separated

4 = Widowed

5 = Single (never married)

o = lingagea ro oe marriea wicnin 12 montns

IF YOU ARE MARRIED OR ENGAGED ANSWER THE NEXT FOUR QUESTIONS. IF YOU ARE NOT

MARRIED OR ENGAGED, ENTER "9" IN THE NEXT 4 ANSWER SPACES AND GO TO QUESTION 9/53.

To whom are you married or engaged?

1 = Active duty military officer.

2 = Active duty enlisted person.

3 = Retired military person.

4 = U.S. Civil Service Employee

(retired military)

5 = U.S. Civil Service Employee (nqt retired military).

6 = Civilian (other than any of the above).

Is your spouse or fiancB(e) employed in one of the

health occupations?

1 = Yes

2 = No

0

9/49

9/50
9/51 Is your spouse or fiance'(e) a

1 = Army Medical Department?

2 = Army (other than AMEDD)

3 = Navy?

4 = Air Force?

5 = Marine Corps?

6 = Other uniformed services?

7 = None of the above

9 = Does not apply

9/52 Does your spouse or fiance (e)

member of the:

have an independent income?

1 = Yes

2 = No

3 = Don't know

9 = Does not apply

EVERYBODY ANSWER, PLEASE

9/53 How many dependents do you claim on your income

tax return (not witholding statement)? Exclude yourself.

9/54 How many of the dependents whom you claim on your

income tax return are under age 18?

9/55 wnich or the following do not legally qualify as yoiar

military dependents but do, in fact, depend

upon you because of such reasons as age, illness,

disability, or familial responsibility?

1 = Spous6

2 = Child (ren)

3 = Parent (S)

4 = Parent (s) -in-law

5 = Brother (s) /Sister (s)

6 = Combination of more than one of the above

7 = Other

8 = No one

9 = Does not apply

9/56 What is today's date?

day

9/58

month

9/60

year (Last

2 digits)

9/62 ±11^12.11111111112.11

47
PLEASE COMMENT

We would appreciate your comments now on two final questions. Please

write your answers out for these two questions.

What do you think is one of the biggest problems in the Army Nurse Corps?

What do you think should be done about it?

48
Your responses will be treated as aciministratively confidential and » will be made available only to the National Bureau of Standards research group.

After completion of the questionnaire, follow this procedure:

J.. Write on the comment sheets any additional comments you would

like to make about the questionnaire, items in the questionnaire,

or any other ideas or recommendations. Put your comment sheets

into your questionnaire booklet.

2. Check your questionnaire to be certain that you responded to

all items that pertained to you and that you entered "9^s" in

the vtnused answer spaces.

- '

" 3. Tear off the bottom part of this page, turn it over to page 50

and sign and date the certificate.

AH . Place your questionnaire booklet and comment sheets — but not

the certificate - in the accompanying envelope and seal it. No postage

need be attached.

5.

'i

Return the certificate to the person monitoring your questionnaire

session.

i 6. Put your envelope in the mail as soon as you can.

'l If you are making a PCS move before October 30, fill out the certificate

j at the bottom of page 50 and carry it with you to your next station but mail

1 the questionnaire now. Give the certificate to the project officer at the

1 next station to avoid completing another questionnaire at the new station. If

ji you are overseas, be certain to mail the envelope in an APO mailbox.

Go Back and Check Each Question

i; To Insure That You Have Left No Blanks

And That No Pages

i

Have Stuck Together

[

!

49

^
The National Bureau of Standards will make a report to

The Office of The Surgeon General on the results of this questionnaire.

Inquiries about obtaining this report may be sent to

Mr. Ralph Swisher

National Bureau of Standards

Washington, D.C. 20234

Thank you very much for the time and thought you have put into helping

the Army Nurse Corps achieve a new perspective.

TEAR OFF, SI(2^ AND HAND IN

Office of The Surgeon General

Department of the Army

Washington, D.C. 20314

Dear Sirs:

This is to certify that I have completed the Army Nurse Corps Officer

world-wide questionnaire and have mailed it to the National Bureau of Standards.

DATE SIGNATORE
CX)M>ENTS

QUESTION NUMBER
COMMENTS

QUESTION NUMBER
Reports Control Symbol

MED- (OT) -295

SURVEY OF NURSING PERSONNEL

SECTION A; PERSONNEL

Cc»iducted by

Technical Analysis Division

National Bureau of Standards

Washington, D.C. 20234

Office of The Surgeon General

Department of the Army

Washington, D.C. 20314

9/72
In this section you are asked to provide a complete "snapshot" of

all nursing personnel throughout your MEDDAC or medical activity, and of all

non-nursing personnel assigned to Nursing Services.

The information required from you will include —

(1) your personnel requirements, according to your latest approved

manpower survey;

(2) your present personnel authorization level;

(3) your recommendations for what you believe to be your present

requirements (your recommended personnel requirements may be

based upon your recommendations to the last manpower survey

undertaken, whether it has been approved or not, or you may

wish to make new recommendations if those you last made are

no longer appropriate to your needs) ;^

(4) personnel actually assigned as of 30 September 1972;

(5) your projections of your requirements five years from now,

according to your best estimate of the effects in your MEDDAC

or installation on nursing personnel requirements

of current trends or anticipated changes in nursing, practice.

On the following pages instructions are provided for you to follow in

presenting each of these sets of information. To complete the data you

will have to use several sources of information:

(1) your TDA or TOE.

(2) your latest approved manpov/er survey;

(3) your personnel authorization level as of the end of Fy72 (do not

use 1st quarter FY73 authorizations for this survey since some MEDDACS may not have them yet and the study requires that all

MEDDACS and medical activities provide information o-p -f-br* c;,-st"« time) .
(4) any manpower survey completed but not approved, along with any

manpower recommendations your ^EDDAC or medical activity made

for that survey;

(5) the organization chart for your MEDDAC or medical activity from

your manual of Organizations and Functions;

(6) personnel records (and Equal Employment records) ; and

(7) your own knowledge of your personnel.

If you need more copies than we have supplied of any of the pages in

this section, you may reproduce them by typewriter or by clearly legible

copying machines. Please do not use wet copy machines.

IMPORTANT

ENCLOSE A COPY OF YOUR MEDICAL ACTIVITY'S MANUAL OF ORGANIZATION AND

FUNCTIONS WITH THE PERSONNEL INFORMATION YOU RETURN TO THE NATIONAL

BUREAU OF STANDARDS

RECORD THE YEAR OF YOUR LAST APPROVED MANPOWER SURVEY (USE THE LAST

2 DIGITS OF THE YEAR) . .

RECORD THE DATE OF ANY SUBSEQUENT MANPOWER SURVEY COMPLETED BUT

NOT YET APPROVED (USE THE LAST 2 DIGITS OF THE YEAR)

WHAT IS THE PROJECTED COMPLETION DATE OF THE NEXT MANPOWER SURVEY

(USE THE LAST 2 DIGITS OF THE YEAR).

COMMENTS

(Last

2 digits)

(Last

2 digits)

(Last

2 digits)

3.
PART I

REQUIRED, AUTHORIZED, AND

RECOMMENDED PERSONNEL

It is important that the information that we have requested be provided

as accxirately as possible. If you have any question about precisely what

is being asked by any of these questions call:

Mr. Ralph Swisher or Mrs. Elizabeth Robertson

(301) 921-2261

at the National Bureau of Standards, Gaithersburg, Md, (Overseas posts use

TWX (Telex 89-8493)

4
PART I

PERSONNEL REQUIREMENTS > AUTHORIZATION, AND RECOMMENDATIONS

Record in schedules 1-8 (pp. 8-15) in the columns indicated the nuitJDer

of personnel required (column A) , authorized (column B) , and recomnended

(column C) , by grade (column D) , MOS (column E) , for each duty position

(column G) , in each MEDDAC element or hospital area of assignment (column F)

identified on your MEDDAC 's or medical activity's organization chart.

Distribute your recognized requirements, authorizations, and recommendations to the organizational areas to which they are allocated in your present

orgainization chart, if they have been so allocated, even if your manpower

survey does not go to that level of detail.

Enter personnel categories in the following order, as applicable.

Additional pages are provided for each of these categories. You can make

further additional copies if vou need them, but make sure they !^-re> rl^arly

legible .

(1) AI^IC Officers

(2) Department of Army Civilian Registered Nurses

(3) Foreign Nationals Utilized as Registered Nurses

(4) Enlisted Nursing Personnel

(5) Department of Army Civilian Nursing Personnel Other Than RN's

(5) Foreign National Nursing Personnel Not Utilized as Registered Nurses

(7) Non-nursing Civilian Personnel Assigned to Nursing Services

If you do not have any of these personnel categories, write "NONE" across

pertinent page.

Where the information requested is a number, put the figures directly in

the space provided, as in the example shown. In D, put numerical grade levels

(0-1, E-1 or GS-1 = 1). Write out Duty Position and MEDDAC Area. Add "(SEP)"

5
to MEDDAC Areas that are physically separated from the hospital f on or

off post.

In the columns for Duty Position and MEDDAC area, there are short

spaces followed by a longer blank. DO NOT WKETE IN THE SHORT SPACES - USE

THE L0N(2:r line C»ILY. The short spaces will be needed by key punchers

processing your answers.

Include under authorized strength, if applicable, permanent party

nursing personnel assigned to non-fixed medical . treatment facilities (that

is. Active Army TOE medical units other than USAR or ARNGUS units on active

duty for training) located within the defined boundaries of yovir MEDDAC

or medical activity, but working within your medical activity. These

will be included as "others" in your TDA or TOE and will be covered in Schedule

X of your Manpower Survey.

6

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<y l-J 0) c D o
ACTUAL PERSONNEL

It is iraportant that the information that we have requested be

provided as accurately as possible. If you have any question about

precisely what is being asked by any of these questions,, call

Mr. Ralph Swisher or Mrs. Elizabeth Robertson

(301) 921-2261

at the National Bureau of Standards, Gaithersburg , Md. (Overseas posts

use TWX (Telex 89-8493))

16
PART II

ACTUAL PERSONNEL

You have been listing personnel in small sets. Now, in schedules

9-17 (pp. 19-27) , list in Colvunn A, by name, each individual

who is presently assigned to your MEDDAC or medical activity in the

personnel category indicated (ANC Officers, DAC Registered Nurses,

Enlisted Nursing Personnel, and so forth) . Put the information that is

requested into each succeeding column, so that on one line you have

recorded all the information that is requested about that individual.

The names are used only to insure that each individual is accounted

for once and only once. You may delete or cut off the name column before

forwarding the data to the National Bureau of Standards

Under Colxamn B, Grade, use the number normally assigned to the

individual's military, civil service, or other grade. For example, 1=0-1

Second Lieutenant, or E-1 Private, or GS-01 in Civil Service or equivalent

grade for foreign nationals. Put a "1" or "01" in the grade column,

depending on the number of blanks.

In the columns requesting Work Area and Duty Position, record the work

area from your MEDDAC or medical activity organization chart. Put down the

area in which personnel are actually working, without respect to where they

are charged against your TDA or TOE. For officers assigned to more than

one working area or more than one duty position within a working area use

additional lines to record additional assignments. Complete "work area",

"duty positions", and "Duty MOS" columns only when using additional lines.

17 0"'
Include, if applicable, permanent party nursing personnel assigned

to non-fixed medical treatment facilities (that is. Active Army TOE

medical tanits other than USAR or ARNGUS units on active duty for training)

located within the defined boundaries of your MEDDAC or medical activity

but working within your medical activity. These will be included as

"others" in you TDA or TOE and will be covered in Schedule X of your Manpower

Survey. Separate these personnel. Place "other" ANC officers at the end

of the mc roster. Put "other'' EM on separate schedule 14 (see instructions

on ANC officer and enlisted niirsing personnel schedules).

18 , \ I'

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PROJECTIONS

It is importcint that the information that we have requested be

provided as accurately as possible. If you have any question about

precisely vhat is being asked by any of these questions, call

Mr. Ralph Swisher or Mrs. Elizabeth Robertson

(301) 921-2261

at the National Bureau of Standards^ Gaithersbvirg, Md. (Overseas posts

use TWX (Telex 89-8493))

28
PART III

PROJECTIONS

In this section you are asked to estimate the future impact on your

MEDDAC or Medical Activity of current and projected trends in nursing, and

the impact of any factors that may be unique to your hospital's situation.

Disregard such factors as the overall size of the Army and the level of

mobilization.

From the perspective of y^ux MEDDAC or medical activity, and

considering the pertinent aspects of the expanded role of the nurse as defined in your MEDDAC or inst.llation, estimate anticipated increases or decreases in requirements 5 yeirs from now for MOS's and types of hospital

services that you think will b<: affected. Consider -

Increase in types of int.iisive care units

Increase in nurses to wfj.k with electronic equipment to support

sophisticated diagnosi and treatment

Preventive medicine

Increasing enphasis on ratpatient care Family planning assists: ce Ambulatory care Health promotion and m^i .ntenance

Ratio of nurse anesthe ; .sts to physician anesthetists

Nurse midwives

Other considerations c which you wish to comment (such as changes cr trends .n nearby hospitals, medical schools,

and nursing eaucatic programs)

In making your projec ions, give the MOS and specialty, as appropriate,

the Nursing Service area, : id indicate the projected degree of change as

a percentage increase or dr urease in 5 years compared to the present. Use

examples projecting from ^. e figures you have already provided under actual

present strength in Sched\i es 9 to 17 (pp. 19-27).

EXAMPLE: MOS 3431 Citpatient Clinic, Increase - 100%

Explain any project -ons if you wish or if the projections do not

appear to be self-eviden : For example, perhaps you have added a new

intensive care unit or an experiencing increases in your ambulatory

Ccore services.

29

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PERSONNEL AVAILABILITY

It is important that the information that we have requested be

provided as accurately as possible. If you have any questions cibout

precisely what is being asked by any of these questions, call

Mr. Ralph Swisher or Mrs. Elizabeth Robertson

(301) 921-2261

at the National Bureau of Standards, Gaithersburg, Md. (Overseas posts

use TWX (Telex 89-8493))

We have asked for personnel availability information as of 27

September in_this part of the survey because that date is most likely t

represent the last normal duty day of the quarter.

31
PART IV

PERSONNEL AVAILABILITY

In this set of questions you are asked to record the availability for

duty of all nursing personnel on Wed. , 27 September 1972. Please review

the entire set of questions carefully before you begin to assemble

the information. (Questions pertain to assigned and "other" personnel)

In the appropriate spaces indicate how many ANC officers were in each

duty status listed below throughout your medical activity on Wednesday,

27 September 1972.

On Duty

Day Off Duty

On Pass

Administrative Absence

On Leave (other than maternity and convalescent leave)

Maternity Leave

TDY Other Than Student

Student Status ("your" working staff when on student status, not

students from other organizations)

Patients, Convalescent Leave, or Sick in Quarters (Exclude Maternity)

Assigned or attached to an organizational element other than Nursing,

Service

Other not available

Of those on duty, how many were on-call?
Indicate below how many Department of Army Civilian Registered

Nurses were in each duty status listed below throughout yo\ar

MEDDAC or medical activity on Wednesday, 27 September 1972.

On Duty

Day Off Duty

Administrative Absence

On Leave (other than maternity and convalescent leave)

Maternity Leave

TDY Other Than Student

Student Status

Sick or Convalescent Leave

Assigned or attached to an organizational element other than

Nursing Service

Other not av;^i I;^b1<a

Of those on duty, how many were on call?

33
OVERSEAS ONLY

Indicate below how many foreign national (coxinterpart) registered

nurses actually utilized in that capacity were in each duty

status listed throughout your MEDDAC or medical activity on Wednesday, 27 September 1972.

On Duty

Day Off Duty

Adrainistrative Leave

On Leave (other than maternity and convalescent leave)

Maternity Leave

TDY Other Than Student

Student Status

Sick or Convalescent Leave

Assigned or attached to an organizational element other than

Nursing Service

Other not available

Of those on duty, how many were on call?

1/
Indicate below how many enlisted nursing personnel were

in each duty status listed on Wednesday, 27 September

1972 throughout your MEDDAC or medical activity. (Include

91A,B,C,D and F personnel reported as actual strengths in

Schedules 13 and 14, pages 23 and 24).

On Duty

Day Off Duty

On Pass

Administrative Absence

On Leave (other than maternity and convalescent leave)

Maternity Leave

TDY Other Than Student

Student Status

Patients, Convalescent Leave, or Sick in Quarters (Exclude Maternity)

Assigned or Attached to an Organizational Element other than nursing

services.

Assigned or attached to other than nursing services awaiting

reclassification

Confined (AR 600-31)

Other not available

Of those on duty, how many were on call?
Indicate below how many Civilian Nursing Personnel other than

Registered Nurses were in each duty status listed throughout

your MEDDAC or medical activity on Wednesday, 27 September 1972.

On Duty

Day Off Duty

Administrative Absence

On Leave (other than maternity and convalescent leave)

Maternity Leave

TDY other than Student

Student Status

Sick or Convalescent Leave

Assigned or attached to an organizational element other than

Nursing Service

Other not available

Of those on duty, how many were on call?

36
OVERSEAS ONLY

Indicate below how many foreign national (covmterpart) nxirsing

personnel not utilized as registered nurses were in each duty

status listed throughout your MEDDAC or medical activity on Wednesday, 27 September 1972.

On Duty

Day Off Duty

Administrative Absence

On Leave (Other than maternity or convalescent leave)

Maternity Leave

TDY Other Than Student

Student Status

Sick or Convalesccint Leave

Assigned or attached to an organizational element other than

Nursing Service

Other not available

Of those on duty, how many were on call?
PERSONNEL TURNOVER

How many ANC officers were assigned to your MEDDAC or medical

activity as of 30 June 1972?

How many Department of Array Civilian Registered Nurses were assigned

to your MEDDAC or medical activity as of 30 June 19727

How many ANC officers were assigned to your medical activity

on PCS during FY727

How many ANC officers were transferred from yo\ir medical activity

on PCS during FY127

How many ANC officers were separated from active duty frcan

your medical activity duiing FY72? .

How many civilian registered nurses joined your medical

activity's staff during FY72?

How many civilian registered nurses resigned or were discharged

from yovir medical activity during Fy72?

Collective BargainiiKf

If any of the personnel in your MEDDAC or medical activity are represented by any collective bargaining agency - union or

association t^ write the name of the recognized bargaining agency

below.

If any collective bargaining agency has requested recognition

as bargaining agent but is not so recognized at this time, write

the name of the union or association below.

38

USCOMM-NBS-DC
Reports Control Symbol

MED- (OT) -295

SURVEY OF NURSING PERSONNEL

SECTION B. FACILITIES AND ACTIVITIES

Conducted by

Technical Analysis Division

National Bureau of Standards

Washington, D.C. 20234

For

Office of The Surgeon General

Department of the Army

Washington, D.C. 20314

9/72
Please read all directions carefully, it is important that all

information be supplied on the same basis and as accurately as possible.

If there are any questions about what is being asked by any of

the questions call

Mr. Ralph Swisher

(301) 921-2261

at the National Bureau of Standards, Gaithersburg, Maryland. (Overseas posts

use TWX (Telex 89-8493)

Make any comments you wish to make on the back of the page(s) to which

the comment refers.
FACILITIES AND ACTIVITIES

Indicate the total number of operating beds set up and

staffed on 30 September 1972.

How many operating beds can you staff with your present

nursing personnel? (Base your answer on the ratio of

nursing personnel to patients established by your last

approved manpower survey.)

Here you are asked to record in general terms the physical layout of

your hospital. For the following 7 items indicate the total number

of each type of separate and combined nursing care units in use in

your hospital during September 1972 and for peak periods during FY 72.

Put zeros in the answer blanks for all types of nursing care units that

are not part of the physical organization of your hospital.

Count rooms and cubicles separately only if they are not part of a ward.

Do not double count. Use the back of the page for aomments if you wish

to clarify your answer.

SEPT PEAK

72 Fy72

Private Rooms (1 bed)

Semi-Private Rooms (2 beds)

Semi -Private Rooms (3-6 beds)

Cubicles (4-12 beds)

Wards: Open Bay Only (12 or more beds)

Wards: Combination of cubicle and private or semi -private rooms

Wards: Other Combinations

Use back of page for comments.

Name and Title

of Individual (s)

Completing this page

3
CENTRALIZED MATERIAL SERVICE

How many ANC officers do you now have in CMS?

How many civilian registered nurses are in CMS?

How many enlisted nursing personnel are in CMS?

How many civilian personnel other than RN's?

For each of the following units in your, hospital select the choice below

that best reflects the extent of CMS services rendered in processing

sterile and nonsterile supplies and equipment for use in giving patient

care in your medical activity.

1 = Complete service by CMS

2 = Mostly done by CMS but some by unit

3 = About half by CMS and half by unit

4 = Mostly done by unit but some by CMS

5 = No CMS service

9 = Not applicable

Hospital Wards

Labor/Delivery Suites

Operating Room Suite

Pharmacy

Radiology

Clinical Laboratory

Hospital Clinics

Troop Medical Clinics

Off-Post Clinics

Other (Specify)

Use back of page for comments

Name and Title

of Individual (s)

Completing this page

4

I
MEDICAL TREATMENT FACILITIES OTHER THAN HOSPITAL

(Use "00" for "none" and "99" for "does not apply".)

How many separate clinics (including half-way houses, troop

medicalAealth clinics, etc.) integral to your medical activity

and requiring nursing personnel (officers, enlisted or civilian)

are located on the same post as your hospital?

How many separate clinics integral to your medical activity

and requiring nursing personnel are located off-post?

How many miles distant from the hospital is the separate

clinic that is farthest from your hospital but integral to

your medical activity?

VThat is the total number of all nursing personnel required

to staff on-post , separated clinics, according to your latest

approved manpower survey?

What is the number of nursing personnel presently authorized

to staff these on-post clinics? (Use end of FY72 authorization)

How many nursing personnel are actually assigned to these oh-post

clinics as of 30 September 1972?

What is the total nvimber of all nursing personnel required

to staff off-post, separate clinics. acro-rrJi to ycvr latcct

approved manpower survey?

What is the number of nursing personnel presently authorized

to staff these off-post clinics? (Use end of FY72 authorization)

How many nursing personnel are actually assigned to these off-post

clinics as of 30 September .1972?

How many of the separate on-post clinics referred to above

operate a separate Centralized Materiel Service (CMS)

How many of the separate off-post clinics referred to above

operate a separate Centralized Materiel Service (CMS)?

Use back of page for comments.

Name and Title

of Individual (s)

Completing this Page

5
TOE MEDICAL UNITS

How many ACTIVE ARMY TOE MEDICAL UNITS, maintained in a training status, are located within the boundaries of your

medical activity as of 30 September 1972? If none, write

in a "0 0".

How many enlisted personnel and officers are there in all these

units who have each of the following PMOS's? Enter "99" by

each MOS if your answer above was "00". Enter "00" by MOS '

not included among the TOE medical unit ' s personnel

How did you obtain these figures?

91A

91B

91C

9 ID

91F

91H If figures were supplied by another xinit, d(

yc'Ji believe they arc (enter on^)

91M

1 = correct?

91N 2 = too high?

3 = too low?

91U 4 = don't know?

3443

3445

3448

ANC Officers with PMOS other than 3 listed (specify)

Use back of page for comments.

Name and Title

of Individual(s)

Completing this Page
TOE MEDICAL UNITS: SUPPORT AND TRAINING

By PMOS, answer the following three questions about those

officers and enlisted personnel of TOE Medical Units, not organic to your

MEDDAC or medical activity, who provided a support service or received

training in the nursing service in the medical treatment facilities of

your medical activity during the last 12 months.

Col. 1. How many, by PMOS, were present for duty only?

Col. 2. How many by PMOS received 0-J-T only?

Col. 3. How many by PMOS, were present for a combination of duty

and 0-J-T? (Exclude personnel reported under 1 and 2.)

1 2 3

Duty OJT Combination

91A

91B

91C

91D

91F

91H

91M

91N

91U

3443

3448

3445

XXX**

officers with PMOS other than those 3 listed (please specify)

Use back of page for comments.

Name and Title of Individual (s)

Completing this page
IN SERVICE EDUCATION AND TRAINING

For each of the five categories of personnel listed below, record

the average number of students per month for FY72. By students

we mean those officers and EMs who received health related inservice

education or training courses. These courses are sometimes called

Inservice Short Term or Long Term Courses, Functional Courses , and

MOS Producing Courses. They may include any formal instruction,

health related, provided by the hospital. Calculate the monthly

average for FY72 by adding the total number for each month, then

dividing by 12, and rounding to nearest whole number.

Officers Enlisted Personnel

Members of Active Army TOE Medical Units

Members of Active Army Medical Units

Organic to Non-medical TOE Organizations

Members of USAR and ARNGUS on ACDUTRA

Members of U.S. Uniformed Services Other

than Army

Foreign Military Observers

Use back of page for comments.

Name and Title

of Individual (s)

Completing this Page

8
INSERVICE EDUCATION AND TRAINING: (Cont.

)

Assigned Personnel

Provide the information requested in columns A through F on all inservice - education and training programs presented by registered nurses {during FY72)

for nursing personnel in your MEDDAC or medical activity. Also include other

health-related courses for which ANC officers were instructors, and nursing

courses for which enlisted nursing service personnel presented instruction.

Column A. Enter the number of times the program of instruction listed was given during FY72 (exclude OJT) .

Column B . How many hours of formal instruction were presented by registered

nurses of your MEDDAC or medical activity in teaching this course?

Column_C. How many hours of formal instruction were presented by enlisted

nursing service personnel?

Column D . How many ANC officers received this program of instruction diiring

Fy72?

Column E . How many enlisted nursing personnel received this program of

instruction during FY72?

Column F . How many civilians received this program of instruction during FY72?

i

A B £ D E F

Formal Orientation

Programs

Monthly Staff

Development Programs (Exclude

Ch ie f Wardmas te r '

Staff Meetings)

Skill Training

(MOS & Functional)

Use back of page for comments.

Name and Title

of Individual ( s

Completing this Page

9
PJSERVICE EDUCATION AND TRAINING: (Cont .

For each of the MOS-producing programs of instruction conducted for nursing

personnel at your MEDDAC or medical activity, list the MOS produced by the

program in Column A, and the number of personnel who completed the program

during FY72 in Column B. List ANC MOS courses and the number completing

them first, then enlisted nursing MOS courses (include only 91A, 91B,

91C, 91D and 91F courses) and the number completing them.

A B

W-IC MOS Number Completed

Enl. MOS Ntjmber Completed

Use back of previous page for comments.

Name and Title of Individual (s)- Completing this Page

10
PATIENT CARE AND TREATMENT UNITS

On the next page record information that relates the physical

organization of facilities, the workload and the staff.

For each kind of patient care and treatment unit listed on page 12, provide the information requested in columns A through

F.

Units listed are not mutually exclusive. Consider each line

an independent question, but only answer for kinds of units you

have in your hospital.

Use the "Other Units" line to account for any units not covered

by the list provided. Enter "00" in units not applicable to

your hospital.

Column A. How many xinits (defined as wards, room or cubicles, but

not as beds) were set up and staffed for use in your hospital during

normal operations in FY 1972? Count rooms and cubicles separately only

if they are not part of a ward. Do not doiable count

Column B. What was the maximum number of units set up and staffed

at any time during FY 1972?

Column C. What was the average daily patient census for each kind of unit

during Fx 1972 (annual patiieni: rorai dividea by 36 and rounded to nearest

whole number)-,? For outpatient clinics, record average daily clinic visits.

Column D. What was the average daily bed occupancy for the hospital

(all lanits) and all intensive care units during FY 1972 (annual bed

occupancy days divided by 366 rounded to nearest whole number)?

Column E. What was the average daily patient census for each kind of

unit during September 1972 (September patient total divided by 30 and

roimded to nearest whole number)? For outpatient clinics, record average

daily clinic visits.

Column F. I'Jhat was the average daily bed occupancy for each kind of unit

during September 1972 (bed occupancy days during September divided by 30

and rounded to nearest whole number)?

Write here the source of the annual paitent total (Column C) or how it was calculated.

Write here the source of the annual bed occupancy days (Column D) or how

it was calculated.
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How many operating and delivery rooms ( not suites) were set up and staffed

Operating

Rooms

Delivery

Rooms

normally during FY72?

maximum during FY72?

during September 1972?

How many admissions were there to your hospital

during FY72?

during September 1972?

How many live births occurred in your hospital

during FY 72?

during September 1972?

Record the total number of outpatient clinic and dispensary visits

' throughout your MEDDAC or medical activity —

- Enter the total number of Medical Care Composite Units (MCCU)

. of work in your medical activity

Enter the total number of MCCUs

during September 1972?

Record the total bed occupied days for all patients

during FY 72?

during September 1972?

during FY 72?

during September 1972?

during FY 72?

13
How many cases of committee certified hospital acquired infections

occurred in your hospital during FY 72? (Infections defined

in accordance with AR 40-2, par. 93b, p. 41.)

How many of these infections were urinary tract infections?

Record here the hospital infection rate certified by your

infection committee (AR 40-2, par. 94a(8), p.44) . (Enter to one decimal place .

In column A , record the average length of stay (days) for patients in your

hospital during FY 72 in each category below. Enter to one decimal place,

for example: 12.7).

In column B , give the number of cases on which the average length of stay is

based.

A B

All patients throughout hospital (beds occupied, not

patient census)

All general surgery patients

Appendicitis only*

. Hernia only*

Cholelithiasis only*

<*Not complicated by any other diagnosis requiring

hospitalization)

14
An intensive care patient is one who is acutely ill and requires continuous

treatment and/or observation.

A minimal care patient is one who requires little or no nursing care.

Use these definitions to answer the next three questions.

What was your total bed occupied days for intensive care patients for September 1972?

What was your total bed occupied days for minimal care patients for September 1972?

What was your total bed occupied days for all other patients

for September 1972?

NOTE : The total of the bed occupied days for the above

three questions should equal the total bed occupied days — reported by the Registrar (Patient Administration) for the

month of September 1972.

IIcv n"iany raLioiis wext; t^erved ro patients m the wards on Wednesday, 27 September 1972?

How many rations were served to patients in the hospital dining

room(s) on Wednesday, 27 September 1972?

Is the total figure (rations served)

1 = typical?

2 = higher than average?

3 = lower than average?

Name and Title

of Individual (s)

Completing this Page

15
In Column A, list the number of patient complaints (not other

complaints) to the Inspector General for each of the months requested.

In Column B, list the number of these complaints that are apparently

related to the quality of patient care. In Column C, record the

average daily number of beds occupied for each month. (Enter to one decimal place.

A B

' C

Patient Complaints about Average Daily

Complaints Quality of Care Beds Occupied

Aug. '71 _ _

Sept. '71 _

Oct. '71 _

Dec. '71 • _

Mar. '72 _

April '72 _

May '72 _

Jxine ' 72

July '72

16

1
How many reports of "Unusual Occurrences" (DA Form 8-249)

were prepared on patients in your MEDDAC or medical

activity during September 1972?

Of the total number above how many unusual occurrences

were

errors in treatment and in medication administration?

patients falling out of bed?

injuries sustained by amb-ulatory patients?

Other (specify)?

17
]
Reports Control Symbi

MED-{OT) -295

SURVEY OF NURSING PERSONNEL

SECTION C. TASKS IN YOUR WARD OR CLINIC

Conducted by

Technical Analysis Division

National Bureau of Standards

Washington, D.C. 202 34

For

Office of The Surgeon General

Department of the Army

Washington, D.C. 20314

9/72

INSTRUCTIONS TO RESPCX^DENT

We have listed on the following pages some activities in which nurses

and nursing personnel may be engaged during their daily work. We have

arranged them in six general areas. Read each list of activities. Think of

all the times any activity might be done within one shift. Then answer

these two questions about each activity:

A. Of all the times the activity is done in your ward or clinic,

how often is it done by registered nurses? (Column A)

B. How often is it done by other nursing personnel (for example,

corpsmen or civilian nursing assistants)? (Column B)

To answer use this scale: •

1 = Never: the job is not here to do (not applicable) or it is done

by someone other than Nursing Service personnel

2 = Seldom: do this once in a while, but no more than 1/4 of the . time it ' s done

3 = Often: do this about 1/2 of the time it's done

4 = Frequently: do this about 3/4 of the time it's done

5 = Routinely: do this all or nearly all of the time it's done

Questions are nxmbered for key punch operators.

ir yod are in a staff cr cupcrviccry petition e.bc'e nn-rcio you should

not be filling out this questionnaire, and should return it to the project

officer or to whoever gave it to you. This auestionnaire is to be completed

only by a head or staff nurse of a ward or clinic.

MAIL SECTION C IN THE SAME ENVELOPE AS YOU MAIL THE ARMY NURSE CORPS OFFICERS

WORLD-WIDE QUESTIONNAIRE.

1
ADMINISTRATIVE/CLERICAL ACTIVITIES

A. Of all the times the activity is done in your ward or clinic

how often is it done by registered nurses?

B. How often is it done by other nursing personnel (such as corpsmen

or civilian nursing assistants)?

Scale

1 = Never

2 = Seldom: once in a while but no more than 1/4 of the time

3 = Often: about half of the times it's done

4 = Frequently: about 3/4 of the times it's done

5 = Routinely: all or nearly all of the times it's done

A B

REGISTERED NURSING PERSONNEL

NURSES OTHER THAN RN '

1/06 Answer and initiate telephone calls.

1/08 Type (as opposed to hzmdwrite) essential

between other services.

1/10 File administrative or clinical record

reports

1/12 Schedule appointments (e.g., clinics,

consultations, etc.) for patients.

1/14 Maintain daily Admission and Disposition

(A&D) rosters on ward lonits.

1/16 Collect records and reports to accompany

patients for appointments, consultations, etc

1/18 Preassemble and maintain supply of clinical

records or outpatient forms in advance of

patients' admissions or visits.

1/20 Requisition supplies, equipment, or

publications.

1/22 Prepare and sign Bulk Drug Order (DA

Form 8-236) for bulk quantities of class

"X" exempt narcotic preparations.
Scale

1 = Never

2 = Seldom: once in a while but no more than 1/4 of the time

3 = Often: about half of the times it's done

4 = Frequently: about 3/4 of the times it's done

5 = Routinely: all or nearly all of the times it's done

A B

REGISTERED NURSING PERSONNEL

NURSES OTHER THAN RN ' S

1/24 Prepare Prescription Form

(DD Form 1289) for bulk quantities

of stock record drugs or preparations.

1/26 Request diets or diet changes and

maintain ward diet rosters.

1/28 [ Prepare written reports for disciplinary

action on patients or personnel.

1/30 Considering all of these activities together, how much do

they interfere with the performance of your cind your staff's

normal nursina duties?

1 = Much interference

2 = Some interference

3 = Little interference

4 = No interference

1/31 When the "seldom done" administrative and clerical activities

are done by nursing personnel, how much do they interfere

with the performance of normal nursing duties?

1 = Much interference

2 = Some interference

3 = Little interference

4 = No interference

9 = Does not apply

3
HOUSEKEEPING ACTIVITIES

A. Of all the times the activity is done in your ward or clinic,

how often is it done by registered niirses?

B. How often is it done by other nxirsing personnel?

Scale

1 = Never

2 = Seldom: once in a while but no more than 1/4 of the time

.3 = Often: about half of the times it's done

4 = Frequently: about 3/4 of the times it's done

5 = Routinely: all or nearly all of the times it's done

A B

REGISTERED NURSING PERSONNEL

NURSES OTHER THAN RN' S

1/32 Perform housekeeping services in space

occupied by patients, e.g., wards, day

rooms, clinic waiting rooms.

1/34 Clean units following patients' discharge

or transfer, including making of unoccupied

ceas

1/36 Clean and straighten medical or administrative

offices, sleeping rooms, dressing rooms, examining rooms, nurses' station, etc.

1/38 Perform housekeeping services in areas other than space occupied by patients,

e.g., corridors, offices, stairwells,

auditoriums , etc

1/40 ___ Collect or empty or clean garbage cans and

wastebaskets.

1/42 Clean and maintain ward nourishment centers.

1/44 __ Paint wards, rooms, radiators, etc. Make

minor carpentry, mechanical, pluinbing, etc. , repairs

1/46 Perform periodic floor refinishing, i.e.,

applying solvent, washing, scrubbing,

and waxing.

1/48 Clean walls, ceilings, window screens, venetion blinds, lights, vent and curtains,

windows, change cubicle drapes.

4 - A
Considering all of these activities together, how much do they

interfere with the performance of your and your staff's normal

nursing duties?

1 = Much interference

2 = Some interference

3 = Little interference

4 = No interference

When the "seldom done" housekeeping activities are done by

nursing personnel, how much do they interfere with the

performance of normal nursing duties?

1 = Much interference

2 = Some interference

3 = Little interference"

4 = No interference

9 = Does not apply
DELIVERY & MESSENGER ACTIVITIES

A. Of all the times the activity is done in your ward or clinic,

how !often is it done by registered nurses?

B. How often is it done by other nursing personnel?

Scale

1 - Never

2 = Seldom: once in a while but no more than 1/4 of the time

3 = Often: about half of the times it's done

4 = Frequently: about 3/4 of the times it's done

5 = Routinely: all or nearly all of the times it ' s done

REGISTERED NURSING PERSONNEL

NURSES OTHER THAN RN '

1/52 Pick up or distribute materials to and

from Message Center or Information Desk.

i/54 Pick up or distribute patients' mail.

1/58 Pick up and return X-ray films or reports

from Radiology Service.

1/60 Pick up and deliver Bulk Drug Orders to

Pharmacy.

1/62 Pick up and deliver emergency ' drug order

requests to pharmacy.

1/64 Pick up and return Centralized Materiel

Service (CMS) supplies and equipment

for routine use.

1/66 Pick up and return CMS supplies or equipment for emergency use.

1/68 Pick up and return medical supplies or equipment.

1/70 Deliver clinical laboratory specimens

to Pathology Service.

1/72 Pick up reports or supplies from Pathology

Service.

1/74 Transport anatomical/tissue specimens or

the deceased to Pathologv Service.
Scale

1 = Never

2 = Seldcffli: once in a while but no more than 1/4 of the time

3 = Often: about half of the tioes. it's done

4 =? Frequently: about 3/4 of the" times it's done

5 = Routinely: all or nearly all of the times it's done

A B

REGISTERED NURSING PERSONNEL'

NURSES OTHER THAN RI^ S

1/76 Pick up general commodity (Q.M.)

supplies or equipment.

1/78 ^ Return meal trays from patients to

food carts or ward kitchen.

. 1/80 9_

2/06 Transport linen to and from laundry.

2/08 Pick up nourishment or special formulas

from Food Service.

2/10 Pick up and return food carts or containers

from Food Service.

2/12 Considering all of these messenger and delivery activities together,

how much do they interfere with th^. p»»-p'^rT"ar.cc cf ycur ar.i youj. ouaTf 's normal nursing duties?

1 = Much interference

2 = Some interference

3 = Little interference

4 = No interference

2/13 When "seldom done" delivery and messenger activities are done by

nursing personnel, how much do they interfere with normal nursing

duties?

1 = Much interference

2 = Seme interference

3 = Little interference

4 = Nc interference

9 = Dees not apply

Use this scale for the next four questions:

1 = Yes

2 = No

2/14 Does the hospital provide messenger service during your shift?

2/15 On Weekends?

2/16 Does the hospital provide pick up and delivery service during

your shift?

On Weekends? fA 2/17 — « 7 t
PERFORMING A SERVICE FOR ANOTHER SERVICE

A. Of all the times the activity is done in your ward or clinic,

how often is it done by registered nurses?

B. How often is it done by other nursing personnel?

Scale

1 = Never

2 = Seldom: once in a while but no more than 1/4 of the time

3 = Often: about half of the times it's done

4 = Frequently: about 3/4 of the times it's done

5 = Routinely: all or nearly all of the times it's done

A B

REGISTERED NURSING PERSONNEL

NURSES OTHER THAN RN '

2/18 Manage or coordinate ambulance Service.

2/20 Add prescribed additives to multiple

units of stock intravenous solutions as an advance preparation measure to provide

a daily supply for using units' consumption.

2/22 Fill or dispense individual prescriptions

from stock drugs (exclude medication

administered to your own patients)^

2/24 Operate pharmacies.

2/26 Administer physical therapy, e.g., whirlpool,

diathermy, etc.

2/28 Perform clinical laboratory procedures

(other than nursing procedures such as Clinitest) ,e.g. , perform urinalysis,

blood counts, blood gas analysis.

2/30 Draw blood specimens for clinical laboratory

examination

2/32 Prepare patients' meals or special feeding ^ formulas or nourishments.

2/34 Serve meal trays or nourishments to patients

from food carts or '.vard kitchens.

8
Scale

1 = Never

2 = Seldom: once in a while but no more than 1/4 of the time

3 = Often: about half of the times it's done

4 = Frequently: about 3/4 of the times it's done

5 = Routinely: all or nearly all of the times it's done

A B

REGISTERED NURSING PERSONNEL

NURSES OTHER THAN RN '

S

2/36 Clean supplies or equipment.

2/38 Sterilize supplies or equipment.

2/40 Assemble and wrap packs for autoclaving.

2/42 Separate and count or sort and shelve linen.

2/44 Considering all of these activities together, how much do they

- interfere with the performance of your and your staff's normal

nursing duties?

1 = Much interference

2 = Some interference

4 = No interference

2/45 When "seldom done" services are performed for other elements or services of your MEDDAC or medical activity, how much do they interfere

with the performance of normal nursing duties?

1 = Much interference

2 = Some interference

'3 = Little interference

4 = No interference

9 = Does not apply

9
CHAPERONE AND ATTEND PATIENTS

A. Of all the times the activity is done in yoiir ward or clinic,

how often is it done by registered nurses?

B. How often is it done by other nursing personnel?

Scale

1 = Never

2 = Seldom: once in a while, but no more than 1/4 of the time

3 = Often: about half of the times it's done

4 = Frequently: about 3/4 of the times it's done

5 = Routinely: all or nearly all of the times it's done

A B

REGISTERED NURSING PERSONNEL

NURSES OTHER THAN EN'S

2/46 . Attend patients going to or from

Operating Room or other patient

care, diagnostic, or treatment units.

2/48 Attend patients on air, rail, or ambulance evacuation.

2/50 Chaperone female patients on other than

assigned unit.

2/52 Considering all of these activities together, how much do they

interfere with the performance of your and your staff's normal

nursing duties?

1 = Much interference

2 = Some interference

3 = Little interference

4 = No interference

2/53 When "seldora done" chaperoning or attending patients i£ done,

how much does it interfere with the performance of normal

nursing duties?

1 = Much interference

2 = Some interference

3 = Little interference

4 = No interference

9 = Does not apply

10

- . I . t
TRANSPORT PATIENTS

A. Of all the times the activity is done in your ward or clinic

/

how often is it done by registered nurses?

B. How often is it done by other nursing personnel?

Scale

1 = Never

2 = Seldom: once in a while but no more than 1/4 of the time

3 = Often: about half of the times it's done

4 = Frequently: about 3/4 of the times it's done

5 = Routinely: all or nearly all of the times it's done

A , B

REGISTERED NURSING PERSONNEL

NURSES OTHER THAN RN '

S

2/54 Take patients to or from specialty

clinics, x-ray labs, etc.

2/56 Take patients to or from administrative

areas, e.g., clothing & baggage, A&D, etc.

2/58 Considering these activities together, how much do they

interfere with the performance of youf and your staff's normal

nursing duties?

1 = huch interference

2 = Some interference

3 = Little interference

4 = No interference

2/59 If patients are "seldom" transported by nursing personnel, how

much does it interfere with normal nursing duties when it does

occur?

1 = Much interference

2 = Some interference

3 = Little interference

4 = No interference

9 = Does not apply

11
1 =

2 =

3 =

A medical ward?

An outpatient clinic?

Other (specify)?

2/61 Do you work on the

1 = Evening shift?

2 = Night shift?

3 = Day shift?

In what nursing service area do you work?

Are there any other duties or services which you or your staff perform

which you feel are non-nursing and time consuming? Please list them here:

How would you describe the situation on your ward with respect to the

main reasons why nursing personnel do or do not do the kinds of tasks

you were asked about in this questionnaire?

12

;OMM-NBS-DC

.5
Reports Control Symbol

MED- (OT)- 295

SURVEY OF NURSING PERSONNEL

SECTION D: NON-NURSING TASKS

Conducted by the Technical Analysis Division

National Bureau of Standards

Washington, D.C. 20234

For the Office of The Surgeon General

Department of the Army

Washington, D.C. 20314

TO BE CO^^PLETED BY THE CHIEF NURSE.

Please list those duties or activities that take Nursing Service

personnel away from their normal duty stations during normal

duty hours.

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(II-9)-9

ANNEX 11-10

Additional Figures for Section 4.5.2, Graphical Relationships

(11-10) -1
y

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1 u. * t t t

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(II-10>-18

41
ANNEX 11-11

Identification and Statistics of MEDDAC Variables,

Additions to Table 4-4 in Section 4.5.3, Geographical

Distribution

(11-11) -1 ail

i
wH<QHSow

v>H

E-i WH

Eh<

EHCO2OH<uMH

EHWQH

(3 (0 •H O

Cu Eh n >-( +J o o x;

Eh !-» o

rH 0)

4->

O

O J-l W o

Eh <

Eh

n

Q

O VD 1 O 03 o o O

OO :H i-O

O CT\ o o VD ^ (J\

O CS

CN 00 ro ro

O

O ro VD ro 00 CN vo o CN <Ti r~ 00 CO in

in ro in ro rH TJ* CN OO VD ro ro rH

in fv: r-t CO rH VD ro "3" C-~ CM rH CN in in

** ^ • ^ H r- VD in rH VD CO o r» 00

r~ in rH rH rH VD '3" rH vo ro

in ro ro VD CN

n * *" o in CN

CN rH * * *

Eh

m Em in Eh in Eh in Eh in Eh in Eh in Eh ^ Eh rH Eh rH Eh iH

VD VD VD VD VD VD VD vo o ^ o cx) O o CO o o o o O CO O ro o in O "a*

rr cn cTi CJ^ rH

m roO CN in a\ cj> ro

rH OvI CO C\ ro Ln CX3 rH in rH vo rH rH "3' rH T o VD rH O 00 00 r~ CN O

in in CN

OO VD c\ ro CNO ^

CN CN

O ro ^ vo 00 CN

in rH CNJ vo rH * * *

Eh in Eh in Eh in Eh in Eh in Eh in Eh in Eh 'a* Eh "a- Eh in .Eh in O M O rn o 00 o o o in O o ^ o o vo ro CO o o

CO \DO fN ro CjI rH 00 CN vo cr> vo rH 00 VD ro

CN in o o <X) VD cr> CN ro o ro CO CN a\ ^ CD <T\ Cr\ O ro CN in rH cr> rH in

cTi in =r rH cr\ rH r-- in rH

ON CTl ui r-- in r- rH vo >H

*" CN CN * * *

Eh ^ Eh ^ Eh E-i fH Eh Eh '3' Eh Eh in Eh ro Eh ro rH i-i rH rH rH rH iH rH rH rH O O o m o in O ro O O o CO o r- O ro o o ro ro O ro • • • CN cTi ro O CN) 00 ro ro O rH ro "nT "d" CN CO VD

in r*- rH in rH r- CO VD r~

O rH r- CO - O CN rH a" CN in ro in -

IS) in 0^ in CN CN CN CN VD

ro VD r~ in r~- CN r~- rH fo

CN in CN in

*• ro 1—

rH rH * * *

Eh F-i VD Eh VD E-I VD Eh VD Eh vo Eh vo Eh CN Eh Eh CO 1 M

r>4

m CN CN

O +> r- e cn • 0 e o rH CO d) O 0 o a fa > fa rH •H -H

CN CN

O Pi o •H <c

Q -P

ISi o <^ 

>i tn nj c >H rH -P C -P • &i 0 fa Cm 13 >H r- c >i •H -H O -H n3 -P P

•H >i

H iH r3

C 4->

C 4JC

O

C

W U5 tn t-. 4J (U

Q

D c o to 0 Eh 0

0) 4J (d CN > CN •H •H

-Hw r~ •H • • o • -P CN JJ E CJ >H •H >l u> V • S-l CP (T3 -rl -H 0 D 0 C4pH O fa > u 0 C3 > CI. >H cn < a > o cs (< o 2 U fa i—

:^ :s :s o u o a

in VD CO ro VD rH r<) CN CN CN <N CN CSJ CN rH ro ro

fO tn VD in CO vo rro ro ro ro ro ro rH in in n sn i rH (N ro 00 o rH J 1 1 rH i rH CN CN

CD<

EhH

OitooKow

CQD

(11-11) ~2 I n 111 r'
iH r-i C +J •H O

ra u

4J 0) o o

-p 2: o o

Eh U

o

Eh <

CO

0 CO 0 0 0 0 0 0 0 n 0 0 0 CTl 0 00 0 in 0 0 0 in

CD CO CO in CO in 00 0 rH in 0 CO vo vo rin CM ro 00 n u> CO m 0 CO 0 00 CN 00 T in rH rn «r CO CT» vo CN rH CTl 00 rH in in CM rH rH ID n CN (N CO CN VO in rH

in n cr> CN in

rH rH rn

Eh ro Eh ^ Eh 0 Eh Eh CT> Eh Eh n Eh m Eh m Eh m Eh rn

in in m vo vo vo vo vo

<Ti 0 0 0 0 in 0 ro 0 0 0 CN 0 vo 0 0 0 0 0 0 0

«^ f-H CO in 00 CO cr> vo vo rH CTl m rH 0 rH CN cNi in ro CM 00 0 0

rH 0 r~ rH 0 C^J rH CM 00 m m

0 rH in rH <7> rn rH n rH

Eh m Eh ro E^ '=1' Eh ^ Eh Eh in Eh in Eh in Eh in Eh in Eh in

ID 0 0 in 0 n 0 0 0 (N 0 0 0 0 0 0 0 0 0 0

00 in in in vo 00 rH 0 0 rn

V£) rH CO CM in n rHCM n ro rH CM -a" in r«

CT» CO CO in rH in 0 rn r~- rH rH rn vo rH CO vo 0 in H rH m vo

rH CN

Eh rH Eh H Eh ro Eh Eh m Eh ro Eh m Eh cn Eh n Eh m Eh m

rH rH rH ft rH rH rH rH rH rH ^ n 0 0 0 0 0 0 0 0 0 vo 0 in 0 vo 0 VO 0 ^

1—1 C^ vo ^ rH '^a* 0 r~ 0 0 0 CN in 0 'a* rH rn CT> rj" 0 —< in CO 0 in r~- in r~ in in m VO m CO n rH cr\ 00 in 0 in CTl n CN 0 rH CM CO CTl U5 <N m rH in n CN CN vo CN 0 in m

rH CM 10 vo rH rH CN

Eh a\ Eh 0 Eh EH 0 Eh cm Eh in Eh in Eh in Eh in Eh in Eh in n

>i

1 U)

rtS -—

0 ^ CSJ >i Da >i Q) w

CO V4 W >H • M CN 4J • \ GJ •rl 0 0 05 um 0 CTl ^ C7> Q Cn 0 CJ \ dJ 0

4-1 >-l 0 s <^ <TN -rl Q) 0 fN W

• D • -H -p • W r- c

c -P CO ^3 -P c \ rH 03 >H n \ 0

0 0 0 C •H a^ rH Pj • 0) 0) cr> •rl Eh • pa M S < -P m 0) c 0) U 10 w W

• 0 CM 1) • • Sh • 0 •r( • >1 •r) cr>u -P r- -p j:: > rH > S

t> — >H r\u \\ 0 U 4-' (-*»-< •rH > l-J < fa Eh cn £h Eh 0 < u w u <:

u u S CO CO CO CO 12 0 o

ro rH rH CN CO n m in in in in r00 00 0 <N in r-~ 00 in ro ro rH

Cl I

1 1 1 CN 1 1 (M n n n

(11-11) -3 I. ''J
iH iH

-H O

fa Eh

o x:o

r-i <D

(B a.

+j o O M

E-" P

W

<T3 :d O O

Eh U

4Ju

• CM o

2

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CO0^

Q

O .H o o o o O CTl O rn o m o r»- o in

• • • • a . • VO T o o rH VO CN CN o o 00 rr T o

iH 00 o CO CN VO O n 00 r^i rH rH in rH

rH ko Ln O CN VO CN VO 0^ 00 o CO VO H rH in VO CN rH iH

rH .-H CN rH rH

VOrH

Eh <N Eh ro Eh -H Eh. O ^ s

Eh O Eh CN Eh CN H rH Eh cs

VO VO VO VO VO VO vo o o o o o o o o o CO o in O CN O o r~ O CN

• » • • VO ro O CN rH in CO CO o VO in rH m 00 VO c^

iH CO n (N rH rH CN CN CN in r- rH VO rH

CTi n n CN CM CN CN rH rH rH

«• -

VO r« rH rH CO

Eh Eh in £h VO Eh VD E-i in Eh Eh in Eh in Eh Eh in o o o o o o O O o o o o o o o o o in o o

• • • • VO r-~ rH rH 00 rH rH CTl "S- CN CO CN in n fvj CM

00 CT\ CN rH CO n [>- CN rH in rH in rH in rH

iH iH fO nH in rH CN CN tH <H rH

« iH rH CTl rH

LO iH

(N

Eh fn Eh n Eh rn Eh m Eh m Eh CO Eh cm Eh CN Eh ro Eh rH rH rH rH rH rH rH rH rH O CO o o o o O CN o O CJ^

(N n rH CN) in ^i* VO n VO O cr> o VO <J> VO CM VO rH o o 00 in CO o ro in rH 00 rH cn O CN in r» CN .-tI m IT). ~" i -?

rH fNJ CN ;^

• • r : m

rH

Eh in Eh in Eh CN Eh -H Eh CN Eh m Eh Eh Eh "3" Eh

CN CN X >< T)

r" h O

(N CJ Jo +> 2

MH u W • (C \ \ CN HH TS U

o cy> n3 r-j >l C^CN CN a. C (C « \ 4J r- to >

01 ifi ra <JH W --^ K \ c u 0) H

s: U o < o o 0 Eh CO CN -H ^ "I

» fO M U U \ > \ u U U >H o w ."h; ' o •H VO 2 fa

r 5 fit ^-11 1 . > > >

o b o o o

o CN rH -—1

m VO CO o

00 CO m 1 m in in VO

O rH o H CM ! in VO

in in rH "

I

r1 » ! 5 in 1 i 1 1 1 1

i 1 s

3

X

(ii-ii)-4
H W

(tJ U

(J <U O J2O

O o r- O CN in fs CO in 03 VO <T^ rH in rH O VO

•

• • » o e » o • e o^ o 1—

I

r-H H 00 CTl OJ .H O rH o o vo rvi vo vo 00

IT) r—i VO CN r~ (N o fN rH ro rH vo n o ro .H vo vo CM ro tH iH in

rH

Eh E-l fM Eh -H Eh rvj E-t <N Eh f-( Eh iH Eh Eh CO

vo vo vo VO vo vo vo in o o O CTl O O o o o 00 O CO O VO O --D o o O ro o in

LP 1—

(

ro ro in rH ro CN CO in O 00 vo ro ro

in iH r~- ^ ro rH . (N vo ro ro ro

ro vo ro rH H

Eh IT) Eh vo E-i vo E-i in E-f in Eh in Eh in Eh in Eh in Eh IT) Eh "S* o o o o o o (J\ ro CO <T» CT\ '^^ rH o vo o in CO r-" o ^ • « • e

f—( <\1 c> ro o \o ro o ro rH rs in iH 00 in in r-- CN o in

in rH rH OsJ ro r-i LO r-f <H rH rH

rH in ro fH rH in rH

rH

EH n Eh Eh rsj Eh ro Eh ro £-1 Eh Eh Eh ^ Eh '3' Eh 00

rH rH .H iH rH iH rH rH o ro O O in r^ rH C7\ vo

1 ^ r~ C7\ ro LO CO CTl rH O rH

fO o in in CN CN vo vo O rH 1 CN rH CPl CM VO

ro LO CN r~- ro

1 <H <-i -H .H CN r~- CTi

1 in vc

i

rH m

(0 Da

+> o

o u

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rH CQ P s

O O

Eh O

Eh ^ Eh vo Eh vo Eh ^ Eh CO Eh ro Eh ro Eh rvj Eh CN Eh in

4J

US

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CN 4J

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(11-11) -5
O

O

O iHO COO (N o o roO 00

O VD r—1 O

VO 00

m cr^ in o 00 CTi CO 00 rH o^ rH

n o 00 vo 00 in

O VD

O CNn VD

n

O VDO VD <n cn in

rH i-H o CN in rH in CN

O rH r~ CN cn

r-l i-i vr>

m CN o in CN

(0 rO r-( rH C -P •H O

fri Eh

Eh cr\ Eh

O Eh

O Eh

O Eh

O Eh

O EhO Eh rH EhO Eh rH Eh in

in VD VD VD VD VD VD VD VD tn o in o o o r~- Ul (N O CO VD CN o O O o O CN O CO

fM in CO vo 00 CN rH

O r-) •C" 00 in 00 CN VD rH cn CO

CO '3' rH u*) in CN rH CM o m CTi VO CN rH

iH

W rH ro rH rH (N

(DU

•P 0) 0

Eh 4Jo

Eh Eh

m Eh Eh

n Ehn Ehn

_ Eh Eh Eh

d Eh in Eh in

CO o cr» o m

O 'a< inO O-l CN VD o ^ O CVJ o r~ o in o r»

K

in v£) (Tl rH VD in CO VD VD in inn CM o rH rH CO CN

rH rH CNJ VD o in CN CN CN o 00 in rH rH rH ca r~-

H

Pi iH CN o

rH

-P o o u o Eh 3U QQ Eh Eh ^ Eh Eh "S- Eh ^ Eh Eh ph in Eh tn Eh

T Eh iH r-i rH rH rH rH rH rH rH rH

2]

OO

O fOO r-, iH o c^

O rH o in o VO rH rH o iH 00 n in Ln i-^ rH m VD cr> m rH o m (N rH CN

in r~ in in o o o ^ CD 00 r-- rH

to iH <N in CN rH CO VD rH r-- rH

m

u •. m <—1 UJ T «' 1 VD rH ON

EhUi -P S H 0 O

Eh

U <

EhCO

Eh (N Eh Eh

n Eh rn Eh

n Eh ro Eh cn Eh CN Eh cn Eh in Eh VD

<^

m • CO CN o tn 1 o 1 0 c CM 1 M C (1) 1 CU CO o r~ e -

Eh Q) ^ >i CO >i

W -r) •H \ o

»=d

W

U r} (0 -r| -rl tn 4-1 S u • Q) u 4J 1 IM (G 4-) -rl O CN o H r-H -P CO W O -rl -H CO •H Di O \ tn P E b i3 c • H m -H c w c cn x: cn G c H (3 j:: -P O -P -C iH o u x: -H GJ -P 0 (U o

Eh -H -P -H in -rl ^ o tn 0 -u x: cn -H Cn 1 •H -H rH u p e d o r3 U CJi +-> n3 rH C 4-> C -H U -rl r; o C -H U CU S (N •H tn Q > 'a O 1 1 O rH rH C C Oi 4J

l-i 4J rH

C VM

J

O <iH 0 <u \ •rl 0 o 0 >, 0 (^J 0 x: 0 Q -H rH > rH -H

iHH • a

a • t3 • O o (N 4J <c!

U

•H \ Cn CL, tjv A-) • > . \ • (3 -P o > < 0 < > CO O [h > u O 1 0 cri 0 e:; 0 CO 0 a Q E-4 u u u o u u > > > u

ITS

a Of o a

a

a

O

O o o • CN in 1

00 CT> o in VO o rH ro ro m CO z

Eh < VO o CN rn in tn o rH VO W (N CM V£> VD VD VD 'D VO VD

to<

Eh ro vo I 1 m 1 • VD • CO < <N (N CN CN Q i

-r

T -t "N ^ VJLX-XJ.J -O 1(6
i

(0a

1^mHuQO

COu

Eh" mH

Eh<

Eh(0oH

Eh<UHHwQ

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Cm Eh H CO

(0

M o x:

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. FORM HBS-IKA n-7i)

U.S. DEPT. OF COMM. I. PUBLICATION OR REPORT NO. 2. Gov't Atcessioa BIBLIOGRAPHIC DATA mrcttj 77 90c Q,^^-i^r„„„^ SHEET NcbiK /5-Zob bJjpplemen.t«. Recipient's Accession No.

4. TITLE AND SUBTITI^

Structure Analysis and Program Planning Study of the

Amy Nurse Corps (ANC) : Part II - Annexes

5. Publicailoa Date October 1973

f*. Petiotaiing Or^^niaation Code

7. AUTHOR(S)

John W. Rowen, Ralph B. Swisher, Patsy B. Sarnders

S. PecJormine Or(5ani2:ation

9. PERFORMING ORGANIZATION NAME AND ADDRESS

NATIONAL BUREAU OF STANDARDS

DEPARTMENT OF COKLVIERCE WASHINGTON, D.C. 20234

"

iO. Ptojeci:/ Task/ Work Utiit No. 4314487

1 !• C*3nrr£ct/Granc No*

12, Sponsoring Organizarion Name and Address Office of Tns Surgeon General

Department of the Army

Washington, D.C. 20314

i Typ^ of Report &: Period CovercG Final 1/72-10/73

14, Sponsoring Agency Code

15. SUPPLEMENTARY NOTES

16. ABSTRACT (A 200-word or less factual summary of most significant information. If document includes a significant bibliography or literature survey, mention it here.) Part II contains appendices and arjiexes, including detailed documentation and the

data collection instruments, for a study of the U.S. Anny Nurse Corps (ANC) con- ducted by the Technical Analysis Division (TAD) of 'die National Bureau of Standards

(NBS) and sponsored by the Office of The surgeon General (OTSG) . The studv focuses

on nurses' attitudes, working er!\ri.roTiment, ?jid A.NC f'^rc? "Structure . It dccu~c~ts

f.hft FnllrywirifT c1-ii/-l>;- TM<-r%^i.(~-t-c- • A —. i-t > ^ / XT - -- -r ^- ^ uiiv.; xtJX^-C: SL.iU*_'_UlC

under alternative policies. The study ccntaLns analyses of individua! and organizational survey questionnaires distributed to appro:dmately 3500 Army nurses and 70

Axiay hospitals worldwide. The project developed an extensive con^uterized data base

and a quantitati/e description of the operating environment of the hospitals in terms

of staff, worklo.ids, quality of patient care and otlier variables. The attitudinal

analysis focuses on issues associated xvith staying in the ANC and professional interests of Axmy Nurses.

17. KEY WORDS (Alphabetical order, separated by semicolons) Activities; ANC; /uTTiy NuTse Corps ; Axmy hospitals; attitudes; attrition; education; force structure; forecasting; manpower; MEDDAC;

modeling; nursing 5;taff; personnel; quality of care; s imulation: survey; training

18. AVAILABILITY STATEMENT

I I UNLMTED.

-tpFl FOR OFFIQAI. DISTRIEUTION. DO NOT RELEASE

TO NTIS.

19. SECURITY CLASS

(THIS REPORT)

UNCL ASSIFIED

20. SECURITY CLASS

(THIS PAGE)

UNCLASSIFIED

21. NO. OF PAGES

416

22. Price

USCOMM-DC 98244-P7>


€

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