JURVEY OF REGISTERED NURSES EMPLOYED IN PHYSICIANS OFFICES SEPTEMBER 1973 A jy I S ¥ v ye /\ } 3 A n : IN a :) : LI My ul a J | In y ole ” wl" ol In? > HN . "RY a a @ . x a y sy ile “Wl Sf £9 | Aut i 3 : i J i / bt Ii" a N il i li itil il | ww” fin uw 23 ] Mi fm Wi ih Il hi 5.SD. J == E— En S— E— - = Sa =— - n oo = oo . > Ee Ble fell me — Old, JURVEY OF REGISTERED NURSES EMPLOYED IN PHYSICIANS OFFICES SEPTEMBER 1973 HEALTH MANPOWER REFERENCES MARCH 1975 DHEW Publication No. (HRA) 75-50 \ US. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE - Public Health Service ® Health Resources Administration. Bureau of Health Resources Development ® Division of Nursing Bethesda, Maryland 20014 / 60! 2Y 75 DISCRIMINATION PROHIBITED--Title VI of the Civil Rights Act of 1964 states: ''No person in the United States shall, on the ground of race, color, or national origin, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any program or activity receiving Federal financial assistance." There- fore, the nurse manpower data collection program, like every program or activity receiving Federal assistance from the Department of Health, Education, and Welfare, must bz operated in compliance with this law. The data for this study were collected under Public Health Service Contract NIH 71-4061 from the Division of Nursing, Health Resources Administration. Division of Nursing project officers are Evelyn Moses, Statistician, and Dolores LeHoty, Program Analyst, Manpower Analysis and Resources Branch. This analysis of the collected data was prepared by Evelyn Moses. For sale by the Superintendent of Documents, U.S. Government Printing Office Washington, D.C. 20402 - Price $1.70 ii RT 120 09 The importance of ambulatory care in health maintenance and Us41 prevention of illness and as a way of reducing the extensive use of inpatient services has brought into focus the need for intensive 1975 examination of current ambulatory health care settings. These PUBL settings serve a threefold purpose: the prevention of illness, the maintenance of health, and the provision of treatment. Within our current health care delivery structure, most ambulatory care is carried out in the private physician's office. Over 50,000 registered nurses are employed in physicians' offices. They con- stitute a fairly large proportion of the nonphysician personnel in these offices and are viewed as a means toward the expansion of services in ambulatory settings. The Division of Nursing, in its review of this situation, and to assist in determining future roles for nurses, felt it important to compile data on this group of nurses that would provide greater insight into the characteristics of those employed and their present functions. Most studies of these nurses were not of recent origin. The latest ones were confined to selected groups of nurses in physicians’ offices or to specific aspects of the functions per- formed by nurses. None of the studies examined the nurses' reasons for choosing the physician's office as a place of employment, nor did they look at other information about the nurses that would help in drawing conclusions about the availability of nurses to fill expanded roles. The Division, therefore, undertook to support a study of registered nurses in physicians' offices to obtain data on the nurses themselves, the settings in which they work, the activities they perform, and the nurses' opinions about this type of nursing and their future role. This report, prepared by Division of Nursing staff from the data gathered by Chilton Research Services, presents a summary of information on nurses in physicians' offices and their work environ- ment. It will be very useful to all those concerned with the ambulatory care setting as a segment of our health delivery system. — ~~ Sn. csv Jessie M. Scott Assistant Surgeon General Director Division of Nursing iii I * - m= E————— = m= s=== = = = = = se= cn —— = = = = n = = Page POreword vensnvusssnncunssssnminsussnmnvnssssunesnsnonnssnnnwne 111 The Study Plan cisen se tosses ati tsa arb sb sais sb sss ies ssssu sess 1 Summary of Findings Characteristics of the Nurses ....iiieeeeeceeecenssncnseses 4 Employment Conditions of the NUrses ....eeeeeessscossnsssss 11 The Role of the Registered NUrSe ...ieeeeeesssoscccssncaasss 1b Participation in Continuing Education ....cceceeecacccsoees 23 CotiCTUSION sevesnnmvsrnsnsnnssrsssnnsssssrnnsessnnnssesrnney oO Appendix A! Tables sicsssssravsansssnsssssnnnssssnmssnsssnnss 33 Appendix B: Advisory Committees ...ceeesscececsscssscssssoncanas 07 Appendix C: Description of Methodology .cceceeecescesssssnsnnss 71 Appendix D: Physician Response FOrM ..cceecessssssscsssassess 81 Appendix E: Nurse Response FOIrmM ...cceeeececcsscccacssascacas 85 T 07 Usanr Sea =a et oo es I amt mie. == = = = mia-c==h- THE STUDY PLAN As the functions within physicians' offices have become more complex and the demand for services has intensified, there has been an increasing use of a variety of personnel in physicians' offices. Traditionally, a fairly large segment of the registered nurse popula- tion has been employed in physicians' offices. Concerns with the administrative, clerical and technical procedures now carried out in physicians' offices and the establishment of multi-physician offices have led to the employment of other types of personnel as well. At the same time, consideration is being given to making the physician's office a more efficient operation through the utilization of personnel other than the physician to carry out a number of the functions which, by custom, were within the role of the physician. Attention centers on registered nurses and their role in the physician's office as a way of affecting some of the envisioned changes. In the 1971 contractual arrangement with the Chilton Research Services, they were asked to conduct a survey of registered nurses in physicians' offices to secure information on: 1. The characteristics of office nurses in terms of age, marital status, dependents, basic and continuing education, and work experience. 2. The salaries, hours of work, fringe benefits, and other conditions of employment. 3. The activities carried out by office nurses in the course of their work. 4. The conditions which may encourage or inhibit the nurse in changing or expanding the professional nursing role in the office setting. 5. The conditions which may encourage or hinder the nurse in securing additional education or training. During the initial planning phase of the study, an ad hoc committee was set up to advise on its nature. After the inception of the study design, an advisory committee was established to assist with some of the decision-making needed for the refinement of the survey. The members of these committees are listed in Appendix B. Also, Sally Hull Jones, Nurse Researcher on the staff at Harvard Medical School, was retained as a consultant to the Division during the forma- tive phases of the project and assisted with the design of the survey forms. The method of approach decided upon was a mail questionnaire study. One of the considerations in setting up the study was the means through which the nurses could be reached for survey purposes. At the time the study was planned, the latest available compilation of nurses was the 1966 Inventory of Registered Nurses.l It was determined that this Inventory could not be used as a source for sampling. The nurses' addresses included in that study would not be sufficiently current and, more importantly, there was no way to update the Inventory to take account of the current nurse population in physicians' offices. Since both the American Medical Association and the American Osteopathic Association maintained current lists of physicians, it was felt that the best approach would be to contact the physicians themselves to obtain the names of the nurses who would receive the survey questionnaire. Accordingly, a two-stage study was planned. The first stage would involve a sample of physicians from whom the names of registered nurses in their employ would be solicited, and the second stage would be a mailing of a questionnaire to a sample of the nurses whose names were provided by the physician. In order to test the methodology determined for the study and to refine the sampling approach, Chilton Research Services conducted a pilot study first. The pilot study, carried out in the fall of 1971, was a miniature of the full-scale study. A mailing of 1,500 physician survey forms was made, and from the responses to that form, a sample of 370 registered nurses was selected to receive the nurse questionnaire forms. Following the receipt of the results of the pilot study, modifications were made in the sampling procedure and the survey forms, and the full-scale study was planned. The full-scale study was conducted by Chilton Research Services in 1973. Physician survey forms were mailed in April 1973 and the data from the nurses was solicited in September 1973. A description of the methodology used in conducting this study is included in Appendix C. A total of 10,120 physicians were sent the physician survey forms. The sample was selected from Fisher-Stevens lists with the physicians stratified according to specialty areas. Usable returns were received from 6,681 physicians. About 1,300 of these were in group practice situations (at least three physicians in office). Because of some doubt as to how these group practice physicians responded to the form, a random sample of 157 of these physicians was selected for telephone call-back to refine the data. 1 Marshall and Moses, RN's 1966, American Nurses' Association, 1969. As indicated, the original sampling design called for the nurses in the survey to be selected on a sampling basis from all those whose names were supplied by physicians. The number of registered nurses’ names furnished in the various physician strata, however, was less than anticipated. Therefore, all the nurses whose names were given by physicians in solo and two-man practices were included in the survey. In addition, all the nurses whose names were furnished by the group practice physicians in the sub-sample were also included in the survey. The nurse sample included 1,856 nurses. Usable completed responses were received from 1,011 nurses. Since there were dispro- portionate sampling and returns from the various medical specialties and office practice settings, weighting procedures were developed for the processing of the data. Therefore, the information on the full- scale nurse study included in this report is based on the responses from the 1,011 nurses after the individual weights were assigned to each of the questionnaires received from the respondents. CHARACTERISTICS OF THE NURSES Practically all the registered nurses employed in physicians’ offices were female and almost all were white. The estimated percent of those who were "other than white' was 1.3. About four out of five were estimated to be "currently married," and almost half were under the age of 40. Almost two-thirds of them had children living at home. About a third of those with children at home had children who were 6 years old or younger. Some differences were noted when the full-time and part-time nurses were looked at separately. For purposes of this survey, the nurses were classified as full time or part time in terms of the number of hours usually worked during the week. Those nurses who worked less than 30 hours a week, but were ''regular" employees, were considered part time. Those who were temporarily in the office on a relief basis were excluded from the survey. Also, about 5 percent of the nurses were wives or mothers of the physician with whom they worked. Since the design of the study excluded these persons from the summary data on employment conditions, the hours in their workweek were not recorded and they were classified as full time. About 30 percent of the respondents were classified as '"part time." After the weights were applied to the responses, it was estimated that 27 percent of the nurses were part time. A much higher proportion of the part-timers than the full-time nurses were 'currently married," 92.7 percent in contrast to 77.5 percent. The part-time nurses were also more likely to have children at home. About 80 percent of all the part-time nurses had children while 56.5 percent of all the full- time nurses had children. Part-time nurses were more likely to have children in the younger age brackets than full-time nurses. About 47 percent of the part-time nurses with children had children 6 years or younger, while 26 percent of the full-time nurses had children of those ages. The average number of children living at home that full- time nurses had was 2.1. The part-timers averaged 2.3. Some comparisons were made with the data derived on office nurses in this survey to the information included on office nurses in the 1972 Inventory of Registered Nurses. The Inventory did not obtain data on the number of children, but it did include information on age, marital status, and whether or not the nurse was part time. The Inventory estimated that there were 54,361 registered nurses employed lRoth and Walden, The Nation's Nurses, 1972 Inventory of Registered Nurses, American Nurses' Association, 1974. / in physicians' or dentists' offices. The number of nurses estimated as being employed in physicians' offices within the scope of this study was 55,617. Unpublished data from the Inventory showed that 37 percent of the nurses who reported themselves as employed in physicians' or dentists' offices in the Inventory indicated that they were part time. As stated previously, it was estimated that 27 percent of the nurses within the scope of this study were part time. A large portion of this difference is probably accounted for by the differences in classification procedures between the two studies. The Inventory has a self-enumeration procedure. The nurses classify themselves according to field of nursing in which they work and whether or not they are full time or part time. Nurses could have classified themselves part time in the Inventory if they worked less than full-time number of hours a week and/or less than a full work year. In addition, nurses who work in physicians' offices on a temporary relief basis could have classified themselves as part- time office nurses. As stated earlier, these nurses were excluded from this study. There appeared to be a similar distribution of the nurses in the two studies in relation to marital status. The age distribution differed somewhat in that the nurses in this study tended to be younger. In terms of the basic nursing education the nurses brought to their positions, 88 percent covered by this study were estimated to have originally graduated from diploma programs, 7 percent from associate degree programs, and 5 percent from baccalaureate programs. Most received their nursing education in United States schools, only 1.7 percent had graduated from foreign nursing schools. Since some of the nurses had additional education to that which they received in basic nursing programs, the distribution of the nurses according to the highest degree held was as follows: Diploma 86.5 percent Associate Degree 7.1 percent Baccalaureate? 5.9 percent Master's? .2 percent The Inventory also demonstrated that diploma graduates constitute a large group among office nurses,with about 84 percent of the Inventory office nurse respondents reporting their highest degree as a diploma. 27ncludes both those with or without nursing majors. The office nurses tended to have prior experience in nonoffice nursing positions. Only 5 percent had not worked in any other type of nursing and 10 percent had worked only 1 year or less in other types of nursing. About half had at least 6 years experience in nursing positions other than office nursing. About half had been in their current positions as office nurses for at least 5 years. Nine percent held these positions for less than 1 year while 15 percent had been there at least 15 years. A large proportion of the nurses came to their current position from other fields of nursing. For the most part, they came from hospital nursing. More than half (59 percent) were employed in hospitals immediately prior to their accepting their current position as office nurses. Twelve percent had been employed in other physician's offices prior to their current position. About 12 percent of the nurses were inactive before being employed in their current position as an office nurse. The part-time nurses were more likely to come from the inactive pool. Seventeen percent of the part-time nurses were inactive prior to taking their current positions, while fewer than 11 percent of the full-time nurses were inactive. For .fewer than 2 percent of the nurses, their current positions were the first job held in nursing. Nurses were most apt to find out about their office nursing positions through personal contact. About 29 percent had first learned of their positions through working in a hospital with which the physician was affiliated and about 30 percent through recommen- dations by friends who were patients, another physician, or some other persons. Social or family relationships or the physician treating a member of the nurse's family were the sources of information on the position for about 17 percent of the nurses. Only 11 percent first learned of their positions through newspaper advertisements or employment agencies. Convenience of working hours and location were reasons most often given for accepting the office nurse position. Seventy-eight percent were attracted by the working hours and 42 percent by the location. Eighty-three percent of all those with children at home were attracted by the convenience of the working hours. Ninety percent of the part-time nurses with children at home found this an important reason for accepting the position. The convenience of the location was also somewhat more often given as a reason by all those with children at home when their responses were compared with all the nurses. This was particularly noticeable among the part-timers with children. Desire to work with the particular physician(s), interest in the physician's specialty, and preference for working with patients in an office setting were each cited by about a third of the nurses. Attraction to salaries and benefits was a reason for accepting the position for about one-fourth of the nurses. An estimated 32 percent of the nurses covered by this study were employed in offices located in the North Central part of the country, and 25 percent were in offices in the Western area. The South had 22 percent of the nurses and the Northeast, 21 percent. The Inventory data on office nurses showed 30 percent in the North Central area and 23 percent in the West. The South had another 23 percent and the Northeast, 24 percent. Of interest in connection with the geographic distribution of nurses employed in physician's offices is the comparison tc all employed nurses and to non-Federal office-based physicians. The following presents these data in broad summary fashion: Comparison of the distribution of registered nurses and physicians within geographic areas of the country Percent Percent of of all non-Federal Percent of Percent of employed physicians Geographic nurses in office nurses nurses in in office- area this study in Inventoryl Inventoryl based practice? Northeast 21 24 32 27 North Central 32 30 28 24 South 22 23 24 27 West 25 23 17 22 lroth and Walden, The Nation's Nurses, 1972 Inventory of Registered Nurses, American Nurses' Association, 1974. Zpoback, Distribution of Physicians in the United States, 1972. Volume I, Center for Health Services Research and Development, American Medical Association, 1973. It was estimated that half the registered nurses in physicians’ offices were employed by physicians who were in solo practice. Sixteen percent were employed in two-physician practice situations and 34 percent in offices where at least three physicians practiced. In terms of the latter group, it was estimated that about 41 percent of those nurses were in fairly large group practice situations (at least 15 physicians in those particular offices). The Northeastern area of the country tended to have the highest proportion of nurses in solo practice offices and the West, the lowest. The following shows the geographic distribution of nurses according to the type of practice: Distribution of registered nurses in physicians’ offices, by geographic area and type of practice Group practice Percent of nurses Percent of in offices Percent nurses in Percent of with at Geographic of all solo practice nurses in two least three area nurses offices physician offices physicians Northeast 21 30 27 5 North Central 32 29 30 36 South 22 26 24 14 West 25 14 19 45 Most solo practice offices in which the registered nurses were employed had relatively few employees. Seventy-one percent of these nurses worked in offices with fewer than five employees. About 14 percent were the only employee in the office. Offices with more than one physician tended to have a greater number of employees. Sixty-two percent of the nurses in these types of offices worked in situations where there were at least 10 employees. In large group practice situations, practically all the nurses worked in situations where there were at least 10 employees. The questionnaires sent to the physicians contained an area for the physicians to indicate the size and composition of their office staff. Based on the estimates made as a result of that survey and the estimate of the number of registered nurses in physicians’ offices from this survey, about 14 percent of the nonphysician personnel in physicians' offices were registered nurses. About 50 percent were secretarial or fiscal personnel. From the survey of the nurses, it was estimated that the largest single proportion of the nurses were working for physicians in family practice. A much smaller proportion, 4 percent, were working for osteopathic physicians. The distribution of the nurses according to the type of specialty of the physician by whom they are employed and the type of office situation is shown on the following table: Distribution of registered nurses in physiciams' offices by medical specialty of physician and type of practice Group practice Percent of nurses Percent of Percent of in offices Percent nurses in nurses in with at Medical of all solo practice offices with least three specialty nurses offices two physicians ' physicians Osteopath 4 5 4 2 Family practice 27 37 21 14 Medical specialty 20 25 20 12 Surgical specialty 15 14 14 17 Obstetrics/ gynecology 13 10 16 16 Pediatrics 11 8 11 15 Multi- specialty 11 2 15 24 About 11 percent of the registered nurses were supervisors of other registered nurses in the offices where they worked. Forty-six percent were the only registered nurse in the physicians’ offices. 11 EMPLOYMENT CONDITIONS OF THE NURSES The area of salaries, hours, and fringe benefits for nurses employed in physicians' offices is one for which little current data are available. Most of the establishments in which these nurses work are relatively small in size; about two-thirds of the nurses were estimated to be employed in situations where there were fewer than 10 employees. Furthermore, as indicated previously, there are no available lists of physicians' offices which employ staff, nor of nurses from which such data can be collected. Therefore, the questionnaire for the nurses contained a series of questions on their salaries, hours of work, and the fringe bemefits which they received in their office nursing positions. The fact that the settings in which the nurses work are relatively small may in a large part account for the general lack of formalized employment practices. This is indicated by only 5 percent of the nurses being covered by formal salary plans, that is, an established starting salary, and maximum salary with a plan of progression from minimum to maximum salary. Even in the somewhat larger settings, a relatively small proportion of the nurses were covered by formal salary structures. In line with this, responses to the question of how salary increases are arranged showed that for a large portion of the nurses they were not on a regularly scheduled basis. Information on the salaries they are currently earning and the basis for calculating these salaries was sought from the nurses. About 34 percent of the nurses were paid on an hourly rate basis and 35 percent on a monthly basis. For about 15 percent of the nurses, salaries were calculated on a weekly basis. Differences in the method of calculation were noted when consideration was given to whether the nurse worked full time or part time. Forty-three percent of the full-time nurses had their salaries calculated on a monthly basis, 17 percent on a weekly basis, and 25 percent on an hourly basis. For part-time nurses, 59 percent were paid en an hourly basis, 13 percent on a monthly basis, and 9 percent on a weekly basis. In order to summarize the data on current earnings, the earning of full-time nurses were converted to annual salaries and those of part-time nurses to hourly rates. It was estimated that the average annual salary of full-time nurses employed in physicians' offices within the scope of the study was $7,734. Since 11 percent of the nurses were supervisors of other registered nurses, the 'nonsupervisory' nurse salaries were looked at separately, as well. It was estimated that the average salary of nonsupervisory nurses was $7,672. The highest average salary was found in the western part of the country and the lowest in the South. The salaries were also looked at in terms of the length of time the nurse had been in that position. The variations in salary according to 12 length of time in the position were not marked. A slightly larger proportion of the nurses with lengths of employment of at least 5 years reported salaries in lower ranges than those with fewer years of employment. However, salary information was not available or annual salaries could not be computed for a larger proportion of those with longer years of employment than for those with fewer years of employment. The average hourly earnings of the part-time nurses was $4.21. As was the case with the full-time nurses, the highest average earnings was found in the West and the lowest in the South. In terms of the length of time they were in their position, the tendency toward more of the longer term nurses to be in the lower salary ranges was more pronounced for the part-time nurses than the full-time nurses. One should note, however, that the hourly earnings could not be determined or the salary was not reported for a substantial proportion of the part-time nurses. Almost 63 percent of the nurses received bonuses in addition to their regular salary. The proportion of full-time nurses and that of part-time nurses who received bonuses was about the same. Nine out of 10 of those receiving bonuses were given one every year. The amount of bonus received was not asked in this survey. Fifty-four percent of the full-time nurses usually worked fewer than 40 hours a week, exclusive of meal time. About 37 percent worked between 30 and 35 hours a week. Twenty-eight percent worked 40 hours a week and 16 percent over 40 hours a week. Fifty-five percent of the part-time nurses usually worked between 20 and 29 hours a week. The median workweek for part-time nurses was 21. About 17 percent of the full-time nurses and 21 percent of the part-time nurses did not work overtime. Among those who did, the majority received some type of compensation for overtime work. Among the part-time nurses, 83 percent of those receiving overtime compensation were given straight-time pay and 10 percent received time-and one-half pay. For full-time nurses, 28 percent of those receiving compensation for overtime were given compensatory time off, 36 percent were given straight-time pay and 29 percent time-and one-half pay. The provision of time-and one-half pay for overtime was more frequently found for nurses employed in group practice situations. Most of the nurses did not have any split shifts in their work- week. Only 9 percent of the full-time nurses and about 11 percent of the part-time nurses had split shifts during their workweek. Weekend work was part of the working arrangements for about 37 percent of the nurses. Although the proportion of full-timers and part-timers involved in weekend work were substantially about the same, a different picture emerges when the size of the office staff is taken into account. Larger proportions of the full-time nurses working in the smaller size 13 offices were involved in weekend work than the part-time nurses in these offices. On the other hand, in offices with 10 or more employees, 42 percent of the part-time nurses as contrasted to 28 percent of the full-time nurses worked on weekends. For the most part, the weekend work was Saturday rather than Sunday work. Practically all the full-time nurses received paid vacations during the year. About 22 percent of the part-time nurses did not receive any paid vacations. The majority of those receiving paid vacations among both the full-and part-time nurses were given 2 weeks. However, some differences were seen when the length of time the nurse had been in the position was considered. Much larger proportions of those with at least 5 years of employment in their positions received 3 or 4 weeks of vacation than those with fewer than 5 years in their positions. Among the part-time nurses, those with longer years of employment were also more likely to receive some paid vacation than those with less years of employment. Almost half the part-time nurses (46 percent) did not receive any paid sick leave. Only 8 percent of the full-time nurses did not receive paid sick leave. The amount of paid sick leave received was subject to individual arrangements with the employer for about 43 percent of the full-time nurses and 30 percent of the part-time nurses. Where a specified number of days per year of paid sick leave was provided to full-time nurses, 65 percent received at least 10 days. Twenty percent were given 12 days per year and 27 percent more than 12 days. Another area of leave which was examined in the study was the provision of time off for attendance at professional or inservice education meetings. A little over a third of the full-time nurses and about one-quarter of the part-time nurses received time off for such meetings with pay. A fairly substantial proportion of the nurses, 39 percent of the full-time ones and almost half the part- time nurses, did not know whether there was any such provision available to them. Holiday leave time was also reviewed. The question asked about the paid holidays received in 1972, since it was assumed that most of these nurses would not be working under structured employment policies arrangements which would have a fixed holiday schedule. About 31 percent of the respondents to the survey did not answer the question or indicated they were in their jobs for only part of 1972 or were not employed until 1973. From the respondents who provided data on this area, it was estimated that 63 percent of the full-time nurses received five or six paid holidays during 1972. For part-time nurses, it was estimated that 40 percent received no paid holidays in 1972 and, for those who did, the provision was most frequently 5 or 6 days. 14 About 45 percent of the full-time nurses were covered by retire- ment or pension plans (other than Social Security) for which their employers paid part or all the premiums, and 36 percent were covered by such hospitalization and/or medical/surgical insurance. The third most frequent insurance plan identified by the nurses from a list of five types of possible coverages provided to them was life insurance. About 26 percent of the full-time nurses were covered by life insurance plans for which their employers paid part or all the premiums. Such plans as hospitalization and/or medical/surgical insurance, life insurance, and profit sharing were less frequently available in solo practice situations than in group practice situations. About 24 percent of the full-time nurses did not have available to them any insurance or retirement plans for which the employer covered part or all the premiums. Part-time nurses were less likely to be covered by insurance or retirement plans than full-time nurses. Almost half, 47 percent, were not covered by any plans. 15 THE ROLE OF THE REGISTERED NURSE In order to obtain an idea of what registered nurses do in physicians' offices, a listing of 36 activities was provided to the nurse who was asked to indicate who regularly performed the activity-- a registered nurse (the respondent and/or another), a physician, and/or staff other than the physician or the registered nurse. The activities, of course, were not inclusive but the listing was designed to get at the range of activities performed. The list as it was provided to the nurse was randomized in that it was not ordered according to type of activity nor to judged level of competency needed, and decisions as to placement position on the list were made from a table of random numbers after first listing alphabetically. For presentation in this report, these activities are classified under two major headings, direct patient care activities and adminis- trative and clerical activities. The patient care area is further subdivided into three categories--general functions, specific tasks, and teaching functions. The following table provides a listing of the activities falling within each of the groups, and the percent of registered nurses regularly performing each activity, if they were activities which were performed in the physician's office in which the nurse was employed. This table indicates what a registered nurse is apt to do in a physician's office if the activity is performed there. Since the study encompassed a diverse set of office structures and diverse physician specialties, a number of the activities, particularly those in the "specific task" area and a few in the "teaching' area were peculiar to certain office structures or physician specialties. Therefore, while the percent of nurses indicated as performing them here might be relatively substantial, the actual percentage of nurses performing these activities, when the broad spectrum of employment situations is taken into account, would be considerably lower. One example of such an activity is '"taking-X-rays.'" About half of the registered nurses were employed in offices where X-rays were not taken. Thus, only 15 percent of the nurses covered by the scope of the study were involved in taking X-rays. Another example is the teaching of family planning. Forty percent of the nurses were in offices where this activity did not take place. Consequently when all nurses are considered, 21 percent carried out this activity. The extent of the activities included in the list which can be generalized to all types of offices in which nurses are employed and those which are selective in nature can be seen in tables 28 and 31 in Appendix A. Most of the data on activities presented in this report deal with the percentage of all nurses covered by the scope of the study performing the activity, regardless of whether the activity is actually performed by anyone in the office. 16 Percent of registered nurses regularly performing selected activities in a physician's office Percent of RN's regularly Activity ” performing} PATIENT CARE FUNCTIONS General Assist physician during patient examination ...ieiiiiiiiiiiiiititittsonssasesaasess 91.7 Prepare for and/or administer first aid ® 8 90 0.0 0 000 000000000000 ® 0 6 0 00 0 00 00000000 90.1 Make decisions independently regarding handling of patients' telephone calls .....c.ee... 79.4 Make suggestion to physician re: patient Need .iievsrvssnmrsvrrumunensnnminssssmnonnonwmnve LoD Coordinate patient treatment plan with Other agenclesS ..vevssssssesssssrsssanmssrnsnseves IB.4 Take patients medical hiStOory ..eeeeeececcessscceees 49.9 Make well/sick patient assesSSmeNt ....eeeeeceseseses 42.6 Perform some or all portions of well/gick patient examinations ....eeeeeeseeseeses 35.3 Evaluate family health .....ieevevseececcesssacceees 16.8 Specific Tasks Take temperature/blood Pressure .....eeecesesesceses 94.8 Administer immunization and parenteral drugs ...ciesescncns EE pp 92.3 Change dressings ...eeveeeesscccessssncasssncccnseeees 85.4 Test vision .tiiieeeeerereeneesssssssssssssessennncee 75.6 Perform urinalysis, hemoglobin or heMOCEIL suvevesvusnssasanvninnsnmussosnnvnnvneswnes 00.0 Remove SULUTES .isncessnnssinsssnsnesnvnssrnnsanvsnnvs 33.1 Test hearing ...eeeeeesccssecs Esser EEEN enna ens 88:2 Remove earwax seceeecons BRAT haa Ad ewes ceseesess 40.4 Take X~T8YS «ceveecescecansss ERNE 30.1 Check fetal heart Dat ssvnivussasweussvnsvesvnnnsne 29.0 Apply cast applications ...eeeesecccsscecccssssncnns 15.9 Do tonometry testing ...... Cute s EST Ye. .. 13.7 Take vaginal smears Gineluding Pap) EERE ERE NE 11.2 Ipercent of registered nurses if activity was performed in office where the nurse was employed. Percent of registered nurses regularly performing selected activities in a physician's office--continued Percent of RN's yesgularly Activity performing Teaching Instruct patients re: preparation for tests/examinationS...eeeeesscesccsesesssscsssssss 90.1 Teach patients how to care for themselves ........ 77.8 Teach patients diet and/or normal nutrition ...... 62.0 Counsel and instruct patient in management of a defined illneSS .eveeeeessoncsasanonesssnneaess 53.8 Instruct and assist patients in exercise program.. 45.0 Teach patients family planning ....ceeeeeeeeeeeess 35.0 ADMINISTRATIVE AND CLERICAL FUNCTIONS Maintain medical supplies and equipment ..... cuven S74 Maintain office supplies and equipment ........... 81.3 Maintain patient record files ..evesvrcvissnsnveee 62.3 Arrange appointments ....eeeessceccccessseseeceess 59.3 Arrange patient appointments in community health facilities or out of community .......... 59.3 Explain doctor's fees to patients ......eeeeeeee.. 49.8 Complete insurance fOTrmMS ccieeevvrevessnnvsnenesas 30.3 Send out patient BILLS sever svvsssvirnsennnsnnine 24.7 18 Another way to look at the activities on the list would be to determine which of the three categories -- a registered nurse, physician, or staff other than the registered nurse or physician -- is most likely to perform the specific activity. Although this was a study of registered nurses rather than one of the offices in which they are employed, some clues can be obtained from the responses the nurses made on who regularly performs the activity. There were 13 activities on the list which appeared most likely to be regularly performed by the physician as evidenced by a higher proportion of nurses assigning the activity to the physician than to the registered nurse or other staff. As the following table shows, there were a number of overlapping activities between the physician and the registered nurse. For only one of the activities on this list, applying cast applications, did the proportion of the nurses identify- ing "other staff" as regularly performing come close to the proportion of nurses identifying registered nurses as regularly performing. The remaining activities on this list seemed least likely to be performed by staff other than the registered nurse or physician. Activities most likely to be performed by the physician 19 Percent RN's identifying activity as regularly Percent RN's performed by regularly Activity physician performing Make well/sick patient assessment ...... 100.0 42.6 Perform some or all portions of well/sick patient examination........ 100.0 35.3 Take vaginal smears (including Pap) .... 94.2 11.2 Counsel and instruct patients in management of defined illness..... ww 84.4 53.8 Evaluate family health .......ccc00e.e 80.5 16.8 Apply cast applicationS .eeeeeececescces 80.4 15.9 Check fetal heart beat .cccecececesvenes 79.9 29.0 Remove SUtUTeS .iieeeeenersoonsscscannns 79.9 53.1 Take patient's medical history.......... 71.0 49.9 Teach patients family planning ......... 69.7 35.0 Remove earwaX (..ueeeeeesocssssssnsnnnns 69.0 40.4 Do tonometry LeSting .iccovensvoesnnnve 63.4 13.7 Instruct and assist patient in eXercisSe program ..eeeeeeesessesscssnse 58.1 45.0 Ipercent of registered nurses if activity was performed in office where the nurse was employed. There were another 13 activities which were most likely to be performed by the registered nurse. 20 Activities most likely to be performed by a registered nurse Percent RN's Percent RN's identifying identifying activity as activity as Percent RN's regularly regularly regularly performed by performed by Activity performing: physician! "other staff" Take temperature/blood PrESBULE yawns viswss runs 94.8 33.9 18.8 Administer immunizations and parenteral drugs.... 92.3 29.4 11.4 Instruct patients re: preparation for tests/ examinationS....eeeeeees 90.1 32.7 29.9 Prepare for and/or adminis- ter first aid sveswvasus 90.1 48.8 12.4 Maintain medical supplies and equipment.ceecececess 87.4 7.4 24.6 Change dressings ......... 85.4 51.9 13.1 Maintain office supplies and equipment....eeeeoes 81.3 4.6 44,2 Teach patients how to care for themselves .... 77.8 63.4 11,9 Test vision eeeeveeseesens 75.6 25.3 22.3 Perform urinalysis, hemo- globin, or hemocrit..... 60.0 15.6 43,2 Arrange patient appoint- ments in community health facilities or out of COMMUNIEY Wer evoooonnses 59.3 33.5 45.0 Coordinate patient treat- ment plan with other B2ENCLIES wunuumnvrsansnns 58.4 5C.2 24.5 Test hearing ...veeeeeeeeees 48.2 38.8 24.5 lpercent of registered nurses if activity was performed in office where nurse was employed. 21 Here it can be seen that the person in the physician's office who would be "next in line" to the registered nurse could be those staff other than the physician or nurse. The categories of activities in which this is most likely to bccur are those of an administrative or clerical nature or laboratory types of work. Of course, this would be expected since a large proportion of the "other" personnel in physicians' offices were clerical or fiscal personnel, or to a lesser extent, technicians. In those instances in which the only type of staff in the physicians' offices was registered nurses (11 percent of the registered nurses were employed in such situations), the registered nurses were more likely to be involved in activities in the administra- tive and clerical area. When the type of office setting in which the nurse was employed is taken into account, those in group practice situations with three or more physicians in the office were the least likely to be involved in the administrative and clerical operations and the laboratory procedures. This, of course, would be in line with the fact that these offices would tend to employ more and varied types of personnel, The specialty of the physician by whom the registered nurse was employed would be expected to have an effect on the nurse's activities. As indicated previously, a number of the listed activities. were those which would be more likely carried out in some types of offices than others. This fact is reflected in the observed data for the patient care activities on the list. Thus, for example, a majority of the registered nurses employed in offices where the physician specialty was obstetrics/gynecology regularly performed the checking of fetal heart beats. For all nurses covered by the scope of the study, the activity of checking fetal heart beats was a regular part of the functions of only 15 percent. However, there is a possibility that nurses may more likely perform this activity in an obstetrical/ gynecological specialty office than in other types of offices where the activity is carried out, since only 29 percent of all the nurses in offices where the activity was performed regularly carried it out. Part-time nurses tended to be less involved in carrying out clerical and administrative activities. For example, in solo practice offices, about 48 percent of the full-time nurses were involved with sending out patient bills, while only 19 percent of the part-time nurses in such offices carried out this activity. The completion of insurance forms was regularly performed by 53 percent of the full-time nurses in solo practice situations and 25 percent of the part-time nurses in such offices. The nurses who had a baccalaureate or master's degree (very few had master's degrees) were much more likely to indicate that they regularly performed such activities as "coordinating patient treatment 22 plans with other agencies," "making decisions independently on tele- phone calls," and "taking patient's medical history" than those who were associate degree or diploma graduates. In addition to the listed activities, several other aspects of the nurse's possible role in a physician's office were included on the questionnaire. Most of the nurses (91 percent) indicated that patients telephoned to speak specifically to them, and that this was done on a frequent basis. Most of them (84 percent) also responded affirmatively to the question on whether there were visits by patients to the office to see the nurse only. The majority of those nurses who had patients coming to see them indicated this happened regularly, while 39 percent stated this occurred occasionally. Two reasons for nurse-patient visits were included on the questionnaire--to receive injections and to receive treatments. Ninety-one percent of those with nurse-patient visits reported these were for receiving injections and 60 percent that they were for receiving treatments. In addition to those stated responses, about 7 percent of the nurses were estimated to have patients visiting them for counseling. The areas covered above all related to "in-office" type of work. The nurses were asked also about certain "out-of-office" patient care activities. Thirty-seven percent of the nurses were involved in some type of "out-of-office'" patient care activities. As would be expected, the part-time nurses were less likely to have '"out-of-office" activities than the full-time ones. The most frequent '"out-of-office'" activity was that of receiving patient telephone calls at home. However, for nurses working in surgical specialty offices, the most frequent activities were scrubbing for the physician in the hospital and/or visiting patients in the hospital. These nurses were also most likely to have "out-of-office" activities. About 31 percent of those with "out-of-office" activities (11 percent of all the nurses) visited patients in their homes. In response to a question on whether there were functions related to patient care which they feel they could carry out but which were not now considered part of their duties, about 34 percent of the nurses felt there were such functions. A diverse list of functions were provided by the nurses, but they tended to be those items included on the list of 36 specified activities. Prominent among those mentioned were suturing, Pap tests, taking histories, patient health education, and physical examinations. A companion question asked the nurses whether there were functions they were now performing which they felt others could do if it were possible to have additional staff in the office. About 40 percent answered this question in the affirmative. The functions they felt others could do were mainly those which were clerical in nature such as filing, billing, bookkeeping, and maintaining supplies. The foregoing material basically provides descriptive information on what the role of the registered nurse may now be in a physician's office setting. Another aspect would be what the nurses see their role as possibly including. They were asked whether they generally favored 23 or opposed the expansion of their role to include more patient care activities previously done by the physician. Two-thirds favored expansion and only 5 percent were opposed. Sixteen percent felt there was no current need for expansion and 10 percent had no opinion on the subject. Those with baccalaureate degrees were most likely to be in favor of expansion with about 91 percent providing this response. While there was little difference between the proportion of associate degree and diploma graduates who indicated they were in favor (68 and 65 percent, respectively), 18 percent of the diploma graduates felt there was no need for such expansion and 22 percent of the associate degree graduates indicated they had no opinion on the subject. In response to a check list of conditions which would encourage expansion of the nurse's role, the majority of all the nurses felt that additional education and training was needed. When this response was looked at in terms of the nurse's educational background, about three-quarters of the associate degree and baccalaureate graduates felt additional education was needed, but only 49 percent of the diploma graduates felt this way. The diploma graduates were most likely to respond that expansion was not indicated for their present position. This seems consistent with the response to the previous question. Baccalaureate graduates were least likely to respond that the physician's permission would be needed as a condition for expansion of their role. Legal protection for the nurse was high on the list, with almost half of the nurses in each of the three educational cate- gories checking it as a condition for expansion. 2 rcludes small proportion of nurses with master's degrees. 25 PARTICIPATION IN CONTINUING EDUCATION The need for continuing education for registered nurses to maintain and update their knowledge and skills in health care has long been recognized. This area has taken on increasing importance in recent times with the growing general concern for continuing education of all health workers. Since office nurses work in small settings, in terms of the numbers of workers in the setting, and often are the only registered nurse on the staff, their opportunities to fill their needs for continuing education may be limited. This study sought some basic information on whether or not the nurses had participated in continuing education experiences, and if they had, the type, and what they felt would encourage them to participate. About 40 percent of the nurses had participated in some type(s) of continuing education experience regarding nursing or a related health field while they had been employed in a physician's office. About 4 percent of those who had particpated had not done so within the 5-year period preceding the study. The participation rates for the full- and part-time nurses were substantially the same. Married nurses tended to be less likely to have participated in continuing education while they had been office nurses than those who were never married or who were widowed, divorced, or separated. About half of those whose highest degree was an associate degree as compared to about 40 percent of those with diploma and 42 percent of those with baccalaureate degrees had had continuing education experiences. Nurses in group practice situations where there were at least three physicians in the office tended to be more likely to participate than those in solo practice or two-physician offices. Of interest in relation to whether or not the nurses had partici- pated in continuing education was the nurse's reaction to the question on the expansion of the nurse's role to encompass more patient care activities previously done by the physician. Almost half the nurses who were in favor of such expansion had had continuing education experiences as compared to about one-quarter of the nurses with other responses to the question. The nurses were supplied with a list of various types of continuing education programs they might have attended and were asked to check those in which they did participate within the 5-year period preceding their responding to this questionnaire. The items on the list which were most frequently indicated were workshops; nursing or health meetings, conferences, conventions, and inservice education seminars/lectures. In each case, it was estimated that about half the nurses who had participated in continuing education programs while they were office nurses had attended programs of those types. 26 About a third had participated in physicians' rounds or lectures. Seventeen percent had been involved in "specialty preparation" programs. However, a review of the responses to this question revealed very few of those indicating they had attended specialty preparation programs were referring to such programs as 'practitioner courses. Most of the specific types of programs mentioned in connection with this response were courses in particular techniques or disease entities. In addition to actual attendance at programs, infcrmation on techniques and current thinking in the health field may be obtained from the reading of magazines or journals in the field. These could also be sources of information on continuing education programs. The nurses were asked about those they usually read. They were provided with a checklist of five and were asked to indicate others. Among the journals listed, 37 percent of the nurses usually read the American Journal of Nursing and 38 percent, RN Magazine. Twenty-five percent usually read the Journal of the American Medical Association and about 29 percent, Medical Economics. About 16 percent of the nurses did not read professional journals of any type on any regular basis. Nursing or other organizations pertaining to nursing or to their particular interests may also be a source of information on continuing education programs and may conduct such programs. To ascertain the access the nurses may have to such sources, they were asked to indicate the organizations to which they belong. Two organizations were specified on the check list, the American Nurses' Association and the National League for Nursing, and they were asked to specify others. About 18 percent belonged to the American Nurses' Association and a little less than 1 percent to the National League for Nursing. About 6 percent belonged to their alumni associations. The question on what would encourage the nurses to further participate in continuing education contained a check list of six items and an area for them to specify other conditions. Relatively few responded with conditions other than those on the list. The condition which was most frequently identified was the establishment of conveniently located, appropriate educational programs. However, differences were noted as to whether the nurses were full time or part time and whether they had participated in continuing education while they were office nurses. Almost 74 percent of the nurses who had participated in continuing education programs felt the establish- ment of ccnveniently located programs was important as contrasted to 53 percent of those who had not participated. '"Tuition-free courses was a condition of encouragement for part-time nurses more frequently than for full-time nurses. ''Child care facilities" had more importance for part-time nurses than full-time nurses. In terms of whether or not part-time nurses had participated in continuing education, 26 percent 27 of the part-timers who had not participated felt a condition of encouragement toward participation would be ''child care facilities." About 9 percent of all the nurses gave importance to this area. As would be expected, nonparticipants were more likely to feel that there was no need for continuing education than participants (18 percent as contrasted to 4 percent). CONCLUSION The study provided a basic overview of registered nurses employed in physicians' offices. It showed their personal characteristics and educational background, the types of settings in which they work, the employment practices in their work settings, and some descriptive data on their functional role. It also provided some insight into what registered nurses employed in these settings think about this employ- ment situation. Registered nurses in physicians' offices, in a large part, were married and have children at home. They were predominately diploma graduates. They were most likely to be attracted to their positions by the convenience of the working hours. Higher concentrations of registered nurses in physicians' offices were found in the western area of the country than were found among all employed nurses or physicians in office-based practices. Over a third of the registered nurses in physicians' offices were employed in group practice settings where at least three physicians were practicing together. In the western area of the country, about 45 percent of the office nurses located there were employed in such group practice settings. As anticipated, most office nurses, almost three-quarters, work in settings where there are relatively few employees, that is, fewer than five employees. About 14 percent were the only employee in the office and 46 percent of all the nurses were the only registered nurse in the office. About 27 percent of all the nurses were regularly employed, part-time employees. As a total group, they appear to be fairly stable employees. About half of all the nurses had been in their current positions for at least 5 years. The majority had been employed in hospitals immediately before taking their current positions as office nurses. : The fact that their work settings were relatively small in size probably accounts for the general lack of formalized employment practices. The average salary of the full-time nurses was $7,734, somewhat lower than that found for registered nurses in other fields of nursing, such as hospital staff positions or staff nursing in community health agencies. Data from an August 1972 study made by the Bureau of Labor Statistics in non-Federal hospitals in 21 metropolitan areas suggest that the average annual salary of a full-time nurse in a hospital staff position in the country would be over $9,000 a year. National League for Nursing data on the annual salaries of nurses in local community health agencies in 1973 also point to salaries of that level. The majority of the nurses receiving 30 paid vacations (about 22 percent of the part-time nurses did not receive any) were given 2 weeks a year. About a quarter of the full-time nurses and almost half of the part-time nurses did not have available to them any insurance or retirement plans for which their employers covered part or all of the premiums. While not providing a definitive description of the functions of these nurses, the study did, through the means of a checklist, seem to indicate that the positions of these nurses parallel those of registered nurses in other types of positions. Included as activities which most of the office nurses regularly performed were assisting physicians during patient examinations; preparing for and/or administering first aid; taking temperature/blood pressure; administering immunizations and parenteral drugs; instructing patients on preparation for tests/examinations; changing dressings, and maintaining medical supplies and equipment. The study did try to ascertain whether the nurses had specialized training such as practitioner courses and whether this would have an effect on the functions carried out. Given the very small proportion of the respondents indicating such specialized training and the overall relatively small number of nurses in the study, no data could be developed along these lines. Some differences in activities did emerge when the data were looked at in terms of various aspects of the employ- ment situation or certain of the characteristics of the nurses. However, the degree to which the nurses' roles may have differed and the actual portion of the nurse's time spent in each activity were not discernible from the study. Such information would only be obtainable in a different type of study, such as one involving interviews, the maintenance of "logs" and/or observations. The information in this study, in addition to providing a general picture of nurses' activities, could serve as background to the structuring of a more comprehensive study of the nurse's role in the physician's office. Of interest in this connection was the nurse's reactions to the question of expansion of their role to encompass more patient care activities previously done by the physician. About two-thirds were in favor of such expansion. The majority of all the nurses felt that additional education and training would encourage the expansion of their roles. Those favoring expansion of the nurse's role were more likely to have had continuing education experiences. About 40 percent of the nurses had had continuing education experiences while they were employed in physicians' offices. The most frequently indicated type of experiences were workshops, nursing or health meetings, conferences, conventions, and inservice education seminars/ lectures. The establishment of conveniently located, appropriate educational programs was most frequently identified as a condition which would encourage participation in continuing education. APPENDI XES 31 10. 11. 12. 13. 14. APPENDIX A List of Tables Estimated number of total nonphysician employees and registered nurses in physicians' offices, 1973 .i.esveecseses Estimated number and percent of registered nurses, by type of practice and number of employees in office, 1973 .... Distribution of nurses according to length of time in their current office nursing position, 1973 .....cceeeeeccases Distribution of nurses according to marital status and presence of children at home, 1973 ...cceeescecccocscosasccnes Percentage of nurses covered by formal salary plans, by size of office and type of practice, 1973 ..cieveecenccscanses Annual salaries of full-time nurses, by geographic region, 1973 ee 0 00 © 6 0 0 00 0 0 00 00 0090 0000S BNLNL ELLOS BLOENPO NNTP Annual salaries of full-time nurses, by length of time in position, 1973 ....... EEE EAN EEE AR STENT IA ETNER ESATO EO ESS Hourly earnings of part-time nurses, by geographic region, 1973 ......... Bessa sss testers ssessetsattseisnainee Hourly earnings of part-time nurses, by length of time in position, 1973 ..... IEEE NEPEAN ENRON CORRS EEE Hours in workweek of full-time nurses, by geographic region, 1973 sesvrvreasnsssrssrvnssstensesescrrcsssgsesascnss Hours in workweek of part-time nurses, by geographic region, 1973 ....... Cees estes s tsetse set atts ssesesetennatnens Overtime provisions provided full-time nurses, by type of practice, 1973 ..ivsuvessvsressavsctcssttascssnscnsecssccnse Overtime provisions provided part-time nurses, by type of practice, 1973 ..... BALEARES RBA ESIC ERRNO Percentage distribution of full-time nurses working split shifts, by type of practice, 1973 ..ciceeieeececccncnns 33 Page 36 37 38 38 39 40 40 41 41 42 42 43 43 44 34 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. 2s. 26. 27. 28. 29. Percentage distribution of part-time nurses working split shifts, by type of practice, 1973 ...ieveeeerennonsonns Percentage of nurses working Saturday and/or Sunday, by size of office staff, 1973 cecveisinvissssntssnsonsasnnnse Weeks of paid vacation of full-time nurses, by length of time in current position, 1973 ...ieiiereeeenrenecencesensns Weeks of paid vacation of part-time nurses, by length of time in current position, 1973 ...eieveveecesecncococnnnns Paid sick leave arrangements for full-time nurses, by size of office Staff, 1973 cissssvstressirinssssssrsnssmensus Paid sick leave arrangements for part-time nurses, by size of office StAff, 1973 wercrssn burs eas sn isss se nivs esses en Time off for attendance at professional or inservice educa- tion meetings granted to full-time nurses, by type of Practice, 1973 ..iiiiiiereeeeeeeeeseeeeossanssssassssconsnnsns Time off for attendance at professional or inservice educa- tion meetings granted to part-time nurses, by type of Practice, 1973 .iiiiiiieeeeeeeaesaoenneneenoonosocssascccsnnsss Insurance and retirement benefits of full-time nurses, by type of practice, 1973 .i.ivieeeeeeenereoneseesannssoncesnns Insurance and retirement benefits of part-time nurses, by type Of practice, 1973 cece tisssstssstssssernsssrvnsssne Percentage of nurses regularly performing selected activities according to whether only RN's in office .veeeeeeveneenencane Percentage of nurses regularly performing selected patient care activities, by type of practice ..eeeieeeeecesseceoncana Percentage of nurses regularly performing selected patient care activities, by specialty of physician for whom they WOT wae en a sats 5088 00b 0s 8 snare els ma nes seve ss sssssesssssssss Percentage of nurses regularly performing selected patient care activities, by full- or part-time employment status .... Percentage of nurses regularly performing selected patient care activities, by highest degree held by nurse ......eoee.. Page 44 44 45 45 46 46 47 47 48 49 50 52 54 56 59 30. 31. 32, 33. 34, 35. 36. 37. Percentage of nurses regularly performing selected adminis- trative and clerical activities, by type of practice ........ 61 Percentage of nurses regularly performing selected adminis- trative and clerical activities, by full- or part-time employment status © 0 0 06 0 0 0 000 00 0600060060060 0606000606000 0000000000000 62 Percentage of nurses regularly performing selected adminis- trative and clerical activities, by highest degree held by NNMUYSE cecoeceeveccccsccscscsscscscsccsscscsssssscsoscsscscccsssocscscscssosossscssscscsos 63 Conditions which would encourage expansion of role, by highest degree held by nurse ...ececeecscenscaceccacesconncns 63 Opinion regarding expansion of role, by highest degree held by nurse © 0 © 000600600060 00060060060600600000000000000000000800000 64 Participation in continuing education, by marital status and presence of children at home, 1973 ....ceeecennnnnacenees 64 Types of continuing education programs in which nurses had participated within a 5-year period ....ceceeeeeeeecceses 65 Conditions which would further encourage participation in continuing education programs ...cccececcccccccacccscccanns 66 36 Table l.--Estimated number of total nonphysician employees and registered nurses in physicians' offices, 1973 Estimated Registered nurses number of Estimated Percent of Type of Practice employees? numbers total employees Total seeeeeeesveeceeeees 397,608 55,617 14.0 Solo practice .eceveeee.. 241,599 27,808 11.5 Group practice........... 155,061 27,809 17.9 lExcludes physicians whose specialties were psychiatry and anesthesiology. Includes osteopathic physicians. These data come from physician part of survey. Individual items do not add to total because of independent weighting of items and exclusion of nonresponses. 3These data are final adjusted weighted estimates from nurse part of survey. 4at least two physicians practicing together. Table 2.——Estimated number and percent of registered nurses, by type of practice and number of employees in office, 1973 Number of All nurses Solo practice Group practice employees Full Part Full Part * Full Part in office Total time timel Total time time Total time timel Estimated number ............ 55,617 40,375 15,242 27,808 20,324 7,484 27,809 20,051 7,758 percent...ceeececcecs 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 1 employee.ceeeecccccenscsnne 7.0 8.7 2,7 14.0 17.1 5.6 .1 .2 = 2-4 employeeS...ceeeeeccccnns 34.0 34.5 32.6 56.6 57.3 54.6 11.3 11.3 11.4 5-9 employeeS...cceeeeececces 25.2 24.4 27.3 24.4 22.3 30.1 26.0 26.5 24.5 10 or more employeeS......... 33.2 31.6 37.4 4.8 3.0 9.7 61.6 60.6 64.1 Not determined......... hE .6 .8 - "2 3 - 1.0 1.4 - Nurses who were "regular employees but worked fewer than 30 hours a week. LE 38 Table 3.--Distribution of nurses according to length of time in their current office nursing position, 1973 (Percent of Nurses) Full- Part- time time Length of time Total nurses nurses Total cvviinninnennnenennaennns 100.0 100.0 100.0 Under 1 year ..veveeeenennnnn. 9,2 10.5 5.8 l year tiveieeeeeernnnnennnnnn 12.8 12.4 13.8 2-4 Years tiiiviierinnnnnnnnns 26.5 24.8 31.1 5-9 Years wisessssocvessveanse 22.6 20.8 27.3 10-14 years vvveeeennnnnnnnnns 13.0 14.2 9.7 15 or more years ........... “w 15.4 16.6 12.3 Not determined ......veveeue.. .3 wd - Tatle 4.--Distribution of nurses according to marital status and presence of children at home, 1973 (Percent of Nurses) Full Part Marital status Total time time TOLAL svwsvuvnsenvuonitsinsoeen 100.0 100.0 100.0 Never married ....veeeeeeeeens 7.0 8.9 2:1 Currently married ssececeseccen 81.7 77.5 92.7 with children at home ..... 56.8 49.8 75.1 Widowed, divorced/separated .. 11.2 13.5 5.2 Not determined ......ceveveee. .1 wl - Table 5.--Percentage of nurses covered by formal salary plans, by size of office and type of practice, 1973 Size of office Total nurses Full Part Total time time Solo practice Full Part Total time time Group practice Full Part Total time time Total sosavncesnossnneyen 5.3 6.0 3.4 1 employee€..ceereeececense 1.7 1.7 1.4 2-4 employeeS...ceecessns 5.1 6.3 2.) 5-9 employeesS...cceececsss 4.0 5.5 C4 10 or more employees..... 6.7 6.7 6.8 4.4 5.5 1.6 1.7 1.7 1.4 5.5 6.7 2.6 2.6 3.8 C4 3.4 7.5 - 6.2 6.6 Sed 3.2 4.4 - 5.2 6.9 ya 7.0 6.6 7.8 6€ 40 Table 6.--Annual salaries of full-time nurses by geographic region, 1973 (Percent of Nurses) Geographic region North- North Annual salary Total east Central South West Totalivwwvvsssnamuss 300.0 100.0 100.0 100.0 100.0 Under $4,000...... cee 1.8 3.6 ic 4.6 - $4 ,000-4,999, cuvevvone 1.7 Ab 2.9 2.3 .6 5,000-5,499....... ye 3.4 2d 5.2 5.2 .7 5,500-5,999..... poe 4.6 5.6 5.8 1.5 5.4 6,000-6,499....000... 7.6 2.8 11.2 10.5 4.2 6,500-6,999......... ” 11.9 12.3 13.9 11.3 9.9 7,000-7,499...cc0.... 11.9 13.5 14.3 12.4 7.8 7,500-7,999..c0000... 12.1 7.6 6.2 19.3 15.1 8,000-8,499..cc000e.e 12.2 6.0 9.3 11.3 20.1 8,500-8,999. ccc 5.2 6.3 7-4 2.9 4.4 9,000-9.999,..uvevins 7.1 9.8 8.6 5.6 5.3 $10,000 and over...... 7.8 7.5 3.6 4.3 15.5 Not determined........ 12.7 22.5 11.5 8.8 11.0 Mean salary.eeeeces... $7,734 $7,764 $7,529 $7,191 $8,442 Table 7.--Annual salaries of full-time nurses, by length of time in position, 1973 (Percent of Nurses) Under Five years Annual salary Total five years or more Totals cervrsruvmmasse 100.00 100.0 100.0 Under $5,000..cc0cec.. 3:5 1.3 5.6 $5,000-5,999....000... 8.0 9.1 7.1 6,000-6,999...00000.. 19.5 19.5 19.8 7,000~7,999.....00... 24.0 27.7 20.9 8,000-8,999...0c00cee 17.4 16.4 18.1 9,000-9,999..cc00cen.e 7.1 9.3 5.2 $10,000 and over...... 7.8 8.4 7.3 Not determined..... ew 12.7 8.3 16.0 41 Table 8.--Hourly earnings of part-time nurses, by geographic region, 1973 (Percent of Nurses) Geographic region North- North Hourly salary Total east Central South West Totalssannsrvnvonsosns 100.0 100.0 100.0 100.0 100.0 Under $2.00..ccececcoes 1.1 1.1 2.1 .5 - $2.00-2.49..c0c0eencnns .6 1.3 .6 - - 2.502.999. cccecccnnne 5.2 5.3 5.0 12.7 1.1 3:00-3:49 teense vnsss 3.7 4.1 5.2 5.0 - 3.50-3.99.cccccecencns 26.1 16.8 27.6 52.1 20.0 4,004.49. cc ienenne — 19.6 33.8 17.0 12.8 10.4 4,504.99. ccceeiennns 7.6 14.2 5.6 _: 6.8 $5.00 and over..cceesse 14.4 6.7 17.0 6.3 24.0 Not determined...c..... 21.7 16.7 19.9 10.3 37.7 Mean earnings.......... $4.21 $4.08 $4.19 $3.75 $4.84 Table 9.--Hourly earnings of part-time nurses, by length of time in position, 1973 (Percent of Nurses) . Under Five years Hourly earnings Total five years or more Total....... SEGRE 100.0 100.0 100.0 Under $2.50.¢cceccecese 1.7 1.9 1.5 $2.50-2.99....... sree 5.2 2.3 8.2 3400=3.99,serunnvenses 29.8 27.4 32.4 4.00-4.99...c00000e ‘ew 27.2 32.6 21.6 $5 and OVer..eessoaness 14.4 17.9 10.7 Not determined......... 21.7 17.9 25.6 42 Table 10.--Hours in workweek of full-time nurses, by geographic region, 1973 (Percent of Nurses) Geographic region North- North Hours worked Total east Central South West Totalesseunesenisns .... 100.0 100.0 100.0 100.0 100.0 30 hOoUTS.eeeeeennnnns sees 12.9 13.3 13.4 16.3 9.0 Over 30,fewer than 35.... 14.9 20.6 17.9 14.7 8.2 35 hours..... tr rane ceene 8.7 12.7 6.2 12.6 5.5 Over 35,fewer than 37.5.. 10.3 9.6 2.5 9.2 14.7 37.5 houLBuisecnvisvssasvs 1.7 .8 1.7 v0 2.0 Over 37.5,fewer than 40.. 5.5 4.9 4.8 7.0 5.3 40 hours....... cece cees 27.6 24.7 28.5 22.7 32.8 Over 40..cveeeeeececeeees 16.2 12.3 18.8 15.2 16.6 Not determined.......c... 2+2 1.1 1.2 .1 5.9 INurses were considered full time if they worked at least 30 hours a week. Table 11.--Hours in workweek of part-time nurses, t by geographic region, 1973 (Percent of Nurses) Geographic region North- North Hours worked Total east Central South West Totaleconvivess EE 100.0 100.0 100.0 100.0 100.0 5-9 hOUTS.veeveseeonsansne 8.1 7.8 11.4 9.3 2.2 10-14 hours...... swmnonse ABed 17.9 10.7 17.3 34.4 15-19 hOUYS.eeeveeoeeanse 16.8 23.5 13.5 23.5 9.7 20-24 hOUTS.eeeseense eee 29.5 39.4 20.2 17.7 39.6 25-29 hOUYS.veveeevoeoees. 25.4 11.4 40.2 32.2 14.1 Not determined........ “ee 1.5 - 4.0 = - Median hours per week.... 21.0 20.1 23.1 20.0 20.5 Ip part- time nurse was defined as a ''regular'" employee whose workweek was fewer than 30 hours. Table 12.--Overtime provisions provided full-time nurses,by type of practice, 1973 (Percent of Nurses) Group practice Solo Two Three or Overtime provision Total practice physicians more physicians Totalevssnrrnsannns toh nn 0 GH 100.0 100.0 100.0 100.0 Get some compensation...ecceceece.. 46.7 36.6 48.3 59.0 Compensatory time off........... 27.7 33.3 33.7 20.8 Straight time pay.scuivcecossvsns 36.3 47.9 36.8 26.7 Time-and-one-half pay....ccceee. 29.0 8.7 19.7 48.9 Other..eeeeeeeeeereseesesaceonne 7.0 10.1 92.7 3:6 No compensation......eceee.. pp 33,2 41.7 42.9 23.1 Do not work overtime..c.eeeeeeceees 16.5 21.5 8.6 13.5 Not determined.....c... cesses enccans 1.6 2 “2 4.4 Table 13.--Overtime provisions provided part-time nurses, by type of practice, 1973 (Percent of Nurses) Group practice Solo Two Three or Overtime provision Total practice physicians more physicians ToLBlevsrnransvvennsnsmmrovsnsnn 100.0 100.0 100.0 100.0 Get some compensatioN..ceceeeeccecss 54.0 47.1 67.1 57.2 Compensatory time off........... 5.7 8.6 9.3 - Straight time pay....ceeeeeeceess 83.4 86.8 81.8 80.4 Time- and-one-half pay...eececess 10.3 3.3 8.9 19.6 Other..ceeeeeeeeeecsccscencanns . wD 1.3 = = No compensation. ivevesssnminnveses 24.7 23.7 23.6 26.9 Do not work overtime...ecececeescss 21.3 29.2 9.3 15.9 ey 44 Table 1l4.--Percentage distribution of full-time nurses working split shifts, by type of practice, 1973 Group practice Solo Two Three or more Shifts worked Total practice physicians physicians Total nurses...... ceenee 100.0 100.0 100.0 100.0 Work split shift....eeev... 8.9 10.0 18.0 3:3 Do not work split shift... 88.5 89.9 82.0 89.7 Not determined.......ee... 2.6 .1 - 7.0 Table 15.--Percentage distribution of part-time nurses working split shifts, by type of practice, 1973 Group practice Solo Two Three or more Shifts worked Total practice physicians physicians Total nursesS...ceeeeeeees 100.0 100.0 100.0 100.0 Work split shift.......... 10.5 15.0 12.7 2.7 Do not work split shift... 85.5 84.9 87.3 85.5 Not determined.......ce0.. 4.0 sk - 11.8 Table 16.--Percentage of nurses working Saturday and/ or Sunday, by size of office staff, 1973 Full - Part- Total time time Size of office staff nurses nurses nurses Totalewvswsswsvononusnes snes +b 38.6 34.4 1 employee..eeersseeneneennnas 41.9 45.5 12.0 2-4 employeeS...cvieeeenns eesss 36,5 40.0 26.5 5-9 employees.sssssssvinssssse 53.7 47.4 35.1 10 or more employeeS...eeeee.. 32.5 28.1 42.3 Table 17.--Weeks of paid vacation of full-time nurses, by length of time in current position, 1973 (Percent of Nurses) Years of employment in current position Total Under 1 2-4 5-9 10-14 15 or Paid vacation nurses 1 year year years years years more years Totaleeeevoeonooooaces 100.0 100.0 100.0 100.0 100.0 100.0 100.0 NOn€.eeoeeesses GEER RE 1.8 «5 1.8 3.9 2.3 1.0 - 1 weekiveooeoeooeooonne 5.8 18.5 9.7 3.6 3.8 1.2 - 2 WeekS.ivrisnveseresnes 52.3 68.8 62.8 70.1 53.3 36.5 18.5 3 WeekS.ieeeoonooonanene 19.3 4.9 4.4 8.2 28.6 24.0 30.9 4 weekSesss sans ensnvns 12.7 vd 7.7 3.1 5:3 23.8 40.4 Other.eeeeeeeees eevee 6.3 4.5 12.2 8.9 1.2 2.0 9.6 Not determined......... 2.5 2.7 1.4 2.2 5.5 1.5 .6 Table 18.--Weeks of paid vacation of part-time nurses, by length of time in current position, 1973 (Percent of Nurses) Years of employment in current position Total Under 1 2-4 5-9 10-14 15 or Paid vacation nurses 1 year year years years years more years Totalissevassssuvnns ’ 100.0 100.0 100.0 100.0 100.0 100.0 100.0 NonfGesvasssvsrnnvvese . 21.8 35.8 32.9 30.8 17.9 7.2 .3 1 weeKRisiivabovosnwnnens 8.0 3.4 6.5 7:3 5.6 6.5 19.6 2 WeekSeeeeovooooonnns ’ 36.2 41.1 42.0 52.5 25.5 25.8 18.2 3 weekBisaververcansnae 13.6 - 4.6 2+9 11.3 45.0 37.9 4 weekS.vcesnn "En 7.8 - - 1.3 i7.1 8.1 15.6 Other.ceeseees SEER aR 11.0 13.6 10.3 4.4 22.6 2.2 8.4 Not determined......... 6.6 6.1 3.7 .6 - 5.2 - SY Table 19.--Paid sick leave arrangements for full-time nurses, by size of office staff, 1973 (Percent of Nurses) Size of office 1 2-4 5-9 10 or more Sick leave arrangements Total employee employees employees employees Totaleesvenwnan ERE TCR PIP PIE . 100.0 100.0 100.0 100.0 100.0 No paid sick leave..eeee... * EE ’ 8.2 18.1 11.6 11.0 “3 Specified number of days of leave... 42.3 17.0 16.8 24.0 85.1 Individual arrangement.....eeeeeces. 43.4 54.5 62.1 63.3 8.8 Not determined........ uses nn 6.1 10.4 9.5 1.7 5.3 Table 20.--Paid sick leave arrangements for part-time nurses, by size of office staff, 1973 (Percent of Nurses) Size of office Z 2-4 5-9 10 or more Sick leave arrangements Total employee employees employees employees Totalecenesrvuosvnsvns PEER 100.0 100.0 100.0 100.0 100.0 No.paid sick leave..eeeeeceeceacens . 46.0 27.4 47.2 52.9 41.1 Specified number of days of leave... 20.9 - 3.9 26.7 33.0 Individual arrangement....ceeeeeeess 29.5 71.9 44.9 16.0 22.9 Not determined.....ceevsee wn wiih way 3.6 «7 4.0 4.4 3.0 9% Table 21.--Time off for attendance at professional or inservice education meetings granted to full- time nurses, by type of practice, 1973 (Percent of Nurses) Group practice Solo Two Three or more Time off provision Total practice physicians physicians Totalesssens BEES SEES EE 100.0 100.0 100.0 100.0 Time Off With pay.eceeceecsceescccececcacacns 35.1 37.2 32.2 34.4 Time off without pay..ceeeeeees asus vey 5.2 2.2 1.8 10.6 Time off not allowed........ FETE "i 16.7 17.7 18.8 14.3 Nurses never asked, didn't know...... Rod 39.3 38.6 44.1 37.7 Other.c.eecesecess ces cccsecsssescsnannannns 1.3 1.6 1.1 .9 Not determined..icsvvsvesssnvssvrvsven i we 2.4 2.7 2.0 2.1 Table 22.--Time off for attendance at professional or inservice education meetings granted to part- time nurses, by type of practice, 1973 (Percent of Nurses) Group practice Solo Two Three or more Time off provision Total practice physicians physicians OLB, is sas RRL E IRATE REESE H bt GE» 100.0 100.0 100.0 100.0 Time off with payisvssisiivansnsresavwnnes 25.4 172.3 25.0 37.6 Time off without pay.ceeeeeeceeeeeeeenenss 3.4 6.4 1.7 - Time off not allowed...eceeeeecsscosocanss 18.6 16.8 22.6 19.1 Nurses never asked, didn't know....v...... 47.4 55.4 43.2 37.8 Othersssssssscessnes sas SARA CERRO 4.7 3.2 7.4 5.5 Not determined...ceeeeecesscocsccssnsocsces «5 +9 wl - LY Table 23.--Insurance and retirement benefits! of full-time nurses, by type of practice, 1973 (Percent of Nurses) Group practice Insurance and Solo Two Three or more retirement benefits Total practice physicians physicians Retirement or pension plan other than Social Security. ssssssv6s00sennnen 44.8 44,5 49.5 43.1 Hospitalization and/or medical/ surgical Insuranceivvsssvinsisssssmerres 35.9 25.9 37.9 47.9 Nurses' professional liability (malpractice iNSUTANCE) eevee eeeeeeeeonns 16.9 11.9 24.9 19.8 Life Insuranteiisceressovensrsvneenssssrses 25.8 15.1 24.5 40.4 Profit sharif ssveinvvivsrssnmssvivssoiiss 17.8 12.8 22.8 22.1 Other... eeeeieeeeeneeeeeeeenennnnnnnnnnns 2:7 2.8 5.8 3.2 NOD w runs ns sas so avs sw ssw sss eves anes vys 23.6 32.3 16.9 15.4 Not determined......ee... CEERI EERE. 2,7 3.8 1.0 2.1 Yepiomer pays part or all of the premiums. 8% Table 24.--Insurance and retirement benefits! of part-time nurses, by type of practice, 1973 (Percent of Nurses) Group practice Insurance and Solo Two Three or more retirement benefits Total practice physicians physicians Retirement or pension plan other than Social Security........ BEE. 24.0 25.9 24.5 20.9 Hospitalization and/or medical/ surgical insurance........ EE 11.5 6.0 12.2 19.9 Nurses' professional liability (malpractice insurance)..eeeeeeceececes 19.6 19.3 16.4 2).7 Life Insurance. ciesscesossvosvnsvrsenes 14.0 5.5 4.9 31.5 Profit shoXing.eenswonvsesensnnsnnsnonns 14.2 9.5 7.6 24,7 Others....... EL PPP TTT I 3.8 4.3 3.6 3.2 BONG ovnvnmmuvrnsnmnvvernssnnnennsnnwmen Biol 53.3 50.8 36.9 Not determined.....cceeeeeceeecesccconnes 4.3 7.0 5.1 - 1 Employer pays part or all of the premiums. 6% 50 Table 25.--Percentage of nurses regularly performing selected activities according to whether only RN's were in office Percentage of RN's performing All RN's only Activity RN's in office PATIENT CARE FUNCTIONS General Assist physician during patient examination........ 91.7 94.4 Coordinate patient treatment plan with Other agency envevvsnsivisssasrrovssrmurnnssrsnnss 53.6 47.0 Evaluate family health...ivvveveerereeenennennnenss 13.0 17.2 Make decisions independently on telephone calls.... 79.4 88.9 Make suggestions to physicians regarding patient NEE. sure tstsnsnnsevensnsseessstsnsssesessnsesnsese 71.6 68.1 Make well/sick patient assessment...........oeeee.. 38.6 35.4 Perform some or all portions of well/sick eXaminALIiONS ess cnvvannnnvirsanvssssnssnnsornrvnery 35.3 33.4 Prepare for and/or administer first aid............ 81.5 7 Take medical hiStOTry.eeeseeeeeeenenenneneanennenees 48.5 49.1 Specific Tasks [o] ~ Administer immunization and parenteral drugs....... Apply cast applications....... SERRE EE RE. Change dressings...eeeevenee.. ceteris ererenttrseenns Check fetal heart beat......... NEBR Do tonometry testing......... EAB ER LEER NES Perform urinalysis, hemoglobin, or hemocrit........ PEHOVE QATWAR vevwann sues nanpsnoibe thinness ssseses REMOVE SULUPEB evens snssssias sisson mnonnsswrtrsens Take temperature or blood PreSSUTE.....eeeeeeeseses Take vaginal smears (including Pap)..eeeeeceeeeeess TAKS X-ray Secus vise sa nas savas ssisssssrnbnnssswnsees Tel NeArInge cnt ivrsssstovrsocsvanennsnssnssessassse Test VisSiome:uiieeeeeerennoneeeseeneonensennnsannns = Ul = 00 © . . | li . WCONONNWEANO®O MF Oo Un wu OHO Fou SWE WY « . . OH POOH NHONMMEOO® uN CVPR ONORON . . Se © BH . 51 Table 25.--Percentage of nurses regularly performing selected activities according to whether only RN's were in office--Continued Percentage of RN's performing All RN's only Activity RN's in office Teaching Counsel and instruct patients in management of defined illneSS..ceeeeeececeeseccncnecnn a 51.4 38.0 Instruct and assist patient in exercise PrOBramM: se covoeoeecoceassscsossosussocscoconcss cee 31.1 36.3 Instruct patients regarding preparation for tests/exanminations. .cisensesssnsnsssirsnons 88.6 91.1 Teach family planning......eceeececccecssccsoncans 20.7 21.2 Teach patients diet and/or normal nutrition....... 52.0 59.7 Teach patients how to care for themselves......... 72.3 72.6 ADMINISTRATIVE AND CLERICAL FUNCTIONS Arrange appointmentS...ceececeeescccecscecscncccons 57.0 84.3 Arrange patient appointments in community health facilities or facilities out of COMMUNIEY.eeeceseecosoasasosssessonsonscsoscsscnsoe 50.5 54.2 Complete insurance fOrmS....ceeeeeescecsccossccsces 29.6 76.5 Explain doctor's fees to patientS....eeee... ews 49.0 83.9 Maintain medical supplies or equipment............ 87.2 95.0 Maintain office supplies or equipment.......ocoe.. 81.1 88.6 Maintain patient record files..... UES ER RG 61.9 92.9 Send out patient billS..e.eeeseecssssosccscnssacoss 23.8 79.8 Table 26.——Percentage of nurses regularly performing selected patient care activities, by type of practice Group practice [49 All Solo Two Three or more Activity nurses practice physicians physicians General functions Assist physician during patient examination..... 91.7 91.0 93.0 92.1 Coordinate patient treatment plan with Other gency svrvssssvvrvecnns cee seseanns ceeenn 53.6 50.6 55.9 57.1 Evaluate family health. covssesnsvannonnsssvnnesn 13.0 15.2 15.6 8.5 Make decisions independently on telephone calls. 79.4 79.2 79.6 79.5 Make suggestions to physician regarding patient need..c.eeeeeceses Caner. ES SU ees 71.6 71.0 71.2 72.9 Make well/sick patient assessment.......... seas 38.6 40.2 44.3 33.6 Perform some or all portions of well/ sick examinationS..eeeceececeecececens vers nmenn 35.3 31.2 35.3 41.4 Prepare for and/or administer first aid......... 81.5 78.0 81.7 86.5 Take medical hiStOrY..eeeeeerseceeecsossesacesanns 48.5 54.1 56.6 36.4 Specific tasks Administer immunizations and parenteral drugs... 88.1 84.6 89.2 92.7 Apply cast applicationS..ceeeeeseseececccccosans 8.6 4.0 2.5 15.8 Change dressingS......... FAR EEE ESRI eo. 81.8 73.3 87.1 91.9 Check fetal hear beat.seeeeeeeseenene FERRER vss 15.0 14.6 19.4 13.4 Do tonometry testing...... TI Si Sn BERT ae 7.2 5.1 6.5 10.8 Perform urinalysis, hemoglobin, or hemocrit..... 50.4 .64.0 64.6 23.3 REMOVE EATWAX es eesosscssssssesssssssssssscecssss 31.3 24.3 26.2 44.1 Remove SULUT@Sessvrssssnsrsrtnrsesevrsnnssnt ses ss 50.7 51.1 48.9 50.9 Take temperature or blood pressure......ceeeeeee 94.2 92.1 95.4 96.7 Take vaginal smears (including Pap)...eceeececees 9.0 5.7 6.1 15.3 Take E-TaYB.versrserssvarsessssssbvmavnnnvnssnvn 14.7 13.4 24.5 11.3 Table 26.--Percentage of nurses regularly performing selected patient care activities, by type of practice--Continued Group practice All Solo Two Three or more Activity nurses practice physicians physicians Specific tasks--continued Test hearing. cvvsavossvcvssvsonnnonavens senses 293.0 23.9 25.0 38.3 Test visioncsissssvwsnvnssscvsssnssrnvsssasces 3659 53.2 57.4 62.1 Teaching functions Counsel and instruct patients in management of defined illnesSS..c.eeeeesececanns gaswaaaes lad 49.4 53.1 53.7 Instruct and assist patient in exercise PEOSTaMe vu sessrsvrasnnsnovnansnswasnnnssssssn Sled 33.9 31.2 26.9 Instruct patients regarding preparation for tests/examinationS.....ceeeeeeeeesccese. 88.6 87.3 90.2 89.8 Teach family planning...cceeeeceececcsscesssss 20.7 23.2 28.6 13.0 Teach patients diet and/or normal nutrition... 52.0 54.6 56.1 46.2 Teach patients how to care for themselves..... 72.3 70.0 74.4 74.8 £5 Table 27.--Percentage of nurses regularly performing selected patient care activities, by specialty of physician for whom they work 12 All Osteo- Family Medical Surgical Ob./ Pedia- Multi- Activity nurses path practice spec. spec. gyn. trics spec. General functions Assist physician during patient examination........... 91.7 92.2 91.4 89.5 94.8 96.9 80.3 96.5 Coordinate patient treatment plan with other agency........ 53.6 51.6 55.4 53.7 50.6 57.9 43.1 59.0 Evaluate family health.......... 13.0 18.9 16.0 12.1 5.5 14.0 16.8 16.7 Make decisions independently on telephone calls.......ee... 79.4 73.2 79.0 79.5 76.3 87.5 74.9 80.6 Make suggestions to physicians regarding patient need........ 71.6 76.4 66.4 73.8 68.7 78.7 69.9 76.3 Make well/sick patient A88EB8MENL eco vnuvssniennesnn vs 38.6 34.1 42.1 31.4 32.2 42.1 53.6 34.9 Perform some or all portions of well/sick examinations..... 35.3 46.3 41.1 38.3 16.5 13.2 32.9 65.0 Prepare for and/or administer first aid........ » REE eee. 81.5 82.4 90.4 76.2 73.2 68.0 82,7 94.9 Take medical history............ 48.5 70.9 54.1 36.1 34.4 59.5 51.7 52,9 Specific tasks Administer immunizations and parenteral drugs....... *Hraam 88.1 86.3 92.7 85.0 77.4 90.4 89.3 93.1 Apply cast applicationS......... 8.6 11.6 8.8 1.1 7.8 0.0 5.2 34.3 Change dressings....... LES. 81.8 85.3 80.0 68.6 89.6 84.3 84.6 92.6 Check fetal heart beat......... . 15.0 14.9 19.5 «3 1.9 54.5 6.4 10.0 Table 27.--Percentage of nurses regularly performing selected patient care activities, by specialty of physician for whom they work--Continued All Osteo- Family Medical Surgical Ob./ Pedia- Multi- Activity nurses path practice spec. spec. gyn. trics spec. Specific tasks--continued Do tonometry testing....... saeense 7142 11.3 7.4 7.8 8.4 0.0 7.5 11.2 Perform urinalysis, eTRglehin, OF HEMOCTI Es suv ovvoss times eens nn 50.4 61.3 77.4 34.4 24.9 65.1 50.6 27.4 Remove earwaX ......veeeeeeeeenn.. 31.3 26.7 37.6 30.4 16.0 9.7 40.0 56.5 Remove sutures.......veveeennenn.. 50.7 52.1 56.9 29.7 63.1 30,7 46.8 58.5 Take temperature or blood PYESSUrCrsenvsnsidisvsssnsawmnes 94.2 93.7 93.4 91:3 95.3 97.3 91.7 98.4 Take vaginal smears (including Pap)eeeeeeeveeennnn.. 9.0 5.6 6.5 6.4 12.1 21.8 4.0 6.1 Take X-TayS.uieeeeeeeeneenenennnns 14.7 20.8 27.7 13.8 11.1 1.5 1.5 15.5 Test hearing: cove vvsovnasonnsnmes 29.0 20.6 33.8 30.3 6.8 4.6 50.7 54.5 Test ViSiONe:eeeeueeeeenneennnnnns 56.9 70.7 75.9 58.8 31:2 12.6 67.1 79.4 Teaching functions Counsel and instruct patients in management of defined illness... 51.4 49.7 50.3 52.0 45.4 55.0 58.3 51.1 Instruct and assist patient in eXercise program.....eeeeeees... 31.1 48.6 42.9 22.0 22.1 50.6 13.2 19.6 Instruct patients regarding preparation for tests/ examinationS.......eovevvennn... 88.6 90.6 92.8 88.7 81.9 92.9 81.7 88.4 Teach family planning............. 20.7 28.3 23.9 12.5 7.8 56.1 4.0 11.9 Teach patients diet and/or normal nutrition........oeev.... 52.0 68.3 60.5 42.0 43.0 61.6 58.0 39.3 Teach patients how to care for eee Ves. vain isr arenes ensvens 72.3 71.1 72.7 69.7 72,1 85.6 62.2 71.1 Table 28.--Percentage of nurses regularly performing selected patient care activities, by full-or part-time employment status All nurses Full-time nurses Part-time nurses Percent in- Percent Percent in- Percent Percent in- Percent dicating not regularly dicating not regularly dicating not regularly Activity done in office perform done in office perform done in office perform General functions Assist physician during patient examination..... 2.6 91.7 2.9 91.4 2.0 92.5 Coordinate patient treat- ment plan with other BEENCY sesossnnnrenssse ses 8.1 53.6 8.7 57.0 6.8 44, Evaluate family health.... 22.8 13.0 23.2 14.3 21.5 9 Make decisions in- dependently on telephone CallBucassrvssnensnnerns 1.8 79.4 2.3 80.1 +3 77.4 Make suggestions to physicians regarding patient need.ceeeeeeenne 11.5 71.6 10.5 73.2 14.3 67.6 Make well/sick patient assesSment..cscesecscess 9.3 38.6 9.7 41.2 8.3 31.8 Perform some or all portions of well/sick 2 2 2 examinationS....ceeeeeeee 353 34.7 36.8 Prepare for and/or adminis- ter first aid.covievsons 9.5 81.5 8.2 84.9 13.1 72.6 Take medical history...... 2.7 48.5 2.6 49.8 3.0 45.3 9G Table 28.--Percentage of nurses regularly performing selected patient care activities, by full-or part-time employment statusl-—Continued All nurses Full-time nurses Part-time nurses Percent in- Percent Percent in- Percent Percent in- Percent dicating not regularly dicating not regularly dicating not regularly Activity done in office perform done in office perform done in office perform Specific tasks Administer immunizations and parenteral drugs.... 4.6 88.1 4.5 87.6 5.1 89.3 Apply cast applications... 46.0 8.6 44.0 9.3 51.2 6.6 Change dressings.......... 4.2 81.8 3.8 82.6 5.2 79.9 Check fetal heart beat.... 48.3 15.0 49.3 14.8 45.8 15.5 Do tonometry testing...... 47.1 7.2 48.4 6.8 43.6 8.4 Perform urinalysis, hemo- globin, or hemocrit..... 16.0 50.4 16.0 50.9 16.0 49.2 Remove €arwaX..eceeeeesse 22.5 31.3 22.8 30.9 21.9 32.3 Remove suturesS....ceeee.c.. 4.6 50.7 4.9 54.0 3.7 42.0 Take temperature or blood pressure.......... .6 94.2 .6 94.1 .6 94.4 Take vaginal smears (including Pap)eceeeee.. 20.1 9.0 20.9 8.5 17.9 10.3 Take X=raySeeeeeeeeoooesos 51.3 14.7 49.5 16.6 55.9 9.6 Test hearing. secvssnessnves 40.0 29.0 41.1 29.1 36.5 28.7 Test vision...... BASE 24.8 56.9 24.1 59.6 26.5 49.6 LS Table 28.--Percentage of nurses regularly performing selected patient care activities, by full- or part- time employment status -—Continued Activity Teaching functions Counsel and instruct patients in management of defined illnessS....... Instruct and assist patient in exercise Programe .ceeeeeses Instruct patients regarding preparation for tests/ examinationS...eeeceesces Teach family planning.. Teach patients diet and/ or normal nutrition...... Teach patients how to care for themselves...ceeeeeee soe Percent Percent in- Percent regularly dicating not regularly done in office perform done in office perform Percent in- Percent Percent in- dicating not regularly dicating not done in office perform 4.4 51.4 3.3 54.0 7.6 44.7 30.8 31.1 31.3 34.0 29.6 23.5 1.6 88.6 1.6 89.7 1.5 85.8 40.9 20.7 43.1 20.1. 35.2 22.2 16.1 52.0 17.7 53.2 2.0 48.8 7.1 72.3 7.4 75.4 6.2 64.2 } INurses were considered 2Not applicable. part time if their usual workweek consisted of fewer than 30 hours. 8S Table 29.--Percentage of nurses regularly performing selected patient care activities, by highest degree held by nurse All Associate Baccalaureate or Activity nurses degree Diploma higher degree General functions Assist physician during patient examination..... 91.7 97.6 91.3 90.4 Coordinate patient treatment plan with other agency......... ovine ava ERR RR EEE RSS. 53.6 51.6 52,7 72.5 Evaluate family healtheeceesesovsicicrsnnes nw iv 13.0 17.4 12,7 11.9 Make decisions independently on telephone calls. 79.4 73.2 78.6 95.8 Make suggestions to physician regarding Patient Need. cov svmrinseninsces ss ta sss sesen a 71.6 72.0 71.0 82.0 Make well/sick patient aSSeSSMENt...........e.. . 38.6 32.4 38.5 48.0 Perform some or all portions of well/ Sick examinations. comnsnssrssvers snr sets i isane 35.3 20.0 36.2 41.4 Prepare for and/or administer first aid......... 81.5 76.5 82.4 77.2 Take medical history.......... » eR 48.5 43.1 48.0 62.9 Specific tasks Administer immunizations and parenteral drugs... 88.1 93.0 87.8 85.7 Arply cast applicationS.......... IRAE CTE, 8.6 4.5 8.8 10.0 Change dressings. .cuccisvvssssesnsssrevrvnsnsanes 81.8 86.6 81.0 87.9 Check fetal heart beat.uveeeeeeeeeeeeeeseesnennns 15.0 14.2 15.3 10.7 Do tonometyy CeStiN€iisssnmvnmes ens ist sess as nne 7.2 6.5 7.4 5.9 Perform urinalysis, hemoglobin, or hemocrit..... 50.4 46.4 51.0 44.0 RETIOVE GarWaResi cin svsossassdestnsstnenanssnees 31.3 18.5 31.8 38.4 Remove SULUYES cus ssmusrsnssmmss sss sss evs isncen 50.7 60.3 50.6 38.8 Take temperatures or blood pPresSSUr€............. 94.2 95.2 93.9 97.0 6S Table 29.--Percentage of nurses regularly performing selected patient care activities, by highest degree held by nurse-—Continued 09 All Associate Baccalaureate or Activity nurses degree Diploma higher degree Specific tasks-conftinued Take vaginal smears (including Pap)...ccceceeee 9.0 3.1 9.1 15.2 Take X~TBYSestussesserssssssstsssensssnvsscssens 14.7 6.6 15.7 9.9 Test hearing. ceeeeceeeeeeessesccaanscssescanssns 29.0 32.7 28.7 29.8 TESt VIiSLiOMeeeeresesensnsnssnsesesnssscnsnsseass 26.9 55.7 56.8 62.5 Teaching functions Counsel and instruct patients in management of defined i1lneSS..eeeeeessscesoosssoccnocns 51.4 45.2 52.4 47.2 Instruct and assist patient in exercise Program...... eR EREB EH Ge nities xa bo ie be lg 31.1 26.8 31.8 27.1 Instruct patients regarding preparation for tests/examinationS..eeeeeseeeeeecsccccassnns 88.6 77.1 88.9 97.8 Teach family planning....ceceeeceeccccccccconcs 20.7 22.2 19.9 28.9 Teach patients diet and/or normal nutrition... 52.0 63.8 51.4 47.2 Teach patients how to care for themselves..... 72.3 77.8 71.6 77.9 Table 30.--Percentage of nurses regularly performing selected administrative and clerical activities, by type of practice Group practice All Solo Two Three or Activity nurses practice physicians more physicians Arrange appointmentS.......e.eeeeeeeeeeee. 57.0 59.9 55.8 53.4 Arrange patient appointments in community health facilities or facilities out of community............. 50.5 52.9 51.9 46.2 Complete insurance forms........ eevnsesvss 29:6 45.6 29.3 6.2 Explain doctor's fees to patients....... .. 49.0 61.9 48.4 30.3 Maintain medical supplies or equipment....... a Tn ier we wie ven reressnensaay STnd 90.9 91.9 19.5 Maintain office supplies and equipment. sss ssnsvesnvvenn % ded BEE rd ... 81.1 83.5 82.8 76.6 Maintain patient record files...... eenweny BLY 72.5 61.3 46.6 Send out patient bills......ceu.. snmeswnee 238 40.1 18.7 2.0 19 Table 3l.--Percentage of nurses regularly performing selected administrative and clerical eceivicies, by full- or part-time employment status 29 All nurses Full-time nurses Percent in- Percent Percent in- Percent dicating not regularly dicating not regularly dicating not Part- time nurses Percent in- Percent regularly Activity done in office perform done in office perform done in office perform Arrange appointments..... 3.8 57.0 2.9 60.2 6.1 48.7 Arrange patient appoint- ments in community health facilities or facilities out of COMMUNItYseeeeoeseannne 14.9 50.5 14.2 54.1 16.6 40.9 Complete insurance forms. 2.3 29.6 1.7 34.3 4.0 17.2 Explain doctor's fees fo patients. isssvvennve 1.6 49.0 1.3 51.6 2.5 42.2 Maintain medical supplies or equipment. vevessvees -e 87.2 +2 88.9 +1 82.8 Maintain office supplies and equipment.......... .2 81.1 ne 84.6 <1 71.8 Maintain patient record Fllegivvinnsnrnsmvmmnns “? 61.9 +1 63.3 2.4 58.1 Send out patient bills... 3.6 23.8 3.4 28.0 3.9 12.7 ljurses were considered part time if their usual workweek consisted of fewer than 30 hours. Table 32.--Percentage of nurses regularly performing selected administrative and clerical activities, by highest degree held by nurse All Associate Baccalaureate or Activity nurses degree Diploma higher degree Arrange appPOINtmMENtS..eeeeeeeeeeseneoeeens 57.0 49.1 56.4 73.7 Arrange patient appointments in community health facilities or facilities out of COMMUN LEY eet vuvesnoesoeneneensnsesasenes 50.5 53.5 49.1 64.2 Complete Insurance formS. csvevessseciosas 29.6 25.0 30.5 24,7 Explain doctor's fees to patients........ . 49.0 50.3 47.9 61.3 Maintain medical supplies or equipment.... 87.2 74.7 87.8 92.3 Maintain office supplies and equipment.... 8l.1 68.5 82.3 78.0 Maintain patient record fileS......eeoe... 61.9 51.7 61.0 85.4 Send out patient billsS...e.eeeeeeenneeennn 23.8 18.2 24.6 17.5 Table 33.--Conditions which would encourage expansion of role, by highest degree held by nurse (Percent of nurses indicating each condition) All Associate Baccalaureate or Type of condition nurses degree Diploma higher degree Additional education and training......... 52.7 78.1 49.2 73.2 Relief from clerical and bookkeeping work. 24.5 30.9 23.1 38.9 Physician's permission needed............. 36.4 45.2 36.5 23.6 Legal protection for nurse......ceeeeeeeen. 47.6 44.0 48.0 45.9 OLRBLSecvessssisstnnsnrnseavsosssenseesssen 3.7 6.0 3.7 1.1 Not indicated for present position or ROHBssssesvesss inv bus soi sPssaae se orenses 27.6 10.1 29.7 17.2 £9 64 Table 34.--Opinion regarding expansion of role, by highest degree held by nurse (Percent of Nurses) All Associate Baccalaureate or Opinion nurses degree Diploma higher degree Total NUrSES..eeceevccse 100.0 100.0 100.0 100.0 In favor of expansion... 67.1 68.4 65.4 90.6 Opposed to expansion.... 5.1 1.2 5.4 5.3 No current need for eXpansSion....ee.. cnnev 10:4 8.5 17.9 2.5 No opinion on expansion. 10.0 21.9 9.8 +5 NO ansSwWeTl.ssvevossese cee 1.4 - 1.5 1.1 Table 35.--Participation in continuing education, by marital status and presence of children at home, 1973 (Percent of Nurses) Full Part Marital status Total time time TOLALevosvennevsosssssnsssnimnne 40.4 40.3 40.9 Never married...cceeceececececccss 47.7 46.3 1 Currently married......ceceee. . 38.4 37.7 40.0 with children at home........ 37.1 39.7 36.4, Widowed, divorced/separated.... 50.8 51.4 Too few nurses in survey to warrant separate presentation of data. Table 36.--Types of continuing education programs in which nurses had participated within a five-year period (Percent of nurses who indicated participation) All Full-time Part-time Type of program nurses nurses nurses College course for credit......... .. 21.6 19.8 26.2 Nursing school alumni association clinical nursing program........ ee 11.7 8.9 19.0 WorkshopS ces wvoceansnces AWE suv 395.7 60.6 42.8 Physicians' rounds/lectures......... 33.0 32.2 35.1 Inservice education seminars/ lectures. .vsvurosrssnsonsonmncsnns . 50.5 47.0 59.8 Nursing or health meetings, } conferences, or conventions..... ve 53.7 50.9 61.3 Hospital/nursing roundS.....eceee... 14.9 16.2 11.3 Specialty preparation in a specialty field..... EEE svevens dul 17.1 18.1 Other........ ERA FTE yy ovine 8.9 9.6 7.0 . No type of program indicated........ 4b 3 .6 No program in past five years....... 4.3 4.1 4.7 Table 37.--Conditions which would further encourage participation in continuing education programs (Percent of Nurses) Those who ha Those who had All Nurses participated not participated Full Part Full Part Full Part Condition time time Total time Total time time Establishment of conveniently located appropriate educa- tional prOSTaM.secessrsvssnsns 60.5 €4.6 73.7 66.4 53.1 49.4 62.9 Tuition free courses......eeee.. 36.8 46.2 39.4 47.2 38.9 36.6 44.7 If job required....eeeeeeeeccnns 34,3 37.9 31.2 31.6 38.5 36.9 42.8 Released time from job.......... 32.8 18.4 27.2 20.9 29.3 33.9 17.3 No need at this time€.....eeeeee. 13.4 10.1 4.1 3.8 18.1 19.4 14.7 Child care facilities....ccev... 5.1 20.6 4.8 10.8 12.1 7.0 25.5 Nurses who had participated at some time while they were employed in a physician's office. 99 67 APPENDIX B AD HOC ADVISORY COMMITTEE OFFICE NURSE SURVEY Office Nurses Miss Katherine Bodenbender c/o Dr. R. H. Bodenbender (General Practice) 1518 Fifth Avenue Moline, Illinois 61265 Mrs. Sheila Bogan c/o Drs. Bulian, Wallace and Cochberg (Obs.) 1180 Beacon Street Brookline, Massachusetts 02146 Miss Rosemarie Egli c/o Dr. Lewis Day (Pediatrics) 4485 Wadsworth Street Denver, Colorado 80033 Mrs. Martha Forejt c/o Dr. Joseph M. Forejt (General Practice) 305 Arch Street Connellsville, Pennsylvania 15425 American Medical Association Mr. Donald Foy Director, Department of Health Manpower American Medical Association 535 North Dearborn Street Chicago, Illinois 60610 American Nurses' Association Mrs. Judith Kim Program Coordinator Nursing Practice Department American Nurses' Association 10 Columbus Circle New York, New York 10019 Miss Evelyn Moses Assistant Director Research and Statistics Department American Nurses' Association 10 Columbus Circle New York, New York 10019 Division of Physician Manpower Dr. Genrose Copley Chief, Professional Activities Branch Division of Physician Manpower, BHRD Health Resources Administration Bethesda, Maryland 20014 Mr. Thomas C. Dundon Chief, Survey and Analysis Section Professional Activities Branch Division of Physician Manpower, BHRD Health Resources Administration Bethesda, Maryland 20014 Division of Nursing Miss Jessie M. Scott Assistant Surgeon General Director, Division of Nursing, BHRD Health Resources Administration Bethesda, Maryland 20014 Dr. Eugene Levine Chief, Manpower Analysis and Resources Branch Division of Nursing, BHRD Health Resources Administration Bethesda, Maryland 20014 Mr. Stanley Siegel Assistant Chief, Manpower Analysis and Resources Branch Division of Nursing, BHRD Health Resources Administration Bethesda, Maryland 20014 68 AD HOC ADVISORY COMMITTEE OFFICE NURSE SURVEY (continued) Mrs. Helen Hudson Public Health Analyst Manpower Analysis and Resources Branch Division of Nursing, BHRD Health Resources Administration Bethesda, Maryland 20014 Miss Dolores M. LeHoty (Project Officer) Program Analyst Manpower Analysis and Resources Branch Division of Nursing, BHRD Health Resources Administration Bethesda, Maryland 20014 Mrs. Ava Dilworth Chief, Research Grants Branch Division of Nursing, BHRD Health Resources Administration Bethesda, Maryland 20014 69 TECHNICAL ADVISORY COMMITTEE OFFICE NURSE SURVEY Mrs. Martha Forejt, RN Office of Dr. Joseph M. Forejt 305 Arch Street Connellsville, Pennsylvania 15425 Mr. Donald Foy Director, Department of Health Manpower American Medical Association 535 North Dearborn Street Chicago, Illinois 60610 Miss Joanne Mazuret, RN Director, Health Manpower Project Hospital Education and Research Foundation Pennsylvania Hospital Association State College, Pennsylvania 16801 Miss Evelyn B. Moses Assistant Director, Research and Statistics Department American Nurses' Association 10 Columbus Circle New York, New York 10019 Miss Naomi Patchin, RN Director, Section on Nursing American Medical Association 535 North Dearborn Street Chicago, Illinois 60610 Dr. Alfred Yankauer Senior Research Associate Harvard School of Public Health 55 Shattuck Street Boston, Massachusetts 02115 Mrs. Sally Jones (Consultant) Department of Preventive and Social Medicine Harvard Medical School 25 Shattuck Street Boston, Massachusetts 02115 Division of Nursing Miss Jessie M. Scott Assistant Surgeon General Director, Division of Nursing, BHRD Health Resources Administration Bethesda, Maryland 20014 Dr. Eugene Levine Chief, Manpower Analysis and Resources Branch Division of Nursing, BHRD Health Resources Administration Bethesda, Maryland 20014 Mr. Stanley Siegel Assistant Chief, Manpower Analysis and Resource Branch Division of Nursing, BHRD Health Resources Administration Bethesda, Maryland 20014 Miss Dolores M. LeHoty (Project Officer) Program Analyst Manpower Analysis and Resources Branch Division of Nursing, BHRD Health Resources Administration Bethesda, Maryland 20014 Miss Helen Foerst Nurse Consultant Community Nursing Branch Division of Nursing, BHRD Health Resources Administration Bethesda, Maryland 20014 Mr. Arthur Testoff Chief, Office of Statistical Services Division of Nursing, BHRD Health Resources Administration Bethesda, Maryland 20014 71 APPENDIX C DESCRIPTION OF METHODOLOGY! At the time the study was being planned, there were approximately 700,000 actively employed registered nurses in the United States and approximately 200,000 physicians in office-based practices. As no current list of registered nurses employed in office-based practices was available, it was reasoned more practical to draw a sample of physicians in office-based practices and obtain from them the names of their office nurses than to draw a sample of registered nurses, relatively few of whom would be working in office-based practices. Since both the American Medical Association and the American Osteopathic Association annually complete directories of physicians, it was possible to use the physicians themselves as the source of information about the location of office nurses. Accordingly, it was decided to make a two-step survey: (1) a survey of office-based medical and osteopathic physicians to obtain the names of registered nurses employed in their offices and (2) a study to be conducted among these office nurses themselves. It was decided that, chronologically, the total project should be carried out in two phases, Phase I, a pilot or feasibility study, and Phase II, the full-scale survey. The basic purpose of Phase I would be to assess the response from both physicians and the office-based nurses whose names they were asked to supply. Included in this phase would be a pilot study among physicians, design and pretest of the nurse's questionnaire and a further pilot study among a sample of nurses drawn from responses to the physicians pilot study. Implementation of Phase II, the full-scale survey, its tabulation and report, would be contingent upon and follow acceptance of the report on Phase I. Following receipt of the results of the Pilot Study, it was determined that the full-scale survey should be undertaken. In the pilot study it was noted that while psychiatrists and osteopathic physicians were willing to complete and return Physician Response Forms, relatively few of them employed registered nurses. The decision was made to eliminate psychiatrists from the full-scale survey since very few of them employed registered nurses, and to increase the 1 Excerpted and adapted from Technical Report prepared and submitted by Chilton Research Services, February 1974, as part of Contract No. NIH 71-4061. 72 number of mailings to osteopathic physicians in an attempt to obtain the names of an adequate number of registered nurses employed by them. It was further decided that because of the nature of their practice, anesthesiologists, radiologists and pathologists should be eliminated from the full-scale survey of physicians. Physician Sample Analysis of the results of the pilot study showed differing response rates by physicians in different medical specialties and in addition, significantly different rates of registered nurse employment. For this reason, the decision was made to sample differing numbers of physicians by medical specialty. This procedure, it was hoped, would furnish the names of approximately equal numbers of registered nurses in each medical specialty. Pilot study data furnished the basis for estimating the number of physicians by medical specialty that would be required to furnish approximately the same number of registered nurse names for each specialty group. The American Medical Association universe of office-based physicians in each medical specialty together with a distribution of the physician sample for the full-scale survey are shown in the following table. Universe and sample size by medical specialty Office based Medical specialty physicians (AMA) Sample size General practice 48,213 552 Medical specialty 26,540 1,115 General medicine 24,624 1,114 General surgery 35,344 595 Surgical specialty 3,459 2,493 Obstetrics/gynecology 14,338 429 Pediatrics 11,03¢C 500 Osteopathy 12,868 3,322 Total 176,416 10,120 Fisher-Stevens, a firm specializing in medical data processing and one of eight organizations authorized by AMA to sell their lists, was asked to supply the required sample by medical specialty. They were asked to provide the names and addresses of the requested number of physicians in office-based practices and to eliminate from the sample all anesthesiologists, pathologists and radiologists. The 73 sample was drawn from their complete listing by means of a systematic probability procedure. It should be noted that the sample obtained from Fisher-Stevens was a sample of the physicians on their lists at a particular point in time. Their lists are of course constantly being updated. Physician Mailing In the first week of April 1973, Physician Response Forms were mailed to a total of 10,120 physicians. Each physician received a letter briefly explaining the purpose of the survey and requesting his cooperation (this was an integral part of the Physician Response Form), and an addressed, postage-paid return envelope. Up to two followup mailings were made to nonrespondent physicians at intervals ranging up to 4 weeks. This interval between mailings was necessary primarily because of the slowness of the mails. Approximately four weeks after the third mailing to nonrespondent physicians, Wide Area Telecommunications Services (WATS) telephone interviewers attempted to contact the offices of the physicians who had not returned a mail questionnaire. Pilot study experience had shown that physicians’ office personnel could, without difficulty, answer the questions on the Physician Response Form. Thus, interviews were conducted with knowledgeable people answer- ing the phone in physicians' offices. Interviewers made no specific attempt to interview the physicians personally, although in some offices the physician was the respondent. When all efforts to complete interviews with nonrespondents had been exhausted, the combined mail and telephone response to the physi- cians survey was 6,681 or 66 percent of the original sample. A breakdown of the combined response by medical specialty and size of practice appears in the table below: 74 Response to physicians' survey By size of practice Original Total Two Specialty sample returns Solo man Group General practice 552 398 275 56 67 Medical specialty 1,115 731 489 127 15 General medicine 1,114 918 453 159 306 General surgery 595 473 238 98 137 Surgical specialty 2,493 1,129 740 166 223 Obstetrics/gynecology 429 366 142 92 132 Pediatrics 500 379 191 61 127 Osteopathy 3,322 2,287 1,616 450 221 Total 10,120 6,681 4,144 1,209 1,328 From the mail and telephone surveys of physicians, approximately 1,300 questionnaires were received from physicians in group practices. There was, however, considerable uncertainty as to how these group physicians had answered their questionnaires. It appears that some of them provided information on the total group regardless of how widely the group was scattered geographically. Others gave information only on personnel at their location while still others responded only in terms of the section or department in which they, themselves, worked. Because of this problem, a random sample of group practice questionnaires, both mail and telephone, was drawn by taking every ninth item from a random start. This procedure yielded 157 questionnaires. WATS calls were made to each of these 157 offices to make sure that each questionnaire contained the data relating to the location of the respondent. That is, that the number of physicians, registered nurses and other personnel noted on the questionnaire was the number located at the address of the respondent physician. Efforts were also made to verify the names of the registered nurses reported and to obtain them if they were not already listed on the questionnaire. During this telephone re-call, it was determined that 18 of the 157 questionnaires could not be used. In 11 cases, the practice had dwindled in size and was no longer a group practice, while in seven instances the group was not involved in private practice. 75 Nurse Sample During the early planning stages of this project it was believed that physicians might furnish registered nurse names in such numbers that sub-sampling would be done to select the names of registered nurses to be included in the survey. The number of registered nurse names furnished in the various strata, however, was less than anticipated. For this reason, all registered nurses whose names were furnished by physicians in solo and two-man practices were included in the survey. In addition, registered nurses whose names were furnished by group practice physicians and whose presence by location were verified in the sub-sample of group physicians were also included in the nurse survey. A total of 1,856 registered nurses were mailed questionnaires. Of this total, 1,571 were sent Questionnzire "A" and 285 were sent Question- naire "B." Questionnaire "A" was designed for nurses employed in offices where physicians were in solo or two-man practices, and Questionnaire "B'" was for nurses employed in offices with three or more physicians. These questionnaires were identical, except for the questions on the first page relating to the office setting in which the nurse worked. The initial mailing of nurse questionnaires was made in September 1973. Each questionnaire was accompanied by a cover letter briefly explaining the survey and requesting the nurse's cooperation, and by a preaddressed, postage-paid return envelope. At approximately 4-week intervals, each nonrespondent nurse was mailed another questionnaire, cover letter and return envelope. A maximum of two such followup mailings were made. Approximately 3 weeks after the second followup mailing to nonrespondent nurses, WATS telephone interviewers attempted to reach each of these nurses by telephone to urge them to complete and return the questionnaire they had received by mail. Attempts were made to reach 632 nonrespondent nurses by telephone, not including those whose questionnaires had been returned by the Post Office as undeliverable. Interviewers were able to speak with 408 of these nurses. They also talked with an additional 100 people in the offices of physicians who had furnished the nurses' names and were told that the nurses were on vacation, leaves of absence or were no longer employed in those offices. Interviewers were unable to locate the remaining nonrespondent nurses for such reasons as no telephone listing for the physician and the number given for the physician was not a working number or was not the physician's number. 76 The combination of mail and telephone measures resulted in usable completed replies from 1,011 nurses, 55 percent of the 1,856 who comprised the original nurse sample. A response analysis by medical specialty of the physician by whom the nurse was employed and by type of office setting is shown below: Combined response to nurses' mail and telephone surveys By type of office setting Original Usable Two Physician's specialty sample returns Solo man Group General practice 157 102 53 38 11 Medical specialty 222 114 77 28 9 General medicine 250 133 77 36 20 General surgery 163 82 49 27 6 Surgical specialty 316 177 121 46 10 Obstetrics/gynecology 189 113 46 51 16 Pediatrics 170 103 47 39 17 Osteopathy 389 187 126 56 5 Total 1,856 1,011 596 321 94 Weighting Procedures The disproportionate sampling of and return from the various medical specialties and size of office settings required the development of weighting procedures in order to replicate the original universes of office-based physicians and nurses. Projection of Office-Based Physicians By Medical Specialty Example: General Practice N = 48,213 (Universe) n = 552 (Sample Size) f =1/87 (Probability of Selection) Since both the mail and telephone returns to the physician survey revealed the presence of nonoffice-based doctors in the American Medical Association listing supplied by Fisher-Stevens, the calculation of reliable estimates of the number of office-based physicians in each medical specialty became a necessary first step in the weighting procedure. 77 This was accomplished by reducing the number of nonrespondent physicians in each specialty by the percentage of nonoffice-based physicians included among the returns and, for purposes of projection only, adding the reduced number to the actual returns in proportion to the response from each size of practice category. Type of practice Total returns Nonreturns added Solo 275 81 Two-man 56 17 Group (3+) 67 20 Projection of Physician Practices (Locations) Since the original universe was comprised of physicians as opposed to practices, the probability of a practice being included in the sample was in direct proportion to the number of physicians in the practice. Thus, duplicate reporting of nurses by two or more physicians in the same practice would result in an over projection of nurses if physicians rather than practices were used as a base for projecting nurses. Accordingly, the next step in the weighting procedure was a calculation of the number of practices/locations in each medical specialty. This was done by multiplying the projected number of physicians in each specialty by the reciprocal of the selection probability for a practice of given size (i.e., solo practice = 1, two-man = 1/2). Probability of Selection of Individual Practice Locations Example: General Practice Solo = 1 Two-man = 2 2 3+ = 6.2 Type of practice Projected physicians Projected locations: Solo 31,079 31,079 Two-man 6,373 3,687 Group (3+) 7,595 1,215 2yeighted mean of M.D.'s in 3+ groups with a G.P. respondent. 78 Projection of Nurses by Specialty and Size of Practice As a basis for weighting the nurses' questionnaire responses, the total number of nurses in each specialty by size of practice cell as projected from the physician's questionnaire was divided by the number of nurse returns from that cell, thus providing the needed weighting factor. Projection of Total Office-Based Nurses The mean number of nurses for each size of practice was determined from the actual number of nurses reported on the physicians' question- naires. The projected practices/locations were then multiplied by the average number of nurses per location to obtain a projection of the number of nurses within each type of practice for each medical specialty as shown in the example below. Type of Projected Average nurses/ Projected practice lccations location nurses Solo 31,079 .310 9,639 Two-man 3,687 .645 2,378 Group (3+) 1,215 3.3 3,949 The above described procedure resulted in a projected total office nurse population of 62,687. Not until the nurse questionnaires were returned was it discovered that some nonregistered nurse personnel and some temporary relief nurses had been erroneously reported by physicians as RN's permanently employed in their practice. This affected the projection factors resulting in an overstatment of total office-based nurses. 79 The unweighted and weighted distribution of erroneously reported nonregistered and temporary relief nurses is shown by medical specialty in the table below. Nonregistered and temporary relief nurses erroneously included in nurse projection based on physicians' questionnaires Specialty Unweighted Weighted General practice 21 5,182 Medical specialty 6 290 General medicine 3 149 General surgery 8 759 Surgical specialty 6 34 Obstetrics/gynecology 4 260 Pediatrics 2 275 Osteopathy 14 118 Weighted Sample of Nurses Adjustment of the weighting factors to compensate for this erroneous reporting on the part of physicians resulted in a corrected office-based RN population of approximately 55,700, distributed by medical specialty and type of practice as shown in the following table. Projected Weighted Projected Weighted RN's RN's Actual RN Specialty RN's RN's Percent Percent Weight Replies Solo Practice General practice......... 9,639 9,646 17.3 17.3 182 53 Medical specialty........ 3,935 3,927 7.1 7.1 51 77 General medicine......... 3,395 3,388 6.1 6.1 44 77 General surgery .......... 4,627 4,606 8.3 8.3 94 49 Surgical specialty....... 418 363 .8 .7 3 121 Obstetrics/gynecology.... 2,496 2,484 4.5 4.5 54 46 Pediatrics, euvsusesessni 2,114 2,115 3.8 3.8 45 47 Osteopathy .....eoeveeennn 1,254 1,260 2.3 2.3 10 126 Two-man General practice......... 2,378 2,394 4.3 4.3 63 38 Medical specialty ........ 1,072 1,064 1.9 1.9 38 28 General medicine......... 1,038 1,044 1.9 1.9 29 36 General SUTZEYY .eeesesens 1,795 1,782 3.2 3.2 66 27 Surgical specialty....... 88 92 v2 .2 2 46 Obstetrics/gynecology.... 1,522 1,530 2.7 2.8 30 51 Pediatrics cise seven nrnvs 860 858 1.5 5:5 22 39 Osteopathy «.ceeeeeeennnns 342 336 +6 +6 6 56 Three or more General practice......... 3,949 3,949 ri | 7.1 359 11 Medical specialty........ 816 819 1:5 1.5 91 9 General medicine......... 3,279 3,280 5.9 5.9 164 20 General surgery.....ee... 3,587 3,588 6.4 6.5 598 6 Surgical specialty....... 58 60 +1 sil 6 10 Obstetrics/gynecology.... 4,503 4,496 8.1 8.1 281 16 PediatriCS ves svn nnennnin si 2,099 2,091 3.8 3.8 123 17 Osteopathy seeeeeececenses 443 445 .8 .8 89 5 Totalicsveosssesesvevices 55,707 55,617 1,011 APPENDIX D : 81 DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE PUBLIC HEALTH SERVICE NATIONAL INSTITUTES OF HEALTH BETHESDA, MARYLAND 20014 BUREAU OF HEALTH MANPOWER EDUCATION = | APRIL, 1973 Dear DocToRr: WE NEED YOUR ASSISTANCE IN OBTAINING A CURRENT LIST OF OFF|CE NURSES. A SURVEY OF REGISTERED NURSES EMPLOYED IN PHYSICIANS' OFFICES IS BEING CONDUCTED BY THE Division oF NURSING, BUREAU OF HEALTH MANPOWER EDUCATION. THE SURVEY WILL INCLUDE NURSES EMPLOYED IN SOLO, PARTNERSHIP, AND GROUP PRACTICE SETTINGS. THE INFORMATION IS IMPORTANT FOR PLANNING ON A NATIONAL BASIS TO MEET THE EDUCATIONAL NEEDS OF NURSES IN ORDER THAT THEY MAY FUNCTION MORE EFFECTIVELY IN EXPANDING PHYSICIANS" SERVICES. OFFICE NURSING 1S THE THIRD LARGEST FIELD OF EMPLOYMENT OF REGISTERED NURSES; APPROXIMATELY 50,000 OF THEM ARE SO EMPLOYED. YET VERY LITTLE CURRENT INFORMATION IS AVAILABLE ON THE CHARACTERISTICS OF THIS GROUP OR GN THEIR ACTIVITIES AS OFFICE NURSES. WE ARE ASKING YOU TO SUPPLY THE NAMES OF REGISTERED NURSES IN YOUR EMPLOY. WE WOULD ALSO LIKE YOU TO ANSWER THE FEW QUESTIONS ON THE FOLLOWING PAGES. THIS INFORMATION IS NEEDED TO HELP US DRAW A SUITABLE NURSE SAMPLE TO REPRESENT THE VARIOUS TYPES OF OFFICE SETTINGS. THE NUMERICAL INFORMATION REQUESTED ON OTHER EMPLOYEES W!LL HELP FILL THE GAP CURRENTLY EXISTING IN INFORMATION ON HEALTH MANPOWER. THE ATTACHED PAGES AND POSTAGE-PAID RETURN ENVELOPE ARE ENCLOSED FOR YOUR USE. IF YOU EMPLOY NO NURSES, PLEASE RETURN THAT INFORMATION SO YOU WILL NOT RECEIVE THE FOLLOW-UP QUEST|ON- NAIRES,. FOLLOWING RECEIPT OF THE NAMES, THE SURVEY QUESTIONNAIRE WILL BE SENT TO THE NURSES THEMSELVES. THEY WILL BE ASKED FOR INFORMATION SUCH AS THEIR AGE, MARITAL STATUS, AND EDUCATIONAL PREPARATION} THEIR SALARIES, WORK SCHEDULES, AND FRINGE BENEFITS; AND THE NATURE OF THEIR ACTIVITIES IN AN OFFICE PRACTICE SETTING, ALL INFORMATION FURNISHED BY YOU AND YOUR NURSE WILL BE CONFIDENTIAL AND WILL BE USED FOR STATISTICAL PURPOSES ONLY. PLANS FOR THE SURVEY HAVE BEEN SHARED WITH THE » AND THEY HAVE EX- PRESSED SUPPORT FOR THE PROJECT. IT IS BEING CARRIED OUT BY HILTON RESEARCH SERVICES oF PHILADELPHIA UNDER CONTRACT WITH THE Division oF NURSING. WE VERY MUCH APPRECIATE YOUR COOPERATING IN THIS ESSENTIAL STEP ON THE STUDY OF OFFICE NURSES, VERY SIN DiRECTOR BUREAU OF HEALTH MANPOWER EDUCATION 1 ENCLOSURE 82 Study #9722 OMB #68-S72170 Expiration Date Chilton Research Services Radnor, Pennsylvania 19089 PHYSICIAN RE FOR OFFICE USE ONLY 6-31-73 { Questionnaire No. (1-5) Sample No. (6-10) SURVEY OF REGISTERED NURSES EMPLOYED IN PHYSICIANS' OFFICES SPONSE FORM CONFIDENTIAL USE OF QUESTION ANSWERS. THIS INFORMATION IS FOR STATISTICAL PURPOSES ONLY AND WILL NOT BE CONNECTED WITH YOUR NAME IN ANY WAY. Which of the following best character- izes the type of office setting in which you see patients? If you deliver patient care in more than one office setting, select only the one in which you deliver over 50% of your office patient care. (CHECK ONE ANSWER) Not in practice. (If you 14 check this answer, it will = not be necessary for you to 1 - continue, Please return questionnaire. Thank you.) Solo office maintained by me 2~- | Partnership 3 = Association 4- [] Corporation 5-0 Group 6 - [1] Other (SPECIFY) 7- [] PLEASE COMPLETE THE REMAINING QUESTIONS IN REFERENCE TO YOUR ANSWER TO QUESTION 1. 4, What is the primary medical specialty of the total practice? (CHECK ONE ANSWER) 16~ Single Specialty l= 1 Multi-specialty 2 - Family practice 3- ! 5. What is your primary medical specialty? (CHECK ONE ANSWER) 17,18~ Family practice 1- Internal Medicine 2 - | Other Medical Specialty (SPECIFY) 3-1] General Surgery 2. How many physicians are there in your practice, including yourself? Total number of physi- cians in practice: 12,13,14- 3. Is this a prepaid practice? 15~ Yes 1 - [J 2- [] No Other Surgical Specialty te (SPECIFY) >] Obstetrics/Gynecology 6 -U] Pediatrics 7 = i Other Specialty (SPECIFY) 8-[] 83 6. In what state is your practice located? State: 19~ 20- 7. Are there any registered nurses employed in your practice? Yes 1-~- No (SKIP TO Q. 10) 2 - 00 8. (IF "YES") By whom are they employed? (CHECK ONE ANSWER) By me Personally d= By the Partnership 2 ~- By the Association 3 = By the Corporation 4 - By the Group 5- By other (SPECIFY) U 0ooooe 9. Please list the names of each of these registered nurses. (May be completed by the administrator.) (ATTACH A SEPARATE SHEET IF NECESSARY) PLEASE TURN TO NEXT PAGE 84 10. Please indicate below the type and number of personnel, both full-time and part- time, now employed in the practice, and the number that would be hired if qualified personnel were available. (Exclude physicians.) (May be completed by the adminis- trator.) 24-3 (7) Check here if practice does not employ any office personnel and is not seeking to hire any office personnel. (PLEASE IGNORE CODE NUMBERS IN THE BOXES BELOW.) Number Additional Personnel Type Of None Employed That Would be Hired Personnel Employed Full-Time Part-Time Full-Time Part-Time 1. Registered Nurses 23=1 25.26.27 28,29, 30 31.32.33 34.35.36 2. Licensed Practical Nurees 2 37,38, 39, 40,41, 42 43,44,45 46,47.4 3. Secretarial (Recep- tionist, Secretary, File Clerk) 3 49,50,51 52,53,54 55,56, 57 58, 59, 60 4, Fiscal Personnel (Accountant, Bookkeeper) 4 61,62 63,64 65, 66 67,68 5. Office Manager (Non-RN) 5 69,70 71,72 73,74 75,76 6. Laboratory Technicians (ASCP Registered) 6 6,7 8,9 10,11 12.13 7. Laboratory Technicians (Non-Registered) 7 14,15 16,17 18,19 20,21 8. X-ray Technicians (ARRT Registered) 8 22,73 24,25 26,27 28,29 9, X-ray Technicians (Non-Registered) 9 30,31 32,33 34,35 36,37 10. Physician Assistant (Non-RN) Q 38,39 40,41 42,43 44,4 11. Medical Assistant 24-1 46,47 48,49 50,51 52,53 12. Service Personnel (Janitor, Maid, Chauffeur) 2 54,55 56,57 58,59 60,61 13. Other (SPECIFY) 0 62.653 64,65 67 68, 69 TOTAL | COMMENTS : 70,71,72,73 74,75,76,77 78- 79~ WE APPRECIATE YOUR COOPERATION -- THANK YOU! APPENDIX E 85 PLEASE RETURN 10: Stupy #9722 FOR OFF ICE USE ONLY Ht LTON RESEARCH SERVICES OMB # 68-572170 QUESTIONNAIRE No. (1-5) RapNOR, PENNSYLVANIA 19089 EXPIRATION DATE 10-15-73 Sa . (6-10 SURVEY OF REGISTERED NURSES wpLE No. (6-10) EMPLOYED IN PHYSICIANS' OFF [CES CONFIDENTIAL USE OF QUESTION ANSWERS. THIS INFORMATION 1S FOR STATISTICAL PURPOSES ONLY AND WILL NOT BE CONNECTED WITH YOUR NAME IN ANY WAY. TYPE OF SETTING = "A" (FOR NURSES IN OFFICES WHERE PHYSICJANS ARE IN SOLO OR TWO-MAN PARTNERSHIP OR ASSOCIATION PRACTICE) CARD COLUMN 11- 1. IF OFFICE IS A TWO-MAN PARTNERSHIP OR ASSOCIATION, DO YOU WORK: (CHECK ONE ANSWER) 21 3 ! EQUALLY WITH BOTH PHYSICIANS LC] MORE WITH ONE PHYSICIAN THAN THE OTHER 2 4 _] WITH ONLY ONE OF THE PHYSICIANS DoES NOT APPLY TO ME = IN SOLO OFFICE 1a. WHAT IS THE PRIMARY MEDICAL SPECIALTY OF THE PHYSICIANS(S) FOR WHOM YOU PERSONALLY WORK? IF YOU WORK FOR MORE THAN ONE PHYSICIAN, CHECK AS MANY AS APPLICABLE. 12- 1 5 13- 14- [] FAMILY PRACTICE [] OTHER SURGICAL SPECIALTY (SPECIFY) 2 [J] internal Mepicine 6 3 [1 OesteTrics/GvnecoLoay 7 OTHER MEDICAL SPECIALTY [] (SPECIFY) - [] PEDIATRICS a [ OTHER SPECIALTY (SPECIFY) L] GENERAL SURGERY 15-16 2. HOW MANY DAYS PER WEEK IS THE PHYSICIAN(S) OFFICE OPEN? (FILL IN APPROPRIATE BLANK) SP 17-19 FIXED SCHEDULE: NUMBER OF DAYS VARIABLE OR FLEXIBLE SCHEDULE: AVERAGE NUMBER OF DAYS 86 PLE TURN TO: Stupy #9722 FOR OFFICE USE ONLY CHILTON RESEARCH SERVICES OMB #68-572170 QUESTIONNAIRE No. (1-5) RADNOR, PENNSYLVANIA ~~ 19089 EXPIRATION DATE: 10-15-73 SURVEY OF REGISTERED NURSES mpLE No. (6-10) EMPLOYED IN PHYSICIANS OFFICES CONFIDENTIAL USE OF QUESTION ANSWERS. THIS INFORMATION IS FOR STATISTICAL PURPOSES ONLY AND WILL NOT BE CONNECTED WITH YOUR NAME IN ANY WAY. wae (FOR NURSES IN_OFFICES WHICH ARE IN ASSOCIATION, CORPORATION OR GROUP TYPE OF SETTING - "BY ‘ppRoTiCE OR OTHER ARRANGEMENT WITH THREE OR MORE PHYSICIANS) colOR0 | 1. FOR HOW MANY PHYSICIANS DO YOU PERSONALLY WORK? 11-12 (NUMBER OF PHYSICIANS) 1a. WHAT 1S THE PRIMARY MEDICAL SPECIALTY OF THE PHYSICIAN(S) FOR WHOM YOU PERSONALLY 13- WORK? IF YOU WORK FOR MORE THAN ONE PHYSICIAN, CHECK AS MANY AS APPLICABLE. 14- 1 5 15- [0 FAMILY PRACTICE [OO OTHER SurGicaL SPECIALTY (SPECIFY) 2 [J INTERNAL MEDICINE 6 3 [OQ 0ssTETRICS/GYNECOLOGY [J OTHER MEDICAL SPECIALTY 7 (SPECIFY) [0 PebiaTrICS 8 4 [O Other SpeciaLTy (SPECIFY) [CO GeNeErRAL SURGERY 16-17 | 2. HOW MANY DAYS PER WEEK 1S THE TOTAL PRACTICE'S OFFICE OPEN? (FILL IN THE APPROPRIATE 6 BLANK.) TFIXED SCHEDULE: NUMBER OF DAYS) (VARIABLE OR FLEXIBLE SCHEDULE: AVERAGE NUMBER OF DAYs 2a. HOW MANY DAYS PER WEEK DO THE PHYSICIANS FOR WHOM YOU PERSONALLY WORK HAVE OFFICE ow : 18-19 HOURS? (FILL IN THE APPROPRIATE BLANK.) (FIXED SCHEDULE: NUMBER OF DAYS) (VARIABLE OR FLEXIBLE SCHEDULE: Average Numer oF DAYS) 87 20-21 24- 25- 26- 27- 28- 29~ 30- 31- 32- 33~ 3. IN WHAT YEAR WERE YOU BORN? YEAR SEX: (CHECK ONE ANSWER) 2 i (] mee [J Femae 5. WHAT IS YOUR MARITAL STATUS? (CHECK ONE ANSWER) i 3 [J CURRENTLY MARRIED [] D1VORCED/SEPARATED 2 a [1 Wioowen [[] Never maRrIED 6. WHAT IS YOUR RACE? (CHECK ONE ANSWER) 1 2 [] wire [] Necro or BLack {J OtHer (SPECIFY) 7 HOW MANY CHILDREN DO YOU HAVE CURRENTLY LIVING AT HOME? (CHECK ONE ANSWER) i J] NOT APPLICABLE TO ME, NO CHILDREN (SKIP TO QUESTION 9) 2 [CL] None Living AT Home (SKIP TO QUESTION 9) CHILDREN CURRENTLY LIVING AT HOME (WRITE IN NUMBER) 8. WHAT |S THE AGE GROUPING OF CHILDREN LIVING AT HOME? (RECORD NUMBER OF CHILDREN FOR EACH GROUP. |F NONE IN GROUP, RECORD ZERO) (NUMBER OF CHILDREN 6 YEARS OR UNDER) (NUMBER OF CHILDREN 13 TO 16 YEARS) (NUMBER OF CHILDREN 7 TO 12 YEARS) (NUMBER OF CHILDREN 17 YEARS & OLDER) 9. ARE YOU RELATED BY BLOOD OR MARRIAGE TO YOUR PHYSICIAN EMPLOYER? 1 2 [] YES J No : IF YES, WHAT IS THE RELATIONSHIP? 10. WHAT IS YOUR BASIC NURSING EDUCATION? (CHECK ONE ANSWER) i 2 3 [] DipLoma [] Associate Decree [[] BACCALAUREATE OR HIGHER DEGREE 88 35-36 37~ 38- 39 40-47 48-50 51-52 11. IN WHAT YEAR WAS THIS RECEIVED? —_— 12. WHAT 1S THE HIGHEST DEGREE THAT YOU HOLD? (CHECK ONE ANSWER) : 5 LJ DipLoma IN NURSING J MasTER'S IN NURSING 6 [] AssociATe DeGREE IN NURS I NG J MASTER'S IN OTHER THAN NURSING 3 7 [] BaccaLAUREATE IN NURSING [] Doctorate (£.G., PH.D., Ep.D., D.Sc.N.) 4 ( } BACCALAUREATE IN OTHER THAN NURSING 13. WAS YOUR BASIC NURSING EDUCATION RECEIVED IN THE UNITED STATES? (CHECK ONE ANSWER) 1 2 ] YES J No 14. ARE YOU CURRENTLY LICENSED TO PRACTICE AS A REGISTERED NURSE IN ONE OF THE 50 STATES OR THE DISTRICT OF COLUMBIA? 1 2 [] YES [] No 14a. IF YES, IN WHICH STATE(S) DO YOU HAVE A CURRENT LICENSE TO PRACTICE AS A REGISTERED NURSE? 15. HOW LONG HAVE YOU BEEN EMPLOYED IN YOUR CURRENT POSITION? YEARS MONTHS 16. HOW DID YOU FIRST HEAR ABOUT YOUR CURRENT POSITION? (CHECK QNE ANSWER ONLY) 1 [] NEWSPAPER ADVERTISEMENT 4 J] RECOMMENDED BY ANOTHER PHYSICIAN RECOMMENDED BY PATIENT/FRIENDS OR 2 THROUGH MEDICAL SOCIETY 5 [] Eo ENDED / 3 [] THROUGH PREVIOUS SOCIAL RELATION- 6 BECAUSE OF EMPLOYMENT IN HOSPITAL IN SHIP WITH PHYSICIAN WHICH PHYSICIAN 1S AFFILIATED 1] OTHER (SPECIFY) 89 53-54 55-56 57-58 59-61 ~ OTHER (SPECIFY) 17. WHY DID YOU ACCEPT YOUR PRESENT POSITION? (CHECK ONE ANSWER, THE SINGLE MAJOR REASON IN Q. 17 COLUMN) 18, WERE THERE ALSO ADDITIONAL REASONS WHICH INFLUENCED YOUR DECISION TO ACCEPT YOUR PRESENT POSITION? |F YES, CHECK ALL ADDITIONAL REASONS IN Q. 18 coLumN. Q. 17 Q. 18 (CHECK ONE) (CHECK AS MANY AS ARE APPROPRIATE) SALARY AND BENEFITS ATTRACTIVE CONVENIENCE OF WORKING HOURS CONVENIENCE OF LOCATION FAMILY RELATIONSHIP WITH PHYSICIAN WANTED TO WORK FOR THIS PARTICULAR PHYSICIAN(S) INTERESTED IN THE PHYSICIAN®S MEDICAL SPECIALTY PREFER WORKING WITH PATIENTS IN AN OFFICE SETTING ONLY JOB AVAILABLE AT THE TIME uo o-dy or 0-000 00 o~ 0 or o-0O-0- 19. IN WHAT SETTING DID YOU WORK AS A NURSE IMMEDIATELY PRIOR TO THE ONE IN WHICH YOU ARE NOW WORKING? (CHECK ONE ANSWER) 1 8 HAVE NOT WORKED FOR 7] M [J NEARe PRIVATE DUTY ] Nurs iNG Home 2 6 9 OJ THIS IS MY FIRST JOB 1] NURS ING SCHOOL CJ ScHooL AS A NURSE 3 A , 7 0 NOTHER PHYSICIAN'S PuBLic HEALTH AGENCY INDUSTRY LL] Office, _______ YEARs ] [] 4 1] Hospi TAL [] OTHER (SPECIFY) 20. INDICATE THE TOTAL NUMBER OF YEARS YOU HAVE WORKED IN NURSING EMPLOYMENT QTHER THAN OFFICE NURSING. (ROUND OFF TO THE NEAREST YEAR) YEARS 90 62- 63-64 65-66 67-68 69= 70- (80-1) 21. WHAT IS YOUR EMPLOYMENT STATUS? 1] REGULAR FULL-TIME 2 | | REGULAR PART-TIME 3 | | TEMPORARY RELIEF 22. WHAT 1S THE TOTAL NUMBER OF HOURS IN YOUR USUAL WORK WEEK, EXCLUSIVE OF MEALTIME? HOURS 23. DOES YOUR WORK WEEK INCLUDE ANY SPLIT SHIFTS? (CHECK ONE ANSWER) i 4 [C] Yes, EVERY workpAY 1] No Bu YES, SOME DAYS DURING THE WORK WEEK [] OTHER (SPECIFY) __ 3 LC] YES, OCCASIONALLY 24. WHAT TYPE OF COMPENSATION DO YOU RECEIVE FOR HOURS WORKED BEYOND YOUR USUAL WORK WEEK? (CHECK THE APPROPRIATE ANSWER) 1 3 ” DO NOT WORK ADDITIONAL [] Compensatory Time-orr [1 tive anp ONE-HALF PAY HOURS 2 4 | STRAIGHT-TIME PAY [] No COMPENSATION [ OTHER (SPECIFY) 25. DO YOU USUALLY WORK ON SATURDAY? (CHECK ONE ANSWER) 1 3 [] YES, EVERY SATURDAY ] No 2 [] YES, BUT ALTERNATE SATURDAYS [] OTHER (SPECIFY) 26. DO YOU USUALLY WORK ON SUNDAY? (CHECK ONE ANSWER) 1 3 ] YES, EVERY SUNDAY ] No 2 L] YES, BUT ALTERNATE SUNDAYS [] OTHER (SPECIFY) 91 27, 1S THERE AN ESTABLISHED SALARY RANGE FOR YOUR POSITION? (AN ESTABLISHED SALARY RANGE 6- IS DEFINED AS A FORMAL SALARY SCALE WITH A DEFINITE MINIMUM AND MAXIMUM SALARY AND AN ESTABLISHED PLAN TO PROGRESS FROM THE MINIMUM TO MAXIMUM SALARY IN THE RANGE). (CHECK ONE ANSWER) 1 2 Vv [1] ves [] No (SKIP TO Qu. 28) [] Don't know (SKIP TO Q. 2g) (IF "YES" IN QUESTION 27, PLEASE CONTINUE): Zan 27a. WHAT IS THE MINIMUM SALARY WITHIN THE RANGE? $ 12-16 278. WHAT IS THE MAXIMUM SALARY WITHIN THE RANGE? $ _— 27c. HOW LONG DOES IT TAKE TO REACH THE MAXIMUM SALARY? 19-20 | 28. IS YOUR SALARY CALCULATED ON THE BASIS OF: (CHECK ONE ANSWER) i 3 [] HourLY RATE [] WEEKLY RATE ] MONTHLY RATE ] PER PATIENT 2 4 6 [7] Dairy rate [7] Br-weekLy rate [] Anna rate [] OTHER (SPECIFY) 27-26 29. HAT, IS YOUR CURRENT GROSS SALARY (BEFORE DEDUCTIONS FOR SOCIAL SECURITY, INCOME TAX, & ? $ PER 30. HOW ARE YOUR SALARY INCREASES ARRANGED? (CHECK ONE ANSWER) 27 1 |_| RecutarLy scHebuLeD [] other (SPECIFY) 2 V [] DEPENDS ON EMPLOYER [1] Don't Know 31. HOW MANY WEEKS OF PAID VACATION DO YOU RECEIVE PER YEAR? (RECORD NUMBER OF WEEKS) 28- 1 2 [] ONE WEEK LC] Two WEEKS [] Otver (SPECIFY) ~~~ ~~ 32. HOW MUCH PAID SICK LEAVE DO YOU RECEIVE? 29-31 | , 3 [1 Pato sick Leave DAYS [[] [INoiviouaL ARRANGEMENT wiTH PER YEAR EMPLOYER 2 [] No PAID sick LEAVE [] OTHER (SPECIFY) 92 33. IF EMPLOYED IN THIS OFFICE THE ENTIRE YEAR OF 1972, HOW MANY PAID HOLIDAYS DID YOU RECEIVE? (Recorp NUMBER OF DAYS) 32-33 0 ] EMPLOYED IN THIS OFFICE ONLY PART OF 1972 34-35 34. WHAT KIND OF EMPLOYEE BENEFITS DO YOU HAVE FOR WHICH YOUR EMPLOYER PAYS EITHER ALL OR PART OF THE PREMIUMS? (CHECK THOSE INSURANCE PLANS WHICH YOU HAVE THROUGH YOUR EMPLOYER) i [] RETIREMENT OR PENSION PLAN OTHER THAN SOCIAL SECURITY (THE KEOGH PLAN, ETC.) 4] HosP I TALI ZATION AND/OR MEDICAL/SURGICAL INSURANCE 4 NURSES' PROFESSIONAL LIABILITY (MALPRACTICE) INSURANCE 4 5 0 [] LIFE INSURANCE [] PROFIT SHARING [] OTHER (SPECIFY) [] NoNE 35. DO YOU RECEIVE A BONUS IN ADDITION TO YOUR REGULAR SALARY? (CHECK ONE ANSWER) 36- 1 2 3 v [] YES, EACH YEAR [] YES, SOME YEARS [] No [] DON'T KNOW 36. |S TIME OFF GRANTED FOR ATTENDANCE AT PROFESSIONAL OR INSERVICE EDUCATION MEETINGS 37- DURING YOUR WORKING HOURS? (CHECK ONE ANSWER) 1 J YES, WITH PAY OC] No, NOT ALLOWED ] OTHER (SPECIFY) [3 YES, WITHOUT PAY u Don't Know, NEVER ASKED 37. DO YOU SUPERVISE OTHER REGISTERED NURSES IN YOUR OFFICE SETTING? 1 38- YES: INDICATE NUMBER OF REGISTERED NURSES SUPERVISED 39-40 2 ] No; | AM THE ONLY REGISTERED NURSE IN OFFICE SETTING 3 1 No; OTHER REGISTERED NURSES IN OFFICE SETTING, BUT | DO NOT SUPERVISE THEM 93 41- 42- 43- 49- 50- 38. ON EACH LINC BELOW, CHECK THE APPROPRIATE BOX OR BOXES INDICATING WHICH PERSONNEL IN YOUR OFFICE REGULARLY PERFORMS THESE AS PART OF THEIR JOB. } REGISTERED NURSE STAFF OTHER THAN SERVICE YOURSELF OTHERS PHYSICIAN RN_OR PHYSICIAN 2 — 4 = REMOVES SUTURES LJ ! LC] PERFORMS SOME on hls 2 3 4 5 PORTIONS OF WELL/SICK 3 — i a PATIENT EXAMINATIONS | [] li L (INCLUDING EARS, EYES, HEART, NEUROLOGICAL EXAMS) 2 4 CHANGES DRESSING [ | i : 2 4 TAKES TEMPERATURE OR : — — BLOOD PRESSURE | y | COORDINATES PATIENT TREAT- 2 MENT PLAN WITH OTHER f AGENCIES LJ 2 APPLIES CAST APPLICATIONS 1] . } - | 2 } TEACHES PATIENTS FAMILY Lo ! PLANNING ol TAKES PATIENT'S MEDICAL HISTORY PERFORMS URINALYSIS, HEMOGLOBIN OR HEMOCRIT COUNSELS AND INSTRUCTS PATIENT IN MANAGEMENT OF A DEFINED ILLNESS ARPANGES APPOINTMENTS Ob CO Oi Ch | Oe 0-0 Oe Ow Ue ee Ue 0 0-3-1 0 Oe O- 0-0 COMPLETES INSURANCE FORMS U-o-o-o0- Oooo o-o-0- oo OOO [FEE 2 3 4 rm— Tr — EVALUATES FAMILY HEALTH [I Ld _1 MAKES SUGGESTIONS TO 2 3 4 PHYSICIAN RF: PATIENT : NEED Ld = 2 - 3 4 REMOVES EAR WAX 1 3 4 MAINTAINS OFFICE SUPPLIES 2 : AND EQUIPLENT r 2 3 4 TAKES Y “PAYS | | ARRANGE PATIENT APPOINT= 2 3 4 MENTS 11 COMMUNITY HEALTH - FACILI1IFS OR FACILITIES L Ll [] OUT OF 1HE COMMUNITY Oe Clo Ov Fe Oo Oe Ck 0-0 Ol [Ce Co Co Ch Ce Le 94 59~ 60- 61~ 63- 66- 67- 68- 69~ 74 73= 74- (80-2) MAKES DECISIONS INDEPEND- ENTLY REGARDING HANDLING OF TELEPHONE CALLS TEACHES PATIENTS DIET AND/OR NORMAL NUTRITION CHECKS FETAL HEART BEAT Ass1STS PHYSICIAN DURING PATIENT EXAMINATION PREPARES FOR/OR ADMINIS= TERS FIRST AID MAINTAINS MEDICAL SUPPLIES AND EQUIPMENT EXPLAINS DOCTOR'S FEES TO PATIENTS TAKES VAGINAL SMEARS {INCLUDING PAP) ADMINISTERS IMMUNIZATIONS AND PARENTERAL DRUGS DOES TONOMETRY TESTING INSTRUCTS PATIENT RE: PREPARATION FOR TESTS/ EXAMS MAINTAINS PATIENT RECORD FILES MAKES WELL/SICK PATIENT ASSESSMENT TEACHES PATIENT HOW TO CARE TOR THEMSELVES SENDS OUT PATIENT BILLS TESTS VISION INSTRUCTS AND ASSISTS PATIENT IN EXERCISE PROGRAM TEST HEARING 5 = = 5 im — ~~ 0-0-0 o-o0-o0-0- 0-0-0 Me C1- [- I [= REGISTERED NURSE w Jo Os [Or Oe Oc > O~ OO» Oe D> Dr Ch De of Iv [ boss bo Io [1] [== 1 Oe Ce Lo Lee Ow Oe Oe Oe Oe Oe Oe Oe Oe Oe De Le PHYSICIAN oe 0-0-0. O° 0 0s 2-0-0 0s De Ue 8 Ls LE STAFF OTHER THAN RN OR PHYSICIAN be Le To [Le [do Oe [Ze OL | 1o [| on CeO Oe Oe Oe Hb 95 9-11 12-13 15- 16~ 39. DO YOU PERFORM ANY SPECIAL OR UNIQUE PATIENT CARE PROCEDURES AS PART OF YOUR REGULAR JOB? (E.G., USING SPECIAL EQUIPMENT) 1 2 ] YES [] No (IF "YES" NAME PROCEDURES) 40. DO YOU ASSIST THE PHYSICIAN IN PERFORMING ANY SPECIAL OR UNIQUE PATIENT CARE PROCEDURES AS PART OF YOUR REGULAR JOB? 1 2 ] YES [] No (IF "YES" NAME PROCEDURES) 41. PLEASE INDICATE WHICH OF THE FOLLOWING OQUT-OF-QFF | CE PATIENT CARE ACTIVITIES YOU PERFORM IN CONNECTION WITH YOUR JOB? (CHECK ALL APPLICABLE ANSWERS) i 3 S C] No PATIENT-CARE OUT-OF- [] VISIT PATIENTS IN ro VISIT PATIENTS AT OFFICE DUTIES HOSP I TAL ' HoME 2 4 SCRUB FOR PHYSICIAN RECEIVE PATIENT OTHER (SPECIFY) [] IN HOSPITAL TELEPHONE CALLS AT [] HOME 42, ARE THERE TIMES WHEN THE PATIENT VISITS THE OFFICE TO SEE ONLY YOU? 1 2 [] ves [] No (SKIP TO QUESTION 43) 42a. [F "YES" HOW OFTEN DOES THIS HAPPEN? 1 2 3 [1] REGULARLY [] OccAasioNALLY [] SELDOM 428. FOR WHAT REASONS DO THE PATIENTS COME TO SEE YOU? 1 2 [] RECEIVE INJECTIONS [] RECEIVE TREATMENTS [] OTHER (SPECIFY) 96 19-20 2% 22-24 43, ARE THERE TIMES WHEN THE PATIENT CALLS BY TELEPHONE TO TALK SPECIFICALLY TO YOU? 1 2 ves [] No (SKIP TO QUESTION 44) 43A. IF "YES" HOW OFTEN DOES THIS HAPPEN? 1 2 i FREQUENTLY | | INFREQUENTLY 44, PRIOR TO YOUR [MPLOYMENT IN A PHYSICIAN(S) OFFICE DID YOU TAKE ANY SPECIAL PREPARATION FOR THTS EMPLOYMENT? 1 2 [] YES (INDICATE THE SPECIALTY [] No PROGRAM TAKEN) 45. HAVE YOU PERSONALLY PARTICIPATED IN ANY TYPE OF CONTINUING EDUCATIONAL PROGRAMS RE- GARDING NURSING OR RELATED HEALTH FIELDS WHILE YOU HAVE BEEN EMPLOYED IN A PHYSICIAN(S) OFFICE? 2 1 [ ] Ves [ ] No (SKIP TO Q. 46) ND 7 IF YES, INDICATE THE TYPES OF PROGRAMS YOU HAVE PARTICIPATED IN DURING THE PAST FIVE YEARS. (CHECK ALL APPLICABLE ANSWERS) [I 1 NONE IN THE PAST FIVE YEARS | L TAKEN COLLEGE COURSE FOR CREDIT ATTENDED NURSING SCHOOL ALUMNI ASSOCIATION CLINICAL NURSING PROGRAMS ATTENDED WORKSHOPS = I Jo — on | k ATTENDED PHYSICIANS' ROUNDS/LECTURES ATTENDED INSERVICE EDUCATION SEMINARS/LECTURES ~ ATTENDED NURSING OR HEALTH MEETINGS, CONFERENCES, OR CONVENTIONS eg] MADE HOSP I TAL/NURSING ROUNDS TAKEN SPECIALTY PREPARATION IN A SPECIALTY FIELD (SPECIFY: ) [|e [Je OTHER (SPECIFY: ) 97 27-28 29-30 i 32- 33-34 46. ARE YOU CURRENTLY ENROLLED IN ANY NURSING SPECIALTY EDUCATIONAL PROGRAM? 1 2 YES, SPECIFY SPECIALTY [] No 47. WHAT CONDITIONS WOULD FURTHER ENCOURAGE YOU TO PARTICIPATE IN CONTINUING EDUCATION PROGRAMS? (CHECK ALL APPLICABLE ANSWERS) 4 6 [] ESTABLISHMENT OF CONVENIENTLY Fan NEED AT THIS IF JoB REQUIRES LOCATED APPROPRIATE EDUCA- IT TIONAL PROGRAMS 2 5 [] TUITION FREE COURSES RELEASED TIME FROM THE JOB FOR PARTICIPATION 3 MM] CHILD CARE FACILITIES AVAILABLE [] omer (sPECIFY) 48. WHAT NURSING/MEDICAL/HOSP I TAL/PROFESSIONAL JOURNALS DO YOU USUALLY READ? (CHECK ALL APPLICABLE ANSWERS) x 3 5 AMER1CAN JOURNAL OF 7 AORN JourNnaL RN MAGAZINE [] Nursing (AJN) [] [J 0 2 4 r= [] JOURNAL OF AMERICAN 7] MEDICAL [ OTHER (SPECIFY) None 1 MepicaL ASSOCIATION Economics ; 49. PLEASE INDICATE NURSING ORGANIZATIONS OR OTHER ORGANIZATIONS HAVING RELEVANCE TO pu TO YOUR JOB IN WHICH YOU CURRENTLY HOLD MEMBERSHIP. (CHECK ALL APPLICABLE ANSWERS | AMERICAN NURSES' ASSOCIATION 3 OTHER (SPECIFY) NaTioNAL LeaGue For NURSING 50. DO YOU GENERALLY FAVOR OR OPPOSE EXPANDING THE NURSE'S ROLE TO INCLUDE MORE PATIENT CARE ACTIVITIES PREVIOUSLY DONE BY THE PHYSICIAN? (CHECK ONE ANSWER) 1 2 3 4 | IN FAVOR OF IT | OPPOSED TO IT , No CURRENT NEED FOR IT No oPiINiON 51. WHAT CONDITIONS WOULD ENCOURAGE EXPANSION OF YOUR NURSE'S ROLE? (CHECK ALL APPLICABLE ANSWERS ) 1 3 , 5 Tr ADDITIONAL EDUCATION AND rm PHYSICIAN'S PERMISSION r LEGAL PROTECTION TRAINING [ | NEepED [] FOR THE NURSE 2 4 1 RELIEF FROM CLERICAL AND NOT INDICATED FOR MY i } OTHER (SPECIFY) BOOKKEEPING WORK [1 CURRENT POSITION 98 36-37 38- 39-40 (80-3) 52., ARE THERE FUNCTIONS RELATED TO PATIENT CARE WHICH YOU FEEL YOU COULD CARRY OUT BUT WHICH ARE NOT CURRENTLY CONSIDERED A PART OF YOUR DUTIES? (CHECK ONE ANSWER) i 2 [1 ves [1] No (skip 10 q. 53) 52a. (IF "YES" SPECIFY FUNCTIONS). 53. IF IT WERE POSSIBLE TO HAVE ADDITIONAL STAFF IN YOUR OFFICE, ARE THERE RESPONSIBILITIES, DUTIES WHICH YOU ARE NOW PERFORMING WHICH YOU FEEL COULD AND SHOULD BE CARRIED OUT BY OTHER WORKERS? 1 2 L] YES ] No 53a. (IF "YES" INDICATE THESE RESPONSIBILITIES/DUTIES AND WHO SHOULD PERFORM THEM). 54. USE THIS SPACE FOR ADDITIONAL COMMENTS. (IF THERE ARE OTHER RNS IN YOUR OFFICE WHOSE DUTIES ARE DIFFERENT FROM YOURS, PLEASE COMMENT ABOUT THE DIFFERENCE). PLEASE INCLUDE YOUR NAME AND ADDRESS IF YOU WOULD LIKE TO RECEIVE A SUMMARY REPORT OF THIS SURVEY. Name ADDRESS DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE PUBLIC HEALTH SERVICE POSTAGE AND FEES PAID U.S. DEPARTMENT OF H.E.W. HEALTH RESOURCES ADMINISTRATION nr 390 BETHESDA, MARYLAND 20014 OFFICIAL BUSINESS PENALTY FOR PRIVATE USE $300 DHEW Publication No. (HRA) 75-50 US. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE Public Health Service ® Health Resources Administration U.C. BERKELEY LIBRARIES C095457179