than full time) in counseling, and 26,000 who spent less than half time in counseling. Nearly three out of four of these counselors were employed in junior and senior high schools. Almost half of the counselors in public secondary schools were men; the proportion of women was much higher in elementary schools.

There is great variation among States and among city school systems within a State in the emphasis placed on counseling and the employment of specially trained counselors. In general, large schools in urban areas are more likely to employ specialized counselors than are smaller schools in rural areas.

Training and Other Qualifications

All school counselors must have State teaching certificates. In addition, as of mid-1958, 29 States and the District of Columbia required special certificates for school counseling. Special certification was provided for but was optional in seven other States. Counselor certification requirements in most States include a master's degree or its equivalent in counselor education as well as several years of teaching experience. At least 1 year of work experience other than teaching is requirement in about half the States providing for certification.

College students preparing to be school counselors usually follow the regular curriculum for teacher education on the undergraduate level; in addition, courses in psychology and sociology are desirable. Most employers prefer that counselors have teaching experience before or while studying for the advanced degree in guidance. In some school systems, teachers who have completed half of the required courses for a master's degree may counsel under supervision while studying additional subjects. Among the subjects usually required are those dealing with the counseling process, understanding the individual, and educational and occupational information. Supervised practice in guidance is included in many training courses. Some knowledge of statistics is necessary for interpreting tests.

It is especially important for counselors to be well adjusted, even tempered, and able to inspire the confidence of students. In a recent survey, school principals given a list of qualifications indicated that they considered the following items

most important in selecting counselors: (a) personality factors, such as emotional stability and maturity, (b) successful teaching experience before entry into counseling, and (c) graduate study in guidance.

An experienced counselor may advance to a position as head of the guidance department of a large school or director of guidance with the county or city board of education. Related fields of employment for persons with guidance training include student personnel work in colleges, work in public or private vocational guidance centers, or industry personnel work.

Employment Outlook

Employment of school counselors, which has risen rapidly since World War II, is expected to increase through the early 1960's. The shortage of qualified counseling personnel appeared, in 1958, to be the major factor limiting the expansion of employment.

In the next few years, the number of openings for counselors is expected to rise both as a result of the expansion of existing counseling activities and the introduction of counseling services in schools that do not now offer them. Estimates made by public school principals in 1956 indicated that about 75,000 persons might be engaged, full time or part time, in counseling by 1960-61– roughly two-thirds more than 5 years earlier. Guidance programs in elementary schools may expand at a rate greater than in secondary schools. Estimates made by principals of elementary schools in 1956 suggested an increase of as much as 18,000 by 1960 in the number of staff members doing some counseling work. Principals also looked forward to having relatively more counselors who would devote full time to counseling activities. Schools will be assisted in strengthening their counseling activities by Federal legislation (National Defense Education Act) enacted in 1958. This provides for financial aid to States to assist in the training of counselors and in establishing guidance programs.

In the long run, the extension of guidance services, the continuing rise in school enrollments, and the replacement of counselors who leave the field should provide an increasing number of openings for qualified workers. However, employment opportunities in particular areas will depend upon

such factors as the wealth of the community and the opinion of school administrators and the general public concerning the need for such services. Although school principals appear desirous of establishing better guidance programs, the problem of financing these services is often a difficult one. In recent years, however, budget allocations for counseling activities have been growing and this trend is expected to continue. There is a growing awareness of the value of guidance services in helping to solve problems pertaining to juvenile delinquency, school dropouts, occupational choice, and job dissatisfaction. Moreover, the importance of identifying and counseling talented students, especially in critical occupational areas such as science and engineering, is focusing attention on the role of the school counselor.

Earnings and Working Conditions

Many school counselors have annual earnings somewhat higher than those of classroom teachers with similar educational preparation and experience. (See statements on elementary and secondary school teachers.) Some counselors work 1 or 2 months more each year than classroom teachers. Furthermore, some school systems pay counselors an additional amount which is not dependent on the length of their work year.

In most school systems, counselors receive regular salary increases as they gain additional counseling experience and education. Directors

and supervisors of guidance in urban school districts of 10,000 to 30,000 population had median (average) salaries of about $5,600 in 1956–57; those in smaller districts made somewhat less and those in large districts made much more, on the average. A few counselors supplement their income by writing textbooks or acting as consultants for private or public counseling centers, government agencies, or private industry.

Where To Go for More Information

Information on specific certification requirements for counselors and institutions offering guidance training is available from the State department of education at each State capital. Information on certification requirements is also contained in the following publication: Guidance Workers Certification Requirements, U.S. Department of Health, Education, and Welfare, Office of Education, Bulletin No. 22, 1957. Available from Superintendent of Documents, Washington 25, D.C. Price 25 cents.

Information on counselor training, under the National Defense Education Act, and on other provisions of the act pertaining to State and local guidance programs is available from the U.S. Department of Health, Education, and Welfare, Office of Education, Washington 25, D.C. General information on the occupation of school counselor may be obtained from:

American Personnel and Guidance Association, 1605 New Hampshire Ave. NW., Washington 9, D.C.

Nearly everyone knows something about what doctors, dentists, and pharmacists do. Many people also have some first-hand knowledge of the duties of nurses, attendants, and other workers who take care of patients in hospitals. Less well known but likewise of great importance to the public health are the large number of people employed behind the scenes in other health service occupations such as laboratory or X-ray technician. Altogether, nearly two million people were employed in the health field in 1955.

Nurses, physicians, pharmacists, and dentists make up the largest of the professional health occupations; in 1955, numbers in these occupations ranged from about 100,000 dentists to more than 425,000 nurses. Among the smaller professions are those of the dietitian, optometrist, chiropractor, veterinarian, and osteopathic physician. Other health service workers, whose jobs generally require less training, include technicians of various types, as well as practical nurses, hospital attendants, and nursing aids. (See p. 269.)

Workers in the health field are employed in many kinds of places including hospitals, clinics, laboratories, pharmacies, nursing homes, industrial plants, private offices, and patients' homes. Those employed in health-related occupations are concentrated in the heavily populated and wealthy sections of the Nation and in big cities, but there are some in every village and town.

The health occupations are a major source of employment for women. Nursing, the largest of the major health service occupations, is second only to teaching as a field of professional employment for women. More than 9 out of 10 registered nurses are women; this is true also of practical nurses and dietitians. Women account for some

what more than half the employed hospital attendants and medical and dental technicians.

Men predominate in most of the professional health occupations and account for at least 90 percent of all dentists, optometists, physicians, veterinarians, and pharmacists. These professions provide numerous opportunities for independent practice.

Health occupations offer employment opportunities for people at all levels of education. For example, in order to practice as a physician, dentist, or pharmacist, it is necessary to complete several years of preprofessional and professional college-level education and pass a State licensing examination. Less formal education-in many cases, high school plus 1 or 2 years of technical training is needed to become a medical laboratory or other technician in the health field. Many health service occupations, including those of the practical nurse and hospital attendant, can usually be entered with still less training.

Employment in the health fields has been increasing and is expected to continue to grow. The country's expanding population and the rising health consciousness of the general public will be reflected in a growing demand for medical, dental, nursing, and other health services. In addition, such factors as the extension of hospitalization and other medical insurance plans, the rapid expansion of expenditures for medical research, and continued provision of health care for veterans and members of the Armed Forces and their families point toward the need for additional health personnel. Moreover, many new workers will be needed each year to replace those who retire, die, or-particularly in the case of women -leave the field for other reasons. Thus, there will be many opportunities for employment in the health occupations over the next decade.

Nature of Work and Where Employed

Registered professional nurses furnish nursing services to patients, either by giving direct nursing care or by supervising allied nursing personnel. As the persons with primary responsibility for carrying out physicians' instructions and with independent nursing duties, professional nurses are important members of the medical health team. Generally, their main concerns are: Care of the sick and injured, prevention of illness, and promotion of good health. They perform such tasks as administering medications and treatments prescribed by a physician; observing, evaluating, and recording symptoms, reactions, and progress of patients; assisting in patient education and rehabilitation; improving the physical and emotional environment of patients; and instructing auxiliary nursing workers or students.

The 460,000 professional nurses employed at the beginning of 1958 made up the largest group of health workers; more than 50,000 of them were working part time. Nurses may be located almost anywhere in the country, since virtually all communities maintain some health facilities and services. About 98 percent of all nurses are women, although an increasing number of men are entering the profession.

In the nursing field, there are several distinct groups of professional nurses specializing in a particular type of patient care and treatment. The largest group of professional nurses (about 63 percent of the total) are hospital nurses, who are concerned mainly with the care and welfare of patients in hospitals and related institutions. Most are general duty nurses, who usually perform the more skilled bedside services, such as caring for a patient after an operation, assisting with blood transfusions and intravenous feeding, and giving medications. General duty nurses often assign to auxiliary workers other duties requiring less extensive training. Some hospital nurses are engaged primarily in administrative or supervisory work. Others specialize in a certain type of service, such as caring for mothers and

Prepared by the Women's Bureau, U.S. Department of Labor.

new babies or assisting physicians in the delivery room or in the operating room.

Private duty nurses (about 15 percent of all professional nurses) are employed directly by patients or their families to give individual nursing care, usually when constant attention is needed. Private duty nurses work in hospitals and patients' homes, frequently in situations which require a considerable degree of independent judgment, since a doctor may not be readily available.

The third largest group of professional nurses are office nurses (approximately 8 percent of the total). Employed mainly by physicians in private practice or in medical clinics and occasionally by dentists, office nurses assist in the care of patients; may perform routine laboratory work; and may also take care of a doctor's appointments, records, and other officework.

Public health nurses (about 6 percent of all professional nurses) are employed by public and private health agencies, including city and county health departments, visiting nurse associations, and schools. They may visit patients in their homes or work in clinics, schools, or offices. Especially concerned with promoting good health and preventing disease and injury, public health nurses may work with community leaders, teachers, parents, and physicians in planning or operating a community health education program. Their diverse duties may include giving first-aid treatment or periodic nursing care as prescribed by a physician, helping prepare booklets and charts on home health and sanitation, demonstrating diet plans to groups of patients, and providing information on disease prevention to families of migrant workers.

Sometimes called industrial nurses, occupational health nurses (about 4 percent of all nurses) give nursing care principally to company employees in business and industry. Interested mainly in keeping employees well and on the job, they may work alone (with a doctor on call) or may be part of a health service department in a large organization. They give emergency treatment for injuries and minor illnesses occurring

at work, arrange for further medical care when necessary, and offer health counseling. They may also assist with health examinations, keep health records of employees, and help develop programs to prevent or control occupational diseases or accidents.

To prepare nursing personnel, nurse educators (3 percent of all nurses) are employed by hospital nursing schools, colleges and universities, public vocational schools, and schools of practical nursing. Their primary duty is to teach students the principles and skills of nursing, both in the classroom and at the bedside. They devise teaching methods, help beginners put nursing theory into practice, and recommend facilities and materials needed in training.

Nurses are also engaged in numerous other specialties as, for example, performing research and analysis of nursing services and serving as executives of professional organizations or on State boards of nursing. Branches of the military service employ professional nurses as commissioned officers, and there are some nurses working overseas for social, religious, and welfare agencies or for the Federal Government.

Training, Other Qualifications, and Advancement

Three types of training programs, namely diploma programs, baccalaureate degree programs, and associate degree programs, offer the preparation required for professional nursing. Traditional diploma programs are conducted by hospital schools and last 3 years. The programs leading to a baccalaureate degree require 4 years of study in a college or university. The newer associate degree programs being introduced into an increasing number of junior and community colleges last approximately 2 years. In the fall of 1958, there were 1,164 programs of these three types in the United States and they had enrolled 113,518 students. Among these, there were 92,419 diploma students (81 percent), 19,195 baccalaureate students (17 percent), and 1,904 associate degree students (2 percent).

Graduation from high school is required for admission to all schools of nursing. Many schools accept only graduates in the upper third or half

years of age, but in most schools the upper-age limit has been relaxed.

In both hospital and collegiate schools, nursing preparation includes classroom work and clinical experience (actual nursing practice). The timing and location of these vary, of course, in different schools. Generally, the first few months, known as the preclinical period, are spent in the classroom-learning the fundamentals of such subjects as anatomy, physiology, microbiology, nutrition, psychology, and basic nursing care. Thereafter, nursing students are assigned to various hospital services and learn how to care for different types of patients. They work, for example, with medical and surgical patients, nursing mothers and children, orthopedic patients, and those with eye, ear, nose, and throat problems. In many collegiate schools, nursing students are assigned also to public health nursing agencies and learn how to care for patients in their homes.

In all good schools of nursing, general education is combined with nursing education. Usually, baccalaureate degree programs require that at least half the training time be spent on general academic subjects and the remaining time on nursing courses and practice. The associate degree programs, which also emphasize general education, include consolidated nursing courses and a minimum amount of repetitive nursing practice.

Tuition and other educational expenses vary widely among schools of nursing, ranging from no cost to $2,000 a year. In some hospital schools, services performed for the hospital by the nursing students compensate for all or part of the training costs. Colleges and universities, on the other hand, charge their regular fees for a full college curriculum. Tuition at junior and community colleges is usually less expensive than in other colleges and universities. Scholarships and loans for nursing education are available from nursing schools, colleges and universities, various civic and professional organizations, women's clubs, and business groups. One foundation recently granted scholarship assistance to candidates for baccalaureate degrees in nursing at 32 colleges and universities. For graduate work in nursing administration, supervision, and education, as well as for public health work, financial assistance

ence and mathematics may also be required. Some

schools admit only persons between 17 and 35

tered by the United States Public Health Service, as well as from many private and public agencies.