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DOCUMENT RESUME

CE 017 782

Health Occupations. Dental Auxilia.u.Les, Nursing,Therapy and Rehabilitation, Health ServicesAdministration. Reprinted from the OccupationalOutlook Handbook, 1978-79 Edition.Bureau of Labor Statistics (DOL), Washington, D.C.Bull-1955-287825p.; Photographs in this document will not reproducewell; Por related documents see CF 017 756-797Superintendent of Documents, O.S. Gtvernment PrintingOffice, Washington, D.C. 20402 ($0.50 per reprint;$8.00 for set of 42)

MP-$0.83 HC-$1.67 Plus Postage.Administrative Personnel; Dental Hygienists; DentalTechnicians; Dentists; *Employment' Opportunities;*Employment Projections; *Employment Qualifications;Employment Trends; *Health Occupations; *HealthPersonnel; Hospital Personnel; Information Sources;Job Skills; Job Training; Nurses; Nurses Aides;*Occupational InformationrOccupational.Mobility;Occupational Therapy Assistants; Physical Therapists;Physic/1 Therapy Aides; Practical Nurses; Promotion(Occupational); Salaries; Speech Therapists;Therapists; Wages; Work Environment

ABSTRACTFocusing on health occupations, this document is one

in a series of 'forty -one reprints from the Occupational OutlookHandbook providing current information and employment projections forindividual occupations and industries through 1985. The specificoccupations covered in this document include dental assistants,dental hygienists, dental laboratory technicians, health servicesadministrators, nursing occupations (registered nurses, licensedpractical nurses, nursing aides, orderlies, and attendants), andtherapy and rehabilitation occupations (occupational therapists,occupational therapy assistants/aides, physical therapists, physicaltherapist assistants/aides, speech pathologists, and audiologists).The following information is presented fur each occupation oroccupational area: a cede number referenced to the Dictionary ofOccupational Titles; a description of the nature of the work; placesof employment; training, other qualifications, and advancement;employment outlook; earnings and working conditions; and sources ofadditional ,information. In addition to the forty-one reprintscovering individual occupations or occupational areas (CE 017757-797), a companion document (CE 017 756) presents employmentprojections for the total labor market and discusses the relationshipbetween job prospects and education. (BM)

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DENTAL ASSISTANTS

(D.O.T. 079.378)

Nature of the Work

Dental assistants work with den-tists as they examine and treat pa-tients. The assistant makes the pa-tients comfortable in the dentalchair, prepares them for treatment,and obtains their dental records. Theassistant hands the dentist the properinstruments and materials and keepsthe patient's mouth clear by usingsuction or othei- devices. Dental as-sistants prepare materials for makingimpressions and restorations and ex-pose radiographs and process dentalX-ray film as directed by the dentist.They also provide oral health instruc-tion and prepare instruments for ster-ilization.

Dental assistants perform a varietyof duties that do not require thedentist's professional knowledge andskill. Some assistants make casts ofthe teeth and mouth from impres-sions taken by the dentist. Thesecasts are used by dentists and techni-cians to make dentures. In someStates, assistants apply medicamentsto the teeth and oral tissue, removeexcess cement used in the filling pro-cess from surfaces of the teeth, -andPlace rubber dams on the teeth toisolate them for individual treatment.Some dental assistants manage theoffice and arrange and confirm ap-pointments, receive patients, keeptreatment records, send bills, receivepayments, and order dental suppliesand materials.

The work of the dental assistantshould not be confused with that ofthe dental hygienist, who must belicensed to scale and polish the teeth.(See statement on dental hygienistselsewhere in the Handbook.)

Places of Employment

Nearly 135,000 persons worked asdental assistants in, 1976; about 1 outof 10 work part time.

Most dental assistants work in pri-vate dental offices, either for individ-ual dentists or for groups of dentists.Many of the remainder work in den-tal schools, hospital dental depart-meats. State and local public health

2

departments, or private clinics. TheFederal Government employs dentalassistants, chiefly in the PublicHealth Service, the Veterans Admin-istration, and the Armed Forces.

Training, Other Qualifies ons,and Advancement

Most dental assistant.f learn theirskills on the job. An increasing num-ber, however, are trained in formalpest-high school programs. Aboui280 'such programs were accreditedby the American Dental Association(ADA) in 1976.

Most post-high school courses indental assisting are given in juniorand community colleges or in voca-tional or technical schools. Morethan three-fourths of these programs

take 1 year to complete and lead to acertificate or diploma. Graduates of2-year programs offered in juniorand community colleges earn an as-sociate degree upon completion ofspecialized training and liberal artscourses. The minimum requirementfor any of these programs is a highschool diploma or its equivalent.Some schools also require typing or ascience course for admission. Al-though some private schools offer 4-to 6-month courses in dental assist-ing, these are not accredited by the'dental profession. Those receivingdental assistant training in the ArmedForces usually qualify for civilianjobs as dental assistants.

High school students interested incareers as dental assistants should

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Most dental assistants learn tneir skills on the sob.

take courses in biology, chemistry,health, typing, and office practices.

Approved dental assisting curricu-lums include classroom and laborato-ry instruction in skills and relatedtheory. Trainees get practical experi-ence in affiliated dental schools, lo-cal clinics, or selected dental offices.

A correspondence course accred-ited by the American Dental Associ-ation is available for employed dentalassistants who are learning on the jobor who otherwise are unable to par-ticipate in regular dental assistingprograms on a full-time basis. Thecorrespondence program is equiv-alent to 1 academic year of study, butgenerally requires aboat 2 years tocomplete.

Graduates of accredited dentalassistant programs who successfullycomplete an examination adminis-tered by the Certifying Board of theAmerican Dental Assistants Associ-ation become Certified Dental Assis-tants. Certification is acknowledge-ment of art assistant's qualificationsbut is not generally required for em-ployment.

After working as dental assistants,some individuals seek to acquireskills and qualifications for practic-ing as dental hygienists. Prospectivedental assistants who foresee thispossibility should plan carefully sincecredit earned in a dental assistantprogram often is not applicabletoward requirements for a dental hy-giene certificate. Some dental assis-tants ecome sales representativesfor arms that manufacture dentalproducts.

Employment Outlook

Employment opportunities fordental assistants are expected to beexcellent through the mid- 1980's, es-pecially for graduates of academicprograms in dental assisting. Part-time opportunities also will be veryfavorable.

Employment of dental assistants isexpected to grow much faster thanthe average for all occupations,largely because recent graduates ofdental schools have been taught touse assistants in their practice. Theincrease in the demand fur dentalservices which stems from popula-tion growth, a growing awareness of

the importance of regular dentalcare, and the increasing ability ofpeople to pay for care also will con-tribute to the demand for dental as-sistants. For example, increased par-ticipation in dental prepayment plansand public programs such as Medi-caid bring dental services within thereach of many who could not affordthem otherwise.

In addition to job openings createdby growth in the demand for dentalassistants, thousands of assistantsalso will be required each year toreplace thine who leave the field.

Earnings and WorkingConditions

Salary depends largely on the assis-tant's education and experience, theduties and responsibilities attachedto the particular job, and geographiclocation. .

In the Federal Goieernment,'expe-rience and the am ant and type ofeducation determi e entrance sala-ries.ries. In 1977, a hig school graduatewho had 6 month i of general experi-ence started at $7,408 a year; gradu-ates of an ADA-approved i -yeartraining program who had an addi-tional year of general experiencecould expect to start at $8,316 ayear. In general, experienced dentalassistants working for the FederalGovernment in 1977 earned averageannual salaries of $9,100. ..

Although the 40-hour workweekprevails for denial assistants, theschedule is likely fo include work onSaturday. A 2- or,3-week paid vaca-tion is common. Some dentists pro-vide sick leave and other benefits.Dental assistants1who work for theFederal Government receive thesame employee benefits as otherFederal workers.

Dental assistants work in a well-lighted, clean environment. Theymust be careful in handling radio-graphic and other equipment.

Sources of Additionalinformation

Iniormation about career opt. artu-nines, scholarships, accredited den-tal assistant progiams, including theLorrespondence program, and re-

quirements for certification is avail-oble from:American Dental Assistants Association, 211

E Chicago Ave., Chicago, III. 606t I.

Other material on opportunitiesfor dental assistants is available from:

Division of Dentistry. Public Health Service.U S tepartment of Health, Education.and Welfare. 9000 Rockville Pike. Be.thesda. Md. 20014.

DENTAL HYGIENISTS

(D.O.T. 078.368)

Nature of the Work

Dental hygienists are oral healthclinici'ans and educators who helpthe public develop and maintaingood oral health. As members of thedental health team, dental hygienistsmay perform preventive and thera-peutic services under the supervisionof the dentist. Specific responsibil-ities of the hygienist vary, dependingon the law of the State where thehygienist is employed, but may in-clude: removing deposits and stainsfrom patients' teeth; providing in-structions for patient seIf-care, anddietetic and nutritional counseling;and the application of medicine forthe prevention of tooth decay. Theytake medical and dental histories, ex-pose and develop dental X-ray films,make model impressions of teeth forstudy, and prepare other diagnosticaids for use by the dentist. Pain con-trol and restorative procedures alsomay be performed by dental hygien-ists in some States.

Dental hygienists who work inschool systems serve in several ca-pacities. Clinical functions include:examination of children's teeth, as-sistance to the dentist in determiningthe dental treatment needed, and re-porting of their findings to parents.They also scale and polish teeth andgive instruction on proper mouthcare. In addition, they develop class-room or assembly programs on oralhealth.

A few dental hygienists assist inresearch projects. Those having ad-vanced training may teach in schoolsof dental hygiene.

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Dental hygienists must be licensed.

Places of Employment employed part time. Most work inprivate dental offices. Public health

Nearly 27.000 persons worked .is agencies, school systems, Industrialdental hygienists in 1976. Many arc plants. clinics, hospitals. dental hy-

4

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giene.

schools, and the Federal Gov-ernment are other sources of em-ployment for dental hygienists. Somewho are graduates of bachelor's de-gree. programs are commissioned of-ficers in the Armed Forces:.,,

1

Training and OtherQualifications 1

Dental hygienists must bejlicensed.To obtain a license in most; States, acandidate Must be a graduhte of anaccredited dental hygiene school andpass both fa written and el nical ex-aminationti For the clinical xamina-don, the applicant is requir d to per-form dentalhygiene pr cedures,such as removing deposits nd stainsfrom a patient's teeth. In 1976, can-didates in 48 States and t e Districtof Columbia could complete part ofthe State licensing requirements bypassing a written examination givenby the National Board of Dental Ex-aminers. Few States permit dentalhygienists licensed in other States topractice in their jurisdictions withoutfurther examination.

In 1976, 182 schooli of dentalhygiene in the United States wereaccredited by the American DentalAssociat ion. Most programs grant anassociate degree; others lead to abachelor's degree. Some institutionsoffer both types of programs. Eigh-teen schools offer master's degreeprograms in dental hygiene or relatedfields.

Completion of an associate degreeprogram usually is sufficient for thedental hygienist who wants to prac-tice in a private dental office. in or-der to do research, teach, and workin public or school health programs,at least a baccalaureate degree usual-ly is required. Dental hygienists witha in astm's degree work as teachers oradministrators in dental hygiene anddental assisting training programs,public health agencies, and in associ-ated research.

Competition is keen for admissionto dental hygiene schools. The mini-mum requirement for admission to aschool of dental hygiene is gradu-ation from high school. Severalschools that offer the bachelor's de-gree admit students to the dental hy-giene program only after they havecompleted 2 years of college Many

.

schools also require that applicantstake an aptitude test given by theAmerican Dental Hygienists' Associ-ation. Dental hygiene training givenin the Armed Forces does not fullyprepare one to pass the licensingexam. but credit for that training maybe granted to those who seek admis-sion to accredited dental hygieneprograms.

The curriculum in a dental hygieneprogram consists of courses in the':asie sciences. dental bziences, clini-cal science, and liberal arts. Theseschools offer laboratory. clinical, andclassroom instruction in subjectssuch as anatomy. physiology, chemis-try. pharmaco:ogy, nutrition, histol-ogy (the study of tissue structure),periodontology (the study of gumdiseases), dental materials, and clini-cal dental hygiene.

People who want to become dentalhygienists should be those who enjoyworking with others. The ability toput patients at ease is helpful. Per-sonal neatness and cleanliness, man-ual dexterity, and good health alsoare important qualities. Among thecourses recommended for highschool students interested in careersin this occupation are biology.health, chemistry, speech. andmathematics.

Employment Outlook

Employment opportunities fordental hygienists are expected to begood through the mid-1980's. De-spite an anticipated rise in the num-ber of graduates from schools of den-tal hygiene. the demand is expectedto he greater than the number avail-able for employment if recent trendsin enrollments continue. There alsoshould be very gcod opportunitiesfor those desiring part-time employ-ment, and for those willing to work inrural areas.

Employment of dental hygienists isexpected to grow much faster thanthe average for all occupations, be-cause or an expanding populationand the growing awareness of the im-portance of regular dental care In-creased participation in dental pre-payment plans and more grouppractice among dentists should resultin new jobs for dental hygienistsDental care rograms for children

also may lead to more employmentopportunities in this field.

Earnings and WorkingConditions'

Earnings of dental hygienists areaffected by the type of employer,education and experience of the indi-vidual hygienist, and the geographiclocation. Dental hygienists who workin private dental offices usually aresalaried employees, although someare paid a commission for work per-formed, or a combination of salaryand commission.

Dental hygienists working full timein private offices earned averagesalaries of about $12,900 a year in1976, according to the limited dataavailable This salary was slightlyabove the average for all nonsupervi-sory workers in private Industry, ex-cept farming. In 1977, the FederalGovernment paid dental hygienistswith no experience starting salariesof $8,316 a year. Experienced dentalhygienists working for the FederalGovernment earned average annualsalaries of $10,500.

Dental hygienists employed fulltime in private offices usually workedbetween 35 and 40 hours a week.They may work on Saturdays or dur-ing evening hours. Some hygienistswork for two dentists or more.

Dental hygienists usually work inclean, well-lighted offices. importanthealth protections for persons in thisoccupation are regular medicalcheckups and strict adherence to es-tablished procedures for using X-rayequipment and for disinfection.

Dental hygienists who wodc forschool systems, health agencies, andthe Federal or State governmentshave the same hours, vacation, sickleave, retirement. and health insur-ance benefits as other workers inthese organizations.


For information about accreditedprograms and the educational re-quirements to enter this occupation,contact:

Office of Ilducittion. American Denil Hygien-ists' Association. 211 B. Chicago Ave .Chicago. Ill 60011

0

Other material on opportunitiesfor dental hygienists is availablefrom:Division of Dentistry. Public Health Service.

U.S. Depanment of Health. Education.and Welfare. 9000 Rockville Pike. Be.thesda. Md. 20014.

The State Board of Dental Exam-iners in each State, or the NationalBoard of Dental Examiners, 211 E.Chicago Ave., Chicago. Ill. 60611,can supply information on licensingrequirements.

DENTAL LABORATORYTECHNICIANS

(D.O.T. 712.381)

Nature of the Work

Dental laboratory techniciansmake dentures (artificial teeth). fab-ricate metal or porcelain crowns andinlays to restore teeth, constructbridges of metal and porcelain to re-place missing teeth, and also makedental orthodontic appliances. Allwork is done following written in-structions submitted by the demist,using impressions made by the den-tist of a patient's teeth or mouth.from which models are made by den-tal stone pourings. Sometimes thesemodel pourings are made by the den-tist. but most often by the technician.

Trainees in beginning jobs usuallymix and pour plaster into casts andmolds and perform other simpletasks. As they gain experience, theydo more difficult laboratory work.Some dental laboratory techniciansdo all kinds of laboratory work. Oth-ers are specialists who make crownsand bridges. arrange artificial teethon dental appliances. make plasticmolds for dentures, work, with dentalceramics (porcelain). or make cast-ings of gold or metal alloys. To per-form thcir work, technicians usesmall hand instruments such as waxspatulas and wax carvers, as well asspecial electric lathes and di ills,high-heat furnaces, metal-meltingtorches, and othcr kinds of special-ized laboratory equipment.

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Dental laboratory technicians generally need 4 to 5 years of training.

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About 42,000 persons worked usdental laboratory technicians in1916. Most work in commerciallaboratories, either as employees oras owners of the business. CommIr-cial laboratories, which handle or-ders from dentists, usually employfewer than 10 technicians. However,.a few large laboratories employ over200 technicians.

About 7,000 dental laboratorytechnicians work in dentists' offices.Others work for hospitals that pro-vide dental services and for the Fed-eral Government, chiefly in VeteransAdministration hospitals and clinicsand in the Armed Forces. Establish-ments that manufacture denial mate-rials and equipment also employtechnicians as technical or sale:, rep-resentatives.

Dental laboratories are locatedmainly in large cities and populousStates. Many laboratories receivework through the mail from dentistswho work a considerable' distanceaway.

Training, Other Qualifications,and Advancement

Although no minimum formal edu-cation is needed to enter this occupa-tion, a high school diploma is an as-s e t . Many dental laboratorytechnicians learn their craft on thejob, although more and more are tak-ing formal training programs beforestarting work. On-the-job trainingusually lasts 4 or 5 years, dependingon the trainee's previous experience,ability to master the techniques, andthe number of specialized areas to belearned. A few public vocational highschools offer courses in dental labo-ratory work that may be taken inconjunction with on-the-job training.

In 1976, 2-year education pro-grams accredited by the AmericanDental Association (ADA) were of-fered in 48 schools. High schoolgraduation or equivalent education isrequired to enter these programs.The first year of training includes for-mal classroom instruction in dentallaw mid ethics, chemistry, ceramics,mclallii.e.y. and other related sub-jects. Daring the second year, thestudent gets supervised practical ex-

perience in the school or dental labo-ratory. After completion of the 2-year training program, the traineemay need about 3 years more ofpractical experience to develop theskills needed to be recognized as awell-quatstied dental laboratory tech-nician. Those receiving dental labo-ratory training in the Armed Forcesusually qualify for civilian jobs asdental laboratory technicians.

Dental laboratory technicians maybecome Certified Dental Techni-cians by passing written and practicalexaminations given by the NationalBoard for Certification, a trust estab-lished by the National Association ofDental Laboratories. Certification isbecoming increasingly important asevidence of a technician's compe-tence Well-qualified technicians ad-vance by becoming supervisors ormanagers in dental laboratories,teachers in dental lab training pro-grams, or salespersons for dentalproducts companies. Some techni-cians become owners of dental labo-ratories.

Among the personal qualificationsthat employers look for in selectingtrainees are a high degree of manualdexterity, good color perception. pa-tier.ce, and a liking for detailed work.High school students interested in ca-reers in this occupation arc advisedto take courses in art, crafts, metalshop, metallurgy, and sciences.

Employment Outlook

Job opportunities for well-quali-fied dental laboratory technicians arcexpected to be excellent through themid-1980's. Some experienced tech-nicians should he able to establishlahoratories of their own. A techni-cian whose work has become knownto several dentists in a communitywill have the best prospects of build-ing a successful business.

Employment of dental laboratorytechnicians is expected to grow fasterthan the average for all occupationsdue to expansion of dental prepay-ment plans and the increasing num-ber of older people who require den-tures. In addition, the number ofdentists is not expected to keep pacewith the demand for their services. todevote more time to treatment of pa-tients, dentists will send more of their

laboratory work to commercialfirms, or hire technicians to work di-rectly for them.

In addition to .job opportunitiescreated by growth, many openingsfor dental laboratory technicians willoccur each year because of the needto replace technicians who die orretire.


Dental laboratory technicians whoworked full-time in commercial labo-ratories received the following aver-age annual salaries in 1976: Traineeswith no experience, $5,600; gradu-ates of 2-year dental technologycourses with no experience. $7.600;technicians with no formal trainingand 2 years of on-the-job experience.$7,300; technicians with 2 to 5 yearsof experience, regardless of training,$9,400; and technicians with morethan 5 years of experience, regard-less of training, up to $18.000. Tech-nicians who specialized in ceramicsreceived the highest salaries (up to$25,000). Large dental laboratoriesemploy supervisors or managers whousually earn more than technicians.In general, earnings of self-employedtechnicians are higher than those ofsalaried workers.

In the Federal Government, gradu-ates of ADA-approved programswith no experience were paid startingsalaries of $8,316 a year in 1977.Experienced dental laboratory tech-nicians employed in the Federal Gov-ernment generally earned between$11.523 and $16,588 annually. withthe average earning $14.000 peryear.

Salaried technicians usually work40 hours a week but sclfemployedtechnicians frequently work longerhours. Many)technicians in commer-cial laboratories receive paid holi-days and vacations and some also re-ceive paid sick leave. bonuses, andother fringe benefits. Techniciansemployed by the Federal Govern-ment have the same benefits as otherFederal employees.


For information about training anda list of approved schools contact.

8

American Dental Association, Council onDental Education, 211 E Chicago Ave..Chicago, HI. 60611

information on scholarships isavailable from dental technologyschools or from the American Fundfor Dental Health. 211 East ChicagoAve., Chicago, Ill. 60611.

For information on career oppor-tunities in commercial laboratoriesand requirements for certification.contact:National Association of Dental Laboratories,

3801 Mt Vernon Ave.. Alexandria, Va.22305.

Information on careers in the den-tal technology field also is availablefrom:Division of Dentistry. Public Health Service,

U S Department of Health, Education,and Welfare, 9000 Rockville Pike, Be-thesda. Md. 20014.

HEALTH SERVICESADMINISTRATORS

(D.O.T. 169.168, 187.118, and187.168)

Nature of the Work

Medical and health care is provid-ed by organizations that. vary fromlarge teaching hospitals to smallwalk-in clinics. Each of these re-quires effective management to func-tion properly. Health administrators,under the general supervision ofboards of directors or other govern-ing bodies, provide this management.

Administrators coordiiiate the var-ious functions and activities thatmake a health organization work.They may do this personally. wherethe organization is small, or direct astaff of assistant administrators inlarger organizations. Health adminis-trators make management decisionson matters such as the need for addi-tional personnel and equipment, cur-rent and future space requirements,and the budget.

Some health services administra-tors. including those who managehospitals or nursing homes, overseenursing, food services, and in-servicetraining programs. Assistant adminis-trators usually direct the daily opera-

7

Administrators coordinate the various activities of a health °roma:Aden.

tions of these departments; how er,the chief executive keeps informedthrough formal and informal meet-ings with the assistants, the medicalstaff, and others. In addition to thesemanagement activities, many healthadministrators help to carry outfundraising drives and promote pub-lic participation in health programs.This phase of the administrator's joboften includes speaking before civicgroups, arranging publicity. and co.ordintating the activities of the or.ganization with those of governmentor community agencies.


About 160,000 persons worked ashealth services administrators in1976. Most administrators work inhealth facilities. including hospitals(which employed about half of alladministrators), nursing and person-al care homes, and health manage-meat firms that provide adrnmistra-tive services to health facilities it a

, specified contract price

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Some health administrators workfor government agencies, includingState and local health departmentsand the U.S. Public Health Service.lit addition, the Federal Governmenthires administrators in Veterans Ad-ministration and Armed Forces hos-pitals and clinics. Others work forvoluntary health agencies that con-duct research and provide care andtreatment for victims of particulardiseases or physical impairments.


Educational requirements forhealth services administrators varyaccording to the position's level ofresponsibility and the size of the or-ganization. Generally, larger organi-zations with more complicated ad-ministrative structures require highercredentials than smaller ones.

Applicants with master's degreesin health or hospital administrationmay l'...: hired as associate or assistantadministrators in hospitals. whilethose with master's degrees in public

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health often find work as programanalysts or program representativesin public health departments. Veryfew master's degree recipients takeentry positions in nursing or personalcare homes, although many nursinghome administrators pursue graduateeducation while employed.

Bachelor's degree recipients usual-ly b4in their careers as administra-tive assistants or department heads inhospitals, or as assistant administra-tors in nursing homes Graduates of2-year, associate degree programsgenerally are hired as unit directoisor assistant department heads in hos-pitals, or as assistants to programrepresentatives in public health de-partments. Some associate degreeholders find assistant administratorjobs in small nursing homes.

The Ph. D. degree usually is re-quired for positions in teaching orresearch, and is an asset for thoseseeking administrative jobs In thelarger, more prestigious health or-ganizatiohs. Although some publichealth departments still require chiefadministrators to be, physicians, thetrend is away from this,

Administrators in Armed ;Forceshospitals usually are career militarypersonnel.

In 1976, over 40 bachelor andassociate degree progiams in healthservices administration were of-feredthe majority were 4-year cur-riculums. In addition, there wereabout 52 programs in hospital orhealth services administration thatled to the master's degree, and 19schools of public health offered pro-grams leading to a master's degree inpublic health.

To enter graduate programs, appli-cants must have a bachelor's degree.with courses in natural sciences, psy-chology, sociology, statistics, ac-counting, and economics. Competi-

4 lion for entry to these programs iskeen, and applicants need above av-erage grades to gain admission. Theprograms generally last about 2 yearsand may include sonic supervised ad-ministrative experience in hospitals,clinics, or health agencies. Programsmay include courses such as hospitalorganization and management, ac-counting and budget control, person-nel administration, public health ad-

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ministration. and the economics ofhealth care.

All States and the District of Co-lumbia require that the administratorof a nursing or personal care hotoebe licensed. Requirements are rotuniform, but they generally specify alevel of education, such as a bache-lor's degree, plus some amount ofexperience in the field.

Personal qualifications needed forsuccess as a health administrator in-clude initiative and an interest inhelping the sick. Adminittratorsshould be able to work with and mo-tivate people, and organize and di-rect large-scale activities. They alsoshould enjoy public speaking.

Health administrators advance inthe profession by taking increasinglymore responsible positions. For ex-ample. some hospital administratorsbegin their careers in small hospitalsin positions with broad responsibil-ities, such as assistant administrator.They advance by moving to jobs asassociate or chief administrator inlarger hospitals. More commonly,they start in a large institution in aposition that is somewhat narrow in

,scope for example, as departmenthead in charge of purchasing. Re-gardless of the path of advancementchosen, the ultimate occupationalgoal4n hospitals and nursing homesisthe job of chief executive or chiefadministrative officer.

Employment Outlook

The number of graduate programsin ,health administration has in-creased rapidly in recent years andadministative specialists with gradu-ate degrees in other fields also haveentered the profession. Consequent-ly, it may become more difficult forthose with less than graduate educa-tion to enter health administration intop management positions. In addi-tion, some administrative jobs willcontinue to be filled by registerednurses. physicians. and members ofreligious communities.

Employment of health services ad-ministrators is expected to growmuch faster than the average for alloccupations to 1985 as the quantityof patient services increases andhealth services mandgeinent be-comes more complex. The demand

for administrators will be stimulatedby the formation of more groupmedical practices and health mainte-nance organizations (facilities thatoffer subscribers a broad range ofmedical services for a monthly feepaid in advance). Administratorsalso will be needed in nursing andconvalescent homes to handle the in-creasing amount of administrativework expected as these facilities ex-pand in size.


Salaries of hospital administratorsdepend on factors such as the level ofjob responsibility; the size, type, andlocation of the hospital; and the sizeof its administrative staff and budget.

Chief administrators in hospitalswith up to 199 beds earned an aver-age of $25.500 a year in 1976. Some,in larger hospitals. earned over$45,000. Recent recipients of mas-ter's degrees in health administrationstarting work in Veterans Adminis-tration (VA) hospitals earned$14,097 a year in 1977. The averagesalary paid administrators of Federalhospitals was $26,700.

Commissioned officers in theArmed Forces who work as hospitaladministrators hold ranks rangingfrom second lieutenant to colonel orfrom ensign to captain. Commandingofficers of large Armed Forces hospi-tals are generally physicians. whomay hold higher ranks. Hospital ad-ministrators in the U.S. Public HealthService are commissioned ,pfficersholding ranks ranging from lieuten-ant (junior grade) to captain in theNavy.

Administrators of nursing and per-sonal care homes usually earn lowersalaries than those paid hospital ad-ministrators in facilities having simi-lar numbers of beds. Most adminis-trators employed by voluntary healthagencies earned between $15,000and $30,000 a year in 1976.

Health administrators often worklong hours. Because health facilitiessuch as nursing homes and hospitalsoperate around the clock, adminis-trators in these institutions may becalled at all hours to settle emergen-cy problems. Also, some travel maybe required to attend meetings or, inthe case of regional. State or localpublic health department and volun-tary health agency administrators, toinspect facilities in the field.

Sources of AdditionalInformation

Information about health adminis-tration :Ind the academic programs inthis field offered by universities, col-leges, and community colleges isavailable from:American College of Hospital Administratioi,

840 North Lake Shore Drive. Chicago.Illinois 60611.

Association of University Programs in HealthAdministration. One Dupont Circle. NW.,Washington. D.C. 20036.

American Public Health Association, Divisionof Program Services,,I015 18th St., NW.,Washington. D.C. 20036.

National Health Council. Health Careers Pro-gram. 1740 Broadway. New York. N.Y.10019.

American College of Nursing Home Adminis-trators, 4650 Bast-West Hwy.. Washing-ton. D.C. 20014.

NURSING OCCUPATIONS

The nursing field, consisting ofregistered nurses; licensed practicalnurses; and nursing aides, orderlies.and attendants, accounts for aboutone-half of total employment amonghealth service workers. Nursing per-sonnel perform a variety of duties tocare for and comfort the sick, the

13

Injured, and others requiring medicalservices.

This section deals in detail with thethree basic nursing occupations.

Registered nurses (RN's) follow themedical regimen prescribed by physi-cians but often must draw on theirprofessional training to make in-

9

About 50 percent of the job openings in healthoccupations during the next 10 Years will befor nursing personnel .

Average annual openings. 1976.85

Other health occuoations

Nursing aides. orderlies.and attendants

$00411 1101101/ o, taboe Suoshes

Licensed Practicalnurses

Registered nurses

Opecent judgments in providingnursing services. Some registerednurses, after advanced training, be-come nurse practitioners and performservices, such as physical examina-tions, that traditionally have beenhandled by physicians. Some nursesbecome head nurses with responsibil-ity for all nursing services of a speci-fied area of an institution, for exam-ple, a pediatrics ward.

Licensed practical nurses pros ideskilled nursing care to sick, injured.and convalescent patients. Theywork under the general supervisionof physicians and registered nurses,and may 'sometimes supervise nurs-ing aides, orderlies, and attendants.

Nursing aides, orderlies, and atten-ants make up the largest group ofnursing personnel. They serve meals,feed patients, and do other tasks thatfree professional and practical nursesfor work requiring professional andtechnical training.

Persons who wish to become regis-tered nurses, licensed practical nurs-es, or nursing aides. orderlies, andattendants should like working withpeople because they must workclosely with other members of thehealth team and care for patientswho are uncomfortable and some-times irritable. Nursing workers mustbe reliable and keep a level head inemergencies.

l0

REGISTERED NURSES

(D.O.T. 075.118 through .378)

Nature of the Work

Nursing plays a major role inhealth care. As important membersof the health care team, registerednurses perform a wide variety offunctions. They observe, evaluate,and record symptoms, reactions, andprogress of patients; administermedications; assist in the rehabilita-tion of patients; instruct patients andfamily members in proper healthmaintenance care; and help maintaina physical and emotional environ-ment that promotes recovery.

Some registered nurses providehospital care. Others perform re-search activities or instruct students.The setting usually determines thescope of the nurse's responsibilities.

Hospital nurses constitute the larg-est group of nurses. Most are staffnurses who provide skilled bedsidenursing care and carry out the medi-cal treatment prescribed by physi-cians. They may also supervise prac-tical nurses, aides. and orderlies.Hospital nurses usually work withgroups of patients that require simi-lar nursing care. For instance, somenurses work with patients who havehad surgery; others care for children.

the elderly, or the mentally ill. Someare administrators of nursing serv-ices.

Private duty nurses give individualcare to patients who need constantattention. The private duty nurse isself-employed and may work in ahome, in a hospital, or in a convales-cent institution.

Office nurses assist physicians,dental surgeons, and occasionallydentists in private practice or clinics.Sometimes they perform routinelaboratory and office work in addi-tion to their nursing duties.

,Community health nurses care forpatients in clinics, homes, schools,and other community settings. Theyinstruct patients and families inhealth care and give periodic care asprescribed by a physician. They mayalso instruct groups of patients inproper diet and arrange for immuni-zations. These nurses work with com-munity leaders, teachers, parents,and physicians in community healtheducation. Some community healthnurses work in schools.

Nurse educators teach students theprinciples and skills of nursing, bothin the classroom and in direct patientcare. They also conduct continuingeducation courses for registerednurses, practical nurses. and nursingassistants.

Occupational health or industrialnurses provide nursing care to em-ployees in industry and governmentand, along with physicians, promoteemployee health. As prescribed by adoctor, they treat minor injusies andillnesses occurring at the place ofemployment, provide for the needednu rsing care, arrange for .furthermedical care if necessary, and offerhealth counseling. They also may as-sist with health examinations and in-oculations.

(Licensed practical nurses whoalso perform nursing services are dis-cussed elsewhere in the Handbook.)

Pieces of Employment

About 960,000 persons worked asregistered nurses in 1976: Aboutone-third worked on a part-time ba-sis.

About three-quarters of all regis-tered nurses worked in hospitals.

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dates for liccnsure. However, a mini-mum Qf a baccalaureate degree ispreferred for those who aspire to ad-ministrative or management posi-tions, and those planning to work inresearch, consultation, teaching, orclinical specialization, which requireeducation at the master's level.Graduation from high school is re-quired for admission to all schools ofnursing.

Diploma programs are conductedby hospital and independent schools

. and usually require 3 years of train-ing. Bachelor's degree programs usu-ally require 4 years of study in a col-lege or university, although a fewrequire 5 years. Associate degreeprograms in junior and communitycolleges require approximately 2years of nursing education. in addi-tion, several programs provide li-censt,d practical nurses with thetraining necessary to upgrade them-selves to registered nurses while theycontinue to work part time. Theseprograms generally offer an associateof arts degree. In 1976, about 1,375programs (associate, diploma, andbaccalaureate) were offered in theUnited States. In addition, there were102 master's degree and 12 doctoraldegree programs in nursing.

Programs of nursing include class-', room, instruction and supervised

nursing practice in hospitals andhealth facilities. Students takecourses in anatomy, physiology, mi-crobiology, nutrition, psychology,and nursing. They also get supervisedclinical experience in the care of pa-tients who have different types ofhealth problems. Students in bache-loies degree programs as well as insome of the other programs are as-signed to community agencies tolearn how to care for patients in clin-ics and in the patients' homes. Vary-ing amounts of general education arecombined with nursing education inall three types of programs.

Students who need financial aidmay qualify for federally sponsorednursing scholarships or low-interestloans. Those who want to pursue anursing career should have a sinceredesire to serve humanity andbe sym-pathetic to the needs of others. Nurs-es must be able to accept responsibil-ity and direct or supervise the

Employment opportunities tor registered nurses sr e expected to be favorable throughthe mid-1980's.

nursing homes, and related institu-tions. Community health nurses ingov.anment agencies, schools, visit-ing nurse associations, and clinicsnumbered about 65,000; purse edu-cators in nursing schools accountedfor about 33.000, and occupationalhealth nurses in industry, about20,000. About I 00.000 more workedin the offices of physicians or otherhealth practitioners. or were privateduty nurses hired directly by pa-tients Most of the others were staffmembers of professional nurse andother organisations or worked forState boards of nursing or rt earthorganizations.


A license is required to practiceprofessional nursing in all States andin the District of Columbia. To get alicense, a nurse must be a graduate ofa school of nursing approved by theState board of nursing and pass awrittcn State competency examina-tion. Nurses may be licensed in morethan one State, either by examinationor endorsement of a license issued byanother State.

Three types of educational pro-grams - diploma, baccalaureate. andassociate degreeprepare candi-

1 9A. he

activity of others; must have initia-tive, and in appropriate situations beable to follow orders precisely or de-termine if additional consultation isrequired; and must use good judg-ment in emergencies. Good mentalhealth is needed in order to copewith human suffering and frequentemergency situations. Staff nursesneed physical stamina because of the

...amount of time spent walking andstanding. .

From stall positions in hospitals,experienced nurses may advance tohead nurse, assistant director, anddirector of nursing services. A mas-ter's degree, however, often is re-quired fdr supervisory and adminis-trative positions, as well as forpositions in nursing education, clini-cal specialization, and research. Pub-lic health agencies ..require a bacca-laureate degree for employment.Advancement may be difficult fornurses who do not have a baccalaure-ate or master's degree in communityhealth nursing.

A growing movement in nursing,generally referred to as the "nursepractitioner program" is openingnew career possibilities. Several post-baccalaureate programs preparenurses for highly independent rolesin the clinical care and teaching ofpatients. These nurses practice in pri-mary roles that include pediatrics,geriatrics, community health, mentalhealth, and medical-surgical nursing.

Employment Outlook

Employment opportunities for reg-istered nurses are expected to be fa-vorable through the mid- 1980's.Some competition for more desir-able, higher paying jobs is expectedin areas where training programsabound, but opportunities for full., orpart-time work in present shortageareas, such as some southern Statesand many inner-city locations, areexpected to be very good through1985. For nurses who have hadgraduate education, the outlook isexcellent for obtaining positions asadministrators, teachers, clinical spe-cialists. and community health nurs-es.

Growth in employment of regis-tered nurses is expected to be fasterthan the average for all occupations

12

because of extensiun of prepaymentprograms for hospitalization andmedical care, expansion of medicalservices as a result of new medicaltechniques and drugs, and increasedinterest in preventive medicine andrehabilitation of the handicapped. Inaddition to the need to fill new posi-tions, large numbers of nurses will berequired to replace those who leavethe field each year.


Registered nurses who worked inhospitals in 1976 received averagestarting salaries of $11,820 a year,according to a national survey con-ducted by the University of TexasMedical Branch. This was above theaverage for nonsupervisory workersin private industry, except farming.Registered nurses in nursing homescan expect to earn slightly less thanthose in hospitals. Salaries of indus-trial nurses averaged $240 a week inmid-1976, according to a survey con-ducted by the Bureau of Labor Sta-tistics.

In 1977, the Veterans Administra-tion paid inexperienced nurses whohad a diploma or an associate degreestarting salaries of $10,370 a year,those with baccalaureate degrees,$12,131. Nurses employed in all Fed-eral Government agencies earned anaverage of $15,500 in 1977.

Most hospital and nursing homenurses receive extra pay for work onevening or night shifts. Nearly allreceive from 5 to 13 paid holidays ayear, at least 2 weeks of paid vaca-tion after 1 year of service, and alsosome type of health and retirementbenefits. .

.


For information on approvedschools of nursing, nursing career's,loans, scholarships, salaries, workingconditions, and employment oppor-tunities, contact:

Coordinator, Undergraduate Programs. De-partment of Nursing Education. Amor'can Nurses' Association. 2420 PershingRd., Kansas City, Mo. 64108.

13

For career information and a i,....t ofschools of nursing, contact:Career Information Services, National League

for Nursing. 10 ColumbUs Circle, NowYork, N.Y. 10019.

Information about employmentopportunities in the Veterans Ad-ministration is available from:Department of Medicine and Surgery, Veter-

ans Administration, Washington, D.C.20420.

LICENSED PRACTICALNURSES

(D.O.T. 079.378)

Nature of the Worko

Licensed practical nurses (LPN's)help care for the physically or men-tally ill and infirm. Under the direc-don of physicians and registerednurses, they provide nursing carethat requires technical knowledgebut not the professional echicationand training of a registered nurse.(See statement on registered nurses.)In California and Texas, licensedpractical nurses are called licensedvocational nurses.

In hospitals, LPN's provide muchof the bedside care needed by pa-tients. They take and record temper-atures and blood pressures, changedressings, administer certain pre-scribed medicines, and help patientswith bathing and other personal hy-giene. They assist physicians and reg-istered nurses in examining patientsand in carrying out nursing proce-dures. They also assist in the deliv-ery, care, and feeding of infants.Some practical nurses work in spe-cialized units such as intensive careunits, recovery rooms, or bum units.They perform special nursing proce-dures and operate sophisticatedequipment to"provide care for seri-ously ill or injured patients. In someinstances, experienced LPN's super-vise huspitd attendants and nursingaides. (See statement on nursingaides, orderlies, and attendants.)

LPN's who work in private homesprovide day-to-day patient care that

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LPN's provide much of the bedside

seldom involves highly technical pro-cedures or .complicated equipment.In addition to providing nursing care,they may prepare meals, sec that pa-ticnts are comfortable and help keepup their morale. Thcy also teach fam-ily members how to perform simplenursing tasks.

In doctors' offices and in clinics,LPN's prepare patients for examina-tion and treatment, administer medi-cations, apply dressings. and teachpatients prescribed health carc regi-mens Thcy also may make appoint-ments and record information about

-.patients.


In 1976. about 460,000 personsworked as LPN'sabout three-fifthsof thcm in hospitals. Most of the

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care needed by hospitat patients.

others worked in nursing homes,clinics, doctors' offices, sanitariums.and other long-term care facilities.Many worked for public health agen-cies and welfare and religious organi-zations. Some self-employed nursesworked in hospitals or in the homesof thcir patients.


All States and thc District of Co-lumbia regulate the preparation aidlicensing of practical nurses. To be.comc licensed, applicants must com-plete a course of instruction in prac-tical nursing that has bccn approvedby thc State board of nursing andpass a written examination. Educa-tional requirements for enrollment inStatc-approved training programs

1 4

range from completion of 'eighth orninth grade to high school gradu-ation. Many schools do not requirecompletion of high school but theygive preference to graduates. Phys-ical examinations and aptitude testsarc usually required. Volunteer hos-pital work can provide a useful back-ground for practical nursing, butmost applicants have no prior workexperience.

In 1976, over 1,35G State-ap-proved programs provided practicalnursing training. Trade, technical, orvocational schools offered more thanhalf of these programs. Other pro-grams were available at junior colleg-es, local hospitals, health agencies,and private educational institutions.Several programs operated by theArmy for military personnel alsowere State-approved for practicalnurse training. Graduates from theseprograms are eligible for licensure.

Practical nurse training programs,are generally I year long and includeboth classroom study and clinicalpractice. Clqssroom instruction cov-ers nursing concepts and principlesand related subjects including anat-omy. physiology, medical-surgicalnursing, pediatrics, obstctrics, psy-chiatric nursing, administration of ,

drugs, nutrition, first aid, and com-munity health. Students learn to ap-ply their skill to an actual nursingsituation through supervised Clinicalexperienceusually in a hospital.

Those who wish to become li-censed practical nurses should have adeep concern for human welfare.They must he emotionally stable be-cause working with sick and injuredpeople sometimes can be upsetting.

As part of a health carc beam, theymust be able to follow orders andwork under close supervision. Goodhealth is very important, as is thephysical stamina needed to workwhile standing a great deal.

Advancement opportunities arelimited without additional training orformal education. In-service educa-tional programs prepare some LPN'sfor work in specialized areas, such aspost-surgery recoirery rooms, or in-tensive care units. Undcr career lad.der programs, nuses' aides may at-tend training to become LPN's whilecontinuing to work part-time. Simi-

13

tally, in some cases, LPN's may pre-pare to become registered nurseswhile they continue to work part-time.

Employment Outlook

The employment outlook forLPN's is expected to be very goodthrough the mid-1980's. Employ-ment is expected to continue to risemuch faster than the average for alloccupations in response to the needsof a growing population and expand-ed public and private health insur-ance plans. Also, newly licensedpractical nurses will be needed eachyear in large numbers to replacethose who die, retire, or leave theoccupation for other reasons.


The average starting -salary ofLPN's in hospitals was about 59,100a year in 1976, according to a nation-al survey conducted by the Universi-ty of Texas Medical Branch.

Federal hospitals offered begin-ning LPN's an annual salary of$7,408 in 1977.

Many hospitals give pay increasesafter specific periods of satisfactoryservice. Practical nurses generallywork 40 hours a week, but often thisworkweek includes some work atnight and on wet.:zends and holidays.Many hospitals provide paid holidaysand vacat*ms, health insurance, andpension I: . ins.

In private homes, LPN's usuallywork 8 to 12 hours a day and gohome at night. Private duty nursingaffords a great deal of independenceto the practical nurse in setting workhours and determining the length andfrequency of vacations.


A list of State-approved trainingprograms and information aboutpractical nursing is available from:National League for Nursing. 10 Columbus

Circle. New York, N.Y. 10019.

National Association for Practical Nurse Edu-cation and Service. Inc.. 122 Ewit 42d St..Suite 1100. New York, N.Y. 10017.

14

. e

For information about a career inpractical nursing, contact:National Federation of Licensed Practical

Nurses. Inc.. 250 West 57th St . NewYork, N.Y. 10019.

Information about employmentopportunities in '. S. Veterans Ad-ministration hospitals is availablefrom your local Veterans Adminis-tration hospital, as well as:Depanment of Medicine. and Surgery, Veter-

ans Administration, Washington. D.C.20420.

NIJRSING AIDES,ORDERLIES, AND

ATTENDANTS

(D.O.T. 355.687 through .887)

Nature of the Work

Nutting aides, orderlies, and atten-dants perform a variety of duties to

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care for sick and injured people. Oth-er job titles include hospital atten-dant, nursing assistant, auxiliarynursing worker, geriatric aide, and (inmental institutions) psychiatric aide.

Nursing aides and orderlies answerpatients' bell calls and deliver mes-sages, serve meals, feed patients whoare unable to feed themselves, makebeds, and bathe and dress patients.They also may give" massages, taketemperatures, arm assist patients ingetting out of bed and walking. Or-derlies escort patients to operatingand examining rooms and transportand set up heavy equipment. Someattendants may work in hospitalpharmacies or supply rooms storingand moving supplies.

The duties of nursing aides dependon the policies of the institutionswi2re, they work, the type of patientbeing cared for, andequally impstantthe capacities and resourceful-ness of the nursing aide or oiderly. Insome hospitals, they may clean pa-tients' rooms and do other houieholdtasks. In others, under the supervi-

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Over 1 million persons worked as nursing aides, orderlies, and attendants in 1978.

15.

sion of registered nurses and licensedpractical nurses, they may assist inthe care of patients. The tasks per-formed for patients differ consider-ably, and depend on whether the pa-tient is confined to bed followingmajor surgery, is recovering after adisabling accident or illness, or needsassistance with daily activities be-cause of infirmity caused by ad-vanced age.

Another occupation similar tonursing aide is homemaker,homehealth aide. Working in the homes ofpatients, they perform duties similarto those of nursing aides, as well asdoing the cooking and other lighthousework. (Sec statement on home-maker-home health aides elsewherein the Handbook.)

.7.


About 1 million persons worked asnursing aides, orderlies, and atten-dants in 1976. Most work in hospi-tals, although a rapidly growing num-ber work in nursing homes and otherinstitutions that provide facilities forlong-term care'and recuperation.


Although some employers preferhigh school graduates, many, such asVeterans Administration hospitals,do not require a high school diploma.Employers often accept applicantswho are 17 or 18 years of age. Oth-ersparticularly nursing homes andmental hospitalsprefcr to hiremore mature persons who are at leastin their mid- twentt 's.

Nursing aides generally are trainedafter they are hired. Some institu-tions combine on-the-job training,under the close supervision of regis-tered or licensed practical nurses,with classroom instruction. Traineeslearn to take and record tempera-tures, bathe patients, change linenson beds that are occupied by pa-tients, and move and lift patients.Training may last several. days or afew months, depending on the poli-cies of the hospital or other institu-tion, the complexity of the dutiesand the aide's aptitude for the work.

Courses in home nursing and firstaid, offered by many public school

systems and other community agen-cies. provide a useful background ofknowledge for the work. Volunteerwork and temporary summer jobs inhospitals and similar institutions alsoare helpful. Applicants should 134;healthy, tactful, patient. understand-ing, emotionally stable, and depend-able. Nursing aides, as other healthworkers, should have a genuine de-sire to help people. be able to workas part of a team, and be willing toperform repetitive, routine tasks.

Opportunities for promotions arelimited without further training.Some acquire specialized training toprepare for bettcr paying positionssuch as hospital operating room tech-nician.

To become licensed practicalnurses. nursing aides must completethe year of specialized training re-quired for licensing. Some in-serviceprograms allow nursing aides to getthis training while they continue towork part time.

Employment Outlook

Employment of nursing aides isexpected to increase faster than theaverage for all occupations throughthe mid-1980's. In addition to thoseneeded because of occupationalgrowth, many thousands of nursingaides will be needed each year toreplace workers who die, retire, orleave the occupation .for other rea-sons.

Although most jobs for nursingaides and orderlies currcntly are inhospitals, most new openings will bein nursing homes, convalescenthomes, and other. long-term care fa-cilities. Major reasons for expectedoccupational growth are the increas-ing need for medical care of a grow-ing population, including a largerproportion of elderly people, and theincreasing ability of people to pay forhealth care, largely as a result of the

growth M public and private healthinsurance.


Nursing aides, orderlies, and atten-dants earned salaries that were belowthe average for all nonsapervisoryworkers in private industry, exceptfarming. Nursing aides employed fulltime by nursing homes and relatedfacilities earned considerably lessthan those in hospitals. Dependingon the experience of the applicant,starting salaries of nursing aides inVeterans Administration hospitalsranged from $125 to $140 a week in1977. The average salary earned bynursing aides employed by the Feder-al Government was $185 a week in1977.

With few exceptions, the sched-uled workweek of attendants in hos-pitals is 40 hours or less. Becausenursing care must be available to pa-tients on a 24-hour-a-day basis,scheduled hours include nightworkand work on weekends and holidays.

Attendants in hospitals and similarinstitutions generally receive paid vit..cations which, after 1 year of service,may be a week or more in length.

,. Paid holidays and sick lea ire, hospitaland medical benefits, shift differen-tials, and pension plans also are avail-able to many hospital employees.


Information about employmentmay be obtained from local hospitalsand nursing homes. Additional infor-mation about the work of nursingaides, orderlies, and attendants Isavailable from:Division of Careers and Recruitment, Ameri-

can Hospital Association. 840 14. LakeShore Dr,. Chicago. HI. 60611.

THERAPY AND REHABILITATIONOCCUPATIONS

Persons disabled by accident,burns, strokes, and disease, as well asthe emotionally disturbed, all benefitfrom the care given by therapy and

is

rehabilitation workers. After an ac-cident or serious illness leaves a vic-tim fully or partially disabled, phys-ical therapists, and physical therapist

15

I

..

assistants and aides work to restorethe patient to the fullest possible lev-el of activity. Occupational therapistsand occupational therapy assistantsand aides guide the disabled furtheralong the road to realizing a satisfy-ing and productive life. They teachdisabled and emotionally disturbedclients skills and crafts that helpbuild coordination and self-confi-dence. and, in many cases, preparethem to return to work. They alsohelp the elderly in nursing homes byinvolving them in interesting and ab-sorbing hobbies. Also described inthis section are speech pathologistsand audiologists, who specialize inhelping those with speech and hear-ing problems to overcome theirhandicaps.

Anyone considering work in one ofthese fields should have a genuineconcern for the physical and emo-tional well-being of others. Emotion-al stability and the ability to maintaina pleasant disposition and a positiveoutlook also are important, because'these workers often deal with clientsaffected by severe handicaps.

Other occupations also provideopportunity for work with the dis-abled and handicapped. Rehabilita-tion counselors-give personal and vo-cational guidance to the physically,mentally, or socially handicapped.Employment counselors work withthe disabled as well as the able-bod-ied in career planning and job adjust-ment. Both occupations, are de-scribed elsewhere in the Handbook.

OCCUPATIONALTHERAPISTS

(D.O.T. 079.128)

Nature of the Work

Occupational therapists plan anddirect educational, vocational, andrecreational activities designed tohelp mentally and physically disabledpatients become self-sufficient. Theyevaluate the capacities and skills ofclients, set goals, and plan a thcrapyprogram together with the client andmembers of a medical team whichmay include physicians, physical

16

therapists, vocational counselors,nurses, social workers, and other snl---cialists.

About two therapis3 oat of fivework with emotionally handicappedpatients, and des rest work withphysically disabled persons. Thescclients represent all age groups anddegrees of disability. Patients partici-pate in occupational therapy to de-termine the extent of abilities andlimitations; to regain physical, men-tal, or emotional stability;_ to relearndaily routines such as eating, dress-ing, writing, and using a telephone;and, eventually, to prepare for ern-ployment.

,

Occupational therapists teachmanual and creative skills such asweaving and leather working, andbusiness and industiial skills such astyping and the use of power tools.These skills are taught to restore mo-bility and coordination and to helpthe patient regain physical and emo-tional stability. Therapists also planand direct games and other activities,especially for children. They may de-

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sigr and make special equipment orsplints to help disabled patients.

Besides working with patients,occupational therapists supervisestudent therapists, occupational ther-apy. assistants, volunteers, and auxil-iary nursing workers. The chief occu-pational therapist in hospitals mayteach medical and nursing studentsthe principles of occupational ther-apy. Many therapists supervise occu-pational therapy departments, coor-dinate: patient activities, or' areconsultants to local and State healthdepartments and mental health agen-cies. Some teach in colleges and uni-versities.


About 10,600 occupational thera-pists were employed in 1976. About4 out of' 10 occupational therapistswork in hospitals. Rehabilitation cen--ters, nursing homes, schools, outpa-tient clinics, community mentalhealth centers, and research centersemploy most of the others. Somework in special sanitariums or camps

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Occupational therapists help eeneiceppie people prepare for employment.

for handicapped children, others inState health departments. Still otherswork in home-care programs for pa-tients unable to attend clinics orworkshops. Some are members of theArmed Forces.


A degree or certification in occu-pational therapy is required to cnterthe profession. In 1976, 49 collegesand universities offered programs inoccupational therapy which were ac-credited by the American MedicalAssociation and the American Occu-pational Therapy Association. All ofthese schools offer bachelor's degreeprograms. Some have 2-year pro-grams and accept students who havecompleted 2 years of college. Somealso offer shorter programs, leadingto a certificate or a master's degreein occupational therapy for studentswho have a bachelor's degree in an-other field. A graduate degree oftenis required for teaching, research, oradministrative work.

Course work in occupational ther-apy programs includes physical, No-logical, and behavioral sciences andthe.application of occupational ther-apy theory and skills. These pro-grams also require students to workfor 6 to 9 months in hospitals orhealth agencies to gain experience inclinical practice. Graduates of dc-credited educational programs areeligible to take the American Occu-pational Therapy Atsr.eiation certifi-cation examination to become a reg-istered occupational therapist(OTR). Occupational therapy assis-tants who are certified by the associ-ation (COTA's) and have 4 years ofapproved work experience also areeligible to take the examination tobecome *registered occupationaltherapists. Those COTA's consider-ing this path of entry to the occupa.don should contact the Dircctor ofCertification of the American Occu-pational Therapy Association toidentify the types of experience re-quired to qualify for the cxaminationand to determine the availabilitysuitable work settings.

Entry to educational programs iskeenly competitive and applicahtsare screened carefully for previous

academic performancc to selectthose most likely to complete theirstudies successfully. Persons consid-ering this profession. therefore,should have above average academicperformance and consistent gradesof "B" or bettcr in science courses,including biology and chemistry.College students who consider trans-ferring from another academic disci-pline to an occupational therapy pro-gram in their sophomorc or juniorycar need Superior grades becausecompetition for entrance to pro-grams is more intense after the fresh-man year.

Personal qualifications needed inthe profession include a sympatheticbut ohjective approach to illness anddisability, maturity, patience, imagi-nation, manual skills, and the abilityto teach. In addition to biology andchemistry, high school students inter-ested in careers as occupationaltherapists are advised to take coursesin health, crafts, and the social sci-ences.

Newly graduated occupationaltherapists generally begin as stafftherapists. Advancement is chiefly tosupervisory or administrative posi-tions; some therapists pursue ad-vanced education and teach or doresearch.

Employment Outlook

Employment in this occupation isexpected to grow much faster thanthe average for all occupations dueto public interest in the rehabilitationof disabled persons and the successof ,established occupational therapyprograms. Many therapists will beneeded to staff hospital rehabilitationdepartments, community health cen-ters, extended care facilities, psychi-atric centers, schools for childrenwith developmental and learning dis-abilities, and community homehealth programs. b

However, the increasing numberof graduates from occupational ther-apy programs may exceed the num-ber of openings that will occur eachycar due to growth in the occupationand replicement of those who willdie or mike. As a result, new gradu-ates may facc competition in somegeographic areas through the mid-1980's.

18


Beginning salarier for new gradu-ates of occupational therapy pro-grams working in hospitals averagedabout $12,000 a year in 1976, ac-cording to a national survey conduct-ed by the University of Texas Medi-cal School. Some experiencedtherapists earned as much as$17,000, and some administrators asmuch as $25,000 to $30,000. In1976, the average salary of experi-enced occupational therapists was I1/2 times the alrerage earnings for allnonsupervisory workers in private in-dustry, except farming.

In 1977, beginning therapists em-ployed by the Veterans Administra-tion (VA) earned starting salaries of$10,370 a year. The average salarypaid occupational therapists workingfur the VA was about $16,000 at thattime.

Many part-time positions are avail-able for occupational therapists.Many therapists work for more thanone employer and must travel be-tween job locations.


For more informatiOn on occupa-tional therapy as a career, write to:American Occupational Therapy Association,

6000 Executive Blvd., Rockville, Md.20852.

Those COTA's interested in quali-fying for the examination to brnea registered occupational therapist(OTR) through acquired work expe-Hence should contact the Director ofCertification at the above address.

OCCUPATIONAL. THERAPYASSISTANTS & AIDES

(D.O.T. 079.368)

Nature of the Work

Occupationil therapy assistantswork under the supervision of profes-sional occupational therapists to helprehabilitate patients who are physi-cally and mentally disabled. They

17

help plan and implement programs ofeducational, vocational; and recrea-tional activities that strengthen pa-tients' muscle power, increase mo-tion and coordination, and developself-sufficiency in overcoming dis-abilities.

Occupational therapy assistantsteach clients self-care skills such asdressing, eating, and shaving; work-related skills such as the use of power

,tools; and recreational and social ac-tivities such as games, dramatics, andgardening. They also may teach cre-ative skills such as woodworking, ce-ramics, and graphic arts.

Assistants must be able to teach abroad range of skills because of thewide variety of patients. They maywork either with groups or with indi-vidual patients. When treating pa-

4r,144:jc

tients with diseases, assistants usuallywork under the supervision of profes-sional occupational therapists. Inother situations, such as organizingcrafts projects for handicapped per-sons living in institutions, they mayfunction independently, with onlyperiodic consultation with profes-sionals.

Occupational therapy aides ordersupplies, prepare work materials, andhelp maintain tools and equipment.They also may keep records on pa-tients, prepare clinical notes, andperform other clerical duties.

Some small occupational therapydepartments may consist only of atherapist and one other worker. inthese cases, the assistant or aide mayassume most of the duties of an occu-pational therapist, within the limits ofhis or her training.

' ru ffel

i.

311101m

ecuastionet therapy assistants must be able to tooth a broad ramp of skills.1

18 \19


About 8,900 people worked asoccupational therapy ;assistants andaides in 1976. Almost half of alloccupational therapy assistants workin hospitals. Others work in nursinghomes, schools for handicapped chil-dren and the mentally retarded, reha-bilitation and day care centers, spe-cial workshops, and outpatientclinics. A small number are membersof the Armed Forces.

Occupational therapy aides workin the same locations as assistants,but they generally are most oftenemployed in hospitals.


Two types of educational pro-grams prepare occupational therapyassistants: junior or community col-lege programs that award an asso-ciate degree upon completion andvocational or technical programs ofabout 1 year's duration. In 1976, 42schools offered educational pro-grams approved by the AmericanOccupational Therapy Association.Most of these are 2-year college pro-grams leading to an associate degree.About one-third are i -year vocation-al and technical school programt Inaddition, the Armed Forces operatea school to train occupational ther-apy assistants.

Graduates of,these programs whosuccessfully complete the written na-tional proficiency examination arecertified by the American Occupa-tional Therapy Association, and re-ceive the title Certified OccupationalTherapy Assistant (COTA). In 1976,about 2,640 employed occupationaltherapy assistants were COTA 's.

Approved programs combineclassroom instruction with at least 2months of supervised practiCal expe-rience. Courses include the historyand philosophy of occupational ther-apy, occupational therapy theory andskills, anatomy and physiology of thehuman body, the effect of illness andinjury on patients, and human devel-opment. Students also practice skillsand crafts they later will teach to pa-tients.

Applicants for training programsmust be high school graduates or the

.equivalent. Among the subjects rec-ommended for high school studentsinterested in the occupational ther-apy field are health, biology, .typing,and the social sciences. Preferencesometimes is given to applicants whohave takeri courses in science andcrafts and have previous work expe-rience in a health care setting.

Occupational therapy aides trainon the job in hospitals and otherhealth care facilities. The length andcontent of their training varies de-pending on the level of difficulty ofthe duties that aides are expected toperform.

Occupational therapy assistantsand aides should like people, havegood physical and mental health, andbe able to establish and maintaineffective interpersonal relationships.They also should have manual skillssince they must teach clients how, touse tools and materials.

Occupational therapy assistantsand aides who work in large healthfadilities begin with routine tasks andmay advance to' more responsibleones as they gain experience. ACOTA with 4 years of approved'work experience may take the exami-nation to become a registered occu-pational therapist (OTR) withoutcompleting the remaining 2 years ofstudy for a bachelor's degree iti occu-pational therapy. Those COTA'sconsidering this path of entry to theoccupational therapy professionshould contact the Director of Certi-fication of the American Occupa-tional Therapy Association to identi-fy the types of experience required toqualify for the examination.

Employment Outlook

The employment of occupationaltherapy assistants and aides is ex-pected to grow much faster than theaverage for all occupations, due topublic interest in the rehabilitation ofdisabled people. All types of healthcare institutions, especially nursinghomes and community health cen-ters, will need more occupationaltherapy assistants through the mid -1980's.

gmployment opportunities Iiii.occupational therapy assistants areexpected to be very good through themid-1980's, particularly for gradu-

1.

ates of approved programs. Manyopenings will be created each year bygrowth in the occupation and evenmore will occur as workers die, re-tire, or leave the field for other rea-sons.

The number of educational pro-grams for occupational therapy assis-tants is expected to increase, with theresult that assistants in some geo-graphical areas may face competitionfor jobs. On a national basis, how-ever, the supply of graduates is likelyto fall short of requirements.

Earnings'and WorkingConditions

in 1976, annual salaries generallyranged from $7,500 to $9,000 forinexperienced assistants. Experi-enced occupational therapy assis-tants earned between $8,500 and$12,000 a year, according to the lim-ited information available. Thosewho completed an approved pro-gram generally earned higher startingsalaries than beginners without anytraining. Occupational therapy assis-tants working for the Veterans Ad-ministration earned starting salariesof $7,408 annually in 1977, and theaverage of salaries paid to all occupa-tional therapy assistants with theFederal Government was about

.$11,500 a year.Occupational therapy aides earned

beginning salaries of about $6,200 ayear in 1976, according to the limit-ed information available.

Occupational therapy assistantsand aides occasionally may workevenings, weekends, and part time.


For information about work op-portunities and programs offeringtraining for occupational therapy as-sistants, contact:

American Occupational Therapy Association,45000 Fvieulive Blvd., Rockville. Md.20852.

,...". Those COTA's interested in quali-

fying for the examination to becomea registered occupational therapist(OTR) through acquired work expe-rience should convict the Director of

20

Certification, American Occupa-tional Therapy Association, at theabove address. ..

PHYSICAL THERAPISTS

(D.O.T. 079.378)

Nature of the Work-.-

Physical therapists help personswirh muscle, nerve, joint, and bonediseases or injuries to overcome theirdisabilities. Their patients include ac-cident victims, crippled children, anddisabled older persons. Physicaltherapists perform and interpret testsand measurements for musclestrength, motor development, func-tional capacity, and respiratory andcirculatory efficiency to develop pro-grams for treatment in cooperationwith the patient's physician. Theyevaluate the effectiveness of thetreatment and discuss the patients'progress with physicians, psycholo-gists, occupatiOnal therapists, andother specialists. When advisable,physical therapists revise the the ra-peutic procedures and treatments.They help disabled persons to accepttheir physical handicaps and adjustto them. They show members of thepatients' families how to continuetreatments at home.

Therapeutic procedures includeexercises for increasing strength, en-durance, coordination, and range ofmotion; electrical stimuli to activateparalyzed muscles; instruction in car-rying out everyday activities and inthe use of helping devices; and theapplication of massage, heat andcold, light, water, or electricity torelieve pain or improve the conditionof muscles and skin.

.. Most physical therapists providedirect care to patients as staff mem-bers, supervisois, or self-employedpractitioners. Physical therapists usu-ally perform their own evaluations ofpatients; in large hospitals,and'Ours-ing homes, however, the director orassistant director of the physicaltherapy department may handle thiswork, which requires extensive train-ing and experience. Therapists maytreat patients with a wide variety.of

19

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f alp

Physical thoroplats dewlap programs for treatment of disabled persons of all egos.

problems, or they may specialize inpediatrics, geriatrics, amputations,arthritis, or paralysis. Others teach orare 'consultants. .


About 25,000 persons worked aslicensed physical therapists in 1976.The largest number work in hospi-tals. Nursing homes employ a grow-ing number of physical therapists,and also contract for the services ofself-employed therapists. Otherswork in rehabilitation centers orschools for crippled children. Somewho work for public health agenciestreat chronically sick patients in theirown homes. Still others work in phy-sicians' offices or clinics, teach inphysital therapy educational -pro-grams, or work for research organi-

20

zations. A few serve as consultants ingovernment and voluntary agenciesor are members of the ArmedForces.

Training, Other Qualifications,and Ad4ancement

All States and the District of Co-lumbia require a license to practicephysical therapy. Applicants for a H-cense must have a degree or certifi-cate from an accredited physicaltherapy educational program and toqualify must pass a State board ex-amination. Applicants may- preparefor State board examinations in phys-ical therapy through one of threetypes of programs, depending uponprevious academic study. Highschool graduates can earn a 4-yearbachelor's degree in physical therapy

2

at a college or university. Studentswho already hold a bachelor's degreein another field, such as biology orphysical education, can earn a sec-ond bachelor's degree or a certifica-tion in physical therapy through spe-cial programs lasting 12 to 16months. These applicants also havethe option of working for a master'sdegree in physical therapy.

In 1976, 11 certificat% programs,76 bachelor's degree programs and 5master's degree programs were ac-credited by the American PhysicalTherapy Aisociatibn and the Ameri-can Medical Association to provideentry level traiqing. There were also17 other master's degree programsthat provided advanced training tothose already in the field. One of thecertificate programs is sponsoredjointly by the U.S. Army and BaylorUniversity; graduates are commis-sioned as officers in the Army.

The physical therapy curriculumincludes science courses such asanatomy, physiology,neuroanatomy.and neurophysiology; it also includesspecialized courses such as biome-chanics of motion, human growthand development, and manifestationsof disease and trauma. Besides re-ceiving classrooin instruction, 'stu-dents get supervised clinical experi-ence administering physical therapyto patients in a hospital or treatmentcenter.

Competition for entry to all phys-ical therapy programs is keen. Insti-tutions offering a physical therapyprogram each year receive manymore applications than the numberof existing places. Consequently, stu-dents seriously interested in attend-ing a physical therapy program mustattain superior grades in their earlierstudies, especially in science courses.

Personal traits that physical thera-pists need include patience. tact, re-sourcefulness, and emotional stabil-ity to help patienti and their familiesunderstand the treatments and adjustto their handicaps. Physical the ra=pists also should have manual,dexter-ity and physical stamina. Many per-sons who want to determine whetherthey have the personal qualitiesneeded for thid occupation volunteerfor summer or part-time work in thephysical therapy department of a

hospital or Clinic. High schoolcourses that are useful includehealth; biology, social science,mathematics, and physical educa-tion.

A graduate degree combined withclinical experience increases opper-tunities for advancement, especiallyto teaching, research, and adminis-trative positions.

Employment Outlook

Emphiyment of physical therapistsis expected to grow faster than theaverage for all occupations throughthe mid-1980's because of increasedpublic recognition of the importanceof rehabilitation. As programs to aidcrippled children and other rehabili-tation activities expand, and as

`.

growth takes place in nursing homesand other facilities for the elderly,many new positions for physicaltherapists are likely to be created.Many part-time positions should con-tinue to be available.

However, the rapidly growingnumber of new graduates is expectedto exceed the number of openings,that will occur each year due togrowth in the occupation and re-placement of those who will die orretire. As a result, new vaduates areexpected to face some competitionthrough the ,mid-1980's. Employ-ment opportunities will be best insurburban and rural areas.


Starting salaries foi new physicaltherapy graduates averaged about811,200 a year in 1976, according toa national survey conducted by theUniversity of Texas Medical School.Earnings of experienced physicaltherapists averaged about $14,000,about one and a half times as muchas average earnings for all nnnsuper.

'visory workers in private industry,except farming.

Beginning therapists employed bythe Veterans Administration (VA)earncd starting salaries of 8 10,473 ayear in 1977. The average salary paidtherapists employed by the 'VA in1977 was 815,700 annually; supervi-sory therapists may earn over820,000.

;


Additional inforMation on a careeras a physical therapist and a list ofaccredited educational programs inphysical therapy are available from:American Physical Therapy Association. 1156

15th St. NW Washington. D.C. 10005.

PHYSICAL THERAPISTASSISTANTS AND AIDES

(D.O.T. 355.878)

Nature of the Work

Physical therapistassistants andaides work under the supervision ofprofessional physical therapists to re-_habilitate disabled persons so. thatthey may again lead useful and pro-ductive lives. They work to restorephysical functions and prevent dis-ability from injury or illness.

Assistants help physical therapiststest patients to determine the extentof their capabilities and the besttreatment for them. Using special

7;-.:4t410".ark,-

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therapy equipment, they apply heat,cold, light, ultra sound, and massage;and report to their supervisors onhow well the patient is responding totreatment. Assistants help patientsperform therapeutic exercises tobuild strength and increase motion aswell as everyday activities such aswalking and climbing stairs. Theyalso help the physical therapist toinstruct patients on how to use artifi-cial limbs, braces, and splints.

Physical therapist aides help- pa-tients prepare for treatment, and mayremove and replace devices such asbraces, splints, and slings and trans-port patients to and from treatmentareas. They may help assistants ortherapists by supporting patients dur-ing treatment. Aides care foi and as-semble treatment equipment. Theyalso make appointments, act as re-ceptionists, and perform other cleri-cal duties.

Some small health care institu-tions, such as small hospitals or nurs-ing homes, employ only one personbesides the therapist in the physicaltherapy departmePt. In this case, theassistant or aide may assume most of

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the duties of the therapist, withirrthelimits of his or her training.


About 12,500 persons worked asphysical therapist assistants and aidesin 1976. Most work in physical ther-apy departments of general and spe-cialized hospitals. ()chefs work inphysicians' or physical therapists' of-fices and clinics, rehabilitation cen-ters, or nursing homes for the chroni-cally ill and elderly. Somecommunity and government healthagencies, schools :or crippled chil-dren, and facilities for the mentallyretarded also employ physical thera-pist assistants and aides. A smallnumber are members of the ArmedForces.


Training requirements for physicaltherapist assistants are not uniformthroughout the country. In 19 States.assistants are licensed. They must begraduates of approved 2-year asso-ciate degree programs and pass, awritten proficiency examination. Afew of these States have a "grandfa-ther" clause that allows the educa-tional requirement to be waived forthose who learned their skills beforeassociate degree programs becameavailable. in States not requiring alicense, physical therapy aides danadvance to assistants by acquiringthe necessary.. knowledge and skillson the job, although employers oftenprefer graduates of approved pro-grams.

There were 37 approved programsto train physical therapist assistantsM 1976.,Most were in junior or com-munity colleges, and all led to an as-sociate degree. Courses include his-tory and philosophy of rehabilitation,human growth and development.anatomy, physiology, and psychol-ogy. Studies also cover physicaltherapist assistant procedures inclUd-ing massage, therapeutic exercises,and heat and. cold therapy. Super-.vised clinical experience alsd is a re-.quirement of physical therapistassistant programs. The MinedForces operate schools to train phys-ical therapist assistants,. but this

22

training does not satisfy academic re-quirements for State licensure and nodegree is awarded to graduates.

Physical therapist aides train onthe job in hospitals and other healthcare facilities. The length and con-tent of these training programs varywidely, depending on the level of dif-ficulty of duties that aides are expect-ed to perform, the particular servicesrequired, by patients in the program,and the amount of time professionaltherapists spend in teaching trainees.Applicants admitted to physicaltherapist aide training programs gen-erally must be high school graduatesor the equivalent. Employers usuallyp refer that aides have previous hospi-tal experience as nursing aides.

High school courses that are help-ful to physical therapist assistantsand aides are 'health, biology, psy-chology, physical education, mathe-matics, and typing.

Physical therapist assistants andaides need good physical health.They also need good manual dexter-ity to adjust equipment, body coordi-nation to assist in positioning pa-tients, and an interest M assisting thephysically handicapped. Emotionalstability is important because assis-tants and aides must maintain a posi-tive, bright outlook white helping pa-tients with very difficult handicaps.Patience and the ability to recognizeand appreciate slight improvementsalso are helpful.

As physical therapist assistants andaides gain experience, they may ad-vance to more responsible dutieswith corresponding pay increases.Some aides may become physicaltherapy assistants on the basis of ac-quired job experience. The opportu-nities for aides to advance in this way

are best in areas where associate de-gree programs for physical therapistassistants are unavailable.

Physical therapist assistants withan associate degree from an ap-proved program sometimes advanceto physical therapists by earning thebachelor's degree in physical ther-apy. A student thinking about thisoption should arrange his or her asso-ciate degree curriculum carefully tocorrespond to the undergraduate re-quirements of the bachelor's degree-program under consideration.

0 7.

Employment Outlook

Job opportunities for physicaltherapist assistants and aides who aregraduates of approved programs areexpected to be excellent through themid-I 980's. In communities wherethere are large classes ilk physicaltherapist,, assistant programs, somegraduates may find it necessary tomono to other locations where noassociate degree programs are avail-abid. For the Nation as a whole, how-ever, the number of openings forphysical therapist assistants causedby growth and replacement needs are :expected to far exceed the number ofgraduates from these programs.

The number of physical therapistassistants and aides is 'expected toincrease faster than the average forail occupations as the demand forprofessional physical therapistsgrows. Overall demand in the fieldstems from increased public aware-ness of the importance of rehabilita-tion and the growing number of nurs-ing homes which provide therapeuticservices to the elderly. Ex. indedphysical therapy services planned byhospitals, nursing homes, schools forcrippled children, facilities for men-tally retarded, and other health andrehabilitation centers are expected to

_further increase the need for physicaltherapist assistants and aious.


In 1976, weekly salaries averagedabout $116 for beginning physicaltherapist aides and about $170 forthose with experience, according tothe limited information available.Physical therapist assistants receivedhigher salaries than aides, beginningat about $175 a week. Experiencedphysical therapist assistants earnedas much as $325 weekly. Physicaltherapist assistants working for theVeterans Administration (VA)earned starting salaries of $115 aweek in 1977, and the average ofsalaries paid to all physical therapistassistants with the VA was about$214 weekly.


Information on a career as a phys-ical therapist assistant or aide and on

A

programs offering training for phys-ical therapist assistant is available:tom:The American Physical Therapy Association.

1156 15th St. NW., Washington. D.C.20005.

SPEECH PATHOLOGISTSAND AUDIOLOGISTS

(DOT. 079.108)

Nature of the Work

About one out of ten Americans isunable to speak or hear cl4sarly. Chil-dren who have trouble speaking orhearing cannot participate fully withother children in play or in normalclassroom activities. Adults havingspeech or hearing impairments oftenhave problems in job adjustment.Speech pathologists and audiologistsprovide direct services to these peo-ple by evaluating their speech or

hearing disorders and then providingtreatment.

The speech pathologist works withchildren and adults who have speech,language, and voice disorders result-ing from causes such as total or par-tial hearing loss, brain injury, cleftpalate, mental retardation, emotionalproblems, or,..foreign dialect. Theaudiologist primarily assesses andtreats hearing problems. Speech andhearing, however, are so interrelatedthat, to be competent in one of thesefields, one must be familiar withboth. -

The duties of speech pathologistsand audiologists vary with education,experience, and place of employ-ment. In clinics, either in schools orother locations, they use diagnosticprocedures to identify and evaluatespeech and hearing disorders. Then,in cooperation with phySicians, psy-chologists, physical therapists, andcounselors, they develop and imple-ment an organized pro ram of ther-apy. Some speech pathologists andaudiologists conduct research such

Speech pathologists and audiologists help people overcome speech and hearingdisorders.

as investigating the causes of com-municative diSorders and improvingmethods for clinical services. Otherssupervise clinical activities.

Speech pathologists and audiolo-gists .;olleges and universittesteach courses: in the principles ofcommunication, communication dis-orders, and clinical techniques; par-ticipate in edUcational programs forphysicians, nurses, and teachers; andwork in university clinics and -.re-search centers. Although mostspeech pathologists and audiologistsdo some administrative work, direc-tors of speech and hearing clinics andcoordinators of speech and hearingin schools, health departments, orgovernment agencies may be totallyinvolved in administration.


Over 380000 persons worked asspeech pathologists and audiologistsin 197. Over one-half worked inpublic schools. Colleges and univer-sities employed many in classrooms,clinics, and research centers. Therest worked in hospitals, speech andhearing centers, government agen-cies, industry, and private practice.

Tralninfl Other Quaillieetions,and Adva*ement

An increasing number of States'require a master's degree or- itsequivalent foe speech pathologistsand audiologistc In addition, manyFederal programs, such as Medicareand Medicaid, require participatingspeech pathologists and audiologiatts.to have a master's degree. SomeStates require a teaching certificateto work in.the public schools. In 29States, those offering speech -pathol-ogy and audiology services outside ofschools must be licensed. Lipensurerequirements vary among the States..

Undergraduate courses in speechpathology and audiology programsinclude anatomy, biology, physiol-ogy, physics, sociology, linguistics,semantics, and phonetics. Courses inspeech and hearing as well as in childpsychology and psychology of the ex-ceptional child also are helpful. Thistraining usually is available at colleg-es that offer a broad liberal arts pro-gram.

4.1 23

In early I977t about 228 collegesand universities offered graduateeducation in Speech pathology and.)audiology. Courses at the graduatelevel include advanced anatomy andphysiology of the areas involved inhearing and speech; acoustics; psy-chological aspects of communica-tion; and analysis of speech produc-tion, language abilities, and auditoryprocesses. Graduate students alsotake courses in the evaluation andremediation of speech, language, andheating disorders. All students at thegraduate level receive supervisedclinical training with clients havingcommunicative disorders.

A limhed number of scholarsfps,fellowships, assistantships, and train-eeships are available in this field.Teaching and training grants to col-leges and universities that have pro-grams in speech and hearing are giv-en by a number of agencies of theU.S. Department of Health, Educa-tion, and Welfarethe Rehabilita-tion Services Administration, theMaternal and Child Health Service,the Office of Education, and the Na-tional Institutes of Health. In addi-tion, some Federal agencies distrib-

; tate money to colleges to aid graduatestudents in speech and hearing pro-grams. A large number of private or-ganizations and foundations also pro-vide financial assistance foreducation in this field.

Meeting the American Speech andHearing Association's (ASHA) re-quirements for a Certificate of Clini-cal Competence usually is necessaryin order to advance professionallyand to earn a higher salary. To carethe CCC, a person must have a mas-ter's degree or its, equivalent andcomplete a one-year internship ap-proved by the Association. Passing anational written examination also isrequired.

Speech pathologists and audiolo-gists should be able to approach'problems objectively and have a con-cern for the needs of others. Theyalso should have considerable pa-tience, because a client's progress of-

24

ten is'slow. A person who desires acareer in speech pathology and audi-ology should be able to accept re-sponsibility, work independently,and direct others. The ability to workwith detail is important. Speech pa-thologists and audiologists receivesatisfaction from seeing clients'speech or hearing improve as a resultof their work.

Employment Outlook

The employment of speech pa-thologists and audiologists is expect-ed to increase faster than the averagefor all other occupations through themid-1980's. However, temporary re-ductions in government spending onspeech and hearing programs maydecrease the number of new posi-tions available at any one time. Al-though some jobs will be availablefor those having only a bachelor'sdegree, the increasing emphasisplaced on the master's degree byState governments, school systems,and Federal agencies will limit op-

, portunities at the bachelor's degreelevel.

While employment opportunitiesfor those with a master's degree gen-erally should be favorable, the largenumber of graduates entering thisfield may cause some competition.Many openings will occur outside ofthe large metropolitan areas andsome graduates will have to relocatein order to find employment. Compe-tition for teaching positioni in collcg-es and universities will' be very strongthroughout the period.

Population growth, which will in-crease the number of persons havingspeech and hearing problems, is oneof the factors underlying the expect-ed expansion in employment ofspeech pathologists and audiologiststhrough the mid-1980's. In addition,there is a trend toware earlier recog-nition and treatment of hearing andlanguage problems in children. Manyschool-age children, thought to havelearning disabilities, actually havelanguage or hearing disorders which

speech pathologists and audiologistscan treat.

Other factors expected to increasedemand for speech pathologists andaudiologists are expansion in expen-ditures for medical research and thegrowing public interest in speech andhearing disorders. State and Federallaws now require school systems toprovide equal educational servicesfor handicapped children, and Medi-care and Medicaid programs haveexpanded their coverage of speechand hearing services.


In 1977, the annual starting salaryin the Federal Government forspeech pathologists and audiologistswith a master's degree was $14,097.Those having a doctoral degree wereeligible to start at 817056. The aver-age salary of all speech pathologistsand audiologists working for the Fed-eral Government was $21,804.

Salaries of speech pathologists ouside,of government tend to be higherin areas- having large urban popula-tions, Many speech pathologists andaudiologists, particularly those incolleges and universities, supplementtheir incomes by acting as .consul-tants, engaging in research projects,and writing books and articles.

Many speech ,pathologists andaudiologists work "'over 40 hours aweek. Almost all receive fringe bene-fits sucks paid vacations, sick leaverand retirement programs.


State departments of educationcan supply information on certifica-tion requirements for those who wishto work in public schools.

A list of college and universityprograms and a booklet on studentfinancial aid as well as general careerinformation are available from:American Speech and Hearing Association.

9030 Old Georgetown Rd.. Washington,D.C. 200t4.

* US. COVEleiUle room arm try 0245.025