Complete this week’s assigned readings, chapters 39-43. After completing the readings, post a short reflection, approximately 1 paragraph in length, discussing your thoughts and opinions about one or several of the specific topics covered in the textbook readings. Identify which one MSN Essential most relates to your selected topic in your discussion. (see attached for master essesntials)

at least 250 words, no scholarly sources are required

Below is chapter 42 please use this for discussion

CHAPTER 42

Is There a Nurse in the House? The Nurses in the U.S. Congress

C. Christine Delnat

“The members of the legislative department …. are numerous. They are distributed and dwell among the people at large. Their connections of blood, of friendship, and of acquaintance embrace a great proportion of the most influential part of the society … they are more immediately the confidential guardians of their rights and liberties.”

James Madison

The U.S. Congress is elected to represent the people of the United States in regularly held democratic elections. There are two houses, the House of Representatives which has 435 voting members serving 2-year terms, and the Senate which has 100 voting members serving 6-year terms. The 113th Congress, elected in November 2012, includes members of many professions, predominantly business, law, public service and politics, and education. However, there are also a number of health care professionals: 19 physicians, 2 dentists, 1 psychiatrist, and 6 nurses (Manning, 2014). The first U.S. Congress met in 1789. In 1992, 203 years later, Eddie Bernice Johnson (Figure 42-1) became the first nurse elected to serve in the U.S. Congress. Congresswoman Johnson (D-TX-30) continues to serve, now joined by Karen Bass (D-CA-33) (Figure 42-2), Diane Black (R-TN-06) (Figure 42-3), Lois Capps (D-CA-23) (Figure 42-4), Renee Ellmers (R-NC-02) (Figure 42-5), and Carolyn McCarthy (D-NY-04) (Figure 42-6).

Although elected to represent their constituents, Congress as a whole does not always reflect the population characteristics of the nation (Heineman, Peterson, & Rasmussen, 1995). For example, 51% of the 2010 U.S. population was female (U.S. Census Bureau, 2010). However, only 18.7% of the 113th Congress was female (Manning, 2014). Fortunately, nursing is well represented in Congress. With 3.1 million nurses in the U.S. (American Nurses Association, 2011), at least 4 nurses would have been expected in the 113th Congress and 6 were elected.

The Nurses in Congress

Nursing is diverse, and the six nurses who served in the 113th Congress reflect that diversity. Rep. Johnson’s background is in psychiatry, Representatives Elmer and McCarthy were intensive care nurses, Rep. Black’s background is emergency nursing, Rep. Capps was a school and community nurse, and Rep. Bass was a nurse before becoming a physician’s assistant. The six nurses who served in the 113th Congress arrived at their positions through uniquely different paths. One replaced a spouse who died while serving in Congress, another ran for office after the incumbent refused to take a stand on gun control following an act of gun violence that killed her husband, several ran for Congress after serving at the state level, and one ran for office because of deeply held opinions on patient rights and access to health care.

The Honorable Karen Bass

Congressmember Bass is a former nurse, physician’s assistant, and nonprofit community activism organization founder who was elected to her second term in the House of Representatives in 2012. She serves California’s 37th Congressional District which includes parts of Central, West, and South Los Angeles. Before Rep. Bass was elected to Congress, she served in the California Assembly, where she earned the distinction of being the first African-American woman in U.S. history to be elected to the powerful role of state Speaker. She serves on the Steering and Policy Committee, which sets policy for the Democratic Caucus and also serves in the Congressional Black Caucus as the Whip for the 113th Congress (Bass, 2014a).

Rep. Bass has taken a strong stand on health care with consistent support of the Affordable Care Act (ACA), the introduction of legislation to increase health care technology in underserved communities, and cosponsoring legislation to improve education on sexually transmitted infections and unintended pregnancies. A life-long advocate for foster children, she founded the Congressional Caucus on Foster Youth, a bipartisan effort with the goals of overhauling the nation’s foster system and providing advocacy for the needs of the nation’s foster children (Bass, 2014b).

The Honorable Diane Black

Diane Black was elected to the Tennessee 6th Congressional District in 2010, on a platform of small government and limited taxes (Black, 2014a). Rep. Black is one of three female U.S. Representatives that use the term title Congressman instead of Congresswoman. Rep. Black has been a registered nurse for over 40 years. She began her career in the emergency department in 1971 and worked as a nurse until 1998, when she was elected to the Tennessee House of Representatives. Rep. Black is a member of the House Committee on Ways and Means and its Subcommittee on Oversight, as well as the Committee on Budget (GOP.gov, 2013).

Rep. Black represents a constituency that believes that the ACA should be repealed and replaced by market-based health care reform (GOP.gov, 2013). Health care legislation that she has sponsored includes Title X Abortion Provider Prohibition, which would prohibit agencies performing abortions from receiving federal family planning assistance; the Health Care Conscience Rights Act, which would prohibit requiring people to purchase health insurance covering abortions; and the Safety Net Abuse Prevention Act of 2013, to terminate the Partnership for Nutrition Assistance Initiative between the United States and Mexico (Black, 2014b).

The Honorable Lois Capps

Congresswoman Lois Capps was a school nurse in Santa Barbara, California, a nursing instructor in Portland, Oregon, holds an MA in Religion from Yale University, and maintains her registered nurse license. She won her seat in the House of Representatives in a special election resulting from the death of her husband, Walter Capps. She holds influential seats on the Committee on Energy and Commerce and the Health, Energy and Power, and Environment and the Economy subcommittees. Rep. Capps maintains that her health care background is very influential in informing her work in Congress. She is also the cochair of the House Cancer Caucus, the Congressional Heart and Stroke Coalition, as well as a founding member of the Congressional Nursing Caucus, the Infant Health and Safety Caucus, and the School Health and Safety Caucus (Capps, 2014a).

Lois Capps’s legislative priorities include better schools, quality health care, and a cleaner environment. Through her leadership in public health, she has sponsored legislation to reduce the nation’s nursing shortage, protect victims of domestic violence, decrease underage drinking, improve mental health services, and improve Medicare coverage for people with Lou Gehrig’s disease. Rep. Capps states that she is committed to increasing access to affordable health coverage and working toward quality health care availability for everyone. According to Rep. Capps, “Our nation’s health care system is broken, but through health care reform we are now taking critical steps to repair it.” (Capps, 2014b)

The Honorable Renee Ellmers

Congresswoman Ellmers was elected in 2010 to serve the constituents of North Carolina’s second District in the U.S. House of Representatives. Rep. Ellmers worked as a nurse for 21 years, first in surgical intensive care, and then with her husband in their general surgery practice. She became interested in politics as a result of health care reform and ran for office on a platform that included repealing the ACA, lowering health care costs, increasing health care access, protecting the physician-patient relationship, and reducing government spending. She serves on the House Energy and Commerce Committee, the Health, Communications, and Technology Subcommittee, and the Oversight and Investigations Subcommittee (Ellmers, 2014a).

Like fellow Congressman Black, Rep. Ellmers believes that health care reform should be based on the free market and that government involvement takes away individuals’ control over their benefits and health care decisions. Rep. Ellmers’ health care related legislative efforts in the 113th Congress included cosponsoring legislation to repeal the ACA, to prohibit abortion after 20 weeks’ gestation, and to allocate money for pediatric research (Ellmers, 2014b).

The Honorable Eddie Bernice Johnson

Congresswoman Eddie Bernice Johnson was the chief psychiatric nurse at the Dallas Veterans Administration Hospital until 1972, when she became the first African-American woman from Dallas, Texas to win an elected office. Elected to the Texas House of Representatives, she then became the first woman in Texas history to lead a major committee, and in 1977 she was tapped by President Jimmy Carter to serve as Regional Director of the U.S. Department of Health, Education, and Welfare. In 1986, she became the first African American to hold the office of Texas State Senator since Reconstruction, and she became known for spearheading measures to improve neighborhoods, health, and childcare. In 1992, Johnson was elected to the U.S. House of Representatives and has become a leader in science, technology, transportation, election reform, and civil rights issues. In December 2010, Congresswoman Johnson was elected as the first African-American female Ranking Member of the House Committee on Science, Space, and Technology (Johnson, 2014a).

A former nurse in the Veterans Administration, Rep. Johnson has a long history of advocating for veterans’ access to mental health services. She has recently sponsored bills to improve community assistance for persons with mental illness, as well as assistance for family caretakers caring for a family member with Alzheimer’s disease (Johnson, 2014b). These bills are currently under legislative review. Rep. Johnson believes that laws need to change for citizens with severe mental illness to have access to nondiscriminatory health care (Johnson, 2013).

The Honorable Carolyn McCarthy

In 1993, Carolyn McCarthy was a New York wife, mother, and nurse. McCarthy’s life changed course on December 7, 1993, when her husband Dennis and son Kevin were shot by a gunman aboard the Long Island Railroad. Her husband died and her son was critically injured. McCarthy, fueled by the senseless tragedy, began to advocate for stiffer gun control. In 1996, the Congressman in her home district voted to repeal a ban on assault weapons causing her to reshape her activism to a campaign, and she won her seat that year to serve in the House of Representatives (WP Politics, 2014).

Although much of her legislative focus has remained on controlling gun violence, Rep. McCarthy has also worked to help shape health care reform. She is a member of the Committee on Education and the Workforce, which is one of the committees responsible for drafting health care reform plans. She believes that reform is necessary and supported the passage of the ACA during the 111th Congress. Other health-related efforts include sponsoring the Children’s Access to Reconstructive Evaluation and Surgery Act in the 110th and 112th Congress, as well as the Student-to-Nurse Ratio Improvement Act in the 112th and 113th Congress, both of which have stalled in committee. Rep. McCarthy has also introduced legislation to help address senior citizen needs through Medicare legislation, and a tax credit for hearing aid assistance. She has been a strong supporter of women’s issues, including breast cancer education and women veterans’ health care (McCarthy, 2014. Rep. McCarthy announced her retirement in January, 2014, after 17 years in Congress.

Evaluating the Work of the Nurses Serving in Congress

The performance of members of Congress has been in the limelight during the 113th Congress. Major partisan differences centering on the ACA and economic policies are blamed for increasing dissatisfaction with members of Congress. Overall approval ratings are reported to be very low by many organizations conducting polls. PollingReport.com provides a compilation of polls related to politics and current political events and is useful in getting an overall picture of how Congress is doing.

The public is increasingly involved in evaluative political dialogue through the steady adoption of new technology. Social media, including Facebook and Twitter, have provided constituents with immediate, up-to-the-moment, unfiltered communication from politicians and are arguably changing the face of political media strategy. Congressmen post to their Twitter accounts, engaging directly with their followers providing direct access to personal thoughts and opinions (Peterson, 2012). Within minutes of a statement being made by a political leader, the public can, and does, begin discussing and analyzing. Regardless of the results of polls, opinions of analysts, or social media judgments, the ultimate evaluation of a Congressman’s success is measured by their reelection.

Political Perspective

There are several tools available for evaluating political perspective. PolitiFact.com is a Pulitzer Prize winning Tampa Bay Times fact-checking project designed to find the truth in American politics. Reporters and editors of The Times evaluate and rate the factuality of comments made by politicians (PolitiFact.com, 2014). A search of PolitiFact can rapidly confirm or debunk statements and helps constituents evaluate their Representatives. Every year, the nonpartisan National Journal uses voting records to compare lawmakers on an ideologic, liberal/conservative scale based on controversial economic, foreign, or social issues (National Journal, 2013). The most recent National Journal ratings of the six nurses in Congress are listed in Table 42-1.

TABLE 42-1

National Journal’s Ratings of the Nurses in the 112th U.S. Congress (2013)

	LIBERAL RATINGS			CONSERVATIVE RATINGS			COMPOSITE SCORE	COMPOSITE SCORE
	E	S	F	E	S	F	Liberal	Conservative
Eddie Bernice Johnson, D-TX	68	80	76	32	0	24	78.0	22.0
Carolyn McCarthy, D-NY	68	77	78	31	30	39	66.5	33.5
Lois Capps, D-CA	74	80	78	25	0	18	81.5	18.5
Karen Bass, D-CA	87	80	88	12	0	0	90.5	9.5
Diane Black, R-TN	0	0	0	90	83	91	6.0	94.0
Renee Ellmers, R-TN	10	0	0	83	83	91	8.8	91.2

Interest Group Ratings

Some interest groups grade, rate, or rank members of Congress on issues of interest to the group. For example, the Cato Institute, a libertarian public policy research organization, evaluates the support that members of Congress provide for open trade. They host an interactive website that allows the user to see how individual Congressmen have voted on legislation affecting free trade (Cato Institute, 2014). The National Rifle Association (2014) graded the 113th Congress on their voting record on gun rights, and The New York Times mapped their ratings in an interactive website (New York Times, 2012). Project Vote Smart is a political website devoted to providing the public with factual, timely, accurate information on politics in the United States. In addition to keeping a searchable database on performance evaluations of politicians from an extensive list of special interest groups, they provide interactive tools that allow comparing elected officials and potential candidates according to issue areas (Project Vote Smart, 2014).

Campaign Financing

There is big money in politics. In 2012, the cost of winning the office of U.S. Representative averaged $1,689,580, and the average cost of a Senate seat was $10,476,451 (Costa, 2013). Candidate’s campaign funds come from a variety of sources, including interest groups, lobbyists, political action committees, organizations, and individuals. The Center for Responsive Politics is a nonpartisan organization dedicated to tracking money and analyzing the effects of money on U.S. politics and public policy. Their website, OpenSecrets.org, houses unbiased information on campaign contributions and lobbying that anyone interested can easily access (Center for Responsive Politics, 2014). Table 42-2 demonstrates overall fund-raising and expenditures of each nurse in Congress during the 2012 congressional election cycle.

TABLE 42-2

Nurses in the 113th Congress: 2012 Election Cycle Fund-Raising

	Raised	Spent
Karen Bass, D-CA	$812,448	$933,375
Diane Black, R-TN	$2,497,751	$2,207,350
Lois Capps, D-CA	$3,325,296	$3,289,188
Renee Ellmers, R-NC	$1,136,890	$1,238,946
Eddie Bernice Johnson, D-TX	$779,237	$882,303
Carolyn McCarthy D-NY	$2,278,000	$1,860,331
	Small Individual	Large Individual	Political Action Committees	Candidate Self-Financing	Other
Karen Bass, D-CA	$21,423 (3%)	$215,672 (31%)	$442,998 (64%)	$0	$12,896 (2%)
Diane Black, R-TN	$50,410 (2%)	$862,880 (35%)	$1,178,331 (48%)	$304,523 (12%)	$41,086 (2%)
Lois Capps, D-CA	$419,388 (13%)	$1,697,422 (51%)	$1,132,703 (34%)	$0	$70,557 (2%)
Renee Ellmers, R-NC	$106,653 (10%)	$349,274 (32%)	$597,024 (55%)	$0	$33,919 (3%)
Eddie Bernice Johnson, D-TX	$23,390 (3%)	$236,340 (30%)	$518,496 (67%)	$1000 (0%)	$12 (0%)
Carolyn McCarthy, D-NY	$718,316 (32%)	$730,072 (32%)	$823,663 (36%)	$0 (0%)	$5950 (0%)

Sources of Campaign Funds

As of 2014, for the first time in history, more than half of the elected Representatives in Congress were millionaires (Center for Responsive Politics, 2014). This has sparked increased public discussion about how well Congress represents the actual population and the increasing wealth inequality. In the United States, 75.4% of all wealth is held by the richest 10% of the people. This is among the highest in the developed nations and has been steadily increasing (Credit Suisse Research Institute, 2013). Two nurses in Congress are in the multimillionaire category: Diane Black with an average net worth of $69.6 million, and Carolyn McCarthy with $4.3 million. With campaigns becoming increasingly expensive, the field of prospective legislators has narrowed. Table 42-2 outlines the campaign financing for the nurses serving in the 113th Congress.

Evaluating members of Congress is difficult. The reader may recall the Hindu fable where six sightless men touching an elephant came to six dif­ferent conclusions about what an elephant was like. The six men touched six different parts and came to six different conclusions about the elephant. Although each man may have been telling a truth, each man was wrong about his conclusion. This also applies in Congress. A true picture of a Congressperson’s effectiveness will necessarily include a variety of measures from a variety of perspectives.