Kimberly Bundley May 23rd 1.

Why would the framers insist that even the most insignificant federal regulations should trump even the most important of state constitutional provisions? The framers would insist that even the most insignificant federal regulations should trump even the most important states constitutional provisions because, the federal law is higher than the state law and controls regulations to prevent conflict and protect the people. 2. If a state makes criminal an action using language identical to language in a federal statute criminalizing the same action, is the state law preempted? Clearly, there would be no conflict between federal and state law, but might state criminal enforcement jeopardize federal enforcement, or might the federal government be seen as having occupied the field of criminal enforcement? No, the state law is not preempted because it is following the federal law. State law would only jeopardize federal enforcement if it interferes with laws broken within the federal boundaries. Because, Preemption can be either express or implied. When Congress chooses to expressly preempt state law, the only question for courts becomes determining whether the challenged state law is one that the federal law is intended to preempt. Implied preemption presents more difficult issues, at least when the state law in question does not directly conflict with federal law. 3. If the federal government has occupied a field of regulation, for preemption purposes it becomes important to precisely identify the boundaries of that field. What suggestions do you have for how that inquiry ought to be conducted? The Court then looks beyond the express language of federal statutes to determine whether Congress has "occupied the field" in which the state is attempting to regulate, or whether a state law directly conflicts with federal law, or whether enforcement.

Kimberly Bundley

May 30th 1. Do all states define registered nursing in the same manner? All states do not define registered nursing in the same manner and must be followed according to that states Board of Nursing. They, however, have similar definitions as it pertains to the general duties and responsibilities of a nurse. The standards of care tend to be defined in the same manner, but the limitations, responsibilities and acceptable practices may not. Hence, the important of knowing the parameters of nursing duties and functions for each state one may work in. 2. What is the scope of licensure for the state where you wish to practice? Scope of registered nurse license (a) In general. -- A license to practice registered nursing authorizes the licensee to practice registered nursing while the license is effective. (b) Name. -- A licensee may practice registered nursing using only the name in which the license has been issued. HISTORY: An. Code 1957, art. 43, 297; 1981, ch. 8, 2; 1990, ch. 6, 11; 1993, ch. 422. 3. What provisions are different between nursing and medical licensure? The provisions that are different between nursing and medical licensures are that nursing is governed by the board of nursing and medical doctors are governed by the Maryland Board of Physicians. In regards to the actual differences, Registered Nurses who are not Advanced Practice Nurses, cannot prescribe medications, cannot diagnose, but can assess and cannot perform medical procedure but can assist with them. As for Advanced Practice Nurses, they can do everything a medical doctor can do, but are sometimes limited on evasive procedures. Moreover, nurses provide holistic care and doctors have a more direct approach. 4. Does the nurse practice act address the legal regulation of nursing, the ethical mandates associated with nursing or both? The nurse practice act does address the legal regulation of nursing. In addition, the ethical mandates associated with nursing in the code of ethics. June 4th

Kimberly Bundley

1. What are the benefits of the nurse licensure compact? Maintaining the concept of states rights, boards of nursing responded to the need for removal of barriers in meeting nursing manpower needs. One mechanism to accomplish this end was the development of the Nurse Licensure Compact, a multistate nurse license structured in much the same way as driver's license compacts. Representatives of State Boards of Nursing developed model compact structure and rules which allow nurses licensed in their state of residence to practice in other participating states without having to obtain additional licenses. Monitoring of nurse licensure and disciplinary information is facilitated through Nurses (nurse system). Nurses, nurse administrators, and the public benefit from the experiences of the 23 states that have implemented the Nurse Licensure Compact. 2. What are the problems associated with the nurse licensure compact? In 1997, the National Council for State Boards for Nursing (NCSBN), a private association of state regulatory agencies, proposed a mutual recognition model of nursing licensure, referred to as the Nurse Licensure Compact (NLC). The Compact is an agreement between two or more states to coordinate activities associated with nurse licensure. Although nurses are not usually schooled in the legal implications of interstate compact administration, it is imperative that all nurses understand the implications a regulatory change, such as a mutual recognition model of nursing licensure, may have on consumers, nurses and the profession. 3. How does the nurse compact impact the states authority to regulate its practice? The United States Congress passed the Telecommunications Act of 1996 in response to the rapidly increasing practice of healthcare by electronic means. The Telecommunications Act called for development of standards and an infrastructure for telecommunications in healthcare. The nursing regulatory model in place at that time required a nurse to obtain licensure in each state where the nurse wished to practice. In addition to the obvious bureaucratic constraints of this model, the Texas Board also had no authority to take action against a nurses license if a patient in Texas was harmed by a nurse practicing remotely in another state. In response to the mandate of the Telecommunications Act, the National Council of State Boards of Nursing (NCSBN) embarked on a 3-year journey to develop a model of Multistate nursing licensure recognition that would "remove regulatory barriers to increase access to safe nursing care." The RN and LPN/VN Nurse Licensure Compact began January 1, 2000, when it was passed into law by the first participating states: Maryland Texas, Utah and Wisconsin.

4. Is the nurse licensure compact an example of federal preemption of the state law?

Kimberly Bundley

The Supremacy Clause of the Constitution preempts state laws that interfere with, or are contrary to, the laws of the Federal Government. But there is a strong presumption against preemption of state authority. Congress intent to preempt state law must be explicitly stated in statutory language or implicitly in the purpose and structure of statute. To date, Congress has been reluctant to exercise this authority with regard to the preemption of state licensure of health professionals.

June 6th

Kimberly Bundley 1. Given the graduated implantation of healthcare reform, what are the proposed implementation dates for the above discussed provisions? The proposed implementation dates for the above discussed provisions are 2010 for Expanded Public Health Service Commissioned Corp and the Ready Reserve Option. In 2011, training program expansion for nurses, Community living assistance services and supports (CLASS program), National Prevention, Health Promotion and Public Health Council strategy development, funding increase for school-based centers and nurse-managed health clinics will be implemented. Then in 2012, there will be the implementation of Accountable Care Organizations (ACOs). Lastly in 2013, American Health Benefit Exchanges and Small Business Health Options Program (SHOP) will be created. 2. Do any of the provisions change the nursing scope of practice? Yes, the provisions change the nursing scope of practice because of the changes in duties for advanced practice nurses. The changes will be of great magnitude because of the advanced practice nurses will meet the demand that primary care physicians are unable to fill. 3. How will the extra funding provided for implementations enhance registered nursing practice? The extra funding provided for implementations will enhance registered nursing practice by supplying monetary support for the nursed-managed health clinics new programs, allow more affordable and needed care, and provide more facilities for treatment that are not restrictive to types of insurance. 4. Do any of the provisions discussed preempt state law? If so explain how. Yes, all of the provisions discussed preempt state law, especially Cost/Funding Provision #2, that generally states that the federal law will be the law that is followed for Medicare fuding unless the state can or exceed the funding cost that the federal law and guidelines provide. 5. What has been the role of the AARP related to health reform? The role of AARP related to health reform is that allows elderly clients/patients to appeal any denials and provides the support needed in doing so and it provides clear explanation and understanding to the new health reform policies and advises on how it can benefit or assist the patient depending on their need.

June 11th

Kimberly Bundley 1. How does HIPAA incorporate health information and health insurance exchange? HIPAA incorporates health information and health insurance exchange by Unique Patient Identifiers (UPI). However, like anything in life, there are disadvantages. As a result, alternatives to the UPI are currently being researched for proposition and even implementation. 2. How will the rollout of health information exchanges and health insurance exchanges change the way nurses practice? The rollout of health information and exchanges and health insurance exchanges will change the way nurses practice by lessening the amount of medical errors, providing efficient and adequate care to patients, accurately treating patients according to current and previous diseases or illnesses, provide better organization and eliminate adverse events as it pertains to coverage. 3. Are their professional nursing standards to address utilization of health information exchanges end electronic health records? There are professional standards to address in the utilization of health information exchanges and electronic health records. The standards include and are not limited to only viewing patient information if the patient is under your care, maintaining confidentiality and ensuring that you log off of your computer each time you are done with usage, as this will prevent someone randomly searching for a patient under you sign on.

June 13th 1. What would you do if you found a billing clerk reviewing the genetic testing results of a patient?

Kimberly Bundley

I would address the billing clerk and remind her that test results are private and depending on the outcome of the conversation I would notify her immediate supervisor. 2. Can nurses discuss amongst each other, on email or twitter, genetic issues related to a specific patient? No, nurses cannot discuss information about a patient via twitter. If it is a work related discussion involving treatment then information can be sent by email as long as the Patients full name is not included. How 3. Could you share genetic information with the sister or brother of a patient who may be predisposed to the same disease? You cannot share genetic information to a Patients siblings even if they are predisposed to the disease because it is unethical unless the Patient signs a release of information form given you permission to discuss the Patients health status. 4. Does the Affordable Care Act address genetic information discrimination? Title II of GINA prohibits discrimination in employment based on genetic information and, with certain exceptions, prohibits an employer from requesting, requiring, or purchasing genetic information. The law prohibits the use of genetic information in employment decisions including hiring, firing, job assignments, and promotionsby employers, unions, employment agencies, and labor management training programs. On March 2, 2009, the Equal Employment Opportunity Commission (EEOC) issued proposed regulations for Title II that generally closely track the statutory language.8

Kimberly Bundley

June 18th 1. What should a nurse if a peer have placed a patient in danger by their failure to provide care or service? Report the incidence to the nursing supervisor. If you are aware of a wrong practice and do not report you may be putting yourself at risk of losing you license. You should also provide constructive feedback to your peer in order to educate and prevent this from happening in the future. If no changes are made then you are responsible for reporting the Nurse to the State Board of Nursing. 2. Should a nurse report discussions conducted with a patients boyfriend to the nurse supervisor? Yes, a nurse should reports discussion if it is relevant information related to the patients care and treatment. 3. What should a nurse do if he/she has reasonable suspicion that a nurse is diverting patient medications? If a nurse suspects a co worker is diverting patient medication the nurse should first talk to their co-worker and encourage them to get help. If the situation does not improve report the nurse to the nursing supervisor or manager. 4. Is it a violation of nurse standards of practice or ethics to under prescribe/administer pain medication? It is a violation of both. According the Nursing Standards of Practice nurses are obligated to be knowledgeable about pain management and to assess pain management. Nurses must also advocate for the Patient if the pain management is not effective. By under prescribing /administering pain medication the nurse is in violation of the patients human rights and thus violates the ethical standards of autonomy, veracity, beneficence, and nonmalfeasance. 5. Does a nurse manager have a legal, ethical or professional duty to report the firing of a nurse? Professional Duty 6. If a nurse has a pattern of practice which reflects illegal activities, i.e. mercy killings, but cannot prove such, should the nurse report such behavior; and if so, to whom?

Kimberly Bundley It should first be reported following the chain of command within the facility employed. If no action takes place then an anonymous letter can be sent to the State Board of Nursing o the Joint Commission. June 20th 1. Who was the first professionally trained African American Nurse? Mary Eliza Mahoney was the first African-American registered nurse in the U.S.A. She was born in Roxbury, Mass., where her parents had relocated from North Carolina; she became interested in nursing when she was a teenager. Unlike many blacks of her day, Mary Mahoney decided not to go into domestic work, but enrolled in nursing school. In 1879, out of a class of 40 students, only she, at age 34, and two other white students, graduated. The rigorous training program included lectures on surgical and childbed nursing and assignment in the hospital's surgical, maternity and medical wards. Sixteen months later, she was one of four who completed the rigorous course (of forty-two who started with her). After graduation she worked primarily as a private duty nurse for the next thirty years all over the Eastern Seaboard of the United States. She ended her nursing career as director of an orphanage in Long Island, New York, the position she had held for a decade. She never married. In 1896, Mahoney became one of the original members of a predominately white Nurses Associated Alumnae of the United States and Canada (later known as the American Nurses Association or ANA). In 1908 she was cofounder of the National Association of Colored Graduate Nurses (NACGN). Mahoney gave the welcoming address at the first convention of the NACGN and served as the association's national chaplain. Mary Eliza Mahoney died January 4, 1926. She is buried in the Woodlawn Cemetery in Everett, Massachusetts. In 1936, the NACGN created an award in honor of Mahoney for women who contributed to racial integration in nursing. This award was then continued by the ANA after the NACGN was dissolved in 1951. In 1976, fifty years after her death, Mary Eliza Mahoney was inducted into the Nursing Hall of Fame. 2. When were African American nurses allowed to take state licensure exams? The concept of permissive licensure does not require that all practitioners have a license to practice nursing. Permissive licensure allowed nurses who met certain standards to use the title, registered nurse. Requirements included graduating from a nursing school that met predetermined standards and passing a comprehensive examination. Permissive licensure allowed nurses to choose whether or not to obtain the additional registered nurse credential. Permissive licensure provided the public with protection by establishing a way for the public to identify a qualified practitioner. Permissive licensure did not protect the title nurse. Anyone could call themselves a nurse, however in order to be called a registered nurse the practitioner had to complete the requirements determined by the state.

Kimberly Bundley North Carolina passed the first permissive licensure legislation in 1903. Prior to 1903, anyone could call themselves a nurse and practice nursing. By 1923, all 48 states had permissive licensure legislation. Women did not receive the right to vote until 1920 which means nursing organizations were lobbing legislators for permissive licensure laws in a time when most nurses could not vote. The magnitude of their accomplishment becomes more apparent when one realizes that without the promise of the votes of constituent nurses in the legislators home district, most law makers were uninterested in helping nursing leaders pass licensure laws. Permissive licensure was the first step toward professional autonomy but nursing leaders continued to pursue mandatory licensure as a requirement for nursing practice. After permissive licensure statutes were enacted, most nursing school graduates sought and received licenses to use the title Registered Nurse. The majority of the nurses practicing who were not licensed were either nursing school graduates who failed the licensing examination or foreign educated nurses. The permissive licensure system continued to allow anyone to call themselves a nurse and practice nursing as long as they didnt use the title Registered Nurse. 3. Who was Ludie C. Andrews? Raising awareness of the accomplishments of Mrs. Ludie Clay Andrews (1875-1969), founder of the Municipal Training School for Colored Nurses and Georgia's "Dean of Black Nurses," remains central to the Conclave's mission. Mrs. Andrews earned a degree in nursing at Spelman Seminary. (Spelman closed its nursing program in 1928.) She was supervisor at another training school in 1914, when the city of Atlanta named her to create the nurse training program for African Americans at Grady Municipal Hospital. While organizing the school, selecting its first students, and working to achieve its accreditation, Mrs. Andrews, at her own expense, continued a legal battle she had initiated with the Georgia Board of Nurse Examiners. She fought for ten years in order to secure for African American graduate nurses the right to sit for the same certification exam taken by white nurses. In 1920, the year the Training School for Colored Nurses graduated its first class, Mrs. Andrews won for her students the right to earn the title, Registered Nurse. The National Grady Nurses Conclave has publicized the accomplishments of Mrs. Andrews with a plaque placed at Grady Hospital, a portrait of her presented to Spelman College, and a major exhibit at the Auburn Avenue Research Library. Since 1975, the Conclave has bestowed as its highest honor the Ludie Andrews Distinguished Service Award. 4. What was the NACGN and how did it address racial intolerance in the nursing profession. This was an organization dedicated to promoting the standards and welfare of Black nurses and breaking down racial discrimination in the profession. This organization served an important need, as Black nurses at that time were not welcome in the American Nurses Association (ANA). The main purpose of the NACGN was to win integration of Black RNs into nursing schools, nursing jobs, and nursing organizations. In the early years, membership was low and the major achievement was the development of a registry of Black nurses.

Kimberly Bundley 5. What was the impact of the Will-Burton Act on hospital development and race relations in health care settings? The National Hospital Program has now been in operation for three years. It has brought about a comprehensive plan showing the location and size of hospital facilities which are needed in each state. For the first time, a definite plan is being followed by each state in determining the location, size, and type of facility which can best meet the hospital and health center needs of the people. Hospital construction plans prepared by each state agency and approved by the U.S. Public Health Service have been extremely valuable in stimulating local communities to construct hospitals and health centers. In addition, the program has resulted in the enactment of hospital licensure laws in many states where none existed previously. The impact of the program on modern design and construction has been gratifying with respect not only to hospitals built under the program, but also to those built without Federal aid. Improved services to patients have likewise resulted from better planned and better designed hospitals. Overall, from 1947 until 1975 (the end of expenditures under the Hill-Burton Act), 6,900 hospitals got assistance. As of the mid-1970s, the nationwide average for beds in community hospitals was at the average Hill-Burton standard of 4.5 beds per 1,000 people, up from fewer than 3 beds per 1,000, the average 20 years before. Many rural areas had access to hospital care for the first time. 6. What is the Ryan White Act; and what has been its impact on the health of African American Men? HIV/AIDS disproportionately impacts certain populations, creating alarming levels of death and disability. African American males have the highest rates of HIV infection. In 2006, the HIV diagnosis rate for all African American males was more than seven times that for White males, more than twice the rate for Hispanic males, and more than twice the rate for African American females. HIV infection rates among African American females are disproportionately high. In 2006, the HIV diagnosis rate for African American females was more than 19 times the rate for White females. In 2006, HIV disease was the sixth leading cause of death among persons 24 through 44 years old, after unintentional injury, cancer, heart disease, suicide, and homicide. It was the fourth leading cause of death for African American males and females aged 25 through 34, and the fourth leading cause of death among Hispanic males and females aged 35 through 44.2 the largest transmission category for people living with HIV/ AIDS consists of men who have sex with men.3