Cherry 23, Ch 14:

5. Mandatory overtime and reduction in RN staff have resulted in decreased client satisfaction and a sentinel event. Management is unwilling to discuss a change in staffing, and collective bargaining interest is sparked. A nurse is approached to sign a union authorization card. If signed, the card: a. authorizes the union to serve as his or her legal representative. b. indicates that the person is requesting additional information about collective bargaining. c. indicates the nurse desires to share information about grievances. d. gives permission for union dues to be deducted from pay.

A A signature on a union authorization card indicates that the nurse gives the union the right to serve as legal representation. DIF: Comprehension REF: pp. 259-260

14. A group of nurses meet with a state representative to explain the importance of allowing registered nurses the right to sign death certificates for patients who were under their care. As constituents and nurses, they requested that the senator vote against the bill restricting this practice. These nurses are serving as: a. lobbyists. b. policymakers. c. officials with regulatory power. d. advocates for the Patient Safety and Quality Improvement Act.

A Lobbyists hope to educate and convince policymakers to respond positively to a particular position on an issue or to follow a particular course of legislative or regulatory action. DIF: Comprehension REF: p. 398

7. Physical therapists are represented by a union, nurses are represented by a separate union, and pharmacists have yet another union within a single agency. This type of union representation is known as: a. occupational unionism. b. industrial unionisms. c. union shop. d. power sharing.

A Occupational unionism indicates separate unions for each occupation in an agency. DIF: Comprehension REF: p. 257

14. A group of nurses are assembling outside a hospital protesting the use of foreign nurses after several nurses were terminated due to what the hospital called recurring "decreased census." The nurses carry signs with messages asking potential patients to seek care elsewhere. The local newspaper picked up the story, and the hospital is receiving negative press. The nurses are participating in: a. picketing. b. collective bargaining. c. a strike. d. arbitration.

A Picketing is a form of protest in which people (called picketers) congregate outside a place of work or location where an event is taking place. Often this is done in an attempt to dissuade others from going in ("crossing the picket line"), but it can also be done to draw public attention to a cause. DIF: Comprehension REF: p. 257

2. Time is becoming crucial for the nurse to address issues related to sponsoring programs to include hearing aid costs as part of Medicare coverage. The nurse involved in grassroots political actions realizes that the least timely method of reaching elected officials would be via: a. letter. b. telephone. c. e-mail. d. facsimile (fax).

A Sending letters is the least timely mode by which to communicate with elected officials; because of the anthrax decontamination process that is now in place, delivery of U.S. mail to Congress and to the White House may be delayed by as long as 3 months, making letters an inefficient means of communicating with policymakers. DIF: Comprehension REF: p. 407

2. A nurse has been asked to serve as the charge nurse on the evening shift. The agency where the nurse is employed is considering unionization. If the charge nurse position is accepted, this nurse: a. can be represented by the union because charge nurses are not considered part of the management team. b. is part of the management team, so union participation would be a conflict of interest. c. can file a grievance that will be arbitrated automatically by the union. d. is ineligible for collective bargaining activities that deal with unfair labor practices.

A Serving as charge nurse is part of a nurse's professional role and not a management function. DIF: Comprehension REF: pp. 263-264

13. If a nurse practicing in a mental health agency could only belong to one professional organization, what criteria could be used to select the organization with the biggest impact? a. The American Nurses Association has a strong voice representing the nation's entire RN population. b. Specialty organizations such as the American Psychiatric Nurses Association lobby for higher education requirements for nurses. c. State nursing associations have limited power because they can lobby only state representatives. d. Professional organizations such as The American Association for the History of Nursing (AAHN) record the history of mental health nursing.

A The American Nurses Association is the voice for all registered nurses. DIF: Application REF: p. 408

Public health policies are created and established to address the needs of the whole population, examples of public health policies would include: (Select all that apply) A. Educating the public about healthier choices B. Ensuring safe food and water in communities C. Promoting physical activity and fitness D. Private Health Insurance E. Preventing Disease outbreaks

A B C E

15. A nurse is concerned about older persons living alone at home without telephone service to contact emergency services. The nurse is advised to take part in grassroots efforts to address the situation. The nurse would: (select all that apply) a. post signs to support the county's political candidates whose platform support services for poor and underserved person such as older adults. b. visit with local politicians running for office and ask specific questions such as, "Would you support providing free emergency telephone service for older adults living alone?" c. limit voting to only presidential elections in which a candidate promises to initiate health care reform related to Medicare for older adults. d. join the American Nurses Association and constituent member association. e. contact representatives from surrounding states to garner support for free medical alert systems for older adults.

A, B, D Working in local political campaigns is an effective grassroots effort. Visiting, e-mailing, calling, and faxing local politicians to support free emergency telephone service for older adults is a grassroots tactic. Joining ANA and state nursing associations supports these organizations' lobbying efforts and is thus a way for individual nurses to influence the issues that nursing associations support. DIF: Application REF: pp. 405-408

18. Mandatory overtime and reduction in RN staff have resulted in decreased client satisfaction and a sentinel event. Management is unwilling to discuss a change in staffing, and collective bargaining interest is sparked. During the pre-election period, what actions by management are prohibited? (select all that apply) a. Seek individuals to spy on coworkers who are possible union supporters. b. Photograph employees participating in information sessions about unionization. c. Visit managers outside work to gain their perception of popularity of unionization. d. Threaten that, should the union win, the company will relocate when there is no intention to relocate. e. Require employees to declare their position on unionization prior to pick up paychecks.

A, B, D, E During the pre-election period, management may not solicit spying. During the pre-election period, management may not photograph employees engaged in union activities. During the pre-election period, management may not lie about what will happen if the union is the victor in an election. During the pre-election period, management may not question employees about their preferences regarding union activity. DIF: Comprehension REF: p. 261

16. A hospital refused to purchase a better grade of utility gloves, even after learning that the cheaper utility gloves are easily punctured during routine use. This unsafe situation led nurses to seek unionization. During the pre-election phase for unionization, which actions by union representatives are prohibited by the National Labor Relations Board? (select all that apply) a. Scheduling a meeting in the agency's cafeteria to determine employees' interest in unionization b. Distributing nondocumented information that female nurses receive lower annual performance evaluations than do male nurses c. Distributing information about the benefits of unionization and grievances in a public parking garage located across from the hospital d. Suggesting to workers the likelihood of job loss should the union not win the election e. Signing authorization cards for employees who are on leave

A, B, D, E Union representatives must meet in nonwork areas. Union representatives must not spread rumors of prejudices. Neither the union nor employers can spread falsehood about potential job loss or repercussion in the event of unionization. Union representatives cannot sign cards for employees. DIF: Application REF: p. 259

13. A nurse is interested in working in a large trauma center that is unionized but does not want to join the union or pay fees. She accepts the position but is not required to join or pay fees to the union based on which law? a. National Labor Relations Act b. Right-to-work law c. National Labor Relations Act d. Taft-Hartley Act

B The right-to-work law prohibits membership or payment of union dues or "fees" a condition of employment, either before or after hiring. DIF: Comprehension REF: p. 257 | p. 260

Mandatory OT and reduction in RN staff have resulted in decreased client satisfaction and a sentinel event. Mgmt is unwilling to discuss a change in staffing, and collective bargaining interest ins sparked. A nurse is approached to sign a union authorization card. If signed, the card: A. authorizes the union to serve as legal representative B. indicates that the person ins requesting additional information about collective bargaining. C. indicates the nurse desires to share information about grievances.

A. Authorizes the union to serve as legal representative

This branch of the government includes the president as well as the executive departments that recommend legislation and promote major policy initiatives: A. executive branch B. judicial branch C. Legislative branch D. tree branch

A. executive branch

COMPLETION 1. A nurse who is interested in graduate school wants to learn about recently passed legislation regarding changes in Medicare reimbursement for care provided by clinical nurse specialists. The best source for information on changes in federal programs is the ____________________.

ANS: Federal Register The Federal Register is the best source of information about proposed rules and regulations for newly enacted legislation and about changes to existing rules for federal programs (www.fr.cos.com). DIF: Knowledge REF: Page 485

2. The greatest barrier to access to health care for a poor Hispanic person living in downtown Chicago is ____________________.

ANS: lack of health insurance Lack of health insurance is the greatest barrier to access to health care and it has a tremendous impact on an individual's health. Studies have consistently found that the uninsured receive less than adequate health care. DIF: Analysis REF: Page 492

2. Time is becoming crucial for the nurse to address issues related to sponsoring programs to include hearing aid costs as part of Medicare coverage. The nurse involved in grassroots political actions realizes that the least timely mode by which to reach elected officials would be via: a. letter. b. telephone. c. e-mail. d. facsimile (fax).

ANS: A Sending letters is the least timely mode by which to communicate with elected officials; because of the anthrax decontamination process that is now in place, delivery of U.S. mail to Congress and to the White House may be delayed by as long as 3 months, making letters an inefficient means of communicating with policymakers. Phone calls are an effective means of getting your message to an elected official because they usually have a staff person who takes phone calls. E-mail is an effective way to communicate with elected officials; e-mailed and faxed messages are some of the best ways to make sure your voice is heard in time to make a difference. Contacting officials by fax is an effective way to communicate with elected officials; e-mailed and faxed messages are some of the best ways to make sure your voice is heard in time to make a difference. DIF: Application REF: Page 490

MULTIPLE RESPONSE 1. A nurse is concerned about older persons living alone at home without telephone service to contact emergency services. The nurse is advised to take part in grassroot efforts to address the situation. The nurse would: (Select all that apply.) a. Post signs to support the county's political candidates whose platform support services for poor and underserved person such as older adults. b. Visit with local politicians running for office and ask specific questions such as "Would you support providing free emergency phone service for older adults living alone?" c. Limit voting to only presidential elections in which the President promises to initiate health care reform related to Medicare for older adults. d. Join the American Nurses Association and constituent member association. e. Contact representatives from surrounding states to garner support for free medical alert systems for older adults.

ANS: A, B, D Working in local political campaigns are effective grassroots efforts. Visiting, emailing, calling, and faxing local politicians to support free emergency telephone service for older adults is a grassroots tactic. Joining ANA and state nursing associations supports lobbying and individual nurses can influence the issues that nursing associations support. Grassroots efforts require the nurse to vote in all elections. Grassroots efforts are at the local level. DIF: Application REF: Pages 488-491

5. Political action committees (PACs) are established for the purpose of: a. financially supporting candidates. b. persuading policymakers to support certain policies. c. lobbying legislators. d. recommending health care policy.

ANS: B A PAC is an arm of an organization, association, or labor union that is formed to persuade a policy maker to support a certain policy or program or, more often, to ensure the election or re-election of policy makers who support the organization's goals. The purposes of a PAC are to persuade policymakers to support certain policies and to support the election or reelection of policymakers who support the organization's goals, even though it may be misconstrued that the PAC provides financial support, lobbying, and recommendations regarding specific legislation. The purposes of a PAC are to persuade policymakers to support certain policies and to support the election or reelection of policymakers who support the organization's goals, even though it may be misconstrued that the PAC provides financial support, lobbying, and recommendations regarding specific legislation. The purposes of a PAC are to persuade policymakers to support certain policies and to support the election or reelection of policymakers who support the organization's goals, even though it may be misconstrued that the PAC provides financial support, lobbying, and recommendations regarding specific legislation. DIF: Comprehension REF: Page 489

10. A concerned nursing student calls the office of an elected official to voice support for the bill to ban smoking in all public places. The secretary asks, "Are you a constituent?" What does the term constituent mean? a. A member of a professional organization who supports the organization's political issue b. A citizen who is registered and is eligible to vote for a representative c. An elected official who proposes legislation to be considered as a potential law d. A member of the House of Representatives who is seeking support for a particular bill

ANS: B A constituent is a citizen who has the opportunity to vote for candidates in elections for representation at local, state, and federal government levels. A member of a professional organization who supports the organization's political issue does not meet the definition of a constituent, which is a citizen who is registered and eligible to vote for a representative. An elected official who proposes legislation to be considered as a potential law does not meet the definition of a constituent, which is a citizen who is registered and eligible to vote for a representative. A member of the House of Representatives who is seeking support for a particular bill does not meet the definition of a constituent, which is a citizen who is registered and eligible to vote for a representative. DIF: Knowledge REF: Page 478

13. Nurses in a nonunionized health care facility are concerned about patient safety because of the requirement for nurses to work overtime. Which organization can address the needs of these nurses? a. United American Nurses b. Center for American Nurses c. Occupational Safety and Health Administration (OSHA) d. American Association for Mandatory Overtime

ANS: B CAN, established in 2003, addresses the needs of individual nurses who are not represented by labor unions by offering tools, services, and strategies designed to make nurses their own best advocates in their practice environments. UAN is the labor union for nurses that represents 104,000 RNs nationwide and is a full-fledged affiliate of both the American Nurses Association and the American Federation of Labor-Congress of Industrial Organizations (AFL-CIO). OSHA is a U.S. government agency that sets and enforces standards related to safety in the workplace; however, this agency does not address mandatory overtime requirements. The American Association for Mandatory Overtime does not exist. DIF: Application REF: Page 491

14. Members of a state's constituent member association meet at a local restaurant to plan a Nurse Walk to support the local food bank. When entering the restaurant, the nurses note the environmental inspection report shows deficiencies because food handlers were not wearing hairnets and rodents were spotted, resulting in a score of 60 out of 100. This certificate of inspection is health policy enforced at which level of government? a. Local b. State c. Federal d. International

ANS: B Health policy at the state level is responsible for ensuring food safety in restaurants. Local policies vary to meet specific needs of residents such as costs of immunization based on income. Federal policy focuses on funding for research and health professional education. "International" is not a level of government. DIF: Application REF: Page 480

1. A bill is pending in the state legislature that will mandate teaching health promotion related to smoking cessation. Which action by the nurse should have the greatest impact on passage of the bill? a. Explain the rationale for the bill to the school board. b. Contact the elected representative's office by phone to request support for the bill. c. Support a health advocate to run for election as state representative. d. Tell all students about the bill.

ANS: B Telephone calls are an effective means of communicating your support for a bill; ask to speak to the staff person assigned to the bill or issue for which the call is being made. After introducing yourself, give a brief and simple message such as, "Please tell Senator/Representative [name] that I support [bill number]." The school board may have some interest in information about the bill, but they may or may not support the bill; the nurse will have a greater effect on passage of the bill if she directly phones the elected representative's office. The nurse is concerned with passing the bill now rather than later, after an election is held. The nurse needs to communicate directly with the representative's office to support the bill rather than just telling the students; however, telling peers and students about the bill might encourage them to call the representative to express their support. DIF: Application REF: Pages 490-491

12. Throughout the history of health care in our nation, one particular piece of federal legislation provided funds for hospital construction. As the number of hospitals rapidly increased, the need for nurses to staff hospitals also increased, and the shift from community-based nursing care to hospital-based nursing care began. This fundamental piece of legislation was the: a. Sheppard-Towner Act. b. Hill-Burton Act. c. Veterans Bill. d. Access to Health Care Bill.

ANS: B The Hill-Burton Act, also known as the Hospital Survey and Construction Act, was enacted in 1950. This act provided funding that resulted in a boom in the construction of hospitals across the country. As the number of hospitals increased rapidly, so did the need for nurses to staff the hospitals. Thus the nurse's role was shifted from community and public health settings to the acute care setting. The Sheppard-Towner Act of 1921 was the first federal policy that provided funding for nursing services and established prenatal and child health centers staffed by public health nurses, with the goal of reducing maternal and infant mortality rates by teaching women about personal hygiene and infant care. "Veterans Bill" is an invented term and not the name of any bill passed by Congress. "Access to Health Care Bill" is an invented term and not the name of any bill passed by Congress. DIF: Comprehension REF: Page 480

6. When the policy process is compared with the nursing process, identifying the issue is consistent with which step of the nursing process? a. Assessment b. Diagnosis c. Planning d. Implementation

ANS: B The diagnosis step in the nursing process is consistent with identification of the targeted issue in the political process. As politically active nurses soon discover, effective involvement in policy development and political activities requires efforts similar to those used in the nursing process. The policy process and the nursing process are systematic approaches that use the nursing process for decision making. The assessment step would involve collecting information and understanding the information collected prior to actual identification of the issue. Planning occurs after the information has been collected and the issue has been identified; generally, an effective policy plan involves input from many sources and perspectives. Implementation occurs after an issue has been identified and a plan has been developed; this plan is then implemented through political action and a set of strategies. DIF: Application REF: Page 486

7. It is important for nurses to know the functions of the branches of the federal government. At a local meeting of the state nurses' association, an officer reminds members that the branch that is capable of originating major policy initiatives is the: a. executive branch. b. legislative branch. c. judicial branch. d. administrative branch.

ANS: B The legislative branch possesses the sole federal power to enact legislation; the legislative branch originates and promotes major policy initiatives and has the power to override a presidential veto. The role of the executive branch is to recommend legislation and promote (but not originate) major policy initiatives; the executive branch also implements laws, manages programs after they have been passed by Congress, writes regulations that interpret statutes (laws), and has the power to veto legislation passed by Congress. The role of the judicial branch is to interpret the Constitution and the various laws that are passed and regulations that are established to ensure that they are not in violation of the Constitution. The federal government does not have an administrative branch; the three branches of the federal government are the legislative, executive, and judicial branches. DIF: Application REF: Page 482, Table 23-2

4. A nurse would like to obtain background information and learn the political platform of a candidate who is running for national office. The nurse should contact the: a. National Registry for Candidates. b. American Nurses Association Nurses Strategic Action Team (N-STAT). c. National League of Nurses. d. National Council of State Boards of Nursing.

ANS: B Through legislative updates, N-STAT keeps members up to date about background information and the platforms of candidates who are running for national office; N-STAT also provides updates about key bills as they move through the legislative process. There is no National Registry for Candidates. The National League of Nurses does not have a political arm for gathering background information and political platform details of candidates. National Council of State Boards of Nursing does not have a political arm for gathering background information and political platform details of candidates. DIF: Application REF: Page 492

8. When a bill is presented to Congress, the subcommittee may choose to "mark up" the bill, meaning to: a. obtain oral testimony about the bill from the executive branch. b. conduct additional hearings about the bill. c. amend the bill before recommending it to the full committee. d. have the full committee vote on recommendations.

ANS: C "Marking up" occurs in step 4 of the legislative process, when the subcommittee can make changes or amendments before recommending the bill to the full committee. The bill dies if the subcommittee does not refer the bill to the full committee. Step 3 in the legislative process, not "marking up," provides an opportunity to obtain written or oral testimony about the bill from the executive branch, experts in a related area, and supporters and opponents of the bill. Additional hearings are not related to "marking up" of the bill; conducting additional hearings occurs in step 5 of the legislative process. Full committee votes on recommendations is part of step 5, in which the full committee votes on recommendations to the House or Senate, a procedure known as "ordering a bill reported." DIF: Analysis REF: Page 483

9. To ensure that new laws are implemented as proposed, nurses must realize that: a. regulations must be enacted exactly as intended by the U.S. Department of Health and Human Services (DHHS). b. hearings to discuss the new laws and regulations are closed to the public, and only lobbyists are invited to attend. c. proposed regulations are published and are open to public comment for a time before they are formally adopted. d. final published regulations only suggest how the law will be implemented.

ANS: C As regulations are being developed by the government agency, public hearings are held to allow individuals to comment on the content of the regulations. Once the proposed regulations have been developed, they must be published and remain open to public comment for a specified length of time before they are adopted. After a bill is passed by Congress, it is referred to an administrative agency under the executive branch for writing of regulations; although most health-related policies fall under the jurisdiction of the DHHS, this might not always be the case. More importantly, implementation of the new legislation can often vary from what was originally intended when Congress debated and passed the bill, depending on how the regulations are written. Hearings are open to the public. Final published regulations carry the force of the law and dictate how the law will actually be implemented. DIF: Analysis REF: Page 485

11. A person who is covered by Medicaid moves from one state to another and asks the nurse at the health department why the benefits changed. The correct response by the nurse is: a. "Local government controls which benefits each county can provide to Medicaid recipients." b. "The federal government does not fund any part of Medicaid, so each state must find ways to pay for benefits." c. "Each state determines benefits on the basis of the present economy." d. "Medicaid is funded by both state and federal governments, but benefits vary from state to state."

ANS: D Medicaid is a program that is funded through a combination of state and federal funds; thus benefits vary from state to state. Local governments do not establish rules related to Medicaid; this occurs at the state level. Medicaid is funded through a combination of state and federal funds. The state of the economy might be only one of many issues that states consider when determining Medicaid benefits. DIF: Analysis REF: Page 480

3. A nurse would like to advocate for increased protective services and reporting mechanisms for elder abuse and attends the "meet the candidate" session at the town hall meeting. This is an important time for the nurse to: a. educate the public about the nurse's political platform. b. be spontaneous and not deliver a rehearsed speech. c. address the person as "candidate" rather than using a first name that implies a working relationship. d. learn what the key issues are in the candidate's platform.

ANS: D Town hall gatherings with nurses allow the candidate to talk about his or her platform to a group of interested voters and afford nurses an opportunity to understand the candidate's vision and to voice their opinions and concerns about health care issues. Educating the public about the nurse's political platform is an ineffective strategy in advocating for a new health policy. Being spontaneous and not delivering a rehearsed speech is an ineffective strategy in advocating for a new health policy. Addressing the person as "candidate" rather than a first name is an ineffective strategy in advocating for a new health policy. DIF: Application REF: Pages 489-490

4. A nurse would like to obtain background information and learn the political platform of a candidate who is running for national office. The nurse should contact the: a. National Registry for Candidates. b. American Nurses Association Nurses Strategic Action Team (N-STAT). c. National League of Nurses. d. National Council of State Boards of Nursing.

B Through legislative updates, N-STAT keeps members up-to-date about background information and the platforms of candidates who are running for national office; N-STAT also provides updates about key bills as they move through the legislative process. DIF: Comprehension REF: p. 408

5. Political action committees (PACs) are established for the purpose of: a. financially supporting candidates. b. persuading policymakers to support certain policies. c. lobbying legislators. d. recommending health care policy.

B A PAC is an arm of an organization, association, or labor union that is formed to persuade a policymaker to support a certain policy or program or, more often, to ensure the election or reelection of policymakers who support the organization's goals. DIF: Comprehension REF: p. 406

8. A concerned nursing student calls the office of an elected official to voice support for the bill to ban smoking in all public places. The secretary asks, "Are you a constituent?" What does the term constituent mean? a. A member of a professional organization who supports the organization's political issue b. A citizen who is registered and is eligible to vote for a representative c. An elected official who proposes legislation to be considered as a potential law d. A member of the House of Representatives who is seeking support for a particular bill

B A constituent is a citizen who has the opportunity to vote for candidates in elections for representation at local, state, and federal government levels. DIF: Knowledge REF: p. 398

6. A group of RNs wish to seek union representation that would protect all workers in the agency including nonlicensed assistive personnel and non-nursing employees such as nutritionists and dietary workers. The type of union being sought is the strongest collective group and is known as a(n): a. occupational union. b. industrial union. c. union shop. d. right-to-work bargaining organization.

B An industrial unionism is a single union for all workers in the agency. DIF: Comprehension REF: p. 257

10. A concern that nurses were being asked to perform tasks that went beyond the state's nurse practice act was brought to the union's attention. Nurses were informed that either mediation or binding arbitration will be used to resolve the issue. A novice nurse asks about the difference between these techniques and is informed that: a. mediation is sanctioned by the National Labor Relations Board (NLRB) to formally discuss concerns with management and labor. b. binding arbitration is a formal discussion between labor and management in which the arbitrator's recommendations are compulsory. c. mediation uses a trained person to negotiate a legally binding plan. d. binding arbitration requires both labor and management to participate in discussions on the least destructive approach to allow self-governance by employees.

B Binding arbitration requires that both parties meet in formal talks, and all parties must obey the arbitrator's recommendations. DIF: Comprehension REF: p. 257

11. Members of a state's constituent member association meet at a local restaurant to plan a Nurse Walk to support the local food bank. When entering the restaurant, the nurses note the environmental inspection report shows deficiencies because food handlers were not wearing hairnets and rodents were spotted, resulting in a score of 60 out of 100. This certificate of inspection is health policy enforced at which level of government? a. Local b. State c. Federal d. International

B Health policy at the state level is responsible for ensuring food safety in restaurants. DIF: Comprehension REF: p. 400

1. A bill is pending in the state legislature that will mandate teaching health promotion related to smoking cessation. Which action by the nurse should have the greatest impact on passage of the bill? a. Explain the rationale for the bill to the school board. b. Contact the elected representative's office by telephone to request support for the bill. c. Support a health advocate to run for election as state representative. d. Tell all students about the bill.

B Telephone calls are an effective means of communicating your support for a bill, next to a face-to-face meeting; ask to speak to the staff person assigned to the bill or issue for which the call is being made. After introducing yourself, give a brief and simple message such as, "Please tell Senator/Representative [name] that I support [bill number]." DIF: Application REF: p. 407

10. Throughout the history of health care in our nation, one particular piece of federal legislation provided funds for hospital construction. As the number of hospitals rapidly increased, the need for nurses to staff hospitals also increased, and the shift from community-based nursing care to hospital-based nursing care began. This fundamental piece of legislation was the: a. Sheppard-Towner Act. b. Hill-Burton Act. c. Veterans Bill. d. Access to Health Care Bill.

B The Hill-Burton Act, also known as the Hospital Survey and Construction Act, was enacted in 1950. This act provided funding that resulted in a boom in the construction of hospitals across the country. As the number of hospitals increased rapidly, so did the need for nurses to staff the hospitals. Thus the nurse's role was shifted from community and public health settings to the acute care setting. DIF: Comprehension REF: p. 401

6. When the policy process is compared with the nursing process, identifying the issue is consistent with which step of the nursing process? a. Assessment b. Diagnosis c. Planning d. Implementation

B The diagnosis step in the nursing process is consistent with identification of the targeted issue in the political process. As politically active nurses soon discover, effective involvement in policy development and political activities requires efforts similar to those used in the nursing process. The policy process and the nursing process are systematic approaches that use the nursing process for decision making. DIF: Application REF: p. 405

7. It is important for nurses to know the functions of the branches of the federal government. At a local meeting of the state nurses' association, an officer reminds members that the branch that is capable of originating major policy initiatives is the _____ branch. a. executive b. legislative c. judicial d. administrative

B The legislative branch possesses the sole federal power to enact legislation; the legislative branch originates and promotes major policy initiatives and has the power to override a presidential veto. DIF: Comprehension REF: p. 403, Table 23-2

15. A hospital is seeking a 2.5% wage reduction for all nurses as part of a new balanced budget plan; however, the plan provides for raises for upper-level management. This plan resulted in a call for a union to protect the nurses. When the union representative arrives, what questions should the nurses ask? (select all that apply) a. Will the dues be used to support charity care when clients are unable to pay? b. How effective has the union been in representing nurses' best interest? c. What percent of dues pays union personnel salaries? d. Are dues used to promote research for terminally ill clients? e. If arbitration is unsuccessful and a strike occurs, will nurses receive compensation during the strike?

B, C, E Laborers (staff nurses) want a union with a successful track record of improving wages and benefits. Union dues are used to support union personnel, and the amount varies among different union groups; the higher the percentage of money that goes to pay union personnel salaries, the less money will be available to support members. Employers are not obligated to pay laborers during a strike, and unions may choose to pay employees while striking. DIF: Application REF: p. 263, Box 14-1

16. A nurse is interested in learning more about health policy and how it might impact nursing practice. She is especially interested in The Patient Protection and Affordable Care Act (PPACA) and how it will travel through the three branches of the federal government. She researches the roles of the legislative branch of the federal government and learns that this branch: (select all that apply) a. determines which laws are constitutional, such as recently deciding the PPACA is constitutional because it is a form of taxation. b. has the exclusive power to determine where federal dollars will be spent, such as supporting the PPACA. c. consists of the Office of the President and 15 executive departments that supported the PPACA. d. has the power to veto laws found constitutional by the Supreme court and therefore could veto the PPACA. e. can override a Presidential veto, making it possible to amend the PPACA even without approval of the President.

B, E The legislative branch possesses the sole power to enact legislation, tax citizens, and allocate federal spending. The legislature can override a presidential vote. DIF: Application REF: p. 403, Table 23-2

1. The most effective means for a nurse to impact the health and wellness of those being cared for at a local hospital is to: a. volunteer at local health screenings held for a variety of health and wellness issues. b. be active in local politics by lobbying city policymakers on health and wellness issues. c. regularly attend the hospital's board meetings to be aware of discussions on policy changes. d. donate to the national political party that advocates health policies that support health and wellness.

B.

3. It is true that the Department of Health and Human Resources is a part of the Executive branch of the federal government and: A determines whether the regulation of health care services is constitutional. B manages federally funded health care programs passed by Congress. C has the sole power to allocate federal health care spending. D can override a presidential veto regarding health care services.

B.

4. Which organization represents nurses and addresses health care issues on a national level? A American Medical Association (AMA) B American Nurses Association (ANA) C National League of Nursing (NLN) D Sigma Theta Tau (STT)

B.

5. A reliable private source of information about major health issues and health care reform is the: A Institute of Medicine. B Kaiser Family Foundation. C Health Care Reform Initiatives. D Agency for Healthcare Research and Quality.

B. .

11. A large corporation employs nurses all over the United States. Nurses in one agency learned that fellow nurses in another agency are striking because they are required to work 16-hour shifts to cover for nurses who have left due to unsafe staffing practices. The union of the nonstriking agency nurses decides to stop work to support the nurses who are striking; thus, this union: a. is placing nurses at risk for a lawsuit because their direct employer did not cause the strike. b. must be an industry union representing both parties. c. is participating in a sympathy strike, which, if done correctly, is legal. d. must pay for any losses incurred by the agency during the strike.

C A sympathy strike occurs when a union stops work to support the strike of another union. DIF: Comprehension REF: p. 257

12. A group of nurses interested in unionizing decides to contact the largest union in the United States representing registered nurses, which is the: a. American Nurses Association. b. United American Nurses. c. National Nurses United. d. National Labor Relations Board.

C In 2009, the National Nurses United became the largest union representing nurses RNs as a result of a merger between the United American Nurses, California Nurses Association, National Nurses Organizing Committee, and Massachusetts Nurses Association. DIF: Comprehension REF: p. 259

1. Nurses in a unionized hospital are paid "compensatory pay" when working holidays equal to the number of hours worked with no extra compensation. Although they have suggested changes during the annual survey of employee satisfaction, management refuses to consider another system for compensatory pay. A trained member listened to both nurses and management to make recommendations that were not legally binding. This type of settlement is termed: a. picketing. b. binding arbitration. c. mediation. d. grievance.

C Mediation enlists the help of a trained person to listen to both sides; however, recommendations are not legally binding. DIF: Comprehension REF: p. 257

9. In recent Gallop Polls, nurses were voted as the most honest with the highest ethical standards of all professions. How does this degree of professionalism affect nurses' desire to participate in organized strikes? a. Nurses most often turn to collective bargaining strategies such as strikes to emphasize client safety initiatives. b. Nurses use evidence-based studies that reflect both management and labor views to support participation in unionization. c. Nurses often find union activities such as strikes in conflict with the need to serve and protect clients and their profession. d. Nurses who strike can be legally punished for abandonment and negligence, considered to be professional misconduct.

C Nurses are client advocates and promotion of professionalism is valued as evidenced by the public's opinion related to honesty and professionalism. DIF: Application REF: p. 262

8. Historically, what movement most influenced unionization in American health care agencies/hospitals? a. Immigration laws protected foreign employees from discrimination in hiring or discharge on the basis of national origin and citizenship status. b. Women entered the workforce, gaining voice to support unions. c. The Industrial Revolution led to poor working conditions and the need to protect workers. d. Nurses were exposed to communicable diseases, which led to death and disability.

C The Industrial Revolution led to people working in factories where poor and unsafe working conditions were widespread. DIF: Comprehension REF: pp. 258-259

12. In the near future, the largest segment of the population will be those over age 65 years. To advocate for this vulnerable population, a nurse was a strong supporter for the Medicare Modernization Act (Medicare Part D), which: a. provided vision care benefits to elderly persons who were diagnosed as legally blind. b. removed limits to access to mental health/substance abuse services which are the most commonly used service in this population. c. provided coverage for medications for Medicare enrollees that constituted a huge expense for the elderly. d. expanded the practice opportunities for advanced practice registered nurses (APRN) who provide the majority of care for this population.

C The Medicare Modernization Act provided medication benefits to Medicare recipients and encouraged policymakers to have oversight to ensure drug effectiveness. DIF: Comprehension REF: p. 401, Table 23-1

4. Nurses in a nonprofit hospital have expressed an interest in forming a union to secure fair wages and ensure client safety. To form a core support group of nurses, the union organizer can conduct meetings to gather initial information: a. away from the worksite with a group of managers to learn both sides of the situation. b. at the worksite with staff nurses who are respected leaders. c. in homes or local businesses with staff nurses. d. after photographing management meeting to discuss their strategies to decrease interest in unionization.

C The union representative meets with laborers (staff nurses) at a nonwork setting to gather information about grievances. DIF: Application REF: p. 260

17. It is important to realize that nurses may seek unionization if: (select all that apply) a. physicians rotate on-call coverage among group members for complicated long-term clients. b. scheduling is presented that provides adequate staffing on holidays by rotation of time off for holidays among nurses. c. incident report trends indicate medication errors are caused by shift reports being taped and heard after nurses from the prior shift have left the unit. d. physicians, nurses, nutritionists, and physical therapists visit concurrently with clients to plan care. e. staff development activities are planned daily at 8 AM for 2 consecutive days to educate staff on new cardiac monitoring procedures while following normal staffing patterns.

C, E Policies where shift reports are taped and heard after a prior shift has left have proved to lead to errors and unsafe care. Staff development activities should be scheduled to allow nurses to attend, and normal staffing patterns or time of training must coincide with nurses' availability and ability to listen to and retain information (such as at the beginning or end of the shift while others provide coverage). DIF: Comprehension REF: p. 262

2. The nurse's role in the process of utilization review was a direct result of which federal health policy? a Hill-Burton Act (1950) b Nurse Practice Act (1910) c The creation of d d dDiagnosis-Related Groups (DRGs) (1983) Balanced Budget Amendment (1997)

C.

Which of the following are not one of the four major recommendations made by the IOM in 2010? (Select all that apply) A. Nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic progression B. Nurses should practice to the full extent of their education and training C. Effective workforce planning and policymaking do not require better data collection and information infrastructure D. Nurses should not be full partners with physicians and other healthcare professionals, in redesigning health care in the US.

C. Effective workforce planning and policymaking do not require better data collection and information infrastructure D. Nurses should not be full partners with physicians and other healthcare professionals, in redesigning health care in the US

9. A person who is covered by Medicaid moves from one state to another and asks the nurse at the health department why the benefits changed. The correct response by the nurse is: a. "Local government controls which benefits each county can provide to Medicaid recipients." b. "The federal government does not fund any part of Medicaid, so each state must find ways to pay for benefits." c. "Each state determines benefits on the basis of the present economy." d. "Medicaid is funded by both state and federal governments, but benefits vary from state to state."

D Medicaid is a program that is funded through a combination of state and federal funds; thus benefits vary from state to state. DIF: Analysis REF: p. 400

3. A nurse has heard rumors that other nurses are interested in unionizing but knows little about the purpose of unions. The nurse's first action is to: a. contact an arbitrator who has worked with other nurses in unions. b. picket the agency where employed to gain inside information as to why unionization is sought. c. sign the dual-purpose union authorization card. d. review the National Nurses United website for collective bargaining information.

D The National Nurses United website gives information about collective bargaining for nurses. DIF: Application REF: p. 259

3. A nurse would like to advocate for increased protective services and reporting mechanisms for elder abuse and attends the "meet the candidate" session at the town hall meeting. This is an important time for the nurse to: a. educate the public about the nurse's political platform. b. be spontaneous and not deliver a rehearsed speech. c. address the person as "candidate" rather than using a first name that implies a working relationship. d. learn what the key issues are in the candidate's platform.

D Town hall gatherings with nurses allow the candidate to talk about his or her platform to a group of interested voters and afford nurses an opportunity to understand the candidate's vision and to voice their opinions and concerns about health care issues. DIF: Application REF: p. 406

17. A nurse who is interested in graduate school wants to learn about recently passed legislation regarding changes in Medicare reimbursement for care provided by clinical nurse specialists. The best source for information on changes in federal programs is the ________________.

Federal Register The Federal Register is the best source of information about proposed rules and regulations for newly enacted legislation and about changes to existing rules for federal programs (www.fr.cos.com). DIF: Knowledge REF: pp. 404-405

Citizens and individuals approach _____ with a problem to be solved or to suggest a policy option to a health problem they have identified.

Policymaker

A course of action undertaken by governments or health care organizations to achieve a particular health outcome is referred to as a _________________.

a. Health Policy Reason: Health policy is a set course of action undertaken by governments or health care organizations to achieve a particular health outcome. REF: p. 398

Guidelines supported by the American Nursing Association (ANA) for communicating with government policy members include: (Select all that apply.)

a. Be brief and concise about what you want to communicate b. Be specific about the issue you are communication about c. Be sure to identify yourself by name and address d. Be persistent by using various accepted forms of communication Reason: Effective communication with law makers includes brief, concise, and specific communication about the topic of interest. Being persistent is appropriate but being aggressive is not. Identifying yourself is the initial step in communication. REF: pp. 407-408

How does health policy become law? (Select all that apply.)

a. Legislative action b. Executive directive c. Judicial decision

Match the Term with its definition

a. Lobbying i. 2- Persuading, educating and/or convincing b. Platformi. 3-Statement of principles and policies c. Constituenti. 1-A person who is legible to vote in federal election d. Stakeholderi. 4- Individual who has an interest in and may be affected by policy

When an unemployed, blind adult requires medical treatment but cannot afford the services, the nurse suggests that the client is possibly eligible for:

a. Medicaid

Examples of state health policies would include: (Select all that apply)

a. Nursing licensure b. Medicaid programs c. Health insurance exchanges d. Children's Health Insurance Program (CHIP)Reason:

19. Another name for an eligible voter is a _________.

constituent DIF: Comprehension REF: p. 398

18. The greatest barrier to access to health care for a poor Hispanic person living in downtown Chicago is lack of health ____________________.

insurance Lack of health insurance is the greatest barrier to access to health care and it has a tremendous impact on an individual's health. Studies have consistently found that the uninsured receive less than adequate health care. DIF: Comprehension REF: p. 409