Ch 23: Health Policy and Politics: Get Involved!

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

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

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

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

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

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

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

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

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

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 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

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