Policy And Politics In Nursing And Healthcare - Revised Reprint , 6th Edition Lecture Notes

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Mason: Policy & Politics in Nursing and Health Care, 6th Edition
Introduction to Instructor's Manual
Alma Dixon
This manual is designed to guide and support faculty who are responsible for teaching
courses for undergraduate nursing students about policy and politics. Although students will
be focused on developing their skills as novice clinicians, it is vital they also recognize the
roles policy and politics play in patient care, the health system, and human health. Learning
about policy and politics will draw students’ attention to many issues in the health system
and to learn about how they can play a role in addressing problems. Major problems that
exist today include:
• The unsustainable high cost of care
• Health care and medical errors
• Inadequate access to care
• The shortage of nursing faculty needed to prepare an adequate nursing workforce
• An insufficient primary care and public health workforce
• Significant disparities in access to care
• An inadequate focus on prevention of disease
• An economy in recession
Learning Outcomes
The Essentials of Baccalaureate Education for Professional Nursing Practice (AACN, 2008)
includes a policy as an essential part of nursing curriculum through Essential V (Healthcare
Policy, Finance, and Regulatory Environments). The following outcomes are suggested as
guideposts for course activities. If you are able to determine that these learning outcomes
were met in prior courses, your task as the instructor will be to reinforce prior knowledge.
Upon completion of this course, the student will be able to:
1. Demonstrate basic knowledge of health care policy, finance, and regulatory
environments, including local, state, national, and global health care trends.
2. Describe how health care is organized and financed, including the implications of
business principles, such as system cost factors.
3. Compare the benefits and limitations of the major forms of reimbursement on the
delivery of health care services.
4. Examine legislative and regulatory processes relevant to the provision of health care.
5. Describe state and national statutes, rules, and regulations that authorize and define
professional nursing practice.
6. Explore the impact of sociocultural, economic, legal, and political factors influencing
health care delivery and practice.

Introduction 2
7. Examine the roles and responsibilities of regulatory agencies and their effect on
patient care quality, workplace safety, and the scope of nursing and other health care
professionals’ practice.
8. Discuss the implications of health care policy on issues of access, equity,
affordability, and social justice in health care delivery.
9. Use an ethical framework to evaluate the impact of social policies on health care,
especially for vulnerable populations.
10. Articulate through a nursing perspective issues concerning health care delivery to
decision makers within health care organizations and other political arenas.
11. Participate as a nursing professional in political processes and grassroots legislative
efforts to influence health care policy.
12. Advocate for patients and the nursing profession.
This manual is designed to be used with Policy & Politics in Nursing and Health Care (6th
edition). Some chapters are noted to be as Highly Recommended reading for all students.
These are the core chapters that address foundational content in policy and politics. Some
chapters are noted to be Suggested; these contain important content and can be assigned
based on the overall design of the course. Other chapters are identified as Optional; these
may be assigned based on individual student interest and learning needs.
The learning outcomes and teaching strategies are designed for specific units instead of
individual chapters. This allows instructors to focus on the broader concepts that will enable
students to apply the knowledge to their clinical experiences and theory learned in prior
nursing courses. Throughout this manual, the emphasis is on application of knowledge rather
than memorization of content. Therefore, chapters entitled “Taking Action” have educational
strategies specifically designed to encourage students to select an area of interest and apply
the skills learned to their clinical practice, experience, and knowledge. Each unit contains
Websites that both instructors and students may use to complete assignments and keep
abreast of the changes in a rapidly evolving health care system.
Policy & Politics in Nursing and Health Care (6th edition) is designed for use across nursing
curricula from undergraduate education to graduate preparation at the Master’s and
Doctorate levels. This manual begins the process by suggesting teaching strategies that lay
the foundation for future study for students who will pursue advanced degrees. For students
who do not advance their education, it suggests educational approaches that expose them to
the major challenges that nurses have always embraced, and that is to effect change for
patients by exercising our single and collective voices on behalf of the most vulnerable and
often disenfranchised members of our society.
References
American Association of Colleges of Nursing. (2008, October 20). The Essentials of
Baccalaureate Education for Professional Nursing Practice. Washington DC: American
Association of Colleges of Nursing.

Mason: Policy & Politics in Nursing and Health Care, 6th Edition
Orientation Class to Policy and Politics in Nursing and Health Care
Alma Dixon
The following is an activity that can be used to stimulate students’ early thinking about
political activity and engagement.
Directions: Distribute the Checklist (Table 1-1) to students. Direct them to complete the
checklist individually. Divide the class in groups and have them discuss the following, based
on their checklist responses.
1. Do you consider yourself to be politically active? Why or why not?
2. Do you feel that you are knowledgeable of the political process?
3. Should nurses be politically active? Why or why not?
4. How can nurses make a difference in the health of their patients and the public by
shaping policy?
5. What do you hope to learn during this course?
A recorder may be appointed to take notes so that students can compare their views from the
beginning of the course to their views at the end of the course.

Orientation Class 2
Engagement and Political Voice Checklist
For each item, check the box that applies
to you. For the item on vote registration,
use the “Yes” or “No” boxes.
Never Sometimes Always Yes No
I work to solve community problems
I volunteer regularly for an environmental
group
I volunteer regularly for a civic or
community organization
I volunteer regularly for any other
organization
I belong or donated money to any group or
organization
Besides donating money, I help raise
money for charitable causes
I have registered to vote
I vote in elections (regular voting)
I volunteer for a political campaign or
candidate
I encourage others to vote
I wear a campaign button or have a sticker
on my vehicle
I volunteer for a candidate, work or
contribute money to a political party, or an
organization that supports candidates
I contacted/visit public officials
I contact a newspaper or magazine
I contact a radio or television news show
I protest
I sign an e-mail petition
I sign a written petition
I boycott companies
I buy something to support the values of a
company
Adapted from Dahl, I., Hoy, A., Meisel, W. (Eds. of the Corella and Bertram F. Bonner
Foundation.) (2006). From community service to political action: A student call for civic
engagement. Princeton NJ: The Bonner Foundation.

Mason: Policy & Politics in Nursing and Health Care, 6th Edition
UNIT 1: INTRODUCTION TO POLICY AND POLITICS IN NURSING AND HEALTH
CARE
Alma Dixon
Highly Recommended Chapters:
Chapter 1: A Framework for Action in Policy and Politics
Chapter 2: A Historical Perspective on Policy, Politics, and Nursing
Chapter 3: Learning the Ropes of Policy, Politics, and Advocacy
Chapter 4: Taking Action: How I Learned the Ropes of Policy and Politics
Chapter 7: The Policy Process
Chapter 8: Political Analysis and Strategies
Chapter 11: Communication Skills for Success in Policy and Politics
Suggested Chapters:
Chapter 5: Advocacy in Nursing and Health Care
Chapter 9: Health Policy, Politics, and Professional Ethics
Chapter 12: Conflict Management in Health Care: The Tipping Point Arrives
Optional Chapters:
Chapter 6: A Primer on Political Philosophy
Chapter 7: The Policy Process
Chapter 10: Using the Power of Media to Influence Health Policy and Politics
UNIT OVERVIEW:
The content in Unit 1 may not have been presented in other nursing courses; therefore, it is
fundamental to understanding policy and politics and the role that a baccalaureate prepared
graduate nurse may play. It begins with an overview of the new Patient Protection and
Affordable Care Act (PPACA) and its potential to reform the health care system and how
health care is delivered. It also contains the review of various types of policies and the forces
that shape health policy. The components of the often maligned, but critical political skill
behaviors are also presented as well as the actions inherent in policy analysis, advocacy, and
political activism. The “Framework for Action,” which was first introduced in Political
Action Handbook for Nurses: Changing the Workplace, Government, Organizations and
Community (Mason & Talbott, 1985) is expanded and updated to focus on the current
spheres of influence, namely, the community, the workforce and workplace, the government,
and the associations and interest groups.
The historical perspective on policy, politics, and nursing lays the foundation for students to
understand the role of nurses’ activism to advance the profession as well as health care. In
addition, the unit describes how the formation of the professional associations placed nursing
as a strong force in addressing the social and political reforms affecting society in the 1800s.
The beginning tension between nursing and the advancement of women in society is also

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UNIT 1 2
reviewed in tandem with the discriminatory practices inherent in society and nursing during
the early 1900s. The impact of public health nursing as a vehicle to address the problems
associated with urbanization, industrialization, and immigration is reviewed as well as the
relationship between the suffrage movement, organized nursing, and modern nursing.
In practice, the baccalaureate prepared graduate is expected to advocate for vulnerable
populations. This unit contains detailed information on advocacy in nursing that can be
applied to the clinical setting. A case study is provided to illustrate the material that was
presented.
RELEVANCE FOR STUDENTS: This unit provides the content to either introduce or
broaden understanding of the complexities of the United States health care system and the
need for fundamental changes in the way resources are allocated. It supplies the historical
context of nursing in shaping policy and the transforming changes that will result from the
enactment of health care reform. This information is important as students learn about the
roles they will play as nurses and as concerned citizens.
LEARNING OBJECTIVES
1. Identify the impact of the Patient Protection and Affordable Care Act (PPACA) on
health care reform.
2. Explain how values and politics shape health policy.
3. Identify the components of political skill and the implications for nurses.
4. Explain how policy analysis, advocacy, interest groups, lobbyists, and the media play
a role in health care and nursing.
5. Describe the Framework for Action including the spheres of influence (the
community, the workforce and workplace, the government, and the associations and
interest groups).
6. Discuss the present and historical application of nursing as “a metaphor for the
struggle for equality of women.”
7. Explain how political activism has influenced the profession of nursing and the
delivery of health care.
8. Identify the steps in political analysis and how they may be applied to an issue in the
workplace or how to advocate for clients.
9. Identify the communication skills needed to be effective in professional and political
arenas.
TEACHING STRATEGIES
The spheres of influence provide a practical framework to organize teaching strategies that
will enable students to learn about political action through application of knowledge.
Therefore the strategies are organized around the community, the workforce and workplace,
the government, and associations and interest groups. Depending on the student evaluation
system used, faculty may consider allocating specific points for each step within each
assignment. In addition, criteria with suggested point allocations are provided to assist in the
evaluation.

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UNIT 1 3
Sphere of Influence 1: The Community
Small Group Assignment
Purpose: To provide students with experience in influencing policy at the community level.
Instructions: Divide the class into groups of 4 to 6 with instructions that each group should
complete the same task.
Vignette Provided to Students: You are completing a clinical rotation in a small
community agency that provides services to pregnant women or women with children under
the age of 3 in an urban area of the southern United States. The racial composition of the
community is 78.1% white, 9.6 % African American, 8.0% Hispanic, 0.3% American
Indian/Alaska Native, 2.0% Asian, and 2.0% other. In 2009, 110,800 women of child-
bearing age resided in the county with 5,300 total births.
Recently you and your fellow students learned that current statistics for the county reveal that
from 2006 to 2008, the infant mortality (number of deaths per 1000 live births) rate was
8.2%; an increase from 6.5% in 2005-2007. For African Americans, the rates were 10.0% in
2005 to 2007 and increased to 14.4% in 2006 to 2008. The local Healthy Start agency
confirms that these data are accurate for the community. In fact, based on a review of deaths
by the coroner, in the last year, the major causes of neonatal and infant demise were low
birth weight, babies sleeping in bed with an adult (roll over/unintentional deaths), and SIDS.
Task: You and your classmates decide to take action. With the assistance of the staff from
the agency and your nursing faculty, you decide to develop a community awareness
campaign.
The Assignment:
1. Name your campaign.
2. Identify community partners to help with your campaign.
3. Identify the stakeholders.
4. Name the resources you will need.
5. Establish a task list.
6. Assign responsibilities.
7. Define a timeline.
8. Describe an evaluation process.
Evaluation Criteria
You will be evaluated on:
1. Your ability to creatively engage the interest of the community by the name of the
campaign………………………………………………………………………10
points
2. Your understanding of the community partners and stakeholders needed to ensure
success of your campaign…………………..………………………30 points
3. Your ability to cite the extent of the resources needed and the time frame to develop
the community awareness campaign………….…………………20 points
4. Your knowledge of the steps involved in evaluating the success of your campaign or
what is needed to improve in the future……………………………..40 points

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UNIT 1 4
Sphere of Influence 2: The Workforce and Workplace:
Small Group or Individual Writing Assignment
Purpose: To provide the experience for students to develop a policy that impacts the
workforce or the workplace.
Instructions: Students select a current problem, for example, the inability of the profession
to establish the BSN as a minimum requirement for entry into practice, or the shortage of
nurses in the United States. Using the “Steps of a Political Analysis” found in Box 8-1 as a
guide, complete the following assignment:
1. Identifying and analyzing the problem
2. Outlining and analyzing proposed solutions
3. Understanding the background of the issue: its history and previous attempts to
address the problem
4. Locating the political setting and structures involved
5. Evaluating the stakeholders
6. Conducting a values assessment
7. Recognizing the resources (both financial and human) needed to reach the intended
goals
8. Analyzing the power bases
Evaluation Criteria
You will be evaluated on your ability to complete the following tasks according to points
designated:
1. Identify and analyze the problem…………………………………………..10 points
2. Outline and analyze proposed solutions………………………………….10 points
3. Explain the background of the issue including its history and previous attempts to address
the problem…………………………………………………………..10 points
4. Identify the entities that have jurisdiction over the problem………………10 points
5. Identify the stakeholders and their potential roles in addressing the problem…10 points
6. Name the inherent values that need to be assessed………………………10 points
7. Determine the resources, both financial and human, needed to bring the issue forward
and to reach a resolution……………………………………………...10 points
8. Analyze the power bases……………………………………………………….10 points
9. Design a plan of action based on your political analysis…………………….20 points
Sphere of Influence 3: The Government
Writing Assignment
Purpose: To provide the opportunity for students to practice influencing policy by
communicating with a legislator about a current health problem.
Instructions: Have students complete the following steps:
1. Select a current health problem that is being debated at the national and/or state level
(e.g., the proliferation of “pill mills” and pain clinics), and state why it is of interest.
2. Identify a legislator (state or federal) and state why that person is the appropriate one
to contact.
3. Draft a letter to the legislator including the proper salutation.

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UNIT 1 5
4. Introduce yourself and your reason for writing.
5. State concisely what you understand to be the current socioeconomic, political, and
ethical issues surrounding the problem.
6. Discuss the implications of the problem for nursing or nursing practice.
7. Make a clear request for action.
8. Request a response.
Evaluation Criteria
You will be evaluated on the following criteria:
1. Identification and description of a current health problem………………20 points
2. Identification of a legislator and the reason for your
selection…………………………………………………………………20 points
3. Preparation of a concise letter that cites the current socioeconomic, political, and
ethical issues surrounding the problem as well as the implications of the problem
for nursing or nursing practice………….30 points
4. Your ability to determine an appropriate action and make a request for that action
………………………………………………………………………30 points
Sphere of Influence 4: Associations and Interest Groups
Writing Assignment
Purpose: To provide the opportunity for students to become familiar with different nursing
associations.
Instructions: Have students complete the following steps:
1. Choose a nursing association.
2. List the mission and purpose of the association
3. How is it governed?
4. What is the legislative agenda of the association?
5. How is that agenda developed? Is the membership involved?
6. How is the agenda communicated to the membership?
7. Does it partner with any coalitions?
8. Does the partnership influence policy on a national or state level? If yes, how?
9. When you graduate will you join the association? If yes, why? If no, why
not?…………………….
Evaluation Criteria
After you have selected a nursing association, you will be evaluated on your ability to answer
the following:
1. What is the mission and purpose of the association?................10 points
2. How is it governed? ...................................................................10 points
3. What is the legislative agenda of the association? ...................10 points
4. How is that agenda developed? ................................................15 points
5. Is the membership involved?........................................................5 points
6. How is the agenda communicated to the membership?...............5 points
7. Does it partner with any coalitions?.............................................10 points

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UNIT 1 6
8. Does the partnership influence policy on a national or state level? If yes, how?
........15 points
9. When you graduate, will you join the association? If yes, why? If no, why not? 20
points
Optional Assignment
Writing Assignment
Purpose: To provide the opportunity for students to select an area of interest in policy and
politics and apply the knowledge to their clinical practice, experience, and knowledge.
Instructions: Students may select a chapter and answer the following:
1. Why did you select this case study?
2. How does it relate to what you understand or have learned about policy and politics
in nursing and health care?
3. How does it relate to your current clinical practice? Give at least one specific
example.
4. How does it relate to what you hope to accomplish in nursing practice?
Evaluation Criteria
You will be evaluated on your ability to apply the knowledge from the chapters in U

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Mason: Policy & Politics in Nursing and Health Care, 6th Edition
UNIT 2: HEALTH CARE DELIVERY AND FINANCING
Alma Dixon
Highly Recommended Chapters:
Chapter 13: The United States Health Care System
Chapter 16: A Primer on Health Economics
Chapter 21: The Uninsured and Underinsured—On the Cusp of Health Reform
Chapter 22: Policy Approaches to Address Health Disparities
Chapter 29: Chronic Care Policy: Medical Homes and Primary Care
Suggested Chapters:
Chapter 14: Financing Health Care in the United States.
Chapter 17: Reforming Medicare
Chapter 18: Children’s Health Insurance Coverage: Medicaid and the State Children’s Health
Insurance Program
Chapter 24: Long-Term Care Policy Issues
Chapter 25: Home Care and Hospice: Evolving Policy
Optional Chapters:
Chapter 15: Could a National Health System Work in the United States?
Chapter 19: The United States Military Health System: Policy Challenges in Wartime and
Peacetime

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UNIT 2 2
interacting components, multiple stakeholders with differing goals and visions, and multiple
consumers with different needs and wants. It expands on the Patient Protection and
Affordable Care Act (PPACA) introduced in Unit 1 and explains how components of the Act
will be used to finance health care reform.
The unit continues with a discussion of the application of economic theory to health care. It
also contains topics related to the demand for and supply of health care, the markets for
hospitals and nurses, the evaluation of costs and benefits of specific health care policies, and
the future of the health care system.
The unit also explores the impact of current health care financing and access to care for the
most vulnerable citizens (infants, children, and older adults).
RELEVANCE FOR STUDENTS: This chapter provides the opportunity to either introduce
or reinforce the content to baccalaureate generalist nurses related to the complexities of the
health care system and the need for fundamental change in the way resources are allocated. It
supplies the historical context of nursing in shaping policy and the transformative changes
that will result from the enactment of health care reform. This information is important as
students learn about the roles they will play as nurses and as concerned citizens.
LEARNING OBJECTIVES
1. Define the roles of patients, providers, and funding sources as fundamental to
understanding the complexities of the current health care system and examine if
reform is needed.
2. Discuss the implications of health care policy on issues related to access, equity,
quality, and cost.
3. Examine the impact of limited access to care by the uninsured, underinsured, and
vulnerable populations such as infants, children, and older adults.
TEACHING STRATEGIES

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UNIT 2 3
9. How will you ensure that clients have easy access to medical information in your
Medical Home (Health Home)?
10. How will you inform the community about your Medical Home (Health Home)?
11. Who are the stakeholders you need to get on board?
12. What opposition do you project will occur with the opening of the Medical Home
(Health Home)?
Evaluation Criteria
You will be graded on the following criteria:
1) Your choice of a health care problem……………………………………..20 points
2) Your ability to choose a community or select an age group most impacted by the
problem………………………………………………………………………..20
points
3) Your creativity to design a Medical Home (Health Home) for patients identified in #2
and to determine the following: …………………………………………40 points
• The current primary care provider and why you identified that person
• The primary care provider you select for Medical Home (Health Home) and why

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UNIT 2 4
2. Your ability to demonstrate an understanding of the relevance of the quote to the role
of government and access to care for the uninsured…………40 points
3. Your ability to organize your thoughts and complete a well written, clear, and
readable paper with
justification……………………………………………………..…30 points
Group Assignment:
Purpose: To provide students with the opportunity to explore a current health legislative
issue that relates to a health disparity at the state or national level.
Instructions: The student is expected to perform a thorough search of the literature, the
media, and discussions with stakeholders such as legislators, consumers, and other health
care professionals about a current health legislative issue. Students will participate on a panel
that will present the following areas or the selected health issue:
1. What is the current legislative or regulatory issue, and why is it being debated?
2. Who is most affected by the legislation?
3. What are the current socioeconomic, political, cultural, and ethical issues surrounding
this topic?
4. Who are the stakeholders?
5. What are the positions of professional health care organizations (ANA, AHA, AMA),
consumers, and the major political parties on the issue?

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UNIT 2 5
Instructions: Step 1: Student may select one of the following chapters:
Chapter 34: Taking Action: Setting Health Care in Its Social Context
Chapter 35: Taking Action: Reimbursement Issues for Nurse Anesthetists: A Continuing
Challenge
Step 2: Answer the following questions:
1. Why did you select the chapter?
2. What did you learn about the role of the nurse as an activist?
3. What problems were encountered?
4. Would you have approached the problem differently? If so, how? If not, why not?
5. What did you learn from the chapter about health care delivery and financing?
6. Would you suggest another policy as an outcome? If yes, what would it be? If not,

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Mason: Policy & Politics in Nursing and Health Care, 6th Edition
UNIT 3: POLICY AND POLITICS IN RESEARCH AND NURSING SCIENCE
Alma Dixon
Highly Recommended Chapters:
Chapter 39: Science, Policy, and Politics
Chapter 40: Research as a Political and Policy Tool
Suggested Chapters:
Chapter 42: Politics and Evidence-Based Practice and Policy
Chapter 43: The Society for Women’s Health Research: Using Evidence-Based Policy to
Improve Health
Chapter 44: Using Research to Advance Healthy Social Policies for Children
Optional Chapters:
Chapter 45: Taking Action: Reefer Madness: The Clash of Science, Politics, and Medical
Marijuana
Chapter 46: Taking Action: The Journey into the Hallowed Halls of Politics: How Nurse
Practitioners Changed Pennsylvania Policy
UNIT OVERVIEW
Unit 3 begins with explaining how

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UNIT 3 2
6. Identify major themes pertaining to social policies for children and the impact of
research on those policies.
7. Identify the role of nursing in advancing controversial research projects using
medical marijuana and screening for Chlamydia as paradigms.
TEACHING STRATEGIES
Writing Assignment
Purpose: To provide students with the opportunity to explore the interface of political
influence and a major health issue using tobacco use as a paradigm.
Instructions: Students are to complete the following steps including answering questions:
1. Trace the history of smoking and its effect on health (locate an article from a nursing
journal on the hazards of smoking).
2. Who were the stakeholders in opposition to smoking?
3. Who were the lobbyists in favor of a hands-off approach?
4. What is the current use of tobacco products (e.g., smokeless tobacco)?
5. What is the current research on the use of these products?
6.

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UNIT 3 3
2. Determine who regulates the scope of practice for the physician and the
NP…………………………………...10 points
3. Summarize the scope of practice including the level of autonomy for each……20
points
4. Identify the barriers to practice…………………………………………….15 points
5. Suggest a policy change……………………………………………………20 points
6. Present a well-written, concise paper……………………………………..25 points
Optional Assignment
Writing Assignment
Purpose: To provide the opportunity for students to select an area of personal interest in
policy and politics in research and nursing science
Instructions: Step 1: Student may select one of the following chapters:
Chapter 45: Taking Action: Reefer Madness: The Clash of Science, Politics, and Medical
Marijuana
Chapter 46: The Journey into the Hallowed Halls of Politics: How Nurse Practitioners
Changed Pennsylvania Policy

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Mason: Policy & Politics in Nursing and Health Care, 6th Edition
UNIT 4: POLICY AND POLITICS IN THE WORKPLACE AND WORKFORCE
Alma Dixon
Highly Recommended Chapters:
Chapter 47: Policy and Politics in the Contemporary Work Environment
Chapter 49: The Nursing Workforce
Chapter 50: Nursing Education Policy: The Unending Debate over Entry into Practice and
the New Debate over Doctoral Degrees
Chapter 52: Global Nurse Migration
Chapter 56: Workplace Abuse in Nursing: Policy Strategies
Suggested Chapters:
Chapter 48: Quality and Safety in Health Care: Policy Issues
Chapter 53: Nurse Staffing Ratios: Policy Options
Chapter 61: Collective Bargaining in Nursing
Chapter 62: Workplace Advocacy
Optional Chapters:
Chapter 51: The Politics of Advanced Practice Nursing
Chapter 54: Taking Action: Aligning Care at the Bedside with the C-Suite
Chapter 55: Taking Action: W

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