Policy & politics in nursing and healthcare 7th ed

Policy & Politics in Nursing and Health Care Seventh Edition

Diana J. Mason, PhD, RN, FAAN

Rudin Professor of Nursing

Co-Director of the Center for Health, Media, and Policy

School of Nursing

Hunter College

City University of New York

New York, New York

Deborah B. Gardner, PhD, RN, FAAN, FNAP

Health Policy and Leadership Consultant, LLC

Honolulu, Hawaii

Freida Hopkins Outlaw, PhD, RN, FAAN

Adjunct Professor

Peabody College of Education

Vanderbilt University

2

Nashville, Tennessee

Eileen T. O'Grady, PhD, NP, RN

Nurse Practitioner and Wellness Coach

McLean, Virginia

3

Table of Contents

Cover image

Title page

Copyright

About the Editors

Contributors

Reviewers

Foreword

Preface

What's New in the Seventh Edition?

Using the Seventh Edition

Acknowledgments Unit 1 Introduction to Policy and Politics in

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Nursing and Health Care

Chapter 1 Frameworks for Action in Policy and Politics

Upstream Factors

Nursing and Health Policy

Reforming Health Care

Nurses as Leaders in Health Care Reform

Policy and the Policy Process

Forces That Shape Health Policy

The Framework for Action

Spheres of Influence

Health

Health and Social Policy

Health Systems and Social Determinants of Health

Nursing Essentials

Policy and Political Competence

Discussion Questions

References

Online Resources

Chapter 2 An Historical Perspective on Policy, Politics, and Nursing

“Not Enough to be a Messenger”

Bringing Together the Past for the Present: What We Learned From History

Conclusion

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Discussion Questions

References

Online Resources

Chapter 3 Advocacy in Nursing and Health Care

The Definition of Advocacy

The Nurse as Patient Advocate

Consumerism, Feminism, and Professionalization of Nursing: the Emergence of Patients' Rights Advocacy

Philosophical Models of Nursing Advocacy

Advocacy Outside the Clinical Setting

Barriers to Successful Advocacy

Summary

Discussion Questions

References

Online Resources

Chapter 4 Learning the Ropes of Policy and Politics

Political Consciousness-Raising and Awareness: the “Aha” Moment

Getting Started

The Role of Mentoring

Educational Opportunities

Applying Your Political, Policy, Advocacy, and Activism Skills

Political Competencies

Changing Policy at the Workplace Through Shared Governance

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Discussion Questions

References

Online Resources

Chapter 5 Taking Action: How I Learned the Ropes of Policy and Politics

Mentors, Passion, and Curiosity

Chapter 6 A Primer on Political Philosophy

Political Philosophy

The State

Gender and Race in Political Philosophy

The Welfare State

Political Philosophy and the Welfare State: Implications for Nurses

Discussion Questions

References

Online Resources

Chapter 7 The Policy Process

Health Policy and Politics

Unique Aspects of U.S. Policymaking

Conceptual Basis for Policymaking

Bringing Nursing Competence Into the Policymaking Process

Conclusion

Discussion Questions

References

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Online Resources

Chapter 8 Health Policy Brief: Improving Care Transitions

Improving Care Transitions: Better Coordination of Patient Transfers among Care Sites and the Community Could Save Money and Improve the Quality of Care1

References

Online Resources

Chapter 9 Political Analysis and Strategies

What is Political Analysis?

Political Strategies

Discussion Questions

References

Online Resources

Chapter 10 Communication and Conflict Management in Health Policy

Understanding Conflict

The Process of Conversations

Listening, Asserting, and Inquiring Skills

Conclusion

Discussion Questions

References

Online Resources

Chapter 11 Research as a Political and Policy Tool

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So What is Policy?

What is Research When It Comes to Policy?

The Chemistry between Research and Policymaking

Using Research to Create, Inform, and Shape Policy

Research and Political Will

Research: Not Just for Journals

Discussion Questions

References

Online Resources

Chapter 12 Health Services Research: Translating Research into Policy

Defining Health Services Research

HSR Methods

Quantitative Methods and Data Sets

Qualitative Methods

Professional Training in Health Services Research

Competencies

Fellowships and Training Grants

Loan Repayment Programs

Dissemination and Translation of Research Into Policy

Discussion Questions

References

Online Resources

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Chapter 13 Using Research to Advance Health and Social Policies for Children

Research on Early Brain Development

Research on Social Determinants of Health and Health Disparities

Advancing Children's Mental Health Using Research to Inform Policy

Research on Child Well-Being Indicators

Research on “Framing the Problem”

Gaps in Linking Research and Social Policies for Children

Nursing Advocacy

Discussion Questions

References

Online Resources

Chapter 14 Using the Power of Media to Influence Health Policy and Politics

Seismic Shift in Media: One-to-Many and Many-to-Many

The Power of Media

Who Controls the Media?

Getting on the Public's Agenda

Media as a Health Promotion Tool

Focus on Reporting

Effective Use of Media

Analyzing Media

Responding to the Media

Conclusion

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Discussion Questions

References

Online Resources

Chapter 15 Health Policy, Politics, and Professional Ethics

The Ethics of Influencing Policy

Reflective Practice: Pants on Fire

Discussion Questions

Professional Ethics

Reflective Practice: Foundational Nursing Documents

Personal Questions

Reflective Practice: Negotiating Conflicts between Personal Integrity and Professional Responsibilities

Personal Question

U.S. Health Care Reform

Reflective Practice: Accepting the Challenge

Personal Question

Reflective Practice: the Medicaid 5% Commitment—an Appeal to Professionalism

Discussion Question

Reflective Practice: Your State Turned Down Medicaid Expansion

Personal Question

Reflective Practice: Barriers to the Treatment of Mental Illness

Personal Question

Ethics and Work Environment Policies

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Mandatory Flu Vaccination: the Good of the Patient Versus Personal Choice

Conclusion

Discussion Questions

References

Online Resources

Unit 2 Health Care Delivery and Financing

Chapter 16 The Changing United States Health Care System

Overview of the U.S. Health Care System

Public Health

Transforming Health Care Through Technology

Health Status and Trends

Challenges for the U.S. Health Care System

Health Care Reform

Opportunities and Challenges for Nursing

Discussion Questions

References

Online Resources

Chapter 17 A Primer on Health Economics of Nursing and Health Policy

Cost-Effectiveness of Nursing Services

Impact of Health Reform on Nursing Economics

Discussion Questions

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References

Chapter 18 Financing Health Care in the United States

Historical Perspectives on Health Care Financing

Government Programs

The Private Health Insurance and Delivery Systems

The Problem of Continually Rising Health Care Costs

The ACA and Health Care Costs

Discussion Questions

References

Online Resources

Chapter 19 The Affordable Care Act: Historical Context and an Introduction to the State of Health Care in the United States

Historical, Political, and Legal Context

Content of the Affordable Care Act

Impact on Nursing Profession: Direct and Indirect

Overall Cost of the Aca

Political and Implementation Challenges

Conclusion

Discussion Questions

References

Online Resources

Chapter 20 Health Insurance Exchanges: Expanding Access to Health Care

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What is a Health Insurance Exchange?

Exchange Purchasers

Other Health Insurance Options

Federal or State Exchanges

State-Based EXCHANGES

Development of the Exchanges

Establishing State Exchanges

The Federal Exchange Rollout: ACA Setback

New York's Success Story

The Oregon Story

Exchange Features

Marketplace Insurance Categories

Role of Medicaid

Nurses' Roles with Exchanges

Consumer Education

State Requirements Include Aprns in Exchange Plans

Assessing the Impact of the Exchanges and Future Projections

Conclusion

Discussion Questions

References

Online Resources

Chapter 21 Patient Engagement and Public Policy: Emerging New Paradigms and Roles

Patient Engagement Within Nursing

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Patient Engagement and Federal Initiatives

The VA System: an Exemplar of Patient-Centered Care

From Patient Engagement to Citizen Health

Conclusion

Discussion Questions

References

Online Resources

Chapter 22 The Marinated Mind: Why Overuse Is an Epidemic and How to Reduce It

Commonly Overused Interventions

Reasons for Overuse

Financial Incentives as the Major Cause of Overuse

The Marinated Mind

Physician and Nurse Acknowledgment of Overuse

Public Reporting to Reduce Overuse

Journalists Advocate for More Transparency About Overuse

Discussion Questions

References

Online Resources

Chapter 23 Policy Approaches to Address Health Disparities

Health Equity and Access

Policy Approaches to Address Health Disparities

Evaluating Patient-Centered Care

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Summary

Discussion Questions

References

Online Resources

Chapter 24 Achieving Mental Health Parity

Historical Struggle to Achieve Mental Health Parity

Implications for Nursing: Mental Health Related Issues and Strategies

Discussion Questions

References

Online Resources

Chapter 25 Breaking the Social Security Glass Ceiling: A Proposal to Modernize Women's Benefits1

Benefits for Women

Strengthening the Program

Changes We Oppose

Strengthening Financing

Discussion Questions

References

Online Resources

Chapter 26 The Politics of the Pharmaceutical Industry

Globalization Concerns

Values Conflict

Direct to Consumer Marketing

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Conflict of Interest

Education

Gifts

Samples

Conclusion

Discussion Questions

References

Online Resources

Chapter 27 Women's Reproductive Health Policy

When Women's Reproductive Health Needs are Not Met

Why Do We Need Policy Specifically Directed at Women?

Women's Health and U.S. Policy

Discussion Questions

References

Online Resources

Chapter 28 Public Health: Promoting the Health of Populations and Communities

The State of Public Health and the Public's Health

Impact of Social Determinants and Disparities on Health

Major Threats to Public Health

Challenges Faced by Governmental Public Health

Charting a Bright Future for Public Health

Discussion Questions

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References

Online Resources

Chapter 29 Taking Action: Blazing a Trail...and the Bumps Along the Way—A Public Health Nurse as a Health Officer

Getting the Job: More Difficult Than You Might Think

Creating Access to Public Health Care in West New York

On-the-Job Training

Political Challenges

Safe Kid Day Arrives

Nurses Shaping Policy in Local Government

Successes and Challenges

References

Chapter 30 The Politics and Policy of Disaster Response and Public Health Emergency Preparedness

Purpose Statement

Background and Significance

Presidential Declarations of Disaster and the Stafford Act

Policy Change After September 11

The Politics Underlying Disaster and Public Health Emergency Policy

The Homeland Security Act

Project Bioshield 2004

Pkemra 2006 and Disaster Case Management

National Commission on Children and Disasters 2009

Threat Level System of the U.S. Department of Homeland Security

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Conclusion

Discussion Questions

References

Online Resources

Chapter 31 Chronic Care Policy: Medical Homes and Primary Care

The Experience of Chronic Care in the United States

Medical Homes

The Role of Nursing in Medical Homes

Patient-Centered Medical Homes: the Future

Discussion Questions

References

Online Resources

Chapter 32 Family Caregiving and Social Policy

Who are the Family Caregivers?

Unpaid Value of Family Caregiving

Caregiving as a Stressful Business

Supporting Family Caregivers

Discussion Questions

References

Online Resources

Chapter 33 Community Health Centers: Successful Advocacy for Expanding Health Care Access

Community Health Centers Demonstrate the Advocacy Process for

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Innovation

The Creation of the Neighborhood Health Center Program

Program Survival and Institutionalization

Continuing Policy Advocacy

The Expansion of Community Health Centers Under a Conservative President

Community Health Centers in the Era of Obamacare

Discussion Questions

References

Online Resources

Chapter 34 Filling the Gaps: Retail Health Care Clinics and Nurse- Managed Health Centers

Retail Health Clinics

Access and Quality in Retail Clinics

Retail Clinics and Cost

Challenges and Reactions to the Model

Nurse-Managed Health Clinics

Future Directions for Retail Clinics and NMHCs

Discussion Questions

References

Online Resources

Chapter 35 Developing Families

The Need for Improvement

Social Determinants and Life Course Model

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Innovative Models of Care

Health Care Reform

Barriers to Sustaining, Spreading, and Scaling-Up Models

Conclusion

Discussion Questions

References

Online Resources

Chapter 36 Dual Eligibles: Issues and Innovations

Who are the Duals?

What are the Challenges?

Health Care Delivery Reforms That Hold Promise

Implication for Nurses

Policy Implications

Discussion Questions

References

Online Resources

Chapter 37 Home Care and Hospice: Evolving Policy

Defining the Home Care Industry

Home Health

Hospice

Home Medical Equipment

Home Infusion Pharmacy

Private Duty

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Reimbursement and Reimbursement Reform

Hospital Use and Readmissions and the Focus on Care Transitions

Quality and Outcome Management

The Impact of Technology on Home Care

Championing Home Care and Hospice and the Role of Nurses

Discussion Questions

References

Online Resources

Chapter 38 Long-Term Services and Supports Policy Issues

Poor Quality of Care

Weak Enforcement

Inadequate Staffing Levels

Corporate Ownership

Financial Accountability

Other Issues

Home and Community-Based Services

Public Financing

Conclusion

Discussion Questions

References

Online Resources

Chapter 39 The United States Military and Veterans Administration Health Systems: Contemporary Overview and Policy Challenges

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The MHS and VHA Budgets

Advanced Nursing Education and Career Progression

Contemporary Policy Issues Involving MHS and VHA Nurses

Post-Deployment Health-Related Needs

References

Seamless Transition

Conclusion

Discussion Questions

References

Online Resources

Unit 3 Policy and Politics in the Government

Chapter 40 Contemporary Issues in Government

Contemporary Issues in Government

The Central Budget Story

Fiscal Policy and Political Extremism

How Will the Nation's Economic Health be Addressed?

The Impact of Political Dysfunction

Polarization

Loss of Congressional Moderates

Gerrymandering

Congressional Gridlock: Where is the President's Power?

Beleaguered Health Care Reform

Implementation Challenges

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Increasing Access

Affordable Care Act Costs and Savings

Legal Challenges to the ACA

Immigration Reform: Will Health Care be Included?

Current Health Care Access

The Ethics and Economics of Access

Immigration Health Care Reform Options

Rising Economic Inequality

Measuring Wealth

The Great Recession Reshaped the Economy

Costs of Economic Inequality

Impact of Economic Inequality on Health Equity

Effectively Addressing Economic Inequality

Proposed Policy Strategies

Climate Change: Impacting Global Health

Climate Change: It's Happening

Mitigation Versus Adaptation

International Progress

Adaptation is Local

Examples of Health in All Policies

Nursing Action Oriented Leadership

Conclusion

Discussion Questions

References

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Chapter 41 How Government Works: What You Need to Know to Influence the Process

Federalism: Multiple Levels of Responsibility

The Federal Government

State Governments

Local Government

Target the Appropriate Level of Government

Pulling It All Together: Covering Long-Term Care

Discussion Questions

References

Online Resources

Chapter 42 Is There a Nurse in the House? The Nurses in the U.S. Congress

The Nurses in Congress

Evaluating the Work of the Nurses Serving in Congress

Political Perspective

Interest Group Ratings

Campaign Financing

Sources of Campaign Funds

References

Online Resources

Chapter 43 An Overview of Legislation and Regulation

Influencing the Legislative Process

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Regulatory Process

Discussion Questions

References

Online Resources

Chapter 44 Lobbying Policymakers: Individual and Collective Strategies

Lobbyists, Advocates, and the Policymaking Process

Lobbyist or Advocate?

Why Lobby?

Steps in Effective Lobbying

How Should You Lobby?

Collective Strategies

Discussion Questions

References

Online Resources

Chapter 45 Taking Action: An Insider's View of Lobbying

Getting Started

Winds of Change Coming in State Legislatures

Political Strategies

There Really is a Need for Lobbyists

Chapter 46 The American Voter and the Electoral Process

Voting Law: Getting the Voters to the Polls

Calls for Reform

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Voting Behavior

Answering to the Constituency

Congressional Districts

Involvement in Campaigns

Campaign Finance Law

Types of Elections

The Morning After: Keeping Connected to Politicians

Discussion Questions

References

Online Resources

Chapter 47 Political Activity: Different Rules for Government- Employed Nurses

Why Was the Hatch Act Necessary?

Hatch Act Enforcement

Penalties for Hatch Act Violations

U.S. Department of Defense Regulations on Political Activity

Internet and Social Media Influence

Conclusion

Discussion Questions

References

Online Resources

Chapter 48 Taking Action: Anatomy of a Political Campaign

Why People Work on Campaigns

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Why People Stop Working on Campaigns

The Internet and the 2012 Election Campaign

Campaign Activities

Discussion Questions

References

Online Resources

Chapter 49 Taking Action: Truth or Dare: One Nurse's Political Campaign

Stepping Into Politics

Ethical Leadership

Making a Difference

Lessons Learned

Chapter 50 Political Appointments

What Does It Take to be a Political Appointee?

Getting Ready

Identify Opportunities

Making a Decision to Seek an Appointment

Plan Your Strategy

Confirmation or Interview?

Compensation

After the Appointment

Experiences of Nurse Appointees

Conclusion

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Discussion Questions

References

Online Resources

Chapter 51 Taking Action: Influencing Policy Through an Appointment to the San Francisco Health Commission

Democracy and Service to the Health Commission

Checks and Balances of Health Commission Activities

Scope of Work of the Health Commission

Infrastructure of the Health Commission

Balancing Health Commission Service with Academia

Introspection: Re-Experiencing Decision Making on the Health Commission

References

Chapter 52 Taking Action: A Nurse in the Boardroom

My Political Career

My Campaign

Campaign Preparation

Launching the Campaign

Lessons Learned

The Future

References

Chapter 53 Nursing and the Courts

The Judicial System

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Judicial Review

Reference

The Role of Precedent

the Constitution and Branches of Government

Impact Litigation

Expanding Legal Rights

Reference

Enforcing Legal and Regulatory Requirements

Antitrust Laws and Anticompetitive Practices

Criminal Courts

Influencing and Responding to Court Decisions

Nursing's Policy Agenda

Discussion Questions

References

Online Resources

Chapter 54 Nursing Licensure and Regulation

Historical Perspective

The Purpose of Professional Regulation

Sources of Regulation

Licensure Board Responsibilities

Licensure Requirements

The Source of Licensing Board Authority

Disciplinary Offenses

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Regulation's Shortcomings

Conclusion

Discussion Questions

References

Online Resources

Chapter 55 Taking Action: Nurse, Educator, and Legislator: My Journey to the Delaware General Assembly

My Political Roots

Volunteering and Campaigning

There's a Reason It is Called “Running” for Office

A Day in the Life of a Nurse-Legislator

What I've Been Able to Accomplish as a Nurse-Legislator

Tips for Influencing Elected Officials' Health Policy Decisions

Is It Worth It?

References

Unit 4 Policy and Politics in the Workplace and Workforce

Chapter 56 Policy and Politics in Health Care Organizations

Financial Pressures From Changing Payment Models

The Broadening Influence of Outcome Accountability

A Door Opens—Policy to Support the Role of the Nurse Practitioner

Conclusion

Discussion Questions

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References

Online Resources

Chapter 57 Taking Action: Nurse Leaders in the Boardroom

Getting Started

Are You Ready?

Discussion Questions

References

Online Resources

Chapter 58 Quality and Safety in Health Care: Policy Issues

The Environmental Context

The Policy Context: Value-Driven Health Care

Value-Based Payment and Delivery Models

Impact of Value-Driven Health Care on Nursing

Conclusion

Discussion Questions

References

Online Resources

Chapter 59 Politics and Evidence-Based Practice and Policy

The Players and Their Stakes

The Role of Politics in Generating Evidence

The Politics of Research Application in Clinical Practice

The Politics of Research Applied to Policy Formulation

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Discussion Questions

References

Online Resources

Chapter 60 The Nursing Workforce

Characteristics of the Workforce

Expanding the Workforce

Increasing Diversity

Retaining Workers

Addressing the Nursing Workforce Issues

Conclusion

Discussion Questions

References

Online Resources

Chapter 61 Rural Health Care: Workforce Challenges and Opportunities

What Makes Rural Health Care Different?

Defining Rural

Rural Policy, Rural Politics

The Opportunities and Challenges of Rural Health

Discussion Questions

References

Online Resources

Chapter 62 Nurse Staffing Ratios: Policy Options

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The Establishment of California's Regulations

What Has Happened as a Result of the Ratios?

What Next?

Discussion Questions

References

Online Resources

Chapter 63 The Contemporary Work Environment of Nursing

Primary Factors

Secondary Factors

American Hospital Association (AHA) Report

Crucial Communication

Discussion Questions

References

Online Resources

Chapter 64 Collective Strategies for Change in the Workplace

Building a Culture of Change

Workplace Cultures Differ

Implementing the Change Decision

Examples of Change Decisions

Conclusion

Discussion Questions

References

Online Resources

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Chapter 65 Taking Action: Advocating for Nurses Injured in the Workplace

Life Lessons

Becoming a Voice for Back-Injured Nurses

Establishing the Work Injured Nurses Group USA (WING USA)

Legislative Efforts to Advance Safe Patient Handling

The Future

References

Chapter 66 The Politics of Advanced Practice Nursing

Political Context of Advanced Practice Nursing

The Political Issues

Toward New APN Politics: Overcoming Appeasement and Apathy

Discussion Questions

References

Chapter 67 Taking Action: Reimbursement Issues for Nurse Anesthetists: A Continuing Challenge

Nurse Anesthesia Practice

Nurse Anesthesia Reimbursement

Advocacy Issues in Anesthesia Reimbursement

TEFRA: Defining Medical Direction

Physician Supervision of CRNAs: Medicare Conditions of Participation

Medicare Coverage of Chronic Pain Management Services

Conclusion

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References

Chapter 68 Taking Action: Overcoming Barriers to Full APRN Practice: The Idaho Story

Background

Nurturing the Passion to Achieve Statutory Change

Building Broad Coalitions and Relationships

Sustaining the Effort and the Vision

Removing Barriers to Autonomous APRN Practice

The Stars Align

The 2012 NPA Revision

Conclusion

Chapter 69 Taking Action: A Nurse Practitioner's Activist Efforts in Nevada

Being a Leader

Activism Means Leaving Your Comfort Zone

Honing Your Verbal and Nonverbal Messages

Activism Requires Funding Knowledge

Developing Activist Skills Through Experience

References

Chapter 70 Nursing Education Policy: The Unending Debate over Entry into Practice and the Continuing Debate over Doctoral Degrees

The Entry Into Practice Debate

The Entry Into Advanced Practice Debate

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Conclusion

Discussion Questions

References

Online Resources

Chapter 71 The Intersection of Technology and Health Care: Policy and Practice Implications

Public Policy Support for HIT

Conclusion

Discussion Questions

References

Online Resources

Unit 5 Policy and Politics in Associations and Interest Groups

Chapter 72 Interest Groups in Health Care Policy and Politics

Development of Interest Groups

Functions and Methods of Influence

Landscape of Contemporary Health Care Interest Groups

Assessing Value and Considering Involvement

Conclusion

Discussion Questions

References

Online Resources

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Chapter 73 Current Issues in Nursing Associations

Nursing's Professional Organizations

Organizational Life Cycle

Current Issues for Nursing Organizations

Conclusion

Discussion Questions

References

Online Resources

Chapter 74 Professional Nursing Associations: Operationalizing Nursing Values

The Significance of Nursing Organizations