Spheres of Influence

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




Nashville, Tennessee

Eileen T. O’Grady, PhD, NP, RN

Nurse Practitioner and Wellness Coach

McLean, Virginia




Table of Contents

Cover image

Title page


About the Editors





What’s New in the Seventh Edition?

Using the Seventh Edition

Acknowledgments Unit 1 Introduction to Policy and Politics in




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 and Social Policy

Health Systems and Social Determinants of Health

Nursing Essentials

Policy and Political Competence

Discussion Questions


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





Discussion Questions


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


Discussion Questions


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




Discussion Questions


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


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


Discussion Questions





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


Online Resources

Chapter 9 Political Analysis and Strategies

What is Political Analysis?

Political Strategies

Discussion Questions


Online Resources

Chapter 10 Communication and Conflict Management in Health Policy

Understanding Conflict

The Process of Conversations

Listening, Asserting, and Inquiring Skills


Discussion Questions


Online Resources

Chapter 11 Research as a Political and Policy Tool




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


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


Fellowships and Training Grants

Loan Repayment Programs

Dissemination and Translation of Research Into Policy

Discussion Questions


Online Resources




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


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





Discussion Questions


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




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


Discussion Questions


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


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





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


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


Discussion Questions


Online Resources

Chapter 20 Health Insurance Exchanges: Expanding Access to Health Care




What is a Health Insurance Exchange?

Exchange Purchasers

Other Health Insurance Options

Federal or State 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


Discussion Questions


Online Resources

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

Patient Engagement Within Nursing




Patient Engagement and Federal Initiatives

The VA System: an Exemplar of Patient-Centered Care

From Patient Engagement to Citizen Health


Discussion Questions


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


Online Resources

Chapter 23 Policy Approaches to Address Health Disparities

Health Equity and Access

Policy Approaches to Address Health Disparities

Evaluating Patient-Centered Care





Discussion Questions


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


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


Online Resources

Chapter 26 The Politics of the Pharmaceutical Industry

Globalization Concerns

Values Conflict

Direct to Consumer Marketing




Conflict of Interest





Discussion Questions


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


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





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


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





Discussion Questions


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


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


Online Resources

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

Community Health Centers Demonstrate the Advocacy Process for





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


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


Online Resources

Chapter 35 Developing Families

The Need for Improvement

Social Determinants and Life Course Model




Innovative Models of Care

Health Care Reform

Barriers to Sustaining, Spreading, and Scaling-Up Models


Discussion Questions


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


Online Resources

Chapter 37 Home Care and Hospice: Evolving Policy

Defining the Home Care Industry

Home Health


Home Medical Equipment

Home Infusion Pharmacy

Private Duty




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


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


Discussion Questions


Online Resources

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




The MHS and VHA Budgets

Advanced Nursing Education and Career Progression

Contemporary Policy Issues Involving MHS and VHA Nurses

Post-Deployment Health-Related Needs


Seamless Transition


Discussion Questions


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


Loss of Congressional Moderates


Congressional Gridlock: Where is the President’s Power?

Beleaguered Health Care Reform

Implementation Challenges




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


Discussion Questions





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


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


Online Resources

Chapter 43 An Overview of Legislation and Regulation

Influencing the Legislative Process




Regulatory Process

Discussion Questions


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


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




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


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


Discussion Questions


Online Resources

Chapter 48 Taking Action: Anatomy of a Political Campaign

Why People Work on Campaigns




Why People Stop Working on Campaigns

The Internet and the 2012 Election Campaign

Campaign Activities

Discussion Questions


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?


After the Appointment

Experiences of Nurse Appointees





Discussion Questions


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


Chapter 52 Taking Action: A Nurse in the Boardroom

My Political Career

My Campaign

Campaign Preparation

Launching the Campaign

Lessons Learned

The Future


Chapter 53 Nursing and the Courts

The Judicial System




Judicial Review


The Role of Precedent

the Constitution and Branches of Government

Impact Litigation

Expanding Legal Rights


Enforcing Legal and Regulatory Requirements

Antitrust Laws and Anticompetitive Practices

Criminal Courts

Influencing and Responding to Court Decisions

Nursing’s Policy Agenda

Discussion Questions


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




Regulation’s Shortcomings


Discussion Questions


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?


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


Discussion Questions





Online Resources

Chapter 57 Taking Action: Nurse Leaders in the Boardroom

Getting Started

Are You Ready?

Discussion Questions


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


Discussion Questions


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




Discussion Questions


Online Resources

Chapter 60 The Nursing Workforce

Characteristics of the Workforce

Expanding the Workforce

Increasing Diversity

Retaining Workers

Addressing the Nursing Workforce Issues


Discussion Questions


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


Online Resources

Chapter 62 Nurse Staffing Ratios: Policy Options




The Establishment of California’s Regulations

What Has Happened as a Result of the Ratios?

What Next?

Discussion Questions


Online Resources

Chapter 63 The Contemporary Work Environment of Nursing

Primary Factors

Secondary Factors

American Hospital Association (AHA) Report

Crucial Communication

Discussion Questions


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


Discussion Questions


Online Resources




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


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


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






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


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


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


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





Discussion Questions


Online Resources

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

Public Policy Support for HIT


Discussion Questions


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


Discussion Questions


Online Resources




Chapter 73 Current Issues in Nursing Associations

Nursing’s Professional Organizations

Organizational Life Cycle

Current Issues for Nursing Organizations


Discussion Questions


Online Resources

Chapter 74 Professional Nursing Associations: Operationalizing Nursing Values

The Significance of Nursing Organizations

Evolution of Organizations

Today’s Nurse

Organizational Purpose

Associations and Their Members

Leadership Development

Opportunities to Shape Policy

Influencing the Organization


Discussion Questions


Online Resources

Chapter 75 Coalitions: A Powerful Political Strategy




Birth and Life Cycle of Coalitions

Building and Maintaining a Coalition: the Primer

Pitfalls and Challenges

Political Work of Coalitions

Evaluating Coalition Effectiveness

Discussion Question


Online Resources

Chapter 76 Taking Action: The Nursing Community Builds a Unified Voice

The Necessity of Coalitions

Coalition Formation

Defining a Coalition’s Success: the Importance of Leadership and Goal Setting

A Perspective on Nursing’s Unified Voice

Nursing Unites: the Nursing Community



Chapter 77 Taking Action: The Nursing Kitchen Cabinet: Policy and Politics in Action

The Context

Discussion Questions





Chapter 78 Taking Action: Improving LGBTQ Health: Nursing Policy Can Make a Difference

LGBTQ Rights in the United States

Nursing and LGBTQ Advocacy

Taking Action



Online Resources

Chapter 79 Taking Action: Campaign for Action

The Future of Nursing Report

A Vision for Implementing the Future of Nursing Report

Success at the National Level

Success at the State Level



Online Resources

Chapter 80 Taking Action: The Nightingales Take on Big Tobacco

Tobacco Kills

Ruth’s Story

The Personal Becomes Political

Compelling Voices

Strategic Planning

Kelly’s Story




Policy Advocacy

Shareholder Advocacy: “the NURSES are Coming…”

Extending the Message

What NURSES Can Do

Nursing is Political

Lessons Learned: Nursing Activism

Discussion Questions


Online Resources

Unit 6 Policy and Politics in the Community

Chapter 81 Where Policy Hits the Pavement: Contemporary Issues in Communities

What is a Community?

Healthy Communities

Partnership for Improving Community Health

Determinants of Health

Discussion Questions


Online Resources

Chapter 82 An Introduction to Community Activism

Key Concepts

Taking Action to Effect Change: Characteristics of Community Activists and Activism




Challenges and Opportunities in Community Activism

Nurses as Community Activists

Discussion Questions


Online Resources

Chapter 83 Taking Action: The Canary Coalition for Clean Air in North Carolina’s Smoky Mountains and Beyond

Lessons in Communicating

Persuasion: the Integrated Resource Plan Example

Speaking to Power

Clean Air: a Mixed Blessing

The Crucible of Financial Challenge

Efficient and Affordable Energy Rates Bill

Nurses’ Role in Environmental Stewardship


Chapter 84 How Community-Based Organizations Are Addressing Nursing’s Role in Transforming Health Care

Community as Partner and the Community Anchor

Accountable Care Community

Superstorm Sandy

the Population Care Coordinator

Hospital Partnerships and Transitional Care

Vulnerable Patient Study





Discussion Questions


Online Resources

Chapter 85 Taking Action: From Sewage Problems to the Statehouse: Serving Communities

Sewage Changed My Life

My Campaigns

The Value of Political Activity in Your Community

Leadership in the International Community

Mentoring Other Nurses for Political Advocacy

Recommendations for Becoming Involved in Politics

Chapter 86 Family and Sexual Violence: Nursing and U.S. Policy

Intimate Partner and Sexual Violence Against Women

State Laws Regarding Intimate Partner and Sexual Violence

Federal Laws Related to Intimate Partner and Sexual Violence

Health Policies Related to Intimate Partner and Sexual Violence

Child Maltreatment

State and Federal Policies Related to Child Maltreatment

Health Policies Related to Child Maltreatment

Older Adult Maltreatment

State and Federal Legislation Related to Older Adult Maltreatment

Health Care Policies Related to Older Adult Maltreatment

Opportunity for Nursing




Discussion Questions


Online Resources

Chapter 87 Human Trafficking: The Need for Nursing Advocacy

Encountering the Victims of Human Trafficking

Advancing Policy in the Workplace

Role of Professional Nursing Associations

Advocating for State Legislation and Policy on Human Trafficking

Advancing Policy Through Media and Technology

Trafficking as a Global Public Health Issue

The World of the Victims

International Policy

U.S. Response to Human Trafficking


Discussion Questions


Online Resources

Chapter 88 Taking Action: A Champion of Change: For Want of a Hug

What Happened?

The Struggle to Find Help

We Got Help, but What About Others?

Commitment in My Community




Meeting Basic Needs

Gang Violence Prevention

It Takes a Village


Chapter 89 Lactivism: Breastfeeding Advocacy in the United States

Why Advocate for Breastfeeding?

The Historic Decline in Breastfeeding in the United States

Culture of Breastfeeding

Action to Support Breastfeeding

The Need for Breastfeeding Advocacy Education

Discussion Questions


Online Resources

Chapter 90 Taking Action: Reefer Madness: The Clash of Science, Politics, and Medical Marijuana

A Plant with an Image Problem

Once upon a Time, Cannabis Was Legal

How and Why Did the Marijuana Prohibition Begin?

My Introduction to the Problem of Medical Cannabis Use

An Opportunity for Education

Barriers and Strategies

Patients Out of Time

The Tide is Shifting




Looking Ahead at a Paradigm Shift


Chapter 91 International Health and Nursing Policy and Politics Today: A Snapshot



Global Health

The Policy Role of the World Health Organization

The Millennium Development Goals

Beyond the Millennium Development Goals

Human Resources for Health

Advanced Nursing Practice

The World Health Organization and Nursing

Nursing’s Policy Voice

Getting Involved

Discussion Questions


Chapter 92 Infectious Disease: A Global Perspective


Determinants of Infectious Disease Introduction and Transmission

Ebola Virus Disease Outbreak: West Africa, 2014

Surveillance and Reporting





Discussion Questions


Online Resources






3251 Riverport Lane St. Louis, Missouri 63043 POLICY & POLITICS IN NURSING AND HEALTH CARE ISBN: 978-0-323-24144-1

Copyright © 2016 by Elsevier Inc. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopy, recording, or any information storage and retrieval system, without permission in writing from the publisher. Details on how to seek permission, further information about the Publisher’s permissions policies, and our arrangements with organizations such as the Copyright Clearance Center and the Copyright Licensing Agency can be found at our website: www.elsevier.com/premissions. This book and the individual contributions contained in it are protected under copyright by the Publisher (other than as may be noted herein).

Notices Knowledge and best practice in this field are constantly changing. As new research and experience broaden our understanding, changes in research methods, professional practices, or medical treatment may become necessary. Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any information, methods, compounds, or experiments described




herein. In using such information or methods they should be mindful of their own safety and the safety of others, including parties for whom they have a professional responsibility. With respect to any drug or pharmaceutical products identified, readers are advised to check the most current information provided (i) on procedures featured or (ii) by the manufacturer of each product to be administered, to verify the recommended dose or formula, the method and duration of administration, and contraindications. It is the responsibility of practitioners, relying on their own experience and knowledge of their patients, to make diagnoses, to determine dosages and the best treatment for each individual patient, and to take all appropriate safety precautions. To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors assume any liability for any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise, or from any use or operation of any methods, products, instructions, or ideas contained in the material herein.

The views expressed in this book are those of the authors and do not reflect the official policy or position of the Department of Defense, Department of Health and Human Services, Department of Veterans Affairs, any other government agency, or the U.S. Government.

Previous editions copyrighted 2014, 2012, 2007, 2002, 1998, 1993, and 1985.

Library of Congress Cataloging-in-Publication Data Policy & politics in nursing and health care / [edited by] Diana J. Mason, Deborah B. Gardner, Freida Hopkins Outlaw, Eileen T. O’Grady.—Seventh edition. p.; cm. Policy and politics in nursing and health care Includes bibliographical references and index. ISBN 978-0-323-24144-1 (pbk. : alk. paper) I. Mason, Diana J., 1948-, editor. II. Gardner, Deborah B., editor. III. Outlaw, Freida Hopkins, editor. IV. O’Grady, Eileen T.,




1963-, editor. V. Title: Policy and politics in nursing and health care. [DNLM: 1. Nursing–United States. 2. Delivery of Health Care– United States. 3. Politics–United States. 4. Public Policy–United States. WY 16 AA1] RT86.5 362.17′3–dc23 2015008880 Senior Content Strategist: Sandra Clark Content Development Manager: Laurie Gower Senior Content Development Specialist: Karen Turner Content Development Specialist: Jennifer Wade Publishing Services Manager: Jeff Patterson Senior Project Manager: Clay S. Broeker Design Direction: Ashley Miner Printed in the United States of America Last digit is the print number: 9 8 7 6 5 4 3 2 1




About the Editors

DIANA J. MASON, PhD, RN, FAAN, is the Rudin Professor of Nursing and Co-Founder and Co-Director of the Center for Health, Media, and Policy (CHMP) at Hunter College and Professor at the City University of New York. She served as President of the American Academy of Nursing (2013-2015) and as Strategic Adviser for the Campaign for Action, an initiative to implement the recommendations from the Institute of Medicine’s Future of Nursing report, to which she contributed. From 2012 to 2015 she served as Co-President of the Hermann Biggs Society, an interdisciplinary health policy salon in New York City.

Dr. Mason was editor-in-chief of the American Journal of Nursing for over a decade. Under her leadership, the journal received numerous awards for editorial excellence and dissemination, culminating in the journal being selected by the Specialized Libraries Association in 2009 as one of the 100 most influential Journals of the Century in Biology and Medicine—the only nursing journal to be selected for this distinction.

As a journalist, she has produced and moderated a weekly radio program on health and health policy (Healthstyles) for 30 years. She blogs for HealthCetera (www.centerforhealthmediapolicy.com) and for the JAMA News Forum. In 2009, she was appointed to the National Advisory Committee for Kaiser Health News—the only nurse and health professional on the Committee.

She is the lead co-editor of The Nursing Profession: Development, Challenges, and Opportunities, part of the Robert Wood Johnson Foundation Health Policy Book Series. She has been the lead co-




editor of all seven editions of Policy & Politics in Nursing and Health Care.

She is the recipient of numerous honors, including Honorary Doctorates from Long Island University and West Virginia University; fellowship in the New York Academy of Medicine; and the Pioneering Spirit Award from the American Association of Critical Care Nurses.

DEBORAH B. GARDNER, PhD, RN, FAAN, FNAP, is a health policy and leadership consultant. She has more than 35 years of health care experience as a clinician, manager, trainer, and consultant delivering care across diverse institutional and community settings. Dr. Gardner practiced as a psychiatric mental health clinical nurse specialist for 15 years. She received a PhD in Nursing Administration and Health Policy from George Mason University.

At the National Institutes of Health (NIH) Clinical Center she established and held the position as the Director of Organizational Planning and Workforce Development for 10 years. She served at the Bureau of Health Professionals, Health Resources and Services Administration (HRSA) as a senior consultant collaborating on the implementation of the Affordable Care Act (ACA) (2010-2012). As the Director of the Hawaii State Center for Nursing, she led the State’s Campaign for Action Coalition, a Robert Wood Johnson Foundation Initiative to support the Institute of Medicine’s Future of Nursing report.

In 2012 she served as a member of the Hawaii Governor’s Healthcare Transformation Steering Committee to assess and refocus Hawaii’s health care delivery system for alignment to the ACA goals.

A Fellow in the American Academy of Nursing and in the National Academy of Practice, she was instrumental in establishing the National Center for Interprofessional Practice and Education in Minneapolis, Minnesota. She has received numerous awards, including the HRSA Administrator’s Special Citation for National Leadership in Interprofessional Education and Collaborative Practice, an International Coaching Federation Award for




Excellence in the Establishment of an Outstanding Executive Coaching Program, the NIH Director’s Award for Outstanding Mentoring and Innovation in Organizational Development Strategies, and the “Profiles in Excellence” alumni honors award from Oklahoma Baptist University.

Dr. Gardner has written numerous book chapters and articles. She serves on the Editorial Board for Nursing Economic$ and writes the Policy and Politics column. She is a professional speaker on interprofessional practice and education teams, advanced practice nursing, and health policy issues.

FREIDA HOPKINS OUTLAW, PhD, RN, FAAN, is an adjunct professor in the Peabody College of Education, Vanderbilt University, Nashville, Tennessee. She served as the Assistant Commissioner, Division of Special Populations, Tennessee Department of Mental Health and Substance Abuse Services. In this role, she helped to develop policies and initiatives that improved treatment for children with mental health and substance abuse issues. She provided leadership in securing $32 million of federal funding to support transforming the mental health system for children and their families and was part of the leadership instrumental in passing legislation to create the Children’s Mental Health Council, which developed a plan for a statewide system of care implementation, which continues today.

She participated in the American Nurses Association Minority Fellowship Legislative Internship Program. Her passion was further ignited when state and national policies impacted delivery of mental health services to children and their families to which she provided mental health services at the University of Pennsylvania nurse-managed health center. Dr. Outlaw received a Department of Health and Human Services Policy Academy Grant to lead a team of child-serving agencies, community stakeholders, families, and youth to work on transforming mental health care for children and families through planning, policy, and practice. Dr. Outlaw a member of the Robert Wood Johnson Foundation (RWJF) Collaborative National Advisory Committee, whose function is to advise the faculty of the RWJF Nursing and Health Policy Collaborative, University of New Mexico, College of Nursing. She




is a Fellow in the American Academy of Nursing and is an active member of the Psychiatric Mental Health and Substance Abuse Expert Panel.

She has written frequently on the areas of depression, impact of racism, and stress on the health of African Americans; management of aggression; seclusion and restraint; religion, spirituality, and the meaning of prayer for people with cancer; and children’s mental health. She has received recognition for her excellence in clinical practice and for her work to improve the mental health of children and their families.

EILEEN T. O’GRADY, PhD, NP, RN, is a certified Nurse Practitioner and Wellness Coach who uses an evidence-based approach with people to reverse or prevent disease. She believes deeply that more attention must be paid to getting us unstuck from lifestyles that do not support wellness.

She speaks professionally at universities, associations, corporations, schools, and communities on the importance of thoughtful self-care, patient engagement, and how to identify and remedy a life that is out of balance. She is currently adjunct faculty in the Graduate Schools of Nursing at Pace University, Georgetown University, Duke University, and George Washington University, where she was given an Outstanding Teacher Award.

She has held a number of leadership positions with professional nursing associations, most notably as a founder and vice chair of the American College of Nurse Practitioners (now the American Association of Nurse Practitioners). She was a 1999 Policy Fellow in the U.S. Public Health Service Primary Care Policy Fellowship and in 2003 was given the American College of Nurse Practitioners Legislative Advocacy Award for her leadership on nurse practitioner policy issues. She is the 2013 recipient of the Loretta Ford Lifetime Achievement Award and the Virginia Council of Nurse Practitioners Advocate of the Year Award.

She is a co-editor and author of Advanced Practice Nursing: An Integrative Approach, 5th edition (Elsevier, 2013) and has authored numerous articles and book chapters as well as a monthly column on advanced practice nursing and health policy for 10 years in




Nurse Practitioner World News.

She has taught nurses and physicians both nationally and internationally with the U.S. Peace Corps. Dr. O’Grady has practiced as a primary care provider for 15 years and is now certified as a life coach through the International Coaching Federation and as an Adult Nurse Practitioner through the American Nurses Credentialing Center. Dr. O’Grady holds three graduate degrees: a Master of Public Health from George Washington University, a Master of Science in Nursing, and a Doctor of Philosophy in Nursing/Health Policy from George Mason University. She has dual citizenship in Ireland and the United States. www.eileenogrady.net





Greg Abell Principal Sound Options Group, LLC Bainbridge Island, Washington

Charles R. Alexandre PhD, RN Director Quality and Regulation Butler Hospital Providence, Rhode Island

Carmen Alvarez PhD, C-NP, CNM Julio Bellber Post-Doctoral Fellow Department of Health Policy George Washington University Washington, DC

Angela Frederick Amar PhD, RN, FAAN Assistant Dean for BSN Education and Associate Professor Nell Hodgson Woodruff School of Nursing Emory University Atlanta, Georgia

Coral T. Andrews MBA, RN, FACHE Founding Executive Director Hawaii Health Connector Honolulu, Hawaii




Susan Apold PhD, RN, ANP-BC, FAAN, FAANP Robert Wood Johnson Foundation Executive Nurse Fellow Clinical Professor of Nursing New York University New York, New York

Kenya V. Beard EdD, GNP-BC, NP-C, ACNP-BC, CNE

Associate Vice President for Curriculum and Instruction Director Center Multicultural Education and Health Disparities Jersey College Teterboro, New Jersey

Mary L. Behrens MS, FNP-BC, FAANP Family Nurse Practitioner Westside Woman’s Clinic Casper, Wyoming

Susan I. Belanger PhD, MA, RN, NEA-BC Director Education, Training, and Research Sibley Memorial Hospital/Johns Hopkins Medicine Assistant Professor School of Nursing and Health Studies Georgetown University Washington, DC

Katherine N. Bent RN, PhD, CNS Assistant Commissioner, Compliance Policy U.S. Food and Drug Administration Silver Spring, Maryland

Jonathan Bentley BS, RN RN Care Coordinator Harris Regional Hospital Sylva, North Carolina

Carmina Bernardo MA, MPH




Doctor of Public Health Student Health Policy and Management Track Graduate Center City University of New York New York, New York

Virginia Trotter Betts MSN, JD, RN, FAAN President and Chief Executive Officer HealthFutures, Inc. Nashville, Tennessee

Linda Burnes Bolton DrPH, RN, FAAN Vice President, Nursing and Chief Nursing Officer Cedars-Sinai Medical Center Los Angeles, California

Marilyn Waugh Bouldin MSN, RN, PNP Member Board of Directors Heart of the Rockies Regional Medical Center Retired Director Chaffee County Public Health Salida, Colorado

Rebecca (Rice) Bowers-Lanier EdD, MSN, MPH, RN President B2L Consulting Richmond, Virginia

Patricia K. Bradley PhD, RN, FAAN Associate Professor College of Nursing Villanova University Villanova, Pennsylvania

Edie Brous MS, MPH, JD, RN Nurse Attorney

New York, New York




Mary Lou Brunell MSN, RN Executive Director Florida Center for Nursing Co-Lead Florida Action Coalition Orlando, Florida

Kelly Buettner-Schmidt PhD, RN Associate Professor of Nursing North Dakota State University Fargo, North Dakota

Josepha E. Burnley DNP, FNP-C Nurse Consultant Health Resources and Services Administration Rockville, Maryland

Rachel Burton Research Associate Health Policy Center Urban Institute Washington, DC

Ann Campbell MPH, MSN, AGPCNP-BC, RN Primary and Palliative Care Nurse Practitioner

Mary Manning Walsh Home

Integrative Health Nurse Practitioner

The Original Bloom

New York, New York

Demetrius Chapman PhD(c), MPH, MSN(R), APRN, PHCNS-BC Associate Director New Mexico Board of Nursing Albuquerque, New Mexico




Peggy L. Chinn PhD, RN, FAAN Professor Emerita University of Connecticut Editor Advances in Nursing Science Oakland, California

Yoon Jeong Choi MSN, MPhil, RN PhD Candidate School of Nursing Columbia University New York, New York

Glenda Christiaens PhD, RN, AHN-BC Former President American Holistic Nurses Association Salt Lake City, Utah

Mary Ann Christopher MSN, RN, FAAN Consultant Avon, New Jersey

Angela K. Clark MSN, PhD(c), RN Graduate Student College of Nursing University of Cincinnati Cincinnati, Ohio

Sean P. Clarke PhD, RN, FAAN Professor and Associate Dean Undergraduate Programs William F. Connell School of Nursing Boston College Chestnut Hill, Massachusetts

Sally S. Cohen PhD, RN, FAAN IOM/AAN/ANA/ANF Distinguished Nurse Scholar-in-Residence (2014-2015) Virginia P. Crenshaw Endowed Chair




Director Robert Wood Johnson Foundation Nursing and Health Policy Collaborative College of Nursing University of New Mexico Albuquerque, New Mexico

Judith B. Collins RNC, MS, WHNP, FAAN Faculty Emerita Schools of Nursing and Medicine Founding Director Health Policy Office and Women’s Health Center Virginia Commonwealth University Richmond, Virginia

Karen S. Cox PhD, FACHE, RN, FAAN Executive Vice President and Co-Chief Operating Officer Children’s Mercy Kansas City Kansas City, Missouri

Barbara I.H. Damron PhD, RN, FAAN Secretary New Mexico Higher Education Department Santa Fe, New Mexico

Patricia D’Antonio PhD, RN, FAAN Killebrew-Censtis Term Professor in Undergraduate Nursing Education Senior Fellow Leonard Davis Institute of Health Economics School of Nursing University of Pennsylvania

Philadelphia, Pennsylvania

C. Christine Delnat MSN, RN Assistant Professor Department of Nursing St. Mary-of-the-Woods College




Terre Haute, Indiana

Erin M. Denholm MSN, RN, RWJENF SVP Clinical Transformation Centura Health Denver, Colorado

Catherine M. Dentinger FNP, MPH Career Epidemiology Field Officer New York City Department of Health and Mental Hygiene Centers for Disease Control and Prevention New York, New York

Betty R. Dickson BS Retired Contract Lobbyist

Barnardsville, North Carolina

Michele J. Eliason PhD Associate Professor Department of Health Education San Francisco State University San Francisco, California

Jeanette Ives Erickson RN, DNP, FAAN, NEA-BC Chief Nurse and Senior Vice President for Patient Care Massachusetts General Hospital Boston, Massachusetts

Carroll L. Estes PhD Professor of Sociology

Founding Director Institute for Health and Aging University of California, San Francisco San Francisco, California

Robin Dawson Estrada PhD, PNP-BC, RN Assistant Professor




College of Nursing University of South Carolina Columbia, South Carolina

Sandra Evans MAEd, RN Executive Director Idaho Board of Nursing Boise, Idaho

Julie Fairman PhD, RN, FAAN Nightingale Professor in Nursing Director Barbara Bates Center for the Study of the History of Nursing Co-Director Robert Wood Johnson Foundation Future of Nursing Scholars Program School of Nursing University of Pennsylvania Philadelphia, Pennsylvania

Lola M. Fehr MS, CAE, PRP, RN, FAAN President Fehr Consulting Resources Greeley, Colorado

Loretta C. Ford PNP, EdD, RN, FAAN, FAANP Professor and Dean Emerita School of Nursing University of Rochester, New York

Elizabeth B. Froh PhD, RN Clinical Supervisor Lactation Team and Human Milk Management Center Children’s Hospital of Philadelphia Philadelphia, Pennsylvania

Beth Gharrity Gardner MA, PhD(c) PhD Candidate Department of Sociology




University of California, Irvine Irvine, California

Catherine Alicia Georges EdD, RN, FAAN Professor and Chairperson Department of Nursing Lehman College Bronx, New York

Rosemary Gibson MSc Senior Advisor The Hastings Center Garrison, New York

Greer Glazer PhD, RN, CNP, FAAN Dean University of Cincinnati College of Nursing Schmidlapp Professor of Nursing Cincinnati, Ohio

Barbara Glickstein MPH, MS, RN Co-Director Center for Health, Media and Policy Hunter College City University of New York New York, New York

Bethany Hall-Long PhD, RNC, FAAN State Senator State of Delaware 10th District Professor of Nursing University of Delaware Newark, Delaware

Mary Mincer Hansen PhD, RN Adjunct Associate Professor MPH Program and Global Health Department Des Moines University Des Moines, Iowa




Tine Hansen-Turton MGA, JD, FCPP, FAAN Chief Executive Officer National Nursing Centers Consortium Chief Strategy Officer Public Health Management Corporation Philadelphia, Pennsylvania

Charlene Harrington PhD, RN Professor Emeritus of Nursing and Sociology School of Nursing University of California San Francisco, California

Mary Ann Hart MSN, RN Program Director Graduate Program in Health Administration Assistant Professor of Nursing and Health Administration School of Nursing, Science, and Health Professions Regis College Weston, Massachusetts

Heidi Hartmann PhD President Institute for Women’s Policy Research Research Professor George Washington University Washington, DC

Susan B. Hassmiller PhD, RN, FAAN Senior Adviser for Nursing Director Future of Nursing: Campaign for Action Robert Wood Johnson Foundation Princeton, New Jersey

Barbara Hatfield RN Former Delegate West Virginia House Charleston, West Virginia




Pamela J. Haylock PhD, RN, FAAN Oncology Care Consultant Medina, Texas Adjunct Instructor Schreiner University Kerrville, Texas

Margaret Wainwright Henbest MSN, RN Executive Director Nurse Leaders of Idaho Boise, Idaho

Karrie Cummings Hendrickson PhD, MSN, RN Finance Clinical Coordinator Department of Analytic Strategy Yale New Haven Health System New Haven, Connecticut

Linda Hirota Hevenor MPH, MS, RN Director of Patient Safety Department of Quality and Operational Excellence Lifespan Providence, Rhode Island

Sarah Hexem JD Law and Policy Program Manager National Nursing Centers Consortium Philadelphia, Pennsylvania

Anne Hudson RN, C, BSN Founder Work Injured Nurses Group USA Public Health Nurse Coos County Public Health Department Coos Bay, Oregon

Randall Steven Hudspeth PhD, MS, APRN-CNP/CNS, FRE, FAANP Executive Clinical Consultant




Hudspeth LLC Boise, Idaho

Lauren Inouye MPP, RN Associate Director of Government Affairs American Association of Colleges of Nursing Washington, DC

Brenda Isaac RN, BSN, MA, NCSN Lead School Nurse Kanawha County Schools Charleston, West Virginia

"Is this question part of your assignment? We can help"