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POLICY & POLITICS IN NURSING AND HEALTH CARE ISBN: 978-1-4377-1416-6

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Library of Congress Cataloging-in-Publication Data
Policy and politics in nursing and health care / [editors] Diana J. Mason, Judith K. Leavitt, Mary W. Chaffee.
—6th ed.
    p. ; cm.
   Rev. ed. of: Policy & politics in nursing and health care. 5th ed. c2007.
   Includes bibliographical references and index.
   ISBN 978-1-4377-1416-6 (pbk.)
1. Nurses—Political activity—United States. 2. Nursing—Political aspects—United States. 3. Medical
policy—United States. 4. Medical care—Political aspects—United States. I. Mason, Diana J., 1948-
II. Leavitt, Judith K. (Judith Kline) III. Chaffee, Mary W. IV. Policy & 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.P58 2012
362.17´3—dc22
2011006309
Editor: Maureen Iannuzzi
Associate Developmental Editor: Julia Curcio
Publishing Services Manager: Jeff Patterson
Senior Project Manager: Clay S. Broeker
Working together to grow
Designer: Paula Catalano libraries in developing countries
www.elsevier.com | www.bookaid.org | www.sabre.org
Printed in the United States of America
Last digit is the print number: 9 8 7 6 5 4 3 2
About the Editors

Diana J. Mason, RN, PhD, FAAN, is the Rudin Profes- of Nursing, the New York Academy of Medicine, and
sor of Nursing at the Hunter College-Bellevue School the West Virginia University Academy of Distin-
of Nursing of the City University of New York, where guished Alumni; and the Pioneering Spirit Award
she directs the Hunter College Center for Health, from the American Association of Critical Care
Media, & Policy. For over 10 years, she served as Nurses. She is a graduate of West Virginia University
Editor-in-Chief of the American Journal of Nursing, School of Nursing (BSN, 1970), St. Louis University
and she continues in an emeritus capacity. Under her (MSN, 1977), and New York University (PhD, 1987).
leadership, the journal received numerous awards for
editorial excellence and dissemination, culminating in Judith K. Leavitt, RN, MEd, FAAN, is a health policy
the journal being selected by the Specialized Libraries consultant. She retired as Associate Professor from the
Association in 2009 as one of the 100 most influential University of Mississippi Medical Center, School of
journals of the century in biology and medicine— Nursing in 2005. She was formerly Executive Director
the only nursing journal to be selected for this of Generations United, a national organization dedi-
distinction. cated to intergenerational policies and programs. She
In 2009, she was appointed to the National Advi- served on the National Advisory Council on Educa-
sory Committee for Kaiser Health News. Since 1986, tion and Practice for the Division of Nursing, U.S.
she has been one of the producers and moderators of Department of Health and Human Services. Ms.
“Healthstyles,” an award-winning, live radio program Leavitt was selected by President Clinton to serve on
in New York City. She was project director for the the Health Professional Advisory Group to the White
WBAI-Global Kids’ Sound Partners for Community House Task Force on Health Care Reform. She served
Health Initiative (funded by the Benton and Robert as the upstate coordinator for Geraldine Ferraro’s
Wood Johnson Foundations) to train New York City 1992 New York campaign for the United States Senate
youth in producing radio programs on preventing and was chairperson of the American Nurses Associa-
teen substance abuse. tion Political Action Committee. She was chair of the
As a researcher, she published a series of studies on New York State Nurses for Political Action and was
managed care arrangements with nurse practitioners. instrumental in the founding of the New York State
From 2006 to 2010, she served as Secretary for the Nurses Association’s Political Action Committee.
American Academy of Nursing, and she continues to Ms. Leavitt is a noted speaker and author of exten-
chair its “Raise The Voice” campaign, an initiative sive writings on policy and politics. Her many awards
funded in part by the Robert Wood Johnson Founda- include the University of Mississippi Medical Center
tion and the Independence Foundation for identify- Nelson Award for Teaching Excellence, the Chancel-
ing and making visible to policymakers and journalists lor’s Award for Teaching Excellence from the State of
the innovative models of care developed by nurses New York, the Health Policy Award from the Division
and the public and private policies that are needed to of Nursing at New York University, the Legislative
sustain and support them. Award from the New York State Nurses Association,
Dr. Mason is the recipient of numerous awards and the Mississippi Nurses Association Nurse of the
and honors, including an Honorary Doctorate of Year, and she is a Fellow of the American Academy of
Humane Letters from Long Island University; an Nursing. Ms. Leavitt earned her BSN from the Uni-
Honorary Doctorate of Science from West Virginia versity of Pennsylvania and her MEd from Teacher’s
University; fellowship in the American Academy College, Columbia University.
iii
iv ABOUT THE EDITORS

Mary W. Chaffee, RN, PhD, FAAN, served in the U.S. was awarded an honorary doctor of science degree
Navy Nurse Corps for 25 years. In her final assign- by the University of Massachusetts at Amherst in
ment on active duty, she was the Disaster Research 2003. Her contributions to Navy Medicine and the
Coordinator in the Disaster Information Manage- Department of Defense have been recognized with
ment Research Center, National Library of Medicine, multiple individual awards including the Legion of
National Institutes of Health in Bethesda, Maryland. Merit. Dr. Chaffee led a Navy Medicine project to
Previously, she served as Director of the Navy Medi- improve hospital preparedness that was recognized as
cine Office of Homeland Security, Bureau of Medi- a finalist in the Harvard University/Kennedy School
cine and Surgery, in Washington, DC and as a Senior of Government “Innovations in American Govern-
Health Policy Analyst in support of the Office of the ment” awards program in homeland security in 2004.
Assistant Secretary of Defense for Health Affairs. Fol- She is a Distinguished Alumna of the University of
lowing the events of September 11, 2001, she served Massachusetts at Amherst and received the Excellence
on temporary assignment in the Federal Emergency in Caring Practices award from the American Associa-
Management Agency’s Emergency Operations Center tion of Critical-Care Nurses. Dr. Chaffee is an honors
in Washington, DC. graduate of the University of Massachusetts at
Dr. Chaffee served as Vice President of the Federal Amherst where she received bachelor’s degrees in
Nurses Association, was elected to the American nursing and public health and completed an intern-
Nurses Association Congress on Nursing Practice and ship at the Welsh National School of Medicine in
Economics, and was an intern in the Office of Senator Cardiff, Wales. She received her doctorate and
Daniel K. Inouye. She was the founding managing master’s degrees in nursing health policy and nurs­
editor of the journal Policy, Politics & Nursing Practice. ing administration from the University of Maryland
A Fellow of the American Academy of Nursing, she at Baltimore.
Contributors

Charles Alexandre, MS, RN Bobbie Berkowitz, PhD, RN, FAAN

Doctoral Candidate Dean
College of Nursing and Health Sciences Columbia University School of Nursing
University of Massachusetts Boston New York, New York
Boston, Massachusetts
Sandra Bishop-Josef, PhD
Chief, Health Professions Regulation
Assistant Director and Associate Research
Division of Environmental & Health Services
Scientist
Regulation
Edward Zigler Center in Child Development &
Rhode Island Department of Health
Social Policy, Child Study Center
Providence, Rhode Island
School of Medicine
Norma Alicea-Alvarez, DNP, CRNP Yale University
Pediatric Nurse Practitioner New Haven, Connecticut
Pediatric Associates, Private Practice
Linda Burnes Bolton, DrPH, RN, FAAN
New Castle, Pennsylvania
Associate Clinical Professor
Susan Apold, PhD, RN, ANP-BC University of California San Francisco
Dean and Professor San Francisco, California
Division of Nursing Vice President, Nursing
Concordia College of New York Cedars-Sinai Medical Center
Bronxville, New York Los Angeles, California
Associate Clinical Professor
Jane H. Barnsteiner, PhD, RN, FAAN
University of California Los Angeles
Professor of Pediatric Nursing
Los Angeles, California
School of Nursing
University of Pennsylvania Rebecca (Rice) Bowers-Lanier, EdD, MS, MPH
Philadelphia, Pennsylvania Legislative Consultant
Macaulay & Burtch, PC
Mary L. Behrens, RN. MSN. FNP-BC
Richmond, Virginia
Family Nurse Practitioner,
Westside Woman’s Clinic Patricia K. Bradley, PhD, RN
Casper, Wyoming Associate Professor
College of Nursing
Katherine N. Bent, RN, PhD, CNS
Villanova University
Chief
Villanova, Pennsylvania
Healthcare Delivery and Methodologies Integrated
Review Group Charlotte Brody, RN
National Institutes of Health National Field Director
Bethesda, Maryland Safer Chemicals, Healthy Families
Esmont, Virginia
Jonathan Bentley, BS, RN
Governing Board Member Edie Brous, RN, BSN, MS, MPH, JD
The Canary Coalition Nurse Attorney
Sylva, North Carolina New York, New York
v
vi CONTRIBUTORS

Mary Lou Brunell, RN, MSN Brenda Cleary, PhD, RN, FAAN
Executive Director Director
Florida Center for Nursing Center to Champion Nursing in America
Orlando, Florida Washington, DC
Kelly Buettner-Schmidt, RN, BSN, MS Elaine Cohen, EdD, RN, FAAN
Department of Nursing Chair Associate Chief, Nursing Quality Improvement
Minot State University The James A. Haley Veteran’s Hospital
Minot, North Dakota Tampa, Florida
Laura Caramanica, RN, PhD Sally S. Cohen, PhD, RN, FAAN
Westchester Medical Center Associate Professor and Director
Executive Director Robert Wood Johnson Foundation
Nursing Institute of Excellence Nursing and Health Policy Collaborative
Vahalla, New York University of New Mexico
Albuquerque, New Mexico
John T. Carlsen, PhD
Director Judith B. Collins, RN, MS, WHNP-BC, FAAN
The Professional Development Institute Associate Professor Emeritus,
Chicago, Illinois School of Nursing and Medicine
Virginia Commonwealth University
Cynthia Caroselli, RN, PhD
Medical College of Virginia
Associate HealthCare System Director for Patient
Richmond, Virginia
Services & Chief Nurse Executive
VA New York Harbor HealthCare System Johnnie Sue Cooper, RN, PhD, BC-FNP
New York, New York Nursing Instructor
Graduate Nursing Department
Christine Ceccarelli, RN, MBA
Mississippi University for Women
Adjunct Faculty Member
Columbus, Mississippi
Division of Nursing
Elms College Leah L. Curtin, RN, ScD(h), FAAN
Chicopee, Massachusetts Clinical Professor
Nursing
Pamela F. Cipriano, PhD, RN, NEA-BC, FAAN
University of Cincinnati
University of Virginia Health System
Cincinnati, Ohio
Charlottesville, Virginia
Executive Editor
Editor-in-Chief
American Nurse Today
American Nurse Today
Healthcom Media
HealthcomMedia
Doylestown, Pennsylvania
Doylestown, Pennsylvania
Jessie Daniels, MA, PhD
Dame June Clark, DBE, PhD, RN, FRCN
Associate Professor
Professor
School of Public Health
Swansea University
Hunter College
Swansea, Wales
City University of New York
United Kingdom
New York, New York
Sean P. Clarke, RN, PhD, FAAN
Catherine R. Davis, PhD, RN
RBC Chair in Cardiovascular Nursing Research
Director
Lawrence S. Bloomberg Faculty of Nursing
Global Research and Test Administration
University of Toronto
CGFNS International, Inc.
Toronto, Ontario
Philadelphia, Pennsylvania
Canada
 CONTRIBUTORS vii

Marie Davis-Williams, MSSW, LCSW Nancy L. Falk, RN, PhD, MBA

Assistant Commissioner, Recovery Services Assistant Professor
and Planning School of Nursing
Mental Health and Developmental Disabilities The George Washington University
Nashville, Tennessee Washington, DC
Betty R. Dickson Stephanie L. Ferguson, PhD, RN, FAAN
Lobbyist Consulting Associate Professor
Barnardsville, North Carolina Stanford University
Amherst, Virginia
Joanne Disch, PhD, RN, FAAN
Clinical Professor and Director Loretta C. Ford, EdD, RN, PNP, FAAN, FAANP
School of Nursing Professor and Dean Emeritus
University of Minnesota School of Nursing
Minneapolis, Minnesota University of Rochester
Rochester, New York
Catherine Dodd, RN, PhD
Director of Nursing
Director
Strong Memorial Hospital, University of Rochester
San Francisco Health Service System
Medical Center
City and County of San Francisco, California
Rochester, New York
Karen Drenkard, PhD, RN, NEA-BC, FAAN
Rebecca Fox
Executive Director
Executive Director
American Nurses Credentialing Center
National Coalition for LGBT Health
Fairfax, Virginia
Washington, DC
Amanda L. Ebner, MA, MEd
Deborah B. Gardner, PhD, RN
PhD Candidate
Senior Advisor
University of California, Irvine
Bureau of Health Professions
Los Angeles, California
Health Resources and Services Administration
Holly Edwards, RN, MEd Rockville, Maryland
Registered Nurse
Carole Gassert, RN, PhD, FACMI, FAAN
Health Services
Associate Professor Emeritus (Retired)
Jefferson Board for Aging
College of Nursing
Charlottesville, Virginia
University of Utah
Carroll L. Estes, PhD, FAAN Salt Lake City, Utah
Professor & Founding Director,
Kristine M. Gebbie, DrPH, RN
Institute for Health & Aging University
Joan Hansen Grabe Dean
San Francisco, California
Hunter-Bellevue School of Nursing
William M. Enlow, DNP, CRNA Hunter College
Assistant Professor of Clinical Nursing City University of New York
Program in Nursing Anesthesia New York, New York
School of Nursing
Greer Glazer, RN, PhD, CNP, FAAN
Columbia University
Dean and Professor
New York, New York
University of Massachusetts Boston
College of Nursing and Health Sciences
Boston, Massachusetts
viii CONTRIBUTORS

Barbara Glickstein, RN, MSN, MPH Susan Hassmiller, PhD, RN, FAAN
New York, New York Senior Advisor for Nursing
Director
Irma Goertzen, RN, MSN
RWJF Initiative on the Future of Nursing
Retired CEO and President
at the IOM
Magee Womens Hospital and Research Institute
Robert Wood Johnson Foundation
Pittsburgh, Pennsylvania
Princeton, New Jersey
Board Chair
Society of Women’s Health Research Barbara B. Hatfield, RN
Washington, DC Delegate
West Virginia House of Delegates
Bethany Hall-Long, PhD, RNC, FAAN
Charleston, West Virginia
State Senator
State of Delaware Donna L. Haugland, MSN, CNP
Professor Chief Nursing Officer
University of Delaware and State of Delaware MinuteClinic
Newark, Delaware St. Paul, Minnesota
David Haltiwanger, PhD Pamela J. Haylock
Director of Clinical Programs and Public Policy Medina, Texas
Chase Brexton Health Services
Susan D. Hellier, DNP, CRNP
Baltimore, Maryland
Women’s Health Nurse Practitioner
Tine Hansen-Turton, MGA, JD Lawrence County OB/GYN Associates
Executive Director New Castle, Pennsylvania
National Nursing Centers Consortium
Karrie Cummings Hendrickson, PhD, RN
Philadelphia, Pennsylvania
Postdoctoral Fellow
Alfreda Harper-Harrison, EdD, MSN, RN, CLNC Yale University School of Nursing
Assistant Professor New Haven, Connecticut
Winston Salem State University
Catherine Hoffman, ScD, RN
Winston-Salem, North Carolina
Senior Researcher, Associate Director
Charlene Harrington, PhD, RN, FAAN Kaiser Commission on Medicaid and the Uninsured
Professor Emeritus Washington, DC
Social and Behavioral Sciences
Anne Hudson, RN, BSN
University of California
Public Health Nurse
Oakland, California
Coos County Public Health Department
Wylecia Wiggs Harris, MM, CAE North Bend, Oregon
Doctoral Student Founder
Capella University Work Injured Nurses’ Group USA (WING USA)
Minneapolis, Minnesota Coos Bay, Oregon
Executive Director
Patricia J. Hughes, EdD, MBA, CRNP
Center for American Nurses
Campus Dean
Silver Spring, Maryland
Chamberlain College of Nursing
Mary Ann Hart, SN, RN, NP-C Arlington, Virginia
Assistant Clinical Professor of Nursing
Brenda C. Isaac, RN, BSN, MA, NCSN
Regis College
Lead School Nurse
Weston, Massachusetts
School Health Services
Kanawha County Schools
Charleston, West Virginia
 CONTRIBUTORS ix

Jean E. Johnson, RN-C, PhD, FAAN Elena Lopez-Bowlan, RN, MSN, APN
Senior Associate Dean, Family Nurse Practitioner
Health Sciences Reno, Nevada
The George Washington University
Robert J. Lucero, PhD, MPH, RN
School of Medicine and Health Sciences
Post-Doctoral Research Fellow
Washington, DC
School of Nursing
Pamela J. Johnson, RN, BSN Center for Evidence-Based Practice in
Clinical Team Leader the Underserved
Advocate Health Care Columbia University
Oakbrook, Illinois New York, New York
Louise Kahn, MSN, MA, PNP John Lumpkin, MD, MPH, FACEP, FACMI
Clinical Educator Senior Vice President
College of Nursing Director Health Care Group
University of New Mexico Robert Wood Johnson Foundation
Albuquerque, New Mexico Princeton, New Jersey
David M. Keepnews, PhD, JD, RN, FAAN Beverly L. Malone, PhD, RN, FAAN
Associate Professor Chief Executive Officer
Hunter-Bellevue School of Nursing National League for Nursing
Hunter College New York, New York
City University of New York
Ruth E. Malone, RN, PhD, FAAN
New York, New York
Professor and Director
Mary Jo Kreitzer, PhD, RN, FAAN Doctoral Specialty in Health Policy
Professor San Francisco School of Nursing
School of Nursing University of California
Director San Francisco, California
Center for Spirituality & Healing
Tracy A. Malone, RN, MSN
University of Minnesota
Executive Director
Minneapolis, Minnesota
US Family Health Plan Alliance, LLC
Phyllis Beck Kritek, RN, PhD, FAAN Arlington, Virginia
Professor, Tenured
Jeannee Parker Martin, RN, MPH
School of Nursing
Associate Clinical Professor
Director
School of Nursing
Center for Spirituality & Healing
University of California San Francisco
University of Minnesota
President/Owner
Minneapolis, Minnesota
The Corridor Group Inc.
Ellen T. Kurtzman, MPH, RN, FAAN San Francisco, California
Assistant Research Professor
Mary Lynn Mathre, RN, MSN, CARN, CLNC
Department of Nursing Education
Legal Nurse Consultant
Washington, DC
Howardsville, Virginia
Sandra B. Lewenson, EdD, RN, FAAN President
Professor Patients Out of Time
Lienhard School of Nursing Howardsville, Virginia
Pace University
Pleasantville, New York
x CONTRIBUTORS

Margaret L. McClure, EdD, RN, FAAN Vanessa D. Newsome, MSEd

Professor Program Coordinator
New York University Will County Health Department
New York, New York Dolton, Illinois
Janice M. McCoy, MSN, MSHSA, RN, CNAA, BC Barbara L. Nichols, DHL, MS, RN, FAAN
Former Chief Nursing Officer Chief Executive Officer
Cape Canaveral Hospital CGFNS International
Cocoa Beach, Florida Philadelphia, Pennsylvania
Ruth Merkatz, PhD, RN, FAAN Karen O’Connor, JD, PhD
Director, Clinical Development, Reproductive Jonathan N. Helfat Distinguished Professor of
Health Political Science
Center for Biomedical Research American University
Population Council Washington, DC
New York, New York
Eileen T. O’Grady PhD, RN, NP
DeAnne K. Hilfinger Messias, PhD, RN, FAAN Lienhard School of Nursing
Associate Professor Pace University
College of Nursing and Women’s and New York, New York
Gender Studies Policy Editor
University of South Carolina American Journal for Nurse Practitioners and
Columbia, South Carolina NP World News
Cranbury, New Jersey
Alfredo Mireles, RN, BSN
Staff Nurse, Psychiatry Doug Olsen, PhD, RN
San Francisco General Hospital Washington, DC
San Francisco, California
Judith A. Oulton, RN, BN, MEd, DSc(hon)
Jessie Marvin Unruh Assembly Fellow
Partner
Office of Assembly Member Anthony Portantino
Oulton, Oulton & Associates
California State Assembly
Geneva, Switzerland
Sacramento, California
Freida Hopkins Outlaw, PhD, RN, FAAN
Alan Morgan, MPA
Five Regional Mental Health Institutions
Chief Executive Officer
State Hospitals
National Rural Health Association
Knoxville, Bolivar, Nashville, Memphis, and
Washington, DC
Chattanooga, Tennessee
John S. Murray, PhD, RN, CPNP, CS, FAAN Assistant Commissioner
Colonel, Air Force Nurse Corps (Retired) Division of Special Populations
Director, Nurse Scientist Tennessee Department of Mental Health and
Children’s Hospital Developmental Disabilities
Boston, Massachusetts Nashville, Tennessee
Mary V. Muse, MSN, RN Elizabeth Parry, MPP
Correctional Health Care Consultant Alexandria, Virginia
Chicago, Illinois
 CONTRIBUTORS xi

Patricia Reid Ponte, RN, DNSc, FAAN, NEA-BC Donna R. Richardson, JD, RN
Adjunct Assistant Professor Director of Governmental Affairs and Professional
School of Nursing Standards
University of Massachusetts, Amherst CGFNS International
Amherst, Massachusetts Philadelphia, Pennsylvania
Associate Professor
Nancy Ridenour, PhD, APRN, BC, FAAN
College of Nursing and Health Sciences
Dean and Professor
University of Massachusetts, Boston
University of New Mexico College of Nursing
Boston, Massachusetts
Albuquerque, New Mexico
Senior Vice President for Patient Care Services,
Chief Nurse Ann Ritter, JD
Nursing and Patient Care Services Director, Health Center Development & Policy
Dana-Farber Cancer Institute National Nursing Centers Consortium
Boston, Massachusetts Philadelphia, Pennsylvania
Director of Oncology Nursing and Clinical
Karen M. Robinson DNS, CNS, PMH-BC, FAAN
Services
Professor
Nursing and Patient Care Services
School of Nursing
Brigham and Women’s Hospital
University of Louisville
Boston, Massachusetts
Louisville, Kentucky
Lynn Price, JD, MSN, MPH
Angela Ross, EdM
Associate Professor
Assistant Director, Workforce Programs
Quinnipiac University
Florida Center for Nursing
New Haven, Connecticut
Orlando, Florida
Chad Priest, RN, JD
Gail E. Russell, EdD, RN, NEA-BC
Chief Executive Officer
Professor and Graduate Program Director
Managed Emergency Surge for Healthcare
College of Nursing
Indianapolis, Indiana
University of Massachusetts Dartmouth
Joyce A. Pulcini, PhD, RN, PNP-BC, FAAN North Dartmouth, Massachusetts
Associate Professor
Yvonne Santa Anna, BSN, RN, MSG
William F. Connell School of Nursing
Vice President, Congressional Relations
Boston College
Fresenius Medical Care North America
Chestnut Hill, Massachusetts
Rockville, Maryland
Frank Purcell, BS
Alice Sardell, PhD
Senior Director
Professor
Federal Government Affairs
Queens College
American Association of Nurse Anesthetists
City University of New York
Washington, DC
Flushing, New York
Joanne Rains Warner, DNS, RN
Rose Sherman, EdD, RN, NEA-BC
Dean and Professor
Director Nursing Leadership Institute & Associate
University of Portland
Professor
Portland, Oregon
Florida Atlantic University
Susan C. Reinhard, RN, PhD, FAAN Boca Raton, Florida
Public Policy Institute
AARP
Washington, DC
xii CONTRIBUTORS

Dennis Sherrod, EdD, RN Susan McDonough Stackpoole, MSN, RN

Professor and Forsyth Medical Center Endowed Former Director Nursing Operations
Chair of Recruitment & Retention Cape Canaveral Hospital
Winston-Salem State University Cocoa Beach, Florida
Winston-Salem, North Carolina
Patricia W. Stone, PhD, FAAN
President
Director of the Center for Health Policy
Center for American Nurses
Professor
Silver Springs, Maryland
School of Nursing
Judith Shindul-Rothschild, PhD, RNPC, DPNAP Columbia University
Associate Professor New York, New York
Nursing
Suzanne Stone, JD
William F. Connell School of Nursing
Vice President
Boston College
Finance and Administration
Chestnut Hill, Massachusetts
National Abortion Federation
Past President
Washington, DC
Massachusetts Nurses Association
Canton, Massachusetts Elyse I. Summers, JD
Director
Linda J. Shinn, MBA, RN, CAE
Division of Education and Development
Principal
Office for Human Research Protections
Consensus Management Group
United States Department of Health and
Indianapolis, Indiana
Human Services
James Mark Simmerman, PhD, RN Rockville, Maryland
Epidemiologist
Elaine Tagliareni, EdD, RN, CNE, FAAN
Bangkok, Thailand
Chief Program Officer
Arlene M. Smaldone, DNSc, RN National League for Nursing
Assistant Professor New York, New York
School of Nursing
Pamela Thompson, MS, RN, FAAN
Columbia University
Chief Executive Officer
New York, New York
American Organization of Nurse Executives
Diane L. Spatz, PhD, RN-BC, FAAN Washington, DC
Helen M. Shearer Associate Professor of Nutrition &
Patricia E. Tobal
Associate Professor of Healthcare of Women and
Hopwood, Pennsylvania
Childbearing Nursing
University of Pennsylvania Corazon Tomalinas, RN, BSN, PHN
Philadelphia, Pennsylvania Santa Teresa Hospital (Former)
Kaiser Permanente
Joanne Spetz, PhD
San Jose, California
Professor
Commissioner
Community Health Systems
FIRST 5
Senior Research Faculty
Santa Clara County, California
Center for the Health Professions
University of California San Francisco
San Francisco, California
 CONTRIBUTORS xiii

Virginia Trotter Betts, MSN, JD, RN, FAAN Jon L. Weakley

Commissioner American University
Tennessee Department of Mental Health and Washington, DC
Developmental Disabilities
Scott Weber, EdD, PhD-c, MSN, RN
Nashville, Tennessee
Assistant Professor
Lauren A. Underwood, MSN, MPH, RN University of Pittsburgh School of Nursing
Johns Hopkins University Pittsburgh, Pennsylvania
Baltimore, Maryland
Ellen-Marie Whelan, RN, NP, PhD
Lynn Unruh, PhD, RN, LHRM Senior Health Policy Analyst and Associate Director
Associate Professor, of Health Policy
University of Central Florida Center for American Progress
Orlando, Florida Washington, DC
Connie Vance, RN, EdD, FAAN Kathleen M. White, PhD, RN, NEA-BC, FAAN
Professor, Director, Doctor of Nursing Practice Program
College of New Rochelle, New York Johns Hopkins University School of Nursing
New Rochelle, New York Baltimore, Maryland
Antonia M. Villaruel, PhD, FAAN Eva Williams, MA, CPG
Associate Dean for Research and Scholarship Staff Research Analyst II
University of Michigan Institute for Health & Aging
Ann Arbor, Michigan University of California
San Francisco, California
Catherine M. Waters, RN, PhD
Professor Michael P. Woody
Department of Community Health Systems Partner
San Francisco School of Nursing East End Group
University of California Washington, DC
San Francisco, California
Lynda Woolbert, MSN, RN, PNP
Health Commissioner
Executive Director
San Francisco Department of Public Health
Coalition for Nurses in Advanced Practice
City & County of San Francisco Department of
West Columbia, Texas
Public Health
San Francisco, California
This page intentionally left blank
Reviewers

Michael D. Aldridge, MSN, RN, CCRN, CNS Margaret Dean, RN, CS-BC, GNP-BC, MSN, APN
Concordia University Texas Associate Faculty
Austin, Texas Nursing and Medical School
Texas Tech University Health Sciences Center
Margaret E. Barnes, RN, MSN
Amarillo, Texas
Indiana Wesleyan University, School of Nursing
Marion, Indiana Deborah Dumphy, APRN, BSN, MS, IBCLC,
RLC, NP-C
Deborah Becker, PhD, ACNP, BC, CCNS Family Nurse Practitioner and International Board
School of Nursing Certified Lactation Consultant
University of Pennsylvania Dawson Pediatrics
Philadelphia, Pennsylvania Dawsonville, Georgia
Marylee Bressie, MSN, RN, CCRN, CCNS, CEN Assistant Professor of Nursing
Providence Hospital North Georgia College & State University
Mobile, Alabama Dahlonega, Georgia
Samford University Maurice Espinoza, RN, CNS, RN, BSN, MSN,
Birmingham, Alabama WCC, CCRN
Barbara Camune, RNC, CNM, WHNP-BC, University of California Irvine Medical Center
DrPH, FACNM Orange, California
Clinical Associate Professor Coordinator Barbara L. Ferguson, RN, MSN, MHA, MBA
Director University of North Carolina Charlotte
Nurse-Midwifery & Women’s Health Nurse Charlotte, North Carolina
Practitioner Programs
Department of Women, Children & Family Health Cris Finn, PhD, RN, FNP, MS, MA, FNE
Science Assistant Professor
College of Nursing Loretto Heights School of Nursing
University of Illinois at Chicago Regis University
Chicago, Illinois Denver, Colorado

Karen Clark, PhD, MSN, BSN, RN, CCRN Joyce Foresman-Capuzzi, BSN, RN,CEN, CTRN,
University of Maryland School of Nursing CCRN, CPN, CPEN, SANE-A, EMT-P
Rockville, Maryland Lankenau Hospital
Wynnewood, Pennsylvania
Rose E. Constantino, PhD, JD, RN, FAAN, FACFE
Mary Anne Hanley, RN, PhD
Department of Health and Community Systems
Perry School of Nursing
School of Nursing
Texas Tech University Health Sciences Center
University of Pittsburgh
Lubbock, Texas
Pittsburgh, Pennsylvania
xv
xvi REVIEWERS

Joellen W. Hawkins, RN, PhD, WHNP-BC, Jacqueline R. Meyer, RN, MSN

FAAN, FAANP Associate Professor
Professor Emerita Assistant Dean
William F. Connell School of Nursing Graduate Program
Boston College School of Nursing
Chestnut Hill, Massachusetts Allen College
Nursing Department Waterloo, Iowa
Writer in Residence Simmons College
Chad Rittle, DNP, MPH, BSN, RN
Boston, Massachusetts
Adjunct Faculty
Leslie C. Hussey, PhD, RN Waynesburg, University
Associate Director of Doctoral Education Waynesburg, Pennsylvania
Wolford College
Mitchell J. Seal, EdD, Med-IT, BSN, RN-BC
Naples, Florida
Head
Karen Kelly, EdD, RN, NEA-BC Ancillary Services Department
Associate Professor and Coordinator Medical Education & Training Campus
Continuing Education Fort Sam Houston, Texas
School of Nursing Adjunct Faculty
Southern Illinois University Edwardsville Health Careers & Nursing Department
Edwardsville, Illinois Cerro Coso College
Ridgecrest, California
Linda U. Krebs, RN, PhD, AOCN, FAAN
College of Nursing Nashat Zuraikat, PhD, RN
University of Colorado Denver Indiana University of Pennsylvania
Aurora, Colorado Indiana, Pennsylvania
Jean Logan, RN, PhD
Professor of Nursing
Grand View University
Des Moines, Iowa
 To the contributors to this book
and
all nurses who influence the health of the public
through policy and politics.
This page intentionally left blank
Contents

UNIT 1 Introduction to Policy and Politics in Nursing and Health Care

1 A Framework for Action in Policy and Politics, 1

Mary W. Chaffee, Diana J. Mason, and Judith K. Leavitt
2 A Historical Perspective on Policy, Politics, and Nursing, 12
Sandra B. Lewenson
3 Learning the Ropes of Policy, Politics, and Advocacy, 19
Judith K. Leavitt, Mary W. Chaffee, and Connie Vance
4 TAKING ACTION How I Learned the Ropes of Policy and Politics, 29
Alfredo Mireles
5 Advocacy in Nursing and Health Care, 31
Chad Priest
6 A Primer on Political Philosophy, 39
Sally S. Cohen
7 The Policy Process, 49
Bobbie Berkowitz
Policy Issue Paper Example: Federal Funding of Nursing Education, 58
Nancy L. Falk
8 Political Analysis and Strategies, 65
Judith K. Leavitt, Diana J. Mason, and Ellen-Marie Whelan
9 Health Policy, Politics, and Professional Ethics, 77
Leah L. Curtin
10 Using the Power of Media to Influence Health Policy and Politics, 88
Jessie Daniels, Barbara Glickstein, and Diana J. Mason
11 Communication Skills for Success in Policy and Politics, 105
Mary W. Chaffee
12 Conflict Management in Health Care: The Tipping Point Arrives, 114
Phyllis Beck Kritek

UNIT 2 Health Care Delivery and Financing

13 The United States Health Care System, 122

Gail E. Russell
xix
xx CONTENTS

14 Financing Health Care in the United States, 135

Joyce A. Pulcini and Mary Ann Hart
15 Could a National Health System Work in the United States?, 147
Kristine M. Gebbie
16 A Primer on Health Economics, 153
Lynn Unruh and Joanne Spetz
17 Reforming Medicare, 162
Susan C. Reinhard
18 Children’s Health Insurance Coverage: Medicaid and the State Children’s Health
Insurance Program, 169
Kathleen M. White
19 The United States Military Health System: Policy Challenges in Wartime and Peacetime, 176
John S. Murray and Mary W. Chaffee
20 The Veterans Administration Health System: An Overview of Major Policy Issues, 182
Cynthia Caroselli
21 The Uninsured and Underinsured—On the Cusp of Health Reform, 187
Catherine Hoffman
22 Policy Approaches to Address Health Disparities, 198
Lauren A. Underwood and Antonia M. Villarruel
23 The Rural Health Care Tundra, 202
Alan Morgan
24 Long-Term Care Policy Issues, 206
Charlene Harrington
25 Home Care and Hospice: Evolving Policy, 214
Jeannee Parker Martin
26 Achieving Mental Health Parity, 220
Freida Hopkins Outlaw, Patricia K. Bradley, and Marie Davis-Williams
27 Integrative Health: Pathway to Health Reform and a Healthier Nation, 225
Mary Jo Kreitzer
28 Nursing’s Influence on Drug Development and Safety, 231
Ruth Merkatz and Elyse I. Summers
29 Chronic Care Policy: Medical Homes and Primary Care, 240
Susan Apold
30 Family Caregiving and Social Policy, 247
Karen M. Robinson and Susan C. Reinhard
31 Retail Health Care Clinics: Filling a Gap in the Health Care System, 252
Donna L. Haugland and Patricia J. Hughes
32 Nurse-Managed Health Centers, 260
Tine Hansen-Turton and Ann Ritter
 CONTENTS xxi

33 Community Health Centers: Successful Advocacy for Expanding Health Care Access, 266
Alice Sardell
34 TAKING ACTION Setting Health Care in Its Social Context, 273
Interview with Ruth Watson Lubic by Diana J. Mason
35 TAKING ACTION Reimbursement Issues for Nurse Anesthetists: A Continuing Challenge, 279
Frank Purcell
36 The Role of Foundations in Improving Health Care, 286
Susan Hassmiller and John Lumpkin
37 Social Security: Key to Economic Security, 292
Carroll L. Estes, Catherine Dodd, and Eva Williams
38 The United Kingdom’s Health System: Myths and Realities, 300
Dame June Clark

UNIT 3 Policy and Politics in Research and Nursing Science

39 Science, Policy, and Politics, 307

Mary W. Chaffee
40 Research as a Political and Policy Tool, 316
Lynn Price
41 Health Services Research: Translating Research into Policy, 322
Patricia W. Stone, Arlene M. Smaldone, William M. Enlow, and Robert J. Lucero
42 Politics and Evidence-Based Practice and Policy, 329
Sean P. Clarke
43 The Society for Women’s Health Research: Using Evidence-Based Policy to Improve Health, 336
Irma Goertzen and Suzanne Stone
44 Using Research to Advance Healthy Social Policies for Children, 340
Sally S. Cohen, Sandra Bishop-Josef, and Louise Kahn
45 TAKING ACTION Reefer Madness: The Clash of Science, Politics, and Medical Marijuana, 345
Mary Lynn Mathre
46 TAKING ACTION The Journey into the Hallowed Halls of Politics: How Nurse Practitioners Changed
Pennsylvania Policy, 354
Norma Alicea-Alvarez and Susan D. Hellier

UNIT 4 Policy and Politics in the Workplace and Workforce

47 Policy and Politics in the Contemporary Work Environment, 358

Pamela Thompson, Laura Caramanica, Elaine Cohen, Patricia Reid Ponte, and Rose Sherman
48 Quality and Safety in Health Care: Policy Issues, 366
Ellen T. Kurtzman and Jean E. Johnson
xxii CONTENTS

49 The Nursing Workforce, 375

Mary Lou Brunell and Angela Ross
50 Nursing Education Policy: The Unending Debate over Entry into Practice and the New Debate over
Doctoral Degrees, 383
Elaine Tagliareni and Beverly L. Malone
51 The Politics of Advanced Practice Nursing, 393
Eileen T. O’Grady and Loretta C. Ford
52 Global Nurse Migration, 401
Barbara L. Nichols, Catherine R. Davis, and Donna R. Richardson
53 Nurse Staffing Ratios: Policy Options, 409
Joanne Spetz
54 TAKING ACTION Aligning Care at the Bedside with the C-Suite, 417
Linda Burnes Bolton and Margaret L. McClure
55 TAKING ACTION When a Hurricane Strikes: The Challenge of Crafting Workplace Policy, 422
Janice M. McCoy and Susan McDonough Stackpoole
56 Workplace Abuse in Nursing: Policy Strategies, 428
Jane H. Barnsteiner
57 TAKING ACTION Advocating for Nurses Injured in the Workplace, 435
Anne Hudson
58 TAKING ACTION Influencing the Workplace by Serving on a Hospital’s Board of Directors, 439
Kristine M. Gebbie
59 The Intersection of Technology and Health Care: Policy and Practice Implications, 444
Linda Burnes Bolton, Pamela F. Cipriano, and Carole Gassert
60 The Influence of Magnet Recognition on Organization and Workplace Policy, 451
Karen Drenkard
61 Collective Bargaining in Nursing, 455
Judith Shindul-Rothschild
62 Workplace Advocacy, 461
Dennis Sherrod, Wylecia Wiggs Harris, and Alfreda Harper-Harrison

UNIT 5 Policy and Politics in the Government

63 Contemporary Issues in Government, 464

Deborah B. Gardner and Amanda L. Ebner
64 How Government Works: What You Need to Know to Influence the Process, 480
Karrie Cummings Hendrickson, Christine Ceccarelli, and Sally S. Cohen
65 An Overview of Legislation and Regulation, 494
Nancy Ridenour and Yvonne Santa Anna
66 Nursing Licensure and Regulation, 506
Edie Brous
 CONTENTS xxiii

67 Regulating Industrial Chemicals to Protect the Environment and Human Health, 514
Charlotte Brody
68 Lobbying Policymakers: Individual and Collective Strategies, 519
Ellen-Marie Whelan and Michael P. Woody
69 TAKING ACTION An Insider’s View of Lobbying, 527
Betty R. Dickson
70 Political Appointments, 533
Judith K. Leavitt and Mary W. Chaffee
71 TAKING ACTION Influencing Policy as a Member of the San Francisco Health Commission, 540
Catherine M. Waters
72 Nursing and the Courts, 544
David M. Keepnews and Virginia Trotter Betts
73 The American Voter and the Electoral Process, 553
Karen O’Connor and Jon L. Weakley
74 TAKING ACTION Anatomy of a Political Campaign, 561
Greer Glazer and Charles Alexandre
75 TAKING ACTION Nurses for Obama: My Advocacy and Experience on the Campaign Trail, 568
Pamela J. Johnson
76 Is There a Nurse in the House? The Nurses in the United States Congress, 572
Mary W. Chaffee
77 TAKING ACTION Nurse, Educator, and Legislator: My Journey to the Delaware General Assembly, 579
Bethany Hall-Long
78 TAKING ACTION Into the Rabbit Hole: My Journey to Service on a City Council, 583
Holly Edwards
79 TAKING ACTION Truth or Dare: One Nurse’s Political Campaign, 587
Barbara B. Hatfield and Brenda C. Isaac
80 Political Activity: Different Rules for Government-Employed Nurses, 590
Tracy A. Malone and Mary W. Chaffee

UNIT 6 Policy and Politics in Associations and Interest Groups

81 Interest Groups in Health Care Policy and Politics, 594

Joanne Rains Warner
82 Current Issues in Nursing Associations, 602
Linda J. Shinn
83 Professional Nursing Associations: Meeting Needs of Nurses and the Profession, 609
Pamela J. Haylock
84 TAKING ACTION The Center to Champion Nursing in America: Mobilizing Consumers and
Other Stakeholders, 618
Brenda Cleary and Susan C. Reinhard