Finkelman, Leadership and Management for Nurses: Core Competencies for Quality
Care, 3rd edition.
1
Chapter 2: Healthcare Policy, Legal Issues, and Ethics in Healthcare Delivery
LEARNING OUTCOMES AND SUGGESTED CLASSROOM AND CLINICAL
ACTIVITIES
LEARNING OUTCOME 1
Explain why nurses should be involved in healthcare policy and the political process.
Suggestions and Strategies for Classroom Experience
• Provide the students with an example of local healthcare policy; e.g., services
offered, quality of care of services, reimbursement issues, and access to care. Ask
students to discuss why it is a health policy, factors relevant to the specific policy,
and how it impacts care in their community.
Suggestions and Strategies for Clinical Experience
• Ask students to identify examples from clinical that support the need for nurses to
be involved in health policy.
LEARNING OUTCOME 2
Examine examples of healthcare policy issues.
Suggestions and Strategies for Classroom Experience
• Ask students to provide examples of private and public policies that they know
Suggestions and Strategies for Clinical Experience
• In clinical conference ask students to identify any private or public policy that
might impact their current practice in clinical.
LEARNING OUTCOME 3
Compare and contrast private and public policy.
Suggestions and Strategies for Classroom Experience
• Considering the examples identified for strategies under Outcome 1, have
students identify whether the situations are private or public policy and explain
why.
• Students also can be asked to do the following: Identify a health policy from the
newspapers, television news, radio news, Internet, etc. Describe the policy,
whether private or public, and how it might impact care in the local community or
state.
Suggestions and Strategies for Clinical Experience
Finkelman, Leadership and Management for Nurses: Core Competencies for Quality
Care, 3rd edition.
2
• Discuss the implications of private policy in the healthcare delivery system.
LEARNING OUTCOME 4
Apply the policy-making process including implications of the political process.
Suggestions and Strategies for Classroom Experience
• Going back to the same examples used in Outcomes 1 and 2, have students
discuss how the political process might have had an impact on the policy.
Suggestions and Strategies for Clinical Experience
LEARNING OUTCOME 5
Discuss how nurses can be involved in the policy-making process.
Suggestions and Strategies for Classroom Experience
• Students can attend a policy-making session of local or state government,
allowing for time to discuss the experience. Students can be asked to critique their
experience.
• If there are nurses in the local area who have testified at the local, state, or
LEARNING OUTCOME 6
Explain how federal and state laws can affect health care.
Suggestions and Strategies for Classroom Experience
• Students can be assigned or can choose one of the legislative examples in this
Suggestions and Strategies for Clinical Experience
Finkelman, Leadership and Management for Nurses: Core Competencies for Quality
Care, 3rd edition.
3
• Are there any examples of legislation that would apply to clinical sites students
have been in or are in at the time of this course? How would it apply?
LEARNING OUTCOME 7
Critique the Patient Protection and Affordable Care of 2010 and the provisions that are
relevant to nursing.
Suggestions and Strategies for Classroom Experience
• Have the students form groups to discuss some of the healthcare reform
provisions located in Appendix B and explain how they would affect their
delivery of care to patients.
Suggestions and Strategies for Clinical Experience
LEARNING OUTCOME 8
Explain how malpractice and negligence relates to nursing practice.
Suggestions and Strategies for Classroom Experience
• Using the slide about negligence, assign students to teams and ask them to
develop examples of negligence as it applies to nursing practice.
Suggestions and Strategies for Clinical Experience
• In the clinical setting during conference, students can be asked to discuss issues
that they think might be examples of concern related to malpractice. They might
investigate how the hospital protects itself from malpractice.
LEARNING OUTCOME 9
Discuss the implications of scope of practice.
Suggestions and Strategies for Classroom Experience
• Ask students to review the state nurse practice act and the ANA Scope and
Suggestions and Strategies for Clinical Experience
• In the clinical setting during conference, students can be asked to discuss how
their practice during clinical experience relates to the scope of practice. The
Finkelman, Leadership and Management for Nurses: Core Competencies for Quality
Care, 3rd edition.
4
LEARNING OUTCOME 10
Apply ethical decision making to management situations.
Suggestions and Strategies for Classroom Experience
• Ask students to create a list of situational examples that apply to the Code for
Nurses.
Suggestions and Strategies for Clinical Experience
• If a healthcare organization used for clinical has an ethics committee, have
students attend a session. Provide for follow-up discussion so that students have
LEARNING OUTCOME 11
Analyze the impact of healthcare fraud on the healthcare system.
Suggestions and Strategies for Classroom Experience
• Discuss student responses to the examples of healthcare fraud found in this
chapter. Students could be asked to research for additional information about
these examples (literature, Internet) and share it with the class.
Suggestions and Strategies for Clinical Experience
• In clinical conference, discuss how healthcare fraud might have an impact on
patient care.
LEARNING OUTCOME 12
Examine how nurses can become involved in reducing healthcare fraud and cope with
ethical dilemmas presented by fraud.
Suggestions and Strategies for Classroom Experience
Suggestions and Strategies for Clinical Experience
• In post-conference, examine if staff nurses would have access to information that
would put them in a position to recognize that healthcare fraud had occurred.
KEY CHAPTER CONCEPTS
1. Nurses practice in the healthcare arena, which is affected by healthcare policy. There is
2. Healthcare policy determines what healthcare services are provided, who provides the
services, who receives services, reimbursement, quality of care, improvement, and
4. Private policy is policy that is developed by either health care organizations or a
profession, such as nursing (see Box 2-3).Public policy is policy that reflects the needs of
<insert Table 2-1>
7. Arriving at the best solution/policy requires careful assessment of the issues. Typical
8. The political process has an impact on making policies. Most policy comes through
legislation, influenced by interest groups and organizations. As changes occur in the
9. Healthcare policy has an impact on services, providers, who receives care,
reimbursement, and quality improvement.
11. Nurses need to be leaders in providing direction for this data collection since data
about their patients and settings affect their practice.
13. Examples of ACA provisions related to nursing include nursing student loans,
14. Box 2-4 describes ACA provisions by year they are to be implemented.
15. Nurses can participate in a variety of ways. Active participation in professional
organizations is one method. Nurses can provide testimony or serve on policy-making
16. Federal and state legislation has a major impact on nursing practice and health care.
17. States play an active role in healthcare policy, legislation, and regulation. They are
19. Nurses may be involved in malpractice, which focuses on a professional standard of
20. Negligence is different from malpractice. Negligence is a failure to do what an
21. The elements that must be met for malpractice are the same as those for negligence,
with the emphasis on what would be expected from a professional. Some of the examples
22. Basic legal terminology is provided in the chapter.
24. Healthcare ethical decision-making focuses on the right and just thing to do, guided
25. Inter-professional ethics committees are used in many organizations to assist staff
26. Professional ethics applies to both nursing management and clinical issues.
27. Each state board of nursing has the responsibility to protect the public health in its
28. Healthcare fraud has been increasing, and this fraud and abuse have affected nursing.
Corporate healthcare fraud has grown as health corporations have grown. Two examples
29. Nurses need to be knowledgeable about and use the Code for Nurses, recognize their
30. There are protections for nurses and all employees who act as whistleblowers (those
that reveal wrongdoing within an organization) to help cope with ethical dilemmas. If the
Finkelman, Leadership and Management for Nurses: Core Competencies for Quality
Care, 3rd edition.
7
31. The Health Insurance Portability and Accountability Act of 1996 (HIPAA)
APPLYING LEADERSHIP AND MANAGEMENT
BSN and Master’s Essentials: Application to Content
Chapter identifies which Essentials apply to the chapter content. This information is
primarily for the instructor, but students should understand how these nursing education
standards apply to the chapter content and the nursing profession.
My Hospital Unit: An Evolving Case Experience
See the overview of the My Hospital Unit feature found in the front of the textbook.
Refer students to the specific My Hospital Unit scenario found in the chapter.
Hospital Unit experience to the next.
Applying AONE Competencies
Engaging in the Content: Critical Thinking and Clinical Reasoning and Judgment
See Discussion Questions and Application Exercises at the end of the chapter. Online
options are noted.
Chapter Features: Case Study and Applying Evidence-Based Practice
The Chapter Features: Case Study and Applying Evidence-Based Practice sections may
ADDITIONAL CASE
This case is not found in the textbook. It may be used for individual or team assignments:
written assignment and classroom or online team discussions. It may also be used as an
essay question for exams.
Case:
The hospital where you work has established a Compliance Committee. A memo was
sent to all staff announcing this new committee. You are sitting a lunch with other staff
nurses you know. One nurse says, “This is just one more committee!” Another one adds,
“And it is very unclear why the hospital needs this committee. What is the purpose?” One
of the unit nurse managers joins the group and hears the conversation. He was at the
nurse manager meeting where the new hospital committee was described. How might he
respond to the following questions?
Questions:
Why would a hospital establish such a committee?
What is the purpose of this committee?
Why should nurses care about this committee?