Revised:  Summer 2003 - Baier

Spring 2001 - Boyd
Fall 2000 - Bernaix and Nehring
 

OBJECTIVES:

The student who successfully completes this course will be able to:

1. Analyze pertinent policy research at the local, state, and national level for its impact on advanced practice nursing and the delivery of health care;

 

2. Evaluate regulatory and legislative processes related to formulation and implementation of health policy;

 

3. Develop a position paper on a specific and timely health policy issue that includes background research and statistics, rationale for position on issue, and steps for implementation that can be shared with the public, other health care providers, and political officials;

4. Compare community-based and institution-based health care delivery systems by emphasizing cost, access, and quality;

 

5. Analyze cost-effective practices with specific outcomes for a specific health care organization.

 

6. Evaluate ethical dilemmas and decision-making within health care delivery systems and the development of health care policy.

 

REQUIRED TEXTS:

 Harrington, C., & Estes, C.L. (2001). Health policy: Crisis and reform in the U.S. health care delivery system (3rd ed.). Boston: Jones & Bartlett

RECOMMENDED RESOURCES:

Critser, G. (2003). Fat land: How Americans became the fattest people in the world. Boston: Houghton Mifflin.

American Nurses Association. (1995). Nursing's social policy statement. Washington, DC: Author.

American Nurses Association. (1996). Scope and standards of advanced practice registered nursing. Washington, DC: Author.

American Nurses Association. (1998). Standards of clinical nursing practice (2nd ed.). Washington, DC: Author.

Obtain "Scope and Standards of Practice" for your specialty practice area. This information can be obtained either through the American Nurses Association webpage or through your specialty organization's webpage. It is very important that as an advanced practice nurse you are familiar the scope and standards of practice that will govern your practice!

You should also have a copy of your State's Nurse Practice Act including any language on advanced nursing practice. You can obtain such a copy from the state's nursing board. The information for Illinois is included under the section, "Regulation of Nursing Practice."

PLANNED LEARNING EXPERIENCES:

Discussion

Presentations and debates

Assigned and suggested readings

Assigned papers

Field trips to attend health policy meetings

METHODS OF EVALUATION

GRADING SCALE

 COURSE ASSIGNMENTS:

Papers, discussion, and presentations

Field trips to attend health policy meetings.

MANUAL OF STYLE:

 American Psychological Association. (2001). Publication manual for the American Psychological Association (5th ed.). Washington, DC: Author.

HANDBOOK POLICY:

 Students are reminded to review their School of Nursing Handbook for current policies and procedures.  The handbook is revised every Fall semester and has been designed to provide supplemental information about policies, procedures, and regulations in the School of Nursing to students enrolled in the graduate program, as well as general information.  Policy changes and announcements made by the School of Nursing will be posted on the hall bulletin board adjacent to faculty offices in Alumni Hall, Room 2117 under the heading of "Policies."  It is the responsibility of the students to keep themselves informed by checking the bulletin boards weekly.

ACADEMIC AND SOCIAL MISCONDUCT STATEMENT:

 SIUE assigns first priority to excellence in education. Further the University values a humane, safe, and supportive environment to aid students in their pursuit of knowledge. The School of Nursing will apply the University policy on academic and social misconduct as outlined and defined in the SIUE Graduate Catalog (1999-2001), the Student Academic Code and the Student Conduct Code ( http://www.siue.edu/POLICIES/ptoc.html#1i ). The Student Council Policy applies to conduct occurring on any property controlled, operated, or owned by the University and conduct in the practicum, clinical settings, or student field trips. Other sites are specified in the Student Conduct Code.

Academic Misconduct: Academic misconduct includes, without limitation, plagiarism, cheating, failure or refusal to follow clinical practice standards, falsifying or manufacturing scientific or educational data and/or misrepresenting data to be a result of scientific or scholarly experiment or research, and soliciting, aiding, abetting, concealing, or attempting such acts.

Social Misconduct: Some of the acts of social misconduct for which students are subject to discipline include: violence, such as "harassment, intimidation, intentional obstruction or interference with anyone's right to attend or participate in any University activity, intentional interference with or disruption of any class, or behavior or conduct which poses a threat to the mental, emotional, or physical well-being of self or others; non-compliance, which is interference or resistance with a reasonable verbal or written instruction or direction; abuse or disorderly conduct.

Any student found to be dishonest or socially irresponsible may incur sanctions appropriate for the incident. Disciplinary sanctions may include a failing grade in the course, removal from a class or clinical area, or disciplinary reprimand, probation, up to Separation from the University.

REGULATION OF NURSING PRACTICE:

The Illinois Nursing Act of 1998 and its Rules for Administration, Licensure, and Discipline govern the education of nursing students and faculty activities for this purpose. The purposes of the Act are to protect the health, welfare, and safety of the citizens of Illinois receiving nursing services and ensure that the practice of nursing receives the confidence of the public. All students must know the Illinois Nursing Act of 1998 and the Rules for its administration. The Act and Rules are available for review in the Office of the Associate Dean for Educational Services in the School of Nursing and at the Reserve Desk in the Library. You may write and get your own copy at the Department of Professional Regulation, 320 W. Washington Street, 3rd floor, Springfield, IL 62786, or phone 217-785-0800 Forms Section.

COURSE CONTENT:

I. Health Care Policy

 A. Historical perspectives
 B. Regulatory and legislative processes
 C. Oversight
 D. Health reform
 E. Medicare/Medicaid
 F. Political action
 G. Health care policy research
 H. Implications for advanced nursing practice

II. Organization of the Health Care System

 A. Types of Organizations
  1. Official
  2. Voluntary
  3. Proprietary
 B. Services
  1. Health promotion and disease/disability prevention
  2. Ambulatory and acute care
  3. Long term and rehabilitative care
 C. Economic models
  1. Fee for service
  2. Managed care
  3. Entrepreneurship
 D. Application of the above to advanced nursing practice

III. Patterns of Health Care Financing

 A. Cost effectiveness and reimbursement issues
  1. Incentives
  2. Cost/benefit analysis
  3. Competition
  4. Allocation of services

IV Ethics and Synthesis: Availability, Accessibility, and Acceptability

 A. Public health model
 B. Care of diverse populations
 C. Quality of care
 D. Implications for advanced nursing practice
 

REFERENCES:

Cost-Effectiveness Analysis

 Allred, C.A., Arford, P.H., Mauldin, P.D., & Goodwin, L.K. (1998). Cost-effectiveness analysis in the nursing literature, 1992-1996.  IMAGE: Journal of Nursing Scholarship, 30, 235-242.

Baradell, J.G. (1994). Cost-effectiveness and quality of care provided by clinical nurse specialists. Journal of Psychosocial Nursing, 32 (3), 21-24.

Buppert, C.N. (1995). Justifying nurse practitioner existence: Hard facts to hard figures. Nurse Practitioner, 20(8), 43-48.

 Buerhaus, P.I. (1998). Milton Weinstein's insights on the development, use, and methodologic problems in cost-effectiveness analysis. IMAGE: Journal of Nursing Scholarship, 30, 223-227.

 Siegel, J. (1998). Cost-effectiveness analysis nursing research - is there a fit? Image, 30, 221-222.

 Stone, P.W. (1998). Methods for conducting and reporting cost-effectiveness analysis in nursing.  IMAGE: Journal of Nursing Scholarship, 30 , 229-234.

Ethics and Health Policy

 Brown, C. (1999). Ethics and health policy: Introduction. Image, 31, 253.

 Brown, C. (1999). Ethics, policy and practice: Interview with Emily Friedman. Image, 31, 255-258.

 Spetz, J. (1999). Victor Fuchs on health care, ethics, and the role of nurses. Image, 31, 255-258.

Nurse Staffing Policy

Bleich, M.R., Hewlett, P.O., Santos, S.R., Rice, R.B., Cox, K.S., & Richmeier, S. (2003). Analysis of the nursing workforce crisis: A call to action. American Journal of Nursing, 103(4), 66-74.

 Harrington, C. (2001). Nursing facility staffing policy: A case study for political change. Policy, Politics, & Nursing Practice, 2 , 117-127.

 Needleman J., Buerhaus P., Mattke S., Stewart M., & Zelevinsky K. (2002).Nurse-staffing levels and the quality of care in hospitals. New England Journal of Medicine, 346 ,1715-1722.

 Nurse staffing linked to patient outcomes. (2001). American Journal of Nursing, 101(8), 20-21. The complete study is available at http://bhpr.hrsa.gov/nursing/staffstudy.htm .

 Sochalski, J. (2001). Quality of care, nurse staffing, and patient outcomes. Policy, Politics, & Nursing Practice, 1 , 9-18.

SUPPLEMENTAL BIBLIOGRAPHY:

Introduction to Health Policy
 Antrobus, S., & Kitson, A. (1999). Nursing leadership: Influencing and shaping health policy and nursing practice. Journal of Advanced Nursing, 29 , 746-753.

 Bagwell, M., & Bush, H. A. (1998). Six steps to better quality nursing care through political action. Journal of Nursing Care Quality, 12 (5), 5-6.

 Fitzgerald, K. (1998). Clinical benchmarking: Implications for perinatal nursing. Journal of Perinatal and Neonatal Nursing, 12 , 23-30.

 Fonteyn, M. (1998). The Agency for Health Care Policy and Research guidelines: Implications for home health care providers. AACN Clinical Issues, 9, 338-354.

 Ford-Roegner, P. A. (1998). Nursing as a road to public policy. Seminars in Nursing Management, 6, 47-50.

 Ginzberg, E. (1999). Health policy agenda for the early 21st century. Journal of Urban Health, 76, 18-25.

 Maslin-Prothero, S., & Masterson, A. (1998). Continuing care: Developing a policy analysis for nursing. Journal of Advanced Nursing, 28, 548-553.

  Mason, D.J., Leavitt, J.K., & Chaffee, M.W. (2002). Policy & politics in nursing and health care (4th ed.). St. Louis: Saunders.

 McCabe, L. R. (1998). Simplify and energize policy development. Nurse Management, 29 (10), 43-45.

 Shi, L., & Singh, D. A. (2001). Delivering health care in America: A systems approach (2nd ed.). Gaithersburg, MD: Aspen.

 Sofarelli, D., & Brown, D. (1998). The need for nursing leadership in uncertain times. Journal of Nursing Management, 6 , 201-207.

 van Rijswijk, L. (1999). Clinical practice guidelines: Moving into the 21st century. Ostomy Wound Management, 45 (1A Suppl) , 47S-53S.

Legislative Issues Affecting Advanced Practice Nurses

 Baltimore, J. J., & Gillett, P. (1998). Clinical nurse specialist prescriptive authority and the legislative process. Advanced Practice Nursing Quarterly, 4, 78-84.

Bauman, A.R., & Kraft, M.R. (2003, January/February). HIPAA: What nurses need to know. Chart, Journal of Illinois Nursing, 100, 4, 12, 13.

 Bradley, E. H., & Rizzo, J. A. (1999). Public information and private search: Evaluating the Patient Self-Determination Act. Journal of Health Politics, Policy and Law, 24, 239-273.

 Catlin, A. J., & McAuliffe, M. (1999). Proliferation of non-physician providers as reported in the Journal of the American Medical Association (JAMA), 1998. Image, 31, 175-178.

 Chute, C. G., Cohn, S. P., & Campbell, J. R. (1998). A framework for comprehensive health terminology systems in the United States: Development guidelines, criteria for selection, and public policy implications. Journal of the American Medical Informatics Association, 5, 503-510.

 Halfon, N., Inkelas, M., DuPlessis, H., & Newacheck, P. W. (1999). Challenges in securing access for children. Health Affiliates, 18 , 48-63.

 Hamric, A. B. (1998). Using research to influence the regulatory process. Advanced Practice Nursing Quarterly, 4 (3), 44-50.

 Minarik, P. (1998). Legislative and regulatory update. Medicare and Medicaid reimbursement: New law and new legislation. Clinical Nurse Specialist, 12 (2), 83-84.

 Ott, B. B. (1999). Advance directives: The emerging body of research. American Journal of Critical Care, 8, 514-519.

 Pearson, L. J. (1999). Annual update on how each state stands on legislative issues affecting advanced nursing practice. Nurse Practitioner, 24 , 16-19, 23-24, 27-30.

 Peters, R. M. (1998). The negative effect of the clinical model of "health": Implications for health care policy. Journal of Health Care Finance, 25, 78-92.

 Pew Health Professions Commission. (1995). Critical challenges: Revitalizaing the health professions for the twenty-first century. Executive summary. San Francisco: Author.

 Pew Health Professions Commission. (1998). Recreating health professional practice for a new century (The fourth report of the Pew Health Professions Commission). San Francisco: Author (Executive summary and selected pages on nursing and advanced practice nursing).

 Upton, D. (1999). Attitudes towards, and knowledge of, clinical effectiveness in nurses, midwives, practice nurses and health visitors. Journal of Advanced Nursing, 29, 885-893.

 Weissert, C. S., & Silberman, S. L. (1998). Sending a policy signal: State legislatures, medical schools, and primary care mandates. Journal of Health Politics and Policy Law, 23, 743-770.

 Whitman, M. (1998). Nurses can influence public health policy. Advanced Practice Nursing Quarterly, 3 (4), 67-71.

Health Care and Delivery Models of Care

 Aprile, A.E. (1995). Prescriptive authority: A practice of medicine? CRNA: The Clinical Forum for Nurse Anesthetists, 6, 2-8.

 Baumann, A. O., Deber, R. B., Silverman, B. E., & Mallette, C. M. (1998). Who cares? Who cures? The ongoing debate in the provision of health care. Journal of Advanced Nursing, 28, 1040-1045.

 Buerhaus, P. I. (1999). Is a nursing shortage on the way? Nursing Management, 30 (2), 54-55.

 Buerhaus, P. I. (1999). Changes in the nurse workforce. Image, 31 , 160.

 Buerhaus, P. I., (1998). Is another RN shortage looming? Nursing Outlook, 46, 103-108.

 Christman, L. (1998). Advanced practice nursing: Is the physician's assistant an accident of history or a failure to act? Nursing Outlook, 46, 294-295.

Diekemper, M., SmithBattle, L., & Drake, M.A. (2003, January 12). Nursing layoffs put county residents at greater risk than officials may realize [Commentary]. St. Louis Post Dispatch, p. B3.

 England, M. J., & Cole, R. F. (1998). Preparing for communities of care for child and family mental health for the twenty-first century. Child and Adolescent Psychiatry Clinics of North America, 7, 469-481, vii.

 Kindig, D. A. (1999). Purchasing population health: Aligning financial incentives to improve health outcomes. Nursing Outlook, 47 , 15-22.

 Gold, M. (1999). The changing US health care system: Challenges for responsible public policy. Milbank Quarterly, 77, 3-37, iii.

 Harrison, J. (1999). Influence of managed care on professional nursing practice. Image, 31, 161-166.

Koniak-Griffin, D., Verzemnieks, I.L., Anderson, N.L.R., Brecht, M.L., Lesser, J, Kim, S., & Turner-Pluta, C. (2003). Nurse visitation for adolescent mothers: Two-year infant health and maternal outcomes. Nursing Research, 52, 127-136.

 Saks, N. P. (1998). Developing an integrated model for outcomes management. Advanced Practice Nursing Quarterly, 4 , 27-32.

 Weiss, M. E. (1998). Case management as a tool for clinical integration. Advanced Practice Nursing Quarterly, 4 , 9-15.

 Wong, S. T. (1998). Outcomes of nursing care: How do we know? Clinical Nurse Specialist, 12, 147-151.

Professional Issues and Organizations

 Byers, J. F., & Brunell, M. L. (1998). Demonstrating the value of the advanced practice nurse: An evaluation model. AACN Clinical Issues, 9, 296-305.

 
Felton, G. (1998). Politicization of health professions regulation. Advanced Practice Nursing Quarterly, 4 (3), 14-23.

 Malloy, C. (1998). Managed care and ethical implications in telephone-based health services. Advanced Practice Nursing Quarterly, 4 (2), 30-33.

 Mundinger, M. O. (1999). Can advanced practice nurses succeed in the primary care market? Nursing Economics, 17 (1), 7-14.

 Nelms, T. P., & Lane, E. B. (1999). Women's ways of knowing in nursing and critical thinking. Journal of Professional Nursing, 15 , 179-186.

 ONCC Research Committee and Executive Staff. (1999). Report of a state-of-the-art knowledge conference on U.S. nursing certification. Image, 31, 51-55.

Using the Internet and Other Technology

 Aucar, J. A., Doarn, C. R., Sargsyan, A., Samuelson, D. A., Odonnell, M. J., & DeBakey, M. E. (1998). Use of the internet for long-term clinical follow-up. Telemedicine Journal, 4, 371-374.

 Connors, H. R. (1998). Telecommunications and rural health care. Advanced Nursing Practice, 6 (6), 40-44, 66.

 Whitten, P., Cook, D. J., Shaw, P., Ermer, D., & Goodwin, J. (1998). Telekid care: Bringing health care into schools. Telemedicine Journal, 4, 335-343.
 

Economic Models of Health Care

 Buerhaus, P. (1998). Financing, demographic and political problems confronting Medicare in the US. Image, 30, 117-123.

 Christianson, J. (1998). Potential effects of managed care organizations in rural communities: A framework. Journal of Rural Health, 14 , 169-179.

 David, B. A. (1999). Nurses' conflicting values in competitively managed health care. Image, 31, 188.

 Dumpe, M. L., Herman, J., & Young, S. W. (1998). Forecasting the nursing workforce in a dynamic health care market. Nursing Economics, 16, 170-179, 188.

 Harrison, J. K. (1999). Influence of managed care on professional nursing practice.Image, 31, 161-166.

 Mechanic, D. (1999). The changing elderly population and future health care needs. Journal of Urban Health, 76, 24-38.

 Yawn, B. P. Casey, M., & Hebert, P. (1999). The rural health care workforce implications of practice guideline implementation. Medical Care, 37, 259-269.

Cost Effectiveness and Reimbursement Issues

 Cassel, C. K., Besdine, R. W., & Siegel, L. C. (1999). Restructuring Medicare for the next century: What will beneficiaries really need? Health Affiliates, 18, 118-131.

 Iris, M. (1999). A review of third-party reimbursement issues for advanced practice nurses. Journal of Psychosocial Nursing and Mental Health Services, 37, 36-40.

 Kastens, J. M. (1998). Integrated care management: Aligning medical call centers and nurse triage services. Nursing Economics, 16, 320-322, 329.

 Levy, J. S. (1999). Marketing service guarantees for health care. Nursing Economics, 17, 214-218.

 Russell, L., Gold, M., Seigel, J., Daniew, N. I., & Weinstein, M. (1996). The role of cost-effectiveness analysis in health and medicine: Consensus statement. JAMA, 276, 1172-1177.

 Safriet, B. J. (1998). Still spending dollars, still searching for sense: Advanced practice nursing in an era of regulatory and economic turmoil . Advanced Practice Nursing Quarterly, 4 (3), 24-33.

 Whitelaw, N. A., & Warden, G. L. (1999). Reexamining the delivery system as part of Medicare reform. Health Affiliates, 18, 132-143.

 Wong, S. T. (1999). Reimbursement to advanced practice nurses (APNs) through Medicare. Image, 31, 167-174.

 Wurzbach, M. E. (1998). Managed care: Moral conflicts for primary health care nurses. Nursing Outlook, 46, 62-66.

Accessibility-Availability

 Bazzoli, G. J., Shortell, S. M., Dubbs, N., Chan, C., & Kralovec, P. (1999). A taxonomy of health networks and systems: Bringing order out of chaos. Health Services Research, 33, 1683-1717.

 Daniels, N. (1999). Decisions about access to health care and accountability for reasonableness. Journal of Urban Health, 76 , 176-191.

 Gulzar, L. (1999). Access to health care. Image, 31 , 13-19.

 Kaplan, D. W., Brindis, C. D., Phibbs, S. L., Melinkovich, P., Naylor, K., & Ahlstrand, K. (1999). A comparison study of an elementary school-based health center: Effects on health care access and use. Archives of Pediatric and Adolescent Medicine, 153, 235-243.

 Mueller, K. J., Ortega, S. T., Parker, K., Patil, K., & Askenazi, A. (1999). Health status and access to care among rural minorities. Journal of Health Care for the Poor and Underserved, 10, 230-249.

 Zuvekas, S. H., & Weinick, R. M. (1999). Changes in access to care, 1977-1996: The role of health insurance. Health Services Research, 34 (1 Pt. 2): 271-279.

Satisfaction-Acceptability

 Donaldson, M. S. (1998). Accountability for quality in managed care. Joint Commission Journal of Quality Improvement, 24 , 711-725.

Future of Health Care

 Collen, M. F. (1999). A vision of health care and informatics in 2008. Journal of the American Medical Informatics Association, 6, 1-5.

Goldsmith, J. (2003). AJN reports: Winning and losing magnet designation. American Journal of Nursing, 103 (5), 25.

 Tiedje, L. B. (1998). Alternative health care: An overview. Journal of Obstetrics, Gynecology, and Neonatal Nursing, 27 (5), S57-S62.

Williams, J.K. (2002). Education for genetics and nursing practice. AACN Critical Issues, 13(4), 492-500.