Chapter 7

Government, the Law, and

Policy Activism

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 Objectives
 Discuss the structure of the U.S. government and health
care roles.
 List the functions of key governmental and quasi-
governmental agencies that affect public health systems
and nursing, both around the world and in the U.S.
 Identify the primary bodies of law that affect nursing and
health care.
 Define key terms related to policy and politics.
 Describe the relationships between nursing practice,
health policy, and politics.
 Develop and implement a plan to communicate with
policymakers on a chosen public health issue.

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 Introduction
 Nurses who select the community as their area
of practice must be especially aware of the
impact of government, law, and health policy on
nursing, health, and the communities in which
they practice.
 Knowing how government, law, and political
action have changed over time is necessary to
understand how the health care system has
been shaped by these factors.

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 Definitions
 Policy
 Health policy
 Politics

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 Governmental Role in
U.S. Health Care
 Three Branches of Government:
 Executive
• U.S. Department of Health and Human Services (USDHHS)
 Legislative
 Judicial
• Police power

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Trends and Shifts in Governmental
Roles
 Wars, economic instability, and political
differences between parties all shaped the
government’s role.
 History of creation of government agencies and
acts for health
 Health Insurance Portability and Accountability Act
 State Child Health Improvement Act
 Public Health Threats and Emergencies Act
 Patient Protection and Affordable Care Act

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Government Health Care Functions
 Direct services
 Financing
 National Institute of Nursing Research (NINR)
 Information
 Health, United States
 Policy setting
 Public protection

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 Healthy People 2020:
An Example of National Health
Policy Guidance
 In 1979 the surgeon general issued a report that began a
20-year focus on promoting health and preventing
disease for all Americans.
 In 1989 Healthy People 2000 became a national effort
with many stakeholders representing the perspectives of
government, state, and local agencies; advocacy groups;
academia; and health organizations.
 Throughout the 1990s states used Healthy People 2000
objectives to identify emerging public health issues.
 Healthy People 2010 focused on a vision of healthy
people living in healthy communities
 Healthy People 2020 has four overarching goals.
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 Organizations and Agencies that
Influence Health
 International Organizations
 World Health Organization (WHO)
• World Health Assembly (WHA)
 Federal Health Agencies
 U.S. Dept. of Health and Human Services (USDHHS)
 Health Resources and Service Administration (HRSA)
 Centers for Disease Control and Prevention (CDC)
 National Institutes of Health (NIH)
• National Institute of Nursing Research (NINR)
• Agency for Healthcare Research and Quality (AHRQ)
• Centers for Medicare and Medicaid Services (CMS)

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 Organizations and Agencies that
Influence Health
 Federal Non-Health Agencies
 Department of Defense
 Department of Labor
 Department of Agriculture
 Department of Justice
 State and Local Health Departments
 Programs vary depending on funding, public
commitment and interest, and access to other
resources
 Coordinating efforts between health departments and
other county/city departments is necessary.

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 Impact of Government Health
Functions and Structures of
Nursing
 The variety and range of functions of
governmental agencies have had a major impact
on the practice of nursing.
 Funding, in particular, has shaped roles and tasks of
population centered nurses.
 The designation of money for specific needs has
led to special and more narrowly focused
nursing roles (i.e., emergency preparedness,
school nursing, and family planning).
 Categorical programs/funding

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 The Law and Health Care
 Constitutional Law
 Legislation and Regulation
• Board of Nursing
• Nurse Practice Act
 Judicial and Common Law

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 Laws Specific to Nursing Practice
 Scope of Practice
 Nurse Practice Act
• Licensure
 Professional Negligence

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Legal Issues Affecting Health Care
Practices
 School and Family Health
 Occupational health
 Home Care and Hospice
 Correctional Health

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 The Nurse’s Role in the Policy
Process
 The number and types of laws influencing health
care are increasing.
 Legislative Action
 Regulatory Action
 The Process of Regulation
 Nursing Advocacy

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