,Contents
Chapter 1: Marching to Lead in Policy ............................................................................................... 3
Chapter 2: Advocating for Nursing and for Health ....................................................................... 11
Chapter 3: Navigating the Political System .................................................................................... 19
Chapter 4: Identifying a Problem and Analyzing a Policy Issue……………………......…….24
Chapter 5: Harnessing Evidence in the Policy Process .............................................................. 34
Chapter 6: Setting the Agenda ........................................................................................................... 40
Chapter 7: Building Capital: Intellectual, Social, Political, and Financial ............................... 48
Chapter 8: Transforming Policy with Innovation ........................................................................... 55
Chapter 9: Implementing the Plan ..................................................................................................... 62
Chapter 10: Influencing Public Opinion and Health Policy Through Media Advocacy ....... 69
Chapter 11: Applying a Nursing Lens to Shape Policy................................................................ 76
Chapter 12: Evaluating Policy: Structures, Processes, and Outcomes .................................. 83
Chapter 13: Eliminating Health Inequities Through National and Global Policy .................. 90
Chapter 14: Valuing Global Realities for Health Policy ............................................................... 98
Chapter 15: Taking Charge of the Future Through Action ....................................................... 105
,Chapter 1: Marching to Lead in Policy
Q1.
A nurse working in a busy emergency department notices that undocumented patients
often avoid seeking care until their conditions are severe. The nurse recalls historical
examples of nurses who spoke out for vulnerable groups. Which action best reflects
active leadership in policy rather than passive participation?
A. Providing extra teaching for undocumented patients about hospital policies
B. Writing a journal article on the hospital’s cultural competence programs
C. Partnering with local advocacy groups to push for policy ensuring access to urgent
care for all individuals regardless of immigration status
D. Waiting for professional organizations to release guidelines before engaging
✅ Correct Answer: C
Rationale: Active leadership requires advocacy that extends beyond the bedside to
influencing systems and policies. Historically, nurses have been change agents who
partnered with communities to promote health equity. Options A and B are important but
limited to practice or academic roles. Option D reflects passivity.
Keywords: Policy leadership, vulnerable populations, advocacy, historical nursing roles
Q2.
Florence Nightingale’s efforts during the Crimean War led to sanitation reforms that
shaped modern public health policy. In today’s context, how can nurses apply a similar
model of leadership?
A. By ensuring strict adherence to hospital infection-control policies
B. By lobbying legislators for funding of national infection-prevention programs
C. By reminding staff about handwashing compliance
D. By teaching nursing students about hospital cleaning protocols
✅ Correct Answer: B
Rationale: Nightingale’s influence came from moving beyond bedside care to systemic
policy reform. Lobbying legislators for national programs mirrors her leadership impact.
Options A, C, and D reflect important practice and education roles but lack the systemic
advocacy component.
Keywords: Florence Nightingale, historical leadership, infection control, lobbying
Q3.
A nurse leader is asked by colleagues why it is necessary for nurses to be politically
,active. What is the most compelling rationale?
A. Policy decisions directly affect nursing practice and patient care outcomes
B. Politics is primarily a responsibility of physicians and administrators
C. Nurses are not trained to understand the complexity of policy-making
D. Political engagement takes away from bedside responsibilities
✅ Correct Answer: A
Rationale: Nurses must engage in policy because decisions about funding, scope of
practice, and health reform directly impact both nursing roles and patient care quality.
Options B, C, and D minimize the professional responsibility emphasized in the chapter.
Keywords: Professional responsibility, policy engagement, nursing advocacy
Q4.
A new nurse hesitates to join the state nurses’ association, saying, “Policy is not my
role; I only provide care.” Which response by a mentor reflects the perspective
emphasized in Marching to Lead in Policy?
A. “You’re right, policy work is usually handled by experienced nurse executives.”
B. “Policy engagement is part of our professional duty because it shapes the conditions
under which we deliver care.”
C. “Bedside nurses are too busy to influence policy, so it’s optional.”
D. “It’s best to wait until you’ve been in practice at least 10 years before joining.”
✅ Correct Answer: B
Rationale: The chapter frames policy engagement as an extension of nursing
responsibility at all levels. Even novice nurses can contribute through associations and
grassroots advocacy. Options A, C, and D reinforce a passive role that the chapter
cautions against.
Keywords: Nursing role, policy responsibility, professional engagement
Q5.
During a hospital committee meeting, a nurse references Lillian Wald’s establishment of
the Henry Street Settlement to argue for stronger community-based health funding.
Which principle is the nurse applying?
A. Policy leadership rooted in nursing’s historical role as advocates for underserved
populations
B. Restricting nursing advocacy to hospital-based initiatives
C. Delaying advocacy until government agencies invite nurses to participate
D. Focusing only on direct patient care rather than systemic change
✅ Correct Answer: A
Rationale: Wald exemplified nurses as policy innovators in community health.
Referencing her work aligns with the historical and contemporary expectation that
,nurses advocate for systemic reforms.
Keywords: Lillian Wald, community health, nursing advocacy, historical leadership
Q6.
A nurse researcher develops data showing that nurse staffing ratios correlate with
patient safety outcomes. To demonstrate active leadership, what is the best next step?
A. Submit the findings to a peer-reviewed journal and stop there
B. Share the findings only with the hospital’s quality department
C. Present the data to legislators to advocate for safe staffing laws
D. Wait for hospital administrators to decide if policy action is needed
✅ Correct Answer: C
Rationale: Transforming evidence into policy action reflects leadership beyond
academic publication. Presenting to legislators ensures data influences systemic
decisions. Options A and B remain limited, and D reflects passivity.
Keywords: Evidence-based policy, staffing ratios, advocacy, leadership
Q7.
Historically, nursing organizations such as the American Nurses Association (ANA)
have pushed for Medicare and Medicaid reforms. How does this historical example
guide contemporary nurses?
A. Nurses should rely only on organizational leaders to address policy
B. Nurses can see themselves as collective forces for systemic change
C. Nurses today no longer need to worry about insurance policy
D. Only advanced practice nurses have the authority to speak on policy
✅ Correct Answer: B
Rationale: The ANA’s history demonstrates that organized nursing advocacy can
influence large-scale health policy. The lesson is collective engagement, not passive
reliance. Options A, C, and D diminish nursing’s broader role.
Keywords: ANA, collective action, Medicare, Medicaid, systemic change
Q8.
A nursing faculty member asks students to analyze the ethical basis for policy
involvement. Which ethical principle best supports nurses’ duty to engage in health
policy?
A. Justice—addressing inequities and ensuring fair access to care
B. Autonomy—focusing only on individual patient decisions
C. Beneficence—limiting care decisions to the clinical level
D. Fidelity—keeping promises to colleagues rather than society
, ✅ Correct Answer: A
Rationale: Justice drives nurses to advocate for systemic equity, making it the
strongest ethical principle underpinning policy engagement. Autonomy, beneficence,
and fidelity are important but narrower in scope.
Keywords: Ethics, justice, equity, nursing responsibility
Q9.
A state senator asks a nurse leader why nurses should be consulted in health reform.
Which response is most aligned with the chapter’s perspective?
A. “Nurses are the largest segment of the healthcare workforce and bring frontline
insights into policy gaps.”
B. “Nurses can help with bedside teaching but may lack policy knowledge.”
C. “Nurses typically prefer to avoid political debates.”
D. “Nurses only participate in policy if administrators request their input.”
✅ Correct Answer: A
Rationale: Nurses’ large numbers and frontline expertise provide unique perspectives
essential to effective health policy. Options B–D minimize the critical role.
Keywords: Nursing workforce, frontline expertise, policy influence
Q10.
A nurse recalls how Clara Barton’s advocacy led to the creation of the American Red
Cross. What lesson does this historical example provide for nurses today?
A. Policy leadership requires courage to create institutions that meet unmet health
needs
B. Nurses should avoid involvement in nonprofit organizations
C. Individual nurses cannot influence health systems without decades of experience
D. Policy work is too far removed from clinical practice to be relevant
✅ Correct Answer: A
Rationale: Barton demonstrated that a single nurse with vision and advocacy could
establish an institution of lasting public health impact. Options B–D contradict the
message of nursing’s historical influence.
Keywords: Clara Barton, Red Cross, historical leadership, advocacy
Q11.
A nurse notices recurring gaps in community vaccination rates. She wants to influence
policy. Which action best exemplifies moving from passive care to policy leadership?
A. Documenting low vaccination rates in patient charts
B. Collaborating with public health officials to propose a community-wide vaccination
Chapter 1: Marching to Lead in Policy ............................................................................................... 3
Chapter 2: Advocating for Nursing and for Health ....................................................................... 11
Chapter 3: Navigating the Political System .................................................................................... 19
Chapter 4: Identifying a Problem and Analyzing a Policy Issue……………………......…….24
Chapter 5: Harnessing Evidence in the Policy Process .............................................................. 34
Chapter 6: Setting the Agenda ........................................................................................................... 40
Chapter 7: Building Capital: Intellectual, Social, Political, and Financial ............................... 48
Chapter 8: Transforming Policy with Innovation ........................................................................... 55
Chapter 9: Implementing the Plan ..................................................................................................... 62
Chapter 10: Influencing Public Opinion and Health Policy Through Media Advocacy ....... 69
Chapter 11: Applying a Nursing Lens to Shape Policy................................................................ 76
Chapter 12: Evaluating Policy: Structures, Processes, and Outcomes .................................. 83
Chapter 13: Eliminating Health Inequities Through National and Global Policy .................. 90
Chapter 14: Valuing Global Realities for Health Policy ............................................................... 98
Chapter 15: Taking Charge of the Future Through Action ....................................................... 105
,Chapter 1: Marching to Lead in Policy
Q1.
A nurse working in a busy emergency department notices that undocumented patients
often avoid seeking care until their conditions are severe. The nurse recalls historical
examples of nurses who spoke out for vulnerable groups. Which action best reflects
active leadership in policy rather than passive participation?
A. Providing extra teaching for undocumented patients about hospital policies
B. Writing a journal article on the hospital’s cultural competence programs
C. Partnering with local advocacy groups to push for policy ensuring access to urgent
care for all individuals regardless of immigration status
D. Waiting for professional organizations to release guidelines before engaging
✅ Correct Answer: C
Rationale: Active leadership requires advocacy that extends beyond the bedside to
influencing systems and policies. Historically, nurses have been change agents who
partnered with communities to promote health equity. Options A and B are important but
limited to practice or academic roles. Option D reflects passivity.
Keywords: Policy leadership, vulnerable populations, advocacy, historical nursing roles
Q2.
Florence Nightingale’s efforts during the Crimean War led to sanitation reforms that
shaped modern public health policy. In today’s context, how can nurses apply a similar
model of leadership?
A. By ensuring strict adherence to hospital infection-control policies
B. By lobbying legislators for funding of national infection-prevention programs
C. By reminding staff about handwashing compliance
D. By teaching nursing students about hospital cleaning protocols
✅ Correct Answer: B
Rationale: Nightingale’s influence came from moving beyond bedside care to systemic
policy reform. Lobbying legislators for national programs mirrors her leadership impact.
Options A, C, and D reflect important practice and education roles but lack the systemic
advocacy component.
Keywords: Florence Nightingale, historical leadership, infection control, lobbying
Q3.
A nurse leader is asked by colleagues why it is necessary for nurses to be politically
,active. What is the most compelling rationale?
A. Policy decisions directly affect nursing practice and patient care outcomes
B. Politics is primarily a responsibility of physicians and administrators
C. Nurses are not trained to understand the complexity of policy-making
D. Political engagement takes away from bedside responsibilities
✅ Correct Answer: A
Rationale: Nurses must engage in policy because decisions about funding, scope of
practice, and health reform directly impact both nursing roles and patient care quality.
Options B, C, and D minimize the professional responsibility emphasized in the chapter.
Keywords: Professional responsibility, policy engagement, nursing advocacy
Q4.
A new nurse hesitates to join the state nurses’ association, saying, “Policy is not my
role; I only provide care.” Which response by a mentor reflects the perspective
emphasized in Marching to Lead in Policy?
A. “You’re right, policy work is usually handled by experienced nurse executives.”
B. “Policy engagement is part of our professional duty because it shapes the conditions
under which we deliver care.”
C. “Bedside nurses are too busy to influence policy, so it’s optional.”
D. “It’s best to wait until you’ve been in practice at least 10 years before joining.”
✅ Correct Answer: B
Rationale: The chapter frames policy engagement as an extension of nursing
responsibility at all levels. Even novice nurses can contribute through associations and
grassroots advocacy. Options A, C, and D reinforce a passive role that the chapter
cautions against.
Keywords: Nursing role, policy responsibility, professional engagement
Q5.
During a hospital committee meeting, a nurse references Lillian Wald’s establishment of
the Henry Street Settlement to argue for stronger community-based health funding.
Which principle is the nurse applying?
A. Policy leadership rooted in nursing’s historical role as advocates for underserved
populations
B. Restricting nursing advocacy to hospital-based initiatives
C. Delaying advocacy until government agencies invite nurses to participate
D. Focusing only on direct patient care rather than systemic change
✅ Correct Answer: A
Rationale: Wald exemplified nurses as policy innovators in community health.
Referencing her work aligns with the historical and contemporary expectation that
,nurses advocate for systemic reforms.
Keywords: Lillian Wald, community health, nursing advocacy, historical leadership
Q6.
A nurse researcher develops data showing that nurse staffing ratios correlate with
patient safety outcomes. To demonstrate active leadership, what is the best next step?
A. Submit the findings to a peer-reviewed journal and stop there
B. Share the findings only with the hospital’s quality department
C. Present the data to legislators to advocate for safe staffing laws
D. Wait for hospital administrators to decide if policy action is needed
✅ Correct Answer: C
Rationale: Transforming evidence into policy action reflects leadership beyond
academic publication. Presenting to legislators ensures data influences systemic
decisions. Options A and B remain limited, and D reflects passivity.
Keywords: Evidence-based policy, staffing ratios, advocacy, leadership
Q7.
Historically, nursing organizations such as the American Nurses Association (ANA)
have pushed for Medicare and Medicaid reforms. How does this historical example
guide contemporary nurses?
A. Nurses should rely only on organizational leaders to address policy
B. Nurses can see themselves as collective forces for systemic change
C. Nurses today no longer need to worry about insurance policy
D. Only advanced practice nurses have the authority to speak on policy
✅ Correct Answer: B
Rationale: The ANA’s history demonstrates that organized nursing advocacy can
influence large-scale health policy. The lesson is collective engagement, not passive
reliance. Options A, C, and D diminish nursing’s broader role.
Keywords: ANA, collective action, Medicare, Medicaid, systemic change
Q8.
A nursing faculty member asks students to analyze the ethical basis for policy
involvement. Which ethical principle best supports nurses’ duty to engage in health
policy?
A. Justice—addressing inequities and ensuring fair access to care
B. Autonomy—focusing only on individual patient decisions
C. Beneficence—limiting care decisions to the clinical level
D. Fidelity—keeping promises to colleagues rather than society
, ✅ Correct Answer: A
Rationale: Justice drives nurses to advocate for systemic equity, making it the
strongest ethical principle underpinning policy engagement. Autonomy, beneficence,
and fidelity are important but narrower in scope.
Keywords: Ethics, justice, equity, nursing responsibility
Q9.
A state senator asks a nurse leader why nurses should be consulted in health reform.
Which response is most aligned with the chapter’s perspective?
A. “Nurses are the largest segment of the healthcare workforce and bring frontline
insights into policy gaps.”
B. “Nurses can help with bedside teaching but may lack policy knowledge.”
C. “Nurses typically prefer to avoid political debates.”
D. “Nurses only participate in policy if administrators request their input.”
✅ Correct Answer: A
Rationale: Nurses’ large numbers and frontline expertise provide unique perspectives
essential to effective health policy. Options B–D minimize the critical role.
Keywords: Nursing workforce, frontline expertise, policy influence
Q10.
A nurse recalls how Clara Barton’s advocacy led to the creation of the American Red
Cross. What lesson does this historical example provide for nurses today?
A. Policy leadership requires courage to create institutions that meet unmet health
needs
B. Nurses should avoid involvement in nonprofit organizations
C. Individual nurses cannot influence health systems without decades of experience
D. Policy work is too far removed from clinical practice to be relevant
✅ Correct Answer: A
Rationale: Barton demonstrated that a single nurse with vision and advocacy could
establish an institution of lasting public health impact. Options B–D contradict the
message of nursing’s historical influence.
Keywords: Clara Barton, Red Cross, historical leadership, advocacy
Q11.
A nurse notices recurring gaps in community vaccination rates. She wants to influence
policy. Which action best exemplifies moving from passive care to policy leadership?
A. Documenting low vaccination rates in patient charts
B. Collaborating with public health officials to propose a community-wide vaccination
