,Contents
Chapter 1 :Informing Public Policy: An Important Role for Registered Nurses
............................................................................................................................... 3
Chapter 2 — News Literacy .............................................................................. 11
Chapter 3 – Problem Identification and Agenda Setting................................. 17
Chapter 4 – Policy Analysis and Design ........................................................... 23
Chapter 5 – Policy Enactment: Legislation and Politics .................................. 29
Chapter 6 – Policy Implementation: Avoiding Policy Failure......................... 35
Chapter 7 – Government Response: Regulation .............................................. 41
Chapter 8 – Health Policy and Social Program Evaluation ............................ 47
Chapter 9 – The Influence of Patient Health Data on Health Policy .............. 53
Chapter 10 – Financing Health Care ................................................................ 59
Chapter 11 – The Impact of Nurse Influence on Global Health Policy .......... 65
Chapter 12 – An Insider’s Guide to Engaging in Policy Activities ................. 71
,Chapter 1 :Informing Public Policy: An
Important Role for Registered Nurses
1. A public health nurse witnesses repeated adverse medication events on a ward caused by
confusing packaging. Which action most directly converts that bedside knowledge into a
persuasive policy intervention for a state-level regulator?
A. Publish a randomized controlled trial testing new packaging formats.
B. Prepare a concise policy brief for the state regulator combining aggregated incident data, root-
cause analysis, and a specific regulatory recommendation.
C. Launch a hospital-level quality improvement (QI) project to change labeling locally.
D. Run for a seat on the state legislature to change laws about packaging.
Answer: B
Rationale: Turning bedside observations into policy requires packaging clinical evidence and
system analysis into a form policymakers can act on — a concise policy brief with aggregated
data, root-cause findings, and a specific regulatory ask is the most direct route to influence a
regulator. Publishing an RCT is valuable but slow and often not needed for regulatory responses;
a local QI project improves local practice but may not change statewide rules; running for office
is a long-term strategy and not the most immediate policy translation mechanism.
Key words: policy brief, evidence translation, regulator, incident data, root-cause.
2. Which of the following is an example of a command-and-control policy instrument that most
directly shapes nursing practice?
A. Public education campaigns about hand hygiene.
B. Financial subsidies for hospitals that meet safety targets.
C. Mandatory licensure requirements and scope-of-practice rules set by statute or regulation.
D. Tax incentives for manufacturers of safety-engineered devices.
Answer: C
Rationale: Command-and-control instruments use legally enforceable rules (laws and
regulations) to mandate behavior; licensure and scope-of-practice requirements are classic
examples that directly constrain and authorize professional practice. Education campaigns are
informational instruments; subsidies and tax incentives are economic instruments.
Key words: command-and-control, licensure, regulation, scope-of-practice.
3. According to Kingdon’s Multiple Streams framework, which activity best fits the policy
stream?
A. Intense media coverage of a local disaster that raises public concern.
B. Development of a set of technically feasible policy proposals by expert committees.
C. A change in public opinion reflected in polling data.
,D. A newly elected government with a different ideological orientation.
Answer: B
Rationale: The policy stream contains the collection of possible policy solutions and alternatives
generated by experts and analysts. Media coverage and public opinion relate to the problem
stream and politics stream respectively; political leadership belongs to the politics stream. The
policy stream is about feasibility, design, and technical viability of options.
Key words: Kingdon, policy stream, proposals, feasibility.
4. A nurse who acts as a knowledge broker between researchers and legislators is most likely to
perform which activity?
A. Administer an evidence-based intervention at the bedside.
B. Translate a complex health services study into a 1-page policy brief with local implications
and a clear legislative ask.
C. File an institutional incident report.
D. Train new nurses on clinical documentation procedures.
Answer: B
Rationale: Knowledge brokers synthesize and translate research into usable formats for
decision-makers — concise briefs with local data and a clear ask are emblematic of this role.
Bedside administration, incident reporting, and clinical training are important, but they are not
the intermediary translation function that defines knowledge brokering.
Key words: knowledge broker, translation, policy brief, local data.
5. Which action would violate standard ethical and legal expectations when a nurse uses patient
cases to advocate for policy change?
A. Asking a discharged patient for written consent to share their story with legislators.
B. Presenting aggregated de-identified data on adverse outcomes to a policymaker.
C. Posting a detailed, identifiable patient medical record on social media to illustrate system
failures without consent.
D. Using a de-identified composite vignette that preserves clinical detail but removes identifying
elements.
Answer: C
Rationale: Sharing identifiable patient records without informed consent violates privacy laws
(e.g., HIPAA in the U.S. context) and professional ethics. Obtaining consent, using aggregated
de-identified data, or composing de-identified composites are acceptable and ethical advocacy
strategies.
Key words: confidentiality, privacy, consent, de-identification, ethics.
6. A nurse preparing a policy case on access to primary care in a rural county should choose
which metric as the strongest evidence of access problems for policymakers?
A. Hospital patient satisfaction scores.
,B. Rate of potentially preventable hospitalizations or ambulatory care-sensitive admissions.
C. Proportion of nurses with advanced degrees.
D. In-hospital mortality for surgical procedures.
Answer: B
Rationale: Potentially preventable hospitalizations (ambulatory care-sensitive admissions) are
widely used indicators of inadequate access to timely primary care — they link primary-care
system performance to downstream hospital utilization. Satisfaction scores and provider
education levels are indirect; surgical mortality is not primarily an access metric for primary
care.
Key words: access to care, ambulatory care-sensitive conditions, preventable hospitalizations.
7. Which event is most likely to open a policy window, enabling rapid adoption of a nursing-led
policy proposal?
A. Publication of a technical modeling paper with complex simulations.
B. A routine annual budget review with predictable timelines.
C. High-profile media coverage of a sentinel event (e.g., preventable maternal death) that focuses
public and political attention.
D. Gradual accumulation of small improvements in quality metrics over a decade.
Answer: C
Rationale: Policy windows open when the problem, policy, and politics streams align — sudden
high-visibility events that attract media and public attention frequently create urgency and
political will to act. Technical papers and gradual improvements may change perceptions over
time but are less likely to create immediate windows.
Key words: policy window, agenda setting, sentinel event, media.
8. A state nursing association aims to expand nurse practitioner (NP) practice authority. Which
combination of tactics is most evidence-based and politically strategic?
A. Rely solely on NP testimonials during floor speeches.
B. Build a multidisciplinary coalition, present rigorous comparative outcome and cost data, and
propose clear regulatory guardrails.
C. Use only emotional appeals at town halls without empirical data.
D. Threaten work stoppages to force legislative action.
Answer: B
Rationale: Expanding scope requires both political strategy and evidence: coalition building
reduces opposition, comparative outcomes and cost data address safety/efficiency concerns, and
proposing regulatory safeguards eases fears about quality. Testimonials and emotional appeals
help but are insufficient alone; strikes are risky ethically and politically.
Key words: scope of practice, coalition, comparative outcomes, regulatory safeguards.
, 9. The legislature enacts a statute that authorizes the State Board of Nursing to “adopt rules
governing telehealth practice for RNs and APNs.” Which statement is correct about the legal
effect?
A. The statute itself contains the detailed telehealth practice standards; no further action is
needed.
B. The State Board of Nursing must now engage in rulemaking to create enforceable regulations
that operationalize the statute’s intent.
C. Individual hospitals write legally binding telehealth laws.
D. Telehealth standards are left entirely to federal agencies and the state board has no authority.
Answer: B
Rationale: A statute can set broad policy direction and delegate authority to an administrative
body; the delegated body (State Board of Nursing) typically develops detailed regulations via
rulemaking to implement the statute. Hospitals cannot enact state law, and federal agencies may
have roles but do not preclude state rulemaking in areas of state licensure.
Key words: statute, delegation, rulemaking, administrative agency.
10. Which activity is most characteristic of the policy implementation stage rather than
enactment or agenda setting?
A. Drafting bills and securing committee sponsors.
B. Publishing administrative rules, training frontline staff, and allocating funds to departments
that will carry out the law.
C. Conducting media campaigns to raise awareness of a problem.
D. Identifying a problem and framing it for policymakers.
Answer: B
Rationale: Implementation is where laws become practice: agencies develop rules, issue
guidance, organize training, and allocate resources to operationalize legislative intent. Drafting
bills and agenda framing belong to enactment/agenda setting. Media campaigns are typically
advocacy/agenda work.
Key words: implementation, rulemaking, training, resource allocation.
11. When a nurse testifies before a legislative committee, which communication approach is
most likely to persuade committee members with limited clinical background?
A. A 20-page technical appendix explaining statistical methods.
B. A one-page executive summary with the problem statement, local data, a clearly defined
policy option, and the measurable expected impact.
C. A long anecdote without data that focuses on emotion.
D. Delivering testimony full of clinical jargon to demonstrate expertise.
Answer: B
Rationale: Policymakers favor concise, actionable materials that link problem to a clear
recommended solution and measurable impact; local data increases relevance. Technical
appendices can be available as supplements but are not persuasive in testimony itself.
Chapter 1 :Informing Public Policy: An Important Role for Registered Nurses
............................................................................................................................... 3
Chapter 2 — News Literacy .............................................................................. 11
Chapter 3 – Problem Identification and Agenda Setting................................. 17
Chapter 4 – Policy Analysis and Design ........................................................... 23
Chapter 5 – Policy Enactment: Legislation and Politics .................................. 29
Chapter 6 – Policy Implementation: Avoiding Policy Failure......................... 35
Chapter 7 – Government Response: Regulation .............................................. 41
Chapter 8 – Health Policy and Social Program Evaluation ............................ 47
Chapter 9 – The Influence of Patient Health Data on Health Policy .............. 53
Chapter 10 – Financing Health Care ................................................................ 59
Chapter 11 – The Impact of Nurse Influence on Global Health Policy .......... 65
Chapter 12 – An Insider’s Guide to Engaging in Policy Activities ................. 71
,Chapter 1 :Informing Public Policy: An
Important Role for Registered Nurses
1. A public health nurse witnesses repeated adverse medication events on a ward caused by
confusing packaging. Which action most directly converts that bedside knowledge into a
persuasive policy intervention for a state-level regulator?
A. Publish a randomized controlled trial testing new packaging formats.
B. Prepare a concise policy brief for the state regulator combining aggregated incident data, root-
cause analysis, and a specific regulatory recommendation.
C. Launch a hospital-level quality improvement (QI) project to change labeling locally.
D. Run for a seat on the state legislature to change laws about packaging.
Answer: B
Rationale: Turning bedside observations into policy requires packaging clinical evidence and
system analysis into a form policymakers can act on — a concise policy brief with aggregated
data, root-cause findings, and a specific regulatory ask is the most direct route to influence a
regulator. Publishing an RCT is valuable but slow and often not needed for regulatory responses;
a local QI project improves local practice but may not change statewide rules; running for office
is a long-term strategy and not the most immediate policy translation mechanism.
Key words: policy brief, evidence translation, regulator, incident data, root-cause.
2. Which of the following is an example of a command-and-control policy instrument that most
directly shapes nursing practice?
A. Public education campaigns about hand hygiene.
B. Financial subsidies for hospitals that meet safety targets.
C. Mandatory licensure requirements and scope-of-practice rules set by statute or regulation.
D. Tax incentives for manufacturers of safety-engineered devices.
Answer: C
Rationale: Command-and-control instruments use legally enforceable rules (laws and
regulations) to mandate behavior; licensure and scope-of-practice requirements are classic
examples that directly constrain and authorize professional practice. Education campaigns are
informational instruments; subsidies and tax incentives are economic instruments.
Key words: command-and-control, licensure, regulation, scope-of-practice.
3. According to Kingdon’s Multiple Streams framework, which activity best fits the policy
stream?
A. Intense media coverage of a local disaster that raises public concern.
B. Development of a set of technically feasible policy proposals by expert committees.
C. A change in public opinion reflected in polling data.
,D. A newly elected government with a different ideological orientation.
Answer: B
Rationale: The policy stream contains the collection of possible policy solutions and alternatives
generated by experts and analysts. Media coverage and public opinion relate to the problem
stream and politics stream respectively; political leadership belongs to the politics stream. The
policy stream is about feasibility, design, and technical viability of options.
Key words: Kingdon, policy stream, proposals, feasibility.
4. A nurse who acts as a knowledge broker between researchers and legislators is most likely to
perform which activity?
A. Administer an evidence-based intervention at the bedside.
B. Translate a complex health services study into a 1-page policy brief with local implications
and a clear legislative ask.
C. File an institutional incident report.
D. Train new nurses on clinical documentation procedures.
Answer: B
Rationale: Knowledge brokers synthesize and translate research into usable formats for
decision-makers — concise briefs with local data and a clear ask are emblematic of this role.
Bedside administration, incident reporting, and clinical training are important, but they are not
the intermediary translation function that defines knowledge brokering.
Key words: knowledge broker, translation, policy brief, local data.
5. Which action would violate standard ethical and legal expectations when a nurse uses patient
cases to advocate for policy change?
A. Asking a discharged patient for written consent to share their story with legislators.
B. Presenting aggregated de-identified data on adverse outcomes to a policymaker.
C. Posting a detailed, identifiable patient medical record on social media to illustrate system
failures without consent.
D. Using a de-identified composite vignette that preserves clinical detail but removes identifying
elements.
Answer: C
Rationale: Sharing identifiable patient records without informed consent violates privacy laws
(e.g., HIPAA in the U.S. context) and professional ethics. Obtaining consent, using aggregated
de-identified data, or composing de-identified composites are acceptable and ethical advocacy
strategies.
Key words: confidentiality, privacy, consent, de-identification, ethics.
6. A nurse preparing a policy case on access to primary care in a rural county should choose
which metric as the strongest evidence of access problems for policymakers?
A. Hospital patient satisfaction scores.
,B. Rate of potentially preventable hospitalizations or ambulatory care-sensitive admissions.
C. Proportion of nurses with advanced degrees.
D. In-hospital mortality for surgical procedures.
Answer: B
Rationale: Potentially preventable hospitalizations (ambulatory care-sensitive admissions) are
widely used indicators of inadequate access to timely primary care — they link primary-care
system performance to downstream hospital utilization. Satisfaction scores and provider
education levels are indirect; surgical mortality is not primarily an access metric for primary
care.
Key words: access to care, ambulatory care-sensitive conditions, preventable hospitalizations.
7. Which event is most likely to open a policy window, enabling rapid adoption of a nursing-led
policy proposal?
A. Publication of a technical modeling paper with complex simulations.
B. A routine annual budget review with predictable timelines.
C. High-profile media coverage of a sentinel event (e.g., preventable maternal death) that focuses
public and political attention.
D. Gradual accumulation of small improvements in quality metrics over a decade.
Answer: C
Rationale: Policy windows open when the problem, policy, and politics streams align — sudden
high-visibility events that attract media and public attention frequently create urgency and
political will to act. Technical papers and gradual improvements may change perceptions over
time but are less likely to create immediate windows.
Key words: policy window, agenda setting, sentinel event, media.
8. A state nursing association aims to expand nurse practitioner (NP) practice authority. Which
combination of tactics is most evidence-based and politically strategic?
A. Rely solely on NP testimonials during floor speeches.
B. Build a multidisciplinary coalition, present rigorous comparative outcome and cost data, and
propose clear regulatory guardrails.
C. Use only emotional appeals at town halls without empirical data.
D. Threaten work stoppages to force legislative action.
Answer: B
Rationale: Expanding scope requires both political strategy and evidence: coalition building
reduces opposition, comparative outcomes and cost data address safety/efficiency concerns, and
proposing regulatory safeguards eases fears about quality. Testimonials and emotional appeals
help but are insufficient alone; strikes are risky ethically and politically.
Key words: scope of practice, coalition, comparative outcomes, regulatory safeguards.
, 9. The legislature enacts a statute that authorizes the State Board of Nursing to “adopt rules
governing telehealth practice for RNs and APNs.” Which statement is correct about the legal
effect?
A. The statute itself contains the detailed telehealth practice standards; no further action is
needed.
B. The State Board of Nursing must now engage in rulemaking to create enforceable regulations
that operationalize the statute’s intent.
C. Individual hospitals write legally binding telehealth laws.
D. Telehealth standards are left entirely to federal agencies and the state board has no authority.
Answer: B
Rationale: A statute can set broad policy direction and delegate authority to an administrative
body; the delegated body (State Board of Nursing) typically develops detailed regulations via
rulemaking to implement the statute. Hospitals cannot enact state law, and federal agencies may
have roles but do not preclude state rulemaking in areas of state licensure.
Key words: statute, delegation, rulemaking, administrative agency.
10. Which activity is most characteristic of the policy implementation stage rather than
enactment or agenda setting?
A. Drafting bills and securing committee sponsors.
B. Publishing administrative rules, training frontline staff, and allocating funds to departments
that will carry out the law.
C. Conducting media campaigns to raise awareness of a problem.
D. Identifying a problem and framing it for policymakers.
Answer: B
Rationale: Implementation is where laws become practice: agencies develop rules, issue
guidance, organize training, and allocate resources to operationalize legislative intent. Drafting
bills and agenda framing belong to enactment/agenda setting. Media campaigns are typically
advocacy/agenda work.
Key words: implementation, rulemaking, training, resource allocation.
11. When a nurse testifies before a legislative committee, which communication approach is
most likely to persuade committee members with limited clinical background?
A. A 20-page technical appendix explaining statistical methods.
B. A one-page executive summary with the problem statement, local data, a clearly defined
policy option, and the measurable expected impact.
C. A long anecdote without data that focuses on emotion.
D. Delivering testimony full of clinical jargon to demonstrate expertise.
Answer: B
Rationale: Policymakers favor concise, actionable materials that link problem to a clear
recommended solution and measurable impact; local data increases relevance. Technical
appendices can be available as supplements but are not persuasive in testimony itself.
