The American Nurses Credentialing Center’s (ANCC) NP certification exams each contain a small section on professional issues, ranging from 6% (FNP) to 9% (ANP) to 16% (GNP) of the total exam content. This section consists of questions about health care policy, principles of ethical decision-making, reimbursement for services, as well as national NP practice concerns. Although it is a small part of the examination, many certification candidates consider this one of the test’s most challenging portions.
Health Care Ethics
Decision-making in health care is guided in part by certain ethical principles. Some of these principles include beneficence, nonmaleficence, autonomy, justice and utilitarianism.
Beneficence is defined as the provider’s obligation to help people in need. Nonmaleficence is the requirement that the provider do no harm, with or without intention. Nonmaleficence is usually viewed as the corollary to beneficence. Autonomy is the right of the competent person to choose a personal plan of life and action by exercising the rights of self-determination, independence and freedom. To ensure patient autonomy, the health care provider must put aside his or her personal or professional opinion of what the patient should do, and provide him or her with unbiased information about the risks and benefits of treatment. The critical next step is for the health care provider to support and respect the patient’s ability to make a well-informed decision. However, autonomy is not an absolute right, with limitations being placed when the person’s autonomy could interfere with the rights, health or well-being of another. For example, a person with active pulmonary tuberculosis cannot simply refuse therapy; to do so would pose a public health hazard. In a situation where the patient is cognitively impaired, decision-making is often deferred to a health care proxy.
Justice states that all patients are to be treated in the same equitable manner regardless of socioeconomic status, ethnicity, sexual orientation, diagnosis or other personal characteristics. And finally utilitarianism is the allocation of health care resources so that the best is done for the greatest number of people. This principle recognizes that health care is a limited resource that needs to be carefully allocated. Increased utilization of primary prevention services, aimed at avoiding health problems, can help with health care cost savings and help actualize the principle of utilitarianism.
Bearing this information in mind, answer the following questions:
1. Which of the following describes the ethical principle of beneficence?
A. The right of the competent person to choose a personal plan of life and action
B. The obligation of the health care provider to help people in need
C. The duty of health care provider to do no harm
D. The responsibility of the healthcare provider to treat all in the same fair manner
Correct answer: B.
2. Which of the following describes the ethical principle of utilitarianism?
A. Health care resources are allocated so that the best is done for the greatest number of people.
B. The health care provider must be truthful and avoid deception.
C. The health care provider has an obligation to be faithful to commitments made to self and others.
D. The responsibility of the health care provider is to treat all people in the same fair manner.
Correct answer: A.
Professional Liability Insurance
Two types of professional liability insurance policies are available. An occurrence basis policy covers injuries that occur during the period the policy was active, regardless of whether the policy is renewed or continues to be in effect. Consider for example an NP who has an occurrence basis liability insurance policy in place in 2008, but allows the policy to lapse during 2009 when she is no longer in practice. In 2010, a malpractice claim is filed against the NP because of a clinical encounter in 2008. This claim would fall within the coverage of an occurrence basis policy.
In contrast, a claims-made policy covers the NP only if the injury occurs within the policy period, and if the claim is filed during the period the policy is in effect – or when an uninterrupted “tail” insurance policy is in effect. Using the earlier example, the NP had a claims-made liability insurance policy in place in 2008, but allows the primary policy to lapse during 2009 when no longer in practice. In 2010, a malpractice claim is filed against the NP based on a clinical encounter in 2008. This claim would not fall within the coverage of a claims-made policy unless an uninterrupted “tail” insurance policy is effect.
Using the above information, answer the following question:
3. What type of professional liability insurance policy covers you only if the injury occurs within the policy period and the claim is filed during the period the policy is in effect?
A. Claims made
B. Occurrence
C. Interval coverage
D. Incident petition
Correct answer: A
NP Practice Issues: State and National
Each state’s board of nursing (BON) is charged with ensuring public safety. The BON sets minimum education, practice and other requirements for all types of nurses, including NPs. Since each state has distinct requirements for NP scope of practice, no questions specific to a certain state’s practice act will appear on national certification exams. Although achieving certification marks an important professional milestone, holding certification is not equivalent to holding an advanced practice nursing license. You must determine your state’s requirements for NP practice and apply for the appropriate advanced practice licensure.
As you prepare for your exam, remember that each certifying body chooses the exact content of the professional issues section. Use this information to guide your study and increase your likelihood of success.
Answer true or false to the following statements:
4. The NP certification exam will contain a number of questions about my state’s NP practice act.
5. Once I am certified, I can practice as a nurse practitioner.
6. The charge of the State Board of Nursing is to ensure public safety.
Correct answers: 4. False. 5. False. 6. True.
By using this information to your advantage you will be able to examine health care ethics, professional liability insurance, and be aware of NP practice issues on both state and national levels. Bearing this information in mind when you sit for the ANCC NP exam will make this portion of the test far less daunting.
References
Aiken T. Ethics in nursing. In Aiken T. Legal, Ethical and Political Issues in Nursing. 2nd ed. Philadelphia, Pa.: F.A. Davis Inc.; 2004: 97-124.
Buppert, C. (2006) Questions and Answers on Malpractice Insurance for Nurse Practitioners, available at http://www.medscape.com/viewarticle/520660, accessed 6.1.08.
Nursing regulation. National Council of State Boards of Nursing, 2008. Available at: https://www.ncsbn.org/515.htm, accessed 6.1.2008.
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This article originally appeared in my quarterly certification column in Advance for Nurse Practitioners and is made available here by the courtesy of Advance. For other articles of interest to Nurse Practitioners, be sure to subscribe to this outstanding journal