by Margaret A. Fitzgerald, DNP, FNP-BC, NP-C, FAANP, CSP, FAAN, DCC
The American Nurses Credentialing Center’s (ANCC) NP certification exams each contain a section on professional issues. This section consists of questions about healthcare policy, principles of ethical decision-making, reimbursement for services, as well as national NP practice concerns. Although it is a smaller part of the examination, when compared to the clinical content, many certification candidates consider this one of the test’s most challenging portions.
Decision making in healthcare 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 healthcare 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 healthcare 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 healthcare proxy.
The principle of justice dictates that all patients are to be treated in the same equitable manner regardless of socioeconomic status, ethnicity, sexual orientation, diagnosis, or other personal characteristics. Utilitarianism is the allocation of healthcare resources so that the best is done for the greatest number of people. This principle recognizes that healthcare is a limited resource that needs to be carefully allocated. Increased utilization of primary prevention services that are aimed at avoiding health problems can help with healthcare 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 healthcare provider to help people in need
C. The duty of healthcare 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. Healthcare resources are allocated so that the best is done for the greatest number of people
B. The healthcare provider must be truthful and avoid deception
C. The healthcare provider has an obligation to be faithful to commitments made to self and others
D. The responsibility of the healthcare 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 occurred while the policy was active, regardless of whether the policy was renewed or is in effect. For instance, consider 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 he/she is 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
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 healthcare ethics and 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.
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., Questions and Answers on Malpractice Insurance for Nurse Practitioners, available at http://www.medscape.com/viewarticle/520660
, accessed 12.11.11.
Scope of Practice: National Council of State Boards of Nursing, Available at https://www.ncsbn.org/ScopeofPractice.pdf
, accessed 12.11.11.
Click here for Fitzgerald Health Education Associates, Inc. NP Certification Review and Advanced Practice Update Courses