NUR 2868 ROLE AND SCOPE EXAM KEY
CONCEPTS AND CLINICAL APPLICATIONS
GUIDE 2026
◉ Describe what cost shifting is and why it is done. What are the
problems with cost shifting? Answer: Unpaid cost must be covered
by those who do pay so the hospital can continue to operate, this
process is called cost shifting. Providers increase their charges
against households and public and private insurers who pay for
their own care plus make some contribution for care of the
uninsured population. This increases insurance premiums, making it
even more difficult for many households and businesses to afford
coverage. The problem of uncompensated care and cost shifting is a
major reason that many people advocated for some form of national
or universal health insurance coverage. More to see on page 111 in
contemporary nursing book.
◉ Give an example of a third party payer. What is their role in
relation to client and the health care provider? Answer: Third party
payers which are entities other than the patient that assumes
responsibility for payment of health charges. Third party payer
interfere with common principles of a competitive market system. A
competitive market system assumes that people make their
decisions to purchase something on the basis of its price, but
healthcare consumers often pay less than the "full price" because
their insurance pays some or all of the cost.
,◉ Define private health insurance. Give an example of it. How does
this differ from Medicaid? Answer: Private insurance accounts for
the largest percentage of coverage for health care with the cost of
providing health insurance to employees passed on by the employer
to the consumer in the pricing of goods and services. This means
that everyone pays a part of the country's health care cost. Some
examples of private insurances would be HMO, PPO and POS. private
insurance is different for Medicaid in these ways first private
insurance has deductibles and copays in which most Medicaid does
not, also private insurance is offered by an employer Medicaid is a
federal program. To find out more see page 113 in contemporary
nursing book.
◉ When looking at Box 7-2, which of the items listed do you utilize
to reduce healthcare costs? Are there any that you had not
considered before? Answer: • Take care of yourself, manage minor
illnesses yourself at home.
• Use the internet to learn more about your health and preventing
disease
• Recognize early warning signs of disease, and get prompt
treatment from your health care provider.
• Practice preventive health with health screenings and routine self-
examinations. Take advantage of free screenings offered at
community sites, hospitals or churches.
,• Develop an active relationship with health care providers to
improve communications. Ask providers to explain the purpose of
all prescribed tests and medications. Become an informed consumer.
• Use emergency care only in emergencies. See your health care
provider during office hours.
• Know health risks for lifestyles choices, such as alcohol and drug
use, dietary habits, sedentary behaviors, and safety at home and
while driving.
• Understand and use the health care benefits of your insurance plan
to stay healthy. Take advantage of all preventive benefits offered.
• Choose nonhospital alternatives for treatment whenever possible.
Take a conservative approach to health care. Comparison shop for
health care alternatives.
• Choose generic drugs whenever possible. Ask your health care
provider to prescribe the least expensive drugs that will provide
positive outcomes.
• Review your health care bills carefully, and notify the provider
and/or facility and/or agency of errors.
◉ Are there any healthcare cost saving methods you had not
considered before? Answer: For me the only ones I have done are:
Taking care of yourself at home, using the internet, only using the
emergency room for emergencies, choosing nonhospital
alternatives, and generic drugs.
, ◉ What is a case manager? Answer: Nursing case management is
defined as a dynamic and systematic collaborative approach to
provide and coordinate health care services to a defined population.
Nurse case managers actively participate with their clients to
identify and facilitate options and services, providing and
coordinating comprehensive care to meet patient-client health
needs, with the goal of decreasing fragmentation and duplication of
care, and enhancing quality cost effective clinical outcomes. Nurse
case managers continually evaluate each individual's health plan and
specific challenges and then seek to overcome obstacles that affect
outcomes. The framework for nursing case management includes
five components: assessment, planning, implementation, evaluation
and interaction. (P369)
◉ What is quality assurance in nursing? Answer: Nurses are most
successful when they demonstrate efficiency of care with
measurable, effective outcomes. Nursing practice in a cost-and
quality-conscious environment is here to stay. Nurses must
constantly challenge current practice for quality improvement and
cost effectiveness. Accurate data must be collected to show cost
containment and positive patient outcomes. P116 (internet) Quality
standards are generally determined by the intended users of a
service or those that commission or regulate it. Quality assurance is
normally sought through a set of activities that are intended to
ensure that services satisfy customer needs and requirements in a
systematic and reliable manner, Information can be collected
through patient surveys, regulators' audits and by seeking the views
of others, via user groups, for example. Other tools can pick up
quality standards. These include key performance indicators and
CONCEPTS AND CLINICAL APPLICATIONS
GUIDE 2026
◉ Describe what cost shifting is and why it is done. What are the
problems with cost shifting? Answer: Unpaid cost must be covered
by those who do pay so the hospital can continue to operate, this
process is called cost shifting. Providers increase their charges
against households and public and private insurers who pay for
their own care plus make some contribution for care of the
uninsured population. This increases insurance premiums, making it
even more difficult for many households and businesses to afford
coverage. The problem of uncompensated care and cost shifting is a
major reason that many people advocated for some form of national
or universal health insurance coverage. More to see on page 111 in
contemporary nursing book.
◉ Give an example of a third party payer. What is their role in
relation to client and the health care provider? Answer: Third party
payers which are entities other than the patient that assumes
responsibility for payment of health charges. Third party payer
interfere with common principles of a competitive market system. A
competitive market system assumes that people make their
decisions to purchase something on the basis of its price, but
healthcare consumers often pay less than the "full price" because
their insurance pays some or all of the cost.
,◉ Define private health insurance. Give an example of it. How does
this differ from Medicaid? Answer: Private insurance accounts for
the largest percentage of coverage for health care with the cost of
providing health insurance to employees passed on by the employer
to the consumer in the pricing of goods and services. This means
that everyone pays a part of the country's health care cost. Some
examples of private insurances would be HMO, PPO and POS. private
insurance is different for Medicaid in these ways first private
insurance has deductibles and copays in which most Medicaid does
not, also private insurance is offered by an employer Medicaid is a
federal program. To find out more see page 113 in contemporary
nursing book.
◉ When looking at Box 7-2, which of the items listed do you utilize
to reduce healthcare costs? Are there any that you had not
considered before? Answer: • Take care of yourself, manage minor
illnesses yourself at home.
• Use the internet to learn more about your health and preventing
disease
• Recognize early warning signs of disease, and get prompt
treatment from your health care provider.
• Practice preventive health with health screenings and routine self-
examinations. Take advantage of free screenings offered at
community sites, hospitals or churches.
,• Develop an active relationship with health care providers to
improve communications. Ask providers to explain the purpose of
all prescribed tests and medications. Become an informed consumer.
• Use emergency care only in emergencies. See your health care
provider during office hours.
• Know health risks for lifestyles choices, such as alcohol and drug
use, dietary habits, sedentary behaviors, and safety at home and
while driving.
• Understand and use the health care benefits of your insurance plan
to stay healthy. Take advantage of all preventive benefits offered.
• Choose nonhospital alternatives for treatment whenever possible.
Take a conservative approach to health care. Comparison shop for
health care alternatives.
• Choose generic drugs whenever possible. Ask your health care
provider to prescribe the least expensive drugs that will provide
positive outcomes.
• Review your health care bills carefully, and notify the provider
and/or facility and/or agency of errors.
◉ Are there any healthcare cost saving methods you had not
considered before? Answer: For me the only ones I have done are:
Taking care of yourself at home, using the internet, only using the
emergency room for emergencies, choosing nonhospital
alternatives, and generic drugs.
, ◉ What is a case manager? Answer: Nursing case management is
defined as a dynamic and systematic collaborative approach to
provide and coordinate health care services to a defined population.
Nurse case managers actively participate with their clients to
identify and facilitate options and services, providing and
coordinating comprehensive care to meet patient-client health
needs, with the goal of decreasing fragmentation and duplication of
care, and enhancing quality cost effective clinical outcomes. Nurse
case managers continually evaluate each individual's health plan and
specific challenges and then seek to overcome obstacles that affect
outcomes. The framework for nursing case management includes
five components: assessment, planning, implementation, evaluation
and interaction. (P369)
◉ What is quality assurance in nursing? Answer: Nurses are most
successful when they demonstrate efficiency of care with
measurable, effective outcomes. Nursing practice in a cost-and
quality-conscious environment is here to stay. Nurses must
constantly challenge current practice for quality improvement and
cost effectiveness. Accurate data must be collected to show cost
containment and positive patient outcomes. P116 (internet) Quality
standards are generally determined by the intended users of a
service or those that commission or regulate it. Quality assurance is
normally sought through a set of activities that are intended to
ensure that services satisfy customer needs and requirements in a
systematic and reliable manner, Information can be collected
through patient surveys, regulators' audits and by seeking the views
of others, via user groups, for example. Other tools can pick up
quality standards. These include key performance indicators and
