NURSING AS A PROFESSION

Profession
Occupation
Calling
With advanced training and experience in a specialized knowledge
Provides service to society
Nursing
Occupation requiring a unique body of knowledge, skills and attitude
Which serves society.
Professional Nurse
A person who has completed a basic nursing education program
Licensed in his / her country or state to practice professional nursing.

Professional Preparation
Have a license to practice nursing in the country
Have a Bachelor of Science degree in Nursing
Be physically and mentally fit
Personal Qualities and Professional Proficiencies
Willingness to work and learn
A warm personality and concern for people
Resourcefulness and creativity
Ability to work cooperatively
Initiative to improve self and service
Competence
Skill in decision-making, communicating, and relating with others and being research oriented
Active participation in issues confronting nurses

Basic Educational Program in Nursing

Until 1983 - Bachelor of Science in Nursing . *
Three-year hospital-based program leading to the title Graduate in Nursing was phased out.
However, effective School Year 1998-1999, the curriculum for the common two-year Associate in Health Science Education
(AHSE) was enforced.*
The BSN Curriculum:
BSN Program offers a competency-based community oriented curriculum
It aims to prepare nurses for entry level positions in any health care setting in the country,
i.e., hospitals, clinics, health care centers, homes, and communities.

Key Areas of Responsibilities

Objective of BSN Program

Caring behavior
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Ability to practice legal, ethico- moral, social responsibilities / accountabilities;
Skill in practicing S-K-As
Nursing students must have graduated from a college of nursing which has been properly accredited to offer the nursing course.

LICENSE
Legal document that permits a person to offer to the public his/her skills and knowledge
Fulfillment of certain established requirements.
Professional Regulation Commission (PRC).
Authority to administer, implement, and enforce the regulatory policies with respect to the regulation and licensing of the
various professions and occupations

Need for Licensure

Protection of health
Licensure discourages misrepresentation as nurses.
Tool for legal control and enforcement of nursing practice.
It is also used to gather statistical data
Registration:
Recording of names of persons who have qualified
Contains the following information.
Full name of registrant
Number and date of registration
Age, sex, and place of birth
Place of business
Post office address
Names of school, college or university from which he or she graduated
Date of such graduation or term of study
All other degrees granted to him or her
A Certificate of Registration is issued

Registration Required
Philippine Nursing Act of 2002, R.A. 9173,
Section 12 and 20
License to practice nursing shall be issued to those who pass the licensure examination or by reciprocity.

Registration by Examination

Examination and Registration: ( R.A 9173, Section12 and 13).

Requirements for Examination:
TOR with SO
RLE
Actual number of OR Scrubs and deliveries assisted
Where applicable:
Birth Certificate
Marriage Certificate
Alien Certificate of Naturalization, and

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 Clearance showing dismissal of case from the court or Prosecutor’s Office, if any.

Registration by Reciprocity (R.A. 9173, Sec. 20)

Reciprocity
Mutuality in the grant and enjoyment of privileges between persons or nations.
“do ut des ”
For a country to expect a favor from another, it should be willing to give a corresponding favor.

Fees for Examination and Registration:

Scope of Examination:
R.A 9173, Section 14

Citizenship Requirements
Article IV Section 1-5 of the 1987 Philippine Constitution:
Section 1
Those who are citizens of the Philippines
Those who elect Philippine citizenship
Section 2
A female citizen of the Philippines who marries an alien shall retain her Philippine citizenship, unless by her act or omission
she is deemed, under the law, to have renounced her citizenship.

Section 3
The Philippine citizenship may be lost or re-acquired in the manner provided for by law.

Section 4
A natural-born citizen is one who is a citizen of the Philippines from birth

“Jus Sanguinis” Doctrine

Nationality of a person is determined by the law of his descent or parantage

“Jus Soli”Doctrine
the nationality of a person is determined by the law of the place of his birth;

Naturalization
is the act of adopting a foreigner and giving him the privileges of a native citizen.

Rating of the Nursing Licensure Examination

Philippine Nursing Act of 2002, R.A 9173, Section 15 ).
- 75% with rating not below 60%
- Specific number of times an examinee may take the licensure exam has been deleted
- Added: Removal examination shall be taken within two years after the last failed examination
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 Oath-Taking of Nurses
All successful candidates in the examination shall be required to take an oath of profession before the Board
Within 15 days upon the release of result
Pledge to support and defend the Constitution
Assisted by the Accredited Professional Organization.

Certificate of Registration / Professional License and Professional Identification Card

A certificate of registration / professional license as a nurse shall be issued to an applicant who passes the examination upon
payment of the prescribed fees.

A professional ID card shall likewise be issued to every registrant upon payment of the required fees.

Annual Registration
Payment for three (3) years
Surcharge of 20% shall be charged for late payment
Considered suspended after 5 years of non payment
Practitioner’s name shall be dropped from the annual roster
The professional may be reinstated only upon application and payment

Automatic Registration of Nurses

All nurses whose names appear at the roster of nurses shall be ipso facto registered as nurses

Non-registration and Non-issuance of

Certificates of registration / Professional
License or Special / Temporary Permit

No person convicted by final judgment of any criminal offense or any person declared by the court to be of unsound mind shall be
registered and be issued a certificate of registration / professional license or a special / temporary permit.

Revocation or Suspension of Certificates:

The license to practice nursing is not a permanent or vested right since it may be granted upon condition and it may be held subject to
conditions.
A license cannot be revoked arbitrarily, it can only be revoked for special causes.

Re-issuance of Revoked Certificates:

Refer to Philippine Nursing Act of 2002, R.A 9173, Section 24
Suspension
Nurse is not allowed to practice temporarily
The license is not confiscated.
Revocation
Means that the license to practice is confiscated either temporarily or permanently.

Due Process of Law

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Twin element of hearing and defense
1. Accused is presumed innocent until proven guilty
2. Right to free access to courts
3. Right to remain silent and to have a competent counsel
4. Right to bail and against excessive bail
5. Presumption of innocence
6. The right to be heard and counsel
7. Right to be informed of the nature of complaint
8. Right to speedy, impartial, public trial
9. Right to meet the witness face to face
10. Production of evidence
11. Right against self-incrimination
12. Information of the rights of accused
13. Right against use of force, violence, threat that vitiates free will
14. Right against cruel punishment
15. Right against excessive fines
16. Right against double jeopardy
Fields of Nursing
Hospital or Institutional Nursing
Public Health Nursing
Private Duty or Special Duty Nursing
Industrial or Occupational Health Nursing
Nursing Education
Military Nursing
School Nursing
Clinic Nursing
Independent Nursing Practice
Hospital or Institutional Nursing
BSN
Registered Nurse
Participates in all phases of patient care
Performs nursing measures
Participation in research and training
Advantages
Presence of Supervisor
Updated with new trends
Undergo rotation to different units
40 hours/week duty with SL, VL
Chance to get promoted

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Salary increases
Important member of the health team
More staff development
Disadvantages
Possibility of understaffing
Some don’t find time to improve their skills
If the hospital is far flung, no CME
Administrative problems and overwork
Nursing Service Administrator
Sec. 29, RA 9173, must possess:
BSN with 9 units MA in Mgt. and Admin
RN
At least 2 years of experience in admin
Member of good standing of APO

CHIEF NURSE
5 years experience in supervisor or mgr.
MAN
Primary Hospitals – sub. sec. a, b, c
Public Health Agencies – priority to MA in Public Health
Military Hospitals – MAN, General Staff Course (GSC)
5 years grace period before effectivity
IRR–Memo Circ.#2000-05 series of 2000, PRC

Nursing Specialty Certification

Sec. 29 – Comprehensive Nursing Specialty Program
Adoption of Nursing Specialty Certification Program
BON Resolution#14, series of 1999
Nursing Certification Council
Funding is PCSO
2 years return of service

Benefits of Certification
Standards improve quality of care
Measures expertise
Continued competence
Confronting the demands of health care
Lifelong learning
Enhances the nurse’s self image
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 Public Health Nursing / Community Health Nursing
Promotion of health and prevention of diseases
Needs a deeper involvement and close cooperation with all members of the health team
Needs effective coordination
Advantages
Focus is on family and community health
Better perspective of health conditions of the community
Maximizes efforts to improvise
Utilization of community resources
Focus of care is more on education
Individuals assumes responsibility for own health care
Disadvantages
Limited mostly to chronic or CD
Exposure to elements
No fixed hours of work
Not as exciting and glamorous
Facilities for care of sick is limited so that skills is also limited
Not immediately aware of trends
Not a place for introverts
No immediate supervisor to consult
In-Service Education Programs
One way of improving service in hospitals and public health agencies
In charge of staff development training and research
Nursing Coordinators
- 4 years of clinical practice and research
- MAN
Nurse Instructors
- 2 years of clinical practice and research
- MAN
Quality Assurance Coordinators
- Clinical nursing and research
- Training in Quality Assurance
Nurses in This Field Need:
1. 2 years in basic nursing practice
2. Skills in teaching, supervision and consultation
3. Relationship to the process of administration and research
4. Understanding of desirable practices
5. Use of problem-solving approach
6. Functions of the revising personnel
7. Understanding of self and others involved in in-service education
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8. Ability to plan and implement programs
Private Duty Nursing
RN who undertakes to gave comprehensive nursing care to a client on a one-to-one ratio
Independent contractor
Patient may be provided care in the hospital or home

General Private Duty Nurse

Assessment and interpretation of the general condition as basis for planning
ID of emotional/social factors
Application of scientific principles
Working with patients family
Utilization of laboratory and diagnostic test
Knowledge and recognition of pharma effects of drugs
Interpretation of doctor’s orders
Private Duty Nurse Specialist
Skill in handling, operating devices
Skill in interpreting data
Skill in observing signs and symptoms
Promptness and adeptness in instituting appropriate nursing measures

Qualifications of a Private Nurse Practitioner

1. RN
2. Professional Tax Receipt, PRC card, and residence certificate
3. 2 years of bedside nursing experience as a professional nurse in a hospital prior to application
4. Recommended by the Director of Nursing service
5. Be a full time private duty nurse
6. Preferably have undergone Critical Care Nursing Course
7. Be a certified IV nurse therapist by the ANSAP (Optional)
Requirements
Orientation in the hospital
Complete paraphernalia
Full white nurse’s uniform
Medical Certificate
2 character references
3 CME’s
Certification as an IV therapist
General Guidelines
Directly under the supervision of the Nursing Service with verbal and written report

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Responsible for nursing care especially a safe, sanitary and healthful environment
Shall endeavor to give complete nursing care before going off duty
Subject to regular audit
Travel Abroad
Passport and other travel papers shouldered by the patient
Should in the possession of the PDN
Travel and accidental insurance of 50k
Salary computed at 8 hrs by 2 shifts
Daily travel allowance is negotiable
Separate room for female PDN and male patient
Hotel, lodging, food expenses paid by employer
PDN is Required To:
Leave with PDNA possible address of destination and tentative duration
Report presence to the nearest nursing org in the area
Report to the PNA arrival to the country
Advantages
The chance to see life as it really is
The opportunity to make real friends
The chance to travel
The ability to own time
Update with trends
Challenge of giving the best
Disadvantages
1. Total dependence of patient
2. PDN graduated so long ago with no upgrade in skills and knowledge
3. There are not enough nurses for PM, holiday, weekends and vacation period
4. Minimizes opportunity for developing good relationships with others
5. Resentment of supervision by hosp staff
6. Little assistance given by the head nurse
7. Little or no participation in prof. activities
8. Experienced PDN receive the same fee as new graduates
9. Greater need for liability insurance
10. No retirement, insurance and medicare benefits unless voluntarily

Occupational Health Nursing / Industrial Nursing

1958, Industrial Nurses in the USA called themselves Occupational Health Nurses
Provides and delivers health care services to workers
BSN
Training in Emergency Nursing

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Knowledge of company policies
Custodians of employees health records
Advantages
Works only during day hours
Off duty during weekends
Seniority wage increases, pensions and insurances
Wide variety of help available
Disadvantages
Often work alone
Bargain for salary
Pay is probably less than in hospital work
Legal responsibility risks
Nursing Education
Career opportunities in nursing education
Chronic teacher shortage in nursing education

Qualification
RN
1 yr of clinical practice in field of specialization
Member of APO (Accredited Professional Organization)
MAN, Education or other Medical Health Sciences
Qualities and Responsibilities
Capability to promote interest
Competence
Resourcefulness with infinite patience. They must inspire students
Expertise in providing nursing care in the chosen field
Good role model

Dean
MAN
5 years of experience in teaching and supervision
Post-Master’s Degree of a Doctorate Degree in Nursing for Graduate Program

Advantages
Salary is higher than those who are working in the hospitals
Nursing Education is interesting, important and challenging
Minimum 24 hours and max 40 hours teaching load
Not that hazardous compared to hospital

Disadvantages
Requires infinite patience to teach

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No work, No pay during breaks
Military Nursing
Tandang Sora 1890
Nurse Corps – before outbreak of WWII
Commonwealth Act # 1- National Defense Act – establishment of a med service in the Army of the Philippines, no corps
Commonwealth Act # 385 – Nurse Corps
September 5, 1938 – Foundation Day
EO # 2167 – April 15, 1940
- Organization of the PA Nurse Corps
RA 479 – June 10, 1950
- Gave credit to the services of Military Nurses during the war
August 1952 – Nurse Corps, AFP
Prior to 1973 – Chief Nurse was merely a staff of the Surgeon General
June 21, 1973
Chief Nurse has been afforded the prerogative to decide on matters affecting the Nurse Corps
Gen. Elvegia R. Mendoza – the first Military Nurse to hold this rank

Qualification for Commission in the Reserve Force Nurse Corps

1. BSN
2. RN
3. Natural Born Citizen
4. Single or has never been married for both male and female candidates
5. Female must not positively be found to have given birth to a living or still born child
6. Mentally and physically fit
7. Pleasing personality and good moral char.
8. Skillful in:
- applying nursing process
- communicating
- making sound rational judgment
9. Willing to work in peaceful and wartime
10. Not be more than 32 yo of age at time of commission
11. Height requirements

- minimum of 62 inches for males

- minimum of 60 inches for females

Qualifications for Commission in the Regular Force Nurse Corps

Pass the rigid screening and battery test
Height requirements
- minimum of 64 inches for males
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 - minimum of 62 inches for females
Not be more than 26 yo at the time of regular commission

Qualifications for General Duty Nurse

Must have the rank of 2LT
Adequate knowledge of general nursing
Must have knowledge of new developments in the nursing field
Demonstrate ability to perform comprehensive nursing care

Medical Corpsmen
Highly trained enlisted personnel who help in the care of patients, especially males
Nursing Attendants
Unskilled non-professionals
Advantages
1. Higher Salary Rate according to rank
a. benefit as 2LT
b. Flight pay for flight nurses = 50%
c. Hazard Pay = 20% of base pay
d. Cold weather allowance
e. Overseas pay
2. Glamour and prestige of the uniform
3. Hospitalization and free medical benefits
4. Military schooling and basic training
5. Opportunity to meet people
6. Opportunity to attend gala, social functions and parade
7. Opportunity to travel abroad
School Health Nursing
Must like children a lot
Responsible for the school’s activities in the areas of health service, health education and environmental health and safety
Health promotion program
Coordination with school personnel
Advantages
Affords one the opportunity to watch children advance from grade to grade
Hours are usually good
There is no shift duty
Disadvantages
Does not update themselves on the current issues
Should enjoy working with children
Educational functions of the school
Clinic Nursing

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Acts as receptionist, answers phone, does the billing, takes x-rays, change dressings
Health education
Assist the physician in procedures
Advantages
Favorable working hours
Satisfaction of working with people
Disadvantages
- Salary slightly lower than hospital nurses

Independent Nursing Practice

Self employed
Provides professional nursing service
Most are community based
Contribute to the improvement of health care in the country
Not included in nursing program

Contracts
Meeting of minds between two persons where they bind themselves to give something or to render services.

As long as it is not contrary to law, morals, good customs, public order and public policy

Kinds of Contracts
1. Formal Contract
- agreement between parties and required in writing
2. Informal Contract
- concluded as a result of a written doc, silent, or oral discussion
3. Express Contract
- Conditions are given orally or in writing

4. Implied Contract
- Result of acts of conduct of the parties to which the law ascribes an objective intention to enter into a contract.
5. Void Contract
- One that is inexistent from the very beginning and therefore may not be enforced
6. Illegal Contract
- One that is expressly prohibited by law

Requisites
1. Two or more persons must participate
2. Parties involved must give consent
3. Subject matter must be specified
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 a. all things which are not outside the commerce of man
b. rights which are not transmissible
c. future inheritance expressly authorized by law
d. all services not contrary to law, morals, good customs, public order and policy
4. Cause of obligation is established
5. Legal capacity
a. legal age
b. sound mind
c. not under influence of intoxicating drugs or duress
d. not suffering from mental disability
Inexistent Contracts
1. Contrary to morals, good customs, public order or policy
2. Cause or object did not exist from the time of transaction
3. Object is outside the commerce of man
4. An impossible service
5. Intention of the parties cannot be ascertained
6. Expressly prohibited or declared void by law
7. Absolutely simulated and fictitious

Voidable Contracts
1. Incapable of giving consent to a contract
2. Consent is vitiated by mistake, violence, intimidation, undue influence or fraud

Illegal Contracts
1. Those that are made in protection of the law
2. Consent obtained by fraud
3. Obtained under duress
4. Obtained under due influence
5. Obtained through material representation
Breach of Contract
1. Prevention of performance
2. Failure to perform because of inconvenience or difficulty
3. Failure of cooperation in performance
4. Abandonment of duty (SENTOSA CASE)
- leaving unconscious patients, going off duty without endorsement, walkout
5. Substitution of performance
6. Failure to use due care
Legal Excuses for Refusing, Neglecting, or Failure to Perform
1. Discovery of material representation

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 2. Where performance is illegal
3. Performance is made impossible by reason of illness
4. Death
5. Performance is made for other reasons
6. Contract is insufficient
Advantages of Written Contract
1. Written contract is certain
2. It can specify a definite time
3. Prevents haggling over compensation
4. Establish standards and protection against discrimination in compensation
5. It is definite on many details
6. Protection against arbitrary action
7. Security for the employee

Ethics

Ethos – moral duty. Refers to a standard of a moral life

Moralis – social consensus about moral conduct

Ethical Principles
1. Telelogical Approach – “telos” or good end,
“the right thing to do is the good thing to do.”
2. Deontological Approach or Duty-oriented Theory
deon = duty
an act depends on the intrinsic nature
3. Virtue Ethics Approach or Aretaic Ethics
Based on the heart of the person performing the act
4. Devine Command Ethics
There is a Supreme Being that sets down the rules to provide guidance
a. Autonomy – autos= self and nomos = governance. Involves self-determination and freedom to choose decision
b. Veracity – Telling the truth.
Benevolent Deception – intentionally withholding information

Ethical Concepts
a. Rights
It is the legal or moral entitlement to do or refrain from doing something
b. Autonomy
Self-determination, not subjected to the controlling constraint of others.

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 c. Beneficence
- To do good and not to do harm
- One ought not to inflict evil or harm or Maleficence
- One ought to prevent evil or harm
- One ought to remove evil of harm
- One ought to do or promote good
d. Justice
The obligation to be fair to all people
e. Fidelity
The obligation to be faithful
f. Veracity
Telling the truth or not intentionally deceiving or mislead

LAW
The sum total of rules and regulations by which society is governed.
Man-made and regulates social conduct in a formal and binding way.

3 Essential Characteristics
Authority or the right to declare that the rule exists
Such rule is pronounced or expressed and that its source can be identified
A right to enforce the same must be provided

History of The Philippine Nursing Law

1. Act No. 2493 of 1915
This act provided for the examination and registration of nurses in the PI
- 20 y/o
- graduate of intermediate course
- 2.5 years of instruction
- called first class nurses
2. Act No. 2808 of 1919
The First True Nursing Law
- Board of Examiners for Nurses
- 1920 – first board examination
3. Republic Act 877 – Philippine Nursing Law – June 19, 1953
- organization of BOE
- provisions regarding nursing schools
- the need for registration as nurse
- prohibition in the practice of nursing with penal provision
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4. Republic Act 4704 of June 18, 1966
Amended certain portion of RA 877
- members of BOE from 3 to 5
- appointed by the president
- master’s degree for the BOE
- disqualifying age limit not over 65yo
- compensation per annum is 18k
- academic qualification of Deans, Directors of Colleges and Schools of Nursing is MAN
- Areas of study required for entrance to colleges and schools of nursing
- the scope of nursing practice was broadened
- date of exam was no longer fixed
- Min. age required of applicants is now 18

5. Republic Act 7164 by Sen. Heherson Alvarez or Philippine Nursing Act of 1991
- redefinition of the scope of nursing practice
- requiring faculty member to resign from his post once appointed to the BON
- MAN as pre-requisite to teaching
- qualifications of administrators of nursing services

RA 9173 Philippine Nursing Act of 2002

BON is composed of a Chairman and 6 members
Submission of names of qualified nominees by the APO to the Commission
Submission to the office of the President
Qualifications of Board Members
Powers and duties of the Board
1. Licensure Examination and Registration
- Specific dates of exam has been deleted
- Specific age of applicants to take exam to be at least 18 yo has been deleted
RA 9173 Philippine Nursing Act of 2002
2. Ratings, Sec. 15 RA 9173
- Specific number of times an examinee may take the licensure exam has been deleted
- Added: Removal examination shall be taken within two years after the last failed examination
RA 9173 Philippine Nursing Act of 2002
3. Revocation and Suspension of Certificate of Registration
- Added: Violation of RA 9173, Implementing Rules and Regulations, the Code of Ethics, the Code of Technical
Standards and policies of the Board
- Added: For practicing during period of suspension
- Period of suspension of registration/ professional license not to exceed 4 years
RA 9173 Philippine Nursing Act of 2002

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4. Rule IV Nursing Education
- Added: Requirement for inactive nurses
Shall undergo 1 month of didactic training and 3 mos. of practicum
- Faculty – clinical experience reduced from 3 year to one year in a field of specialization
-Dean – at least 5 years of experience in teaching
RA 9173 Philippine Nursing Act of 2002
5. Nursing Practice
- Deleted: Special training in IV injections
- Added: Special training for suturing lacerated perineum
- Added: Observe the code of ethics and the code of technical standards
Scope of Nursing Practice
When he/she singly or in collaboration with another, initiates and performs nursing services to individuals, families and
communities in any health care setting.
When he/she provide nursing care during conception, labor, delivery, infancy, childhood, toddler, pre-school, school age,
adolescence, adulthood and old age
RA 9173 Philippine Nursing Act of 2002
6. Health Human Resource Production and Utilizations
- comprehensive nursing specialty program
- Salary – Not lower than SG 15 pursuant to RA 6758 or Compensation and Classification Act of 1989
- Funding of Specialty Program – PCSO
- Incentives and Benefits – free hospital, scholarship grants, standard nurse patient ratio
7. Rule VII. Penal and Miscellaneous Provisions
- Not less than 50k nor more than 100k
- Imprisonment of not less than one year nor more than 5 years
- Or both fine and imprisonment upon the discretion of the Board

Qualification to Practice Nursing

Passed the written exams given by the BON (Sec. 12)
Registered by reciprocity (Sec. 20)
Has a special or temporary permit (Sec. 21)

Reciprocity
“do ut des” = for a country to expect a favor from another, it should be willing to give a corresponding favor
Sec 20 of RA 9173
The requirements for registration is substantially the same
Filipino nurses are granted the same privileges and on the same basis as their citizens.
Granting of same privileges as those accorded to its subjects
Applicant is a Registered Nurse under the law of her/his country
Requirements for registration or licensing are substantially the same
Applicant has resided in the Philippines for at least three consecutive years as provided by RA 5181

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 Special / Temporary Permit
License nurses whose service is for a fee, internationally well known specialists or outstanding experts in any branch of nursing
Medical Mission
Employment by schools / colleges of nursing as exchange professors in a branch of nursing

Laws Affecting Nurses and Nursing

1. Statutory Law
Composed of enacted law and regulatory law or administrative law
2. Common Law
Common usage, custom and judicial decisions or court rulings. Previous judicial decisions or rulings in court cases are
also used.
3. Labor Code
Defines among other things, hours of work, contract and nurse staffing in industrial clinics
4. Civil Service Law (PD 807)
Provides for recruitment and selection of employees in government service
5. Executive Order # 180
Upholds the exercise of the right to organize of government employees
6. Magna Carta of Public Health Workers
(RA 7305)
Has provisions on the benefits, rights and responsibilities of public health workers
7. CBA
8. Salary Standardization Law (RA 6758)
Standardization of salaries of those working in government
9. RA 7041
Publishing presence of vacant positions
10. RA 7877 – Anti-Sexual Harassment Act
Committed by any person who exercises authority, moral ascendancy over another
11. RA 7877 – Anti-Sexual Harassment Act
Committed by any person who exercises authority, moral ascendancy over another…by demanding, requesting or
requiring sexual favor regardless of whether or not…is accepted by the object of sexual solicitation
12. RA 6713 – Code of Conduct and Ethical Standards for Public Officials and Employees
Public officials and employees shall at all times be accountable to the people.
13. PD 807 – Civil Service Rules and Regulations
Promotes morale and the highest degree of responsibility, integrity, loyalty, efficiency and professionalism. Public office is
a public trust. Grounds for disciplinary action
14. RA 8344 - Act Penalizing the Refusal of Hospitals and Medical Clinics to Administer Appropriate Initial Medical Treatment
and Support in Emergency Cases
In emergency cases, it is unlawful to request, demand, or accept any deposit as a prerequisite for confinement or
treatment
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15. RA 7160 – Local Government Code
Devolution of health services from the National Government to the Local Government Units. Provincial, district and
municipal hospitals were devolved to the provincial govt while the health centers/rural health units were devolved to the
municipal government
Legal Liabilities of Nursing
Negligence
Commission or omission of an act, pursuant to a duty, that a reasonably prudent person in the same or similar
circumstances would or would not do, and acting or non-acting is the proximate cause of injury to another person or his
property

Elements of Professional Negligence

Existence of a duty
Breach of duty
Foreseeability of harm
Breach resulted in an injury
Specific Examples of Negligence
1. Failure to report observations to attending physicians.
2. Failure to exercise the degree of diligence which the circumstances of the particular case demands
3. Mistaken identity
4. Wrong medicine, concentration, route and dose
5. Defects in the equipment such as stretchers and wheelchairs may lead to falls thus injuring the patient
6. Errors due to family assistance
7. Administration of medicine without a doctor’s prescription

Res Ipsa Loquitor

That the injury was of such nature that it would not normally occur unless there was a negligent act on the part of someone
That the injury was caused by an agency within control of the defendant
That the plaintiff himself did not engage in any manner that would tend to bring about the injury
Examples
Presence of sponges in the patient’s abdomen after an operation
Fracture of a newly delivered baby born by breech presentation
Paralysis due to an injection to the buttocks of the client

Malpractice
Improper or unskillful care of patient by a nurse
Stepping beyond one’s authority with serious consequences
Malpractice is the term for negligence of professional personnel

Force Majeure
An irresistible force, one that is unforeseen or inevitable
Circumstances such as floods, fire, earthquakes and accidents fall under this doctrine
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Nurses who fail to render service during these circumstances are not held negligent

Doctrine of Respondeat Superior

“Let the master answer for the acts of the subordinate.”
Examples
The hospital will be held liable, if, in an effort to cut down on expenses it decides to hire underboard nurses or midwives in
place of professional nurses, and these persons proved to be incompetent
Surgeon will be held responsible in case a laparatomy pack is left in pt.’s abdomen

Incompetence
Absence of education, training, experience and personality to carry out the services for which they are responsible
Medical Orders, Drugs and Medications
RA 6675 – only validly registered medical, dental and veterinary practitioners, whether in private institution/corporation or in the
govt. are authorized to prescribe drugs.
Verbal orders can be minimized if the nurse seeks a clear understanding from the physician

Medical Orders, Drugs and Medications

Norton vs Argonaut Insurance Co.
- Give 3 cc lanoxin today for 1 dose only
- lanoxin have two forms, injectable and elixir
SOMERA CASE
Novocaine and 10% coccaine
Clear ambiguous orders
Demonstrate courage and determination

IV Therapy and Legal Implications

Legal Right is based on the Philippine Nursing Act of 1991 sec. 28
In the administration of intravenous injections, special training shall be required according to protocols established
Nurses have to undertake a certified training course on IV therapy
BON Res. 8 – liable criminally under sec 30 art VII or administratively under sec 21 art III

Telephone Orders
Messages may sound unclear
No signature of the physician and later may be denied
Should be limited to extreme emergency
Read back order
Signed by the physician within 24 hours
Refer to policy of the hospital
Consent
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Authorization by a patient or a person authorized by law to give consent on the patient’s behalf, that changes touching from non-
consensual to consensual
Usually for diagnostic procedures and initial treatment deemed necessary by the medical staff

Informed Consent
The diagnosis and explanation of the condition
A fair explanation of the procedures to be done and used and the consequences
A description of alternative treatments or procedures
A description of the benefits to be expected
The prognosis if recommended care is refused
Consent
Proof of consent
Who must consent
Consent of minors
Consent of mentally ill
Emergency situation
Refusal to consent
Consent for sterilization
Medical Records
Nurses are legally and ethically bound to protect the patient’s chart from unauthorized persons
Value is both scientific and legal
Medical Records in Legal Proceedings
Important evidence in legal proceedings such as police investigations, determining cause of death and or extent of injury
By virtue of subpoena duces tecum
Torts
A legal wrong
Committed against a person or property
The person who has been wronged seeks compensation for the injury he has suffered from the wrong doer
1. Assault and Battery
- Assault is the imminent threat of harmful or offensive bodily contact
- Threat to touch in such circumstances as to cause the other to believe that it will be carried out
- Battery is an intentional, unconsented touching of another person
- Implied consent for treatment
- Refusal of contact
- Injection
- Injury brought by restraint
2. False imprisonment or Illegal Detention
- unjustifiable detention of a person without a legal warrant within boundaries fixed by the defendant by an act or
violation of duty intended to result in such confinement

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 - Communicable disease
- Mentally ill
- Patients insisting in leaving
3. Invasion of Right to Privacy and Breach of Confidentiality
- Right to be left alone
- Right to be free from unwarranted publicity and exposure to public view
- Right to live without having anyone’s name, picture or private affairs made public against one’s will
- Divulging information from a patient’s chart to unauthorized persons
- Publication of any picture of a malformed baby without the consent of the parents
- Revelation of the contents of the records of the patient without his consent
- Non-professional person viewing a woman in labor
4. Defamation
- Character assassination, be it written or spoken, constitutes defamation
- SLANDER – oral defamation by speaking unprivileged or false words by which his reputation is damaged
- LIBEL – defamation by written words, cartoons or such representations that cause a person to be avoided, or injure him in
his work
- Exchange of remarks between two persons does not constitute defamation
- There must be a third person who hears or reads the comment
- Truth is an available defense
Crimes, Misdemeanors and Felonies
1. CRIME – an act committed or omitted in violation of the law.
1. Criminal act
2. Evil or criminal intent

In criminal action, the state seeks the punishment of the wrongdoers.

Conspiracy to commit a crime
- Two or more persons agree to commit a felony and decide to do it.
- PRINCIPALS – those who take direct part in the execution of the act, induce others to commit it.
- ACCOMPLICES – not being principals, cooperate in the execution of the offense by previous or simultaneous act
- ACCESSORIES – those who take part subsequent to its commission by profiting themselves or assisting the offender
to profit from the effects of the crime by:
1. concealing or destroying the body of the crime
2. harboring, concealing or assisting in the escape of the principal, due to abuse of public function or a
Recidivist
2. Criminal Actions
- Acts or offenses against public welfare
- MISDEMEANOR – criminal offense which does not in law amount to felony
- Punishment is a fine or less than a year imprisonment

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 - FELONY – public offense for which a convicted person is liable to be sentenced to death or imprisonment in jail or
penitentiary
- Felony is committed with deceit and fault
- DECEIT exist when the act is performed with deliberate intent
- FAULT when the wrongful acts result from imprudence, negligence or lack of skill or foresight
3. Criminal Negligence
- RECKLESS IMPRUDENCE – a person does an act or fails to do it voluntarily but without malice from which material
damage results immediately
- SIMPLE IMPRUDENCE – a person did not use precaution and the damage was not immediate or the impending
danger was not evident of manifest.
4. Criminal Intent
- State of mind of a person at the time the criminal act is committed , that is he/she knows that an act is not lawful and
still decided to do it anyway
- Freedom and intelligence, without which there is no crime.
- Insanity, accident, necessity, compulsion
5. Classes of Felonies
- Consummated – when all of the elements necessary for its execution and accomplishment are present
- Frustrated – when the offender performs all the acts or execution which will produce the felony but do not produce it
- Attempted – the offender commences the commission of the same directly by overt acts and does not perform all of the
acts which shall produce the felony by some cause other than own desistance
6. Felonies according to degree of punishment
- Grave felonies – death or 6 years to life imprisonment or fine not exceeding 6k
- Less grave felonies – correctional (1 month to 6 years or a fine not exceeding 6k but not less than 200
- Light felonies – arresto menor – 1 day to 30 days of a fine not exceeding 200

Lack of Education
Is not mitigating in:
Rape
Forcible abduction
Arson
Treason
Crimes against chastity
Acts committed in a merciless or heinous manner
Moral Turpitude
An act contrary to the accepted and customary rule of right and duty between men

Murder
Unlawful killing of a human being with intent to kill.
Death from abortion is murder

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Euthanasia is also considered murder

Homicide
Killing of a human being by another committed without criminal intent
Abortion
Expulsion of the product of conception before the age of viability
In the United States, abortion is practiced under certain conditions
In the Philippines, abortion is murder

Infanticide
Killing of a child less than 3 years of age
Penalty of imprisonment ranging from 2 years, four months and one day to six years

Parricide
Crime committed by one who kills his/her father, mother or child whether legitimate or illegitimate, or any of his/her ascendants or
descendants or his/her spouse
Penalty of life imprisonment (reclusion perpetua) to death
Robbery
The taking of personal property of another person from him or in his presence
Nurse taking patient’s cash or jewelry while the latter was sleeping

Controlled Substances
RA 6425 – The Dangerous Drugs Act of 1972
Administration and regulation of the manufacture, distribution and dispensing of controlled drugs
Doctor with such license prescribe these drugs in a yellow form
Simulation of Birth, Substitution or Abandonment of a Child
Simulation – committed by one who enters in a birth certificate a birth that did not occur
Substitution of child or abandonment with intent to cause such child to lose his/her civil status shall be punishable by simulation of
birth
Points to Observe in Order to Avoid Criminal Liability
1. Be familiar with the Phil. Nursing Law
2. Beware of laws that affect nursing practice
3. Get a copy of your job description, rules and regulations
4. Upgrade your skills and competence
5. Accept only such responsibility that is within the scope of your job description
6. Do not delegate your responsibility to others
7. Determine whether subordinates are competent when delegating
8. Develop good interpersonal relationship with co-workers
9. Consult superiors for problems that may be too big to handle
10. Verify orders that are not clear to you or those that seem to be erroneous

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11. The doctors should be informed about the patients conditions
12. Keep accurate and adequate records
13. Patients are entitled to an informed consent
WILLS
Legal declaration of a person’s intentions upon death
TESTAMENTARY DOCUMENT – takes effect after the death of its maker, to control the deposition of his estate
DECEDENT – person whose property is transmitted through succession whether or not he left a will
TESTATOR – if he left a will
TESTATRIX – person making a will is a woman
HEIR – person called to succession either by the will or operation of law
TESTATE – person dies leaving a will
INTESTATE – without a will
PROBATE – validation of will in court
HOLOGRAPHIC WILL – written, dated and signed by the testator, need not be witnessed
NUNCUPATIVE WILL – oral will
- made during last illness
- done in the place of death
- one or more witness
- put in writing within a given no. of days

TESTAMENTARY CAPACITY
1. Intention, right age, sound mind at the time of execution. He must be free from undue influence
2. Testator shall name the person who will be in charge of carrying out the will
3. Properties must be disposed with legal requirements
4. Signed by the testator, attested by at least 3 witnesses, language must be known to the testator
5. Acknowledged before a notary public
6. Witnesses shall be of sound mind, 18 yo, not blind, deaf or dumb and able to read and write
7. A married woman may make a will without the consent of husband

Nurse’s Obligation
Note soundness of patient’s mind
Freedom from fraud or undue influence
The patient was above 18 yrs old
Should note that the will was signed by the testator
That the witnesses are all present and signed the will
Make notation on the patient’s chart
Statutes of Limitation
Witness become less reliable
Difficult to procure records

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Death may intervene
Destruction of documents
Negligence / Malpractice = 2 to 3 years
Criminal Cases = 2 to six years
Murder = no time limit
Labor Case = 5 years
Witness
Subpoena duces tecum – served to a witness requiring him to bring records, papers in his possession which may help clarify the
matter in issue
Subpoena Testificandum – Legal documents
Privileged Communication
Man and wife
Lawyer and client
Physician and patient
Priest and person making confession

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