PROFESSIONAL ADJUSTMENT AND NURSING PNA - Philippine Nurses Association

JURISPRUDENCE
✓ Founded by Anastacia Tupaz on September
Professional Adjustment 2,1922
✓ definition of term ✓ Original name: Filipino Nurse Association
✓ Areas of professional practice
✓ Duties/Function of nursing Nursing is a profession “AAACCESS”

Legal Responsibility ✓ Accountability – liability

✓ Informed consent o Criminal (court)
• Legal age (18 and above) ▪ Plaintiff – the who complaints
• Emergency/unconscious (signed by ▪ Respondent/defendant –
doctor) (nurse)
✓ Delegation ▪ Punishment: imprisonment
✓ Drugs and prescription or fine
✓ Documentation o Civil (court)
▪ Money or damages
Crimes Affecting Nurses o Administrative (PRC)
Ethical Principles ▪ Complainant (patient)
Laws Affecting Nurses ▪ Respondent (nurse)
✓ history of nursing ▪ Summon – a copy of a
✓ Related laws complaint to you
✓ RA 9173 (75% average and average of 60 • Given for purposes of
for each NP) due process
o Conditionally pass – you passed ▪ Punishment: reprimine/fine,
the board exam but you failed one Suspension of not more than
np 4 years or revocation of your
▪ You can retake the np only license
within 2 years ✓ Autonomy - independent nursing
▪ Should be 75 intervention
✓ Altruism/Altruistic attitude - selfless
Profession attitude (patient first)
✓ Caring role or Caring Profession (Jean
• “Is calling in which its members profess to Watson)
have acquired a specialized body of ✓ Competency - necessary training or skills
knowledge and skills acquired through ➢ How to have competency?
training or by experience so that they may o In service training (training
guide others in this special field”. inside the hospital)
✓ Nursing is a profession o Continue of Professional
✓ “Calling” means service oriented to Development/Education
PATIENT (CPD)
✓ What you need to do to become a • Mandatory
member of profession? • 15 units
• Licensure and Registration • Renewal is a mere
o Registration comes priviledge
after oath taking - Renewal: On or before of your birthdate
• After passing the board exam, after 3 years
get registered. • Exception to the rule
✓ Body of knowledge and skills o First renewal
• Competency - necessary o If you are already
training of skills working abroad
✓ Recipient of care – patient - 15 units needed to renew license
✓ Purpose of Nursing: Patient - Formal CPD – enrolled, actual schooling,
centered or client focused attending Master’s degree
- Informal CPD - attending seminars or
training for a day
 - Self guided training – webinars o PD996
- CPD council for nursing – submit ▪ Expanded Program Immunization
certificate of trainings/webinars attended ▪ EPI Law of the Philippines
✓ Ethics for nurse ▪ Compulsory immunization among
✓ Service Oriented children below 8 years old against
✓ Specialized body of knowledge and skills common diseases
▪ Immunization done every
Professional Duties of a Nurse under RA 9173 WEDNESDAY
- scope of nursing practice o PD825
Note: ▪ Environmental sanitation Law of
Negligece – inside the practice of nurses the Philippines
Malpractice – outside the practice of nurse ▪ External/ outside environment
▪ Control of pollution, anti littering
✓ C – Care in all healthcare setting campagin, proper disposal
• Promotive, Preventive, Curative, o PD 856
Rehabilatative ▪ Sanitation code of the
✓ H – Health teaching/education Philippines
✓ A – Access of patient to healthcare services ▪ Internal environment
✓ N – Nursing process ▪ Sanitation for the establishment
✓ C – Charting/medical record that offer foods and water supply
✓ E – Educating and Training students ▪ Prohibted to sell food and water
• Staff nurse should be directly without this code
accountable for mistakes of students ▪ Note: All establish that offer
not CI. services of sex worker (bar). They
✓ S – Supervision of subordinates need to undergo std screening for:
• Nursing Assistants • Syphilis q 6 wks
• Proper delegation • Gonorrhea q 2 wks
✓ CO – Collaboration of patient’s care ▪ Note: HIV is voluntary
• “Multidisciplinary approach”
• Proper collaboration of patient care o RA 9288
with different member of healthcare ▪ Newborn Screening Act
team ▪ Mandatory screening among
o Intra prof collaboration - newborn babies against congenital
Nurse to nurse (ex. child disease
endorsement) ▪ Requires compulsory screening for
o Inter prof collaboration - newborn babies under 6
Nurse to doctor congenital diseases
o Interdepartmental ▪ Normal baby – within 24 hours
collaboration - ICU to ward ▪ Critical baby – within a week/7
o Interagency collaboration - days
referred to other hospital (lying o RA 10354
to hospital) ▪ Reproductive healkth law
✓ E – Execution of valid doctor’s order ▪ All filipino must have access to
reproductive health
AREAS OF NURSING PRACTICE ▪ Responsibility of the nurse: helath
teaching to guide couple in
1. Institutional Nursing decision making
✓ Hospital based Nurses
✓ Functions are supervised/delegated ✓ P – physical and social adjustments to
✓ Acquire different areas of specialization clients coming from various cultures
✓ Full coordination with other HCT ✓ P – participate with all members of the
community and health care team
2. Community Health Nursing/Public Health
Nursing – 4 Ps Congenital Diseases under RA 9288
✓ P – promotive of public health 1. Congenital hypothyroidism
✓ P – prevention of disease 2. Congenital adrenal hyperplasia
 3. Penile ketonuria (PKU) ✓ Treatment or surgery must be explained
4. Galactosemia ✓ Understood by patient
5. Glucose 6-phosphate dehydrogenase ✓ Matured
6. Maple serum urine disease (most • Physical
prevalent) (problem in kidney) • Mental
o Due to antibiotics and pain reliever
taken by mothers 1. Voluntary consent/ Voluntariness
✓ Liability of nurse
3. Occupational Health Nursing/ Industrial • Assault - mental fear or mental
Nurse threats
Note: PHN go to Mayor for funding of supply • Battery - physical introduction of
RA 7160 force
- Local Government Code
- Purpose: decentalization or devolution of 2. Opportunity to ask question
health care ✓ Don't give consent if the patient still has
- Alma ata declaration (russia) adopted questions
through LOI 949 (primary health care law) ✓ Allow doctor to explain / refer the patient to
surgeon for reexplanation
Curative/Rehabilitative
✓ C – care for sick/injured laborers 3. Treatment or surgery must be explained to
✓ R – referral patient
✓ V – visit and follow up ✓ “WHO EVER SHOULD BE THE ONE TO
Promotive/ Preventive (health teaching) PERFORM THE PROCEDURE, IS THE
✓ N – nutrition ONE WHO WILL OBTAIN A CONSENT”
✓ S – safety and sanitation in the workplace ✓ Legally who explains the surgical procedure
✓ C – counseling on ORDI (occupation related to the patient? Ans. Surgeon
disease and injuries) ✓ Legally who explains the medical procedure
to the patient? Ans. Physician
Note: Factory workers should have near hospital / ✓ Role of nurse on consent – assistant and
facility within 50 meters witness only
✓ Avoid the use of medical term
[Link] Educator/Clinical Instructor
QUALIFICATIONS: “AMOR” 4. Understood by the patient
✓ A – ACCREDITED NURSING ORG. (PNA) ✓ If patient speak in unknown language, find
✓ M – MAN IN NSG OR OTHER ALLIED someone/coworker who can translate and
HEALTH COURSES understand the language
✓ O – ONE (1) YEAR CLINICAL EXP.
✓ R – RN 5. Matured or Capacity
✓ Physical
Legal Aspect in Nursing • Age (18 years old and above)
✓ Mental
Informed consent • Anything that will affect the LOC of
• Bioethical involved: Autonomy the patient
o “ako mismo” • Psych patient can’t sign the consent
o let the patient be the one to decide Side question:
• Signature of patient or legal guardian 1. Petra is 16 years old impregnated by his 21
• Covers: y/o bf, she is about to give birth, who should
o Treatment sign the consent?
o Alternatives a) Petras boyfriend
o Risk b) Petra herself
o Side effects c) Parents
d) Any member of the family
Five Characteristics of Good Consent “VOTUM” 2. Patient needs undergo surgery and OR
- If kulang ng isa or dalawa, INVALID nurse already given the patient preoperative
✓ Voluntary medication but you observe that the pt
✓ Opportunity to ask questions
 consent is not yet signed. What should the • PRC license number
nurse first do? b. Patients
Answer: call the attention of surgeon • Name
and cancel the surgery • Age
• Sex
Note: Parents/ Relatives only gives consent if the c. Rx (treatment)
patient is minor, unconscious, or with mental illness • Name of the drug
• Date of prescription
Substitute/proxy consent • The frequency (interval) and
duration (how long) of its
This chronological sequence is used only in intake
minor patient and psych patient RA 6675 – Generic Act
✓ Parents o Purpose: so that the patient can
✓ Relatives choose among the different brand
✓ Next of kin name of a particular generic name
• next in line relative o Prescribe GN or GN(BN) are allowed
✓ ER…. MD but never the BN alone
• during emergency, doctor's order
will do 3. Observe the 10R’s of Medication
o Paternalism Administration
• another person decides for the • Right patient
patient o Wrist band - most universally
• for example: the physician signs acceptable method to
the consent in behalf of the determine right identity if the
patient’s ability to give consent patient
o Asking the patient’s name –
Chronological sequence if already 18 years old and second most acceptable. If no
above: wrist band and patient is
✓ Spouse conscious
✓ Any adult child/children o Confirm identity by asking
✓ Parents the mother – if the patient is
✓ Brothers/sister pediatrics
✓ Relatives/guardian Note!
✓ Nurses are only bound to follow drug orders
Documents Needed for PRC only if made into writing and signed by the
physician himself to minimize errors and
✓ Birth Certificate (PSA) doubts
• Passport ✓ Nurses may demand clarification of any
✓ Transcript of Record (TOR) written order which may appear erroneous,
✓ Last day of filing in PRC – October 2024 doubtful or dubious.
✓ Anything which is not put into writing and
Medication, Drugs and Prescription Rules signed by the physician is considered as not
having ben ordered or prescribed at all.
1. In the Philippines, nurses are generally not
allowed to prescribe. Only registered 4. Verbal or Telephone
medical, dental and veterinary practitioners • Applicable only if emergency
are authorized to prescribe drugs. • In ordinary cases, a nurse should not
• Malpractice – a nurses who shall follow any oral or telephone orders for
prescribed or suggest drugs to drug administration, except during an
patient w/o doctor’s order emergency situation.
• Wherein the accepting nurse
2. Three (3) informations demands the ordering physician to
a. MD sign his own orders immediately as
• Name of physician possible or within the next 24
• Address or Location of clinic hours.
 • Remember that the possibility of error SUBPOENA
is great with verbal order. Repetition • Generic name/term for “legal order coming
and clarification is necessary to from the court” (may pinapakuha ang court)
prevent error • 2 Types:
• Doctor's order sheet: ➢ Subpoena decus tecum
o Date • Documents
o Time ➢ Subpoena as Testificandum
o Name of physician
• Witness
o Complete drug order
Note: a chart is legal document because
Note!
whatever is put into writing is conclusive
✓ Do not end call without repeating the order
for clarification
DO’s and Dont’s in Charting
✓ And when the doctor arrives in hospital, let
him/her countersign (whichever is earlier)
DO’s in charting “FLIP”
5. Doubts or Errors • Full, Factual and Accurate
• Call the attention of physician • Legible
• Let him be the one to correct himself • Immediately
• Personal
Note!
✓ Treatment must be explained to the patient Full, Factual and Accurate
✓ Any untoward side effect must be reported to • Don’t document what you didn't see or hear
prescribing physician
✓ In administering drugs using intravenous Two (2) Styles or Charting
route, it is mandatory that a nurse obtained ✓ Narrative
proper training. If not, refuse said order or • Chronological
task and delegate to trained to trained IV • Baseline charted Q shift
nurse • Lengthy, time consuming
• Document even there is no problem
DOCUMENTATION/RECORDING/CHARTING
to patient
✓ POMR (problem oriented medical record)
✓ Legally who owns the patient’ chart? • Focus (FDAR)
• HOSPITAL • Document only if there is a
✓ Who is the safe keeper of the pts chart PROBLEM. If none, no charting
(medical record/medico legal record) inside needed
the hospital?
FDAR
• Medical record section/office Date/Time FOCUS Progress note:
✓ Within how many years should the hospital DAR
keep the medical record?
• Within 5 years (3-5 years) upon • DAR
death or discharge of the patients
➢ DATA - subjective or objective that
• Medico legal record – keep until supports the focus (concern)
there is a pending case - Example: Complaining of
pain at incision site on level of
Purposes of Charting/Documentation #7
“CLEARS” ➢ ACTION - Nursing Intervention
✓ Communication - Example: Repositioned for
✓ Legal document comfort, Demerol 50mg IM
✓ Evidence given
✓ Assurance of continuous care ➢ RESPONSE - patients response to
✓ Research intervention (Charted at a later date)
✓ Statistics - Example: States a decrease
in Pain, “feels much better”
Legible – readable ✓ Nurses are allowed to perform Internal
Examination in the absence of maternal and
Immediately upon the procedure fetal abnormality or complication (NSD)
• ADDENDUM - additional late
entry/documentation 3. Illegal detention / False Imprisonment
➢ Limit the patient movement from one
Personal/Confidential place to another
• You should not ask others to document for ➢ Voluntary admission (under LOC)
you Exemption to the rule:
• How to sign in chart in right way? a. Court Order
✓ “Mica Mae Nacional. RN” b. Danger to himself and others
c. Extremely communicable disease
DONT’s in Charting “LISA” Note: Restraint
• L – Language, Jargons or words which
• Tie knot and tie loosely for emergency
are unacceptable
situations
• I – Improper corrections
• Doctor’s order for restrain should be sigmed
• S – Spaces and skips
within 24 hours
• A – Abbreviation
• Offer food and toileting ebery 2 hours
Improper Correction • Only use for the safety of the patient not for
• draw a one or two straight line DIGOKIN the convinience of the nurse
• Write what error or mistake made • Restrain not more than 2 hours
• Dated and initial/sign of the nurse • Check the V/S, Circulation and Breathing
Spaces and skips every 30 mins
• Draw one (1) line and sign
Abbreviation 4. Abortion – Termination of the product of
• Some medical term if improperly conseption 3 – 6 mos or 12 – 24 weeks
abbreviated can lead to confusion AOG
5. Infanticide – killing an infant wthin 3 days
Crimes affecting Nurses or less than 72 hopurs
6. Parricide – killing a person whom you have
CRIMINAL LIABILITIES AFFECTING a relationship with (mother, father, siblings)
NURSES 7. Homicide – somebody was killed and
usually a product of negligence
1. Professional Negligence 8. Murder – there is an intent to kill a person
➢ Definition – injury inside the scope (planned)
of nursing 9. Stimulation of Birth/baby switching –
➢ Types substituting one child to another child or
➢ Elements destroying identity of the baby by faking
a. Duty birth certificate
b. Failure to do the said duty 10. Perjury – lying on the court/ providing false
c. Injury, harm, death oral testimony
d. Causation 11. Falsification of Documents – providing
Res ipsa loquitor – the resulting injury of the fake documents
patient will be the evidence of the negligence of 12. Unjust fixation – anything that will annoy
the nurse. you
13. Assult – mental fear or mental threat
2. Malpractice 14. Battery – application physical force
➢ Injury outside the scope of nursing 15. Slander – orally destroying the moral
➢ Example: prescribing drugs reputation of other
Note: 16. Libel – defamation that is put in publication
✓ Nurses are allowed to perform suturing of 17. Ciber libel – defamation that is put into
perineal laceration after SPECIAL social media or internet
TRAINING
 LAWS AFFECTING NURSES ✓ Hear and decides cases
- Negligence and malpractice
RA 9173 – PHILIPPINE NURSING LAW OF 2002 involving nurses
(present) - Suspension (not more that 4 years)
ACT 2808 – FIRST NURSING LAW (1919) or Revocation of license
• 3 members of BON for Board examiners for - Revocation – licensed can be
Nurses revoked
1920 – FIRST OFFICIAL BOARD EXAM IN THE o Wait for 4 years
PHILIPPINES o Apply for petition of Letter of
RA 8981 – PRC MODERNIZATION ACT Reissuance in PRC
• [Link] - License is a priviledge not a right
✓ Accredited different Nursing Organization
RA 9173 (OCT 21, 2002) ✓ Guideline for safe nursing
✓ Board of Nursing
✓ DEAN REQUIREMENT TO BECOME DEAN OF THE
✓ Clinical Instructor COLLEGE OF NURSING
✓ Nursing Service Administrator (supervisor, ✓ RN
manager, chief nurse ✓ MAN
✓ Nursing Licensure Examinees ✓ 5 YEARS NURSING EXPERIENCE

BOARD OF NURSING QUALIFICATIONS REQUIREMENT TO BECOME CLINICAL

✓ 10 years nursing practice, but the last 5 INSTRUCTOR IN NURSING “AMOR”
years must be in the Philippines
✓ M.A.N ✓ A - accredited nursing organization
✓ Accredited Nursing Organization (PNA) ✓ M – MAN/ other allied health courses
✓ Three – year term ✓ O – one-year clinical Nursing practice
✓ Seven Man Team (1 chairman, 6 members) ✓ R – RN.
✓ Immediately resigned upon appointment
✓ Not convicted of any crime SUPERVISOR/MANAGER COMMUNITY/COVT MILITARY
HOSP
✓ Citizen and Resident of the Philippines
B – BSN/RN
A – Accredited Org.
POWERS AND FUNCTIONS OF BON N – nine units/ NSG MGT
T – Two (2) years-
✓ Licensure exam (formulate questions) experience
CHIEF/DIRECTOR Add only Master’s in SAME + GSC
✓ Issue COR (certificate of registration) after PHN or CHN (general staff
OATH RN + MAN + course/ basic
- Provided by PRC Chairman and 5 YRS SUPERVISOR EXP military
(Except. If Primary Hosp training)
BON
- Evidence that you passed the board
EXAMINEES
exam
o License
Documents needed to pass to PRC before NLE:
o COR (lupon)
✓ CGM (optional)
✓ Monitor standards of nursing practice in the
✓ Proofs of Valid Holder of Filipino Citizenship
Philippines
(PSA)
✓ Education
✓ Proofs of Valid Holder of a BSN Degree
- BON has a power to inspect and
only form schools whose curriculum is
recommend
approved by the CHED (TOR)
- CHED has a power to open and
1. Requirement
close institution
2. Pay 900 pesos and secure NOA (notice of
o 5 consecutive years of less
admission)
than 30% passing rate
3. Acquire the Required Ratings
✓ Code of ethics
- Formulate the 2003 COE together “In order to pass the examination, an examinee
with PRC must obtain a general average of at least
seventy-five percent (75%) with a rating of not
below sixty percent (60%) in any subject. An
 examinee who obtains an average rating of
seventy-five percent (75%) or higher but gets a
rating below sixty percent (60%) in any subject
must take must the examination again but only in
the subject/subjects where he/she is rated below
sixty percent (60%). In order to pass the
succeeding examination, an examinee must
obtain a rating of at least seventy-five percent
(75%) in the subject/subjects repeated”

OATH AND REGISTRATION

REGISTRATION
3 types:
1. Ordinary
2. Special
- Temporary
- Given to foreign nurse
o Well known
o Mission or work
o To educate or train filipino
nurses
3. Reciprocity
- Licensed RN in foreign country
- The country must offer opportunity
for Filipinos

For Nurses Who Were Inactive For Five

Consecutive Years
• 1 month didactic
• 3 months practicum