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NURSING JURISPRUDENCE
PROFESSIONAL ADJUSTMENT Growth of the whole person in the development of his capabilities to make him fit to assume his new position It is the development of the whole individual physical, mental, spiritual, social and emotional
Profession
A. Definition An occupation requiring advanced training in a specific/specialized knowledge which provides service to society in that special field B. Characteristics Autonomy Accountability Authority Altruism C. Criteria Must satisfy an indispensable need of society Adequate pre-professional training Exercises discretion and judgment Live up to an established code of ethics Constantly enlarges body of knowledge it uses D. Professional Behavior of Nurses Assesses, plans, implements and evaluates theory, research and practice in nursing. These behaviors are reflected entirely in nursing process Accepts, promotes and maintains the interdependence of theory, research and practice. These three elements make nursing a profession and not a task centered activity Communicates and disseminates theoretical knowledge, practical knowledge and research findings to the nursing community Upholds the service orientation of nursing in the eyes of the public. Many consider altruism (selfless concern for others) the hallmark of a profession. Nursing has a tradition of service to others. This service, however, must be guided by certain rules, policies or code of ethics Preserves and promotes the professional organization as the major referent. Operation under the umbrella of a professional organization differentiates a profession from an occupation E. Roles of the Professional Nurse Care Provider The chief goal of the nurse in this role is to convey understanding about what is important and to provide support Communicator Nurses communicate pertinent information verbally at change-of-shift reports, when clients are transferred to another unit, at client rounds and when clients are discharged to another health care agency Teacher MERGE-MANILA: 28 A.M Bldg. Quezon Avenue, Quezon City Tel: (02)742-0022/7411336
Counselor The process of helping a client to recognize and cope with stressful psychological or social problems Client Advocate Involves promoting what is best for the client. Ensuring that the clients needs are met and protecting the clients rights. Change Agent A person who initiates change or who assists others in making modifications in themselves or systems. Leader and Manager Researcher F. Personal Appearance of a Nurse Every nurse should feel pride and act with dignity whenever wearing the nurses uniform The professional duties of a nurse require her to be always neat and wellgroomed A neat and tidy appearance is an indication of good taste, refinement and an asset that can earn for a nurse the respect of clients, superiors and the public
Socialization
A. Definition Process by which a person learn the ways of a group or society in order to become a functioning participant It is a reciprocal learning process that occurs through interaction with other people. This learning can be conscious, unconscious, formal or informal. The nursing student becomes socialized to the nursing profession through interaction with nursing faculty, practicing nurses, nursing student colleagues, and media portrayals of nursing. Through this interaction, the nurse learns the knowledge required to practice as an effective nurse B. Benners Stages of Nursing Expertise 1. Novice : A nursing student or any nurse entering a clinical setting No experience Ability is extremely limited, inflexible and governed by structured rules and protocols 2. Advanced Beginner : Demonstrates a marginally accepted performance Has had experience with enough real situations to be aware of the meaningful aspects of a situation Example: The ability to recognize a clients readiness to learn how to manage a treatment plan 3. Competent : A nurse who has been on the job in a similar situation for 2 or 3 years Develops when the nurse consciously and deliberately plans nursing care and coordinates multiple complex care demands Demonstrates organizational ability but lacks the speed and flexibility Knows how to prioritize care requirements for an individual or group of patients Example: Competent nurse will ensure that intravenous infusions are running, that clients are receiving required medications, and that a clients urgent physical needs are met before other needs are dealt with 4. Proficient : Perceives situations as a whole rather than in terms of chopped up parts or aspects, and performance is guided by maxims (reflect the nuance of situation). Understand a situation as a whole because they perceive its meaning in terms of long-term goals Example: A nurse weaning a client from respirator assesses the clients vital signs to discover any significant finding, but even then the nurse is aware that elevated readings may indicate anxiety. The nurse weighs the decision to medicate to calm the client down against the knowledge that the medication may impair breathing. The nurse makes the decision according to the demands of the situation and the lessons of past experience MERGE-MANILA: 28 A.M Bldg. Quezon Avenue, Quezon City Tel: (02)742-0022/7411336
5. Expert : No longer relies on rules, guidelines, or maxims to connect understanding of the situation to an appropriate action Highly developed perceptual acuity or recognitional ability and their performance is fluid, flexible and highly proficient
Fields of Nursing
1. Hospital or Institutional Nursing Nursing in hospitals and related health facilities (nursing homes and neighborhood clinics) The nurse cares for the patient in the hospital or in the out patient department The nurse performs nursing measures that will meet the patients physical, emotional, social and spiritual health needs while in the institution and helps him and his family plan for his further health care needs when he returns home Advantages: Presence of a supervisor whom one can consult Up-to-date with new trends in medicine Rotation to different units and have a chance to determine their special area of choice Provisions for sick leaves, holidays and vacations with pay Staff development programs Disadvantages: Great possibility of understaffing which may require nurses to put in overtime work Bulk of work = no time to improve skills Administrative problems and overworks may tend to dissatisfy the staff nurse 2. Public Health Nursing or Community Health Nursing Emphasis: promotion of health and prevention of diseases Advantages: Gives a better perspective of the health condition of the community Maximizes efforts to improvise where there are no sufficient facilities Disadvantages: Cases are limited mostly to communicable/chronic diseases No fixed hours of work. Nurse may be called any time Facilities for care of the sick are limited 3. Private Duty Nursing A registered nurse who provides comprehensive nursing care to a client (1:1 ratio) Independent contractor Patient may be provided care in the home or in the hospital Advantages: The ability to own time, adjust work and private life satisfactorily and direct off-duty time into enjoyable leisure The challenge of giving his/her best in providing care and having the satisfaction of seeing its results Disadvantages: Create a situation in which the patients become totally dependent on them Not enough private duty nurses for evening and night shifts for holiday, week-ends and vacation periods
MERGE-MANILA: 28 A.M Bldg. Quezon Avenue, Quezon City Tel: (02)742-0022/7411336
Little assistance is given by the Head Nurse when the patient is critically ill and the private duty nurse needs help in giving treatment or in changing the position of the patient No retirement, insurance and Medicare benefits unless they provide these for themselves Two Categories: a. General Private Duty Nurse can provide basic nursing care to any type of patient b. Private Duty Nurse Specialist In addition to the foregoing abilities expected of the general nurse practitioner, they can demonstrate skill in handling, operating and monitoring complicated devices; interpreting ECG, EEG and laboratory diagnostic results and skill in observing favorable or untoward signs and symptoms manifested by the client 4. School Nursing Supplements the work of the physician in providing medical needs in school Responsible for the schools activities in the area of health service, health education and environmental health and safety Advantages: Opportunity to watch children advance from grade to grade in school health. Hours are usually good and there is no shift duty Disadvantages: Many school nurses do not update themselves on the current issues in nursing making them unaware of changes in nursing practice 5. Clinic Nursing Acts as a receptionist, answers phone, does the billing , takes x-rays and ECGs and assists in physical examinations Advantages: Favorable working hours Disadvantages: Generally, they receive a slightly lower salary than hospital nurses 6. Advanced Practice Nursing Synonymous with specialization Umbrella term for nurses who have specialized education and experience beyond the basic nursing program Knowledge skills are obtained through graduate in nursing (masters degree or doctoral degree) The clinical specialist is an expert practitioner within a specialized field of nursing (cancer, rehabilitation, care of patients with ostomies etc.) 7. Occupational Health Nursing or Industrial Nursing Specialty practice that provides and delivers health care services to workers The practice focuses on promotion, protection and supervision of workers health within the context of safe and healthy work environment This field requires special skills. A good preparation is 1 year or more in Emergency Nursing. Helpful skills include ability to take and read ECGs, eye screening and audiometer testing, laboratory tests and X-ray Advantages: Works only during day hours Disadvantages: Have to bargain individually for their salaries Often works alone and must therefore possess maturity, experience & wise judgment 8. Nursing Education MERGE-MANILA: 28 A.M Bldg. Quezon Avenue, Quezon City Tel: (02)742-0022/7411336
Employed in teaching or administration of a school of nursing or other educational institution Advantages: Salary is higher than nurses working in a hospital 9. Military Nursing Ensures that the soldier, his family and other significant groups will have adequate personal care, maintenance, safety and comfort Advantages: High salary rate and allowances (hazard pay, cold weather clothing) Opportunity to travel abroad Glamour and prestige of uniform Hospitalization and free medical benefits for parents, dependents, authorized relatives with specialists care
NURSING ETHICS
Ethical issues involve in nursing practice A. Definitions Ethics Means moral duty A standard to examine and understand moral life Moral philosophy furnishing the norm by which relations among men are regulated Morals Human conduct of ethics; application of ethics Personal standards of right and wrong Professional Ethics A branch of moral science concerned with the obligations that a member of the profession owes to the public Health care Ethics The division of ethics that relates to human health Resides in the realm of human values, morals, customs, personal beliefs and faith Bio-Ethics Ethics that focuses on moral issues in the field of health care Ethics applied to life
B. Importance of Nursing Ethics It makes clear why one act is better than the other Keeps an orderly social life by having agreements, understanding, principles or rules or procedures Moral conduct and ethical systems must be intelligently appraised and criticized Seeks to point out to men the true value of life and attempts to stimulate the moral sense, discover true values of life and inspire men to gain values C. Ethical principles and other approaches Teleology Looks to the consequences of an action in judging whether the action is right or wrong Utilitarianism: the greatest good for the greatest number and the end justify the means. Saving the mothers life justifies (the end) the abortion (the means or act)
Human need determines what is or what is not ethical. If the act helps people, then it is a good act, and if it hurts people, then it is a bad one. Deontology Morality of a decision is not determined by its consequences. It emphasizes duty, rationality and obedience to rules A person is morally good and admirable if his actions are done from a sense of duty and reason Example 1: A nurse might believe it is necessary to tell the truth no matter who is hurt. Example 2: Any termination of life is a violation to the rule of Thou shall not kill. And therefore, would abort fetus regardless of the consequences to the mother. Virtue Ethics Approach Known as Aretaic Ethics which focuses primarily on the heart of the person performing the act. It focuses on the traits and virtues of a good person such as courage, temperance, wisdom and justice Divine Command Ethics Based on the theory that there is a Supreme or Divine being that sets down the rules to provide guidance to moral decisions. Applicable to cases of abortion and euthanasia D. Ethical Principles Autonomy Autos self nomos governance The right to make ones own decisions (this includes, right to refuse treatment) The person making the decision must be deemed competent, must be of legal age and he/she is not coerced to do so Beneficence Good must be done to either oneself or to others Doing acts of kindness and mercy that directly benefit the patient Do what is good and perform for good as moral obligation Nonmaleficence Evil or harm should not be inflicted either on oneself or on to others Avoid inflicting harm as a moral obligation Primary obligation of health care providers: No harm inflicted on their patients in whatever form Double Effect An act is done with two effects: one is good and the other is evil Conditions to justify an action that has both good and bad effects: The act must be in itself morally good or at least, morally indifferent (neutral). The act by its very nature must be good. Its goodness proceeds from (originate) within itself The good effect must directly proceed from (originate) the act itself and not from the evil effect. The good effect of the action must not come from an evil effect but must come from the action itself directly. The good result is the one that is being directly willed and not the evil result in the performance of an act The motive of the agent must be holy and honest. The good act must be willed and the evil merely allowed. This can be proven when the evil effect just follows after the good effect is achieved MERGE-MANILA: 28 A.M Bldg. Quezon Avenue, Quezon City Tel: (02)742-0022/7411336
There must be sufficient reason for the performance of an act in its attainment of the good effect. There must be sufficient reason to permit the evil effect. Sufficiency of reason exists when there is no other means by which the desired good effect can be achieved Veracity Truth telling Fidelity Concept of faithfulness and the practice of keeping promises. Stewardship Refers to the expression of ones responsibility to take care of, nurture and cultivate what has been entrusted to him Justice Equitable or equal distribution of health care resources and goods National Health Insurance Act of 1995 (RA 7875) by Fidel V. Ramos. This act provides for a universal compulsory health insurance program in the country. Employees from private and public sectors are covered with Medicare privileges. Self employed (drivers, vendors, beauticians) may become member of SSS and will be entitled to insurance benefits, hospitalization and discounted out patient services Senior Citizens Act (RA 7432) gives honor and justice to the elderly by giving 20% discount in public establishments (restaurants, pharmacies, public utility vehicles and hospitals) Triage Schemes to determine who should be served first. One criterion is medical prognosis which gives priority to patients who is most likely to survive. The next criterion is social utility or social value worth, the ability to pay or first come first served basis. Totality The whole is greater than any of its parts Paternalism Professionals who restricts others autonomy to protect that person from perceived/anticipated harm Appropriate when a patient is judged to be incompetent or to have diminished decision making capacity Literally means acting in a fatherly manner (leadership, benevolent decision making, protection and discipline). A form of advocacy when we COMBINE genuine concern for the patient with a belief that the patient is unable to make autonomous decision
CODE OF ETHICS
A. Definition A formal statement of groups ideals and values A set of ethical principles that reflects the groups moral judgments overtime, and serves as a standard for their professional actions B. Functions To inform the public about the minimum standards of the profession and to help them understand professional nursing conduct To provide a sign of the professions commitment to the public it serves To provide general guidelines for the professional behavior To remind nurses of the special responsibility they assume when caring for the sick C. Code of Good Governance General Principles Service to others implies commitment to a life of sacrifice and genuine selflessness MERGE-MANILA: 28 A.M Bldg. Quezon Avenue, Quezon City Tel: (02)742-0022/7411336
Integrity & Objectivity Refraining from engaging in any activities that would prejudice their abilities to ethically carry out their duties nor make any representations that would likely cause a reasonable person to misunderstand and be deceived Professional Competence Keeping up with new knowledge and techniques in their field and upgrade their level of competence, taking part in a lifelong continuing education program Solidarity & Teamwork Each professional shall maintain and support one professional organization Social and Civic responsibility Carrying out ones professional duties with due consideration of the broader interest of the public and serve them with professional concern Global competitiveness Shall remain open to the challenges of a more dynamic and interconnected world, rise up to global standards and maintain professional practices fully aligned with global best practices Equality of all professions Treating colleagues with respect and striving to be fair in dealings with one another D. Responsibilities of Nurses to their Clients Primary responsibility: Give the client the kind of care his/her condition needs regardless of his/her race, creed, color, nationality or status Should not accept tips or expensive gifts that may induce them to give more care to favored patients and neglect those who cannot give The nurse can plan with the client and family a specific nursing care of the client according to his needs or the needs of his family A nurse is expected to be more compassionate to the client than the doctor Responsible to give facts or information to the client and his family which they are entitled to know Should guard as a sacred trust, any confidential or private information about the client. The privacy of communication and correspondence shall be inviolable except upon lawful order of the court or when the public safety and order require otherwise Tarasoff Case: Prosinjit Podder, an Indian Graduate student, studying at Berkeley, begins to date Tatiana Tarasoff. They kiss. He feels that she is his. He gets upset when she expresses interest in other men. He goes to counseling at the University Health Service. He tells the psychologist, Dr. Moore, that he wants to get a gun and shoot Tarasoff. Dr. Moore sends letter to campus police, they investigate Podder, they think he is not a danger, tell him to avoid Tatiana. When Tatiana returns from Brazil at the end of summer, Podder stalks, stabs her to death. E. Responsibilities of Nurses to their Colleagues Nurses shall adjust themselves to the organization and know its policies and procedures They shall establish good working relationships with co-workers If one has grievance this should be brought to the attention of the proper authority rather than talk about it with others who may not able to help F. Responsibilities of Nurses to themselves A nurse should be zealous in her professional growth by keeping abreast with the latest trends in nursing science A nurse must not perform any act or transaction that may discredit himself/herself or the profession; and to bring to the attention of proper authorities an unethical conduct of any registered nurse
LEGAL ASPECTS OF NURSING PRACTICE

A. Definition Law MERGE-MANILA: 28 A.M Bldg. Quezon Avenue, Quezon City Tel: (02)742-0022/7411336
Man made rules which regulate social conduct in a formally prescribed and legally binding matter Juris Juris jus meaning law Prudence Prudence prudential meaning knowledge Jurisprudence Jurisprudence study of the law Nursing Jurisprudence Nursing Jurisprudence study of law that affects the nursing practice B. Types of Law Private Law Also called civil law Deals with relationships between private individual. Man versus Man Categories: Contract Tort Public Law A law that affects the general public Criminal Law deals with disputes between individual and society as a whole Misdemeanor less serious crime Felony
Contract
Meeting of minds between two persons whereby one binds himself, with respect to the other, to give something or to render service Kinds of contract o Formal - written o Informal oral o Express Contract - conditions (restrictions) and terms (specified period) of the contract are given orally or in writing o Implied Contract - one that has not been explicitly agreed to by the parties but that the law nevertheless considers its existence. In contractual relationship between the nurse and client, clients have the right to expect that nurses caring for them have the competence to meet their needs. This implies that the nurse has the responsibility to remain competent. The nurse has the associate right to expect the client to provide accurate information as required. Elements of contract o participants: 2 or more o consent of the parties involved o activity must be legal o Cause of obligation is establishedthe time, price and subject are expressed. A time or event when performance must be made (meet commitments) o competent parties 18 years old Sound mind Not under the influence of drugs Not under fear of bodily harm Breach of contract is the failure to perform an agreement, without legal excuse
Tort
Any civil wrong (injury) committed against a person or persons property. Persons claimed to be responsible for the tort are sued for damages (monetary compensation for the injured party) Types o Intentional Assault - Threatening or attempting to inflict immediate offensive physical contact or bodily harm Battery - Unconsented touching of another person; Intentionally or recklessly causing offensive physical contact or bodily harm (as by striking or by administering a poison or drug) that is not consented to by the victim False Imprisonment or Illegal Detention - unjustifiable detention of a person Invasion of Privacy - The right to be left alone, right to be free from unwarranted publicity and exposure to public view. Nurse may become liable if they divulge information from a patients chart to unauthorized persons When to divulge information? When the safety of another person/public is at risk Criminal cases Patient consented Defamation - character assassination Two forms: Slander - speaking false words by which his reputation is damaged Libel - written words, cartoons or representations that cause a person to be avoided or ridiculed o Unintentional Malpractice bad practice stepping beyond ones authority with serious consequences Negligence conduct that falls below the standard of care. This is the failure to exercise the care that a reasonably prudent person would do. Types: Commission with action which would not have been done by a reasonable person Omission without action Elements: Duty Breach of Duty Forseeability of Harm Injury DOCTRINE OF RES IPSA LOQUITUR The thing speaks for itself. The injury in itself gives compelling evidence that there was negligence on the part of the nurse Conditions: - The accident must be of a kind which ordinarily does not occur in the absence of someones negligence - The accident must be caused by an agency or instrumentally within the control of the defendant - The accident must not have been due to any voluntary action or contribution on the part of the injured party DOCTRINE OF RESPONDEAT SUPERIOR The master (employer) assumes responsibility for the conduct of the servant (employee) and can also be held responsible Liability is expanded to include the master as well as the employee and not a shift of liability from the servant to the master. When a person injures another because of his negligence, he remains fully responsible MERGE-MANILA: 28 A.M Bldg. Quezon Avenue, Quezon City Tel: (02)742-0022/7411336
DOCTRINE OF FORCE MAJEUR Act of God Irresistible force, unforeseen or inevitable Floods, fire, earthquakes Nurses who fail to render services under these circumstances are not held negligent
Felony
Serious crime A person is liable to be sentenced to death or to be imprisoned in a penitentiary or prison Committed with: o dolo act that is performed with deliberate intent o culpa wrongful acts result from imprudence, negligence or lack of skill Reckless Imprudence When a person does an act or fails to do an act voluntarily but without malice (desire to cause pain), from which the material damage results immediately o Somera Case Convicted of Homicide through Reckless Imprudence. Penalty imposed on Somera is 1 year imprisonment and to pay the damages amounting to Php 1,000.00 Simple Imprudence The person did not use precaution and the damage was not immediate Persons who commit felonies: o Principals Took a direct part in the execution of the act. Directly force or induce others to commit it (master mind) o Accomplice Cooperated in the execution of the offense by previous or simultaneous act Absent when the crime was committed but gave pre-assistance Accessory before the fact o Accessory If the person benefited from the products of the crime Concealing or destroying the body of the crime in order to prevent its discovery By assisting in the escape of the principal of the crime Classifications: o Consummated when all the elements necessary for its execution and accomplishment are present o Frustrated When the offender performs all the acts or execution which will produce the felony as a consequence but which nevertheless do not produce it by reason of cause independent of the will of the perpetrator o Attempted When the offender commences the commission of a felony directly by overt acts and does not perform all the acts of execution which should produce the felony by reason of some cause other than his own spontaneous desistance Degree of Punishment: o Grave Felony 6 years & 1 day to reclusion perpetua (life imprisonment), pay P6,000 and above o Less Grave 1 month & 1 day to 6 years, pay the amount not more than P6,000 but not less than P200.00 o Light arresto menor (1day to 30 days) and a fine of not less than P200.00 MERGE-MANILA: 28 A.M Bldg. Quezon Avenue, Quezon City Tel: (02)742-0022/7411336
Civil liability - Potential responsibility for payment of damages or other court-enforcement in a lawsuit Criminal liability - It means open to punishment for a crime
Circumstances affecting criminal liability: Justifying Circumstance The act complained of is considered to have been done within the bounds of law; hence, it is legitimate and lawful in the eyes of the law There is no crime or criminal There is no criminal liability as well as civil liability Elements of self-defense: 1. Unlawful aggression 2. Reasonable necessity of the means employed to prevent or repel it 3. Lack of sufficient provocation on the part of the person defending himself >> If one of these 3 elements is lacking; this becomes incomplete selfdefense and it becomes mitigating circumstances<< Anyone who acts in defense of the person or the rights of his/her spouse Anyone who acts in defense or right of stranger Not be induced by revenge, resentment or evil motives A person who acts in obedience to an order issued by a superior for some lawful purpose wherein the order must be lawful, or the order must be for some lawful purpose Exempting Circumstance The act complained of is actually wrongful, but the actor acted without voluntariness Since the act complained of is actually wrongful, there is a crime. But because the actor acted without voluntariness, there is absence of dolo or culpa. There is no criminal There is a crime but there is no criminal, there is a civil liability for the wrong done. But there is no criminal liability Examples: 1. Insane unless acted during lucid interval Lucid Interval An insane person has a normal state of mind during a lucid interval. If the crime is committed during a lucid state of the mind, exempting circumstance cannot be invoke 2. Imbecile 3. Less than 9 years old 4. More than 9 years old but less than 15 years of age UNLESS acted with discernment 5. A person who acts under compulsion of an irresistible force Mitigating Circumstance Circumstances which reduce the penalty of the crime but does not erase criminal liability nor change the nature of the crime Examples: 1. voluntary surrender 2. Age of convict is below 18 years old or above 70 years old 3. Blind, deaf and mute 4. Sufficient provocation or threat on the part of the offended party immediately preceded the act Aggravating Circumstance Circumstances which increases the criminal liability of the offender or make his guilt more severe Examples: 1. The offender takes advantage of his public position
The act is committed with insult or in disregard of the respect of the offended party on account of his/her rank, age, or sex or that it is committed in the dwelling of the offended party, if the latter has not given provocation 3. Crime committed on the occasion of a conflagration, shipwreck, earthquake, epidemic or other calamities 4. The crime is committed in consideration of a price, reward or promise 5. Act is committed with evident premeditation Alternative Circumstance Those which must be taken into consideration as aggravating or mitigating according to the nature and effects of the crime and other condition Taken into consideration 1. Relationship 2. Intoxication 3. Education
2.
CRIMES Homicide - Killing of a person without criminal intent Murder - Killing of a person with premeditation (planning) Parricide - Killing of father, mother, spouse, child, ascendant, descendants Infanticide - Killing of a child younger than 3 days old Abortion - Expulsion of products of conception before age of viability (<20 weeks) Simulation of Birth - Destruction of the identity of the child (Ex: switching of babies, fake registration of birth) Perjury - Lying under oath Forgery - Fake signature Robbery Anyone who gets the personal property of another with the use force, violence or intimidation Theft - anyone who gets the personal property of another without the latters permission
LEGAL RESPONSIBILITIES IN NURSING PRACTICE Carrying out a Physicians order It is the nurses responsibility to seek clarification of ambiguous or seemingly erroneous orders from the prescribing physician If the order is neither ambiguous nor erroneous, the nurse is responsible for carrying it out Nurses shall remember that any medical act delegated to them is illegal If any medical orders were not carried out for some reason , such shall not only be brought to the attention of the physician but also noted properly in the patients chart Unauthorized Discharge of Clients When a client insists on leaving the hospital against medical advise (AMA), the nurse should require client to sign a form whereby the client assumes full responsibility for leaving the hospital and releases the hospital personnel from any responsibility Telephone Orders MERGE-MANILA: 28 A.M Bldg. Quezon Avenue, Quezon City Tel: (02)742-0022/7411336
Only in an extreme emergency and when no other resident is available should a nurse receive telephone orders The nurse should read back the order to the physician to make certain the order has been correctly written. Such order should be signed by the physician on his/her next visit within 24 hours It is in the interest of safety that only those who have more experience and a greater knowledge of drugs should receive the order Witnessing a consent The doctor should give as much information about a contemplated procedure and the patient should receive enough information to allow him to give an informed consent for such procedure or treatment The nurse witnesses the exchange between the doctor and the patient; establishing that the client really did understand and was really informed. The nurse witnesses the clients signature The patient is the one who gives the consent in his own behalf. If he is incompetent or physically unable and is not an emergency case, consent must be taken from another who is authorized to give it in his behalf Parental consent is not needed if a minor is married or emancipated It is only in case of emergency where the consent requirement does not apply. Inaction at such time may cause greater injury, but, if time is available and an informed consent is possible, it is best that consent should be taken for the protection of all the parties concerned Both the husband and the wifes consent are needed to the procedure if the operation is primarily to accomplish sterilization. When the sterilization is medically necessary and sterilization is an incidental result (abruptio placenta or ectopic pregnancy), patients consent alone is sufficient Hospital Records Written records are among best forms of evidences A patients chart which is correctly and accurately accomplished is not only valuable as evidence in legal proceedings but also useful as guide in the treatment of patient Not admissible in evidence AGAINST the CLIENT because they are considered privileged communication between the physician and the patient >>Privileged Communications are statements uttered in good faith. These are NOT permitted to be divulged in a court of justice. EXCEPTION: criminal case, if the patient consented and if the patient sued a doctor for damages<< Patients have the right to confidentiality of these records, nurses are legally and ethically bound to protect the patients chart from unauthorized persons Nurse as a Midwife A registered nurse who passed the midwife examination given by the Board of Midwifery is entitled to practice as a midwife A certificate of registration as a midwife may also be issued to any registered nurse as long as the nurse is able to present at least 20 delivery cases he/she handled Practice of Medicine by a Nurse Restricted only in cases of epidemics or national emergencies whenever services of a duly registered physician are not available
Through a special authorization given by the Department of Health (this automatically ceases when the epidemic is declared terminated by Secretary of Health) Fraudulent Practice in Nursing Presenting as his or her own the nurse registration of another Giving false or forged evidence to the Board of Nursing in order to obtain a registration certificate Using a revoked or suspended certificate Using the nurses uniform and cap without holding a valid certificate Legal Risks for Defective Equipment While the nurse may or may not be responsible for inspecting the equipment for optimum functioning, she should see to it that all pieces of equipment are regularly inspected, maintained and are functioning properly She should document the times she requested these to show that she was able to foresee the improper functioning of equipment like wheelchairs, stretchers, suction machines etc. Nurses Obligation in the Execution of a Will A will is defined as an act whereby a person is permitted, with formalities prescribed by law, to control to a certain degree the disposition of his estate, to take effect after his death The nurse should note the soundness of the patients mind and that there was freedom from fraud or undue influence (he/she was not induced to make someone beneficiary of the will The nurse should make a notation on the patients chart the apparent mental and physical condition of the patient at the time of making the will and also the fact of his making the will Principles: 1. The making of the will is strictly a personal act 2. Physical ailments and debility due to old age preclude the possession of mental capacity to make a will 3. Person less than 18 years old cannot make a will 4. In order to make a will, the testator must be of sound mind at the time of its execution; the testator was able, at the time of making the will, to know the nature of estate to be disposed of, the proper objects of his bounty and the character of the act 5. It is signed by the testator A person witnessing a will is disqualified from inheriting anything Decedent a person who died leaving his property behind Testator a person who died with a will Intestate a person who died without a will Kinds of will: 1. Holographic hand written by the testator and it is not notarized. Witnesses are not needed 2. Nuncupative oral or verbal will and is not applicable in the Philippines 3. Ordinary or Notarial Will a will prepared by another person different from the testator. It is notarized and needs 3 witnesses who must sign the will in the presence of one another Witnesses to Wills: 1. Any person of sound mind 2. 18 years old and above 3. Not blind and not deaf MERGE-MANILA: 28 A.M Bldg. Quezon Avenue, Quezon City Tel: (02)742-0022/7411336
4. Able to read and write 5. Persons who are not convicted of falsification of documents, perjury or false testimony When the testator dies, his will shall be brought to the court to see if its genuine Allowance of Wills: 1. No will shall pass either real or personal property unless it is proved and allowed in proper courts Disallowance of Wills: 1. The testator was insane and mentally incapable of making a will 2. The will was procured through improper pressure for the benefit of the beneficiary 3. The signature of the testator was procured by fraud or trick 4. The testator executed the will through force Good Samaritan Acts Laws designed to protect health care providers who provide assistance at the scene of an emergency against claims of malpractice unless it can be shown that there was a gross departure from the normal standard of care or willful wrongdoing on their part Releases the Good Samaritan from legal liability for injuries caused under such circumstances, even if the injuries resulted from negligence of the person offering emergency aid Do Not Resuscitate (DNR) Orders No Code or DNR may be ordered for clients who are in a stage of terminal, irreversible illness or expected death Require that no effort be made to resuscitate the client in the event of a respiratory or cardiac arrest DNR orders must be clearly documented, reviewed and updated periodically to reflect changes in the clients condition
Four children/dependents for tax exemption Any person between 14 and 18 years of age may be employed in any non-hazardous undertaking as determined by the Secretary of Labor Maternity leave of at least two weeks prior to the expected date of delivery and another four weeks after normal delivery or abortion, with full pay based on her regular or average weekly wages The maternity leave shall be paid by the employer only for the first four deliveries by a woman Creation of the Philippine Regulation Commission PRC 223 New Labor Code of the Philippines 442 Nutrition Program of the Philippines 491 Month of July shall be designated as nutrition month Allowing former Filipino professionals to practice their 541 respective professions in the Philippines Child & Youth Welfare Code 603 Rights of the Child Employee Compensation and State Insurance Fund 626 Medical Services Immediately after an employee contracts sickness or sustains an injury, he shall be provided by the System during the subsequent period of his disability with such medical services and appliances as the nature of his sickness or injury and progress of his recovery may require, subject to the expense limitation prescribed by the Commission (Employees' Compensation Commission) Birth Registration Law 651 Babies born must be registered in the office of the local civil registrar of the place of birth within thirty (30) days after birth, by the attending physician, nurse, midwife, hilot or hospital or clinic administrator or, in default of the same, by either parent or a responsible member of the family or any person who has knowledge of the birth If there was no attendant at birth, then the parents or the responsible member of the family alone shall be primarily liable in case of failure to register the new born child Penalty for Improper Garbage Disposal 825 Any person, who shall litter or throw garbage, filth, or other waste matters in public places, such as roads, canals esteros or parks, shall suffer an imprisonment of not less than 5 days nor more than one year or a fine of not less than P100 nor more than Php 2, 000.00 or both such fine and imprisonment at the discretion of the Court or tribunal, without prejudice to the imposition of a higher penalty under any other law or decree Code in Sanitation 856 Consists of Sanitary permit, types of water examination, water supply etc. Applicants for marriage license shall, upon filing an 965 application therefore, be obliged to receive instructions and information on family planning and responsible parenthood from the Family Planning Office No marriage license shall be issued by the Local Civil Registrar unless the applicants present a certificate, issued at no cost to the applicants, by an Office of Family Planning that they had received instructions and information on family planning and responsible parenthood Compulsory Immunization of children under 8 years old 996 Basic immunization services shall include: (a) BCG Vaccination against tuberculosis; (b) Inoculation against diphtheria, tetanus, and pertussis; (c) Oral poliomyelitis MERGE-MANILA: 28 A.M Bldg. Quezon Avenue, Quezon City measles; (e) immunization; (d) Protection against Tel: (02)742-0022/7411336 Immunization against rubella; and (f) such other basic immunization services for infants and children below eight years of age which the Council for the Welfare of Children may recommend to the Secretary of Health
69 148
Liability of Nurses for the Work of Nursing Aides Nursing Aides responsibilities pertain to the routine care of chronically ill patients. They are therefore responsible for their own actions Nurses should not delegate their functions to nursing aides. If a nurse does this and the latter commits a mistake then the person responsible is the nurse Responsibilities of Nurses to a Rape Victim Preserve possible evidence It is the womans decision about whether or not to file charges and testify against the perpetrator Victim must sign consent forms before any photographs or hair and nail samples are taken
BRIEF HISTORY OF PHILIPPINE NURSING LAW Act 2493 1915 Regulated the practice of medicine Had something to do with nursing Provided for the examination and registration of nurses Act 2808 1919 True Nursing Law Placed under Department of Interior Chief Executive officer: Physician Creation of the Board of Examiners for Nurses RA 877 1953 Philippine Nursing Law The Board was composed of three (3) nurses: 1 Chairman, 2 Members Important sections: No License = NO PRACTICE!!! Appending to his/her name BSN RN without having been conferred such title or degree RA 7164 1991 PNA through Heherson Alvarez This law removed the age limit for members of the Board, and required ten (10) years of continuous practice of the profession prior to appointment Faculty Member requirement --Masters degree in nursing or related fields LAWS AFFECTING NURSING PRACTICE Presidential Decree (PD) Executive Orders (EO) Milk Code of the Philippines 51 No facility of the health care system shall be used for the purpose of promoting infant formula or other products Health workers shall encourage and promote breastfeeding No health workers shall give samples of infant formula to pregnant women and mothers of infants or members of their families Family Code of the Philippines 209 Establishing the presidential awards for the cleanest 214 and greenest local government units of the Philippines The award shall be in the form of Presidential Trophy and a Cash Prize of not less than One Million Pesos (P 1,000,000.00) for livelihood projects, to be sourced from the President's Social Fund MERGE-MANILA: 28 A.M Bldg. Quezon Avenue, Quezon City Tel: (02)742-0022/7411336
Bakuna ang Una sa Sanggol at Ina Attaining World Health Organization's (WHO) goals To eliminate Measles and Neonatal Tetanus, Eradicate Polio, Control Hepatitis B and other vaccinepreventable diseases Mass measles vaccination campaign for all children 9 months -48 months old nationwide Department of Education shall ensure the complete vaccination status of all children entering primary school. It shall further ensure that mothers of all children with incomplete immunization shall be informed of the immunization program being provided by the government Local Government Units shall ensure that every pregnant mother and infant are given complete immunization FREE OF CHARGE Department Circulars Include Lactational Amenorrhea Method as a specific 33-B program method offered to couples as an alternative family planning method immediately after delivery
663
69-A
Allowing trained Hilots to attend normal home deliveries especially in areas where services of Registered Midwife or Licensed Trained Health Personnel is not available at all times Hilot practice is not encouraged in localities where there are adequate professional health workers to attend to birth/home deliveries Trained hilots must attend to deliveries within their area limits Trained hilots must report births, neonatal, perinatal mortality to the nurses and midwives and participate in the campaign for birth registration Trained hilots must call the aid of the professional/trained personnel and to refer difficult and abnormal cases to hospitals when needed
Republic Acts (RA) Privilege Tax Law Persons employed in any branch of the service of the Government of the Philippines whose entire professional services are devoted exclusively thereto are exempted from paying professional tax Hospital Licensure Act An Act Requiring the Licensure of all Hospitals in the Philippines and Authorizing the Bureau of Medical Services to Serve as the Licensing Agency Permanent Residence and Reciprocity Generics Act of 1998 An act to promote, require and ensure the production of an adequate supply, distribution, use and acceptance of drugs and medicines identified By their Generic Names Local Autonomy Code Philippine Nursing Act of 1991 Magna Carta for Disabled Persons

1612
4226
5181 6675
7160 7164 7277 7305
Magna Carta for Public Health Workers In case a Public Health Worker is found by the Civil
7432
7610 7719
7875
7876
7877 8203 8423
Service Commission to be unjustly dismissed from the service, he/she shall be entitled to reinstatement without loss of seniority rights and payment of back wages/salaries and other benefits with twelve percent (12%) interest computed from the time such salaries and other benefits were withheld up to the time reinstatement Senior Citizen Act of 1992 An Act to Maximize the Contribution of Senior Citizens to Nation Building, Grant Benefits and Special Privileges Senior Citizen shall mean any resident of the Philippines at least sixty (60) years old The grant of twenty percent (20%) discount from all establishments relative to utilization of transportation services, hotels and similar lodging establishment, restaurants and recreation centers and purchase of medicines anywhere in the country Special Protection of Children Against Abuse, Exploitation and Discrimination Act National Blood Services Act of 1994 Act promoting voluntary blood donation, providing for an adequate supply of safe blood Voluntary donors shall likewise be provided nonmonetary incentives as may be determined by the Department National Health Insurance Act of 1995 The Program shall provide all citizens with the mechanism to gain financial access to health services, in combination with other government health programs Senior Citizens Center Act of the Philippines Center refers to the place established by this Act with recreational, educational, health and social programs and facilities designed for the full enjoyment and benefit of the senior citizens in the city or municipality The centers shall identify the needs, trainings, and opportunities of senior citizens in the cities and municipalities The Centers shall also initiate, develop and implement productive activities and work schemes for senior citizens in order to provide income or otherwise supplement their earnings in the local community Anti-Sexual Harassment Act of 1995 Authority, influence or moral ascendancy over another demands, requests or requires any sexual favors Special law on counterfeit Drugs Republic Act No. 8423 - Traditional and Alternative Medicine Act (TAMA of 1997 To promote and advocate the use of traditional, alternative, preventive, and curative health care modalities that have been proven safe, effective, cost effective and consistent with government standards on medical practice
8976
9165 9257
Philippine Food Fortification Act of 2000 Sangkap Pinoy Seal Program (SPSP) - a strategy to encourage food manufacturers to fortify processed foods or food products with essential nutrients at levels approved by the DOH The seal is a guide used by consumers in selecting nutritious foods The fortification of staple foods based on standards set by the DOH through the BFAD is hereby made mandatory for the following: 1. Rice - with Iron 2. Wheat flour - with vitamin A and Iron 3. Refined sugar - with vitamin A 4. Cooking oil - with vitamin A Dangerous Drugs Act of 2002

9288
Expanded Senior Citizens Act of 2003 An Act Granting Additional Benefits and Privileges to Senior Citizens Amending for the Purpose Republic Act No. 7432 Otherwise Known As "An Act To Maximize the Contribution of Senior Citizens to Nation Building, Grant Benefits and Special Privileges and for other Purposes Newborn Screening The National Newborn Screening System shall ensure that every baby born in the Philippines is offered the opportunity to undergo newborn screening and thus be spared from heritable conditions that can lead to mental retardation and death if undetected and untreated.

Board Resolutions
187 S. 1991 217 S. 1992 220 466 S. 2008
Renewal of Professional License Delisting of delinquent professionals Promulgation of the Code of Ethics for Nurses
The CPE programs consist of properly planned and structured activities ,the implementation of which requires the participation of a determined group of professionals to meet the requirements of maintaining and improving the occupational standards and ethics of the professionals Letters of Instruction Preference given to members of accredited professional 100 organization for employment
949
Legal basis of Primary Health care
Pronouncements Last week of October Second week of January March 8 May 8
Nurses Week National Cancer Consciousness Week International Womens Day World Red Cross Day
April 7 May 7 May 12 June 27 August 1 December 1
World Health Day National Health Workers Day International Nurses Day World Diabetes Day World Breastfeeding Day World AIDS Day
HOUSE BILL #5043 Reproductive Health, Responsible Parenthood and Population Development Act of 2008 Believes that sustainable human development is better assured with manageable population with healthy, educated and productive citizens S - sexual and reproductive health education - sexually transmitted disease preventions and management C - contraceptives and family planning A - age-appropriate reproductive health education

N D A L -
no certificate of compliance will not be issued with marriage license decrease teenage pregnancy, maternal and infant mortality rates abortion remains a crime but post abortion complications shall be treated in humane and non judgmental manner ligation All public hospitals should make available to indigent mothers, upon the mothers request the procedure of ligation WITHOUT cost to her
Republic Act No. 9173

October 21, 2002 AN ACT PROVIDING FOR A MORE RESPONSIVE NURSING PROFESSION, REPEALING FOR THE PURPOSE REPUBLIC ACT NO. 7164, OTHERWISE KNOWN AS "THE PHILIPPINE NURSING ACT OF 1991" AND FOR OTHER PURPOSES Be it enacted by the Senate and the House of Representatives of the Philippines in Congress assembled: ARTICLE I Title Section 1. Title - This Act shall be known as the "Philippine Nursing Act of 2002." ARTICLE II Declaration of Policy Section 2. Declaration of Policy It is hereby declared the policy of the State to assume responsibility for the protection and improvement of the nursing profession by instituting measures that will result in relevant nursing education, humane working conditions, better career prospects and a dignified existence for our nurses. The State hereby guarantees the delivery of quality basic health services through an adequate nursing personnel system throughout the country. ARTICLE III Organization of the Board of Nursing MERGE-MANILA: 28 A.M Bldg. Quezon Avenue, Quezon City Tel: (02)742-0022/7411336
Section 3. Creation and Composition of the Board. - There shall be created a Professional Regulatory Board of Nursing, hereinafter referred to as the Board, to be composed of a Chairperson and six (6) members. They shall be appointed by the president of the Republic of the Philippines from among two (2) recommendees, per vacancy, of the Professional Regulation Commission, hereinafter referred to as the Commission, chosen and ranked from a list of three (3) nominees, per vacancy, of the accredited professional organization of nurses in the Philippines who possess the qualifications prescribed in Section 4 of this Act. Section 4. Qualifications of the Chairperson and Members of the Board. The Chairperson and Members of the Board shall, at the time of their appointment, possess the following qualifications: (a) Be a natural born citizen and resident of the Philippines; (b) Be a member of good standing of the accredited professional organization of nurses; (c) Be a registered nurse and holder of a master's degree in nursing, education or other allied medical profession conferred by a college or university duly recognized by the Government: PROVIDED, That the majority of the members of the Board shall be holders of a master's degree in nursing: Provided, further, That the Chairperson shall be a holder of a master's degree in nursing; (d) Have at least ten (10) years of continuous practice of the profession prior to appointment: Provided, however, That the last five (5) years of which shall be in the Philippines; and (e) Not have been convicted of any offense involving moral turpitude; Provided, That the membership to the Board shall represent the three (3) areas of nursing, namely: nursing education, nursing service and community health nursing. Section 5. Requirements Upon Qualification as Member of the Board of Nursing. - Any person appointed as Chairperson or Member of the Board shall immediately resign from any teaching position in any school, college, university or institution offering Bachelor of Science in Nursing and/or review program for the local nursing board examinations or in any office or employment in the government or any subdivision, agency or instrumentality thereof, including government-owned or controlled corporations or their subsidiaries as well as these employed in the private sector. He/she shall not have any pecuniary interest in or administrative supervision over any institution offering Bachelor of Science in nursing including review classes. Section 6. Term of Office. - The Chairperson and Members of the Board shall hold office for a term of three (3) years and until their successors shall have been appointed and qualified: Provided, That the Chairperson and members of the Board may be re-appointed for another term. Any vacancy in the Board occurring within the term of a Member shall be filled for the unexpired portion of the term only. Each Member of the Board shall take the proper oath of office prior to the performance of his/her duties. The incumbent Chairperson and Members of the Board shall continue to serve for the remainder of their term under Republic Act No. 7164 until their replacements have been appointed by the President and shall have been duly qualified. Section 7. Compensation of the Board Members. - The Chairperson and Members of the Board shall receive compensation and allowances comparable to the compensation and allowances received by the Chairperson and members of other professional regulatory boards. Section 8. Administrative Supervision of the Board, Custodian of its Records, Secretariat and Support Services. - The Board shall be under the administrative supervision of the Commission (PRC). All records of the Board, MERGE-MANILA: 28 A.M Bldg. Quezon Avenue, Quezon City Tel: (02)742-0022/7411336
including applications for examinations, administrative and other investigative cases conducted by the Board shall be under the custody of the Commission. The Commission shall designate the Secretary of the Board and shall provide the secretariat and other support services to implement the provisions of this Act. Section 9. Powers and Duties of the Board. - The Board shall supervise and regulate the practice of the nursing profession and shall have the following powers, duties and functions: (a) Conduct the licensure examination for nurses; (b) Issue, suspend or revoke certificates of registration for the practice of nursing; (c) Monitor and enforce quality standards of nursing practice in the Philippines and exercise the powers necessary to ensure the maintenance of efficient, ethical and technical, moral and professional standards in the practice of nursing taking into account the health needs of the nation; (d) Ensure quality nursing education by examining the prescribed facilities of universities or colleges of nursing or departments of nursing education and those seeking permission to open nursing courses to ensure that standards of nursing education are properly complied with and maintained at all times. The authority to open and close colleges of nursing and/or nursing education programs shall be VESTED on the COMMISSION ON HIGHER EDUCATION upon the written recommendation of the Board; (e) Conduct hearings and investigations to resolve complaints against nurse practitioners for unethical and unprofessional conduct and violations of this Act, or its rules and regulations and in connection therewith, issue subpoena ad testificandum and subpoena duces tecum to secure the appearance of respondents and witnesses and the production of documents and punish with contempt persons obstructing, impeding and/or otherwise interfeming with the conduct of such proceedings, upon application with the court; (f) Promulgate a Code of Ethics in coordination and consultation with the accredited professional organization of nurses within one (1) year from the effectivity of this Act; (g) Recognize nursing specialty organizations in coordination with the accredited professional organization; and (h) Prescribe, adopt issue and promulgate guidelines, regulations, measures and decisions as may be necessary for the improvements of the nursing practice, advancement of the profession and for the proper and full enforcement of this Act subject to the review and approval by the Commission. Section 10. Annual Report. - The Board shall at the close of its calendar year submit an annual report to the President of the Philippines through the Commission giving a detailed account of its proceedings and the accomplishments during the year and making recommendations for the adoption of measures that will upgrade and improve the conditions affecting the practice of the nursing profession. Section 11. Removal or Suspension of Board Members. - The PRESIDENT MAY REMOVE OR SUSPEND any member of the Board after having been given the opportunity to defend himself/herself in a proper administrative investigation, on the following grounds; (a) Continued neglect of duty or incompetence; (b) Commission or toleration of irregularities in the licensure examination; and (c) Unprofessional immoral or dishonorable conduct. ARTICLE IV MERGE-MANILA: 28 A.M Bldg. Quezon Avenue, Quezon City Tel: (02)742-0022/7411336
Examination and Registration Section 12. Licensure Examination. - All applicants for license to practice nursing shall be required to pass a written examination, which shall be given by the Board in such places and dates as may be designated by the Commission: Provided, That it shall be in accordance with Republic Act No. 8981, otherwise known as the "PRC Modernization Act of 2000." Section 13. Qualifications for Admission to the Licensure Examination. - In order to be admitted to the examination for nurses, an applicant must, at the time of filing his/her application, establish to the satisfaction of the Board that: (a) He/she is a citizen of the Philippines, or a citizen or subject of a country which permits Filipino nurses to practice within its territorial limits on the same basis as the subject or citizen of such country: Provided, That the requirements for the registration or licensing of nurses in said country are substantially the same as those prescribed in this Act; (b) He/she is of good moral character; and (c) He/she is a holder of a Bachelor's Degree in Nursing from a college or university that complies with the standards of nursing education duly recognized by the proper government agency. Section 14. Scope of Examination. - The scope of the examination for the practice of nursing in the Philippines shall be determined by the Board. The Board shall take into consideration the objectives of the nursing curriculum, the broad areas of nursing, and other related disciplines and competencies in determining the subjects of examinations. Section 15. Ratings. - In order to PASS THE EXAMINATION, an examinee 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 the examination again but only in the subject or 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 or subjects repeated. Section 16. Oath. - All successful candidates in the examination shall be required to take an oath of profession before the Board or any government official authorized to administer oaths prior to entering upon the nursing practice. Section 17. Issuance of 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. Every CERTIFICATE OF REGISTRATION/PROFESSIONAL LICENSE shall show the full name of the registrant, the serial number, the signature of the Chairperson of the Commission and of the Members of the Board, and the official seal of the Commission. A professional identification card, duly signed by the Chairperson of the Commission, bearing the date of registration, license number, and the date of issuance and expiration thereof shall likewise be issued to every registrant upon payment of the required fees. License is a legal document given by the government that permits a person to offer to the public his skills and knowledge in a particular jurisdiction PRIMARY PURPOSE = Protect the health of the people
Other purposes:
o Discourages misrepresentation
o Most important tool for legal control o Gather statistical data about nurses Section 18. Fees for Examination and Registration. - Applicants for licensure and for registration shall pay the prescribed fees set by Commission. Section 19. Automatic Registration of Nurses. - All nurses whose names appear at the roster of nurses shall be automatically or ipso facto registered as nurses under this Act upon its effectivity. Section 20. Registration by Reciprocity. A certificate of registration/professional license may be issued without examination to nurses registered under the laws of a foreign state or country: PROVIDED, That the requirements for registration or licensing of nurses in said country are substantially the same as those prescribed under this Act: Provided, further, That the laws of such state or country grant the same privileges to registered nurses of the Philippines on the same basis as the subjects or citizens of such foreign state or country. Section 21. Practice Through Special/Temporary Permit. - A special/temporary permit may be issued by the Board to the following persons subject to the approval of the Commission and upon payment of the prescribed fees: (a) Licensed nurses from foreign countries/states whose service are either for a fee or free if they are internationally well-known specialists or outstanding experts in any branch or specialty of nursing; (b) Licensed nurses from foreign countries/states on medical mission whose services shall be free in a particular hospital, center or clinic; and (c) Licensed nurses from foreign countries/states employed by schools/colleges of nursing as exchange professors in a branch or specialty of nursing; Provided, however, That the special/temporary permit shall be effective only for the duration of the project, medical mission or employment contract. Section 22. 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 involving moral turpitude or any person guilty of immoral or dishonorable conduct 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. The Board shall furnish the applicant a written statement setting forth the reasons for its actions, which shall be incorporated in the records of the Board. Section 23. Revocation and suspension of Certificate of Registration/Professional License and Cancellation of Special/Temporary Permit. The Board shall have the power to revoke or suspend the certificate of registration/professional license or cancel the special/temporary permit of a nurse upon any of the following grounds: (a) For any of the causes mentioned in the preceding section; (b) For unprofessional and unethical conduct; (c) For gross incompetence or serious ignorance; (d) For malpractice or negligence in the practice of nursing; (e) For the use of fraud, deceit, or false statements in obtaining a certificate of registration/professional license or a temporary/special permit; (f) For violation of this Act, the rules and regulations, Code of Ethics for nurses and technical standards for nursing practice, policies of the Board and the Commission, or the conditions and limitations for the issuance of the temporarily/special permit; or (g) For practicing his/her profession during his/her suspension from such practice; MERGE-MANILA: 28 A.M Bldg. Quezon Avenue, Quezon City Tel: (02)742-0022/7411336
Provided, however, That the suspension of the certificate of registration/professional license shall be for a period NOT to exceed four (4) years. Section 24. Re-issuance of Revoked Certificates and Replacement of Lost Certificates. - The Board may, after the expiration of a maximum of four (4) years from the date of revocation of a certificate, for reasons of equity and justice and when the cause for revocation has disappeared or has been cured and corrected, upon proper application therefore and the payment of the required fees, issue another copy of the certificate of registration/professional license. A new certificate of registration/professional license to replace the certificate that has been lost, destroyed or mutilated may be issued, subject to the rules of the Board. ARTICLE V Nursing Education Section 25. Nursing Education Program. - The nursing education program shall provide sound general and professional foundation for the practice of nursing. The learning experiences shall adhere strictly to specific requirements embodied in the prescribed curriculum as promulgated by the Commission on Higher Education's policies and standards of nursing education. Section 26. Requirement for Inactive Nurses Returning to Practice. - Nurses who have not actively practiced the profession for five (5) consecutive years are required to UNDERGO one (1) month of didactic training and three (3) months of practicum. The Board shall accredit hospitals to conduct the said training program. Section 27. Qualifications of the Faculty. - A member of the faculty in a college of nursing teaching professional courses must: (a) Be a registered nurse in the Philippines; (b) Have at least one (1) year of clinical practice in a field of specialization; (c) Be a member of good standing in the accredited professional organization of nurses; and (d) Be a holder of a master's degree in nursing, education, or other allied medical and health sciences conferred by a college or university duly recognized by the Government of the Republic of the Philippines. In addition to the aforementioned qualifications, the DEAN OF A COLLEGE must have a MASTER'S DEGREE IN NURSING. He/she must have at least FIVE (5) YEARS OF EXPERIENCE IN NURSING. ARTICLE VI Nursing Practice Section 28. Scope of Nursing. - A person shall be deemed to be practicing nursing within the meaning of this Act when he/she singly or in collaboration with another, initiates and performs nursing services to individuals, families and communities in any health care setting. It includes, but not limited to, nursing care during conception, labor, delivery, infancy, childhood, toddler, preschool, school age, adolescence, adulthood, and old age. As independent practitioners, nurses are primarily responsible for the promotion of health and prevention of illness. A members of the health team, nurses shall collaborate with other health care providers for the curative, preventive, and rehabilitative aspects of care, restoration of health, alleviation of suffering, and when recovery is not possible, towards a peaceful death. It shall be the duty of the nurse to: (a) Provide nursing care through the utilization of the nursing process. Nursing care includes, but not limited to, traditional and innovative MERGE-MANILA: 28 A.M Bldg. Quezon Avenue, Quezon City Tel: (02)742-0022/7411336
approaches, therapeutic use of self, executing health care techniques and procedures, essential primary health care, comfort measures, health teachings, and administration of written prescription for treatment, therapies, oral topical and parenteral medications, internal examination during labor in the ABSENCE of antenatal bleeding and delivery. In case of suturing of perineal laceration, SPECIAL TRAINING SHALL BE PROVIDED according to protocol established; (b) Establish linkages with community resources and coordination with the health team; (c) Provide health education to individuals, families and communities; (d) Teach, guide and supervise students in nursing education programs including the administration of nursing services in varied settings such as hospitals and clinics; undertake consultation services; engage in such activities that require the utilization of knowledge and decision-making skills of a registered nurse; and (e) Undertake nursing and health human resource development training and research, which shall include, but not limited to, the development of advance nursing practice; Provided, That this section shall not apply to nursing students who perform nursing functions under the direct supervision of a qualified faculty: Provided, further, That in the practice of nursing in all settings, the nurse is duty-bound to observe the Code of Ethics for nurses and uphold the standards of safe nursing practice. The nurse is REQUIRED to maintain competence by continual learning through continuing professional education to be provided by the accredited professional organization or any recognized professional nursing organization: Provided, finally, That the program and activity for the continuing professional education shall be submitted to and approved by the Board. Section 29. Qualification of Nursing Service Administrators. - A person occupying SUPERVISORY OR MANAGERIAL positions requiring knowledge of nursing must: (a) Be a registered nurse in the Philippines; (b) Have at least two (2) years experience in general nursing service administration; (c) Possess a degree of Bachelors of Science in Nursing, with at least nine (9) units in management and administration courses at the graduate level; and (d) Be a member of good standing of the accredited professional organization of nurses; Provided, That a person occupying the position of chief nurse or DIRECTOR OF NURSING service shall, in addition to the foregoing qualifications, possess: (1) At least five (5) years of experience in a supervisory or managerial position in nursing; and (2) A master's degree major in nursing; Provided, further, That for PRIMARY HOSPITALS, the maximum academic qualifications and experiences for a chief nurse shall be as specified in subsections (a), (b), and (c) of this section: Provided, furthermore, That for chief nurses in the public health nursing shall be given priority. Provided, even further, That for CHIEF NURSES IN MILITARY HOSPITALS, PRIORITY shall be given to those who have finished a master's degree in nursing and the completion of the General Staff Course (GSC): Provided, finally, That those occupying such positions before the effectivity of this Act shall be given a period of five (5) years within which to qualify. ARTICLE VII Health Human Resources Production, Utilization and Development Section 30. Studies for Nursing Manpower Needs, Production, Utilization and Development. - The Board, in coordination with the accredited professional MERGE-MANILA: 28 A.M Bldg. Quezon Avenue, Quezon City Tel: (02)742-0022/7411336
organization and appropriate government or private agencies shall initiate undertake and conduct studies on health human resources production, utilization and development. Section 31. Comprehensive Nursing Specialty Program. - Within ninety (90) days from the effectivity of this Act, the Board in coordination with the accredited professional organization recognized specialty organizations and the Department of Health is hereby mandated to formulate and develop a comprehensive nursing specialty program that would upgrade the level of skill and competence of specialty nurse clinicians in the country, such as but not limited to the AREAS of critical care, oncology, renal and such other areas as may be determined by the Board. The beneficiaries of this program are OBLIGED TO SERVE in any Philippine hospital for a period of AT LEAST TWO (2) YEARS and continuous service. Section 32. Salary. - In order to enhance the general welfare, commitment to service and professionalism of nurses the minimum base pay of nurses working in the public health institutions shall not be lower than salary grade 15 prescribes under Republic Act No. 6758, otherwise known as the "Compensation and Classification Act of 1989": Provided, That for nurses working in local government units, adjustments to their salaries shall be in accordance with Section 10 of the said law. Section 33. Funding for the Comprehensive Nursing Specialty Program. The annual financial requirement needed to train at least ten percent (10%) of the nursing staff of the participating government hospital shall be chargeable against the income of the Philippine Charity Sweepstakes Office and the Philippine Amusement and Gaming Corporation, which shall equally share in the costs and shall be released to the Department of Health subject to accounting and auditing procedures: Provided, That the department of Health shall set the criteria for the availment of this program. Section 34. Incentives and Benefits. - The Board of Nursing, in coordination with the Department of Health and other concerned government agencies, association of hospitals and the accredited professional organization shall establish an incentive and benefit system in the form of free hospital care for nurses and their dependents, scholarship grants and other non-cash benefits. The government and private hospitals are hereby mandated to maintain the standard nurse-patient ratio set by the Department of Health. ARTICLE VIII Penal and Miscellaneous Provisions Section 35. Prohibitions in the Practice of Nursing. - A fine of NOT less than Fifty thousand pesos (P50,000.00) NOR MORE THAN One hundred thousand pesos (P100,000.00) or imprisonment of not less than one (1) year nor more than six (6) years, OR BOTH, upon the discretion of the court, shall be imposed upon: (a) any person practicing nursing in the Philippines within the meaning of this Act: (1) without a certificate of registration/professional license and professional identification card or special temporary permit or without having been declared exempt from examination in accordance with the provision of this Act; or (2) who uses as his/her own certificate of registration/professional license and professional identification card or special temporary permit of another; or (3) who uses an invalid certificate of registration/professional license, a suspended or revoked certificate of registration/professional license, or an expired or cancelled special/temporary permits; or MERGE-MANILA: 28 A.M Bldg. Quezon Avenue, Quezon City Tel: (02)742-0022/7411336
(4) who gives any false evidence to the Board in order to obtain a certificate of registration/professional license, a professional identification card or special permit; or (5) who falsely poses or advertises as a registered and licensed nurse or uses any other means that tend to convey the impression that he/she is a registered and licensed nurse; or (6) who appends B.S.N./R.N. (Bachelor of Science in Nursing/Registered Nurse) or any similar appendage to his/her name without having been conferred said degree or registration; or (7) who, as a registered and licensed nurse, abets or assists the illegal practice of a person who is not lawfully qualified to practice nursing. (b) any person or the chief executive officer of a judicial entity who undertakes in-service educational programs or who conducts review classes for both local and foreign examination without permit/clearance from the Board and the Commission; or (c) any person or employer of nurses who violate the minimum base pay of nurses and the incentives and benefits that should be accorded them as specified in Sections 32 and 34; or (d) any person or the chief executive officer of a juridical entity violating any provision of this Act and its rules and regulations. ARTICLE IX Final Provisions Section 36. Enforcement of this Act. - It shall be the primary duty of the Commission and the Board to effectively implement this Act. Any duly law enforcement agencies and officers of national, provincial, city or municipal governments shall, upon the call or request of the Commission or the Board, render assistance in enforcing the provisions of this Act and to prosecute any persons violating the same. Section 37. Appropriations. - The Chairperson of the Professional Regulation Commission shall immediately include in its program and issue such rules and regulations to implement the provisions of this Act, the funding of which shall be included in the Annual General Appropriations Act. Section 38. Rules and Regulations. - Within ninety (90) days after the effectivity of this Act, the Board and the Commission, in coordination with the accredited professional organization, the Department of Health, the Department of Budget and Management and other concerned government agencies, shall formulate such rules and regulations necessary to carry out the provisions of this Act. The implementing rules and regulations shall be published in the Official Gazette or in any newspaper of general circulation. Section 39. Reparability Clause. - If any part of this Act is declared unconstitutional, the remaining parts not affected thereby shall continue to be valid and operational. Section 40. Repealing Clause. - Republic Act No. 7164, otherwise known as the "Philippine Nursing Act of 1991" is hereby repealed. All other laws, decrees, orders, circulars, issuances, rules and regulations and parts thereof which are inconsistent with this Act are hereby repealed, amended or modified accordingly. Section 41. Effectivity. - This act shall take effect fifteen (15) days upon its publication in the Official Gazette or in any two (2) newspapers of general circulation in the Philippines. Approved, FRANKLIN DRILON JOSE DE VENECIA JR. President of the Senate Speaker of the House of MERGE-MANILA: 28 A.M Bldg. Quezon Avenue, Quezon City Tel: (02)742-0022/7411336
Representatives This Act, which originated in the House of Representative, was finally passed by the House of Representatives and the Senate on October 15, 2002 and October 8, 2003 respectively. OSCAR G. YABES ROBERTO P. NAZARENO Secretary of Senate Secretary General House of Representatives Approved: October 21, 2002 GLORIA MACAPAGAL-ARROYO President of the Philippines
Prepared by: Mr. Reynaldo Donghit, USRN

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MULTI-EDUCATIONAL REVIEW GROUP EXPERTS, INC.

MERGE-MANILA: 28 A.M Bldg. Quezon Avenue, Quezon City Tel: (02)742-0022/7411336

MERGE-MANILA: 28 A.M Bldg. Quezon Avenue, Quezon City Tel: (02)742-0022/7411336

LEGAL ASPECTS OF NURSING PRACTICE

MERGE-MANILA: 28 A.M Bldg. Quezon Avenue, Quezon City Tel: (02)742-0022/7411336

MERGE-MANILA: 28 A.M Bldg. Quezon Avenue, Quezon City Tel: (02)742-0022/7411336

MERGE-MANILA: 28 A.M Bldg. Quezon Avenue, Quezon City Tel: (02)742-0022/7411336

MERGE-MANILA: 28 A.M Bldg. Quezon Avenue, Quezon City Tel: (02)742-0022/7411336

7160 7164 7277 7305

MERGE-MANILA: 28 A.M Bldg. Quezon Avenue, Quezon City Tel: (02)742-0022/7411336

7877 8203 8423

MERGE-MANILA: 28 A.M Bldg. Quezon Avenue, Quezon City Tel: (02)742-0022/7411336

187 S. 1991 217 S. 1992 220 466 S. 2008

Legal basis of Primary Health care

Pronouncements Last week of October Second week of January March 8 May 8

MERGE-MANILA: 28 A.M Bldg. Quezon Avenue, Quezon City Tel: (02)742-0022/7411336

April 7 May 7 May 12 June 27 August 1 December 1

Republic Act No. 9173

MERGE-MANILA: 28 A.M Bldg. Quezon Avenue, Quezon City Tel: (02)742-0022/7411336

Prepared by: Mr. Reynaldo Donghit, USRN

MERGE-MANILA: 28 A.M Bldg. Quezon Avenue, Quezon City Tel: (02)742-0022/7411336

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