CHOOSING, RETAINING, RESIGNING AND DISMISSAL FROM A POSITION

CONTRACT
GUIDELINES IN CHOOSING A FIELD IN NURSING
THE FIRST CONSIDERATION THAT A NURSE MUST MAKE IS SELF-EVALUATION.
NURSES NEED TO CONSIDER THEIR:
 CAPACITIES
 INTEREST
 QUALIFICATION
 GOALS
FACTORS TO CONSIDER IN MAKING A SELF EVALUATION
QUALIFICATION
 EDUCATION QUALIFICATION
 DOES IT FIT THE JOB YOU'RE APPLYING FOR
 REQUIRED TO HAVE A BACHELOR'S DEGREE IN NURSING
 DEANS, CHIEF NURSE OR DIRECTORS OF NURSING SERVICE ARE REQUIRED TO
HAVE A MASTER DEGREE IN NURSING

YEARS OF EXPERIENCE AND TRAINING

 WHAT ARE YOUR EXPERIENCES AND TRAINING?
 ARE THESE RELEVANT TO THE POSITION YOUR APPLYING FOR?
 SPECIAL AREAS LIKE OR,ICU AND ER REQUIRE NURSES WHO HAVE EXPERIENCE
IN THESE AREA
 STAFF NURSE POSITION DO NOT REQUIRE EXPERIENCE BUT EXPERIENCE CAN
STILL HELP IN THEIR APPLICATIONS
AGE AND PHYSICAL CONDITION
 MOST EMPLOYERS PREFER YOUNG NURSES FOR BEGINNING POSITIONS
 OLDER NURSES MAY FEEL UNEASY TO START A NEW IN STAFF POSITION BUT MAY
BE COMFORTABLE IN ADMINISTRATIVE POSITION IF QUALIFIED
 POSITION IN PUBLIC HEALTH  MAY REQUIRE EXTENSIVE EVALUATION.
 ADMINISTRATION POSITIONS REQUIRE NURSES WHO ARE MATURE IN JUDGEMENT
AND DECISION MAKING.

EMOTIONAL STABILITY AND GOALS IN LIFE

 HOW IS YOUR EMOTIONAL SELF?
 CAN YOU BE CALM UNDER STRESS?
  DO YOU GET ALONG WITH PEOPLE?
 WILL YOU RATHER BE ALONE OR IN A CROWD?
 WHAT IS YOUR PRIMARY AIM IN GOING TO NURSING?
YOUR OWN OBJECTIVE AND PHILOSOPHY IN LIFE WILL DETERMINE TO GREAT

EXTENT THE KIND OF FIELD YOU WISH TO GET INTO
FACTORS IN SELECTING FIELD OF NURSING
1.) KIND OF WORK TO BE PERFORMED- ARE YOU PREPARED FOR THE JOB? CAN YOU WORK
UNDER STRESS? DO YOU GET ALONG WELL WITH PEOPLE? ARE YOU INTERESTED IN IT?WHAT
KIND OF SKILLS ARE NEEDED? IS IT HAZARDOUS?
2.) AVAILABILITY OF THE WORK- WILL YOU CHOOSE A FIELD OF NURSING THAT IS
CROWDED? OR WHERE THERE IS A SHORTAGE OF WORKERS? 
3.) HOURS OF WORK- HOW MANY HOURS A DAY OR WEEK DO YOU GO ON DUTY? IS YOUR
WORK ROTATED IN SHIFTS? WILL YOU BE PAYED FOR THE EXTRA HOURS OF DUTY YOU WILL
PERFORM?
4.) QUALIFICATION-WHAT ARE THE REQUIREMENTS IN TERMS OF EDUCATIONAL
QUALIFICATION? EXPERIENCE? TRAINING?
5.) OPPORTUNITIES FOR ADVANCEMENT- WHAT CHANCES DO YOU HAVE IN BEING
PROMOTED AFTER SEVERAL YEARS OF EMPLOYMENT? WILL THEY ALLOW YOU TO GO TO
SCHOOL IF YOU DESIRE?ARE YOU ALLOWED TO ATTEND PROFESSIONAL MEETING/SEMINARS
ON OFFICIAL TIME.
6.) METHOD OF ENTERING-DO YOU NEED AN EXAMINATION TO ENTER? DO YOU NEED
SOMEONE TO RECOMMEND YOU?
7.) EARNING- HOW MUCH IS THE INITIAL SALARY? THE MAXIMUM SALARY? IS SALARY PAID
WEEKLY OR EVERY FIFTEEN DAYS? IS ADDITIONAL PAY GIVEN FOR OVERTIME WORK?
8.)FRINGE BENEFITS- HOW MANY DAYS OF VACATION AND SICK LEAVES ARE GIVEN?
MATERNITY LEAVES? EDUCATION LEAVE?
9.) OTHER BENEFITS- ARE INSURANCE, MEDICARE, RETIREMENT BENEFITS PROVIDED FOR?
CAN NURSES PARTICIPATE IN DISCUSSION OF CONDITION OF WORK

A LETTER OF APPLICATION
IS IMPORTANT BECAUSE IT ENABLES THE EMPLOYER TO JUDGE THE APPLICANT
SCHOLARSHIP ABILITY. EMPLOYERS TAKE INTEREST IN A WELL-WRITTEN LETTER OF
APPLICATION AND USUALLY ARRANGE FOR AN INTERVIEW WHEN THEY SEE ONE.
 
USEFUL POINTER IN MAKING A LETTER OF APPLICATION
 USE CLEAN, WHITE, UNLINED PAPER- IF YOUR WORKING IN A AGENCY , DO NOT USE
THE AGENCY,STATIONERY WITH LETTERHEAD
 USE INK OR BALLPEN IN WRITING- YOU MAY WANT TO TYPE THE LETTER IF YOU SO
PREFER
  USE PROPER SALUTATION- PREFERABLY KNOW THE NAME OF THE PERSON TO WHOM
THE LETTER IS TO BE ADDRESSED
 OBSERVE PROPER MARGIN AND PARAGRAPHING- USE GOOD  ENGLISH AND
CORRECT SPELLING
 WRITE IN A COURTEOUS MANNER- ASK PERMISSION BEFORE USING A PERSON’S
NAME AS REFERENCE.
 ENCLOSE RETURN POSTAGE- SO THAT THE PERSON TO WHOM THE LETTER IS
ADDRESSED WILL BE ENCOURAGED TO REPLY AND WILL NOT HAVE TO SPEND FOR
POSTAGE IN DOING SO.

A LETTER OF APPLICATION MUST CONTAIN THE FOLLOWING:

1.) SOURCE AND PURPOSE

 THE FIRST PARAGRAPH USUALLY CONTAINS THE SOURCE OF INFORMATION
CONCERNING THE VACANCY AND THE NURSE’S INTENT TO APPLY TO THE POSITION
2.) QUALIFICATION
 THE SECOND AND THIRD PARAGRAPHS MUST CONTAIN THE APPLICANT’S
QUALIFICATION THE SCHOOL OR COLLEGE FROM WHERE HE/SHE GRADUATED AND
THE YEAR OF GRADUATION
3.) REFERENCE
 AT LEAST THREE NAMES OF PERSONS WHO HAVE GIVEN CONSENT TO THE USE OF
THEIR NAMES MAY BE USED AS REFERENCE. 
4.) A REQUEST FOR A PERSONAL INTERVIEW
 IF TIME AND DISTANCE PERMITS IS USUALLY INDICATED IN THE LAST PARAGRAPH
RESUME
 THE BASIC COMPONENT OF A RESUME INCLUDE THE NAME, ADDRESS, PHONE NUMBER,
EDUCATION, EXPERIENCE, CONTINUING EDUCATION, HONORS AWARDS, AND
PROFESSIONAL AFFILIATION.
 THE RESUME SHOULD BE CHECKED  FOR TYPOGRAPHICAL ERRORS OR MISSPELLED
WORDS. AND ALL INFORMATION SHOULD BE ACCURATE
 THE COVER LETTER THAT ACCOMPANIES THE RESUME SHOULD BE ADDRESSED TO THE
RIGHT PERSON , USUALLY THE CHIEF NURSE, NURSING DIRECTOR OR ASSISTANT
DIRECTOR FOR NURSING DEPENDING ON THE  POSITION TITLE WHICH VARIES FROM
INSTITUTION TO ANOTHER.
PERSONAL INTERVIEW
 AN INTERVIEW IS A FACE-TO-FACE CONFERENCE BETWEEN TWO PEOPLE ABOUT
SOMETHING. AN INTERVIEW BETWEEN AN APPLICANT AND A PROSPECTIVE EMPLOYER
GIVES BOTH A CHANCE TO ASSESS EACH OTHER.
 FOR THE EMPLOYER, IT GIVES HIM/HER A CHANCE TO ASSESS THE APPLICANT’S
PERSONALITY, ALERTNESS IN ANSWERING QUESTION, POISE COMMAND OF THE SPOKEN
LANGUAGE AND THE LIKE.
 FOR THE APPLICANT , IT GIVES HIM/HER A BACKGROUND OF THE INSTITUTION, ITS
POTENTIAL AS A WORKING PLACE, ITS PHILOSOPHY AND OBJECTIVES, THE WORKING
CONDITIONS, AMONG OTHERS
  THEREFORE IT IS A TWO WAY PROCESS IN WHICH BOTH THE EMPLOYER AND
APPLICANT DISCUSS CONDITIONS OF WORK AND OTHER RELATED TOPICS.

POINTERS TO HELP PREPARE FOR AN INTERVIEW

1.) MAKE AN APPOINTMENT EITHER BY MAIL OR BY TELEPHONE- THE NURSING OFFICE
OR PERSONNEL DIVISION SCHEDULES TIME TO CONDUCT INTERVIEW

2.) BE AT TIME AT THE APPOINTMENT TIME- IT IS NECESSARY THEREFOR THAT YOU START
EARLY FROM YOUR PLACE SO THAT YOU ARE AT THE AGENCY TEN TO FIFTEEN MINUTES
BEFORE THE TIME SO YOU CAN RELAX AND APPEAR UNHURRIED.

3.) KNOW SOMETHING ABOUT THE INSTITUTION WHERE YOU WILL BE APPLYING SO
THAT YOU CAN ANSWER QUESTIONS INTELLIGENTLY- IF POSSIBLE KNOW THE NAME OF
THE PERSON WHO WILL INTERVIEW YOU SO YOU CAN USE IT.

4.) BE AT YOUR BEST- IF YOU ARE A FEMALE, BE NEAT, HAVE A SIMPLE HAIRDO AND
MODERATE MAKE UP, AND WEAR A CONSERVATIVE DRESS REACHING BELOW THE KNEE. IF
YOU’RE A MALE BE LIKEWISE IMPECCABLY GROOMED, COVER ANY TATTOO. DO NOT WEAR
RINGS OR FACIAL PIERCINGS.
5.) BE COURTEOUS AND AT EASE- KNOCK BEFORE YOU ENTER. GREET THE PERSON WHO
LETS YOU IN AND THE PERSON WHO WILL INTERVIEW YOU WITH COURTESY AND A FIRM
HANDSHAKE.

6.) BRING CREDENTIALS SUCH AS YOUR REGISTRATION CARD AND RESIDENCE

CERTIFICATE, TAX ACCOUNT NUMBER, AND THE LIKE- IF POSSIBLE BRING SMALL
PHOTOGRAPH TO ENCLOSE IN A PERSONNEL DATA FORM.

7.) ASK QUESTION THE JOB- IT MAY HELP IN DECIDING IF YOU LIKE THE POSITION

8.) THANK THE INTERVIEWER FOR GIVING YOU SOME OF HIS OR HER TIME- IF THERE ARE
OTHER  APPLICANTS TO BE INTERVIEWED, DO NOT DELAY THE INTERVIEW UNNECESSARILY.

9.) GIVE YOURSELF TIME TO THINK ABOUT THE POSITION- NOTIFY THE PROSPECTIVE
EMPLOYER IF YOU HAVE CHANGED YOUR MIND OR HAVE TRANSFERRED TO ANOTHER
ADDRESS,

10.) IF THE PROSPECTIVE EMPLOYER DOES NOT ANSWER , YOU MAY WRITE A FOLLOW-
UP LETTER STATING YOUR INTEREST IN THE POSITION- IT IS POSSIBLE THAT THEY MAY
NOT HAVE AN IMMEDIATE VACANCY BUT YOUR LETTER WILL SHOW THAT YOU ARE
INTERESTED AND THEY MAY GIVE FIRST PREFERENCE SHOULD ONE OCCUR.

RETAINING A POSITION
 ONCE YOU HAVE OBTAINED A POSITION, STRIVE TO RETAIN IT AND BE SUCCESSFUL IN
THAT CHOSEN FIELD.
SUGGESTION ON HOW TO BE SUCCESSFUL IN YOUR CHOSEN FIELD:
1.) HAVE ADEQUATE KNOWLEDGE AND PREPARATIONS FOR THE JOB
2.) HAVE A WELL DEVELOPED PERSONALITY
3.) DEVELOP GOOD RELATIONSHIPS WITH YOUR CO WORKERS BY:
A) BEING ENTHUSIASTIC IN AND DEDICATED TO YOUR WORK AND BEING SINCERE
AND CONSIDERATE TO OTHER.
B)BEING TACTFUL AND DEPENDABLE
C)DEVELOPING AN ABILITY TO ADHERE TO SOCIAL AMENITIES AND BEING SOCIALLY
COMPATIBLE
D) HAVING SELF CONFIDENCE AND BEING CHEERFUL
E) OFFERING HELP WHEN NEEDED
4.) DEVELOP PROFICIENCY IN COMMUNICATION, BOTH IN ORAL AND IN WRITTEN FORMS
5.) BE ABLE TO ADJUST TO WORKING CONDITIONS AND TO LIFE PATTERNS
CHARACTERISTICS OF PARTICULAR OCCUPATION AND COMMUNITIES.
6.) KEEP ABREAST WITH THE ADVANCES IN MEDICINE, NURSING AND RELATED TO SCIENCE
BY READING PROFESSIONAL LITERATURE AND ATTENDING ACTIVITIES OF PROFESSIONAL
ORGS.

CAUSES OF FAILURE
1.) INCOMPETENCE OF THE LACK OF THE REQUIRED ABILITY AND KNOWLEDGE FOR THE
PARTICULAR JOB.

2.) POOR INTERPERSONAL RELATIONSHIPS LACK OF COOPERATION WITH CO-WORKERS,

DISHONESTY AND BOASTFULNESS AND INABILITY TO GET ALONG WITH PEOPLE.

3.) PERSONALITY DEFECTS SUCH AS IMPRUDENCE IN CHOOSING FRIENDS INSINCERITY ,

CONCEIT, SARCASM, LACK OF TACT, ENVY , DISCOURTESY, BEING TO ARGUMENTATIVE,
APATHY TOWARDS WORK OR BEING  TOO SENSITIVE

4.) INADEQUATE KNOWLEDGE IN SOCIAL CONDUCT, TOO LITTLE TIME FOR RELAXATION AND
RECREATION , UNWHOLESOME OR UNWISE CHOICE OF RECREATION.

5.) INDIFFERENCE TO NEED FOR PERSONAL GROWTH, ALWAYS FINDING REASON FOR NOT
ATTENDING PROFESSIONAL MEETING OR JOINING PERSONAL ORGANIZATION

RESIGNING FROM JOB

 THERE ARE MANY REASONS WHY NURSES RESIGN FROM THEIR JOB. PRIMARILY IS TO
SEEK A BETTER POSITION WHETHER IN THE PHILIPPINES OR ABROAD. OTHER REASONS
MAY BE INABILITY TO ADJUST TO WORK SITUATION, MARRIAGE, CHILDREN AND/OR
TRANSFER OF FAMILY TO OTHER PLACES
 IT IS SUGGESTED THAT  NURSES KEEP THEIR POSITIONS FOR AT LEAST TWO YEARS IF
THE POSITION IS ACCEPTABLE TO THEM. THE FIRST YEAR IS USUALLY SPENT IN
ADJUSTING TO THE POSITION, THE SECOND IN HELPING THEM FIND A FIELD IN NURSING
SPECIALLY OF THEIR CHOICE.
  IF NURSES FEEL UNSUITED TO THEIR POSITION AND FEEL THAT THE ADVANTAGES OF
LEAVING FAR OUTWEIGH THE REASONS FOR STAYING IT MAY BE WISE TO MAKE
CHANGES.
 USE PRUDENCE IN ACCEPTING ANOTHER POSITION. BE SURE IT HAS MORE TO OFFER IN
TERMS OF SALARY, OPPORTUNITY FOR PROMOTION , ADVANCEMENT OR
PROFESSIONAL GROWTH, AND BETTER CHANCES OF ADJUSTING TO THE NEW POSITION
THAN THE PRESENT ONE
 A SELF ANALYSIS MAY BE NECESSARY INCLUDING THE REASON FOR TRANSFERRING
IMPROVEMENTS MAY HAVE TO BE MADE SO THAT UNPLEASANT TRAITS MAY NOT BE
CARRIED ON THE TO THE NEW POSITION
 GIVE ADVANCE NOTICE . A MONTH IS USUALLY ENOUGH FOR THOSE HOLDING STAFF
NURSE POSITIONS.
 LEAVE WITH A CLEAN RECORD. CLEARANCE INCLUDES NON-LIABILITY FROM
RESPONSIBILITIES.

A LETTER OF RESIGNATION MUST OBSERVE THE FOLLOWING

1.) GIVE THE DATE OF RESIGNATION- IT IS GOOD PRACTICE TO COMPLETE THE MONTH
FROM THE DATE THE NOTICE OF RESIGNATION IS FIELD.
2.) STATE THE REASON FOR RESIGNING- ALTHOUGH YOU MAY HAVE HAD AN UNHAPPY
EMPLOYMENT EXPERIENCE, IT IS IMPORTANT TO BE  COURTEOUS BECAUSE THE LETTER IS
USUALLY ON FILE AND IS USUALLY REFERRED TO WHEN THE NEED ARISES.
3.) EXPRESS GRATITUDE FOR KINDNESS AND CONSIDERATION GIVEN DURING THE
PERIOD OF EMPLOYMENT- EXPRESS REGRET FOR LEAVING REGARDLESS OF THE REASON
4.) ATTACH CLEARANCE FOR MONEY, WORK, AND PROPERTY RESPONSIBILITIES- NEVER
WALK OFF FROM POSITION. THIS WILL MAKE ONE LIABLE FOR BREACH OF CONTRACT OR
ABANDONMENT OF DUTY.
DISMISSAL FROM POSITION
 IT IS SELDOM THAT A NURSE GETS DISMISSED. THIS IS USUALLY DONE FOR CAUSE ON
THE PART OF THE NURSE. REASON MAY INCLUDE NEGLIGENCE, INCOMPETENCE,
MALPRACTICE, UNPROFESSIONAL BEHAVIOR OR BREACH OF CONTRACT.
 IN ASSUMING DUTIES AND RESPONSIBILITIES , NURSES SHOULD BE MORE PRUDENT IN
THEIR ACTIONS IN ORDER THAT DISMISSAL CAN BE AVOIDED AS SUBSEQUENT
EMPLOYMENT IS JEOPARDIZED.
SUCCESSION PLANNING IN NURSING

 MANY NURSES LEAVE THEIR PRESENT JOBS BECAUSE THE OPPORTUNITY FOR THE
ADVANCEMENT IS POOR. THOSE IN EXECUTIVE AND ADMINISTRATIVE POSITIONS
SHOULD MAKE FORMAL SUCCESSION PLANS TO HELP THEM RETAIN THE NURSES
 SUCCESSION PLANNING ENCOMPASSES THE FOCUSED, FORMAL ASSESSMENT AND
DEVELOPMENT OF EMPLOYEES FOR FUTURE POSITIONS OF LEADERSHIP. MOST
ORGANIZATIONS INCLUDE THIS SCHEME IN THE STAFF DEVELOPMENT PROGRAMS SO
THAT THEIR EMPLOYEES MAY LOOK UNTO THE FUTURE AND PLAN FOR THEIR
ADVANCEMENT.
 IT IS CLAIMED THAT INTERNAL PROMOTIONS HELP RETAIN EMPLOYEES WHO ARE PART
OF THE CULTURE AND BELIEVE IN THE VALUES OF THE ORGANIZATION.
CRITERIA  TO MEET OWN NEED OF SUCCESSION PLANNING
1.) NEXT IN RANK- MANY OF THOSE NEXT IN THE LINE OF SUCCESSION HAVE ACTED AS
UNDERSTUDIES OF THEIR SUPERIORS AND HAVE ASSUMED THE POSITION ID THEIR
SUPERIORS ARE ON AN OFFICIAL LEAVE OF ABSENCE.
2.) EXPERIENCE- MANAGERIAL ADMINISTRATIVE POSITIONS REQUIRE 3-5 YEARS OF
EXPERIENCE
3.) EDUCATION- THOSE THAT HOLD THE HIGHEST POSITION IN THE NURSING SERVICE ARE
REQUIRED TO HAVE AT LEAST A MASTERS DEGREE IN NURSING AS REQUIRED BY THE
PHILIPPINES NURSING LAW
4.) LEADERSHIP TRAINING PROGRAM- PARTICIPATION IN LEADERSHIP TRAINING
PROGRAMS IS CONSIDERED.
5.) INTERVIEW- IT SHOWS THE POTENTIAL OF THE CANDIDATE TO USE CRITICAL THINKING
AND INDEPENDENT JUDGEMENT.
6.) PERFORMANCE EVALUATION- A PERFORMANCE EVALUATION OF VERY SATISFACTORY
SHOULD BE CONSIDERED IN SUCCESSION PLANNING.

CANDIDATE FOR MANAGERIAL POSITIONS ARE ADVISED TO ASK THEMSELVES THE

FOLLOWING:
1.) DO I HAVE THE PASSION FOR LEADERSHIP?

2.) DO I UNDERSTAND THE JOB REQUIREMENTS?

3.) WHAT SUPPORT I WOULD BE AVAILABLE AND WHERE WOULD I LEARN A NEW SKILL?

4.) WOULD I HAVE MENTORS?

5.) WHAT DO I WANT TO BE DOING IN FIVE YEAR?

 IF YOUR ANSWERS TO THE QUESTIONS ARE POSITIVE THE CHANCES FOR SUCCESS IN
THIS POSITION TO BE TAKEN IS GREAT, THERE ARE ALSO MANY WAYS OF MEASURING
SUCCESS OF A SUCCESSION PLANNING PROGRAM. ONE RECOMMENDATION IS FOR THE
ORGANIZATION TO USE A BALANCED SCORECARD APPROACH WHICH USES LEADING
INDICATOR FOR SUCCESS

LEADING INDICATOR MAY BE AS FOLLOWS: 

 INCREASED JOB SATISFACTION
 INCREASED AWARENESS FOR OPPORTUNITY FOR GROWTH
 INCREASED NUMBER OF POTENTIAL CANDIDATE WHO COMPLETED THE DEVELOPMENT
PLANS
 INCREASED APPRECIATION BY POTENTIAL CANDIDATES OF THE VALUE OF THE
PROCESS
 INCREASED  PARTICIPATION IN LEARNING AND DEVELOPMENT ACTIVITIES
 HIGHER PERCENTAGE OF LEADER AS ACTIVE MENTORS OR COACHES AND THOSE
PROMOTED TO LEADERSHIP POSITIONS
 CONTRACTS

A CONTRACT IS A MEETING OF MINDS BETWEEN TWO PERSONS WHEREBY ONE BINDS

HIMSELF, WITH RESPECT TO THE OTHER, TO GIVE SOMETHING OR TO RENDER SOME
SERVICE.

KINDS OF CONTRACTS

1.) A FORMAL CONTRACT REFERS TO AN AGREEMENT AMONG PARTIES INVOLVED AND IS

REQUIRED TO BE IN WRITING BY SOME SPECIAL LAWS. EXAMPLES ARE MARRIAGE
CONTRACTS, MORTGAGES, DEEDS OR SALE OR WORK CONTRACTS.
2.) AN INFORMAL CONTRACT IS ONE WHICH IS CONCLUDED AS THE RESULT OF A WRITTEN
DOCUMENT OR CORRESPONDENCE WHERE THE LAW DOES NOT REQUIRE THE SAME TO BE IN
WRITING, OR AS THE RESULT OF ORAL AND SPOKEN DISCUSSION BETWEEN THE PARTIES OR
CONDUCT BETWEEN THE PARTIES, EVIDENCE AND INTENTION TO CONTRACT.
3. AN EXPRESS CONTRACT IS ONE IN WHICH THE CONDITIONS AND TERMS OF THE CONTRACT
ARE GIVEN ORALLY OR IN WRITING BY THE PARTIES CONCERNED. AN EXAMPLE OF THIS IS
USUALLY FOUND IN FORMAL CONTRACTS WHEREIN THE KIND OF SERVICES OFFERED,
SALARY, DATE AND TIME OF EFFECTIVITY INCLUDING FRINGE BENEFITS, IF ANY, ARE
SPECIFIED.
4.) AN IMPLIED CONTRACT IS ONE THAT IS CONCLUDED AS A RESULT OF ACTS OF CONDUCT
OF THE PARTIES TO WHICH THE LAW ASCRIBES AN OBJECTIVE INTENTION TO ENTER INTO A
CONTRACT. TO AVOID SUBSEQUENT PROBLEMS, NURSES ARE ADVISED TO CLARIFY THE
TERMS AND CONDITIONS OF EMPLOYMENT BEFORE ASSUMPTION OF WORK WITH THE
PROSPECTIVE EMPLOYER. 
5.) A VOID CONTRACT IS ON THAT IS INEXISTENT FROM THE VERY BEGINNING AND
THEREFORE MAY NOT BE ENFORCED.
6.) AN ILLEGAL CONTRACT IS ONE THAT IS EXPRESSLY PROHIBITED BY LAW.

REQUISITES OF A CONTRACT
1.) TO HAVE A CONTRACT, TWO OR MORE PERSON MUST PARTICIPATE.
2.) THE PARTIES INVOLVED MUST GIVE CONSENT TO THE CONTRACT.
3.) THE OBJECT WHICH IS THE SUBJECT MATTER, OF THE CONTRACT MUST BE SPECIFIED
SUCH AS:
 ALL THINGS WHICH ARE NOT OUTSIDE THE COMMERCE OF MAN;
  ALL RIGHTS WHICH ARE NOT INTRANSMISSIBLE;
 FUTURE INHERITANCE IN CASES EXPRESSLY AUTHORIZED BY THE LAW;
 ALL SERVICES WHICH ARE NOT CONTRARY TO LAW, MORALS, GOOD CUSTOMS, PUBLIC
ORDER, AND PUBLIC POLICY, 
4. THE CAUSE OF OBLIGATION IS ESTABLISHED. THE TIME, PRICE AND SUBJECT MATTER ARE
EXPRESSED. GENERALLY, THE LENGTH OF TIME OF A CONTRACT FOR SERVICES IS AT LEAST
EQUAL TO THE PERIOD FOR WHICH WAGES OR SALARIES ARE PAYABLE. THUS, IF ONE IS
ENGAGED ON YEARLY RATES, THE LENGTH OF TIME OF THE CONTRACT WILL BE AT LEAST
ONE YEAR.
5.) CONTRACTING PARTIES MUST HAVE THE LEGAL CAPACITY TO ENTER INTO A CONTRACT.
THEY MUST;
 BE OF LEGAL AGE;
 BE OF SOUND MIND;
 NOT BE UNDER THE INFLUENCE OF INTOXICATING DRUGS, OR FEAR OF BODILY HARM;
AND
 NOT BE SUFFERING FROM PHYSICAL DISABILITY FROM SUCH AS THOSE WHO ARE
 MENTALLY INCOMPETENT.
INEXISTENT CONTRACTS
THE FOLLOWING CONTRACTS ARE VOID OR INEXISTENT FROM THE BEGINNING.
1.) THOSE WHO CAUSE, OBJECT OR PURPOSE ARE CONTRARY TO LAW, MORALS, GOOD
CUSTOMS, PUBLIC ORDER OR PUBLIC POLICY. 
2.) THOSE WHOSE CAUSE OR OBJECT DID NOT EXIST FROM THE TIME OF TRANSACTION.
3.) THOSE WHO OBJECT IS OUTSIDE THE COMMERCE OF MAN.
4.) THOSE WHICH CONTEMPLATE AND IMPOSSIBLE SERVICE.
5.) THOSE WHERE THE INTENTION OF THE PARTIES RELATIVE TO THE PRINCIPAL OBJECT
CANNOT BE ASCERTAINED.
6.) THOSE EXPRESSLY PROHIBITED OR DECLARED VOID BY LAW.
7.) THOSE WHICH ARE ABSOLUTELY STIMULATED OR FICTITIOUS.
VOIDABLE CONTRACTS
 THE FOLLOWING CONTRACTS ARE VOIDABLE OR ANNULLABLE, EVEN THOUGH THERE
MAY HAVE BEEN NO DAMAGE TO THE CONTRACTING PARTIES.
1.) THOSE CONTRACTS WHEREIN ONE OF THE PARTIES IS INCAPABLE OF GIVING CONSENT TO
A CONTRACT.
2.) THOSE WHOSE CONSENT IS VITIATED BY MISTAKE, VIOLENCE, INTIMIDATION, UNDUE
INFLUENCE OR FRAUD
ILLEGAL CONTRACTS
 CONTRACTS OBTAINED THROUGH USE OF FRAUD, UNDUE INFLUENCE OR DURESS IN
SECURING SUCH, AND THOSE THAT ARE EXPRESSLY PROHIBITED BY LAW ARE ILLEGAL.
1.) THOSE ARE MADE IN PROTECTION OF THE LAW. IF A NURSE PROCEEDS TO ADMINISTER
INTRAVENOUS INJECTION WITHOUT SPECIAL TRAINING AND ACCORDING TO PROTOCOL
ESTABLISHED, SHE/HE VIOLATES RA 9173, THE PHILIPPINE NURSING ACT OF 2002.
2.) CONSENT OBTAINED BY FRAUD. IF A NURSE OBTAINED THE CONSENT OF A PATIENT OR
THE FAMILY TO BE GIVEN SERVICES, THROUGH MISREPRESENTATION THAT SHE/HE IS
LICENSED ALTHOUGH SHE/HE IS NOT, SUCH CONTRACT IS ILLEGAL.
3.) THOSE OBTAINED UNDER DURESS. DURESS MEANS ACTUAL OR THREAT OF VIOLENCE OR
IMPRISONMENT IN ORDER TO OBTAIN CONSENT. A NURSE MAY BE FORCED TO SIGN A
CONTRACT UNDER THREAT OF DISMISSAL. 
4.)  THOSE OBTAINED UNDER UNDUE INFLUENCE. IF A NURSE WHO HAS BEEN TAKING CARE
OF AN ELDERLY PATIENT USES HER CLOSE RELATIONSHIP TO ACQUIRE HIGH SALARY OR
OTHER OPTIONS AS PROPERTY, SUCH CONTRACT IS INVALID AS IT IS ILLEGAL.
5.) THOSE OBTAINED THROUGH MATERIAL MISREPRESENTATION. ASIDE FROM FRAUD,
MATERIAL MISREPRESENTATION MAY PERMIT A PERSON TO AVOID OR CANCEL A
CONTRACT. SUPPOSE A MIDWIFE APPLIED AS NURSE IN AN AGENCY AND WAS SOON FOUND
OUT NOT TO BE A REGISTERED NURSE, THE CONTRACT THAT SHE SIGNED BECOMES ILLEGAL
BECAUSE SHE MISLED THE EMPLOYER THAT SHE IS A NURSE.
BREACH OF CONTRACT
BREACH OF CONTRACT IS FAILURE TO PERFORM AN AGREEMENT, WHETHER EXPRESSED OR
IMPLIED, WITHOUT CAUSE.
1.) PREVENTION OF PERFORMANCE;
2.) FAILURE TO PERFORM BECAUSE OF INCONVENIENCE OR DIFFICULTY;
3.) FAILURE OF COOPERATION IN PERFORMANCE;
4.) ABANDONMENT OF DUTY (I.E., LEAVING UNCONSCIOUS PATIENTS, GOING OFF-DUTY
WITHOUT ENDORSEMENT, LOAFING WHILE ON DUTY); 
5.) SUBSTITUTION OF PERFORMANCE; AND 
6.) FAILURE TO USE DUE CARE.
LEGAL EXCUSES IN REFUSING, NEGLECTING OR FAILURE TO PERFORM A CONTRACT
FOLLOWING ARE LEGAL EXCUSES IN REFUSING, NEGLECTING OR FAILURE TO PERFORM A
CONTRACT:
1.) DISCOVERY OF MATERIAL MISREPRESENTATION MADE AND RELIED UPON;
2.) WHERE PERFORMANCE WOULD BE ILLEGAL;
3.) WHERE PERFORMANCE IS MADE IMPOSSIBLE BY REASON OF ILLNESS;
4.) WHERE PERFORMANCE IS MADE IMPOSSIBLE BY DEATH OF PATIENT OR NURSE;
5.) WHERE PERFORMANCE IS MADE FOR OTHER REASONS; AND
6.) WHERE CONTRACT IS INSUFFICIENT
ADVANTAGES OF WRITTEN CONTRACTS
1.) A WRITTEN CONTRACT IS CERTAIN. IT AVOIDS THE UNCERTAINTY OF HUMAN MEMORY.
2.) IT CAN SPECIFY A DEFINITE TIME WITHIN WHICH IT IS BINDING SO AS TO PROTECT BOTH
SIDES AGAINST SUDDEN CHANGES WITHOUT NOTICE. IT ALSO FIXES A TIME LIMIT AFTER
WHICH CONDITIONS ARE NO LONGER BINDING BUT MAY BE OPENED FOR RE-DISCUSSION.
3.) IT SETS A STANDARD AND RELIEVES AN INDIVIDUAL PROFESSIONAL PERSON FROM
HAGGLING OVER COMPENSATION.
4.) IT IS MORE LIKELY TO BE OPENED AND WELL-KNOWN SO THAT THE USE OF WRITTEN
CONTRACTS TENDS TO ESTABLISH MINIMUM STANDARDS FOR PROFESSIONAL
PRACTITIONERS AND TO PROTECT THEM AGAINST DISCRIMINATION IN COMPENSATION
5.) IT IS DEFINITE AND CAN BE DEFINITE ON MANY DETAILS, WHICH MAY OTHERWISE
STIMULATE FAVORITISM OR CAPRICE EVEN AMONG PROFESSIONALS, SUCH AS HOURS OF
WORK, VACATION OF ALLOWANCES, HOLIDAY PRIVILEGES, HEALTH AND INSURANCE
PROVISIONS.
6.) IT CAN PROVIDE A DEFINITE PROCEDURE IN CASE OF COMPLAINTS ABOUT STANDARD
WORK, SO THAT THE EMPLOYER HAS A CLEAR COURSE AND THE PROFESSIONAL NURSE HAS
PROTECTION AGAINST ARBITRARY ACTION.
7.) IT CREATES A MINIMUM OF CERTAINTY AND SECURITY FOR THE PROFESSIONAL
EMPLOYEE SO THAT HE/SHE IS FREE TO CONCENTRATE ON HIS/HER WORK WITHOUT
CONCERN FOR THE DETAILS, WHICH THE WRITTEN HAS SETTLED.

NURSING ETHICS
INTRODUCTION
▪ PEOPLE’S PERCEPTIONS OF ETHICAL BEHAVIOR ARE OFTEN TIED TO THEIR PERSONAL
BELIEF SYSTEMS, SUCH AS RELIGIOUS BELIEFS, BUT RELIGIOUS BELIEFS VARY
WIDELY.
▪ ETHICAL BEHAVIOR CONSISTS OF FOLLOWING THE LAWS, BUT AS HISTORY CLEARLY
SHOWS, SOME LAWS (SUCH AS SEGREGATION LAWS) HAVE BEEN PROFOUNDLY
UNETHICAL.
▪ ETHICAL BEHAVIOR
✔ IS OFTEN CONSIDERED THAT WHICH IS ACCEPTED BY SOCIETY AS A
WHOLE, BUT AGAIN, HISTORY DOES NOT SUPPORT THAT VIEW.
✔ SOME SOCIETIES, FOR EXAMPLE, SUPPORT FEMALE GENITAL
MUTILATION, AND THIS IS NOW CONSIDERED BY MUCH OF THE
WORLD TO BE UNETHICAL.
✔ SOME CLEAR ETHICAL STANDARDS THAT APPLY TO THE FIELD OF
NURSING, AND NURSES ARE EXPECTED TO ADHERE TO A CODE OF
ETHICS IN ALL PROVISIONS OF CARE AS WELL AS IN THEIR
PERSONAL AND PROFESSIONAL LIVES.
▪ NURSES MUST BE KNOWLEDGEABLE ABOUT THE LAWS THAT IMPACT NOT ONLY
THEIR PERSONAL CONDUCT BUT ALSO THE FIELD OF NURSING AS A WHOLE.
❑ ETHICAL PRINCIPLES ARE THE BASIS OF ALL NURSING PRACTICE AND PROVIDE A
FRAMEWORK TO HELP THE NURSE IN ETHICAL DECISION MAKING.
❖ THE PRIMARY ETHICAL PRINCIPLES :
1. BENEFICENCE: ACTING FOR THE GOOD AND WELFARE OF OTHERS AND
INCLUDING SUCH ATTRIBUTES AS KINDNESS AND CHARITY.
2. NONMALEFICENCE: ACTING IN SUCH A WAY AS TO PREVENT HARM TO OTHERS
OR TO INFLICT THE MINIMAL HARM POSSIBLE.
 3. AUTONOMY: RECOGNIZING THE INDIVIDUAL’S RIGHT TO SELF-DETERMINATION
AND DECISION-MAKING.
4. JUSTICE: ACTING IN FAIRNESS TO ALL INDIVIDUALS, TREATING OTHERS EQUALLY
AND SHOWING ALL INDIVIDUALS THE SAME DEGREE OF RESPECT AND CONCERN.
5. VERACITY: BEING TRUTHFUL, TRUSTWORTHY, AND ACCURATE IN ALL
INTERACTIONS WITH OTHERS.
6. FIDELITY: BEING LOYAL AND FAITHFUL TO INDIVIDUALS WHO PLACE TRUST IN THE
NURSE.
7. INTEGRITY: ACTING CONSISTENTLY WITH HONESTY AND BASING ACTIONS OF
MORAL STANDARDS.
CODES OF ETHICS
⮚ THE EARLY DAYS OF THE NURSING PROFESSION, A CONCERN WITH A CODE OF
ETHICS HAS BEEN CENTRAL TO NURSING PRACTICE TO SERVE AS A GUIDE FOR
INCORPORATING ETHICAL PRINCIPLES INTO PRACTICE.
⮚ THE “NIGHTINGALE PLEDGE,” A MODIFICATION OF THE HIPPOCRATIC OATH (5TH
TO 6TH CENTURY BC), WAS FIRST DEVELOPED IN 1893 AND NAMED IN HONOR OF
FLORENCE NIGHTINGALE.
⮚ THE “NIGHTINGALE PLEDGE” WAS MODIFIED IN 1935 TO SLIGHTLY MODERNIZE
THE LANGUAGE (REPLACING SHALL WITH WILL AND AIDING THE PHYSICIAN
WHILE WIDENING THE ROLE OF THE NURSE TO INCLUDE PUBLIC HEALTH,
“MISSIONER OF HEALTH”):

▪ THE ANA CODE OF ETHICS SERVES TO GUIDE NURSES IN MAINTAINING ETHICAL

STANDARDS AND IN ETHICAL DECISION-MAKING AS WELL AS OUTLINING THE
OBLIGATIONS NURSES HAVE TO PATIENTS AND TO THE NURSING PROFESSION.
❖ THE PROVISIONS FOCUS ON :
❖ 1: RESPECT FOR HUMAN DIGNITY: THE NURSE MUST SHOW RESPECT FOR THE
INDIVIDUAL AND CONSIDER MULTIPLE FACTORS (BELIEF SYSTEMS,
GENDER/SEXUAL IDENTIFICATION, VALUES, RIGHT TO SELF-DETERMINATION,
AND SUPPORT SYSTEMS) WHEN PLANNING AND PROVIDING CARE. THE NURSE
ENSURES PATIENTS ARE FULLY INFORMED AND PREPARED TO MAKE DECISIONS
ABOUT THEIR HEALTHCARE AND TO CARRY OUT ADVANCE HEALTH CARE
PLANNING.

❖ 2: COMMITMENT TO PATIENTS: THE NURSE MUST ALWAYS REMEMBER THAT THE

PRIMARY RESPONSIBILITY IS TO THE PATIENT AND SHOULD HELP TO RESOLVE
CONFLICTS THAT MAY OCCUR BETWEEN THE PATIENT AND OTHERS AND AVOID
CONFLICTS OF INTEREST OR BREACH OF PROFESSIONAL BOUNDARIES.

❖ 3: PROTECTION OF PATIENTS’ RIGHTS: THE NURSE MUST BE AWARE OF LEGAL

AND MORAL RESPONSIBILITIES RELATED TO THE PATIENTS’ RIGHTS TO PRIVACY
AND CONFIDENTIALITY (AS OUTLINED BY HIPAA REGULATIONS) AND
PARTICIPATION IN RESEARCH.

❖ 4: ACCOUNTABILITY: THE NURSE BEARS PRIMARY RESPONSIBILITY FOR THE CARE

OF THE PATIENT AND MUST PRACTICE IN ACCORDANCE TO NOT ONLY THE CODE
 OF ETHICS BUT ALSO THE STATE NURSE PRACTICE ACT AND ANY REGULATIONS
OR STANDARDS OF CARE THAT APPLY TO NURSING AND HEALTHCARE.

❖ 5: PROFESSIONAL GROWTH: THE NURSE MUST STRIVE ALWAYS TO PROMOTE

HEALTH, SAFETY AND WELLBEING OF SELF AND OTHERS. THE NURSE MUST, IN
ALL CIRCUMSTANCES, MAINTAIN PERSONAL INTEGRITY AND REPORT
VIOLATIONS OF MORAL STANDARDS. THE NURSE HAS A RIGHT TO REFUSE TO
PARTICIPATE IN ACTIONS OR DECISIONS THAT ARE MORALLY OBJECTIONABLE
BUT CANNOT DO SO IF THIS REFUSAL IS BASED ON PERSONAL BIASES AGAINST
OTHERS RATHER THAN LEGITIMATE MORAL CONCERNS.

❖ 6: IMPROVEMENT OF HEALTHCARE ENVIRONMENT: THE NURSE MUST RECOGNIZE

THAT SOME VIRTUES ARE EXPECTED OF NURSES, INCLUDING THOSE ASSOCIATED
WITH WISDOM, HONESTY, AND CARING FOR OTHERS, AND THAT THE NURSE HAS
ETHICAL OBLIGATIONS TOWARD OTHERS. THE NURSE IS ALSO RESPONSIBLE FOR
CREATING AND SUSTAINING A MORAL WORKING ENVIRONMENT.

❖ 7: ADVANCEMENT OF THE PROFESSION: THE NURSE MUST CONTRIBUTE TO THE

PROFESSION THROUGH PRACTICING WITHIN ACCEPTED STANDARDS, ENGAGING
IN SCHOLARLY ACTIVITIES, AND CARRYING OUT OR APPLYING RESEARCH WHILE
ENSURING THE RIGHTS OF THE PATIENTS ARE PROTECTED.

❖ 8: HEALTH PROMOTION EFFORTS: THE NURSE RECOGNIZES THAT HEALTH IS A

UNIVERSAL RIGHT FOR ALL INDIVIDUALS AND COLLABORATES WITH OTHERS TO
ENSURE IMPROVEMENT IN THE GENERAL HEALTH AND TO REDUCE DISPARITIES.
THE NURSE REMAINS SENSITIVE TO CULTURAL DIVERSITY AND TAKES ACTION
AGAINST HUMAN RIGHTS VIOLATIONS, SUCH AS GENOCIDE, AND OTHER
SITUATIONS THAT MAY ENDANGER HUMAN RIGHTS AND ACCESS TO CARE

❖ 9: PARTICIPATION IN GOALS OF THE PROFESSION: THE NURSE MUST PROMOTE

AND SHARE THE VALUES OF THE PROFESSION AND TAKE ACTION TO ENSURE
THAT SOCIAL JUSTICE IS CENTRAL TO THE PROFESSION OF NURSING AND
HEALTHCARE.

❖ THE INTERNATIONAL COUNCIL OF NURSES, WHOSE GOAL IS TO REPRESENT

NURSES THROUGHOUT THE WORD, ALSO DEVELOPED A CODE, WHICH SERVES AS
THE BASIS FOR NURSING PRACTICE:

❖ THE ICN CODE OF ETHICS FOR NURSES, FIRST ADOPTED IN 1953 AND REVISED IN
2012.
THE ICN CODE OF ETHICS FOCUSES ON FOUR DIFFERENT ELEMENTS: NURSES AND
1. PEOPLE: THOSE IN NEED OF CARE ARE THE PRIMARY RESPONSIBILITY OF THE
NURSE, WHO MUST SHOW RESPECT FOR DIVERSITY AND CULTURAL DIFFERENCE,
UPHOLD THE PATIENTS’ RIGHTS TO PRIVACY AND CONFIDENTIALITY, AND
PROMOTE SOCIAL JUSTICE AND PROFESSIONAL VALUES.
2. PRACTICE: THE NURSE MUST PRACTICE RESPONSIBLY AND RECOGNIZE
ACCOUNTABILITY FOR ACTIONS, DELEGATIONS, PERSONAL CONDUCT, AND
PROVISIONS OF CARE.
 3. PROFESSION: THE NURSE MUST UPHOLD THE VALUES OF THE PROFESSION AND
PROMOTE THE PROFESSION.
4. COWORKERS: THE NURSE MUST DEMONSTRATE RESPECT FOR COLLEAGUES AND
COLLABORATE WITH THEM IN THE PROVISION OF CARE BUT MUST PROTECT
PATIENTS FROM NEGLIGENT OR IMPAIRED HEALTHCARE PROVIDERS.
5. ADDITIONALLY, CODES OF ETHICS HAVE BEEN DEVELOPED SPECIFICALLY FOR
SOME CERTIFICATIONS AND SPECIALTIES WITHIN THE FIELD OF NURSING.

MORAL AND SPIRITUAL RESPONSIBILITIES OF NURSES

MORAL PRINCIPLES
• NURSES, WHATEVER THEIR RELIGION, MUST BE GOD-LOVING AND GOD-FEARING.
THEY MUST REALIZE THAT THE NURSING PROFESSION IS A COMMITMENT BOTH TO
GOD AND PEOPLE. THEY SHOULD EMPHASIZE THE IMPORTANCE OF PROVIDING
SPIRITUAL CARE AS A VITAL ASPECT OF NURSING CARE. THEY MUST UPHOLD THE
SANCTITY OF HUMAN LIFE.
• WHEN A NURSE IS CONFRONTED WITH SITUATIONS WHERE MORAL JUDGMENT IS
NECESSARY, THE NURSE MAY BE GUIDED BY PRINCIPLES OR RULES.
THE GOLDEN RULE
• “DO UNTO OTHERS WHAT YOU WOULD LIKE OTHERS DO UNTO YOU.”
• SINCE NURSES LIKE OTHERS TO TREAT THEM KINDLY AND WITH RESPECT, THEY
SHOULD BE WILLING TO DO THE SAME TO OTHERS TOO.
THE TWO-FOLD EFFECT
WHEN A NURSE IS FACED WITH A SITUATION WHICH MAY HAVE BOTH GOOD AND BAD
EFFECTS, HOW SHOULD SHE CHOOSE WHICH ONE TO FOLLOW?
• THE BASIS OF ACTION MAY BE THE FOLLOWING:
• THAT THE ACTION MUST BE MORALLY GOOD;
• THAT THE GOOD EFFECT MUST BE WILLED AND THE BAD EFFECT MERELY
ALLOWED;
• THAT THE GOOD EFFECT MUST NOT COME FROM AN EVIL ACTION BUT FROM THE
INITIAL ACTION ITSELF DIRECTLY; AND
• THAT THE GOOD EFFECT MUST BE GREATER THAN THE BAD EFFECT.
• IT IS NOT MORALLY GOOD IF A BOY STEALS IN ORDER TO ALLEVIATE HIS HUNGER
BECAUSE THE ACTION ITSELF IS ALREADY BAD. ON THE OTHER HAND, IF A
PATIENT WHO HAS CANCER OF THE UTERUS SUBMITS TO HYSTERECTOMY SHE
WILL NOT BE ABLE TO BEAR A CHILD. IF SHE DOES NOT HAVE THE OPERATION,
SHE WILL DIE. IT IS THE GYNECOLOGIST’S INTENTION TO HELP THE MOTHER AND
NOT TO HARM HER. THE SURGEON'S ACTION IS MORALLY GOOD SINCE SAVING
THE MOTHER'S LIFE IS OF PRIMARY IMPORTANCE. ALSO THE DOCTOR HIMSELF
DID NOT WILL THAT THE PATIENT LOSE HER CHILD-BEARING FUNCTION.
THE PRINCIPLE OF TOTALITY
THE WHOLE IS GREATER THAN ANY OF ITS PARTS.
• SUPPOSE A MAN'S FOOT IS GANGRENOUS, SHOULD HE CONSENT TO AN
AMPUTATION? SINCE THE AMPUTATION WILL SAVE THE PATIENT'S LIFE AND HE
CAN STILL WALK THROUGH THE AID OF CRUTCHES OR ARTIFICIAL LIMBS, HE CAN
CONSENT TO AN OPERATION. THE NURSE CAN HELP THE PATIENT UNDERSTAND
THIS.
EPIKIA
“EXCEPTION TO THE GENERAL RULE.”
• IT IS A REASONABLE PRESUMPTION THAT THE AUTHORITY MAKING THE LAW WILL
NOT WISH TO BIND A PERSON IN SOME PARTICULAR CASE, EVEN THOUGH THE
CASE IS COVERED BY THE LETTER OF THE LAW.
• IF A MENTAL PATIENT WENT BERSERK AND THE DOCTOR COULD NOT BE
CONTACTED, THE PATIENT MAY BE RESTRAINED BY VIRTUE OF EPIKIA. ANOTHER
EXAMPLE OF THIS IS ALLOWING A RELATIVE TO SEE A SERIOUSLY ILL PATIENT
WHO EXPRESSES THE DESIRE TO SEE THE FORMER ALTHOUGH IT IS NOT YET
VISITING HOURS.
OTHER PRINCIPLES
• 5. ONE WHO ACTS THROUGH AN AGENT IS HIMSELF RESPONSIBLE. FOR EXAMPLE, A
PATIENT WANTS TO HAVE AN ABORTION AND ASKS A NURSE IF SHE CAN DO IT. THE
NURSE REFUSES, BUT THEN RECOMMENDS A DOCTOR WHO IS CAPABLE OF
PERFORMING AN ABORTION. THE NURSE BECOMES LIABLE TO SUCH A CRIME,
SINCE HE/SHE IS AN ACCOMPLICE OF THE SAID DOCTOR.
• 6. NO ONE IS OBLIGED TO BETRAY HIMSELF/HERSELF. IN TESTIFYING BEFORE A
COURT, NO ONE CAN FORCE ANY PERSON TO ANSWER A QUESTION IF SUCH WILL
INCRIMINATE HIM/HER.
• 7. THE END DOES NOT JUSTIFY THE MEANS. GIVING A SLEEPING TABLET TO A
CHRONICALLY ILL PERSON SO HE/SHE CAN DIE IN PEACE IS MORALLY WRONG. A
PHYSICIAN IN THE UNITED STATES ASSISTED A WOMAN DIAGNOSED AS HAVING
ALZHEIMER'S DISEASE, IN COMMITTING SUICIDE. THIS IS BOTH LEGALLY AND
MORALLY WRONG.
• 8. DEFECTS OF NATURE MAY BE CORRECTED. PATIENTS WITH A HARELIP OR CLEFT
PALATE MAY HAVE THEIR DEFECTS CORRECTED BY PLASTIC SURGERY. WHAT
SHALL BE THE ROLE OF THE NURSE IN A CASE IN WHICH PARENTS OF A SEVERELY
DEFORMED NEWBORN CHILD (DOWN'S SYNDROME WITH INTESTINAL ATRESIA)
REFUSE TO FEED AND ALLOW THEIR CHILD TO STARVE TO DEATH? WITHHOLDING
NUTRITION CAN CONSTITUTE NURSING NEGLECT AND EXPOSE THE NURSE TO
CRIMINAL CHARGES OF NEGLIGENCE OR CONSPIRACY TO COMMIT MURDER.
• 9. IF ONE IS WILLING TO COOPERATE IN THE ACT, NO INJUSTICE IS DONE TO
HIM/HER. SUPPOSE A PATIENT SUBJECTS HIMSELF/HERSELF WILLINGLY TO AN
EXPERIMENTAL DRUG AND HE/SHE HAS BEEN TOLD OF THE POSSIBLE EFFECTS OF
THE SAME, IS OF RIGHT AGE, AND IS SANE, THERE IS NO VIOLATION OF HUMAN
RIGHTS.
• 10. A LITTLE MORE OR LESS DOES NOT CHANGE THE SUBSTANCE OF AN ACT. IF A
NURSE GETS MEDICINE FROM A HOSPITAL STOCK WITHOUT PERMISSION OR
WITHOUT PRESCRIPTION, HE/SHE WILL BE GUILTY OF THEFT EVEN IF HE/SHE GOT
ONLY ONE TABLET OF THE SAME.
• 11. THE GREATEST GOOD FOR THE GREATEST NUMBER. DURING AN EPIDEMIC,
IMMUNIZATION AGAINST COMMUNICABLE DISEASES IS ADMINISTERED TO THE
PEOPLE. ALTHOUGH THERE MAY BE SOME WHO MAY HAVE SLIGHT REACTIONS TO
THE VACCINE, THE GREATER MAJORITY OF THE POPULATION SHALL BE
CONSIDERED RATHER THAN THE ISOLATED FEW. THIS IS CALLED THE UTILITARIAN
PRINCIPLE.
• 12. NO ONE IS HELD TO THE IMPOSSIBLE. TO PROMISE THAT A PATIENT WITH HEART
TRANSPLANT WILL LIVE MAY BE AN IMPOSSIBILITY. YET, SUCH PROCEDURES ARE
DONE IN THE HOPE OF SAVING OR PROLONGING A PATIENT’S LIFE. THE DOCTOR OR
THE NURSE CANNOT BE HELD TO THE IMPOSSIBLE IF THEY HAVE DONE THEIR BEST
TO TAKE CARE OF THE PATIENT AND THE LATTER DIES.
• 13. THE MORALITY OF COOPERATION. FORMAL COOPERATION IN AN EVIL ACT IS
NEVER ALLOWED. IMMORAL OPERATIONS SUCH AS ABORTION SHALL NOT BE
PARTICIPATED UPON BY A NURSE EVEN IF THE DOCTOR COMMANDS IT.
• 14. PRINCIPLE RELATING TO THE ORIGIN AND DESTRUCTION OF LIFE. ONE OF GOD'S
COMMANDMENTS IS “THOU SHALL NOT KILL.” IF GOD HAS GIVEN MAN A LIFE, WILL
IT MEAN THAT GOD HAS ALREADY CEDED HIS RIGHT TO MAN? AND IF LIFE
 CONTAINS WITH IT A FREE WILL FOR MAN TO PERFORM WHAT HE THINKS IS BEST
FOR HIM AND HIS ENVIRONS, WHERE, THEN, DOES THE RIGHT OF GOD BEGIN?
WHERE DOES THE RIGHT OF MAN BEGIN OR END? ASSUMING THAT GOD GAVE LIFE
TO MAN, WHO WILL KNOW THAT GOD DOES ABHOR A MAN WHO TAKES HIS OWN
LIFE? MAN MAY APPEAR ONLY A PUPPET OF GOD, IF GOD WILL NOT LET GO OF HIS
CREATION – MAN - TO DO WHAT IS BEST FOR HIM, I.E., INCLUDING EUTHANASIA.
EUTHANASIA
• EUTHANASIA IS DIRECT KILLING OF PEOPLE WHO MAY NOT HAVE COMMITTED ANY
CRIME DESERVING OF DEATH, BUT BECAUSE OF MENTAL OR PHYSICAL DEFECTS,
ARE CONSIDERED WORTHLESS TO SOCIETY. MERCY KILLING IS NOT ALLOWED
BECAUSE IT WILL LESSEN THE INCENTIVE FOR MEDICAL RESEARCH. IT WILL ALSO
BE POSSIBLE TO ARRANGE FOR THE DEATH OF AN ENEMY OR A WEALTHY
RELATIVE. MANY PATIENTS SURPRISE DOCTORS BY RECOVERING FROM ILLNESS. IN
LEGALIZED EUTHANASIA, THEY ARE ALREADY DEAD.
• GIVING OF NARCOTICS TO A DYING PERSON SHALL BE WITHHELD IF THERE IS NO
PHYSICAL PAIN. HE MUST BE LEFT CONSCIOUS FOR AS LONG AS GOD DOES NOT
TAKE HIS CONSCIOUSNESS AWAY.
• THE STATE RECOGNIZES THE SANCTITY OF HUMAN LIFE. IT SHALL PROTECT THE
LIFE OF THE MOTHER AND THE UNBORN FROM THE TIME OF CONCEPTION. ANY
DIRECT ATTACK ON THE LIFE OF A FETUS FOR WHATEVER CAUSE IS IMMORAL. A
FETUS SHALL BE BURIED IN CONSECRATED GROUNDS. IF IT IS DEAD AND CAME
FROM A DEAD MOTHER, IT SHALL BE BURIED WITH THE MOTHER.
SPIRITUAL COMMITMENT OF NURSES
• WHEN WE SPEAK OF HOLISTIC CARE THIS MEANS THAT THE SPIRITUAL ASPECT IS
INCLUDED AS WELL.
• THE CODE OF ETHICS FOR FILIPINO NURSES LISTS PROVISION OF SPIRITUAL
ENVIRONMENT AS ONE OF THE RESPONSIBILITIES OF THE NURSE. CHRISTIAN
NURSES OFTEN REFER TO THE BIBLE FOR INSPIRATIONAL PASSAGES THAT WILL
ENHANCE AND STRENGTHEN THEIR LOVE AND CONCERN FOR THEIR FELLOWMEN.
MUSLIMS FIND APPROPRIATE PASSAGES IN THEIR QURAN.
• THE NURSE'S MINISTRY IS REFLECTED IN GOD'S TWO GREAT COMMANDMENTS:
“LOVE THE LORD GOD WITH ALL YOUR HEART, AND WITH ALL YOUR SOUL AND
WITH ALL YOUR MIND” AND “LOVE YOUR NEIGHBORS AS YOURSELF.”
• THE ROLE OF NURSES IN PROVIDING NON-PREJUDICIAL, NON-DISCRIMINATORY
CARE CAN WELL BE BASED ON THE STORY OF THE GOOD SAMARITAN. GOD HAS
ASKED US TO LOVE ONE ANOTHER AS HE LOVES US.
THE GOOD SAMARITAN LAW
• THERE ARE MANY PERSONS WHO REFUSE TO GIVE EMERGENCY AID TO VICTIMS OF
ACCIDENTS DUE TO LIABILITIES THEY MAY INCUR LATER. ALTHOUGH NO ONE IS
LEGALLY COMPELLED TO DO SO, IT WILL NOT BE ETHICALLY AND MORALLY RIGHT
TO LEAVE PERSONS WITHOUT AID ESPECIALLY IF ONE HAS THE SKILL AND THE
KNOWLEDGE TO SAVE LIVES.
• IN THE UNITED STATES, THE GOOD SAMARITAN LAW HAS BEEN PASSED TO
ENCOURAGE ON-THE-SPOT VOLUNTEER FIRST AID IN EMERGENCY SITUATIONS BY
PERSONS WITH THE PROPER KNOWLEDGE AND SKILL. A NURSE THEREFORE WHO
RENDERS FIRST AID OR TREATMENT AT THE SCENE OF AN EMERGENCY AND WHO
DOES SO WITHIN THE STANDARD OF CARE, ACTING IN GOOD FAITH, IS RELIEVED OF
THE CONSEQUENCES OF THE ACT.
• THE GOOD SAMARITAN ACT IS BASED ON THE BIBLICAL STORY OF A MAN WHO
AIDED AN INJURED PERSON WHO WAS WAYLAID BY THIEVES AND WAS LEFT HALF-
DEAD. THE SAMARITAN TOOK CARE OF HIM WITH COMPASSION, BOUND UP HIS
WOUNDS, BROUGHT HIM TO AN INN, AND TOOK CARE OF HIM. JESUS TOLD THE
STORY OF THE GOOD SAMARITAN TO ILLUSTRATE HOW WE CAN LOVE OUR
NEIGHBORS.
END OF LIFE CARE
 • STANDARD VII END-OF-LIFE CARE (ANSAP STANDARDS OF NURSING PRACTICE 2008)
STATES THAT: “THE NURSE PROVIDES AN END-OF-LIFE CARE THROUGH PROVISION
OF OPTIMUM COMFORT AND RESPECT FOR PATIENT'S DIGNITY.”
• RESPECT FOR THE PATIENT'S RELIGION AND CULTURAL PREFERENCES AND
PRACTICES IS EVIDENT. IF THERE IS DANGER OF DEATH, ROMAN CATHOLIC
PATIENTS ARE OBLIGED TO RECEIVE THE SACRAMENTS. CONFESSION AND
COMMUNION ARE RECOMMENDED. IF THE PATIENT IS ADMITTED TO THE HOSPITAL,
HE/SHE ES MUST BE INFORMED OF THE AVAILABILITY OF A PRIEST TO CARE FOR
HIS/HER SPIRITUAL NEEDS. THE NURSE IS OBLIGED TO CALL THE PRIEST WHEN
NEEDED.
• WHEN DANGER OF DEATH IS REMOTE, REFERENCE WHEN PRIEST IS MAKING
ROUNDS IS SUFFICIENT. WHEN A PATIENT IS RECEIVING OPIATES, DELAY ITS
ADMINISTRATION UNTIL THE PRIEST ARRIVES SO THAT THE PATIENT NE CAN HAVE
THE OPPORTUNITY TO EXPRESS SORROW FOR HIS/HER SINS AND NE MAKE HIS/HER
CONFESSION. THE DYING PATIENT'S BILL OF RIGHTS IS INCLUDED IN APPENDIX W.
• THE NON-ROMAN CATHOLIC PATIENT LIKEWISE LOOKS UP TO HIS OR HER
MINISTER FOR SPIRITUAL GUIDANCE. A PRUDENT NURSE ANTICIPATES OF THIS
NEED OF THE PATIENT AND MAKES ARRANGEMENTS WITH THE MINISTER OR IMAM.
IN THE ABSENCE OF ONE, THE NURSE CAN READ FAVORITE PASSAGES FROM THE
BIBLE FOR THE PATIENT. THE LORD'S PRAYER MAY BE RECITED FOR OR WITH THE
PATIENT.
• MUSLIM NURSES PROVIDE COMFORT AND PRAYERS TO PATIENTS OF THE SAME
FAITH BY QUOTING PASSAGES FROM THE QURAN. "PATIENTS ARE ENCOURAGED TO
PUT THEIR TRUST IN ALLAH FOR HE IS COMPASSIONATE AND MERCIFUL AND
SHALL RELIEVE THEM OF THEIR BURDENS.“
• "ALLAH IS THE LORD OF KINDNESS TO BELIEVERS; HE IS THEIR PROTECTOR AND
THE BEST OF THEIR HELPERS; HE LOVES THOSE WHO PUT 10 THEIR TRUST (IN HIM)
AND HE LOVES THOSE WHO DO GOOD. IN SERVING THE SICK AND THE DYING,
ALLAH ASSURES THAT FOR THOSE WHO KEEP THEIR DUTY TO THE LORD, FOR
THEM ARE GARDENS UNDERNEATH WHICH RIVERS FLOW, WHEREIN THEY WILL BE
SAFE FOREVER." IN GENERAL, IT IS THE NURSE WHO RECOGNIZES THE SPIRITUAL
NEEDS OF THE PATIENT AND GIVES THE LATTER PEACE OF MIND AND COMFORT TO
FACE WHAT LIES AHEAD OF HIM/HER.
• THE NURSE SHOULD NOT DISCONTINUE THE SUPPORT OF PATIENTS AT HIGH RISK FOR
DEATH OR SEVERELY IMPAIRED FUNCTIONAL RECOVERY WITHOUT OFFERING THE
PATIENT AND FAMILY THE ALTERNATIVE OF CARE FOCUSED ENTIRELY ON COMFORT.
ALTHOUGH MANY PATIENTS AND THEIR FAMILIES PREFER AVOIDANCE OF EXTENDED
LIFE-SUPPORT MEASURES, AGGRESSIVE LIFE-SUSTAINING THERAPIES ARE OFTEN
USED AT LEAST IN PART TO ELICIT PATIENT/FAMILY PREFERENCES AND TO PROVIDE
PATIENT-CENTERED CARE.
• ROUTINELY DISCUSSING THESE PREFERENCES AND THE ALTERNATIVE OF PALLIATIVE
CARE COULD IMPROVE THE QUALITY OF DYING AND REDUCE FAMILY DISTRESS AND
BEREAVEMENT.
LIFE IN GOD’S SERVICE
• NURSES CAN USE THEIR DIFFERENT GIFTS IN ACCORDANCE WITH THE GRACE THAT
GOD HAS GIVEN THEM. IF THEIR GIFT IS TO SPEAK GOD'S MESSAGE, THEY SHOULD
DO IT ACCORDING TO THE FAITH THAT THEY HAVE; IF IT IS TO SERVE, THEY
SHOULD SERVE; IF IT IS TO TEACH, THEY SHOULD TEACH; IF IT IS TO ENCOURAGE
OTHERS, THEY SHOULD DO SO.
• WHOEVER SHARES WITH OTHERS SHOULD DO SO GENEROUSLY; WHOEVER HAS
AUTHORITY SHOULD WORK HARD; WHOEVER SHOWS KINDNESS TO OTHERS
SHOULD DO SO CHEERFULLY.
THE CODE OF ETHICS
FOR FILIPINO NURSES