Professional Adjustment

Lecturer: Atty. Rafael A. Dela Cruz III, RN, MSN, JD, LLM (c)

If you want to pass the boards, think like the people who made the boards.
Good faith is presumed in every action.

Filing a Case
1. Duty
- form of obligation
- right is asserted, obligation is enforced/respected

2. Breach of Duty
- Failure to perform the duty through omission and commission
- Omission: No action done
- Commission: Action was done

3. Proximate Injury
- May be divided into two: proximate cause and injury

Sources of Right
San ung sources of Left?HAHAHAHHA CIARA HUHUHUHUHUHU :((
Law Contract Delict

- Promulgated by a - Agreement between the - Crime

supreme party about the object and
authority/being consideration
- Law will kick in/prevail - The law between the parties;
if the contract is contract will prevail if it is in
contrary to the law. compliance with the law

1. Consent
- Consent vs. Assent
- Consent applies for age of
majority (18+); formerly 14
(male) and 16 (female)
- Assent refers to
consenting without being
in the age of majority; not
present in PH law; present
in foreign countries

2. Object
- What you give ?? (e.g. we
give our attention to the
lecturer)
3. Consideration
- What you receive ?????
(e.g. the lecturer gives
knowledge)

Sample Question:
The client died. The body of the client was lost. Who is liable?
A. Mortician - “undertaker/embalmer” stipulated in Section 89 of PD 856 (Code of Sanitation)
B. MD
C. RN
D. UAP

If a person died, the body of the patient will become a special property called an “Estate”

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Complainants of the case include the spouse, children, parents, and collateral (relatives)

PD 603
- states that any medical practitioner/health care provider should report in writing the act of
abuse against the child to (any of) the PNP, DSWD, or Prosecutor [fiscal]

RA 7610 - AN ACT PROVIDING FOR STRONGER DETERRENCE AND SPECIAL PROTECTION

AGAINST CHILD ABUSE, EXPLOITATION AND DISCRIMINATION, AND FOR OTHER PURPOSES

RA 9262 - Anti-Violence Against Women and Children Act

- Encompasses physical/psychological violence, emotional abuse, economic abuse, etc.

PD 169 - If there is a case of physical injury, it must be reported to the PH Constabulary → PNP

RA 10932 (amending RA 8344)

- Anti-Deposit Law
- RN’s duty: provide medical care to clients, especially during emergency situations (including
pregnancies where there is a threat to the life of the unborn)
- give basic emergency care kahit walang bayad uu not admit
- For COVID (+) patients with emergency s/sx = law is applicable
- Ambulance use is FREE for all LGU’s
- If patient is non-compliant (refuses to pay expenses upon admission), the hospital can sue
the patient under RA 9439

Duty
- form of obligation
- right is asserted, obligation is enforced/respected
Types of Duty
1. Normal - prudent person = negligence
2. Professional - attaches only if profession is regulated by the state; if the profession affects
the public, the state has the right to regulate the profession

Which of the following is NOT a characteristic of a profession?

A. Ethics - Profession = Code of Good Governance = Code of Ethics
B. Specialized training = every profession must always have specialized training
C. Professional membership - PRC eme
D. Research = According to the PRC, research is not considered as a characteristic of a
profession in the PH (contrary to NCLEX)

Which of the following is the source for the CoE for nurses?
A. Code of Good Governance
B. Int’l Council for Nurses - source of old CoE
C. Int’l Council for Nurses and Doctors
D. Int’l Council for Nurses 2008 - source of old CoE

Three A’s
1. Authority - the mastery of knowledge and skills not common to the public
2. Accountability - hallmark of a profession; not the same with “responsibility” which
attaches to both professional and non-professional
3. Autonomy - As a professional, rule of credit & discredit, do not overstep professional
boundaries.

A patient requires IFC. The medical intern wrongly inserted the IFC into the vagina of the patient.
The nurse saw that the intern is about to reinsert the IFC into the urethra of the patient.

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 A. Incident Report
B. Report to Nurse Supervisor
C. Hold the arms of the intern
D. Offer a new IFC
E. Offer yourself to insert the IFC

Conflict Resolution steps: (1) Confront, (2) Document, and (3) Report
Rely on scientific evidence.
Do not use ethics as a primary reason for answering questions; it is only a subsidiary concept.

Rule of credit & discredit:

- All members of the HC Team are professionals, each one is an autonomous practitioner.
- Do not discredit other professionals to credit yourself.

The means are regulated, the end is not (Dela Cruz, 2022).

Negligence - committed by a non-professional (e.g., doing/failure to do a procedure by a normal,

prudent person that is not expected of them)

Malpractice - a duty of a professional was breached and was not followed

A patient has a positive skin test result. The nurse still gave the medication.
Is it negligence or malpractice?
→ Malpractice

If a student nurse commits an error, the clinical instructor is held liable since s/he is the professional
in charge.
→ (Student nurse cannot be charged with malpractice since s/he is not a professional)

Breach of Duty
- Failure to perform the duty through omission and commission
- Omission: No action done
- Commission: Action was done
Misdemeanors
1. Nonfeasance - failure to perform an act that is required by the law
2. Misfeasance - a transgression, especially the wrongful exercise of lawful authority.
3. Malfeasance - committing an act that is illegal in nature.

Proximate Injury
- The invasion of right
- The proximate cause is liable for the proximate injury that may happen

Proximate Cause → Proximate Injury

*Intervening Cause - diversion of actions/interventions that were done that may make the
proximate cause voided of the latter injury that has happened.

*In law, damnum absque injuria is a phrase expressing the principle of tort law in which some
person causes damage or loss to another, but does not injure them.
*Destierro - banishment from the area of the crime (approximately 5-25 km)

IMBESTIGADOR

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 Criminal Case

Plaintiff (People of the PH) Accused

● Life, Liberty, Property at stake

● Life can be removed (death penalty)
● Liberty can be removed (criminal case can lead to imprisonment)
● Property can be removed (paying of fines)

A criminally liable person is also civilly liable.

*Proof beyond reasonable doubt - moral certainty; any doubt that the person committed the
crime, they will be acquitted

- Harder to prove

Civil Case

Complainant Defendant

*Preponderance of evidence - both complainant and defendant have rights; whose evidence of
right has more weight

● Property can be affected

Administrative Case

Complainant Respondent

Privilege can be removed

The State has the right to remove a privilege

BON - has administrative authority

Practice of profession is a mere privilege; not a property right

RA 10912 - CPD Law authored by Sen. Antonio Trillanes

*Substantial evidence - relevant and competent evidence sufficient enough to support a

conclusion

- Easier to prove

Probable Cause (Preliminary Investigation)

Complainant Respondent

80% cases filed against nurses: adultery, concubinage, bigamy, gross immorality

CRIMINAL APPARENT INJURY MATERIAL INJURY IMMEDIACY

NEGLIGENCE

SIMPLE (-) (+) ⬇︎ (-)

IMPRUDENCE Injury may only Minimal injury Foreseeable but not

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 happen thereafter, but direct
it will not be apparent
at the time that the
negligent act is
committed

RECKLESS (+) (+) ⬆︎ (+)

IMPRUDENCE Injury is apparent at Vast injury Foreseeable
the time that the
negligent act is
committed

Doctrines of Negligence and Malpractice

Res ipsa loquitur - the thing speaks for itself; thing/injury

- Doctrine for the Poor
Expert Testimony
- Only needed In some cases lang daw, not commonly used kase expensive
- The experts speak for the case
- Technical knowledge

Doctrine of Common Knowledge

- Res ipsa loquitur can be used; no need for expert testimony

Doctrine of Command Responsibility

- Respondeat Superior - let the master answer
- No dilution of the liability; no dilution of liabilities = both are liable

Vicarious Liability - responsibility for another’s action.

- E.g., medical director will be vicariously liable for the actions of the subordinates
- Derivative liability
- RA 9344 - Juvenile Delinquency Act states that a wrongful act of the child does not hold
the child liable, but the parents will be vicariously liable.

Personal Liability - responsibility for one’s action.

Liability - lorde
- Criminal - personal and intransmissible
- Civil - Article 2180 of the Civil Code (Doctrine of Respondeat Superior)
- Administrative - personal and intransmissible

Captain of the Ship Doctrine

- Not applicable in the PH; an American case law
- Has shifts in liabilities

Force Majeure (Fuerza mayor)

- Act of God
- There is no voluntariness on the part of the respondent because it is
unforeseeable/foreseeable and inevitable
- No element of control or voluntariness
- The purpose of force majeure is to be used as an exculpatory defense (to remove liability).
- NOT ALWAYS an exculpatory defense, but can MITIGATE the liability

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Somera Principle
- Independent judgment principle; nurse cannot use the excuse that they are only executing
the orders of the doctor
- See case here:
https://umanitoba.ca/faculties/arts/departments/philosophy/ethics/media/Nurses_New_Rol
e.pdf

BOARD QUESTIONS:
1. When a patient falls from a bed, which of the following is your most immediate action?
a. report to the head nurse and call someone to help
b. determine any injury or harm
c. refer to the resident on duty
d. put the patient back to bed

2. A patient died due to error in the blood type used for blood transfusion. The nurse will be
considered negligent and the doctrine that would apply is:
a. res ipsa loquitur
b. respondeat superior
c. respondeat loquitur - WOF BON neologism
d. force majeure

3. In determining whether a nurse is negligent or not, the following conditions should be considered
except:
a. the nurse failed to do her duty
b. it is the nurse's duty to protect the patient from injury
c. an injury resulted from the nurse's failure to do her duty
d. whether the action of the nurse is intentional or not

Culpa - fault
Dolo - deceit; intentional

4. Which of the following behaviors of a nurse constitutes negligence?

a. do not answer a call at 2 AM of a townmate to help his wife who has severe
abdominal pain (Negligence)
b. failure to diagnose the case of ailment (Malpractice)
c. ignoring a complaint made by a patient (Malpractice)
d. maintaining patent airway during the acute stage of a cord injury (Malpractice)

5. On admission at the emergency room, the client is perspiring profusely, breathing hardly and
complaining of dizziness and palpitations. The nurse on duty left the room to call for the doctor.
This act of the nurse may be a ground for:
a. reckless imprudence
b. professional negligence X (Eliminate similar options)
c. malpractice X
d. breach of trust (estafa)

6. A nurse pulled the patient's bed away from the rail. The bed legs collapsed which causèd injury
on the leg of the patient. The injury is a sufficient evidence of negligence using the doctrine:
a. Respondeat superior
b. force majeure
c. res ipsa loquitur
d. captain of the ship

7. The doctrine of respondeat superior applies:

a. Where injury results outside scope of authority
b. when injury occurs in the course of employment

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 c. when injury occurred outside commerce of man (illegal)
d. when instrumentality was within control of the servant

8. The test for liability under the doctrine of respondeat superior is the:
a. power of master over servant
b. injury itself - RIL
c. extent of damage caused - RIL
d. circumstances surrounding the act - FM

9. The basis for liability of a surgeon in the operating room:

a. respondeat superior
b. captain of the ship doctrine
c. corporate liability - (vicarious liability)
D. force majeure

Nurse Practice Act

- Term used in the United States
- Basis for the Standards of Nursing Practice
- RA 9173 = copied from State of Illinois eyy mayennn

Philippine Nursing Act of 2002

Brief History
● The first “True Nursing Law” is promulgated in March 1, 1919 (Act 2808 - Philippine
Nursing Act of 1919)
- BON = Chairperson is an MD; other two members are RN
● RA 877 is promulgated in June 19, 1953
- Author of RA 877 is first lady senator of the Republic of the Philippines, Sen.
Geromina Pecson.
- BON = Chairperson and members are RN
- Amended the Act 2808
● RA 4707 - added members of BON
● RA 6136 - Parenteral administration must be supervised by a medical doctor
● RA 7164 - Authored by Sen. Heherson Alvarez; 1 chairperson, 4 members
● RA 9173 - Philippine Nursing Act of 2002, approved on October 21, 2002
○ The implementing rules and reg of the said law was passed through:
BON Resolution 425, s. 2003
○ BON possesses Quasi-legislative power (makes laws with limited
applicability, only to nurses)

Persons Instrumental to Enactment of RA 9173

● Main Author: Sen. Juan Flavier (Father of Community Medicine) (HB1084)
● Passed to Senator Loren Legarda and Sen. Manny Villar (SB 2292)
● Endorsed to House Speaker De Venecia and Senate President Franklin Drilon
● Signed into Law by Former President Gloria Macapagal Arroyo

“Frustrated” Philippine Nursing Act of 2015

● Cong. Paquiz (Ang NARS Partylist Representative) - HB 6411
● Senator Nancy Binay (SB 2720 first); Sen. Teofisto Guingona (SB 2720 second)
● Proposed a Salary Grade of 15 that was analogous in private institutions → Philippine
Hospitals Association were against it as it could cause bankruptcy → PNoy agreed →
Vetoed by PNoy

Board of Nursing Appointment Process

Step 1: Nomination
- Nominated by Accredited Professional Organization: Philippine Nurses Association

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 - Total of 3 nominees per vacancy
- Seat (including chair) = 7 - based on the RA 9173, not from RA 7164
- Members (not including chair) = 6
Step 2: Recommendation
- PRC will make a recommendation; PRC will make 2 recommendees
- Endorsed to President of the Philippines

Step 3: Issuance of Appointment

Step 4: Acceptance of Appointment, Assumption
Step 5: Oath of Office

Madam B. is nominated to be a BON, is he or she required to resign from her post as

Dean of the College of Nursing?
→ NOT YET… (Nomination process only, not yet appointed)
→ Yes if APPOINTED already (as indicated in the RA 9173)
→ Once a dean assumes office, he/she is deemed resigned from any educational
institution he/she is affiliated with.

Types of Appointment
● Regular - normal appointment process
● Ad Interim - used to fill in the unexpired portion of the term; panakip-butas
● Hold Over - no new appointment is made; you have to stay there whether you like it or not;
resignation will be revoked; position is inescapable

June 2006 PNLE Leakage Scandal shet may math AHHAHAHA

Term
- Title to the office set forth by the law
- E.g. BON 1 term = 3 years, eligible for re-appointment → 2 terms = 6 years (but can take
ad interim post as successor)
- Exceed 2 terms if under holdover

Tenure
- Actual holding of office
- Years in office spent

QUALIFICATIONS:
- Continuing in character, any violation warrants disqualification from the post

● Natural-born citizen of the Philippines

- Jus sanguini - Philippines
- Jus soli - America
- US Embassy is an extension of the territory of the US
● Good Standing member of the Philippine Nurses’ Association
○ Paid all dues
○ Membership to the PNA is a mere invitation
● Master’s Degree holder
○ Chairperson:
■ Masters in Nursing
■ Master of Arts in Nursing
■ Masters of Science in Nursing
○ Member:
■ Any Master’s degree (MAN, MSc, MA, MAEd, etc)
○ 3 common areas of nursing practice: Service, Education, Community Health
Nursing
● 10 years of continuous practice; last 5 years in the Philippines.

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 ● Must not be convicted of any criminal offense or moral turpitude

Quo warranto - by what authority are you doing it; used to test a person's legal right to hold an
office, not to evaluate the person's performance in the office. (e.g., Grace Poe’s citizenship case)
Mea culpa - through my fault
Moral turpitude - does not need a law to judge something that is bad

Functions of the BON

● Executive - execute/ implement the law
Republic Act 8981
- Philippine Modernization Act of 2000
- Commission (PRC): custodian of records
- BON: makes the questions of the boards; recommends and advisory of nursing
schools
- Both BON and PRC conduct the PNLE
- CHED: opens and closes nursing schools; if a nursing school’s passing rate is 3%
for the past 5 years, the CHED can close the school
- Discretionary closure: CHED is allowed to close the school with due process
if the school has a passing rate of 5% for the last 3 years

● Legislative - make and enact the law

Quasi-legislative function of BON
- BON resolutions
- BON resolution 425, s. 2003 - implementing rules and guidelines of RA
9173
- Promulgation of Code of Ethics for Nurses

RA 10912 - CPD Law

- PRC Resolution No. 2019-1146, s. 2019
- Nurses are required 15 units by the PRC for them to renew their license in
accordance with the updated PRC resolution.
- Nurses are required 45 units by the PRC for them to renew their license as stated
by the law.

● Judiciary - decide cases, apply the law and interpret the law
Quasi-judicial function of the BON
- Has the right to issue subpoena (Sub= under; Poena= penalty)

2 Types of Subpoena:
Subpoena Duces Tecum - must comply and submit documents
Subpoena Ad Testificandum - must testify in person at court

BON - Issuance of the Certificate of Registration; best evidence to prove you are privileged to
practice nursing
PRC - Issuance of Nursing License

Certificate of Registration is not canceled; it is revoked. PRC license is canceled.

Suspension - Valid COR; however, the privilege of practice is suspended (temporary; maximum of
4 years)
Revocation - Invalid COR; can no longer practice the profession (permanent); can apply for
reissuance to the BON.

The major responsibility of the BON is to ensure that RA 9173 is properly implemented.
Which of the following is not within the jurisdiction of the BON?
a. Setting minimum standards of practice

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 b. Establishing the implementing rules and regulations
c. Disciplining those unfit to practice nursing
d. Approving nursing education program - CHED

Position Masters Years of Experience

BON Chair: Masters in Nursing (Nx) 10-5

Member: Nx/Ed/AHP

Clinical Instructor / Nx/Ed/AHP (Any masteral degree) 1

Faculty

Dean Nx 5

Chief Nurse / Military Hospital: 5 (Managerial /

Nursing director General Staff Course and Nx Administrative experience)

Public Health Institutions:

Masters in Public Health

Supervisor No need for masters but must have 9 units 2 years general service
in graduate studies (managerial and administration
administrative course)

Chief Nurse 9 units

Primary hospital Managerial and Administrative nurse 2 general Nx Sx
Administration

Staff Nurse

Inactive Nurse
- 5 years, must undergo 2 types of training

2 Types of Training
1. Practicum - OJT; (PracTHREEcum) → 3 months
2. Didactic - lecture; 1 month

Passing the NLE

● GWA of 75%
● No grade lower than 60%

Removal Exam
● Should be taken within 2 years when the Conditionally Passed student took the last NLE
● Passing grade is 75%

ADVANCED PRACTICE NURSING

Nurses are allowed to perform vaginal repair (episiorrhaphy) provided they have undergone training
under the hospices of ANSAP (Association of Nursing Service Administrators of the Philippines).
ANSAP is the lead agency in coordination with the MCNAP)

Nurses are allowed to perform internal examinations unless the patient is actively bleeding.

PH Nursing Act of 1953 - Doctor must supervise nurse in parenteral administration

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PH Nursing Act of 1991 - Nurses allowed to perform IV therapy provided they undergo 3-day IVT
training

PH Nursing Act of 2002 - Nurses can freely give intravenous medication

Casus Omissus - intention of the legislature is to remove such specific provision from the law

Business Judgment Rule

- Discretion of every corporate/institution relative to the qualifications that they should set

Continuing Professional Education vs. Continuing Professional Development

CPE CPD

PRC Resolution No. 179, s. 2004
- Mandates that every professional must
accumulate a total of 60 CPE units
every 3 years.
- PRC license expires on your birthday
on the third year
- Ex. If your birthday is in
September, you have the whole
month to renew.
Earned Units: 60
R.A. 10912 (CPD Law of 2016)
- authored by Sen. Antonio Trillanes
- Mandatory
Earned Units:15 units (45 → 15 units)
Implementation: ASEAN Integration;
Interprofesional Movement - a concept that
allows professionals to have uniformity in
practice in the same field. BEneficial to
professionals who plan to work in ASEAN
countries.

Exceptions: Working Abroad Professional Quality Factor (PQF)

- a score that enables you to enter “white
- Not mandatory collar jobs” otherwise “blue collar jobs
e.g. caregivers etc.”
- Scores range from 1 to 12.
- Highest PQF in PH is 8.

Republic of the Philippines - Spain Treaty

- Has a Reciprocity of Profession; choose an economically advanced country that has wide
reciprocity so you do not have to spend 200 USD every year for that principle.

Al’s Toy Barn Prediction: “July 2022 board question: ASEAN countries will be asked?”

Alien Employment Permit Special Temporary Permit

Principle: Reciprocity - Grounds for Issuance of STP

Wide Reciprocity: ● Medical Mission - fast issuance
State of Arkansas ● Expert
● Exchange Professors
Albany, New York
Note: permit is only for the specific ground

Functus Officio - your official function is done

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