NUR 412 – Nursing Leadership and Management

Module 4: Ethico- Legal and Moral considerations in Nursing

Leadership and Management

Introduction

Being a leader is indeed a tough task. Guiding fellow human beings on what
should be done is difficult because everyone might be having an idea on how to tackle
issues. Nevertheless, we will feature on some of the common challenges that leaders
and top leaders face in organizations.
Ethical issues arise depending on the society or group that people come from
while the moral of doing things depend on whether the act is right or wrong to be done.
When an action is defined to be right or wrong, the main idea implemented is the moral
act (Bullough, 2011). Legal leadership is/are the way(s) in which the leaders conduct
the roles given to them by the society. The legal leadership is controlled by the laws that
are put in place to govern and protect the people from performing crime and other illegal
acts that are against the law (Joyner, & Payne, 2002). Professional people like doctors
use ethics that are laid down based on the kind of profession. However, morals are set
based on the subliminal nature of performing things that are acceptable to the society

Learning Outcome

At the end of this module, the students will be able to;

1. Adhere to ethico-legal considerations when providing safe, quality and
professional nursing care;
2. Apply ethical reasoning and decision-making process to address situations of
ethical distress and moral dilemma;
3. Adhere to established norms conduct based on the Philippine Nursing Law and
other legal regulatory and intuitional requirements relevant to safe nursing
practice.
4. Protect client rights based on “Patient’s Bill of Rights and obligations.
5. Implement strategies/ policies related to informed consent as it applies in multiple
contexts.

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Learning Content

Lesson 1: Ethico-Moral Aspects of Nursing

1. Code of Ethics for Filipino Nurses

The professional code of ethics for Filipino nurses strongly

emphasizes the four-fold responsibility of the nurse, the universality of
nursing practice, the scope of their responsibilities to the people they serve,
to their co-workers, to society and environment, and to their profession.
The Code of Ethics used by Filipino nurses prior to 1984,was the
code promulgated by the International Council for Nurses. [The ICN is the
organization through which nurses all over the world collaborate in
strengthening nursing service, nursing education and professional ethics. It
is composed of the national nursing association from each member-country. In
1929, PNA became a member of ICN. In 1982, the PNA Special Committee
developed a Code of Ethics for Filipino Nurses, but was not implemented.
In 1984, the Board of Nursing [The BON supervises and regulates the
practice of the nursing profession. adopted the Code of Ethics of the ICN, adding
“promotion of spiritual environment”] as the fifth-fold responsibility of the nurse.
In 1989, the Code of Ethics promulgated by the PNA was approved by the
Professional Regulation Commission [PRCis the agency that has the power to
regulate established professions in the Philippines and to examine applicants to
practice the same.]And was recommended for use. This was approved In
October 25, 1990 by the general assembly of the PNA .
In July 14, 2004, a new Code of Ethics for Filipino Nurse was
adopted under R.A. 9173 and was promulgated by the BON.
The Code of Ethics for Filipino Nurses embodies ethical principles
and guidelines to be observed, stipulated under seven (7) articles. The
ethical principles are stated below.

Article I Preamble

Sec. 1. Health is a fundamental right. The Filipino RN, believing in the

worth and dignity of each human being, recognizes the primary responsibility to
preserve health at all cost. This responsibility encompasses promotion of health,
prevention of illness, alleviation of suffering, and restoration of health. However,
when the foregoing are not possible, assistance towards a peaceful death shall
be his/her obligation.
Sec. 2. To assume this responsibility, RNs have to gain knowledge and
understanding of man’s cultural, social, spiritual, psychological, and ecological

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 aspects of illness, utilizing the therapeutic process. Cultural diversity and political
and socio-economic status are inherent factors to effective nursing care.
Sec. 3. The desire for the respect and confidence of clientele,
colleagues, co-workers, and the members of the community provides the
incentive to attain and maintain the highest possible degree of ethical conduct.

Article II Registered nurses and people

Sec. 4. Ethical Principles
1. Values, customs, and spiritual beliefs held by individual shall be respected.
2. Individual freedom to make rational and unconstrained decisions shall be respected.
3. Personal information acquired in the process of giving nursing care shall be held in
strict confidence.
Sec. 5. Guidelines to be observed
Registered nurses must
a. consider the individuality and totality of patients when they administer care;
b. respect the spiritual beliefs and practices of patients regarding diet and treatment;
c. uphold the rights of individuals; and
d. take into consideration the culture and values of patients in providing nursing
care. However, in the event of conflicts, their welfare and safety must take precedence.
Article IIIRegistered Nurses and Practice
Sec. 6. Ethical Principles
1. Human life is inviolable.
2. Quality and excellence in the care of patients are the goals of nursing practice.
3.Accurate documentation of actions and outcomes of delivered care is the
hallmark of nursing accountability.
Sec. 7. Guidelines to be observed
Registered nurses must
a. know the definitionand scope of nursing practice which are in the provisions of
R. A. No. 9173, known as the “Philippine Nursing Act of 2002” and Board Res. No.
425, Series of 2003, the “Rules and Regulations Implementing the Philippine
Nursing Act of 2002,” (the IRR);

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b.be aware of their duties and responsibilities in the practice of their profession
as defined in the “Philippine Nursing Act of 2002” and the IRR;
c. acquire and develop the necessary competence in knowledge, skills, and
attitudes to effectively render appropriate nursing services through varied learning
situations;
d. if they are administrators, be responsible in providing favorable
environment for the growth and development of Registered Nurses in their charge;
e.be cognizant that professional programs for specialty certification by the BON
are accredited through the Nursing Specialty Certification Council (NSCC);
f. see to it that quality nursing care and practice meet the optimum standards of
safe nursing practice;
g. insure that modification of practice shall consider the principles of safe nursing
practice;
h. Insure that modification of practice shall consider the principles of safe nursing
practice;
i. If in position of authority in a work environment, be normally and legally responsible
for devising a system of minimizing occurrences of ineffective and unlawful nursing
practice
j. ensure that patients’ records shall be available only if they are to be issued to those
who are professionally and directly involved in their care and when they are required by
law
SECTION 8. Ethical Principle
4. Registered Nurses are the advocates of the patients: they shall take appropriate
steps to safeguard their rights and privileges.
Guidelines to be observed: REGISTERED Nurses must
a. respect the “Patients’ Bill of Rights” in the delivery of nursing care. b. provide the
patients or their families with all pertinent information except those which may be
deemed harmful to their well-being. c. uphold the patients’ rights when conflict arises
regarding management of their care.
SECTION 10. Ethical Principle
5. Registered Nurses are aware that their actions have professional, ethical, moral, and
legal dimensions. They strive to perform their work in the best interest of all concerned.
SECTION 11. Guidelines to be observed: REGISTERED Nurses must:

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a. perform their professional duties in conformity with existing laws, rules regulations.
Measures, and generally accepted principles of moral conduct and proper decorum.
b. not allow themselves to be used in advertisement that should demean the image of
the profession (i.e. indecent exposure, violation of dress code, seductive behavior, etc.).
c. decline any gift, favor or hospitality which might be interpreted as capitalizing on
patients.
d. not demand and receive any commission, fee or emolument for recommending or
referring a patient to a physician, a co-nurse or another health care worker; not to pay
any commission, fee or other compensations to the one referring or recommending a
patient to them for nursing care.
e. avoid any abuse of the privilege relationship which exists with patients and of the
privilege access allowed to their property, residence or workplace.

ARTICLE IV REGISTERED NURSES AND CO-WORKERS

SECTION 12. Ethical Principles
1. The Registered Nurse is in solidarity with other members of the healthcare team in
working for the patient’s best interest. 2. The Registered Nurse maintains collegial and
collaborative working relationship with colleagues and other health care providers.
SECTION 13. Guidelines to be observed: REGISTERED Nurses must
a. maintain their professional role/identity while working with other members of the
health team.
b. conform with group activities as those of a health team should be based on
acceptable, ethico-legal standards.
c. contribute to the professional growth and development of other members of the
health team.
d. actively participate in professional organizations.
e. not act in any manner prejudicial to other professions.
f. honor and safeguard the reputation and dignity of the members of nursing and other
professions; refrain from making unfair and unwarranted comments or criticisms on their
competence, conduct, and procedures; or not do anything that will bring discredit to a
colleague and to any member of other professions.
g. respect the rights of their co-workers.

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ARTICLE V REGISTERED NURSES, SOCIETY, AND ENVIRONMENT SECTION 14.
Ethical Principles

1. The preservation of life, respect for human rights, and promotion of healthy
environment shall be a commitment of a Registered Nurse.
2. The establishment of linkages with the public in promoting local, national, and
international efforts to meet health and social needs of the people as a contributing
member of society is a noble concern of a Registered Nurse.
SECTION 15. Guidelines to be observed:
REGISTERED Nurses must
a. be conscious of their obligations as citizens and, as such, be involved in community
concerns.
b. be equipped with knowledge of health resources within the community, and take
active roles in primary health care.
c. actively participate in programs, projects, and activities that respond to the problems
of society.
d. lead their lives in conformity with the principles of right conduct and proper decorum.
e. project an image that will uplift the nursing profession at all times.

2. THE ICN CODE OF ETHICS FOR NURSES

An international code of ethics for nurses was first adopted by the International Council
of Nurses (ICN) in 1953. It has been revised and reaffirmed at various times since, most
recently with this review and revision completed in 2012.
PREAMBLE
Nurses have four fundamental responsibilities: to promote health, to prevent illness, to
restore health and to alleviate suffering. The need for nursing is universal.
Inherent in nursing is a respect for human rights, including cultural rights, the right to life
and choice, to dignity and to be treated with respect. Nursing care is respectful of and
unrestricted by considerations of age, colour, creed, culture, disability or illness, gender,
sexual orientation, nationality, politics, race or social status.

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Nurses render health services to the individual, the family and the community and
coordinate their services with those of related groups.
The ICN Code of Ethics for Nurses has four principal elements that outline the
standards of ethical conduct.
ELEMENTS OF THE CODE
1. Nurses and people. The nurse’s primary professional responsibility is to people
requiring nursing care.
In providing care, the nurse promotes an environment in which the human rights,
values, customs and spiritual beliefs of the individual, family and community are
respected.
The nurse ensures that the individual receives accurate, sufficient and timely
information in a culturally appropriate manner on which to base consent for care
and related treatment.
The nurse holds in confidence personal information and uses judgement in
sharing this information. The nurse shares with society the responsibility for
initiating and supporting action to meet the health and social needs of the public,
in particular those of vulnerable populations.
The nurse advocates for equity and social justice in resource allocation, access to
health care and other social and economic services.
The nurse demonstrates professional values such as respectfulness,
responsiveness, compassion, trustworthiness and integrity.
2. Nurses and practice. The nurse carries personal responsibility and accountability
for nursing practice, and for maintaining competence by continual learning.
The nurse maintains a standard of personal health such that the ability to provide
care is not compromised.
The nurse uses judgement regarding individual competence when accepting and
delegating responsibility.
The nurse at all times maintains standards of personal conduct which reflect well
on the profession and enhance its image and public confidence.
The nurse, in providing care, ensures that use of technology and scientific
advances are compatible with the safety, dignity and rights of people.
The nurse strives to foster and maintain a practice culture promoting ethical
behaviour and open dialogue.

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 3. Nurses and the profession. The nurse assumes the major role in determining and
implementing acceptable standards of clinical nursing practice, management,
research and education.
The nurse is active in developing a core of research-based professional
knowledge that supports evidence-based practice.
The nurse is active in developing and sustaining a core of professional values.
The nurse, acting through the professional organization, participates in creating a
positive practice environment and maintaining safe, equitable social and
economic working conditions in nursing.
The nurse practices to sustain and protect the natural environment and is aware
of its consequences on health.
The nurse contributes to an ethical organizational environment and challenges
unethical practices and settings.
4. Nurses and co-workers. The nurse sustains a collaborative and respectful
relationship with co-workers in nursing and other fields.
The nurse takes appropriate action to safeguard individuals, families and
communities when their health is endangered by a co-worker or any other person.
The nurse takes appropriate action to support and guide co-workers to advance
ethical conduct.

Lesson 2: Legal Aspect

The Nursing Act of 2002 (RA, 9173)

➢ It is 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.

Legal Responsibilities of a Nurse

It is stated in the RA 9173 of 2002, Article 6, Sec. 28 that 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, pre-

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 school, school age, adolescence, adulthood and old age. As independent
practitioners, nurses are primarily responsible for the promotion of health and
prevention of illness. As 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 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.

Negligence
Negligence is a failure to use such care as a reasonably prudent and careful person
would use under similar circumstances.

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 Malpractice
It is the "improper or unethical conduct or unreasonable lack of skill by a holder of a
professional or official position; often applied to physicians, dentists, lawyers, and
public officers to denote negligent or unskillful performance of duties when
professional skills are obligatory. Malpractice is a cause of action for which damages
are allowed."4 Malpractice is defined variously under state nurse practice acts,
institutional policies, and federal guidelines such as JCAHO standards, all of which
may be taken into consideration in court.
Contract/Wills/Testament
It is a legal document that states and explains a formal agreement between two
different people or groups, or the agreement itself
Labor law
Primarily concerns the rights and responsibilities of unionized employees. Some
groups of employees find unions beneficial, since employees have a lot more power
when they negotiate as a group rather than individually. Unions can negotiate for
better pay, more convenient hours, and increased workplace safety. However,
unions do not have limitless power. Leaders must treat all union members fairly and
refrain from restricting union members' rights to speech, assembly, and voting
powers.
Magna Carta of Public Health Workers (Republic Act 7305)
Purposes of this Act, "health workers" shall mean all persons who are engaged in health
and health-related work, and all persons employed in all hospitals, sanitaria, health
infirmaries, health centers, rural health units, barangay health stations, clinics and other
health-related establishments owned and operated by the Government or its political
subdivisions with original charters and shall include medical, allied health professional,
administrative and support personnel employed regardless of their employment status.
Salary Standardization Law
RA No. 114661, otherwise known as the "Salary Standardization Law of 2019," modifies
the Salary Schedule for Civilian Personnel and authorizes the grant of additional
benefits.
The modified Salary Schedule for Civilian Personnel shall be implemented in four (4)
tranches, from FY 2020 to FY 2023.
RA No. 11466 also provides for the grant of the Mid-Year Bonus as part of the
Incentives under the Total Compensation Framework (TCF). Likewise, it states that the
Program on Awards and Incentives for Service Excellence (PRAISE) instituted by the
Civil Service Commission (CSC) pursuant to the provisions of Executive Order (EO) No.

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292 (Administrative Code of 1987) shall be categorized under the Incentives component
of the TCF
Updates on Salary of Nurses in the Government
➢ "The implementation of the salary adjustment shall take effect when
the decision of the Supreme Court had become final and executory,
but not earlier than the start of Fiscal Year 2020," the proposed
national budget reads.
➢ Alliance of Health Workers President Robert Mendoza hopes this
provision will not be deleted once Congress convenes a bicameral
conference committee, which will thresh out differences in the Senate
and House versions of the budget.
➢ "Malaking tulong po ang dagdag na ito. 'Di ba nagtaasan ang presyo
ng bilihin, sinasabi na tumaas ang bilihin? Ang buying capacity
nabawasan ng 2 thousand to 3 thousand (This increase will be a big
help. The prices of goods increased. Our buying capacity decreased
by P2,000 to P3,000)," Mendoza said.
➢ Senators Richard Gordon and Christopher "Bong" Go said it is about
time government nurses are given proper compensation.
➢ "This is a long overdue compensation denied to them. Hindi na natin
sila paghihintayin pa. Magkakaroon na sila ng increase sa sweldo as
soon as January of next year, (We won't let them wait much longer.
They will receive salary increases as soon as January of next year)"
Go said.
➢ The 2020 budget cleared both houses of Congress earlier this year,
unlike in 2019 when the spending plan was delayed over allegations of
anomalous insertions by lawmakers. Malacañang assured that
President Rodrigo Duterte will scrutinize the appropriations bill before
signing it.

Social Security System (SSS)

➢ A system of federally funded services and payments to help support
the needy, the aged, and the temporarily unemployed as well as
providing support for needy, dependent, disabled, or neglected
children, rehabilitation for the disabled, and a host of other social
services. The system was established as part of the New Deal and is
funded by payroll taxes paid by workers and employers.

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 Government Service Insurance System (GSIS)
➢ Created by Commonwealth Act No. 186 and Republic Act No. 8291
(GSIS Act of 1997), GSIS is a social insurance institution that provides
a defined benefit scheme under the law. It insures its members against
the occurrence of certain contingencies in exchange for their monthly
premium contributions.
➢ GSIS members are entitled to an array of social security benefits, such
as life insurance benefits, separation or retirement benefits, and
disability benefits.
➢ GSIS is also the administrator of the General Insurance Fund by virtue
of RA 656 (Property Insurance Law). It provides insurance coverage to
government assets and properties that have government insurable
interests.
PhilHealth
➢ The National Health Insurance Program was established to provide
health insurance coverage and ensure affordable, acceptable,
available and accessible health care services for all citizens of the
Philippines. It shall serve as the means for the healthy to help pay for
the care of the sick and for those who can afford medical care to
subsidize those who cannot. It shall initially consist of Programs I and II
or Medicare and be expanded progressively to constitute one universal
health insurance program for the entire population. The program shall
include a sustainable system of funds constitution, collection,
management and disbursement for financing the ailment of a basic
minimum package and other supplementary packages of health
insurance benefits by a progressively expanding proportion of the
population. The program shall be limited to paying for the utilization of
health services by covered beneficiaries. It shall be prohibited from
providing health care directly, from buying and dispensing drugs and
pharmaceuticals, from employing physicians and other professionals
for the purpose of directly rendering care, and from owning or investing
in health care facilities. (Article III, Section 5 of RA 7875 as amended)

Pag-Ibig
➢ The Home Development Mutual Fund (abbreviated as HDMF), more
popularly known as the Pag-IBIG Fund, is a Philippine government-
owned and controlled corporation under the Department of Human
Settlements and Urban Development responsible for the administration
of the national savings program and affordable shelter financing for

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 Filipinos employed by local and foreign-based employers as well as
voluntary and self-employed members. It offers its members short-term
loans and access to housing programs.

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