Lecture 1
HEALTH - RELATED ENTREPRENEURIAL ACTIVITIES
IN THE COMMUNITY SETTING
Project EntrepreNurse
- Initiative of Department of Labor and Employment (DOL
- Introduces HOME HEALTHCARE INDUSTRY IN THE
PHILIPPINES
FRAMEWORK: FOURmula ONE for HEALTH
COMPETENCY STANDARDS IN CHN
1. Safe and Quality Nursing Care
- knowledge of the health/illness status of the client, soun
decision-making; safety, comfort, privacy, administration
of meds and health therapeutics and nursing process.
2. Management of resources and environment
- organization of workload; use of financial resources for
client care; the mechanism to ensure the proper
functioning of equipment and maintenance of a safe
environment
3. Health Education
- assessment of client’s learning needs; development of
health education plan and learning materials and
implementation and evaluation of health education plan
4. Legal Responsibility
- adherence to the nursing laws as well as to national, lo
and organizational policies including documentation of
care given to clients
5. Ethico-Moral Responsibility
- respect for the rights of the client; responsibility and
accountability for own decisions and actions; and
adherence to the international and national codes of
ethics for nurses
6. Personal and Professional Development
- identification of own learning needs, pursuit of continuin
education; involvement in professional image; positive
attitude towards change and criticism
7. Quality Improvement
- data gathering for quality improvement; participation in
nursing rounds; identification and reporting of solutions
identify problems related to client care.
8. Research
- research-based formulation of solutions to problems in
client care and dissemination and application of researc
findings
9. Records Management
- accurate and updated documentation of client care whi
observing legal imperatives and record keeping
10. Communication
- uses therapeutic communication techniques, identifies
verbal and nonverbal cues, responds to client needs wh
using formal and informal channels of communication a
appropriate information technology
11. Collaboration and Teamwork
- establishment of collaborative relationships with
colleagues and other members of health team
HISTORY OF PUBLIC HEALTH AND PUBLIC HEALTH
NURSING IN THE PHILIPPINES
1577 - Franciscan Friar Juan Clemente opened a medical
dispensary in Intramuros for the indigent
1690 - Dominican Father Juan de Pergero worked toward
installing a water system in San Juan del Monte and Manila
1805 - smallpox vaccination was introduced by Francisco
de Balmis, the personal physician of King Charles IV of
Spain
1876 - first medicos titular were appointed by the Spanish
government
1888 - 2-year courses consisting of fundamental medical
and dental subjects were first offered in the University of
Santo Tomas. Graduated were known as
“cirujanosministrantes” and served as male nurses and
sanitation inspectors
1901 – United States Philippines Commission, through Act
157, created the Board of Health of the Philippine Islands
with a Commissioner of Public Health , as its chief executive
officer (now the Department of Health
Fajardo Act of 1912 – created sanitary divisions made up
of one to four municipalities. Each sanitary division had a
president who had to be a physician
1915 - the Philippine General Hospital began to extend
public health nursing services in the homes of patients by
organizing a unit called Social and Home Care services
Asociacion Feminista Filipina (1905) – Lagota de Leche
was the first center dedicated to the service of mothers and
babies
1947 – the Department of Health was reorganized into
bureaus: quarantine, hospitals that took charge of the
municipal and charity clinics, and health with the sanitary
divisions under it.
1954 – Congress passed RA 1082 or the Rural Health Act
which provided the creation of RHU in every municipality
RA 1891 – enacted in 1957 amended certain provisions in
the Rural Health Act
- Created 8 categories of rural health units corresponding
to the population size of the municipalities
RA 7160 (Local Government Code) – enacted in 1991,
amended the devolution of basic health services including
health services, to local government units and the
establishment of a local health board in every province and
city or municipality
Millennium Development Goals – adopted during the
World Summit in September 2000
FOURmula One (F1) for health, 2005 and Universal Health
Care 2010 – agenda launched in 1999
Universal Health Care – aims to achieve the health system
goals of better health outcomes, sustained health financing,
and a responsive health system that will provide equitable
access to health care
PILOT REGION
Davao Region
● Region XI
● Jalilo Dela Torre: DOLE Regional Director of
Davao
● Initial Budget: 2.5M

4 ELEMENTS
● Good Governance
● HealthFinancing
● Health Regulation
● HealthService Delivery
GOALS:
● Better Health Outcome
● Equitable Healthcare Financing
● More responsive healthcare system
LEGAL BASIS:
❖ RA 9173 Article VISec28
Republic of the Philippines
Congress of the Philippines
Metro Manila
Twelfth Congress
Second Regular Session
Begun and held in Metro Manila, on Monday, the twenty-second
day of July, two thousand two.
[REPUBLIC ACT NO. 9173]
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 Republic Act No. 7164
TITLE AN ACT REGULATING THE PRACTICE OF NURSING IN THE
SECTION 1. Title. — This Act shall be known as the “Philippine
Nursing Act of 2002.”
Be it enacted by the Senate and House of Representatives of
ARTICLE VI the Philippines in Congress assembled:
NURSING PRACTICE
SEC. 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,
pre-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.
❖ RA 7164 Article V Sec27
Republic of the Philippines
Congress of the Philippines
Metro Manila
Eighth Congress
November 21, 1991
PHILIPPINES
ARTICLE I
TITLE
Section 1. Title. – This Act shall be known as the "Philippine
Nursing Act of 1991."
ARTICLE V
NURSING PRACTICE
Section 27. Scope of Nursing. – A person shall be deemed to
be practicing nursing within the meaning of this Act when he,
for a fee, salary or other reward or compensation, singly or in
collaboration with another, initiates and performs nursing
services to individuals, families and communities in various
stages of development towards the promotion of health,
prevention of illness, restoration of health, and alleviation of
suffering through:
(a) Utilization of the nursing process, including assessment,
planning, implementation and evaluation of nursing care.
Nursing care includes, but not limited to, traditional and
innovative approaches in self-executing nursing
techniques and procedures, comfort measures, health
teaching and administration of legal and written
prescription for treatment therapies, medication and
hypodermic intramuscular or intravenous injections:
Provided, however, That, in the administration of
intravenous injections, special training shall be required
according to protocol established;
(b) Establishment of linkages with community resources and
coordination of the health team;
 (c) Motivation of individuals, families and communities; HEALTH SECTOR JOB OPPORTUNITIES OR JOB OPTIONS
resources and coordination of services with other ● Part timeor fulltimeprivatenurses (inthehomesofpatients
members of the health team; who can affordtopay)
(d) Participation in teaching, guidance and supervision of ● Medical Representativefordrug stores/companies
student in nursing education programs, including
● Medical ResearchConsultants/Assistants
administering nursing services in varied settings such as
hospitals, homes, communities and the like; undertaking ● Technical AssistanceConsultants/Providers
consultation services; and engaging in such other BUSINESS SECTOR JOB OPPORTUNITIES OR JOB
activities that require the utilization of knowledge and OPTIONS
decision-making skill of a registered nurse; and
● Transcription Services (international) and engage in other
(e) Undertaking nursing and health manpower development
training and research and soliciting finances therefor, in non-nursing related enterprise
cooperation with the appropriate government or private BUSINESS PLANS
agency: Provided, however, That this provision shall not ★ REVIEW CENTER
apply to nursing students who perform nursing functions ★ HOSPICE, DOMICILIARY AND HEALTH CARE
under the direct supervision of qualified faculty. FACILITIES
COLLABORATING AGENCIES: ★ PUBLIC HEALTH ADVOCACY
1. DOLE (Department of Labor and Employment ★ Home Healthcare Services
2. DOH (Department of Health) ★ Emergency Medical Services
3. OHNAP (Occupational Health Nurses Association of the ★ Wellness and Fitness Management
Philippines (OHNAP), Inc) ★ Medical Mission
4. UPCN (University of the Philippines) ★ Periodic Physical Examination
5. PRC-BON (Philippine Regualtion Commission- Board of SOURCES OF REVENUE
Nursing ● Senators and Congressman
6. PNA (Philippine Nurses Association) ● Government Units
7. DTI (Department of Trade and Industry) ● Health Maintenance Organizations
● Local and Foreign Donors
OTHER DOH PROGRAMS ● PhilHealth
❖ PROJECT NARS AIMS:
- (NURSE ASSIGNED IN RURAL SERVICES, REDUCE THE COST OF QUALITY HEALTHCARE
2009) - for the country’s indigent population by bringing primary
❖ RN HEALS health care services to poor rural communities
- (REGISTERED NURSES FOR HEALTH EMPLOYMENT OPPORTUNITIES FOR RNs
ENHANCEMENT AND LOCAL - Maximize employment opportunities for the countries
SERVICES,2010) unemployed nurses
National Health Workforce Support System ACHIEVE MILLENNIUM DEVELOPMENT GOAL ON
❖ NDP (Nurse Deployment Program, 2014) MATERNAL AND CHILD HEALTH
➢ one of the strategies to achieve the overall goal - Utilize the country’s unemployed human resources for
of UHC health of the delivery of public health services
❖ HRH (Human Resource for Health, 2005-2030)
➢ deployment program to augment the health
workforce in LGU and provide experience and
training
THE POSSIBLE ENTREPRENEURSHIP AND JOB OPTIONS
FOR MEDICAL PRACTITIONERS
ACADEMIC SECTOR JOB OPPORTUNITIES OR JOB
OPTIONS
● Teachers/ Professors
● Clinical InstructorsFor Nurses
● Academic Research Assistants
● Field Coordinators
HEALTH SECTOR OPPORTUNITIES OR JOB OPTIONS
● Part-time RHU / Hospital Nurses
● Manage/ Operate BirthingCenters
● Manage/ Operate Care Homes for Elderly,
differently-abled persons and other patients needing
chronic care
Lecture 2
NURSING CARE VALUES AS A COMMUNITY HEALTH NURSE
Values
➔ Goals and beliefs that establish behavior and provide a
basis for decision-making.
➔ In a profession, values are standards for action that are
preferred by experts and professional groups and establish
frameworks for evaluating behavior.
➔ Nursing is a profession rooted in professional ethics and
ethical values, and nursing performance is based on such values.
Professional Nursing Values
PROFESSIONAL NURSING VALUES
Community Health Nursing is a nursing specialty
focused on public health. Community health nurses cater on
not only individual clients but also family clients and even an
entire community. Community health nurses follow the same
professional nursing values as every other nurse but encompass,
in their nursing care, all the individuals part of the community.
Professional nursing values are defined as beliefs or
ideals that guide interactions with patients, colleagues, other
professionals, and the public. These values begin to form
during nursing school and continue to develop through
interactions in the work setting. Nurses will encounter ethical
issues and dilemmas throughout their careers. When they do so,
their values will play an integral role in how they handle each
situation they face. While personal values are formed and used
throughout daily life by all individuals, nurses have a special set of
values they will use to make decisions or judgments throughout
their careers. These values are professional nursing values.
WHAT ARE THE 7 ETHICAL PRINCIPLES ON WHICH THE
NURSING CODE OF ETHICS IS BASED?
THE 7 ETHICAL PRINCIPLES THE NURSING CODE OF
ETHICS IS BASED UPON INCLUDE:
1. Beneficence:
- Beneficence is the act of doing what is good and right for
the patient. This ethical principle encompasses charity
and kindness, which require actions by the nurse to
benefit others.
2. Nonmaleficence:
- Nonmaleficence means not harm (intentional or
unintentional). Nurses must provide care that reflects
standards to avoid or minimize risk to the patient,
healthcare team, or organization.
3. Justice:
- Justice is fairness and impartiality. Nurses must make
impartial, fair decisions regarding patient care without
regard to a patient's race, age, sexual orientation, or
economic status.
4. Accountability:
- Accountability means accepting responsibility for one’s
actions.
5. Autonomy:
- Autonomy is the ethical principle demonstrated when a
nurse accepts the patient as a unique person with the
right to his own opinions, values, beliefs, and right to
make his own decisions.
6. Fidelity:
- Fidelity is the practice of being faithful to a person, belief,
or cause. It involves keeping one’s promises. In nursing,
fidelity involves being true to the profession and honoring
the responsibility of providing safe, competent,
high-quality nursing care.
7. Veracity:
- Veracity is the principle of truth-telling. It requires nurses
to be honest in their interactions with patients and
colleagues.
CODE OF ETHICS FOR NURSES IN THE PHILIPPINES
BOARD OF NURSING
Board Resolution No. 220
Series of 2004
PROMULGATION OF THE CODE OF ETHICS FOR
REGISTERED NURSES
WHEREAS, the Board of Nursing has the power to promulgate
a Code of Ethics for Registered Nurses in coordination and
consultation with the accredited professional organization
(Sec. 9, (g), Art. III of R.A. No. 9173, known as the “Philippine
Nursing Act of 2002);
WHEREAS, in the formulation of the Code of Ethics for
Registered Nurses, the Code of Good Governance for the
Professions in the Philippines was utilized as the principal
basis therefor: All the principles under the said Code were
adopted and integrated into the Code of Ethics as they apply
to the nursing profession;
WHEREAS, the promulgation of the said Code as a set of
guidelines, regulations or measures shall be subject to
approval by the Commission (Sec. 9, Art. II of R.A. No. 9173);
and
WHEREAS, the Board, after consultation on October 23, 2003,
at Iloilo City with the accredited professional organization of
registered nurses, the Philippine Nurses Association, Inc
(PNA), and other affiliate organizations of Registered Nurses,
decided to adopt a new Code of Ethics under the
afore-mentioned new Law;
NOW, THEREFORE, the Board hereby resolved, as it now
resolves, to promulgate the hereunder Code of Ethics for
Registered Nurses
ARTICLE I
PREAMBLE
SECTION 1.
Health is a fundamental right of every individual. The Filipino
registered nurse, believing in the worth and dignity of each
human being, recognizes the primary responsibility to
preserve health at all costs. This responsibility encompasses
the 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.
SECTION 2.
To assume this responsibility, registered nurses have to gain
knowledge and understanding of man’s cultural, social, spiritual,
physiological, psychological, and ecological aspects of illness,
utilizing the therapeutic process. Cultural diversity and political
and socio-economic status are inherent factors to effective
nursing care.
SECTION 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
SECTION 4.
Ethical Principles
1. Values, customs, and spiritual beliefs held by individuals
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.
SECTION 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.
d. take into consideration the culture and values of patients
in providing nursing care. However, in the event of
conflicts, their welfare and safety take precedence
SECTION 6.
Ethical Principles
1. Human life is inviolable.
2. Quality and excellence in the care of the patients are the
goals of nursing practice.
3. Accurate documentation of actions and outcomes of
delivered care is the hallmark of nursing accountability.
ARTICLE III
REGISTERED NURSES AND PRACTICE
SECTION 7.
Guidelines to be observed:
REGISTERED Nurses must
a. Know the definition and scope of nursing practice which
are in the provisions of R. A. No. 9173, known as the
“Philippine Nursing Act of2002” and Board Res. No. 425,
Series of 2003, the “Rules and Regulations Implementing
the Philippine Nursing Act. of 2002”, (the IRR).
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 standard of safe nursing practice.
g. insure that modification of practice shall consider the
principles of safe nursing practice.
h. 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.
i. 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
the management of their care
SECTION 9.
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 10.
Guidelines to be observed:
REGISTERED Nurses must
a. perform their professional duties in conformity with
existing laws and rules and regulations. measures, and
generally accepted principles of moral conduct and
proper decorum.
b. not allow themselves to be used in advertisements 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 compensation to the
one referring or recommending a patient to them for
nursing care.
 e. avoid any abuse of the privileged relationship that exists
with patients and of the privileged access allowed to their
property, residence or workplace
ARTICLE IV
REGISTERED NURSES AND CO-WORKERS
SECTION 11.
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 a collegial and
collaborative working relationship with colleagues and
other healthcare providers
SECTION 12.
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.
ARTICLE V
REGISTERED NURSES, SOCIETY, AND ENVIRONMENT
SECTION 13.
Ethical Principles
1. The preservation of life, respect for human rights, and
promotion of a 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 the health and social needs of the people as
contributing member of society is a noble concern of a
Registered Nurse
SECTION 14.
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
ARTICLE VI
REGISTERED NURSES AND THE PROFESSION
SECTION 15.
Ethical Principles:
1. Maintenance of loyalty to the nursing profession and
preservation of its integrity are ideal.
2. Compliance with the by-laws of the accredited
professional organization (PNA), and other professional
organizations of which the Registered Nurse is a member
is a lofty duty.
3. Commitment to continual learning and active
participation in the development and growth of the
profession are commendable obligations.
4. Contribution to the improvement of the socio-economic
conditions and general welfare of nurses through
appropriate legislation is a practice and a visionary
mission.
SECTION 16.
Guidelines to be observed:
Registered Nurses must
a. be members of the Accredited Professional Organization
(PNA).
b. strictly adhere to the nursing standards.
c. participate actively in the growth and development of the
nursing profession.
d. strive to secure equitable socio-economic and work
conditions in nursing through appropriate legislation and
other means
e. assert for the implementation of labor and work
standards
ARTICLE VII
ADMINISTRATIVE PENALITIES, REPEALING CLAUSE, AND
EFFECTIVITY
SECTION 17.
The Certificate of Registration of Registered Nurse shall
either be revoked or suspended for violation of any provisions
of this Code pursuant to Sec. 23 (f), Art. IV of R. A. No. 9173
and Sec. 23 (f), Rule III of Board Res. No. 425, Series of 2003,
the IRR.
SECTION 18.
The Amended Code of Ethics promulgated pursuant to R.
A. No. 877 and P.D. No. 223 is accordingly repealed or
superseded by the herein Code.
===============================================
10 Most Common Violations Of The Nursing Code
Of Ethics
1. Violations of Patient Privacy (Violation of ANA Code of
Ethics Provision 3.1):
One of the most common violations of the Nursing Code
of Ethics is the violation of a patient's right to privacy.
Violation of a patient's privacy can occur in several ways. To
prevent this type of Code of Ethics violation, nurses must be
careful to discuss patient information only with the people
providing care for the patient and anyone else the patient or
his legal representative approves. Conversations regarding a
patient should occur away from the public and in areas
designated for care.
2. Failure to Promote a Safe Healthcare Environment
(Violation of ANA Code of Ethics Provision 6.3): Nurses are
responsible for knowing which acts or behavior constitute unsafe
nursing practices. Further, the ANA Nursing Code of Ethics
encourages nurses to avoid any behavior that jeopardizes patient
or nursing safety and well-being. Any time nurses feel the need to
question any behavior and its ethicality, they should be able to do
so without fear of negative consequences. However, even in the
face of unfavorable consequences, the nurse should always err
on the side of provisions outlined in the Nursing Code of Ethics.
3. Ethical dilemmas regarding informed consent are common
(Violation of ANA Code of Ethics Provision 1.4): Healthcare
providers must explain treatment options and procedures and
obtain consent from the patient or her legal representative before
care is administered. Before patients or their representatives can
submit informed consent, the nurse's responsibility is to make
sure they understand all aspects of the proposed treatment. If a
patient does not fully understand a proposed treatment and is
afraid to ask questions, the nurse may assume he understands
and proceed with care, creating a violation of the Code of Ethics
which protects the patient's right to make informed decisions for
himself.
4. Lack of professional growth
(Violation of ANA Code of Ethics 5.2): Healthcare is ever-growing
and expanding. New medications are developed daily. According
to the American Nurses Association Code of Ethics, nurses must
evaluate their own performance and competencies and strive for
personal and professional growth. Professional growth in nursing
requires a lifelong commitment to learning. When nurses do not
pursue avenues to expand their knowledge and develop new
skills, their disinterest can result in the delivery of patient care that
is not up to date with current standards.
5. Allowing Personal Biases and/or Beliefs to Interfere with
Patient Care (Violation of ANA Code of Ethics Provision 2.1):
There are instances when nurses have the right to refuse to
participate in certain activities or assignments. One example of
when it is appropriate to decline participation in the care of a
patient is if the type of care being provided conflicts with the
nurse's religious beliefs. While it is sometimes acceptable for
nurses to refuse to participate in a type of care, it is never
appropriate to refuse care based on the nurse's personal dislike
for or discrimination against a person. For example, it is
inappropriate for a nurse to refuse patient care when the patient is
a prison inmate because the nurse disagrees with the inmate's
illegal behavior.
6. Failure to Report Suspected Impairment of a
Coworker/Peer (Violation of ANA Code of Ethics Provision 3.6):
Understandably, nurses may feel apprehensive about reporting
suspected impaired behavior of a coworker. However, the Nursing
Code of Ethics is clear about the importance of protecting patients
and the profession by addressing impaired practice.
7. Withholding Important Information from Patients About
Their Health (Violation of ANA Code of Ethics Provision 1.4): At
times, nurses are faced with the ethical dilemma of being asked to
withhold the seriousness of a diagnosis from their patients. It is
not uncommon for family members to want to spare their loved
ones the anguish of knowing how dire their health situation is.
However, if the patient is of sound mind, it is his right to make
decisions about his care, including deciding who else can
know about his illness, disease, or prognosis.
8. Avoiding Action Against Questionable Practices
(Violation of ANA Code of Ethics 3.5): A nurse’s primary focus
should be the health, safety, and well-being of patients. If a
nurse suspects inappropriate or unethical practices regarding
the provision or denial of care, their concerns should be
expressed. Failure to address questionable practices put the
patient, healthcare team, and the profession at risk for harm.
Therefore, the nurse must always address concerns with the
person carrying out the practice and, if appropriate, escalate
the concern to a higher authority.
9. Not Accepting Responsibility for One’s Judgment and
Nursing Actions (Violation of ANA Code of Ethics 4.3): Even
the best nurses have bad days and make mistakes. One of
the most professional characteristics a nurse can
demonstrate is the willingness to be accountable and
responsible for his own actions. Being ethical means being
accountable for one’s nursing judgment and actions, even if it
means owning up to a mistake or a misunderstanding.
10. Delegating Assignments to the Appropriate Person
(Violation of ANA Code of Ethics 4.4): Charge nurses, nurse
supervisors, and administrative nurses assign nursing staff to
care for patients and perform specific procedures or
treatments. While the nurse may have authority to delegate,
the nurse also has the responsibility to make decisions based
upon the knowledge and skills of the nurse to whom
assignments are delegated. Nurses who delegate
assignments to personnel who are not adequately trained or
comfortable providing that type of care violate the patient's
right to safe care and the Nursing Code of Ethics.
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7 Consequences of Violating The Nursing Code Of Ethics
Violations of the ANA Nursing Code of Ethics for nurses can
have dire consequences. Nurses need to be aware of the
possible consequences of violating the Code and make every
effort to avoid violations. The following are examples of
consequences associated with Code of Ethics violations for
nurses.
1. Disciplinary Action from Employer:
Nurses who violate ethical codes of conduct can expect
to face disciplinary action from their employers. Depending
on the violation and whether the nurse has a history of
previous misconduct, the nurse could face a verbal or written
reprimand or suspension.
2. Loss of Job:
When violations of the Nursing Code of Ethics are
repeated, the nurse could face termination. It is the nurse and
healthcare organization's responsibility to hold patient safety,
privacy, and care in the highest regard. If a nurse fails to
follow the provisions outlined by the Code of Ethics, it can
result in loss of job.
3. Disciplinary Action from the State Board of Nursing:
Any action that constitutes a violation of the Nursing
Code of Ethics may be reported to the Board of Nursing that
holds jurisdiction over the nurse’s license. As such, it is the
discretion of the Board to determine what action, if any, will
be taken against the nurse.
4. Loss of Nursing License: SCHOLARLY INQUIRY, PROFESSIONAL STANDARDS
In some cases, especially if previous disciplinary action DEVELOPMENT, AND THE GENERATION OF BOTH
did not correct behavior, nurses can face loss of their nursing NURSING AND HEALTH POLICY.”
license following ethical violations. 8. “THE NURSE COLLABORATES WITH OTHER HEALTH
5. May be Subject to a Civil Personal Injury Claim: PROFESSIONALS AND THE PUBLIC TO PROTECT
When nurses violate the Code of Ethics, they open HUMAN RIGHTS, PROMOTE HEALTH DIPLOMACY, AND
themselves up for risk of facing civil litigation. Patients or their REDUCE HEALTH DISPARITIES.”
designated representatives may make a claim in civil court based 9. “THE PROFESSION OF NURSING, COLLECTIVELY
on the nature of the violation. If the case is ruled in favor of the THROUGH ITS PROFESSIONAL ORGANIZATIONS, MUST
plaintiff, the nurse could face far-reaching financial, social, and ARTICULATE NURSING VALUES, MAINTAIN THE
psychological effects. INTEGRITY OF THE PROFESSION, AND INTEGRATE
6. Criminal Prosecution: PRINCIPLES OF SOCIAL JUSTICE INTO NURSING AND
While many breaches of the ANA Code of Ethics for HEALTH POLICY.”
nurses are considered civil matters, some violations can result in The American Nurses Association Code of Ethics
criminal prosecution and penalties. For example, some HIPAA interpretative statements in this section deal with professional
(Health Insurance Portability and Accountability Act) violations nursing organizations and their roles in the delivery of
carry criminal penalties. professional nursing care.
7. Loss of Professional Relationships:
As if disciplinary actions, loss of job or license, and the
risk of legal action were not enough, nurses who violate ethical
codes of contact are at risk of losing professional relationships.
Professional peers may personally like another nurse but often
find it in their best interest to step away from relationships with
unethical nurses to protect their reputations.
WHAT ARE THE 9 CODE OF ETHICS FOR NURSES?
The 9 provisions of the ANA CODE OF ETHICS for Nurses
are a guide for carrying out nursing responsibilities consistent
with high-quality nursing care and in alignment with the ethical
obligations of the nursing profession. The following is a detailed
explanation of the 9 provisions of the nursing code of ethics +
interpretive statements every nurse needs to know about.
1. “THE NURSE PRACTICES WITH COMPASSION AND
RESPECT FOR THE INHERENT DIGNITY, WORTH, AND
UNIQUE ATTRIBUTES OF EVERY PERSON.”
2. “THE NURSE'S PRIMARY COMMITMENT IS TO THE
PATIENT, WHETHER AN INDIVIDUAL, FAMILY, GROUP,
COMMUNITY, OR POPULATION.”
3. “THE NURSE PROMOTES, ADVOCATES FOR, AND
PROTECTS THE RIGHTS, HEALTH, AND SAFETY OF THE
PATIENT.”
4. “THE NURSE HAS AUTHORITY, ACCOUNTABILITY, AND
RESPONSIBILITY FOR NURSING PRACTICE; MAKES
DECISIONS; AND TAKES ACTION CONSISTENT WITH
THE OBLIGATION TO PROMOTE HEALTH AND TO
PROVIDE OPTIMAL CARE.”
5. “THE NURSE OWES THE SAME DUTIES TO SELF AS TO
OTHERS, INCLUDING THE RESPONSIBILITY TO
PROMOTE HEALTH AND SAFETY, PRESERVE
WHOLENESS OF CHARACTER AND INTEGRITY,
MAINTAIN COMPETENCE, AND CONTINUE PERSONAL
AND PROFESSIONAL GROWTH.”
6. “THE NURSE, THROUGH INDIVIDUAL AND COLLECTIVE
EFFORTS, ESTABLISHES, MAINTAINS, AND IMPROVES
THE ETHICAL ENVIRONMENT OF THE WORK SETTING
AND CONDITIONS OF EMPLOYMENT THAT ARE
CONDUCIVE TO SAFE, QUALITY HEALTH CARE.”
7. “THE NURSE, IN ALL ROLES AND SETTINGS, ADVANCES
THE PROFESSION THROUGH RESEARCH AND