Professional and

Personal Development
 Choosing, Retaining,
Resigning & Dismissal from
a Position
Guidelines in choosing a Job

Qualifications- does it fit the job you are applying

for?
Years of experience & training-
are your experiences and training relevant to
what you are applying for?
Consider your age & physical condition
Emotional stability & goals in life-
can you be calm under severe stress?
Do you get along well with people?
What is your primary aim in taking up nursing: for
money or the satisfaction in helping people?
Factors in Selecting a Job

Kind of work to be performed

Are you prepared for the job?
Can you work under stress
Do you get along well with people?

Availability of the work

Is there a shortage of workers?
 Guidelines in choosing a Job

Hours of work
Are you rotated on shifts?
How many hours a day or week do you
go on duty?

Qualifications
What are the requirements in terms of
educational qualifications?
Experience?
Training?
 Factors in Selecting a Job

Opportunities for advancement

What chances do you have of being promoted after several years of
employment?
Will be allowed to pursue continuing education?

Method of entering
Do you need an examination to enter?
Do you need someone to recommend you?
 Factors in Selecting a Job
Earnings
How much is the initial salary?
Is salary paid weekly or every 15 days?

Fringe benefits
How many days of vacation & sick, maternity leaves are given?

Other benefits
Are insurances, medicare, retirement benefits provided for?
Pointers in making a Letter of Application

Use clean, white, unlined paper

Use ink or ball pen in writing
Use proper salutation
Write in a courteous manner
Enclose return postage
Contents of Letter of Application

1st paragraph- Source & purpose

Source of info concerning vacancy & nurses
intent to apply
2nd & 3rd paragraphs- Qualifications
College from where he/ she graduated, year
of graduation, experience & training
Reference
3 names
Last paragraph- Request for personal interview
 SELECTION OF PERSONNEL

1. RECRUITMENT --- process of enlisting personnel for employment

METHODS:
advertising
word of mouth
employee recommendation
2. SCREENING- recruiter uses data about the applicants to determine if he/ she
is qualified and meets the minimum requirement

PHILOSOPHIES:
1. screen out applicants who do not fit the image of the agency
2. try to fit the job to a promising client
3. try to fit the applicant to the job

3. INTERVIEW

4. ORIENTATION --- process of becoming familiar with a new environment and

adapting well to it
Interview

Face to face conference between two people about

something
Employer-
assess applicants personality
Alertness in answering questions
Poise
Command of the spoken language
Applicant-
Background of institution; potential as a working
place
Philosophy & objectives
Working conditions
Pointers in preparing for an Interview

Make appointment either by mail or phone

Be at the place at the appointed time
Know something about the institution where you
are applying
Be at your best
Knock before you enter
Bring credentials (PRC card, residence
certificate, TIN, etc) & other things needed (ID
pictures, ball pen)
 Pointers in preparing for an Interview

Ask questions about the job

Thank interviewer for giving you some of his time
Give yourself time to think about the position
Write a follow- up letter if prospective employer does not answer your call
A WELL-DEFINED ORIENTATION PROGRAM WOULD INCLUDE:

a tour to the physical facilities

introduction to co-workers
description of the organizational structure of the institution
information on the philosophy, goals, policies and standards
of the institution
functions of the members of the health team
 Orientation

Part of staff development; when policies, regulations and job

descriptions are communicated to the newly employed nurse,
uncertainties are diminished, anxiety is reduced and
misunderstandings are prevented.
Reasons for Resigning from the Job

Seek better positions locally or abroad

Inability to adjust to work situation,
marriage, children, etc
Points in writing a Letter of Resignation

Give date of resignation

State reason for resigning
Express gratitude for kindness &
consideration given during period of
employment
Attach clearance for money, work &
property responsibilities
 Definition of Terms

Ethics
- concerned with the study of social morality
and philosophical reflection on its norms and
practices. Answers the question: What
should I do in this situation?

method of inquiry about the rightness or

wrongness of human actions; the practices or
beliefs of a group; and the standards of moral
behavior described in the groups formal code
of ethics
Nursing ethics branch of moral science
which treats of the duties of a member of
the nursing profession towards her co-
professional nurses, to her profession &
other professions, to her co- workers &
other members of the health team, to her
clients & to the public in general.
Code of Nursing Ethics deals with the
fourfold responsibility of nurses; nursing
universality; the scopes of services rendered
by the nurses; their responsibilities to the
people, to their practice, to society, to their
co-workers, and to the profession.
Morality - private, personal standard of
what is right and wrong.

Moral issues- those which are essential,

basic or important and deal with important
social values or norms:
o Respect for life,
o Freedom and love;
o Issues that provoke the conscience as guilt,
shame, self- esteem, courage or hope
Moral Philosophy- philosophical discussion
of what is considered good or bad, right or
wrong, in terms of moral issues.

Bioethics ethics as applied to life

situations (e.g. decisions about
euthanasia, prolonging life, abortion)
 Patients Bill of Rights:

1. The patient has the right to considerate and

respectful care.
2. Except in emergencies when the patient lacks
decision-making capacity and the need for
treatment is urgent, the patient is entitled to the
opportunity to discuss and request information
related to the specific procedures and / or
treatments, the crisis involved, the possible length
of recuperation, and the medically reasonable
alternatives and their accompanying risks and
benefits.
3. The patient has the right to make decisions
about the plan of care prior to and during the
course of treatment and to refuse a
recommended treatment or plan of care to the
extent permitted by law and hospital policy and
to be informed of the medical consequences of
this action.

4.The patient has the right to have an advance

directive (such as a living will, health care)
concerning treatment or designating a surrogate
decision maker with the expectation that the
hospital will honor the intent of that directive to
the extent permitted by law and hospital policy.
4. The patient has the right to every
consideration of his privacy.

5. The patient has the right to expect that all

communications and records pertaining to
his / her care should be treated as confidential
by the hospital.

6. The patient has the right to review the records

pertaining to his / her medical care and to
have the information explained or interpreted
as necessary except when restricted by law.
7. The patient has the right to expect that, within its
capacity and policies, a hospital will make reasonable
response to the request of a patient for appropriate
and medically indicated care and services.

8. The patient has the right to ask and be informed

existence of business relationships among the
hospital, educational institutions, other health care
providers, or players that may influence the patients
treatment and care.
9. The patient has the right to consent to or
decline to participate in proposed research
studies or human experimentation affecting his
care and treatment or requiring direct patient
involvement, and to have those studies fully
explained prior to consent.

10. The patient has the right to expect

reasonable continuity of care when appropriate
and to be informed by physicians and caregivers
of available and realistic patient care options
when hospital care is no longer appropriate.
11. The patient has the right to be informed
of hospital policies and practices that relate
to patient care, treatment, and
responsibilities.
Patients Responsibilities

Providing information
Complying with instructions
Informing the physician of refusal to treatment
Paying hospital charges
Following hospital rules and regulations
Showing respect and consideration
 Code of Ethics for Nurses in the
Philippines

Prior to 1984- the Code of Ethics used by

Filipino nurses - code promulgated by the
ICN

1982 the PNA Special committee, under

Dean Emeritus Julita V. Sotejo developed a
Code of Ethics for Filipino nurses. This was
approved by the House of Delegates of the
PNA but was not implemented.
1984 - The BON, PRC adopted the Code of
Ethics of the ICN through Board Resolution
No. 633 adding promotion of spiritual
environment as the fifth-fold responsibility
of the nurse. This was enforced up to 1989.

1989- The Code of Ethics promulgated by

the PNA was approved by the PRC and
through Board Resolution No. 1955 was
recommended for use. This was approved by
the general assembly of the Philippine
Nurses Association during the Nurses Week
convention in October 25, 1990.
Amended Code of Ethics for Nurses:

Pursuant to section 3 of Republic Act

No. 877, known as the Philippine
Nursing Law, and Section 6 of P.D. No.
223

Foreword. Health is a fundamental

right of every individual. The nurses
primary responsibility is to preserve
health at all cost. This responsibility
encompasses promotion of health,
prevention of illness, alleviation of
suffering and restoration of health.
Nurses and People:

Values, customs and spiritual beliefs held

by individuals are to be respected.
Nurses and Practice:

Nurses are accountable for their own nursing

practice. They are responsible for their
personal and professional growth and
development.
Nurses and Co-workers:

Nurses maintain collaborative working

relationships with their co-workers and
other members of the health team. They
recognize their capabilities and limitations,
and those of their co-workers in accepting
or when delegating responsibilities to the
team members.
Nurses and Society:

Nurses are contributing members of

society. They assume responsibilities
inherent in being members and citizens of
the community / society in which they live
/ work.
Nurses and the Profession:

Nurses are expected to be members of

professional organizations of nurses.
Inherent in this is the responsibility to
support and uphold their constitutions and
by-laws.
Sanctions

A nurse who is found, after due process, to

have violated any provision of this Code of
Ethics, shall be guilty of unprofessional and
unethical conduct and shall suffer the sanction
of censure or reprimand, suspension or
revocation of her / his certificate of
registration.
Nurses Bill of Rights:

1.Right to practice in a manner that fulfills

their obligations to society and to those who
receive nursing care.

2.Right to practice in environments that allow

them to act in accordance with professional
standards and legally authorized scopes of
practice.

3.Right to a work that supports and facilitates

ethical practice, in accordance with the Code
of Ethics for nurses and its interpretive
statements.
4. Right to freely and openly advocate for
themselves and their patients, without fear of
retribution.

5. Right to fair compensation for their work,

consistent with their knowledge, experience,
and professional responsibilities.

6. Right to a work environment that is safe for

themselves and their patients.

7. Right to negotiate the conditions of their

employment, either as individuals or
collectively, in all practice settings.
 Responsibilities of Nurses to
Themselves:

1.Every possible means shall be utilized by

them to develop their skills.

2.Their conduct must bring credit to the

profession.

3.Try to look neat and attractive. Female-

moderate make-up and neat hair style.
Wear uniforms that are neither too short
nor tight-fitting
4. Male nurses- clean shaven, with hair
clipped close to the nape instead of flowing
to the shoulders.

5. Uniform shall be specified in the policy of

the hospital / agency. Worn only when on
duty. Dining in public, shopping or going to
the market while in uniform is discouraged.
Nurses caps are worn only while on duty.
These are either carried in bags or are left
in their places of assignment.
6. Jewelries such as earrings, necklaces, or
bracelets are not worn while on duty. However,
wedding rings, school rings or school pins may
be worn.

7. Nurses are looked upon by nursing students

as their role models.
Sincere and compassionate attitudes towards
patients
 Responsibilities of the Nurse to the
Physician:

1.Provide nursing care through the

utilization of the nursing process.
. traditional and innovative approaches
. therapeutic use of self
. executing health care techniques and
procedures, comfort measures, health
teachings
. 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 cases of suturing of perineal
laceration, special training shall be
provided according to protocol
established.

2. Not only carry out doctors order but to

help plan and implement patient care as
well. Report patients condition including
results of therapies

3. Bring to attention of physician if medical

orders were not carried out for some reason
(e.g., medications are unavailable, or a
patient refuses to accept them) and note
properly in the patients chart.
4. Familiarize themselves with the various
routines, methods or idiosyncrasies of
physicians. In case the patient has a
complaint against the physician, this shall
be tactfully brought to the latters
attention.

5. Remember that any medical act

relegated (consign; commend; entrust) to
them is illegal because it is specified in the
Medical Law that any licensed nurse who
does this, even if supervised, can be held
for illegal practice of medicine.
 RESPONSIBILITIES OF THE NURSE
TO THE PATIENT.

Primary responsibility: to give him / her

the kind of care his / her condition
needs regardless of his / her race,
creed, color, nationality or status.
 RESPONSIBILITIES OF THE NURSE
TO THE PATIENT.

1.The patient and his / her family are

entitled to know information or facts
within the limits determined by the
physician.

2. Any information gathered by the nurse

during the course of caring for the
patient shall always be treated
confidential. This duty extends even
after the patients death.
3. Do not accept tips or expensive gifts that
may induce them to give more care to favored
patients and neglect those who cannot give.

4. When a nurse is engaged by a patient or

any agency, she / he shall complete said
service on the length of time stipulated in the
contract.
Moral Principles
When a nurse is confronted with situations
where moral judgment is necessary, the
nurse may be guided by the following
principles or rules:

1.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 same to others too.
 2. The Two-fold Effect when a nurse
is faced with a situation which may have
both good and bad effects, 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
That the good effect must be greater
than the bad effect.
Examples:
It is not morally good if a boy steals in order
to alleviate his hunger because the action
itself is already bad.
If the patient who has a 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
gynecologists intention to help the mother
and not to harm her. The surgeons action is
morally good since saving the mothers life
is of primary importance. Also the doctor
himself did not will that the patient lose her
child-bearing function.
3. Epikia Exception to the general rule.

Examples:
If a mental patient went berserk and the
doctor could not be contacted, the patient
may be restrained by virtue of EPIKIA.

Allowing a relative to see a seriously ill

patient who expresses the desire to see the
former although it is not yet visiting hours.
4. One who acts through an agent is
himself responsible

Example: A patient wants to have an abortion

and asks a nurse if she can do it. The nurse
refuses, but recommends a doctor who is
capable of performing. The nurse is liable to
such crime, since he / she is an accomplice of
the said doctor.

5. No one is obliged to betray himself /

herself. In testifying before the court, no
one can force any person to answer a question
if such will incriminate him / her.
6. The end does not justify the means.
Example: Giving sleeping tablet to a
chronically ill person so she / he can die in
peace is morally wrong.

7. Defects of nature may be corrected.-

Example: Patient with a Harelip or cleft palate
may have their defects corrected by plastic
surgery.
8. If one is willing to cooperate in the act,
no injustice is done to him / her. -
Example: A patient subjects himself / herself
willingly to an experimental drug and she / he
has been told of the possible effects of the
same, is of right age, and is sane, there is no
violation of human rights.

9. A little more or less does not change

the substance of an act.
Example: If a nurse gets medicine from the
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.
10. The greatest good for the greatest
number.
Example: During an epidemic, immunization
against communicable diseases is administered to
the people. If 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.

11. No one is held to the impossible.

Example: To promise that a patient with heart
transplant will live may be impossible. Yet, such
procedures are done in the hope of saving or
prolonging a patients 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.
12. 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.

13. Principle relating to the origin and

destruction of life. One of GODs
commandments is Thou shall not kill.
 Euthanasia- 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..

Giving 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.
Euthanasia

The state shall protect the life of the

mother and the unborn since conception.
Any direct attack on the life of the fetus
for whatever cause is immoral.
The fetus shall be buried in consecrated
grounds. If it is dead and came from a
dead mother, it shall be buried with the
mother.
 Ethical Principles
1. Autonomy
Self- governing
An individual has the right to make
decisions and take independent actions
without external control.
Based on the belief that a person has
unconditional value and has the capacity
to determine own destiny
Examples
Consent on all treatments
Knowing policies on advance directives
like DNR
Privileged Communication
Physical privacy
 Respect for Autonomy

Belief a person has unconditional value

Capacity to determine own destiny
With understanding
Without controlling influences
Recognize persons capacity and
perspective
Right to hold views
Right to make choices
Actions taken based on personal values
and beliefs.
Persons who lack capacity to
be autonomous

Infants
Irrationally suicidal individuals
Drug-dependent individuals
2. Beneficence
Do good. The duty to do good to others
and maintain balance between benefits
and harms
One person takes action for the good
of another person.
Act in ways that benefit others
3 major components

Do or promote good
Prevent harm
ICN Code of Ethics (2000)- The nurse takes
appropriate action to safeguard individual
when their care is endangered by a co- worker
or any other person
Remove evil or harm
Express concern to person carrying out
questionable practice
Report practice to proper authority
BENEFICENCE

X has a duty to benefit Y provided:

Y is at significant risk
Xs action is needed
Xs action is likely to succeed
There is no significant risk for X
The benefit to Y outweighs any
harm for X
Examples
Providing ALL patients including terminally ill
patients with EQUAL CARING attention
Organ donations
Treating every patient with respect and
courtesy
Obligation to help others further their
legitimate and important interests
Contribute to the well being of another
Situation No. 1

NORMA BRINGS LUNCH

FROM HOME EVERYDAY.
ONE DAY SHE NOTICED A
SMALL, THIN BOY
WATCHING HER AS SHE
EATS. THE BOY EXTENDS
HIS HANDS ASKING FOR
FOOD.
Situation No. 2

MON, A SO-SO
SWIMMER, SEES
MARCO
DROWNING.
Situation No. 3

A PATIENT
REQUESTS THE
NURSE TO STAY
WITH HER
BECAUSE SHE
FEELS VERY
LONELY.
3. Nonmalfeasance
Do no harm
Do not commit acts that cause
deliberate harm Ex. Experimental
research
Avoid harm as a consequence of doing
good Ex. Immunization of infants
X has a right not to be harmed.
Y has an obligation not to harm X.

Harm may be physical, mental,

psychological, social, financial, spiritual,
etc.
Examples
Working within the scope of nursing
practice
Observing safety rules and precautions
Perform procedures according to
protocols. Never do shortcuts!
Ask appropriate person if in doubt or
unsure
Continuing Professional Update
 Situation No. 1

TONY HAS AIDS. HE IS

BEDRIDDEN AND
EMACIATED. HE ASKS
THE DOCTOR TO GIVE
HIM MEDICINE TO END
HIS LIFE.
Situation No. 2

INA IS A 24-YEAR
OLD SINGLE
SCHOOLTEACHER
WHO WAS RAPED 6
WEEKS AGO. INA
WANTS AN
ABORTION.
Situation No. 3

PERLA HAS A LUMP IN

HER BREAST. WHEN
SHE CONSULTS AT THE
PUBLIC HOSPITAL, THE
DOCTOR SHOWS HER
TO 8 MEDICAL
STUDENTS AND
INSTRUCTS THEM TO
FEEL THE LUMP.
4. Veracity

*Obligation to tell the truth

*Not to lie or deceive others
 Rules of Veracity

Obligation to tell the truth

Not to lie or deceive others
Respect for others
Implicit promise
Relationships of trust
Examples

Admit mistakes promptly. Offer to do

whatever is necessary to correct them
Refusal to participate in any fraud
Give an honest days work every day
5. Confidentiality

Non- disclosure of private or secret

information with which one is entrusted
Limits of Confidentiality

Harm principle- maintaining confidentiality

will result in preventable wrongful harm to
others Ex. Venereal disease
Vulnerability principle- risk or susceptibility
to harm when vulnerable individuals have
a relative inability to protect themselves
Ex. Child abuse
 Confidential information may be
revealed only when:

The patient himself / herself permits

such revelation
The case is Medico-Legal such as
attempted suicide, gunshot wounds
The patient is ill of communicable
disease and public safety may be
jeopardized
Given to members of health team if
information is relevant to his or her
care.
Situation 1

RICK IS A PSYCHIATRIC
PATIENT WHO BECOMES
VIOLENT AND TRIES TO
KILL OTHERS. MOST OF
THE TIME HIS DOCTORS,
KEEP HIM UNDER
SEDATION IN ORDER TO
CONTROL HIM.
Situation 2

CARA IS 4 MONTHS
PREGNANT WHEN
DISCOVERED TO HAVE
CANCER OF THE
UTERUS. THE DOCTOR
ADVISES IMMEDIATE
REMOVAL OF THE
UTERUS TO SAVE
CARAS LIFE. IF DONE,
CARAS BABY WILL DIE.
6. Justice
Fair, equitable and appropriate treatment
To each equally
To each according to need
To each according to merit
To each according to social contribution
To each according to the persons rights
To each according to individual effort
To each as you would be done by
To each according to the greatest good to the
greatest number
Examples
Treating patients equally regardless of
economic or social background
Knowing laws on abuses
Basic Principles of Justice
Equals must be treated equally
Fundamental needs
Distributive justice
Effort
Contribution
Merit
Free-market exchange
Situation 1

ERNIE ENJOYS LISTENING

TO GOOD MUSIC. HE
PLAYS HIS MUSIC LOUD
EVEN IF HIS DORMMATES
ARE STUDYING.
Situation 2

AT A PRIVATE HOSPITAL, THE

RICH GET THE HOSPITAL SUITES
AND PRIVATE NURSES; THE
POOR ARE ADMITTED TO THE
WARDS WITH ONE NURSE IS TO
16 PATIENTS.
COST OF MEDICINE AND
LABORATORY TESTS ARE
HIGHER FOR THE RICH AND
LOWER FOR THE POOR. THE
POOR ARE USED AS TEACHING
AND RESEARCH SUBJECTS.
7. Fidelity
Concept of faithfulness and the practice
of keeping promises
Upholding the professions code of ethics
Practice within the scope of nursing
Examples:
a. Contracts
b. loyalty within the nurse- patient
relationship
Others...
SANCTITY OF LIFE
the perspective of that life is
the highest good, and is
considered sacred.

Thus all forms of life, including

mere biologic existence should
take precedence over external
criteria for judging quality of
life.
SANCTITY OF LIFE
Life is not to be violated, opposed, or destroyed
but is to be affirmed, cherished, respected,
defended, and preserved.

Commitment to the principle of the inviolability

of life means choosing life and fighting to
protect it.

X has a right to life.

Y has a duty not to kill X.
Situation 1

Mang Sedong is a 70-year old post stroke

patient who is unable to care for himself.
He lies in bed non-communicative, non-
responsive to ordinary stimulation,
urinating and defecating without control.
His heart however continues to beat and
his lungs to breathe. His family cannot
afford to care for him and so abandons
him. A neighbor suggests that
medications be withheld to let him die.
STEWARDSHIP

Man has dominion over Gods

creations, himself (life and health), other
creatures and the environment.

One should reasonably, responsibly and

respectfully protect them or benefit from
them for service, and not domination.
SUBSIDIARITY

Every creature should be entrusted with

the functions he is capable of performing.

It relates to human dignity and recognizes

persons as free and responsible agents
able to care and make decisions for them.

It focuses on the giving aid and support.

Situation 1
An elderly man presents himself to the ER. He has
contractures and paralysis of his left hand and is
aphasic. Upon questioning, he removes his left shoe
and points to his big toe. The nurse is unable to
gather additional information from him because of
his difficulty in communicating. She asks if someone
is accompanying him. He shakes his head. The
nurse asks him how he came to the hospital. He
shows her a drivers license. Subsequently the
nurse leaves the room and returns a few minutes
later to find that the patient has left the hospital
having received no care.
Questions
What are the ethical implications in this
situation?
What ethical principles are involved?
Should the nurse locate the patient and ensure
that he is not endangering himself or others by
driving? Would this be a breach of
confidentiality? Autonomy?
How does the nurse express fidelity in this
situation?
What is the beneficent action?
Situation 2
Martha is a seventy five year old woman who
has terminal cancer of the bladder. During the
course of her therapy, she sustains third degree
radiation burns to her lower abdomen and pelvic
area. Her wounds are extensive and deep
involving her abdominal wall, bladder and
vagina. The doctor orders frequent medicinal
douches and wound irrigation. These treatments
are very painful and the patient wants the
treatment discontinued but is too timid to
actually refuse them. The doctor will not change
the order.
Questions
Discuss the situation in terms of
beneficence and nonmalfeasance
How does this patient express her
autonomy?
What is the nurses responsibility in
assisting the patient to maintain
autonomy?
How does the nurse deal with conflicting
loyalties and principle?
Situation 3
Lora is a seventeen year old cheerleader. She
comes to the local family planning clinic
requesting birth control pills. She is very
attractive, neat and a pleasant patient. In the
process of completing the initial physical
examination, the nurse practitioner finds
evidence of physical abuse. Lora hesitantly and
tearfully admits that her stepfather has sexually
abused her. The law requires that the nurse
report any suspicion of child abuse. On the other
hand, the code of ethics requires that the nurse
maintain confidentiality.
Questions
What are the principles involved?
Does the nurses obligation to report the incident
of child abuse supersede the obligation to
maintain confidentiality- particularly that the
patient requested confidentiality?
What are the options for the nurse?
What are the possible outcomes of the different
options?
Does Loras autonomy outweigh the nurse/s
responsibility to report the abusive situation?
 Le g a l
p e c t s o f
As
Nu r s i n g
Specific Laws
Act 2493: Medical Act of 1915;
provided for the examination and
registration of nurses in the
Philippines
Provisions: applicant must be 20
years old, must be physically and
mentally healthy, good moral
character, instructions is only 2 and
half years
* First-Class Nurses: graduate of the
program
 Act 2808: the First True Nursing
Law of 1919
Provisions:
1. Created the First Board of
Examiners for Nurses
2. First Board Examination was
conducted in 1920
 R.A. 877: The Second Nursing Law

Salient Provisions:
1. Inhibition of the Practice of Nursing: No
person shall practice nursing without a
certificate of registration issued by the
BON

2. Penal Provision: A person who is found

guilty of the practice of nursing without
been duly registered is guilty of
misdemeanor, and may be sentenced to a
fine of not less than one year or more than
five years, or both in the discretion of the
court.
 R.A. 4704: amended certain portion of
the
R. A. 877 with the following provisions:
1. Membership of the BON: from 3 to 5
2. Membership to BON is thru
Presidential Appointment and no longer
from the Commission of Civil Service
3. Academic Requisite of the BON
Member is a Masters Degree
4. Age limit to disqualify a BON
Member: 65 years old
5. Increase in the Monetary
Compensation of BON to Php 18,000 as
provided by the Appropriation Act
6. Academic Requisite for the Principals,
Deans and Directors of Colleges and
Schools of Nursing: Masters Degree
7. Areas of Study: Generalized to include
courses on physical, biological, social,
behavioral sciences, humanities,
chemistry, psychology and zoology

8. Scope of Nursing: Broadening of the

Scope: emphasis on whole management of
care and professional practice of nursing

9. Date of Examination: no longer fixed

10. Minimum Age Requirement for

Admission to Examination: from 21 to 18,
provided practice of those who passed
shall be 21.
 R.A 6136: Amended R.A. 877
Section 17 stating the application
and execution of legal orders in
writing concerning treatments and
medications including hypodermic
and intramuscular injections;
provided that intravenous injection
maybe administered under the
direction and presence of the
physician
 R. A. 7164: Philippine Nursing Act of
1991
Salient Changes:
Redefinition of the scope of nursing
practice, emphasis on:
a. the use of nursing process as a
scientific discipline in arriving at an
appropriate nursing action and care

b. teaching, management, leadership

and decision making roles of the nurse

c. the undertaking of and participation in

research
2. Requiring a faculty member who was
appointed to the Board to resign from his
or her teaching position at the time of
appointment

3. Updating a faculty educational

qualification to Masters Degree in Nursing

4. Specifications of qualifications of
administrators of nursing services

5. Inclusion of the phrase unethical

conduct as one of the reasons for
revocation and suspension of certificate of
 R.A 9173: The Philippine Nursing Act
of 2002
Salient Features:
1. Composition of the Board: 1 Chair and 6
Members

2. Qualification requirement: Should resign from

teaching, review and private sector

3. Examination: No refresher course after 3

failures

4. Provides temporary permit to practice nursing

5. Deletion of the upper 40% requirement in

6. Qualification of Faculty: at least 1 year of
clinical practice; M.A degree for Dean

7. Scope of Nursing Practice:

a. Clientele: specified stages of
development
b. Nursing Care: training for suturing of
perineal laceration; provision of health
education
c. Code of Ethics: duty bound to observe it
d. Standards of Nursing Practice: Maintain
competence through CPE
8. Qualification of Nursing Administrator:
Specification of the areas of specialization,
for a military hospital: General Military
Course, for Public Health: CHN or Public
Health major
Profession

A calling in which members

profess to have acquired special
knowledge, by training or
experience or both, so that they
may guide, serve or advice
others in that special field
Characteristics of a profession
Special Education
Code of ethics
Research Orientation
Autonomy, Authority, Accountability
Body of knowledge
Service Orientation
Professional organization
Professional
Nursing
The performance for salary or
remuneration, of professional
nursing service, particularly that
of diagnosing and treating
human responses and potential
health problems.
Legal Basis of Professional
Nursing Practice

Republic Act 9173 (The Nursing law of

2002)

> Defines nursing, set standards for the

nursing profession and give guidance in
the scope of practice.
> Contains general statements of
appropriate nursing actions
> Goal: protection of the general public
LICENSE
A license is legal document given by the
government that permits a person to offer to
the public his or her skills and knowledge in
a particular jurisdiction, where such practice
would otherwise be unlawful without a
license.

Purpose:
To protect the health of the people by establishing
minimum standards which qualified practitioners
must meet
 REGISTRATION
Registration is the recording of names
of persons who have qualified under the
law to practice their respective
professions. Nurses name is recorded in
a registry or registration book which
contains the following information:
1. full name of registrant;
2. number and date of registration;
3. age, sex , and place of birth;
3. place of business;
4. post office address;
5. name of school, college or university from
which he or she graduated or in which he or
she has studied;

6. date such graduation or term of study,

together with the time spent in the study of
the profession elsewhere, if any; and

7. all other degrees granted to him or her

from other institutions of learning.
REGISTRATION

Under the Philippines Nursing

Act of 2002, R.A. 9173, Sections
12 and 20 state that license to
practice nursing shall be issued
to those who pass the licensure
examination or by reciprocity.
 Registration by Examination

Applicants for registration as a nurse &

issuance of a certificate of registration and
professional ID card shall be required to
pass a written examination
 Qualifications for Admission to the Licensure
Examination (Philippine Nursing Act of 2002)

(a)A citizen of the Philippines, or a citizen or

subject of a country which permits Filipino nurses
to practice within its territorial limits on the same
basis as the subject or citizen of such country:

Provided, That the requirements for the registration

or licensing of nurses in said country are
substantially the same as those prescribed in this
Act;
(b) Of good moral character; and

(c) A holder of a Bachelor's Degree in

Nursing from a college or university that
complies with the standards of nursing
education duly recognized by the proper
government agency.
 Qualifications for Admission to the Licensure
Examination

A. A citizen of the Philippines , or a citizen or

subject of a country which permits Filipino
nurses to practice within its territorial limits
on the same basis as the subject or citizen
of such country.
 JUS SANGUINIS doctrine: nationality of a
person is determined by the law of his descent
or parentage; the child follow the citizenship of
his father

JUS SOLI doctrine: nationality of a person is

determined by the law of the place of his birth;
the child born in a foreign country , whatever
maybe the citizenship of the father, is the
citizenship of the country

NATURALIZATION: act of adapting a foreigner

and giving him the privileges of a native citizen
 Qualifications for Admission to the Licensure
Examination

B. Is of good moral character; and

C. Is a holder of a Bachelors Degree in
Nursing from a college or university that
complies with the standards of nursing
education duly recognized by the proper
government agency.
Rating of the Nursing Licensure Examination

-An examinee must obtain a general average of at least

seventy-five percent (75%) with a rating not below sixty
percent (60%) in any subject
-an examinee who obtains an average rating of seventy-
five percent (75%) or higher but gets a rating below sixty
percent (60%) in any subject must take the examination
again but only in the subjects where he/she is rated below
sixty percent (60%)
-In order to pass the succeeding examination, an
examinee may obtain a rating of at least seventy-five
percent (75%) in the subject repeated

- Renewal examination shall be taken within two years

after the last failed examination
Requirements for Examination

1.Original transcript of records with Special

Order from the Department of Education,
Culture and Sports unless he/she is a
graduate of a Level II accredited nursing
program;

2. For state colleges and universities, original

transcript of records with date of
graduation;
3. Record of actual related learning
experience for the entire Bachelor of Science
in Nursing program duly assigned by the
Chief Nurse of the hospital or her duly
authorized representative in addition to that
of the Dean of the nursing school and the
clinical instructor;

4. Actual number of operation room scrubs

and deliveries assisted, signed by the Chief
Nurse or her duly authorized representative
in addition to that Dean of the nursing school
and the cilinical instructor;
5. Where applicable:
A. Birth Certificate
B. Marriage Certificate
C. Alien Certificate of Naturalization
D. Clearance showing dismissal of
case from the Court or
Prosecutors Office, if any.
The application form, together with the
requirements, should be filed on or before
the the date set Professional regulation
Commission.
Registration by Reciprocity

Mutuality in the grant & enjoyment of privileges

between persons or nations
 Certificate of registration/ professional license
may be issued without examination to nurses
registered under the laws of a foreign state or
country provided:

Requirements for registration or licensing of

nurses in said country is substantially the same
as those prescribed under RA 9173

The laws of such state or country grant the

same privileges to registered nurses of the
Philippines on the same basis as the subjects or
citizens of such foreign state or country
 PRACTICE THROUGH
SPECIAL/TEMPORARY PERMIT
A. Licensed nurses from foreign
countries/states whose service are either
for a fee or free if they are internationally
well-known specialist or outstanding
experts in any branch or specialty of
nursing;
B. Licensed nurses from foreign
countries/states on medical mission whose
services shall be free in a particular
hospital, center or clinic; and
C. Licensed nurses from foreign
countries/states employed by
schools/colleges of nursing as exchange
professors in a branch or specialty of
nursing
 GROUNDS FOR REVOCATION OR
SUSPENSION OF LICENSE
* For any of the causes mentioned in
Section 22 of RA 9173
(No person convicted by final judgment of
any criminal offense involving moral
turpitude or any person guilty of immoral
or dishonorable conduct or any person
declared by the court to be of unsound
mind shall be registered and be issued a
certificate of registration/professional
license or a special/temporary permit.)
* For unprofessional and unethical conduct
Revocation and Suspension of Certificate of
Registration:

Grounds:
1. Negligence: an act of omission and
commission

Elements:
a. Existence of a duty on the part of the
charged
b. Failure to meet the standard of due care
c. Foreseeability of harm resulting from
failure
to meet the standard
d. The fact that the breach of the standard
Requirements for Examination
Original transcript of record with date of
graduation, with SO from CHED
Actual RLE signed by CN of hospital, the
Dean & CI
OR & DR cases signed by CN of hospital,
the Dean & CI
Birth certificate, marriage certificate, alien
certificate, clearance showing dismissal of
case
Fees for Examination and Registration

Applicants for licensure and for registration

shall pay the prescribed fees set by
Commission.
Scope of Examination- Shall be determined
by the Board taking into consideration the
following:
objectives of the nursing curriculum
the broad areas of nursing
other related disciplines and
competencies in determining the subjects
of examinations.
Citizenship Requirements
Citizens of the Philippines (Art IV Sect 1-5 of
1987 Philippine constitution:
Section 1-
- At the time of adoption of 1987
constitution
Elect Phil citizenship pursuant to
provisions of 1935 Constitution
Section 2- A female citizen of the Philippines
who marries an alien unless she renounces
her citizenship
 Citizenship Requirements
Section 3- Citizenship may be lost or re- acquired in
the manner provided by law
Section 4- Natural- born citizen who is a citizen of
the Philippines from birth
Jus sanguinis doctrine- determined by law of his
descent or parentage; child follows citizenship of his
father
Jus soli doctrine- citizenship is determined by
place of his birth; if a child is born in another country,
whatever the citizenship of his father is a citizen of
that country
Licensing Board
Professional Regulation Commission-
regulates established professions in the
Philippines
Professional Regulatory Board of Nursing-
regulatory power with respect to the
nursing profession
Organization & Composition
Board of Nursing
Composition
1 Chairperson & 6 members representing
nursing education, nursing service &
community health
May be appointed by:
Regular appointment by PNA Commissioner
PRC President of the Philippines
Ad interim- to fill in a vacancy
Doctrine of Hold- over- permitted to continue to
exercise functions after end of lawful term
 Qualifications of Members of the Board

(a)A natural born citizen and resident of the

Philippines;

(b) A member of good standing of the accredited

professional organization of nurses;

(c) A registered nurse and holder of a master's

degree in nursing, education or other allied
medical profession (majority shall be holders of a
master's degree in nursing; Chairperson shall be a
holder of a master's degree in nursing;
(d) Have at least ten (10) years of continuous
practice of the profession the last five (5) years of
which shall be in the Philippines; and

(e) Not have been convicted of any offense

involving moral turpitude
Requirements Upon Qualification as Member
of the Board of Nursing

Shall immediately resign from any teaching

position offering Bachelor of Science in Nursing
and/or review program for the local nursing board
examinations
Requirements Upon Qualification as Member of
the Board of Nursing
Shall immediately resign from any office or
employment in the government or any agency
including government-owned or controlled
corporations as well as those employed in the
private sector.

Not have any pecuniary interest in, or

administrative supervision over any institution
offering Bachelor of Science in Nursing including
review classes.
 Term of Office

Shall hold office for a term of three (3) years and

until their successors shall have been appointed
and qualified. Provided, that
No Chairperson and member shall be appointed
&/ or reappointed for more than 2 terms or for a
period of 6 years

Appointments to a vacancy that occurs before

the expiration of the term of office of the
Chairperson/ Member shall cover only the
unexpired portion of the term of the immediate
predecessor
 Term of Office

Shall take the oath of office prior to

performing their duties

The incumbent Chairperson and Members

of the Board shall continue to serve for the
remainder of their term under Republic Act
No. 7164 until their replacements have
been appointed by the President and shall
have been duly qualified.
Compensation of the Board Members

The Chairperson and Members of the Board shall

receive compensation and allowances
comparable to the compensation and allowances
received by the Chairperson and members of
other professional regulatory boards.

Principle of Quantum meruit- as much as they

deserve
 Removal or Suspension of Board
Members
The president may remove or suspend any member
of the Board after having been given the
opportunity to defend himself/herself in a proper
administrative investigation, on the following
grounds:
(a)Continued neglect of duty or incompetence;

(b) Commission or toleration of irregularities in the

licensure examination; and

(c) Unprofessional immoral or dishonorable conduct.

 Revocation and suspension of Certificate of
Registration/Professional License and
Cancellation of Special/Temporary Permit

The Board shall have the power to revoke or

suspend the certificate of
registration/professional license or cancel the
special/temporary permit of a nurse upon any of
the following grounds:
(a) For unprofessional and unethical conduct;

(b) For gross incompetence or serious ignorance;

(c) For malpractice or negligence in the practice of

nursing;
(d) For the use of fraud, deceit, or false statements
in obtaining a certificate of registration/professional
license or a temporary/special permit;

(e) For practicing his/her profession during his/her

suspension from such practice;

Provided, however, That the suspension of the

certificate of registration/professional license shall
be for a period not to exceed four (4) years.
 Re-issuance of Revoked Certificates and
Replacement of Lost Certificates
The Board may, after the expiration of a maximum of
four (4) years from the date of revocation of a
certificate, for reasons of equity and justice and
when the cause for revocation has disappeared or
has been cured and corrected, upon proper
application and the payment of the required fees,
issue another copy of the certificate of
registration/professional license.

A new certificate of registration/professional license

to replace the certificate that has been lost,
destroyed or mutilated may be issued, subject to the
rules of the Board.
 Rating of Nurse Licensure Exam

Section 15.

a general average of at least seventy-five

percent (75%) with a rating of not below sixty
percent (60%) in any subject.
 Rating of Nurse Licensure Exam
Average rating of seventy-five percent (75%) or
higher but gets a rating below sixty percent
(60%) in any subject must take the examination
again but only in the subject or subjects where
he/she is rated below sixty percent (60%).

In order to pass the succeeding examination, an

examinee must obtain a rating of at least
seventy-five percent (75%) in the subject or
subjects repeated.

Renewal examination shall be taken within 2

years after the last failed exam
Reconsideration of Ratings
May be entertained only on grounds of
mechanical, clerical or clear errors
If conclusively shown there is malfeasance
in the rating of papers
Filed within 90 days from date of official
release of exam results
 Oath- taking of Nurses

Required to take an oath of profession before

the Board or any government official
authorized to administer oaths prior to entering
upon the nursing practice.
 Oath- taking of Nurses

Mass oath- taking- 15 days upon release of

results of exam
Professional oath- pledge to support & defend
Constitution, true faith & allegiance to
Constitution, obey laws, legal orders & decrees,
adherence to ethical & professional standards of
nursing
Issuance of Certificate of
Registration

A certificate of registration/professional license

shall be issued to an applicant who passes the
examination upon payment of the prescribed
fees.
Every certificate of registration/professional
license shall show the full name of the registrant,
the serial number, the signature of the
Chairperson of the Commission and of the
Members of the Board, and the official seal of
the Commission.
 Issuance of Certificate of
Registration

A professional identification card, duly signed

by the Chairperson of the Commission, bearing
the date of registration, license number, and
the date of issuance and expiration thereof
shall likewise be issued to every registrant
upon payment of the required fees.
Automatic Registration of Nurses
All nurses whose names appear at the
roster of nurses shall be automatically or
ipso facto registered as nurses under this
Act upon its effectivity.
Nurses shall pay a fee for 3 years which
shall be paid on the professionals birth
month
PHILIPPINE
LAWS
 Laws related to
Nursing
RA 9173 (Phil. Nursing Act of 2002) An act
providing for a more responsive nursing profession
repealing RA 7164, otherwise known as the Phil.
Nursing Act of 1992

BON RESOLUTION 425 s. 2004 Implementing

Rules and Regulations of RA 9173
 Laws related to
Nursing
BON RESOLUTION 8 s. 1994 Special Training on
Intravenous injections for nurses

BON RESOLUTION 110 s. 1998 Adoption to a

guide to evaluate compliance with standards for safe
nursing practice
 Laws related to
Nursing
BON RESOLUTION 14 s. 1999 Adoption of the
Nursing Specialty Certification Program and creation
of the Nurse Specialty Certification Council

BON RESOLUTION 118 s. 2002 Guidelines for

implementation of BON 14

Proclamation # 539 Nurses Week Celebration

every last week of October
 Laws related to
Nursing
Letter of Instruction 1000 Members of accredited
professional organizations given preference in hiring
or attendance to seminars
ILO Convention # 149 Improvement of life and work
conditions of nursing personnel

RA 8344 Hospitals/doctors to treat emergency cases

referred for treatment

Presidential Decree 541 Allows Filipino

professionals to practice their profession during their
stay in the country
Laws on Children, Women &
Family
Executive Order 209 Family Code of the
Philippines
Presidential Decree 48 Four children with paid
maternity leave privilege
Presidential Decree 69 Four children for personal
tax exemption
Presidential Decree 491 Nutrition Program

Presidential Decree 603 Child and youth welfare

code
Laws on Children, Women &
Family
Presidential Decree 651 Birth registration within 30
days following delivery

Presidential Decree 965 Family Planning and

Responsible Parenthood instructions prior to
issuance of marriage license

Presidential Decree 996 Compulsory Immunization

for children below 8 years old against preventable
diseases
Laws on Children, Women &
Family
Presidential Decree 791 Revised Population Act as
implemented by POPCOM (commission on
Population)
Executive Order 51 Philippine Milk Code

Proclamation 6 United Nations Goal on Universal

Child Immunization by 1990

Republic Act 6725 Prohibition on discrimination

against women
Laws on Children, Women &
Family
Republic Act 7610 Special Protection of Children
against child abuse, exploitation, and discrimination

Republic Act 7432 Senior Citizens Act

Republic Act 9262 Act against violence to women

and children

Republic Act 7877 Anti-sexual Harassment Act of

1995
Laws affecting the Community

Republic Act 7160 Local Government Code

Republic Act 7305 Magna Carta for Public Health

Care Workers

Presidential Decree 825 Anti-improper Garbage

Disposal

Presidential Decree 856 Code of Sanitation

Laws affecting the Community

Letter of Instruction 949 Legal Basis for Primary

Health Care
Republic Act 1082 Creation of Rural Health Units
all over the Philippines

Republic Act 3573 Reporting of Communicable

Diseases
Republic Act 4073 Treatment of Leprosy at
government hospitals, clinics, rural health unit or by
a duly licensed physician
Laws affecting the Community

Republic Act 6972 Day Care Center in every

barangay

Republic Act 7883 Barangay Health Workers

Benefits and Incentives Act of 1992

Republic Act 8749 Clean Air Act

Laws on Employment

Presidential Decree 442 New Labor Code of the

Philippines
Presidential Decree 626 Employee Compensation
and State Insurance Fund

Presidential Decree 851 Thirteenth Month Pay for

all employees

Presidential Decree 1519 Medicare Benefits to all

Government Employees
Laws on Employment

Executive Order 180 Guidelines on the Right to

Organize of government employees

Republic Act 1080 Civil Service Eligibility

Republic Act 6713 Code of Conduct and Ethical

Standards for Public Officials and Employees

Republic Act 6727 Wage Rationalization

Laws on Employment

Republic Act 6758 Salary Standardization of

Government Employees

Republic Act 7641 New Retirement Law of

employees in the private sector

Republic Act 7875 National Health Insurance Act of

1995
Laws on Employment

Republic Act 8282 Social Security Law of 1997

Republic Act 8291 Government Service Insurance

Act of 1997
Others
Republic Act 2382 Philippine Medical Act

Republic Act 2644 Midwifery Law

Republic Act 6425 Dangerous Drugs Act

Republic Act 6675 Generics Act of 1988

Republic Act 1054 Free emergency, medical and

dental attendance to his employees and laborers to
be provided by employers
 NURSING EDUCATION
Qualifications of the Faculty:
A member of the faculty in a college of nursing
teaching professional courses must:
1. Be a registered nurse in the Philippines
2. Have at least one (1) year of clinical practice in a field
of specialization
3. Be a member of good standing in the accredited
professional organization of nurses
4. Be a holder of a masters degree in nursing ,
education, or other allied medical and health sciences
conferred by a college or university duly recognized by
the Government of the Republic of the Philippines
 NURSING EDUCATION

A Dean should possess:

Masters Degree in Nursing

Must have at least five (5) years of
experience in teaching and supervision
 NURSING SERVICE
Qualifications of Nursing Service
Administrators
Section 29 of RA 9173 specifies that a person
occupying supervisory or managerial positions
requiring knowledge of nursing must:
1. Be registered nurse in the Philippines
2. Have at least two (2) years of experience in general
nursing service administration
3. Possess a degree of Bachelor of Science in Nursing ,
with at least nine (9) units in management and
administration courses at the graduate level
4. Be a member of good standing of the accredited
professional organization of nurses
If a person occupying position of Chief
Nurse or Director of Nursing service shall , in
addition of foregoing qualifications possess:

1. At least five (5) years of experience in a

supervisory or managerial position in nursing

2. A master degree major in Nursing

 Nursing Jurisprudence
Department of law which comprises all the legal
rules and principles affecting the practice of
nursing the study and interpretation of rules and
principles and their application in the regulation on
the practice of nursing
 RESPONSIBILITY AND
ACCOUNTABILITY FOR THE
PRACTICE OF PROFESSIONAL
NURSING
When nurses undertake to practice their
profession, they are held responsible and
accountable for the quality of performance
of their duties. Nurses employed in an
agency, institution or hospital directly
responsible to their immediate supervisors.
 Accountability
Being answerable to someone for
something one has done

Related to both RESPONSIBILITY and

ANSWERABILITY

An implicit contract between the patient and

the nurse
Mechanisms of Accountability
Ways to define relationships between the
nurse and the society or the client thereby
acknowledging both the professional and
public responsibility

Includes code of ethics, standards of

nursing practice, nursing practice acts,
nursing theory and research
Legal Liabilities of Nursing
Law
are rules and regulations established by a
governing authority (sovereign power) to
institute and maintain orderly coexistence
by commanding what is right and
prohibiting what is wrong.
Functions of Law in the Society

define relationships among members of a

society and state; which activities are
permissible or not

describe what forces maybe applied to maintain

rules and by when is to be applied.

provide solutions to problems

refine relationship between person and group

when conditions of life change.
Basic Principles of Law

Based on concern for justice and fairness

Characterized by change

Actions are judged on basis of universal

standards of what is similarly trained, reasonable
and prudent person would do in similar
circumstances

Each individual has right and responsibilities

The Controlling Authority
Government: embodiment of such control
is the Constitution
Constitution is the fundamental law of the
land
Constitution contains principles on which
the government is founded; regulates the
sovereign powers; directs to which the
powers are entrusted; specifies manner by
which the powers are exercised
Pronouncement of the Law
Declared in writing: to enforce control

Sources of Pronouncements:
1. Constitution
2. Statutes or Legislations
3. Regulations
4. Judicial Decisions
5. Presidential Decrees
6. LOI
Rules of Conduct
Provided by the law making body
Issued in writing
Provisions on consequences for violations
Types of Law

Laws govern the relationship of private individuals with

government.

Public Law

Refers to the body of law that deals with relationship

between individual and the government and the
governmental agencies.

An important segment of public law is criminal law

which deals with actions against the safety and
welfare of the public. Examples are homicide,
manslaughter and theft.
Public Law

Criminal Law branch of jurisprudence that

teaches the nature, extent and degrees of every
crime, and adjusts to its adequate and necessary
penalty.

International Law or the law of nations, is the law

which regulates the intercourse of nations

Political law that branch of jurisprudence which

treats of the science of politics or the organization
of government
Private Law or Civil Law

is the body of law that deals with

relationship among private individuals.
It can be categorized into a variety of
legal specialties such as contract law
and tort law
Contract law involves the
enforcement of agreements among
private individuals

Torts laws define and enforce duties

and rights among private individuals
that are not based on contractual
agreement.
Private Law or Civil Law
Civil law branch of law which has the double
purpose of organizing the family and regulating
property

Commercial Law branch of the law which

related to the rights of property and the relations
of persons engaged in commerce.

Remedial Law branch of law which prescribes

method of enforcing rights or of obtaining redress
for their invasion
Sources of Law

Constitution

The constitution of the Philippines is the

supreme law of the country. It established the
general organization of the government, grants
certain powers to the government, and places
limits on what government may do. The
constitution created legal rights and
responsibilities and the foundation for a
systems of justice.
Legislation (Statutory law)
Laws enacted by any legislative body are
called statutory laws.

Administrative Law

When a state legislature passes a structure,

an administrative agency is given the
authority to crate rules and regulation to
enforce the statutory laws.
Functions of law in the profession

Provides a framework for establishing what nursing

actions in the care of patients are legal.

Delineates the nurses responsibilities from those of

other professionals.

Helps to establish the boundaries of independent

nursing actions.

Assists in maintaining a standard of nursing practice

by making nurses accountable to the law.
Legal Offenses
Other Definitions

Murder killing of another person other than

relative with proven malice or
premeditation

Parricide killing of father, mother or child, whether

legitimate or illegitimate, or any of his ascendants or
descendants including the spouse.

Homicide killing of any human creature. It is not

necessarily a crime, committed without criminal
intent and without criminal consequence.
Infanticide killing a child less than 3 days of age

Abortion expulsion of fetus so early that it has not

yet acquired the power of sustaining independent
life

Simulation of Birth substituting one child to

another, falsification of birth favoring adoption

Rape Forcible penetration of organ of copulation

or any inanimate object to any body orifice of the
offended party

Child molestation engaging in any sexual act

with a person under age 18
 Negligence- the commission or
omission of an act, pursuant to a duty, that
a reasonably prudent person in the same or
similar circumstance would not do, and
acting or the non-acting of which is the
proximate cause of injury to another person
or his property.

If a person charged with negligence

shows that she meets or even surpasses
this standard then there is no negligence or
carelessness. But if the defendants actions
fail to meet the standard, then there has
been negligence.
The elements of professional negligence:

Existence of a duty on the part of the person

charged to use due care under
circumstances

Failure to meet the standard of due care

The foreseeability of harm resulting from

failure to meet the standard, and

The fact that the breach of this standard

resulted in an injury to the plaintiff.
Common acts of negligence:

Burns resulting from hot water bags, heat

lamps, vaporizers, sitz bath
Objects left inside the patients body such as
sponges, suction tips, loose dentures lodged
in the patients trachea
Falls of the elderly, confused, unconscious,
sedated patients, or those who are not fully
recovered from anesthesia
Falls of children whose side rails of beds
were not pulled up and locked
Failure to observe and take appropriate
action as needed.
 Other examples:
Failure to report observations to attending
physicians.

Example: A nurse failed to report to the doctor

that the toes of a patient with leg cast were
cyanotic and cold to touch. The leg became
gangrenous and had to be amputated below the
knee.

Failure to exercise the degree of diligence which

the circumstances of the particular case demands.

Example: A community health nurse who attended

the delivery of a patient who had no prenatal care.
The baby was born spontaneously but the placenta
was not expelled after 30 minutes. She advised that
the mother be brought to the hospital. The patient
 Mistaken identity

Example: Drugs given to the wrong

person especially if the latter is confused
or unconscious and could not respond to
the nurses verification of identity.

Wrong medicine, wrong concentration,

wrong route, wrong dosage
 Defects in the equipment such as
stretchers and wheelchairs may lead to
falls thus inquiring the patient.

Errors due to family assistance.

Example: A nurse asked a relative to

apply HWB to the body of a chilling child
and the latter suffered burns. The nurse
would be held liable for failure to test the
temperature of the water and / or for
failure to check whether the mother knew
what was expected of her during such
assistance.
 Administration of medicine without a
doctors prescription.

Example: Injecting Penstrep to a boy

who had a swollen foot. The nurse
informed the parents that she was not a
doctor. Upon insistence of the parents to
have their child treated, she informed
them that the doctor usually gave
Penstrep injections in such cases. She
injected the medicine without a doctors
prescription. The boy died of cardio-
respiratory failure secondary to
anaphylactic shock due to the injection of
the drug. The nurse was found guilty as
 Examples:

A patient came in walking to the Out-

Patient Clinic for injection. Upon
administering the injection to his buttocks,
the patient experienced extreme pain. His
leg felt weak and he was subsequently
paralyzed.

The presence of sponges in the patients

abdomen after an operation.

Fracture of a newly-delivered baby born by

breech presentation.
Malpractice

Professional negligence
Failure to meet the standards of
acceptable care which results to harm to
other person
Negligence that occurred while the
person was performing as a professional
Malpractice

-improper or unskillful care of a patient

by a nurse.

-stepping beyond ones authority with

serious consequences.

-negligence or carelessness of
professional personnel.

Standard of care decides what a

prudent person would do under similar
circumstances.
Elements of Negligence and
Malpractice

1. Duty
2. Breach of Duty
3. Foreseeability & Causation
4. Harm or injury
5. Damages
Doctrines Applicable To
Negligence Suits
1.Doctrine of Respondeat Superior

- let the master answer for the acts

of the subordinate. The liability is
expanded to include the master as well
as the employee. Therefore, when a
person, through his negligence, injures
another, he remains fully responsible.
This doctrine applies only to those
actions performed by the employee
within the scope of his employment.
Three conditions required to establish a
defendants negligence without proving
specific conduct:

That the injury was of such nature that it

would not normally occur unless there was a
negligent act on the part of someone
That the injury was caused by an agency
within control of the defendant
That the plaintiff himself did not engage in
any manner which would tend to bring about
the injury.
Examples:
The hospital will be held liable, if, in an effort
to cut down on expenses it decides to hire
underboard nurses or midwives in place of
professional nurses, and these persons prove
to be incompetent.

The surgeon will be held responsible in case

a laparotomy pack is left in a patients
abdomen.

Private duty nurses are considered

independent contractors. They are liable for
their own negligent actions.
 2. Res Ipsa Loquitur

the thing speaks for itself

when a thing which has caused an injury is shown

to be under the management of the party charge with
negligence, the accident is as such as in the ordinary
course of thing will not happen if those who have such
management used proper care, the accident itself
affords reasonable evidence in the absences of an
explanation by the parties charge that is those from
the want of proper care.
 Three elements

(1) the event would have not occurred if

the nurse exercised prudent care,

(2) the accident occurred within exclusive

control of the nurse

(3) no voluntary action was done by the

injured party.
Doctrine of Force Majeure

-an irresistible force or superior force; one

that is unforeseen or inevitable. Under the Civil
Code of the Philippines, no person shall be
responsible for those events which cannot be
foreseen, or which, though foreseen, are
inevitable, except in case expressly specified
by law.

-floods, fire, earthquake, and accidents -

nurses who fail to render service during these
circumstances are not held negligent

Habitual tardiness due to heavy traffic

is not considered an excuse for Force
Majeure.
Incompetence

Incompetence is the lack of ability, legal

qualifications or fitness to discharge the
required duty. Although a nurse is
registered, if in the performance of her
duty she manifests incompetency, there is
ground for revocation or suspension of her
certificate of registration.
Definition
Laws: sum total of rules and
regulations by which society is
governed; rules of conduct
pronounced by controlling authority
and which maybe enforced
System of binding rules of action or
conduct that governs the behavior of
people in respect to relationships
with others and with the government
(Guido, 1997)
 Nurses and legal offenses

Crimes

Actions/behaviors which violate law and is

punishable by fine, imprisonment or
death

Criminal offenses are composed of two

elements:
Criminal act
Evil / Criminal intent
 Criminal Intent

Is the state of mind of a person at the

time the criminal act is committed, that is,
he / she knows that an act is not lawful
and still decided to do it anyway.
Deliberate intent includes two other
elements without which there can be no
crime:
freedom
Intelligence
- When a person accused of the crime
offers evidence showing insanity,
necessity, compulsion, accident, or infancy
the court will decide if he did not commit a
criminal offense and will declare the
 Classifications of Criminal
Negligence:

1. Reckless imprudence when a person

does an act or fails to do it voluntarily
but without malice, from which material
damage results immediately.

2. Simple Imprudence means that the

person or nurse did not use precaution
and the damage was not immediate or
the impending danger was not evident
or manifest.
 Criminal liabilities can be classified
according to:

a. Manner of commission

Dolo deceit; deliberate intent

Culpa - fault; product of imprudence,

negligence, lack of foresight or skills
 b. Degree of Participation

1.Principals - those who take a direct

part in the execution of the act; who directly
force or induced others to commit it; or who
cooperate in the commission of the offense
by another act without which it would not
have been accomplished.

2. Accomplices - those persons who

cooperate in the execution of the offense. To
hold the person liable as an accomplice, it
must be shown that he had knowledge of the
criminal intention of the principal.
3. Accessories- those who, having knowledge of the
commission of the crime, either as principals or
accomplices, take part subsequent to its commission
by profiting themselves or assisting the offender to
profit from the effects of the crime by concealing or
destroying the body of the crime, or the effects or
instruments thereof, in order to prevent its discovery
or by harboring, concealing, or assisting in the
escape of the principal of the crime, provided the
accessories act with abuse of their public functions or
are known to be habitually guilty of some other
crimes.
 Stage of Execution

Consummated when all elements are

necessary for its execution and
accomplishment are present.
Frustrated when the offender performs all
the acts or execution which will produce it.
Attempted there is an attempt to commit a
felony when the offender commences the
commission of the same directly by overt (open
or manifest) acts, and does not perform all the
acts or execution which shall produce the
felony, by reason of some cause or accident
other than his own spontaneous desistance.
 Types of Crimes according to
Severity

a. Felony: committed with deceit and

fault. A deceit exists when the act is
performed with deliberate intent and there
is fault when the wrongful acts result from
imprudence, negligence, or lack of skill or
foresight.
a serious crime that carry significant fines
and jail sentences. E.g. murder, arson,
burglary, rape, extortion, kidnapping
Example of Felonies Committed
by Nurses

Unauthorized removal of life support

from a terminally ill patient (First
degree murder)
Unintentional death brought by
administration of a medication to
which the patient is allergic (Second
degree murder)
 Types of Crimes according to
Severity

b. Misdemeanor: a criminal offense which

does not in law amount to felony.
Punishment is usually a fine or
imprisonment for a term of less than one
year
Example:
Assault and Battery like giving injection

without consent
 Circumstances Affecting Criminal Liability

1. Justifying Circumstances A person may not

incur criminal liability under the following
circumstances:
a. When he /she acts in defense of his / her person
or rights provided that:
There is an unlawful aggression on the part of
the offended or injured party.
There is reasonable necessity for the means
employed by the person defending himself /
herself to prevent such aggression; and
There is lack of sufficient provocation on the
part of the person defending himself.
b. When he / she acts in defense of the person
or the rights of his / her spouse, ascendants, or
legitimate or natural or adopted brothers and
sisters, or relative by affinity in the same
degree.
c. When he / she acts in defense of the person
or right of a stranger.
d. When any person who, in order to avoid
an evil or injury, does an act which causes
damage to another provided that the evil
sought to be avoided actually exists, the
injury feared is greater than that done to
avoid it and there is no other practical and
less harmful means to prevent it.
e. When he / she acts in the fulfillment of a
duty or in lawful exercise of a right or
office.
2. Exempting Circumstances The
following persons are expressly exempted by
law from criminal liability for the crime they
may have committed:
An Imbecile or an insane person, unless
the latter has acted during a lucid
(mentally sound) interval;
A person under nine (9) years of age;
A person over nine (9) years of age and
under fifteen (15) unless he / she acted
with discernment;
 Any person who, while performing a lawful
act with due care, causes an injury which is
merely an accident without fault or
intention of causing it;
Any person who acts under the compulsion
of an irresistible force;
Any person who acts under the impulse of
an uncontrollable fear of an equal or
greater injury
Any person who fails to perform an act
required by law, when prevented by some
lawful or insuperable cause.
3. Mitigating Circumstances are those
which do not constitute justification or
excuse of the offense in question, but which,
in fairness and mercy, may be considered as
extenuating or reducing the degree of moral
culpability.
Circumstances which are otherwise
justifying or exempting were it not for the
fact that all requisites necessary to justify
the act or to exempt the offender from
criminal liability in the respective cases are
not attendant.
 When the offender has no intention to
commit so grave a wrong as the one
committed.
When the offender is under eighteen years of
age or over seventy years old.
When sufficient provocation or threat on the
other part of the offended party immediately
precedes the act.
When the act is committed in the immediate
vindication of a grave offense to the one
committing the felony, his / her spouse,
ascendants, descendants, natural or adopted
brothers or sisters, or relative by
 When the person acts upon an impulse so powerful as
naturally to have produced an obfuscation (confusion).
When the offender voluntarily surrenders himself to a
person in authority or his agents, or that he / she
voluntarily confesses his / her guilt before the court prior
to the presentation of the evidence for the prosecution.
When the defender is deaf and dumb, blind or otherwise
suffering from some physical defect which thus restricts
his / her means of action, defense or communication
with his / her fellow beings.
When the offender is suffering from such illness as
would diminish the exercise of his / her willpower
without, however, depriving him / her of consciousness
of his / her acts.
4. Aggravating Circumstances are those
attending the commission of a crime and
which increase the criminal liability of the
offender or make his guilt more severe.
When the offender takes advantage of his
public position;
When the crime is committed in contempt of
or with insult to public authorities
 When the act is committed with insult or in
disregard of the respect of the offended party on
account of his / her rank, age , or sex or that it is
committed in the dwelling of the offended party, if
the latter has not given provocation
When the act is committed with abuse or
confidence or obvious ungratefulness
When the crime is committed in a place of worship
When the crime is committed on the occasion of a
conflagration (large disastrous fire), shipwreck,
earthquake, epidemic or other calamity or
misfortune
 When the crime is committed in consideration of a
price, reward, or promise;
When the crime is committed by means of inundation
( to cover with of something), fire , explosion,
standings of a vessel or intentional damage thereto,
derailment of a locomotive, or the use of any other
artifice involving great waste and ruin;
When the act is committed with evident
premeditation or after an unlawful entry;
When craft, fraud, or disguise is employed; and
When the wrong done in the commission of the crime
is deliberately augmented by causing other wrongs
not necessary for its commission.
 5. Alternative Circumstances are
those which must be taken into consideration
as aggravating or mitigating according to the
nature and effects of the crime and other
conditions attending its commission. The
alternative circumstance of relationship shall
be taken into consideration when the
offended party is the spouse, ascendant or
descendant, legitimate, natural or adopted
brother or sister, or relative by affinity in the
same degree of the offender.
 LACK OF EDUCATION IS NOT
MITIGATING IN:

Rape
Forcible abduction
Arson
Treason
In crimes against chastity like seduction and
acts of lasciviousness;
Those acts committed in a merciless or
heinous manner
 Points to Observe in Order to Avoid
Criminal Liability

1.Be very familiar with the Philippine Nursing

Law.
2.Be aware of laws that affect nursing
practice. Ignorance of the law excuses no
one.
3.At the start of employment, get a copy of
your job description, the agencys rules,
regulations and policies.
4.Upgrade your skills and competence.
5. Accept only such responsibility that is
within the scope of your employment and
your job description.
6. Do not delegate your responsibility to
others.
7. Determine whether your subordinates are
competent in the work you are assigning
them.
8. Develop good interpersonal relationships
with your co-workers, whether they can be
your supervisors, peers, or subordinates.
9. Consult your superiors for problems that
may be too big for you to handle.
10. Verify orders that are not clear to you or
those that seems to be erroneous.
11.The doctors should be informed about
the patients conditions.
12. Keep in mind the value and necessity of
keeping accurate and adequate records.
13. Patients are entitled to an informed
consent.
 Examples of Torts :
1. Assault and Battery.
Assault is the imminent threat of harmful or
offensive bodily contact. It is unjustifiable to touch
another person, or to threaten to do so in such
circumstances as to cause the other to reasonably
believe that it will be carried out.
Battery is an intentional, non-consented touching of
another person. It is therefore, important that before a
patient can be touched, examined, treated or subjected
to medical / surgical procedures, he must have given a
consent to this effect. If consent has not been secured,
the person performing the procedure may be liable for
battery.
Example Battery

When a person comes to the hospital, it is

implied that he consents to be treated.
However, he may refuse certain contacts. If
he refuses an injection and the nurse gives
it anyway, the latter can be charged for
battery.
The patient who gets injured while being
restrained may cause the attendant or the
nurse to be liable for assault and battery.
 2. False Imprisonment or Illegal detention.
False imprisonment means the unjustifiable
detention of a person without a legal warrant within
boundaries fixed by the defendant by an act or violation of
duty intended to result in such confinement.
If the patient has communicable disease, however,
the hospital cannot be charged for false imprisonment if
it compels the patient to stay in the hospital. Mentally-ill
patients may also be kept in the hospital if there is
danger that they may take their own lives or jeopardize
the lives and property of others.
 Patient insisting on leaving the hospital
cannot be detained, instead, the probable
consequences of their actions must be
explained by a competent doctor or medical
staff. Notation in their chart should be
made and a release form should be signed
by the patient and / or his guardian.
 3. Invasion Of Right to Privacy and
Breech of Confidentiality

The right to privacy is the right to be left

alone, the right to be free from unwarranted
publicity and exposure to public view as well
as the right to live ones life without having
anyones name, picture or private affairs
made public against ones will.
Nurses may become liable for invasion of
right to privacy if they divulge information
from a patients chart to improper sources or
unauthorized persons.
 Publication of any picture of a patient or a
malformed baby without the consent of the
parents or revelation of the contents of the
records of the patient without his consent
constitute tort.
When a nurse permits a non-professional
person (usually a male helper) to view a
woman in labor inside the delivery room.
 4. Defamation
In general, character assassination, be it
written or spoken, constitutes defamation.

Slander is oral defamation of a person

by speaking unprivileged or false words by
which his reputation is damaged.

Libel is defamation by written words,

cartoons or such representations that cause a
person to be avoided, ridiculed or held in
contempt or tend to injure him in his work.
 Liability for the Work of Nursing
Students

Nursing Act of 2002 R.A 9173

nursing students do not perform professional
nursing duties
Measures to avoid/ minimize errors :

should always be under the supervision of their

clinical instructors.
should be given assignments that are at their level
of training, experience, and competency.
 should be advised to seek guidance especially if
they are performing a procedure for the first time.
should be oriented to the policies of the nursing
unit where they are assigned.
should be assessed frequently to determine their
strength and weaknesses.
Frequent conferences with the student will reveal
their problems which they may want to bring to
the attention of their instructors or vice-versa.
Legal Safeguards
Self-Protection of the Nurse

familiarity with the laws, code of ethics,

rules and regulation, and standards of
practice
clinical competence
cultural sensitivity and respect
self-awareness
sound management
concept of personal liability
documentation/recording
Incidents Reports
Purpose of incident reports:

to memorize in writing any unusual event at time of its

occurrence by a person who was a direct personal
witness. It is generally used for management and
documentation purposes only.

The whole purpose of incident reporting is to LEARN

from the mistakes and how to eliminate, reduce and
manage the risks we have to deal with on a daily basis.
It cannot be used as evidence in lawsuits.
What an incident report should contain

The date
The place
The position of the individual reporting
(not necessarily the name)
A description of the incident or issue
Whom it is reported to
What should be done to correct it

A space for follow up reporting

The signature of the individual reporting

The date and time the reporting is

received by the Risk Manager

> Action of the Risk Manager

 Common situations that require
Incident report

Break in aseptic technique

Incorrect sponge count in surgery
Medical legal incident
Client or family refuses treatment as
ordered and refuses to sign consent
 Client or family voices dissatisfaction with
care and situation, cannot be or has not
been resolved

Complication from diagnostic or treatment

procedures ( e.g. blood sample stick,
biopsy, x-ray, invasive procedure.
Bronchoscopy)
Failure to report change in patients
condition
Falls
Patient is burned
 TELEPHONE ORDERS

Legal risk: The signature of the ordering

physician is not present and this order may later
be denied in case errors happen or court
litigations arise.
 Doctors should limit telephone orders to
extreme emergency situations
Only in an extreme emergency should a
nurse receive telephone orders.
The nurse should read back such order
to the physician to make certain the
order has been correctly written.
Such order should be signed by the
physician on his / her next visit within
24 hours.
The nurse should sign the name of
physician per her own and note the
time the order was received.
 It is safer that when a telephone order is
given, another resident physician or intern
in the same service receive it.

There should be a clear hospital policy that

is within the bounds of the medical and the
nursing laws regarding telephone orders to
avoid misunderstanding not only for the
individuals concerned but also for the
hospital as well.
Consent
 Consent- a free and rational act that
presupposes knowledge of the thing to which
consent is being given by a person who is
legally capable to give consent. The
physician should give as much information
about a contemplated procedure and the
patient should receive enough information to
allow him to give an informed consent for
such procedure or treatment.
 It is the nurse who actually secures the
consent of the patient upon admission.
Consent must be obtained from the patient
or his authorized representative who may be
his parent or guardian. It is only in case of
emergency where the consent requirement
does not apply.
for diagnostic procedures and initial
treatment
before any medical or surgical procedure
can be performed
 Essential elements of informed
consent:

The diagnosis and explanation of the

condition
A fair explanation of the procedures to be
done and used and the consequences
A description of alternative treatments or
procedures
A description of the benefit to be expected
The prognosis, if the recommended care,
procedure, is refused.
 Proof of Consent.
A written consent should be signed to show
the procedure is the one consented to and
that the person understands the nature of
the procedure, the risks involved and the
possible consequences.

A signed special consent is necessary

before any medical or surgical treatment is
done such as x-rays, special laboratory
tests, blood transfusions, operations, cobalt
therapy or chemotherapy, and the line.
 Who Must Consent:
The patient gives his consent. If he is
incompetent (minors or the mentally ill) or
physically unable and is not an emergency
case, consent must be taken from another
who is authorized to give it in his behalf.

Consent of Minors:
Parents or someone standing in their
behalf, gives the consent to medical or
surgical treatment of a minor. Parental
consent is not needed however, if the minor is
married or otherwise emancipated.
Consent of Mentally Ill:
The consent must be taken from the
parents or legal guardian.

Emergency Situation:
No consent is necessary because inactions
at such time may cause greater injury.
Ex. A mother, who is on the advanced stage of
labor, or a patient, who goes to the
emergency room, gives an implied consent to
an immediate treatment or attendance.
If time is available and an informed consent
is possible, it is best that this be taken for
the protection of all the parties concerned.
 Refusal to Consent:

A patient who is mentally and legally

competent has the right to refuse the touching of
his body or to submit to a medical or surgical
procedure no matter how it necessary, nor how
imminent the danger to his life or health if he fails
to submit to treatment. Ex. patients who may
refuse blood transfusion because of their
religious beliefs (Jehovahs witnesses)
 If a patient still refuses to sign the consent form
after a thorough explanation, he should be made
to fill out the release form to protect the hospital
and its personnel from any liability. If he refuses
to sign the release form, this should be noted in
his chart. The competent person has a legal and
ethical right to refuse treatment, and this right is
formally established.
 Consent for Sterilization:

Sterilization is the termination of the

ability to produce off-springs.
The husband and the wife must consent
to the procedure if the operation is
primarily to accomplish sterilization.
When the sterilization is medically
necessary and the sterilization is an
incidental result such as in cases of
Abruptio Placentae, ectopic pregnancies or
ruptured uterus, the patients consent
alone is sufficient.
Incident Reports
Purpose of incident reports:

to memorize in writing any unusual event at time of its

occurrence by a person who was a direct personal
witness. It is generally used for management and
documentation purposes only.

The whole purpose of incident reporting is to LEARN

from the mistakes and how to eliminate, reduce and
manage the risks we have to deal with on a daily basis.
It cannot be used as evidence in lawsuits.
What an incident report should contain

> The date

> The place
> The position of the individual reporting
(not necessarily the name)
> A description of the incident or issue
> Whom it is reported to
What should be done to correct it

What has been done to correct it

A space for follow up reporting

The signature of the individual reporting

The date and time the reporting is received

by the Risk Manager

> Action of the Risk Manager

Common situations that require
Incident report

Break in aseptic technique

Incorrect sponge count in surgery
Medical legal incident
Client or family refuses treatment as
ordered and refuses to sign consent
 Client or family voices dissatisfaction with care
and situation, cannot be or has not been resolved

Complication from diagnostic or treatment

procedures ( e.g. blood sample stick, biopsy, x-
ray, invasive procedure. Bronchoscopy)

Failure to report change in patients condition

Falls

Patient is burned
Liability of Nurses for the Work of
Nursing Aides
Nursing aides perform selected nursing activities
under the direct supervision of nurses. They are
usually given on-the-job training by the Training
Staff.

Their responsibilities usually pertain to the routine

care of chronically ill patients.
Liability of Nurses for the Work of
Nursing Aides

Nurses should not delegate their functions to

nursing aides since the Philippine Nursing Act
specifies the scope of nursing practice of
professional nurses. If a nurse delegates her
functions to a nursing aide and the latter
commits a mistake then the person
responsible is the nurse.
 Liability of Nurses for the Work of
Nursing Aides

Nurses are enjoined to supervise their

subordinates and see to it that they perform
only those which they gave been taught to
do and those which they are capable of
doing.
Liability for the Work of Nursing
Students
Under the Philippine Nursing Act of 2002 R.A. 9173,
nursing students do not perform professional nursing
duties. They are to be supervised by their Clinical
Instructors. In order that the errors committed by
nursing students will be avoided and/or minimized, the
following measures should be taken:

1) Nursing students should always be under the

supervision of their Clinical Instructors.

2) They should be given assignments that are at their level

of training, experience, and competency.
3) They should be advised to seek guidance
especially if they are performing procedure for the
first time.

4) They should be oriented to the policies of the

nursing unit where they are assigned.

5) Their performance should be assessed frequently

to determine their strengths and weaknesses.

6) Frequent conferences with the students will reveal

their problems which they may want to bring to the
attention of their instructors or vice-versa.
Discussions of these problems will iron out doubts
and possible solutions may be provided.
 However, it must be emphasized that although
nursing students are not employees of the
hospital they are entrusted with the
responsibility of providing supervised nursing
care to the patients.

The patients can expect that the care given by

the students will be a manner consistent with
that which a reasonably prudent person will
give.
 Both the clinical instructor and the
staff nurse in the clinical area where
nursing students are assigned should
coordinate in assessing the competence
of nursing students before they are
allowed to give care to patients so that
the risks of injury to the same will be
avoided.
MEDICAL ORDERS, DRUGS, AND
MEDICATIONS

The dependent and coordinated

function of the nurse pertains to the
application and execution of written legal
orders of physicians concerning
treatment and medications.
Only when these orders are legal in
writing and bear the doctors signature
does the nurse have the legal right to
follow them.
MEDICAL ORDERS, DRUGS, AND
MEDICATIONS

Written orders are better understood

and chances of error are minimized if
they are clear, specific, complete and
legible.
 Verbal orders can be minimized if the
nurse seeks a clear understanding from the
physicians in establishing a policy concerning
the importance of
written orders.
 The general rule requiring a nurse to
execute all lawful orders of a physician is
tempered by common sense.

The nurse must not execute an order if

she is reasonably certain it will result in
harm to the patient. In such case she must
speak out and risk incurring the
physicians resentment or ire rather than a
lawsuit.
 POINTS TO OBSERVE IN ORDER TO
AVOID CRIMINAL LIABILITY
Be very familiar with the Philippine Nursing law
Beware of laws that affect nursing practice
At the start of employment, get a copy of your job
description, the agencys rules, regulations and
policies
Upgrade your skills and competence
Accept only such responsibility that is within the
scope of your employment and your job description
Do not delegate your responsibility to others
 Determine whether your subordinates are
competent in the work you are assigning them

Develop good interpersonal relationships with

your coworkers, whether they be your
supervisors, peers or subordinates

Consult your superiors for problem that may

be too big for you to handle
 Verify orders that are not clear to you or those
that seem to be erroneous

The doctors should be informed about the

patients conditions

Keep in mind that value and necessity of keeping

accurate and adequate records

Patients are entitled to an informed consent

Wills
 Will- legal declaration of a persons intentions
upon death. It is called a Testamentary
Document because it takes effect after the death
of its maker. It is an act whereby a person is
permitted with the formalities prescribed by law,
to control to a certain degree the deposition of his
estate, to take effect after his death.

Decedent- a person whose property is

transmitted through succession whether or not
he left a will. If he left a will, he is also called a
Testator. If the person making a will is a
woman she is called a Testatrix.

Heir- a person called to succession either by

the provision of a will or by operation of law.
 Testate- a person who dies leaving a will

Intestate- one who dies without a will

Probate- Validation of a will in court

Administrator- one who administers the

provision of the will

Holographic Will- a will which is written,

dated and signed by the testator
Nuncupative Will or Nuncupation- an oral
will

Restrictions:
such will be made during the persons last
illness
that it be done in place in which he died
that he asked one or more witnesses to the
will
that the will be put in writing within a given
number of days, and
that it be offered for probate within a
specified time.
 Essentials of Will :

1.The testator must have the expressed

intention of making a will.
. 18 years of age & above
. sound mind and clear thinking ability
. free from undue influence.
2. The testator shall name the person who
will be in-charge of carrying out the
provisions of the will.

3. Properties must be disposed in accordance

with legal requirements.

4. The will must be signed by the testator,

attested and signed by at least three (3)
witnesses in his presence and of one another.
It must be in a language or dialect known to
the testator.
5. Every will must be acknowledged before
a notary public by the testator and
witnesses.

6. Not blind, deaf or dumb, and able to read

and write.

7. A married woman may make a will

without the consent of her husband and
without the authority of the court. She may
dispose by will all of her separate property
as well as her share of the conjugal
partnership or absolute community
property.
The Nurses Obligation in the Execution of a
Will

1.Note the soundness of the patients

mind, that there was freedom from fraud or
undue influence and that the patient was
above 18 years of age.
2.Note that the will was signed by the
testator, that the witnesses were all present
at the same time and signed the will in the
presence of the testator.
3. Make a notation on the patients chart
of the apparent mental and physical condition
of the patient at the time of making a will and
also the fact of his making the will.
Kinds of Contracts
1. Formal- agreement among parties
involved; required to be in writing Ex.
Marriage contract
2. Informal- result of oral or spoken
discussion between parties
3. Expressed- conditions & terms of the
contract are given orally or in writing by
the parties concerned Ex. Salary & fringe
benefits
4. Implied- concluded as a result of acts of
conduct of the parties to which the law ascribes
an objective intention to enter into a contract;
one in which there has been no discussions
between parties, but the law considers that a
contract exists.

5. Void- nonexistent from the very beginning &

therefore may not be enforced
ADVANTAGES OF WRITTEN
CONTRACTS
A written contract is certain. It avoids the
uncertainty of human memory.

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 rediscussion.

It sets a standard and relieves an individual

professional person from haggling over
compensation.
 It is more likely to be open 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.

It is definite and can be definite on many details

which may otherwise stimulate favouritism or
caprice even among professionals, such as
hours of work, vacation allowances, holiday
privileges, health and insurance provisions.
 It can provide a definite procedure in case
of complaints about substandard work, so
that the employer has a clear course and
the professional nurse has protection
against arbitrary action.
 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 contract has settled.

Definite commitments stipulated in a

contract are hours of work and salary,
length of time of contract, days of off duty,
details of duties and responsibilities
including the course to be taken in case of
non-fulfilment of the terms of contract.
VOIDABLE CONTRACTS

Those contracts wherein one of the

parties is incapable of giving consent to
a contract.

Those whose consent is vitiated by

mistake, violence, intimidation, undue
influence or fraud.
ILLEGAL CONTRACTS
Those that are made in protection of the
law.
Consent obtained by fraud.
Those obtained under duress. Duress
means actual or threat of violence or
imprisonment in order to obtain consent.
Those obtained under undue influence.
Those obtained through material
misrepresentation.
Prerequisites in entering a contract

Be of legal age

Be sound of mind

Not under the influence of intoxicating

substances or fear of bodily harm

Mentally competent
 Elements of a valid contract

1. Agreement/ Mutual consent contracts must

be binding for both parties

2. Legal Subject matter nothing in the contacts

is contrary to law or public order

3. Cause of the obligation which is established

4. Contractual capacity parties are eligible to

enter a contract
Inexistent Contracts
Those whose cause, object or purpose
are contrary to law, morals, good customs,
public order or public policy
Those whose cause or object did not exist
from the time of transaction
Those whose object is outside the
commerce of man
Those which contemplate an impossible
service
Inexistent Contracts
Those where the intention of the parties
relative to the principal object cannot be
ascertained
Those expressly prohibited or declared
void by law
Those which are absolutely simulated or
fictitious
BREACH OF CONTRACT
Failure to perform an agreement, whether expressed or
implied, without cause.

The following constitute breach of contract for nursing

services:
prevention of performance;
failure to perform because of inconvenience or
difficulty;
failure of cooperation in performance;
abandonment of duty;
substitution of performance; and
failure to use due care.
LEGAL EXCUSES IN REFUSING, NEGLECTING
OR FAILURE TO PERFORM A CONTRACT

Discovery of material misrepresentation made

and relied upon
Where performance will be illegal
Where performance is made impossible by
reason of illness
Where performance is made impossible by
death of patient or nurse
Where performance is made for other reasons
Where contract is insufficient
Legal excuses in refusing/
neglecting a contract
Discovery of material misrepresentation made
and relied upon
Where performance will be illegal
Where performance is made impossible by
reason of illness
Where performance is made impossible by
death of patient or nurse
Where performance is made for other reasons
Where contract is insufficient
Termination of Contract

Most nurse patient contracts end when

Treatment is complete
Bills has been paid
Waiver to discharge against medical
advise has been signed
Other Laws
Clean Air Act
Waste management
Family Code
Local Government Code
Dangerous Drugs Act
Generics Act
Health Insurance
Breastfeeding