NCM 119-A: Nursing Leadership, Management, and Professional Adjustment
Lecture / Week 1-2
Leadership
• Leadership is a mode of social influence
which make the most of the efforts of
others toward the achievement of a
greater good.
Management
• The practice of leadership roles in
governance and decision-making within
the field of nursing that employ nurses is
referred to as nursing management.
• It comprises management-wide
procedures like staffing, planning,
organizing, directing, and managing.
Nursing Leadership and Management
• Nursing leadership and management
refer to the roles of nursing professionals
who direct nursing staff, oversee the
organizational structure of medical
processes and lead nursing teams in
providing patient care.
Principles of Management
• Henry Fayol, also known as the ‘father
of modern management theory’ gave a
new perception of the concept of
management.
• He introduced a general theory that can
be applied to all levels of management
and every department.
• The Fayol theory is practiced by the
managers to organize and regulate the
internal activities of an organization. He
concentrated on accomplishing
managerial efficiency.
1. Division of Work
• It improves the productivity, efficiency,
accuracy and speed of the workers.
• This principle is appropriate for both the
managerial as well as a technical work
level.
2. Authority and Responsibility
• These are the two key aspects of
management:
o Authority facilitates the management
to work efficiently.
o Responsibility makes them
responsible for the work done under
their guidance or leadership.
(dinelegate)
3. Discipline
• Employees good behavior also helps
them smoothly build and progress in their
professional careers.
4. Unity of Command
• This means an employee should have
only one boss and follow his command.
• If an employee has to follow more than
one boss, there begins a conflict of
interest and can create confusion.
5. Unity of Direction
• This means all the person working in a
company should have one goal and
motive which will make the work easier
and achieve the set goal easily.
6. Subordination of Individual Interest
• This indicates a company should work
unitedly towards the interest of a
company rather than personal interest.
• Be subordinate to the purposes of an
organization. This refers to the whole
chain of command in a company.
7. Remuneration
• This plays an important role in motivating
the workers of can be monetary or non-
monetary.
• However, it should be according to an
individual’s efforts they have made.
8. Centralization
• The concentration of control of an activity
or organization under a single authority.
9. Scalar Chain
• In this principle highlights that the
hierarchy steps should be from the top to
the lowest.
• This is necessary so that every employee
knows their immediate senior also they
should be able to contact any, if needed.
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 10. Order
• A company should maintain a well-
defined work order to have a favorable
work culture.
• The positive atmosphere in the
workplace will boost more positive
productivity.
11. Equity
• All employees should be treated equally
and respectfully.
• It’s the responsibility of a manager that no
employees face discrimination.
12. Stability
• An employee delivers the best if they feel
secure in their job.
• It is the duty of the management to offer
job security to their employees.
13. Initiative
• The management should support and
encourage the employees to take
initiatives in an organization.
• It will help them to increase their interest
and make then worth.
• Workplace initiative is the ability to
independently assess issues and initiate
solutions. Workplace initiative includes a
mix of skills that can help you both come
up with new approaches to workplace
problems and communicate them to
other employees and management.
14. Esprit de Corps
• It is the responsibility of the management
to motivate their employees and be
supportive of each other regularly.
• Developing trust and mutual
understanding will lead to a positive
outcome and work environment.
Early Management Theories
Scientific Management
• Frederick Winslow Taylor Frederick
Winslow Taylor was an engineer for
Bethlehem Steel in 1889, when he
decided to analyze the issue of
soldiering, which is when workers are
deliberately working under capacity.
• The process that Taylor laid out was a
template for other organizations:
▪ Each task should be studied
scientifically to determine the best way
to perform it.
▪ Workers should be carefully selected
and trained to perform the tasks.
▪ Managers and workers should
cooperate to ensure efficient
production.
▪ Managers should plan, and workers
should be responsible for
implementing those plans.
Administrative Management Theory
• The Administrative Theory of
Management was first generalized by
Henri Fayol (1841-1925) with his work
and publications, Fayol's 14 Principles of
Management (1888) and Administration
Industrielle et Generale (1916).
• Fayol is considered the father of
Administrative Management Theory,
often called Process Theory or Structural
Theory.
• As a member of the classical theory
movement, Fayol's work was unique from
that of Taylor, who focused on worker
efficiency.
• Henri Fayol, in his classic 1916 book,
Administration Industrielle et Generale,
Fayol laid out an informative
categorization of managerial functions.
These functions include:
▪ Planning
▪ Organizing
▪ Commanding
▪ Coordinating
▪ Controlling
Bureaucratic Management Approach
• Max Weber developed a bureaucratic
approach to management.
• He believed bureaucracy was the most
efficient way to set up an organization,
administration, and organizations.
• Max Weber believed that Bureaucracy
was a better than traditional structures.
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• In a bureaucratic organization, everyone
is treated equal, and the division of labor
is clearly described for each employee.
• In his approach, Weber proposed:
▪ Hierarchal management structure.
▪ Division of labor.
▪ Formal selection process for new
employees.
▪ Career orientation.
▪ Formal rules and regulations.
▪ Impersonality.
Behavioral Management Theory
• Behavioral management theory is often
called human relations movement
because it addresses the human
dimension of work.
• Behavioral theories believed that a better
understanding of human behavior at
work such as motivation, conflict,
expectations, and group dynamics
improved productivity.
Key Contributors:
• Mary Parker Follet (late 1800s/early
1900s)
▪ “Authority should go with knowledge”
– employee job self determination
• Elton Mayo (early 1900s)
▪ Management involvement with
workers more important than physical
work conditions
• Douglas McGregor (mid 1900s)
▪ Theory X and Theory Y
▪ Theory X – is a behavioral style for
workplace management; it's defined
by a strict rule of law. Setting defined
theories for our managing styles
helps us to establish workplace
standards.
▪ Theory Y – is a participative
approach to enhance employee
motivation where the manager has an
optimistic view of their team
members. Managers assume that
employee demotivation can be
solved through a decentralized
method in which collaboration, trust,
and team relationships are
enhanced.
Modern Management Theory
• The modern management
theory believes that employees work for
numerous reasons, including to achieve
satisfaction, happiness and desired
lifestyles.
• With this theory, managers understand
employees' behaviors and needs and
can implement strategies to meet those
needs and support their skill
development over time.
Quantitative Approach
• Quantitative methods emphasize
objective measurements and the
statistical, mathematical, or numerical
analysis of data collected through polls,
questionnaires, and surveys, or by
manipulating pre-existing statistical data
using computational techniques.
System Approach
• Systems approach is based on the
generalization that everything is inter-
related and interdependent. A system is
composed of related and dependent
element which when in interaction, forms
a unitary whole.
• A system is simply a combination of
things or parts forming a complex whole.
Contingency Approach
• Is a management theory that suggests
the most appropriate style of
management is dependent on the
context of the situation and that adopting
a single, rigid style is inefficient in the
long term.
Management Process
• It is a process that brings scarce human
and material resources together and
motivates people to achieve common
organizational goals.
• It is not a one-time act but an ongoing
progression of complementary activities.
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 Roles that Managers Fulfill in an Informational Management Roles
Organization • The managerial roles in this category
• There are ten management roles which involve processing information.
was published by Mintzberg on 1. Monitor – In this role, you regularly
management in 1990: seek out information related to your
1. Figurehead organization and industry, looking for
2. Leader relevant changes in the environment.
3. Liaison You also monitor your team, in terms
4. Monitor of both their productivity, and their
5. Disseminator well-being.
6. Spokesperson 2. Disseminator – This is where you
7. Entrepreneur communicate potentially useful
8. Disturbance Handler information to your colleagues and
9. Resource Allocator your team.
10. Negotiator 3. Spokesperson – Managers
represent and speak for their
The 10 roles are then divided up into three organization. In this role, you're
categories: responsible for transmitting
information about your organization
CATEGORY ROLES and its goals to the people outside it.
Interpersonal Figurehead
Leader Decisional Management Roles
Liaison • The managerial roles in this category
Informational Monitor involve using information.
Disseminator 1. Entrepreneur – As a manager, you
Spokesperson create and control change within the
Decisional Entrepreneur organization. This means solving
Disturbance problems, generating new ideas, and
Handler implementing them.
Resource Allocator 2. Disturbance Handler – When an
Negotiator organization or team hits an
unexpected roadblock, it's the
Interpersonal Management Roles manager who must take charge. You
1. Figurehead – As a manager, you have also need to help mediate disputes
social, ceremonial and legal within it.
responsibilities. You're expected to be a 3. Resource Allocator – You'll also
source of inspiration. People look up to need to determine where
you as a person with authority, and as a organizational resources are best
figurehead. applied. This involves allocating
2. Leader – This is where you provide funding, as well as assigning staff
leadership for your team, your and other organizational resources.
department or perhaps your entire 4. Negotiator – You may be needed to
organization; and it's where you manage take part in, and direct, important
the performance and responsibilities of negotiations within your team,
everyone in the group. department, or organization.
3. Liaison – Managers must communicate
with internal and external contacts. You Strategic Planning Process
need to be able to network effectively on • Strategic planning is a process in which
behalf of your organization. (linkages) an organization's leaders define their
vision for the future and identify their
organization's goals and objectives.

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• The process includes establishing the
sequence in which those goals should be
realized so that the organization can
reach its stated vision.
Vision
• Providing quality and compassionate
nursing care.
• Creating positive work environments that
foster and support professional growth
and development.
• Partnering with other disciplines and
patients/families in the provision of
healthcare.
• Establishing the standards for nursing
practice.
Mission
• A nurse mission statement is a
declaration of the values and goals of
your nursing career.
• It's what drives your career, tells people
what you're all about and what you aim to
bring to the table.
Philosophy
• A philosophy of nursing is a statement
that outlines a nurse's values, ethics, and
beliefs, as well as their motivation for
being part of the profession.
• It covers a nurse's perspective regarding
their education, practice, and patient care
ethics.
Objectives
• A nurse manager aims at efficient
administration of the health care unit as
well as effective supervision over her
subordinates.
• She is expected to carry out clinical
responsibilities as well as other duties
such as competent handling, correct
evaluation of staff performance and
proper management of staff.
Core Values
• Core values of nursing include altruism,
autonomy, human dignity, integrity,
honesty, and social justice.
• The core ethical values are generally
shared within the global community, and
they reflect the human and spiritual
approach to the nursing profession.
Standards Of Nursing Practice
• The Standards of Professional Nursing
Practice are authoritative statements of
the duties that all registered nurses,
regardless of role, population or specialty
are expected to perform competently
(ANA, 2010, p. 2).
• As defined by the American Nurses'
Association (ANA), standards of nursing
practice consist of three components:
• Professional standards of care define
diagnostic, intervention, and
evaluation competencies.
• Professional performance standards
identify role functions in direct care,
consultation, and quality assurance.
Standard 1. Assessment
The registered nurse collects comprehensive
data pertinent to the healthcare consumer’s
health or the situation.
Standard 2. Diagnosis
The registered nurse analyzes the
assessment data to determine the diagnoses
or issues.
Standard 3. Outcome Identification
The registered nurse identifies expected
outcomes for a plan individualized to the
healthcare consumer or the situation.
Standard 4. Planning
The registered nurse develops a plan of care
that prescribes strategies and interventions
to attain expected outcomes.
Standard 5. Implementation
The nurse implements the interventions
identified in the plan.
• Standard 5A. Coordination of Care
• Standard 5B. Health Teaching and
Health Promotion
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• Standard 5C. Consultation (Graduate
Prepared Specialty or Advanced Practice
Nurse)
• Standard 5D. Prescriptive Authority and
Treatment (Advanced Practice Nurse)
Standard 15. Resource Utilization
The registered nurse utilizes appropriate
resources to plan and provide nursing
services that are safe, effective, and
financially responsible.

Standard 6. Evaluation Standard 16. Environmental Health

The registered nurse evaluates progress The registered nurse practices in an
toward attainment of outcomes. environmentally safe and healthy manner.

Standard 7. Ethics Source:

American Nurses Association (ANA) Scope and
The registered nurse practices ethically. Standards of Nursing Practice, 2010

Standard 8. Education 2012 National Nursing Core Competency

The registered nurse attains knowledge and Standards (2012 NNCCS)
competence that reflects current nursing The various competencies and performance
practice. indicators are spelled out to serve as guide
in the development of our plan of care.
Standard 9. Evidence-Based Practice and
Research
The registered nurse integrates evidence
and research findings into practice.

Standard 10. Quality Of Practice

The registered nurse contributes to quality
nursing practice.

Standard 11. Communication

The registered nurse communicates
effectively in a variety of formats in all areas
of practice.

Standard 12. Leadership

The registered nurse demonstrates
leadership in the professional practice
setting and the profession.

Standard 13. Collaboration

The registered nurse collaborates with the
healthcare consumer, family, and others in
the conduct of nursing practice.

Standard 14. Professional Practice

Evaluation
The registered nurse evaluates her or his
own nursing practice in relation to
professional practice standards and
guidelines, relevant statutes, rules and
regulations.

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I. Beginning Nurse’s Role on Client Care

RESPONSIBILITY COMPETENCIES
1. Practices in accordance with legal principles and the code of
5
ethics in making personal and professional judgment.
2. Utilizes the nursing process in the interdisciplinary care of
clients that empowers the clients and promotes safe quality 7
care.
3. Maintains complete, accurate and up to date recording and
3
reporting system.
4. Establishes collaborative relationship with colleagues and other
members of the team to enhance nursing and other health care 2
services.
5. Promotes professional and personal growth and development. 4
TOTAL 21

II. Beginning Nurse’s Role on Management and Leadership

RESPONSIBILITY COMPETENCIES
1. Demonstrates management and leadership skills to provide
4
safe and quality care
2. Demonstrates accountability for safe nursing practice. 3
3. Demonstrates management and leadership skills to deliver
health programs and services effectively to specific client 2
groups in the community settings.
4. Manages a community/village-based health facility/component
9
of a health program or a nursing service.
5. Demonstrates ability to lead and supervise nursing support
8
staff.
6. Utilizes appropriate mechanism for networking, linkage
4
building and referrals.
TOTAL 30

III. Beginning Nurse’s Role on Research

RESPONSIBILITY COMPETENCIES
1. Engages in nursing or health related research with or under the
4
supervision of an experienced researcher.
2. Evaluates research study/report utilizing guidelines in the
4
conduct of a written research critique.
3. Applies the research process in improving client care in
partnership with a quality improvement/quality 4
assurance/nursing audit team.
TOTAL 12

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NCM 119-A: Nursing Leadership, Management, and Professional Adjustment
Lecture / Week 3-5
Management Functions
• Planning
• Organizing
• Staffing
• Leading or Directing
• Controlling
Planning
• Planning is the process of thinking about
and organizing the activities required to
achieve a desired goal.
• Planning is also a management process,
concerned with defining goals for a
company's future direction and
determining the missions and resources
to achieve those targets.
Reasons For Planning
1. It Helps to Set the Right Goals
• A plan is a course of action towards
the realization of the goal, it also
supports SMART (Specific,
Measurable, Attainable, Realistic,
Time bound) goal setting.
• Planning helps the organization to
critically assess the goal to see if it’s
realistic.
• It facilitates decision making and
allows setting a time frame by
predicting when the organization can
achieve its goal.
• It also defines how to measure
performance against the set goals and
whose responsibility it will be.
2. It Sets Objectives and Standards for
Controlling
• A primary function of strategic formal
planning is providing direction to
lower-level managers, allowing the
development of tactical goals.
• The planning objectives for each
organizational department helps
managers to prioritize activities
depending on their relevance to the
goal.
• Planning also sets the standards for
assessing performance.
o Without such standards,
managers wouldn’t be able to
intervene and take corrective
actions to stay on track, which
would also threaten the goal.
3. It Reduces Uncertainty
• The uncertainty of the future puts the
great risk on organizations
sustainability, for it is always difficult to
manage through change.
• No organization can control the
economic and competitive
environment; thus, the ability to
anticipate challenges and have
contingency plans in place is the best
alternative.
• Planning involves an intentional
critical evaluation of the available data
and experts’ predictions.
• This makes planning in management
very helpful in terms of reducing the
uncertainty of the future and avoiding
the risks.
4. It Eliminates Overlapping of Wasteful
Activities
• Effective planning gives clarity about
the responsibilities and expectations
of each department, team, and even
team member.
• This helps to make sure that the
activities don’t overlap and improves
co-ordination.
• It helps to determine which activity is
wasteful and does not contribute to
reaching the goal.
• Eliminating such activities will not
only reduce wastage and save
valuable time and resources but also
improve productivity and motivation.
5. It Ensures Efficient use of Resources
• Planning makes the use of human
and material resources as efficient as
possible.
• Starting the management process
with a good plan that focuses on the
ultimate goal and considers available
capabilities, you can see many
opportunities to cut expenses.
• Without such a plan, it is easy to fall
for appealing B2B offers.
o This can waste organizational
resources on the raw materials
that the employees cannot
Jazmin Ann Bignotea 1
 process in a due time, expensive
robotics, or online software that
speeds up only one aspect of the
process not affecting the overall
result.
6. It Promotes Innovation
• If the organization has a challenging
goal on the one hand, and the
possibility of hurdles and market
change on the other hand, it starts
brainstorming creative ideas and
solutions.
• Determining a future course of action
is an important function of
management.
• Keeping a focus on the need to reach
the goal, employees or management
can spot new opportunities for
business development, suggest new
products or services, or discover new
target markets.
• Planning becomes a continuous
process that encourages creative
strategic thinking and innovation.
7. It Improves Decision Making
• Planning improves decision-making
processes and time management in
two ways.
1. it helps managers to keep the
focus on a goal and thus ask
themselves how alternative
courses of action might facilitate,
or delay reach it
2. The plan allows managers to be
more farsighted: having a clear
road map, they can think what
effect an adopted decision will
have on some long-term tasks
and activities.
• Without such a plan, managers’
decisions may not be strategic but
based only on the available data and
current situation.
8. It Boosts Motivation and Team Spirit
• It is a common fact that people feel
more engaged and motivated if they
understand the relevance of their
work.
o Planning shows the link between
individual input and a larger goal,
which it helps to achieve.
• It also shows that each person in the
business environment is
indispensable to reaching the
common goal.
o This helps to reduce internal
competition and nurture
community and team spirit. You
can use motivational quotes in
your pep talks to help enthuse
your team.
9. It Helps to Earn Credibility and Trust
of Stakeholders
• All managers understand that a solid
plan is needed to persuade creditors
and investors to help.
• Having a formal business plan readily
available will have a great impact if
you need to find and engage new
investors in a short period of time.
• The availability of clear goals and a
formal plan also shows your social
responsibility and increases the trust
of employees and clients.
10. It Gives a Competitive Edge and
Allows Strategic Positioning
• Planning involves getting a realistic
view of organizational strengths and
weaknesses, as well as revealing the
gaps and vulnerabilities of the
competitors.
• Acting upon this data rather than
inertly performing the same actions
gives a great competitive edge.
• Planning helps to reveal the growing
markets and enter them with new
products or services earlier than any
other competitor, enjoying the first-
mover advantage.
Types of Planning
• Planning is one of the four functions of
management that allows a manager to
develop and implement strategic action
steps aimed at reaching an
organizational goal.
• There are three major types of planning,
which include:
Jazmin Ann Bignotea 2
 o Operational
o Strategic
o Tactical
o Contingency
Operational Planning
• Is the process of planning strategic goals
and objectives to technical goals and
objectives.
• It describes milestones, conditions for
success, and explains how, or what
portion of, a strategic plan will be put into
operation during a given operational
period, in the case of commercial
application, a fiscal year or another given
budgetary term.
• An operational plan is the basis for and
justification of an annual operating
budget request.
• Therefore, a five-year strategic plan
would typically require five operational
plans funded by five operating budgets.
Strategic Planning
• Strategic planning is a process in which
organizational leaders determine their
vision for the future as well as identify
their goals and objectives for the
organization.
• The process also includes establishing
the sequence in which those goals
should fall so that the organization is
enabled to reach its stated vision.
Tactical Planning
• Tactical planning is the step taken after a
business or team creates a strategic plan
to break that plan into smaller objectives
and goals.
• A tactical plan is used to define goals and
determine how they will be achieved
through actions and steps.
Contingency Planning
• A contingency plan in project management is
a defined, actionable plan that is to be
enacted if an identified risk becomes a
reality. It is essentially a “Plan B”, to be put in
place when things go differently than
expected.
Hierarchy of Planning
• A planning hierarchy represents the
organizational levels and units in your
company for which you want to plan.
• A planning hierarchy is a combination of
characteristic values based on the
characteristics of one information
structure.
A. Scope of Planning
• The purpose of scope planning is to
ensure that all the required work and only
the required work is clearly identified that
the deliverables and outcomes are
documented, and that the boundary
conditions are adequately defined to
complete the project successfully.
• Scope planning involves identifying the
goals, objectives, tasks, resources,
budget, and timeline.
• Scope planning refers to a project
management process that defines
boundaries and deliverables. The basic
matrix of a scope planning analysis
consists of three main categories:
Initiation, planning, and definition, with
two control categories: Verification, and
change control interspersed between the
three main categories.
• The project SWOT analysis is performed
to gain an understanding of and act upon
the project's capabilities and
environment.
• The scope statement is effective in
establishing the project baseline and
boundary conditions, which cannot be
compromised without consent of the
approving managers.
B. Modes of Planning
Jazmin Ann Bignotea 3
• It is a way or manner in which something occurs or
is experienced, expressed, or done.
Tools for Management and Planning are:
1. The Affinity Diagram
• Is a tool that gathers large amounts of
language data (ideas, opinions,
issues) and organizes them into
groupings based on their natural
relationships.
• The Affinity process is often used to
group ideas generated by
Brainstorming.
4. The Matrix Diagram
2. The Tree Diagram
• A tree diagram is a tool in the fields of
general mathematics, probability, and
statistics that helps calculate the
number of possible outcomes of an
event or problem, and to cite those
potential outcomes in an organized
way.
5. Prioritization Matrices
3. The Interrelationship Diagram
• An interrelationship diagram is defined
as a new management planning tool
that depicts the relationship among
factors in a complex situation.
• The interrelationship diagram shows
cause-and-effect relationships.
• Its main purpose is to help identify
relationships that are not easily
recognizable.
• A matrix diagram is defined as a new
management planning tool used for
analyzing and displaying the
relationship between data sets.
• The matrix diagram shows the
relationship between two, three, or
four groups of information.
• A Prioritization Matrix is a useful
technique to identify which problems
Jazmin Ann Bignotea 4
 are the most important to work on
solving first.
• The Matrix helps you rank problems or
issues generated through
brainstorming, using weighted criteria
that are important to your project
and/or organization.
6. The Process Decision Program Chart
(PDPC)
• The process decision program chart
(PDPC) is defined as a new
management planning tool that
systematically identifies what might go
wrong in a plan under development.
• By using PDPC, you can either revise
the plan to avoid the problems or be
ready with the best response when a
problem occurs.
7. The Activity Network Diagram
• An Activity Network Diagram is a
diagram of project activities that
shows the sequential relationships of
activities using arrows and nodes.
• An Activity Network Diagram is a
diagram of project activities that
shows the sequential relationships of
activities using arrows and nodes.
Proactive vs Reactive Planning
✓ Proactive approach focuses on
eliminating problems before they have a
chance to appear
✓ Reactive approach is based on
responding to events after they have
happened.
✓ The difference between these two
approaches is the perspective each one
provides in assessing actions and
events.
Philosophy
• Management philosophy is a set of
beliefs or rules used by managers to help
them make decisions.
• It must be simple enough and easy to
remember.
Vision
• In the context of management, a vision is
an expression of what the organization
wants to become, what it wants to be, to
be known as or to be known for.
• The vision comes from the leaders – it is
how they express the future for the
organization or its strategic direction.
Mission
• In the context of management, a mission
is a quest, a journey to a destination in
which the whole organization is engaged.
• The mission statement tells us what our
goal is – where are we going. It provides
the compass setting for the organization.
Jazmin Ann Bignotea 5
• It is how the organization is going to
achieve its vision.
Goals
• Goals are outcome statements that
define what an organization is trying to
accomplish, both programmatically and
organizationally.
• Goals are usually a collection of related
programs, a reflection of major actions of
the organization, and provide rallying
points for managers.
Budgeting
• A budget is an estimation of revenue and
expenses over a specified future period
of time and is utilized by governments,
businesses, and individuals.
• A budget is basically a financial plan for
a defined period, normally a year that is
known to greatly enhance the success of
any financial undertaking.
Budgeting Process
• The budgeting process is the process of
putting a budget in place.
• This process involves planning and
forecasting, implementing, monitoring
and controlling, and finally evaluating the
performance of the budget.
• A budget is essential for any
organization. It helps to keep track of its
income and expenditure.
Fiscal Planning
• Is a plan that uses numerical data to
predict the activities of an organization
over a period of time.
• Desired outcome of budgeting is maximal
use of resources to meet organizational
short/long term needs, mechanism for
planning and control.
• Calculating Nursing Care Hours.
• Nursing Care Hours / Patients Per Day.
Types of Budgets
• Operating Budget
o The operating budget includes all full-
time equivalent personnel and all
expenses and revenue for day-in and
day-out operations.
o It's the most critical budget an
organization develops, implements
and monitors.
o A nurse manager must take timely
action when costs exceed revenues.
• Capital Budget
o The capital budget includes major
movable equipment and fixed assets.
o The capital budget that nurses and
nurse managers are generally
responsible for is the major movable
equipment budget.
o Each organization defines the minimal
amount that must be budgeted in the
capital budget.
o The monies that an enterprise
allocates for the purchase of fixed and
durable goods.
o In a hospital, the capital budget is
used to purchase beds, buildings,
equipment, and other items that are
not part of its operating costs.
Costing out of Nursing Services
• The definition of costing out nursing
services: Costing nursing care: Is the
process of estimating the monetary
(fiscal or financial) value of providing
nursing care to patients.
Cost-effectiveness (sulit in tagalog)
• Producing good results without costing a
lot of money cost-effective measures to
combat poverty
Health Care Financing
• Health financing refers to how financial
resources are used to ensure that the
health system can adequately cover the
collective health needs of every person.
o It is a foundational component that
impacts the entire health system's
performance, including the delivery
and accessibility of primary health
care.
• Financing schemes for health care are
the arrangements through which people
pay for and obtain health services.
Jazmin Ann Bignotea 6
 o There are three main categories of
financing scheme:
- Government & compulsory
schemes (HF. 1)
- Voluntary health care schemes
(HF. 2)
- Direct payments by households or
Household out-of-pocket (HF.3)
Resource Management
• Resource management is the process of
pre-planning, scheduling, and allocating
your resources to maximize efficiency.
• Resource management is acquiring,
allocating and managing the resources,
such as individuals and their skills,
finances, technology, materials,
machinery and natural resources
required for a project.
• Resource management ensures that
internal and external resources are used
effectively on time and to budget.
ABC Inventory
• ABC analysis is an inventory
management technique that determines
the value of inventory items based on
their importance to the business.
• ABC ranks items on demand, cost and
risk data, and inventory mangers group
items into classes based on those
criteria.
Time Management
• “Time management” is the process of
organizing and planning how to divide
your time between specific activities.
• Time management is the process of
planning and exercising conscious
control of time spent on specific activities,
especially to increase effectiveness,
efficiency, and productivity.
o Using time effectively gives the person
"choice" on spending or managing
activities at their own time and
expediency.
• Maximizing Personal time
o Maximizing your time is about
properly prioritizing things and doing
what is really important to you.
• Maximizing Managerial Time
1. Set goals correctly.
• Set goals that are achievable and
measurable.
2. Prioritize wisely.
• Prioritize tasks based on
importance and urgency.
3. Set a time limit to complete a task.
4. Take a break between tasks.
5. Organize yourself.
6. Remove non-essential
tasks/activities.
7. Plan ahead.
• Maximizing Organizational Time
• 5 Strategies to Improve
Organizational Effectiveness
1. Make Use of Human Resources.
2. Focus on Education and Growth.
3. Keep the Customers in Mind.
4. Work on Quality Services or
Products.
5. Use Technology.
Here are some of the most important
indicators to watch when evaluating
organizational effectiveness:
1. Management.
2. Workforce Performance and Productivity.
3. Accountability.
4. The Employee Experience.
5. Organizational Performance.
6. Organizational Strategy.
7. Tools and Technology.
Organizing
• Determine what task are to be done, who
is to do these, how the tasks are to be
grouped, who reports to whom and what
decisions are to be made.
• It is a form of identifying roles and
relationships of each staff on order to
delineate specific tasks or functions that
will carry out organizational plan s and
objectives.
• Process of identifying and grouping the
work to be performed, defining and
delegating responsibility and authority
and establishing relationships for the
purpose of enabling the people to work
Jazmin Ann Bignotea 7
 more effectively together in
accomplishing objectives.
Organizing as a Process
• It refers to the building of a structure that
will provide for the separation of activities
to be performed and for the arrangement
of these activities in a framework which
indicates their hierarchal importance and
functional association.
Organizing Process Includes:
• Identifying and defining basic tasks.
• Delegation of authority and assigning
responsibility
• Establishing relationships
Three Forms of Authority
• Line Authority – is a direct supervisory
authority from supervisor to
subordinates.
o Chain of Command – unbroken line of
reporting relationships that extends
through the entire organization. The
line defines the chain of command and
the formal decision-making structure.
o Unity of Command – within the chin
states that, each person in the
organization should take orders and
reports only to one person.
o Span of Control – refers to the number
of employees that should be placed
under the direction of one leader-
manager.
• Staff Authority – authority that is based
on the expertise and which usually
involves advising the line managers.
• Team Authority – is granted to
committees or work teams involved in an
organization’s daily operations. Work
teams are group of operating employees
who shared a common vision, goals and
objectives.
Organizational Chart
• Drawing that shows how the parts of the
organizations are link.
• It depicts the formal organizational
relationship, areas of responsibility and
accountability and channel of
communication.
• Depicts an organization’s structure.
Organizational Structure
• Depicts and identifies role and
expectations, arrangement of positions
and working relationships.
1. Dotted or Unbroken line
– represents staff positions/staff
authority (advisor to the line
managers).
2. Centrality – refers to the location of
a position on an organizational chart
where frequent and various types of
communication occur. Determined by
organizational distance; those with
small organizational distance receive
more information than those who are
more peripherally located.
Jazmin Ann Bignotea 8
 3. Solid Horizontal Line – represent
same positions but different
functions.
4. Solid Vertical Line – chain of
command form authority
subordinates (line authority)
Managerial Level
• Refer to table above
Patterns of Organizational Structure
1. Tall/Centralized Structure
• Responsible for only few subordinates so
there is narrow span of control
• Because of the vertical in nature, there
are many levels of communication
• Communication is difficult and messages
do not get to the top.
• Workers are boss-oriented because of
close contact with their supervisor.
2. Flat/Decentralized Structure
• Characterized by few levels and a broad
span of control
• Communication is easy and direct
• Advantages:
1. Shortens the administrative distance
from the top to the lower
2. Solutions to problems are easily
carried out/fast response
3. Workers developed their abilities and
autonomy
• Disadvantage:
1. Impractical in large organization.
to
Types of Organizational Structure
1. Line Organization / Bureaucratic /
Pyramidal
• There is clearly defined superior-
subordinate relationship
• Power is concentrated at the top
2. Flat/Horizontal Organization
• Decentralized type
• Applicable in small organization
• Nurses become productive and directly
involved in the decision-making skills
• Workers become satisfied
3. Functional Organization
• Permits a specialist to aid line position
within a limited and clearly defined scope
of authority
4. Ad Hoc Organization
• Modification of bureaucratic structure
5. Matrix Structure
• Focus on both product and functions
• Most complex
• Has both vertical and horizontal chain of
command and line of communication
Staffing
• Staffing patterns refers to the number
and types or categories of staff assigned
to the wards in a hospital.
• Staffing patterns that accommodate
imbalanced patient to nurse ratios can
affect nursing staff negatively.
• Process of assigning competent people
to fulfill the roles designated for the
Jazmin Ann Bignotea 9
 organizational structure through
recruitment, selection and development,
induction, and orientation of the new staff
of the goals, vision, mission, philosophy
etc.
Staffing Process
• Preparing to Recruit – types and number
of personnel
• Attracting a Staff – formal advertisement
• Recruiting and Selecting a Staff –
interview > induction > orientation > job
order > pre-employment testing > signing
of contract
• Staffing Pattern – plan that articulates
how many and what kind of staff are
needed/shift or per day in > unit or in >
department.
Two Ways of Developing a Staffing
Pattern
• Determine the # of nursing care hours
needed/patient
o Generating the full-time equivalents of
an employee
• Determine the nurse-patient ratio in
providing nursing care
o FTE – measure of work committed of
full-time employee
▪ 1.0 FTE = works 5 days/week, 8
hours/day
▪ 0.5 FTE = part time employee who
works 5 days/2 weeks.
Considerations in Staffing Pattern
1. Benchmarking
• Management tool for seeking out the best
practice in one’s industry to improve
one’s performance.
• Process of measuring products,
practices, and services against best
performing organization as a tool for
identifying desired standards of
organizational performance.
2. Regulatory Requirements – mandated
by RA
3. Skill Mix – percent or ratio of
professionals to non-professional.
Ex: 40 FTE (20 RN + 20 non-RN) = 50%
RN mix
4. Staff Support – staff support in place for
the operations of the units or department.
5. Historical Information – review of any
data on quality or staff perception
regarding the effectiveness of the
previous staffing pattern.
Selection
• Selection is the process of identifying an
individual from a pool of job applicants
with the requisite qualifications and
competencies to fill jobs in the
organization. This is an HR process that
helps differentiate between qualified and
unqualified applicants by applying
various techniques.
• Orientation
✓ it's designed to ensure all nurses
receive consistent information
regarding policies, procedures, and
documentation within their new
healthcare facility.
• Job description
✓ A job description is a useful, plain-
language tool that explains the tasks,
duties, function, and responsibilities of
a position. It details who performs a
specific type of work, how that work is
to be completed, and the frequency and
the purpose of the work as it relates to
the organization's mission and goals.
Patient Classification System
• Refers to measurement systems in
nursing that reflect actual patient care
needs for staffing purposes.
• The term also is referred to as Acuity
Systems, although the concept of
“Acuity” denotes unidimensional illness
severity in the medical sense.
• Measuring tool used to articulate the
nursing workload for specific patient or
group of patients over a specific time.
• Measuring tool used to articulate the
nursing workload for specific patient or
group of patients over a specific time.
Jazmin Ann Bignotea 10
• Patient Acuity – measure of nursing
workload that is generated for each
patient.
Patient Care is Classified According to:
• Self-care or minimal care patients can
carry ADL, e.g., hygiene, meals etc.
• Intermediate or moderate care requires
some help from the nursing staff with
special treatments or certain aspects of
personal care, e.g., patients with IV
fluids. catheter, respirator, etc.
• Total care patients are those who are
bedridden and who lack strength and
mobility to do average daily living. Ex:
patients on CBR, immediate post-op,
with contraptions.
• Intensive care patients are those who are
critically ill and in constant danger of
death or serious injury.
o Ex: comatose, bedridden etc.
Scheduling
• Is a timetable showing planned workdays
and shifts for nursing personnel.
Issues to consider in scheduling staff:
1. Patient type and acuity
2. Number of patients
3. Experience of Staff
4. Support available to the staff
Shifting Variations
• Traditional Shifting Patterns
✓ shift (8 hr shift)
✓ 12 hr shift
✓ 10 hr shift
• Weekend option
• Rotating work shift
• Self-scheduling – staff makes their own
schedule
• Permanent work shift
• Floaters – “on-call”
Forty Hour Week Law – based on RA 5901
• No work, no pay
• Entitled to 2-week sick leave and off duty
for 2 days
• Special Holidays – with pay
Modalities of Care
• It refers to the way nursing care is
organized and provided. It depends on
the philosophy of the organization,
nurse staffing and client population.
a. Case Method
• In case method, the nurse cares for one
patient whom the nurse cares for
exclusively.
• The Case Method evolved into what we
now call private duty nursing.
• It was the first type of nursing care
delivery system.
b. Total Patient Care
• A nurse provides full and complete
treatment to all the patients they see.
With that shift, each patient’s needs are
primarily addressed by a nurse, and in
some situations until the patient’s
symptoms have subsided, the nurse is
at ease providing care.
• The RN is responsible for several
patients.
c. Primary Nursing
• This modality is that one nurse cares for
one group of patients with a 24-hour
accountability for planning their care.
• a Primary Nurse (PN) cares for her
primary patients every time she works
and for as long as the patient remains
on her unit.
• This is a decentralized delivery model:
more responsibility and authority are
placed with each staff nurse.
d. Team Nursing
• The Team Leader has a core of staff
reporting to her, and together they work
to disseminate the care activities.
• The team member possessing the skill
needed by the individual patient is
assigned to that patient, but the Team
Leader still has accountabilities for all of
the care.
• Team conferences occur in which the
expertise of every staff member is used
to plan the care.
e. Modular Nursing
• This is a modification of team and
primary nursing.
Jazmin Ann Bignotea 11
 • It is a geographical assignment of
patient that encourages continuity of
care by organizing a group of staff to
work with a group of patients in the
same locale.
f. Functional Nursing
• It is a task-oriented method wherein a
particular nursing function is assigned
to each staff member.
• The medication nurse, treatment nurse
and bedside nurse are all products of
this system.
• For efficiency, nursing was essentially
divided into tasks, a model that proved
very beneficial when staffing was poor.
• The key idea was for nurses to be
assigned to tasks, not to patients.
Directing
Directing or Leading
• Act of issuing of orders, assignments,
instructions, to accomplish organizational
goals and objectives.
• Delegation – entails responsibility
• Assignments – no responsibility
Elements of Directing
1. Communication
2. Delegation
3. Motivation
4. Coordination
5. Evaluation
Leadership Theories
• Leadership theories are schools of
thought brought forward to explain how
and why certain individuals become
leaders.
• The theories emphasize the traits and
behaviors that individuals can adopt to
boost their own leadership abilities.
Behavioral Theory
• The behavioral leadership theory focuses
on how leaders behave and assumes
that these traits can be copied by other
leaders.
Contingency Theory
• Refers to an organization theory that
asserts that there is no single best way
for making decisions, leading a company,
and organizing a corporation.
• The theory says that an effectiveness of
management is contingent and is
dependent upon internal and external
environment.
• It is also termed as situational theory of
management.
Great Man Theory
• Leaders are born with just the right traits
and abilities for leading – charisma,
intellect, confidence, communication
skills, and social skills.
• The theory suggests that the ability to
lead is inherent – that the best leaders
are born, not made. It defines leaders as
valiant, mythic, and ordained to rise to
leadership when the situation arises.
• The term “Great Man” was adopted at the
time because leadership was reserved
for males, particularly in military
leadership.
The Trait Theory
• Is very similar to the Great Man Theory.
• It is founded on the characteristics of
different leaders – both the successful
and unsuccessful ones.
• The theory is used to predict effective
leadership.
• The identified characteristics are
compared to those of potential leaders to
determine their likelihood of leading
effectively.
• They focus on the physiological attributes
such as appearance, weight, and height;
demographics such as age, education,
and familial background; and
intelligence, which encompasses
decisiveness, judgment, and knowledge.
Situational Theory
• The Situational Theory is like the
Contingency Theory as it also proposes
that no one leadership style supersedes
others.
Jazmin Ann Bignotea 12
• As its name suggests, the theory implies
that leadership depends on the situation
at hand.
• Leaders should always correspond their
leadership to the respective situation by
assessing certain variables such as the
type of task, nature of followers, and
more.
Leadership Styles
These can be broadly grouped into 5
different categories:
Authoritarian Leadership
• Authoritarian leadership, also known as
autocratic leadership, is a management
style in which an individual has total
decision-making power and absolute
control over his subordinates.
• Shouting and corporal punishment are
also common with the authoritarian style.
People with this parenting style often use
punishment rather than discipline. They
are commonly not willing or able to
explain the reasoning behind their rules.
Participative Leadership
• Participative leadership is a style of
leadership in which all members of the
organization work together to make
decisions.
• Participative leadership is also known as
democratic leadership, as everyone is
encouraged to participate.
• The founder of Microsoft, Bill Gates is a
true participative leadership example. He
is known to take suggestions from
colleagues and teams. He understands
how imperative it is to value the
knowledge and skills of team members.
Delegative Leadership
• Also known as "laissez-faire leadership",
a delegative leadership style focuses on
delegating initiative to team members.
• This can be a successful strategy if team
members are competent, take
responsibility and prefer engaging in
individual work.
Transactional Leadership
• Transactional leadership, also known as
managerial leadership, is a leadership
style where the executive relies on
rewards and punishments to achieve
optimal job performance from his or her
subordinates.
Transformational Leadership
• Transformational leadership is defined as
a leadership approach that causes
change in individuals and social systems.
• It creates valuable and positive change in
the followers with the end goal of
developing followers into leaders.
Leadership Skills
• Leadership skills are the strengths and
abilities individuals demonstrate that help
the oversee processes, guide initiatives,
and steer their employees toward the
achievement of goals.
Case analysis
• A case analysis in business is a study of
a nursing problem. Anyone conducting a
case analysis can use evidence to
propose viable solutions to nursing
problems, then provide
recommendations on the best way to
implement these solutions to produce the
desired results.
Decision making
• Decision-making is a fundamental
concept of nursing practice that conforms
to a systematic trajectory involving the
assessment, interpretation, evaluation
and management of patient-specific
situations (Dougherty et al, 2015).
Bases of Power
The five bases of power:
• Legitimate — arises from the belief that
a person has the formal right to make
demands, and to expect others to be
compliant and obedient.
• Reward — These results from one
person’s ability to compensate another
for compliance.
• Expert — Based on a person’s high
levels of skill and knowledge.
Jazmin Ann Bignotea 13
• Referent —The result of a person’s
perceived attractiveness, worthiness and
right to others’ respect.
• Coercive — This comes from the belief
that a person can punish others for
noncompliance.
Principles of Delegation
dissatisfaction and low productivity.
Reasons are:
✓ Managers who are lazy
✓ Manager who are overburdened
and exhausted
• Improper Delegation – delegating at the
wrong person, time, tasks and beyond
the capability of the subordinates.

Delegation Steps in Effective Delegating

• Act of assigning to someone else a 1. Plan ahead
portion of the work to be done with 2. Identify necessary skills and levels
corresponding authority, responsibility, 3. Select most capable personnel
and accountability (ARA). 4. Communicate goal clearly
• According to ANA, it is the transfer of 5. Empower the delegate
responsibilities for the performance of the 6. Set deadlines and monitor progress
task from one person to another 7. Model the role and provide guidance
• Much of the work of manager is 8. Evaluate performance
accomplished by transferring the
responsibilities to subordinates.
Communication
Good Reasons for Delegation • Exchange of ideas, thoughts, or
• Manager delegate routine task so that information through verbal speech,
they are free to handle problems that are writing and signals.
more complex or require higher level of
expertise Barriers in Communication
• Delegate routine task if someone else is 1. Physical Barriers
better prepared or has greater expertise • Environmental factors that prevent
or knowledge in solving the problems or reduce the opportunities for
communication.
Managers who do not delegate • Ex: Distance and Noise
• Does not trust 2. Social and Psychological Barriers
• Fear of mistake • Blocks or inhibitors of
• Fear of criticism communication that rise from the
• Fear of own ability to delegate judgment, emotions, social values of
people: stress, trust, fear,
Common Errors in Delegation defensiveness
• Under delegating – systems from the • Internal climate (values, feelings,
manager’s false assumptions that temperament, and stress levels) and
delegation maybe interpreted as a lack of external climate (weather, timing,
ability on his part to do the job correctly temperature, lack of validation to the
and competently. message).
• Reasons are: 3. Semantics
✓ Managers believe that they can do the • Words, figures, symbols,
work faster and better penmanship, and interpretation of
✓ Managers believe that the the message through signs and
responsibility may be rejected if symbols.
delegated. 4. Interpretations
• Over delegating – subordinates become
overburdened which may lead to

Jazmin Ann Bignotea 14

• Defects in communication skills by
verbalizing, listening, writing, reading and
telephony
Motivation Theories
• Motivation theory is the study of how to
learn and understand what inspires a
person to pursue a specific result.
• This theory has many uses, including in
psychology and sociology, but it’s also
important for businesses, especially in
relation to management.
Motivation Theories in Nursing
• Proper motivation results in more job
satisfaction, which, in the case of
nursing, determines better patient
outcomes. Among the motivational
theories that can be applied in nursing is
Maslow’s Theory of Motivation,
Herzberg’s Motivation-Hygiene Theory,
and McClelland’s Achievement
Motivation Theory.
Maslow’s Theory of Motivation
• Maslow’s pyramid includes physiological,
safety, social, esteem, and self-
actualization needs (Kaur, 2013).
• An employee will be motivated to perform
the duties on a necessary level if the
mentioned requirements are satisfied
within a workplace.
• the employer should recognize
employees’ accomplishments, provide
financial security, provide opportunities
for socialization, and promote a healthy
workforce (Kaur, 2013).
• As applied for nursing, it means that
nurses should have the possibility of
continuous development in their
profession, which adds self-esteem. The
shifts should be organized appropriately
to provide enough time for rest and self-
education.
• Timely wages, according to the duties
performed, add to the feeling of financial
security.
Herzberg’s Motivation-Hygiene Theory
• Motivation-Hygiene Theory by Herzberg
was used aa a framework for the study of
job satisfaction among nurses (McGlynn,
Griffin, Donahue, & Fitspatric, 2012).
• Hygiene includes maintenance factors
such as salary, bonuses, and staffing.
Consideration to these factors helps to
avoid dissatisfaction. But it does not
guarantee satisfaction.
• Satisfaction “are related to the nature of
the work itself and rewards that flow
directly from the performance of that
work” (McGlynn et al., 2012, 261).
• In reality, the components of job
satisfaction are attitude, achievement,
recognition, work itself, responsibility,
and advancement (McGlynn et al., 2012).
• As for nursing, the managers should take
care of the mentioned components to
preserve a high level of job satisfaction
and motivation.
McClelland’s Achievement Motivation
Theory
• McClelland defines three primary needs.
These are achievement, power, and
affiliations.
• People who need achievements are
motivated by challenging tasks, set
goals, and performance feedback.
• The employees with the need for power
want to have some influence on the
others or provide control.
• People with the need for affiliation desire
approval and acceptance and take care
of the feelings and values of ten other
people.
• When it comes to nursing, Achievement
Motivation Theory can be used with a
personal approach. The tasks and
functions can be distributed among the
nursing staff, considering the type of
needs and thus increase motivation.
Time Management
• Time management is the process of
planning and exercising conscious
control of time spent on specific activities,
especially to increase effectiveness,
efficiency, and productivity.
Jazmin Ann Bignotea 15
• It involves the balancing of various
demands upon a person relating to work,
social life, family, hobbies, personal
interests, and commitments with the finite
nature of time.
• Using time effectively gives the person
"choice" on spending or managing
activities at their own time and
expediency.
Conflict Management
• Conflict Management involves the steps
undertaken to prevent the conflict at the
right time and helps to resolve it in an
effective and smooth manner.
• No conflict can just start on its own. There
must be an event or an incident to trigger
the same.
• Through conflict management, one finds
out the possible events which can start a
conflict and tries his level best to avoid
them.
Controlling
• Controlling is one of the important
functions of a manager.
• Controlling function of a manager is the
most common function.
• Managers at all levels of management –
Top, middle, and lower need to perform
controlling function to keep control over
activities in their areas.
Budgeting
• is a process of projection of revenues and
expenses, cash flows, production lines,
working capital requirements, capital
expenditure, etc. in respect of near future
years, which is based on some rationale
logic about the prospects and using the
experience in past till date, presented to
the management of the company for
decision making.
Types of Budgeting
Base Budgets
• is a basic budget prepared by the
organization also call as a “going
concern”.
• This defines the basic revenues &
expenses that will help the organization
to survive in near future.
• “Going concern” means the organization
is currently having only cash profits.
• Its focus is to strictly cut on the expenses
to every extent possible.
• This budget will only outline the expense
which is of utmost necessity to keep the
organization in track.
Activity-Based Budgets
• This is a cost-saving budget. The focus is
on the expenses incurred on each activity
of the organization.
• Organizations that are in the business for
more than 5 years, typically prepare such
budgets with the intent to cut down costs
on few activities.
• For example, hiring employees is an
activity. Instead of outsourcing the hiring
activity, the company can decide to do in-
house interviews to select appropriate
employees.
• This budget should also specify the
alternative means of doing the same
activity.
• Under this heading, different budgets
may be prepared for the different
activities of the organization.
Zero-Based Budgets
• the budget is prepared without referring
to past experiences & starting afresh. But
that does not mean, to say ad hoc
figures. Obviously, there must have a
basis for your thought.
• Please note, zero-based budgets do not
mean baseless or vague figures.
• This helps an organization to develop
innovative methods in doing certain
activities within organizations.
Kaizen Budget
• “Kaizen” is a Japanese word that means
“change for better”. It also means
continuous improvement in different
phases of the organization.
Jazmin Ann Bignotea 16
• The main purpose of continuous
improvements in quality, sales & costs.
• Japanese firms never compromise with
the quality front of the products.
• This approach of budgeting helps the
organization to strive for cost-cutting
together with achieving the best quality.
• This budget is normally made for longer
terms than other budgets.
Costing of Nursing Services
• Nursing services costing has been a
major interest to nurses for a long period
of time.
• Determination of nursing costing is useful
in order to show the effectiveness of
nursing practice in an improved and
affordable health care delivery system.
• This has been a major concern of
managers that has the mind of quality
and affordable health services.
• The treatment or intervention should be
considered as “product” of nursing care
and should provide an explainable term
for billing
Benefits that are derivable from having a
standardized nursing care costing
includes:
• Charging out nursing services allows the
customer to pay for what he or she gets.
• Customers realized that direct care has a
fixed price value. This allows them to
understand cost of the health care and
value it.
• Hospitals can receive compensation for
what they provided, to maximized profits.
• Nurses can be viewed as a revenue
generator rather than expenditure
channel.
• Charging a fee for services helps
enhance professionalism of nursing
through the traditional reimbursement.
• Costing out services stimulates
productivity.
• There is room for budget control through
cost accounting system facilities.
• Cost accounting system allows
assessment and change the nursing
departments wants thereby establishing
reputation for innovation
Performance Evaluation/Appraisal
• A nursing performance evaluation is a
written assessment of a nurse's work
performance.
• Also known as a performance appraisal,
the evaluation is typically done on a
regular basis, which may be quarterly,
semi-annually, or annually.
• Feedback is one of the essential
components in nursing curriculum.
• If the feedback to be effective, it should
be given in regular manner on their
performance in a supportive
environment.
• The nursing educators and supervisors
should ensure they provided feedback in
a timely manner and specific to the
learner's performance.
Staff Development
• Staff development is a process directed
towards the personal and professional
growth of nurses and other personal
while they are employed by a health care
agency.
• Staff development refers to all training
and education provided by an employee
to improve the occupational and personal
knowledge, skills and attitudes of rested
of rested employees.
Quality Improvement / Quality
Management
• Continuous quality improvement is a
pathway of improving healthcare delivery
by identifying gaps, implementing and
monitoring corrective measures and
studying its effectiveness.
• Quality management in nursing and
health care focuses on providing
excellent care to patients and ensuring
that health care professionals follow the
right processes and guiding principals to
reduce the risk of harm.
Nursing Audits
Jazmin Ann Bignotea 17
• is a review of the patient record designed
to identify, examine, or verify the
performance of certain specified aspects
of nursing care by using established
criteria.
• is the process of collecting information
from nursing reports and other
documented evidence about patient care
and assessing the quality of care using
quality assurance programs.
• is a detailed review and evaluation of
selected clinical records by qualified
professional personnel for evaluating
quality of nursing care.
• A concurrent nursing audit is
performed during ongoing nursing care.
• A retrospective nursing audit is
performed after discharge from the care
facility, using the patient's record.
Purpose of Nursing Audit
1. To evaluate the nursing care given.
2. To achieve deserved and feasible
quality of nursing care.
3. Stimulant to better records.
4. Focuses on care provided and not on
care provider.
Nursing Rounds
• A nursing round is one which presents an
overview of certain aspects of the nursing
or medical care of all patients on the ward
or of selected patients.
What does variance mean in nursing?
• A patient variance is an irregularity that is
associated with the patient themselves
and not the health care provider or the
facility.
• For example, the development of a
pressure ulcer secondary to the patient's
immobility and poor nutritional status is
an example of a patient related variance.
• Variances, or deviations from practice,
that lead to a quality defect or problem
are reported.
• Variances can be classified as a
practitioner variance, a
system/institutional variance, a patient
variance, a random variance and a
specific variance.
Variance Reports
• A variance report compares actual to
expected results. The typical format is to
first present the actual results, followed
by the expected results (in the form of a
budgeted or standard number), after
which the variance amount and variance
percentage are stated.
• A variance report is not there to place
blame, it is there to identify a problem
with a process so the incident will be less
likely to happen again. All will be
documented on an approved variance
report form.
• Incidents
• Accidents
• injuries
Incident and Accident
• An incident is defined as any event that
is not consistent with the routine
operation of the organization or the
routine care of a particular patient or may
have implications or be of interest to
hospital and/or home care
administration.
• An accident is defined as an act or event
that occurs during patient care which
may cause harm to the patient and/or
employee.
Types of Incidents/Accidents (hereby
referred to as incidents)
• Any incidents where patient or employee
health, safety or welfare is adversely
affected.
• Deviations from company policies,
procedures, operating practices and
professional standards of practice.
• Equipment problems, malfunctions, or
hazards.
• Safety hazards
• Possible exposure to HIV and other
blood borne viruses/pathogens.
Sentinel Event
Jazmin Ann Bignotea 18
• A sentinel event is a patient safety event
that results in death, permanent harm, or
severe temporary harm.
• Sentinel events are debilitating to both
patients and health care providers
involved in the event.
Identifying the Need or Situation Where
Reporting of an Incident, Event, Irregular
Occurrence or Variance is Appropriate
• All incidents, events, irregular
occurrences, and variances must be
identified and reported according to the
particular health care facility's policies
and procedures.
• The purpose of this reporting is to give
the health care facility and the health care
professionals the opportunity to address
the issue and prevent the occurrence of
future incidents, events, irregular
occurrences, and variances.
• The data collected on these reports is
analyzed, tracked and trended over time
in a blame free environment that is
consistent with the health care facility's
culture of safety.
• Nurses must immediately report all client
care issue, concern or problem to the
supervising nurse, the charge nurse
and/or the performance improvement or
risk management department according
to the reporting policies and procedures
of the particular facility.
• All incidents, accidents, adverse events,
irregular occurrence and variances
require the completion of a written report
that will be sent to the risk management
and/or performance improvement
department as per the specific facility's
established policies and procedures.
• Incidents, accidents, and events that
must be reported and documented
include occurrences that are not
expected, not normal, irregular, and
potentially or actually harmful to the
patient, staff, visitors and others.
6 Steps of Problem Solving
Step 1: Identify and Define the Problem
• It is not difficult to overlook the true
problem in a situation and focus your
attention on issues that are not relevant.
• it is important that you look at the
problem from different perspectives.
• This provides a broad view of the
situation that allows you to weed out
factors that are not important and identify
the root cause of the problem.
Step 2: Analyze the Problem
• Break down the problem to get an
understanding of the problem. Determine
how the problem developed. Determine
the impact of the problem.
Step 3: Develop Solutions
• Brainstorm and list all possible solutions
that focus on resolving the identified
problem.
• Do not eliminate any possible solutions at
this stage.
Step 4: Analyze and Select the Best
Solution
• List the advantages and disadvantages
of each solution before deciding on a
course of action.
• Review the advantages and
disadvantages of each possible solution.
Determine how the solution will resolve
the problem.
• What are the short-term and long-term
disadvantages of each solution?
• What are the possible short-term and
long-term benefits of each solution?
• Which solution will help you meet your
goals?
Step 5: Implement the Solution
• Create a plan of action.
• Decide how you will move forward with
your decision by determining the steps
you must take to ensure that you move
forward with your solution.
• Execute your plan of action.
Step 6: Evaluate the Solution
• Monitor your decision.
Jazmin Ann Bignotea 19
• Assess the results of your solution. Are
you satisfied with the results?
• Did your solution resolve the problem?
• Did it produce a new problem?
• Do you have to modify your solution to
achieve better results?
• Are you closer to achieving your goal?
What have you learned?

Jazmin Ann Bignotea 20

NCM 119-A: Nursing Leadership, Management, and Professional Adjustment
Lecture / Week 6
Ethico-Moral Responsibility
1. Autonomy
• The right/freedom to decide (the patient
has the right to refuse despite the
explanation of the nurse)
• Example: surgery, or any procedure
2. Nonmaleficence
• The duty not to harm/cause harm or inflict
harm to others (harm maybe physical,
financial or social)
• Example: A surgeon happens to be
passing and examines the man,
suspecting that he is on the brink of
rupturing his appendix. The surgeon
decides the best course of action is to
remove the appendix in situ, using his
trusty penknife.
3. Beneficence
• It is defined as kindness and charity,
which requires action on the part of the
nurse to benefit others.
• Example:
o An idea that the work of the nurse is
to promote good for the patients.
o Always for the benefit of the patients
4. Justice
• Equality/fairness in terms of
resources/personnel
• Example:
o Training nurses to advocate for
patients
o Administrators can provide training
to ensure that nurses are culturally
competent, advocating for patient
rights, and providing the highest
level of medical care to all
individuals.
5. Veracity
• The act of truthfulness
• Example:
o It is the historical correctness of a
biography, the veracity of the story.
o The verifiable facts in an honest
environmental report are
an example of veracity.
6. Fidelity
• Faithfulness/loyalty to clients
• Example: Healthcare professionals must
keep confidential information personal to
the patient.
Code of Ethics
• A code of ethics is a guide of principles
designed to help professionals conduct
business honestly and with integrity.
• A code of ethics document may outline
the mission and values of the business or
organization, how professionals are
supposed to approach problems, the
ethical principles based on the
organization's core values, and the
standards to which the professional is
held.
Code of Ethics for Nurses in the
Philippines
• The code of ethics for registered nurses
was promulgated by the Philippine
Regulatory Board of Nursing in
consultation and coordination with the
Philippine Nurses Association, with the
code of good governance for the
profession in the Philippines as primary
basis, as mandated by the article III,
section 9, of republic 9173 to serve as
ethico-legal basis in the practice of the
nursing profession in the Philippines.
International Council of Nursing (ICN)
Code of Ethics for Nurses
Elements of the Code
1. Nurses and People
2. Nurses and Practice
3. Nurses and the Profession
4. Nurses and Co-Workers
The most important principles that should be
considered in nursing profession are:
1. Respecting the patient/client and
preserving human dignity
2. Altruism and sympathy
3. Devotion to professional obligations
4. Accountability, responsibility and
conscience
5. Justice in services
6. Commitment to honesty and loyalty
Jazmin Ann D. Bignotea 1
7. Maintaining patient’s privacy, and
commitment to confidentiality, and trust
8. Continuous improvement of scientific and
practical competence
9. Promote the awareness of professional
rules and ethical guidelines, and
respecting them
10. Mutual respect and appropriate
communication with other health care
providers
11. Respecting autonomy of the
patient/client
12. Compassion and kindness
Ethical Guidelines
1. Nurses and People
The Nurse should:
• Make effort for: improvement of
community health, prevention of
diseases, restoration of health and
alleviation of pain and suffering of
patients; and consider these as her/his
main mission.
• Offer the nursing care regardless of race,
nationality, religion, culture, gender, age,
socioeconomic status, political
conditions, physical or mental illness, or
any other factor; and strive to eliminate
injustice and inequality in society.
• Provide the nursing care to client/patient
with respect to the human rights while
considering; to the extent it is possible;
values, socio-cultural traditions, and
religious beliefs of patient/client.
• Educate the community in term of health
promotion and disease prevention and
consider it as one of his/her most
important responsibilities. Nursing care
and standard teaching must be
presented in a way to fit the culture,
beliefs, values and individual’s needs.
• Be sensitive to the challenges and ethical
issues, in both community and
workplace, that could undermine the
sanctity of the nursing profession; and
offer the appropriate solution when is
necessary.
• While cooperating and coordinating with
other individuals, groups and social
institutions, try to address social needs
and resolve ethical issues raised in the
area of health care.
• Pay special attention to vulnerable
groups and individuals such as children,
elderly, people with physical disability,
mental illness, and so on.
• While have attention to the medical
health at the local level, endeavor to
achieve the health goals in national and
international levels.
• Perform his/her responsibilities, in crises
and natural disasters such as war,
earthquake, flood, and disease epidemic,
while taking the necessary precautions.
2. Nurses and the Profession
The Nurse should:
• Take into account ethical
responsibilities, as well as the legal and
professional liabilities, when
implementing the nursing interventions
and making the clinical decisions.
• Within the limits of his/her power and
duties, attempt to provide a safe and
healthy environment for the client /
patient.
• Maintain the safety of the client / patient
by being on time, efficient performance of
the professional duties, and accurate and
complete recording of the performed
care.
• Provide the best care to the client /
patient; based on professional standards
which is resulted from valid research and
reliable evidence.
• Carry out all the nursing interventions
with respect to the client / patient and
his/her family.
• Do his/her maximum effort to conserve
patient’s confidentiality and privacy, and
respect autonomy, and obtain the
informed consent.
• Prevent the probable damage to the
client / patient by detecting and reporting
the professional errors of medical team.
• In case of mistake in nursing
interventions, explain honestly to the
client / patient, and proceed with
Jazmin Ann D. Bignotea 2
 truthfulness and fairness in any
circumstances.
• Maintain and enhance his/her physical,
mental, social, and spiritual abilities.
• Keep his /her knowledge and skills up to
date, in order to maintain the professional
competence.
• Have the capability and knowledge of
effective and safe nursing care, without
direct supervision, and be accountable
for his/her actions.
• Perform in a way that nobody could
question his/her professional credibility
and dignity.
• Be cautious about misuse of his/her
name and position for commercial
advertising of products.
• Avoid the acceptance of any gift or
benefit from the client / patient or their
relatives, which may cause any limitation
either now or in the future.
3. Nurses and Practice
The Nurse should:
• Introduce him /herself with name, title
and his/her professional role to the client
/ patient.
• Provide all the nursing interventions with
respect to the client / patient and
preserving their dignity.
• Consider the client / patient’s demands
regardless of their age, sex, race,
economic status, lifestyle, culture,
religion, political beliefs and physical
abilities.
• Perform the nursing care based on
current knowledge and common sense.
• Produce a gentle behavioral and verbal
communication, in a way that with
attracting the client/ patient trust, their
needs and concerns could be
understood.
• Before performing any nursing
interventions, obtain the patient or his/her
legal guardian consent. In this regard, the
nurse should provide sufficient
information about nursing intervention for
the patient, so that she/he could have the
possibility of well-informed acceptance or
rejection of the service.
• When presenting or applying a new
product in clinical practice, have a
complete knowledge of its risks.
Moreover, provide the client / patient with
the necessary information about benefits
and disadvantages of the product, hence
they could have the possibility of
informed choice.
• Be aware that no one has the right to
consent in place of a competent adult. In
case of children, giving the consent is
one of the legal guardian’s
responsibilities.
• In order to empower the client / patient,
educate him/her and their family, in frame
of care plan and discharge program.
• As an exception, in case of an
emergency, when the immediate
therapeutic action is mandatory for
saving the client / patient’s life, start the
necessary intervention without patient’s
consent.
• Perform the appropriate intervention
based on existing standards and
patient’s higher interests, when obtaining
the informed consent or realizing the
patient’s wishes is not possible.
• Apply the safety measures to be sure that
nursing interventions are harmless, and
when is necessary, consult this matter
with other health team members.
• Consider all the information given or
obtained during the care process as the
professional secrets, and do not reveal
them without client / patient’s permission
except in legally permissible cases.
• Employ the medical information of client /
patient only for health-related purposes
(treatment, research) and in patient’s
interest. Inform the client / patient that
part of his/ her medical record might be
disclosed to other team members for
medical consultation.
• Using the medical information of the
client / patient in research or education
should be with their permission.
Presentation of the result must be done
without mentioning the name, address or
any other information that could lead to
identification of the patient.
Jazmin Ann D. Bignotea 3
• Respect the patient privacy when
performing any nursing intervention.
• When performing the ideal service is
unfeasible, continue the health care, in
best of his /her ability, until establishment
of a new health care program.
• Provide the care for injured or patients in
emergency situations, even outside the
workplace.
• In case of dissatisfaction of the client /
patient or other problem, respect their
right to change the charged nurse or
other health care providers, and as much
as possible, try to satisfy the client /
patient in this matter.
• In case of noticing a violation of
standards of care, inform the authorities
who have sufficient power for
improvement of condition.
• Report any objection or problem of
patient to the ward supervisor.
• Avoid any action, even in patient’s
request, that requires ethical, legal or
religious violation.
• Assist the patients who spend the last
days of their life for accepting the reality
and to appropriately planning of their
demands, including performing the
religious practices or recording their wills.
4. Nurses and Co-workers
The Nurse should:
• Cooperate with medical team members,
the client / patient, and their family, for
more efficient presentation of nursing
interventions.
• Contribute the client / patient or legal
guardian in making decision about
nursing interventions.
• Share his/her professional knowledge
and experience with other colleagues.
• Establish a good relation based on
mutual trust, with medical team.
• Have a respectable conduct with other
nurses, professors and students.
• In case of any conflict of interest in the
care of the client / patient, discuss it with
senior colleagues and the principals,
while giving the priority to preserving the
clients / patients’ rights.
• Establish a respectful professional
relationship with co-workers in various
levels, including the head nurse,
supervisor, nursing director and
department heads.
• Confronting any ethical challenge,
consult the hospital ethics committee for
decision-making.
Nursing Director should:
• Act as a role model for other nurses in all
aspects of professional carrier.
• Put his/her maximum efforts into the
transfer of legal and ethical information to
other nurses.
• Provide the necessary conditions for
participation of nurses in continuous
training program.
• When required, consult ethicists, in order
to resolve the ethical problems, occur
during nursing interventions.
• According to the hierarchy, collaborated
with other colleagues, act in line with
client / patient’s interest.
• With the aim of improving the service
quality, do his/her maximum effort to
maintain a good working environment
and increase professional motivation.
• Behave fairly in the process of evaluation
and promotion of nurses while
considering the professional standards
and nursing ethics code.
5. Nursing, Education, and Research
• Nursing professors should employ their
maximum efforts to update their scientific
knowledge, and to promote ethical
knowledge and conduct.
• The relationship between professors and
students in scientific, educational and
research environments should be based
on professional ethics and mutual
respect.
• Nursing professors should make effort to
improve students’ knowledge and skills
and promote their ethical and
professional performance.
• Consider carefully and accurately the
patient’s rights and ethical concerns, in
cases of using the patients for
educational purposes.
Jazmin Ann D. Bignotea 4
• Medical services should not be affected if
client / patient or their family do not wish
would to-cooperate in education of the
students.
• To improve the healthcare services, the
quality of nursing training courses,
existing guidelines and standards must
be continually reviewed and revised.
• Nurses, who are involved in research,
must pass the specific training courses,
have knowledge about the research
regulations, and be familiar with national,
general, and specific ethical guidelines
and be pledged to these regulations.
• Nurses should not use their professional
positions to convince the client / patient
to participate in the research project.
• Refusal of participation in the research
project by the patient or his/her family
should not influence the delivery of the
nursing interventions.
• Clinical nurses should make effort to
enhance the expertise and clinical
capacities of nursing and midwifery
students.
Rights of Clients
Clients have the right to:
• receive humane care and treatment, with
respect and consideration
• privacy and confidentiality when seeking
or receiving care except for life
threatening situations or conditions
• confidentiality of your health records
• receive accurate information concerning
diagnosis, treatment, risks, and
prognosis of an illness or health condition
• ask about reasonable alternatives to care
at Health Care institution or outside
facilities
• a second professional opinion regarding
diagnosis or treatment
• participate actively in decisions regarding
one’s healthcare and treatment
• accessible information regarding the
scope and availability of services
• be informed about any legal reporting
requirements regarding any aspect of
screening or treatment
• a copy of your medical record upon
request and written authorization
• file a complaint with the director of Health
Care institution regarding any concerns
related to the privacy, confidentiality or
security of your medical record
• review and amend your medical record
• revoke your authorization to release
except to the extent that action has not
already been taken
• a copy of any fees and charges related to
your visit
Clients have a responsibility to:
• provide complete information about one’s
illness/problem, to enable proper
evaluation and treatment
• ask questions to ensure an
understanding of the condition or
problem
• show respect to health personnel and
other patients
• reschedule/cancel an appointment so
another person may see a physician
• pay bills or file health claims in a timely
manner
• use prescription or medical devices for
oneself only
• inform the practitioner(s) if one’s
condition worsens, or an unexpected
reaction occurs from a medication
• provide requests for permission to
release health records in writing to health
care institution.
Ethical Decision Making
• Ethical decision-making refers to the
process of evaluating and choosing
among alternatives in a manner
consistent with ethical principles. In
making ethical decisions, it is necessary
to perceive and eliminate unethical
options and select the best ethical
alternative.
Ethical Frameworks for Decision Making
• Utilizing the ethical principles of:
o Autonomy
o Beneficence
o Nonmaleficence
o Fidelity
Jazmin Ann D. Bignotea 5
 o Justice
o Paternalism
• As outlined by the American Nurses
Association (ANA) provides us with a firm
foundation for ethical decision making.
Ethical Leadership in Nursing
• Ethical leadership in nursing has shifted
to fulfilling the universal ethical principles
in nursing which are autonomy,
beneficence, fidelity, justice,
nonmaleficence, and veracity (Henry, et
al., 2016).
• Justice is the fair treatment that is
offered.
• Nonmaleficence is that nurses will do no
harm to their patient.
Professional Autonomy
• Professional Autonomy is autonomous in
the sense that professions voluntarily
create their own code of ethics on the
basis of this active and positive freedom
and comply with the code by themselves.
• This will describe the legitimacy of this
positive freedom for professional careers
as physicians' discretion.
Personal Work Ethics
• Personal ethics refers to a person's
beliefs about what's right and wrong and
guides individuals in the decisions they
make both in and out of the workplace.
• Your unique ethics will determine how
you handle certain situations at work as
well as how you grow and develop within
your career.
Moral Responsibility
• Moral - personal/private interpretation
from what is good and bad.
• Moral responsibility is the status of
morally deserving praise, blame, reward,
or punishment for an act or omission in
accordance with one's moral obligations.
Deciding what counts as "morally
obligatory" is a principal concern of
ethics.
• Moral principles are guidelines that
people live by to make sure they are
doing the right thing. These include
things like honesty, fairness, and
equality. Moral principles can be different
for everyone because they depend on
how a person was raised and what is
important to them in life.
Moral Principles
1. Golden Rule
• The golden rule is a philosophy for
leading one's life that suggests that other
people should be treated fairly and with
respect.
• Essentially, people act for the good of
others, because they would like to be
treated in the same way.
2. The Principle of Totality
• The principle of totality states that all
decisions in medical ethics must prioritize
the good of the entire person, including
physical, psychological and spiritual
factors.
• The whole is greater than any of its parts.
Suppose a man’s foot is gangrenous,
should he consent to an amputation?
Since the amputation will save the
patient’s life and he can still walk through
the aid of crutches or artificial limbs, he
can consent to an operation.
3. Epikia
• Principle of Epikia (epikia) is a moral
principle applicable to nursing because it
is actually used by taking or treating
some acts as exceptions to the rule.
• Example is allowing a relative to see a
seriously ill patient who expresses the
desire to see the former although it is not
yet visiting hours.
4. One who acts through as agent is
herself responsible – (instrument to the
crime)
• For example, a patient wants to have an
abortion and asks a nurse if she can do
it.
• The nurse refuses, but then recommends
a doctor who is capable of performing an
Jazmin Ann D. Bignotea 6
 abortion. The nurse becomes liable to
such crime, since he/she is an
accomplice of the said doctor.
5. No one is obliged to betray himself.
• No one can force any person to answer a
question if such will incriminate him/her.
6. The end does not justify the means.
• Good intentions do not make an act good
if the means being used are sinful.
• Example: Giving a sleeping tablet to a
chronically ill person so he/she can die in
peace is morally wrong. A physician in
the US assisted a woman, diagnosed as
having Alzheimer’s disease, in
committing suicide. This is both legally
and morally wrong.
7. Defects of nature maybe corrected.
• Congenital defects like cleft lip/cleft
palate can be corrected by plastic
surgery.
• Example: cheiloplasty
8. If one is willing to cooperate in the
act, no justice is done to him.
• Suppose a patient subjects
himself/herself willingly to an
experimental drug and he/she has been
told of the possible effects of the same, is
of right age, and is sane, there is no
violation of human rights.
9. A little more or a little less does not
change the substance of an act.
• If a nurse gets a medicine from a hospital
stock without permission or without
prescription, he/she will be guilty of theft
even if he/she got only one tablet of the
same.
10. No one is held to the impossible
• To promise that a patient with heart
transplant will live may be an
impossibility. Yet, such procedures are
done in the hope of saving or prolonging
a patient’s life.
• The doctor or the nurse cannot be held to
the impossible if they have done their
best to take care of the patient and the
latter dies.
Added Moral Principles
1. Don't kill.
2. Speak the truth.
3. Be careful with what you say and do
to others.
4. Respect the property of others.
5. Treat people in need or distress as
we would want to be treated if our
situation were reversed.
Legal Aspects of Nursing
Republic Act No. 9173
• An act providing for a more responsive
nursing profession, repealing for the
purpose republic act no. 7164, otherwise
known as “The Philippine Nursing Act of
1991” and for other purposes.
ARTICLE I
TITLE
SEC. 1. Title. — This Act shall be known as
the “Philippine Nursing Act of 2002.”
ARTICLE II
DECLARATION OF POLICY
SEC. 2. Declaration of Policy. — It is
hereby declared the policy of the State to
assume responsibility for the protection and
improvement of the nursing profession by
instituting measures that will result in
relevant nursing education, humane working
conditions, better career prospects and a
dignified existence for our nurses.
The State hereby guarantees the delivery of
quality basic health services through an
adequate nursing personnel system
throughout the country.
ARTICLE III
ORGANIZATION OF THE BOARD OF
NURSING
SEC. 3. Creation and Composition of the
Board. — There shall be created a
Professional Regulatory Board of Nursing,
hereinafter referred to as the Board, to be
Jazmin Ann D. Bignotea 7
composed of a Chairperson and six (6)
members. They shall be appointed by the
President of the Republic of the Philippines
from among two (2) recommendees, per
vacancy, of the Professional Regulation
Commission, hereinafter referred to as the
Commission, chosen and ranked from a list
of three (3) nominees, per vacancy, of the
accredited professional organization of
nurses in the Philippines who possess the
qualifications prescribed in Section 4 of this
Act.
SEC. 4. Qualifications of the Chairperson
and Members of the Board. — The
Chairperson and Members of the Board
shall, at the time of their appointment,
possess the following qualifications:
(a) Be a natural born citizen and resident of
the Philippines;
(b) Be a member of good standing of the
accredited professional organization of
nurses;
(c) Be a registered nurse and holder of a
master’s degree in nursing, education
or other allied medical profession
conferred by a college or university duly
recognized by the
Government: Provided, That the
majority of the Members of the Board
shall be holders of a master’s degree in
nursing: Provided, further, That the
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
prior to appointment: Provided,
however, That the last five (5) years of
which shall be in the Philippines; and
(e) Not have been convicted of any offense
involving moral turpitude;
Provided, That the membership to the Board
shall represent the three (3) areas of nursing,
namely: nursing education, nursing service
and community health nursing.
SEC. 5. Requirements Upon Qualification
as Member of the Board of Nursing. —
Any person appointed as Chairperson or
Member of the Board shall immediately
resign from any teaching position in any
school, college, university or institution
offering Bachelor of Science in Nursing
and/or review program for the local nursing
board examinations or in any office or
employment in the government or any
subdivision, agency or instrumentality
thereof, including government-owned or
controlled corporations or their subsidiaries
as well as those employed in the private
sector. He/she shall not have any pecuniary
interest in or administrative supervision over
any institution offering Bachelor of Science in
Nursing including review classes.
SEC. 6. Term of Office. — The Chairperson
and Members of the Board shall hold office
for a term of three (3) years and until their
successors shall have been appointed and
qualified: Provided, That the Chairperson
and Members of the Board may be
reappointed for another term.
Any vacancy in the Board occurring within
the term of a Member shall be filled for the
unexpired portion of the term only. Each
Member of the Board shall take the proper
oath of office prior to the performance of
his/her 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.
SEC. 7. Compensation of 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.
SEC. 8. Administrative Supervision of the
Board, Custodian of its Records,
Secretariat and Support Services. — The
Board shall be under the administrative
supervision of the Commission. All records of
the Board, including applications for
examinations, administrative and other
investigative cases conducted by the Board
shall be under the custody of the
Jazmin Ann D. Bignotea 8
Commission. The Commission shall
designate the Secretary of the Board and
shall provide the secretariat and other
support services to implement the provisions
of this Act.
SEC. 9. Powers and Duties of the Board.
— The Board shall supervise and regulate
the practice of the nursing profession and
shall have the following powers, duties and
functions:
(a) Conduct the licensure examination for
nurses;
(b) Issue, suspend or revoke certificates of
registration for the practice of nursing;
(c) Monitor and enforce quality standards of
nursing practice in the Philippines and
exercise the powers necessary to
ensure the maintenance of efficient,
ethical and technical, moral and
professional standards in the practice of
nursing taking into account the health
needs of the nation;
(d) Ensure quality nursing education by
examining the prescribed facilities of
universities or colleges of nursing or
departments of nursing education and
those seeking permission to open
nursing courses to ensure that standards
of nursing education are properly
complied with and maintained at all
times. The authority to open and close
colleges of nursing and/or nursing
education programs shall be vested on
the Commission on Higher Education
upon the written recommendation of the
Board;
(e) Conduct hearings and investigations to
resolve complaints against nurse
practitioners for unethical and
unprofessional conduct and violations of
this Act, or its rules and regulations and
in connection therewith, issue subpoena
ad testificandum and subpoena duces
tecum to secure the appearance of
respondents, and witnesses and the
production of documents and punish
with contempt persons obstructing,
impeding and/or otherwise interfering
with the conduct of such proceedings,
upon application with the court;
(f) Promulgate a Code of Ethics in
coordination and consultation with the
accredited professional organization of
nurses within one (1) year from the
effectivity of this Act;
(g) Recognize nursing specialty
organizations in coordination with the
accredited professional organization;
and
(h) Prescribe, adopt, issue and promulgate
guidelines, regulations, measures and
decisions as may be necessary for the
improvement of the nursing practice,
advancement of the profession and for
the proper and full enforcement of this
Act subject to the review and approval by
the Commission.
SEC. 10. Annual Report. — The Board shall
at the close of its calendar year submit an
annual report to the President of the
Philippines through the Commission giving a
detailed account of its proceedings and the
accomplishments during the year and
making recommendations for the adoption of
measures that will upgrade and improve the
conditions affecting the practice of the
nursing profession.
SEC. 11. 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.
ARTICLE IV
EXAMINATION AND REGISTRATION
SEC. 12. Licensure Examination. — All
applicants for license to practice nursing
shall be required to pass a written
examination, which shall be given by the
Board in such places and dates as may be
designated by the Commission: Provided,
Jazmin Ann D. Bignotea 9
That it shall be in accordance with Republic
Act No. 8981, otherwise known as the “PRC
Modernization Act of 2000.”
SEC. 13. Qualifications for Admission to
the Licensure Examination. — In order to
be admitted to the examination for nurses, an
applicant must, at the time of filing his/her
application, establish to the satisfaction of
the Board that:
(a) He/she is 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) He/she is of good moral character; and
(c) He/she is 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.
SEC. 14. Scope of Examination. — The
scope of the examination for the practice of
nursing in the Philippines shall be
determined by the Board. The Board shall
take into consideration the objectives of the
nursing curriculum, the broad areas of
nursing, and other related disciplines and
competencies in determining the subjects of
examinations.
SEC. 15. Ratings. — In order to pass the
examination, an examinee must obtain a
general average of at least seventy-five
percent (75%) with a rating of 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 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.
SEC. 16. Oath. — All successful candidates
in the examination shall be 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.
SEC. 17. Issuance of Certificate of
Registration/Professional License and
Professional Identification Card. — A
certificate of registration/professional license
as a nurse 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.
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.
SEC. 18. Fees for Examination and
Registration. — Applicants for licensure
and for registration shall pay the prescribed
fees set by Commission.
SEC. 19. 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.
SEC. 20. Registration by Reciprocity. — A
certificate of registration/professional license
may be issued without examination to nurses
registered under the laws of a foreign state
or country: Provided, That the requirements
for registration or licensing of nurses in said
country are substantially the same as those
prescribed under this Provided, further, That
the laws of such state or country grant the
same privileges to registered nurses of the
Jazmin Ann D. Bignotea 10
Philippines on the same basis as the shall have the power to revoke or suspend
subjects or citizens of such foreign state or the certificate of registration/professional
country. license or cancel the special/temporary
permit of a nurse upon any of the following
SEC. 21. Practice Through grounds:
Special/Temporary Permit. — A (a) For any of the causes mentioned in the
special/temporary permit may be issued by preceding section;
the Board to the following persons subject to (b) For unprofessional and unethical
the approval of the Commission and upon conduct;
payment of the prescribed fees: (c) For gross incompetence or serious
(a) Licensed nurses from foreign ignorance;
countries/states whose service are (d) For malpractice or negligence in the
either for a fee or free if they are practice of nursing;
internationally well-known specialists (e) For the use of fraud, deceit, or false
or outstanding experts in any branch statements in obtaining a certificate of
or specialty of nursing; registration/professional license or a
(b) Licensed nurses from foreign temporary/special permit;
countries/states on medical mission (f) For violation of this Act, the rules and
whose services shall be free in a regulations, Code of Ethics for nurses
particular hospital, center or clinic; and and technical standards for nursing
(c) Licensed nurses from foreign practice, policies of the Board and the
countries/states employed by Commission, or the conditions and
schools/colleges of nursing as limitations for the issuance of the
exchange professors in a branch or temporary/special permit; or
specialty of nursing; (g) For practicing his/her profession during
Provided, however, That the his/her suspension from such practice;
special/temporary permit shall be effective Provided, however, That the suspension of
only for the duration of the project, medical the certificate of registration/professional
mission or employment contract. license shall be for a period not to exceed
four (4) years.
SEC. 22. Non-registration and Non-
issuance of Certificates of SEC. 24. Re-issuance of Revoked
Registration/Professional License or Certificates and Replacement of Lost
Special/Temporary Permit. — No person Certificates. — The Board may, after the
convicted by final judgment of any criminal expiration of a maximum of four (4) years
offense involving moral turpitude or any from the date of revocation of a certificate, for
person guilty of immoral or dishonorable reasons of equity and justice and when the
conduct or any person declared by the court cause for revocation has disappeared or has
to be of unsound mind shall be registered been cured and corrected, upon proper
and be issued a certificate of application therefor and the payment of the
registration/professional license or a required fees, issue another copy of the
special/temporary permit. certificate of registration/professional
The Board shall furnish the applicant a license.
written statement setting forth the reasons for A new certificate of registration/professional
its actions, which shall be incorporated in the license to replace the certificate that has
records of the Board. been lost, destroyed or mutilated may be
issued, subject to the rules of the Board.
SEC. 23. Revocation and Suspension of
Certificate of Registration/Professional ARTICLE V
License and Cancellation of NURSING EDUCATION
Special/Temporary Permit. — The Board

Jazmin Ann D. Bignotea 11

SEC. 25. Nursing Education Program. —
The nursing education program shall provide
sound general and professional foundation
for the practice of nursing.
The learning experiences shall adhere
strictly to specific requirements embodied in
the prescribed curriculum as promulgated by
the Commission on Higher Education’s
policies and standards of nursing education.
SEC. 26. Requirement for Inactive Nurses
Returning to Practice. — Nurses who have
not actively practiced the profession for five
(5) consecutive years are required to
undergo one (1) month of didactic training
and three (3) months of practicum. The
Board shall accredit hospitals to conduct the
said training program.
SEC. 27. Qualifications of the Faculty. —
A member of the faculty in a college of
nursing teaching professional courses must:
(a) Be a registered nurse in the Philippines;
(b) Have at least one (1) year of clinical
practice in a field of specialization;
(c) Be a member of good standing in the
accredited professional organization of
nurses; and
(d) Be a holder of a master’s 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.
In addition to the aforementioned
qualifications, the dean of a college must
have a master’s degree in nursing. He/she
must have at least five (5) years of
experience in nursing.
ARTICLE VI
NURSING PRACTICE
SEC. 28. Scope of Nursing. — A person
shall be deemed to be practicing nursing
within the meaning of this Act when he/she
singly or in collaboration with another,
initiates and performs nursing services to
individuals, families and communities in any
health care setting. It includes, but not limited
to, nursing care during conception, labor,
delivery, infancy, childhood, toddler, pre-
school, school age, adolescence, adulthood
and old age. As independent practitioners,
nurses are primarily responsible for the
promotion of health and prevention of illness.
As members of the health team, nurses shall
collaborate with other health care providers
for the curative, preventive, and rehabilitative
aspects of care, restoration of health,
alleviation of suffering, and when recovery is
not possible, towards a peaceful death. It
shall be the duty of the nurse to:
(a) Provide nursing care through the
utilization of the nursing process.
Nursing care includes, but not limited to,
traditional and innovative approaches,
therapeutic use of self, executing health
care techniques and procedures,
essential primary health care, comfort
measures, health teachings, and
administration of written prescription for
treatment, therapies, oral, topical and
parenteral medications, internal
examination during labor in the
absence of antenatal bleeding and
delivery. In case of suturing of perineal
laceration, special training shall be
provided according to protocol
established;
(b) Establish linkages with community
resources and coordination with the
health team;
(c) Provide health education to individuals,
families and communities;
(d) Teach, guide and supervise students
in nursing education programs
including the administration of nursing
services in varied settings such as
hospitals and clinics; undertake
consultation services; engage in such
activities that require the utilization of
knowledge and decision-making skills
of a registered nurse; and
(e) Undertake nursing and health human
resource development training and
research, which shall include, but not
limited to, the development of advance
nursing practice;
Provided, That this section shall not apply to
nursing students who perform nursing
functions under the direct supervision of a
qualified faculty: Provided, further, That in
the practice of nursing in all settings, the
Jazmin Ann D. Bignotea 12
nurse is duty-bound to observe the Code of
Ethics for nurses and uphold the standards
of safe nursing practice. The nurse is
required to maintain competence by
continual learning through continuing
professional education to be provided by the
accredited professional organization or any
recognized professional nursing
organization: Provided, finally, That the
program and activity for the continuing
professional education shall be submitted to
and approved by the Board.
SEC. 29. Qualifications of Nursing
Service Administrators. — A person
occupying supervisory or managerial
positions requiring knowledge of nursing
must:
(a) Be a registered nurse in the Philippines;
(b) Have at least two (2) years experience in
general nursing service administration;
(c) Possess a degree of Bachelor of Science
in Nursing, with at least nine (9) units in
management and administration courses
at the graduate level; and
(d) Be a member of good standing of the
accredited professional organization of
nurses;
Provided, That a person occupying the
position of chief nurse or director of nursing
service shall, in addition to the foregoing
qualifications, possess:
1) At least five (5) years of experience in a
supervisory or managerial position in
nursing; and
2) A master’s degree major in nursing;
Provided, further, That for primary hospitals,
the maximum academic qualifications and
experiences for a chief nurse shall be as
specified in subsections (a), (b), and (c) of
this section:
Provided, furthermore, That for chief nurses
in the public health agencies, those who
have a master’s degree in public
health/community health nursing shall be
given priority.
Provided, even further, That for chief nurses
in military hospitals, priority shall be given to
those who have finished a master’s degree
in nursing and the completion of the General
Staff Course (GSC):
Provided, finally, That those occupying such
positions before the effectivity of this Act
shall be given a period of five (5) years within
which to qualify.
ARTICLE VII
HEALTH HUMAN RESOURCE
PRODUCTION, UTILIZATION AND
DEVELOPMENT
SEC. 30. Studies for Nursing Manpower
Needs, Production, Utilization and
Development. — The Board, in coordination
with the accredited professional organization
and appropriate government or private
agencies shall initiate, undertake and
conduct studies on health human resource
production, utilization and development.
SEC. 31. Comprehensive Nursing
Specialty Program. — Within ninety (90)
days from the effectivity of this Act, the Board
in coordination with the accredited
professional organization, recognized
specialty organizations and the Department
of Health is hereby mandated to formulate
and develop a comprehensive nursing
specialty program that would upgrade the
level of skill and competence of specialty
nurse clinicians in the country, such as but
not limited to the areas of critical care,
oncology, renal and such other areas as may
be determined by the Board.
beneficiaries of this program are obliged to
serve in any Philippine hospital for a period
of at least two (2) years of continuous
service.
SEC. 32. Salary. — In order to enhance the
general welfare, commitment to service and
professionalism of nurses, the minimum
base pay of nurses working in the public
health institutions shall not be lower than
salary grade 15 prescribed under Republic
Act No. 6758, otherwise known as the
“Compensation and Classification Act of
1989”: Provided, That for nurses working in
local government units, adjustments to their
salaries shall be in accordance with Section
10 of the said law.
Jazmin Ann D. Bignotea 13
SEC. 33. Funding for the Comprehensive
Nursing Specialty Program. — The annual
financial requirement needed to train at least
ten percent (10%) of the nursing staff of the
participating government hospital shall be
chargeable against the income of the
Philippine Charity Sweepstakes Office and
the Philippine Amusement and Gaming
Corporation, which shall equally share in the
costs and shall be released to the
Department of Health subject to accounting
and auditing procedures: Provided, That the
Department of Health shall set the criteria for
the availment of this program.
SEC. 34. Incentives and Benefits. — The
Board of Nursing, in coordination with the
Department of Health and other concerned
government agencies, association of
hospitals and the accredited professional
organization shall establish an incentive and
benefit system in the form of free hospital
care for nurses and their dependents,
scholarship grants and other non-cash
benefits. The government and private
hospitals are hereby mandated to maintain
the standard nurse-patient ratio set by the
Department of Health.
ARTICLE VIII
PENAL AND MISCELLANEOUS
PROVISIONS
SEC. 35. Prohibitions in the Practice of
Nursing. — A fine of not less than Fifty
thousand pesos (P50,000,00) nor more than
One hundred thousand pesos (P100,000.00)
or imprisonment of not less than one (1) year
nor more than six (6) years, or both, upon the
discretion of the court, shall be imposed
upon:
(a) any person practicing nursing in the
Philippines within the meaning of this
Act:
(1) without a certificate of
registration/professional license
and professional identification
card or special temporary permit
or without having been declared
exempt from examination in
accordance with the provision of
this Act; or
(2) who uses as his/her own
certificates of
registration/professional license
and professional identification
card or special temporary permit
of another; or
(3) who uses an invalid certificate of
registration/professional license,
a suspended or revoked
certificate of
registration/professional license,
or an expired or cancelled
special/temporary permit; or
(4) who gives any false evidence to
the Board in order to obtain a
certificate of
registration/professional license,
a professional identification card
or special permit; or
(5) who falsely poses or advertises
as a registered and licensed
nurse or uses any other means
that tend to convey the
impression that he/she is a
registered and licensed nurse; or
(6) who appends B.S.N./R.N.
(Bachelor of Science in
Nursing/Registered Nurse) or
any similar appendage to his/her
name without having been
conferred said degree or
registration; or
(7) who, as a registered and
licensed nurse, abets or assists
the illegal practice of a person
who is not lawfully qualified to
practice nursing.
(b) any person or the chief executive officer
of a juridical entity who undertakes in-
service educational programs or who
conducts review classes for both local
and foreign examination without
permit/clearance from the Board and the
Commission; or
(c) any person or employer of nurses who
violate the minimum base pay of nurses
and the incentives and benefits that
should be accorded them as specified in
Sections 32 and 34; or
(d) any person or the chief executive officer
of a juridical entity violating any
Jazmin Ann D. Bignotea 14
 provision of this Act and its rules and
regulations.
ARTICLE IX
FINAL PROVISIONS
SEC. 36. Enforcement of this Act. — It
shall be the primary duty of the Commission
and the Board to effectively implement this
Act. Any duly law enforcement agencies and
officers of national, provincial, city or
municipal governments shall, upon the call or
request of the Commission or the Board,
render assistance in enforcing the provisions
of this Act and to prosecute any persons
violating the same.
SEC. 37. Appropriations. — The
Chairperson of the Professional Regulation
Commission shall immediately include in its
program and issue such rules and
regulations to implement the provisions of
this Act, the funding of which shall be
included in the Annual General
Appropriations Act.
SEC. 38. Rules and Regulations. — Within
ninety (90) days after the effectivity of this
Act, the Board and the Commission, in
coordination with the accredited professional
organization, the Department of Health, the
Department of Budget and Management and
other concerned government agencies, shall
formulate such rules and regulations
necessary to carry out the provisions of this
Act. The implementing rules and regulations
shall be published in the Official Gazette or
in any newspaper of general circulation.
SEC. 39. Separability Clause. — If any part
of this Act is declared unconstitutional, the
remaining parts not affected thereby shall
continue to be valid and operational.
SEC. 40. Repealing Clause. — Republic
Act No. 7164, otherwise known as the
“Philippine Nursing Act of 1991” is hereby
repealed. All other laws, decrees, orders,
circulars, issuances, rules and regulations
and parts thereof which are inconsistent with
this Act are hereby repealed; amended or
modified accordingly.
SEC. 41. Effectivity. — This Act shall take
effect fifteen (15) days upon its publication in
the Official Gazette or in any two (2)
newspapers of general circulation in the
Philippines.
This Act which originated in the House of
Representatives was finally passed by the
House of Representatives and the Senate on
October 15, 2002, and October 8, 2002,
respectively.
Approved: OCT 21 2002
(Sgd.) GLORIA MACAPAGAL-ARROYO
President of the Philippines
Legal Responsibility
• means specific duties imposed upon a
person to care or provide for another
including liability for personal obligations
as granted through a Power of Attorney
or Court order.
Nurses’ Legal Responsibilities
1. Be responsible for his or her own acts.
2. Protect the rights and safety of patients.
3. Witness, but not obtain informed consent
for procedures.
4. Document and communicate information
regarding client care.
5. Refuse to carry out orders that the nurse
believes to be harmful to the client.
6. Perform acts allowed by the nurse’s state
nurse practice act.
7. Reveal client’s confidential info onlynto
appropriate persons.
8. Perform acts for which the nurse is
qualified either by education or
experience.
9. Witness a will (not a legal obligation).
10. Restrain clients only in emergencies to
prevent injury to self or others.
Other Laws Affecting Nursing Profession
and the Nurse
• Philippine Health Care Laws Republic
Act – an act passed by the Congress of
the Philippines, while the form of
government is Republican government.
Jazmin Ann D. Bignotea 15
• Republic Act 349 – Legalizes the use of
human organs for surgical, medical and
scientific purposes.
• Republic Act 1054 – Requires the owner,
lessee or operator of any commercial,
industrial or agricultural establishment to
furnish free emergency, medical and
dental assistance to his employees and
laborers.
• Republic Act 1080 – Civil Service
Eligibility
• Republic Act 1082 – Rural Health Unit
Act
• Republic Act 1136 – Act recognizing the
Division of Tuberculosis in the DOH
• Republic Act 1612 – Privilege
Tax/Professional tax/omnibus tax should
be paid January 31 of each year
• Republic Act 1891 – Act strengthening
Health and Dental services in the rural
areas
• Republic Act 2382 – Philippine Medical
Act which regulates the practice of
medicines in the Philippines
• Republic Act 2644 – Philippine Midwifery
Act
• Republic Act 3573 – Law on reporting of
Communicable Diseases
• Republic Act 4073 – Liberalized
treatment of Leprosy
• Republic Act 4226 – Hospital Licensure
Act requires all hospital to be licensed
before it can operative
• Republic Act 5181 – Act prescribing
permanent residence and reciprocity as
qualifications for any examination or
registration for the practice of any
profession in the Philippines
• Republic Act 5821 – The Pharmacy Act
• Republic Act 5901 – 40 hours work for
hospital workers Republic Act 6111 –
Medicare Act
• Republic Act 6365 – Established a
National Policy on Population and
created the Commission on population
• Republic Act 6425 – Dangerous Drug Act
of 1992
• Republic Act 6511 – Act to standardize
the examination and registration fees
charged by the National Boards, and for
other purposes.
• Republic Act 6675 – Generics Act of
1988
• Republic Act 6713 – Code of Conduct
and Ethical Standards for Public Officials
and Employees
• Republic Act 6725 – Act strengthening
the prohibition on discrimination against
women with respect to terms and
condition of employment
• Republic Act 6727 – Wage
Rationalization Act
• Republic Act 6758 – Standardized the
salaries Republic Act 6809 – Majority age
is 18 years old
• Republic Act 6972 – Day care center in
every Barangay
• Republic Act 7160 – Local Government
Code
• Republic Act 7164 – Philippine Nursing
Act of 1991
• Republic Act 7170 – Law that govern
organ donation
• Republic Act 7192 – Women in
development nation building
• Republic Act 7277 – Magna Carta of
Disabled Persons
• Republic Act 7305 – The Magna Carta of
public Health Workers
• Republic Act 7392 – Philippine Midwifery
Act of 1992
• Republic Act 7432 – Senior Citizen Act
• Republic Act 7600 – Rooming In and
Breastfeeding Act of 1992
• Republic Act 7610 – Special protection of
children against abuse, exploitation and
discrimination act
• Republic Act 7624 – Drug Education Law
• Republic Act 7641 – New Retirement
Law
• Republic Act 7658 – An act prohibiting
the employment of children below 15
years of age
• Republic Act 7719 – National Blood
Service Act of 1994
• Republic Act 7875 – National Health
Insurance Act of 1995
Jazmin Ann D. Bignotea 16
• Republic Act 7876 – Senior Citizen
Center of every Barangay
• Republic Act 7877 – Anti-sexual
harassment Act of 1995
• Republic Act 7883 – Barangay Health
workers Benefits and Incentives Act of
1992
• Republic Act 8042 – Migrant Workers
and Overseas Filipino Act of 1995
• Republic Act 8172 – Asin Law Republic
Act 8187 – Paternity Leave Act of 1995
• Republic Act 8203 – Special Law on
Counterfeit Drugs
• Republic Act 8282 – Social Security Law
of 1997 (amended RA 1161)
• Republic Act 8291 – Government Service
Insurance System Act of 1997 (amended
PD 1146)
• Republic Act 8344 – Hospital Doctors to
treat emergency cases referred for
treatment
• Republic Act 8423 – Philippine Institute
of Traditional and Alternative Medicine
• Republic Act 8424 – Personal tax
Exemption
• Republic Act 8749 – The Philippine
Clean Air Act of 1999
• Republic Act 8981 – PRC Modernization
Act of 2000
• Republic Act 9165 – Comprehensive
Dangerous Drugs Act 2002
• Republic Act 9173 – Philippine Nursing
Act of 2002
• Republic Act 9288 – Newborn Screening
Act
Presidential Decree – An order of the
President. This power of the President which
allows him/her to act as legislators was
exercised during the Marshall Law period.
• Presidential Decree 46 – An act making
it punishable for any public officials or
employee, whether of the national or
local government, to receive directly or
indirectly any gifts or valuable things
• Presidential Decree 48 – Limits benefits
of paid maternity leave privileges to four
children
• Presidential Decree 69 – Limits the
number of children to four (4) tax
exemption purposes
• Presidential Decree 79 – Population
Commission
• Presidential Decree 147 – Declares April
and May as National Immunization Day
• Presidential Decree 148 – Regulation on
Woman and Child Labor Law
• Presidential Decree 166 – Strengthened
Family Planning program by promoting
participation of private sector in the
formulation and implementation of
program planning policies.
• Presidential Decree 169 – Requiring
Attending Physician and/or persons
treating injuries resulting from any form of
violence.
• Presidential Decree 223 – Professional
Regulation Commission
• Presidential Decree 442 – Labor Code
Promotes and protects employee's self-
organization and collective bargaining
rights. Provision for a 10% right
differential pay for hospital workers.
• Presidential Decree 491 – Nutrition
Program
• Presidential Decree 539 – Declaring last
week of October every as Nurse’s Week.
October 17, 1958
• Presidential Decree 541 – Allowing
former Filipino professionals to practice
their respective professions in the
Philippines so they can provide the latent
and expertise urgently needed by the
homeland
• Presidential Decree 568 – Role of Public
Health midwives has been expanded
after the implementation of the
Restructed Health Care Delivery System
(RHCDS)
• Presidential Decree 603 – Child and
Youth Welfare Act / Provision on Child
Adoption
• Presidential Decree 626 – Employee
Compensation and State Insurance
Fund. Provide benefits to person covered
by SSS and GSIS for immediate injury,
illness and disability.
Jazmin Ann D. Bignotea 17
• Presidential Decree 651 – All births and
deaths must be registered 30 days after
delivery.
• Presidential Decree 825 – Providing
penalty for improper disposal garbage
and other forms of uncleanliness and for
other purposes.
• Presidential Decree 568 – Role of Public
Health midwives has been expanded
after the implementation of the
Restructed Health Care Delivery System
(RHCDS)
• Presidential Decree 1359 – A law
allowing applicants for Philippine
citizenship to take Board Examination
pending their naturalization.
• Presidential Decree 1519 – Gives
medicare benefits to all government
employees regardless of status of
appointment.
• Presidential Decree 1636 – requires
compulsory membership in the SSS and
self-employed
• Presidential Decree 4226 – Hospital
Licensure Act
Proclamation – an official declaration by the
Chief Executive / Office of the President of
the Philippines on certain programs / projects
/ situation
• Proclamation No.6 – UN’s goal of
Universal Child Immunization; involved
NGO’s in the immunization program
• Proclamation No. 118 – Professional
regulation Week is June 16 to 22
• Proclamation No. 499 – National AIDS
Awareness Day
• Proclamation No. 539 – Nurse’s Week –
Every third week of October
• Proclamation No. 1275 – Declaring the
third week of October every year as
“Midwifery Week”
Letter Of Instruction – An order issued by
the President to serve as a guide to his/her
previous decree or order.
• LOI 47 – Directs all school of medicine,
nursing, midwifery and allied medical
professions and social work to prepare,
plan and implement integration of family
planning in their curriculum to require
their graduate to take the licensing
examination.
• LOI 949 – Act on health and health
related activities must be integrated with
other activities of the overall national
development program. Primary Health
Care (10-19-79)
• LOI 1000 – Government agencies should
be given preference to members of the
accredited professional organization
when hiring
Executive Order – an order issued by the
executive branch of the government in order
to implement a constructional mandate or a
statutory provision.
• Executive Order 51 – The Milk Code
• Executive Order 174 – National Drug
Policy on Availability, Affordability, Safe,
Effective and Good Quality drugs to all
• Executive Order 180 – Government
Workers Collective Bargaining Rights
Guidelines on the right to Organize of
government employee.
• Executive Order 203 – List of regular
holidays and special holidays
• Executive Order 209 – The Family Code
(amended by RA 6809)
• Executive Order 226 – Command
responsibility
• Executive Order 503 – Provides for the
rules and regulations implementing the
transfer of personnel, assets, liabilities
and records of national agencies whose
functions are to be devoted to the local
government units.
• Executive Order 857 – Compulsory
Dollar Remittance Law Other Important
Information Administrative Order 114 –
Revised/updated the roles and functions
of the Municipal Health Officers, Public
Health Nurses and Rural Midwives ILO
Convention 149 – Provides the
improvement of life and work conditions
of nursing personnel.
Malpractice and Negligence Act
Jazmin Ann D. Bignotea 18
Negligence is defined as a “failure to use
such care as a reasonably prudent and
careful person would use under similar
circumstances.”
Malpractice – improper or unethical conduct
or unreasonable lack of skill by a holder of a
professional or official position; often applied
to physicians, dentists, lawyers, and public
officers to denote negligent or unskillful
performance of duties when professional
skills are obligatory.
According to Joint Commission on
Accreditation of Healthcare Organizations
(JCAHO)
The following terms were used in the
documentation that described the negligent
behavior:
• Lack of.
• Failure to.
• Ineffective.
• Improper.
• Incomplete.
The negligence categories include:
• Failure to use equipment responsibly.
• Failure to follow standards of care.
• Failure to document.
• Failure to communicate.
• Failure to act as a patient advocate.
• Failure to assess and monitor.
The most common examples of nursing
malpractice include:
• Failing to properly monitor a patient and
missing a change in their vital signs
• Failing to respond to a patient in a timely
manner
• Failing to call a physician for assistance,
when needed
• Failing to update a patient’s chart with
any changes in his or her progress
• Using incorrect abbreviations on a
patient’s chart
• Failing to accurately record a patient’s
condition in their chart
To get a better idea of what nursing home
negligence can entail, review this list of
examples:
• Advanced stage bedsores (i.e.,
pressure ulcers)
• Malnutrition
• Dehydration
• Undiagnosed medical conditions
• Overmedication
• Falling from bed
• Falling from walking without
assistance (when a supportive device
was needed)
• Falling on wet or slippery floors
Contract
• an agreement between two or more
parties which has a binding nature, in
essence, the agreement with legal
enforceability is said to be a contract.
• It creates and defines the duties and
obligations of the parties involved.
Will
• A will is the legal expression of a man’s
wishes as to the disposition of his
property after his death. An instrument in
writing, executed in form of law, by which
a person makes a disposition of his
property, to take effect after his death.
A Last Will and Testament – referred to
simply as a “Will,” is a legal document in
which an individual records his wishes as to
how his possessions and affairs should be
handled after his death.
Legal Protection in Nursing Service
Documentation
• All relevant information must be
recorded.
• All paper records must be legible, signed
and dated.
• Records must be contemporaneous,
accurate and kept up to date.
• Records must be written in plain English
avoiding jargon.
• Records must clearly distinguish
between statements of fact and opinion.
• Paper records if moved to a new location
must be monitored and kept securely.
Jazmin Ann D. Bignotea 19