Nursing Jurisprudence For in House Review

Nursing Law, Jurisprudence and
Professional Ethics: Definition
Ms. MAY JACKLYN C. RADOC-SAMSON, RN, RPT

Overview
 Nursing law, jurisprudence and ethics are
important aspects of nursing practice,
education, and administration
 Total quality patient care

STATISTICS OF CASES FILED AGAINST
Dentists/Physicians/NURSES
As of September 2006
PENDING DECIDED BOARD
20 3 DENTISTRY
356 13 MEDICINE
111 3 NURSING
Malpractice cases
vs. Doctors in General
(1993-2006)
90
80
70
60
50
40
30
20
10
0
93 94 95 96 97 98 99 0 1 2 3 4 5 6 7
Profile of complainant patients (review of 60 cases ) . . . .
Mindanao
Visayas
5%
10%
Luzon
17%
Metro
manila
68%
Place of Incident
Elementary
13%
College High
School
55% 27%
5%
Vocational
Level of Education
Others
10% Gov’t
34% /relative
Doctor / 20%
Relative
36%
Relatives
(within 6th degree) Lawyer /
relative
HOSPITAL/CENTER
NURSE
Doctors
Overview: Nursing
 Nutrix (Latin)– nourish; nursing mother
 Makes progress in all areas: education,

education, administration and research
 An Art, Science, Social Science

Overview: Nursing as an Art
 Deals with skills that require dexterity and

competence
Overview: Nursing as a Science
 Systematic and well-defined body of
knowledge
 No room for:
◦ Unrationalized experience
◦ Intuitive expectation
◦ Unfounded assumption
Overview: Nursing as a Social
Science
 Interest is man
Overview: Nursing
 Nursing exploits research
 Always in the process of constant change

Overview: Nursing
 International Code of Nurses
 Fundamental responsibilities of Nursing:
◦ Promote health
◦ Prevent illness
◦ Restore health
◦ Alleviate sufferings
Overview: Nursing
 Concerned not only with diseases
 …but with the whole person

Overview: Nursing
 Important characteristics of Nursing:
 Nursing is caring
 Nursing involves close, personal contact with the
recipient of care
 Nursing is concerned with services that take
humans into account as physiological, psychological
and sociologic organisms
 Nursing is committed to personalized services for
all persons without regard to color, creed, social or
economic status
 Nursing is committed to promoting individual,
family, community and national health goals
 Nursing is committed to involvement in ethical,
legal and political issues in the delivery of health
Law
 Latin word: lex
 Set of rules established by a governing power
to regulate conduct of people
 Guide actions
 Impose sanctions
 Obligatory
Law
 Ignorantia legis neminem excusat
 Commands the people to do right and

prevents them from doing wrong
 Standards crafted by leaders or rulers of

presumed ethics and wisdom
Law
 “Law then is based upon ethics, not vice versa,
because rights are based upon legitimate human
needs”
 We preserve the integrity of the people/patient
 How?
 By giving them their rights or freedoms
 In that way, Law we satisfy their human needs

Law
 If we satisfy their needs, we allow them to
practice their personal values
 Is there a claim, a demand, or a customary right?
 Are we doing something right?
 If we are doing something ethically correct, then

a standard should be created
 This standard is can now be the law…

Law
 Human conduct can also be regulated by
morals
 Moral regulation is a personal undertaking
 Voluntary
◦ Does not impose sanctions
Law
 Law and morals are both products of
social conscience
 Morals is more extensive
 Law gives premium to justice and

equality rather than morality per se
issue on battered maids

Jurisprudence
 Juris and prudentia (Latin)
 Juris: law or legal
 Prudentia: knowledge, wisdom, or prudence
 Jurisprudence: understand the fundamental

nature of the law, and to analyze its purpose,
structure, and application
 Achieve and promote justice
 Synonymous to law
knowledgeable on the repercussions of actions

Jurisprudence
 What law is?
 What the law ought to be?

Ethics
 Ethos (Greek) – custom or particular behavior
 Deals with the morality of human acts or

conduct
 Shows the way to a right moral decision

Ethics
 Determines which actions are truly humans
 …which actions or things help us fulfill

human needs
 …and decide what to do when values seem in

conflict
Nursing Ethics
 Covers not only the general duty of nurses to

provide care, but also the noble responsibility
to inform and educate patients of their health
needs
Nursing Professional Ethics
 Deals with the moral and ethical behavior of

nurses in the practice of the Nursing
profession
Nursing Jurisprudence
 Branch of law that deals with the study of

nursing laws, lawsuits, liabilities, legal
principles, rules and regulations, case laws,
and doctrines affecting the nursing practice
Nursing Legislation
 Body of laws enacted by the constituent

assembly (Congress) and approved by the
head of state (President), directly affecting
the Nursing practice, Nursing education, and
nursing administration
Medical Ethics vs. Nursing Ethics
 Medical ethics is placed on top of Nursing

ethics
 Views Nursing only as an occupation or

vocation subordinate to medicine
The Professional Nurse
Nursing as a Profession
 Profession – an occupation or calling
requiring advanced training and experience
 Requires intensive training and academic

preparation
 Service-oriented and non-profit motivated
 Has its own unique body of knowledge
 Means of employment, occupation
 International Confederation of Nurses, 1987
 Encompasses the promotion of health,

prevention of illness and care of the
physically ill, mentally ill, and disabled people
of all ages, in all healthcare and other
community settings
 World Health Organization
 Both an art and science that requires the

understanding and application of knowledge
and techniques derived from the humanities
and the physical, social, mental and biological
sciences
 WHO defines the functions of the nurse:
 Providing and managing direct practical

Nursing
 Teaching patients, clients and health care
personnel
 Acting as an effective member of the health
care team
 Developing Nursing practice based on critical
thinking and research

 American Nurses’ Association
 Diagnosis and treatment of human responses

to actual or potential health problems
 Why do we need to define Nursing?
 Help understand the competencies and

professional accountability of the nurse
 Help in the formulation of standards, policies
and laws
 Point the scope and limitations of Nursing
practice to guide researchers on areas that

require further studies
 In 1892, Nursing was already described as a

profession in a magazine article entitled “A
New Profession for Women”
 Nine criteria that contribute to
professionalism
 1. There is an educational background

required to ensure safe and effective practice
◦ Bachelor of Science in Nursing
◦ CHN, OB, Pedia, MS, Psyche, Funda, Management
◦ 11 key areas of responsibility
 1. Safe and quality Nursing care
 2. Management of resources and environment
 3. Health education
 4. Legal responsibility
 5. Ethico-moral responsibility
 6. Personal and professional development
 7. Quality improvement
 8. Research
 9. Record Management
 10. Communication
 11. Collaboration and teamwork
 2. Members of the profession adhere to a

code of ethics
◦ Philippine Code of Ethics for nurses
 3. Members participates in professional

organizations
◦ PNA
 4. Members are accountable for continuing

education and competency
◦ Master’s and Doctor’s degree
◦ In-service programs
◦ Seminars
◦ CPE
 5. Professionals publish and communicate
their knowledge and advances in their
profession
 6. Members of the profession are

autonomous and self-regulating
◦ BON
 7. Professionals are involved in community

services.
 8. A profession develops, evaluates and uses

theory as a basis for practice
 9. Members of the profession are involved in

research
Becoming a Nurse…
 BSN: sole Nursing Education program since
1983
 Competency-based
 Community-oriented
Becoming a Nurse…
 A graduate nurse is presumed to possess:
 Critical and creative thinking

 Caring behavior
 Ability to practice legal, ethico-moral, social
responsibilities/accountabilities
 KSAV
Becoming a Nurse…
 Professional Nursing vs. Nursing rendered
not by a nurse:
 The clinical judgment inherent in the process

of assessment, diagnosis, intervention, and
evaluation
 The knowledge that is the basis of the
assessment of need and the determination of

action to meet the need
Becoming a Nurse…
 Professional Nursing vs. Nursing rendered not
by a nurse:
 The personal accountability for all decisions

and actions, including the decision to delegate
to others
 The structured relationship between the nurse

and the patient which incorporates
professional regulation and a code of ethics
within a statutory framework
 Completed basic Nursing education
 Licensed
 Name and licensed number is entered in the
Commissioner’s registry book
 Must be physically and mentally fit

 Concerned with those basic truths that
contribute to personal growth
 Must develop a personal philosophy of life
 Good personality
Positive Attributes or Values that
Nurses should develop
 Honesty
 Loyalty
◦ Speaking well about co-workers and the institution

where you work
 Tolerance
◦ Respect and accept others as humans
◦ Allowing a patient to verbalize his feelings
 Judgment
◦ Ability to use one’s intellectual capacity to form
sound opinions
◦ Questioning an unclear doctor's order before acting
Positive Attributes or Values that
Nurses should develop
 Reliability
◦ Dependability; responsibility
◦ Reporting for duty during holidays
 Motivation
◦ Aiming to give the best quality to patients
 Resourcefulness
 Moderation
◦ Maintain harmony and balance

◦ Indulging in food, material, goods, that provide
pleasure or enjoyment to the sense in controlled
manner
8 Be-Attitudes of a Nurse
 1. Acceptance
◦ Acceptance of others is indicative of self-maturity
◦ Changing what can be changed within oneself
 2. Helpfulness
 3. Friendliness
◦ Pleasant interaction with others

 4. Firmness
 5. Permissiveness
◦ Loosening or tightening the reign of authority

8 Be-Attitudes of a Nurse
 6. Limit-setting
 7. Sincerity
◦ Recognizing one’s angers, fears, and other feelings

 8. Competence
◦ Displaying knowledge and ability to deal with
situations
Stages of Competence
 Novice
◦ Beginning Nursing student
◦ Nurse entering a situation in which he had no
previous experience
◦ Behavior is limited
 Advanced Beginner
◦ Marginally acceptable performance
Stages of Competence
 Competent
◦ 2 – 3 years
 Proficient
◦ Whole, instead of aspects
◦ Manages nursing care rather than performing tasks
 Expert
◦ Intuitive grasp of the problem
◦ No longer relies on guidelines
Roles and Functions of a
Professional Nurse
 Care Provider
 Communicator
 Teacher
 Counselor
 Client Advocate
◦ Ensures that the needs are met

◦ Promotes what is best for the client
 Change Agent
 Leader
 Manager
Roles and Functions of a
Professional Nurse
 Researcher
 Case manager
 Collaborator
Legal Bases of Nursing
Ms. MAY JACKLYN C. RADOC, RN, RPT
 Nursing Practice = Nursing Education
 Success of Nursing Practice = rests on a

sound educational foundation of nurses
 Success of Nursing Education = determined

by the nurses’ feat in practice
 Nursing Education
 Preparation of students
 Nursing Practice
 Provide quality Nursing Services
 Improve Nursing care

Nursing Education Nursing Practice
Nursing Regulation
 Does everyone has the right to Nursing
Education?
 Article XIV, Section 1 of the 1987 Constitution

◦ Education, Science and Technology, Arts, Culture,
and Sports
 Section 1. The State shall protect and

promote the right of all citizens to quality
education at all levels and shall take
appropriate steps to make such education
accessible to all.
 The State shall protect and promote the right
of all citizens to quality education at all
levels…
 Nursing schools are encouraged to:
◦ Implement standards for admission

◦ Qualifying examinations for year level
promotion
◦ Quality point indices
 The State shall take appropriate steps to
make such education accessible to all…
 Does not mean being in favor for general

accessibility in gross disregard of standards
and qualifications for admission
 …makes it accessible to those who are fit and

prepared for Nursing or other profession
 DECS vs Roberto Rey San Diego (1989)
 The Court feels that it is not enough to simply

invoke the right to quality education as a
guarantee of the Constitution: one must show
that he is entitled to it because of his
preparation and promise. The private
respondent has failed the NMAT five times.
While his persistence is noteworthy, to say the
least, it is certainly misplaced, like a hopeless
love.
 No depreciation is intended or made against
the private respondent. It is stressed that a
person who does not qualify in the NMAT is
not an absolute incompetent unfit for any
work or occupation.
 The only inference is that he is a probably

better, not for the medical profession, but for
another calling that has not excited his
interest.
 In the former, he may be a bungler or at least
lackluster; in the latter, he is more likely to
succeed and may even be outstanding. It is
for the appropriate calling that he is entitled
to quality education for the full harnessing of
his potentials and the sharpening of his latent
talents toward what may even be a brilliant
future
 We cannot have a society of square pegs in

round holes, of dentists who should never
have left the farm and engineers who should
have studied banking and teachers who could
be better as merchants
 It is time indeed that the State took decisive
steps to regulate and enrich our system of
education by directing the student to the
course for which he is best suited as
determined by initial tests and evaluations.
Otherwise, we may be "swamped with
mediocrity," in the words of Justice Holmes,
not because we are lacking in intelligence but
because we are a nation of misfits.
Republic Act No. 9173
 Begun and held in Metro Manila, on Monday,
the twenty-second day of July, two thousand
two.
 enacted by the Senate and the House of

Representatives of the Philippines in
Congress on October 21, 2002
 Known as Philippine Nursing Act of 2002

 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 II: Declaration of Policy
 Section 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.
Nursing Education:
CMO No. 14
Commission on Higher Education
 Republic Act No.7722
 AN ACT CREATING THE COMMISSION ON
HIGHER EDUCATION, APPROPRIATING FUNDS
THEREFORE AND FOR OTHER PURPOSES
 SECTION 1. Title - This act shall be known as

the "Higher Education Act of 1994".
 SEC. 2 Declaration of Policy - The State shall
protect, foster and promote the right of all
citizens to affordable quality education at all
levels and shall take appropriate steps to
ensure that education shall be accessible to all.
The State shall likewise ensure and protect
academic freedom and shall promote its
exercise and observance for the continuing
intellectual growth, the advancement of
learning and research, the development of
responsible and effective leadership, the
education of high-level and middle-level
professionals, and the enrichment of our
 SEC. 2 Declaration of Policy - …State-
supported institutions of higher learning shall
gear their programs to national, regional or
local development plans. Finally, all
institutions of higher learning shall exemplify
through their physical and natural
surroundings the dignity and beauty of, as
well as their pride in, the intellectual and
scholarly life.
 SEC. 3. Creation of the Commission on Higher
Education - In pursuance of the
abovementioned policies, the Commission on
Higher Education is hereby created,
hereinafter referred to as the Commission
 SEC. 3. Creation of the Commission on Higher
Education - …The Commission shall be
independent and separate from the
Department of Education, Culture and Sports
(DECS), and attached to the Office of the
President for administrative purposes only. Its
coverage shall be both public and private
institutions of higher education as well as
degree-granting programs in all post-
secondary educational institutions, public and
private
Introduction
 The BSN program therefore, aims to prepare a nurse who,
upon completion of the program, demonstrates beginning
professional competencies:
 1. Safe and quality Nursing care

 Demonstrate knowledge base on the health/illness status of individual/ groups
 Provides sound decision making in the care of individuals
 Promotes safety and comfort and privacy of patients
 Sets priorities in nursing care based on patient’s needs
 Ensures continuity of care
 Administers medications and other health therapeutics
 Utilizes nursing process as framework for Nursing
 Performs comprehensive and systematic Nursing assessment
 2. Management of resources and environment

 Organizes work load to facilitate patient care
 Ensures functioning of equipment
 Maintains a safe environment
 3. Health education
 Assess learning needs of the patient and family
 Develop health education plan based on assessed and anticipated needs
 Develops learning materials for health education
 Implements the health education plan
 Evaluates the outcome of health education
Introduction
 4. Legal responsibility
 Adheres to practices in accordance with the Nursing law and other
relevant legislation including contracts and informed consent
 Adheres to organizational policies and procedures, local and national
 Documents care rendered to patients
 5. Ethico-moral responsibility
 Respects the rights of individual/groups
 Accepts responsibility and accountability for own decision and actions
 Adhere to the national and international code of ethics for nurses
 6. Personal and professional development
 Identifies own learning needs
 Pursues continuing education
 Gets involved in professional organizations and civic activities
 Projects a professional image of the nurse
 Possesses a positive attitude towards change and criticisms
 Performs functions according to professional standards
Introduction
 7. Quality improvement
 Gathers data for quality improvement
 Participates in nursing audits and rounds
 Identifies and report variances
 Recommends solutions to identified problems
 8. Research
 Gather data using different methodologies
 Recommends actions for implementation
 Disseminates results of research findings
 Applies research findings in nursing practice
 9. Record Management
 Maintains accurate and updated documentation of patient care
 Records outcomes of patient care
 Observes legal imperatives in record keeping
 10. Communication
 Establishes rapport with patients, significant others and members of the health care team
 Identifies verbal and non-verbal cues
 Utilizes formal and informal channels
 Responds to need of the clients
 Uses appropriate information technology to facilitate communication
 11. Collaboration and teamwork
 Establishes collaborative relationship with colleagues and other members of the health
team
 Collaborates plan with other members of the health team
Authority to Operate
 All private higher education institutions
(PHEIs) intending to offer the Bachelor of
Science in Nursing program must first secure
proper authority from the Commission in
accordance with existing rules and
regulations. State universities and colleges
(SUCs) and local colleges and universities
(LCUs) should strictly adhere to the
provisions of these policies and standards.
Program Description
 The BSN is a four-year program consisting
of general education and professional
courses. Professional courses begin in the
first year and threads through the
development of competencies up the fourth
year level. The BSN program provides an
intensive Nursing practicum that will refine
clinical skills from the first year level to
ensure basic clinical competencies required
of a beginning nurse practitioner.
Level Objectives
 At the end of the first year, the students shall have
acquired an understanding and awareness of
themselves as an individual and as a member of the
family, the community, and the world with
emphasis on personal, societal and professional
values responsibilities, rights, and an awareness of
physical, social and cultural milieu.
 At the end of the second year, the student shall

have acquired the holistic understanding of the
human person as a bio-psycho cultural being
focusing on the concept of health and illness as it
is related to the care of the mother and child in
varied settings. The student shall be able to
demonstrate the competencies in the key areas of
responsibility.
Level Objectives
 At the end of the third year, given actual
clients/situation with various physiologic and
psychosocial alterations.
 At the end of the fourth year, given actual

clients/situation the student shall be able to
demonstrate competencies in all the key
areas of responsibility.
Curriculum Outline
 Total Units of General Education (GE)
Courses: 87 Units
 Total Units of Professional Courses: 115 Units
 Total Units of Related Learning Experiences:

46 Units / 2,346 hours
 Total Laboratory Units: 10 Units / 540 hours

Program Administration
 The College shall be administered by a full-time dean with the following
qualifications:
a. a Filipino citizen;
b. a Registered Nurse in the Philippines with current and valid PRC ID;
c. a holder of Master’s degree in Nursing (MAN, MN, MSN) conferred by a
college or university duly recognized by the CHED
d. has at least one (1) year of clinical practice and a total of at least five (5)
years teaching, administrative and supervisory experiences in Nursing
education;
e. should be physically and mentally fit;
f. must be of good moral character;
g. has no other teaching assignments or administrative functions in other
public/private institutions or higher education institutions;
h. a member of good standing of accredited professional nursing
organization;
i. upon appointment, he/she must be an active member of good standing
of
the Association of Deans of Philippine College of Nursing (ADPCN); and,
j. upon appointment, he/she should have a duly notarized employment
contract of at least one (1) academic year renewable annually. The
contract should specify academic rank.
Program Administration
 The Dean shall have the following functions and responsibilities:
a. Prepares short term and long term plans;
b. Initiates curriculum development programs;
c. Plans a rational faculty, academic and non-academic load;
d. Leads in the faculty and staff development programs;
e. Manages human, financial and physical resources;
f. Manages student development programs;
g. Manages department/college office operations;
h. Leads development and utilization of instructional resource
materials;
i. Pursues personal and professional development;
j. Collaborates with the health services, affiliation agencies and
other
academic units in the implementation of instructional programs;
k. Monitors proper implementation of the programs;
l. Initiates research and community extension projects/programs;
m. Establishes internal and external linkages;
n. Obtains recognition/accreditation of the nursing program; and
o. Evaluates the performance results of the nursing program.
Faculty Qualifications/Requirements
 For faculty members teaching professional
courses:
a. a Registered Nurse in the Philippines with

current/valid PRC ID;
b. a holder of Master’s degree in Nursing (MAN,

MN, MSN), Education or other allied medical and
health sciences conferred by a college or
university duly recognized by the Commission on
Higher Education;
c. shall have at least one (1) year of clinical practice
d. a member of good standing of accredited

 The following conditions of employment must be
observed:
a. The salary of faculty shall be commensurate with
his/her academic rank.
b. Full time faculty member who teaches professional
courses shall be responsible for both classroom
and Related Learning Experiences (RLEs).
 Upon appointment, a faculty member should have a

duly notarized employment contract for at least
one (1) academic year renewable annually
specifying academic rank in accordance with his
academic training and clinical expertise. The
recognized ranks are: instructor, assistant
professor, associate professor and professor.
 The College of Nursing shall have an updated five-
year faculty development program (FDP). The FDP
consists of written activities and programs toward
the development of the faculty for intellectual,
personal, and professional as well as moral and
spiritual growth. The program may be in the form of:
 a. graduate studies
 b. scholarship and research grants
 c. in-service and continuing training programs
 d. clinical skills enhancement on official basis for at
least two weeks per year

 Full-time faculty members may carry a
combined RLE and teaching load of not more
than thirty-six (36) units per semester which
includes consultation hours and other activities
related to RLE instruction, research and
extension services. One hour of RLE
supervision is equivalent to one (1) unit credit.
 Nurses from affiliating agencies employed as
preceptors or clinical instructors must be
oriented to the BSN Curriculum and the
expectation of the course.
Library
 The Head librarian should:
a) be a registered librarian;
b) be a holder of Masters’ degree in Library
Science; and,
c) have an appropriate professional training.
 The library should be staffed with one full

time registered librarian for every 1,000
students and a ratio of 1 librarian to 2
staff/clerks.
Library
 Library holdings should conform with existing
requirements for libraries. There should have five
(5) book titles per professional subject found in
the curriculum at a ratio of one (1) volume per
fifteen (15) students enrolled in the program.
Book titles must be of recent edition, published
within the last five (5) years. The higher education
institution [HEI] is encouraged to maintain
periodicals and other non-print materials relevant
to the nursing program to aid the faculty and
students in their academic work. CD-ROMs may
complement a library’s book collection but should
not be considered replacement for the same.
Library
 Opening of new BSN program shall have at least
3,000 total number of books accessioned, 30% of
which shall consist of professional books. Ten
percent (10%) of the total professional book
collection shall be of Filipiniana collection.
 For the opening of new BS nursing program, the
HEI shall have a regular and updated subscription
to at least seven (7) professional foreign nursing
journals and at least two (2) local journals in the
following areas:
a. Maternal and Child Nursing
b. General Nursing
c. Nursing Research
d. Psychiatric Nursing
e. Nursing Management/Leadership
f. Pediatric Nursing
g. Medical-Surgical Nursing
Classroom Requirements
 For regular lecture class, the class size shall
have a maximum of 50 students.
 For science laboratory class, the class size

shall have a maximum of 25 students
 For special lectures, a class size of more than

45 students may be allowed as long as the
required facilities are provided.
 The classroom area shall have at least 7

meter x 9 meter or 63 square meters.
Nursing Skills Laboratory
 An amphitheater-style demonstration
room that can accommodate a maximum
of 50 students at one time with lavatory
and running water;
 Ratio of bed to practicing students is 1:2
or a practice area for return
demonstration where there is one (1) bed
to two (2) students at any given time;
 At least two (2) doors which will serve as
an entrance and exit;
Nursing Skills Laboratory
 At least one (1) fire extinguisher placed outside the

door in each science laboratory/nursing skills
laboratory. The fire extinguisher must have a
record of refill and expiry date attached to the unit;
 Basic demonstration models namely:
 1. Birthing model
 2. Newborn Model
 3. Adult bisexual model with the following
contraptions for:
3.1 basic life support
3.2. tracheostomy care
3.2. colostomy care
3.3 catheterization
3.4 enema
3.5. parenteral/intravenous (IV)
Clinical Facilities and Resources
 The BASE HOSPITAL of a nursing school should
meet the following requirements:
 a. Has current accreditation by the DOH-Bureau
of Licensing and Regulation as Level IV Hospital
(Tertiary Care/Teaching/Training Hospital).
However, Level III Hospitals (Secondary Care
Hospitals) may be considered provided that the
hospital can provide the following:
a.1. adequate case load for the number of
students enrolled
a.2. adequate facilities for the teaching and
learning needs of the students.
 b. Has minimum capacity of 100 beds with
general services and
minimum bed occupancy of eighty percent (80%);
 c. Should be accessible and located within the

region where the nursing school is situated. In the
case of Nursing schools located in Metro Manila, the
base hospital should be located within Metro Manila.
 d. Sixty per cent (60%) of the total bed capacity of

the base hospital shall be used for the RLEs of
students.
 e. Should have a master rotation plan indicating the

schedule/areas of all the schools utilizing the
hospital for training of students.
 Affiliation Hospital is a health facility being
utilized by the higher education institution in
specialized areas for supplementary clinical
learning of students such as mental,
orthopedics and communicable diseases.
 Cross regional affiliations will not be allowed

unless in cases where specialty areas cannot
be found in the region.
 The base hospital/s, affiliation hospital/s and
community health agency/ies being used by the
students for RLEs either conducted in urban or
rural community should have the following
facilities:
a. classroom for conference

b. library
c. comfort room
d. dressing room
e. lounge
f. locker
Instructional Standards
 The ratio of faculty to student in Science
laboratory class is 1:25 while regular classroom is
1:50. The institution shall provide for a
systematic and continuing plan of evaluation of
the student’s progress through a marking system
that is consistent and congruent to set objectives.
 Faculty teaching the lecture shall supervise

students in their RLE. In the case of team
teaching, there should be close coordination and
collaboration between the lecturer and the clinical
faculty.
Ratio of Students to Clientele

Level 1st 2nd Summer
Semester Semester
I NA 1:1 1:1
II 1:1 1:2 1:2
III 1:2-3 1:3-4 NA
IV 1:5 1:6 NA
Ratio of Faculty to Students in RLE (Skills Lab)
Semester Semester
I NA 1:8 1:8
II 1:8 1:8 1:8
III 1:10-12 1:10-12 NA
IV 1:12-15 1:12-15 NA
Ratio of Faculty to Students in RLE (Clinical)

Semester Semester
I NA NA NA
II 1:8 1:8 1:8
III 1:10-12 1:10-12 NA
IV 1:12-15 1:12-15 NA
 For government recognition, an increase in
student population shall be subject to
proportionate increase of resources both in
classroom and clinical area subject to CHED
approval. For this purpose, CHED Regional
Offices shall strictly monitor compliance
herein.
 Nursing schools that are in existence for a
period of five (5) years are encouraged to

undergo program accreditation.
Research Requirements
 The administration shall encourage and
support research among its students and
faculty and promote utilization of research
findings to guide and improve Nursing
practice, educational management and
other aspects of the Nursing program.
 All students shall complete a research
project during the course of study.
Research Requirements
 Faculty research outputs and publications
shall be considered in faculty promotions
and academic ranking. Strict adherence to
ethics in research must be observed.
 There shall be an adequate budget allocated

for research and publications. A functional
research committee or office should
support research and publication activities.
Sanctions
 The average passing rate obtained by HEIs
for the past three (3) years shall be the
basis of phasing-out of the program.
 The computation of the 30% shall only

involve the ratings of the examinees who
took the Nurse Licensure Examination for
the first time.
Sanctions
 The average national passing percentage in
the Philippine Nurses Licensure Examination
from 2004 to 2008 is 45.91%. Two thirds
(2/3) of 45.91% is thirty percent (30%), the
basis for the implementation of gradual
phase-out.
Sanctions
 Thus, in the initial implementation for the
gradual phase out of the Nursing program, an
average of below 30% for a three-year period
(SY 2010-2011, 2011-2012, 2012-2013) in
the Philippine Nurse Licensure Examination
starting from 2013 shall be implemented by
the CHED
Sanctions
 The official results of the Nurse Licensure
Examination from the Board of Nursing of the
Professional Regulation Commission shall be
the basis in phasing-out of nursing programs.
 The performance of the school shall be based

upon the average rating obtained within the
school-year, namely ratings in the June and
December examinations. If the school has only
one examination undertaken in a year, this
shall be considered the annual rating.
Transitory Provision
 Higher education institutions that have been
granted permit or recognition to offer the BS
Nursing program are required to fully comply
with all the requirements in this CMO within
three (3) years after the date of effectivity.
There shall be close monitoring of Nursing
programs by the Commission.
Effectivity Clause
 ThisCMO shall take effect starting

School Year 2009-2010, fifteen
(15) days after its publication in
the Official Gazette or in a
newspaper of national circulation.
Nursing Regulation
Organization of the Board of
Nursing
 There shall be created a Professional
Regulatory Board of Nursing, hereinafter
referred to as the Board, to be composed of a
Chairperson and six (6) members.
Nursing
 They shall be appointed by the President of
the Republic of the Philippines from among
two (2) recommendee, per vacancy, of the
Professional Regulation Commission, herein
after 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
Organization of the Board of Nursing
 (a) Be a natural born citizen and resident of the Philippines.
 (b) Be a number 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 offenses 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.
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 other 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.
Nursing
 He / she shall not have any pecuniary interest

in or administrative supervision over any
institution offering Bachelor of Science in
Nursing including review classes.
Nursing
 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.
Nursing
 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.
Nursing
 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
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.
Nursing
 Powers and Duties of the Board:
 (a) Conduct the licensure examination for

nurses
 (b) Issue, suspend or revoke certificates of

registration for the practice of Nursing;
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 of Higher
Nursing
 (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
there with, issue subpoena ad testificandum and
subpoena duces tecum to ensure 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.
Nursing
 (f) Promulgate a Code of Ethics in

coordination and consultation with the
accredited professional organization of
nurses with one (1) year from the Effectivity
of this Act;
 (g) Recognize nursing specially organizations

in coordination with the accredited
professional organization;
Nursing
 (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.
Nursing
 Removal or Suspension of Board Members:
 (a) Continued neglect of duly or

incompetence;
 (b) Commission or toleration or irregularities
in the licensure examination;

 (c) Unprofessional, immoral or dishonorable
conduct.
Examination and Registration
 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
 Qualifications for Admission to Licensure
Examination:
 (a) He / she is a citizenship of the Philippines,
or a citizen 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.
 Qualifications for Admission to Licensure
Examination:
 (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 he standards of Nursing
education duly recognized by the proper
government agency.
 Ratings:
 In order to pass the examination, an

examinee must obtain the general average of
at least seventy-five percent (75 %) with a
rating of not below sixty percent (60 %) in any
subject.
 Ratings:
 An examinee who obtains an average rating

of seventy-five percent (75 %) or higher but
gets a rating below sixty percent (60 %) in any
subject must take the examination again but
only in the subjects or subjects where he/she
is rated below sixty percent (60 %).
 In order to pass the succeeding examination
an examinee must obtained a rating of t least

seventy-five percent (75 %) in the subject or
subjects repeated.
 Oath:
 All successful candidates in the examination

shall 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.
 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 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
every registrant upon payment of the
required fees.
 Automatic Registration of Nurse:
 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.
Nursing Practice
Nursing Practice
 Complied with the requirements of:
 RA 7722 (Higher Education Act of 1994)

 RA 8981 (The PRC Modernization Act)
 RA 9173 (The Phil. Nursing Act of 2002)
Nursing Practice
 In RA 9173, 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, toddler, pre-school, school age,

adolescence, adulthood and old age.
Nursing Practice
 As independent practitioners:
 Nurses are primarily responsible for the

promotion of health and prevention of illness.
Nursing Practice
 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 peaceful
death.
Scope of Nursing Practice
 Extent or range of health care activities which
a nurse can perform
 Free
 Fee, salary, reward, compensation
 Duties of a nurse:
 A. Provide Nursing care through the utilization

of the Nursing process.
◦ Nursing care included, 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
 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
 E. Undertake Nursing and health human

resource development training and research
which shall include, but not limited to, the
development of advance Nursing practice;
 In the practice of Nursing in all settings:
 The nurse is duty – bound to observe the

Code of ethics for nurses and uphold the
standards of safe Nursing practice.
 The nurse is required to maintain competence

by continual learning through continuing
professional education to be provided by the
accredited professional organization or any
recognized professional Nursing organization.
 The new Nursing law encourages nurses to

expand their practice by pursuing advanced
or specialty trainings
 The widened scope of nursing allows a nurse
to expand its Nursing clinical practice to
include:
 A. Internal examination during labor and

delivery
 B. Suturing of perineal lacerations
 C. Parenteral medications

of the nursing process.
 PRC Resolution No 2004-179 series of 2004
 Standard Guidelines and Procedures for the

Implementation of the Continuing
Professional Education for all Professionals
 Whether for compensation or gratuitously:
 Nurses are held liable for charges of

professional misconduct of fault or
negligence resulting to injury or death of the
patient
 Nurses are held liable also for a supervising
nurse of students on duty under RLE for the

fault or negligence of the latter
 PRC-BON Resolution No. 14, series of 1999
 Adoption of Nursing Specialty Certification

Program and Creation of a Nursing Specialty
Certification Council (NSCC)
 Upgrade the level of skill and competence of

specialty nurse clinicians
 Nurse clinician
 Clinical nurse specialist
Group Specialty Focus
Group 1 Community Health Family; community
Nursing Specialty High-risk groups
Group 2 Medical-Surgical Cardiovascular

Nursing Specialty Pulmonary
Neurology
Gerontology
Critical Care Nursing
Nephrology
Group 3 Mother and Child Health Newborn
Nursing Specialty Child
Reproductive stages of life
High-risk groups
Nursing Specialty Certification
Program
 Nursing specialty certifications can be
obtained from:
 Nursing Specialty Certification Council
 Level I = Nurse Clinician I

 Level II = Nurse Clinician II
 Level III = Clinical Nurse Specialist
Program
 Composed of:
 Didactic training
 Practicum
 Written examination
Program
 Certified copy of TOR of BSN and graduate

MN degrees
 Documents showing completion of the
requirements
 Recommendation of NSCC to BON for
issuance of certification
Program
 Valid for 5 years
 renewable
Program
 The annual financial requirement needed to
train at least ten percent (10%) of the Nursing
staff of the participating government
hospitals shall be chargeable against the
income of:
◦ Philippine Charity Sweepstakes Office
◦ Philippine Amusement and Gaming
Corporation
 The Department of Health shall set the

criteria for the availment of this program.
Expanded Nursing Practice
 Internal examination and suturing of perineal
laceration
◦ Prepared by ANSAP and MCNAP
◦ Standards of Safe Nursing Practice: Internal

Examination and Suturing of Perineal Wounds
laceration
 Internal Examination - an examination of the

female internal reproductive organs by means
of insertion of the examiner’s gloved fingers
into the vaginal canal
laceration
 Suturing laceration – repair of the of the first

and second-degree laceration in the absence
of a physician
laceration
 24-hour didactic lecture

 Practicum
 Minimum experience of 3 years in the:

 LR/DR
 Lying-in Clinic
 Independent practitioner in the community
setting
laceration
 To obtain a Certificate of Training:
 Written exam
 Completion of actual cases
◦ Performing IE safely and with minimum discomfort
◦ Collecting assessment data as basis for pan of care
◦ Safe suturing of perineal lacerations
 Completion of cases
◦ 3 correctly performed IE
◦ 3 supervised suturing of perineal lacerations
 Intravenous therapy
 Stated in RA 7164; includes:
 Intravenous injections :
◦ Drugs
◦ Fluids and electrolytes
◦ Blood and blood products
 Insertion of a needle or butterfly in
intravenous infusions
 ITP is prescribed by ANSAP
 Any RN without training who administered

injections to a patient whether causing or not
an injury or death to the patient shall be held
liable criminally or administratively.
 Discussion of concepts in IVT

 Demonstration of skills in access related
situations
 24-hour didacic lecture = 50%

 Practicum = 50%
 Evaluation:
 Written exam – pre- and post-test
 Completion of actual cases:
◦ Initiating and maintaining peripheral IV

infusion (6 cases)
◦ Administering IV drugs (6 cases)
◦ Administering and maintaining blood and
blood components (2 cases)
 Administration of parenteral medication
 subQ
 ID
 Epidural, intrathecal routes
 Continuous epidural infusion of local
anesthetics and narcotics

of the Nursing process.
 Administration of parenteral medication
 A nurse must refuse to administer a drug:

◦ A. that is an apparent excess
◦ B. that appears to be inappropriate
◦ C. that has possible side effects that may
require immediate medical intervention
◦ D. that he feels that his training or knowledge
of drug is inadequate for the situation
 Advanced nursing practice abroad:
 CRNP
 Nurse anesthetist
 Acute care nurse practitioners
 Adult nurse practitioners
 Geriatric nurse practitioners
 Family nurse practitioners
 Neonatal nurse practitioners
 Nurse midwifery practitioners
 Pediatric nurse practitioners
 Oncology nurse practitioners
 Psychiatric mental health practitioners
 CNOR
 CRNFA

Inactive Nurses
 One who has not actively practiced the
profession for 5 consecutive years
 To go back:
◦ 1 month of didactic training
◦ 3 months of practicum in a hospital
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 in administration courses at the
graduate level
 d. Be a member of good standing of the

accredited professional organization of
nurses
 For chief nurses or director of Nursing
service:
 a. At least five (5) years of experience in a

supervisory or managerial position in Nursing
 b. A master’s degree major in Nursing;

 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)
Salary
 The minimum base pay of nurses working in
the public health institutions shall not be
lower then salary grade 15 prescribed under:
 Republic Act No. 6758
 “Compensation and Classification Act of

1989”,
Prohibitions in the Nursing Practice
 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
 (2) Who uses his/her own certificates or
registration/professional license and
temporary permit of another
 (3) Who uses an invalid certificates of

registration/professional license, a suspended
or revoked certificate of
registration/professional license, or an expired
or cancelled special/temporary permit
 (4) Who gives any false evidence to the Board
in order to obtain a certificate of
registration/professional license, a
permit
 (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
 (6) Who appends BSN/RN (Bachelor of Science
in Nursing/Registered Nurse) or any similar
appendage to his/her name without having
been conferred said degree or registration
 (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
 (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
 (d) Any person or the chief executive officer

of a juridical entity violating any provision of
this Act and its rules and regulations
Public Health Nursing: Positions and
Qualifications
Public Health Nurse Supervising Public

(PHN) (Nurse II and III) Health Nurse
• BSN • BSN
• RN • RN
• Master’s Degree in
Nursing or Public
Health
• 5 years experience
as PHN
Qualifications
 Nurse Instructor II:
• BSN
• RN
• Master’s Degree in Nursing
• 3 years experience as a CHN
• Special training as nurse instructor
Qualifications
Regional Training Nurse Regional Nurse Supervisor/

Regional Public Health Nurse
• BSN • BSN
• RN • RN
• Master’s Degree in • Master’s Degree in Public
Nursing or Public Health or Master’s Degree
Health in Nursing, major in CHN
Administration
• 6 years experience, 3 • 5 years experience in
years of which are in CHN, 2 years of which are
training or Nursing in supervisory position
Qualifications
 Nurse Program Supervisor:
• BSN
• RN
• Master’s Degree in Public Health or Master’s
Degree in Nursing, major in PHN Administration
and Supervision
• 7 years experience in CHN or training
Qualifications
Chief Nurse Assistant Chief Nurse

• BSN • BSN
• RN • RN
• Master’s Degree in • Master’s Degree in
Public Health, major in Public Health, major in
CH Administration or CH Administration or
Master’s Degree in Master’s Degree in
Nursing, major in CHN Nursing, major in CHN
• 5 years experience in • 5 years experience in
CHN, 3 years of which CHN, 2years of which
are in supervisory are in supervisory
Qualifications
Occupational Health Occupational Health

Nurse Nurse Supervisor
• BSN • BSN
• RN • RN
• With units in • 5 years experience in
Occupational Health Occupational Health
Nursing Nursing
Standard Criteria of Nursing
Personnel
 PRC-BON Resolution No. 82
 Set, adopt and promulgate:
 Standards of Safe Nursing Practice

Standards: Nursing Administrator
 Licensed
 Master’s Degree in Nursing Administration
 5 years in Nursing supervisory or
administrative position
 Note: for a hospital with below 50-bed

capacity:
◦ Licensed
◦ At least 2 years of experience in general Nursing
Service Administration
◦ At least 9 units of Management in the graduate
course
Standards: Nursing Administrator
 Planning/budgeting
 Organizing
 Directing/supervising
 Controlling
Standards: Assistant Nursing
Administrator
 Nursing Service
 Research and Training
 Licensed
 Master’s Degree in Nursing Administration
 5 years in Nursing supervisory or
administrative position
 Note: for a 200-bed capacity:

 Assistant Nursing Administrator = Research
and Training
Standards: Nurse
Supervisor/Coordinator
 Licensed
 9 units in the graduate level
 3 years of experience as a senior nurse or
head nurse
Standards: Senior Nurse/Head Nurse
 Licensed
 9 units in the graduate level
 2 years of experience as a staff nurse (with a
very satisfactory performance rating)

Standards: Staff Nurse/Clinic
Nurse/School Nurse
 Licensed
 BSN degree
Practice of Midwifery by a Nurse
 RA No 7392
 Philippine Midwifery Act of 1992
 No person is allowed to practice or offer to

practice midwifery in the Philippines if she
does not hold a valid certificate of
registration from the Board of Midwifery and
a professional license as midwife.
 Services required an understanding of the

principles and application of procedures and
techniques in the supervision and care of
women in pregnancy, labor and puerperium
 Management of normal deliveries including:
◦ The performance of internal examination during

labor except when patient is with antenatal
bleeding
◦ Health education of the patient, family and
community
◦ Primary health care services in the community
including nutrition and family planning
 Carrying out the written order of the
physician with regard to antenatal, intranatal
and postnatal care of the normal pregnant
woman
 In giving immunization, including oral and

parenteral dispensing of the oxytocic drug
after delivery of the placenta, suturing the
perineal lacerations to control bleeding
 To give intravenous fluid during obstetrical
emergencies provided they have been trained
for that purpose
 May inject vitamin K to the newborn

Practice of Medicine by a Nurse
 Under the Medical Act, no person shall
engage in the practice of medicine in the
Philippines unless he is a holder of a valid
certificate of registration duly issued to him
by the Board of Medicine
 Circumstances with which nurses can legally
practice medicine :
◦ During epidemics and national

emergencies, whenever the services of
duly registered physicians are not
available.
 Note:
 Special authorization may be given by the

Secretary of Health.
 Such authorization shall automatically cease

when the epidemic or national emergency is
declared terminated by the Secretary of
Health.
PROVISIONS
RA 9173 Provisions on Nursing Purpose of
Education Inclusion/Improvement
• Rules on licensure exam • In R.A. 7164, if the exam
with the exclusion of a was taken for 3 times
requirement of the without passing, a
refresher course. refresher course is
required. While in R.A.
9173, the taker could
have the exam countless
times without a refresher
course
PROVISIONS
• Addition of a section: • 1 month didactic program
Requirements for nurses and 3 months practicum
who have not actively in any hospital accredited
practiced for 5 to conduct continuing
consecutive years. education units. This
ensures the quality and
competency of the nurse.
PROVISIONS
• Revision on the • Deans of the college
qualifications of the should be equipped with
faculty and dean of the the right knowledge and
College of Nursing. mastery of the subject.
The Dean should have
sufficient experience on
how to manage the
college.
PROVISIONS
• Simplification but • It makes the scope of
comprehensiveness in nursing practice easier to
the scope of Nursing understand and apply. At
practice. the same time, it sets a
higher standard and
quality of all nurses is
maintained.
PROVISIONS
• Refocusing on continuing • Trainings and seminars
professional education updates all nurses with
with trainings and current setups and new
seminar information, procedures,
and skills.
PROVISIONS
• Enrichment on the • In R.A. 7164, A Master of
qualifications of Nursing Arts in Nursing Major in
service administrators by Nursing Service
giving priority to those Administration and 9 units
with Master’s degree in of Management courses
Nursing and general staff is required. The new
course. provision only gives
power to those who are
qualified and already
have the degree.
PROVISIONS
• This act also repealed • This act allowed more
Section 23 Article IV of aspiring nurses to enroll
R.A. 7164 that states in the Colleges of
“Applicants desiring to Nursing.
enroll in nursing course
must belong to the 40%
of the graduating class in
general secondary
education duly certified
by the principal.”
Nursing Law and
Jurisprudence
Reason to study Nursing law and
Jursiprudence
 Nurses are vulnerable to lawsuits
 Constant exposure of nurses to charges of

professional misconduct (for self-confidence
and self-protection)
 Nursing is at the crossroad of challenges with

the advent of medical tourism
Jurisprudence on fault and
negligence
 Nurses are:
 At FAULT:
 When his action is contrary to what should have
been done to the patient
 Considered NEGLIGENT:
 When there is failure in observing the necessary
protection of interests and wellness of the patient
(degree of care, precaution, vigilance) whereby
such patient suffers and injury or death)
BASIC LIABILITIES
CRIMINAL (Law-Revised
Penal Code and Special Laws)
CIVIL (Law-Civil Code)
ADMINISTRATIVE
(Law or Ethics /Nursing Act and
Code of Nursing Ethics)
What is the so called “norm” or standard in HOSPITAL,
medical or Nursing practice
Picart vs Smith, 27 Phil 809
“Would a prudent man, in the position

of the person to whom negligence is
attributed, foresee harm to the person
injured as a reasonable consequence of the
course about to be pursued? If so, the law
imposes a duty on the actor to refrain
from the course or to take precaution
against its mischievous result, and the
failure to do so constitutes negligence.”
What is the so called “norm” or standard in HOSPITAL, medical
or nursing practice
Picart vs. Smith , 27 Phil 809
Test:
“Face with the same situation and
similar circumstance, will other
practitioner (hospital owner, doctor or nurse) act
in the same way?”
Jurisprudence on negligence test
 Reasonable foresight of harm,
followed by ignoring the
admonition
Law
Natural Law Positive Law
Divine Law Human Law
General or Public Law Individual or Private Law

Law
 Elements of a human positive law:
◦ Reasonable rule of action

◦ Due promulgation
◦ Promulgation by competent
authority
◦ Sanction imposed for
disobedience
Law and Jurisprudence in Nursing
Practice
 Constitutional law
 Treats the nature of constitutions, their

adoptions and amendments, their
construction and interpretation, and the
validity of legal enactments
Practice
 Constitutional law
 Cumulative or evolved vs conventional

 Written vs unwritten
 Rigid vs flexible
Practice
 Criminal law
 Defines crimes, treats of their nature and

provides for their punishment
◦ Rules for deciding what has been done

amounts to a crime
◦ Whether the accused has committed a
crime
◦ The punishment or sanction
Practice
 Criminal law
 Covers offenses resulting to injuries or death

of the patient
 Features of injuries:
◦ Nature
◦ Location
◦ Size, shape and incursion
◦ Color
◦ Number
Practice
 Criminal law
 Classifications of death:
◦ Natural
◦ Suicide
◦ Homicide/murder/parricide
◦ Accident
◦ Undetermined
Practice
 Criminal law
 Useful pieces of evidences:
◦ Body
◦ Objects on or with the body
◦ Injuries sustained
◦ Tissues and body fluids
Practice
 Criminal law
 Act No. 3815
Revised Penal Code

of the Philippines
Practice
 Civil law
 Organization of the family and the regulation

of property
 Persons and family relations, property rights

and ownership, obligations and contracts,
and special contracts
Practice
 Civil law
 Republic Act No. 386
New Civil Code / Civil

Code of the
Philippines
Practice
 Civil law
 Executive Order 209
 Family Code
Practice
 Labor law
 Relationship of employers and employees
 Employment standards and other legal

framework
Practice
 Labor law
 Labor standards law

◦ Sets out the minimum terms and conditions and
benefits of employment that employers must
provide or comply with
 Labor relations law
◦ Status, rights and duties and the institutional
mechanisms that govern the individual and
collective interactions of employers and
employees
Practice
 Labor law
 PD No. 442
Labor Code of the

Philippines
Practice
 Administrative law
 Activities or functions of executive or

administrative agencies:
◦ Bureaus
◦ Departments
◦ Boards
◦ Commissions
Practice
 As defined by Roscoe Pound:
 …under which the executive department of

the government, acting in a quasi-legislative
or quasi-judicial capacity, interferes with the
conduct of the individual for the purpose of
promoting the well-being of the community
Practice
 EO No. 292
 Administrative Code of the

Philippines
Practice
 Civil Service law
 Civil service in all branches, subdivisions,

instrumentalities and agencies of the
government
 Intended not to penalize anyone

Practice
 Eradicate the system of appointment to public

service based on political considerations and
to eliminate as far as practicable the element
of partisanship, and personal favoritism in
making appointments.
Practice
 Primary purpose:
◦ Establish a merit system in the selection of public
officers and employees
 General purpose:
◦ Provide a progressive system of personnel
administration to ensure maintenance of an honest,
efficient, progressive and courteous civil service in
the Philippines
Practice
 PD 807
 Civil Service Decree of the

Philippines
Practice
 Case law
 Decisions of the Supreme Court interpreting

the laws or the Constitution or applying them
to certain sets of facts or actual cases and
controversies
Lawsuit
 Every negligent act or professional
misconduct committed by a nurse could
result to criminal, civil (tort/breach), and/or
administrative charges or lawsuits
 Action, complaint, charge, case, legal

proceeding brought to the court, tribunal or
quasi-judicial body, in which the party
commencing the case seeks for a legal
remedy
Lawsuit
Civil Plaintiff vs Defendant
Criminal People vs Accused
Administrative Complainant vs
Respondent
Liability
 Obligation or duty which is owed by one
person to another to refrain from some
course of conduct injurious to the latter or to
perform some act or to do something for the
benefit of the latter and for breach of which
the law gives remedy to the latter as
damages, restitution, specific performance,
and/or injunction
Liability
 Accountability
 Obligation to pay money, do or refrain to do

something, and/or serve penalty
Civil Actions and Civil Liabilities
 The civil liabilities of nurses may arise from
contracts, torts, or crimes
 The civil liability from contracts occurs when a

nurse commits fault or negligence resulting to a
breach of contract to provide and tender safe
nursing services to patients
 The civil liability from torts takes place when a
nurse commits a negligent act or fault sans any
contractual relationship
 The civil liability from crimes arises when a nurse
commits a crime (restitution, reparation of damage
caused, and indemnification for consequential
damages)
 In case of death arising from a crime, the
damages awarded by the court to the heirs of
the victim are:
◦ Indemnities for the death of the victim
◦ Indemnity for the loss of earning capacity
of the deceased
◦ Moral damages
◦ Exemplary damages
◦ Attorney’s fees
◦ Expense of litigation
P 50,000
 Civil liability arises from contracts or torts
 If there is a pre-existing contractual

relationship, a nurse can be accused of fraud,
negligence, or violation of contractual
obligation resulting to damage, injury or death
(culpa contractual)
 If there is a no pre-existing contractual
relationship, a nurse can be accused of
negligence or fault , resulting to damage,
injury or death (culpa aquiliana)
 Culpa contractual – when a nurse is obligated
to perform a particular health service or
intervention to a patient and he causes death
or injury, the nurse is liable for breach of
contract
 Violates the stipulation under the contract
 Direct or personal liability

 Solidary or joint liability
 Provisions of the New Civil Code:
 A contract is a meeting of minds between two

persons where one binds himself, with
respect to the other, to give something or to
do some service (Article 1305)
 Contracts are perfected by mere consent

(Article 1315)
 Provisions in the New Civil Code:
 Those who, in the performance of their

obligation, are guilty of fraud, negligence, or
delay, are liable for damages (Article 1170)
 When through the accident or other cause a

person injured or become seriously ill, and he
is treated while he is not in a condition to give
consent, he is liable to pay for the services of
the physician or other persons, unless the
service has been rendered out of pure
 Culpa aquiliana – in the absence of any
contractual relationship, a nurse may be
liable for damages or injuries sustained by
any person arising from the negligent
conduct of the former
 Breach of a professional duty to any person
fixed by the laws and such breach constitutes

violation of a private legal right
 E.g. when a nurse intervenes in a medical
procedure or provides nursing care without

the consent of the patient or hospital and his
action causes harm or injury
 “Whoever by act or omission causes damage
to another, there being fault or negligence, is
obliged to pay for the damage done.”
 Principle of justice – the injured person

acquires the right to be indemnified and the
person causing the damage the obligation to
repair it.
 Requisites of a civil liability:
 A. there must be damage which must be

proven by the party claiming it
 B. there must be an unlawful act or omission
amounting to fault or negligence

 C. there must be direct causal connection
between the damage and act/omission

 Culpa contractual – diligence of a good father
of a family
 Culpa aquiliana – juris tantum, rebuttable

only by proof of observance of a diligence of
a good father of a family
 Tort – a legal wrong, committed against a
person or property independent of a contract
which renders the person who commits it
liabl for damages in a civil action
Civil Actions and Civil Liabilities:
Torts
 Assault and battery
 Assault – imminent threat of harmful or

offensive bodily contact
 Battery – intentional, unconsented touching of

another person (securing consent)
 It is unjustifiable to touch another person, or to

threaten to do so to cause the other to
reasonably believe that it will be carried out
Torts
 False Imprisonment or Illegal Detention
 Unjustifiable detention without a legal

warrant within boundaries fixed by the
defendant by an act or violation of duty
intended to result in such confinement
Torts
 Examples of exception:
 Patients with communicable disease
 Mentally-ill patients (take their lives or
jeopardize the lives of others
Torts
 RA 9439
Anti-Patient Illegal
Detention Law
Torts
 Invasion of Right to Privacy and Breach of
Confidentiality
 Right to privacy – to be left alone, free from

unwarranted publicity and exposure to public
view
 E.g.
 Revelation of contents of the patient records
 Publication of any picture of a malformed baby
without consent
 A nurse permits a non-professional person to
Torts
 Defamation
 Character assassination
Torts
 Defamation
 Slander – oral defamation of a person by

speaking unprivileged or false words by
which his reputation is damaged
 Libel – defamation by written words, cartoons

or such representations that cause a person
to be avoided, ridiculed or held in contempt
must be heard or read by a third party

Torts
 Kinds of damages recoverable by the
aggrieved party
 Actual or compensatory damages – losses

that are actually sustained by the plaintiff
(put the injured party in a position in which
he was before he was injured
Torts
 Moral damages – awarded by reason of
physical suffering, mental anguish, fright,
serious anxiety, besmirched reputation,
wounded feelings, moral shock, social
humiliation and similar injury
 Nominal damages – awarded for vindication

or recognition of a legal right
Torts
 Temperate or moderate damages – more than
nominal but less than compensatory damages
 Pecuniary loss has been suffered but it’s

amount cannot, from the nature of the case,
be proved with certainty
Torts
 Liquidated damages – damages agreed upon
by the parties to a contract, to be paid in case
of breach thereof
 Exemplary or corrected damages – imposed

by way of example or correction for the
public good
Criminal Actions and Criminal
Liabilities
 Crime – an act committed or omitted in
violation of the law
 Criminal action may arise when a person

perpetrates a crime, violates a special penal
law, or local government ordinances
Liabilities
 If the crime is punishable by:
 RPC – felony
 Special law – offense
 Ordinance - infraction
Liabilities
 Criminal actions – deal with acts or offenses

against public welfare
 Vary from minor offenses and misdemeanors

to felonies
Liabilities
 Misdemeanor - fine or imprisonment for a

term of less than one year
 Felony – sentenced to death or imprisonment

in a penitentiary or prison
Liabilities
 Criminal intent – the state of mind of a
person at the time the criminal act is
committed, that is, he or she knows that an
act is not lawful and still decided to do it
anyway
 2 elements:
◦ FREEDOM
◦ INTELLIGENCE
Liabilities
 Freedom – makes one a human being, not a

tool
 Intelligence – moral capacity to determine

right from wrong, and to realize the
consequences of one’s acts
Liabilities
 Negative factors of crimes:
◦ Insanity
◦ Imbecility
◦ Necessity
◦ Compulsion
◦ Accident
◦ Infancy
Liabilities
 Conspiracy to commit a crime:
◦ Exists when two or more persons agree to commit a
felony and decide to do it.
 PRINCIPALS – those:
 who take a direct path in the execution of the
act;
 who directly force or induce others to commit
it;
 who cooperate in the commission of the
offense by another act without which it would

not have been accomplished
Liabilities
 ACCOMPLICES – are those persons who, not

being principals, cooperate in the execution
of the offense
 One should have knowledge of the criminal

intention of the principal
Liabilities
 ACCESSORIES – having knowledge of the
crime, assist the offender to profit from the
effects of the crime
◦ Concealing or destroying the body of
the crime
◦ Concealing or destroying the
instruments to prevent its discovery
◦ Concealing or assisting in the escape
of the principal of the crime
Criminal Actions: Classes of Felonies
 Felonies (delitos) are classified according to
the degree of acts of execution:
 CONSUMMATED – when all the elements
necessary for its execution and

accomplishment are present
 FRUSTRATED – when the offender performs

all of the acts or execution which will produce
the felony as a consequence but which
nevertheless, do not produce it by reason of
causes independent of the will of the
perpetrator
 ATTEMPTED – the offender commences the

commission of the act, and does not perform
all the acts or execution which shall produce
the felony, by reason of some cause or
accident other than his own spontaneous
desistance.
 Felonies are classified according to the degree
of punishment:
 GRAVE FELONIES – the law attaches the capital

punishment (death) or penalties which in any
of their periods are afflictive
◦ Imprisonment ranging from 6 years and 1
day to life imprisonment
◦ Fine not exceeding P6,000.00
◦ Prision correccional - 6 months and 1 day

to 6 years
 LESS GRAVE FELONIES – law punishes with
penalties which in their maximum period are
correctional
◦ Imprisonment ranging from 1 month and
1 day to 6 years
◦ Fine not exceeding P6,000.00 but not less
than P200.00
◦ Arresto mayor - Imprisonment ranging

from 1 month and 1 day to 6 months
 LIGHT FELONIES – infraction of the law for the

commission of which the penalty of:
◦ Imprisonment for 1 day to 30 days

(arresto menor)
◦ Fine not exceeding P200.00
◦ Both
 Other penalties:
 Reclusion Perpetua- imprisonment for at
least 30 years after which the convict

becomes eligible for pardon
 Reclusion Temporal- 12 years and 1 day to

20 years
 Prision Mayor - 6 years and 1 day to 12 years

Liabilities
 Felonies are committed by:
 deceit (dolo)
 fault (culpa)
Liabilities
 There is deceit when the act is performed

with deliberate intent
 There is fault when the wrongful act results

from imprudence, negligence, lack of
foresight, or lack of skill.
Liabilities
 Under FAULT (culpa):
 CRIMINAL NEGLIGENCE
Liabilities
 Classes of crime:
 Dolo:
 Intentional or malicious crimes (mala in se)
 Crimes as violations of special law (mala
prohibita)
 Culpa:
 Criminal Negligence
Liabilities
 Negligence is deficiency of perception or lack
of foresight: the failure to foresee impending
injury, thoughtlessness, failure to use
ordinary care.
 Imprudence is deficiency of action in avoiding

an injury due to lack of skill.
 Both result to a culpable felony.

Criminal Actions: Criminal
Negligence
 Criminal negligence:
 Reckless imprudence – doing or failing to do an

act resulting to injuries or death due to an
inexcusable lack of precaution
◦ Immediate personal harm

◦ Preventable in the exercise of reasonable
care
◦ Danger to another is visible and consciously
appreciated by the accused
Criminal Actions: Criminal
Negligence
 Criminal negligence:
 Simple imprudence - lack of precaution

displayed in those cases in which the damage
impending to be caused is not immediate nor
the danger clearly manifest.
Liabilities: Criminal Negligence
CRIMINAL NEGLIGENCE
CIVIL LIABILITY CRIMINAL LIABILITY
Indemnification for Deprivation of liberty

damages or compensation (imprisonment)
1 to 4 years and 2 months 1 to 6 months

(reckless imprudence) (simple imprudence)
Circumstances Affecting Criminal
Liabilities: Justifying Circumstances
 Justifying circumstances
 1. Anyone who acts in defense of his person

or rights, provided that the following
circumstances concur;
◦ Unlawful aggression on the part of the offended.

◦ Reasonable necessity of the means employed to
prevent or repel it.
◦ Lack of sufficient provocation on the part of the
person defending himself.
 2. Any one who acts in defense of the person
or rights of his spouse, ascendants,
descendants, or legitimate, natural or adopted
brothers or sisters, or his relatives by affinity
in the same degrees and those consanguinity
within the fourth civil degree, provided that the
first and second requisites prescribed in the
next preceding circumstance are present, and
the further requisite, in case the revocation
was given by the person attacked, that the one
making defense had no part therein.
 3. Anyone who acts in defense of the person or rights
of a stranger, provided that the first and second
requisites mentioned in the first circumstance of this
Art. are present and that the person defending be not
induced by revenge, resentment, or other evil motive.
 4. Any person who, in order to avoid an evil or injury,

does not act which causes damage to another,
provided that the following requisites are present;
◦ That the evil sought to be avoided actually exists;

◦ That the injury feared be greater than that done to avoid it;
◦ That there be no other practical and less harmful means of
preventing it.
 5. Any person who acts in the fulfillment of a
duty or in the lawful exercise of a right or
office.
 6. Any person who acts in obedience to an

order issued by a superior for some lawful
purpose.
Liabilities: Exempting Circumstances
 Exempting Circumstances
 1. An imbecile or an insane person, unless the

latter has acted during a lucid interval.
◦ When the imbecile or an insane person has

committed an act which the law defines as a felony
(delito), the court shall order his confinement in one
of the hospitals or asylums established for persons
thus afflicted, which he shall not be permitted to
leave without first obtaining the permission of the
same court.
 2. A person under nine years of age.
 3. A person over nine years of age and under

fifteen, unless he has acted with discernment,
in which case, such minor shall be proceeded
against in accordance with the provisions of
Art. 80 of this Code.
◦ When such minor is adjudged to be criminally
irresponsible, the court, in conformably with the
provisions of this and the preceding paragraph, shall
commit him to the care and custody of his family who
shall be charged with his surveillance and education
otherwise, he shall be committed to the care of some
institution or person mentioned in said Art. 80.
 4. Any person who, while performing a lawful act with
due care, causes an injury by mere accident without
fault or intention of causing it.
 5. Any person who act under the compulsion of

irresistible force.
 6. Any person who acts under the impulse of an

uncontrollable fear of an equal or greater injury.
 7. Any person who fails to perform an act required by

law, when prevented by some lawful insuperable cause.
Liabilities: Mitigating Circumstances
 Mitigating Circumstances
 1. Those mentioned in the preceding chapter, when all

the requisites necessary to justify or to exempt from
criminal liability in the respective cases are not
attendant.
 2. That the offender is under eighteen year of age or

over seventy years. In the case of the minor, he shall
be proceeded against in accordance with the
provisions of Art. 80.
 3. That the offender had no intention to commit so

grave a wrong as that committed.
 4. That sufficient provocation or threat on the
part of the offended party immediately preceded
the act.
 5. That the act was committed in the immediate

vindication of a grave offense to the one
committing the felony (delito), his spouse,
ascendants, or relatives by affinity within the
same degrees.
 6. That of having acted upon an impulse so

powerful as naturally to have produced passion or
obfuscation.
 7. That the offender had voluntarily surrendered himself
to a person in authority or his agents, or that he had
voluntarily confessed his guilt before the court prior to
the presentation of the evidence for the prosecution;
 8. That the offender is deaf and dumb, blind or otherwise

suffering some physical defect which thus restricts his
means of action, defense, or communications with his
fellow beings.
 9. Such illness of the offender as would diminish the

exercise of the will-power of the offender without
however depriving him of the consciousness of his acts
Liabilities: Aggravating Circumstances
 Aggravating Circumstances
 1. That advantage be taken by the offender of

his public position.
 2. That the crime be committed in contempt or

with insult to the public authorities.

 3. That the act be committed with insult or in

disregard of the respect due the offended party
on account of his rank, age, or sex, or that is be
committed in the dwelling of the offended party,
if the latter has not given provocation.
 4. That the act be committed with abuse of
confidence or obvious ungratefulness.
 5. That the crime be committed in the palace of the

Chief Executive or in his presence, or where public
authorities are engaged in the discharge of their
duties, or in a place dedicated to religious worship.
 6. That the crime be committed in the night time,

or in an uninhabited place, or by a band, whenever
such circumstances may facilitate the commission
of the offense.
Band: an offense committed by three armed malefactors

 7. That the crime be committed on the occasion
of a conflagration, shipwreck, earthquake,
epidemic or other calamity or misfortune.
 8. That the crime be committed with the aid of

armed men or persons who insure or afford
impunity.
 9. That the accused is a recidivist.
 10. That the crime be committed in

consideration of a price, reward, or promise.
 11 That the craft, fraud or disguise be employed.
 12. That advantage be taken of superior strength, or

means be employed to weaken the defense.
 13. That means be employed or circumstances brought

about which add ignominy to the natural effects of the
act.

 14. That the crime be committed after an unlawful entry.

◦ There is an unlawful entry when an entrance of a crime a wall,
roof, floor, door, or window be broken.
 15. That the wrong done in the commission of the crime

be deliberately augmented by causing other wrong not
Liabilities: Alternative Circumstances
 Alternative Circumstances
 Alternative circumstances are those which

must be taken into consideration as
aggravating or mitigating according to the
nature and effects of the crime and the other
conditions attending its commission.
◦ relationship,
◦ intoxication
◦ degree of instruction and education of the offender.
 The alternative circumstance of relationship

shall be taken into consideration when the
offended party in the spouse, ascendant,
descendant, legitimate, natural, or adopted
brother or sister, or relative by affinity in the
same degrees of the offender.
 Relationship:
 Aggravating: physical injuries inflicted by a

descendant to an ascendant
 Mitigating: the accused aided his brother in

the fight against the offended party
 Intoxication:
 Mitigating: the offender has committed a

felony in a state of intoxication, if the same is
not habitual or subsequent to the plan to
commit said felony
 Aggravating: the offender has committed a

felony in a state of intoxication when the
intoxication is habitual or intentional
 Degree of education:
 Mitigating: lack of sufficient intelligence and

knowledge of the full significance of one’s act
 Aggravating:
◦ Rape
◦ Forcible abduction
◦ Arson
◦ Treason
◦ Crimes against chastity (seduction and acts of
lasciviousness)
◦ Acts committed in merciless or heinous manner
Criminal Actions: mala in se
 Moral turpitude:
◦ Act of baseness, vileness or depravity in
social duties which a man owes to his
fellow man or society on general
 Murder:
◦ The unlawful killing of one human by
another, especially with premeditated
malice or intent to kill
 Homicide:
◦ The killing of one human being by another
human being.
◦ It may be committed without criminal intent
 Abortion:
◦ The intent of prematurely ending a
pregnancy, wilfully or unlawfully
 Infanticide:
◦ Killing of a child less than 3 days of age
◦ Imprisonment of 2 years, 4 months, 1 day
to 6 years
 Parricide:
◦ The murdering of one's father, mother, or
other near relative.
◦ Penalty of reclusion perpetua to death
 Robbery:
 The felonious taking of the property of
another from his or her person or in his or

her immediate presence, against his or her
will, by violence or intimidation.
 Controlled Substance:
 RA 6425 (Dangerous Drug Act of 1972)
 Prescription of drugs is in yellow form
 Rape:
 Committed by a man who shall have carnal knowledge

of a woman under any of the following circumstances:
◦ a) Through force, threat, or intimidation;
◦ b) When the offended party is deprived of reason or
otherwise unconscious;
◦ c) By means of fraudulent machination or grave
abuse of authority; and
◦ d) When the offended party is under twelve (12)
years of age or is demented, even though none of
the circumstances mentioned above be present.
 Rape:
 Committed by any person who, under any of

the circumstances mentioned in paragraph 1
hereof, shall commit an act of sexual assault
by inserting his penis into another person's
mouth or anal orifice, or any instrument or
object, into the genital or anal orifice of
another person.
 Sexual harassment:
◦ Work, education or training-related sexual
harassment is committed by an employer,
employee, manager, supervisor, agent of the
employer, teacher, instructor, professor, coach,
trainor, or any other person who, having authority,
influence or moral ascendancy over another in a
work or training or education environment,
demands, requests or otherwise requires any
sexual favor from the other, regardless of whether
the demand, request or requirement for
submission is accepted by the object of said Act.
RA 7877
 Mutilation:
◦ Lopping or clipping off of some parts of the
body resulting to the deprivation of some
essential organs for reproduction
◦ Castration
 Physical injury:
◦ Committed when a person wounds, beats, or
assaults another resulting to serious, less
serious or slight physical injuries
◦ If incapacity of labor lasted from:

 1 to 9 days = slight physical injuries
 10 days or more = less serious physical
injuries
 More than 30 days = serious physical
injuries
 Simulation of birth:
◦ Committed by one who enters in a birth
certificate a birth that did not occur
 Substitution of one child for another;

Abandonment of a legitimate child
◦ 6 years and 1 day to 12 years (Prison mayor)

◦ Fine not exceeding P1,000
Administrative Action and
Administrative Liabilities
 A disciplinary action would arise from:
 ADMINISTRATIVE OFFENSE
 …every act or omission which amounts to, or

constitutes, any ground for disciplinary action
ADMINISTRATIVE
LIABILITY
Government or Private hospital or

public nurses company nurses
 Nurses who work in the government:
 CIVIL SERVICE LAWS
 Civil Service Commission

 Office of the Ombudsman
 Head of the Government Office
prohibit forum shopping

 Nurses who work in the private hospital:
 LABOR CODE
 Employee-employer relationship
 Private hospitals has usually an in-house
mechanism for administrative disciplinary

action of its employees
 Collective bargaining agreement
 Employer-employee relationship:
 Four-way test:
 Selection and engagement of the employee

 Payment of wages
 Power of dismissal
 Power to control the employee’s conduct
 Nurses who work in the government and
private hospitals:
 Three-fold lawsuit
 Law prohibits double recovery

 Unjust enrichment at the expense of another
 Three-fold policy
 With pending administrative cases, civil or

criminal complaints for the same negligent
act can be filed jointly or separately
 Criminal cases can be filed first with the

Office of the Prosecutor or the Office of the
Ombudsman
 Office of the Prosecutor or the Office of the

Ombudsman:
 Mandated by the law to determine the

existence of prima facie
on first examination, a matter appears to be self-evident from the facts

 Administrative offenses:
 “No person shall be deprived of life, liberty or

property without due process of law.” (Article III,
Section 1, 1987 Constitution)
 Due process requires hearing and notice
 “A law which hears before it condemns, which

proceeds upon inquiry and renders judgment
only after trial.”
 Administrative due process:
 1. right to notice
 2. reasonable opportunity to appear and
defend his right, introduce witnesses and

evidences
 3. constituted tribunal
 4. finding or decision by the tribunal
supported by a substantial evidence
 Kinds of administrative offenses:
 1. GRAVE OFFENSES punishable with

DISMISSAL at the first offense
 GRAVE OFFENSES punishable with DISMISSAL
at the first offense
 Falsification of official document

 Receiving for personal use of a fee, gift or
other valuable things in the course of official

duties in the hope or expectation of receiving
a favor
 Soliciting or accepting any gift, gratuity,
favor, entertainment etc.

 Disloyalty to the RP and Filipino people
 Nepotism
 2. GRAVE OFFENSES punishable with SUSPENSION
at the first offense (6 months to 1 year) and
DISMISSAL at the second offense
 Oppression
 Disgraceful and immoral conduct
 Inefficient and incompetence in the performance
of official duties
 Frequent unauthorized absence or tardiness
 Refusal to perform official duty
 Gross insubordination
 3. LESS GRAVE OFFENSES punishable with
SUSPENSION at the first offense (1 to 6 months)
and DISMISSAL at the second offense
 Simple neglect of duty

 Simple misconduct
 Gross discourtesy
 Insubordination
 Habitual drunkenness
 Unfair discrimination in rendering public service
due to party affiliation or preference
 4. LIGHT OFFENSES
 1st offense: reprimand

 2nd offense: suspension 1 to 30 days
 3rd offense: dismissal
 LIGHT OFFENSES
 Discourtesy in the course of duties

 Improper or unauthorized solicitation of
contribution from subordinate employees
 Gambling
 Refusal to render overtime service
 Lending money at usurious rates of interest
Acts and Transactions of Nurses in
the Government
 Financial and material interest prohibition
 Outside employment and other related
activities prohibition
 Disclosure and/or misuse of confidential
information
 Solicitation or acceptance of gift
Change of Citizenship
 “Public officers and employees owe to the
State and the Constitution allegiance at all
times, and any public officer or employee
who seeks to change his citizenship or
acquire status of an immigrant of another
country during his tenure shall be dealt with
law.”
Administrative Penalties against
Nurses in Public Service
 Removal or dismissal from service
 Forced resignation with or without prejudice
to benefits
 Demotion in rank
 Suspension for not more than 1 year without
pay
 Fine in the amount of not exceeding 6
months salary
 Transfer
 Reprimand
Nurses in Private Sector
 Illegality of the act of dismissal = discharge

without just cause
 Illegality in the manner of dismissal =

dismissal without due process
 An employer may terminate an employment
for any of the following causes (New Labor
Code):
 Serious misconduct or willful disobedience

 Gross and habitual neglect by the employee
of his duties
 Willful breach of the trust
 Commission of a crime or offense
 An employer may terminate an employment
due to the following authorized causes:
 Installation of labor-saving devices

 Redundancy
 Retrenchment to prevent losses
 Closing or cessation of operation
Civil Action Plaintiff Preponderance
of evidence
Criminal People or the Proof beyond

Action State reasonable
doubt
Administrative Complainant Substantial

Action evidence
Legal Doctrines in Medical-
Nursing Jurisprudence
Specific Examples of Negligence
 1. Failure to report observations to attending
physicians
 2. Failure to exercise the degree of diligence,

which the circumstances of the particular
case demands
 3. Mistaken identity
 4. Wrong medicine, wrong concentration,

wrong route, and wrong dose
Specific Examples of Negligence
 5. Defects in the equipment such as
stretchers and wheelchairs may lead to falls
thus injuring the patients
 6. Errors due to family assistance
 7. Administration of medicine without a

doctor’s prescription
Bonus pater familias
 Good father of a family
 The employer ultimately becomes liable on

his own negligence
 Negligent in the selection of his employees

(culpa in eligiendo)
 Negligent in the supervision of his employees
(culpa in vigilando)
Doctrine of Bonus Pater Familias
 Rebutted by juris tantum (disputable
presumption)
 Useful and effective legal defense in civil

actions for quasi-delicts, not in civil actions
for breach of contract
Doctrine of Respondeat Superior
 Let the master answer
 Let the master answer for the acts of the
subordinate
 The negligence of the employee, in the course

of his employment, is conclusively presumed
(jure et de jure) to be the negligence of the
employer
 Observes and follows by the court in an action

for breach of contract
Doctrine of Respondeat Superior
 The liability is expanded to include the
master as well as the employee and not a
shift of liability from the subordinate to the
master
Corporation
COLLEGE/
UNIVERSITY
HOSPITAL
Nursing
Students
Consultant
Employer-Employee
Relationship
Nurse
Nursing Aide
Supreme Court Decisions . . .
December 29, 1999
RAMOS VS. COURT OF APPEALS

G.R. No. 124354
SC: “Captain of the Ship Doctrine applies . .

. The attending physician is responsible for
the negligent acts of the staff under his control
and supervision . . .”
Doctrines: Civil Liabilities
Ostensible
OstensibleAgent
Agent Borrowed
BorrowedServant
Servant Captain
Captainof
ofthe
theShip
Ship
Hospital
Surgeon / Clinician
Pathologist Radiologist
Technicians
Nurses Anesthesiologist
Sonologists s
Resident
Technologists
Physicians
December, 2006:
Rogelio Nogales, et al, vs Capitol

Medical Center, et al, G.R. No. 142625
Ostensible Agent
January 31, 2007
Professional Services, Inc. vs. Agana, (G.R. No.

126297), and Agana vs. Juan Fuentes (G.R. No.
126467),
Corporate Negligence
“Recent years have seen the “Doctrine of
Corporate Negligence” as the judicial answer to the
problem of allocating hospital’s liability for the negligent
acts of health practitioners, absent facts to support the
application of Respondeat Superior or apparent authority.
Its formulation proceeds from the judiciary’s
acknowledgment that in these modern times, the duty of
providing quality medical service is no longer the sole
prerogative and responsibility of the physician. The
modern hospitals have changed structure. Hospitals
now tend to organize a highly professional medical staff
whose competence and performance need to be
monitored by the hospitals commensurate with their
inherent responsibility to provide quality medical care.”
DOCTRINE OF VICARIOUS LIABILITY
Doctrine of Imputed Negligence/Command

Responsibility.
Vicarious liability means the responsibility of

a person, who is not negligent, for the
wrongful conduct or negligence of another.
BORROWED SERVANT DOCTRINE
By fiction of law, they are deemed borrowed

from the hospital by someone and for any
wrongful act committed by them during the
period, their temporary employer must be
held liable for the discharge of their acts and
duties;
CAPTAIN-OF-THE-SHIP DOCTRINE
This doctrine explains the liability of the
surgeon not only for the wrongful acts of
those who are under his physical control but
also those wherein he has extension of
control.
Doctrine of Negligent Conduct
 The fault of negligence of the employee
(nurse) is the direct or sole cause of breach of
contract resulting to damage or injury to the
other party.
Doctrine of Res Ipsa Loquitor
 The thing speaks for itself
 Applied to physical torts where the res (thing)

need not be explained beyond the obvious
facts as shown
 No further proof is required
 The need for expert medical testimony is
dispensed with because the injury itself is a

proof of negligence
Doctrine of Res Ipsa Loquitor
 Conditions required:
 The injury was of such nature that it would

not normally occur unless there was a
negligent act on the part of someone
 The injury was caused by an agency within
control of the defendant

 The plaintiff himself did not engaged in any
matter that would tend to bring about the

injury
Doctrine of Common Knowledge
 Expert witness is not necessary for the proof

of negligence in non-technical matters or
those of which an ordinary person may be
expected to have knowledge of, or where the
lack of skill or want of care is obvious as to
render expert testimony unnecessary
Doctrine of Damnum Absque Injuria
 Although there was physical damage, there

was no legal injury
Doctrine of Force Majeure
 Force majeure = irresistible force, one that is
unforeseen or inevitable
 Also known as “vis mayor” or fuerza mayor”
 The intervention of irresistible force in any

nursing action that causes damage or injury to
a patient may free or exempt a nurse from any
criminal liability if he can show that he exercise
due care and diligence in the performance of
his function
Doctrine of Stare Decisis
 Stare decisis et non qieta movere
 Stand by decisions and do not move that
which is quiet
 To abide or adhere to decided cases
 Needs to be followed as a precedent in

subsequent litigation, by the same court and
by courts of lower rank
Doctrine of Nolo Contendere
 I do not wish to contend
 Plea of “ No Contest”
 The defendant does not admit nor deny the

charges, but will accept the penalties for the
crime without protest.
Doctrine of Nolle Prosequi
 Unwilling to pursue
 Unwilling to follow through
 May have the effect of dismissal of the case

because the complainant or plaintiff is no
longer interested to prosecute the case
Doctrine of Informed Consent
 2 parts:
 INFORMATION
 CONSENT
CONSENT
Ethics Requirement
INFORMED
CONSENT
LEGAL
Information
Comprehension
Voluntariness
 Information – there must be disclosure of the
physician of the facts surrounding the
disease and the physician’s treatment of the
client so the client have full comprehension
 Consent – free and rational act that which

presupposes knowledge of the thing to which
consent is being given by a person who is
legally capable to give consent
 Voluntary
 Authorization
 It is established principle of law that every
human being of adult years and of sound
mind has the right to determine what shall be
done with his own body
 Elements:
 1. Diagnosis and explanation of the condition

 2. Fair explanation of the procedures to be
done and the consequences

 3. Description of alternative treatments or
procedures
 4. Description of the benefits expected
 5. Material rights, if any
 6. Prognosis, if the procedure is refused
WHO CAN GIVE CONSENT?
PATIENT SPOUSE CHILDREN
GRANDPARENTS PARENTS
BROTHERS
SISTERS
NEAREST KIN
STATE
administrative consent
CONSENT . . .
WHO HAS THE DUTY TO

EXPLAIN?
NURSE DOCTOR
NURSING PROCEDURES MEDICAL PROCEDURES
PATIENT
Admitting
Consent of Minors
 Parents
 Parental consent is not needed, however, if

the minor is married or otherwise
emancipated
Consent of Mentally Ill
 Parents or legal guardian
Consent for Emergency Situation
 NO CONSENT IS NECESSARY because inaction
may cause greater injury
 If time is available and an informed consent is

possible, it is best that this be taken for the
protection of all the parties concerned
 Implied consent
Consent for Sterilization
 Sterilization – termination of the ability to
produce offsprings
 Husband and the wife gives consent
 If sterilization is an incidental result such as

in abruptio placenta, ectopic pregnancies, or
ruptured uterus, the patient’s consent alone
is sufficient
Refusal to Consent
 A patient who is mentally and legally
competent has the right to refuse medical
and surgical procedures
Other Legal Aspects
and the Nurse
Medical Orders and Medications
 RA 6675 – Generics Acts of 1988
 Only validly registered medical, dental,
veterinary practitioners, whether in private
institutions or government, are authorized to
prescribe drugs
 Prescriptions made by unauthorized persons

constitute ILLEGAL PRACTICE
 Requires that drugs be written in their

generic names
 RA 2832 – Medical Act of 1959

 RA 4419 – Dental Act
 RA 382 – Veterinary Act
 RA 5921 – Pharmacy Act
 All prescriptions must contain the following

information:
◦ Name of the prescriber
◦ Office address
◦ Professional registration number
◦ Professional tax receipt number
◦ Patient’s name
◦ Age and sex
◦ Date and prescription
 Function of the nurse:
 Execution of written legal orders of
physicians concerning treatment and
medications
 Only when the orders are LEGAL IN WRITING

and BEAR THE DOCTOR’S SIGNATURE does
the nurse have the right to follow them
Telephone Orders
 Doctors should limit telephone orders to
extreme emergency situations where there is
no alternative
 Nurses should accept telephone orders only

in:
◦ Extreme emergency
◦ No other resident or intern is available
Telephone Orders
 Nurses should READ BACK orders to make certain
that it has been correctly received and written on
the patient’s chart
 Have another nurse listen on the phone as

witness, who then initials the order for verification
of accuracy.
 The verbal order should be signed on the

physician’s next visit within 24 hours
 Nurse should sign the name of the physician per

her own and note the time the order was received
Medical Records
 Nurses must remember:
 IF IT WAS NOT CHARTED, IT WAS NOT
OBSERVED OR DONE
 Nurses are expected to record fully, accurately,

legibly, and promptly their observations from
admission to discharge
 Nurses are responsible for safeguarding the

patient’s records from loss, destruction or
from access by persons who are not legally
authorized to read such
Medical Records
 Permission has to be taken from the hospital
authorities for authorization to secure any
information from the patient’s chart
 Subpeona duces tecum:

◦ It is usually the medical records librarian
who testifies that the patient’s records are
kept an protected from unauthorized
handling and change
Charting Done by Nursing Students
 When the clinical instructor countersigns the
charting of students:
 He attests he has knowledge of

information and that it is accurate
and authentic
Legal Risks for Defective Equipment
 The nurse:
 Should make sure that the equipment used in

procedures and treatments is not defective
 Should see to it that all pieces of equipment

are regularly inspected, maintained and are
functioning properly.
Points to Observe by Nurses in Order
to Avoid Criminal Liability
 Be very familiar with the Philippine Nursing Law.
 Beware of laws affect nursing practice.
 At the start of employment, get a copy of your

job description, the agency’s rules, regulations
and policies.
 Upgrade your skills and competence.
 Accept only such responsibility that is within the

scope of your employment and job description.
 Do not delegate your responsibility to others.
 Determine whether your subordinates are

competent in the work you are assigning them.
 Develop good interpersonal relationships with

your co-workers, whether they be your
supervisors, peers, subordinates.
 Consult your superiors for problems that may be

too bog for you to handle
 Verify orders that are not clear to you and
may seem erroneous
 Doctors should be informed about the

patient’s condition
 Keep in mind the value and necessity of

keeping accurate and adequate records
 Patients are entitled to an informed consent

Wills
 A legal declaration of a person’s intentions
upon death.
 Called TESTAMENTARY DOCUMENT because it

takes effect after the death of its maker
 A person is permitted with the formalities

prescribed by the law, to control to a certain
degree the deposition of his estate, to take
effect after his death
Wills
 Decedent – person whose property is transmitted
through succession whether or not he left a will
 Testator (testatrix) – if the decedent left a will
 Heir – person called to succession either by the

provision of a will or by operation of law
 A person who dies leaving a will is said to have

died testate
 A person who dies without a will is said to have

died intestate
Will
 Probate – validation of a will in court
 Administrator – one who administers the

provisions of the will
 Holographic will – written, dated and signed

by the testator; may me made in and out of
the country and need not a witness
◦ In the probate of a holographic will, it is necessary
that at least one witness who knows the
handwriting and signature of the testator explicitly
declares that the will and signature are in the
handwriting of the testator
Will
 Nuncupative will or nuncupation – oral will
 Restrictions:
◦ Such will be made during the person’s last
illness
◦ Be done in the place in which he died
◦ Asked one or more witnesses to the will
◦ Be put in writing within a given number of
days
◦ Be offered for probate within a specified
time
Will
 Essentials of will to meet legal requirements:
 The testator must have the expressed

intention of making a will.
◦ Right age (those under 18 cannot make a
will)
◦ Sound mind
◦ Clear thinking ability at the time of its
execution
◦ Free from undue influence
Will
 Testator should name the person in-charge of
carrying out the provisions of the will
 Properties must be disposed in accordance with

legal requirements
 Will must be signed by the testator, attested and

signed by at least three witnesses in his presence
and of one another.
◦ Must be in language known to the testator
 Every will must be acknowledged before a notary

public by the testator and witnesses
Will
 Witnesses shall be:
◦ Sound mind
◦ 18 years of age or more
◦ Not blind, deaf, or dumb
◦ Able to read and write
 A married woman may make a will without

the consent of the husband and authority of
the court
◦ May dispose her separate property
◦ May dispose her share of conjugal property
Will
 Nurses’ Obligations:
 Note the soundness of the patient’s mind

 Note that there was freedom from fraud or
undue influence
 Patient is above 18 years of age
 Will was signed by the testator
 Witnesses are present at the same time and
signed the will in the presence of the testator

 Testify during the probate
Gifts
 A way of disposing property, aside from
executing a will
 Legal requirements:
◦ Gifts must consist of personal property

◦ There must be an intention to make the gifts
◦ There must be an indication of transfer of
control over such property
◦ There must be acceptance by the recipient
Gifts
 Gifts causa mortis / donatio causa mortis –
gifts made by a person in anticipation of
death or belief in approaching death
 Revocable and subject to the claims of the

donor’s creditors without proof of intent to
defraud them
Nurses as Witnesses
 Subpoena ad testificandum
 Subpoena duces tecum
 Nurses as witnesses:
◦ Seek the aid or counsel of a lawyer
◦ Testify only on what she knows (testimony of

facts)
 Testimony of opinions are only given by
expert witnesses
Nurses as Witnesses
 Nurses as witnesses:
◦ Use words and terms that the average person
can understand
◦ Speak only the truth (otherwise, perjury)
◦ Have privilege against self-incrimination
false swearing under the oath

Witness
 Hearsay evidence is not admissible in court
 Privileged communications are statements

uttered in good faith. They are not permitted
to be divulged in a court of justice.
 Evidence may be established by records,

documents, exhibits, objects etc.
 Testimony is an evidence.
Witness
 Witness is cross-examined to challenge or
disprove the testimony
 The judge renders a judgment based on the

verdict.
Ante-mortem Statements
 Dying declarations
 Considered hearsay evidence except when
made by a victim of a crime
 If a nurse receives a dying declaration:

◦ Write down the person’s actual words.
◦ Repeat back what she wrote.
◦ Statements are to be signed by the person
making declaration, if possible.

Nursing Jurisprudence For in House Review

Uploaded by

Document Information

Original Description:

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Nursing Jurisprudence For in House Review

Uploaded by

Copyright:

Available Formats

Nursing Law, Jurisprudence and

Professional Ethics: Definition

Ms. MAY JACKLYN C. RADOC-SAMSON, RN, RPT

 Total quality patient care

 Makes progress in all areas: education,

 An Art, Science, Social Science

 Deals with skills that require dexterity and

 Nursing exploits research

 Always in the process of constant change

 Fundamental responsibilities of Nursing:

 Concerned not only with diseases

 …but with the whole person

to regulate conduct of people

 Commands the people to do right and

 Standards crafted by leaders or rulers of

 We preserve the integrity of the people/patient

 By giving them their rights or freedoms

 In that way, Law we satisfy their human needs

 Is there a claim, a demand, or a customary right?

 Are we doing something right?

 If we are doing something ethically correct, then

 This standard is can now be the law…

 Moral regulation is a personal undertaking

 Morals is more extensive

 Law gives premium to justice and

issue on battered maids

 Jurisprudence: understand the fundamental

 Achieve and promote justice

knowledgeable on the repercussions of actions

 What law is?

 What the law ought to be?

 Deals with the morality of human acts or

 Shows the way to a right moral decision

 Determines which actions are truly humans

 …which actions or things help us fulfill

 …and decide what to do when values seem in

 Covers not only the general duty of nurses to

 Deals with the moral and ethical behavior of

 Branch of law that deals with the study of

 Body of laws enacted by the constituent

 Medical ethics is placed on top of Nursing

 Views Nursing only as an occupation or

 Requires intensive training and academic

 Encompasses the promotion of health,

 Both an art and science that requires the

 Providing and managing direct practical

thinking and research

 American Nurses’ Association

 Diagnosis and treatment of human responses

 Help understand the competencies and

practice to guide researchers on areas that

 In 1892, Nursing was already described as a

 1. There is an educational background

 2. Members of the profession adhere to a

 3. Members participates in professional

 4. Members are accountable for continuing

 6. Members of the profession are

 7. Professionals are involved in community

 8. A profession develops, evaluates and uses

 9. Members of the profession are involved in

 Critical and creative thinking

 The clinical judgment inherent in the process