I. PERSONAL AND PROFESSIONAL GROWTH AND DEVELOPMENT a. Historical Perspectives in Nursing

The Philippine Nurses Association (PNA) established in 1922 was responsible in lobbying our government for the adoption of the recommendations made by the International Labor Organization in 1977 with regard the status of the economic and social welfare of our nursing personnel. The Professional Regulation Commission of the Philippines duly recognizes the PNA as the leading Association of nurses in the country. In 1924, it published a standardized curriculum for schools of nursing to adopt.

The following were the first groups interested and registered with the Philippine Nurses’ Association (PNA), to wit:

                 Academy of Nursing of the Philippines, Inc. (ANPHI)                  Association of Deans & Principals of Schools and Colleges of Nursing of

the Philippines (ADPSCNP)                  Association of Nursing Administrators of the Philippines ( ANSAP)                  Association of Private Duty Nurse Practitioners of the Philippines (APDNPP)                  Critical Care Nurses’ Association of the Philippines (CCNAP)                  Catholic Nurses Guild of the Philippines (CGNP)                  Golden Age Nurses Association (GANA)                  Ministry of Health National League of Nurses (MHNLN)                  Occupational Health Nurses Association of the Philippines (OHNAP)                  Operating Room Nurses Association of the Philippines (ORNAP)                  Philippine Nurse Midwifery Society                  Philippine Nursing Students Association (PNSA)                  Philippine Orthopedic Nurses Society                  Psychiatric Nursing Specialists Foundation of the Philippines, Inc. (PNSI)                  Philippine School Nurses Association (PSNA)

The following are the later members of the PNA:

                 Association of Diabetes Nurse Educators of the Philippines (ADNEP)                  Graduate Nurses Christian Fellowship (GNCF)                  Integrated Nurses Association of the Philippines (IRNUP)                  National League of Philippine Government Nurses (NLPGN)                  Maternal and Child Nurses Association of the Philippines (MCNAP)                  Military Nurses Association of the Philippines (MNAP)                  Philippine Oncology Nurses Association (PONA)

Philippine Orthopedic Nurses Society (PONS)

TIMELINE IN THE NURSING HISTORY:

In the early dawn of human history, diseases or il lness were often related to superstitious beliefs and the treatment also often involved magical cures.

The Sumerian Civilization is believed to have recorded in a clay-tablet 4,000 years ago some healing prescriptions but did not specify the il lnesses.

The Code of Hammurabi traceable to the Babylonian empire in 1900 BC documented regulations pertaining to sanitation and public health, the practice of surgery, differentiation in the practice of human against veterinary medicine, a table of fees for operations and penalties for violation of the code. During these early days, nursing practice was vaguely described as those who render comfort and support to patient. In the Old Testament, it made mention of women as nurses who provided care for infants and children, the sick and dying

The Greek and Roman empires related the care of the sick and those injured to the mythologies that they have created and believed that the gods and goddesses possessed special healing powers. Hygeia, daughter of Greek god Asklepios, the chief healer, was revered to be the embodiment of the nurse.

Ancient India – Nursing functions were being carried out by male nurses provided they meet the four qualifications:

1.              knowledge of the manner in which drugs should be prepared for administration

2.              cleverness3.              devotedness to the patient4.              purity of mind and body

Christian Benevolence- “love thy neighbor as thyself” had a significant impact on the development of Western Nursing.

The principle of “Good Samaritan” is the basis of caring for most Christians that eventually laid down some principles of nursing.

During the time of the Roman Empire, rich matrons such as Fabiola used their wealth to provide houses of care and healing that served as the early hospitals for the poor, sick and the homeless.

The Time of Crusades ( Holy mission or pilgrim to regain the Holy land by the Christians), knights were trained to provide care for the wounded soldiers in the battle – this is perhaps the earliest recognition of men providing nursing care.

Camillus De Lellis – considered the patron saint of nurses was the founder of the Nursing Order of the Ministries who provided care to the sick and the poor.

Florence Nigthangle born from a wealthy family chose to dedicate her life in providing care for the sick and injured especially during the Crimean War. She also started a school to train nurses in 1860, which eventually sparked the development of Modern Nursing.

NURSING AS A PROFESSION

Profession - “ an occupation or calling requiring advanced training and experience in some specific or specialized body of knowledge which provides service to society in that special field.”

It is a calling that requires special knowledge, skill and preparation.

“ a calling in which its members profess to have acquired special knowledge, by training or by experience or by both, so that they may guide or advice or serve others in that special field.”

A profession is generally distinguished from other kinds of occupations/vocations by: 1. Requirement of prolonged, specialized training to acquire a body of knowledge pertinent to the role to be performed usually entrusted to higher education. 2. An orientation of the individual toward service, either to a community or to an organization.3. The members must be united and identified through their membership and they must be clearly separated from the laypeople or the ordinary congregations.4. The society which it intends to serve has an indispensable need for such services and which others cannot provide and the society accepts it.5. The techniques or skills applied are the product of scientifically proven and long experience.6. Requirement to exercise discretion and judgment as to the time and manner of the performance of the duty.7. The presence of common values, cultures, and norms uniquely found among its members which are also being guided by its own code of ethics.8. The ability to continue its research to expand constantly its body of knowledge.

Characterist ics of a profession:1. Autonomy – (independence and self-governance) the ability to chart or carve its own

destiny independent from others.2. Authority – possession of highly advanced and competent skills/mastery of such

knowledge and skills not available to the general public.3. Accountability – responsibility/liability to own up its actions.

Nursing- “is primarily assisting the individual (sick or well) in the performance of those activities contributing to health, or its recovery (or to a peaceful death) that he would perform unaided if he had the necessary strength, will, or knowledge. It is likewise the unique contribution of nursing to help individual to be independent of such assistance as soon as possible.” (Virginia Henderson, 1958; 1978)Nursing is putting “the patient in the best condition for nature to act.” This description/definition was given by Florence Nightangle, dubbed as the first nursing theorist. She made use of the environment (clean and healthy surrounding) in the recovery of an il l patient.Nursing- is the diagnosis and treatment of human responses to actual and potential health problems (ANA).

The common focus of nursing is the need to provide humanistic and holistic care that includes the four areas related to health:

1. Health Promotion2. Health Maintenance3. Health Restoration4. Care of the Dying

RA 9173 or the Phil ippine Nursing Act of 2002 gives the meaning of nursing practice through the following:-alone or in collaboration with another, initiates and performs nursing services to individuals, families and communities in any health care setting that includes:

1. nursing care during conception, labor, delivery, childhood, adulthood and old age2., promotion of health and prevention of il lness.

3. collaboration with other health care providers for the curative, preventive, and rehabilitative aspects of cares, restoration of health, alleviation of suffering and when recovery is not possible towards a peaceful death.Nursing Practice – covers the three areas of nursing, namely: nursing education, nursing service, and community health nursing (Rule 1 Sect. 3 (d) IRR RA 9173).Professional Nurse – a person whose name and registration/professional license number is entered in the Commission’s registry book and computerized database as legally authorized to practice the nursing profession (Rule 1 Sect. 3 (e) IRR RA 9173).Practicing Professional Nurse- a person who is engaged in the practice of nursing profession or is performing acts or activities, whether regularly or occasionally, including one who is employed in a government office or in a private firm, company or corporation whose duties require knowledge and application of the nursing profession (Rule 1 Sect. 3 (f) IRR RA 9173).Foreign Professional Nurses – foreign nationals who, being licensed professional nurses in their own countries, are authorized by existing laws to practice their profession either as holders of a certificate of registration and professional identification card or a special/temporary permit in the Philippines subject to some provisions of RA 9173 (Rule 1 Sect. 3 (g) IRR RA 9173).Nursing Specialty Program – a training and development program intended to develop/enhance the skills, to which a registered nurse devotes himself /herself whether as a vocation or profession to enable him/her to provide nursing service in specific areas in accordance with the ethics of the profession and applicable law.

THEORETICAL FOUNDATION OF NURSING APPLIED IN HEALTH CARE SITUATIONSPurposes of Nursing Theories and Conceptual Frameworks ( Kozier et al.,45)

Provide direction and guidance for:a.              structuring professional nursing practice, education and researchb.            Differentiating the focus of nursing from other professions.

Assist nurses to describe, explain and predict everyday experiences. Serves to guide assessment, intervention, and evaluation of nursing care Provide a rationale for collecting reliable and valid data about the health status of

clients, which are essential for effective decision making and implementation. Help to establish criteria to measure the quality of nursing care Help build a common nursing terminology to use in communicating with other health

professionals. Ideas are developed and works defined. Enhance autonomy (independence and self-governance) of nursing through defining

its own independent functions. Provide a general focus for curriculum design Guide curricular decision making Offer framework for generating knowledge and new ideas Assist in discovering knowledge gaps in the specific field of study Offer a systematic approach to identify questions for study, select variables,

interpret findings, and validate nursing interventionsConcepts – are abstract ideas or mental images of phenomena or reality. It can be concrete ideas that can be mentally pictured (eg. Cars, cellphones, house); or it can be abstract ideas (eg. Powerlessness, adaptation, nursing).Nursing theories addresses the following four major concepts:

1. Person or client2. Environment3. Health/il lness

4. NursingConceptual Framework – group of related concepts. It can also be viewed as an umbrella under which many theories can exist (Cresia & Parker 1991,p7).Conceptual Model- is a system of related concepts or a conceptual diagram.Model- graphic il lustration of relationships.Theory- is made up of concepts and propositions; however, a theory accounts for phenomena with much greater specificity.

GENERAL THEORIES IN NURSINGNightangle’s Environmental theory – Florence Nightangle, “the mother of modern nursing” espoused her theory focusing on the environment. She linked health with five environmental factors:

1. pure or fresh air2. pure water3. efficient drainage4. cleanliness5. l ight

Henderson’s Definit ion of Nursing - The definition of nursing given by Virginia Henderson in 1955 became a milestone in the development of nursing as discipline apart from medicine. The focus on her Nursing Concept is to help individuals and families gain independence in meeting the 14 fundamental needs;

1. Breathing normally2. Eating and drinking adequately3. Eliminating body wastes4. Moving and maintaining desirable position5. Sleeping and resting6. Selecting suitable clothes7. Maintaining body temperature within normal range by adjusting clothing and

modifying the environment8. Keeping the body clean and well-groomed to protect the integument9. Avoiding dangers in the environment and avoiding injuring others

(10)Communicating with others in expressing emotions, needs, fears, or opinions(11)Worshipping according to one’s faith(12) Working in such a way that one feels a sense of accomplishment(13) Playing or participating in various forms of recreation(14) Learning, discovering, or satisfying the curiosity that leads to normal development and health, and using available health facilit ies.Rogers’s Science of Unitary Human Beings - Martha Rogers views the person as an irreducible whole, the whole being greater than the sum of its parts. Her Key concepts in describing the individual are energy fields, openness, pattern and organization, and multidimensionality. She described the Unitary Man as:

1. Irreducible, four-dimensional energy field identified by pattern.2. Manifesting characteristics different from the sum of the parts3. Interacts continuously and creatively with the environment4. Behaving as a totality5. Participating creatively in change

Orem’s Self Care Deficit Theory – Dorothy Orem developed the self-care deficit theory that includes self-care, self-care deficit and nursing system. She believed that the self-care of the individuals and the self-care of dependents are learned behaviors that individuals initiate and perform on their own behalf to maintain life, health, and well-being. According to Rogers, there are three kinds of self-care requisites:

1. Universal requisites ( common to everybody like maintenance of air, water etc…)2. Developmental requisites3. Health deviation requisites

Roy’s Adaptation Model – Sister Callista Roy focuses on the individual as a biophysical adaptive system. Both the individual and the environment are sources of stimuli that require modification to promote adaptation, an ongoing purposive response. Roy identified three classes of stimuli:

1. Focal Stimulus: the internal or external stimulus most immediately confronting the person and confronting the behavior.

2. Contextual stimuli: all other internal or external stimuli present3. Residual Stimuli: beliefs, attitudes, or traits having an intermediate effect on the

person’s behavior but whose effects are not validated.King’s Goal Attainment Theory – Imogene King based her theory from the conceptual framework of three dynamic interacting systems:

1. personal system concepts: perception, self, body image, growth and development, space and time

2. Interpersonal system concepts: interaction, communication, transaction, role, and stress.

3. Social system concepts: organization, authority, power, status, and decision making.Neuman’s Health Care Systems Model – Betty Neuman views the client as an open system consisting of a basic structure or central core of energy resources (physiologic, psychologic, sociocultural, developmental, and spiritual) surrounded by two concentric boundaries or rings referred to as lines of resistance. She identified individual’s response to stress and the nursing interventions to be carried out on three preventive levels:

1. Primary prevention2. Secondary prevention3. Tertiary Prevention

Johnson’s Behavioral System Model - Dorothy Johnson defines a system as a whole that functions as a whole by virtue of the interdependence of its parts. A behavioral system is patterned, repetitive and purposeful. Johnson’s key concepts describes the individual as a behavioral system composed of seven subsystems:

1. attachment-affi l iative subsystem provides survival and security.2. Dependency subsystem promotes helping behavior that calls for a nurturing

response.3. Ingestive system satisfies appetite.4. Eliminative subsystem excretes body wastes.5. Sexual subsystem functions dually for procreation and gratification.6. Achievement subsystem attempts to manipulate the environment.7. Aggressive subsystem protects and preserves the self and society within the limits

imposed by the society.Peplau’s Psychodynamic Nursing Theory- Hildegard Peplau introduced and defined psychodynamic nursing as understanding one’s own behavior to help others identify felt difficulties and applying principles of human relations to problems arising during the experience. She also described the nurse-patient relationship in four phases:

1. Orientation – patient seeks help and the nurse assists patient to understand the problem and the extent of need for help.

2. Identification - patient assumes a posture of dependence, interdependence, and independence in relation to the nurse

3. Exploitation - patient uses available services on the basis of self interest and needs4. Resolution - old needs and goals are put aside and new ones adopted.

Leininger’s Transcultural Care Theory – Madeleine Leininger established the transcultural nursing which she defined as a major area of nursing that focuses on comparative study and analysis of different cultures and subcultures in the world, with respect to their:

1. Caring behavior2. Nursing care3. Health values4. Beliefs5. Patterns

Watson’s Philosophy and Science of Caring – Jean Watson believes the practice of caring is central to nursing; it is a unifying focus for practice. According to her, there are two major assumptions that underlie human care (carative factors):

1. care and love constitute the primal and universal psychic energy2. care and love are requisite for our survival and the nourishment of the society

FIELDS OF NURSINGThe Fields of Nursing may be classified in general as follows:

1. Hospital Nursing or the Institutional Nursing2. Public Health Nursing3. Community Health Nursing4. School Nursing or Nursing Education5. Occupational Health Nursing or Industrial Nursing6. Military Nursing7. Clinic Nursing8. Independent Nursing Practice9. Private Duty Nursing

Institutional Nurses- those employed as staff nurses or nursing personnel in a hospital setting or similar institutions.Public Health Nurse – is one who provides nursing care and counsel to persons and families, either to individual or groups in clinics, in their homes, in school, and at their place of work, and cooperates with others in health promotion.Community Health Nurse – a nurse whose work combines the element of nursing and public health practice and takes place outside the therapeutic institutions.School Nurse – a registered nurse employed to work in educational institutions to participate in health programmes for school-aged children. Responsibilit ies include monitoring growth and development, screening health problems and supporting those pupils with special needs.Occupational Health Nurse/ Industrial Nurse – one employed in industry that gives immediate care to il l or injured workers, follows up on the sick and the injured, and helps develop accident prevention and health programs for the workers.Maternal and Child Health Nurse – one who cares for and safeguards the health of mothers and children.Nurse Educator – a nurse employed in the teaching or administrative staff of a school of nursing or other educational institution for nurses.Pediatric Care Nurse – a registered nurse qualified in the nursing care of the sick child.Private Duty Nurse – is a registered nurse who independently contracts with a patient; a private duty nurse is responsible for the total nursing care of the patient during the period she is with him.Nursing Administrator – is a professional nurse who is a member of the administrative staff of a hospital, medical center, public health agency, or a similar institution and who, as a member of the administrative staff, participates in formulating the policy and objectives of such.

Clinical Nurse Special ist – A professional nurse, who has had special training and experience in a particular clinical specialty, often holds a degree, and is prepared to give expert care to the acutely or chronically il l and to assist clients to maintain health.

ETHICO-MORAL RESPONSIBILITYEthics – part of philosophy that deals with systematic approaches to questions of morality.- a term for the study of how we make judgments regarding right and wrong.

a system of MORAL PRINCIPLES or moral standards governing conduct.Morals- human conduct in the application of ethics. Concerned with JUDGMENT PRINCIPLES of right and wrong in relation to human actions and character.Nursing Ethics – the code governing the NURSE’S BEHAVIOR, especially towards patients, employing authority and to the profession.Beneficence - any action that would BENEFIT others. The principle that imposes upon the practitioner to seek the good for the patients under all circumstances. Beneficence connotes positive action toward preventing or removing harm and promoting good such as:

1. One ought to prevent evil or harm2. One ought to remove evil or harm3. One ought to do or promote good.

Nonmaleficence – states the idea to REFRAIN from inflicting harm. “one ought NOT to inflict evil or harm. The admonition of nonmaleficence is stated in the negative manner while the beneficence is in the positive.Justice – The basic principle that deals with FAIRNESS, just deserts, and entitlements in the distribution of goods and services. In health care, justice seems to point to distributive justice that deals with the allocation of scarce resources. ARTICLE XIII of the 1987 Constitution provides: The State shall adopt an integrated and comprehensive approach to health development and shall endeavor to make essential goods; health and social services available to all people at affordable cost. There shall be priority for the needs of the underprivileged, the sick, the elderly and the disabled, the women and the children. The State shall endeavor to provide free medical care to paupers, establish and maintain an effective food and drug regulatory system, and undertake appropriate health manpower and development and research responsive to the country’s health needs and problems. It shall establish a special agency for disabled persons for their rehabilitation.Some methods of distributing goods and services in our society are as follows:

1. To each, an equal share2. To each, according to need3. To each, according to effort4. To each, according to contribution5. To each, according to merit6. To each, according to ability to pay

Autonomy - In health care, it means the form of personal LIBERTY, where the individual is free to choose and implement ones’ own decisions, free from deceit, duress, constraint, or coercion. Three Basic elements involved:

1. ability to decide2. power to act upon your decisions3. a respect for the individual autonomy of others.

Stewardship – refers to the actions made for by the health practitioner IN BEHALF of the patient and for the greater benefit of the patient.Truth Tell ing/Veracity – The patient must tell the truth in order that appropriate care can be provided. The health practitioner needs to disclose FACTUAL INFORMATION so that the patient can exercise personal autonomy.

Confidential i ty - is also known as PRIVILEGED COMMUNICATION which refers to any information obtained by the nurse or the health team during the course of caring for the patient. The information gathered may only be disclosed under the following:

1. the patient agrees to divulge such information with written consent2. the information is material in a criminal case investigation3. if public safety is jeopardized (communicable disease)4. such information is relevant to his care to be util ized by other health team

Privi l iged Communication may be divided into two classes:1. Absolute privileged communication – is one made in the interest of the public service

or the due administration of justice and is practically limited to legislative and judicial proceedings and other actions of the state.

2. Qualified privileged communication – is a slanderous statement uttered in good faith, and made on a proper occasion, from a proper motive, based upon a probable cause and in honest belief that such statement is true.

MORAL PRINCIPLES GOLDEN RULE – “ Do unto others what you would like others do unto you”. It is a basic

moral principle that if you want others to respect you, you must also accord respect to them.

THE TWO FOLD-EFFECT - facing a situation which would have good and bad effects requires the following basis for arriving a decision:

a. that the action must be morally goodb. that the good effect must be willed and the bad effect merely allowedc. that the good effect must not come from an evil action but from initial action

itself directly; andd. that the good effect must be greater than the bad effect.

THE PRINCIPLE OF TOTALITY – states that the whole is always greater than its parts. To save the patients’ l ife as a whole, it is justified under this principle to surgically cut-off a disease body part of the patient.

EPIKIA – “exception to the general rule”. It is reasonable presumption that the authority making the law will not wish to bind a person in some particular case, even though the case is covered by the letter of the law.

If a mentally il l patient becomes berserk and the doctor could not be contacted, the patient may be restrained by virtue of epikia.Another example of this is allowing a relative to see a seriously il l patient who expresses the desire the relative although it is not yet visiting hours

THE END DOES NOT JUSTIFY THE MEANS – giving a sleeping tablet to a chronically il l person so he/she can de in peace is morally wrong.

THE GREATEST GOOD FOR THE GREATEST NUMBER – during an epidemic, immunization against communicable diseases is administered to the people. Although there may be some who may have slight reactions to the vaccine, the greater majority of the population shall be considered.

NO ONE IS HELD TO THE IMPOSSIBLE – the doctors and nurses are not guarantors of l ife. They cannot be held liable as long as they have done everything that modern medicine can afford to save a patient from dying.

THE MORALITY OF COOPERATION – formal cooperation in an evil act is never allowed. A nurse shall not participate upon immoral operations such as abortion even if the doctor commands it.

PRINCIPLE RELATING TO THE ORIGIN AND DESTRUCTION OF LIFE – mercy kill ing or euthanasia is not allowed because it will lessen the incentive to medical research. The state recognizes the sanctity of l ife. It shall protect the life of the mother and the unborn

since conception. Any direct attack on the life of a fetus for whatever cause is immoral. A fetus shall be buried in consecrated grounds. If it is dead and came from dead mother, it shall be buried with the mother.

Privacy – the right to be left alone or be apart from others. This right is guaranteed by most civil ized state laws and enshrined also in the patients’ bill of rights. The patient has the right to every consideration of his privacy concerning his own medical care program. Case discussion, consultation, examination and treatment are confidential and should be conducted discreetly. Those not directly involved in his care must have the permission of the patient to be present. This right also includes privacy of one’s thoughts, opinions and physical presence and privacy of one’s records.Informed Consent –The patient UNDERSTANDS the reason for the proposed intervention, with its benefits and risks, and agrees to the treatment by affixing his signature in the consent form. It generally contains the following elements:

1. disclosure2. understanding3. voluntariness4. competence5. permission giving In our present jurisdiction under the 1987 Constitution, the age of majority is 18

years old. It means that only 18 years old and above can sign for themselves in legal matters such as the signing of consent (hospital admission, contracts, will etc..)

The Patients Bil l of Rights (Fi l ipino)

1. The patient has the right to considerate and respectful care, irrespective of socioeconomic status

2. The patient has the right to obtain from his physician complete current information concerning his diagnosis, treatment and prognosis in terms the patient can reasonably be expected and understand. When it is not medically advisable to give such information to the patient, the information should be made available to an appropriate person in his behalf. He has the right to know by name and in person, the physician and nurse responsible in coordinating his care.

3. The patient has the right to receive from his physician information necessary to give informed consent prior to the start of any procedure and/or treatment. Except in emergencies, such information for informed consent should include but not necessarily limited to the specific procedure and/or treatment, the medically significant risks involved, and the probable duration of incapacitation. Where medically significant alternatives for care or treatment exist, or when the patient requests information concerning medical alternatives, the patient has the right to such information. The patient has also the right to know the name of the person responsible for the procedures and/or treatment.

4. The patient has the right to refuse treatment/lifegiving measures, to the extent permitted by law, and to be informed of the medical consequences of his action.

5. The patient has the right to every consideration of his privacy concerning his own medical care program. Case discussion, consultation, examination and treatment are confidential and should be conducted discreetly. Those not directly involved in his care must have the permission of the patient to be present.

6. The patient has the right to expect that all communication and records pertaining to his care should be treated confidential.

7. The patient has the right to expect that within its capacity, a hospital must make reasonable response to the request of patient for services. The hospital must

provide evaluation, service and/or referral as indicated by the urgency of care. When medically permissible a patient may be transferred to another facility only after he has received complete information concerning the needs and the alternatives to such transfer. The institution to which the patient is to be transferred must first have accepted the patient for transfer.

8. The patient has the right to obtain information as to any relationship of the hospital to other health care and educational institutions in so far as his care is concerned. The patient has the right to obtain information as to the existence of any professional relationship among individuals, by name, who are treating him.

9. The patient has the right to be advised if the hospital proposes to engage in or perform human experimentation affecting his care or treatment. The patient has the right to refuse or participate in such research project.

10. The patient has the right to expect reasonable continuity of care; he has the right to know in advance what appointment times the physicians are available and where. The patient has the right to expect that the hospital will provide a mechanism whereby his physicians or a delegate of the physician of the patient’s continuing health care requirements following discharge informs him.

11. The patient has the right to examine and receive an explanation of his bill regardless of source of payment.

12. The patient has the right to know what hospital rules and regulations apply to his conduct as a patient.

The PATIENTS RESPONSIBILITIES towards his care in the hospital:

1. Providing information – It is a responsibility of the patient to provide the staff with accurate and complete information, to the best of his knowledge, about the history of his il lness, complaints. If the patient is unable to do so, then her immediate family member may give such information.

2. Complying with instructions – the patient is responsible for complying with the treatment recommended by the attending physician or health team that is primarily responsible for his care.

3. Informing the physician of refusal to treatment – A patient who refuses treatment or to be compliant with the treatment regimen must inform the physician of his decision.

4. Paying the hospital charges – upon admission, the patient understands that he or she must pay the charges that he or she may incur in th course of her treatment. The exception is of course if the patient is admitted on charity hospitals giving everything for free.

5. Adherence to hospital rules and regulations – the patient is also governed by the rules and regulation of the hospital which he or she is seeking medical help for his/her condition. The patient or the immediate family member must read the rules or must be informed about the policy of the hospital and must adhere to them.

6. Consideration and respect for others – the patient must also show respect for other patients admitted in the hospital.

NURSES’ BILL OF RIGHTS

1. Nurses have the right to practice in a manner that fulfi l ls their obligation to society and to those who receive nursing care.

2. Nurses have the right to practice in environments that allow them to act in accordance with professional standards and legally authorized scopes of practice.

3. Nurses have the right to a work environment that supports and facilitates ethical practice, in accordance with the code of Ethics for nurses and its interpretive statements.

4. Nurses have the right to freely and openly advocate for themselves and their patients, without fear or retribution

5. Nurses have the right to a fair compensation for their work, consistent with their knowledge, experience, and professional responsibilit ies.

6. Nurses have the right to a work environment that is safe for themselves and their patients.

7. Nurses have the right to negotiate the conditions of their employment, either as individuals or collectively, in all practice settings.

BASIC HUMAN RIGHTS ON RESEARCH SUBJECTS:

1. Right to informed consent2. Right to refuse and/or withdrawal from participation3. Right to privacy4. Right to confidentiality5. Right to be protected from harm

CODE OF ETHICS IN NURSING

The fundamental responsibility of the nurse is fourfold: to promote health, to prevent il lness, to restore health and to alleviate suffering.

The need for nursing is universal. Inherent in nursing is respect for life, dignity and the rights of man. It is unrestricted by consideration of nationality, race, creed, color, age sex, politics, or social status.

Nurses render health services to the individual, the family and the community and coordinate their services with those of related groups.

The following Code for Nurses, adopted by the Council of National Representatives of the International Council of Nurses was also adopted by the Board of Nursing and became an integral part of the amended “Code of Nursing Ethics in the Philippines”:Nurses and People

The nurse’s primary responsibility is to those people who require nursing care.The nurse, in providing care, promotes an environment in which the values, customs and spiritual beliefs of the individual are respected.The nurse holds in confidence personal information and uses judgment in sharing this information.Nurses and Practice

The nurse carries personal responsibility for nursing practice and for maintaining competence by continual learning.

The nurse maintains the highest standards of nursing care possible within the reality of a specific situationThe nurse uses judgment in relation to individual competence when accepting and delegating responsibilit ies.The nurse when acting in a professional capacity, should at all times maintain standards of personal conduct which reflect credit upon the profession.Nurses and Society

The nurse shares with other citizens the responsibility for initiating and supporting action to meet the health and social needs of the public.

Nurses and the Profession The nurse plays the major role in determining and implementing desirable standards

of nursing practice and nursing education.The nurse is active in developing a core of professional knowledge.The nurse, acting through the professional organization, participates in establishing and maintaining equitable social and economic working conditions in nursing.

AMENDED CODE OF ETHICS FOR NURSESTheir conduct should be such that would bring credit to the profession. Just like any

other professional, nurses are looked upon with respect in the community. They should therefore endeavor to live a life that would uphold their self-respect.

Especially when nurses are on duty, they should try to look neat and attractive. Female nurses are advised to use moderate make-up and have a neat hairstyle. They should wear uniforms that are not too short or tight fitting that would tend to restrict movements, nor expose unnecessarily any part of the body while giving care to the patients. Clean uniforms and clean bodies tend to enhance the image of nurses. Use of anti-perspirant is advised most specially during hot summer months.

Male nurses are likewise advised to be clean, shaven, hair clipped close to the nape of the neck instead of flowing to the shoulders.

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

Nurses are looked upon by nursing students as their role models. Therefore, especially while they are on duty, they should act in a manner that is worth emulating. Sincere and compassionate attitudes toward patients are caught by those around them. Soon their working environment becomes permeated with good working relationships that are so vital in dealing with patients.

LEGAL RESPONSIBILITYLegal Aspects in the Practice of Nursing

The law has always governed the practice of modern nursing. This what makes the every erroneous nursing action liable to the law, either answerable to the Civil Law or the Criminal Law or both. The key word to remember in the legal responsibility of nurses is ACCOUNTABILITY. The professional nurse is expected to render reasonably competent nursing care to avoid getting entangled with the long arm of the law. Anything short of such standard required that would cause harm or injury to the patient makes the nurse responsible or liable to the law by way of negligence or even malpractice suit. The safe way to avoid such potential legal problems is amplified in the Philippine Nursing Act of 2002 (RA9173) – that is, for nurses to util ize the nursing process in the performance of their function and observe the provision of RA 9173 which governs the practice of nursing in the Philippines.

The Phil ippine Nursing Act of 2002 (RA 9173) Article VIII Section 35 enumerates the prohibitions in the practice of nursing: A fine of not less than 50,000.00 nor more than 100,000.00 or imprisonment of not less than 1 year nor more than 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 RA 9173 of 2002:

1. without certificate of registration/professional license and professional identification card or special temporary permit or without having been declared exempt from examination in accordance with the provision of this Act; or

2. who uses as his/her own certificates of registration/ professional license and professional identification card or special/temporary permit of another; or

3. who uses an invalid certificate of registration/professional license, a suspended or revoked certificate of registration/professional license, or an expired or cancelled special/temporary permit; or

4. who gives any false evidence to the Board in order to obtain a certificate of registration/professional license, a professional identification card or special permit; or

5. who falsely poses or advertises as a registered and licensed nurse or uses any other means that tend to convey the impression that he/she is registered and licensed nurse; or

6. who appends B.S.N./R.N. or any similar appendage to his/her name without having been conferred said degree or registration; or

7. who, as a registered and licensed nurse, abets or assists the il legal 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 local and foreign examination without permit/clearance from the board and the Commission; or

c. any person or employer of nurses who violate the minimum base pay of nurses and the incentives and benefits that should be accorded them as specified in Sections 32 and 34; or

d. any person or the chief executive officer of a juridical entity violating any provision of this Act and its rules and regulations.

An Act providing for more responsive nursing profession, repealing for the purpose Republic Act 7164, otherwise known as the “Philippine Nursing Act of 1991” and for other purposes.

(Note: The following presentation is the reproduction of RA 9173 with explanation on selected articles appearing in the italics)

ARTICLE I TITLESECTION 1. Title – This Act shall be known as the Philippine Nursing Act of 2002.”

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.

ARTICLE III ORGANIZATION OF THE BOARD OF NURSINGSECTION 3. Creation and composit ion of the Board - There shall be created a created a Professional Regulatory Board of Nursing, hereinafter referred to as the Board, to be composed of a Chairperson and six (6) members. They shall be appointed by the President of the Republic of the Philippines from among the two (2) recommendees, per vacancy, of the accredited professional organization of nurses in the Philippines who possess the qualifications prescribed in Section 4 of this Act.

NOTE: The   structure   of   the  members   of   the   Board   of   Nursing   was   augmented   from   5  members   under   RA 7164   to   7  members   in   RA   9173.   The   chairperson   shal l   have   s ix  members,   shal l   cover   the   three   areas   of   nursing, namely:  nursing  educat ion,  nursing  service,  and  community  heal th  nursing.  The  members  now are  selected   from  two recommendees   coming   from   the   endorsement   of   Accredi ted   Professional   Organizat ion   (Phi l ippine   Nursing Associat ion)  which   also   pre-selected   their   endorsement   not   later   than   three  months   pr ior   to   expected   vacancy   from three   nominees   per   vacancy   unl ike   under   RA   7164   where   the   President   appoints   the  members   f rom   12   nominees. The   7   posi t ions   in   the   Board   of   Nursing   does   not   (   mandatory)   require   that   a l l   posi t ions   be   f i l led   up   in   order   to funct ion  , i f   the major i ty  posi t ions are occupied  then  i t  const i tute   the Board  to  funct ion. SECTION 4. Qualif ications of the Chairperson and the Members of the Board. – The Chairperson and the Members of the Board shall, at the time of their appointment, possess the following qualifications:

a. Be a natural born citizen and resident of the Philippines;NOTE:  Natural  born  Fi l ip ino  c i t izen  are   those  Fi l ip ino  who,   s ince  bir th  did  not  make  any  posi t ive  act   to  perfect   their  c i t izenship.

b. Be a member of good standing of the accredited professional organization of nurses;

NOTE:   The   Accredi ted   Professional   Associat ion   (APO)   recognizes   the   Phi l ippine   Nurses   Associat ion   (PNA)   as ment ioned   in   the   Implement ing  Rules  and  Regulat ion  of  RA  9173.  The  other  exist ing  members  of  PNA ment ioned   in the prel iminary  chapter  of   th is reviewer  are deemed also accredi ted  to sat isfy   th is  requirement. ( c ) Be a registered nurse and holder of a master’s degree in nursing, education or other al l ied 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 master’s degree in nursing.NOTE:  The new requirement   for   the  members  of   the  Board   is  a  departure   f rom  the previous   requirement   requir ing  al l members   of   the  Board   to   be  master ’s   degree   holder   in  Nursing.  RA   9173   provides   that   only   the   chairperson   and   a major i ty   (not   a l l   the  members)   of   the  members  must   be  master ’s   degree   holder   in   nursing   and   the   other  members may be master ’s  degree holder   in educat ion or other  a l l ied heal th profession. (d) Have at least ten years (10) years of continuous practice of the profession prior to appointment: Provided, however, That the last five years (5) of which shall be in the Philippines; andNOTE: This   new   provis ion   which   was   s i lent   in   the   previous   law   al lows   the   member   of   the   Board   to   qual i fy   as   a nominee   even   i f   she   pract iced   nursing   abroad,   only   that ,   the   last   f ive   years   before   the   appointment,   that   member must  have pract iced her nursing profession  in  the Phi l ippines .

e.              Not have been convicted of any offense involving moral turpitude;Provided, That the membership to the Board shall represent the three areas of nursing, namely: nursing education, nursing service and community health nursing.NOTE:   Take   note   of   the   key   word,   convicted.   An   ongoing   prosecut ion   in   a   cr iminal   case   does   not   const i tute   a hindrance   to   being   nominated   as   a  member   to   the  Board   because   the   law   speaks   of   convict ion  which  means   that   a competent   court   had   rendered   already   i ts   f inal   decis ion   on   the   case.   I f   such  member  was   convicted   in   the   past   for  cr ime  involv ing moral   torpid i ty,  even  i f   the penal ty  was served,   is  a prohibi t ion   to be nominated  in  the Board. SECTION 5. Requirements Upon Qualif ications as Member of the Board of Nursing. – Any person appointed as Chairperson or Member of the Board shall immediately resign from any teaching position in any school, college or university or institution offering Bachelor of Science in Nursing and/or review program for the local nursing board examinations or in any office or employment in the government or any of its subdivision, agency or instrumentality thereof, including government-owned or controlled – corporations or their subsidiaries as well as those employed in the private sector. He/she shall not have any pecuniary interest in or administrative supervision over any institution offering Bachelor of Science in Nursing including review classes.NOTE:   The   qual i f icat ion   required   by   th is   Act   means   that   they   must   be   sat isf ied   at   the   t ime   of   Appointment.   The President   is   the only person who can appoint  such member of   the Board and such appointment  commences only af ter the  President  approves   through her  s ignature   in   the  appointment  paper.  This   fur ther  means   that  even  i f   the  nominee is   not   yet   qual i f ied   dur ing   the   recommendat ion   per iod,   he/she   shal l   have   t ime   to   perfect   or   sat isfy   a l l   the requirements   before   the  President   s igns   her   appointment.   A  member  may   cont inue   to   teach   in   a   nursing   inst i tut ion and may only resign dur ing  the  t ime that  she  is  appointed.

SECTION 6. Term of Off ice. The Chairperson and Members of the Board shall hold office for a term of three (3 years) and until their successors shall have been appointed and qualified: Provided, That the Chairperson and Members of the Board may be reappointed for another term.Any vacancy in the Board occurring within the term of a member shall be fil led for the unexpired portion of the term only. Each Member of the Board shall take the proper oath of office prior to the performance of his/her duties.The incumbent Chairperson and Members of the Board shall continue to serve for the remainder of their term under RA 7164 until their replacements have been appointed by the President and shall have been duly qualified.NOTE: The  maximum number  or   years   that   a  member   can  stay  as  a  member  of   the  Board   is   s ix   years  because   from their  or ig inal  appointment  of   three  years,   they  are  st i l l   e l ig ib le   to  be   re-appointed   for  another   three  years.  However, the   Hold-over   doctr ine   appl ies   to   th is   provis ions   because   i t   speci f ical ly   provides   that   a   member   shal l   cont inue   to hold of f ice unt i l   their  successors  shal l  have been appointed and qual i f ied. SECTION 7. Compensation of Board Members. – The Chairperson and Members of the Board shall receive compensation and allowances received by the Chairperson and Members of other professional regulatory boards. SECTION 8. Administrative Supervision of the Board, Custodian of i ts Records, Secretariat and Support Services. – The Board shall be under the administrative supervision of the Commission. All records of the Board, including applications for examinations, administrative and other investigative cases conducted by the Board shall be under the custody of the 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.SECTION 9. Powers and Duties of the Board. – The Board shall supervise and regulate the practice of the nursing profession and shall have the following powers, duties and functions:

a. Conduct the licensure examination for nurse;b. Issue, suspend or revoke certificates of registration for the practice of nursing;c. Monitor and enforce quality standards of nursing practice in the Philippines and

exercise the powers necessary to ensure the maintenance of efficient, ethical and technical, moral and professional standards in the practice of nursing taking into account the health needs of the nation;

d. Ensure quality nursing education by examining the prescribed facilit ies 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 Education upon written recommendation of the Board.

e. Conduct hearings and investigations to resolve conduct and violations of this Act, or its rules and regulations and in connection therewith, issue subpoena ad testificandum and subpoena duces tecum to secure the appearance of respondents and witnesses and the production of documents and punish with contempt persons obstructing, impeding and/or otherwise interfering with the conduct of such proceedings, upon application with the courts;

f. Promulgate a Code of Ethics in coordination and consultation with the accredited professional organization of nurses within one (1) year from the effectivity of this Act;

g. Recognize nursing specialty organizations in coordination with the accredited professional organization; and

h. Prescribe, adopt, issue and promulgate guidelines, regulations, measures and decisions as may be necessary for the improvement of the nursing practice, advancement of the profession and for the proper and full enforcement of this Act subject to the review and approval by the Commission.

NOTE:  The  adopt ion  and   regulat ion  of  a  Code  of  Ethics  and  Code  of  Technical  Standards   for   the  pract ice  of  nursing are   new   addi t ion   in   the   powers   of   the   Board   included   in   th is   law.   The   Board   also   exercises   quasi- judic ia l   powers because   they  can  issue subpoena duces  tecum (court  order ing   the person   to  br ing  documents  wi th  himsel f   to  appear before   the   court)   and   subpoena   ad   test i f icandum   (court   order ing   the   person   to   be   present   before   the   court) .   The Board   can  also   punish   a   person  by  way  of   contempt.   This   power   is   exercised  only   by   competent   courts   but   the   law delegates   such   powers   to  the   Board   of   Nursing   through   the   legis lat ion   of   RA   9173.Under   th is   Act,   the   Board   of nursing now recognizes special ty  organizat ions  wi th   the accredi ted professional  organizat ions. SECTION 10. Annual Report . – The Board shall at the close of its calendar year submit an annual report to the President of thePhilippines through the Commission giving a detailed account of its proceedings and the adoption of measures that will upgrade and improve the conditions affecting the practice of the nursing profession. SECTION 11. Removal or Suspension of Board Members . – The President may remove or suspend any member of the Board after having been given the opportunity to defend himself/herself in a proper administrative investigation, on the following grounds:

a. Continued neglect of duty or incompetence;b. Commission or toleration of irregularities in the licensure examination; andc. Unprofessional, immoral or dishonorable conduct.

NOTE:  Only   the  President   of   the  Phi l ippines has   the   sole  power   to   remove  or   suspend   the  members  of   the  Board  of Nursing.   The  members   of   the  Board   being  President ia l   appointees   are   the   al ter   ego   of   the  President,  which  means that   they are under   the whims and capr ices of   the appoint ing of f icer  wi th respect   to   their  stay  in  the of f ice.

ARTICLE IV EXAMINATION AND REGISTRATIONSECTION 12. Licensure Examination. – All applicants for licensure to practice nursing shall be required to pass a written examination, which shall be given by the Board in such places and dates as maybe designated by the Commission: Provided, that it shall be in accordance with Republic Act No. 8981, otherwise known as the “PRC Modernization Act of 2000.”NOTE: Speci f ic   dates  as  provided   for   in   the  previous   law  are  no   longer  ment ioned   in   the  new   law.   I t   used   to  be  not ear l ier   than one month and not  later   than two months af ter   the c losing of  each semestral   term. SECTION 13. Qualif ications for Admission to the Licensure Examination. – In order to be admitted to the examination for nurses, an applicant must, at the time of fi l ing his/her application, establish to the satisfaction of the Board that:

a. He/she is a citizen of the Philippines, or a citizen or subject of a country which permits Filipino nurses to practice within its territorial l imits on the same basis as the subject or citizen of such country:

Provided: That the requirements for the registration or licensing of nurses in said country are substantially the same as those prescribed in this Act;

b. He/she is good moral character; and c. He/she is a holder of a Bachelor ’s Degree in Nursing f rom a col lege or universi ty that compl ies wi th the

standards of nursing educat ion duly recognized by the proper government agency .NOTE:   Under   the   previous   law,   no   examinee   shal l   take   the   l icensure   exam   below   the   age   of   18.   I t   is   no   longer included  in  the new nursing  law. SECTION 14. Scope of Examination. – The scope of the examination for the practice of nursing in the Philippines shall be determined by the Board. The Board shall take into consideration

the objectives of the nursing curriculum, the broad areas of nursing and other related disciplines and competencies in determining the subject examinations.NOTE:  The scope of  examinat ion  for  nursing  is  determined by  the Board of  Nursing alone and not   in  conjunct ion  wi th the PNA or  the PRC. SECTION 15. Ratings. – In order to pass the examination, an examinee must obtain a general average of at least seventy-five percent (75%) with a rating of not below sixty percent (60%) in any subject. An examinee who obtains an average rating of seventy-five (75%) or higher but gets a rating below sixty-percent (60%) in any subject must take the examination again but only in the subject or subjects where he/she is rated below sixty percent (60%). In order to pass the succeeding examination, an examinee must obtain a rating of at least seventy-five percent (75%) in the subject or subjects repeated.NOTE:   speci f ic   number   of   t imes,  which   an   examinee   can   take   the   l icensure   exam,   is   now   abol ished   under   the   new nursing   law.   I t  a lso deleted  the mandatory   requirement  of  at tending  a  refresher  course  af ter   fa i lure   to  pass  the nurse l icensure   examinat ion   in   three   takes.   The   removal   to   take   the   examinat ion   is   wi th in   two   years   af ter   the   last   fa i led examinat ion.  The examinee  who  fa i led  may  take only   the subject  which  she  fa i led   i f  h is/her  average   is  75 % but  wi th a   grade  of   below  60%  in   any   subject .   The   law  however   is   s i lent   about   the   prohibi t ion   of   the   examinee   in   taking   the ent i re  set  of  examinat ion.   In   the   interpretat ion  of   laws –   i f   the   law  is  s i lent  on a  matter ,   then  i t  must  be construed   in  favor   to  a   s ide   that   is   not   onerous  or   burdensome   to   the  people.  To   retake   the  examinat ion   in  a   subject  matter   that the examinee fa i led  the  last   t ime and to  target  a rat ing of  75% in  that  subject  area rather   than 60% only  i f   the person  retakes   the   ent i re   set ,   is   onerous   on   the   part   of   the   examinee.   This   provis ion   must   be   construed   in   favor   of   the examinee.   He/She   must   have   the   opt ion   to   retake   the   ent i re   examinat ion   wi th   the   or ig inal   passing   rate   of   75% average   wi th   no   grade   below   60%   in   any   subject   area   or   he/she  may   retake   only   that   subject   area   where   he/she fa i led  the  last   t ime provided he/she obtained an average of  75% or  above  SECTION 17. Issuance of Certif icate of Registration/Professional License and Professional Identif ication Card. – A certificate of registration/professional license as a nurse shall be issued to an applicant who passes the examination upon payment of the prescribed fees. Every certificate of registration/professional license shall show the full name of the 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 l ikewise be issued to every registrant upon payment of the required fees. SECTION 18. Fees for Examination and Registration . – Applicants for licensure and for registration shall pay the prescribed fees set by Commission.SECTION 19. Automatic Registration of Nurses. - All nurses whose names appear at the roster of nurses shall be automatically or ipso facto registered as nurses under this Act upon its effectivity.NOTE:   Though   the   law   provides   for   the   automat ic   enrolment   in   the   roster   of   nurses   af ter   passing   the   l icensure examinat ion,   the Code of  Ethics  formulated under   th is  Act   invi tes  the nurse  to become a member of   the PNA. SECTION 20. Registration by Reciprocity . – A certificate of registration/professional license may be issued without examination to nurses registered under the laws of a foreign state or country: Provided, That the requirements for registration or licensing of nurses in said country are substantially the same as those prescribed under this Act: Provided, further, That the laws of such state or country grant the same privileges to registered nurse of the Philippines on the same basis as the subjects or citizens of such foreign state or country. SECTION 21. Practice Through Special /Temporary Permit- A special/temporary permit may be issued by the Board to the following persons subject to the approval of the commission and upon payment of the prescribed fees:

a. Licensed nurses from foreign countries/states whose service are either for a fee or free if they are internationally well-known specialists or outstanding experts in any branch or specialty of nursing;

b. Licensed nurses from foreign countries/states on medical mission whose services shall be free in a particular hospital, center or clinic; and

c. Licensed nurses from foreign countries/states employed by school/colleges of nursing as exchange professors in a branch or specialty of nursing;

Provided, however, That the special/temporary permit shall be effective only or the duration of the project, medical mission or employment contract. SECTION 22. Non-registration and Non-issuance of Certif icates of Registration/Professional License or Temporary Permit. – No person convicted by final judgment of any criminal offense involving moral turpitude or any person guilty of immoral or dishonorable conduct or any person declared by the court to be of unsound mind shall be registered and be issued a certificate of registration/professional license or a special/temporary permit.The Board shall furnish the applicant a written statement setting forth the reasons for its actions, which shall be incorporated in the records of the Board SECTION 23. Revocation and Suspension of Certif icate of Registration/Professional License and Cancellat ion of Special /Temporary Permit .- The Board shall have the power to revoke or suspend the certificate of registration/professional license or cancel the special/temporary permit of a nurse upon any of the following grounds:

a. For any of the causes mentioned in the preceding section;b. For unprofessional and unethical conduct;c. For gross incompetence or serious ignorance;d. For malpractice or negligence in the practice of nursing;e. For the use of fraud, deceit, or false statements in obtaining a certificate of

registration/professional license or a temporary/special permit; orf. For practicing his/her profession during his/her suspension from such practice

.Provided, however, That the suspension of the certificate of registration/professional license shall be for a period not to exceed four (4) years.NOTE: Sect ion   23   ( f )   is   an   addi t ion   in   th is   new   law.  The   suspended  nurse   cannot   pract ice   nursing   profession  whi le serving his/her  suspension orders.  Take note of   the maximum per iod of  suspension,   i t  cannot go beyond four  years. SECTION 24. Re-issuance of Revoked Certif icates and Replacement of Lost Certif icates.- The Board may, after the expiration of a maximum of four (4 ) years from the date of revocation of a certificate, for reasons of equity and justice and when the cause for revocation has disappeared or has been cured and corrected, upon proper application therefore and the payment of the required fees, issue another copy of the certificate of registration/professional license.A new certificate of registration/professional license to replace the certificate that has been lost, destroyed or mutilated may be issued, subject to the rules of the Board.

ARTICLE V NURSING EDUCATIONSECTION 25. Nursing Education Program. – The nursing education program shall provide sound general and professional foundation the practice of nursing.The Learning experiences shall adhere strictly to specific requirements embodied in the prescribed curriculum as promulgated by the Commission on Higher Education’s policies and standards of nursing education.

SECTION 26. Requirement for Inactive Nurses Returning to Practice. – Nurses who have not actively practiced the profession for five (5) years are required to undergo one month of didactic training and three months of practicum. The Board shall accredit hospitals to conduct the said training program.NOTE:   th is   is   a   new   provis ion   providing   for   the   guidel ines   of   inact ive   nurses   who   wish   to   return   to   pract ice   their nursing career.  Didact ic   t ra in ing means a  lecture  program. SECTION 27. Qualif ications of the Faculty . – A member of the faculty in a college of nursing teaching professional courses must:

a. Be a registered nurse in the Philippines;b. Have at least one (1) year of clinical practice in a field of specialization;c. Be a member of good standing in the accredited professional organization of nurses;

andd. Be a holder of a master’s degree in nursing, education, or other allied medical and

health sciences conferred by a college or university duly recognized by the Government of the Republic of the Philippines.

In addition to the aforementioned qualifications, the dean of a college must have a master’s degree in nursing. He/she must have at least five (5) years of experience in nursing.NOTE:  The   requirement   for   the   c l in ical   exper ience  of   a   facul ty  was   reduced   from   three   years   in   the  previous   law   to only  one year   in   the new  law.  The  requirement   for   the  dean was  increased   from  three  years   to   f ive  years   in   teaching and supervis ing a nursing educat ion program.

ARTICLE VI NURSING PRACTICESECTION 28. Scope of Nursing. A person shall be deemed to be practicing nursing within the meaning of this Act when he/she singly or in collaboration with another , initiates and performs nursing services to individuals, families and communities in any health care setting. It includes but not limited to, nursing care during conception, labor, delivery, infancy, childhood, toddler, pre-school, school age, adolescence, adulthood and old age. As independent practitioners, nurses are primarily responsible for the promotion of health and prevention of il lness. As Members of the Health Team, nurses shall collaborate with other health care providers for the curative, preventive, and rehabilitative aspects of care, restoration of health, alleviation of suffering, and when recovery is not possible, towards a peaceful death. It shall be the duty of the nurse to:

a. Provide nursing care through the util ization of the nursing process. Nursing care includes, but not limited to, traditional and innovative approaches, therapeutic use of self, executing health care techniques and procedures, essential primary health care, comfort measures, health teachings, and administration of written prescription for treatment, therapies, oral, topical and parenteral medications, internal examination during labor in the absence of bleeding and delivery. In case of suturing of perineal laceration, special training shall be provided according to protocol established;

b. Establish linkages with community resources and coordination with the health team;c. Provide health education to individuals, families and communities;d. Teach, guide and supervise students in nursing education programs including the

including the administration of nursing services in varied settings such as hospitals and clinics; undertake consultation services; engage in such activities that require the util ization of knowledge and decision-making skills of a registered nurse; and

e. Undertake nursing and health and health human resource development training and research, which shall include, but not limited to, the development of advance nursing practice;

Provided: That this section shall not apply to nursing students who perform nursing functions under the direct supervision of a qualified faculty: Provided further, That in the

practice of nursing in all settings, the nurse is duty-bound to observe the Code of Ethics for nurses and uphold the standards of safe nursing practice. The nurse is required to maintain competence by continual learning through continuing professional education to be provided by the accredited professional organization or any recognized professional organization or any recognized professional nursing organization: Provided, finally, That the program and activity for the continuing professional education shall be submitted to and approved by the Board.NOTE:   The   new   law   deleted   already   the   special   requirement   of   undergoing   IV   therapy   tra in ing   before   a   nurse   can administer   IV  medicat ions.   However,   the  Nursing   Service   Administrator   st i l l   requires   formal   t ra in ing   in   th is   aspect. The new  law also added  the special   t ra in ing  for  sutur ing  the  lacerated per ineum being undertaken by  the Associat ion of  Nursing Service Administrators  wi th   the Maternal  and Chi ld  Associat ion of   the Phi l ippines (  MCNAP ). SECTION 29. Qualifications of Nursing Service Administrators.- A person occupying supervisory or managerial positions requiring knowledge of nursing must:

a. Be a registered nurse in the Philippines;b. Have at least two (2) years experience in general nursing service administration;c. Possess a degree of Bachelor of Science in Nursing, with at least nine (9) units in

management and administration courses at the graduate level; andd. Be a member of good standing of the accredited professional organization or nurses;

Provided, That a person occupying the position of chief nurse or director of nursing service shall, in addition to the foregoing qualifications, possess:

1. At least five (5) years of experience in a supervisory or managerial position in nursing; and

2. A masters degree major in nursing;Provided, further, That for primary hospitals, the maximum academic qualifications and experiences for a chief nurse shall be as specified in subsections (a),(b), and (c) of this section: Provided, furthermore, That for chief nurses in the public health agencies, those who have a master’s degree in public health/community health nursing shall be given priority. Provided, even further, That for chief nurses in military hospitals, priority shall be given to those who have finished a master’s degree in nursing and the completion of the General Staff Course (GSC): Provided, finally, That those occupying positions before the effectivity of this Act shall be given a period of five (5) years within which to qualify.

ARTICLE VII HEALTH HUMAN RESOURCE PRODUCTION, UTILIZATION AND DEVELOPMENT

SECTION 30. Studies for Nursing Manpower Needs, Production, Uti l ization and Development.- The Board, in coordination with the accredited professional organization and appropriate government or private agencies shall initiate, undertake and conduct studies on health human resource production, util ization and development. SECTION 31. Comprehensive Nursing Specialty Program.- Within ninety (90) days from the effectivity of this Act , the Board in coordination with the accredited professional organization, recognized specialty organizations and the Department of Health is hereby mandated to formulate and develop a comprehensive nursing specialty program that would upgrade the level of skill and competence of specialty nurse clinicians in the country, such as but not limited to the areas of the critical care, oncology, renal and such other areas as may be determined by the Board.The beneficiaries of this program are obliged to serve in any Philippine hospital for a period of at least two (2) years of continuous service.NOTE:   The   Board   is   mandated   to   formulate   and   develop   a   comprehensive   nursing   special ty   program   that   would upgrade   the   levels   of   ski l ls   and   competency   of   special ty   nurse   c l in ic ians   in   the   country.   This   is   a   new  provis ion   of the Nursing  law.

SECTION 32. Salary. – In order to enhance the general welfare, commitment to service and professionalism of nurses, the minimum base pay of nurses working in the public health institutions shall not be lower than the salary grade 15 prescribed under Republic Act No. 6758, otherwise known as the “Compensation and Classification Act of 1989”. Provided , That for nurses working in local government units, adjustments to their salaries shall be in accordance with Section 10 of the said law. SECTION 33. Funding for the Comprehensive Nursing Specialty Program . – The annual financial requirement needed to train at least ten percent (10%) of the nursing staff of the participating government hospital shall be chargeable against the income of Philipine Charity Sweepstakes Office and the Philippine Amusement Gaming Corporation, which shall equally share in the costs and shall released to the Department of Health subject to the accounting and auditing procedures: Provided, That the Department of Health shall set the criteria of this program.SECTION 34. Incentives and Benefits.- The Board of Nursing, in coordination with the Department of Health and other concerned government agencies, association of hospitals and the accredited professional organization shall establish an incentive and benefit system in the form of free hospital care for nurses and their dependents, scholarship grants and other non-cash benefits. The government and private hospitals are hereby mandated to maintain the standard nurse-patient ratio set by the Department of Health.

ARTICLE VIII PENAL AND MISCELLANEOUS PROVISIONS

SECTION 35. Prohibit ions in the Practice of Nursing . - A fine of not less than 50,000.00 nor more than 100,000.00 or imprisonment of not less than 1 year nor more than 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 RA 9173 of 2002:

1.              without certificate of registration/professional license and professional identification card or special temporary permit or without having been declared exempt from examination in accordance with the provision of this Act; or

2.              who uses as his/her own certificates of registration/ professional license and professional identification card or special/temporary permit of another; or

3.              who uses an invalid certificate of registration/professional license, a suspended or revoked certificate of registration/professional license, or an expired or cancelled special/temporary permit; or

4.              who gives any false evidence to the Board in order to obtain a certificate of registration/professional license, a professional identification card or special permit; or

5.              who falsely poses or advertises as a registered and licensed nurse or uses any other means that tend to convey the impression that he/she is registered and licensed nurse; or

6.              who appends B.S.N./R.N. or any similar appendage to his/her name without having been conferred said degree or registration; or

7.              who, as a registered and licensed nurse, abets or assists the il legal 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 local and foreign examination without permit/clearance from the board and the Commission; or( c ) any person or employer of nurses who violate the minimum base pay of nurses and the incentives and benefits that should be accorded them as specified in Sections 32 and 34; or

( d ) any person or the chief executive officer of a juridical entity violating any provision of this Act and its rules and regulations.NOTE:  The new  law also   increased  the  penal  provis ions   regarding  v io lat ions  of   the  Nursing   law.  The  f ine  was  raised from the minimum 10,000 and maximum of 40,000 to a minimum of  50,000 and maximum of 100,000.00.

ARTICLE IX FINAL PROVISIONS

SECTION 36. Enforcement of this Act . – It shall be the primary duty of the Commission and the Board to effectively implement this Act. Any duly law enforcement agencies and officers of national, provincial, city or municipal governments shall, upon the call or requests of the Commission or the Board render assistance enforcing the provisions of this Act and to prosecute persons violating the same.` SECTION 37. Appointments . – The Chairperson of the Professional Regulation Commission shall immediately include in its program and issue such rules and regulations to implement the provisions of this Act, the funding of which shall be included in the Annual General Appropriations Act. SECTION 38. Rules and Regulations . – Within ninety (90) days after the effectivity of this Act, the Board of Commission, in coordination with the accredited professional organization, the Department of Health, the Department of Budget and Management and other concerned government agencies, shall formulate such rules and regulations necessary to carry out the provisions of this Act. The implementing rules and regulations shall be published in the Official Gazette or in any newspaper of general circulation.SECTION 39. Separabil i ty Clause. – If any of this Act is declared unconstitutional, the remaining parts not affected thereby shall continue to be valid and operational. SECTION 40. Repealing Clause . – Republic Act No. 7164, otherwise known as the “Philippine Nursing Act of 1991” is hereby repealed. All other laws, decrees, orders, circulars, issuances, rules and regulations and parts thereof which are inconsistent with this Act are hereby repealed, amended or modified accordingly.SECTION 41. Effectivity. – This Act shall take effect fifteen (15) days upon its publication in the official publication in the Official Gazette or in any two (2) newspapers of general circulation in the Philippines.

       Act # 1931 – Created for the ESTABLISHMENT OF NURSING SCHOOLS in the country under the Bureau of Education in 1909.

       Act # 1975 – An act that transferred the school of NURSING UNDER THE BUREAU OF HEALTH.

       Act # 2468 – An act that authorized the GRANTING OF THE TITLES of graduate in nursing and midwifery from the school of nursing of Philippine General Hospital in 1915.

       Act # 2808 – This act provided for the earliest and TRUE NURSING LAW that served as the basis of the practice of nurses in the Philippines in 1919 and a year after its passage, the first local l icensure or board examination for nurses was held in 1920. The First Board Examiners were created under act # 2808 composed of three members then appointed by the Secretary Interior. The chairman was a doctor of medicine and the other two are registered nurses who must possess an experience in the nursing profession for at least five years and with a reputable character.

       RA # 649 – provided for the standardization of nurses’ salaries both in institutions and in public health.

       RA # 465 – an act which STANDARDIZED THE FEES charged by the Examining Boards for Examination and Registration .

       RA # 546 – An act that reorganized and placed all the BOARD OF EXAMINERS under the direct supervision of the President of thePhilippines.

       RA # 877 – An Act also known as the “Phil ippine Nursing Law of 1953 ” approved on June 19, 1953. This Law was sponsored by Senator Geromina T. Pecson which enacted “ to regulate the practice of nursing in the Philippines and to set up provisions for the registration of nurses, for the establishment and maintenance of standards of nursing education and nursing practice”.

       RA # 1080 – This act approved on 1954 is also known as, An Act Declaring the Bar and Board Examinations as “ CIVIL SERVICE EXAMINATIONS ” which means that when a four year degree course graduate had passed the board examinations or the Bar examinations for lawyers they automatically become first grade civil service eligible.

       RA # 997 – This Republic Act in 1954 ABOLISHED THE DIVISION OF NURSING and created a decentralized organization with a chief Public Health Nurse consultant in the office of the Secretary of Health, and five consultant positions in nursing; namely, in Maternal and Child Health, in Preventable Diseases, in Institutional Nursing, in Nursing Education, and in Hospital Standardization.

       RA # 4704 – This act in 1966 AMENDED THE PHILIPPINE NURSING LAW OF 1953 otherwise known as RA 877 and introduced some minor revisions of the said act due to some developments of the practice of nursing in the country.

       RA # 6136 – In 1971, This Republic Act introduced other MINOR REVISIONS IN THE NURSING

LAW of 1966 thus amending RA 4704 of 1966.        RA 7164 – PHILIPPINE NURSING ACT OF 1991 was sponsored by Senator Heherson Alvarez and

was approved and signed by President Corazon Aquino on November 21, 1991.         ILO convention 149 and Recommendations 157 – In 1977, the Philippine Nurses Association,

formerly known as the Filipino Nurses Association established in 1922 lobbied our government for the adoption of ILO 149 and Recommendations 157 that were adopted in Geneva. It set the concerns of employment of nursing personnel and the CONDITIONS

OF THE LIFE AND WORK OF NURSES and in 1978; the PNA passed The Declaration on the Economic and Social Welfare of Filipino Nurses.

       Proclamation No. 539 – The President of the Philippines declared on October 17, 1958 that the last week of October (through this proclamation ) as the “ NURSES WEEK”

       Presidential Decree No. 223 – This decree formed the PROFESSIONAL REGULATION COMMISSION on June 23, 1973. Among its power is the regulation of different profession which used to be under the Civil Service Commission.

       RA 6511 – This Act Amended RA 465 in 1972, which STANDARDIZED the examination and REGISTRATION fees charged by the various Board Examiners.

       Letter of Instruction No. 1000 – this required that the members of Accredited Professional Organizations (eg. PNA) shall be given PRIORITY in the HIRING of employees in the government service and in the engagement of professional services.

       RA 1612 – Refers to the payment of PRIVILEGE TAX before any business or occupation can be lawfully begun or pursued.

       RA 7392 – This Act provided that only licensed midwives could practice and that nurses must pass first the MIDWIFERY EXAMINATION before they can practice midwifery

       RA 2382 – PHILIPPINE MEDICAL ACT ; defines the practice of medicine in the Philippines. Section 10 of this Act provides: Act constituting the practice of medicine. A person shall

be considered as engaged in the practice of medicine who shall for compensation, fee, salary, or reward in any form paid to him directly or through another or even without the same may physically examine any person, and diagnose, treat, operate or prescribe any remedy for any human disease, injury, deformity, physical, mental, physical condition or ailment nature, real or imaginary, regardless of the remedy or treatment administered, prescribed or recommended.

       RA 5181 – An act that prescribes PERMANENT RESIDENCE and reciprocity as qualifications for any examination or registration for the practice of any profession in the Philippines

       Presidential Decree 541 – a decree allowing former Filipino (BALIKBAYANS) professionals to practice their respective profession in the Philippines.

       RA 6425 – “DANGEROUS DRUG ACT” enacted in 1972 declaring that sale, administration, delivery, distribution, and transportation of prohibited drugs are punishable by law.

       Act No. 3573 – This Act in 1929 declared that all COMMUNICABLE DISEASES shall be REPORTED to the nearest health station, and that any person may be inoculated, administered or injected with prophylactic preparations.

       RA 1082 – creation of RURAL HEALTH UNITS in the Philippines.        RA 4073 – liberalizes the LEPROSY TREATMENT. No person shall be confined in leprosarium

unless such disease requires institutional treatment.        Presidential Decree 996 – COMPULSORY IMMUNIZATION for all children below eight years old.        RA 8981 – “ PRC MODERNIZATION ACT OF 2000” This Act gave the Professional Regulatory

Commission its regulatory powers and is now an agency of its own.        Presidential Decree 825 – provided penalty for improper disposal of GARBAGE and other forms

of unclealiness.        Presidential Decree 856 – CODE OF SANITATION, provides for control of all factors in man’s

environment that affect health including the quality of water, food, milk, control of insects, animal carriers, transmitters of disease, sanitary and recreation facilit ies, noise, unpleasant odors and control of nuisance.

       Presidential Decree 148 – “ WOMAN AND CHILD LABOR LAW” The employable age is 16 years and above and further provides for the privileges of working women.

       RA 6365 – established a National Policy on Population and created the Commission on Population (POPCOM).

       PD 791 – revised population Act. Empowered nurses and midwives to provide, dispense and administer acceptable METHODS OF CONTRACEPTION after having undergone training and having been granted authorization by POPCOM.

       PD 166 – Strengthened FAMILY PLANNING programs through participation of private organizations and individuals in the formulation and implementation of the program planning policies.

       General Order No. 18 – enjoins all citizens of the Philippines, universities, colleges, schools, government offices, mass media, voluntary and religious organizations of all creeds, business and industrial enterprises to promote the concept of family welfare, responsible parenthood and family planning.

       Letter of Instruction No. 47 – directs all schools of medicine, nursing, midwifery and allied medical professions and social work to prepare, plan, and implement the INTEGRATION OF

FAMILY PLANNING in their curricula and to require from their graduates sufficient appropriate licensing examination.

       Department of Labor Order No. 7 – requires all industrial establishments to provide FAMILY PLANNING SERVICES.

       PD 48 – limits paid MATERNITY LEAVE privileges to four children.        PD 69 – limits the number of children to FOUR for TAX EXEMPTIONS purposes.        PD 965 – requires that couples intending to get married must first undergo a family

planning and responsible PARENTHOOD INSTRUCTION prior to the issuance of marriage license.

       RA 1054 – requires the owner, lessee or operator of any commercial, industrial or agricultural establishment to furnish free EMERGENCY, medical, and dental ASSISTANCE to his employees and laborers.

       RA 4226 – HOSPITAL LICENSURE ACT requires all hospital in the country to be licensed before it can offer to serve the community. The licensing agency is the Office For Hospital and Medical Services, Department of Health.

       RA 5901 – nurses working in agencies with 100-bed capacity and/or above and are working in area of one mill ion population are supposed to WORK 40 HOURS A WEEK.

       PD 442 – LABOR CODE OF THE PHILIPPINES provides the right of the workers to self-organization and collective bargaining agreement.

       PD 603 – CHILD AND YOUTH WELFARE CODE protects and promotes the rights and welfare of children and youth.

       PD 651 – decrees the REGISTRATION OF BIRTH of a child within 30 days with the Civil Registrar.

       PD 1519 – MEDICARE BENEFITS TO ALL GOVERNMENT EMPLOYEES regardless of status of appointment.

       PD 626 – EMPLOYEE COMPENSATION AND STATE INSURANCE FUND

       RA 6675 – GENERICS ACT OF 1998

       RA 6758 - standardized the salaries of government employees which include the nursing personnel.

       RA 7160 – LOCAL GOVERNMENT CODE OF 1991devolution of powers from national to local government.

       RA 7305 – MAGNA CARTA FOR PUBLIC HEALTH WORKERS

       RA 7600 – ROOMING-IN AND BREASTFEEDING ACT OF 1992 provides that babies born in private and government hospitals should be roomed-in with their mothers to promote breastfeeding and ensure safe and adequate nutrition to children.

       EO 51 – MILK CODE

       RA 7432 – SENIOR CITIZENS ACT does honor and justice to our people’s long tradition of giving high regard to elderly. 20% discount in all public establishments such as restaurants, pharmacies, public util ity vehicles and hospitals.

       PRC Resolution No. 2004-17 Series of 2004 – RE-IMPLEMENTED CONTINUING PROFESSIONAL

EDUCATION requiring sixty (60) credit units for three years for professionals with bachelor’s degree

Contract – (Article 1305 New Civil Code) defines contract: A contract is a meeting of minds between two persons whereby one binds himself, with respect to the other, to give something or to render some service.

A contract, from the Latin word “contractus” and from the French word “contract,” is “ a juridical convention manifested in legal form, by virtue of which, one or more persons ( or parties) bind themselves in favor of another or others, or reciprocally, to the fulfi l lment of a prestation to give, to do or not to do.”

It is the agreement of two or more persons ( or parties ) for the purpose of creating, modifying, or extinguishing a juridical relation between them.

Characterist ics of Contracta. Freedom ( or liberty) to stipulate provided not contrary to law, morals, good customs,

public order, or public policyb. Obligatory force and compliance in good faithc. Perfection by mere consent as a ruled. Both parties are mutually bounde. Relatively ( Generally it is binding only between parties, their assigns, and heirs) The contracting parties may establish such stipulations, clauses, terms as they may

deem convenient, provided they are not contrary to law, morals, good customs, public order, or public policy. (1306 NCC)

The contracts must bind both contracting parties; its validity or compliance cannot be left to the will of one of them.(1308 NCC)

stipulates that contract takes effect only between the parties, their assigns and heirs.(1311 NCC)

any third person who induces another to violate his contract shall be liable for damages to the other contracting party.

Contracts are perfected by mere consent and from that moment the parties are bound not only to the fulfi l lment of what has been expressly stipulated but also to all the consequences which, according to their nature, may be in keeping with faith, usage and the law. (1315 NCC)

ESSENTIAL REQUISITES OF A CONTRACTThere is no contract unless the following requisites concur:

1. CONSENT2. OBJECT certain which is the subject matter of the contract3. CAUSE o f the obligation which is established CONSENT is manifested by the meeting of the offer and the acceptance upon the thing

and the cause which are to constitute the contract. Consent must be given freely and voluntarily Consent must be given by a capacitated person Consent must not be vitiated Under the 1987 Constitution, the age of majority is now fixed at 18 years old. This is

now the legal age where a person can sign or give consent to contracts or any valid legal acts. Thus, by this provision of the constitution, there are no more emancipated minors who can give consent in the Philippines.

Insane or demented persons, and deaf-mutes who do not know how to write cannot give consent.

Contracts entered into during lucid intervals are valid Contracts agreed to in a state of drunkenness or during hypnotic spell are voidable A contract where consent is given through mistake, violence, intimidation, undue

influence, or fraud is voidable. There is violence when in order to wrest consent, serious or irresistible force is

employed. There is intimidation when one of the contracting parties is compelled by a

reasonable and well grounded fear of an imminent and grave evil upon his person or property, or upon the person or property of his spouse, descendants or ascendants, to give his consent.

There is undue influence when a person takes improper advantage of his power over the will of another, depriving the latter of a reasonable freedom of choice.

There is fraud when, through insidious words or machinations of one of the contracting parties, the other is induced to enter into a contract which, without them, he would not have agreed to.

OBJECT of contracts are all things which are not outside the commerce of men, including future things

All rights which are not intransmissible may also be the object of contracts All services which are not contrary to law, morals, good customs, public order, or

public policy may likewise be the object of contract. Impossible things or services cannot be the object of contracts. The object of the contract must be determinate as to its kind FORMS OF CONTRACT . (1356 NCC) Contracts shall be obligatory, in whatever form they

may have been entered into, provided all the essential requisites for their validity are present

However, there are times when the law requires that a contract be in some form in order to be valid or enforceable.

The following are void or inexistent contracts:1. When the cause, object or purpose of the contract is contrary to law, morals, good

customs, public order, or public policy2. When the contract is absolutely simulated or fictitious3. When the cause or object of the contract did not exist at the time of the making of

the contract4. If the object of the contract is outside the commerce of men5. If the contract contemplates or intends a performance of an impossible service6. If the intention of the contracting parties cannot be ascertained7. If the contract is expressly prohibited by law or declared by laws as invalid or

ineffective Voidable contracts are valid contracts until annulled by a competent court The action to annul voidable contracts shall be brought within four years. This period

begins: In cases of intimidation, violence or undue influence, from the time the defect of the consent ceases.

SUCCESSION – is a mode of acquisition by virtue of which property, rights, and obligations to the extent of the value of the inheritance, of a person are transmitted through his death to another or others either by his will or by operation of law. (774 NCC)DECEDENT – is the general term applied to the person whose property is transmitted through succession, whether or not he left a will. If he left a will, he is also called the testator.TESTATOR – a male decedentDEVISEE – is a person to whom a gift of real property (eg. Land, house) is given by virtue of a willLEGATEE – is a person whom a gift of personal property (eg. Money, Jewelry) is given by virtue of a will

The inheritance includes all property, rights and obligations which are not extinguished by his death

The rights to succession are transmitted from the moment of death of the decedent. An HEIR is a person called to succession either by the provision of a will or by

operation of the law.WIILL – is an act whereby a person is permitted, with the formalities prescribed by law, to control to a certain degree the disposition of his estate, to take effect after his death.

The making of a will is strictly personal act; it cannot be left in whole or in part to the discretion of a third person, or accomplished through the instrumentality of an agent or attorney.

All persons who are not expressly prohibited by law may make a will Persons of either sex under eighteen years of age cannot make a will In order to make a will it is essential that the testator be of sound mind at the time of

its execution. To be of sound mind, it is not necessary that the testator be in full possession of all

his reasoning faculties, or that his mind be wholly unbroken, unimpaired, or unshattered by disease, injury or other cause.

It shall be sufficient if the testator was able at the time of making the will to know the nature of the estate to be disposed of, the proper objects of his bounty, and the character of the testamentary act.

The law presumes that every person is of sound mind Testamentary Capacity is the capacity to comprehend the nature of the transaction

in which the testator is engaged at the time to recollect the property disposed of and the persons who would naturally be supposed to have claims upon the testator and to comprehend the manner in which the instrument will distribute his property among the objects of his bounty.

a married woman may make a will without the consent of her husband, and without the authority of the court

a married woman may dispose by will of all her separate property as well as her share of the conjugal partnership or absolute community property.(802 NCC)

Every Will must be in writing and executed in a language or dialect known to the testator(803 NCC)

NOTARIAL WILL is a will that must be signed by the testator or if written by some other person, it must be done in his presence and under his express direction

A notarial will or an ordinary will must be subscribed and attested by three or more credible witnesses

A notarial will must be acknowledged before a notary public If the testator be deaf, or a deaf-mute – he must personally read the will if he is able

to do so; otherwise, he must designate two persons to read it and communicate to him in some practicable manner its contents. If the testator is blind, the will must be read to him twice; once, by one of the subscribing witnesses and again, by the notary public before whom the will is acknowledged.

The requirement of the will must be in writing but it does not mean that the testator must himself perform the mechanical work of writing the will, except in the case of a holographic will, which must be entirely written, dated and signed by the hand of the testator himself.

The requirement that the testator must sign the will is satisfied by the use of his thumb mark, the sign of the cross, or the initials or portion of the name of the testator.

Where the testator directs another person to sign his name, it is essential that the person so directed write the testator’s name; it is not sufficient for the other to write his name only.

HOLOGRAPHIC WILL is a will entirely written dated and signed by the testator Any person of sound mind and of the age of eighteen years or more, and not blind,

deaf or dumb, and able to read and write, may be a witness to the execution of a will.

The following are disqualified from being witnesses to a will:

1. any person not domiciled in the Philippines2. Those who have been convicted of falsification of a document, perjury or false

testimony A will may be revoked by the testator at any time before his death. Any waiver or

restriction of this right is voidThe following Will shall be disallowed in any of the following cases:

1. If the formalities required by law have not been complied with;2. If the Testator was insane, or otherwise mentally incapable of making a will, at the

time of its execution3. If it was executed by undue through force or under duress, or the influence of fear,

or threats;4. If it was procured by undue and improper pressure and influence, on the part of the

beneficiary or of some other person;5. If the signature of the testator was procured by fraud;6. If the testator acted by mistake or did not intend that the instrument he signed

should be his will at the time affixing his signature thereto.The law provides for the following kinds of Will:

1. Ordinary or Notarial Will2. Holographic will3. Mixed will

Criminal law – is that branch of law which defines crime and treats of their nature. Ignorance of the law excuses no one from compliance therewith Laws take effect after 15 days from the publication in the official gazette or any

newspaper of national circulation. It serves as a constructive notice to all persons so that no one is exempted from complying with the law or to claim that he or she is ignorant from the passage of that law.

The power to define and punish an act is within the powers of the Legislative Department (House of Congress) where the legislative power is vested in the fundamental law and has the power to define and punish an act or omissions as a crime. The Chief Executive has also the prerogative.

Limitations in enacting Penal Laws1.              GENERALITY2.              TERRITORIALITY3.              IRRETROSPECTIVITY OR PROSPECTIVITY

Limitations in enacting Penal Laws1. it cannot enact an ex post facto law nor a bill of attainder2. it must be of general application3. it cannot provide for a cruel, degrading or inhuman punishment nor can it impose

excessive fines. Theories of Criminal Law 1. Classical Theory –

a. man is essentially a moral creature with an absolutely free will to choose between good and evil and therefore more stress is placed upon the result of the felonious act

b. Basic criminal l iability is human free will and the purpose of penalty is retribution.

c. Crime is a juridical entity and penalty is an evil and a means of juridical tutelage

2. Posit ivist Theory – Man is subdued occasionally by strange and morbid phenomenon which conditions him to do wrong in spite of or contrary to his volition. The basis of criminal responsibility of the criminal is his dreadfulness or dangerous state.

The major source of our criminal law is Act # 3815 otherwise known as the Revised Penal Code of the Philippines that took effect on January 1, 1932.

Crime consists of internal and external acts. Internal acts are not punished in our jurisdiction.

Voluntariness is an element of felony because if an act is committed or performed with deliberate intent then it implies that the act is voluntary or freely committed.

Felony is an act or omission punishable by the law A felony may be committed by means of DOLO (deceit) or CULPA (fault)

The distinction of dolo and culpa: while both are voluntary, dolo is intentional, whereas culpa is not. Where there is intent there can be no negligence. In culpable felonies, intent is replaced by fault.

Dolo (deceit) involves malice or deliberate intent; culpa (fault) results from negligence , imprudence, lack of foresight or lack of skill.

Imprudence is deficiency in action Negligence is deficiency of perception. Negligent act must be voluntary- example ( an incidental dropping of pistol and fired

and hit someone, there is no liability )Elements of Dolo :

1. Freedom2. Intelligence3. Intent

Elements of Culpa:1. Freedom2. Intelligence3. Negligence or imprudence Intel l igence – is the moral capacity to determine what is right from what is wrong and

to realize the consequences of one’s acts.

Intent – is a mental state, the existence of which is shown by the overt acts of a person.

A crime may be committed without criminal intent by means of culpa and offenses punishable by special laws.

Criminal l iability shall be incurred by any person committing a felony although the wrongful act done be different from that which he intended. By any person performing an act which would be an offense against persons or property, were it not the inherent impossibility of its accomplishment or on account of the employment or inadequate or ineffectual means.

STAGES OF FELONY

1. Consummated – all elements necessary for execution and accomplishment are pesent.2. Frustrated – the offender has performed all the acts of execution to produce the felony

as a consequence but the crime does not result due to some cause independent of the will of the offender.

3. Attempted – the offender begins the commission of the felony by direct overt acts but does not perform all the acts of execution which should produce the felony as a consequence by reason of some cause or accident other than his own spontaneous desistance

SUBJECTIVE & OBJECTIVE PHASE OF FELONY : The subjective phase is that portion of execution of the crime starting from the point where he stil l has the control of his acts. If it reaches the point where he has no more control over his acts, the subjective phase has passed. If the subjective phase is not yet passed, the felony would be mere attempt. If it has already passed but the felony is not yet produced, as a rule it is frustrated.Objective phase is the result of the acts of execution that is the accomplishment of crime. Consummated. CIRCUMSTANCES AFFECTING CRIMINAL LIABILITY

1. Justifying Circumstance – the acts of the actor are in accordance with the law , hence he incurs no criminal and civil l iability ( no crime, no criminal).

2. Exempting Circumstance – those wherein there is an absence in the agent of the crime any of all the conditions that would make an act voluntary and hence, although there is no criminal l iability, there is civil l iability ( no criminal but there is crime ).

3. Mitigating Circumstances – those that have the effect of reducing the penalty due to the lesser perversity of the offender.

4. Aggravating Circumstance – those which increases the penalty.5. Alternative Circumstance – either aggravating or mitigating depending on the facts of the

situation.JUSTIFYING CIRCUMSTANCES:

1. Self- defense2. Defense of Relative3. Defense of stranger4. State of necessity5. Fulfil lment of duty6. Obedience to superior order

EXEMPTING CIRCUMSTANCE1. Imbecility and Insanity2. Minority3. Accident4. Compulsion of Irresistible force5. Lawful causes6. Instigation and entrapment

MITIGATING CIRCUMSTANCES1. Passion or obfuscation2. Voluntary Surrender3. Voluntary plea of guilty4. Deaf, and dumb, blind5. Il lness that diminishes the exercise of will power6. Lack of instruction7. Incomplete self-defense8. Offender is below 18 or over 70 years old9. When the act is committed in the immediate vindication of a grave offense

AGGRAVATING CIRCUMSTANCES1. Taking advantage of official position2. Crime is committed in contempt of or with insult to public authorities3. Crime committed with insult or disregard due to offended by age, sex or rank4. Crime is committed in the dwelling of the offended5. Abuse of confidence or obvious ungratefulness

6. Nighttime7. Band8. Uninhabited place9. Crime committed during calamity10. Recedivism11. Habituality12. Crime committed in consideration of price, promise or reward.13. By means of fire,explosion,poison and stranding of a vessel14. Evident premeditation15. Craft, fraud or disguise is employed16. Advantage taken of superior strength17. Means employed to weaken defense18. Treachery19. Adds ignominy to the natural effects of the crime20. Unlawful entry

ALTERNATIVE CIRCUMSTANCE1. degree of relationship2. intoxication3. i l l iteracy or lack of education

* CLASSIFICATION OF FELONIES1. GRAVE2. LESS GRAVE3. LIGHT FELONIES

PERSONS CRIMINALLY LIABLE FOR FELONIES When several persons take part in the commission of a crime it does not necessarily

follow that their participation in it is equal. Some may have a greater or more important in it than others. Consequently, their l iability also varies according to the position they occupy in the commission of the felony, that is, whether they are principals, accomplices, or accessories

This classification of offenders does not apply when there is conspiracy to commit a crime because of the rule that the act of one is the act of all.

A Juridical person cannot be punished like a natural person because they are only acting through their officers, generally, an officer of a corporation who commits a violation is the one criminally liable.

1. (Art. 16) The following are criminally liable for grave and less grave felonies:A. PRINCIPAL

B. ACCOMPLICE

C. ACCESSORIES

for light felonies:a. principalsb. accomplices2. The following are considered Principals (Art. 17) :

a. those who take a direct part in the execution of the act;*to be considered as a principal by direct part icipation , it is essential that the offender (a) participated in the criminal resolution as shown by his prior or simultaneous acts (b) carried out the plan and personally took part in its execution, and (c) performed acts tending directly to the same end. Accordingly, if he was not present at the scene of the crime, he cannot be deemed to be a principal by direct participation.

b. those who directly force or induce others to commit i t ;* Principal by inducement presupposes that the offender himself is determined to commit the felony; he must have persistently clung to his determination; he offers the strongest of temptations sufficient to induce the commission or exercises ascendancy to compel

obedience and the inducement must be the determining cause for the commission of the crime.Where the inducer only made remarks or gave an order after the fatal blow had been struck, he cannot be punished as a principal by inducement.

c. those who cooperate in the commission of the offense by another act without which it would not have been accomplished;

* principal by indispensable cooperation must have concurred in the criminal resolution and cooperated by performing another act indispensable for the commission of the felony agreed upon. His cooperation is similar to that of an accomplice but is of greater degree because of its indispensability to the accomplishment of the offender’s objective, while that of an accomplice is of a lesser and minor importance.3. Accomplices (Art. 18) - are those persons who, not being included in article 17, cooperate in the execution of the offense by previous or simultaneous acts* Under American law, accomplices are accessories before the fact* to be considered an accomplice, the offender must have known of the criminal design of the principal by direct participation and concurs therein. The acts of the accomplice should not produce the most serious effect on the victim, otherwise he will be a principal. The acts of an accomplice is similar to those of a principal by cooperation, but may be distinguished from the latter in that, although the acts of the accomplice are necessary for the commission of the crime, they are not indispensable. An example would be if a nurse agrees to prepare a 20 cc lethal drug to be used by the nurse’s friend on victim A and did inject a 10 cc kill ing victim A but the other 10 cc was injected on another victim B to which the nurse does not know about, the nurse cannot be held criminally liable to the second victim B but an accomplice to victim A only.

3. Accessories (Art. 19) – are those who, having knowledge of the commission of the crime, and having participated therein, either as principals or accomplices, take part subsequent to its commission in any of the following manners:

a. by profit ing themselves or assisting the offender to profit by the effects of the crme.* the acts of an accessory are always performed after the commission of the crime by the principal and that the accessory had no participation therein in any form (accessory after the fact). An example is a daughter who stole an earrings and the mother pawned them, the mother is guilty as an accessory.

b. by concealing or destroying the body of the crime, or the effects or instruments thereof, in order to prevent its discovery.

* The prescribed acts of the accessory must have been intended to prevent discovery of the crime , hence mere silence does not make one an accessory. The body of the crime is equivalent to the corpus delicti.

c. by harboring , concealing, or assisting in the escape of the principal of the crime, provided the accessory acts with abuse of his public functions.

* this provision distinguishes a person either as a public officer or a private individual. They may have different penalties. NURSES AND CRIMES

The professional practice of a nurse entails with it the legal responsibilit ies that he or she must know and understand in order to avoid liabilit ies in the discharge of her functions.

The following are crimes that a nurse must be familiar with:        ASSAULT – An unlawful attempt or offer to beat or to do bodily injury to another.        BATTERY – The unlawful beating or touching of another person. The unlawful beating or

use of force upon a person without his consent.

       MURDER – is the unlawful kil l ing of a human being by another with intent to kil l (DOLO is an element).

       HOMICIDE – is the kill ing of a human being by another without deliberate intent to kil l.        ABORTION – Termination or expulsion of the product of conception even before the age of

viability. Abortion is a crime penalized in our jurisdiction. A nurse who advises a woman on what drugs to take is criminally liable.

        INFANTICIDE - kil l ing of a child less than three days of age.        PARRICIDE – is committed by one who kills his/her father, mother or child whether

legitimate or il legitimate, or any of his/her ascendants or his/her espouse.        SEXUAL HARASSMENT – is committed by a person who, having authority, influence or moral

ascendancy over another in a work, training or education environment, demands, requests or otherwise requires any sexual favor from the other regardless of whether such demand, request or requirement for submission is accepted.

        ILLEGAL DETENTION – any private individual who shall detain another or, in any other manner, deprive him of his liberty.

       ARBITRARY DETENTION – any person in authority (public officer) who shall detain another or, in any other manner, deprive him of his liberty.

       SIMULATION OF BIRTH – any person who shall substitute one child for another or who shall conceal or abandon any legitimate child with intent to cause such child to lose its civil status. CRIMINAL NEGLIGENCE – is negligence of such character or occurring under such

circumstances, as to be punishable as a crime by statute. PROFESSIONAL NEGLIGENCE – breach of professional duty. Negligence committed in the

practice of a profession. NEGLIGENCE - is often referred to as that “doing of a thing which a reasonably prudent

man would not have done and not doing a thing which a reasonably prudent man would have done”. It also refers to the commission or omission of an act, pursuant to a duty, that a reasonably prudent person in the same or similar circumstance would do or would not do, and acting or the non-acting of which is the proximate cause of injury to another person or his property

The elements of professional negligence are:1. existence of a duty on the part of the person charged to use due care under

circumstances2. failure to observe such duty3. such failure resulted to injury or harm The test for negligence: “ would a prudent man, in the position of the person to

whom negligence is attributed, foresee harm to 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 that course or to take precaution against its mischievous results, and the failure to do so constitutes negligence.

Reasonable foresight of the harm and ignoring such foresight is constitutive fact in negligence.

If such negligence is the proximate cause of the injury or harm, then the person causing such negligence is liable for damages under the law

A failure of the nurse to apprise or report to the physician his/her observation like sudden increase in BP or sudden drop of vitals signs and such failure to report resulted to the death or injury to the patient, then the nurse is liable for negligence.

Observance of the standard of care as prescribed by RA 9173 is the only for nurses to avoid negligence/malpractice suits in the practice of their profession in the Philippines.

Wrong medication or wrong drug given to another patient constitute negligence on the part of the nurse

MALPRACTICE - refers to a negligent act committed in the course of professional performance. Any professional misconduct, unreasonable lack of skill or fidelity in professional or fiduciary duties ; evil practice; or il legal or immoral conduct; improper discharge of professional duties, or failure to meet the standard of care of a professional which results in harm to another.

to go beyond the practice of nursing as prescribed by RA 9173, like for example, the nurse suturing in a surgical procedure without special training or the nurse prescribing medicine or drugs, is malpractice. It means encroaching on the practice of other profession where the nurse is not supposed to perform as prescribe by the law.

Negligence is malpractice Malpractice is determined if the nurse owed a duty to the client and did not carry out

the duty, and the client was injured because the nurse failed to perform the duty. If a nurse gives care that does meet appropriate standards, he or she may be held

liable for negligence. Negligence encompasses (includes) the concepts of foreseeability of harm to the

person injured and of a duty of care toward that person. Article 20 of the New Civil Code of the Philippines provides that every person who,

contrary to law, willfully or negligently causes damage to another shall indemnify the latter for the same. This means that negligent acts resulting to injuries must be indemnified in monetary terms.

INCOMPETENCE- is the lack of ability, legal qualifications or fitness to discharge the required duty. Incompetence is now included as a ground for revocation/suspension of the certificate of registration as a nurse.

DOCTRINE OF RES IPSA LOQUITOR – it l iterally means, “ let the thing speak for itself”. This is a legal doctrine usually used in lit igations involving negligence or malpractice suits. If the plaintiff (the one bringing an action in court) offers such evidence under this doctrine, then no other evidence is necessary. An example would be sponges left inside the abdomen of the patient after surgery – the fact that there is the sponge left is evidence by itself that can speak that negligence was indeed committed and the court may no longer ask for other evidence to prove the occurrence of such negligence. There are three conditions for the application of this doctrine:

1. the accident must be of a kind which ordinarily does not occur in the absence of someone’s negligence

2. the accident must be caused by an agency or instrumentality within the exclusive control of the defendant ( one being sued in a civil case)

3. the accident must not have been due to any voluntary action or contribution on the part of the plaintiff ( injured party )

DOCTRINE OF RESPONDEAT SUPERIOR – it means “let the master answer; let the principal answer for the acts of his agent”. Respondent superior simply provides that where one acts through the agency of another , then , in the contemplation of the law , he is himself acting so as to make him responsible for the acts of his servant. This doctrine is founded on the principle that he who expects to derive advantage from an act which is done by another

must answer for any injury which a third person may sustain from it. Master-servant or employer-employee relationship must exist for this doctrine to apply. DOCTRINE OF FORCE MAJEURE – vis major, an act of God, irresistible force, one that is unforeseen, inevitable. Natural calamities like strong typhoons or floods that would deter the nurse to report for duty in the hospital for her shift is an example of this doctrine. Even if the hospital needs her to report or some untoward incidents happened in the hospital, which would not happen if the nurse were there does not constitute any liability on the part of the nurse because of this doctrine. NURSE AS A WITNESS – Any information obtained in the course of caring for the patient by the health team ( doctor, nurses, medtechs) or any matters communicated by the patient to the nurse is considered privilege. The nurse cannot testify in a civil case for any privilege communication except when the patient allows such testimony or the patient himself offered such information first in a court hearing or when the health of the many will be jeopardized. This seal of secrecy will remain forever until removed by the patient. However, any privileged communication may be divulged in a criminal proceeding even without the consent of the patient where such information was obtained. LIABILITY FOR FALSE TESTIMONY – any person who shall give false testimony in any criminal case, either against or in favor of the defendant, shall be liable to punishment as provided by the law. The punishment, depending on the case, ranges from imprisonment to paying fines and/or both. The nurse can commit this violation if he/she is negligent on charting or erroneously altering her entry in the charts.

The hospital records, even if the patient was already discharged are part of public documents, which can be summoned in any court hearing should the need arises. Most of the time, it is the record custodian of the institutions who is given the subpoena duces tecum or subpoena ad testificandum by the court. However, the nurses who made the entries in the chart, if clarification is needed may also be summoned to appear in a court hearing through the service of subpoena.

A patient’s chart that is correctly and accurately accomplished is not only valuable as evidence in legal proceedings but also useful as guide in the proper treatment of the patient.

Doctor’s Orders – as mandated by law, nurses must execute such orders for the treatment of the patient, deviation or failure to perform this lawful duty can make the nurse criminally and civil ly l iable and her license may be revoked or suspended. The nurse must exercise certain degree of judgment in carrying out the doctor’s order. If in the assessment of the nurse that such order may cause some injury to the patient, then she is morally obligated to verify such orders before carrying them out. The verification must be made to the person giving such order. The nurse must be assertive enough to protect the welfare of the patient (stewardship) and also to protect his/her professional career from lawsuits arising from erroneous carrying out of doctor’s orders. Should the doctor insist in carrying out a questionable order, the nurse must refer the matter to her immediate superior and must properly document the actions taken.

Telephone Orders – the following guidelines may be observed in carrying out orders of the physician given through telephone:

a. the nurse must chart the date and exact time when the order was givenb. the nurse must repeat and record the telephone order

c. the nurse must sign the order; begin with t.o. (telephone order) write the doctor’s name, and then signature the order

d. if another nurse witnessed the order, then her signature must also followe. if another physician or intern or resident is present in the station where such

order was given, then it is prudent that the phone call is given to that doctor so they can discuss the order properly and that doctor can sign the orders given in a telephone.

f. The physician must sign the telephone order as soon as he is around or within 24 hours depending on the policy of the hospitals.

Reporting Responsibil i t ies – the nurse are required to report certain communicable diseases or criminal activities such as abuse, gunshot wounds, assaults, homicides, and suicides to the appropriate authorities.

Incidental Report – the nurse must write incidental report to protect themselves from sanctions. The matters that must be reported are those that deviate from the norms or standard in the performance of their duties. This is also done so that proper remedy can be reached in a given crisis or situation. The report must always be addressed to the immediate superior or proper authorities ( eg. DSWD,PNP,RITM etc…).

Charting Done by students – the clinical instructor or the nurse on duty must sign the charting done by the student as required by RA 9173. Those persons signing such charting attests that the charting made by the student are accurate and authentic and consequently takes or assumes the responsibility from that charting.

* PROFESSIONAL ADJUSTMENT - means “ the preparation of a student nurse for the responsibilit ies of professional and social l ife, by the development of her capacities in a way that would make her fit to enter upon the practice of nursing.” “Being a nurse means more than just doing a good job; it means involving one’s self in the pressing health problems of the community; it means listening, understanding, communicating, and working with others whose life styles, beliefs, morals, values and culture may differ from those of the nurse.” ( robles,183) * HOLD-OVER DOCTRINE – simply requires those who have been appointed to continue serving or holding their position even if their terms has already lapsed, until such time that their successor or replacement shall have qualified and appointed. Under RA 9173, members of the Board of Nursing are appointed by the President of the Philippines and confirmed by the Commission on Appointments. Members of the Board of Nursing may be appointed by:

1. Regular appointment . – The Philippine Nurses Association certifies for the Appointment to the Board of Nursing from the three (3) nominees per vacancy and the Board shall endorse two (2) nominees per vacancy to the President.

2. Ad interim Appointment – A board member is appointed in the meantime to fi l l in a vacancy or perform the duties of an office during the absence of the regular incumbent. There is no definite term of appointment.

Republic of the Phil ippines

Professional Regulation CommissionManila

BOARD OF NURSINGBoard Resolution No. 425

Series of 2003

IMPLEMENTING RULES AND REGULATIONS OF THE “PHILIPPINE NURSING ACT OF 2002 ”(Republic Act No. 9173)

BACKGROUND This Implementing Rules and Regulations (IRR) is being issued pursuant to Section 38, Article IX of Republic Act (RA) No. 9173, entitled “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”, mandating the Professional Regulatory Board of Nursing, hereinafter referred to as the Board, and the Professional Regulation Commission, hereinafter referred to as Commission, in coordination with the Accredited Professional Organization (APO), the Department of Health (DOH), the Department of Budget and Management (DBM) and other concerned government agencies to formulate the necessary rule and regulations that will effectively implement the provisions of the law. RULE ICOVERAGE, POLICY STATEMENT, AND DEFINITION OF TERMS SECTION 1. Tit le. – This Resolution shall be known as the “Rules and Regulations Implementing the Philippine Nursing Act of 2002”, referred to in short as IRR. SECTION 2 .   Declarat ion   of   Pol icy . – It is hereby declared the policy of the State to assume responsibility for the protection and improvement of nursing profession by instituting measure that will result in relevant nursing education, humane working conditions, better career prospects and a dignified existence for our nurses. SECTION 3. Defin i t ion   of   Terms. – As used in this IRR, the following terms are construed as follows:

a. New Nursing Act – RA No. 9173, otherwise known as the “Philippine Nursing Act of 2002”

b. Commission – the Professional Regulation Commission (PRC) created under Section 3 of RA No. 8981.

c. Board – the Professional Regulatory Board of Nursing created under Section 3. Article II of RA No. 9173.

d. Nursing Practice – covers the three (3) areas of nursing namely nursing education, nursing service and community health nursing.

e. Professional Nurse – a person whose name and registration/professional license number id entered in the Commission’s registry book and computerized database as legally authorized to practice the nursing profession.

f. Practicing Professional Nurse – a person who is engaged in the practice of nursing profession or is performing acts or activities, whether regularly or occasionally, including one who is employed in a government office or in a private firm, company or corporation whose duties require knowledge and application of the nursing profession.

g. Foreign Professional Nurses – foreign nationals who, being licensed professional nurses in their own countries, are authorized by existing laws to practice their profession either as holders of a certificate of registration and a professional identification card or a special/temporary permit in the Philippines, subject to the provisions of subsections (j) and (l) of Section 7 of RA No. 8981 and other pertinent provisions of said RA No. 8981 and RA No. 9173.

h. Nursing Specialty Program – a training and development program intended to develop/enhance the skills, to which a registered nurse devotes himself/herself whether as a vocation or profession, to enable him/her to provide nursing service in specific areas in accordance with the ethics of the profession and applicable law.

i. Public health Institution – any organization that pursues the aims of public health through the provision of services (e.g. Local Government Units through its Rural Health Units) research (e.g. Research Institute for Tropical Medicine) training 9e.g.

College of Public Health) management of programs/projects (e.g. Department of Health) or advocacy 9e.g. health Alliance for Democracy) to include schools.

j. Accredited Professional Organization (APO) – The Philippine Nurses Association (PNA), Inc. or any professional organization of Nurses which now or may hereinafter, is accredited by the Commission.

RULE I ICOMPOSITION OF THE BOARD, APPOINTMENT, QUALIFICATIONS, TERM OF OFFICE AND COMPENSATION OF CHAIRPERSON AND MEMBERS, THEIR REMOVAL AND SUSPENSION, REQUIREMENTS UPON QUALIFICATION AS MEMBERS OF THE BOARD OF NURSING, SUBMISSION OF REPORTS, AND THEIR POWERS AND DUTIES.

SECTION 4. Composi t ion   of   the   Board. – The Board created under Section 3. Article III of the said Nursing Act shall be composed of a Chairperson and six (6) members, representing the three (3) areas of nursing. The Board shall be under the administrative supervision and control of the Commission, and as such:

a. 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: and

b. The Commission shall designate the Secretary of the Board and shall provide the secretariat and other support services needed by the Board to implement the provisions of the said Nursing Act.

SECTION 5. Appointment. – The Chairperson and six members shall be appointed by the President of the Republic of the Philippines upon the recommendation of the Commission: Provided, That all those who will be recommended by the Commission to the President for the appointment shall be duly licensed/registered nurses chosen only from among the nominees submitted by the accredited professional organization of nurses in the Philippines to the Commission to fi l l up vacancies. For this purpose, the following shall strictly be observed/complied with:

a. The commission shall, before the last year of the term of office of any member, notify and request the accredited professional organization of nurses in the Philippines to submit to the Commission at least three (3) qualified nominees per vacancy.

b. The accredited professional organization of nurses shall upon receipt of the Commission’s request screen and rank qualified nurses only for the purpose and submit three (3) nominees, per vacancy, to the Commission not later than three months before the vacancy occurs.

c. The Commission upon receipt of the list of nominees of the accredited professional organization of nurses in the Philippines shall rank said nominees and submit to the President of the Philippines two (2) nominees per vacancy, not later than two (2) months before the vacancy occurs, with the request that the appointment be issued not later than thirty (30) days before the scheduled licensure examinations.

d. Reappointment shall be subject to the provisions of E.O. No. 496.e. The necessary operating procedures to ensue strict compliance therewith shall be

embodied in a Memorandum of Agreement (MOA) by the Commission and the accredited professional organization of nurses.

SECTION 6. Qual i f icat ion   of   the  Chairperson  and  Members. – The Chairperson and members of the Board shall, at the time of the appointment possess the following qualifications:

a. Be a natural born citizen and resident of the Philippines.b. Be a member of good standing of the accredited professional organization of nurses:c. Be a registered nurse and holder of a master’s degree in nursing, education or other

allied medical profession conferred by a college or university duly recognized by the Government, provided that the Chairperson and majority of the Members must be holders of a master’s degree in nursing.

d. Must have at least ten (10) years of continuous practice of the profession prior to appointment, the last five (5) years of which must be in the Philippines; and

e. Must not have been convicted of any offense involving moral turpitude. SECTION 7 . Term of  Off ice. – The Chairperson and Members shall hold office for a period of three (3) years and until their succession shall have been appointed and qualified, provided that

a. No Chairperson and Member shall be appointed and/or reappointed for more than two (2) terms or a period of six (6) years.

b. Appointments to a vacancy that occurs before the expiration of the term of office of the Chairperson/member shall cover only the unexpired portion of the term of the immediate predecessor.

c. The Chairperson and Members shall take the proper oath of office prior to the performance of his/her duties.

The incumbent Chairperson and Members of the Board shall continue to serve for the remainder of their term under R.A. No. 7164 until their replacements shall have been appointed by the President and shall have been duly qualified.SECTION 8. Removal   or   Suspension   of   the   Board   Members . – The President may remove or suspend any member of the Board after having been given the opportunity to defend himself/herself in a proper administrative investigation to be conducted by the commission on the following grounds:

a. Continued neglect of duty or incompetence;b. Commission or toleration of irregularities in the licensure examination; andc. Unprofessional, immoral or dishonorable conduct.

SECTION 9. Compensat ion   of   Board   of  Members . – The Chairperson and Members of the Board shall receive compensation and allowances comparable to the compensation and allowances received by the Chairperson and members of other professional regulatory boards from the Commission. SECTION 10. Requirements   upon  Qual i f icat ions   as   Chairperson   and  Member   of   the   Board . – Any person appointed as Chairperson or Member of the Board shall:

a. Immediately resign from any teaching position in any school, college, university or institution offering Bachelor of Science in Nursing and/or review program for the local nursing board examinations.

b. Immediately resign from any office or employment in the private sector and/in the government and any subdivision, agency or instrumentality thereof, including government-owned and/or-controlled corporations or their subsidiaries.

c. Not have any pecuniary interest in or administrative supervision over any institution offering Bachelor of Science in Nursing including review classes.

Pecuniary interest refers to involvement of husband/wife, children, brothers/sisters, mother/father in any activity that will conflict with her position in the Board, particularly money matters. SECTION 11. Powers,  Dut ies,   Funct ions   and  Responsibi l i ty   of   the  Board. – The Board shall supervise and regulate the practice of the nursing profession in the Philippines. As such, pursuant to the provisions of R.A. No. 9173 and R.A. No. 8981, otherwise known as the “PRC Modernization Act of 2000”, the Board shall have the following specific powers, functions, duties and responsibilit ies:

a. Conduct the licensure examination for nurses;b. Issue, suspend or revoke certificates of registration for the practice of nursing;c. Monitor and enforce quality standards of nursing practice in the Philippines and

exercise the powers necessary to ensure the maintenance of efficient, ethical and

technical, moral and professional standards in the practice of nursing taking into account the health needs of the nation;

d. Ensure quality nursing education by examining the prescribed facilit ies of universities or colleges of nursing or departments of nursing education and those seeking permission to open nursing courses to ensure that standards of nursing education are properly complied with and maintained at all times. The authority to open and close colleges of nursing and/or nursing education programs shall be vested on the commission on Higher Education upon written recommendation of the Board.

e. Conduct hearings and investigations to resolve complaints against nurse practitioners for unethical and unprofessional conduct and violation of this Act. Or its rules and regulations. In connection therewith, the Board, upon application with the court, is empowered to:

1. Issue subpoena ad testificandum and subpoena duces tecum to secure the appearance of respondents and witnesses and the production of documents: and

2. Punish with contempt person obstructing, impeding and/or otherwise interfering with the conduct of such proceedings.

f. Adopt and promulgate a Code of Ethics and a Code of Technical Standards for the practice of nursing in coordination and consultation with the accredited professional organization of nurses within one (1) year from the affectivity of the subject Nursing Act.

g. Recognize nursing specialty organizations in coordination with the accredited professional organization: the recognition of nursing specialty organizations shall be based on the criteria jointly developed by the Board of Nursing and the Accredited Professional Organization.

h. Subject to the review and approval of the Commission, prescribe, adopt, issue and promulgate guidelines, regulations, measures, and decisions as may be necessary for the improvement of nursing practice, advancement of the profession, and for the proper and full enforcement of the provisions of the “Philippine Nursing Act of 2002”; and

i. Submit an annual report to the Commission at the close of its calendar year giving detailed account of its proceedings and the accomplishments during the year and making recommendations for the adoption of measures that will upgrade and improve the conditions affecting the practice of the nursing profession.

RULE I I IEXAMINATION AND REGISTRATIONS

SEC TION 12 . Licensure  Examinat ion. – All applicants for registration as a nurse and issuance of a certificate of registration and professional identification card to practice nursing shall be required to pass a written examination which shall be given by the Board in such places and dates as maybe designated by the Commission. Such examination must be in accordance with and fully compliant with R. A. No. 8981. SECTION 13. Qual i f icat ions   for   Admission   to   the   Licensure   Examinat ion . – In order to be admitted to the examination for nurses, an applicant must, at the time of fi l ing his/her application, establish to the satisfaction of the Board of the following:

a. He is a citizen of the Philippines, or if a citizen or subject of a country which permits Filipino nurses to practice within its territorial l imits on the same basis as the subject or citizen of such country, that is, the requirements for the registration or licensing of nurses is said country are substantially the same as those prescribed in this Act.

b. He/she is good moral character; and

c. He/she is a holder of Bachelor’s Degree in Nursing from a college or university that complies with the standards of nursing education duly recognized by the proper government agency.

SECTION 14. Scope of  Examinat ion . – The Board shall determine the scope of the examination for the practice of nursing in the Philippines taking into consideration the objectives of nursing curriculum, the board areas of nursing, and other related disciplines and competencies in determining the subjects of examinations. SECTION 15. Ratings. – In order to pass the examinations, the following shall be fully complied with:

a. An examinee must obtain a general average of at least seventy-five percent (75%) or higher with a rating of not below sixty percent (60%) in any subject:

b. Any examinee who obtained an average rating of 75% or higher but with a rating of below 60% in any subject shall be required to take the examination again but only on subjects where he/she is rated below 30%. However, in order to pass the succeeding examination, he/she must obtain a rating of at least 75% in the subject or subjects repeated.

c. Removal examination shall be taken within two years after the last failed examination.

SECTION 16. Oath. – All successful candidates in the examination must first take an oath of profession before the Board, a Commission official duly designated by it, or any government official authorized to administer oaths before entering upon the practice of nursing. SECTION 17. Issuance   of   Cert i f icate   of   Registrat ion/Professional   L icense   and   Professional   Ident i f icat ion 

Card. – All successful candidates shall, upon payment of prescribed fees, be issued the following:

a. Certificate of Registration/professional License bearing the (i) full name of the registrant, (i i) serial number, (ii i) the signature of the Chairperson of the Commission, (iv) signature of the Members of the Board, and (v) official seal of the Commission and of the Board; and

b. Professional Identification card, duly signed by the Chairperson of the Commission, bearing the (i) date of registration, (ii) l icense number, and (ii i) date of issuance and expiration date.

SECTION 18. Fees  for  Examinat ion and Registrat ion. – Applicants for licensure and for registration shall pay the prescribed fees set by the Commission. SECTION 19. Automat ic   Registrat ion   of   Nurses. – All nurses whose names appear at the Roster or Registry Book of Nurses shall be automatically or ipso  facto registered as nurses under this Act upon its affectivity. SECTION 20. Registrat ion   by   Reciproci ty . – A foreign nurse shall be registered without examination and issued with a certificate of registration/professional license and a professional identification card provided that he/she is a nurse registered under the laws of a foreign state or country, subject to the following conditions:

a. That the requirements for registration or licensing of nurses in said country are substantially the same as those prescribed under this Act; and

b. That the laws of such state or country grant the same privileges to registered nurses of the Philippines on the same basis as the subjects or citizens of such foreign state or country.

SECTION 21. Pract ice   Through   Special /Temporary   Permit. – Subject to the prior approval of the Commission and upon payment of the prescribed fees, the Board may issue a Special/Temporary permit which shall be effective only for the duration of the project, medical mission or employment of contract, to the following:

a. Licensed nurses from foreign countries/states whose service are either for a fee or free if they are intentionally well-known specialists or outstanding experts in any branch of specialty of nursing;

b. Licensed nurses from foreign countries/states on medical mission whose service shall be free in a particular hospital, center or clinic; and

c. Licensed nurses from foreign countries/states employed by schools/colleges ad exchange professors in any branch of specialty nursing.

SECTION 22. Non-Registrat ion   and   Non-Issuance   of   cert i f icates   of   Registrat ion/Professional   L icense   or 

Special /Temporary   Permit – The following shall not be registered and issued Certificate of Registration/Professional Licensed and Professional Identification Card or granted Special/Temporary Permit:

a. Any person convicted by the final judgment of any criminal offense involving moral turpitude;

b. Any person guilty of immoral or dishonorable conduct; andc. Any person declared by the court to be of unsound mind.

The board shall furnish the applicant a written statement setting forth the reasons for its actions, which shall be incorporated in the records of the Board. SECTION 23. Revocat ion   and  Suspension   of  Cert i f icate   of  Registrat ion/Professional   L icense   and  Cancel lat ion of  Special /Temporary  Permit – The following shall be grounds for the Board to exercise its power to revoke and suspend Certificate of Registration/Professional License and to cancel Special/Temporary Permit of a nurse:

a. For any of the causes mentioned in Section 22 of RA No. 9173;b. For unprofessional and unethical conduct;c. For gross incompetence or serious ignorance;d. For malpractice or negligence in the practice of nursing;e. For the use of fraud, deceit, or false statements in obtaining a certificate of

registration/professional license or a special/temporary permit;f. For violation of RA No. 9173 and this IRR, Code of Ethics for nurses and Code of

Technical Standards for nursing practice, policies of the Board and the Commission, or the conditions and limitations for the issuance of the special/temporary permit; or

g. For practicing his/her profession during his/her suspension from such practice. For this purpose, the suspension of the Certificate of Registration/Professional License shall be for a period not to exceed four (4) years. SECTION 24. Re-issuance   of   Revoked   Cert i f icate   and   Replacement   of   Lost   Cert i f icates. – Upon proper application and payment of the required fees, the Board may, for reasons of equity and justice and subject to the rules of the Board, issue another copy of the Certificate of Registration/professional License under the following instances only:

a. After the expiration of a maximum period of four (4) years from the date of revocation of a certificate;

b. When the cause for revocation has disappeared or has been cured and corrected; and

c. When the request is to replace lost, destroyed or mutilated certificate/license.

RULE IVNURSING EDUCATION

SECTION 25. Nursing  Educat ion  Program . – The nursing education program shall provide sound general and professional foundation for the practice of nursing taking into consideration the learning outcomes based on national and universal nursing care competencies. The learning experiences shall adhere strictly to specific requirements embodied in the prescribed curriculum as promulgated by the Commission on Higher Education’s policies and standards of nursing education.

SECTION 26 . Requirement   for   Inact ive  Nurses  Returning   to  Pract ice . – Nurses who have not actively practiced the profession for five 95) consecutive years are returning to the practice of the nursing profession undergo one (1) month of didactic training and three (3) months of practicum. For this purpose, the Board shall accredit hospitals to conduct the said training. The accredited hospitals shall develop training programs based on guidelines formulated by the Board of Nursing. SECTION 27. Qual i f icat ions   of   the   Facul ty. – A member of the faculty in a college of nursing teaching professional courses must:

a. Be a registered nurse in the Philippines;b. Have at least one (1) year of clinical practice in a field of specialization of nurses;

andc. Be a member of good standing in the accredited professional organization of nurses;

andd. Be a holder of master’s degree in nursing, education, or other allied medical and

health sciences conferred by a college or university duly recognized by the Government of the republic of the Philippines.

RULE VNURSING PRACTICE

SECTION 28. Scope of  Nursing.  – A person shall be deemed to be practicing nursing within the meaning of RA No. 9173 when he/she singly or in collaboration with another, initiates and performs nursing services to individuals, families and communities in any health care setting. It includes, but not limited to, nursing care during conception, labor, delivery, childhood, adulthood and old age. As member independent practitioners, nurses are primarily responsible for the promotion of health and prevention of il lness. As members of the health team, nurses shall collaborate with other health care providers for the curative, preventive, and rehabilitative aspects of cares, restoration of health, alleviation of suffering, and when recovery is not possible, towards a peaceful death.Duties and responsibilit ies of a nurse:

a. Provide nursing care through the util ization of the nursing process. Nursing care includes, but not limited to, traditional and innovative approaches, therapeutic use of self, executing health care techniques and procedures, essential primary health care, comfort measures, health teaching and administration of written prescription for treatment, therapies, oral, topical and parenteral medications, internal examination during labor in the absence of antenatal bleeding and delivery. In case of suturing of perineal laceration, special training shall be provided according to protocol established.

b. Establish linkage 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 hospital and clinics:e. Undertake consultation services:f. Engage in such activities that require the util ization of knowledge and decision-

making skills of a registered nurse: andg. Undertake, nursing and health human resource development training and research,

which shall include, but not limited to, the development of advance nursing practice. The above enumerated provisions shall not apply to nursing students who perform nursing functions under the direct supervision of a qualified faculty. However, a nurse, while in the practice of nursing in all settings, is duly-bound/required to:

a. Observe the Code of Ethics and the Code of Technical Standards for nurses;b. Uphold the standards for safe nursing practice; and

c. Maintain competence by continual learning through continuing professional education to be provided by the accredited professional organization or any recognized nursing organization. For this purpose, the program and activity for the continuing professional education shall be submitted to and approved by the Board.

SECTION 29. Qual i f icat ion   of   Nursing   service   Administrators . – The following are the mandatory requirements for Nursing Service Administrators occupying positions as follows.

1. Supervisory or Managerial Positionsa. Be a registered nurse in the Philippinesb. Have at least two (2) years experience in general nursing service administration.c. Possess a degree of Bachelor of Science in Nursing with at least nine (9) units in

management and administration course at the graduate level; andd. Be a member of good standing of the accredited professional organization of nurses.2. Chief Nurse or Director of Nursing

In addition to the above requirements must also have:a. At least five (5) years of experience in a supervisory or managerial position in

nursing; andb. A master’s degree in nursing3. Chief Nurse for primary Hospitalsa. Be a registered nurse in the Philippinesb. Have at least two (2) years experience in general nursing service administration; andc. Possess a degree of Bachelor of Science in Nursing, with at least nine (9) units in

management and administration course at the graduate level. SECTION 30. Prior i ty   in Appointments . – The following shall strictly be observed/complied with:

1. Appointment for a Chief Nurse in the public health agencies. – Priority shall be given to those who have master’s degree in public health/community health nursing.

2. Appointment for a Chief Nurse 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).

Those occupying such positions before the affectivity of this Act shall have a period of five (5) years within which to comply with the above requirements to qualify thereof.

RULE VIHEALTH RESOURCE PRODUCTION,UTILIZATION AND DEVELOPMENT

SECTION 31. Studies   for  Nursing  Manpower  Needs,  Product ion,  Ut i l izat ion  and  Development. – The board, in coordination with the accredited professional organization and appropriate government or private agencies, shall initiate, undertake, and conduct studies on health human resource production, util ization and development. SECTION 32. Comprehensive   Nursing   Special ty   Program . – The Board, in coordination with the accredited professional organization, recognized specialty organizations, and the DOH, is hereby mandated to upgrade the level of skill and competence of specialty nurse clinicians in the country, such as but not limited to the areas of critical care, oncology, renal and thereon shall be subject to approval by the Commission and shall be effective after its complete or full publication in the Official gazette or newspaper of general circulation, which ever is earlier. The beneficiaries of the said program are issued a certificate of the completion and obliged to serve in any PhilippinesHospital for at least two (2) years of continuous service. SECTION 33. Salary – The minimum base pay of nurses working in the public health institutions shall not be lower than the 1 s t step or hiring rate prescribe for salary Grade 15 pursuant to RA No. 6758, otherwise known as the “Compensation and Classification of Act

of 1989”. However, for nurses working in local government units, adjustment to their salaries shall be in accordance with Section 10 of the same Act. The implementation of this Section shall strictly be in accordance with the rules and regulations that will prescribe in a circular that will be issued by the DBM. SECTION 34. Funding   for   the   Comprehensive   Nursing   Special ty   Program . – The annual financial requirements to train at least ten percent (10%) of the nursing staff of the participating government hospital shall be chargeable against the income of the Philippine Charity Sweepstake Office and the Philippine Amusement and gaming Corporation, which shall equally share in the cost and shall release said funds to the DOH subject to the usual accounting and auditing procedures. For this purpose, the DOH shall set the criteria for the availment of this program. SECTION 35. Incent ives   and   Benef i ts . – The incentives and benefits referred to in subject Nursing Act shall be limited to non-cash benefits, such as free hospital care for nurses and their dependents, scholarship grants and other similar non-cash benefits. For this purpose, (i) The Board, DOH, DBM, in coordination with other concerned government agencies, association of hospitals and the accredited professional organization shall formulate and establish the necessary incentives and benefit system and the corresponding rules and regulations for its implementation, and (ii) as part of the improved working condition of nurses, the government and private hospitals are mandated to maintain the standard nurse-patient ratio set by the DOH.

RULE VIIPENAL AND MISCELLANEOUS PROVISIONS

SECTION 36. Prohibi t ion   in   the  pract ice  of  Nursing . – A fine of not less than Fifty thousand pesos (P50, 000.00) nor more than One hundred thousand pesos (P100, 00000) 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:

1.              Any person practicing nursing in the Philippines within the meaning of this Act:a.              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 provisions of RA No. 9173; or

b. who uses as his/her own certificates of registration/professional license and professional identification card or special temporary permit of another; or

c. who uses as invalid certificate of registration/professional license, a suspended or revoked certificates of registration/professional license, or an expired or cancelled special/temporary permit; or

d. who gives any false evidence to the Board in order to obtain a certificate of registration/professional license, a professional identification card or special permit; or

e. who falsely poses or advertises as registered and licensed nurse or uses any other means that tend to convey the impression that he/she is a registered and licensed nurse; or

f. who appends B.S.N., R.N. (bachelor of Science in Nursing Registered Nurse) or any similar appendage to his/her name without having been conferred said degree or registration; or

g. who as a registered and licensed nurse, abets or assists the il legal practice of a person who is not lawfully qualified to practice nursing.

2. any person or the chief executive officer of a juridical entity who undertakes in-service educational programs or who conducts review classes for both

local and foreign examination without permit/clearance from the Board and the Commission; or

3. any person or employer of nurses who violate the minimum base pay of nurses and the incentives and benefits that should be accorded them as specified in Sections 32 and 34, Article VII of RA No. 9173, as implemented by Sections 33 and 35 of this IRR; or

4. any person of the chief executive officer of a judicial entity violating any provisions of RA No. 9173, as implemented by this IRR.

RULE VII I

FINAL PROVISIONS SECTION 37. Enforcement  of   the  Provis ions  of  RA No.  9173,  as   Implemented  by   th is   IRR. – It shall be the primary duty of the Commission and the Board to effectively implement the provisions of RA No. 9173 and this IRR. SECTION 38. Assistance   of   Law   Enforcement   Agency. – any duly authorized law enforcement agencies and officers of national, provincial, city or municipal governments shall upon the call or request of the Commission or the Board, render assistance in enforcing the provisions of RA No. 9173 and this IRR and to prosecute any person violating the same. For orderly implementation of this provision, the Commission and the Board may enter into a Memorandum of Agreement with each law enforcement agency and subject a government offices providing for the procedures to be followed for the call or request for assistance. SECTION 39. Appropr iat ions. – The amount necessary to carry out the initial implementation of RA No. 9173 shall be charged against the current year’s appropriation of the Commission for the purpose as provided in the General Appropriations Act (GAA). Thereafter, such amount as may be necessary for the continued implementation of the said Act shall be included in the program of the Commission in the succeeding GAA. For this purpose, the Board and the Commission shall issue the necessary rules and regulations, in coordination with the professional organization, DOH, DBM and other concerned agencies. SECTION 40. Separabi l i ty   Clause. – If any provision of this IRR or the application of such provision to any person or circumstances is declared invalid or unconstitutional, the remainder of this IRR or application of such provisions to other persons or circumstance shall not be affected by such declaration. SECTION 41. Repeal ing   Provis ions . – Any issuance of the Board or Commission or of their respective chairpersons, including resolutions, memorandum, office orders/circulars, etc., or any part thereof which is/are in conflict with the provisions of this herein IRR are deemed superseded or modified accordingly. SECTION 42 .   Ef fect iv i ty . – This IRR shall take effect after fifteen (15) days following its complete or full publication in the Official gazette or any two 920 newspapers of national circulation in the Philippines, whichever comes first. PROMULGATED in the City of Manila, Philippines on this 22 n d day of October, 2003 .