Fabros, Daniel

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Fabros, Daniel Vincent E.BSN IV-4

Topic: Code of EthicsGoal for Discussion: At the end of the discussion, awareness and application of

the imparted knowledge should be secured.

Provision 1 The nurse, in all professional relationships, practices withcompassion and respect for the inherent dignity, worth, and uniqueness of everyindividual, unrestricted by considerations of social or economic status, personalattributes, or the nature of health problems.

1.1 Respect for human dignityA fundamental principle that underlies all nursing practice is respect for theinherent worth, dignity, and human rights of every individual. Nurses take intoaccount the needs and values of all persons in all professional relationships.

1.2 Relationships to patientsThe need for health care is universal, transcending all individual differences. Thenurse establishes relationships and delivers nursing services with respect forhuman needs and values, and without prejudice. An individuals lifestyle, valuesystem and religious beliefs should be considered in planning health care withand for each patient. Such consideration does not suggest that the nursenecessarily agrees with or condones certain individual choices, but that the nurserespects the patient as a person.

1.3 The nature of health problemsThe nurse respects the worth, dignity and rights of all human beings irrespectiveof the nature of the health problem. The worth of the person is not affected bydisease, disability, functional status, or proximity to death. This respect extendsto all who require the services of the nurse for the promotion of health, theprevention of illness, the restoration of health, the alleviation of suffering, and theprovision of supportive care to those who are dying. The measures nurses take to care for the patient enable the patient to live withas much physical, emotional, social, and spiritual well-being as possible. Nursingcare aims to maximize the values that the patient has treasured in life andextends supportive care to the family and significant others. Nursing care isdirected toward meeting the comprehensive needs of patients and their familiesacross the continuum of care. This is particularly vital in the care of patients andtheir families at the end of life to prevent and relieve the cascade of symptomsand suffering that are commonly associated with dying.Nurses are leaders and vigilant advocates for the delivery of dignified andhumane care. Nurses actively participate in assessing and assuring theresponsible and appropriate use of interventions in order to minimizeunwarranted or unwanted treatment and patient suffering. The acceptability andimportance of carefully considered decisions regarding resuscitation status,
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withholding and withdrawing life-sustaining therapies, forgoing medicallyprovided nutrition and hydration, aggressive pain and symptom management andadvance directives are increasingly evident. The nurse should provideinterventions to relieve pain and other symptoms in the dying patient even whenthose interventions entail risks of hastening death. However, nurses may not act

with the sole intent of ending a patients life even though such action may bemotivated by compassion, respect for patient autonomy and quality of lifeconsiderations. Nurses have invaluable experience, knowledge, and insight intocare at the end of life and should be actively involved in related research,education, practice, and policy development.

1.4 The right to self-determinationRespect for human dignity requires the recognition of specific patient rights,particularly, the right of self-determination. Self-determination, also known asautonomy, is the philosophical basis for informed consent in health care. Patientshave the moral and legal right to determine what will be done with their own

person; to be given accurate, complete, and understandable information in amanner that facilitates an informed judgment; to be assisted with weighing thebenefits, burdens, and available options in their treatment, including the choice ofno treatment; to accept, refuse, or terminate treatment without deceit, undueinfluence, duress, coercion, or penalty; and to be given necessary supportthroughout the decision-making and treatment process. Such support wouldinclude the opportunity to make decisions with family and significant others andthe provision of advice and support from knowledgeable nurses and other healthprofessionals. Patients should be involved in planning their own health care tothe extent they are able and choose to participate.Each nurse has an obligation to be knowledgeable about the moral and legalrights of all patients to self-determination. The nurse preserves, protects, andsupports those interests by assessing the patients comprehension of both theinformation presented and the implications of decisions. In situations in which thepatient lacks the capacity to make a decision, a designated surrogate decisionmaker should be consulted. The role of the surrogate is to make decisions as thepatient would, based upon the patients previously expressed wishes and knownvalues. In the absence of a designated surrogate decision-maker, decisionsshould be made in the best interests of the patient, considering the patientspersonal values to the extent that they are known. The nurse supports patientself-determination by participating in discussions with surrogates, providingguidance and referral to other resources as necessary, and identifying andaddressing problems in the decision-making process. Support of autonomy in thebroadest sense also includes recognition that people of some cultures place lessweight on individualism and choose to defer to family or community values indecision-making. Respect not just for the specific decision, but also for thepatients method of decision-making, is consistent with the principle of autonomy.Individuals are interdependent members of the community. The nurse recognizesthat there are situations in which the right to individual self-determination may beoutweighed or limited by the rights, health and welfare of others, particularly in


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relation to public health considerations. Nonetheless, limitation of individual rightsmust always be considered a serious deviation from the standard of care,

justified only when there are no less restrictive means available to preserve therights of others and the demands of justice.

1.5 Relationships with colleagues and othersThe principle of respect for persons extends to all individuals with whom thenurse interacts. The nurse maintains compassionate and caring relationshipswith colleagues and others with a commitment to the fair treatment of individuals,to integrity-preserving compromise, and to resolving conflict. Nurses function inmany roles, including direct care provider, administrator, educator, researcher,and consultant. In each of these roles, the nurse treats colleagues, employees,assistants, and students with respect and compassion. This standard of conductprecludes any and all prejudicial actions, any form of harassment or threateningbehavior, or disregard for the effect of ones actions on others. The nurse valuesthe distinctive contribution of individuals or groups, and collaborates to meet the

shared goal of providing quality health services.

Provision 2 The nurse's primary commitment is to the patient, whether anindividual, family, group, or community.

2.1 Primacy of the patients interestsThe nurses primary commitment is to the recipient of nursing and healthcareservicesthe patientwhether the recipient is an individual, a family, a group, ora community. Nursing holds a fundamental commitment to the uniqueness of theindividual patient; therefore, any plan of care must reflect that uniqueness. Thenurse strives to provide patients with opportunities to participate in planning care,assures that patients find the plans acceptable and supports the implementationof the plan. Addressing patient interests requires recognition of the patientsplace in the family or other networks of relationship. When the patients wishesare in conflict with others, the nurse seeks to help resolve the conflict. Whereconflict persists, the nurses commitment remains to the identified patient.

2.2 Conflict of interest for nursesNurses are frequently put in situations of conflict arising from competing loyaltiesin the workplace, including situations of conflicting expectations from patients,families, physicians, colleagues, and in many cases, healthcare organizationsand health plans. Nurses must examine the conflicts arising between their ownpersonal and professional values, the values and interests of others who are alsoresponsible for patient care and healthcare decisions, as well as those ofpatients. Nurses strive to resolve such conflicts in ways that ensure patientsafety, guard the patients best interests and preserve the professional integrityof the nurse.

Situations created by changes in healthcare financing and delivery systems, suchas incentive systems to decrease spending, pose new possibilities of conflict


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between economic self-interest and professional integrity. The use of bonuses,sanctions, and incentives tied to financial targets are examples of features ofhealthcare systems that may present such conflict. Conflicts of interest may arisein any domain of nursing activity including clinical practice, administration,education, or research. Advanced practice nurses who bill directly for services

and nursing executives with budgetary responsibilities must be especiallycognizant of the potential for conflicts of interest. Nurses should disclose to allrelevant parties (e.g., patients, employers, colleagues) any perceived or actualconflict of interest and in some situations should withdraw from furtherparticipation. Nurses in all roles must seek to ensure that employmentarrangements are just and fair and do not create an unreasonable conflictbetween patient care and direct personal gain.

2.3 CollaborationCollaboration is not just cooperation, but it is the concerted effort of individualsand groups to attain a shared goal. In health care, that goal is to address the

health needs of the patient and the public. The complexity of healthcare deliverysystems requires a multi-disciplinary approach to the delivery of services that hasthe strong support and active participation of all the health professions. Withinthis context, nursings unique contribution, scope of practice, and relationshipwith other health professions needs to be clearly articulated, represented andpreserved. By its very nature, collaboration requires mutual trust, recognition,and respect among the healthcare team, shared decision-making about patientcare, and open dialogue among all parties who have an interest in and a concernfor health outcomes. Nurses should work to assure that the relevant parties areinvolved and have a voice in decision-making about patient care issues. Nursesshould see that the questions that need to be addressed are asked and that theinformation needed for informed decision-making is available and provided.Nurses should actively promote the collaborative multi-disciplinary planningrequired to ensure the availability and accessibility of quality health services to allpersons who have needs for health care.

Intra-professional collaboration within nursing is fundamental to effectivelyaddressing the health needs of patients and the public. Nurses engaged innonclinical roles, such as administration or research, while not providing directcare, nonetheless are collaborating in the provision of care through theirinfluence and direction of those who do. Effective nursing care is accomplishedthrough the interdependence of nurses in differing rolesthose who teach theneeded skills, set standards, manage the environment of care, or expand theboundaries of knowledge used by the profession. In this sense, nurses in all rolesshare a responsibility for the outcomes of nursing care.

Nurses are leaders and vigilant advocates for the delivery of dignified andhumane care. Nurses actively participate in assessing and assuring theresponsible and appropriate use of interventions in order to minimizeunwarranted or unwanted treatment and patient suffering. The acceptability and


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importance of carefully considered decisions regarding resuscitation status,withholding and withdrawing life-sustaining therapies, forgoing medicallyprovided nutrition and hydration, aggressive pain and symptom management andadvance directives are increasingly evident. The nurse should provideinterventions to relieve pain and other symptoms in the dying patient even when

those interventions entail risks of hastening death. However, nurses may not actwith the sole intent of ending a patients life even though such action may bemotivated by compassion, respect for patient autonomy and quality of lifeconsiderations. Nurses have invaluable experience, knowledge, and insight intocare at the end of life and should be actively involved in related research,education, practice, and policy development.

2.4 Professional boundariesWhen acting within ones role as a professional, the nurse recognizes andmaintains boundaries that establish appropriate limits to relationships. While thenature of nursing work has an inherently personal component, nurse-patient

relationships and nurse-colleague relationships have, as their foundation, thepurpose of preventing illness, alleviating suffering, and protecting, promoting, andrestoring the health of patients. In this way, nurse-patient and nurse-colleaguerelationships differ from those that are purely personal and unstructured, such asfriendship. The intimate nature of nursing care, the involvement of nurses inimportant and sometimes highly stressful life events, and the mutual dependenceof colleagues working in close concert all present the potential for blurring oflimits to professional relationships. Maintaining authenticity and expressingoneself as an individual, while remaining within the bounds established by thepurpose of the relationship can be especially difficult in prolonged or long-termrelationships. In all encounters, nurses are responsible for retaining theirprofessional boundaries. When those professional boundaries are jeopardized,the nurse should seek assistance from peers or supervisors or take appropriatesteps to remove her/himself from the situation.

Provision 3 The nurse promotes, advocates for, and strives to protect thehealth, safety, and rights of the patient.

3.1 PrivacyThe nurse safeguards the patients right to privacy. The need for health caredoes not justify unwanted intrusion into the patients life. The nurse advocates foran environment that provides for sufficient physical privacy, including privacy fordiscussions of a personal nature and policies and practices that protect theconfidentiality of information.top

3.2 ConfidentialityAssociated with the right to privacy, the nurse has a duty to maintainconfidentiality of all patient information. The patients well-being could be

jeopardized and the fundamental trust between patient and nurse destroyed byunnecessary access to data or by the inappropriate disclosure of identifiable


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patient information. The rights, well-being, and safety of the individual patientshould be the primary factors in arriving at any professional judgment concerningthe disposition of confidential information received from or about the patient,whether oral, written or electronic. The standard of nursing practice and thenurses responsibility to provide quality care require that relevant data be shared

with those members of the healthcare team who have a need to know. Onlyinformation pertinent to a patients treatment andwelfare is disclosed, and only tothose directly involved with the patients care. Duties of confidentiality, however,are not absolute and may need to be modified in order to protect the patient,other innocent parties, and in circumstances of mandatory disclosure for publichealth reasons.

Information used for purposes of peer review, third-party payments, and otherquality improvement or risk management mechanisms may be disclosed onlyunder defined policies, mandates, or protocols. These written guidelines mustassure that the rights, well-being, and safety of the patient are protected. In

general, only that information directly relevant to a task or specific responsibilityshould be disclosed. When using electronic communications, special effortshould be made to maintain data security.

3.3 Protection of participants in researchStemming from the right to self-determination, each individual has the right tochoose whether or not to participate in research. It is imperative that the patientor legally authorized surrogate receive sufficient information that is material to aninformed decision, to comprehend that information, and to know how todiscontinue participation in research without penalty. Necessary information toachieve an adequately informed consent includes the nature of participation,potential harms and benefits, and available alternatives to taking part in theresearch. Additionally, the patient should be informed of how the data will beprotected. The patient has the right to refuse to participate in research or towithdraw at any time without fear of adverse consequences or reprisal.Research should be conducted and directed only by qualified persons. Prior toimplementation, all research should be approved by a qualified review board toensure patient protection and the ethical integrity of the research. Nurses shouldbe cognizant of the special concerns raised by research involving vulnerablegroups, including children, prisoners, students, the elderly, and the poor. Thenurse who participates in research in any capacity should be fully informed aboutboth the subjects and the nurses rights and obligations in the particular researchstudy and in research in general. Nurses have the duty to question and, ifnecessary, to report and to refuse to participate in research they deem morallyobjectionable.

3.4 Standards and review mechanismsNursing is responsible and accountable for assuring that only those individualswho have demonstrated the knowledge, skill, practice experiences, commitment,and integrity essential to professional practice are allowed to enter into and


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continue to practice within the profession. Nurse educators have a responsibilityto ensure that basic competencies are achieved and to promote a commitment toprofessional practice prior to entry of an individual into practice. Nurseadministrators are responsible for assuring that the knowledge and skills of eachnurse in the workplace are assessed prior to the assignment of responsibilities

requiring preparation beyond basic academic programs.The nurse has a responsibility to implement and maintain standards ofprofessional nursing practice. The nurse should participate in planning,establishing, implementing, and evaluating review mechanisms designed tosafeguard patients and nurses, such as peer review processes or committees,credentialing processes, quality improvement initiatives, and ethics committees.Nurse administrators must ensure that nurses have access to and inclusion oninstitutional ethics committees. Nurses must bring forward difficult issues relatedto patient care and/or institutional constraints upon ethical practice for discussionand review. The nurse acts to promote inclusion of appropriate others in alldeliberations related to patient care.

Nurses should also be active participants in the development of policies andreview mechanisms designed to promote patient safety, reduce the likelihood oferrors, and address both environmental system factors and human factors thatpresent increased risk to patients. In addition, when errors do occur, nurses areexpected to follow institutional guidelines in reporting errors committed orobserved to the appropriate supervisory personnel and for assuring responsibledisclosure of errors to patients. Under no circumstances should the nurseparticipate in, or condone through silence, either an attempt to hide an error or apunitive response that serves only to fix blame rather than correct the conditionsthat led to the error.

3.5 Acting on questionable practiceThe nurses primary commitment is to the health, well-being, and safety of thepatient across the life span and in all settings in which healthcare needs areaddressed. As an advocate for the patient, the nurse must be alert to and takeappropriate action regarding any instances of incompetent, unethical, illegal, orimpaired practice by any member of the healthcare team or the healthcaresystem or any action on the part of others that places the rights or best interestsof the patient in jeopardy. To function effectively in this role, nurses must beknowledgeable about the Code of Ethics, standards of practice of the profession,relevant federal, state and local laws and regulations, and the employingorganizations policies and procedures.

When the nurse is aware of inappropriate or questionable practice in theprovision or denial of health care, concern should be expressed to the personcarrying out the questionable practice. Attention should be called to the possibledetrimental affect upon the patients well-being or best interests as well as theintegrity of nursing practice. When factors in the healthcare delivery system orhealthcare organization threaten the welfare of the patient, similar action should


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be directed to the responsible administrator. If indicated, the problem should bereported to an appropriate higher authority within the institution or agency, or toan appropriate external authority.

There should be established processes for reporting and handling incompetent,

unethical, illegal, or impaired practice within the employment setting so that suchreporting can go through official channels, thereby reducing the risk of reprisalagainst the reporting nurse. All nurses have a responsibility to assist those whoidentify potentially questionable practice. State nurses associations should beprepared to provide assistance and support in the development and evaluation ofsuch processes and reporting procedures. When incompetent, unethical, illegal,or impaired practice is not corrected within the employment setting and continuesto jeopardize patient well-being and safety, the problem should be reported toother appropriate authorities such as practice committees of the pertinentprofessional organizations, the legally constituted bodies concerned withlicensing of specific categories of health workers and professional practitioners,

or the regulatory agencies concerned with evaluating standards or practice.Some situations may warrant the concern and involvement of all such groups.Accurate reporting and factual documentation, and not merely opinion, undergirdall such responsible actions. When a nurse chooses to engage in the act ofresponsible reporting about situations that are perceived as unethical,incompetent, illegal, or impaired, the professional organization has aresponsibility to provide the nurse with support and assistance and to protect thepractice of those nurses who choose to voice their concerns. Reporting unethical,illegal, incompetent, or impaired practices, even when done appropriately, maypresent substantial risks to the nurse; nevertheless, such risks do not eliminatethe obligation to address serious threats to patient safety.

3.6 Addressing impaired practiceNurses must be vigilant to protect the patient, the public, and the profession frompotential harm when a colleagues practice, in any setting, appears to beimpaired. The nurse extends compassion and caring to colleagues who are inrecovery from illness or when illness interferes with job performance. In asituation where a nurse suspects anothers practice may be impaired, the nursesduty is to take action designed both to protect patients and to assure that theimpaired individual receives assistance in regaining optimal function. Such actionshould usually begin with consulting supervisory personnel and may also includeconfronting the individual in a supportive manner and with the assistance ofothers or helping the individual to access appropriate resources. Nurses areencouraged to follow guidelines outlined by the profession and policies of theemploying organization to assist colleagues whose job performance may beadversely affected by mental or physical illness or by personal circumstances.Nurses in all roles should advocate for colleagues whose job performance maybe impaired to ensure that they receive appropriate assistance, treatment andaccess to fair institutional and legal processes. This includes supporting thereturn to practice of the individual who has sought assistance and is ready to


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resume professional duties.

If impaired practice poses a threat or danger to self or others, regardless ofwhether the individual has sought help, the nurse must take action to report theindividual to persons authorized to address the problem. Nurses who advocate

for others whose job performance creates a risk for harm should be protectedfrom negative consequences. Advocacy may be a difficult process and the nurseis advised to follow workplace policies. If workplace policies do not exist or areinappropriatethat is, they deny the nurse in question access to due legalprocess or demand resignationthe reporting nurse may obtain guidance fromthe professional association, state peer assistance programs, employeeassistance program or a similar resource.

Provision 4 The nurse is responsible and accountable for individual nuringpractice and determines the appropriate delegation of tasks consistent with thenurse's obligation to provide optimum patient care.

4.1 Acceptance of accountability and responsibilityIndividual registered nurses bear primary responsibility for the nursing care thattheir patients receive and are individually accountable for their own practice.Nursing practice includes direct care activities, acts of delegation, and otherresponsibilities such as teaching, research, and administration. In each instance,the nurse retains accountability and responsibility for the quality of practice andfor conformity with standards of care.Nurses are faced with decisions in the context of the increased complexity andchanging patterns in the delivery of health care. As the scope of nursing practicechanges, the nurse must exercise judgment in accepting responsibilities, seekingconsultation, and assigning activities to others who carry out nursing care. Forexample, some advanced practice nurses have the authority to issue prescriptionand treatment orders to be carried out by other nurses. These acts are not actsof delegation. Both the advanced practice nurse issuing the order and the nurseaccepting the order are responsible for the judgments made and accountable forthe actions taken.

4.2 Accountability for nursing judgment and actionAccountability means to be answerable to oneself and others for ones ownactions. In order to be accountable, nurses act under a code of ethical conductthat is grounded in the moral principles of fidelity and respect for the dignity,worth, and self-determination of patients. Nurses are accountable for judgmentsmade and actions taken in the course of nursing practice, irrespective ofhealthcare organizations policies or providers directives.

4.3 Responsibility for nursing judgment and actionResponsibility refers to the specific accountability or liability associated with theperformance of duties of a particular role. Nurses accept or reject specific roledemands based upon their education, knowledge, competence, and extent of


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experience. Nurses in administration, education, and research also haveobligations to the recipients of nursing care. Although nurses in administration,education, and research have relationships with patients that are less direct, inassuming the responsibilities of a particular role, they share responsibility for thecare provided by those whom they supervise and instruct. The nurse must not

engage in practices prohibited by law or delegate activities to others that areprohibited by the practice acts of other healthcare providers.

Individual nurses are responsible for assessing their own competence. When theneeds of the patient are beyond the qualifications and competencies of thenurse, consultation and collaboration must be sought from qualified nurses, otherhealth professionals, or other appropriate sources. Educational resources shouldbe sought by nurses and provided by institutions to maintain and advance thecompetence of nurses. Nurse educators act in collaboration with their students toassess the learning needs of the student, the effectiveness of the teachingprogram, the identification and utilization of appropriate resources, and the

support needed for the learning process.

4.4 Delegation of nursing activitiesSince the nurse is accountable for the quality of nursing care given to patients,nurses are accountable for the assignment of nursing responsibilities to othernurses and the delegation of nursing care activities to other healthcare workers.While delegation and assignment are used here in a generic moral sense, it isunderstood that individual states may have a particular legal definition of theseterms.

The nurse must make reasonable efforts to assess individual competence whenassigning selected components of nursing care to other healthcare workers. Thisassessment involves evaluating the knowledge, skills, and experience of theindividual to whom the care is assigned, the complexity of the assigned tasks,and the health status of the patient. The nurse is also responsible for monitoringthe activities of these individuals and evaluating the quality of the care provided.Nurses may not delegate responsibilities such as assessment and evaluation;they may delegate tasks. The nurse must not knowingly assign or delegate toany member of the nursing team a task for which that person is not prepared orqualified. Employer policies or directives do not relieve the nurse of responsibilityfor making judgments about the delegation and assignment of nursing caretasks.

Nurses functioning in management or administrative roles have a particularresponsibility to provide an environment that supports and facilitates appropriateassignment and delegation. This includes providing appropriate orientation tostaff, assisting less experienced nurses in developing necessary skills andcompetencies, and establishing policies and procedures that protect both thepatient and nurse from the inappropriate assignment or delegation of nursingresponsibilities, activities, or tasks.


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Nurses functioning in educator or preceptor roles may have less directrelationships with patients. However, through assignment of nursing careactivities to learners they share responsibility and accountability for the careprovided. It is imperative that the knowledge and skills of the learner be sufficient

to provide the assigned nursing care and that appropriate supervision beprovided to protect both the patient and the learner.

Provision 5 The nurse owes the same duties to self as to others, including theresponsibility to preserve integrity and safety, to maintain competence, and tocontinue personal and professional growth.

5.1 Moral self-respectMoral respect accords moral worth and dignity to all human beings irrespective oftheir personal attributes or life situation. Such respect extends to oneself as well;the same duties that we owe to others we owe to ourselves. Self-regarding duties

refer to a realm of duties that primarily concern oneself and include professionalgrowth and maintenance of competence, preservation of wholeness of character,and personal integrity.

5.2 Professional growth and maintenance of competenceThough it has consequences for others, maintenance of competence andongoing professional growth involves the control of ones own conduct in a waythat is primarily self-regarding. Competence affects ones self-respect, self-esteem, professional status, and the meaningfulness of work. In all nursing roles,evaluation of ones own performance, coupled with peer review, is a means bywhich nursing practice can be held to the highest standards. Each nurse isresponsible for participating in the development of criteria for evaluation ofpractice and for using those criteria in peer and self-assessment.Continual professional growth, particularly in knowledge and skill, requires acommitment to lifelong learning. Such learning includes, but is not limited to,continuing education, networking with professional colleagues, self-study,professional reading, certification, and seeking advanced degrees. Nurses arerequired to have knowledge relevant to the current scope and standards ofnursing practice, changing issues, concerns, controversies, and ethics. Wherethe care required is outside the competencies of the individual nurse,consultation should be sought or the patient should be referred to others forappropriate care.

5.3 Wholeness of characterNurses have both personal and professional identities that are neither entirelyseparate, nor entirely merged, but are integrated. In the process of becoming aprofessional, the nurse embraces the values of the profession, integrating themwith personal values. Duties to self involve an authentic expression of ones ownmoral point-of-view in practice. Sound ethical decision-making requires therespectful and open exchange of views between and among all individuals with
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relevant interests. In a community of moral discourse, no one persons viewshould automatically take precedence over that of another. Thus the nurse has aresponsibility to express moral perspectives, even when they differ from those ofothers, and even when they might not prevail.This wholeness of character encompasses relationships with patients. In

situations where the patient requests a personal opinion from the nurse, thenurse is generally free to express an informed personal opinion as long as thispreserves the voluntariness of the patient and maintains appropriate professionaland moral boundaries. It is essential to be aware of the potential for undueinfluence attached to the nurses professional role. Assisting patients to clarifytheir own values in reaching informed decisions may be helpful in avoidingunintended persuasion. In situations where nurses responsibilities include carefor those whose personal attributes, condition, lifestyle or situation is stigmatizedby the community and are personally unacceptable, the nurse still rendersrespectful and skilled care.

5.4 Preservation of integrityIntegrity is an aspect of wholeness of character and is primarily a self-concern ofthe individual nurse. An economically constrained healthcare environmentpresents the nurse with particularly troubling threats to integrity. Threats tointegrity may include a request to deceive a patient, to withhold information, or tofalsify records, as well as verbal abuse from patients or coworkers. Threats tointegrity also may include an expectation that the nurse will act in a way that isinconsistent with the values or ethics of the profession, or more specifically arequest that is in direct violation of the Code of Ethics. Nurses have a duty toremain consistent with both their personal and professional values and to acceptcompromise only to the degree that it remains an integrity-preservingcompromise. An integrity-preserving compromise does not jeopardize the dignityor well-being of the nurse or others. Integrity-preserving compromise can bedifficult to achieve, but is more likely to be accomplished in situations where thereis an open forum for moral discourse and an atmosphere of mutual respect andregard.

Where nurses are placed in situations of compromise that exceed acceptablemoral limits or involve violations of the moral standards of the profession,whether in direct patient care or in any other forms of nursing practice, they mayexpress their conscientious objection to participation. Where a particulartreatment, intervention, activity, or practice is morally objectionable to the nurse,whether intrinsically so or because it is inappropriate for the specific patient, orwhere it may jeopardize both patients and nursing practice, the nurse is justifiedin refusing to participate on moral grounds. Such grounds exclude personalpreference, prejudice, convenience, or arbitrariness. Conscientious objectionmay not insulate the nurse against formal or informal penalty. The nurse whodecides not to take part on the grounds of conscientious objection mustcommunicate this decision in appropriate ways. Whenever possible, such arefusal should be made known in advance and in time for alternate arrangements


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to be made for patient care. The nurse is obliged to provide for the patientssafety, to avoid patient abandonment, and to withdraw only when assured thatalternative sources of nursing care are available to the patient.

Where patterns of institutional behavior or professional practice compromise the

integrity of all its nurses, nurses should express their concern or conscientiousobjection collectively to the appropriate body or committee. In addition, theyshould express their concern, resist, and seek to bring about a change in thosepersistent activities or expectations in the practice setting that are morallyobjectionable to nurses and jeopardize either patient or nurse well-being.

Provision 6 The nurse participates in establishing, maintaining, and improvinghealth care environments and conditions of employment conducive to theprovision of quality health care and consistent with the values of the professionthrough individual and collective action.

6.1 Influence of the environment on moral virtues and valuesVirtues are habits of character that predispose persons to meet their moralobligations; that is, to do what is right. Excellences are habits of character thatpredispose a person to do a particular job or task well. Virtues such as wisdom,honesty, and courage are habits or attributes of the morally good person.Excellences such as compassion, patience, and skill are habits of character ofthe morally good nurse. For the nurse, virtues and excellences are those habitsthat affirm and promote the values of human dignity, well-being, respect, health,independence, and other values central to nursing. Both virtues and excellences,as aspects of moral character, can be either nurtured by the environment inwhich the nurse practices or they can be diminished or thwarted. All nurses havea responsibility to create, maintain, and contribute to environments that supportthe growth of virtues and excellences and enable nurses to fulfill their ethicalobligations.

6.2 Influence of the environment on ethical obligationsAll nurses, regardless of role, have a responsibility to create, maintain, andcontribute to environments of practice that support nurses in fulfilling their ethicalobligations. Environments of practice include observable features, such asworking conditions, and written policies and procedures setting out expectationsfor nurses, as well as less tangible characteristics such as informal peer norms.Organizational structures, role descriptions, health and safety initiatives,grievance mechanisms, ethics committees, compensation systems, anddisciplinary procedures all contribute to environments that can either presentbarriers or foster ethical practice and professional fulfillment. Environments inwhich employees are provided fair hearing of grievances, are supported inpracticing according to standards of care, and are justly treated allow for therealization of the values of the profession and are consistent with sound nursingpractice.


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6.3 Responsibility for the healthcare environmentThe nurse is responsible for contributing to a moral environment that encouragesrespectful interactions with colleagues, support of peers, and identification ofissues that need to be addressed. Nurse administrators have a particularresponsibility to assure that employees are treated fairly and that nurses are

involved in decisions related to their practice and working conditions.Acquiescing and accepting unsafe or inappropriate practices, even if theindividual does not participate in the specific practice, is equivalent to condoningunsafe practice. Nurses should not remain employed in facilities that routinelyviolate patient rights or require nurses to severely and repeatedly compromisestandards of practice or personal morality.

As with concerns about patient care, nurses should address concerns about thehealthcare environment through appropriate channels. Organizational changesare difficult to accomplish and may require persistent efforts over time. Towardthis end, nurses may participate in collective action such as collective bargainingor workplace advocacy, preferably through a professional association such as

the state nurses association, in order to address the terms and conditions ofemployment. Agreements reached through such action must be consistent withthe professions standards of practice, the state law regulating practice, and theCode of Ethics for Nurses. Conditions of employment must contribute to themoral environment, the provision of quality patient care and professionalsatisfaction for nurses.The professional association also serves as an advocate for the nurse byseeking to secure just compensation and humane working conditions for nurses.To accomplish this, the professional association may engage in collectivebargaining on behalf of nurses. While seeking to assure just economic andgeneral welfare for nurses, collective bargaining, nonetheless, seeks to keep theinterests of both nurses and patients in balance.

Provision 7 The nurse participates in the advancement of the professionthrough contributions to practice, education, administration, and knowledgedevelopment.

7.1 Advancing the profession through active involvement in nursingand in healthcare policyNurses should advance their profession by contributing in some way to theleadership, activities, and the viability of their professional organizations. Nursescan also advance the profession by serving in leadership or mentorship roles oron committees within their places of employment. Nurses who are self-employedcan advance the profession by serving as role models for professional integrity.Nurses can also advance the profession through participation in civic activitiesrelated to health care or through local, state, national, or international initiatives.Nurse educators have a specific responsibility to enhance students commitmentto professional and civic values. Nurse administrators have a responsibility tofoster an employment environment that facilitates nurses ethical integrity andprofessionalism, and nurse researchers are responsible for active contribution to


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the body of knowledge supporting and advancing nursing practice.

7.2 Advancing the profession by developing, maintaining, andimplementing professional standards in clinical, administrative, andeducational practice

Standards and guidelines reflect the practice of nursing grounded in ethicalcommitments and a body of knowledge. Professional standards and guidelinesfor nurses must be developed by nurses and reflect nursings responsibility tosociety. It is the responsibility of nurses to identify their own scope of practice aspermitted by professional practice standards and guidelines, by state and federallaws, by relevant societal values, and by the Code of Ethics.

The nurse as administrator or manager must establish, maintain, and promoteconditions of employment that enable nurses within that organization orcommunity setting to practice in accord with accepted standards of nursingpractice and provide a nursing and healthcare work environment that meets the

standards and guidelines of nursing practice. Professional autonomy and self-regulation in the control of conditions of practice are necessary for implementingnursing standards and guidelines and assuring quality care for those whomnursing serves.

The nurse educator is responsible for promoting and maintaining optimumstandards of both nursing education and of nursing practice in any settings whereplanned learning activities occur. Nurse educators must also ensure that onlythose students who possess the knowledge, skills, and competencies that areessential to nursing graduate from their nursing programs.

7.3 Advancing the profession through knowledge development,dissemination, and application to practiceThe nursing profession should engage in scholarly inquiry to identify, evaluate,refine, and expand the body of knowledge that forms the foundation of itsdiscipline and practice. In addition, nursing knowledge is derived from thesciences and from the humanities. Ongoing scholarly activities are essential tofulfilling a professions obligations to society. All nurses working alone or incollaboration with others can participate in the advancement of the professionthrough the development, evaluation, dissemination, and application ofknowledge in practice. However, an organizational climate and infrastructureconducive to scholarly inquiry must be valued and implemented for this to occur.Provision 8 The nurse collaborates with other health professionals and thepublic in promoting community, national and international efforts to meet healthneeds.

8.1 Health needs and concernsThe nursing profession is committed to promoting the health, welfare, and safetyof all people. The nurse has a responsibility to be aware not only of specifichealth needs of individual patients but also of broader health concerns such as


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world hunger, environmental pollution, lack of access to health care, violation ofhuman rights, and inequitable distribution of nursing and healthcare resources.The availability and accessibility of high quality health services to all peoplerequire both interdisciplinary planning and collaborative partnerships amonghealth professionals and others at the community, national, and international

levels.

8.2 Responsibilities to the publicNurses, individually and collectively, have a responsibility to be knowledgeableabout the health status of the community and existing threats to health andsafety. Through support of and participation in community organizations andgroups, the nurse assists in efforts to educate the public, facilitates informedchoice, identifies conditions and circumstances that contribute to illness, injuryand disease, fosters healthy life styles, and participates in institutional andlegislative efforts to promote health and meet national health objectives. Inaddition, the nurse supports initiatives to address barriers to health, such as

poverty, homelessness, unsafe living conditions, abuse and violence, and lack ofaccess to health services.

The nurse also recognizes that health care is provided to culturally diversepopulations in this country and in all parts of the world. In providing care, thenurse should avoid imposition of the nurses own cultural values upon others.The nurse should affirm human dignity and show respect for the values andpractices associated with different cultures and use approaches to care thatreflect awareness and sensitivity.

Provision 9 The profession of nursing value, for maintaining the integrity of theprosession and its practice, and for shaping social policy.

9.1 Assertion of valuesIt is the responsibility of a professional association to communicate and affirm thevalues of the profession to its members. It is essential that the professionalorganization encourages discourse that supports critical self-reflection andevaluation within the profession. The organization also communicates to thepublic the values that nursing considers central to social change that willenhance health.

9.2 The profession carries out its collective responsibility throughprofessional associationsThe nursing profession continues to develop ways to clarify nursingsaccountability to society. The contract between the profession and society ismade explicit through such mechanisms as (a) The Code of Ethics for Nurses,(b) the standards of nursing practice, (c) the ongoing development of nursingknowledge derived from nursing theory, scholarship, and research in order toguide nursing actions, (d) educational requirements for practice, (e) certification,and (f ) mechanisms for evaluating the effectiveness of professional nursing


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actions.

9.3 Intraprofessional integrityA professional association is responsible for expressing the values and ethics ofthe profession and also for encouraging the professional organization and its

members to function in accord with those values and ethics. Thus, one of itsfundamental responsibilities is to promote awareness of and adherence to theCode of Ethics and to critique the activities and ends of the professionalassociation itself. Values and ethics influence the power structures of theassociation in guiding, correcting, and directing its activities. Legitimate concernsfor the self-interest of the association and the profession are balanced by acommitment to the social goods that are sought. Through critical self-reflectionand self-evaluation, associations must foster change within themselves, seekingto move the professional community toward its stated ideals.

9.4 Social reform

Nurses can work individually as citizens or collectively through political action tobring about social change. It is the responsibility of a professional nursingassociation to speak for nurses collectively in shaping and reshaping health carewithin our nation, specifically in areas of healthcare policy and legislation thataffect accessibility, quality, and the cost of health care. Here, the professionalassociation maintains vigilance and takes action to influence legislators,reimbursement agencies, nursing organizations, and other health professions. Inthese activities, health is understood as being broader than delivery andreimbursement systems, but extending to health-related sociocultural issuessuch as violation of human rights, homelessness, hunger, violence, and thestigma of illness.


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Daniel Vincent E. FabrosBSN IV-4

Republic Act No. 9173AN ACT PROVIDING FOR A MORE RESPONSIVE NURSING PROFESSION,REPEALING FOR THE PURPOSE REPUBLIC ACT NO. 7164, OTHERWISEKNOWN AS "THE PHILIPPINE NURSING ACT OF 1991" AND FOR OTHERPURPOSES

Be it enacted by the Senate and the House of Representatives of the Philippinesin Congress assembled:

ARTICLE ITitleSection 1. Title. - This Act shall be known as the "Philippine Nursing Act of 2002."

ARTICLE IIDeclaration of PolicySection 2. Declaration of Policy.It is hereby declared the policy of the State toassume responsibility for the protection and improvement of the nursingprofession by instituting measures that will result in relevant nursing education,humane working conditions, better career prospects and a dignified existence forour nurses.

The State hereby guarantees the delivery of quality basic health services throughan adequate nursing personnel system throughout the country.

ARTICLE III

Organization of the Board of NursingSection 3. Creation and Composition of the Board. - There shall be created aProfessional Regulatory Board of Nursing, hereinafter referred to as the Board, tobe composed of a Chairperson and six (6) members. They shall be appointed bythe president of the Republic of the Philippines from among two (2)recommendees, per vacancy, of the Professional Regulation Commission,hereinafter referred to as the Commission, chosen and ranked from a list of three(3) nominees, per vacancy, of the accredited professional organization of nursesin the Philippines who possess the qualifications prescribed in Section 4 of this

Act.

Section 4. Qualifications of the Chairperson and Members of the Board. - TheChairperson and Members of the Board shall, at the time of their appointment,


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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 professionalorganization 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 oruniversity duly recognized by the Government: Provided, That the majorityof the members of the Board shall be holders of a master's degree innursing: Provided, further, That the Chairperson shall be a holder of amaster's degree in nursing;(d) Have at least ten (10) years of continuous practice of the professionprior to appointment: Provided, however, That the last five (5) years ofwhich shall be in the Philippines; and(e) Not have been convicted of any offense involving moral turpitude;Provided, That the membership to the Board shall represent the three (3)

areas of nursing, namely: nursing education, nursing service andcommunity health nursing.

Section 5. Requirements Upon Qualification as Member of the Board of Nursing.- Any person appointed as Chairperson or Member of the Board shallimmediately resign from any teaching position in any school, college, universityor institution offering Bachelor of Science in Nursing and/or review program forthe local nursing board examinations or in any office or employment in thegovernment or any subdivision, agency or instrumentality thereof, includinggovernment-owned or controlled corporations or their subsidiaries as well asthese employed in the private sector. He/she shall not have any pecuniaryinterest in or administrative supervision over any institution offering Bachelor ofScience in Nursing including review classes.

Section 6. Term of Office.. - The Chairperson and Members of the Board shallhold office for a term of three (3) years and until their successors shall have beenappointed and qualified: Provided, That the Chairperson and members of theBoard may be re-appointed for another term.

Any vacancy in the Board occurring within the term of a Member shall be filled forthe unexpired portion of the term only. Each Member of the Board shall take theproper oath of office prior to the performance of his/her duties.The incumbent Chairperson and Members of the Board shall continue to servefor the remainder of their term under Republic Act No. 7164 until theirreplacements have been appointed by the President and shall have been dulyqualified.

Section 7. Compensation of the Board Members. - The Chairperson andMembers of the Board shall receive compensation and allowances comparableto the compensation and allowances received by the Chairperson and members


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of other professional regulatory boards.

Section 8. Administrative Supervision of the Board, Custodian of its Records,Secretariat and Support Services. - The Board shall be under the administrativesupervision of the Commission. All records of the Board, including applications

for examinations, administrative and other investigative cases conducted by theBoard shall be under the custody of the Commission. The Commission shalldesignate the Secretary of the Board and shall provide the secretariat and othersupport services to implement the provisions of this Act.

Section 9. Powers and Duties of the Board. - The Board shall supervise andregulate the practice of the nursing profession and shall have the followingpowers, duties and functions:

(a) Conduct the licensure examination for nurses;(b) Issue, suspend or revoke certificates of registration for the practice of

nursing;(c) Monitor and enforce quality standards of nursing practice in thePhilippines and exercise the powers necessary to ensure the maintenanceof efficient, ethical and technical, moral and professional standards in thepractice of nursing taking into account the health needs of the nation;(d) Ensure quality nursing education by examining the prescribed facilitiesof universities or colleges of nursing or departments of nursing educationand those seeking permission to open nursing courses to ensure thatstandards of nursing education are properly complied with and maintainedat all times. The authority to open and close colleges of nursing and/ornursing education programs shall be vested on the Commission on HigherEducation upon the written recommendation of the Board;(e) Conduct hearings and investigations to resolve complaints againstnurse practitioners for unethical and unprofessional conduct and violationsof this Act, or its rules and regulations and in connection therewith, issuesubpoena ad testificandum and subpoena duces tecum to secure theappearance of respondents and witnesses and the production ofdocuments and punish with contempt persons obstructing, impedingand/or otherwise interfeming with the conduct of such proceedings, uponapplication with the court;

(f) Promulgate a Code of Ethics in coordination and consultation with theaccredited professional organization of nurses within one (1) year from theeffectivity of this Act;(g) Recognize nursing specialty organizations in coordination with theaccredited professional organization; and(h) Prescribe, adopt issue and promulgate guidelines, regulations,measures and decisions as may be necessary for the improvements of thenursing practice, advancement of the profession and for the proper andfull enforcement of this Act subject to the review and approval by the


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Commission.

Section 10. Annual Report. - The Board shall at the close of its calendar yearsubmit an annual report to the President of the Philippines through theCommission giving a detailed account of its proceedings and the

accomplishments during the year and making recommendations for the adoptionof measures that will upgrade and improve the conditions affecting the practice ofthe nursing profession.

Section 11. Removal or Suspension of Board Members. - The president mayremove or suspend any member of the Board after having been given theopportunity to defend himself/herself in a proper administrative investigation, onthe following grounds;

(a) Continued neglect of duty or incompetence;(b) Commission or toleration of irregularities in the licensure examination;

and(c) Unprofessional immoral or dishonorable conduct.

ARTICLE IVExamination and Registration

Section 12. Licensure Examination. - All applicants for license to practice nursingshall be required to pass a written examination, which shall be given by theBoard in such places and dates as may be designated by the Commission:Provided, That it shall be in accordance with Republic Act No. 8981, otherwiseknown as the "PRC Modernization Act of 2000."

Section 13. Qualifications for Admission to the Licensure Examination. - In orderto be admitted to the examination for nurses, an applicant must, at the time offiling 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 acountry which permits Filipino nurses to practice within its territorial limitson the same basis as the subject or citizen of such country: Provided, Thatthe requirements for the registration or licensing of nurses in said countryare substantially the same as those prescribed in this Act;(b) He/she is of good moral character; and(c) He/she is a holder of a Bachelor's Degree in Nursing from a college oruniversity that complies with the standards of nursing education dulyrecognized by the proper government agency.

Section 14. Scope of Examination. - The scope of the examination for thepractice of nursing in the Philippines shall be determined by the Board. TheBoard shall take into consideration the objectives of the nursing curriculum, thebroad areas of nursing, and other related disciplines and competencies indetermining the subjects of examinations.


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Section 15. Ratings. - In order to pass the examination, an examinee must obtaina general average of at least seventy-five percent (785%) with a rating of notbelow sixty percent (60%) in any subject. An examinee who obtains an averagerating of seventy-five percent (75%) or higher but gets a rating below sixty

percent (60%) in any subject must take the examination again but only in thesubject or subjects where he/she is rated below sixty percent (60%). In order topass the succeeding examination, an examinee must obtain a rating of at leastseventy-five percent (75%) in the subject or subjects repeated.

Section 16. Oath. - All successful candidates in the examination shall be requiredto take an oath of profession before the Board or any government officialauthorized to administer oaths prior to entering upon the nursing practice.

Section 17. Issuance of Certificate of Registration/Professional License andProfessional Identification Card. - A certificate of registration/professional license

as a nurse shall be issued to an applicant who passes the examination uponpayment of the prescribed fees. Every certificate of registration/professionallicense shall show the full name of the registrant, the serial number, the signatureof the Chairperson of the Commission and of the Members of the Board, and theofficial seal of the Commission.

A professional identification card, duly signed by the Chairperson of theCommission, bearing the date of registration, license number, and the date ofissuance and expiration thereof shall likewise be issued to every registrant uponpayment of the required fees.

Section 18. Fees for Examination and Registration. - Applicants for licensure andfor registration shall pay the prescribed fees set by Commission.Section 19. Automatic Registration of Nurses. - All nurses whose names appearat the roster of nurses shall be automatically or ipso facto registered as nursesunder this Act upon its effectivity.

Section 20. Registration by Reciprocity. - A certificate of registration/professionallicense may be issued without examination to nurses registered under the laws ofa foreign state or country: Provided, That the requirements for registration orlicensing of nurses in said country are substantially the same as those prescribedunder this Act: Provided, further, That the laws of such state or country grant thesame privileges to registered nurses of the Philippines on the same basis as thesubjects or citizens of such foreign state or country.Section 21. Practice Through Special/Temporary Permit. - A special/temporarypermit may be issued by the Board to the following persons subject to theapproval of the Commission and upon payment of the prescribed fees:(a) Licensed nurses from foreign countries/states whose service are eitherfor a fee or free if they are internationally well-known specialists oroutstanding experts in any branch or specialty of nursing;


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(b) Licensed nurses from foreign countries/states on medical missionwhose services shall be free in a particular hospital, center or clinic; and(c) Licensed nurses from foreign countries/states employed byschools/colleges of nursing as exchange professors in a branch orspecialty of nursing;

Provided, however, That the special/temporary permit shall be effective only forthe duration of the project, medical mission or employment contract.Section 22. Non-registration and Non-issuance of Certificates ofRegistration/Professional License or Special/Temporary Permit. - No personconvicted by final judgment of any criminal offense involving moral turpitude orany person guilty of immoral or dishonorable conduct or any person declared bythe court to be of unsound mind shall be registered and be issued a certificate ofregistration/professional license or a special/temporary permit.The Board shall furnish the applicant a written statement setting forth the reasonsfor its actions, which shall be incorporated in the records of the Board.

Section 23. Revocation and suspension of Certificate of Registration/ProfessionalLicense and Cancellation of Special/Temporary Permit. - The Board shall havethe power to revoke or suspend the certificate of registration/professional licenseor cancel the special/temporary permit of a nurse upon any of the followinggrounds:

(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 acertificate of registration/professional license or a temporary/specialpermit;

(f) For violation of this Act, the rules and regulations, Code of Ethics fornurses and technical standards for nursing practice, policies of the Boardand the Commission, or the conditions and limitations for the issuance ofthe temporarily/special permit; or(g) For practicing his/her profession during his/her suspension from suchpractice;Provided, however, That the suspension of the certificate ofregistration/professional license shall be for a period not to exceed four (4) years.

Section 24. Re-issuance of Revoked Certificates and Replacement of LostCertificates. - The Board may, after the expiration of a maximum of four (4) yearsfrom the date of revocation of a certificate, for reasons of equity and justice andwhen the cause for revocation has disappeared or has been cured andcorrected, upon proper application therefor 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


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has been lost, destroyed or mutilated may be issued, subject to the rules of theBoard.

ARTICLE VNursing Education

Section 25. Nursing Education Program. - The nursing education program shallprovide sound general and professional foundation for the practice of nursing.The learning experiences shall adhere strictly to specific requirements embodiedin the prescribed curriculum as promulgated by the Commission on HigherEducation's policies and standards of nursing education.

Section 26. Requirement for Inactive Nurses Returning to Practice. - Nurses whohave not actively practiced the profession for five (5) consecutive years arerequired to undergo one (1) month of didactic training and three (3) months ofpracticum. The Board shall accredit hospitals to conduct the said trainingprogram.

Section 27. Qualifications of the Faculty. - A member of the faculty in a college ofnursing 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 professionalorganization of nurses; and(d) Be a holder of a master's degree in nursing, education, or other alliedmedical and health sciences conferred by a college or university dulyrecognized by the Government of the Republic of the Philippines.In addition to the aforementioned qualifications, the dean of a college musthave a master's degree in nursing. He/she must have at least five (5)years of experience in nursing.

ARTICLE VINursing PracticeSection 28. Scope of Nursing. - A person shall be deemed to be practicingnursing within the meaning of this Act when he/she singly or in collaboration withanother, initiates and performs nursing services to individuals, families andcommunities in any health care setting. It includes, but not limited to, nursingcare during conception, labor, delivery, infancy, childhood, toddler, preschool,school age, adolescence, adulthood, and old age. As independent practitioners,nurses are primarily responsible for the promotion of health and prevention ofillness. A members of the health team, nurses shall collaborate with other healthcare providers for the curative, preventive, and rehabilitative aspects of care,restoration of health, alleviation of suffering, and when recovery is not possible,towards a peaceful death. It shall be the duty of the nurse to:

(a) Provide nursing care through the utilization of the nursing process.Nursing care includes, but not limited to, traditional and innovative


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approaches, therapeutic use of self, executing health care techniques andprocedures, essential primary health care, comfort measures, healthteachings, and administration of written prescription for treatment,therapies, oral topical and parenteral medications, internal examinationduring labor in the absence of antenatal bleeding and delivery. In case of

suturing of perineal laceration, special training shall be provided accordingto protocol established;(b) establish linkages with community resources and coordination with thehealth team;(c) Provide health education to individuals, families and communities;(d) Teach, guide and supervise students in nursing education programsincluding the administration of nursing services in varied settings such ashospitals and clinics; undertake consultation services; engage in suchactivities that require the utilization of knowledge and decision-makingskills of a registered nurse; and(e) Undertake nursing and health human resource development training

and research, which shall include, but not limited to, the development ofadvance nursing practice;Provided, That this section shall not apply to nursing students who performnursing 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 toobserve the Code of Ethics for nurses and uphold the standards of safe nursingpractice. The nurse is required to maintain competence by continual learningthrough continuing professional education to be provided by the accreditedprofessional organization or any recognized professional nursing organization:Provided, finally, That the program and activity for the continuing professionaleducation shall be submitted to and approved by the Board.

Section 29. Qualification of Nursing Service Administrators. - A person occupyingsupervisory 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 serviceadministration;(c) Possess a degree of Bachelors of Science in Nursing, with at leastnine (9) units in management and administration courses at the graduatelevel; and(d) Be a member of good standing of the accredited professionalorganization of nurses;Provided, That a person occupying the position of chief nurse or director ofnursing service shall, in addition to the foregoing qualifications, possess:(1) At least five (5) years of experience in a supervisory or managerialposition in nursing; and(2) A master's degree major in nursing;Provided, further, That for primary hospitals, the maximum academicqualifications and experiences for a chief nurse shall be as specified insubsections (a), (b), and (c) of this section: Provided, furthermore, That for chief


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nurses in the public health nursing shall be given priority. Provided, even further,That for chief nurses in military hospitals, priority shall be given to those whohave finished a master's degree in nursing and the completion of the GeneralStaff Course (GSC): Provided, finally, That those occupying such positionsbefore the effectivity of this Act shall be given a period of five (5) years within

which to qualify.

ARTICLE VIIHealth Human Resources Production, Utilization and DevelopmentSection 30. Studies for Nursing Manpower Needs, Production, Utilization andDevelopment. - The Board, in coordination with the accredited professionalorganization and appropriate government or private agencies shall initiateundertake and conduct studies on health human resources production, utilizationand development.

Section 31. Comprehensive Nursing Specialty Program. - Within ninety (90) days

from the effectivity of this Act, the Board in coordination with the accreditedprofessional organization recognized specialty organizations and the Departmentof Health is hereby mandated to formulate and develop a comprehensive nursingspecialty program that would upgrade the level of skill and competence ofspecialty nurse clinicians in the country, such as but not limited to the areas ofcritical care, oncology, renal and such other areas as may be determined by theBoard.

The beneficiaries of this program are obliged to serve in any Philippine hospitalfor a period of at least two (2) years and continuous service.

Section 32. Salary. - In order to enhance the general welfare, commitment toservice and professionalism of nurses the minimum base pay of nurses workingin the public health institutions shall not be lower than salary grade 15 prescribesunder Republic Act No. 6758, otherwise known as the "Compensation andClassification Act of 1989": Provided, That for nurses working in localgovernment units, adjustments to their salaries shall be in accordance withSection 10 of the said law.

Section 33. Funding for the Comprehensive Nursing Specialty Program. - Theannual financial requirement needed to train at least ten percent (10%) of thenursing staff of the participating government hospital shall be chargeable againstthe income of the Philippine Charity Sweepstakes Office and the Philippine

Amusement and Gaming Corporation, which shall equally share in the costs andshall be released to the Department of Health subject to accounting and auditingprocedures: Provided, That the department of Health shall set the criteria for theavailment of this program.

Section 34. Incentives and Benefits. - The Board of Nursing, in coordination withthe Department of Health and other concerned government agencies,


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association of hospitals and the accredited professional organization shallestablish an incentive and benefit system in the form of free hospital care fornurses and their dependents, scholarship grants and other non-cash benefits.The government and private hospitals are hereby mandated to maintain thestandard nurse-patient ratio set by the Department of Health.

ARTICLE VIII

Penal and Miscellaneous ProvisionsSection 35. Prohibitions in the Practice of Nursing. - A fine of not less than Fiftythousand pesos (P50,000.00) nor more than One hundred thousand pesos(P100,000.00) or imprisonment of not less than one (1) year nor more than six(6) years, or both, upon the discretion of the court, shall be imposed upon:(a) any person practicing nursing in the Philippines within the meaning ofthis Act:(1) without a certificate of registration/professional license andprofessional identification card or special temporary permit or

without having been declared exempt from examination inaccordance with the provision of this Act; or(2) who uses as his/her own certificate of registration/professionallicense and professional identification card or special temporarypermit of another; or(3) who uses an invalid certificate of registration/professionallicense, a suspended or revoked certificate ofregistration/professional license, or an expired or cancelledspecial/temporary permits; or(4) who gives any false evidence to the Board in order to obtain acertificate of registration/professional license, a professionalidentification card or special permit; or(5) who falsely poses or advertises as a registered and licensednurse or uses any other means that tend to convey the impressionthat he/she is a registered and licensed nurse; or(6) who appends B.S.N./R.N. (Bachelor of Science inNursing/Registered Nurse) or any similar appendage to his/hername without having been coferred said degree or registration; or(7) who, as a registered and licensed nurse, abets or assists theillegal practice of a person who is not lawfully qualified to practicenursing.(b) any person or the chief executive officer of a judicial entity whoundertakes in-service educational programs or who conducts reviewclasses for both local and foreign examination without permit/clearancefrom the Board and the Commission; or(c) any person or employer of nurses who violate the minimum base payof nurses and the incentives and benefits that should be accorded them asspecified in Sections 32 and 34; or(d) any person or the chief executive officer of a juridical entity violatingany provision of this Act and its rules and regulations.


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ARTICLE IXFinal ProvisionsSection 36. Enforcement of this Act. - It shall be the primary duty of theCommission and the Board to effectively implement this Act. Any duly law

enforcement agencies and officers of national, provincial, city or municipalgovernments shall, upon the call or request of the Commission or the Board,render assistance in enforcing the provisions of this Act and to prosecute anypersons violating the same.

Section 37. Appropriations. - The Chairperson of the Professional RegulationCommission shall immediately include in its program and issue such rules andregulations to implement the provisions of this Act, the funding of which shall beincluded in the Annual General Appropriations Act.

Section 38. Rules and Regulations. - Within ninety (90) days after the effectivity

of this Act, the Board and the Commission, in coordination with the accreditedprofessional organization, the Department of Health, the Department of Budgetand Management and other concerned government agencies, shall formulatesuch rules and regulations necessary to carry out the provisions of this Act. Theimplementing rules and regulations shall be published in the Official Gazette or inany newspaper of general circulation.

Section 39. Reparability Clause. - If any part of this Act is declaredunconstitutional, the remaining parts not affected thereby shall continue to bevalid 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 areinconsistent with this Act are hereby repealed, amended or modified accordingly.Section 41. Effectivity. - This act shall take effect fifteen (15) days upon itspublication in the Official Gazette or in any two (2) newspapers of generalcirculation in the Philippines.

Documents

Fabros, Daniel