Fabros, Daniel

Fabros, Daniel Vincent E.
BSN IV-4

Topic: Code of Ethics
Goal 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 with
compassion and respect for the inherent dignity, worth, and uniqueness of every
individual, unrestricted by considerations of social or economic status, personal
attributes, or the nature of health problems.

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

1.2 Relationships to patients
The need for health care is universal, transcending all individual differences. The
nurse establishes relationships and delivers nursing services with respect for
human needs and values, and without prejudice. An individual’s lifestyle, value
system and religious beliefs should be considered in planning health care with
and for each patient. Such consideration does not suggest that the nurse
necessarily agrees with or condones certain individual choices, but that the nurse
respects the patient as a person.

1.3 The nature of health problems
The nurse respects the worth, dignity and rights of all human beings irrespective
of the nature of the health problem. The worth of the person is not affected by
disease, disability, functional status, or proximity to death. This respect extends
to all who require the services of the nurse for the promotion of health, the
prevention of illness, the restoration of health, the alleviation of suffering, and the
provision of supportive care to those who are dying.
The measures nurses take to care for the patient enable the patient to live with
as much physical, emotional, social, and spiritual well-being as possible. Nursing
care aims to maximize the values that the patient has treasured in life and
extends supportive care to the family and significant others. Nursing care is
directed toward meeting the comprehensive needs of patients and their families
across the continuum of care. This is particularly vital in the care of patients and
their families at the end of life to prevent and relieve the cascade of symptoms
and suffering that are commonly associated with dying.
Nurses are leaders and vigilant advocates for the delivery of dignified and
humane care. Nurses actively participate in assessing and assuring the
responsible and appropriate use of interventions in order to minimize
unwarranted or unwanted treatment and patient suffering. The acceptability and
importance of carefully considered decisions regarding resuscitation status,
withholding and withdrawing life-sustaining therapies, forgoing medically
provided nutrition and hydration, aggressive pain and symptom management and
advance directives are increasingly evident. The nurse should provide
interventions to relieve pain and other symptoms in the dying patient even when
those interventions entail risks of hastening death. However, nurses may not act
with the sole intent of ending a patient’s life even though such action may be
motivated by compassion, respect for patient autonomy and quality of life
considerations. Nurses have invaluable experience, knowledge, and insight into
care at the end of life and should be actively involved in related research,
education, practice, and policy development.

1.4 The right to self-determination
Respect for human dignity requires the recognition of specific patient rights,
particularly, the right of self-determination. Self-determination, also known as
autonomy, is the philosophical basis for informed consent in health care. Patients
have the moral and legal right to determine what will be done with their own
person; to be given accurate, complete, and understandable information in a
manner that facilitates an informed judgment; to be assisted with weighing the
benefits, burdens, and available options in their treatment, including the choice of
no treatment; to accept, refuse, or terminate treatment without deceit, undue
influence, duress, coercion, or penalty; and to be given necessary support
throughout the decision-making and treatment process. Such support would
include the opportunity to make decisions with family and significant others and
the provision of advice and support from knowledgeable nurses and other health
professionals. Patients should be involved in planning their own health care to
the extent they are able and choose to participate.
Each nurse has an obligation to be knowledgeable about the moral and legal
rights of all patients to self-determination. The nurse preserves, protects, and
supports those interests by assessing the patient’s comprehension of both the
information presented and the implications of decisions. In situations in which the
patient lacks the capacity to make a decision, a designated surrogate decision
maker should be consulted. The role of the surrogate is to make decisions as the
patient would, based upon the patient’s previously expressed wishes and known
values. In the absence of a designated surrogate decision-maker, decisions
should be made in the best interests of the patient, considering the patient’s
personal values to the extent that they are known. The nurse supports patient
self-determination by participating in discussions with surrogates, providing
guidance and referral to other resources as necessary, and identifying and
addressing problems in the decision-making process. Support of autonomy in the
broadest sense also includes recognition that people of some cultures place less
weight on individualism and choose to defer to family or community values in
decision-making. Respect not just for the specific decision, but also for the
patient’s method of decision-making, is consistent with the principle of autonomy.
Individuals are interdependent members of the community. The nurse recognizes
that there are situations in which the right to individual self-determination may be
outweighed or limited by the rights, health and welfare of others, particularly in
relation to public health considerations. Nonetheless, limitation of individual rights
must always be considered a serious deviation from the standard of care,
justified only when there are no less restrictive means available to preserve the
rights of others and the demands of justice.

1.5 Relationships with colleagues and others
The principle of respect for persons extends to all individuals with whom the
nurse interacts. The nurse maintains compassionate and caring relationships
with colleagues and others with a commitment to the fair treatment of individuals,
to integrity-preserving compromise, and to resolving conflict. Nurses function in
many 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 conduct
precludes any and all prejudicial actions, any form of harassment or threatening
behavior, or disregard for the effect of one’s actions on others. The nurse values
the 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 an
individual, family, group, or community.

2.1 Primacy of the patient’s interests
The nurse’s primary commitment is to the recipient of nursing and healthcare
services—the patient—whether the recipient is an individual, a family, a group, or
a community. Nursing holds a fundamental commitment to the uniqueness of the
individual patient; therefore, any plan of care must reflect that uniqueness. The
nurse strives to provide patients with opportunities to participate in planning care,
assures that patients find the plans acceptable and supports the implementation
of the plan. Addressing patient interests requires recognition of the patient’s
place in the family or other networks of relationship. When the patient’s wishes
are in conflict with others, the nurse seeks to help resolve the conflict. Where
conflict persists, the nurse’s commitment remains to the identified patient.

2.2 Conflict of interest for nurses
Nurses are frequently put in situations of conflict arising from competing loyalties
in the workplace, including situations of conflicting expectations from patients,
families, physicians, colleagues, and in many cases, healthcare organizations
and health plans. Nurses must examine the conflicts arising between their own
personal and professional values, the values and interests of others who are also
responsible for patient care and healthcare decisions, as well as those of
patients. Nurses strive to resolve such conflicts in ways that ensure patient
safety, guard the patient’s best interests and preserve the professional integrity
of the nurse.

Situations created by changes in healthcare financing and delivery systems, such
as incentive systems to decrease spending, pose new possibilities of conflict
between economic self-interest and professional integrity. The use of bonuses,
sanctions, and incentives tied to financial targets are examples of features of
healthcare systems that may present such conflict. Conflicts of interest may arise
in 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 especially
cognizant of the potential for conflicts of interest. Nurses should disclose to all
relevant parties (e.g., patients, employers, colleagues) any perceived or actual
conflict of interest and in some situations should withdraw from further
participation. Nurses in all roles must seek to ensure that employment
arrangements are just and fair and do not create an unreasonable conflict
between patient care and direct personal gain.

2.3 Collaboration
Collaboration is not just cooperation, but it is the concerted effort of individuals
and 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 delivery
systems requires a multi-disciplinary approach to the delivery of services that has
the strong support and active participation of all the health professions. Within
this context, nursing’s unique contribution, scope of practice, and relationship
with other health professions needs to be clearly articulated, represented and
preserved. By its very nature, collaboration requires mutual trust, recognition,
and respect among the healthcare team, shared decision-making about patient
care, and open dialogue among all parties who have an interest in and a concern
for health outcomes. Nurses should work to assure that the relevant parties are
involved and have a voice in decision-making about patient care issues. Nurses
should see that the questions that need to be addressed are asked and that the
information needed for informed decision-making is available and provided.
Nurses should actively promote the collaborative multi-disciplinary planning
required to ensure the availability and accessibility of quality health services to all
persons who have needs for health care.

Intra-professional collaboration within nursing is fundamental to effectively
addressing the health needs of patients and the public. Nurses engaged in
nonclinical roles, such as administration or research, while not providing direct
care, nonetheless are collaborating in the provision of care through their
influence and direction of those who do. Effective nursing care is accomplished
through the interdependence of nurses in differing roles—those who teach the
needed skills, set standards, manage the environment of care, or expand the
boundaries of knowledge used by the profession. In this sense, nurses in all roles
share a responsibility for the outcomes of nursing care.

Nurses are leaders and vigilant advocates for the delivery of dignified and
humane care. Nurses actively participate in assessing and assuring the
responsible and appropriate use of interventions in order to minimize
unwarranted or unwanted treatment and patient suffering. The acceptability and
importance of carefully considered decisions regarding resuscitation status,
withholding and withdrawing life-sustaining therapies, forgoing medically
provided nutrition and hydration, aggressive pain and symptom management and
advance directives are increasingly evident. The nurse should provide
interventions to relieve pain and other symptoms in the dying patient even when
those interventions entail risks of hastening death. However, nurses may not act
with the sole intent of ending a patient’s life even though such action may be
motivated by compassion, respect for patient autonomy and quality of life
considerations. Nurses have invaluable experience, knowledge, and insight into
care at the end of life and should be actively involved in related research,
education, practice, and policy development.

2.4 Professional boundaries
When acting within one’s role as a professional, the nurse recognizes and
maintains boundaries that establish appropriate limits to relationships. While the
nature of nursing work has an inherently personal component, nurse-patient
relationships and nurse-colleague relationships have, as their foundation, the
purpose of preventing illness, alleviating suffering, and protecting, promoting, and
restoring the health of patients. In this way, nurse-patient and nurse-colleague
relationships differ from those that are purely personal and unstructured, such as
friendship. The intimate nature of nursing care, the involvement of nurses in
important and sometimes highly stressful life events, and the mutual dependence
of colleagues working in close concert all present the potential for blurring of
limits to professional relationships. Maintaining authenticity and expressing
oneself as an individual, while remaining within the bounds established by the
purpose of the relationship can be especially difficult in prolonged or long-term
relationships. In all encounters, nurses are responsible for retaining their
professional boundaries. When those professional boundaries are jeopardized,
the nurse should seek assistance from peers or supervisors or take appropriate
steps to remove her/himself from the situation.

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

3.1 Privacy
The nurse safeguards the patient’s right to privacy. The need for health care
does not justify unwanted intrusion into the patient’s life. The nurse advocates for
an environment that provides for sufficient physical privacy, including privacy for
discussions of a personal nature and policies and practices that protect the
confidentiality of information.
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3.2 Confidentiality
Associated with the right to privacy, the nurse has a duty to maintain
confidentiality of all patient information. The patient’s well-being could be
jeopardized and the fundamental trust between patient and nurse destroyed by
unnecessary access to data or by the inappropriate disclosure of identifiable
patient information. The rights, well-being, and safety of the individual patient
should be the primary factors in arriving at any professional judgment concerning
the disposition of confidential information received from or about the patient,
whether oral, written or electronic. The standard of nursing practice and the
nurse’s responsibility to provide quality care require that relevant data be shared
with those members of the healthcare team who have a need to know. Only
information pertinent to a patient’s treatment and welfare is disclosed, and only to
those directly involved with the patient’s 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 public
health reasons.

Information used for purposes of peer review, third-party payments, and other
quality improvement or risk management mechanisms may be disclosed only
under defined policies, mandates, or protocols. These written guidelines must
assure that the rights, well-being, and safety of the patient are protected. In
general, only that information directly relevant to a task or specific responsibility
should be disclosed. When using electronic communications, special effort
should be made to maintain data security.

3.3 Protection of participants in research
Stemming from the right to self-determination, each individual has the right to
choose whether or not to participate in research. It is imperative that the patient
or legally authorized surrogate receive sufficient information that is material to an
informed decision, to comprehend that information, and to know how to
discontinue participation in research without penalty. Necessary information to
achieve an adequately informed consent includes the nature of participation,
potential harms and benefits, and available alternatives to taking part in the
research. Additionally, the patient should be informed of how the data will be
protected. The patient has the right to refuse to participate in research or to
withdraw at any time without fear of adverse consequences or reprisal.
Research should be conducted and directed only by qualified persons. Prior to
implementation, all research should be approved by a qualified review board to
ensure patient protection and the ethical integrity of the research. Nurses should
be cognizant of the special concerns raised by research involving vulnerable
groups, including children, prisoners, students, the elderly, and the poor. The
nurse who participates in research in any capacity should be fully informed about
both the subject’s and the nurse’s rights and obligations in the particular research
study and in research in general. Nurses have the duty to question and, if
necessary, to report and to refuse to participate in research they deem morally
objectionable.

3.4 Standards and review mechanisms
Nursing is responsible and accountable for assuring that only those individuals
who have demonstrated the knowledge, skill, practice experiences, commitment,
and integrity essential to professional practice are allowed to enter into and
continue to practice within the profession. Nurse educators have a responsibility
to ensure that basic competencies are achieved and to promote a commitment to
professional practice prior to entry of an individual into practice. Nurse
administrators are responsible for assuring that the knowledge and skills of each
nurse 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 of
professional nursing practice. The nurse should participate in planning,
establishing, implementing, and evaluating review mechanisms designed to
safeguard 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 on
institutional ethics committees. Nurses must bring forward difficult issues related
to patient care and/or institutional constraints upon ethical practice for discussion
and review. The nurse acts to promote inclusion of appropriate others in all
deliberations related to patient care.

Nurses should also be active participants in the development of policies and
review mechanisms designed to promote patient safety, reduce the likelihood of
errors, and address both environmental system factors and human factors that
present increased risk to patients. In addition, when errors do occur, nurses are
expected to follow institutional guidelines in reporting errors committed or
observed to the appropriate supervisory personnel and for assuring responsible
disclosure of errors to patients. Under no circumstances should the nurse
participate in, or condone through silence, either an attempt to hide an error or a
punitive response that serves only to fix blame rather than correct the conditions
that led to the error.

3.5 Acting on questionable practice
The nurse’s primary commitment is to the health, well-being, and safety of the
patient across the life span and in all settings in which healthcare needs are
addressed. As an advocate for the patient, the nurse must be alert to and take
appropriate action regarding any instances of incompetent, unethical, illegal, or
impaired practice by any member of the healthcare team or the healthcare
system or any action on the part of others that places the rights or best interests
of the patient in jeopardy. To function effectively in this role, nurses must be
knowledgeable about the Code of Ethics, standards of practice of the profession,
relevant federal, state and local laws and regulations, and the employing
organization’s policies and procedures.

When the nurse is aware of inappropriate or questionable practice in the
provision or denial of health care, concern should be expressed to the person
carrying out the questionable practice. Attention should be called to the possible
detrimental affect upon the patient’s well-being or best interests as well as the
integrity of nursing practice. When factors in the healthcare delivery system or
healthcare organization threaten the welfare of the patient, similar action should
be directed to the responsible administrator. If indicated, the problem should be
reported to an appropriate higher authority within the institution or agency, or to
an appropriate external authority.

There should be established processes for reporting and handling incompetent,
unethical, illegal, or impaired practice within the employment setting so that such
reporting can go through official channels, thereby reducing the risk of reprisal
against the reporting nurse. All nurses have a responsibility to assist those who
identify potentially questionable practice. State nurses associations should be
prepared to provide assistance and support in the development and evaluation of
such processes and reporting procedures. When incompetent, unethical, illegal,
or impaired practice is not corrected within the employment setting and continues
to jeopardize patient well-being and safety, the problem should be reported to
other appropriate authorities such as practice committees of the pertinent
professional organizations, the legally constituted bodies concerned with
licensing 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, undergird
all such responsible actions. When a nurse chooses to engage in the act of
responsible reporting about situations that are perceived as unethical,
incompetent, illegal, or impaired, the professional organization has a
responsibility to provide the nurse with support and assistance and to protect the
practice of those nurses who choose to voice their concerns. Reporting unethical,
illegal, incompetent, or impaired practices, even when done appropriately, may
present substantial risks to the nurse; nevertheless, such risks do not eliminate
the obligation to address serious threats to patient safety.

3.6 Addressing impaired practice
Nurses must be vigilant to protect the patient, the public, and the profession from
potential harm when a colleague’s practice, in any setting, appears to be
impaired. The nurse extends compassion and caring to colleagues who are in
recovery from illness or when illness interferes with job performance. In a
situation where a nurse suspects another’s practice may be impaired, the nurse’s
duty is to take action designed both to protect patients and to assure that the
impaired individual receives assistance in regaining optimal function. Such action
should usually begin with consulting supervisory personnel and may also include
confronting the individual in a supportive manner and with the assistance of
others or helping the individual to access appropriate resources. Nurses are
encouraged to follow guidelines outlined by the profession and policies of the
employing organization to assist colleagues whose job performance may be
adversely affected by mental or physical illness or by personal circumstances.
Nurses in all roles should advocate for colleagues whose job performance may
be impaired to ensure that they receive appropriate assistance, treatment and
access to fair institutional and legal processes. This includes supporting the
return to practice of the individual who has sought assistance and is ready to
resume professional duties.

If impaired practice poses a threat or danger to self or others, regardless of
whether the individual has sought help, the nurse must take action to report the
individual to persons authorized to address the problem. Nurses who advocate
for others whose job performance creates a risk for harm should be protected
from negative consequences. Advocacy may be a difficult process and the nurse
is advised to follow workplace policies. If workplace policies do not exist or are
inappropriate—that is, they deny the nurse in question access to due legal
process or demand resignation—the reporting nurse may obtain guidance from
the professional association, state peer assistance programs, employee
assistance program or a similar resource.

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

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

4.2 Accountability for nursing judgment and action
Accountability means to be answerable to oneself and others for one’s own
actions. In order to be accountable, nurses act under a code of ethical conduct
that is grounded in the moral principles of fidelity and respect for the dignity,
worth, and self-determination of patients. Nurses are accountable for judgments
made and actions taken in the course of nursing practice, irrespective of
healthcare organizations’ policies or providers’ directives.

4.3 Responsibility for nursing judgment and action
Responsibility refers to the specific accountability or liability associated with the
performance of duties of a particular role. Nurses accept or reject specific role
demands based upon their education, knowledge, competence, and extent of
experience. Nurses in administration, education, and research also have
obligations to the recipients of nursing care. Although nurses in administration,
education, and research have relationships with patients that are less direct, in
assuming the responsibilities of a particular role, they share responsibility for the
care provided by those whom they supervise and instruct. The nurse must not
engage in practices prohibited by law or delegate activities to others that are
prohibited by the practice acts of other healthcare providers.

Individual nurses are responsible for assessing their own competence. When the
needs of the patient are beyond the qualifications and competencies of the
nurse, consultation and collaboration must be sought from qualified nurses, other
health professionals, or other appropriate sources. Educational resources should
be sought by nurses and provided by institutions to maintain and advance the
competence of nurses. Nurse educators act in collaboration with their students to
assess the learning needs of the student, the effectiveness of the teaching
program, the identification and utilization of appropriate resources, and the
support needed for the learning process.

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

The nurse must make reasonable efforts to assess individual competence when
assigning selected components of nursing care to other healthcare workers. This
assessment involves evaluating the knowledge, skills, and experience of the
individual 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 monitoring
the 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 to
any member of the nursing team a task for which that person is not prepared or
qualified. Employer policies or directives do not relieve the nurse of responsibility
for making judgments about the delegation and assignment of nursing care
tasks.

Nurses functioning in management or administrative roles have a particular
responsibility to provide an environment that supports and facilitates appropriate
assignment and delegation. This includes providing appropriate orientation to
staff, assisting less experienced nurses in developing necessary skills and
competencies, and establishing policies and procedures that protect both the
patient and nurse from the inappropriate assignment or delegation of nursing
responsibilities, activities, or tasks.

Nurses functioning in educator or preceptor roles may have less direct
relationships with patients. However, through assignment of nursing care
activities to learners they share responsibility and accountability for the care
provided. It is imperative that the knowledge and skills of the learner be sufficient
to provide the assigned nursing care and that appropriate supervision be
provided to protect both the patient and the learner.

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

5.1 Moral self-respect
Moral respect accords moral worth and dignity to all human beings irrespective of
their 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 professional
growth and maintenance of competence, preservation of wholeness of character,
and personal integrity.

5.2 Professional growth and maintenance of competence
Though it has consequences for others, maintenance of competence and
ongoing professional growth involves the control of one’s own conduct in a way
that is primarily self-regarding. Competence affects one’s self-respect, self-
esteem, professional status, and the meaningfulness of work. In all nursing roles,
evaluation of one’s own performance, coupled with peer review, is a means by
which nursing practice can be held to the highest standards. Each nurse is
responsible for participating in the development of criteria for evaluation of
practice and for using those criteria in peer and self-assessment.
Continual professional growth, particularly in knowledge and skill, requires a
commitment 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 are
required to have knowledge relevant to the current scope and standards of
nursing practice, changing issues, concerns, controversies, and ethics. Where
the care required is outside the competencies of the individual nurse,
consultation should be sought or the patient should be referred to others for
appropriate care.

5.3 Wholeness of character
Nurses have both personal and professional identities that are neither entirely
separate, nor entirely merged, but are integrated. In the process of becoming a
professional, the nurse embraces the values of the profession, integrating them
with personal values. Duties to self involve an authentic expression of one’s own
moral point-of-view in practice. Sound ethical decision-making requires the
respectful and open exchange of views between and among all individuals with
relevant interests. In a community of moral discourse, no one person’s view
should automatically take precedence over that of another. Thus the nurse has a
responsibility to express moral perspectives, even when they differ from those of
others, 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, the
nurse is generally free to express an informed personal opinion as long as this
preserves the voluntariness of the patient and maintains appropriate professional
and moral boundaries. It is essential to be aware of the potential for undue
influence attached to the nurse’s professional role. Assisting patients to clarify
their own values in reaching informed decisions may be helpful in avoiding
unintended persuasion. In situations where nurses’ responsibilities include care
for those whose personal attributes, condition, lifestyle or situation is stigmatized
by the community and are personally unacceptable, the nurse still renders
respectful and skilled care.

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

Where nurses are placed in situations of compromise that exceed acceptable
moral 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 may
express their conscientious objection to participation. Where a particular
treatment, intervention, activity, or practice is morally objectionable to the nurse,
whether intrinsically so or because it is inappropriate for the specific patient, or
where it may jeopardize both patients and nursing practice, the nurse is justified
in refusing to participate on moral grounds. Such grounds exclude personal
preference, prejudice, convenience, or arbitrariness. Conscientious objection
may not insulate the nurse against formal or informal penalty. The nurse who
decides not to take part on the grounds of conscientious objection must
communicate this decision in appropriate ways. Whenever possible, such a
refusal should be made known in advance and in time for alternate arrangements
to be made for patient care. The nurse is obliged to provide for the patient’s
safety, to avoid patient abandonment, and to withdraw only when assured that
alternative 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 conscientious
objection collectively to the appropriate body or committee. In addition, they
should express their concern, resist, and seek to bring about a change in those
persistent activities or expectations in the practice setting that are morally
objectionable to nurses and jeopardize either patient or nurse well-being.

Provision 6 The nurse participates in establishing, maintaining, and improving
health care environments and conditions of employment conducive to the
provision of quality health care and consistent with the values of the profession
through individual and collective action.

6.1 Influence of the environment on moral virtues and values
Virtues are habits of character that predispose persons to meet their moral
obligations; that is, to do what is right. Excellences are habits of character that
predispose 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 of
the morally good nurse. For the nurse, virtues and excellences are those habits
that 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 in
which the nurse practices or they can be diminished or thwarted. All nurses have
a responsibility to create, maintain, and contribute to environments that support
the growth of virtues and excellences and enable nurses to fulfill their ethical
obligations.

6.2 Influence of the environment on ethical obligations
All nurses, regardless of role, have a responsibility to create, maintain, and
contribute to environments of practice that support nurses in fulfilling their ethical
obligations. Environments of practice include observable features, such as
working conditions, and written policies and procedures setting out expectations
for 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, and
disciplinary procedures all contribute to environments that can either present
barriers or foster ethical practice and professional fulfillment. Environments in
which employees are provided fair hearing of grievances, are supported in
practicing according to standards of care, and are justly treated allow for the
realization of the values of the profession and are consistent with sound nursing
practice.

6.3 Responsibility for the healthcare environment
The nurse is responsible for contributing to a moral environment that encourages
respectful interactions with colleagues, support of peers, and identification of
issues that need to be addressed. Nurse administrators have a particular
responsibility 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 the
individual does not participate in the specific practice, is equivalent to condoning
unsafe practice. Nurses should not remain employed in facilities that routinely
violate patient rights or require nurses to severely and repeatedly compromise
standards of practice or personal morality.
As with concerns about patient care, nurses should address concerns about the
healthcare environment through appropriate channels. Organizational changes
are difficult to accomplish and may require persistent efforts over time. Toward
this end, nurses may participate in collective action such as collective bargaining
or workplace advocacy, preferably through a professional association such as
the state nurses association, in order to address the terms and conditions of
employment. Agreements reached through such action must be consistent with
the profession’s standards of practice, the state law regulating practice, and the
Code of Ethics for Nurses. Conditions of employment must contribute to the
moral environment, the provision of quality patient care and professional
satisfaction for nurses.
The professional association also serves as an advocate for the nurse by
seeking to secure just compensation and humane working conditions for nurses.
To accomplish this, the professional association may engage in collective
bargaining on behalf of nurses. While seeking to assure just economic and
general welfare for nurses, collective bargaining, nonetheless, seeks to keep the
interests of both nurses and patients in balance.

Provision 7 The nurse participates in the advancement of the profession
through contributions to practice, education, administration, and knowledge
development.

7.1 Advancing the profession through active involvement in nursing
and in healthcare policy
Nurses should advance their profession by contributing in some way to the
leadership, activities, and the viability of their professional organizations. Nurses
can also advance the profession by serving in leadership or mentorship roles or
on committees within their places of employment. Nurses who are self-employed
can advance the profession by serving as role models for professional integrity.
Nurses can also advance the profession through participation in civic activities
related to health care or through local, state, national, or international initiatives.
Nurse educators have a specific responsibility to enhance students’ commitment
to professional and civic values. Nurse administrators have a responsibility to
foster an employment environment that facilitates nurses’ ethical integrity and
professionalism, and nurse researchers are responsible for active contribution to
the body of knowledge supporting and advancing nursing practice.

7.2 Advancing the profession by developing, maintaining, and
implementing professional standards in clinical, administrative, and
educational practice
Standards and guidelines reflect the practice of nursing grounded in ethical
commitments and a body of knowledge. Professional standards and guidelines
for nurses must be developed by nurses and reflect nursing’s responsibility to
society. It is the responsibility of nurses to identify their own scope of practice as
permitted by professional practice standards and guidelines, by state and federal
laws, by relevant societal values, and by the Code of Ethics.

The nurse as administrator or manager must establish, maintain, and promote
conditions of employment that enable nurses within that organization or
community setting to practice in accord with accepted standards of nursing
practice 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 implementing
nursing standards and guidelines and assuring quality care for those whom
nursing serves.

The nurse educator is responsible for promoting and maintaining optimum
standards of both nursing education and of nursing practice in any settings where
planned learning activities occur. Nurse educators must also ensure that only
those students who possess the knowledge, skills, and competencies that are
essential to nursing graduate from their nursing programs.

7.3 Advancing the profession through knowledge development,
dissemination, and application to practice
The nursing profession should engage in scholarly inquiry to identify, evaluate,
refine, and expand the body of knowledge that forms the foundation of its
discipline and practice. In addition, nursing knowledge is derived from the
sciences and from the humanities. Ongoing scholarly activities are essential to
fulfilling a profession’s obligations to society. All nurses working alone or in
collaboration with others can participate in the advancement of the profession
through the development, evaluation, dissemination, and application of
knowledge in practice. However, an organizational climate and infrastructure
conducive to scholarly inquiry must be valued and implemented for this to occur.
Provision 8 The nurse collaborates with other health professionals and the
public in promoting community, national and international efforts to meet health
needs.

8.1 Health needs and concerns
The nursing profession is committed to promoting the health, welfare, and safety
of all people. The nurse has a responsibility to be aware not only of specific
health needs of individual patients but also of broader health concerns such as
world hunger, environmental pollution, lack of access to health care, violation of
human rights, and inequitable distribution of nursing and healthcare resources.
The availability and accessibility of high quality health services to all people
require both interdisciplinary planning and collaborative partnerships among
health professionals and others at the community, national, and international
levels.

8.2 Responsibilities to the public
Nurses, individually and collectively, have a responsibility to be knowledgeable
about the health status of the community and existing threats to health and
safety. Through support of and participation in community organizations and
groups, the nurse assists in efforts to educate the public, facilitates informed
choice, identifies conditions and circumstances that contribute to illness, injury
and disease, fosters healthy life styles, and participates in institutional and
legislative efforts to promote health and meet national health objectives. In
addition, the nurse supports initiatives to address barriers to health, such as
poverty, homelessness, unsafe living conditions, abuse and violence, and lack of
access to health services.

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

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

9.1 Assertion of values
It is the responsibility of a professional association to communicate and affirm the
values of the profession to its members. It is essential that the professional
organization encourages discourse that supports critical self-reflection and
evaluation within the profession. The organization also communicates to the
public the values that nursing considers central to social change that will
enhance health.

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

9.3 Intraprofessional integrity
A professional association is responsible for expressing the values and ethics of
the profession and also for encouraging the professional organization and its
members to function in accord with those values and ethics. Thus, one of its
fundamental responsibilities is to promote awareness of and adherence to the
Code of Ethics and to critique the activities and ends of the professional
association itself. Values and ethics influence the power structures of the
association in guiding, correcting, and directing its activities. Legitimate concerns
for the self-interest of the association and the profession are balanced by a
commitment to the social goods that are sought. Through critical self-reflection
and self-evaluation, associations must foster change within themselves, seeking
to move the professional community toward its stated ideals.

9.4 Social reform
Nurses can work individually as citizens or collectively through political action to
bring about social change. It is the responsibility of a professional nursing
association to speak for nurses collectively in shaping and reshaping health care
within our nation, specifically in areas of healthcare policy and legislation that
affect accessibility, quality, and the cost of health care. Here, the professional
association maintains vigilance and takes action to influence legislators,
reimbursement agencies, nursing organizations, and other health professions. In
these activities, health is understood as being broader than delivery and
reimbursement systems, but extending to health-related sociocultural issues
such as violation of human rights, homelessness, hunger, violence, and the
stigma of illness.
























Daniel Vincent E. Fabros
BSN IV-4

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

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

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

Section 4. Qualifications of the Chairperson and Members of the Board. - The
Chairperson and Members of the Board shall, at the time of their appointment,
possess the following qualifications:

(a) Be a natural born citizen and resident of the Philippines;
(b) Be a member of good standing of the accredited professional
organization of nurses;
(c) Be a registered nurse and holder of a master's degree in nursing,
education or other allied medical profession conferred by a college or
university duly recognized by the Government: Provided, That the majority
of the members of the Board shall be holders of a master's degree in
nursing: Provided, further, That the Chairperson shall be a holder of a
master's degree in nursing;
(d) Have at least ten (10) years of continuous practice of the profession
prior to appointment: Provided, however, That the last five (5) years of
which shall be in the Philippines; and
(e) Not have been convicted of any offense involving moral turpitude;
Provided, That the membership to the Board shall represent the three (3)
areas of nursing, namely: nursing education, nursing service and
community health nursing.

Section 5. Requirements Upon Qualification as Member of the Board of Nursing.
- Any person appointed as Chairperson or Member of the Board shall
immediately resign from any teaching position in any school, college, university
or institution offering Bachelor of Science in Nursing and/or review program for
the local nursing board examinations or in any office or employment in the
government or any subdivision, agency or instrumentality thereof, including
government-owned or controlled corporations or their subsidiaries as well as
these 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.

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

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

Section 7. Compensation of the Board Members. - The Chairperson and
Members of the Board shall receive compensation and allowances comparable
to the compensation and allowances received by the Chairperson and members
of other professional regulatory boards.

Section 8. Administrative Supervision of the Board, Custodian of its Records,
Secretariat and Support Services. - The Board shall be under the administrative
supervision of the Commission. All records of the Board, including applications
for examinations, administrative and other investigative cases conducted by the
Board shall be under the custody of the 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 nurses;
(b) Issue, suspend or revoke certificates of registration for the practice of
nursing;
(c) Monitor and enforce quality standards of nursing practice in the
Philippines and exercise the powers necessary to ensure the maintenance
of efficient, ethical and technical, moral and professional standards in the
practice of nursing taking into account the health needs of the nation;
(d) Ensure quality nursing education by examining the prescribed facilities
of universities or colleges of nursing or departments of nursing education
and those seeking permission to open nursing courses to ensure that
standards of nursing education are properly complied with and maintained
at all times. The authority to open and close colleges of nursing and/or
nursing education programs shall be vested on the Commission on Higher
Education upon the written recommendation of the Board;
(e) Conduct hearings and investigations to resolve complaints against
nurse practitioners for unethical and unprofessional conduct and violations
of this Act, or its rules and regulations and in connection therewith, issue
subpoena ad testificandum and subpoena duces tecum to secure the
appearance of respondents and witnesses and the production of
documents and punish with contempt persons obstructing, impeding
and/or otherwise interfeming with the conduct of such proceedings, upon
application with the court;

(f) Promulgate a Code of Ethics in coordination and consultation with the
accredited professional organization of nurses within one (1) year from the
effectivity of this Act;
(g) Recognize nursing specialty organizations in coordination with the
accredited professional organization; and
(h) Prescribe, adopt issue and promulgate guidelines, regulations,
measures and decisions as may be necessary for the improvements 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.

Section 10. Annual Report. - The Board shall at the close of its calendar year
submit an annual report to the President of the Philippines through the
Commission giving a detailed account of its proceedings and the
accomplishments during the year and making recommendations for the adoption
of measures that will upgrade and improve the conditions affecting the practice of
the nursing profession.

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;
and
(c) Unprofessional immoral or dishonorable conduct.

ARTICLE IV
Examination and Registration

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

Section 13. Qualifications for Admission to the Licensure Examination. - In order
to be admitted to the examination for nurses, an applicant must, at the time of
filing his/her application, establish to the satisfaction of the Board that:
(a) He/she is a citizen of the Philippines, or a citizen or subject of a
country which permits Filipino nurses to practice within its territorial limits
on the same basis as the subject or citizen of such country: Provided, That
the requirements for the registration or licensing of nurses in said country
are substantially the same as those prescribed in this Act;
(b) He/she is of good moral character; and
(c) He/she is a holder of a Bachelor's Degree in Nursing from a college or
university that complies with the standards of nursing education duly
recognized by the proper government agency.

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 subjects of examinations.

Section 15. Ratings. - In order to pass the examination, an examinee must obtain
a general average of at least seventy-five percent (785%) with a rating of not
below sixty percent (60%) in any subject. An examinee who obtains an average
rating of seventy-five percent (75%) or higher but gets a rating below sixty
percent (60%) in any subject must take the examination again but only in the
subject or subjects where he/she is rated below sixty percent (60%). In order to
pass the succeeding examination, an examinee must obtain a rating of at least
seventy-five percent (75%) in the subject or subjects repeated.

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

Section 17. Issuance of Certificate of Registration/Professional License and
Professional Identification Card. - A certificate of registration/professional license
as a nurse shall be issued to an applicant who passes the examination upon
payment of the prescribed fees. Every certificate of registration/professional
license shall show the full name of the registrant, the serial number, the signature
of the Chairperson of the Commission and of the Members of the Board, and the
official seal of the Commission.

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

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.

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 nurses 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
schools/colleges of nursing as exchange professors in a branch or
specialty of nursing;
Provided, however, That the special/temporary permit shall be effective only for
the duration of the project, medical mission or employment contract.
Section 22. Non-registration and Non-issuance of Certificates of
Registration/Professional License or Special/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 Certificate of Registration/Professional
License and Cancellation of Special/Temporary Permit. - The Board shall have
the power to revoke or suspend the certificate of registration/professional license
or cancel the special/temporary permit of a nurse upon any of the following
grounds:

(a) For 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;

(f) For violation of this Act, the rules and regulations, Code of Ethics for
nurses and technical standards for nursing practice, policies of the Board
and the Commission, or the conditions and limitations for the issuance of
the temporarily/special permit; or
(g) 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.

Section 24. Re-issuance of Revoked Certificates and Replacement of Lost
Certificates. - The Board may, after the expiration of a maximum of four (4) years
from the date of revocation of a certificate, for reasons of equity and justice and
when the cause for revocation has disappeared or has been cured and
corrected, upon proper application 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
has been lost, destroyed or mutilated may be issued, subject to the rules of the
Board.

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

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

Section 27. Qualifications of the Faculty. - A member of the faculty in a college of
nursing teaching professional courses must:
(a) Be a registered nurse in the Philippines;
(b) Have at least one (1) year of clinical practice in a field of specialization;
(c) Be a member of good standing in the accredited professional
organization of nurses; and
(d) Be a holder of a master's degree in nursing, education, or other allied
medical and health sciences conferred by a college or university duly
recognized by the Government of the Republic of the Philippines.
In addition to the aforementioned qualifications, the dean of a college must
have a master's degree in nursing. He/she must have at least five (5)
years of experience in nursing.

ARTICLE VI
Nursing Practice
Section 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, preschool,
school age, adolescence, adulthood, and old age. As independent practitioners,
nurses are primarily responsible for the promotion of health and prevention of
illness. A members of the health team, nurses shall collaborate with other health
care providers for the curative, preventive, and rehabilitative aspects of care,
restoration of health, alleviation of suffering, and when recovery is not possible,
towards a peaceful death. It shall be the duty of the nurse to:

(a) Provide nursing care through the utilization of the nursing process.
Nursing care includes, but not limited to, traditional and innovative
approaches, therapeutic use of self, executing health care techniques and
procedures, essential primary health care, comfort measures, health
teachings, and administration of written prescription for treatment,
therapies, oral topical and parenteral medications, internal examination
during labor in the absence of antenatal bleeding and delivery. In case of
suturing of perineal laceration, special training shall be provided according
to protocol established;
(b) establish linkages with community resources and coordination with the
health team;
(c) Provide health education to individuals, families and communities;
(d) Teach, guide and supervise students in nursing education programs
including the administration of nursing services in varied settings such as
hospitals and clinics; undertake consultation services; engage in such
activities that require the utilization of knowledge and decision-making
skills of a registered nurse; and
(e) Undertake nursing and health human resource development training
and research, which shall include, but not limited to, the development of
advance nursing practice;
Provided, That this section shall not apply to nursing students who perform
nursing functions under the direct supervision of a qualified faculty: Provided,
further, That in the practice of nursing in all settings, the nurse is duty-bound to
observe the Code of Ethics for nurses and uphold the standards of safe nursing
practice. The nurse is required to maintain competence by continual learning
through continuing professional education to be provided by the accredited
professional organization or any recognized professional nursing organization:
Provided, finally, That the program and activity for the continuing professional
education shall be submitted to and approved by the Board.

Section 29. Qualification 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 Bachelors of Science in Nursing, with at least
nine (9) units in management and administration courses at the graduate
level; and
(d) Be a member of good standing of the accredited professional
organization of nurses;
Provided, That a person occupying the position of chief nurse or director of
nursing service shall, in addition to the foregoing qualifications, possess:
(1) At least five (5) years of experience in a supervisory or managerial
position in nursing; and
(2) A master's degree major in nursing;
Provided, further, That for primary hospitals, the maximum academic
qualifications and experiences for a chief nurse shall be as specified in
subsections (a), (b), and (c) of this section: Provided, furthermore, That for chief
nurses in the public health nursing shall be given priority. Provided, even further,
That for chief nurses in military hospitals, priority shall be given to those who
have finished a master's degree in nursing and the completion of the General
Staff Course (GSC): Provided, finally, That those occupying such positions
before the effectivity of this Act shall be given a period of five (5) years within
which to qualify.

ARTICLE VII
Health Human Resources Production, Utilization and Development
Section 30. Studies for Nursing Manpower Needs, Production, Utilization and
Development. - The Board, in coordination with the accredited professional
organization and appropriate government or private agencies shall initiate
undertake and conduct studies on health human resources production, utilization
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
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 and continuous service.

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 salary grade 15 prescribes
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 the Philippine Charity Sweepstakes Office and the Philippine
Amusement and Gaming Corporation, which shall equally share in the costs and
shall be released to the Department of Health subject to accounting and auditing
procedures: Provided, That the department of Health shall set the criteria for the
availment of this program.

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. Prohibitions in the Practice of Nursing. - A fine of not less than Fifty
thousand pesos (P50,000.00) nor more than One hundred thousand pesos
(P100,000.00) or imprisonment of not less than one (1) year nor more than six
(6) years, or both, upon the discretion of the court, shall be imposed upon:
(a) any person practicing nursing in the Philippines within the meaning of
this Act:
(1) without a certificate of registration/professional license and
professional identification card or special temporary permit or
without having been declared exempt from examination in
accordance with the provision of this Act; or
(2) who uses as his/her own certificate 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 permits; or
(4) who gives any false evidence to the Board in order to obtain a
certificate of registration/professional license, a professional
identification card or special permit; or
(5) who falsely poses or advertises as a registered and licensed
nurse or uses any other means that tend to convey the impression
that he/she is a registered and licensed nurse; or
(6) who appends B.S.N./R.N. (Bachelor of Science in
Nursing/Registered Nurse) or any similar appendage to his/her
name without having been coferred said degree or registration; or
(7) who, as a registered and licensed nurse, abets or assists the
illegal practice of a person who is not lawfully qualified to practice
nursing.
(b) any person or the chief executive officer of a judicial entity who
undertakes in-service educational programs or who conducts review
classes for both local and foreign examination without permit/clearance
from the Board and the Commission; or
(c) any person or employer of nurses who violate the minimum base pay
of nurses and the incentives and benefits that should be accorded them as
specified in Sections 32 and 34; or
(d) any person or the chief executive officer of a juridical entity violating
any provision of this Act and its rules and regulations.

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 request of the Commission or the Board,
render assistance in enforcing the provisions of this Act and to prosecute any
persons violating the same.

Section 37. Appropriations. - The Chairperson of the Professional Regulation
Commission shall immediately include in its program and issue such rules and
regulations to implement the provisions of this Act, the funding of which shall be
included in the Annual General Appropriations Act.

Section 38. Rules and Regulations. - Within ninety (90) days after the effectivity
of this Act, the Board and the Commission, in coordination with the accredited
professional organization, the Department of Health, the Department of Budget
and Management and other concerned government agencies, shall formulate
such rules and regulations necessary to carry out the provisions of this Act. The
implementing rules and regulations shall be published in the Official Gazette or in
any newspaper of general circulation.

Section 39. Reparability Clause. - If any part 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 Gazette or in any two (2) newspapers of general
circulation in the Philippines.