FINALS - NCM 119 Lec

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FINALS: NCM 119 1

FINALS: NCM 119 Lec b. Eg. Introvert, lack of self-confidence, lack of trust
Prof. Trina Tan 3. Absence of controls that warn of impending difficulties
a. Eg. doesn’t want to have solutions to problems
DIRECTING 4. Aversion to taking a risk
● Issuance of assignments, orders, and instructions that permit a. “Ako nalang kasi baka may mangyari”
the worker to understand what is expected of him or her, and b. Eg - you do it yourself because you foresee a problem
the guidance and overseeing of the worker so that he or she Do Not Delegate:
can contribute effectively and efficiently to the attainment of ● Any part of NCP
organizational objectives ○ ADPIE
○ Supervision ○ Turning kasi you have to assess for sores
● DELEGATION– is the sharing of responsibility and ● Health teaching
accountability with subordinates and holding them ○ Because it is a product of a RNs knowledge and
accountable for their performance experience
○ ARA - Authority , Responsibility, and Accountability ● Activities that requires specialized skills, nursing judgment
○ NOTE: Directing should be aligned with the company ○ Collection of specimens can be delegated.
objective and job description ○ Assessment of pt is not delegated.
Reasons for Delegation Which task can be delegated to a nursing attendant?
1. Saves time and can help develop others a. Assessing a febrile pt
2. Maximize the use of the talents of staff associates b. Administration of insulin (needs nursing skill and judgment)
a. More than expected skills/ nursing skills c. Pulling out a catheter from a pt
i. Communication skills d. Monitoring of vs (assessment parin)
** Standardized/Routinary Activities can be delegated
ii. Computer skills
The following task can be delegated to a nursing attendant EXCEPT?
iii. Foreign language
a. Feeding a mentally retarded pt
3. Uses latent abilities in personnel that contribute to their
b. Pulling out a catheter from a pt
growth and development
c. Transferring a pt from bed to chair
a. Potentials d. Taking of VS
b. Long hidden abilities; rediscovering abilities ** Unstable, abnormal, critical - RN
Guidelines for Effective Delegation Stable , normal, noncritical - can be delegated
1. Give a clear description of what it is you want the employee to
do CONTROLLING
a. must be specific, clear and detailed ● Other term: EVALUATION
2. Share with the employee the outcome you expect and by when ● An on-going function of management which occurs during
3. Discuss the degree of responsibilities and authority that the planning, organizing, and directing activities.
employee will have ○ Anytime during the planning, organizing, and directing
4. Ask the employee to summarize the main points of the task activities you can evaluate.
● Includes assessing and regulating performance in accordance
that has been delegated
with the plans that have been adopted, the instructions issued,
Areas of Delegation and the principles established.
● Routine tasks ● Terms to take into mind:
○ Periodically ginagawa ○ Performance evaluation to performance appraisal.
○ Eg - staff nurse delegates tasks to nursing attendants (i.e, ○ Performance improvement
transporting of patient from bed to chair, turning the px) ; Purposes of Evaluation
➢ Provide constructive feedback
bed bath, morning care, offering bedpan, VS in ward– it
○ to correct to be able to develop the performance
depends on the px status (RN takes VS in ICU) ➢ Determine the progress and worthiness of individual nurse for
● Tasks for which you don’t have time greater responsibilities.
○ Meetings (depends) ➢ Serve as a basis for promotion and increase in salary or other
○ Eg - “bring this to this ward; send this to the laboratory; get similar rewards.
this from the pharmacy” *for promotion only 1-2 levels higher
● Problem solving Performance Appraisal
● Control process in which employee’s performance is evaluated
○ Can be delegated kase mas madaming insights na
against standards.
makukuha but always depends on the case/situation *checks for highest appraisal
● Change in your own job emphasis ● The most valuable tool in controlling human resources and
○ At the moment ang focus mo yung VS pero bigla nagkaron productivity.
ng arrest, pwede mo idelegate na yung VS sa iba since ● It reflects how well the nursing personnel have performed
ikaw need sa pag-revive during a specific period of time.
● Capability building ○ May parameters as basis: May Graduate degree ba?
Madami bang seminars na na-attend? CPE? Part of diff.
○ Look for a certain area to improve - if tingin mo may
committees? Member of diff associations? etc.
potential sya sa specific na gawain na yun, sya na pagawin Criteria For Evaluation (Academe Setting)
mo para maimprove 1. Doctorate - 40
Areas not to be Delegated 2. CPE - 50
1. The power to discipline 3. Activities (CPD - Continuing Professional Development) - 30
2. Responsibility for maintaining morale 4. Association/organization - 20
5. Creative works (books/manual) - 50
3. Overall control
6. Research - 50
4. The “hot potato” 7. Evaluation - 40
a. Hot issue that could affect the whole institution 8. Committee
Barriers to Delegation 9. Extra -
1. “I can do it better myself” 10. Student evaluation, Peer evaluation - 75
a. “Ako nalang kasi mas magaling ako sakanila” Rankings
2. Lack of ability to direct ● Instructor D
○ C
a. “Ako nalang kasi baka hindi sila sumunod”
○ B

BSN4 JJC-JS-HJE (22-23)


FINALS: NCM 119 2

○ A High Reliability Organizations (HRO)


● Asst Prof C ● Are organizations that perform well (minimal catastrophic
○ B error)
○ A ● High reliability - minimal to NO ERROR
● Associate Prof C ○ Airline industry - zero errors dapat; every 6 months ang
○ B evaluation via simulation
○ A ○ Healthcare industry - hanggang minimal errors lang
● Full Professor B dapat
○ A Health-Care Quality
***(lowest to highest rank) ● Degree to which health services for individuals and
Errors in Performance Evaluation populations increase the livelihood of desired health
1. Contrast - Rating the person opposite u see yourself outcomes and are consistent with current professional
2. Central tendency - pag naggrade 5 5 5 5 5 or 11111 hindi iba knowledge
iba, kasi centralized ● Workers must be updated by trainings
3. Halo - rating employee based on positive trait ● Defining HC quality is difficult
4. Horns - rating employee based on negative traits ● Measuring HC Quality is even more difficult
performance should always be based on standards (reference/ There should be Control Criteria or STANDARDS
quality) ● Vary from institution; In place
Criteria For Evaluation (Hospital Setting) ● Employee must be aware that performance will be measured
DATA (TOOLS): against the standards
1. Performance Evaluation Checklist (PEC) Standards: is a predetermined level of excellence that serves as a
2. Attendance in seminars and workshops guide for practice; must be objective, measurable and achievable
3. Anecdotal notes of the manager Characteristics of Standards:
4. Medical records (charts) - 1. Predetermined
5. Incident report 2. Established by an authority
● Who will evaluate the SNs? Supervisors. 3. Communicated and accepted by people affected by them
● Patient satisfaction is not a reliable parameter to Standards for Practice - define the scope and dimensions of
evaluate a performance of a nurse. Supervisor should be professional nursing
the one to evaluate, not the patient. ● Reference - R.A. 9173
● Supervisor also the one who checked the charts ○ An act providing for a more responsive nursing
● Performance evaluation is done at least every 2-3 years profession, repealing for the purpose republic Act No.
Purposes of Performance Appraisal 7164, otherwise known as "the Philippine Nursing Act of
1. Determine salary standard and merit increases 1991" and for other purposes.
2. Select qualified individuals for promotion or transfer Benchmarking - the process of measuring products, practices, and
a. transfer but increase in position = Promotion services against best performing organizations - as a tool for
b. transfer with same position = transfer identifying desired standards of organizational performance
c. not all transfers are a good thing, sometimes transfer is a - Titignan, lalampasan yung standards ng isang institution
silent killer, negative means yun, causing employees to - How you set yourself
resign on their own. Depende sa hospital policy, minsan - EX: post grad degree sa nrmf, kinompare muna postgrad
maganda ang transfer for employee development, minsan sa ibang school magkano tuition ganern. Benchmark sa
para mag-resign k na nang kusa
mga same institution hindi sa pipichugin.
3. Identify unsatisfactory employees for demotion or termination
a. pag nademote, same salary pa rin. EX: from dean to
faculty member
ACCOUNTABILITY
Leadership and Management in Professional Nursing Practice, Michael Aldridge
4. Make inventories of talents within the institution ● Accountability is foundational to professional nursing practice and is
a. talent - special skills
often referred to as the “hallmark of professionalism” (Oyetunde & Brown,
i. Ex: creative writing
2012). Being accountable can be described in a few ways.
5. Determine training and developmental needs of employees
● According to the American Nurses Association (ANA, 2015), nursing
a. create programs depends on deficiency of ur staff
based on PEC accountability requires nurses to be answerable for their actions and act
6. Improve the performance of work groups by examining, according to a code of ethical conduct.
improving, correcting interrelationships between members ○ Such ethical conduct includes abiding by the principles of
7. Improve communication between members, supervisors, and beneficence, respect for human dignity, veracity, fidelity, loyalty, and
employees and reach an understanding on the objectives of patient autonomy.
the job ● Leonenko and Drach‐Zahavy (2016) describe how professional
8. Establish standards of supervisory performance accountability impacts all aspects of patient care, such as activities of
9. Discover the aspirations of employees and reconcile these daily living, health promotion, patient teaching, counseling, and
with the goals of the institutions collaboration with the interprofessional team (provider, therapy, dietician,
*aspire - mas specific compare sa ambition etc.).
10. Provide employee recognition for accomplishments
○ While some education may not be provided by the nurse, such as
11. Inform employee where they stand
mobility exercises from physical therapy, it is the nurse’s
Management by Objectives: Is an excellent tool for determining an
individual employee’s progress because it incorporates both the responsibility to ensure all services and education are in place and
employee’s assessment and the organization. monitored throughout care.
Peer Review: Peers rather than supervisor carry out monitoring and ● Accountable nurses will focus on instilling the patient’s trust in not only
assessing work performance oneself, but the nursing profession as a whole
Quality Control ● Patients can earn the trust of the profession when they see team
● Refers to activities that are used to evaluate, monitor or cohesiveness, collaboration, and nurses working together towards a
regulate services rendered to consumers (patients, students) common goal (Leonenko & Drach‐Zahavy, 2016).
○ Quality standards - gagawin lahat ng institution para Accountability can be seen throughout all aspects of nursing practice, such
kayanin maachieve as:
○ There should be something or someone in place para ➢ Ensuring/providing safe, quality care
….. para ano be? ➢ Delegation
If nursing will strive for excellence ➢ Following (and questioning) policy and procedures
● QC criteria should be developed and pushed to optimum ➢ Practicing within the guidelines of the Nurse Practice Act
rather than minimum levels ➢ Maintaining confidentiality
● Process of QC must be on-going/continuous. ➢ Questioning standard of care, provider’s orders
● Effective QC requires managers with skill in LM ➢ Alignment of care to organizational practices, philosophy
➢ Competence in clinical skills

BSN4 JJC-JS-HJE (22-23)


FINALS: NCM 119 3

➢ Lifelong learning accountability to oneself, the patient/family, peers, the institution, and/or
➢ Patient advocacy (Battié, & Steelman, 2014) society are at risk. Familiarity with the NPA ensures accountability.
Accountability is a broad concept that is closely related to other concepts. It
will be important to understand the differences between the following Nurses should review their NPA regularly to check for updates, and most
concepts: importantly, when changing jobs or taking on a formal leadership role. Laws
● Accountability: within the NPA pertain to certain settings and roles.
○ Judgment and action on the part of the nurse
○ Answerable to self and others for judgments and actions (ANA, Foundational Documents
2015a) Standards of Professional Practice
Accountability is an essential element of nursing practice within the Scope and
● Responsibility:
Standards of Practice. Below are a few examples where accountability and
○ Accountability or liability associated with performance of a nursing
responsibility for nursing practice are illustrated throughout the Standards of
task associated with one’s role
Professional Performance.
○ Portion of the responsibility can be shared with others involved in
● Standard 7: Ethics
the situation (ANA, 2015a)
○ “Demonstrates professional accountability and responsibility for
● Answerability:
nursing” practice (ANA, 2015c, p. 67).
○ The requirement to offer answers, rationale, and explanations (ANA,
● Standard 10: Collaboration
2015)
○ “Clearly articulates the nurse’s role and responsibilities within the
● Authority:
team” (ANA, 2015c, p. 73).
○ The position to make a decision and influence others to act
● Standard 11: Leadership
● Autonomy:
○ “Retains accountability for delegated nursing care” (ANA, 2015c, p.
○ the authority to use professional knowledge and judgment to make
75).
decisions and take action (Skår, 2009)
● Standard 15: Professional Practice Evaluation
Accountability as a “… a willingness to answer for results and behavior” Cox ○ “Ensures that nursing practice is consistent with regulatory
and Beeson (2018) requirements pertaining to licensure, relevant statutes, rules, and
regulations” (ANA, 2015c, p. 81).
When nurses are accountable for their actions, they have made a promise to ○ “Uses organizational policies and procedures to guide professional
own that action, leading to learning lessons from making mistakes and
practice” (ANA, 2015c, p. 81).
successes. People don’t hold others accountable, it’s the individual’s job to be
accountable. ○ “Delegates in accordance with applicable legal and policy
parameters” (ANA, 2015c, p. 81).
In today’s healthcare settings, accountability in nursing practice revolves
around activities associated with providing quality care, including: Nursing’s Social Policy Statement
● Assessments (patients or otherwise, depending on setting/role) ● Nursing’s social responsibility, accountability and contribution to
● Interventions (nursing care) healthcare (ANA, 2015b)
● Health outcomes (reduced infection rates, falls) ● The nursing profession is entrusted with providing quality, ethical care to
● Costs (containment) society.
● The ANA is responsible for ensuring societies’ needs are met by
Transfer of accountability from one nurse to another is like a silent contract. articulating, maintaining, and strengthening the social contracts between
For example, in an acute care setting, when a nurse receives report from the the nursing profession and society.
outgoing nurse, there is a transfer of accountability from one person to
another. The oncoming nurse is responsible and answerable for the behaviors Code of Ethics
and outcomes of a group of 43 patients for the duration of the shift. Thus, ● The (ANA, 2015a) Code of Ethics sets forth the values and obligations of
anytime a nurse establishes a professional relationship with a patient the nurse.
(depending on role/setting), there is a binding agreement where the nurse is ● Provision 4 has a core focus on accountability and responsibility, stating,
legally bound (see Nurse Practice Act below) to implement care according to “The nurse has authority, accountability, and responsibility for nursing
the patient’s needs and wishes. practice; makes decisions; and takes action consistent with the
obligation to promote health and to provide optimal care” (ANA, 2015a, p.
State Boards of Nursing 59).
● As mentioned earlier, accountability within the nursing profession ● The nurse’s ethical obligation is to protect and be accountable to oneself,
ensures safe, quality care. In order to protect the public and to ensure and also to the general public.
optimum care, nursing practice is regulated by state agencies.
● The U.S. Boards of Nursing (BON) are jurisdictional governmental The following four interpretive statements from Provision 4 further illustrate
agencies that have been established by each state government with the the depth of accountability and responsibility in nursing practice:
mission to protect the public’s health by overseeing nursing practice ● 4.1 Authority, Accountability, and Responsibility
(National Council of State Boards of Nursing [NCSBN], 2020) ○ Accountable for one’s own practice, care ordered by a provider, care
● The NCSBN (2020) administers and coordinates services to all state coordination.
BONs. The NCSBN works with each state BON to ensure nursing ● 4.2 Accountability for Nursing Judgments, Decisions, and Actions
accountability through a number of organizational activities, including ○ Nurses must follow a code of ethical conduct.
standards for safe nursing practice, issuing licenses to practice nursing, ○ Follow the scope and standards of nursing practice.
license verification, monitoring licensees’ compliance to state BON laws, ● 4.3 Responsibility for Nursing Judgments, Decisions, and Action
and taking action against nurses who have exhibited unsafe nursing ○ The nurse is always accountable for judgments, decisions, and
practice (NCSBN, 2020). actions, though the employer may be jointly responsible depending
on the situation.
Nurse Practice Act ○ Nurses accept or reject an assignment based on education,
Individual states, or jurisdictions, have a law called the nurse practice act experience, competence, and risk for patient safety
(NPA), which is enforced by the BON in each state (NCSBN, 2020a). The NPA ● 4.4 Assignment and Delegation of Nursing Activities or Tasks
includes the following information: ○ Assignments and delegation activities must be consistent with the
● Qualifications for licensure Nurse Practice Act, organizational policy, and nursing standards of
● Nursing titles that can be used practice.
● Scope of practice (what the nurse is allowed to do) ○ Assess individual competence prior to assigning (ANA, 2015a, p.
● Actions that can or will occur if nurses do not follow the laws 59).

The scope of practice is in place to safeguard patient care and maximize


health outcomes. When nurses practice outside of their scope of practice,

BSN4 JJC-JS-HJE (22-23)


FINALS: NCM 119 4

● Shared accountability occurs when team members support each other,


BSN Essentials work together to ensure a safe working environment, and act as role
The BSN Essentials illustrate the outcomes for baccalaureate nursing models to demonstrate a culture of respect. If nurses need to speak up
education (AACN, 2008). Note that the BSN Essentials will soon be updated about a concern, they need to do so in a constructive, considerate way.
from the 2008 version. Accountability and responsibility are a major ● Communication with team members should be provided consistently, in a
component of the nine essentials, see below for more information: way that does not cause embarrassment or anger. When team members
● Assumptions of a Baccalaureate Generalist Nurse consistently share feedback with each other it reinforces the desire for a
○ Assume accountability for one’s own and delegated nursing care supportive, cohesive team.
● Roles for the Baccalaureate Generalist Nurse ● The goal is to create an environment where suggestions for change are
○ The use of the term “professional” implies the formation of a expected and become the norm. Establishing a culture of trust, respect,
professional identity and accountability for one’s professional image and support leads to a healthy work environment and quality safe patient
● Essential II: Basic Organizational and Systems Leadership for Quality care (Battié, & Steelman, 2014).
Care and Patient Safety
○ Apply leadership concepts, skills, and decision making in the Accountability to the Employer
provision of high quality nursing care, healthcare team 46 ● Nurses are accountable to their employers by following their rules and
coordination, and the oversight and accountability for care delivery regulations and fulfilling their job duties.
in a variety of settings ● Since nurses must be accountable with the laws set forth in the NPA, they
● Essential VI: Interprofessional Communication and Collaboration for need to verify organization policies do not conflict with NPA regulations.
Improving Patient Health Outcomes Nurses risk violating regulations if they do not review the NPA regularly.
○ Individual accountability/shared accountability ● Nurses are also responsible, and held accountable, for monitoring
● Essential VIII: Professionalism and Professional Values unlicensed personnel. Nurses can improve accountability to their
○ Professionalism involves accountability for oneself and nursing employer by taking an active role in organization-wide committees
practice, including continuous professional engagement and focused on improving the delivery of care.
lifelong learning
● Essential IX: Baccalaureate Generalist Nursing Practice Accountability to the Patient
○ Demonstrate clinical judgment and accountability for patient ● Patients have the right to safe, quality care. Nurses are held accountable
outcomes when delegating to and supervising other members of to their patient by fulfilling their obligations set for in the Scope and
the healthcare team (AACN, 2008). Standards of Practice and the Code of Ethics.
● As previously stated, these two foundational documents illustrate the
TYPES OF ACCOUNTABILITY requirement of all registered nurses to provide exemplary care to
Nurses are accountable for their actions to themselves, their peers, employer, individuals in need of healthcare.
healthcare consumers, society, and the nursing profession (ANA, 2015c). ● Nurses can also be accountable to their patients by educating them
about the Hospital Compare website. All hospitals are now required to
Accountability to Self post health outcomes and other measures at the Hospital Compare
● Nurses must be accountable to themselves, otherwise they risk website so patients can make choices about where to receive care.
accountability to their peers and their patients. ● The following is a brief list of the outcomes found in the Hospital
● Nurses work very long hours, often working well past a 12-hour shift to Compare website:
complete care, documentation, and report to the oncoming nurse. A ○ Timely and effective care
nurse may resent having to work a 13- or 14-hour shift, especially when ○ Healthcare associated infections (HAI)
compensation may not cover the extra time on the unit. ○ Adverse effects (i.e. mortality rates)
● Miller (2012) explains the importance of strengthening personal ○ Patient satisfaction/experiences
accountability in situations where a nurse may begin complaining or
blaming others about the long hours or other issues that are beyond the The quality measures available from the Hospital Compare website
nurse’s control. Personal accountability begins with looking inward, rather (https://www.medicare.gov/hospitalcompare/search.html) provides the
than pointing fingers. Miller (2012) suggests asking oneself two healthcare system and nurses important data that helps them be more
important questions: competitive with other healthcare systems, thus, further improving quality care.
○ What can I do? ● Nurses need to be aware their patients often enter the healthcare system
○ How can I help? with increased knowledge of healthcare in general and awareness of the
● Instead of just complaining to the manager about the long shift or a organization’s level of quality care. Patients may have a sense of what to
different problem, nurses need to offer their assistance on how to find a expect from nurses when they begin receiving care, and nurses must be
resolution and offer their help with 47 carrying out the solution. Part of prepared to work with patients in a collaborative way. Like any other
resolving problems is being part of the solution. business, healthcare organizations and their employees must be
● Nurses who refuse to complain, and instead choose to find solutions, accountable to their patients and their needs.
become empowered. Choosing to be positive, and part of the solution, ● Since the healthcare system has moved towards a proactive, preventive
leads to improving one’s personal accountability. care approach, nurses need to provide patients with the education and
● As previously mentioned, working long hours in a stressful environment tools to promote health and well- being in order to prevent illness and
requires nurses to have adequate physical stamina and emotional disease.
stability. Fatigue, minor illnesses, and a stressful personal life can ● As nurses develop relationships with their patients, it will be important to
negatively impact professional practice. Working extra shifts in addition understand their distinct needs and how they relate to health promotion
to a very busy life can also hamper practice. Maintaining a healthy activities.
lifestyle, including adequate sleep, diet, and exercise, and having a ● For example, determining any barriers and motivating factors will be
balanced work-personal life, is essential for one’s personal accountability. important for nurses to include in their collaborative efforts with patients.
● Working in an unsafe practice setting is another example where nurses ● When nurses create a plan that is patient-centered, and focused on
need to be accountable to themselves. Some examples include working current evidence to offer safe, quality care, nurses are taking the right
in an unfamiliar setting or having a high-acuity/high patient load steps to being accountable to their patients.
assignment. Nurses need to view refusal to work in an unsafe setting as Accountability to Society
a way to protect the public, and to be personally accountable. Be sure to ● One of the characteristics of a profession is service to society.
follow organizational policies on how to refuse and/or make a statement Consumers have the right to receive safe, quality care, and nurses are
about working in an unsafe environment. held accountable to meet the healthcare needs of society.
● To meet these needs and requirements, nurses are obligated to stay
Accountability to Peers abreast of current literature, attain continuing education, maintain skill
● Also known as shared accountability competencies, and more.

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FINALS: NCM 119 5

● Through the NPA and the ANA’s Nursing’s Social Policy Statement, nurses only when nurses have demonstrated sufficient competence and
are legally held accountable to provide professional nursing care that confidence with the skill.
meets the required scopes and standards of practice. ● When nurses are answerable for their knowledge, skills, and actions, their
Accountability to the Nursing Profession level of respect and nursing autonomy grows. The general public needs
● Just as nurses are advocates for their patients, they must also be strong nurses to be competent; therefore, when nurses demonstrate their
advocates for the nursing profession. strengths by providing competent care, they maintain the trust and
● Through participation in professional nursing organizations, nurses need respect of their patients including the healthcare system as a whole.
to promote safe, quality nursing care, improved nursing autonomy, ● As described earlier, autonomy is centered around nurses making
nurses’ rights, and more. Nurses need to support professional independent decisions about care based on their knowledge, judgment,
organizations as a way to be accountable to the nursing profession and experience.
(Battié, & Steelman, 2014). ● Autonomy is related to accountability because nurses who make
● Nurses can demonstrate their accountability by the following activities: independent decisions, or any decision for that matter, are accountable
○ Participate in organization-sponsored conferences and activities for their actions. Autonomous decisions are made to ensure appropriate
○ Stay current with recommended practices within one’s specialty care, maintain high quality care, and satisfy the patient or healthcare
○ Political advocacy consumer.
○ Vote for candidates who support the profession’s mission (Battié, & Shared Governance
Steelman, 2014) - is an organizational model defined as “... a structure within the process of
● Nurses play an important role in shaping the nursing profession through practicing professional nursing that results in favorable nurse, patient,
formulating its own policies and laws. Nurses work collaboratively to and organizational outcomes” (Church, Baker, & Berry, 2008, p. 36).
formulate the profession’s scope, standards of care, licensing, entry into - The two main assumptions of shared governance models are:
practice, and more. 1) redistribute decision-making power from managers to staff [nurses],
● Provision 3 in the ANA (2015a) Code of Ethics states, “The nurse and
promotes, advocates for, and protects the rights, health, and safety of the 2) nurses have the interest in being part of the decision-making process
patient” (p. 41). (Anthony, 2004).
● Interpretive statement 3.5 explains how nurses must act on questionable Golanowski, Beaudry, Kurz, Laffey, and Hook (2007) explains shared
practice. Nurses must be alert to all instances of incompetent, unethical, governance as a decision-making model containing four major concepts:
illegal, or impaired practice by another member of the healthcare team, ● Accountability: the foundational concept, includes authority (power to
which includes issues that occur within the entire healthcare system. make decisions), autonomy (right to make independent decisions), and
● Nurses must take action to resolve such issues in order to protect the control (ability to act)
healthcare consumer from injustice or injury. ● Equity: measure of all team members contributions to the outcome
● The Code of Ethics directs nurses not only to recognize questionable ● Partnership: relationships among the team members with a focus on the
practice due to impairment, such as substance abuse, but nurses are also outcome
obligated with assisting each other with obtaining treatment. Weber ● Ownership: invested in the organization, able to articulate personal
(2017) states substance and alcohol abuse is a significant issue for the contribution to the outcome
nursing profession. Chemically addicted nurses and other healthcare Shared governance can transform nurses’ personal practice and benefit
workers pose a danger to themselves, patients, team members, and the healthcare organizations in many ways, including:
organization. ● Empowerment of practice (Hess, 2004)
● Manthey (2018) discusses how nurses are at an increased risk for ● Improved nurse satisfaction (Church et al., 2008; Golanowski et al., 2007)
addiction due to working in highly stressful environments, easy access to ● Improved patient satisfaction scores (Church et al., 2008)
highly addictive substances, and a “conspiracy of silence” that prevents ● Reduced mortality and healthcare-acquired infection rates (Church et al.,
treatment. Thomas and Siela (2011) states at least 1 in 10 nurses will 2008)
develop a substance abuse disorder, similar to the general public. ● Reduced nurse turnover and vacancy rates (Church et al., 2008)
● Nurses must be acutely aware of the high risk of addiction to alcohol and ● Improved staff morale (Golanowski et al., 2007)
illegal substances for oneself. When nurses observe impaired practice or ● Improved staff member participation (Golanowski et al., 2007)
unsafe patient care from a coworker and believe wrongdoing has ● Personal and professional development (Golanowski et al., 2007)
occurred (such as drug-diverting), nurses must be prepared to report this Improved levels of morale, job satisfaction, and empowerment leads nurses to
unethical behavior. Reporting such behaviors to authorities is known as being happier, and more fulfilled in their daily work. Patients can sense when
whistleblowing. their caregivers (nurses and staff members) exhibit more cheerful and
● Whistleblowing is defined as “the disclosure by organisation members contented behaviors, which may translate to feelings of being cared for, and
(former or current) of illegal, immoral or illegitimate practices under the having a satisfied patient experience.
control of their employers, to persons or organizations that may be able
In order for a shared governance model to bring about positive outcomes, both
to effect action” (Near & Miceli, 1985, p. 4).
nurses and managers need to buy into the idea that nurses need to have a
● Protecting patients from harm is one of the guiding principles of the
voice in decisions that impact their practice, and the delivery of healthcare.
nursing profession. Nurses owe it to themselves, and their patients to
Delegation
ensure be alert to impaired practice and reporting such behaviors.
● Delegation is defined as, “The transfer of responsibility for the
● In order to ensure the nursing profession continues to be known as an
performance of a task from one individual to another while retaining
honorable and noble profession, nurses need to support and mentor their
accountability for the outcome” (ANA, 2015c, p. 86).
peers throughout one’s career.
● The ANA and NCSBN (2019) created the Joint Statement on Delegation in
Nursing Judgment and Action
order to support and guide nurses on how to use delegation safely and
● Nurses practice and act within a learned code of ethics they implicitly
effectively. These organizations share the following definition and
follow when making judgments about care. Nurses practice by the
meanings about delegation:
principle of fidelity (being faithful, honest), respect for dignity, work, and
● The process for a nurse to direct another person to perform nursing tasks
patient autonomy when taking action.
and activities. The nurse retains the accountability for the delegated task
● Nurses are accountable for judgments made about care. When nurses
(ANA & NCSBN, 2019, para 3). The two organizations further delineate:
assume accountability and responsibility for their patients, they fulfill
○ NCSBN: nurse transfers authority
their commitment to practice with compassion and respect for patients.
○ ANA: nurse transfer of responsibility
● The ANA (2010a) states, “The moral standard of the profession is one to
● Nurses often work in chaotic healthcare environments, have a large
which nurses must hold themselves and their peers in order to be held
patient load, a high acuity assignment with complex patient needs, with
accountable in for their practice” (p. 46).
an added emphasis on patient satisfaction.
● Nurses must either reject or accept role demands based on one’s level of
● These are just a few factors that leave nurses no choice but to delegate
education, knowledge, competence, and experience.
tasks to other members of the healthcare team. Delegation frees up
● Nurses must assess their own competencies and seek out necessary
education, consultation, and collaboration. Tasks should be performed

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FINALS: NCM 119 6

nurses’ valuable time so nurses can attend to more complex patient care
MANAGING HUMAN RESOURCES
tasks.
Performance Appraisal
● Delegation is an essential skill of professional nursing practice, and when
● Employees generally want their managers to tell them three things: what
done correctly, can result in safe and effective nursing care (ANA, 2019).
they should be doing, how well they’re doing it, and how they can improve
● Delegation is an expectation and responsibility of nursing practice as
their performance.
identified in the ANA Standards of Professional Performance, Standard
● Good managers address these issues on an ongoing basis.
15, Resource Utilization: “Delegates elements of care to appropriate
● On a semiannual or annual basis, they also conduct formal performance
healthcare workers in accordance with any applicable legal or policy
appraisals to discuss and evaluate employees’ work performance.
parameters or principles” (ANA, 2015c, p. 81).
The Basic Three-Step Process
In order to delegate, nurses must consider the following:
Appraisal systems vary both by organization and by the level of the employee
● Nurses’ legal authority to practice
being evaluated, but as you can see in Figure 12.8, it’s generally a three-step
● Context of their practice
process:
● Nurse Practice Act regulations
1. Before managers can measure performance, they must set goals and
● Professional standards
performance expectations and specify the criteria (such as quality of
● Employer’s policies and procedures on delegation (ANA, 2019)
work, quantity of work, dependability, initiative) that they’ll use to measure
Creating a Culture of Accountability
performance.
● It is essential to view accountability as a process of supporting others
2. At the end of a specified time period, managers complete written
who want to be accountable for the work they accomplish.
evaluations that rate employee performance according to the
● Nurses in leadership positions, whether formal (i.e. nurse manager) or
predetermined criteria.
informal (i.e. charge or staff nurse), should reflect on their thoughts about
3. Managers then meet with each employee to discuss the evaluation.
accountability in order to get a full understanding of one’s thoughts on
Jointly, they suggest ways in which the employee can improve
the topic.
performance, which might include further training and development.
● Reflection is an important first step because leaders set the tone for the
work setting and understanding oneself better can impact thinking and
actions for the future (Cox & Beeson, 2018). Some questions to consider
include:
○ Do you set a tone of learning from mistakes or do you focus on
punishing?
○ Do you focus on blaming others or fix the system?
○ Are you the first or last to admit your own mistakes? (Cox & Beeson,
2018) It sounds fairly simple, but why do so many managers report that, except for
Cox and Beeson (2018) explains the three major components of firing people, giving performance appraisals is their least favorite task? To get
accountability: some perspective on this question, we’ll look at performance appraisals from
● Clear expectations: clearly explain the expectations by answering the 4- both sides, explaining the benefits and identifying potential problems with some
Ws and the 1-H, such as: of the most common practices.
○ What needs to be done? Among other benefits, formal appraisals provide the following:
○ Why is this important? ● An opportunity for managers and employees to discuss an employee’s
○ When does it need to be completed? performance and to set future goals and performance expectations.
○ Who else will I be working with on the project? ● A chance to identify and discuss appropriate training and
○ How do I begin? career-development opportunities for an employee.
● Follow-through: connect with staff to offer motivation or inspiration to ● Formal documentation of the evaluation that can be used for salary,
carry out the task or project: promotion, demotion, or dismissal purposes
○ Mentoring As for disadvantages, most stem from the fact that appraisals are often used
○ Coaching to determine salaries for the upcoming year. Consequently, meetings to
○ Guiding discuss performance tend to take on an entirely different dimension: the
○ Feedback manager may appear judgmental (rather than supportive), and the employee
○ Encouragement may get defensive.
○ Support This adversarial atmosphere can make many managers not only
● Rewards or consequences uncomfortable with the task but also less likely to give honest feedback. (They
○ Reward: A pat on the back when the task is complete. Be sincere may give higher marks in order to avoid delving into critical evaluations.)
and timely HR professionals disagree about whether performance appraisals should be
○ Consequence: be firm and compassionate linked to pay increases. Some experts argue that the connection eliminates the
Summary of How to Enhance Accountability manager’s opportunity to use the appraisal to improve an employee’s
● Clear and open communication performance. Others maintain that it increases employee satisfaction with the
● Skill competency process and distributes raises on the basis of effort and results.
● Advanced education 360-Degree and Upward Feedback
● Collaboration with peers, managers Instead of being evaluated by one person, how would you like to be evaluated by
● Clear expectations several people—not only those above you in the organization but those below
● Participate in professional organization opportunities and beside you?
● Support peers, mentor new nurses, offer guidance ● The approach is called 360-degree feedback, and the purpose is to
● Read the NPA regularly, especially when changing roles/settings ensure that employees (mostly managers) get feedback from all
● Delegate directions—from supervisors, reporting subordinates, coworkers, and
● Ask yourself, “What can I do? and “How can I help?” even customers.
● Maintain a healthy lifestyle; physically, emotionally, spiritually ● If it’s conducted correctly, this technique furnishes managers with a range
● Choose to be positive, find a solution of insights into their performance in a number of roles.
● Participate in organization-wide committees ● Some experts, however, regard the 360-degree approach as too
● Be compassionate, listen cumbersome. An alternative technique, called upward feedback, requires
● Organize a shared governance model for your unit/organization only the manager’s subordinates to provide feedback.
● Compare employer’s policies/processes to NPA ● Computer maker Dell uses this approach as part of its
manager-development plan.
● Every year, 40,000 Dell employees complete a survey in which they rate
their supervisors on a number of dimensions, such as practicing ethical

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business principles and providing support in balancing work and personal ● Failing to be clear about what’s expected of subordinates
life. Dell uses survey results for development purposes only, not as direct ● Showing favoritism in compensation, rewards, or promotions
input into decisions on pay increases or promotions. Holding managers accountable for excessive turnover can help alleviate the
Retaining Valuable Employees “bad-boss” problem, at least in the long run.
● When a valued employee quits, the loss to the employer can be serious. In any case, whenever an employee quits, it’s a good idea for someone—other
Not only will the firm incur substantial costs to recruit and train a than the individual’s immediate supervisor—to conduct an exit interview to find
replacement, but it also may suffer temporary declines in productivity and out why.
lower morale among remaining employees who have to take on heavier Knowing why people are quitting gives an organization the opportunity to
workloads. correct problems that are causing high turnover rates.
● Given the negative impact of turnover—the permanent separation of an Involuntary Termination
employee from a company—most organizations do whatever they can to ● Some companies employ a process called Forced Ranking to manage out
retain qualified employees. Compensation plays a key role in this effort: their under-performers. In this approach, only a certain percentage of
companies that don’t offer competitive compensation packages tend to employees can receive a particular performance evaluation score, which
lose employees. forces some employees to the bottom of the distribution—sort of the
● Other factors also come into play, such as training and development, as opposite of a curved exam score.
well as helping employees achieve a satisfying work/non-work balance. ● The employee pool in question is typically made up of those who do
In the following sections, we’ll look at a few other strategies for reducing similar kinds of work. Ideally after being given some amount of time to
turnover and increasing productivity. improve, those who remain at the bottom of the performance distribution
Creating a Positive Work Environment are then separated from the company. As you can imagine, this practice
● Employees who are happy at work are more productive, provide better has caused a fair amount of controversy!
customer service, and are more likely to stay with the company. ● Before we leave this section, we should say a word or two about
● A study conducted by Sears, for instance, found a positive relationship termination— getting fired. Though turnover—voluntary separations—can
between customer satisfaction and employee attitudes on ten different create problems for employers, they’re not nearly as devastating as the
issues: a 5 percent improvement in employee attitudes results in a 1.3 effects of involuntary termination on employees. Losing your job is what
percent increase in customer satisfaction and a 0.5 percent increase in psychologists call a “significant life change,” and it’s high on the list of
revenue. “stressful life events” regardless of the circumstances.
Employee-Friendly Workplace ● Sometimes, employers lay off workers because revenues are down and
● What sort of things improve employee attitudes? The 12,000 employees they must resort to downsizing—to cutting costs by eliminating jobs.
of software maker SAS Institute fall into the category of “happy workers.” Sometimes a particular job is being phased out, and sometimes an
They choose the furniture and equipment in their offices, eat subsidized employee has simply failed to meet performance requirements.
meals at one of three on- site restaurants, and enjoy other amenities like Employment at Will
a 77,000 square-foot fitness center. Is it possible for you to get fired even if you’re doing a good job and there’s no
● They also have job security: no one’s ever been laid off because of an economic justification for your being laid off? In some cases, yes—especially if
economic downturn. The employee-friendly work environment helps SAS you’re not working under a contract.
employees focus on their jobs and contribute to the attainment of ● Without a formal contract, you’re considered to be employed at will, which
company goals. Not surprisingly, it also results in very low 3 percent means that both you and your employer have the right to terminate the
turnover. employment relationship at any time. You can quit whenever you want,
Recognizing Employee Contributions but your employer can also fire you whenever they want.
● Thanking people for work done well is a powerful motivator. ● Fortunately for employees, over the past several decades, the courts have
● People who feel appreciated are more likely to stay with a company than made several decisions that created exceptions to the employment-at-will
those who don’t. doctrine.
● While a personal thank-you is always helpful, many companies also have ● Since managers generally prefer to avoid the expense of fighting wrongful
formal programs for identifying and rewarding good performers. discharge claims in court, many no longer fire employees at will.
● The Container Store rewards employee accomplishments in a variety of ● A good practice in managing terminations is to maintain written
ways. documentation so that employers can demonstrate just cause when
● For example, employees with 20 years of service are given a “dream terminating an employee.
trip”—one employee went on a seven day Hawaiian cruise. ● If it’s a case of poor performance, the employee would be warned in
● The company is known for its supportive environment and in 2016 advance that his or her current level of performance could result in
celebrated its seventeenth year on Fortune’s 100 Best Companies to Work termination and then be permitted an opportunity to improve
For performance.
Involving Employees in Decision Making ● When termination is necessary, communication should be handled in a
- Companies have found that involving employees in decisions saves private conversation, with the manager explaining precisely why the
money, makes workers feel better about their jobs, and reduces turnover. action is being taken.
- Some have found that it pays to take their advice. When General Motors
asked workers for ideas on improving manufacturing operations,
management was deluged with more than 44,000 suggestions during one RA 9173
quarter. AN ACT PROVIDING FOR A MORE RESPONSIVE NURSING PROFESSION,
- Implementing a few of them cut production time on certain vehicles by 15 REPEALING FOR THE PURPOSE REPUBLIC ACT NO. 7164, OTHERWISE KNOWN
percent and resulted in sizable savings. AS "THE PHILIPPINE NURSING ACT OF 1991" AND FOR OTHER PURPOSES
- Similarly, in 2001, Edward Jones, a personal investment company, faced a *** 9 important points
difficult situation during the stock-market downturn. Costs had to be cut, ARTICLE 1: Title
and laying off employees was one option. Instead, however, the company SECTION 1 - Title
turned to its workforce for solutions. As a group, employees identified “Philippine Nursing Act of 2002”
cost savings of more than $38 million. At the same time, the company ***RA 7164 - 1991 - hindi na ginagamit
convinced experienced employees to stay with it by assuring them that ARTICLE 2: DECLARATION OF POLICY
they’d have a role in managing it. SECTION 2 - Declaration Policy
Why People Quit Protection and improvement of:
As important as such initiatives can be, one bad boss can spoil everything. The - Nursing education
way a person is treated by his or her boss may be the primary factor in - Working conditions
determining whether an employee stays or goes. People who have quit their - Better career prospects
jobs cite the following behavior by superiors: - Dignified existence
● Making unreasonable work demands - Appropriate nurse patient ratio
● Refusing to value their opinions

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ARTICLE 3: ORGANIZATION OF THE BOARD OF NURSING 2. Ad interim appointment


SECTION 3 - Creation and Composition of the Board a. When one is appointed to serve only for an unexpired period of term
Regulate nursing profession of a regular appointee .
- BON or the board b. If a regular appointee vacates his , the vacancy will be filled for
- Appointing officials unexpired term portion only
Per Vacant Position: c. Continuing the unexpired term
● pNa - PNA: nominates (3) 3. Hold over appointment
○ nominates 21 most qualified members a. When period of term is about to lapse, expire, or end and the
○ By Accredited professional officer appointee is requested to stay in power until another appointee is
● pRc - PRC: recommends (2 out of 3 nominees) filled.
○ recommends 14 b. In other words, standby lng pala amputa
● pAngulo - PRESIDENT: will appoint from the two recommendees c. Remaining as a BON until a new member is appointed
○ 7 appoint BONs SECTION 7 - Compensation of the Board
○ Merit - Credentials ● The Chairperson and Members of the Board shall receive compensation
○ Fit to work/fitness and allowances comparable to the compensation and allowances
○ Integrity received by the Chairperson and members of other professional
Composition of BON: regulatory boards.
- 1 Chairperson SECTION 8 - Administrative Supervision of the Board, Custodian of its
- 6 Members Records, Secretariat and Support Services
**BOARDS QS: How many persons compose the BON? – 7 ● The Board shall be under the administrative supervision of the
SECTION 4 - Qualifications of the BON Commission. All records of the Board, including applications for
1.Natural born Filipino citizen and resident of the philippines examinations, administrative and other investigative cases conducted by
a. Natural born the Board shall be under the custody of the PRC.
- Filipino citizens who didn’t apply to any act to acquire his ● The Commission shall designate the Secretary of the Board and shall
citizenship. provide the secretariat and other support services to implement the
- Filipino citizen by blood provisions of this Act.
- Jus Sanguinis - both parents are Filipinos (used in PH) ***BON - under prc
- Jus Soli - citizenship is determined by place of birth (used in US) SECTION 9 - Powers and Duties of the Board.
b. Naturalized 1. Conduct the NLE
- Needs citizenship; denouncement of nationality to acquire another a. Board exam - BoN
citizen b. Dates, Venues - PRC
***Can a person change his citizenship from time to time? - YES (Political term) 2. Issue, suspend or revoke licenses
***Can a person change his nationality from time to time? NO (Ethnic term) a. Due process needed before trials and punishments
2. RN with a Master’s Degree 3. Conduct hearing and investigations to resolve complaints against nurses
- RN+MAN a. Quasi-judicial power
- RN+MAEd i. Functioning like a court, but independent court
- RN+ MA OF ANY ALLIED HEALTH PROFESSION ii. Malpractice, negligence
***Majority of the BON must be RN, MAN (majority=more than half of the grp) iii. Quasi: Almost, Partly, Seemingly
***At least four of the BON must have a master’s degree 4. Prescribe, promulgate and enforce a Code of Ethics, practice guidelines,
● Chairperson must be RN, MAN regulations, and measures and decisions for the improvements of the
● Members must represent 3 areas of nursing nursing practice
○ Nursing Education, Nursing Service, & Community Health Nursing a. Quasi-legislative power
3. Member of Philippine Nurses Association b. Executive power - BoN enforces the code of ethics and other
RA: 9173 - accredited professional organization guidelines or regulations
● Nurses must renew their Memberships annually or every 3 years 5. Monitor and enforce quality standards of nursing practice
4. At least 10 years of continuous practice (last 5 years in PH) a. Core Competency Standards – used as unifying frameworks of
5. Never convicted of any offense involving moral turpitude nursing practice and education; use as performance of evaluation
- Crimes of baseness, vileness, or depravity tools
- Any act contrary to the law 6. Ensure quality nursing education
➢ Abduction with consent, Bigamy, Concubinage, Smuggling, Rape, - By examining the prescribed facilities of universities or colleges of
Estafa / falsification of document, Bribery, Profiteering, Robbery , nursing or departments of nursing education and those seeking
Murder, Illicit sexual relationship with fellow worker permission to open nursing courses to ensure that standards of nursing
SECTION 5 - Requirements Upon Appointment as a BoN education are properly complied with and maintained at all times
Immediately resign from any: - BON cannot close any nursing schools, recommend lng
● Teaching position (any BSN, review programs - Power to open or close a nursing school→ CHED
● Any employment (government/private sectors) - taking advantage of their 7. Recognize nursing specialty organizations
positions ● Critical Care Nurses Association of the Philippines (CCNAPI)
They shall not have: ● Gerontology Nurses Association of the Philippines (GNAP)
- Monetary / financial interest ● Military Nurses Association of the Philippines (MNAP)
- Connection / administrative position in any college of nursing or any ● Operating Room Nurses Association of the Philippines (ORNAP)
review program ● Mother and Child Nurses Association of the Philippines (MCNAP)
- Cannot set up their own review centers ● Renal Nurses Association of the Philippines (RENAP)
- Cannot publish their own books ● Philippine Oncology Nurses Association (PONA)
- Unfair advantage against their competitors ● Psychiatric-Mental Health Nurses Association of the Philippines, Inc.
SECTION 6 - Term of Office (PMHNAP)
1 term = 3 years SECTION 10. Annual Report
- Can be reappointed for another term Submit an annual report to the President of the Philippines through the
- Oath taking to the President of the Philippines Commission giving a detailed account of its proceedings and the
3 kinds of Appointment accomplishments during the year
1. Regular appointment SECTION 11 - Removal or Suspension of Board Members
a. For 3 years to serve sa BoN = 1 term ● Commission or toleration of irregularities in the licensure examination
○ Eg: Leakage of exam
● Unprofessional immoral, unprofessional, or dishonorable conduct.

BSN4 JJC-JS-HJE (22-23)


FINALS: NCM 119 9

● Continued neglect of duty or incompetence; declared by the court to be of unsound mind shall be registered and be issued a
ARTICLE IV: EXAMINATION AND REGISTRATION certificate of registration/professional license or a special/temporary permit.
SECTION 12 - Philippine Nurse Licensure Examination SECTION 23 - Suspension and Revocation of License
● BSN grad must pass PNLE to work Grounds
● BON conducts the NLE 1. The causes for non issuance in section 22
● PRC - scheduling, venues 2. Unprofessional and unethical conduct
● RA 8981 - a. Acts that are unbecoming of a professional
PRC MODERNIZATION ACT OF 200: Computerization of all board exams i. Work related
Qualifications for PNLE admission ii. Not work related
1. Filipino Citizen 3. Gross incompetence or serious ignorance
a. Natural born or naturalized 4. Malpractice or negligence
b. Foreign citizens, but only if the country you came from with a. Malpractice
reciprocity treaty - Going beyond the scope of nursing
2. BSN degree - Doing the procedure a wrong way
a. Transcript of record b. Negligence
b. RLE requirements - Failing to perform duties of a nurse.
c. All documents must be genuine - Res Ipsa Loquitor - liable ang isang tao sa ginawa nya
3. Having good moral character - Respondeat superior - employers are held reliable because
Note: There is no age requirement to take the exam, but must be 18 to acquire employees must be properly selected by the employer
the license - RA 6809 5. Fraud, deceit, false statements in obtaining the license
SECTION 14 - SCOPE OF PNLE 6. Violation of the Code of Ethics for nurses
1. 7. Practicing while the license is suspended
2. 11 key areas of responsibility SECTION 24 - Re-Issuance of Revoked Certificates and Replacement of Lost
3. Fundamentals Certificates
4. Maternal and child 1. Lost or destroyed
5. CHN a. A new license may be reissued upon payment
6. Medical and Surgical Nursing 2. Suspended
7. Mental Health and Psychiatric Nursing a. No need to reapply.
500 items (NP1-5; 100 items each) b. Can resume practice after suspension period (Max 4 years)
SECTION 15 - Ratings 3. Revoked
Passing score: a. Can be reapplied provided that 4 years have lapsed upon proper
★ General Average: 75% application and the payment of the required fees
★ No grade <60% in any subject b. Cause is corrected or has disappeared
An examinee who obtains an average rating of seventy-five percent (75%) or ARTICLE V: NURSING EDUCATION
higher but gets a rating below sixty percent (60%) in any subject must take the SECTION 25 - Nursing Education Program.
examination again but only in the subject or subjects where he/she is rated The learning experiences shall adhere strictly to specific requirements embodied
below sixty percent (60%). In order to pass the succeeding examination, an in the prescribed curriculum as promulgated by the Commission on Higher
examinee must obtain a rating of at least seventy-five percent (75%) in the Education's policies and standards of nursing education.
subject or subjects repeated. SECTION 26 - Requirement for Inactive Nurses Returning to Practice.
***RECOUNT IS NOT ALLOWED Nurses who have not actively practiced the profession for five (5) consecutive
***RETAKE IS UNLIMITED (RA 9173) years are required to undergo one (1) month of didactic training and three (3)
- (old) RA 7164: 3 Retakes– NEED REFRESHER months of practicum
***NO ROUNDING OFF SECTION 27 - Qualifications of the Faculty
***RETAKE ALL SUBJECTS IF FAILED TO PASS THE FIRST RETAKE OF EXAM ● Be a registered nurse in the Philippines;
SECTION 16 - Oath ● Have at least one (1) year of clinical practice in a field of specialization
All successful candidates in the examination shall be required to take an oath of ● Be a member of good standing in the accredited professional organization
profession before the Board or any government official authorized to administer of nurses;
oaths prior to entering upon the nursing practice. ● Be a holder of a master's degree in nursing, education, or other allied
1. PRC Official medical and health sciences conferred by a college or university duly
2. Mayor recognized by the Government of the Republic of the Philippines.
3. Ambassador ***In addition to the aforementioned qualifications, the dean of a college must
4. President have a master's degree in nursing. He/she must have at least five (5) years of
SECTION 17 - Issuance of PRC License experience in nursing.
- After paying fees and being under oath, the nurse can now receive the PRC ARTICLE VI: NURSING PRACTICE
license card; Permission to practice SECTION 28 - Scope of Nursing
- Validity period is 3 years and is renewable during the birth month of the A person shall be deemed to be practicing nursing within the meaning of this
professional Act when he/she singly or in collaboration with another, initiates and performs
- Jurisdictional nursing services to individuals, families and communities in any health care
SECTION 18 - Fees for Examination and Registration. setting.
SECTION 19 - Automatic Registration of Passers It includes, but not limited to, nursing care during conception, labor, delivery,
- Ipso Facto RN infancy, childhood, toddler, preschool, school age, adolescence, adulthood, and
- Based on the fact that nakalagay yung name sa passers old age.
SECTION 20 - Registration by rRciprocity As independent practitioners, nurses are primarily responsible for the
- Bilateral agreement for nurses between PH and other countries promotion of health and prevention of illness.
- Reciprocity (Reciprocus) - Give and take agreements A member of the health team, nurses shall collaborate with other health care
- Do Ut Des - “I give thay may also give” providers for the curative, preventive, and rehabilitative aspects of care,
SECTION 21 - Practice through special/temporary permit restoration of health, alleviation of suffering, and when recovery is not possible,
1. Internationally well-known specialists / outstanding experts towards a peaceful death.
2. Foreign nurses on a free medical mission It shall be the duty of the nurse to:
3. Exchange professors ➢ Provide nursing care through the utilization of the nursing process.
SECTION 22 - Non-Registration and Non-issuance of Certificates ➢ Establish linkages with community resources and coordination with the
No person convicted by final judgment of any criminal offense involving moral health team;
turpitude or any person guilty of immoral or dishonorable conduct or any person ➢ Provide health education to individuals, families and communities

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FINALS: NCM 119 10

➢ Teach, guide and supervise students in nursing education programs 2. Who uses as his/her own certificate of registration/professional license
including the administration of nursing services in varied settings and professional identification card or special temporary permit of another;
➢ Undertake nursing and health human resource development training and 3. Who uses an invalid certificate of registration/professional license, a
research, which shall include, but not limited to, the development of a suspended or revoked certificate of registration/professional license, or an
advanced nursing practice expired or canceled special/temporary permits;
SECTION 29 - Qualification of Nursing Service Administrators 4. Who gives any false evidence to the Board in order to obtain a certificate of
A person occupying supervisory or managerial positions requiring knowledge of registration/professional license, a professional identification card or
nursing must: special permit;
1. Be a registered nurse in the Philippines; 5. Who falsely poses or advertises as a registered and licensed nurse or uses
2. Have at least two (2) years experience in general nursing service any other means that tend to convey the impression that he/she is a
administration; registered and licensed nurse;
3. Possess a degree of Bachelors of Science in Nursing, with at least nine (9) 6. Who appends B.S.N./R.N. (Bachelor of Science in Nursing/Registered
units in management and administration courses at the graduate level; and Nurse) or any similar appendage to his/her name without having been
4. Be a member of good standing of the accredited professional organization coferred said degree or registration;
of nurses 7. A registered and licensed nurse, abets or assists the illegal practice of a
Provided, That a person occupying the position of chief nurse or director of person who is not lawfully qualified to practice nursing.
nursing service shall, in addition to the foregoing qualifications, possess: Any person or the chief executive officer of a judicial entity who undertakes
1. At least five (5) years of experience in a supervisory or managerial position in-service educational programs or who conducts review classes for both local
in nursing; and foreign examination without permit/clearance from the Board and the
2. A master's degree major in nursing; Commission;
ARTICLE VII: HEALTH HUMAN RESOURCES PRODUCTION, UTILIZATION AND Any person or employer of nurses who violate the minimum base pay of
DEVELOPMENT nurses and the incentives and benefits that should be accorded them as
SECTION 30 - Studies for Nursing Manpower Needs, Production, Utilization specified in Sections 32 and 34;
and Development Any person or the chief executive officer of a juridical entity violating any
The Board, in coordination with the accredited professional provision of this Act and its rules and regulations.
organization and appropriate government or private agencies shall initiate, ARTICLE IX: FINAL PROVISIONS
undertake and conduct studies on health human resources production, Section 36. Enforcement of this Act.
utilization and development. Section 37. Appropriations
SECTION 31 - Comprehensive Nursing Specialty Program Section 38. Rules and Regulations.
The Board in coordination with the accredited professional Section 39. Reparability Clause
organization recognized specialty organizations and the Department of Health is Section 40. Repealing Clause
hereby mandated to formulate and develop a comprehensive nursing specialty Section 41. Effectivity.
program that would upgrade the level of skill and competence of specialty nurse *** This Act, which originated in the House of Representative was finally passed
clinicians in the country, such as but not limited to the areas of critical care, by the House of Representatives and the Senate on October 15, 2002 and
oncology, renal and such other areas as may be determined by the Board. The October 8, 2003 respectively.
beneficiaries of this program are obliged to serve in any Philippine hospital for a *** Approved: October 21, 2002 by GLORIA MACAPAGAL-ARROYO
period of at least two (2) years and continuous service.
SECTION 32 - Salary
In order to enhance the general welfare, commitment to service and
ETHICO-MORAL AND LEGAL ASPECTS OF
professionalism of nurses the minimum base pay of nurses working in the NURSING
public health institutions shall not be lower than salary grade 15 prescribes Ethics
under Republic Act No. 6758, otherwise known as the "Compensation and
● Principles of standard, dictated upon the society
Classification Act of 1989": Provided, That for nurses working in local
● Would come out if there will be a DILEMMA.
government units, adjustments to their salaries shall be in accordance with
○ In ethics, mapa-mali ka o tama ka, ikaw responsable sa
Section 10 of the said law.
magiging desisyon mo.
SECTION 33 - Funding for the Comprehensive Nursing Specialty Program ○ In law naman, pag mali ka. Kulong ka.
The annual financial requirement needed to train at least ten percent ● Concerned with the study of social morality and philosophical
(10%) of the nursing staff of the participating government hospital shall be
reflection on its norms and practices.
chargeable against the income of the Philippine Charity Sweepstakes Office and
○ Answer the question: What should I do in this situation?
the Philippine Amusement and Gaming Corporation, which shall equally share in
● Method of inquiry about the rightness or wrongness of human
the costs and shall be released to the Department of Health subject to
accounting and auditing procedures: Provided, That the department of Health
actions; the practices or beliefs of a group; and the standards
shall set the criteria for the availment of this program. of moral behaviors described in the group’s formal code of
SECTION 34 - Incentives and Benefits ethics.
The Board of Nursing, in coordination with the Department of Health ○ Nothing is considered right or wrong
and other concerned government agencies, association of hospitals and the ○ Standards/ principle of proper conduct
○ Dictated by the society (depende kung san nagmula)
accredited professional organization shall establish an incentive and benefit
system in the form of free hospital care for nurses and their dependents,
Nursing Ethics - branch of moral science which treats of the duties
scholarship grants and other non-cash benefits. The government and private of a member of the nursing profession towards her co-professional
hospitals are hereby mandated to maintain the standard nurse-patient ratio set nurses, to her profession & other professions, to her co-worker &
by the Department of Health. other members of the health team, to her clients & to the public in
- Kasama talaga sa incentives general.
ARTICLE VIII: PENAL AND MISCELLANEOUS PROVISIONS ● Pwede ba mag refuse ang nurse kahit nasa US ka to not assist
SECTION 35 - Prohibitions in the Practice of Nursing in abortion?
A fine of not less than P50,000.00 nor more than P100,000.00 or imprisonment ○ Yes. You just have to tell your supervisor na “it is
of not less than 1 year nor more than 6 years, or both, upon the discretion of the because of my spiritual/religious beliefs.”
court, shall be imposed upon: ○ Once you do not know what to do, consult with the
Any person practicing nursing in the Philippines within the meaning of this Act: code of nursing ethics.
1. Without a certificate of registration/professional license and professional “Code of Nursing Ethics” - deals with fourfold responsibility of
identification card or special temporary permit or without having been
nurses; nursing universality; the scopes of services rendered by the
declared exempt from examination in accordance with the provision of this
nurses; their responsibilities to the people, to their practice, to
Act;
society, to their co-workers, and to the profession.
● Expected behavior of nurses

BSN4 JJC-JS-HJE (22-23)


FINALS: NCM 119 11

● Fifth fold na daw now and with respect, they should be willing to do the same to
● Ano bang gagawin ko dito? others too.
○ Reference is the code of ethics. ○ Basic/Simple; Applicable to all person and situations
Morality - private, personal standard of what is right and wrong. 2. The Two-Fold Effect - when a nurse is faced with situation
Moral Issues - those which are essential, basic or important and which may have both good and bad effects, the basis of
deal with important social values or norms; action may be the following:
● Respect for life ○ That action must be morally good
● Freedom and love ○ The the good effect must be willed and the bad effect
● Issues that provoke the conscience as guilt, shame, merely allowed
self-esteem, courage or hope ○ That the good effect must not come from evil action but
Moral Philosophy - philosophical discussion of what is considered from the initial action itself directly.
good or bad, right or wrong, in terms of moral issues. ○ That the good effect must be greater that the bad effect
Bioethics - ethics as applied to “life situations “ (e.g. decisions i. Eg. High-risk pregnant mother, who will you choose
to save?
about euthanasia, prolonging life, abortion)
■ Just let it flow, try to save both of them.
Code of Ethics for Nurses in the Philippines
■ Dun sa event na need mo na pinili, hindi ikaw
● Prior to 1984 - The Code of Ethics used by Filipino nurses -
magdedecide.
code promulgated by the ICN (International Council of Nuses)
- An action comes with a good and bad effect but you do
● 1982 - the PNA special committee, under Dean Emeriturus
not use evil action to have a good effect
Julita V. Sotejo developed a Code of Ethics for Filipino nurses.
- Help nurses to JUSTIFY THE DECISIONS
This was approved by the House of Delegates of the PNA but
Examples:
was not implemented
➢ It is not morally good if a boy steals in order to alleviate his
● 1984 - The BON, PRC adopted the Code of ethics of ICN,
hunger because the action itself is already bad
through Board Resolution No. 633 adding “promotion of
➢ If the patient who has a cancer of the uterus submits to
spiritual environment’ as the fifth-fold responsibility of the
hysterectomy she will not be able to bear a child. If she does
nurse. This was enforced up to 1989.
not have the operation, she will die. It is the gynecologist’s
● 1989 - the code of ethics promulgated by the PNA was
intention to help the mother and not to harm her. The surgeon’s
approved by the PRC and through Board resolution No. 1955
action is morally good since having the mother’s life is primary
was recommended for use. This was approved by the general
importance. Also the doctor himself did not will that the patient
assembly of the Philippine Nurses Association during the
lose her child-bearing function.
Nurses Week convention on October 25, 1990.
3. Epikia - “exception to the general rule.”
Amended Code of Ethics for Nurses:
Examples:
Pursuant to Section 3 of Republic Act No. 877, known as the
➢ If a mental patient went berserk and the doctor could not be
Philippine Nursing Law, and Section 6 of P.D. No. 223.
contacted, the patient may be restrained by virtue of EPIKIA.
Foreword: Health is a fundamental right of every individual. The
➢ Allowing a relative to see a seriously ill patient who expresses
nurses’ primary responsibility is to preserve health at all cost. This
the desire to see the former although it is not yet visiting hours.
responsibility encompasses promotion of health, prevention of
○ Pagbibigyan, kasi justifiable naman.
illness, alleviation of suffering and restoration of health.
○ Abortion is not ethically correct.
This is old (no. 877 - 1950 pa ito)
4. One who acts through an agent is himself responsible
Nurses and People: Values, customs, and spiritual beliefs held by
Example: A patient wants to have an abortion and asks a nurse if
individuals are to be respected
she can do it. The nurse refuses, but recommends a doctor who is
- Primer ito ng code of ethics ng nurses
capable of performing. The nurse is liable to such crime, since he /
- Ang inaallow lang is values and beliefs
she is an accomplice of the said doctor.
- You can say “NO” if you’re given a task
5. No one is obliged to betray himself / herself
Nurses and Practice: Nurses are accountable for their own nursing
Example: In testifying before the court, no one can force any person
practice. They are responsible for their personal and professional
to answer a question if such will incriminate him / her.
growth and development.
6. The end does not justify the means
Nurses and Co-workers: Nurses maintain collaborative working
Example: Giving sleeping tablet to a chronically ill person so she/he
relationships with their co-workers and other members of the health
can die in peace is morally wrong
team. They recognize their capabilities and limitations, and those of
7. Defects of nature may be corrected
their co-workers in accepting, or when delegating responsibilities to
Example: Patient with a Harelip or cleft palate may have their defects
the team members. [[know your limits]]
corrected by plastic surgery.
Nurses and Society: Nurses are contributing members of society.
8. A little more or less does not change the substance of an act
They assume responsibilities inherent in being memes and citizens
Example: a patient subjects himself/herself willingly to an
of the community / society in which they live / work.
experimental drug and she / he has been told of the possible effects
Is it mandatory to be a member of PNA? Expected lang.,, oo
of the same, is of right safe, and is sane, there is no violation of
Sanctions
human rights.
● A nurse who is found, after due process, to have violated any
9. A little more or less does not change the substance of an act.
provision of this Code of Ethics, shall be guilty of
Example: if a nurse gets medicine from the hospital stock without
unprofessional and unethical conduct and shall suffer the
permission or without prescription, he/she will be guilty of theft even
sanction of censure or reprimand, suspension or revocation of
if he/ she got only one tablet of same.
her/his certificate of registration.
10. The greatest good for the greatest number
○ RA 9173
Example: During an epidemic, immunization against communicable
○ Grounds for revocation ng license
disease is administered to the people. If there may be some who
Moral Principles
may have slight reactions to the vaccine, the greater majority of the
When a nurse is confronted with situations where moral judgment is
population shall be considered rather than the isolated few.
necessary, the nurse may be guided by the following principles or
11. No one is held to the impossible
rules:
Example: To promise that a patient with heart transplant will live may
1. The Golden Rule - “Do unto others what you would like others
be impossible. Yet, such procedures are done in the hope of saving
to do unto you.” Since nurses like others to treat them kindly

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FINALS: NCM 119 12

or prolonging a patient's life. The doctor or the nurse cannot be held ■ Abortion - expulsion of fetus so early that is has not
to the impossible if they have done their best to take care of the yet acquired the power of sustaining independent
patient and the latter dies. life
● 20 weeks of viability - there is a case na
12. The morality of cooperation - Formal cooperation in an evil
nagbebeat na yung puso during this time
act is never allowed. Immortal operations such as abortion ● Age of viability in law= 28 weeks/7mo.
shall not be participated upon by a nurse even if the doctor ● Before: Born before 28 weeks (7 mons) but di
commands it. nabuhay- no rights, no death cert, still not
13. Principle relating to the origin and destruction of life - One of considered as a human being
God’s commandments is “Thou shall not kill.” ● Born before 28 weeks (7 mons) pero nabuhay/
survived within 24 hrs- may rights, may death
LEGAL LIABILITIES OF NURSING cert, considered human being
LAW ● ***In punto de vista- 7 mons is the age of
○ Are rules and regulations established by a governing authority viability
(sovereign power) to institute and maintain orderly ● ***20-28 weeks
coexistence by commanding what is right and prohibiting ■ Simulation of birth - substituting one child to
what is wrong another, falsification of birth favoring adoption
○ Above everything, may supreme law pa rin ● Napag-palit yung baby
Functions of Law in the Society ● Not paying attention and observing the
● Define relationships among members of a society and state; standards
which activities are permissible or not ● Causing losing of a person’s civil status.
● Describe what forces may be applied to maintain rules and by ■ Rape - Forcible penetration of organ of copulation or
when is to be applied. any inainimate object to any body orifice of the
● Provide solutions to problems offended party.
● Refien relationship between person and group when ● As nurses, we need to identify during our
conditions of life change. practice.
■ Child molestation - engaging in any sexual act with
Types of Law
a person under age 18
Law govern the relationship of private individuals with government.
Public Law
UNINTENTIONAL TORT
● Refers to the body of law that deals with relationship between Negligence
individual and the government and the governmental - The commission (ginawa) or omission (hindi ginawa) of an act,
agencies. pursuant to a duty, that a reasonably prudent person (hindi
● An important segment of public law is criminal law which gagawin ng maingat na nurse) in the same or similar
deals with actions against the safety and welfare of the public. circumstance would not do, and acting or the non-acting of
Examples are homicide, manslaughter and theft which is the proximate cause of injury (direct cause of injury) to
Private law or Civil law another person or his property.
● Is the body of law that deals with relationship among private - If a person charged with negligence shows that she meets or
individuals. It can be categorized into a variety of legal even surpasses this standard then there is no negligence or
specialties such as contract law and tort law. carelessness. But if the defendant (nurse)’s actions fail to meet
● Pay damages - compensatory or monetary the standard, then there has been negligence.
● Without imprisonment The Elements of Professional Negligence
○ Not all civil case has corresponding to criminal law ● Existence of a duty on the part of the person charged to use
since walang kulong due care under circumstances
● Cases: ● Failure to meet the standard of due care.
○ Contract law ○ You fail to raise the side rails
Example: rent sa dorm tas alis eh may kontrata indi ● The foreseeability of harm resulting from failure to meet the
mo na makukuha yung advance payment ata bayad standard, and
na yun sa damages mo ○ Nahulog ang pasyente tas nahulog
○ Tort - any wrongdoing ● The fact that the breach of this standard resulted in an injury
■ Intentional to the plaintiff.
● Assault & Battery ○ Ipapatahi mo yung ulo, maeextend stay sa hospital all
● Defamation of character [Slander (oral) and of the expenses will be paid by u
Libel (written)] Common Acts of Negligence
● Invasion of privacy ● Burns resulting from hot water bags, heat lamps, vaporizers,
● Illegal detention/false imprisonment sitz bath
Anti-illegal detention (PH) ● Objects left inside the patient’s body such as sponges, suction
■ Unintentional tips, loose denture lodged in the patient’s trachea
● Negligence & Malpractice ○ Res ipsa loquitur
○ Negligence: Naoverdose mo yung px ● Falls of the elderly, confused, unconscious, sedated patients,
○ Criminal / Felony: kapag namatay si px or those who are not fully recovered from anesthesia
dahil sa negligence ● Falls of children whose side rails of beds were not pulled up
Criminal and locked
● Have corresponding liability to civil law ● Failure to observe and take appropriate action as needed.
● Crime against the state ● Failure to report observations to attending physicians
● With imprisonment and damages ○ A nurse failed to report to the doctor that the toes of a
● Cases: patient with leg cast were cyanotic and cold to touch.
○ Felony - acts or omissions punishable by law not only The leg became gangrenous and had to be amputated
committed by means of deceit but also by fault. below the knee
■ Murder - Killing of another person other than ● Failure to exercise the degree of diligence which the
relative with proven malice or premeditation circumstances of the particular case demands
■ Homicide - killing of any human creature. It is not ○ A community health nurse who attended the delivery of
necessarily a crime, committed without criminal a patient who had no prenatal care. The baby was born
intent and without criminal consequence. spontaneously but the placenta was not expelled after
■ Parricide - killing of father, mother or child, whether 30 minutes. She advised that the mother be brought to
legitimate or illegitimate, or any of his ascendants the hospital. The patient died. The nurse was found
or descendants including the spouse. guilty of negligence.
● Killing of your siblings wil be under homicide or ● Mistaken identity.
murder depending on intent. - Example: drugs given to the wrong person especially if
■ Infanticide - killing a child less than 3 days of age the latter is confused or unconscious and could not
respond to the nurse's verification of identity.
BSN4 JJC-JS-HJE (22-23)
FINALS: NCM 119 13

● Wrong medicine, wrong concentration, wrong route, wrong ● That the plaintiff or complainant (patient, nagsampa ng case)
dosage. himself did not engage in any manner which would tend to
● Defects in the equipment such as stretchers and wheelchairs bring about the injury
may lead to falls thus inquiring the patient - There should be an act of negligence
○ Always assess and check tas refer mo kung may mali. Examples:
● Errors due to family assistance ● The hospital will be held liable, if, in an effort to cut down
- Example: A nurse asked a relative to apply HWB to the on expenses it decides to hire underboard nurses or
body of a chilling child and the latter suffered burns. midwives in place of professional nurses, and these
The nurse would be held liable for failure to test the persons prove to be incompetent.
temperature of the water and/ or for failure to check ● The surgeon will be held responsible in case a laparotomy
whether the mother knew what was expected of her pack is left in a patient’s abdomen.
during such assistance ● Private duty nurses are considered independent
● Administration of medicine without doctor’s prescription. contractors. They are liable for their own negligent
- Example: Injecting Penstrep to a boy who had swollen actions.
foot. The nurse informed the parents that she was not a 2. Res Ipsa Loquitur
doctor. Upon insistence of the parents to have their ➢ “The things speaks for itself”
child treated, she informed them that the doctor usually ➢ When a thing which has caused an injury is shown to be
gave Penstreo injections in such cases. She injected the under the management of the party charged with
medicine without a doctor’s prescription. The boy died negligence, the accident is as such as in the ordinary
of cardiorespiratory failure secondary to anaphylactic course of thing will not happen if those who have such
shock due to the injection of the drug. The nurse was management used proper care, the accident itself affords.
found guilty as charged. The reasonable evidence in the absences of an
- Example: A patient came in walking to the OPD for explanation by the parties charge that is those from the
injection. Upon administering the injection to his want of proper care.
buttocks, the patient experienced extreme pain. His leg 3 Elements of Res Ipsa Loquitur:
felt weak and he was subsequently paralyzed. a. The event would have not occurred if the nurse exercised prudent
● The presence of sponges in the patient’s abdomen after an care.
operation i. Observed proper protocol
● Fracture of newly-delivered baby born by breech presentation b. The accident occurred within the exclusive control of the nurse
○ Malpractice c. No voluntary action as done by the injured party
■ Violating the Midwifery Law (midwife lang ang 3. Doctrine of Force Majeure (Pwersa mayor/ acts of god)
pwede mag-paanak) ➢ An irresistible force or superior force; one that is
MALPRACTICE unforeseen or inevitable. Under the Civil Code of the
● Professional negligence. Philippines, no person shall be responsible for those
● Failure to meet the standards of acceptable care which results events which cannot be foreseen, or which, though
in harm to other people. foreseen, are inevitable, except in cases expressly
● Negligence that occurred while the person was performing as specified by law.
a professional ➢ Floods, fire, earthquake, and accidents: nurses who fail to
● Improper or unskillful care of a patient by a nurse. render service during these circumstances are not held
● Stepping beyond one’s authority with serious consequences. negligent
● Negligence or carelessness of professional personnel. ➢ Habitual tardiness due to heavy traffic is not considered an
● Standard of care decides what a prudent person would do excuse for force majeure.
under similar circumstances. INCOMPETENCE
● Nasa SCOPE NG NURSING PRACTICE (stepping beyond your ● Lack of ability, legal qualifications, or fitness to discharge the
scope) required duty.
Elements of Negligence and Malpractice ● Although a nurse is registered, if in the performance of her
1. Duty duty she manifests incompetency, there is ground for
2. Breach of duty revocation or suspension of her certificate of registration.
3. Foreseeability and causation NURSES AND LEGAL OFFENSES
4. Harm or injury Crimes
5. Damages ● actions/behaviors which violate law and is punishable by fine,
NEGLIGENCE VS. MALPRACTICE imprisonment or death
● Malpractice: can only be accused of professionals. ● Criminal offenses are composed of two elements:
● Negligence: can be accused to non-professionals ○ Criminal act
Examples: ○ Evil/Criminal intent
- Labandera nalagyan ng colorx yung paborito mong damit. Criminal Intent
Negligence ito pero hindi ito malpractice dahil hindi siya ● Is the state of mind of a person at the time the criminal act is
professional. committed, that is, he/she knows that an act is not lawful and
- Yung driver na dumaan sa zigzag tapos nahulog sa bangin. still decided to do it anyway.
Negligence ito pero hindi ito malpractice. Deliberate intent includes two other elements without which there
● Professional means graduate from 4 year course with license can be no crime:
A graduate from a 4 years nursing course is called a nurse but ● Freedom: “coercion”
not a professional nurse. ● Intelligence: “wala sa tamang pagiisip”
Doctrines Applicable to Negligence Suits ○ When a person accused of the crime offers evidence
1. Doctrine of Respondeat Superior showing insanity, necessity, compulsion, accident or
➢ “Let the master answer for the acts of the subordinate.” infancy the court will decide if he did not commit a
(master of nurse: hospital) The liability is expanded to criminal offense and will declare the person not guilty
include the master as well as the employee. Classifications of Criminal Negligence:
➢ Therefore, when a person, through his negligence, injuries 1. Reckless Imprudence - when a person does an act or fails to
another, he remains fully responsible. This doctrine applies do it voluntarily but without malice, from which material
only to those actions performed by the employee within damage results immediately. very fatal result
the scope of his employment. 2. Simple Imprudence - means that the person or nurse did not
➢ Master - employer of the employee. For nurses, the use precaution and the damage was not immediate or the
hospital is the master of the nurse. impending danger was not evident or manifest. hindi nagcause
Three conditions required to establish a defendant’s negligence Criminal Liablities can be Classified According to:
without proving specific conduct:
ng lives
a. Manner of Commision
● That the injury was of such nature that it would not normally
i. Dolo: Deceit, deliberate intent
occur unless there was a negligent act on the part of someone
ii. Culpa: Fault; product of imprudence, negligence, lack of
● That the injury was caused by an agency within the control of
the defendant (nurse, sinampahan ng kaso) foresight and skills

BSN4 JJC-JS-HJE (22-23)


FINALS: NCM 119 14

b. Degree of Participation A. When he /she acts in defense of his / her person or rights
i. Principals: Those who take a direct part in the provided that:
execution of the act; who directly force or induced ● There is an unlawful aggression on the part of the
others to commit it; or who cooperate in the offended or injured party.
commission of the offense by another act without wc it ● There is reasonable necessity for the means employed
would not have been accomplished. by the person defending himself / herself to prevent
1. Inducement - mastermind such aggression; and
a. Ex. Bf na inutusan magpa-abort gf niya ● There is lack of sufficient provocation on the part of the
2. Direct participation - ikaw; abortionist and yung person defending himself.
nagpa-abort ○ Pauwi na tas need tumawid sa overpass, tas may
3. Indispensable cooperation - nagsupport sa plan nakita kang hinoholdap, tas tumulong ka at napatay
a. Ex. Hinawakan ng friend yung person sa mo
dalawang arms para masaksak ○ Self defense - love one, friend even stranger
ii. Accomplices: Those persons who cooperate in the ○ Ang nag self defense → makakaharm =gain
execution of the offense. To hold the person liable as an aggression
accomplice, it must be shown that he had knowledge of B. When he / she acts in defense of the person or the rights of
the criminal intention of the principal. PROFIT his / her spouse, ascendants, or legitimate or natural or
NAGTAGO NG CRIMINAL,EVIDENCE
1. Nagrefer NAGASSIST SA PAGESCAPE adopted brothers and sisters, or relative by affinity to the same
2. Co-Principal → present during the crime degree.
iii. Accessories: Those who, having knowledge of the C. When he / she acts in defense of the person or right of a
commission of the crime, either as principals or stranger.
accomplices, take part subsequent to its commission D. When any person who, in order to avoid an evil or injury, does
by profiting themselves or assisting the offender to an act which causes damage to another provided that the evil
profit from the effects of the crime by concealing or sought to be avoided actually exists, the injury feared is
destroying the body of the crime, or the effects or greater than that done to avoid it and there is no other
instruments thereof, in order to prevent its discovery or practical and less harmful means to prevent it.
by harboring, concealing, or assisting in the escape of a. Naitulak at napatay just for self defense
the principal of the crime, provided the accessories act E. When he / she acts in the fulfillment of a duty or in lawful
with abuse of their public functions or are known to be exercise of a right or office.
habitually guilty of some other crimes. 2. Exempting Circumstances - The following persons are expressly
Classification of Felony according to execution: exempted by law from criminal liability for the crime they may have
Stage of Execution committed:
● Consummated ● An Imbecile or an insane person, unless the latter has acted
○ When all elements are necessary for its execution and during lucid (mentally sound) interval;
accomplishment are present. ● A person under nine (15) years of age;
○ Binaril kita ○ Kiko Pangilinan created The Juvenile Justice and
● Frustated Welfare Act is a child protection measure. Children in
○ When the offender performs all the acts or execution conflict with the law and children at risk are victims of
which will produce it. circumstances beyond their control. They are victims of
○ Binaril kita pero di kita napatay abuse, of dysfunctional families and insensitive
● Attempted communities.
○ There is an attempt to commit a felony when the offender ● Any person who, while performing a lawful act with due care,
commences the commission of the same directly by overt causes an injury which is merely an accident without fault or
(open or manifest) acts, and does not perform all the acts intention of causing it;
or execution which shall produce the felony, by reason of ● Any person who acts under the compulsion of an irresistible
some cause or accident other than his own spontaneous force
desistance. ● Any person who acts under the impulse of an uncontrollable
○ Binaril kita pero di ka tinamaan fear of an equal or greater injury
Types of Crimes According to Severity ○ Crimes of passion
a. Felony: committed with deceit and fault. ○ Under acts of emotion
● A deceit exists when the act is performed with deliberate ● Any person who fails to perform an act required by law, when
intent and there is fault when the wrongful acts result from prevented by some lawful or insuperable cause.
imprudence, negligence, or lack of skill or foresight. 3. Mitigating Circumstances - are those which do not constitute
● a serious crime that carries significant fines and jail justification or excuse of the offense in question, but which, in
sentences. E.g. murder, arson, burglary, rape, extortion, fairness and mercy, may be considered as extenuating or reducing
kidnapping the degree of moral culpability.
Example of Felonies Committed by Nurses: ● Circumstances which are otherwise justifying or exempting
● Unauthorized removal of life support from a terminally ill were it not for the fact that all requisites necessary to justify
patient (First degree murder) the act or to exempt the offender from criminal liability in the
● Unintentional death brought by administration of a medication respective cases are not attendant.
to which the patient is allergic (Second degree murder) ● When the commit has no offender has as grave а wrong
b. Misdemeanor: a criminal offense which does not in law amount to intention as the one committed.
felony. Punishment is usually a fine Or imprisonment for a term of ● When the offender is under eighteen years of age or over
less than one year seventy years old.
Example: Assault and Battery like giving injection without consent; ● When sufficient provocation or threat on the other part of the
Jaywalking offended party immediately precedes the act.
Circumstances Affecting Criminal Liability ● When the act is committed in the immediate vindication of a
1. Justifying Circumstances - A person may not incur criminal grave offense to the one committing a felony, his / her spouse,
liability under the following circumstances:

BSN4 JJC-JS-HJE (22-23)


FINALS: NCM 119 15

ascendants, descendants, natural or adopted brothers or Sources of Law


sisters, or relative ● Constitution
○ Mitigating: Tatay na sumugod dahil nagsumbong ang ○ Supreme law of the Philippines
anak ○ Bill of Person’s Right
● When the person acts upon an impulse so powerful as ○ Mga ginawa mo, dito titignan (kung ilang years
naturally to have produced an obfuscation (confusion). makukulong)
● When the offender voluntarily surrenders himself to a person ● Legislative Law
in authority or his agents, or that he / she voluntarily ○ Law makers
confesses his / her guilt before the court prior to the ○ Nandun sa Congress & Senate
presentation of the evidence for the prosecution. ○ Statutory law (May mga RA, republic acts)
● When the defender is deaf and dumb, blind or otherwise ● Common Law
suffering from some physical defect which thus restricts his / ○ Galing sa courts / different courts
her means of action, defense or communication with his / her ○ Depends on the Judges
fellow beings. ● Executive Law
● When the offender is suffering from such illness as would ○ Presidential Decree and Executive Order
diminish the exercise of his / her willpower without, however, ■ Coming from the president
depriving him / her of consciousness of his / her acts.
4. Aggravating Circumstances - are those attending the commission
of a crime and which increase the criminal liability of the offender or
make his guilt more severe.
● When the offender takes advantage of his public position;
● When the crime is committed in contempt of or with insult to
public authorities
● When the act is committed with insult or in disregard of the
respect of the offended party on account of his / her rank, age,
or sex or that it is committed in the dwelling of the offended
party, if the latter has not given provocation
● When the act is committed with abuse or confidence or
obvious ungratefulness
● When the crime is committed in a place of worship
● When the crime is committed on the occasion of a
conflagration (large disastrous fire), shipwreck, earthquake,
epidemic or other calamity or misfortune
● When the crime is committed in, consideration of a price,
reward, or promise;
● When the crime is committed by means of inundation (to
cover with of something), fire , explosion, standings of a
vessel or intentional damage thereto, derailment of a
locomotive, or the use of any other artifice involving great
waste and ruin;
● When the act is committed with evident premeditation or after
an unlawful entry;
● When craft, fraud, or disguise is employed; and
● When the wrong done in the commission of the crime is
deliberately augmented by causing other wrongs not
necessary for its commission.
5. Alternative Circumstances - are those which must be taken into
consideration as aggravating or mitigating according to the nature
and effects of the crime and other conditions attending its
commission. The alternative circumstance of relationship shall be
taken into consideration when the offended party is the spouse,
ascendant or descendant, legitimate, natural or adopted brother or
sister, or relative by affinity in the same degree as the offender.
● Alcoholic – diminished judgment
○ Repeatedly → aggravating
Lack of Education Is Not Mitigating In:
● Rape
● Forcible abduction
● Arson
● Treason
● In crimes against chastity like seduction and acts of
lasciviousness;
● Those acts committed in a merciless or heinous manner
ADMINISTRATIVE LIABILITY
● Filed for those who work under the government (ex. HCW in
PGH, etc)
● Policeman (ex. sasampahan po namin sila ng kaso etc.)

BSN4 JJC-JS-HJE (22-23)

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