Ethico-Moral and Legal Aspects of Nursing

by
Dr. Leonida T. Zulueta R.N.,M.A.N.

Ethico-Moral Aspects

Ethics is the study of the standards of conduct and moral judgment.

 It is the study of morality
 It deals with the study on how people make judgment in regard to right or wrong
 It is about making choices that are best for the individual or society at certain times and in particular situations and
then evaluating such choices and outcomes.

Morals – are specific ways of behavior or of accomplishing ethical practices.

 Morality refers to the rightness or wrongness of an action and is based largely upon a society’s mores or customs.
 It refers to social consensus about moral conduct for human beings and society.
 According to Joseph Fletcher
 Morality is what you believe is right and good
 Ethics is the critical reflection about morality and rational analysis about it

Professional Ethics – is a branch of moral science concerned with the obligations that a member of the profession owes to the
public.
Health care Ethics – is the division of ethics that relates to the human health (values, morals, customs, personal beliefs, and
faith)

Bioethics – is a specific domain of ethics that focuses on moral issues in the field of health care
 It is a systematic study of human behavior in the field of life science and health care in the light of moral values and
principles.

Nursing Ethics – is concerned with the principles of right conduct as they apply to the nursing profession.
 It is the examination of all ethical and bio-ethical issues from the prospective of nursing theory and nursing ethics
(Johnson)

ETHICAL PRINCIPLES & OTHER APPROACHES

Telelogical Approach
 “the right thing to do is the good thing to do”
 The act is right when it is useful in bringing about a desirable or good end
 also termed as utilitarianism
 If it helps people, then it is a good act, and if it hurts people, then it is the bad one.
 Guidelines for making Ethical Decisions
1. Consideration for people as a human beings
2. Consideration of consequences
3. Proportionate good to come from the choices
4. Propriety of actual need over ideal or potential needs

5. A desire to enlarge choice and reduce chance

6. A courageous acceptance of the consequences

Deontological Approach or Duty-Oriented Theory

 Immanuel Kant defines a person as a “rational being with freedom and social worth”
 A person is morally good and admirable if his actions are done from a sense of duty and reason.

VERACITY
Refers to telling the truth or not intentionally deceiving or misleading patients.
 There are times , however, that the physician or health practitioner requested not to tell the truth to relative the
exact nature of the patient’s illness
 Sometimes the relative requests the physician not to tell the patient his true diagnosis or condition.

 At times the practitioner himself intentionally withholds information according to his sound judgment when such
revelation would do more harm to an emotionally unstable or depress person. This is called BENEVOLENT DECEPTON.
BENEFICENCE
 Refers to the obligation to do good, not harm, to other people
 It promotes doing acts of kindness and mercy that directly benefit the patient
 These acts promote the health of the patient, prevent illness or complications, alleviate suffering and assist toward
peaceful death if the inevitable comes

NON MALEFICENCE
 The prohibition of intentional harm
Example:
Reporting unethical practice of a colleague to appropriate authorities.
 Nurses should not participate in treatments or procedures that will harm the patient. They should make their stand
known and should withdraw from the team if what to be done is against their conscience

JUSTICE
Refers to the obligation to be fair to all people
 Refers to the right to demand to be treated justly, fairly, and equally

 The fair opportunity rule is based on the equalitarian theory that

emphasizes equal access to goods and services
 The utilitarian theory employs the maxim “The greatest good for the greatest number”

Code of Nursing Ethics

Deals with the
• fourfold responsibility of nurses
• nursing universality
• the scopes of services rendered by the nurses
• their responsibilities to the people, to their practice, to society, to their co-workers, and to the profession.

Code of Ethics for Nurses in the Philippines

- Prior to 1984, the Code of Ethics used by Filipino nurses was the code promulgated by the International Council of Nurses.
1982 - the Philippine Nurses Association Special committee, under the Chairmanship of Dean Emeritus Julita V.
Sotejo developed a Code of Ethics for Filipino nurses.
 This was approved by the House of Delegates of the Philippine Nurses Association but was not implemented.

1984- The Board of Nursing, Professional Regulation Commission adopted the Code of Ethics of the International Council for
Nurses through Board Resolution No. 633 adding “promotion of spiritual environment” as the fifth-fold responsibility of the
nurse.
 This was enforced up to 1989.

1989 - The Code of Ethics promulgated by the Philippine Nurses Association was approved by the Professional Regulation
Commission and through Board Resolution No. 1955 was recommended for use.
 This was approved by the general assembly of the Philippine Nurses Association during the Nurses Week
convention in October 25, 1990.

Amended Code of Ethics for Nurses

- Pursuant to section 3 of Republic Act No. 877, known as the Philippine Nursing Law, and Section 6 of P.D. No. 223, the
amended Code of Ethics for Nurses recommended and endorsed by the Philippine Nurses Association was adopted to govern
the practice of nursing in the Philippines.

Health is a fundamental right of every individual.

 The nurses’ primary responsibility is to preserve health at all cost.
 promotion of health
 prevention of illness
 alleviation of suffering
 restoration of health.
 Inherent in nursing is respect for human rights, including the right to life, to dignity and to treated with respect.
 Nursing care is unrestricted by considerations of age, colour, creed, culture, disability or illness, gender, nationality,
politics, race or social status.
 Society is ever-changing and nurses respond to change.
 Respect for the rights and dignity of individuals is basic to the practice of the profession.
 Nurses render health services to the individual, the family and the community and coordinate their services with
those of related groups.

Nurses and People

 The nurse’s primary responsibility is to people requiring nursing care.

• Nurses must consider the individuality and totality of their clients when administering care.
• They must not be instruments in the violation of individual rights.
• Nurses must respect the spiritual beliefs and practices of their clients regarding diet and treatment.

 Nurses will hold in strict confidence personal information acquired in the process of giving nursing care. They use
discriminative judgment in sharing this information.
 Nurses must hold in confidence personal matters committed to their care.
• They must take into consideration the culture and values of clients in providing nursing care but in the event of
conflicts’ welfare must take precedence

Nurses and Practice

 Nurses are accountable for their own nursing practice. They are responsible for their personal and professional
growth and development.
1.The definition and scope of nursing practice is that which is within the provision of the Philippine Nursing Act of 2002.
2.Nurses must know their responsibilities in the practice of their profession. They must adhere to the highest standards of
nursing practice.
3. Nurse must adequate and develop the necessary competence (knowledge, skills and attitudes) to effectively render proper
nursing services through formal, non-formal, structured and unstructured learning situations.
4. Continuing education aims for the achievement of competence of the individual nurse in terms of knowledge, attitude, and
skills.
5.Nurse administrators are responsible for providing favorable environment for the growth and development of nurses in
their charge.
6.Accreditation for professional programs shall be undertaken by the PRC.
7. Nurses shall be answerable for culpable (deserving blame) negligence, malpractice, and wrongful acts or omission in the
performance of their duties
8. Accountability for nursing practice considers the adeptness of the nurse in diagnosis and treatment of human responses as
evidenced by the patient’s ability to cope with the following:
a. Activities of daily living
b. Development / maturational and adaptive functions; and
c. Stresses ( environmental, psychological, and physiological ).

Nurses and Co-workers

 Nurses maintain collaborative working relationships with their co-workers and other members of the health team.
 They recognize their capabilities and limitations, and those of their co-workers in accepting or when delegating
responsibilities to the team members.
• Nurses must establish their professional roles / identity while working with other members of the health team.
• Conformity with group activities such as those of a health team shall be based on acceptable, ethico-legal standards.
• Nurses contribute to the professional growth and development of other members of the health team.
• Active participation in organizations within the hospital and outside the hospital is encouraged.
• Nurses should not act in any manner prejudicial to other professions.

6. Nurses should honor and safeguard the reputation and dignity of the members of nursing and other professions. They shall
refrain from making unfair and unwarranted comments or criticisms on their competence, conduct, and procedure or do
anything that will bring discredit to a colleague and to any member of the other professions.
7. Nurses shall respect the right of their co-workers.
Nurses and Society
1. Nurses are contributing members of society.
2. They assume responsibilities inherent in being members and citizens of the community / society in which they live /
work.
• They must be conscious of their obligations as citizens and as such be involved in community concerns.
• Being equipped with knowledge of health resources within the community, they take active roles in primary health
care such as health information dissemination, referral, and rendering of actual care.
3. Nurses must actively participate in programs that answer the problems of society.
4. Nurses must lead their lives in conformity with the principles of right conduct and proper decorum.
5. Nurses recognize the need for change and initiate, participate in, and support activities to meet the health and social
needs of the people.
• Nurses must be aware of the issues in the community and must have their stand.
• Nurses must project an image that will uplift the nursing profession.
• Nurses must be actively involved in socio-civic organization of the community.
Nurses and the Profession
1. Nurses are expected to be members of professional organizations of nurses.
2. Inherent in this is the responsibility to support and uphold their constitutions and by-laws.
• Nurses are enjoined to be members of the PNA and avail of the prevailing continuing education unit privilege.
• Heads of nursing groups / organizations shall be responsible for the membership of their constituents in the PNA.
Sanctions
A nurse who is found, after due process, to have violated any provision of this Code of Ethics
 shall be guilty of unprofessional and unethical conduct
 and shall suffer the sanction of censure or reprimand, suspension or revocation of her / his certificate of
registration.

RESPONSIBILITIES OF THE NURSE TO THE PATIENT

1. The primary responsibility of the nurse to the patient is to give him the kind of care his condition needs regardless of his race, creed,
color, nationality / status.
2. In so doing, the patient’s care shall be based on needs, the physician’s orders and the ailment; and shall involve the patient and / or
his family so that he or any of the family can participate in his care.
• Nurses are advised to become familiar with the patient’s Bill of Rights and observe its provisions.
• The patient and his family are entitled to know information or facts within the limits determined by the physician.
3.If the patient insists on knowing what his diagnosis is, the nurse may only repeat what the doctor wishes to disclose.
4. Any information gathered by the nurse during the course of caring for the patient shall always be treated confidential. This duty
extends even after the patient’s death. Confidential information may be revealed only when:
a. The patient himself / herself permits such revelation as in the case of claim for hospitalization, insurance benefits, among
others;
b. The case is Medico-Legal such as attempted suicide, gunshot wounds which have to be reported to the local police or NBI
or other Law enforcers.
c. The patient is ill of communicable disease and public safety may be jeopardized; and
d. Given to members of health team if information is relevant to his or her care.
5. Because nurses are given compensation for their services, they should not accept tips or expensive gifts that may induce them to
give more care to favored patients and neglect those who cannot give. It is advocated that they treat patients in a manner that will
show concern whether the patient is rich or poor.
6. When a nurse is engaged by a patient or any agency, she / he shall complete said service on the length of time stipulated in the
contract. She / he may not leave a patient or any agency without proper permission or resignation or without relief. A nurse can be
sued for breech of contract or abandonment of duty if she / he did.
7. Confidential information is only revealed as provided for by law in Article IV, Section 4 of the New Constitution, which states that:
“The privacy of communication and correspondence shall be inviolable except upon lawful order of the court or when public safety
and order require otherwise.”

Patient’s Responsibilities
-Providing information
• Complying with instructions
• Informing the physician of refusal to treatment
• Paying hospital charges
• Following hospital rules and regulations
• Showing respect and consideration
Patient’s Bill of Rights
1. The patient has the right to considerate and respectful care.
2. The patient has the right to and is encouraged to obtain from physicians and other direct caregivers relevant, current, and
understandable information concerning diagnosis, treatment, and prognosis.
 Except in emergencies when the patient lacks decision-making capacity and the need for treatment is urgent, the
patient is entitled to the opportunity to discuss and request information related to the specific procedures and / or treatments,
the crisis involved, the possible length of recuperation, and the medically reasonable alternatives and their accompanying
risks and benefits.
3. The patient has the right to make decisions about the plan of care prior to and during the course of treatment and to refuse a
recommended treatment or plan of care to the extent permitted by law and hospital policy and to be informed of the medical
consequences of this action.
4. The patient has the right to have an advance directive (such as a living will, health care) concerning treatment or designating a
surrogate decision maker with the expectation that the hospital will honor the intent of that directive to the extent permitted by law and
hospital policy.
5. The patient has the right to every consideration of his privacy. Case discussion, consultation, examination, and treatment should be
conducted so as to protect each patient’s privacy.
6. The patient has the right to expect that all communications and records pertaining to his / her care should be treated as confidential
by the hospital, except in cases such as suspected public health hazards where reporting is permitted or required by law.
7. The patient has the right to review the records pertaining to his / her medical care and to have the information explained or
interpreted as necessary except when restricted by law.
8. The patient has the right to expect that, within its capacity and policies, a hospital will make reasonable response to the request of a
patient for appropriate and medically indicated care and services. The hospital must provide evaluation, service, and / or referral as
indicated by the urgency of the case.
9. The patient has the right to ask and be informed existence of business relationships among the hospital, educational institutions,
other health care providers, or players that may influence the patient’s treatment and care.
10. The patient has the right to consent to or decline to participate in proposed research studies or human experimentation affecting
his care and treatment or requiring direct patient involvement, and to have those studies fully explained prior to consent. A patient
who declines to participate in research or experimentation is entitled to the most effective care that the hospital can otherwise provide.
11. The patient has the right to expect reasonable continuity of care when appropriate and to be informed by physicians and
caregivers of available and realistic patient care options when hospital care is no longer appropriate
12. The patient has the right o be informed of hospital policies and practices that relate to patient care, treatment, and responsibilities.
13. The patient has the right to be informed of available resources for resolving disputes, grievances, and conflicts, such as ethics
committees, patient representatives, or other mechanisms available in the institution.
14. The patient has the right to be informed of the hospital’s charges for services and available payment methods

Nurses’ Bill of Rights

1. Nurses have the right to practice in a manner that fulfills their obligations to society and to those who receive nursing care.
2. Nurses have the right to practice in environments that allow them to act in accordance with professional standards and legally
authorized scopes of practice.
3. Nurses have the right to a work that supports and facilitates ethical practice, in accordance with the Code of Ethics for nurses and its
interpretive statements.
4. Nurses have the right to freely and openly advocate for themselves and their patients, without fear of retribution.
5. Nurses have the right to fair compensation for their work, consistent with their knowledge, experience, and professional
responsibilities.
6. Nurses have the right to a work environment that is safe for themselves and their patients
7. Nurses have the right to negotiate the conditions of their employment, either as individuals or collectively, in all practice settings.

Responsibilities of the Nurse to the Physician

Section 28 (a) of R.A. 9173 states that:
1. It shall be the duty of the nurse to provide nursing care through the utilization of the nursing process.
2. Nursing care includes, but not limited to
 traditional and innovative approaches
 therapeutic use of self
 executing health care techniques and procedures
 comfort measures
 health teachings
 Administration of written prescription for treatment, therapies, oral, topical and parenteral medications
 internal examination during labor in the absence of antenatal bleeding and delivery.
 In case of suturing of perineal laceration, special training shall be provided according to protocol established.
3. It is expected that nurses will not only carry out doctor’s order but to help plan and implement patient care as well. Patient’s
condition should be reported including results of therapies so that management of care can be properly monitored and modified as
necessary.
4. If any of the medical orders were not carried out for some reason (e.g., medications are unavailable, or a patient refuses to accept
them), such shall not only be brought to the attention of the physician but also noted properly in the patient’s chart. Explore patient’s
reason for refusal. Clarify misconceptions as needed.
5. Nurses shall familiarize themselves with the various routines, methods or idiosyncrasies of physicians, so that smooth relationships
can be maintained. In case the patient has a complaint against the physician, this shall be tactfully brought to the latter’s attention.
6. Nurses shall remember that any medical act relegated (consign; commend; entrust) to them is illegal because it is specified in the
Medical Law that any licensed nurse who does this, even if supervised, can be held for illegal practice of medicine.

Responsibilities of Nurses to their Colleagues

1. Nurses are expected to be able to get along smoothly with their colleagues.
• There may be instances where a nurse may have a different opinion, or may not like certain people. This shall be an
exception rather than the rule. A mature person easily blends in any situation.
2. Nurses shall adjust themselves to the organization and know its policies and procedures. They shall establish good working
relationships with co-workers.
3. It is important that nurses know their place in the total organization so that they may cooperate, coordinate and maximize
their work.
4. Loyalty and consideration of others while at work will foster these relationships further.
5. Nurses who are cranky, too sensitive, who “backbite,” who do not see any good in their colleagues, are the type of nurses who will
not be happy in their work.
6. Situations such as, when nurses see their colleagues neglect their duties or are incompetent shall be brought to the attention of the
immediate superior or appropriate authority within the agency setting before any life could be endangered.
7. Constructive criticism is always welcome but not fault-finding.
8. Fault-finders, gossipers, and those who are fond of intrigues will surely resent it too if they become the target of their own practices.

9.Since nurses carry personal responsibility for nursing practice and for maintaining competence by continuous learning, it is expected
that every possible means shall be utilized by them to develop their skills.
10.Their conduct must bring credit to the profession. Just like any other professional, nurses are looked upon with respect in the
community.
 They shall therefore endeavor to live a life that will uphold their self respect.
11.Especially when nurses are on duty, they shall try to look neat and attractive.
 Female nurses are advised to use moderate make-up and have a neat hair style.
 They shall wear uniforms that are neither too short nor tight-fitting that will tend to restrict movements, nor
expose unnecessarily any part of the body while giving care to the patients.
 Clean uniforms and clean bodies tend to enhance the image of nurses.
 Use of anti-perspirant is advised most especially during hot summer months.
12.. Male nurses are likewise advised to be clean shaven, with hair clipped close to the nape instead of flowing to the shoulders.
13.. The use of the uniform shall be specified in the policy of the hospital / agency.
 It shall be worn only when on duty.
 Dining in public, shopping or going to the market while in uniform is discouraged.
 Nurses’ caps are worn only while on duty.
 These are either carried in bags or are left in their places of assignment.
• Jewelries such as earrings, necklaces, or bracelets are not worn while on duty. However, wedding rings, school rings or
school pins may be worn.
• Nurses are looked upon by nursing students as their role models.
14.Therefore, especially while they are on duty, they must act in a manner that is worth emulating.
 Sincere and compassionate attitudes towards patients are caught by those around them.

Moral and Spiritual responsibilities of Nurses

Nurses, whatever their religion is, must be God-loving and God-fearing.
1. They must realize that the nursing profession is a commitment both to God and people.

2.They should emphasize the importance of providing spiritual care as a vital aspect of the nursing care.
3.They must uphold the sanctity of human life.

Moral Principles
When a nurse is confronted with situations where moral judgment is necessary, the nurse may be guided by the
following principles or rules:
1.The Golden Rule - God said, “Do unto others what you would like others do unto you.” Since nurses like others to treat them
kindly and with respect, they should be willing to do same to others too.
2.The Two-fold Effect – When a nurse is faced with situation which may have both good and bad effects, how should
she choose which one to follow? The basis of action may be the following:
3.That the action must be morally good
4.That the good effect must be willed and the bad effect merely allowed
- That the good effect must not come from an evil action but from the initial action itself directly
- That the good effect must be greater than the bad effect.
  It is not morally good if a boy steals in order to alleviate his hunger because the action itself is already
bad.
 On the other hand, if the patient who has a cancer of the uterus submits to hysterectomy she will not be
able to bear a child. If she does not have the operation, she will die. It is the gynecologist’s intention to help the mother and not
to harm her.
 The surgeon’s action is morally good since saving the mother’s life is of primary importance. Also the
doctor himself did not will that the patient lose her child-bearing function.
7.The Principle of Totality – The whole is greater than any of its parts.
Suppose a man’s foot is gangrenous, should he consent to an amputation?
 Since the amputation will save the patient’s life and he can still walk through the aid of crutches or
artificial limbs, he can consent to an operation
8.Epikia – “Exception to the general rule.”
It is a reasonable presumption that the authority making the law will not wish to bind a person in some particular
case. Even though the case is covered by the letter of the law.
Example:
- If a mental patient went berserk and the doctor could not be contacted, the patient may be restrained by virtue of
EPIKIA.
-Allowing a relative to see a seriously ill patient who expresses the desire to see the former although it is not yet visiting
hours
9. One who acts through an agent is himself responsible
Example:
 A patient wants to have an abortion and asks a nurse if she can do it. The nurse refuses, but then
recommends a doctor who is capable of performing an abortion. The nurse becomes liable to such crime, since she is an
accomplice of the said doctor.
10.. No one is obliged to betray himself
11. In testifying before the court, no one can force any person to answer a question if such will incriminate (to charge with or
prove involvement in a crime) him / her.
12. The end does not justify the means
- Giving sleeping tablet to a chronically ill person so he can die in peace is morally wrong.
13.Defects of nature may be corrected
- Patient with a Harelip or cleft palate may have their defects corrected by plastic surgery.
 What shall be the role of the nurse in a case in which parents of a severely deformed newborn child
(Down’s Syndrome with Intestinal atresia) refuse to feed and allow their child to starve to death?
 Withholding nutrition can constitute nursing neglect and expose the nurse to criminal charges of
negligence or conspiracy to commit murder.
14. If one is willing to cooperate in the act, no injustice is done to him
- Suppose the patient subjects himself willingly to an experimental drug and he has been told of the possible effects
of the same, is of right age, and is sane, there is no violation of human rights.
15. A little more or less does not change the substance of an act
- If a nurse gets medicine from the hospital stock without permission or without prescription, he / she will be guilty
of theft even if he / she got only one tablet of the same.
16. The greatest good for the greatest number
 During an epidemic, immunization against communicable diseases is administered to the people.
 Although there may be some who may have slight reactions to the vaccine, the greater majority of the
population shall be considered rather than the isolated few.
17. No one is held to the impossible
 To promise that a patient with heart transplant will live may be impossibility. Yet, such procedures are
done in the hope of saving or prolonging a patient’s life.
 The doctor or the nurse cannot be held to the impossible if they have done their best to take care of the
patient and the latter dies.
18. The morality of cooperation
Formal cooperation in an evil act is never allowed.
 Immoral operations such as abortion shall not be participated upon by a nurse even if the doctor
commands it.
19. Principle relating to the origin & destruction of life. –
One of GOD’s commandments is “Thou shall not kill.”

Euthanasia - is direct killing of those people who may not have committed any crime deserving of death, but because of mental
or physical defects, are considered worthless to society.
- Giving narcotics to a dying person shall be withheld if there is no physical pain.
 He must be left conscious for as long as God does not take his consciousness away.
 The state recognizes the sanctity of human life. It shall protect the life of the mother and the unborn since conception.
 Any direct attack on the life of the fetus for whatever cause is immoral.
 The fetus shall be buried in consecrated grounds. If it is dead and came from a dead mother, it shall be buried with the
mother.

The Good Samaritan Law:

 Many persons who refuse to give emergency aid to victims of accidents due to liabilities they may incur later.
 Although no one is legally compelled to do so, it will not be ethically and morally right to leave persons without aid
especially if one has the skills and the knowledge to save lives.
 The Good Samaritan Act is based on the biblical story of a man who aided an injured person who was waylaid by thieves
and was left half-dead.
 The Samaritan took care of him with compassion, bound up his wounds, brought him to an inn, and took care of him.

Laws Governing the Practice of Nursing

Law
 Is “ the sum total of rules and regulations by which society is governed”.
 It is man-made and regulates social conduct in a formal and binding way. It reflects society’s needs, attitudes, and mores.”
 It is a rule of conduct pronounced by controlling authority and which may be enforced.

Essential characteristics of every law:

• The authority or the right to declare that the rule exists.
• Rule is pronounced or expressed and that its source can be identified.
• A right to enforce the same must provided.

Principal sources of the pronouncement of laws

1.The Constitution – the fundamental law of the government
- It contains the principles on which the government is founded
- Regulates the division of sovereign powers
- Directs to what persons each of these powers is to be entrusted
- Specifies the manner by which these power shall be exercised
2.The Statutes or legislations
3.The regulations issued by the Executive Branch of the government
4.Case decisions or judicial opinions
5.Presidential Decrees
6.Letters of Instruction.

Philippine Nursing Law

 Act No. 2493 of 1915 – contains the first law that had to do with the practice of nursing
 This act provided for the examination and registration of nurses in the Philippines
 The applicants needed to be only 20 years old, of good physical health and of good moral character
 Graduates of intermediate courses of public schools could enter the school of nursing which was then giving only 21/2
years of instruction
 These graduates are called first-class nurses
 Those who desired to be second-class nurses filed an application with the district health officer in the district where they
resided

1. Act 2808 (1919) known as the First True Nursing Law

 It created a board of examiners for nurses
 1920 - the first board of examination in the Philippines was given

2. On June 19, 1953, the Congress enacted The Philippine Nursing Law otherwise known as Republic Act 877
Provisions included are:
 Organization of the Board of Examiners for nurses
2. provisions regarding nursing schools and colleges, examination, registration of nurses
3. provisions relative to the practice of nursing
 Unless exempt from registration, no person shall practice or offer to practice nursing in the Philippines without
holding a valid certificate of registration as nurse issued by the Board of Examiners for nurses

3. Republic Act 4704 (June 18, 1966) amended certain portions of R.A. 877
Salient changes are:
• The membership of the Board of Examiners for Nurses was increased from 3 to 5 members
2. Members of the Board were to be appointed by the President of the Philippines with the consent of the Commission on
Appointments and no longer “upon recommendation of the Commission of Civil Service”

3. The requisite academic degree for members of the Board was a Master’s Degree, instead of a Baccalaureate Degree in
Nursing.
• A disqualifying age limit for a Board Member was fixed.
 No person was eligible for membership in the board if he / she was over 65 years of age, heretofore, no such age
disqualification was provided by law.
• The maximum total compensation of which a member of the Board of Examiners for Nurses could receive was
raised from Ph 12,000 per annum as provided in the 1965-1966 Appropriation Act (R.A. No. 4642) to Ph 18,000 yearly
6. The academic qualification for Deans, Directors and principals of Colleges and Schools of Nursing was raised from the level
of a Baccalaureate Degree to that of a Master’s Degree in Nursing.
7. The areas of study required for entrance to colleges and schools of nursing were generalized to include courses in physical,
biological, social and behavioral sciences, as well as humanities, chemistry, psychology and zoology.
8. The scope of nursing practice was broadened to circumscribe the whole management of the care of patients and the acts
constituting professional practice of nursing were spelled out to include such services as:
4. Reporting
5. Recording and evaluation of a patient’s case
6. Supervision of persons contributing to the nursing care of patients
7. execution of nursing procedures and techniques
8. direction and education to secure physical and mental care
9. and the application and execution of physician’s orders concerning treatment and medication.

• The date of holding of nurse’s examination was no longer fixed but adjusted to the official closing of the semestral
term of classes in colleges and schools of nursing.

10. The minimum age required for applicants for admission to the nurse’s examination was lowered from 21 to 18 years of
age, but no candidate who passed the examination was permitted to practice the profession until he/she reached the age of 21
years
 Before, students took specific liberal arts subjects prior to entrance to the school of nursing
 Students now enroll to the college of nursing of their choice after graduation from high school but, as required by
the Philippine Nursing Act of 1991 R.A. 7164 they must belong to the upper 40% of the graduating class in their high school

 Republic Act 7164 introduced by Senator Heherson Alvarez codified and revised all the laws regulating the practice
of nursing in the Philippines known as the “Philippine Nursing Act of 1991”

Changes made are:

• Redefinition of the scope of nursing practice to emphasize
a. The use of nursing process as a scientific discipline in arriving at an appropriate nursing action and care
b. The teaching, management, leadership, and decision making roles of the nurse
c. The undertaking of and participation in studies and research by nurses
2. Requiring a faculty member who was appointed to the Board of Nursing to resign from her teaching position at the time of
appointment as provided in R.A.877 as amended.
3. Updating a faculty’s educational qualification by requiring a Master’s Degree in Nursing or related fields or its equivalent
in terms of experience and specification as pre-requisite to teaching.
• Specification of qualifications of administrators of nursing services
• Inclusion of the phrase “Unethical Conduct” as one of the reasons for revocation and suspension of certificate of
registration

10. Proclamation No. 539 dated October 17, 1958 – the President of the Philippines declared the last week of October of
every year beginning 1958 as the Nurses’ Week
 the purpose of dedicating a period in a year for the promotion of the ideals of the nursing profession was to develop
consciousness and availability of nursing resources in the Philippines

11. Presidential decree No. 223 issued on June 23, 1973 created the Professional Regulation Commission and prescribed
its powers and functions. Where before the function to regulate the different professions was under the Civil Service
Commission now belonged to PRC under the office of the Pres. Of the Philippines

Changes and additional provisions affected by the act:

12. The fee for nurse’s examination was increased from Ph50 to Ph 75.00 and the fee for registration as nurse after
passing the examination was increased from Ph20 to Ph 40.00
2. An applicant for registration as nurse without examination had to pay a statutory fee equal to the sum of the examination
fee and a registration fee, or a total of Ph115.00

3. The annual registration fee should be paid on or before the 20th of January of the year. Failure to pay entails 20%
surcharge for every year. Non-payment of the fee for 5 consecutive years, certificate of registration is considered suspended
and name is removed from the annual roster.

4. Nurses in inactive status were exempted from paying the annual registration fee, provided the Board of Nursing was
informed. Reinstatement could be done through a letter of request and the payment of annual registration fee for the current
year.

13. PRC Memorandum No. 90-11 dated August 20, 1090 provided new rates for examination and registration
14. For professions needing a Baccalaureate Degree the examination fee was Ph350.00 and for those with less than
Baccalaureate Degree it was Ph250

2. Initial registration fee for professions needing Baccalaureate Degree was Ph250.00 while those with less a Baccalaureate
Degree the fee was Ph175.00

3. Annual registration fee for professions needing Baccalaureate Degree was Ph40.00 and for those less than Baccalaureate
Degree was Ph30.00 and for renewal Ph10.00 processing fee was charged and payable on the professional’s birth month

15. LOI No. 1000 dated March 20, 1980 from then President Ferdinand E. Marcos requiring members of accredited
professional organizations shall be given priority in the hiring of employees in the government service and in the
engagement of professional services.

16. Republic Act 1612 a privilege tax shall be paid before any occupation or business can lawfully begun.
 Nurse was Ph50.00 payable annually on or before January 31.
 Any person who pursued any occupation without paying the tax required by law was liable to pay a fine not
exceeding Ph1,000.00 or imprisonment not exceeding 6 months
 Any person who did not pay his annual privilege tax for the current year was fined not less than Ph200.00 and not
more than Ph500.00
 Nurses working in the government service were exempted from paying the privilege tax.

17. R.A. 1080 those who passed the bar and board examination were declared to be civil service eligibles
18. Before the passage of this act, a nurse had to take the Civil Service Examination to enter government service.

19. R.A.7392 amended R.A. 2644 known as the Midwifery Law on June 18, 1960
 Provides that only those who were licensed midwives could practice
 Nurses according to this act should pass the Examination for Midwives and be registered upon payment of
prescribed fee.
 To submit to the Midwifery Board a certificate from the Chief of the Hospital that they actually had attended at
least twenty (20) deliveries and should pay the corresponding fees for examination and registration.

20. Presidential Decree 541 allows former professionals to practice their respective profession in the Philippines.
 Balikbayans may practice their profession during the period of their stay in the country.

21. Republic Act 6425 known as the Dangerous Drug Act was passed in 1972 which states that
 The sale, administration, delivery, distribution and transportation of prohibited drugs are punishable by law
 The penalty of imprisonment ranging from 12 years and 1 day to 20 years and a fine ranging from 12 thousand to
twenty thousand pesos shall be imposed upon any person who shall sell, administer, deliver, give way to another, distribute,
dispatch in transit or transport prohibited drugs or act as a broker in such transactions.
 The maximum penalty prescribed in this act shall be imposed to any practitioner and the additional penalty of
revocation of her license to practice her profession
 Should prohibited drug be the proximate cause of death of the victim, the penalty of life imprisonment to death and
a fine ranging from 20 to 30 thousand be imposed to the pusher.

 Section 8. Possession or use of prohibited drugs

 The penalty of imprisonment ranging from 6 years and 1 day to 12 years and a fine ranging from Ph6000 to
Ph12000.00 shall be imposed upon a person who unless authorized by law shall posses prohibited drug.

 Section 15.
 The penalty of imprisonment ranging from 6 years and 1 day to 12 years and a fine ranging from Ph6000 to
Ph12000.00shall be imposed upon any person who unless authorized by law, shall sell, dispense, deliver. Transport or
distribute any regulated drugs.
 Sec.16. Possession or use of Regulated Drugs
 The penalty of imprisonment ranging from 6 months and one day to 4 years and a fine ranging from Ph600 to
Ph4000.00 shall be imposed upon any person who shall possess or use any regulated drug without the corresponding license or
Rx.

22. Republic Act 6675 or the Generics Act of 1988 is an act to promote, require and ensure the production of an
adequate supply, distribution, use and acceptance of drugs and medicines identified by their generic names.
Medicines are prescribed in generics

23. R.A. 7305 known as “The MAGNA Carta for Public Health Workers” authored by Senator Edgardo Angara and
was approved Pres. Corazon C. Aquino on March 26, 1992 with the following objectives:
 To promote and improve the social and economic status of health workers
 To develop their skills and capabilities
 To encourage those qualified and with abilities to remain in government service.

24. R.A. 7600 or the Rooming-In and Breastfeeding Act of 1992

 Provides that babies born in private and government hospitals should be roomed-in with their mothers to promote
breastfeeding and ensure safe and adequate nutrition to children.

 The penalty of imprisonment ranging from 6 months and 1 day to 6 years and a fine ranging from Ph600 to
Ph6000.00 shall be imposed upon any person who, unless authorized by law, shall possess or use Indian hemp.