Nursing Leadership AND Management Notes
Nursing (nurse)
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Introduction to Nursing Management
of a firm determines to a large extent, its
productivity and profitability.
2. System of authority, management first
develops with top individuals determining the
course of action for the rank and file. The
constitutional management emphasizes
definite and consistent concern for policies
and procedures in dealing with the working
group. A line toward a democratic and
participative approach follows as employee
receive higher education.
3. Class and status system this is from
sociologist’s point of view that managers have
become an elite group of brains and
education. This class is based on education
and knowledge. Managers continue to expand
their horizons in an effort to attain the
ultimate in life or goal.
Nursing Management
1. is a guide for nurses who wants to learn
the concepts behind Nursing
Management.
2. This will also guide nurses to organizing,
staffing, scheduling directing and
controlling, it also deals with the
application of the concepts, principles,
theories and methods of developing
nursing leaders and managers in the
hospital or any settings.
Management
3.
is an old French term its means “the
directing”. There are many definition of
management is. It is a universal
process. It is the process of
coordinating and supervising personnel
and resources to accomplish
organizational goals.
4. Also it is to design and maintain an
internal environment in which people
working together in groups. That can
perform effectively and efficiently
towards the attainment of group goals.
5. Management is being use in running a
business, practice ones’ profession, and
day to day interaction. A thorough
knowledge in management includes:
time, resources and workforce.
THEORIES X and Y
According to Venson, (2010) management is a
process by which a cooperative group directs actions
towards common goals, it involves technique by
which a distinguished group of people coordinates the
services of people. It also includes moral and ethical
standards in the selection of right ends toward which
managers should strive.
There are (3) three-fold concept to emphasize the
broader scope of management, (Harbizon and Myers)
1. Economic source is one of the factors of
production together with land, and capital.
Industrialization increases, management is
substituted by labor and capital. Management
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Fatigue study
Method study
Time study
Motion study
Different piece wage system
Mental revolution
Frank and Lilian Gilbreth – “The First Lady
of Management”
 Use motion picture to develop work
efficiency.
 “Therbligs” - 17 classification of hand
movements.
 Develop Job Simplification. Subject of
the book “Cheaper by the Dozen
THEORIES OF MANAGEMENT
Henry Gantt – Disciple of Frederick Taylor
A. Scientific Management Theory (1900-1930)
 Frederick Taylor – father of scientific
management
 How people work
 Theories of management do not
remain static
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The following are the four principles of scientific
management:
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1. Traditional “Rule of Thumb” means
organizing work must be replaced
with scientific methods. Give allotted
time to workers in accomplishing their
task.
2. Workers can be hired, trained and
promoted based on their competence
and abilities.
3. Employees are entitled of receiving
financial rewards, and incentives for
worked accomplished because he
viewed humans as “economic
animals’ motivated solely by money.
4. Maintain good interpersonal
relationship between the workers and
managers they should be cooperative
and interdependent and the work
should be shared equally.
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B. Classical Organization Theories
Henry Fayol – known as the “Father of the
Management Process School” (1925)
identified management functions of
planning, organization, command,
coordination, and control Luther Gulick
(1937) expanded on Fayol’s’ management
functions he mentioned that they are
“seven activities in management” staffing,
directing. Coordinating. Reporting, and
budgeting-POSDCORB. Often times
Managers considered this as the process of
management. HE STUDIED THE FUNCTIONS
OF THE MANAGERS AND CONCLUDED
THAT MANAGEMENT IS UNIVERSAL.
SCIENTIFIC TECHNIQUES OF TAYLOR
 Functional foremanship
 Standardization and Simplification of work
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Develop Gantt Chart
Advocates for a humanitarian
management
It was formulated for providing graphic
schedule for planning and controlling
of the work, and recording progress
towards stage of a project
The chart has modern variation PERT
(Program Evaluation and Review
Techniques)
He linked the bonus paid managers to
how well they taught their employees
to improve performance
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Management Process:
Theory”, popularized the term “span of control and
unity of command.
a. Planning it is determining philosophy, goals and
objective, policies, procedures and rules.
b. Organizing it includes establishing the
organizational structure to carry out plans
Determining the most appropriate type of
patient care delivery.
c. Staffing functions consist of recruiting
interviewing, hiring and orienting staff.
d. Directing it includes several staffing functions
such as motivating, managing conflict.
Delegating, communicating, facilitating
collaboration.
e. Controlling functions include performance
appraisals. Fiscal accountability, quality control,
legal and ethical control.
B. Human Relation Management (1930-1970)
Mary Parker Follett (1926) one of the first
theorist to suggest basic principles of what
today would be called participative decision
making or participative management. She
believed that managers should have authority
with one another, rather than over
employees, that solution could be easily be
found that could satisfied both employee
without dominating each other.
Elton Mayo – Discovered that expert
seeking to improve worker efficiency has to
take into account the human dimension of
work
Jacob Moreno – developed a system of
pairings called Sociometry, believes that
people are attracted to, repulsed by or just
indifferent towards each other.
FAYOL’S 14 PRINCIPLES OF MANAGEMENT
1. DIVISION OF WORK
2. AUTHORITY AND RESPONSIBILITY
He recommended centralization through the
use of a scalar chain or levels of authority,
responsibility accompanied by authority, unity
of command and direction so that each
employee receives orders from ONLY ONE
SUPERIOR
3. DISCIPLINE- “A PLACE FOR EVERY THING AND
EVERY THING IS IN PLACE”
4. UNITY OF COMMAND
5. UNITY OF DIRECTION
6. SUBORDINATE OF INDIVIDUAL INTEREST TO
GENERAL INTEREST
7. REMUNERATION OF PERSONNEL
8. CENTRALIZATION
9. SCALAR CHAIN
10. ORDER
11. EQUITY
12. STABILITY OF TENURE OF PERSONNEL
13. INITIATIVE
14. ESPRIT DE CORPS
A. Behavioral Science
Abraham Maslow – developed the
Hierarchy of Needs
 Physiologic Needs
 Safety and Security Needs
 Love and Belonging Needs
 Self-Esteem Needs
 Self- Actualization
Frederick Herberzg – develop taxonomy of
job situation.
 Believes in job satisfiers/ motivation factor
and dissatisfies/ hygiene factor
William Ouchi – develop Theory Z by
comparing the Japanese organization to the
American organization.
Douglas McGregor (1960) theorizing that
managerial attitude about employees this
could be correlated to employee’s
satisfaction. He labeled Theory X and theory
Y. Theory X, manager’s beliefs that their
employee are basically lazy.
Max Weber – is the “Father of Organizational
Management”. He developed the organizational
chart. According to him there are 3 basis of authority
traditional, charismatic and rational authority.
William Blake – develop the Managerial
Grid
Lyndal Urwick she combined the theories of Taylor
and Fayol to develop the classic Organizational
Types of Managers in Managerial Grid
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 The contingency perspective refutes
universal principles of management by stating
that a variety of factors, both internal and
external to the firm, may affect the
organization’s performance.
 Therefore, there is no “one best way” to
manage and organize because circumstances
vary
Impoverish Manager
Country Club Manager
Organizational Man Manager
Authority Obedient Manager
Team Manager
Levels of Management
1. Top Level Manager – look at the
overall operation of the organization.
- Coordinate internal and external
affairs of the organization. - Makes
the major decisions - Determines the
organization’s mission/ vision
statement, philosophy, policies and
procedures. - Creates goals and
allocate resources.
 Contemporary approach means new, recent or
current approaches in the field of management
EXAMPLE: The way company was running
100 years ago is different from today.
However, one steel company today might
say they use “contemporary
management” meaning they use the same
type of management that other steel
companies use today.
 Contingency Approach – a management approach
the recognizes organizations as different, which
means they face different situations
(contingencies) and require different ways of
managing.
Assumes there is no best way to manage.
 The environment impacts the organization and
managers must be flexible to the act to
environmental changes.
 The way the organization is designed and
control systems selected defend on the
environment.
Technological environments change rapidly, so
must managers.
 System Approach – a set of interrelated and
interdependent parts arranged in a manner that
produces a unified whole
6. Process closed system: system that are
not influence by and do not interact
with their environment.
7. Open system: systems that interact with
their environment
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2. Middle Level Manager – coordinates
activities of different department Receives policies from the top-level
manager. - Makes specific objectives
and programs.
3. First Level Manager – directly
responsible for the actual production
of services. - Act as a link between the
higher-level managers and nonmanagers.
Skills of a Manager according to Katz
1. Technical Skill – knowledge and proficiency in
activities involving methods, procedures and
process.
2. Human Skill – ability to work with people Create a harmonious working relationship.
3. Conceptual Skill – ability to see the overall
picture to identify important elements in a
situation and to understand the relationship
among the elements. And identifying
pertinent factors, responding to the big
problems, and discarding irrelevant facts.
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Other approach according to Summer
1. Knowledge factors refer to ideas, concepts, or
principles that can be expressed and are
accepted because they have logical proofs.
2. Attitude factors relate to those beliefs,
feelings, and values that may be used on
emotions and may not be subjected to
conscious verbalization.
3. Ability factor skill, art, judgement, and
wisdom. They abstract factors but they direct
one’s thinking to factors that can be
developed by the individual manager who
takes time to consider them.
Roles of a Manager
1. Interpersonal Role, the manager acts as:
a. Symbol because of the position he/she
occupies and consists of such duties as
signing of papers/documents required by
the organization.
b. Leader, who hires, trains, encourages,
fires, remunerates, and judges
c. Liaison Officer between outside contacts
such as community, suppliers and the
organization
2. Informational Role, the manager does;
a. Disseminates Information, from both
external and internal sources
b. Monitors information
c. Spokesperson or representative of the
organization. He/she represents the
subordinates to superiors and the upper
management to the subordinates.
3. Decisional Role makes him/her
a. Problem Solver/ Trouble Shooter, who
handles unexpected situations such as
resignation of subordinates, firing or
subordinates, and loss of clients
b. Innovator/ Entrepreneur a designer to
improve projects that direct and control
change in the organization
c. Negotiator when conflict arise
LEADERSHIP – lt is important to remember though
that a job title alone does not make a person leader.
Only a person’s behavior determines if he or she holds
a leadership role.
The manager is a person who brings things about the
one who accomplishes, has the responsibility, and
conducts. A leader is the person who influences and
guides direction, opinion, and course of action.
There are several definitions of what leadership is:
 A process of influence in which the leader
influences others toward goal achievement
 The process of influencing the activities of an
organized group in its efforts toward goal setting
and goal achievement
 Is about creating change. It involves establishing a
direction, aligning people through empowerment,
motivating and inspiring them toward producing
useful change and achieving the mission.
 It Is the vital ingredient that transforms a crowd
into a functioning, useful organizations.
Nursing Leadership – process whereby nurse
influences one or more persons to achieve a
specific goal in the provision of quality nursing
care.
COMPARISON BETWEEN LEADERSHIP AND
MANAGEMENT
Leaders need to do the right things, are challenged by
change, focus on purposes and have a future time
frame.
Leaders
 Often do not have delegated authority but
obtain power through other means, such as
influence.
 Have a wider variety of roles than managers.
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 Focus on group process, information
gathering, feedback, and empowering others.
 May or may not be part of the formal
hierarchy of the organization.
 Emphasize interpersonal relationship
 Direct willing followers
 Have goals that may or may not reflect those
of the organization.
Leaders display both instrumental
(technical) and supportive (socially
oriented) leadership behavior
 Great leaders arise when situation
demands it.
2. Trait Theory
 Traits are inherent (before). Traits can be
learned (now)
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Managers do things right are challenged by continuity
and focus on structures and procedures in a present
time frame. They ask who, what, when, where and
how as the use schedules to get to the destinations
and evaluate human performance.
Manager
 Are assigned a position by the organization.
 Have a legitimate source of power due to
delegated authority that accompanies their
position
 Have a specific duties and responsibilities they
are expected to carry out.
 Emphasize control, decision making, decision
analysis, and results.
 Manipulate people, the environment, money,
time, and other resources to achieve the goals
of the organization.
 Have a greater format responsibility and
accountability for rationality and control than
leaders.
 Direct willing and unwilling subordinates.
Leaders
 Often do not have delegated authority but
obtain power through other means, such as
influence.
 Have a wider variety of roles than managers.
 Focus on group process, information
gathering, feedback, and empowering others.
 May or may not be part of the formal
hierarchy of the organization.
 Emphasize interpersonal relationship
 Direct willing followers
 Have goals that may or may not reflect those
of the organization.
3. Charismatic Theory
 Leaders possess charisma (an inspirational
quality that some leaders possess that makes
others feel better in their presence.)
4. Situational Theory: Traits required of a leader
differ according to varying situations
(variables)
Variables:
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DIFFERENT THEORIES OF LEADERSHIP EARLY
LEADERSHIP
1. Great Man theory: (1900-1940)
 Leaders are born.
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Identified traits: energy, affection,
enthusiasm, ambition, aggressiveness,
decisiveness, self-assurance, selfconfidence, friendliness, affection,
honesty, fairness, loyalty, dependability,
technical mastery, teaching skill.
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personality of the leader
performance requirements of both the
leader and followers
attitudes, expectations and needs of
the leader and followers
a. Degree of interpersonal
contact possible
b. Time pressures
c. Physical environment
d. Organizational structure
e. Influence of the leader
outside the group
Nature of the organization
4. Contingency Theory: (Fred Fiedler, 1960s)
According to Fiedler no leadership style is ideal
for every situation. The interrelationship
between the group’s leader and its members
were most influenced by the manager’s ability
to be a good leader.
- 3 aspects of a situation that structure
the leaders:
a. Leader-member relations- assessed
through
Group Atmosphere Scale 8 7 6 5 4 3 2
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1. Friendly unfriendly
2. Accepting rejecting
3. Satisfying frustrating
4. Enthusiastic unenthusiastic
5. Productive non productive
6. Warm cold
7. Cooperative uncooperative
8. Supportive hostile
9. Interesting boring
10. Successful unsuccessful
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b. Task structure:
High if it’s easy to define and measure
a task
Low if it’s difficult to define a task and
to measure progress toward its
completion
4 criteria to determine the degree of
task structure:
1) goal clarity;
2) extent to which a decision can be
verified knowing who is responsible for
what;
3) multiplicity of goal paths, number of
solutions
4) specificity of solution, number of
correct answers
3. Accepting, considerate leadership style
probably will be most productive.
5. Path goal Theory:
People act as they do because they
expect their behavior to produce
satisfactory results
- Structured activities were more
productive and successful
6. Situational Leadership Theory (Paul Hersey &
Kenneth Blanchard) (1950-1980)
- Predicts the most appropriate
leadership style from the level of
maturity of the followers through the
four quadrant model, a horizontal
continuum registers low emphasis on
the accomplishment of tasks on the
left side to emphasis on task behavior
on the right side
- The vertical continuum depicts low
emphasis on interpersonal
relationships at the bottom to high
emphasis on relationships at the top
- The lower left quadrant represents
laissez -faire type of leadership with
little concern for production or
relationship
LEADERSHIP STYLES BY HERSEY & BLANCHARD
1. DIRECTING STYLE: - this is a high task, low
relationship style and is effective when
subordinates are low in motivation and ability
2. COACHING STYLE: - this is a high-task, high
relationship style and is effective when
subordinates have adequate motivation but
low ability
3. SUPPORTING STYLE: - this is a low-task,
high-relationship style and is effective when
subordinates have adequate ability but low
motivation
4. DELEGATING STYLE: - this is a low-task, lowrelationship style and is effective when
subordinates are very high in ability and
motivation.
c. Position power- authority inherent in a position
(use rewards and punishment)
Note; Fiedler says that one can predict the most
productive leadership styles
1. Task is structured, leader disliked, then
diplomatic
2. Task is ambiguous, leader is liked, then seek
cooperation
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7. Transactional Theory
- Exchange posture that identifies needs
of followers and provides rewards to
meet those needs in exchange for
expected performances
- Leaders focuses on a day-to-day
operation
8. BEHAVIORAL THEORY is a management
philosophy that evaluates leaders according to
the actions they display in the work place. To be
effective leader is to learn a certain set of
behaviors. A leadership theory developed,
researchers changed from studying what traits
the leader had and placed emphasis on what he
or she did, the leadership style of leadership.
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CONTEMPORARY LEADERSHIP
1. Transformational theory:
 Promotes employee development
 Attends to needs and motives of
followers
 Inspires through optimism
 Influences changes in perception
 Provides intellectual stimulation
 Encourages followers’ creativity
3 LEADERSHIP STYLES (Kurt Lewin, et al 1930) His
breathrough occurred when he and White (9151) and
Lippitt (1960) identified with common leadership
styles.
2. Servant Leadership – they are more
concerned with the needs of other than
themselves and lead through their service.
They foster a service inclination in others that
promotes collaboration, teamwork, and
collective activism.
1. Authoritarian
Uses positional and personal power
- Demanding and controlling
- Emphasis is on difference in status ( “I”
and you “you”).
- Others are directed/ motivated with
commands
- Critism is punitive
- Communications flow up & downward
- Decision making does not involve
others
2. Democratic
- Allows for group governance through
collaboration or group efforts
- Situation of trust and openness
Decision making involves others
- Less control is maintained
- Economic and ego rewards are used to
motivate.
- Emphasis is on “we” rather than I and
you.
- Criticism is constructive
3. Laissez-faire
Leaving workers without direction and
supervision and allows them to plan
- Leader uninvolved, disinterested,
withdrawn.
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Permissive with little or no control
Uses upward and downward
communication between members of
the group
Places emphasis on the group
Does not criticize
3.
Authentic leader – a leader manager arsenal,
in order to lead, leaders must be true to
themselves and their values and act.
Authentic or congruent leadership theory
differs from traditional transformational
leadership theory.
4. Thought leader applies to a person who is
recognized among his or her peers for
innovative ideas and demonstrates the
confidence to promote those ideas
POWER the ability to impose the will of one person or
group to bring certain behaviors in other person or
groups.
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Reward Power it is the leader or manager’s
power comes from the ability to reward
others for complying.
Coercive Power based on a fear of
punishment if one fails to conform., an
opposite of reward power,
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to project nursing staff needs for the next
shift.
 The advantage of using a PCS is that it is an
objective approach to determining staffing
based on patient care needs: a sicker patient
requires more nursing care and therefore
would have a higher acuity level.
Legitimate Power the right of the manager or
leader to influence and the staff member an
obligation to accept that influence.
Referent Power is based on identification with
a leader and what that leader symbolizes. The
leader is admired and exerts influence
because the followers desire to be like the
leader.
Expert Power gained through knowledge,
skills, information, experience and
competence. Their expertise gains people
respect and compliance.
Information Power comes from knowledge,
access to information, and the sharing of
information. It is especially powerful when
others need the information.
Connection Power comes from formal or
informal coalitions and interpersonal relations
and links to prestigious and influential people
within and outside of the organization.
 Patient classification systems (PCS), also
known as workload management, or patient
acuity tools, were developed in 1960s.
MODULE 2
PATIENT CARE DELIVERY SYSTEM
Nursing process is
defined as a systematic,
rational method of
planning and providing
individualized nursing
care.
It is utilized to identify a
client’s health status and
actual or potential health
care problems or needs, to establish plans to meet
the identified needs, and to deliver specific nursing
interventions to meet those needs.
MODALITIES OF CARE
 There are five most well-known means of
organizing nursing care for patient care
delivery. These are the functional nursing,
team and modular nursing, primary nursing,
and case management.
 Each of these basic types has undergone
many modifications, often resulting in new
terminology. An example is the primary
nursing which was once called case method
nursing and is now frequently referred to as
PATIENT CLASSIFICATION SYSTEM
 A patient classification system (PCS) predicts
patient needs and requirements for nursing
care. A PCS groups patients according to
acuity of illness and complexity of nursing
activities necessary to care for the patients.
 Typically, patient acuity data are collected
every shift by nursing staff and are analyzed
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professional practice model. Team nursing is
sometimes called partners in care or patient
service partners, and case managers assume
different titles depending on the setting in
which they provide care.
Case Method Nursing or Total Patient Care Nursing
Total patient care – nurses assume total responsibility
for meeting all needs of assigned patients during their
time on duty
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As task – it is a method by which staff
member (licensed and unlicensed) perform
specific tasks for a large group of patients
rather than care for specific patients
For the entire shift nurse takes care of
patient. Initially occurred in ICU units
The Case Method evolved into what we now
call private duty nursing. It was the first type
of nursing care delivery system
Advantages:
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Consistency in carrying out the nursing care
plan
Patient needs are quickly met as high number
of RN hours are spent on the patient
Relationship based on trust is developed
between the RN and the patient’s family
Direct care nurse’s role:
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Nurse manager’s role
 Must be sensitive to the quality of
patient care delivered and the
institution’s budgetary constraints
 Achieving patient outcomes
 By using effective management and
leadership skills, can improve the
staff’s perception of their lack of
independence
 Rotate assignment among staff
 Staff meetings should be conducted
frequently, this encourage staff to
express concerns and empowers
them with the ability to communicate
about patient care and functions
Provide holistic care (physical, emotional) to a
group of patients during defined work time
The nurse must complete the functions of
care (assessment, personal hygiene and
teaching the patient and family)
No delegation of tasks
Functional nursing
 It is a task-oriented method wherein a
particular nursing function is assigned to each
staff member. The medication nurse,
treatment nurse and bedside nurse are all
products of this system. For efficiency,
nursing was essentially divided into tasks, a
model that proved very beneficial when
staffing was poor. The key idea was for nurses
to be assigned to tasks, not to patients
Advantages:
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A very efficient way to delivery care
Could accomplish a lot of tasks in a small
amount of time
Staff members do only what they are capable
of doing
Least costly as fewer RN’s are required
Advantages:
Disadvantages:
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Care of patients become fragmented and
depersonalized
Patients do not have one identifiable nurse
Very narrow scope of practice for RN’s
Leads to patient and nurse dissatisfaction
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Each member’s capabilities are maximized so
job satisfaction should be high
Patients have one nurse (team leader) with
immediate access to other health providers
Disadvantages:
Team Nursing
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 Most commonly used model and is still in use
today. Developed in the 1950’s in order to
somewhat ameliorate the fragmentation that
was inherent in the functional model
 The goal of team nursing is for a team to work
democratically. Ideal team, an RN assigned as
a team leader for a group of patients
 Ancillary personnel collaborate in providing
care to a group of patients under the direction
of a professional nurse
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Requires a team spirit and commitment to
succeed
RN may be the team leader one day and a
team member the next, thus continuity of
patient care may suffer
Care is till fragmented with only 8 or 12 hours
accountability
Primary Nursing
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The hallmark of this modality is that one
nurse care for one group of patients with a
24-hours accountability for planning their care
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In other words, a primary nurse (PN) cares for
her primary patients every time she works
and for as long as the patient remains her unit
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An Associate Nurse cares for the patient in
the PN’s absence and follows the PN’s
individualized plan of care. This is a
decentralized delivery model more
responsibility and authority is placed with ach
staff nurse
Nurse manager’s role
 Teaching and coordinating patient activities
 Responsible for more than one unit
 Determine which nurse are competent and
interested in becoming a charge nurse or a
team leader
 Provide an adequate staff mix
 Orient team members to the team nursing
system
 Providing continuing education
Charge nurse’s role
 Act as a liaison between the team leaders and
other healthcare provider
 Provide support for the teams on a shift by
shift
Direct care nurse’s role
 Team nursing used the strengths of each
caregiver
 Some nurses become known for their
expertise in some tasks (IV), will start IV for
patients under the guidance and supervision
of the team leader
 Direct patient care activities under the
direction of the team leader
 Nurse acts as a responsible for knowing the
condition and needs of all patients assigned to
the team and for planning individual care
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Associate nurses:
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Is an RN who has been delegated to provide
care to the patient according to the primary
nurse’s specification. When the primary nurse
is not on duty
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If the patient develops additional
complications, the associate nurse notifies the
primary nurse
Provides input to the patient’s plan of care
Case Management
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Advantages:
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Increased satisfaction for patients and nurses
More professional system, RN plans and
communicates with all healthcare members.
RN’s are seen as more knowledgeable and
responsible
RN’s more satisfied because they continue to
learn as part of the in-depth care they are
required to deliver to their patient
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Is a process of coordinating healthcare by
planning, facilitating and evaluating
interventions across levels of care to achieve
measurable and quality outcomes
It may be within the wall of hospitals or
beyond the walls
It became popular and effective method to
manage shortened lengths of stay for patients
while achieving desired patients outcomes
and to prevent expensive hospital readmissions
Disadvantages:


Only confines a nurse’s talents to a limited
number of patients, so other patients cannot
benefit if the RN is competitive
Can be intimidating for RN’s who are less
skilled and knowledgeable
Modular Nursing (District Nursing)

This is a modification of team and primary
nursing. It is a geographical assignment of
patient that encourages continuity of care by
organizing a group of staff to work with a
group of patients in the same locale
The case manager
Advantages:


Useful where there are few RN’s
RN’s plan their care
The case manager may help the family to
identify all the options for care and
treatment, ask questions to obtain greater
understanding of the overall problem, and
work with the family in the decision-making
process. The private case manager is paid by
the client or family usually based on the hours
of service provided

The case manager role requires not only
advanced nursing skills but also managerial
and communication skills professional nurse
assigned responsibility for this process

Follow the patient from the diagnostic phase
through hospitalization, rehabilitation and
back to home care
Advantages:
Disadvantages:


For the nurse
Paraprofessionals do technical aspects of
nursing care.
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Enhancing nurse’s professional development
and job satisfaction
-
Facilitating the transfer of knowledge or
expert clinical staff novice staff
Assists with decision-making by ensuring that
plans are made in advance for the next
needed step, and helps to ensure that the
patient receives care that will achieve the
most positive outcomes in the most efficient
manner. This process helps to eliminate costly
delays in progress.

Advantages:





Nurses are allowed to work in specialized roles
for which they were educated, leading to greater
career satisfaction
Disadvantages:
Critical pathway

Successful case management relies on the
critical pathways to guide care. The term
critical path, also called a care map. Refers to
the expected outcomes and care strategies
developed by the collaborative practice team.
It provide direction for managing the care of a
specific patient during a specified time period.
Comprehensive pre-printed standard plan
reflecting ideal course of treatment for
diagnosis or procedure especially with
relatively predictable outcomes
The critical pathway may need to be revised
or additional data may be needed before
changes are made

Nurses who have experience, knowledge and
capability to function beyond their original
education may not be recognized
Organizations that have determined minimal
educational requirements for RN positions may
have difficulty in recruiting staff with the
requisite credentials
Clinical Nurse Leader Model

Advantages:



Accommodate unique characters and
conditions of patient
Reduce costs and length of stay
Use appropriate sources
Disadvantages:


The critical pathway may need to be revised
or additional data may be needed before
changes are made
The critical path must induce a means to
identify variances easily and to determine
whether the outcome has been met
This was developed with the goal to improve
the quality of patient care across the
continuum and as a way to engage highly
skilled clinicians in outcome-based practice
and quality improvement. The CNL has
responsibilities including designing,
implementing, and evaluating patient care by
coordinating, delegating, and supervising the
care provided by an inter professional team.
The nurse in this role is the leader in the
healthcare delivery system and is not in an
administrative or managerial role The CNL is a
provider and coordinator of care and fosters
inter professional and intra professional
communication.
Synergy Model for Patient Care

Differentiated practice

Nursing competencies are generally measured
in three areas; technical skills, communication
and management of care or leadership skills
Is a method that sorting nursing practice
roles, function and work based on education
experience, and competence or some
combination of them
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the model was originally developed for critical
care units, it has been used in a variety of
clinical settings. This model includes eight
patient characteristics (resiliency,
vulnerability, stability, complexity, resource
availability, participation in care, participation
in decision making, and predictability, and
eight nursing characteristics or competencies
derived from patient’s needs (clinical
judgment, advocacy and moral agency, caring
time and effort. Informal structure is also
useful when the formal structure becomes
non-effective.
 The communication network used in informal
structure is known as grapevine. This is
considered to be the heart of the informal
organization as these are communications
that occur in the break room, down the halls,
during the carpool, and in between work that
allows relationships of informal groups to
develop.
practices, collaboration, systems thinking,
response to diversity, facilitation to learning,
and clinical inquiry).
Transforming Care at the Bedside

The goal of this model is to empower nurses
and other healthcare team members to
redesign work processes to improve the
quality of patient care and decrease turnover.
Five themes comprise the TCAB model of
care: transformational leadership, safe and
reliable care, vitality and teamwork, patient
centered care, and value-added care
processes
Terminologies
Patient- and Family-Centered Care Model


This model places an emphasis on
collaborating and planning care with patients
(and their families) of all ages, at all levels of
care, and in all healthcare settings (Conway,
2006). In the patient-focused care, the RN is
the coordinator and planner of care who
brings as many care services to the patient as
possible; in patient- and family-centered care,
the patient has control over his or her care,
and all health-care decisions are made with
the RN as a collaborator in his or her care.




FORMAL AND INFORMAL ORGANIZATIONAL
STRUCTURE

 In formal structure, managerial authority,
responsibility, and accountability is clearly
defined. Roles and functions are outlined,
people have specific task to perform, and rank
and hierarchy are apparent. Informal
structure, according to Education Portal
(2003-2013), is the channel “that fills in the
gaps with connections and relationships that
illustrate how employees network with one
another to get the work done.”
 As supported by Schatz (2013) informal
structures are typically centered on
camaraderie and often produce direct
response from individuals, saving people’s
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Patient classification systems - also known as
workload management or patient acuity tools
Case method nursing or total patient care
nursing – oldest form of patient care
organization and is still widely used today
Functional nursing – the modality of care that
requires the completion of specific tasks by
different nursing personnel
Team nursing – typically uses a nurse-leader
who coordinates team members of varying
educational preparation and skill sets in the
care of a group of patients
Modular nursing – uses mini-teams, typically
an RN and unlicensed health-care workers, to
provide care to a small group of patients,
usually centralized geographically
Primary care nursing – one health-care
provider (typically the RN) has a 24-hour
responsibility for care planning and
coordination
Case management – a collaborative process
that assesses, plans, implements, coordinates,
monitors, and evaluates opinions and services
to meet an individual’s health needs through
communication and the use of available
resources to promote quality and costeffective outcomes
Accountability – taking full responsibility for
the quality of work and behavior while
engaged in the presence of the profession.
Authority – the right to act or make decisions
without approval of higher administrators. It
includes the right to extract obedience from
subordinates. In government hospitals, flow


of authority is from the Chief of Hospital
down to the Heads of the various Divisions
such as the Administrative Officer, the Chief
of the Nursing Division, and the Chief of
Clinics.
Communication – the transmission of
information between persons.
Power – the ability to influence another to
behave in accordance with one’s wishes.
This goal blended well with the goal of the ILO
project to improve Nursing Education and practice
through the dissemination of materials and
training of nurses. Specifically the project aims to:
1. Establish the team and system for
implementing the project,
2. Develop and implement the training design
and materials aligned with the revised
NNCCS competencies,
3. Pilot the training course in Luzon, Visayas
and Mindanao,
4. Recommend strategies to address
sustainability concerns.
MODULE 3
National Nursing Care Competency Standards
(NNCCS)
SIGNIFICANCE:
 The development of the NNCCS for nursing
practice started in 2001 through the initiative
of the Professional Regulation Commission Board of Nursing (PRC-BON) which created a
National Task Force for Core Competency
Standards Development
 In the foreword of the 2012 NNCCS,
Professional Regulation Commission Chair T.R.
Manzala stated: “Out of this lengthy process
emerged the Revised Nursing Core
Competency Standards, emphasizing the
three roles of the nurse: Beginning Nurses’
Role on Client Care, Beginning Nurses’ Role
on Management and Leadership and
Beginning Nurses’ Role in Research as well as
four types of clients of the nurse. With the
promulgation of the 2012 NNCCS, the
succeeding stage is its implementation and
evaluation in both nursing education and
nursing service in all settings. This will be a
collaborative activity of all partners of the
PRC-BON.
 This collaboration materialized when the
Commission on Higher Education (CHED)
obtained a grant from the International
Labour Organization (ILO). This project
entitled “Nursing Core Competencies for
Master Trainers in Nursing Education and
Practice” is the initial step in the
implementation of the 2012 NNCCS.




Basic Nursing Education Program in the
Philippines through CHED
Competency-based test framework
development of course syllabi and test
questions for “entry level” nursing practice in
the board licensure examination for nurses
Standards of professional nursing practice in
various setting in the Philippines
All related evaluation tools in various practice
settings in the Philippines
10 KEY PHASES:
Phase 1 – Work Setting scenario
Phase 2 – Validation studies of roles and
responsibilities/Benchmarking
Phase 3 – Integrative review of outputs from the
validation strategies
Phase 4 – Core competency consensual validation
Phase 5 – Conduct of public hearing
Phase 6 – Promulgation of the revised and modified
core competency standards.
Phase 7 – Printing of the revised and modified core
competency standards.
Phase 8 – Training in the implementation of the
revised core competency standards.
Phase 9 – Implementation of the revised core
competency standards.
GOALS AND OBJECTIVES OF THE PROJECT
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Phase 10 – Evaluation of effectiveness of the revised
core competency standards
Patient Care Safety Standards

Keeping patients safe: Transforming the Work
Environment of Nurses made it explicit that
nurses are the healthcare service professional
most likely to intercept errors and prevent
harm to patients.

Given the role that nurses play in care and
quality improvement, it is important for
nurses to know what proven techniques and
interventions they can use to enhance patient
and organizational outcomes


formulate standards of what is expected
from health providers; communicates;
provide training;
 enforce the standards that comes with
the policies and give the patients a
voice through a feedback system or a
patient satisfaction survey
3. Reporting System
The National Patient Safety Committee shall
develop and institutionalize a pro-active
reporting and learning system that requires its
leadership to encourage reporting of events
4. Feedback and Communication Performance
feedback and benchmarking mechanism

Safety in healthcare organizations aims to
prevent harm to patients, their families and
friends, healthcare professionals, contract of
service workers, volunteers, and the many
other individuals whose activities bring them
into an environment.
Safety is one aspect of quality where quality
includes not only avoiding, preventable harm,
but also making appropriate care available
providing effective services to those who
could benefit from them and not providing
ineffective or harmful services.
KEY ELEMENTS OF PATIENT SAFETY
1. Leadership
 Leadership and political commitment are
essential at the health facility level
where patient safety becomes an
integral component of quality care
The Leadership shall address strategic
priorities for institutional development.
 Its culture and infrastructure, engage its
various stakeholders, communicate and
build awareness.
2. Institutional Development
Approaches to institutionalize patient safety
and quality in the health facilities will have to
consider the following:
 financial and human resource;
 facility and equipment management;
 strengthen management responsibility,
 authority and competency;

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to communicate leadership responses
to the reports shall be established
to demonstrate commitment
to patient safety and ensure continuous
improvement.
5. Adverse Event Prevention and Risk
Management
 Risk and reduction strategies thorough
patient
 Risk assessment,
 patient feedback survey health
technology assessment and safety
assessment code
6. Disclosure of Reported Serious Events
 The reporting system ensures
confidentiality of individual cases.
 The events can be made available to the
public through - disclosure of results of
investigation, - summary reports or
annual reports that summarize events
and actions taken
7. Professional Development




Training and supervision of the
healthcare staff to improve their
decision and clinical judgments is
imperative.
 It is necessary to instill standard norms
of behavior of courtesy, promptness
and efficiency among the healthcare
workers and improve the quality of
service given to patients.
8. Patient Centered care and Empowerment of
Consumers

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
Nurses and Doctors are bombarded
with information and urgent tasks
throughout the day without checklist,
scheduled, and other methods of
monitoring task, it would be nearly
impossible to keep track of
everything.
 Reporting incidents and learning from
them is critical to implementing staff
safety.
 For example unintentional exposure
to aggressive substances is taken less
seriously than needle stick injuries
3. Optimize staff scheduling
 Hospital management faces many
challenges – two of the most areas,
finding enough qualified people to fill
their teams.
 When hospital teams are
understaffed, employees are
overworked, and the risk of safety
incidents increase.
 While management needs to control
labor costs for hospitals to remain
profitable, there needs to be a
balance between minimizing cost and
maximizing staff safety.
4. Improve patient handling
 Moving and handling patients can be
one of the most physically demanding
aspects of healthcare professions.
 Dependency of patients on nursing
staff (2) increases and equipment gest
more complex, patient-handling
methods form the past might not be
as effective today.
5. Use safer medical equipment Medical device
is quickly improving, and recent innovations,
eliminate health risks that plagued staff and
patients in the past.
 Improving Infection Control
 Helping prevent needlestick injuries
 Reducing medication errors (by
reducing stopcock manipulations)
 Increasing protection against
exposure to blood and drugs
 Minimizing disconnections, air
embolism and misconnections
Patients must be at all centers of
patient safety initiatives and must be
partners in all aspects of the process.
Patient centered care and patient safety
is a national priority and a core agenda to improve quality care in all health - to
protect patients, form faulty system

Importance of Safety in Healthcare
1. Improve patient satisfaction and clinical
outcomes.
2. Ensure accuracy of patient’s identification.
3. Enhance the effectiveness of communication
among healthcare personnel.
4. Improve the safety of using medications.
5. Reduce the risk of healthcare associated
infections
6. Reduce the risk of harm resulting from
injuries.
7. Improve staff productivity and retention rate.
8. Increase awareness of occupational health
and environmental control like ergonomicallydesigned workplace.
9. Workers must be trained to. Workers also
must be convinced why it is important to pay
attention to prevention and be educated
about the benefits in terms of reduced pain
and discomfort of adopting good practices
and work methods.
10. A strong ergonomics integration prevents
injuries and increases productivity. Together,
they make the workplace safer and reduce
costs.
5 Ways to Improve Staff Safety in Healthcare
1. Promote a culture of safety
 Company culture heavily influences
the general attitude of a working
environment.
 Hospitals that place a big emphasis on
staff safety are more likely to prevent
incidents because safety is aligned
with professionalism in the
workplace.
2. Measure the performance of safety protocols
 One of the fundamental practices that
make hospitals as effective as they
are is the use of record keeping.
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Nursing Actions to Improve Patient Safely
1. Knowledge and implementation about
healthcare policies and procedures.
2. Open communication and teamwork among
all other healthcare providers.
3. Review the medication rights before giving
the medications.
4. Engage in creating and updating reporting
system to avoid a blaming culture,
5. Involve in research and evidence-based
activities for better decision making.
6. Be updated on all life-saving certification like
CPR, BLS, ACLS, PALS, NALS and other Nursing
Specialty Certification Programs.
7. Engage in hospital committees to make the
healthcare system safe, effective and patientcentered.
8. Be responsible in reporting all errors and near
misses not only for the patient to prevent
sentinel and adverse events to happen again.
9. Ensure better lighting and less clutter in the
work areas.
The registered nurse collects comprehensive
data pertinent to the healthcare consumer’s
health and/or the situation.
standard 2. diagnosis

The registered nurse analyzes the assessment
data to determine the diagnoses or the issues.
standard 3. outcomes

identification The registered nurse identifies
expected outcomes for a plan individualized
to the healthcare consumer or the situation.
standard 4. planning

The registered nurse develops a plan that
prescribes strategies and alternatives to attain
expected outcomes.
standard 5. implementation



Standards of Professional Nursing Practice (American
Nurses Association, 2015)
The Standards of Practice describe a competent level
of nursing care as demonstrated by the critical
thinking model known as the nursing process. The
nursing process includes the components of
assessment, diagnosis, outcomes identification,
planning, implementation, and evaluation.
Accordingly, the nursing process encompasses
significant actions taken by registered nurses and
forms the foundation of the nurse’s decision-making.


The registered nurse implements the
identified plan.
standard 5a. coordination of care The
registered nurse coordinates care delivery.
standard 5b. health teaching and health
promotion The registered nurse employs
strategies to promote health and a safe
environment.
standard 5c. consultation The graduate-level
prepared specialty nurse or advanced practice
registered nurse provides consultation to
influence the identified plan, enhance the
abilities of others, and effect change.
standard 5d. prescriptive authority and
treatment The advanced practice registered
nurse uses prescriptive authority, procedures,
referrals, treatments, and therapies in
accordance with state and federal laws and
regulations.
standard 6. Evaluation

The registered nurse evaluates progress
toward attainment of outcomes
standard 7. ethics
standard 1. assessment

The registered nurse practices ethically.
standard 8. education
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Terminologies
The registered nurse attains knowledge and
competence that reflects current nursing
practice.

standard 9.

Evidence-based practice and research The
registered nurse integrates evidence and
research findings into practice.


standard 10. Quality of practice

The registered nurse contributes to quality
nursing practice.


standard 11. communication

The registered nurse communicates
effectively in all areas of practice.
standard 12. leadership

the registered nurse demonstrates leadership
in the professional practice setting and the
profession.


standard 13. collaboration

The registered nurse collaborates with
healthcare consumer, family, and others in
the conduct of nursing practice.
MODULE 4
standard 14. professional practice evaluation

The registered nurse evaluates her or his own
nursing practice in relation to professional
practice standards and guidelines, relevant
statutes, rules, and regulations.
Code of Ethics for Filipino Nurses
Code of Good Governance

standard 15. resource utilization

The registered nurse utilizes appropriate
resources to plan and provide nursing services
that are safe, effective, and financially
responsible.
standard 16. environmental health

Effective - providing services based on
scientific knowledge to all who could benefit
and refraining from providing services to
those not likely to benefit.
Efficient - avoiding waste, including waste of
equipment, supplies ideas and energy
Equitable - providing care that does not vary
in quality because of personal characteristics
such as gender, geographic location and
socio-economic status (IOM, 2001).
Patient-Centered - providing care that is
respectful of and responsive to patient
preferences, needs, values and ensuring that
patient values guide all clinical decisions.
Patient Safety - is defined as “the prevention
of harm of patients through the prevention,
avoidance of risk, adverse outcomes, or
injuries stemming from the process of
healthcare. It is the degree to which the risk
of an intervention and risk in the care
environment are reduced for a patient and
other people, including healthcare providers.
Safety - avoiding injuries to patients from the
care that is intended to help them.
Timely - reducing waiting time and sometimes
harmful delay for both those who receive and
those who give care.

Promulgated by the professional Regulation
Commission on July 23, 2003 states that the
hallmark of all professionals is their
willingness to accept a set of professional and
ethical principles which they will follow in the
conduct of their everyday lives.
To cover an environment of good governance
in which all Filipino professionals shall
perform their duties.
General Principle
1. Service to others
- A commitment to a life of sacrifice and
genuine selflessness in carrying out their
professional duties.
The registered nurse practices in an
environmentally safe and healthy manner.
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2. Integrity and Objectivity
- To perform responsibilities with the
highest sense of integrity with nationalism
and spiritual values.
3. Professional Competence
- Undertaking only those professional
service they can reasonably deliver.
4. Solidarity and Teamwork
- Maintain and support one professional
organization for all its members
5. Social and Civic Responsibility
- Always carry out their professional duties
with due consideration of the interest of
the public.
6. Global Competitiveness
- Remain open to the challenges of a more
dynamic and interconnected world, rise
up to global standards.
7. Equality of All Professionals
- All professionals shall treat their colleague
with respect and strive to be fair in their
dealings with one another.
 The professional COE for Filipino nurses
provide direction for nurses to act morally.
 In 1982, the PNA, under the chairmanship of
Dean Emeritus Julita V. Sotejo, developed a
COE for Filipino Nurses.
 In 1984, the BON, PRC adopted COE of the ICN
through Board Resolution No. 633 adding
“Promotion of Spiritual Environment”, it was
enforced up to 1989.
 In 1989, The COE promulgated by the PNA
was approved by the PRC through Board
Resolution No. 1955.
Importance of Ethics:
1. Ethics may clear why one’s act is better than
the other.
2. Ethics keep an orderly social life by having
agreement, understanding, principles of rules
or procedure
3. Ethics seeks to point out to men the true
value of life and inspire men to gain values
Concepts of Nursing Ethics:
1. Nursing practice is predicted on the ideals of
service
2. Nursing practice is premised on personal
sacrifices and devotion to duty for the benefit
of the people
3. Primary objective is to render satisfactory
professional service
4. A nurse must be devoted to her professional
duties and have genuine concern in the
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advancement of her profession for public
health welfare.
5. The nurse has the obligation to uphold the
noble traditions of the profession.
Amended COE for Nurses:
 Pursuant to Sec. 3 of R.A. 877, and P.D No.
233, the amended COE for nurses
recommended and endorsed by the PNA was
adopted to govern the practice of nursing in
the Philippines
 A new COE for RN has been promulgated by
the BON, in coordination and in consultation
with PNA. IN its formulation, the Code of
Good Governance for professions was
adopted and integrated, as they apply to the
nursing profession
Article I – Preamble
Sec. 1
- Health is a fundamental right of every
individual
Sec. 2
- RN have to gain knowledge and
understanding of man’s cultural, social,
spiritual aspects of illness, utilizing the
therapeutic process
Sec. 3
- The desire for the respect and confidence of
client, colleagues, etc.
Article II – RN and People
RN must:
a) Consider the individuality and totality of
patients when they administer care.
b) Respect the spiritual beliefs and practices of
patients.
c) Uphold the rights of individuals
d) Take into consideration the culture and values
of patients in providing nursing care
e) Should promote learning for the client
f) Expected to be more compassionate to the
client than the physician.
g) Responsible to give facts and information to
the client & family
Article III – RN and Practice
RN must:
a) Know the definition and scope of nursing
practice
b) Be aware of their duties and responsibilities in
the practice of their profession
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c) Acquire and develop the necessary
competence in SKA to appropriately render
nursing service
d) See to it that quality nursing care and practice
meet the optimum standard of safe nursing
practice
e) Nurses are advocates of the patients, they
safeguard their rights and privileges
f) Respect the patients’ bill of rights
g) Perform professional duties in conformity
with existing rules & Laws
h) Decline any gift or favor. Not demand &
receive commission
Article IV – RN and Co-workers
RN must:
a) Maintain their profession role / Identity while
working with other members of the health
team
b) Contribute with profession growth and
development of other members
c) Actively participate in professional
organization
d) Honor and safeguard the reputation and
dignity of the members of nursing and other
profession
e) Respect the rights of their co workers
f) Should be friendly and cordial to each other
g) Should avoid rivalry, and refrain from making
unfair criticism
Article V – RN and Society and Environment
 Preservation of life, respect for human rights
and promotion of healthy environment
 Establishment of linkages with the public in
promoting local, national and international
efforts to meet health and social needs of the
people
RN must:
a) Be conscious about their obligations as
citizens, be involved in community concerns.
b) Be equipped with knowledge of health
resources within the community and take
active roles in primary health care.
c) Actively participate in programs, projects, and
activities that responds the problem of the
society
d) Lead their lives in proper conformity with the
principles of right conduct.
e) Project and image that would uplift the
nursing profession at all times.
Contracts, Wills, and Consent
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

A CONTRACT is a meeting of minds between
two persons whereby one binds himself, with
respect to the other, to give something or to
render some service.
A contract is a promise or a set of promises
which the law recognizes as a duty and when
that duty is not performed, the law provides a
remedy.
When a nurse enters into a contract with an
employer, it is usually an agreement to be
paid a certain amount of money and be
provided certain benefits in exchange for such
services.
Kinds of Contracts
1. Formal Contract
 Refers to an agreement among parties
involved and is required to be in writing by
some special laws.
 Examples are marriage contracts, mortgages,
and deeds of sale or work contracts
2. Informal Contract
 Is one which is concluded as the result of a
written document or correspondence where
the law does not require the same to be
written, or as the result of oral and spoken
discussion between the parties or conduct
between the parties, evidence and intention
to contract.
3. Voidable Contract
 An agreement which is enforceable by law at
the option of one or more of the parties
thereto, but not at the option of the other or
others, is a voidable contract.
 A contract is voidable when one of the parties
to the contract has not exercised his free
consent. One of the essential elements of a
formation of a contract for example, free
consent, is absent.
 All voidable contracts are those which are
induced by coercion fraud or
misrepresentation. The person whose consent
is not freely given may avoid a contract. It
therefore continues to be valid till the party
whose consent is caused by coercion, undue
influence, fraud or misrepresentation choose
to avoid the contract within a reasonable
time. Contract then is not binding on the
other party.
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8. Express Contract -When the terms of a
contract are reduced in writing or are agreed
upon by spoken words at the time of its
formation, the contract is express.
 An example of this is usually found in formal
contracts wherein the kind of services
offered, salary, date and time of effectivity
including fringe benefits, if any, are specified.
 If a private duty nurse is asked by a physician
to go on special duty for his patient and the
patient himself and his relatives do not object
to the service, it is implied that the private
duty nurse will be paid under the doctrine of
facio ut des which means ”I do that you may
give.”
9. Implied Contract -The terms of a contract are
inferred from the conduct or dealing between
the parties. When the proposal or acceptance
of any promise is made otherwise than in
words, the promise is said to be implied.
 Such an implied promise leads to an implied
contract.
 Example: A boards a bus. It is implied from his
conduct that A has entered onto an implied
promise to purchase a ticket.
10. Quasi-Contract
 Certain relations resemble those created by a
contract. Certain obligations which are not
contracts in fact but are so in the
contemplation of law.
 A’ supplies necessity to ‘B’ who is not capable
of contracting and reimbursing to ‘A’. A is
entitled to be reimbursed from B’s property.
4. Void Contract
 Contract which ceases to be enforceable by
law becomes void, when it ceases to be
enforceable.
 A void contract is a nullity from its inception.
No rights accrue there under.
 A contract may also be originally valid when
entered into but subsequently due to change
in the events or circumstances, it may become
void. It should be noted that there cannot be
a void contract because when the contract is
void, it is no contract at all. The right
expression therefore is void agreement and
not void contract
5. Unenforceable Contract -A contract which
cannot be enforced is a valid contract in law,
but is incapable of proof, and therefore
cannot be enforced in the Court of Law.
 Lack of capacity- It’s expected that both (or
all) parties to a contract have the ability to
understand exactly what it is they are
agreeing to
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Duress
Undue influence
Misrepresentation
Nondisclosure
Unconscionability
Public policy
Mistake
Executed Contract -Where both the parties
have performed their obligation, it is an
executed contract. Even when one party to
the contract has performed his share of the
obligation, the contract is executed through
to the other party is still under an outstanding
obligation to perform his part of the promise.
7. Executory Contract
 Here neither party to the contract has
performed his share of the obligation, for
example, both the parties have yet to perform
their promises, the contract is executory.
 In an executed contract one party has already
performed his part of the agreement while
the other party has to perform his par.
 In an executory contract both the parties have
to perform their mutual promises and the fact
that they have to perform their parts of the
contract does not affect the validity of the
contract.
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Quasi contracts raise out of obligation
enjoyed by one person from the voluntary
acts of the other which are not intended to be
performed gratuitously
Example: a person orders perishable items
online by providing his address and paid for
the same. At the time of the delivery of the
goods, the delivery man delivers it to the
wrong address. The receiving party then,
instead of denying the delivery, accepts the
order and consumes the same
The case went to the court and then the court
ordered to issue a quasi-contract according to
which the recipient has to pay back the cost
of the item to the party who the person who
paid for the item initially. So, in this case, the
benefits of the goods have been enjoyed by
the receiving party so such a receiving party is
bound to give compensation to the former
party.
11. Contingent Contract -A contingent is one in
which a promise is conditional and the
contract shall be performed only on the
happening of some future uncertain even
 ‘A’ contracts to pay B Rs 10,000, if B’s house is
burnt. This is a contingent contract
 For example: a contingency fee agreement
most common in a personal injury lawsuits
may sate that the attorney’s fee will be 30%
of all funds recovered or, alternatively, 33%
after all expenses of the case are paid
REQUISITES OF A CONTRACT
1. To have a contract, two or more persons must
participate.
2. The parties involved must give consent to the
contract.
3. The object which is the subject matter of the
contract must be specified such as:
a. all things which are not outside the
commerce of man;
b. all rights which are not in transmissible;
c. future inheritance in cases expressly
authorized by law; and
d. all services which are not contrary to law,
morals, good customs, public order, and
public policy.
4. The cause of obligation is established. The
time, price, and subject matter are expressed.
Generally, the length of time of a contract for
services is at least equal to the period for
which wages or salaries are payable. Thus, if
one is engaged on yearly rates, the length of
time of the contract will be at least one year.
5. Contracting parties must have the legal
capacity to enter into a contract. They must
a. be of legal age;
b. be of sound mind;
c. not be under the influence of
intoxicating drugs, or fear of bodily
harm; and. not be suffering from physical
disability such as those who are mentally
incompetent.
 Married women have the full
capacity to go into a contract except
in some cases when it is specified
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that the husband should agree to
such a contract.
Examples are in selling or
mortgaging of property. Married
female nurses will need written
consent from their husbands if they
are going to work abroad.
INEXISTENT CONTRACT
The following contracts are void or inexistent from the
beginning.
 Those whose cause, object or purpose are
contrary to law, morals, good customs, public
order or public policy
 Those whose cause or object did not exist
from the time of transaction.
 Those whose object is outside the commerce
of man.
 Those which contemplate an impossible
service.
 Those were the intention of the parties
relative to the principal object cannot be as
certain
 Those expressly prohibited or declared void
by law.
 Those which are absolutely simulated or
fictitious.
VOIDABLE CONTRACTS
The following contracts are voidable or annullable,
even though there may have been no damage to the
contracting parties.
 Those contracts wherein one of the parties is
incapable of giving consent to a contract.
 Those whose consent is vitiated by mistake,
Violence, intimidation, undue influence or
fraud.
ILLEGAL CONTRACTS
Contracts obtained through use of fraud (deception
and trickery,) undue (unlawful) influence or duress
(coercion) in securing such, and those that are
expressly prohibited by law are illegal. Following are
examples of illegal contracts:
1. Those that are made in protection of the law.
If a nurse proceeds or administer intravenous
injection without special training and
according to protocol established, she/he
violates RA 9173, the Philippine Nursing Act of
2002,
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2. Consent obtained by fraud. If a nurse
obtained the consent of a patient or the
family to be given services, through
misrepresentation that she/he is licensed
although she/he is not, such a contract is
illegal.
3. Those obtained under duress. Duress means
actual or threat of violence or imprisonment
in order to obtain consent. A nurse may be
forced to sign a contract under threat of
dismissal.
4. Those obtained under undue influence. If a
nurse who has been taking care of an elderly
patient uses her close relationship to acquire
high salary or other options as property, such
contract is invalid as it is illegal.
5. Those obtained through material
misrepresentation. Aside from fraud,
material misrepresentation may permit a
person to avoid or cancel a contract. Suppose
a midwife applied as nurse in an agency
and was soon found not to be a
registered nurse, the contract that she
signed becomes illegal because she misled the
employer that she is a nurse.
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ADVANTAGES OF WRITTEN CONTRACTS
Many nurses fear written contracts. The following are
the advantages of written contracts over oral ones.
 A written contract is certain. It avoids the
uncertainty of human memory.
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BREACH OF CONTRACT
Breach of contract is failure to perform an agreement,
whether expressed or implied, without cause. The
following constitute breach of contract for nursing
services:
 prevention of performance;
 failure to perform because of inconvenience
or difficulty; failure of cooperation in
performance;
 abandonment of duty (i.e., leaving
unconscious patients,
 going off-duty without endorsement, loafing
While on duty);
 substitution of performance; and
 failure to use due care.
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LEGAL EXCUSES IN REFUSING, NEGLECTING OR
FAILURE TO PERFORM A CONTRACT
Following are legal excuses in refusing, neglecting or
failure to Perform a contract:
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discovery of material misrepresentation made
and relied upon;
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where performance would be illegal; where
performance is made impossible by reason of
illness;
where performance is made impossible by
death of patient or nurse;
where performance is made impossible by
death of patient or nurse;
where performance is made for other
reasons; and
where contract is insufficient.
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It can specify a definite time within which it is
binding so as to protect both sides against
sudden changes without notice. It also fixes a
time limit after which conditions are no longer
binding but may be opened for discussion.
It sets a standard and relieves an individual
professional person from haggling over
compensation. It is more likely to be open and
well-known so that the use of written
contracts tends to establish minimum
standards for professional practitioners and to
protect them against discrimination in
compensation.
It is definite and can be definite on many
details which may otherwise stimulate
favoritism or caprice even among
professionals, such as hours of work, vacation
allowances, holiday privileges, health and
insurance provisions.
It can provide a definite procedure in case of
complaints about substandard work, so that
the employer has a clear course and the
professional nurse has protection against
arbitrary action.
It creates a minimum of certainty and security
for the professional employee so that he/she
is free to concentrate on his/her work without
concern for the details which the written
contract has settled.
Definite commitments stipulated in a contract
are hours of work and salary, length of time of
contract, days of off duty, details of duties
and responsibilities including the course to be
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taken in case of non-fulfillment of the terms
of contract
WILL
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Is a legal declaration of person’s intentions
upon death?
It is called a testamentary document because
it takes effect after the death of its maker
It is an act whereby a person is permitted with
the formalities prescribed by law, to control
to a certain degree the deposition of his
estate, to take effect after his death.
Kinds of Will
1. Holographic Will
 Must be entirely written, dated, and signed by
the hand of the testator himself.
 In the probate of a holographic will, it is
necessary that at least one witness who
knows the handwriting and signature of the
testator explicitly declares that the will and
the signature are in the handwriting of the
testator.
2. Oral Wills, Nuncupative Wills, Deathbed
Wills
An Oral Will is spoken/oral, rather than
written. This type of Will is usually made
before witnesses. The Testator will say out
loud to someone else how he/she wants
his/her property and assets to be distributed
after death.
3. Nuncupative Will or noncupation
 An Oral Will that have at least two witnesses
and meets specific statutory guidelines.
 Restrictions to the oral will are that such will
be made during the person’s last illness, that
it be done in the place in which he died, that
he asked one more witnesses to the will, that
the will be put in writing within a given
number of days, and that it be offered to:
probate within a specified time.
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TESTAMENTARY CAPACITY AND INTENT
Following are the essentials of will to meet legal
requirements:
 The testator must have the expressed
intention of making a will. He must be of the
right age. A person under 18years of age
cannot make a will. He is required to be of
sound mind and must be free from undue
influence.
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Terminologies:
1. Decedent
 Is a person whose property is transmitter
through succession whether or not he left a
will
2. Testator
 Is the deceased person who made a last will
and testament
Testatrix
If the person making a will is a woman
Heir
Is a person called to succession either by the
provision of a will by operation of law
Testate
Having made a valid will before one dies
Intestate
One who dies without a will
Probate
Is a special proceeding to establish the validity
of a will. Probate is mandatory, which means
that no will passes either real or personal
property unless it is proved and allowed in a
proper court
Administrator
One who administers the provision of the will
The testator shall name the person who will
be in charge of carrying out the provisions of
the will.
Properties must be disposed of in accordance
with legal requirements.
The will must be signed by the testator,
attested, and signed by at least three
witnesses in his presence and of one another.
Every will must be acknowledged before a
notary public by the testator and witnesses.
Witnesses to the wills shall be of sound mind,
18 years of age or more, not blind, deaf or
dumb, and able to read and write.
A married woman may make a will without
the consent of her husband and without the
authority of the court.
THE NURSE’S OBLIGATIONS IN THE EXECUTION OF A
WILL
 They should note the soundness of the
patient's mind (that he/she understood the
act of making a will) and that there was
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freedom from fraud or undue influence
(he/she was not induced to make someone
the beneficiary of the will) and that the
patient was above 18 years of age.
He/she should note that the will was signed
by the testator, that the witnesses were all
present at the same time and signed the will
in the presence of the testator.
GIFTS
Another way of disposing of property, aside from
executing a will is by gifts.
 The gift must consist of personal property
 There must be an intention to make the gifts;
 There must be an indication of transfer of
control over such property; and
 There must be acceptance by the recipient
 Gifts made by a person because of
anticipation of death or belief in approaching
death are called gifts causa mortis or donation
causa mortis.
LEGAL PROCEDURE AND TRIAL
 In a trial, the judicial procedure is to ascertain
facts by hearing evidence, determine which
facts are relevant, apply the appropriate
principle of law, and pass judgment.
COMMENCEMENT OF THE ACTION
 The first step in the trial process is to
determine what kind of legal action to take. If
the action relates to negligence, the correct
action would be negligence; and if it related
to contract, the proper action would be for
breach of contract.
STATUES OF LIMITATION
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Complaint must be made within a specific
time or the right to complain may be lost
forever. There is a time limit in filing cases
because witnesses become less reliable after
passage of time.
Claims for negligence or malpractice vary
from two (2) to three (3) years. In criminal
cases, statutes of limitation vary from two (2)
to six (6) years except in cases where murder
is committed in which there is no time limit.
PLEADING
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Each party presents a statement of facts or
pleading to the court. First pleading is
generally known as the complaint or petition.
In less serious crimes known as misdemeanor,
these pleadings are called complaints while in
crimes of more serious nature known as
felonies, the pleadings are called indictments.
FUNDAMENTAL REQUIREMENTS OF DUE PROCESS
 SEC 12.
 Any person under investigation for the
commission of an offense shall have the
right to be informed of his right to remain
silent and to have competent and
independent counsel preferably of his own
choice.
 No torture, force, violence, threat,
intimidation, or any other means which
vitiate the free will shall be used against
him
 Any confession or admission obtained in
violation of these or section 17 here of
shall be inadmissible in evidence against
him
 The law shall provide for penal or civil
sanctions for violations of this sections as
well as compensation to and rehabilitation
of victims of torture or similar practices,
and their families.
 SEC 13
 All persons, except those charged with
offenses punishable by reclusion perpetua
when evidence of guilt is strong, shall,
before conviction, be baliable by sufficient
sureties, or be released on recognizable as
may be provided by law. The right to bail
shall be impaired even when the privileged
of the writ of habeas corpus is suspended.
Excessive bail shall not be required.
 SEC 14
 No person shall be held to answer for a
criminal offense without due process of
law
 In all criminal prosecutions, the accused
shall be presumed innocent until the
contrary is proved
PRE-TRIAL PROCEDURES
 This is an informal discussion between the
judge and attorney to eliminate matters not
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in dispute, agree on issues, and settle
procedural matters relating to the trial. Cases
are often settled at this point.
TRIAL
 At the trial, facts of the case are determined,
the principles of law relating to those facts are
applied and a conclusion as to liability is
reached. The judge determines the facts and
applies the law.
WITNESS
The necessity of testimony by any person in a legal
proceeding is determined by the attorneys for the
parties.
 Subpoenaa court summons is served directing
a witness to appear and give testimony on the
date and time ordered.
 Subpoena duces tecum is served to a witness
requiring him to bring records, papers, and
the like which may be in his possession and
which may help clarify the matter in issue.
She should testify only on what she knows
based on facts. This is called testimony of
facts.
 Testimony of opinion may only be given by
expert witnesses. An expert witness is one
who is qualified to testify based on special
knowledge, skill, experience, and training. She
should neither hesitate to say she does not
know, nor answer any question that might
incriminate her. This is known as the privilege
against self-incrimination.
 Dying declarations or ante-mortem
statements are considered hearsay evidence
except when made by a victim of a crime.
APPEALS
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An appellate court reviews the case, and
when the case is decided by it, the final
judgment results and the matter is ended.
EXECUTION OF JUDGMENT
 Generally, lawsuits against hospitals or
physicians and nurses involve recovery of
money damages. The defendant is compelled
to execute the judgment. Failure to obey will
be regarded as contempt of court and will
result in fine or imprisonment.
 Doctors should limit telephone orders to
extreme emergency situations where there is
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no alternative. The use of a telephone in a
non-emergency as a substitute for the
physician himself can lead to serious errors
and may border on malpractice.
Only in an extreme emergency and when no
other resident or intern is available should a
nurse receive telephone orders.
The nurse should read back such an order to
the physician to make certain the order has
been correctly received and written on the
patients' chart.
Such order should be signed by the physician
on his/her next visit within 24 hours. The
nurse should sign the name of the physician
on her own and note the time the order was
received. Should any problem arise, the order
should be referred back to the ordering
physician. It is safer that when a telephone
order is given, another resident physician or
intern in the same service receive it since the
latter can discuss with the former the actual
condition of the patient.
CONSENT TO MEDICAL AND SURGICAL PROCEDURES
 Consent
 is defined as a “free and rational act that
presupposes knowledge of the thing to
which consent is being given by a person
who is legally capable of giving consent.”
The consent signed by the patient or his
authorized representative/legal guardian
upon admission is for the initial diagnosis
and treatment.
 Nature of Consent
 Consent is an authorization, by a patient or
person authorized by law to give the
consent on the patient’s behalf, that
changes touching, for example, from nonconsensual to consensual.
 Informed Consent
 Hayt and Hayt state that “it is an
established principle of law that every
human being of adult years and sound
mind has the right to determine what shall
be done with his own body.
 Essential Elements:
 the diagnosis and explanation of the
condition
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 A fair explanation of the procedures
to be done and used and the
consequences of
 A description of alternative
treatments or procedures
 A description of the benefits to be
expected
 Material rights if any
 the prognosis, if the recommended
care, procedure, is refused
Proof of consent
 A written consent should be signed to
show that the procedure is the one
consented to and that the person
understands the nature of the procedure,
the risks involved and the possible
consequences.
Who Must Consent?
 Ordinarily, the patient is the one who gives
the consent in his own behalf. However, if
he is incompetent (minors or mentally ill)
or physically unable and is not an
emergency case, consent must be taken
from another who is authorized to give it in
his behalf.
Consent of Minors
 Parents or someone standing in their
behalf, Parental consent is not needed,
however, if the minor is married or
otherwise emancipated.
Consent of Mentally ILL
 A mentally incompetent person cannot
legally sign; consent must be taken from
the parents or legal guardian.
Emergency Situation
 No consent is necessary because inaction
at such time may cause greater injury.
Refusal to Consent
 A patient who is mentally and legally
competent has the right to refuse the
touching of his body or to submit to a
medical or surgical procedure no matter
how necessary, nor the imminent danger
to his life or health if he fails to submit to
treatment.
Consent for Sterilization
 The husband and the wife must consent
to the procedure if the operation is
primarily to accomplish sterilization.
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CHARTING DONE BY NURSING STUDENTS
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When a nurse or a clinical instructor
countersigns the charting of a nursing
student, he/she attests that he/she has
personal knowledge of information and that
such is accurate and authentic. Anyone who
countersigns without verification commits
herself to possible legal risks.
Criminal Liabilities and Legal Responsibilities of a
Nurse
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As Nurses starts to practice their profession,
Nurses liability has increased. Assuming
authority, responsibility, accountability for
their professional practice, professional
nurses increasingly are being subjected to
scrutiny by Boards of Nursing Representing
the law, the scope of nursing practice to
protect the public welfare. Nurses are also
increasingly being subjected to malpractice
lawsuits. When nurses become defendants in
legal actions, Other nurse serve as expert
witnesses both for the defense (representing
the practitioner) and the prosecution
(representing the plaintiff). Expert witnesses
testify to the standard of care required of the
health care provider and whether it was met.
For these reasons, professional nurses need
basic knowledge of the legal aspects of
nursing.
Responsibility and Accountability for the
practice of Professional Nursing Professional
nurses undertake to practice their profession,
they are held responsible and accountable
for the quality of performance of their duties.
Once they are employed in any institution, or
hospital are directly responsible to their
immediate supervisors. Private duty nurses,
being independent practitioners, are held to a
standard of conduct that is expected of
reasonably prudent nurses. A standard is the
desired and achievable level of performance
against which actual practice is compared.
Standards serve as benchmark against which
to plan, to implement and assess quality of
services and to show that nursing is
accountable to society, to consumers of
nursing services and to governments as well
 Defects in the equipment such as
stretchers and wheelchairs may lead to
falls thus injuring the patients
 Administration of medicine w/o a doctor’s
prescription
 Errors due to family assistance
as to the profession of nursing and individual
members, Venson, (2016).
PROFESSIONAL NEGLIGENCE AND MALPRACTICE
 Standard
 Desired and achievable level of
performance against which actual practice
is compared.
 Serves as benchmark against which to
plan, to implement and assess quality of
services
 Intentional Wrongs
 Tortious acts that a nurse may be held
liable which arise in performance of her
duties
 Negligence
 Refers to the commission or omission of
an act, pursuant to a duty, that a
reasonably prudent person in the same or
similar circumstances would or would not
do, and acting or the non-acting of which
is the proximate cause of injury to
another person or his property.
 If a person charged with negligence shows
that she meets or even surpasses this
standard, then there is no negligence or
carelessness. But if the defendant’s
action fails to meet the standard, then
there has been negligence.
Elements of professional Negligence
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Existence of a duty
Failure to meet the standard of due care
Foreseeability of harm
Injury to the plaintiff
Examples of Negligence
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Failure to report observations to attending
physicians
Failure to exercise the degree of diligence
which the circumstances of the particular case
demands
 Mistaken identity
 Wrong medicine, wrong concentration,
wrong route, wrong dose
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Civil Code, Article 19
 One shall act with justice, give every man his
due, and observe honesty and good faith.
Civil Code, Article 20
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Those who, in the performance of their
obligations through negligence cause any
injury to another are liable for damages.
3 conditions required to establish a defendant’s
negligence
 Injury was of such nature that it would not
normally occur unless there was a negligent
act on the part of someone
 Injury was caused by an agency w/in control
of the defendant
 Plaintiff himself did not engage in any manner
that would tend to bring about the injury
 Example:
 A patient came in walking to the outpatient clinic for injection. Upon
administering the injection tohis buttocks,
the patient experienced extreme pain.
His leg felt weak and he was subsequently
paralyzed. His sciatic nerve was injured.
 The presence of sponges in the patient’s
abdomen after an operation.
 Fracture on a newly-delivered baby born
by breech presentation.
DOCTRINE Of RES IPSA LOQUITUR “the thing speaks
for itself”
 The injury could not have happened if
someone was not negligent that no further
proof is required.
 Example: forceps left inside the abdominal
cavity after a TAHBSO procedure
MALPRACTICE
 Improper or unskillful care of the patient by a
nurse; also denotes stepping beyond one’s
authority with serious consequences
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Term of negligence of professional personnel
(Professional Negligence)
Used properly only when it refers to a
negligent act committed in the course of
professional performance
Example: Giving of Anesthesia by a nurse or
prescribing medicines.
DOCTRINE OF FORCE MAJEURE
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An Irresistible force, one that is unforeseen or
inevitable.
Under the Civil Code of the Philippines, no
person shall be responsible for those events
which cannot be foreseen, or which, though
foreseen, are inevitable, except in cases
expressly specified by law
Ex.floods, fire, earthquakes and accidents fall
under this doctrine and nurses fail to render
service during this circumstance are not held
negligent.
DOCTRINE OF RESPONDEAT SUPERIOR
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“Let the master answer for the acts of the
subordinate.”
The liability is expanded to include the master
as well as the employee and not a shift of
liability from the subordinate to the master
Example:
 The hospital will be held liable, if, in an
effort to cut down on expenses if decides
to hire under board nurses or midwives in
place of professional nurses, and these
persons prove to be incompetent.
 The surgeon will be held responsible in
case a laparotomy pack is left in a
patient’s abdomen.
Note: Private duty nurses, however, are
considered independent contractors. They
are liable for their own negligent actions.
LIABILITY FOR WORK OF NURSE TRAINEES AND
NURSE VOLUNTEERS
 Nurses are responsible and accountable for
their practice, nurse volunteers should
exercise utmost caution, critical thinking and
independent judgment to prevent incurring
liabilities which may be hard to get out of.
LIABILITY OF NURSES FOR THE WORK OF NURSING
AIDES
 Nurses should not delegate their functions to
nursing aides since the Philippine nursing act
specifies the scope of nursing practice of
professional nurses.
 Nurses are enjoined to supervise their
subordinates and see to it that they perform
only those which they have been taught to do
and those which they are capable of doing.
 Nursing aids are responsible for their actions
 Nurses should not delegate their functions to
nursing aides.
 Nursing aides perform selected nursing
activities under the direct supervision of
nurses.
LIABILITY FOR THE WORK OF NURSING STUDENTS




INCOMPETENCE
 Lack of ability, or legal qualifications and
being unfit to discharge the required duty. It
is a ground for the revocation and suspension
of her certificate of registration.
 Ex. A nursing assistant giving IV medication to
the patient.
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RA 9173 –nursing students do not perform
professional nursing duties.
Nursing students should be under supervision
of their clinical instructors.
In order that the errors committed by nursing
students will be avoided or minimized, the
following measures should be taken:
Nursing students should always be under
supervision of their clinical instructors.
 They should be given assignments that
are their level of training experience and
competency.
 They should be advised to seek guidance
if they are performing a procedure for the
first time
 They should be oriented to the policies
where they are assigned.
 Their performance should be assessed
frequently to determine their strengths
and weaknesses.
Legal Defense in Negligence



When Nurses know and attain the standard of
care giving service and that they have
documented the care they give.
If the patient’s careless conduct contributes
to his own injury.


ADVOCACY



Helping others grow and self-actualize by
informing them of their rights and
ascertaining that they have the right
information on which to base their decisions.
The Code of Ethics for Registered Nurses, Sec.
8and Sec. 9
Guidelines to be Observed:
1. Registered nurses are the advocates of
the patients.
2. Nurses should be able to advocate for
themselves and the profession.
MEDICAL ORDERS, DRUGS, AND MEDICATIONS RA
6675
 Only validly registered medical, dental and
veterinary practitioners, whether in private
institutions, corporations or in the
government, are authorized to prescribe
drugs.
 Requires that the drug be written in their
generic names.
 Only when these orders are legal writing
and bear the doctor’s signature thus the
nurse has the legal right to follow them.
 The nurse must not execute an order if
she is reasonably certain it will result in
harm to the patient.
PHARMACY ACTRA 5921
All prescriptions must contain the following
information:
 Name of the prescriber
 Office address


Professional registration number
Professional tax receipt number


Patient’s/client’s name, age,sex
Date of prescription
In the administration of intravenous
injections, special training shall be required
according to protocol established”.
Basis of nurse’s legal right to give IV injection.
Board of nursing resolution no. 8 states that
any registered nurse without such training
and who administers IV injections to patients
should be held liable, either criminally or
administratively or both.
SCOPE OF DUTIES AND RESPONSIBILITIES IN
INTRAVENOUS THERAPY
1. Interpretation of the doctor’s orders for
intravenous therapy
2. Performance of venipuncture, insertion of
needles, cannulas except TPN and cut down
3. Preparation, administration, monitoring and
termination of intravenous solution such as
additives, intravenous medications, and
intravenous push
4. Administration of blood/blood products as
ordered by physicians
5. Recognition of solution and medicine
incompatibilities
6. Maintenance and replacement of sites,
tubing’s, dressings in accordance with
established procedures
7. Establishment of flow rate of solutions,
medicines, blood and blood components
8. Utilization of thorough knowledge and
proficient technical ability in the use/care,
maintenance, and evaluation of intravenous
equipment
9. Nursing management of TPN, outpatient
intravenous care
10. Maintenance of established infection control
and aseptic nursing interventions
11. Maintenance of appropriate documentation
associated with the preparation,
administration and termination of all forms of
intravenous the therapy
TELEPHONE ORDERS

INTRAVENOUS THERAPY AND LEGAL IMPLICATIONS
Philippine nursing act of 1991 section 28 “
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Only in an extreme emergency and when no
other resident or intern is available should a
nurse receive telephone orders
The nurse should read back such an order to
the physician to make certain the order has
been correctly written

 Unjustifiable detention of a person
without legal warrant within boundaries
fixed by the defendant by an act or
violation of duty intended to result in
such confinement.
 Ex. Patient insists on leaving the hospital,
probable consequences of their action
explained by the doctor or medical staff,
he is still allowed to go home against
medical advice In order not to be charged
with false imprisonment
 However, if patient has a communicable
disease, hospital cannot be charged with
false imprisonment in order to protect the
public.
d. Invasion of Right to Privacy and Breach of
Confidentiality
 The right to be left alone, right to be free
of unwanted publicity and exposure to
public view
 Privacy relates to a person or identity.
Example: curtains are used during bed
bath procedure to provide privacy of the
patient
 Confidentiality relates to data or
information about an individual.
 Example: patient’s charts are not shared
with nurses who have not have direct
involvement in the care of the patient.
e. Defamation
 Character assassination, be it written or
spoken.
 Slander –oral or spoken defamation
 Libel –written defamation (cartoon
characters, words written or essay). There
must be a third person who hears or
reads the comment.
 There must be a third person who hears
or reads the comment.
Such an order should be signed by the
physician on his next visit within 24 hours.
MEDICAL RECORDS
 Supplies rich material for medical and nursing
research
 Serves as a legal protection for the hospital,
doctor, and nurse by reflecting the disease or
condition of the patient and his management.
 ” if it was not charted, it was not observed or
done”.
 Nurses are expected to record fully,
accurately, legibly and promptly their
observations from admission to the time of
the patient’s discharge.
 Nurses are legally and ethically bound to
protect the patient’s chart from unauthorized
persons
CHARTING DONE BY STUDENT NURSES
 When a nurse or clinical instructor counter
signs the charting of the nursing student,
he/she has personal knowledge of
information and that such is accurate and
authentic.
 Anyone who countersigns without verification
commits herself to possible legal risks.
CRIMES AFFECTING NURSING PRACTICE/ REGISTERED
NURSES
TORT

A tort is a legal wrong, committed against a
person or property independent of a contract
which renders the person who commits it
liable for damages in a civil action
 Examples
a. Assault
 Imminent threat of a harmful or offensive
bodily contact.
 Verbal threat
 Ex: A nurse threatens a geriatric patient
when he will take his medications
b. Battery
 Intentional, unconsented touching of
another person.
 Ex. When the patient refuses the IM
injection of medication but the nurses
give it anyway, he can be charged with
battery
c. False Imprisonment or Illegal Detention
CRIMES, MISDEMEANORS, AND FELONIES
Crime
Defined as an act committed or omitted in
violation of the law
 It has 2 elements: (1) criminal act and (2) evil
or criminal intent
Conspiracy to commit a crime
 Conspiracy to commit a crime exists when 2
or more persons agree to commit a crime or
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felony and decide to do it. They can be
classified as
 Principal
 Has committed a direct part in the
execution of the act.
 He/she directly force or induce others to
commit the act.
 Considered as the mastermind of the
crime: principal by inducement
Accomplices
 Cooperates in the execution of the offense by
previous or simultaneous act and has
knowledge of the criminal intention of the
principal
Accessory
 Have knowledge of the commission of the
crime
 Take part subsequent to its commission by
profiting themselves or assisting the offender
to profit from the effects of the crime
 Provides exit strategy
Criminal Actions
 Deals with acts or offenses against public
welfare. These vary from minor offenses and
misdemeanors to felonies.
Misdemeanor
 Is a general name for a criminal offense which
does not in law amount to felony?
 Punishment is usually fine or imprisonment in
term of less than one year
Felony
Public offense for which a convicted person is
liable to be sentenced to death or to be
imprisoned in a penitentiary or prison? A
felony Is committed with deceit and fault.
 Deceit exists when the act is performed with
deliberate intent and there is fault when the
wrongful acts result from imprudence,
negligence, or lack of skill or foresight.
Criminal Negligence may be classified into:
 Reckless Imprudence when a person does an
act or fails to do it voluntarily but without
malice, from which material damage results
immediately.
 Simple Imprudence the person or nurse did
not use precaution and the damage was not
immediate or the impending danger was not
evident or manifested immediately.
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Criminal Intent
 State of mind of a person at the time of the
criminal act is committed. The person is
aware that the act is unlawful but commits it
anyway. Deliberate intent includes two
elements without which can be no crime.
These are freedom and intelligence.

However, when the person offers evidence of
insanity, necessity, compulsion or accident or
infancy, the court will decide if he is not guilty
of the criminal offense.
Classified according to the degree of the acts of
execution
a. Consummated
 When all the elements necessary for its
execution and accomplishment are present.
 Ex. The nurse wanted to commit euthanasia
and had given an overdose of morphine that
leads to patient’s deathb.
b. Frustrated
 When the offender performs all the acts or
execution which will produce the felony as a
consequence but which nevertheless, do not
produce it by reason of causes independent of
the will of the perpetrator.
 Ex. Nurse was hired to give poison to a
geriatric patient by a relative for inheritance.
However, the patient was revived after the
poison was given.
c. Attempted
 When the offender commences the
commission of the same directly by overt
(open or manifest) acts due to unforeseen
circumstances there was no complete
execution to produce the desired felony.
 Ex. Respiratory Physiotherapist planned to
poison a geriatric patient with an overdose
of inhaled anesthetic but due to lack of
available supply, the patient was only kept
drowsy and not comatose or dead.
Felonies classified according to the degree of
punishment
a. Grave felonies
 those to which the law attaches the capital
punishment (death) or penalties which in any
of their periods are afflictive imprisonment
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requisites mentioned in the first
circumstance and that the person
defending is not included by revenge,
resentment or other evil motives
c. When any person who, in order to avoid
an evil or injury, does not an act which
causes damage to another provided that
the evil sought to be avoided actually
exists, the injury feared is greater that
done to avoid it and there is no other
practical and less harmful means to
prevent it.
d. Fulfillment of a duty or lawful exercise of
right or office, Ex: police officers
shooting a drug addict to defend oneself
from getting shot back
2. Exempting circumstances
 The following persons may be exempted from
the crime they have committed:
 Imbecile or insane person, unless the latter
has acted during a lucid interval.
 Person less than 9 years ‘old
 Person over 9 years of age and under fifteen
unless he/she acted with discernment
 Any person while performing a lawful act with
due care he/she causes merely an accident
without fault or intention or causing it
 Any person under compulsion of an
irresistible force
 Any person who acts under the impulse of an
uncontrollable fear of an equal or greater
injury
 Any person who fails to perform an act
required by law when prevented by some
lawful or insuperable cause.
3. Mitigating circumstances
 Those which do not constitute justification or
excuse of the offense in question, but which
in fairness and mercy, may be considered as
extenuating degree of moral culpability. The
following are some of the circumstances
considered by law to be mitigating and Lessen
the criminal liability of the offenders.
 When the offender has no intention to
commit so grave a wrong as the one
committed
 When the offender is under eighteen years of
age or over seventy years old.
ranging from 6 years and 1 day to life
imprisonment or fine not exceeding
php6,000.00.
b. Less Grave felonies
 Law punishes with penalties which in their
maximum period are correctional.
Imprisonment from one month and one day
to six years Fine not exceeding php 6,000.00
c. Light felonies
 Those infractions of law for the commission of
which the penalty of arresto menor
Imprisonment for one day to 3o days or a Fine
not exceeding php200.00. Light felonies are
punishable only when they have been
consummated, with the exception of those
committed against a person or property.
Criminal Liability
 Nurse may incur criminal liability or subject
herself to criminal prosecution either by
committing a felony or by performing an act
which would be an offense against person or
property. Ignorance of the law is not an
excuse for failure to comply therewith.
 Violators of the criminal law cannot escape
punishment on the ground of ignorance of the
law.
CIRCUMSTANCES AFFECTING CRIMINAL LIABILITY
1. Justifying circumstances as a person may not
incur criminal liability under the following
circumstances:
 When he/she acts in defense of his/her
person or rights provided that:
a. There is an unlawful aggression on the
part of the offended or injured party;
b. There is reasonable necessity for the
means employed by the person defending
himself/herself to prevent such
aggression.
 There is lack of sufficient provocation on the
part of the person defending himself.
a. When he/she acts in defense of the
person or the rights of his/her spouse,
ascendants, descendants, or legitimate
or natural or adopted brothers or sisters,
or relatives
b. When he/she acts in defense of the
person or rights of a stranger provided
that the first circumstances and second
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When sufficient provocation or threat on the
part of the offended party immediately
precedes the act.
 Act is committed in the immediate vindication
of grave offense to the one committing the
felony, his/her spouse, ascendants, legitimate,
natural or adopted brothers or sisters, or
relative by affinity within the same degree.
 Offender voluntarily surrenders himself to a
person in authority or authority
 Defender is deaf and dumb, blind or
otherwise suffering from some physical
defects which does restricts his/her means of
actions, defense Or communication with
fellow beings.
 Suffering from such illness as would diminish
the exercise of his/her will power without,
depriving him/her consciousness of his/her
acts
 Note: Lack of education is not mitigating in:
a. Rape
b. Forcible abduction
c. Arson.
d. Treason
e. In crimes against chastity like seduction
and acts of lasciviousness
f. Those acts committed in a merciless or
heinous manner
4. Aggravating circumstances
 Attending the commission of crime and which
increase the criminal liability of the offender
or make his guilt or more severe.
 The following are Some of the circumstances
that consider the law as aggravating
 When the offender takes advantage of
his public position.
 Crime is committed in place of worship
 Act is committed with evident
premeditation or after an unlawful
entry
 Act committed with abuse or
confidence or obvious ungratefulness
 When the crime committed in
consideration of a price, reward, or
promise
 Crime is committed on occasion of a
conflagration, shipwreck, earthquake,
epidemic or other calamity or
misfortune
 When craft, fraud or disguise was
employed
 When the wrong done in the
commission of the crime is deliberate
augmented by causing other wrongs not
necessary for its commission.
5. Alternative circumstances
 Taken into consideration as aggravating or
mitigating according to the nature and effects
of the crime and other conditions attending to
its commission
 Relationship is aggravating in physical injuries
inflicted by a descendant upon as ascendant.
 It is mitigating when an accused aided his/her
brother in the fight against the offended party
 Intoxication of the offender as mitigating
when the offender committed the felony in a
state of intoxication.
 When intoxication is habitual or intentional, it
can be an aggravating circumstance.
 Illiteracy is mitigating if there is lack of
sufficient intelligence and knowledge of the
full significance of one’s act.
 Lack of education is not mitigating in: rape,
force abduction, arson, treason, crimes
against chastity like seduction and acts of
lasciviousness and acts committed in
merciless or heinous manner
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MORAL TURPITUDE
 act of baseness, vileness or depravity in social
or public duties which a man owes to his
fellow man or to society in general. It is
contrary to the accepted and customary right
and duty between men.
MURDER

unlawful killing of a human being with intent
to kill. Ex. Euthanasia and abortion
HOMICIDE
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killing of a human being by another. It may be
committed without criminal intent by any
person who kills another other than his
father, mother, child or ascendants or
descents, spouse without any of the
circumstances attendant the crime of murder
being present.
ABORTION
 expulsion of a product of conception before
the age of viability. In law, any person with
the intention of prematurely ending a
pregnancy willfully or unlawfully does any act
to cause the same is guilty of procuring
abortion.
INFANTICIDE
 killing of child less than 3 days of age. The
mother who commits this crime shall suffer
penalty of imprisonment ranging from 2
years, four months and one day to 6 years.
PARRICIDE

crime committed when one kills his/her
father, mother or child whether legitimate or
illegitimate, his/her ascendants or
descendants or his spouse. A person
convicted shall be imposed of penalty for life
imprisonment (reclusion perpetua) to death.
ROBBERY
 crime against person or property of taking
personal property of another person. Ex.
Nurse takes patient’s cash or jewelry while
patient is sleeping.
CONTROLLED SUBSTANCES RA 6425 (Dangerous
Drugs Act of 1972)

covers administration and regulation of
manufacture, distribution and dispensing of
controlled drugs. Authorized persons to
prescribe or dispense these drugs require to
register and have special license for this
purpose. Controlled drugs are kept in locked
cabinets and are documented and counted
every shift
birth, prison mayor and a fine not exceeding
one thousand pesos.
Things to remember in order to avoid criminal
liability
1. Be very familiar with the Philippine nursing
law.
2. Beware of laws that affecting nursing practice
3. At the start of employment, get a copy of your
job description, the agency’s rules, regulations
and policies.
4. Upgrade your skills and competence
5. Accept only such responsibility that is within
the scope of your employment and your job
description.
6. Do not delegate your responsibilities to
others.
7. Determine whether your subordinates are
competent in the work you are assigning
them.
8. Develop good interpersonal relationships with
your co-workers, whether they be your
supervisors, peers or subordinates.
9. Consult your superior for problems that may
be too big for you to handle.
10. Verify orders that are not clear to you or
those that seem to be erroneous.
11. The doctors should be informed about the
patient's conditions.
12. Keep in mind the values and necessity of
keeping accurate and adequate records
13. Patients are entitled to an informed consent.
RA 9173 Philippine Nursing Act of 2002

SIMULATION OF BIRTH, SUBSTITUTION OF ONE
CHILD FOR ANOTHER OR ABANDONMENT OF
LEGITIMATE CHILD


Simulation of birth –one who enters in a birth
certificate a birth that did not occur. It is a
crime against the civil status of a person.
Substitution of one child for another or
concealing or abandoning any legitimate child
with intent to cause such a child his/her civil
status shall be punishable for simulation by
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Composed of 9 articles and 41 sections
 Article I –S1. Title “Philippine Nursing Act
of 2002”
 A II –S2. Declaration of the Policy
 AIII–S3. Organization of the Board of
Nursing
 Composed of a chairperson and 6
members
S4. Qualifications of the chairperson & members of
the board
a. Be a natural born citizen and resident of the
Philippines;
b. Be a member of good standing of the
accredited professional organization of
nurses;
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c. Be a registered nurse and holder of a
master's degree in nursing, education or
other allied medical profession conferred by
a college or university duly recognized by the
Government: Provided, That the majority of
the members of the Board shall be holders of
a master's degree in nursing: Provided,
further, That the Chairperson shall be a holder
of a master's degree in nursing
d. Have at least ten (10) years of continuous
practice of the profession prior to
appointment: Provided, however, That the
last five (5) years of which shall be in the
Philippines; and
e. Not have been convicted of any offense
involving moral turpitude; Provided, That the
membership to the Board shall represent the
three (3) areas of nursing, namely: nursing
education, nursing service and community
health nursing.
S5. Requirements Upon Qualification as Member of
the Board of Nursing
 Any person appointed as Chairperson or
Member of the Board shall immediately
resign from his/her work.
S6. Term of Office
The Chairperson and Members of the Board
shall hold office for a term of three (3) years
and until their successors shall have been
appointed and qualified: Provided, That the
Chairperson and members of the Board may
be re-appointed for another term.
S7. Compensation of the Board Members
 They shall receive compensation and
allowances comparable to the compensation
and allowances received by the Chairperson
and members of other professional regulatory
boards.
S8.Administrative Supervision of the Board,
Custodian of its Records, Secretariat and Support
Services
 Commission (PRC)
S9. Powers and Duties of the Board
The Board shall supervise and regulate the
practice of the nursing profession and shall
have the following powers, duties and
functions:
a. Conduct the licensure examination
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b. Issue, suspend or revoke certificates of
registration for the practice of nursing;
c. Monitor and enforce quality standards of
nursing practice in the Philippines and
exercise the powers necessary to ensure
the maintenance of efficient, ethical and
technical, moral and professional
standards in the practice of nursing
taking into account the health needs of
the nation;
d. Ensure quality nursing education by
examining the prescribed facilities of
universities or colleges of nursing or
departments of nursing education and
those seeking permission to open
nursing courses to ensure that standards
of nursing education are properly
complied with and maintained at all
times. The authority to open and close
colleges of nursing and/or nursing
education programs shall be vested on
the Commission on Higher Education
upon the written recommendation of the
Board;
e. Conduct hearings and investigations to
resolve complaints against nurse
practitioners for unethical and
unprofessional conduct and violations of
this Act
f. Promulgate a Code of Ethics
g. Recognize nursing specialty organization
h. Prescribe, adopt issue and promulgate
guidelines, regulations, measures and
decisions as may be necessary for the
improvements of the nursing practice,
advancement of the profession and for
the proper and full enforcement of this
Act subject to the review and approval
by the Commission.
S10. Annual Report
 The Board shall at the close of its calendar
year submit an annual report to the President
of the Philippines through the Commission.
S11. Removal or Suspension of Board Members
 The president may remove or suspend any
member of the Board on the following
grounds;
a. Continued neglect of duty or
incompetence;
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b. Commission or toleration of irregularities
in the licensure examination; and
c. Unprofessional immoral or
dishonourable conduct.
Article IV. Examination & Registration
S12.Licensure Examination
 Written examination
S13. Qualifications for Admission to the Licensure
Examination
a. A citizen of the Philippines, or a citizen or
subject of a country which permits Filipino
nurses to practice within its territorial limits
on the same basis as the subject or citizen of
such country: Provided, That the
requirements for the registration or licensing
of nurses in said country are substantially the
same as those prescribed in this Act;
b. good moral character
c. a holder of a Bachelor's Degree in Nursing
from a college or university that complies
with the standards of nursing education duly
recognized by the proper government agency.
S14. Scope of Examination
 The Board shall take into consideration the
objectives of the nursing curriculum, the
broad areas of nursing, and other related
disciplines and competencies in determining
the subjects of examinations
S15. Ratings
 An examinee must obtain a general average
of at least 75% with a rating of not below 60%
in any subject. An examinee who obtains an
average rating 75%) or higher but gets a rating
below sixty percent (60%) in any subject must
take the examination again but only in the
subject or subjects where he/she is rated
below sixty percent (60%). In order to pass
the succeeding examination, an examinee
must obtain a rating of at least (75%) in the
subject or subjects repeated.
S16. Oath
S17. Issuance of Certificate of Registration /
Professional License and Professional Identification
Card.
 A certificate of registration/professional
license as a nurse shall be issued to an
applicant who passes the examination upon
payment of the prescribed fees
S18. Fees for Examination and Registration
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S19. Registration by Reciprocity
A certificate of registration/professional
license may be issued without examination to
nurses registered under the laws of a foreign
state or country:
 Provided, That the requirements for
registration or licensing of nurses in said
country are substantially the same as those
prescribed under this Act: Provided, further,
That the laws of such state or country grant
the same privileges to registered nurses of the
Philippines on the same basis as the subjects
or citizens of such foreign state or country.
S21. Practice through Special/ Temporary Permit
a. Licensed nurses from foreign countries/ states
whose service are either for a fee or free if
they are internationally well-known specialists
or outstanding experts in any branch or
specialty of nursing;
b. Licensed nurses from foreign countries/states
on medical mission whose services shall be
free in a particular hospital, center or clinic;
and
c. Licensed nurses from foreign countries/states
employed by schools/colleges of nursing as
exchange professors in a branch or specialty
of nursing;
 Provided, however, That the
special/temporary permit shall be effective
only for the duration of the project, medical
mission or employment contract

S22. Non-registration and Non-issuance of
Certificates of Registration/ Professional License or
Special/ Temporary Permit.
 No person convicted by final judgment of any
criminal offense involving moral turpitude or
any person guilty of immoral or dishonorable
conduct or any person declared by the court
to be of unsound mind shall be registered and
be issued a certificate of
registration/professional license or a
special/temporary permit.
S23. Revocation and suspension of Certificate of
Registration/ Professional License and Cancellation
of Special/ Temporary Permit
a. For any of the causes mentioned in the
preceding section;
b. For unprofessional and unethical conduct;
c. For gross incompetence or serious ignorance;
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d. For malpractice or negligence in the practice
of nursing;
e. For the use of fraud, deceit, or false
statements in obtaining a certificate of
registration/professional license or a
temporary/special permit
f. For violation of this Act, the rules and
regulations, Code of Ethics for nurses and
technical standards for nursing practice,
policies of the Board and the Commission, or
the conditions and limitations for the issuance
of the temporarily/special permit; or
g. For practicing his/her profession during
his/her suspension from such practice;
provided, however, that the suspension of the
certificate of registration/professional license
shall be for a period not to exceed four (4)
years.
S24. Re-issuance of Revoked Certificates and
Replacement of Lost Certificates
 Board may, after the expiration of a maximum
of four (4) years from the date of revocation
of a certificate, for reasons of equity and
justice and when the cause for revocation has
disappeared or has been cured and corrected,
upon proper application therefore and the
payment of the required fees, issue another
copy of the certificate of
registration/professional license
Article V. Nursing Education
S25. Nursing Education Program
 The nursing education program shall provide
sound general and professional foundation for
the practice of nursing.
S26. Requirement for Inactive Nurses Returning to
Practice
 Nurses who have not actively practiced the
profession for five (5) consecutive years are
required to undergo one (1) month of didactic
training and three (3) months of practicum.
S27. Qualifications of the Faculty
a. Be a registered nurse in the Philippines;
b. Have at least one (1) year of clinical practice
in a field of specialization;
c. Be a member of good standing in the
accredited professional organization of
nurses; and
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d. Be a holder of a master's degree in nursing,
education, or other allied medical and health
sciences
 In addition to the aforementioned
qualifications, the dean of a college must have
a master's degree in nursing. He/she must
have at least five (5) years of experience in
nursing.
Article VI. Practice
S28. Scope of Nursing
 It shall be the duty of the nurse to:
 Provide nursing care through the
utilization of the nursing process. Nursing
care includes:
a. In case of suturing of perineal
laceration, special training shall be
provided according to protocol
established;
b. establish linkages with community
resources and coordination with the
health team;
c. Provide health education to
individuals, families and communities;
d. Teach, guide and supervise students
in nursing education programs
including the administration of
nursing services in varied settings
such as hospitals and clinics;
undertake consultation services;
engage in such activities that require
the utilization of knowledge and
decision-making skills of a registered
nurse; and
e. Undertake nursing and health human
resource development training and
research, which shall include, but not
limited to, the development of
advance nursing practice;
 Provided, That this section shall not apply to
nursing students who perform nursing
functions under the direct supervision of a
qualified faculty:
 Provided, further, That in the practice of
nursing in all settings, the nurse is duty-bound
to observe the Code of Ethics for nurses and
uphold the standards of safe nursing practice.
The nurse is required to maintain competence
by continual learning through continuing
professional education to be provided by the
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and was soon found not to be a
registered nurse, the contract that she
signed becomes illegal because she misled the
employer that she is a nurse.
BREACH OF CONTRACT
Breach of contract is failure to perform an agreement,
whether expressed or implied, without cause. The
following constitute breach of contract for nursing
services:
 prevention of performance;
 failure to perform because of inconvenience
or difficulty; failure of cooperation in
performance;
 abandonment of duty (i.e., leaving
unconscious patients,
 going off-duty without endorsement, loafing
While on duty);
 substitution of performance; and
 failure to use due care.
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LEGAL EXCUSES IN REFUSING, NEGLECTING OR
FAILURE TO PERFORM A CONTRACT
Following are legal excuses in refusing, neglecting or
failure to Perform a contract:
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
discovery of material misrepresentation made
and relied upon;
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It sets a standard and relieves an individual
professional person from haggling over
compensation. It is more likely to be open an
well-known so that the use of written
contracts tends to establish minimum
standards for professional practitioners and t
protect them against discrimination in
compensation.
It is definite and can be definite on many
details which may otherwise stimulate
favoritism or caprice even among
professionals, such as hours of work, vacation
allowances, holiday privileges, health and
insurance provisions.
It can provide a definite procedure in case of
complaints about substandard work, so that
the employer has a clear course and the
professional nurse has protection against
arbitrary action.
It creates a minimum of certainty and security
for the professional employee so that he/she
is free to concentrate on his/her work withou
concern for the details which the written
contract has settled.
Definite commitments stipulated in a contrac
are hours of work and salary, length of time o
contract, days of off duty, details of duties
and responsibilities including the course to be
3.
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4.
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taken in case of non-fulfillment of the terms
of contract
WILL
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Is a legal declaration of person’s intentions
upon death?
It is called a testamentary document because
it takes effect after the death of its maker
It is an act whereby a person is permitted with
the formalities prescribed by law, to control
to a certain degree the deposition of his
estate, to take effect after his death.
5.
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6.
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7.
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Kinds of Will
1. Holographic Will
 Must be entirely written, dated, and signed by
the hand of the testator himself.
 In the probate of a holographic will, it is
necessary that at least one witness who
knows the handwriting and signature of the
testator explicitly declares that the will and
the signature are in the handwriting of the
testator.
2. Oral Wills, Nuncupative Wills, Deathbed
Wills
An Oral Will is spoken/oral, rather than
written. This type of Will is usually made
before witnesses. The Testator will say out
loud to someone else how he/she wants
his/her property and assets to be distributed
after death.
3. Nuncupative Will or noncupation
 An Oral Will that have at least two witnesses
and meets specific statutory guidelines. 0
 Restrictions to the oral will are that such will
8.

Testatrix
If the person making a will is a woman
Heir
Is a person called to succession either by the
provision of a will by operation of law
Testate
Having made a valid will before one dies
Intestate
One who dies without a will
Probate
Is a special proceeding to establish the validit
of a will. Probate is mandatory, which means
that no will passes either real or personal
property unless it is proved and allowed in a
proper court
Administrator
One who administers the provision of the will
TESTAMENTARY CAPACITY AND INTENT
Following are the essentials of will to meet legal
requirements:
 The testator must have the expressed
intention of making a will. He must be of the
right age. A person under 18years of age
cannot make a will. He is required to be of
sound mind and must be free from undue
influence.
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The testator shall name the person who will
be in charge of carrying out the provisions of
the will.
Properties must be disposed of in accordance
with legal requirements.
The will must be signed by the testator,
attested, and signed by at least three
witnesses in his presence and of one another
be made during the person s last illness, that
it be done in the place in which he died, that
he asked one more witnesses to the will, that
the will be put in writing within a given
number of days, and that it be offered to:
probate within a specified time.
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Terminologies:
1. Decedent
 Is a person whose property is transmitter
through succession whether or not he left a
will
2. Testator
 Is the deceased person who made a last will
and testament
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witnesses in his presence and of one another
Every will must be acknowledged before a
notary public by the testator and witnesses.
Witnesses to the wills shall be of sound mind,
18 years of age or more, not blind, deaf or
dumb, and able to read and write.
A married woman may make a will without
the consent of her husband and without the
authority of the court.
THE NURSE’S OBLIGATIONS IN THE EXECUTION OF A
WILL
 They should note the soundness of the
patient's mind (that he/she understood the
act of making a will) and that there was
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freedom from fraud or undue influence
(he/she was not induced to make someone
the beneficiary of the will) and that the
patient was above 18 years of age.
He/she should note that the will was signed
by the testator, that the witnesses were all
present at the same time and signed the will
in the presence of the testator.

FUNDAMENTAL REQUIREMENTS OF DUE PROCESS
 SEC 12.
 Any person under investigation for the
commission of an offense shall have the
right to be informed of his right to remain
silent and to have competent and
independent counsel preferably of his own
choice.
 No torture, force, violence, threat,
intimidation, or any other means which
vitiate the free will shall be used against
him
 Any confession or admission obtained in
violation of these or section 17 here of
shall be inadmissible in evidence against
him
 The law shall provide for penal or civil
sanctions for violations of this sections as
well as compensation to and rehabilitation
of victims of torture or similar practices,
and their families.
 SEC 13
 All persons, except those charged with
offenses punishable by reclusion perpetua
when evidence of guilt is strong, shall,
before conviction, be baliable by sufficient
sureties, or be released on recognizable as
may be provided by law. The right to bail
shall be impaired even when the privileged
of the writ of habeas corpus is suspended.
Excessive bail shall not be required.
 SEC 14
 No person shall be held to answer for a
criminal offense without due process of
law
 In all criminal prosecutions, the accused
shall be presumed innocent until the
contrary is proved
GIFTS
Another way of disposing of property, aside from
executing a will is by gifts.
 The gift must consist of personal property
 There must be an intention to make the gifts;
 There must be an indication of transfer of
control over such property; and
 There must be acceptance by the recipient
 Gifts made by a person because of
anticipation of death or belief in approaching
death are called gifts causa mortis or donation
causa mortis.
LEGAL PROCEDURE AND TRIAL
 In a trial, the judicial procedure is to ascertain
facts by hearing evidence, determine which
facts are relevant, apply the appropriate
principle of law, and pass judgment.
COMMENCEMENT OF THE ACTION
 The first step in the trial process is to
determine what kind of legal action to take. If
the action relates to negligence, the correct
action would be negligence; and if it related
to contract, the proper action would be for
breach of contract.
STATUES OF LIMITATION


Complaint must be made within a specific
time or the right to complain may be lost
forever. There is a time limit in filing cases
because witnesses become less reliable after
passage of time.
Claims for negligence or malpractice vary
from two (2) to three (3) years. In criminal
cases, statutes of limitation vary from two (2)
to six (6) years except in cases where murder
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is committed in which there is no time limit.
Each party presents a statement of facts or
pleading to the court. First pleading is
generally known as the complaint or petition.
In less serious crimes known as misdemeanor
these pleadings are called complaints while in
crimes of more serious nature known as
felonies, the pleadings are called indictments
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PRE-TRIAL PROCEDURES
 This is an informal discussion between the
judge and attorney to eliminate matters not
judge and attorney to eliminate matters not
PLEADING
in dispute, agree on issues, and settle
procedural matters relating to the trial. Cases
are often settled at this point.
TRIAL
 At the trial, facts of the case are determined,
the principles of law relating to those facts are
applied and a conclusion as to liability is
reached. The judge determines the facts and
applies the law.
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WITNESS
The necessity of testimony by any person in a legal
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no alternative. The use of a telephone in a
non-emergency as a substitute for the
physician himself can lead to serious errors
and may border on malpractice.
Only in an extreme emergency and when no
other resident or intern is available should a
nurse receive telephone orders.
The nurse should read back such an order to
the physician to make certain the order has
been correctly received and written on the
patients' chart.
Such order should be signed by the physician
on his/her next visit within 24 hours. The
nurse should sign the name of the physician
on her own and note the time the order was
received. Should any problem arise, the order
should be referred back to the ordering
physician. It is safer that when a telephone
order is given, another resident physician or
intern in the same service receive it since the
latter can discuss with the former the actual
condition of the patient.
proceeding is determined by the attorneys for the
parties.
 Subpoenaa court summons is served directing
a witness to appear and give testimony on the
date and time ordered.
 Subpoena duces tecum is served to a witness
requiring him to bring records, papers, and
the like which may be in his possession and
which may help clarify the matter in issue.
She should testify only on what she knows
based on facts. This is called testimony of
facts.
 Testimony of opinion may only be given by
expert witnesses. An expert witness is one
who is qualified to testify based on special
knowledge, skill, experience, and training. She
should neither hesitate to say she does not
know, nor answer any question that might
incriminate her. This is known as the privilege
against self-incrimination.
 Dying declarations or ante-mortem
statements are considered hearsay evidence
except when made by a victim of a crime.
CONSENT TO MEDICAL AND SURGICAL PROCEDURES
 Consent
 is defined as a “free and rational act that
presupposes knowledge of the thing to
which consent is being given by a person
who is legally capable of giving consent.”
The consent signed by the patient or his
authorized representative/legal guardian
upon admission is for the initial diagnosis
and treatment.
 Nature of Consent
 Consent is an authorization, by a patient o
person authorized by law to give the
consent on the patient’s behalf, that
changes touching, for example, from nonconsensual to consensual.
 Informed Consent
 Hayt and Hayt state that “it is an
established principle of law that every
human being of adult years and sound
mind has the right to determine what shal
be done with his own body.
 Essential Elements:
 the diagnosis and explanation of the
condition
APPEALS

An appellate court reviews the case, and
when the case is decided by it, the final
judgment results and the matter is ended.
EXECUTION OF JUDGMENT
 Generally, lawsuits against hospitals or
physicians and nurses involve recovery of
money damages. The defendant is compelled
to execute the judgment. Failure to obey will
be regarded as contempt of court and will
result in fine or imprisonment.
 Doctors should limit telephone orders to
extreme emergency situations where there is
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 A fair explanation of the procedures
to be done and used and the
consequences of
 A description of alternative
treatments or procedures
 A description of the benefits to be
expected
 Material rights if any
 the prognosis, if the recommended
care, procedure, is refused
 Proof of consent
 A written consent should be signed to
show that the procedure is the one
consented to and that the person
understands the nature of the procedure,
the risks involved and the possible
consequences.
 Who Must Consent?
 Ordinarily, the patient is the one who gives
the consent in his own behalf. However, if
he is incompetent (minors or mentally ill)
or physically unable and is not an
emergency case, consent must be taken
from another who is authorized to give it in
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his behalf.
 Consent of Minors
 Parents or someone standing in their
CHARTING DONE BY NURSING STUDENTS

When a nurse or a clinical instructor
countersigns the charting of a nursing
student, he/she attests that he/she has
personal knowledge of information and that
such is accurate and authentic. Anyone who
countersigns without verification commits
herself to possible legal risks.
Criminal Liabilities and Legal Responsibilities of a
Nurse
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As Nurses starts to practice their profession,
Nurses liability has increased. Assuming
authority, responsibility, accountability for
their professional practice, professional
nurses increasingly are being subjected to
scrutiny by Boards of Nursing Representing
the law, the scope of nursing practice to
protect the public welfare. Nurses are also
increasingly being subjected to malpractice
lawsuits. When nurses become defendants in
legal actions, Other nurse serve as expert
witnesses both for the defense (representing
the practitioner) and the prosecution
(representing the plaintiff). Expert witnesses
testify to the standard of care required of the
health care provider and whether it was met.
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

Parents or someone standing in their
behalf, Parental consent is not needed,
however, if the minor is married or
otherwise emancipated.
Consent of Mentally ILL
 A mentally incompetent person cannot
legally sign; consent must be taken from
the parents or legal guardian.
Emergency Situation
 No consent is necessary because inaction
at such time may cause greater injury.
Refusal to Consent
 A patient who is mentally and legally
competent has the right to refuse the
touching of his body or to submit to a
medical or surgical procedure no matter
how necessary, nor the imminent danger
to his life or health if he fails to submit to
treatment.
Consent for Sterilization
 The husband and the wife must consent
to the procedure if the operation is
primarily to accomplish sterilization.
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For these reasons, professional nurses need
basic knowledge of the legal aspects of
nursing.
Responsibility and Accountability for the
practice of Professional Nursing Professional
nurses undertake to practice their profession,
they are held responsible and accountable
for the quality of performance of their duties
Once they are employed in any institution, or
hospital are directly responsible to their
immediate supervisors. Private duty nurses,
being independent practitioners, are held to a
standard of conduct that is expected of
reasonably prudent nurses. A standard is the
desired and achievable level of performance
against which actual practice is compared.
Standards serve as benchmark against which
to plan, to implement and assess quality of
services and to show that nursing is
accountable to society, to consumers of
nursing services and to governments as well
 Defects in the equipment such as
stretchers and wheelchairs may lead to
falls thus injuring the patients
 Administration of medicine w/o a doctor’
prescription
 Errors due to family assistance
as to the profession of nursing and individual
members, Venson, (2016).
PROFESSIONAL NEGLIGENCE AND MALPRACTICE
 Standard
 Desired and achievable level of
performance against which actual practice
is compared.
 Serves as benchmark against which to
plan, to implement and assess quality of
services
 Intentional Wrongs
 Tortious acts that a nurse may be held
liable which arise in performance of her
duties
 Negligence
 Refers to the commission or omission of
an act, pursuant to a duty, that a
reasonably prudent person in the same or
similar circumstances would or would not
do, and acting or the non-acting of which
is the proximate cause of injury to
another person or his property.
 If a person charged with negligence shows
that she meets or even surpasses this
standard, then there is no negligence or
carelessness. But if the defendant’s
action fails to meet the standard, then
there has been negligence.
Civil Code, Article 19
 One shall act with justice, give every man his
due, and observe honesty and good faith.
Civil Code, Article 20

3 conditions required to establish a defendant’s
negligence
 Injury was of such nature that it would not
normally occur unless there was a negligent
act on the part of someone
 Injury was caused by an agency w/in control
of the defendant
 Plaintiff himself did not engage in any manne
that would tend to bring about the injury
 Example:
 A patient came in walking to the outpatient clinic for injection. Upon
administering the injection tohis buttocks
the patient experienced extreme pain.
His leg felt weak and he was subsequently
paralyzed. His sciatic nerve was injured.
 The presence of sponges in the patient’s
abdomen after an operation.
 Fracture on a newly-delivered baby born
by breech presentation.
Elements of professional Negligence

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
Existence of a duty
Failure to meet the standard of due care
Foreseeability of harm
Injury to the plaintiff
Examples of Negligence
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Failure to report observations to attending
Those who, in the performance of their
obligations through negligence cause any
injury to another are liable for damages.
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DOCTRINE Of RES IPSA LOQUITUR “the thing speaks
for itself”
 The injury could not have happened if
someone was not negligent that no further



proof is required.
Example: forceps left inside the abdominal
cavity after a TAHBSO procedure
physicians
Failure to exercise the degree of diligence
which the circumstances of the particular case
demands
 Mistaken identity
 Wrong medicine, wrong concentration,
wrong route, wrong dose
MALPRACTICE
 Improper or unskillful care of the patient by a
nurse; also denotes stepping beyond one’s
authority with serious consequences
Term of negligence of professional personnel
(Professional Negligence)
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Used properly only when it refers to a
negligent act committed in the course of
LIABILITY FOR WORK OF NURSE TRAINEES AND
NURSE VOLUNTEERS
 Nurses are responsible and accountable for
their practice, nurse volunteers should
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exercise utmost caution, critical thinking and
independent judgment to prevent incurring
liabilities which may be hard to get out of.
professional performance
Example: Giving of Anesthesia by a nurse or
prescribing medicines.
LIABILITY OF NURSES FOR THE WORK OF NURSING
AIDES
 Nurses should not delegate their functions to
nursing aides since the Philippine nursing act
specifies the scope of nursing practice of
professional nurses.
 Nurses are enjoined to supervise their
subordinates and see to it that they perform
only those which they have been taught to do
and those which they are capable of doing.
 Nursing aids are responsible for their actions
 Nurses should not delegate their functions to
nursing aides.
 Nursing aides perform selected nursing
activities under the direct supervision of
nurses.
DOCTRINE OF FORCE MAJEURE
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
An Irresistible force, one that is unforeseen or
inevitable.
Under the Civil Code of the Philippines, no
person shall be responsible for those events
which cannot be foreseen, or which, though
foreseen, are inevitable, except in cases
expressly specified by law
Ex.floods, fire, earthquakes and accidents fall
under this doctrine and nurses fail to render
service during this circumstance are not held
negligent.
DOCTRINE OF RESPONDEAT SUPERIOR




“Let the master answer for the acts of the
subordinate.”
The liability is expanded to include the master
as well as the employee and not a shift of
liability from the subordinate to the master
Example:
 The hospital will be held liable, if, in an
effort to cut down on expenses if decides
to hire under board nurses or midwives in
place of professional nurses, and these
persons prove to be incompetent.
 The surgeon will be held responsible in
case a laparotomy pack is left in a
patient’s abdomen.
Note: Private duty nurses, however, are
considered independent contractors. They
are liable for their own negligent actions.
LIABILITY FOR THE WORK OF NURSING STUDENTS
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
INCOMPETENCE
 Lack of ability, or legal qualifications and
being unfit to discharge the required duty. It
is a ground for the revocation and suspension
of her certificate of registration.
 Ex. A nursing assistant giving IV medication to
the patient.
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RA 9173 –nursing students do not perform
professional nursing duties.
Nursing students should be under supervision
of their clinical instructors.
In order that the errors committed by nursing
students will be avoided or minimized, the
following measures should be taken:
Nursing students should always be under
supervision of their clinical instructors.
 They should be given assignments that
are their level of training experience and
competency.
 They should be advised to seek guidance
if they are performing a procedure for the
first time
 They should be oriented to the policies
where they are assigned.
 Their performance should be assessed
frequently to determine their strengths
and weaknesses.
Legal Defense in Negligence



When Nurses know and attain the standard of
care giving service and that they have
documented the care they give.
If the patient’s careless conduct contributes
to his own injury.
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
ADVOCACY



Helping others grow and self-actualize by
informing them of their rights and
ascertaining that they have the right
information on which to base their decisions.
The Code of Ethics for Registered Nurses, Sec.
8and Sec. 9
Guidelines to be Observed:
1. Registered nurses are the advocates of
the patients.
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2. Nurses should be able to advocate for
themselves and the profession.
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In the administration of intravenous
injections, special training shall be required
according to protocol established”.
Basis of nurse’s legal right to give IV injection
Board of nursing resolution no. 8 states that
any registered nurse without such training
and who administers IV injections to patients
should be held liable, either criminally or
administratively or both.
SCOPE OF DUTIES AND RESPONSIBILITIES IN
INTRAVENOUS THERAPY
1. Interpretation of the doctor’s orders for
intravenous therapy
2. Performance of venipuncture, insertion of
needles, cannulas except TPN and cut down
3. Preparation, administration, monitoring and
termination of intravenous solution such as
additives, intravenous medications, and
MEDICAL ORDERS, DRUGS, AND MEDICATIONS RA
6675
 Only validly registered medical, dental and
veterinary practitioners, whether in private
institutions, corporations or in the
government, are authorized to prescribe
drugs.
 Requires that the drug be written in their
generic names.
 Only when these orders are legal writing
and bear the doctor’s signature thus the
nurse has the legal right to follow them.
 The nurse must not execute an order if
she is reasonably certain it will result in
harm to the patient.
4.
5.
6.
7.
8.
9.
10.
PHARMACY ACTRA 5921
All prescriptions must contain the following
information:
 Name of the prescriber
 Office address
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Professional registration number
Professional tax receipt number


Patient’s/client’s name, age,sex
Date of prescription
11.
intravenous push
Administration of blood/blood products as
ordered by physicians
Recognition of solution and medicine
incompatibilities
Maintenance and replacement of sites,
tubing’s, dressings in accordance with
established procedures
Establishment of flow rate of solutions,
medicines, blood and blood components
Utilization of thorough knowledge and
proficient technical ability in the use/care,
maintenance, and evaluation of intravenous
equipment
Nursing management of TPN, outpatient
intravenous care
Maintenance of established infection control
and aseptic nursing interventions
Maintenance of appropriate documentation
associated with the preparation,
administration and termination of all forms of
intravenous the therapy
TELEPHONE ORDERS

INTRAVENOUS THERAPY AND LEGAL IMPLICATIONS
Philippine nursing act of 1991 section 28 “
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Only in an extreme emergency and when no
other resident or intern is available should a
nurse receive telephone orders
The nurse should read back such an order to
the physician to make certain the order has
been correctly written

Such an order should be signed by the
physician on his next visit within 24 hours.
MEDICAL RECORDS
 Supplies rich material for medical and nursing
research
 Serves as a legal protection for the hospital,
doctor, and nurse by reflecting the disease or
condition of the patient and his management.
 ” if it was not charted, it was not observed or
done”.
 Nurses are expected to record fully,
accurately, legibly and promptly their
observations from admission to the time of
the patient’s discharge.
 Nurses are legally and ethically bound to
protect the patient’s chart from unauthorized
persons
CHARTING DONE BY STUDENT NURSES
 When a nurse or clinical instructor counter
signs the charting of the nursing student,
he/she has personal knowledge of
information and that such is accurate and
authentic.
 Anyone who countersigns without verification
commits herself to possible legal risks.
CRIMES AFFECTING NURSING PRACTICE/ REGISTERED
NURSES
TORT
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A tort is a legal wrong, committed against a
person or property independent of a contract
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 Unjustifiable detention of a person
without legal warrant within boundaries
fixed by the defendant by an act or
violation of duty intended to result in
such confinement.
 Ex. Patient insists on leaving the hospital,
probable consequences of their action
explained by the doctor or medical staff,
he is still allowed to go home against
medical advice In order not to be charged
with false imprisonment
 However, if patient has a communicable
disease, hospital cannot be charged with
false imprisonment in order to protect th
public.
d. Invasion of Right to Privacy and Breach of
Confidentiality
 The right to be left alone, right to be free
of unwanted publicity and exposure to
public view
 Privacy relates to a person or identity.
Example: curtains are used during bed
bath procedure to provide privacy of the
patient
 Confidentiality relates to data or
information about an individual.
 Example: patient’s charts are not shared
with nurses who have not have direct
involvement in the care of the patient.
e. Defamation
 Character assassination, be it written or
spoken.
 Slander –oral or spoken defamation
Slander oral or spoken defamation
 Libel –written defamation (cartoon
characters, words written or essay). There
must be a third person who hears or
reads the comment.
 There must be a third person who hears
or reads the comment.
which renders the person who commits it
liable for damages in a civil action
 Examples
a. Assault
 Imminent threat of a harmful or offensive
bodily contact.
 Verbal threat
 Ex: A nurse threatens a geriatric patient
when he will take his medications
CRIMES, MISDEMEANORS, AND FELONIES
Crime
b. Battery
 Intentional, unconsented touching of
another person.
 Ex. When the patient refuses the IM
injection of medication but the nurses
give it anyway, he can be charged with
battery
c. False Imprisonment or Illegal Detention
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Defined as an act committed or omitted in
violation of the law
 It has 2 elements: (1) criminal act and (2) evil
or criminal intent
Conspiracy to commit a crime
 Conspiracy to commit a crime exists when 2
or more persons agree to commit a crime or
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felony and decide to do it. They can be
classified as
 Principal
 Has committed a direct part in the
execution of the act.
 He/she directly force or induce others to
commit the act.
 Considered as the mastermind of the
crime: principal by inducement
Accomplices
 Cooperates in the execution of the offense by
previous or simultaneous act and has
knowledge of the criminal intention of the
principal
Criminal Intent
 State of mind of a person at the time of the
criminal act is committed. The person is
aware that the act is unlawful but commits i
anyway. Deliberate intent includes two
elements without which can be no crime.
These are freedom and intelligence.

Classified according to the degree of the acts of
execution
a. Consummated
 When all the elements necessary for its
execution and accomplishment are present.
 Ex. The nurse wanted to commit euthanasia
and had given an overdose of morphine that
leads to patient’s deathb.
b. Frustrated
 When the offender performs all the acts or
execution which will produce the felony as a
consequence but which nevertheless, do not
produce it by reason of causes independent o
the will of the perpetrator.
 Ex. Nurse was hired to give poison to a
geriatric patient by a relative for inheritance.
However, the patient was revived after the
poison was given.
c. Attempted
 When the offender commences the
commission of the same directly by overt
(open or manifest) acts due to unforeseen
circumstances there was no complete
execution to produce the desired felony.
 Ex. Respiratory Physiotherapist planned to
poison a geriatric patient with an overdose
of inhaled anesthetic but due to lack of
available supply, the patient was only kept
drowsy and not comatose or dead.
Accessory
 Have knowledge of the commission of the
crime
 Take part subsequent to its commission by
profiting themselves or assisting the offender
to profit from the effects of the crime
 Provides exit strategy
Criminal Actions
 Deals with acts or offenses against public
welfare. These vary from minor offenses and
misdemeanors to felonies.
Misdemeanor
 Is a general name for a criminal offense which
does not in law amount to felony?
 Punishment is usually fine or imprisonment in
term of less than one year
Felony
Public offense for which a convicted person is
liable to be sentenced to death or to be
imprisoned in a penitentiary or prison? A
felony Is committed with deceit and fault.
 Deceit exists when the act is performed with
deliberate intent and there is fault when the
wrongful acts result from imprudence,
negligence, or lack of skill or foresight.
Criminal Negligence may be classified into:
 Reckless Imprudence when a person does an
act or fails to do it voluntarily but without
malice, from which material damage results
immediately.
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 Simple Imprudence the person or nurse did
not use precaution and the damage was not
However, when the person offers evidence of
insanity, necessity, compulsion or accident or
infancy, the court will decide if he is not guilty
of the criminal offense.
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Felonies classified according to the degree of
punishment
a. Grave felonies
not use precaution and the damage was not
immediate or the impending danger was not
evident or manifested immediately.
ranging from 6 years and 1 day to life
imprisonment or fine not exceeding
php6,000.00.
b. Less Grave felonies
 Law punishes with penalties which in their
maximum period are correctional.
Imprisonment from one month and one day
to six years Fine not exceeding php 6,000.00
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c. Light felonies
 Those infractions of law for the commission of
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those to which the law attaches the capital
punishment (death) or penalties which in any
of their periods are afflictive imprisonment
requisites mentioned in the first
circumstance and that the person
defending is not included by revenge,
resentment or other evil motives
c. When any person who, in order to avoid
an evil or injury, does not an act which
causes damage to another provided that
the evil sought to be avoided actually
exists, the injury feared is greater that
done to avoid it and there is no other
practical and less harmful means to
prevent it.
d. Fulfillment of a duty or lawful exercise of
right or office, Ex: police officers
shooting a drug addict to defend oneself
from getting shot back
2. Exempting circumstances
 The following persons may be exempted from
the crime they have committed:
 Imbecile or insane person, unless the latter
has acted during a lucid interval.
 Person less than 9 years ‘old
 Person over 9 years of age and under fifteen
unless he/she acted with discernment
 Any person while performing a lawful act with
due care he/she causes merely an accident
without fault or intention or causing it
 Any person under compulsion of an
irresistible force
 Any person who acts under the impulse of an
uncontrollable fear of an equal or greater
injury
 Any person who fails to perform an act
required by law when prevented by some
lawful or insuperable cause.
3. Mitigating circumstances
 Those which do not constitute justification or
excuse of the offense in question, but which
in fairness and mercy, may be considered as
extenuating degree of moral culpability. The
following are some of the circumstances
considered by law to be mitigating and Lessen
the criminal liability of the offenders.
 When the offender has no intention to
commit so grave a wrong as the one
committed
 When the offender is under eighteen years of
age or over seventy years old.
which the penalty of arresto menor
Imprisonment for one day to 3o days or a Fine
not exceeding php200.00. Light felonies are
punishable only when they have been
consummated, with the exception of those
committed against a person or property.
Criminal Liability
 Nurse may incur criminal liability or subject
herself to criminal prosecution either by
committing a felony or by performing an act
which would be an offense against person or
property. Ignorance of the law is not an
excuse for failure to comply therewith.
 Violators of the criminal law cannot escape
punishment on the ground of ignorance of the
law.
CIRCUMSTANCES AFFECTING CRIMINAL LIABILITY
1. Justifying circumstances as a person may not
incur criminal liability under the following
circumstances:
 When he/she acts in defense of his/her
person or rights provided that:
a. There is an unlawful aggression on the
part of the offended or injured party;
b. There is reasonable necessity for the
means employed by the person defending
himself/herself to prevent such
aggression.
 There is lack of sufficient provocation on the
part of the person defending himself.
a. When he/she acts in defense of the
person or the rights of his/her spouse,
ascendants, descendants, or legitimate
or natural or adopted brothers or sisters,
or relatives
b. When he/she acts in defense of the
person or rights of a stranger provided
that the first circumstances and second
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When sufficient provocation or threat on the
part of the offended party immediately
precedes the act.
Act is committed in the immediate vindication
of grave offense to the one committing the
felony, his/her spouse, ascendants, legitimate,
natural or adopted brothers or sisters, or
relative by affinity within the same degree.
Offender voluntarily surrenders himself to a
person in authority or authority
Defender is deaf and dumb, blind or
otherwise suffering from some physical
defects which does restricts his/her means of
actions, defense Or communication with
fellow beings.
Suffering from such illness as would diminish
the exercise of his/her will power without,
depriving him/her consciousness of his/her
acts
Note: Lack of education is not mitigating in:
a. Rape
b. Forcible abduction
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c. Arson.
d. Treason
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 When craft, fraud or disguise was
employed
 When the wrong done in the
commission of the crime is deliberate
augmented by causing other wrongs no
necessary for its commission.
5. Alternative circumstances
 Taken into consideration as aggravating or
mitigating according to the nature and effect
of the crime and other conditions attending t
its commission
 Relationship is aggravating in physical injuries
inflicted by a descendant upon as ascendant.
 It is mitigating when an accused aided his/he
brother in the fight against the offended part
 Intoxication of the offender as mitigating
when the offender committed the felony in a
state of intoxication.
 When intoxication is habitual or intentional, i
can be an aggravating circumstance.
 Illiteracy is mitigating if there is lack of
sufficient intelligence and knowledge of the
full significance of one’s act.
 Lack of education is not mitigating in: rape,
e. In crimes against chastity like seduction
and acts of lasciviousness
f. Those acts committed in a merciless or
heinous manner
4. Aggravating circumstances
 Attending the commission of crime and which
increase the criminal liability of the offender
or make his guilt or more severe.
 The following are Some of the circumstances
that consider the law as aggravating
 When the offender takes advantage of
his public position.
 Crime is committed in place of worship
 Act is committed with evident
premeditation or after an unlawful
entry
 Act committed with abuse or
confidence or obvious ungratefulness
 When the crime committed in
consideration of a price, reward, or
promise
 Crime is committed on occasion of a
conflagration, shipwreck, earthquake,
epidemic or other calamity or
misfortune
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force abduction, arson, treason, crimes
against chastity like seduction and acts of
lasciviousness and acts committed in
merciless or heinous manner
MORAL TURPITUDE
 act of baseness, vileness or depravity in socia
or public duties which a man owes to his
fellow man or to society in general. It is
contrary to the accepted and customary right
and duty between men.
MURDER

unlawful killing of a human being with intent
to kill. Ex. Euthanasia and abortion
HOMICIDE
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killing of a human being by another. It may b
committed without criminal intent by any
person who kills another other than his
father, mother, child or ascendants or
descents, spouse without any of the
circumstances attendant the crime of murder
being present.
birth, prison mayor and a fine not exceeding
one thousand pesos.
ABORTION
 expulsion of a product of conception before
the age of viability. In law, any person with
the intention of prematurely ending a
pregnancy willfully or unlawfully does any act
to cause the same is guilty of procuring
abortion.
Things to remember in order to avoid criminal
liability
1. Be very familiar with the Philippine nursing
law.
2. Beware of laws that affecting nursing practice
3. At the start of employment, get a copy of you
job description, the agency’s rules, regulation
and policies.
4. Upgrade your skills and competence
5. Accept only such responsibility that is within
the scope of your employment and your job
description.
6. Do not delegate your responsibilities to
others.
7. Determine whether your subordinates are
competent in the work you are assigning
them.
8. Develop good interpersonal relationships with
your co-workers, whether they be your
supervisors, peers or subordinates.
9. Consult your superior for problems that may
be too big for you to handle.
10. Verify orders that are not clear to you or
those that seem to be erroneous.
11. The doctors should be informed about the
patient's conditions.
12. Keep in mind the values and necessity of
keeping accurate and adequate records
13. Patients are entitled to an informed consent.
INFANTICIDE
 killing of child less than 3 days of age. The
mother who commits this crime shall suffer
penalty of imprisonment ranging from 2
years, four months and one day to 6 years.
PARRICIDE

crime committed when one kills his/her
father, mother or child whether legitimate or
illegitimate, his/her ascendants or
descendants or his spouse. A person
convicted shall be imposed of penalty for life
imprisonment (reclusion perpetua) to death.
ROBBERY
 crime against person or property of taking
personal property of another person. Ex.
Nurse takes patient’s cash or jewelry while
patient is sleeping.
CONTROLLED SUBSTANCES RA 6425 (Dangerous
Drugs Act of 1972)

covers administration and regulation of
manufacture, distribution and dispensing of
controlled drugs. Authorized persons to
prescribe or dispense these drugs require to
register and have special license for this
purpose. Controlled drugs are kept in locked
cabinets and are documented and counted0
every shift
RA 9173 Philippine Nursing Act of 2002
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Composed of 9 articles and 41 sections
 Article I –S1. Title “Philippine Nursing Act
of 2002”
 A II –S2. Declaration of the Policy
 AIII–S3. Organization of the Board of
Nursing
 Composed of a chairperson and 6
members
SIMULATION OF BIRTH, SUBSTITUTION OF ONE
CHILD FOR ANOTHER OR ABANDONMENT OF
LEGITIMATE CHILD

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Simulation of birth –one who enters in a birth
certificate a birth that did not occur. It is a
crime against the civil status of a person.
Substitution of one child for another or
concealing or abandoning any legitimate child
with intent to cause such a child his/her civil
status shall be punishable for simulation by
c. Be a registered nurse and holder of a
master's degree in nursing, education or
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S4. Qualifications of the chairperson & members of
the board
a. Be a natural born citizen and resident of the
Philippines;
b. Be a member of good standing of the
accredited professional organization of
nurses;
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b. Issue, suspend or revoke certificates of
registration for the practice of nursing;
other allied medical profession conferred by
a college or university duly recognized by the
Government: Provided, That the majority of
the members of the Board shall be holders of
a master's degree in nursing: Provided,
further, That the Chairperson shall be a holder
of a master's degree in nursing
d. Have at least ten (10) years of continuous
practice of the profession prior to
appointment: Provided, however, That the
last five (5) years of which shall be in the
Philippines; and
e. Not have been convicted of any offense
involving moral turpitude; Provided, That the
membership to the Board shall represent the
three (3) areas of nursing, namely: nursing
education, nursing service and community
health nursing.
S5. Requirements Upon Qualification as Member of
the Board of Nursing
 Any person appointed as Chairperson or
Member of the Board shall immediately
resign from his/her work.
S6. Term of Office
c. Monitor and enforce quality standards o
nursing practice in the Philippines and
exercise the powers necessary to ensure
the maintenance of efficient, ethical and
technical, moral and professional
standards in the practice of nursing
taking into account the health needs of
the nation;
d. Ensure quality nursing education by
examining the prescribed facilities of
universities or colleges of nursing or
departments of nursing education and
those seeking permission to open
nursing courses to ensure that standards
of nursing education are properly
complied with and maintained at all
times. The authority to open and close
colleges of nursing and/or nursing
education programs shall be vested on
the Commission on Higher Education
upon the written recommendation of th
Board;
e. Conduct hearings and investigations to
resolve complaints against nurse
practitioners for unethical and
unprofessional conduct and violations of
this Act
f. Promulgate a Code of Ethics
g. Recognize nursing specialty organization
h. Prescribe, adopt issue and promulgate
guidelines, regulations, measures and
decisions as may be necessary for the
improvements of the nursing practice,
advancement of the profession and for
the proper and full enforcement of this
Act subject to the review and approval
by the Commission.
S10. Annual Report
 The Board shall at the close of its calendar
year submit an annual report to the President
of the Philippines through the Commission.
S11. Removal or Suspension of Board Members
 The president may remove or suspend any
member of the Board on the following
grounds;
a. Continued neglect of duty or
incompetence;
The Chairperson and Members of the Board
shall hold office for a term of three (3) years
and until their successors shall have been
appointed and qualified: Provided, That the
Chairperson and members of the Board may
be re-appointed for another term.
S7. Compensation of the Board Members
 They shall receive compensation and
allowances comparable to the compensation
and allowances received by the Chairperson
and members of other professional regulatory
boards.
S8.Administrative Supervision of the Board,
Custodian of its Records, Secretariat and Support
Services
 Commission (PRC)
S9. Powers and Duties of the Board
The Board shall supervise and regulate the
practice of the nursing profession and shall
have the following powers, duties and
functions:
a. Conduct the licensure examination
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S19. Registration by Reciprocity
b. Commission or toleration of irregularities
in the licensure examination; and
c. Unprofessional immoral or
dishonourable conduct.
Article IV. Examination & Registration
S12.Licensure Examination
 Written examination
S13. Qualifications for Admission to the Licensure
Examination
a. A citizen of the Philippines, or a citizen or
subject of a country which permits Filipino
nurses to practice within its territorial limits
on the same basis as the subject or citizen of
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such country: Provided, That the
requirements for the registration or licensing
A certificate of registration/professional
license may be issued without examination to
nurses registered under the laws of a foreign
state or country:
 Provided, That the requirements for
registration or licensing of nurses in said
country are substantially the same as those
prescribed under this Act: Provided, further,
That the laws of such state or country grant
the same privileges to registered nurses of th
Philippines on the same basis as the subjects
or citizens of such foreign state or country.
S21. Practice through Special/ Temporary Permit
a. Licensed nurses from foreign countries/ state
whose service are either for a fee or free if
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of nurses in said country are substantially the
same as those prescribed in this Act;
b. good moral character
c. a holder of a Bachelor's Degree in Nursing
from a college or university that complies
with the standards of nursing education duly
recognized by the proper government agency.
S14. Scope of Examination
 The Board shall take into consideration the
objectives of the nursing curriculum, the
broad areas of nursing, and other related
disciplines and competencies in determining
the subjects of examinations
S15. Ratings
 An examinee must obtain a general average
of at least 75% with a rating of not below 60%
in any subject. An examinee who obtains an
average rating 75%) or higher but gets a rating
below sixty percent (60%) in any subject must
take the examination again but only in the
subject or subjects where he/she is rated
below sixty percent (60%). In order to pass
the succeeding examination, an examinee
must obtain a rating of at least (75%) in the
subject or subjects repeated.
S16. Oath
S17. Issuance of Certificate of Registration /
Professional License and Professional Identification
Card.
 A certificate of registration/professional
license as a nurse shall be issued to an
applicant who passes the examination upon
payment of the prescribed fees
S18. Fees for Examination and Registration
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they are internationally well-known specialist
or outstanding experts in any branch or
specialty of nursing;
b. Licensed nurses from foreign countries/states
on medical mission whose services shall be
free in a particular hospital, center or clinic;
and
c. Licensed nurses from foreign countries/states
employed by schools/colleges of nursing as
exchange professors in a branch or specialty
of nursing;
 Provided, however, That the
special/temporary permit shall be effective
only for the duration of the project, medical
mission or employment contract
S22. Non-registration and Non-issuance of
Certificates of Registration/ Professional License or
Special/ Temporary Permit.
 No person convicted by final judgment of any
criminal offense involving moral turpitude or
any person guilty of immoral or dishonorable
conduct or any person declared by the court
to be of unsound mind shall be registered and
be issued a certificate of
registration/professional license or a
special/temporary permit.
S23. Revocation and suspension of Certificate of
Registration/ Professional License and Cancellation
of Special/ Temporary Permit
a. For any of the causes mentioned in the
preceding section;
b. For unprofessional and unethical conduct;
c. For gross incompetence or serious ignorance;
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d. For malpractice or negligence in the practice
of nursing;
e. For the use of fraud, deceit, or false
statements in obtaining a certificate of
registration/professional license or a
temporary/special permit
f. For violation of this Act, the rules and
regulations, Code of Ethics for nurses and
technical standards for nursing practice,
policies of the Board and the Commission, or
the conditions and limitations for the issuance
of the temporarily/special permit; or
g. For practicing his/her profession during
his/her suspension from such practice;
provided, however, that the suspension of the
certificate of registration/professional license
shall be for a period not to exceed four (4)
years.
S24. Re-issuance of Revoked Certificates and
Replacement of Lost Certificates
 Board may, after the expiration of a maximum
of four (4) years from the date of revocation
of a certificate, for reasons of equity and
justice and when the cause for revocation has
disappeared or has been cured and corrected,
upon proper application therefore and the
payment of the required fees, issue another
copy of the certificate of
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registration/professional license
d. Be a holder of a master's degree in nursing,
education, or other allied medical and health
sciences
 In addition to the aforementioned
qualifications, the dean of a college must hav
a master's degree in nursing. He/she must
have at least five (5) years of experience in
nursing.
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Article VI. Practice
S28. Scope of Nursing
 It shall be the duty of the nurse to:
 Provide nursing care through the
utilization of the nursing process. Nursing
care includes:
a. In case of suturing of perineal
laceration, special training shall be
provided according to protocol
established;
b. establish linkages with community
resources and coordination with the
health team;
c. Provide health education to
individuals, families and communities
d. Teach, guide and supervise students
in nursing education programs
including the administration of
nursing services in varied settings
such as hospitals and clinics;
undertake consultation services;
Article V. Nursing Education
S25. Nursing Education Program
 The nursing education program shall provide
sound general and professional foundation for
the practice of nursing.
S26. Requirement for Inactive Nurses Returning to
Practice
 Nurses who have not actively practiced the
profession for five (5) consecutive years are
required to undergo one (1) month of didactic
training and three (3) months of practicum.
S27. Qualifications of the Faculty
a. Be a registered nurse in the Philippines;
b. Have at least one (1) year of clinical practice
in a field of specialization;
c. Be a member of good standing in the
accredited professional organization of
nurses; and
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engage in such activities that require
the utilization of knowledge and
decision-making skills of a registered
nurse; and
e. Undertake nursing and health human
resource development training and
research, which shall include, but not
limited to, the development of
advance nursing practice;
Provided, That this section shall not apply to
nursing students who perform nursing
functions under the direct supervision of a
qualified faculty:
Provided, further, That in the practice of
nursing in all settings, the nurse is duty-bound
to observe the Code of Ethics for nurses and
uphold the standards of safe nursing practice
The nurse is required to maintain competenc
by continual learning through continuing
professional education to be provided by the

ARTICLE VII. Health Human Resources Production,
Utilization and Development
accredited professional organization or any
recognized professional nursing organization:
Provided, finally, That the program and
activity for the continuing professional
education shall be submitted to and approved
by the Board.
S30. Studies for Nursing Manpower Needs,
Production, Utilization and Development
S31. Comprehensive Nursing Specialty Program
S29. Qualification of Nursing Service Administrators.
-A person occupying supervisory or managerial
positions requiring knowledge of nursing must:
a. Be a registered nurse in the Philippines;
b. Have at least two (2) years’ experience in
general nursing service administration;
c. Possess a degree of Bachelors of Science in
Nursing, with at least nine (9) units in
management and administration courses at
the graduate level; and
d. Be a member of good standing of the
accredited professional organization of
nurses;
 Provided, That a person occupying the
position of chief nurse or director of
nursing service shall, in addition to the
foregoing qualifications, possess:
1. At least five (5) years of experience
in a supervisory or managerial
position in nursing; and
2. A master's degree major in nursing;
 Provided, further, That for
primary hospitals, the maximum
academic qualifications and
experiences for a chief nurse
shall be as specified in
subsections (a), (b), and (c) of
this section: Provided,
furthermore, That for chief
nurses in the public health
nursing shall be given priority.
Provided, even further, That for
chief nurses in military hospitals,
priority shall be given to those
who have finished a master's
degree in nursing and the 0
completion of the General Staff
S32. Salary
 The minimum base pay of nurses working in
the public health institutions shall not be
lower than salary grade 15 prescribes under
Republic Act No. 6758, "Compensation and
Classification Act of 1989“
 Provided, That for nurses working in local
government units, adjustments to their
salaries shall be in accordance with Section 10
of the said law.
S33. Funding for the Comprehensive Nursing
Specialty Program
S34.Incentives and Benefits
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Article VIII
Penal and Miscellaneous Provisions
S35. Prohibitions in the Practice of Nursing
 A fine of not less than (P50,000.00) nor more
than (P100,000.00) or imprisonment of not
less than one (1) year nor more than six (6)
years, or both, upon the discretion of the
court, shall be imposed upon:
a. any person practicing nursing in the
Philippines within the meaning of this
Act:
1. without a certificate of
registration/professional license
and professional identification card
or special temporary permit
2. who uses as his/her own certificate
of registration/professional license
and professional identification card
or special temporary permit of
another; or
3. who uses an invalid certificate of
Course (GSC): Provided, finally,
That those occupying such
positions before the effectivity of
this Act shall be given a period of
five (5) years within which to
qualify.
4. who gives any false evidence to the
Board in order to obtain a
certificate of
registration/professional license, a
professional identification card or
special permit; or
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5. who falsely poses or advertises as a
registered and licensed nurse or
registration/professional license, a
suspended or revoked certificate of
registration/professional license, or
an expired or cancelled
special/temporary permits; or
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 Essential drug list–list of drugs prepared
by DOH on the basis of health conditions
in the Philippines as well as
internationally accepted criteria.
RA 9165 –COMPREHENSIVE DANGEROUS
DRUG ACT OF 2002(repealing RA 6425)
Prohibited acts:
 Sell, administer, deliver or distribution
uses any other means that tend to
convey the impression that he/she
is a registered and licensed nurse;
or
6. who appends B.S.N./R.N. (Bachelor
of Science in Nursing/Registered
Nurse) or any similar appendage to
his/her name without having been
coferred said degree or registration;
or
7. who, as a registered and licensed
nurse, abets or assists the illegal
practice of a person who is not
lawfully qualified to practice
nursing.
b. any person or the chief executive officer of a
judicial entity who undertakes in-service
educational programs or who conducts review
classes for both local and foreign examination
without permit/clearance from the Board and
the Commission; or
c. any person or employer of nurses who violate
the minimum base pay of nurses and the
incentives and benefits that should be
accorded them as specified in Sections 32 and
34; or
d. any person or the chief executive officer of a
juridical entity violating any provision of this
Act and its rules and regulations.
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Article IX
Final Provisions
Other Laws Affecting Nursing Profession and the
Nurse
 REPUBLIC ACT–an act passed by the Congress
of the Philippines.
 RA 6675-GENERIC DRUG ACT OF 1988
 Generic name–identification of drugs
with scientifically and internationally
recognized active ingredient.
 Brand name –propriety name given by
manufacturer
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and transport of prohibited drugs
 Importation of prohibited drugs
 Den or drive
 Employees or visitors of dens
 Manufacture
 Use and possession
 Culture of plants
RA 6425 –DANGEROUS DRUG ACT
 Provision of S2-codefor selected doctors
who can prescribe narcotic drugs
RA 7877 –ANTI-SEXUAL HARASSMENT LAW
 Authority, influence or moral ascendancy
over another demands, requests or
requires any sexual favors.
 Work related
 Education related
 Training related
RA 7610 –Anti Child Abuse
RA 7658 –An Act Prohibiting the Employment
of Children below 15 years of age
RA 9262 –ANTI VIOLENCE AGAINST WOMEN
AND THEIR CHILDREN
RA 8172 –Salt Iodization Law
RA 3573 –An Act Providing for the Prevention
and Suppression of Dangerous Communicable
Diseases
RA 7432 –Senior Citizen Act
RA 8423 –Established the traditional and
alternative health care
RA 8344 –An act penalizing the refusal of
Hospitals and medical Clinics to administer
appropriate initial treatment and support in
emergency cases
RA 7305 –MAGNA CARTA OF PUBLIC HEALTH
WORKERS
 Has provisions on the benefits, rights an
responsibilities of public health workers
 Entitlement and protection:
 Discrimination is prohibited
 Understaffing and overstaffing not
allowed
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 Due process observed
 Normal hours of work, overtime pay,
night shift dif, salary scale
 Payment of salaries in legal tender
 Hazard allowance
 Right to self-organization
RA 8749 –PHILIPPINES CLEAN AIR ACT OF
1999
RA 6173 –CODE OF CONDUCT AND
moduleSTANDARDS FOR PUBLIC OFFICIALS
AND EMPLOYEES
RA 7160 –LOCAL GOVERNMENT CODE
RA 2644 –PHILIPPINES MIDWIFERY ACT
RA 2382 –PRACTICE OF MEDICINE BY A NURSE
RA 7600 –ROOMING IN AND BREASTFEEDING
ACT OF 2002
RA 7164 -Philippine Nursing Act of 1991
RA 9173-Philippine Nursing Act of 2002
RA 1080 -Civil Service Eligibility for those who
passed board and bar exams
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RA 2328 -Philippine Medical Act
RA 1612 -Privilege Tax Law -professional tax
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PRESIDENTIAL DECREE–an order of the
president in his capacity to act as legislator.
 PD 603 –CHILD AND YOUTH WELFARE CODE
 Highlights the role of the nurse which
include:
 Registration of births
 Child’s health
 Freedom of expression
 Child’s inherent right to life
 Basic health service
 It includes the rights and duties of parents
over their children.
 Parental authority
 Joint
 Grandparents
 Eldest brother or sister
 Nearest next of kin
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RA 9439 –Hospital Detention Law
RA 8187-granting 7 days paternity leave
RA 8171-Prevention & Control of Diabetes
Mellitus Act
Public Act 2808-The first True Nursing Law
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RA 1612 Privilege Tax Law professional tax
payment
RA 5181 -Permanent residence and
Reciprocity
RA 1082 -Rural Health Units all over the
Philippines
RA 4073 -Liberalizes leprosy treatment
RA 1054 -Free emergency medical treatments
to employees and laborers
RA 4226 -Hospital Licensure Act
RA 5901 -40 hours/week for nurses in with
100-bed capacity...
RA 3573 -Reporting of Communicable
Diseases
RA 6111 -Medicare Act
RA 6713 -Code of Conduct and Ethical
Standards for Public Officials/Employees
RA 6758 -Salary Standardization Law
RA 7277 -Magna Carta of Disabled Persons
RA 7624 -Drug Education Law
RA 6972 -Day Care Center for every barangay
RA 7170 -Organ Donation
RA 349 -Legalized use of human organs for
scientific purposes
RA 9505-Cheaper medicines Act
RA 877 (1953) –Philippine Nursing Law
RA 8991-PRC modernization Act of 2000
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 Guardian appointed by the court
PD 651 –Requires immediate registration of
birth within 30 days
PD 996 –Provided for compulsory basic
immunization for infants and children below 8
years old
PD 856 –Code of Sanitation
PD 825 –Garbage Disposal Act
PD 418 –FAMILY CODE
 Promote the concept of family responsible
parenthood and family planning.
PD 626 –EMPLOYEE COMPENSATION AND
STATE INSURANCE FUND
 Injury/ death that are work related are
compensable.
PD 807 –CIVIL SERVICE LAW
 Provides for recruitment and selection of
employees in government service.
PD 442 –LABOR CODE OF THE PHILIPPINES
 Provides for the rights, benefits and
privileges of employees in the private
sector.
 Vacation leave, sick leave, nsd-10%,
overtime pay,
 Right of women workers
 Right to self-organization
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MODULE 5
PD 223 -Professional Regulation Commission
(PRC)
 Creation of Board of Nursing
 Professional Regulation Commission has
the power to recommend nominee
members of the board to the President
of the Republic, June 22, 1973
PD 143 -Woman and Child Labor Law (no child
below 14 shall be employed)
PD 69 -Four children for tax exemption
PD 541 -Practice of profession in the
Philippines by former professionals
PD 48 -Four children for maternity privilege
PD 965 -Family Planning and Responsible
Parenthood
PD 1519 -Medicare Benefits for all
government employees
PD 1636 -Compulsory membership to SSS of
self-employed persons
EXECUTIVE ORDER
 An order issued by the executive
department in order to implement a
constitutional or a statutory provision.
EO 51 –Milk Code
EO 209 –Family Code
Models and Theories of Communication
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EO 203 –List of Regular Holidays and Special
days
EO 180 –Guidelines on the right to organize of
Government Employees
EO 857 -Compulsory Dollar Remittance Law
EO -174 -National Drug Policy (availability,
affordability or safe, effective, quality drugs)
Board Resolutions
 No. 633 series of 1984 -ICN Code of 0
Ethics
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The Transmission Model of
Communication describes
communication as a linear, one-way
process in which a sender intentionally
transmits a message to a receiver (Ellis &
McClintock, 1990). The communication
encounter us viewed more as a target or
end point rather than a part of an
ongoing process. In this model, the
receiver either successfully receives and
understands the message or not. The
sender is expected to ensure the
message is successfully conveyed
The Interaction Model of
Communication describes
communication as a process in which
participants alternate positions as sende
and receiver and generate meaning by
sending messages and receiving
feedback within physical and
psychological contexts (Schramm, 1997)
In this model, feedback which includes
messages sent in response to other
messages, is included and makes
communication a more interactive, twoway process.
The Transactional Model of
Communication describes
communication as not an exchange of
messages, but also as a way to create
relationships, form intercultural
alliances, shape our self-concepts, and
engage with others in dialogue to create
 No. 1955 s. 1989 -PNA Code of Ethics
 No. 1930s. 1985-CPE for Nurses
 No. 187 s. 1991 -Renewal of Professional
license
 No. 217s. 1992 -Delisting of delinquent
professionals
 Letters of Instructions
 LOI 949 -Legal Basis of Primary Health
Care
 LOI 100 -Preference given to members of
accredited professional organization for
employment and seminars
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communities. In this model, participants
are not just senders and receivers, but
termed communicators and are
simultaneously senders and receivers.
Peplau’s Theory of Interpersonal
Relations. Hildegard Peplau defined
nursing as an “interpersonal, therapeutic
process that takes place when
professionals, specifically educated to be
nurses, engage in therapeutic
relationships with people who are in
need of health services.” She posited
that nurse-patient relationships must
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pass through three phases in order to be
successful:
(a) orientation phase,
(b) identification,
(c) exploitation, and
(d) resolution.
Orientation Phase – Starts with the
definitions of the problem. The nurse’s
assessment of the patient’s health and
situation is vital in this phase. The patient
seeks assistance, tells the burse what he or
she needs, asks questions, and shares
preconceptions and expectations based on
past experiences.
Identification phase – Includes the selection
of the appropriate assistance by a
professional. The patient begins to feel as if
he or she belongs, and feels capable with
dealing with the problem which decreases the
feeling of helplessness and hopelessness. The
development of a nursing care plan is
performed in this phase.
Exploitation Phase – Utilizes professional
assistance for problem-solving alternatives.
When communicating with the patient, the
nurse should use the interview techniques to
explore, understand, and adequately deal
with the underlying problem. This phase is the
implementation of the nursing care plan.
Resolution Phase – This is the termination of
the professional relationship after the
patient’s needs have been met through the
collaboration of patient and nurse. This is the
evaluation of the nursing process.
regimens effectively. For this reason, they
utilize healthcare facilities more frequently
and have higher mortality rates.
 Cultural Diversity – Culture affects
communication in how the content is
conveyed, emphasized, and understood
 Cultural Competence – This affects the way\y
healthcare providers interact with each other
and with the populations they service. To
practice, cultural competence, healthcare
professionals need to recognize and relate
how culture is reflected in each other and in
the individuals with whom they interfere.
 Interprofessional Communication Education
of Healthcare Providers – Challenges may
also occur when communicating with
professionals in other disciplines and may
include use of concepts and terminology
common to once specific discipline but not
well understood by members of other
professions. These may affect another
professional’s understanding of the meaning
or value of the situation.
Written Communication within the Organization
Barriers to Communication Among Health-Care
Providers and HealthCare Recipients
Schwarts, Lowe, & Sinclair (2010) identified many
challenges that impede communication in healthcare
setting. These include low health literacy, cultural
diversity, cultural competence of healthcare provider,
and lack of interpersonal communication education of
providers.
 Low Health Literacy – individuals who lack the
skills necessary to acquire and use healthcare
information are less likely to manage their0
chronic conditions and/or medication
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1. Memo Writing
The written communication used most by
managers in their daily work life is the memo
Perkins and Brizee (2013) suggest that
business memos have a twofold purpose:
They bring attention to problems and they
solve problems. Business memos, according
to Perkins and Brizee (2013) suggest that
business memos should be composed of the
following components:
 Header (includes the to, from, date, and
subject lines): one eighth of the memo
 Opening, context, and task (includes the
purpose of the memo, the context and
problem, and the specific assignment or
task): one fourth of the memo
 Summary, discussion segment (the
details that support your ideas or plan):
one half of the memo
 Closing segment, necessary attachment
(the action that you want your reader to
take and a notation about what
attachments are included): one eighth o
the memo.
refer to meeting minutes to make future decisions
about how to move forward with decisions or new
projects.
In addition, because writing is a learned skill that
improves with practice, Writing Help Central, suggests
the following in writing professional correspondence:
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Keep your message short and concise.
Less than once page is always preferred.
Use bullets to highlight key points.
Use the first paragraph to express the
context or purpose of the memo and to
introduce the problem. In the next
paragraphs, address what has been done
or needs to be done to address the
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problem at hand.
Add a conclusion to summarize the
Steps on How to Record Meeting Minutes
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1. Plan and outline. The secretary or whoever
will be recording the minutes should meet wi
the chairperson before the meeting begins to
decide on an agenda for the meeting to keep
meeting minutes organized and easy to
record.
2. Record taking at the meeting. Take detailed
notes for each agenda item which include:
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Decision made
Actions taken or agreed to be taken
Next steps moving forward
Voting outcomes including who made
the motion and how each member
voted
 Any motions that were rejected
 Items to be held over
 New business
 The date and time of the next
meeting Ask for clarification if
necessary to ensure that the notes
are accurate.
3. Writing the minutes. Using the detailed notes
the recorder will then write the final draft of
the meeting minutes. The recorder should do
this as soon as possible. Many corporations
use a standard template that includes the
following information:
 Opening – Meeting title, location,
time, and date
 Present members – Include full
names and titles
 Absent members – Include full names
and titles
 Approval of the agenda – Should
indicate if the agenda was approved
and distributed
 Approval of the previous minutes –
Should indicate of the previous
minutes were approves and
distributed
 Business from previous meeting –
Summary of the business that was
discussed in the previous meeting
memo, to clarify what the reader is
expected to do, and to address any
attachments that are a part of the
memo.
 Focus on the recipient’s needs. Make
sure that your communication addresses
the recipient’s expectations and what he
or she needs to know.
 Use simple language so that the message
is clear. Keep paragraphs to less than
three or four sentences.
 Review the message and revise as
needed. Always reread the written
communication before sending it. Look
for areas that might be misunderstood.
Pay attention to tone.
 Use spelling and grammar checks to be
sure that the communication looks
professional. Remember that your
document is a direct reflection of you,
and even the most important message
will likely be ignored if the
communication is perceived as
unprofessional.
2. Meeting minutes are notes or records, usually
taken by the secretary that contains the details
of what transpired in a meeting, the issues that
were discussed, motions proposed, and any
votes taken. If a member did not attend a
corporate meeting, they can refer to the
meeting notes to find out any important
information they have missed
(contractscounsel.com).
Purpose of Meeting Minutes are used to capture
important details in a meeting. Boards will often
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 New business – Summary of each
agenda item discussed at the current
meeting. This should include a
description of the action, rational
behind the decision, and major
arguments for or against the action
 Additions to the agenda – Any
additional motions that were not
listed on the next meeting agenda
 Agenda for the next meeting – Topics
to be discussed at the next meeting
 Adjournment – Time the meeting
ended and date and time of the next
meeting
4. Submission and approval. The meeting
minutes must include the name of the person
who made the minutes and the name of the
person who approved it. The chairperson
usually reviews and approves the minutes for
circulation.
5. Distribution of meeting minutes. It is usually
the responsibility of the secretary to
distribute the meeting minutes to the
members.
0
Reports in Nursing
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those that still have to be done, observations
about the patient’s family as these relate to
his/her problems, effects of nursing and
medical measures, priorities which the
incoming shift nurses must attend to, and
instructions for procedures that must be
done. Any information that may alarm the
patient and/or his/her family is reported out
of hearing. The report is given in a low voice
to prevent others from hearing. Change-ofshift reports should be done quickly and
efficiently.
b. Audio-tape Report – This is made by the
outgoing nurse and is relayed by the incoming
nurse. The disadvantage of this report is that
immediate answers cannot be provided if any
problems arise unlike in oral reports or those
made during nursing rounds which can permi
immediate feedback when needed.
c. Nursing rounds – These are made at the
patient’s bedside. The patient’s care plan is
discussed. This enables the patient and his
family to participate in the discussion, pose
questions or seek clarifications. At the same
time, the nurse can perform an additional and
needed assessment, evaluate the patient’s
progress and determine the interventions tha
best meet his/her needs.
According to Venzon, reports are oral, taped or
written exchanges of information between nurses
and/pr members of the health team. These include
change-of-shift reports, telephone orders and reports,
and transfer reports.
Telephone Reports
Nurses should only receive telephone orders only in
extreme emergency and when there is no other
resident or medical intern is available. The nurse
should read back the order to the physicians to make
sure that the order received is correct. The order mus
be signed by the ordering physician once he/she
returns to the hospital. The nurse should note the
date and time when the order was made , when
he/she wrote the order, the name of the physician
making the order, then sign his/her own name,
including designation.
Change-of-Shift Reports. This is a system of
communication aimed at transferring essential
information and holistic care for patients. Its purpose
is to provide continuity of patient care for 24 hours. It
may be given orally, by audio tape recording, or at the
bedside during nursing rounds. Oral reports are
initially given at the nurses’ station or conference
room with nurses from both shifts attending.
a. Oral Report – Prior to the nursing rounds, a
pre-conference is made at the nurses’ station
or conference room. Essential information
includes the patient’s name, their medical
diagnosis, nursing diagnosis and related
causes, diagnostic measures completed and
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Transfer Reports
The transfer report accompanies the patient and
contains information that the receiving nurse needs t
know for continuity of care. This includes a summary
0
4. Determine the date, time, and location for the
meeting, and invite attendees. To maximize
meeting attendance, ask attendees what date
and time would work with their schedules.
5. Create the meeting agenda. It should contain the
following components:
 Title of the group meeting
 Date, time, and location of the meeting
 Purpose(s) for the meeting in sentence
form
 Agenda items, time allotted for each item,
and person responsible for reporting on
each item.
6. Send the meeting agenda out at least 1 week
before the meeting so that attendees come
prepared. Send a meeting reminder 2 days
before the meeting.
of the medical progress up to the time of transfer and
is usually made by a physician, current health status,
current nursing diagnosis or health problems and care
plan, or critical assessments or interventions to be
completed after transfer and the special equipment
necessary. An oral report is usually made by the
accompanying nurse so that additional information
can be made or clarified. The patient’s chart also
accompanies the patient together with the transfer
report.
A post-operative patient transferred back to his
original unit after surgery will need a transfer report
from the Recovery Room if he stayed there. The
transfer report will show a progression of reports
from the Operating Room to the Recovery Room until
the time of transfer. It will include the kind of surgery
the patient underwent, the kind of anesthesia used,
the medications received by the patient both in the
Operating and Recovery Rooms, his or her general
condition while in these units, condition on transfer,
continuing medications, and treatment, and
assessments to be done.
During the Meeting
1. Ensure that the participants’ comfort needs are
met by arranging the seating in an oval or circular
shape and preferably around a table.
2. Ask for volunteers to fulfill the following roles.
When a patient is to be transferred to another
agency, proper coordination must first be made to
ensure that the agency has the proper services and
facilities needed by the patient. A transfer report
accompanies the patient. The patient’s medical record
or chart is left at the original agency
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Recorder
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As discussed by Cherry & Jacobs (2014),
the following steps must be undertaken
to manage effective meetings.
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Pre-meeting Work
1. Determine the specific purpose(s) for the
meeting (What do you want to accomplish in 0the
meeting?).
Leader
Timekeeper
3. The leader guides the meeting by:
Preparation and Conduct of Meetings
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Processing one agenda at a time.
Allowing the timekeeper to do his or her job
to keep the meeting on track.
Debriefing the end of the meeting by asking
these questions: “What went well with the
meeting?” and “What can we improve upon
for the next meeting?” These questions
should be used at the end of each meeting t
improve subsequent meetings.
2. Create a list of meeting topics, such as revisions
to nursing handbook” or “new admission policy.”
Create a fact sheet related to each topic to
distribute with the agenda.
3. Determine the meeting attendees. They are
individuals, groups, or department
representatives with valuable insight or who are
affected by decisions made during the meeting.
Internal customers are employed by the organization
and may include patient care staff members, staff
members of other departments (laboratory, dietary),
0
administrators, social workers, dietitians, and
therapists. For example, nurses should view staff
Patient Satisfaction and Customer Service Provider
External customers are not employed by the
organization and include patients and families, in
addition to physicians and others who serve as
referral sources for new patients. Payers (insurance
companies, managed care plans) are also being
considered as primary external customers.
0
 To provide evidence of actions and decisions
 To support accountability and transparency
 To comply with legal and regulatory
obligations, including employment, contract
and financial law as well as the data
members as customers and determine how to meet
their needs to facilitate effective and efficient work
performance. The needs of internal customers who
help manage an effective nursing unit such as
housekeeping, maintenance, laboratory, and social
services should be considered.
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MODULE 6
BENEFITS OF RECORD MANAGEMENT
 Records management (RM) is the supervision
and administration of digital or paper records,
regardless of format.
 It is a systematic and effective control of
records (both paper and electronic). It aims
to ensure that records are accurate and
reliable, can be retrieved speedily and
efficiently, and efficiently, and are kept for no
longer than necessary. It is crucial to all
organizations. Unless records are managed
efficiently it is possible to conduct business, to
account for what happened in the past, or to
make decisions are kept for no longer than
necessary.
 Records management activities include the
creation, receipt, maintenance, use and
disposal of records. Documentation may exist
in contracts, memos, paper files, electronic
files, reports, emails, videos, instant message
logs database records. Paper records may be
stored in physical boxes on-premises or at a
storage facility. Digital records may be stored
on storage media in-house or in the cloud.
 The goal of records management is to help an
organization keep the necessary
documentation accessible for both business
operations and compliance audits.
 Saves time by ensuring that records can be
found easily and quickly
 Save space by preventing records from being
kept longer than
 Necessary
 Saves money by reducing storage costs and
maintenance costs
 Improves efficiently by ensuring records are
readily accessible legally
 Improves compliance by keeping records in
line with legal and regularly requirements
 Keeps records under control by preserving
data and preventing accumulation control of
epheral material
 Improves the quality of information, providing
staff with access to accurate and reliable
quality records security
 Increases the security of confidential records
continuity
 Support business continuity and risk
management
 Records are managed efficiently and can be
easily assessed and used
 Records are stored as cost effectively as
possible and when no longer required they
are disposed of in a timely and efficient
manner.
IMPORTANCE OF RECORD MANAGEMENT
0
protection act and freedom of information ac
To protect the interests of staff, students and
other stakeholders
Help to address complaints or legal processes
To support patient choice and control over
treatment and services
To support day to day business of the health
care delivery
To support evidenced based practice
To assist clinical and other types of audits
To support sound administrative and
managerial decision making.
To support improvement in clinical
effectiveness through research
0
 Complies with requirements concerning
records and records management practices to
ensure compliance with institution
 Records of longer term value are identified
and protected for historical and other
research.
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Record
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It is a permanent written communication that
documents information relevant to a client’s
health care management. E.g. chart is a
continuing account of client health care status
and need.
A record is a clinical, scientific, administrative
and legal document relating to the nursing
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care given to the individual family and
community.
Records should be written with clearly and
appropriately
Records should contain facts based on
observation conversation and action
Select relevant facts and the recording should
be neat, complete and uniform
Records should be written immed
an interview
Records are confidential documen
SAFEKEEPING AND RELEASE OF RECORDS
1. Sentinel events
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is a patient safety event that results in
death, permanent harm, or severe
temporary harm. Sentinel events are
debilitating to both patients and health
care providers involved in the event.
The most common sentinel events are
wrong-site surgery, foreign body
retention, and falls. They are followed by
suicide, delay in treatment, and
medication errors. The risk of suicide is
the highest immediately following
hospitalization, during the inpatient stay,
or immediately post-discharge
2. Anecdotal
Sample of records
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Administrative records of Grants/Contracts
Bid documents
Blueprint of facilities
Consent forms-adult-minor
Endowment Fund Records
Equipment inventory reports
General ledgers
Meeting minutes
Payroll folders
Contracts-purchase lease rental, and etc.
is an observation that is written like a
short story. They are descriptions of
incidents or events that are important to
the person observing. Anecdotal records
are short, objective and as accurate as
possible
3. Incident report
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Records in the Nursing Office and Unit
4. Kardex
 Administrative records: organogram, job
description, procedure manual
 Personnel records: personal files, records
 Patient records send to medical center
chief/medical director
 Leave record, duty roster, minutes of the
meeting, budget etc.
 Miscellaneous: circular log book, formats, etc.
5. Patients chart/records
6. 201 file
Nurses responsibility for record keeping and
recording
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Principles of Record Writing
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Nurses should develop their own method of
expression and form in record writing
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Keep under safe custody of nurse
No individual sheet should be separated
Not accessible to patient and visitors
Strangers is not permitted to read records
Records are not handed over to the legal
advisors without written permission of the
administration
Handed carefully, not destroyed
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 Provides baseline data to estimate the long
term changes related to services
Identified with bio-data of the patients such
as name, age, admission number, diagnosis,
etc.
Never sent outside the hospital without the
written administrative permission
Administrative Purpose of clinical records
Nursing Administrator’s Responsibility
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 Protection from loss
 Safeguarding its concerns
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 Completeness
 Responsibility for nurse notes
 Admission record
 Scientific value of the nurse notes
 Record of order carried out
Individual Staff Record
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A separate set of record is needed for staff, giving
details of their sickness and absences.
Ward Records
Importance of Records in Hospital (For individual an
family)
 Reducing or increase in beds
 Change in medical staff and non-nursing
personnel for the ward
 The introduction and patient of support
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Characteristic of a Good Record and Reporting
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Accuracy
Consciousness
Thoroughness
Up to date
Legal documents: poisoning, assault, rape,
leaving against medical advice
(LAMA/HAMA/DAMA)
Research or statistics rates
Audit and nursing audit
- is the process of collecting information
from nursing reports and other
documented evidence about patient care
and assessing the quality of care by the
use of quality assurance programmes. ... A
retrospective nursing audit is performed
after discharge from the care facility,
using the patient's record.
Quality of care
Continuity of care
Informative purposes: MEN census
Teaching purposes of students
Diagnostic purposes: test reports
Serve the history of the client
Assist in the continuity of cares
Evidence to support if legal issues arise
Assess health needs: research and teaching
For the Doctor
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Serve the guide for diagnosis, treatment,
follow up and evaluation
 Organization
 Confidentiality
 Objectivity
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Purposes of Record
For the Nurses
 Supply data that are essential for program
planning and evaluation
 Provide the practitioner with data required
for the application of professional services for
the improvement of family health
 Used as tools of communication between
health workers the family and other
development personnel
 Shows the health problem in the family and
other factors that affect health
 Indicates plan for future
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Indicate progress and continuity of care
Self-evaluation of medical practice
Protect doctor in legal issues
Used for teaching and research
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Document nursing service rendered
Planning and evaluation of service for future
improvement
Guide for professional growth
Communication tool between nurse and othe
staff involved in the care
Indicate plan for future
For Authorities
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Statistical Information
Administrative control
Future reference
Evaluation of care in terms of quality, quantity
and adequacy
Help supervisor to evaluate service
Guide staff and students
Legal evidence of service rendered by each
employee
Provide justification of expenditure of funds
administrators on a personal as well as
organizational level.
PURPOSE OF PLANNING
1. Planning increases the chances of success.
2. It forces analytic thinking and evaluation of
alternatives
3. It establishes a framework for decision making
that is consistent with to Management
MODULE 8
objectives.
A. PLANNING
4. It orients people to action instead of reaction
 a basic function of management, is a principal
5. It includes day-to-day and future-focus
duty of all managers, is a critically important
managing
to and precedes all other management
6. It helps to crisis management and provides
functions. It is a systematic process and
decision-making flexibility
requires knowledgeable activity based on
7. It provides a basis for managing organizational
sound managerial theory.
and individual and individual performance
 Planning is defined as deciding in advance, it
8. It increases employee involvement and
directs our thinking on what we expect to do,
improves communication
why it will be done, who is going to do it, and
9. It is cost effective
how when and where to be done.
 The first element of management defined by
Henry Fayol is planning in which he defines as
IMPORTANCE OF PLANNING
making a plan of action to provide
foreseeable future. According to him that plan
Nurse Manager must know how to plan for the
must have unity, continuity, flexibility, and
following reasons:
precision. The plan should be included annual
1. Planning leads to the achievement of goals and
and 1o year forecasts, taking advantage of
objectives.
input of others
Workers relate what they do to
 Planning facilitates the art of handling people.
meaningful results. It ensures alignment
Because planning fail, it requires moral
of nursing unit/department and financial
courage. Effective planning requires
plans with the strategic plan.
continuity of tenure. Good planning is a sign
Thus, increase the probability of
of competence, (Marquis and Huston 2017).
achieving organizational goals, vision, an
 Planning is designed for the nurse
mission. Also, it establishes a framework
administrators who are seeking more
for decision making consistent with top
effective means of improving current and
management objectives.
future performance. It offers principles of
planning and decision-making guides in
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nursing practice. It deals with those aspects
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2. Planning is gives meaning to work.
Employees or workers experience
of planning that directly affects the nurse
greater satisfaction if what they do
becomes meaningful to them. Ensures
diagnostic work up in the Out-patient
safe and quality care through awareness
Department. Minor surgeries are also
of individual responsibility and
done at the OPD so that more hospital
accountability.
beds can be allotted to critically-ill
patients or for those needing specialized
3. Planning provides for effective use of available
services.
resources and facilities.
The best use of personnel and material
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resources prevents wastage.
4. Planning helps in coping with crises. Hospitals
8. Planning improves communication and team
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collaboration through people involvement in
planning activities.
9. Planning provides the basis for control.
9. Planning provides the basis for control.
4. Planning helps in coping with crises. Hospitals
It becomes the basis for evaluating
must provide for disaster plans.
the accomplishment of the set
It allows the workers to function more
programs/activities.
clearly and efficiently when actual
10. Planning is necessary for effective control,
emergencies occur such as fire, typhoons,
earthquakes, or during New Year
Nurse- managers evaluate the environment or
celebrations and or other occasions when
setting in which they work or where the patients are
more people are likely to get hurt.
confined and make necessary recommendations to
Manages risk and copes with crisis
make hospital conditions more therapeutic not only
situations.
for the patients but for the workers as well.
5. Planning is cost effective.
Performance of workers and evaluation of services to
Cost can be controlled through
patients’ base on criteria set during the planning stag
planning for efficient operation. Projecting
will indicate whether standards of care are met and
the number of operations in a given day,
whether changes are indicated.
including daily dressings, helps in
determining accurately the needed weekly
supplies in the surgical units so as to
prevent undersupply, oversupply or
SCOPE OF PLANNING
pilferages.
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6. Planning is based on past and future activities.
The Top Management or the Nursing Directors,
Chief Nurses or Directors of Nursing and their
Evaluation of programs. Schedules,
assistants are the one who set the overall goals
and activities whether successful or not,
and policies of an organization. It’s their
prevents and/or reduces the recurrence of
responsibility to covers the over-all management
problems and provides better ideas in
of the organization’s Nursing Service.
modifying or avoiding them.
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7. Planning leads to the realization of the need for
The Middle management or Nursing Supervisors
direct the activities to actually implement the
change.
broad operating policies of the organization such
Discovers the need for change that
as staffing and delivery of services to the units.
leads to create new services and
The formulation of policies, rules and
productivity.
regulations, methods and procedures for
Many of the hospitals have found out
intermediate level planning for ongoing activities
that in-patient hospital days can greatly
and projects is done in coordination with top
reduce by having the laboratory and
management and those in the lower level.
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At the lower or first –level management, the
The community it serves, this includes the kind of
Head Nurses or Senior Nurses (including Charge
people served their needs, expectations, literacy rate
Nurses or team Leaders) do the daily and weekly
economic levels, employment rates, demographic
plans for the administration of direct patient care
statistics, cultural values, values and services available
in their respective units.
in the community.
The goals of care, vary according to the needs of the
CHARACTERISTICS OF A GOOD PLAN
community, agency, trends in technology and in
1. Be precise with clearly-worded objectives,
changing needs of the community, agency, trends in
including desired results and methods of
technology and in changing concepts of the nurses’
evaluation.
roles and functions.
2. Be guided by policies and/or procedures
B. Setting the Vision, Mission, Philosophy, Goals
and Objectives
affecting the planned actions.
3. Indicate priorities.
4. Develop actions that are flexible and realistic in
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terms of available personnel, equipment,
facilities, and time.
5. Develop a logical sequence of activities.
6. Include the most practical methods for achieving
each objective.
7. Pervade the whole organization.
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Most often, the purpose and philosophy are
explicitly stated and detailed in a formal
mission statement. This mission statement
reflects the organization’s values and
provides the reader with and indication of
the behavior and strategic actions that can
be expected from that organization.
Mission statement outlines the agency’s
reason for existing (whether hospital or