Ethico-Legal and Moral Considerations in Nursing Leadership and Management

Code of Ethics

is a set of principles and standards that guides professionals in making ethical decisions and behaving responsibly in their practice

Code of Good Governance

1. July 23, 2003

2. 42 Professional Regulatory

• promulgated by the Professional Regulation Commission on (1)__

• is a set of principles that promotes responsible, ethical, transparent, and accountable professional practice.

• is adopted by the Professional Regulation Commission and the (2)__ Professional Regulatory Boards to cover an environment of good governance in which all Filipino professionals shall perform their duties

• Service to Others

• Integrity and Objectivity

• Professional Competence

• Solidarity and Teamwork

• Social and Civic Responsibility

• Global Competitiveness

• Equity of All Professions

General Principles of the Code of Good Governance

(SIPSSGE)

1. Health

2. R.A. No. 9173, known as the “Philippine Nursing Act 2002”and Board Res. No. 425, Series of 2003, the “Rules and Regulations Implementing the Philippine Nursing Act. Of 2002”

3. Nursing Specialty Certification Council

4. “Patients’ Bill of Rights”

5. Philippines Nurses Association

1. __ is a fundamental right of every individual

2. nursing law

3. meaning of NSCC

4. Respect the “__ ” in the delivery of nursing care.

5. meaning of PNA

1. Philippine Nursing Law

2. Creating the Professional Regulation Commission and Prescribing its Powers and Functions

SECTION 19. The Amended Code of Ethics promulgated pursuant to R. A. No. 877 and P.D. No. 223 is accordingly repealed or superseded by the herein Code.

1. title of RA 877

2. title of PD 223

ICN (International Council of Nurses)

• was first adopted by the International Council of Nurses (ICN) in 1953.

• Most recently with this review and revision completed in 2021

• A statement of the ethical values, responsibilities and professional accountabilities of nurses and nursing students.

• It guides ethical nursing practice and decision-making across different nursing roles and settings

PURPOSE;

• It defines and guides ethical nursing practice within the different roles nurses assume.

• Serve as a framework for ethical nursing practice and decision-making to meet professional standards

• It provides ethical guidance in relation to nurses' roles, duties, responsibilities, behaviours, professional judgement and relationships with patients, other people who are receiving nursing care or services, co-workers and allied professionals.

• Nurses and patients or other people requiring care or services

• Nurses and practice

• Nurses and the profession

• Nurses and global health

4 Principal Elements for Ethical Conduct

Nurses and patients or other people requiring care or services care

• Nurses' primary professional responsibility is to people requiring nursing care and services.

• Nurses promote an environment in which the human rights, value: customs, religious and spiritual beliefs are acknowledged and respected by everyone.

• Nurses respect the privacy and confidentiality of colleagues and people requiring care and uphold the integrity of the nursing profession.

• Nurses share with society the responsibility for initiating and supporting action to meet the health and social needs of all people.

• Nurses advocate for equity and social justice in resource allocation, access to health care and other social and economic services.

• Nurses demonstrate professional values such as respect, justice, responsiveness, caring, compassion, empathy, trustworthiness and integrity. Nurses facilitate a culture of safety in health care environments.

Nurses and Practice

• Nurses carry personal responsibility and accountability for ethical nursing practice, and for maintaining competence by continual learning.

• Nurses maintain fitness to practice so as not to compromise the ability to provide quality, safe care.

• Nurses practice their individual competence and regulated scope of practice and use of judgment when accepting and delegating responsibility.

• Nurses maintain a person's right to give and withdraw consent to access their personal, health and genetic information. Nurses are active participants in the promotion of patient safety.

• Nurses are accountable for data integrity to support and facilitate ethical standards of care

Nurses and The Profession

• Nurses assume the major leadership role in determining and implementing evidence-informed, acceptable standards of clinical nursing practice, management, research and education.

• Nurses and nursing scholars are active in expanding research-based, current professional knowledge that supports evidence-informed practice.

• Nurses are active in developing and sustaining a core of professional values.

• Nurses, through their professional organizations, participate in creating a positive and constructive practice environment where practice encompasses clinical care, education, research, management and leadership.

• Nurses contribute to positive and ethical organizational environments and challenge unethical practices and settings.

• Nurses engage in the creation, dissemination and application of research that improves outcomes for individuals, families and communities.

• Nurses prepare for and respond to emergencies, disasters, conflicts, epidemics, pandemics, social crises and conditions of scarce resources

Nurses and Global Health

• Nurses value health care as a human right, affirming the right to universal access to health care for all.

• Nurses uphold the dignity, freedom and worth of all human beings and oppose all forms of exploitation, such as human trafficking and child labour

• Nurses lead or contribute to sound health policy development.

• Nurses contribute to population health and work towards the achievement of the United Nations Sustainable Development Goals(SDGs).

• Nurses recognise the significance of the social determinants of health.

• Nurses collaborate and practise to preserve, sustain and protect the natural environment and are aware of the health consequences of environmental degradation

• Nurses collaborate with other health and social care professions and the public to uphold principles of justice by promoting responsibility in human rights, equity and fairness and by promoting the public good and a healthy planet.

• Nurses collaborate across countries to develop and maintain global health and to ensure policies and principles for this.

1. 1 Chairperson, 6 Members

2. President of the Philippines.

3. 2

4. 3

5. Section 4

1. composition of the BON

2. Appointed by the __ of the Philippines.

3. PRC provides __ recommendees per vacancy.

4. These are selected/ranked from __ nominees per vacancy submitted by the accredited professional organization of nurses.

5. Appointees must meet Section __ qualifications

1. master's degree

2. 10 years

3. 5 years

Section 4 — Qualifications of Chairperson and Members

1. Chairperson must have a __ in nursing.

2. Have at least __ years continuous nursing practice before appointment.

3. Last __ years of practice must be in the Philippines.

1. 3 years

2. reappointed

3. Vacancy

4. oath of office

Section 6 — Term of Office

1. Term: __ years

2. Continues until successor is appointed and qualified. May be __ for another term.

3. __ → replacement serves only the unexpired term.

4. Members must take their __ before performing duties.

• Existing Board members under RA 7164 continue until replacements are appointed and qualified.

1. CHED

2. subpoena ad testificandum

3. subpoena duces tecum

4. 1 year

1. __, not the Board, has authority to open/close nursing colleges/programs, but based on the written recommendation of the Board

2. Issue __ → requires a person to appear/testify.

3. Issue __ → requires production of documents

4. Develop the Code of Ethics for Nurses in coordination with the accredited professional organization within __ year from effectivity

1. PRC Modernization Act of 2000

1. title of RA 8981

1. 75%

2. 60%

3. 75%

3. below 60%; Retake

4. 75%

Section 15 — Ratings

To pass:

1. At least __% general average

2. Not below __% in any subject

If:

3. General average = __% or higher

3. But one/more subjects = below __% → __ only the subject(s) below 60%.

For the retaken subject:

4. Must obtain at least __% to pass.

1. professional oath

2. board

3. government official authorized

Section 16 — Oath

1. Successful examinees must take the __

Oath is before:

2. __, OR

3. __ to administer oaths.

Must take oath before entering nursing practice.

Certificate of Registration/Professional License, containing:

1. Full name

2. Serial number

3. Signatures of PRC Chairperson and Board members

4. Official PRC seal

Also receives a Professional Identification Card (PIC) containing:

1. Date of registration

2. License number

3. Date of issuance

4. Date of expiration

5. Signature of PRC Chairperson

Section 17 — Certificate/License and PIC

After passing and paying required fees, nurse receives: Certificate of Registration/Professional License, containing:

1. F__

2. S__

3. S__

4. O__

Also receives a Professional Identification Card (PIC) containing:

1. D__

2. L__

3. D__

4. D__

5. S__

ipso facto

Section 19 — Automatic Registration

Nurses already listed in the official roster of nurses are automatically/“__” registered under RA 9173 when the law takes effect.

1.laws

2.RA 9173

3.same privileges

1. project, medical mission, employment contract

Section 20 — Registration by Reciprocity

A foreign nurse may receive registration without examination if:

1.Registered under the __ of a foreign country/state;

2.Its registration/licensing requirements are substantially equivalent to __; AND

3.That country gives Filipino RNs the __ on the same basis as its own citizens/subjects.

1. Permit is valid only for the duration of: P__, M__, E

1. RA 9173

2. Rules/regulations

3. Code of Ethics

4. Technical standards

5. Board/PRC policies

1. 4 years

Section 23 — Revocation/Suspension/Cancellation

Board may revoke/suspend a nursing license or cancel a temporary/special permit for:

6.Violation of:

1. R__

2. R__

3. C__

4. T__

5. B__

6. Conditions/limitations of special/temporary permit 7.Practicing while under suspension

1. Maximum license suspension = __ years

1. 1 month didactic training

2. 3 months practicum

Section 26 — Inactive Nurses Returning to Practice

Nurses who have not actively practiced for 5 consecutive years must complete:

1. __ month __

2. __ months __

1. Registered Nurse

2. 1 year

3. member

4. Nursing, Education, Allied medical/health sciences

5. government-recognized institution.

1. master's degree

2. 5 years

Section 27 — Qualifications of Faculty

Faculty teaching professional nursing courses must:

1. Be a __ in the Philippines.

2. Have at least __ year clinical practice in a specialization.

3. Be a __ in good standing of the accredited professional nursing organization.

4. Hold a master's degree in: N__, E__, A__

5. Degree must be from a __.

 

Dean additionally must:

1. Have a __ in nursing

2. Have at least __ years nursing experience.

Health promotion

Illness prevention

As independent practitioners, nurses are primarily responsible for:

H__

I__

Curative care

Preventive care

Rehabilitative care

Restoration of health

As members of the healthcare team, nurses collaborate in: C__
P__

R__

R__

A.

1. Traditional approaches

2. Innovative approaches

B.

1. Connect with community resources.

2. Coordinate with the healthcare team.

C.

1. Individuals

2. Families

D.

1. Participate in nursing education programs.

2. Provide consultation services

E.

1. Conduct nursing/health research.

2. development of advanced nursing practice

Specific Nursing Duties

A. Provide nursing care using the nursing process. Nursing care includes:

1. T__

2. I__

B. Establish linkages

1. C__

2. C__

C. Health education. Provide health education to:

1. I__

2. F__

D. Teaching/supervision and consultation

1. P__

2. P__

E. Research and development

1. C__

2. D__

Continuing Professional Education (CPE)

• Nurses must maintain competence through __

• is provided by the accredited professional organization or recognized professional nursing organization.

• programs/activities must be submitted to and approved by the Board.

1. Registered Nurse; Philippines

2. 2 years; general nursing service administration

3. BSN

4. 9 graduate-level units; management and administration

5. Member

For supervisory/managerial positions requiring nursing knowledge:

1. Registered __ in the __

2. At least __ years experience in __

3. __ degree

4. At least __ graduate-level units in __ and __

5. __ in good standing of accredited professional organization

1. 5 years

2. Master's; nursing

Chief Nurse/Director of Nursing Service — Additional Requirements

1. At least __ years supervisory/managerial nursing experience

2. __ degree major in __

1. Master's; nursing

2. General Staff Course (GSC)

Military hospitals:

Priority to chief nurses who have:

1. __ degree in __

2. Completed __

1. 90 days

2. 2 years

Section 31 — Comprehensive Nursing Specialty Program

Within (1)__ days from effectivity, the Board, together with:

• Accredited professional organization

• Recognized specialty organizations

• Department of Health

must formulate/develop a Comprehensive Nursing Specialty Program.

Purpose:

Upgrade skills and competence of specialty nurse clinicians.

Examples:

• Critical care

• Oncology

• Renal nursing

• Other areas determined by the Board

Program beneficiaries must serve in a Philippine hospital for at least (2)__ continuous years.

1. salary grade 15

2. RA 6785

3. Compensation and Classification Act of 1989.

Section 32 — Salary

Minimum basic pay of nurses working in public health institutions must not be lower than:

• Salary Grade (1)__ under RA (2)__ — (3)__

For nurses employed by LGUs, salary adjustments follow Section 10 of RA 6758.

1. 10%

2. Philippine Charity Sweepstakes Office

3. Philippine Amusement and Gaming Corporation

Section 33 — Funding for Specialty Program

Annual funding needed to train at least (1)__% of nursing staff of participating government hospitals is charged to:

2. (PCSO)

3. (PAGCOR)

1. ₱50,000–₱100,000

2. 1–6 years

3. Or both

Section 35 — Prohibited Acts in Nursing Practice

Penalty:

1. Fine: ₱__

2. Imprisonment: __ years

3. Or __, at court's discretion

1. Practicing without proper authorization

2. Using another person's credentials

3. Using invalid credentials

4. Giving false evidence

5. Falsely representing oneself as an RN

Illegal acts include:

1. __ (No certificate of registration/license + PIC; No special/temporary permit ;Not legally exempt from examination)

2. __ (Using another person's: License, PIC, Special/temporary permit)

3. __ (Invalid license; Suspended license; Revoked license; Expired/cancelled special or temporary permit)

4. __ (Providing false evidence to obtain: License; PIC; Special permit)

5. __ (Falsely posing/advertising as a registered licensed nurse; Any act that gives the impression that one is an RN)

6. Improper use of BSN/RN

7. Assisting illegal nursing practice

8. Unauthorized review/in-service programs

9. Violating nurse compensation/benefits

10. Other violations

Illegal acts include:

6. __ (Using B.S.N./R.N. or similar title without actually having: The BSN degree, or RN registration)

7. __ (A licensed nurse who helps an unqualified person illegally practice nursing)

8. __ (Conducting nursing in-service education or review classes for local/foreign examinations without Board and PRC permit/clearance)

9. __ (Person/employer who violates minimum nurse salary or required incentives/benefits under Sections 32 and 34.)

10. __ (Any person or juridical entity violating RA 9173 or its implementing rules.)

• Official Gazette

• Any newspaper of general circulation

IRR must be published in:

• __, OR

• __ of general circulation

15

Section 41 — Effectivity

RA 9173 takes effect: __ days after publication

• In the Official Gazette, OR

• In any two newspapers of general circulation in the Philippines.

1. Constitutional Law

2. Statutory Law

3. Administrative Law

4. Common Law

TYPES OF LAWS

1. __ - the body of law that defines the structure, powers, and limits of government branches while protecting the fundamental rights of citizens

2. __ - Enacted by government bodies

3. __ - Regulations adopted by agencies to implement Statutory Law

4. __ - Decisions of courts setting precedents

1. Criminal Acts

2. Civil Acts

TWO CLASSES OF WRONGFUL ACTS

1. __ - Conduct that is harmful or offensive to society

2. __ - Wrongs that violate rights of individuals

• JUDICIAL RISK

• TORT

• PERSONAL (DIRECT) LIABILITY

• VICARIOUS (INDIRECT) LIABILITY

• NEGLIGENCE

• MALPRACTICE

• INTENTIONAL TORT

• STRICT LIABILITY TORT

CIVIL ACTS

(JDPVNMIS)

1. JUDICIAL RISK

2. TORT

3. PERSONAL (DIRECT) LIABILITY

4. VICARIOUS (INDIRECT) LIABILITY

1. Uncontrollable variables that increase risk (judge / jury having a bad day; suing another without real justification)

2. Wrongful act committed against another person, organization, or property that causes harm

3. Imposed on the person who committed the wrongful act

4. Imposed on a person or organization that did not commit an act, but is associated with the liable person.

1. NEGLIGENCE

2. MALPRACTICE

3. INTENTIONAL TORT

4. STRICT LIABILITY TORT

1. unintentional tort; failure to do what a prudent person would do

2. Failure to do what a prudent professional would do; professional negligence

3. Wrongful act intended to cause harm

4. Others endangered unintentionally; Faulty equipment, potential dangers

Nurse Managers

ARE RESPONSIBLE FOR:

● Upholding policies of their healthcare organization.

● Ensuring that laws of society at local, state and national levels. (including anti discrimination laws, employee-related laws, etc.)

● Ensuring that management and employees follow policies and laws.

1. Personal Negligence in Clinical Practice

2. Liability for Delegation and Supervision

3. Liability of Health Care Organizations

THREE MAIN LEGAL CONCERNS

Personal Negligence in Clinical Practice

• Ethical obligation to non maleficence (do no harm)

• Professional Negligence

• unreasonable actions

• failure to meet standards

• failure to act and prevent harm

Liability for Delegation and Supervision

• The nurse is responsible for tasks that she delegates to others.

• The nurse must monitor and supervise staff who are performing delegated tasks.

• If a staff member delegated to perform the task makes an error, the delegating nurse is also liable

Liability of Health Care Organizations

• Face extensive liability from Several sources

• Have “deep pockets”

• Are almost always named as defendants in liability cases

• Must also have policies and follow laws regarding discrimination, hiring, performance appraisals, management of problem.

• Duty of care was owed to injured party

• There was breach of that duty

• The breach of duty caused injury

• Plaintiff suffered actual harm or damages

Four Elements of Professional Liability

To establish legal liability injured party (plaintiff) must prove:

(DTTP)

Patient falls

Burns

Use of restraints

Medication errors

Common Examples of Negligence (PBUM)

ethical issue

• When you have to judge what is right or wrong

• Choosing between options

• Deciding whether to do something or do nothing

• Should I or shouldn’t I ?

• Weighing up the potential impact of your decisions or actions

• A dilemma – making a difficult choice

Magna Carta Of Public Health workers

• in the Philippines is a comprehensive legislative framework that aims to protect, empower, and support the country’s public health workforce, ensuring they can effectively carry out their vital duties and responsibilities

• The law provided public health workers with job security and tenure, protecting them from arbitrary dismissal or termination, and ensuring they can carry out their duties without fear of losing their positions

• The law encourages and supports the continuous professional development of public health workers, providing them with access to training, education, and skill-building opportunities to enhance their knowledge and expertise

1. PROHIBITION ON ARBITRARY DISMISSAL

2. SALARY STANDARDIZATION AND INCREASE

3. IMPROVED BENEFITS AND INCENTIVES

4. PROFESSIONAL DEVELOPMENT OPPORTUNITIES

Key Provisions Of The Magna Carta

1. The Magna Carta prohibits the arbitrary dismissal of public health workers, ensuring job security and stability

2. The Magna Carta mandates the standardization and increase of salaries for public health workers, providing fair and equitable compensation.

3. The Magna Carta outlines enhanced benefits and incentives for public health workers, including increased leave credits, hazard pay, and other allowances

4. The Magna Carta guarantees access to continuous professional development and training programs for public health workers, fostering career growth and skill enhancement

1. OCCUPATIONAL SAFETY AND HEALTH PROTECTIONS

2. Improved Working Conditions

3. PROFESSIONAL DEVELOPMENT OPPORTUNITIES

Key Provisions Of The Magna Carta

1. The Magna Carta established strict occupational safety and health protocols to safeguard the well-being of public health workers, particularly during disease outbreaks or emergencies

2. mandates that public health workers must be provided with adequate facilities, equipment, and safety measures to ensure their wellbeing and enable them to effectively carry out their duties. This includes access to properly equipped medical facilities, personal protective equipment, and other necessary resources to safeguard their health and safety while on the job

3. Specialized training in epidemiology; Advanced courses in public health policy; Leadership development workshops; Continuing education credits in infectious disease control

1. PROTECTIONS FROM ARBITRARY DISMISSAL

2. SECURITY OF TENURE

3. EQUAL TREATMENT AND NON-DISCRIMINATION

4. DISCIPLINARY PROCEDURES

5. GRIEVANCE MECHANISM

Job Security And Tenure

1. The Magna Carta prohibits the arbitrary dismissal or demotion of public health workers, ensuring they cannot be terminated or demoted without just cause.

2. Public health workers are granted security of tenure, meaning they cannot be removed from their positions without due process and valid reasons.

3. The Magna Carta guarantees that public health workers will not be discriminated against or treated unfairly due to their age, gender, civil status, disability, or other personal characteristics.

4. The Magna Carta outlines clear and fair disciplinary procedures that must be followed if any action is taken against a public health worker, ensuring due process and the right to defend themselves.

5. Public health workers are given access to a grievance mechanism where they can file complaints or appeals against any unjust actions taken against them, ensuring their rights are protected.

1. RECOGNITION OF CONTRIBUTIONS

2. OPPORTUNITIES FOR ADVANCEMENT

3. CAREER DEVELOPMENT

Recognition and Promotion

1. The law acknowledges the valuable contributions made by public health workers in improving the overall health and well being of the population.

2. The law provides various opportunities for public workers to advance their careers, including through training, professional development, and promotional opportunities.

3. The law supports the continuous growth and development of public health workers, ensuring they have the necessary resources and support to enhance their skills and knowledge, and progress in their chosen fields

Contracts

1. Consent

2. Object

3. Cause

4. Agreements

• is an agreement between two or more parties that creates obligations; generally have the force of law between the parties.

Key principles under the Civil Code:

1. __ – parties agree freely.

2. __ – the subject matter is definite or determinable.

3. __ – the legal reason or consideration for the agreement.

4. __ cannot generally violate law, morals, public order, or public policy. Example: An employee signs an employment contract with a hospital specifying salary, duties, working hours, and benefits.

Wills & Testaments

1. Notarial will

2. Holographic will

1. Testator

2. Heirs

3. Legitime .

4. Executor

• is a legal document expressing how a person's property should be distributed after death.

Common Philippine forms include:

1. __ – must comply with formal requirements, including signing and witnessing.

2. __ – entirely handwritten, dated, and signed by the testator.

Important concepts include:

1. __ – person making the will.

2. __ – persons legally entitled to inherit.

3. __ – portion of the estate reserved by law for compulsory heirs.

4. __ – person appointed to carry out the will.

Labor Law

governs the relationship between employers and workers.

Major topics include:

• Employment contracts

• Minimum labor standards

• Wages and benefits

• Working hours and overtime

• Rest days and holidays

• Leave benefits

• Occupational safety and health

• Termination of employment

• Illegal dismissal Labor unions and collective bargaining

• Employer–employee disputes