LEGAL ASPECTS OF NURSING

The Philippine Nursing Law

Definition and Meaning of Law

The word "law" may be defined as a rule of conduct pronounced by

controlling authority, which may be enforced. There are three essential
characteristics of every law. The first one is the authority or the right to declare
the rule exists. The second is that such rule is pronounced or expressed and
that its source can be identified. Lastly, A right to enforce the same must be
provided.

Nursing Jurisprudence

Department of law which comprises all legal rules and principles effecting the
practice of nursing includes the study and interpretation of rules and principles and
their application in the regulation of the practice of nursing

Functions of Law in Nursing

-provides a framework for establishing what nursing actions in the care of patients
are legal

-delineates the nurse’s responsibilities from those of other professionals

-helps to establish the boundaries of independent nursing actions

-assists in maintaining a standard of nursing practice by making nurses

accountable to the law

Brief History of the Philippine Nursing Law

The first law that had to do with the practice of nursing was contained in Act
No.2493 in 1915, which regulated the practice of medicine. This act provided
for the examination and registration of nurses in the Philippine Islands. During that
time, the applicants need to be only twenty years old, of good physical health
and good moral character. Graduates of intermediate courses of the public
school could enter the school of nursing, which was then giving only two
years, and a half of instruction. These graduates were called first class
nurses. Those who desired to be second-class nurses filed an application with
the district health officer in the district where they resided.

In 1919 Act 2808 was passed-this is known as the First True Nursing Law. It
created among others a board of examiners for nurses. However, it was in 1920 that
the first board examination in the Philippines was given.

On June 19, 1953, the Philippine Nursing Law or R.A. 877 was passed. This
act regulated the practice of nursing in the Philippines. One of the landmarks
in the history of the nursing profession in the Philippines is the Presidential
Proclamation of a Nurses' Week.

Under Proclamation No. 539 dated October 17, 1958 the President of the
Philippines designated the last week of October every year beginning in 1958
as Nurses' Week.

On June 18, 1966, Republic Act 4704 amended certain portions of R.A. 877.
The following were included among the salient changes:

a. The scope of nursing practice was broadened to circumscribe the

whole management of the care of patients and the acts constituting
professional practice of nursing were spelled out to include such
services as reporting, recording and evaluation of a patient’s case,
execution of nursing procedures and techniques, direction and education to
secure physical and mental care and the application and execution of
physician’s orders concerning treatment and medication.
b. The minimum age required of applicants for admission to the
nurse’s examination was lowered from 21 to 18 years of age, but no
candidate who passed the examination was permitted to practice the
profession until he or she reached the age of 21.

Republic Act 7164, introduced by Senator Heherson Alvarez, codified and

revised all the laws regulating the practice of nursing in the Philippines. It was known
as the Philippine Nursing Act of 1991.

In October 21, 2002,Republic Act No. 9173otherwise known as “The

Philippine Nursing Act of 2002” replaced R.A. 7164 .

There are laws governing the practice of Nursing, one of which is House Bill No.
4955, AN ACT PUNISHING THE MALPRACTICE OF ANY
MEDICALPRACTITIONER IN THE PHILIPPINES AND FOR OTHER PURPOSES

Legal Liabilities in Nursing

As nurses begin their professional obligations, their legal responsibilities begin as

well. Their license to practice attests that they are qualified under the law to
practice their profession. The Philippine Nursing Act of 1992 is the best guide
the nurse can utilize as it defines the scope of nursing practice. There are also
standards of care that may be used as criteria in evaluating their work. The nurses
are enjoined to be familiar with the Philippine Nursing Law, and the standards of
nursing care, other laws which affect nursing practice and their code of ethics.

Responsibility and Accountability for the Practice of Professional Nursing

When nurses undertake to practice their profession, they are held responsible
and accountable for the quality-of performance of their duties. Nurses employed in
an agency, institution, or hospitals are responsible directly to their immediate
supervisors. Private duty nurses, being independent practitioners, are held to a
standard of conduct that is expected of reasonably prudent nurses. The
standard is clearly defined, legal expectation to which nurses are held
accountable. A nurse assumes responsibility and accountability for all nursing care
delivered.

Responsibility

-refers to the execution of duties associated with a nurse’s particular role. That
is, the nurse is responsible for providing care within established
standards of the profession. The responsible nurse demonstrates
characteristics of reliability and dependability.

Accountability

-refers to the ability to answer for one’s own actions. The nurse is accountable
to herself most of all. He/she also balances accountability to the patient, the
profession, the employing institution, and society.

Liability

-an obligation one has incurred or might incur through any act or failure to act.

-When the nurse fails to meet the legal expectations of care, the client can
initiate action if harm or injury is incurred by the client.

Professional Negligence

The term 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 is the proximate cause of injury
to another person or his property. The elements of professional negligence are (1)
existence of a duty on the part of the person charged to use due care under
circumstances, (2) failure to meet the standard of due care, (3) the
foreseeability of harm resulting from failure to meet the standard, and (4) the
fact that the breach of this standard resulted in an injury to the plaintiff.

Malpractice

Malpractice in the usual sense implies the idea of improper or unskillful care of a
patient by a nurse. It would also see that malpractice also denotes stepping
beyond one's authority with serious consequences.
Medical Orders, Drugs, and Medications

R.A. 6675 states that only validly registered medical, dental and
veterinary practitioners, whether in private institution/ corporation or in the
government, are authorized to prescribe drugs. Prescriptions made by unauthorized
persons constitute illegal practice of medicine, dentistry or veterinary medicine
and is punishable under R.A. 2832 of the Medical Act of 1959, R.A. 4419 of the
Dental Act, and R.A. 382 or the Veterinary Act.

In accordance with R.A. 5921, or the Pharmacy Act as amended, 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 and sex, and date of prescription.
R.A. 6675 requires that the drugs be written in their generic names.

The dependent and coordinated function of the nurse pertains to the

application and execution of written legal orders of physicians concerning
treatment and medications. Only when these orders are legal in writing and bear
the doctor’s signature does the nurse have the legal right to follow them. Written
orders are better understood and chances of error are minimized if they are clear,
specific, complete and legible.

Verbal orders can be minimized if the nurse seeks a clear

understanding from the physicians in establishing a policy concerning the
importance of written orders. The general rule requiring a nurse to execute all
lawful orders of a physician is tempered by common sense. The nurse must not
execute an order if she is reasonably certain it will result in harm to the patient.
In such case she must speak out and risk incurring the physician’s resentment
or ire rather than a lawsuit.

It is preferable to raise the matter of carrying out the procedure as a

point of clarification in a tactful, acceptable manner .

A nurse must see to it that she understands the action of a drug, its
minimum and maximum dosages, route of administration, and untoward effects
sothat she may skillfully, safely, and effectivelycarry them out. She should be able to
report and record the effects on the patient so that the doctor can judge its
therapeutic value and know when to discontinue its use.

Tests and treatments should be explained to the patient in accordance

with the general plan of his care so that the patient can give full consent and
cooperate in its implementation. Any unfavorable psychologic or physical
reaction should be likewise reported so that the proper action may be taken.
Sometimes, however, refusal may be due to inaccurate presentation of facts.
Patients must receive special sympathetic attention from the nurses. Every effort
should be made to correct inaccurate views and modify superficially-held beliefs.
Intravenous Therapy and Legal Implications

Nurses now participate in complex intravenous therapy procedures that

were once performed only by doctors. Because of this change, nurses must
remember that their legal right to give intravenous injections is based on the
Philippine Nursing Act of 1991 Section 28which state that "in the administration of
intravenous injections, special training shall be required according to protocol
established. "Therefore, nurses have to undertake a certified training course on
intravenous therapy.

In giving intravenous injections, nurses should also follow the policies of

their agencies. Even if nurses have formal training on IV therapy, if the
hospital does not allow them to do so, then they may not do the procedure.

Board of Nursing Resolution no. 8 states that any registered nurse without
such training and who administers IV injections to patients, shall be held
liable, either criminally under Sec. 30 ( c) Art. VII of said law or administratively
under Sec. 21 Art. III or both (whether causing or not injury or death to the patient).

Telephone Orders

There are legal risks by telephone orders. These may be misunderstood or

misinterpreted by the receiving nurse. Sometimes too, messages from telephones
may sound unclear or garbled because of some trouble in the telephone lines.
Most importantly, the signature of the ordering physician is not present and
this order may later be denied in case errors exist or court litigations arise. 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 to give consent.” The consent signed by the
patient or his authorized representative/legal guardian upon admission is for
the initial diagnosis and treatment. Subsequent treatments/operations require
individual, informed consent. Before any medical or surgical procedure can be
performed on a patient, consent must be obtained from the patient or his
authorized representative who may be his parent or guardian. It is only in case of
emergency where the consent requirement does not apply. The physician should
give as much information about a contemplated procedure and the patient should
receive enough information to allow him to give an informed consent for such
procedure or treatment. The intentional touching or unlawful beating of another
person without authorization to do so is a legal wrong called battery. Nature of
Consent. Consent is an authorization, by a patient or a person authorized by
law to give the consent on the patient's behalf that changes a touching from
non-consensual to consensual. It is the nurse who actually secures the consent
of the patient upon admission. This consent is usually for diagnostic
procedures and initial treatment deemed necessary by the medical staff. To
substantiate the patient’s consent, a written authorization is needed as proof
against any liability that may arise due to an alleged unlawful touching of a
patient. Informed consent. “It is 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. He may choose whether to be treated or not and to what
extent, no matter how necessary the medical care, or how imminent the danger to
his life or health if he fails to submit to treatment.”The essential elements of
informed consent include (1) the diagnosis and explanation of the condition;
(2) a fair explanation of the procedures to be done and used and the
consequences; (3) a description of alternative treatments or procedures; (4) a
description of the benefits to be expected; (5) material rights if any; and
(6)the prognosis, if the recommended care, procedure, is refused. Proof of
Consent. A written consent should be signed to show that the procedure was
the one consented to and that the person understood the nature of the procedure,
the risks involved and the possible consequences. A signed special consent is
necessary before any medical or surgical treatment is done such as x-rays,
special laboratory tests, blood transfusions, operations, cobalt therapy, or
chemotherapy and the like. Who Must Consent. Ordinarily, the patient is the one
who gives the consent in his own behalf. However, if he is incompetent (such as
in the case of minors or the mentally ill) or physically unable and is not an
emergency case, consent must be taken from another who is authorized to give itin
his behalf. Consent of Minors. Parents, or someone standing in their behalf,
give the consent to medical or surgical treatment of a minor. Parental consent
is not needed however, if the minor is married or otherwise emancipated. Consent
of Mentally ill . A mentally incompetent person cannot legally consent to medical or
surgical treatment. The consent must be taken from the parents or legal
guardian. Emergency Situation. When an emergency exists, no consent is
necessary because inaction at such time may cause greater injury. A mother
who is on the advanced stage of labor or a patient who goes to the emergency
room gives an implied consent to an immediate treatment or attendance. However, if
time is available and an

informed consent is possible, it is best that this be taken for the protection of all
parties concerned. Refusal to Consent. A patient who is mentally and legally
competent (sane mind and of legal age) has the right to refuse to permit touching of
his body or to submit to a medical or surgical procedure no matter how necessary,
nor how imminent the danger to his life or health if he fails to submit to
treatment. Examples are patients who, because of their religious beliefs, may refuse
blood transfusion. A patient may refuse to consent due to inadequate
information regarding the procedure to be done. If after the explanation, he still
refuses to sign the consent form, he should be made to fill out the release form to
protect the hospital and/or agency and its personnel from any liability that may result
from his refusal. If he refuses to sign the release form, this should be noted in his
chart. The competent person has a legal and ethical right to refuse treatment, and
this right is formally established. Consent for Sterilization. Sterilization is the
termination of the ability to produce off springs. The husband and the wife must
consent to the procedure if the operation is primarily to accomplish sterilization.
When the sterilization is medically necessary, the sterilization is an incidental
result such as in cases of abruptio placenta, ectopic pregnancies or ruptured
uterus, the patient's consent alone is sufficient. Medical Records The value of
medical records is both scientific and legal. As a record of illness and
treatment, it saves duplication in future cases and aids in prompt treatment.
The record supplies rich material for medical and nursing research. It serves as
a legal protection for the hospital, doctor and nurse by reflecting the disease or
condition of the patient and his management. Nurses must remember the rule. "If it
was not charted, it was not observed or done. ”In the performance of their duties,
nurses are expected to record fully, accurately, legibly, and promptly their
observations from admission to the time of the patient’s discharge. Daily notes
should include not only medications and treatments given or rendered but also
the physical and emotional symptoms exhibited by the patient. The nurses’
notes are aids to medical diagnosis and in understanding the patient’s behavior.
Since patients have the right to confidentiality of these records, nurses are legally
and ethically bound to protect the patient’s chart from unauthorized persons.
Permission has to be taken from the hospital authorities for authorization to secure
any information from the patient’s chart. Nurses are responsible for safeguarding
the patient’s record from loss or destruction or from access by persons who are
not legally authorized to read such. Legal Responsibilities of Students Nursing
students are responsible for acquiring the knowledge and skills necessary
to become a safe practitioner. Included in this knowledge and skill
development is the awareness of ethical principles and the process of ethical
decision making. Nursing students must act as reasonably prudent persons,
equivalently with education and experience, when performing nursing duties.
They must perform only those tasks that they are competent to perform. Liability for
the Work of Nursing Students Under the Philippine Nursing Act of 2002 R.A.
9173, nursing students do not perform professional nursing. They are to be
supervised by their Clinical Instructors. In order that the errors committed by
nursing students will be avoided/minimized, the following measures should be
taken: 1.Nursing students should always be under the supervision of their
Clinical Instructors.2.They should be given assignments that are in level of
their training, experience and competency.3.They should be advised to seek
guidance specially if they are performing a procedure for the first time.4.They
should be oriented to the policies of the nursing unit where they are
assigned.
5.Their performance should be assessed frequently to determine their
strengths and their weaknesses.6.Frequent conferences with the students will
reveal their problems, which they may want to bring to the attention of their
instructors or vice-versa. Discussions of these problems will iron out doubts and
possible solutions may be provided Charting Done by Nursing Students When a
nurse or a clinical instructor countersigns the charting of a nursing student,
she attests that she has personal knowledge of information and that such is
accurate and authentic. Anyone who countersigns without verification commits
herself to possible legal risk.

Source: Venzon, L. & Venzon, R. (2010). Professional Nursing in the Philippines

11thedition
The rationale of REPUBLIC ACT OF 9173 is to regulate the practice of nursing and
the enforcement of law to an administrative agency or BON that is charged with
maintaining the balance between the rights of the nurse to practice nursing and the
responsibility to protect the public health, safety, and welfare of its citizens.