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Chapter 01: Professional Nursing Practice

Oct 03, 20249 min read

A summary of Professional Reviewer Dr./Atty. Glenn R. Luansing’s Professional Nursing Practice, Ethics, and Jurisprudence, Chapter 01: Professional Nursing Practice. “Chapter One of this book focuses on the discussion of professional nursing practice and its challenges, with an extensive explanation on various areas of nursing practice and the inherent professional duties and accountabilities among nurses.”

CITE

Luansing, G. (2023). Professional Nursing Practice. In Professional Nursing Practice, Ethics, and Jurisprudence (pp. 1-84). C&E Publishing. ISBN:978-971-98-1932-5.

Nursing as a Profession

A Profession is a calling requiring specialized knowledge and intensive academic preparations. In nursing, it is the performance, for a fee or a salary, of professional services e.g. responsible nursing care, observation of symptoms, accurate reporting and documentation, supervision of others, execution of nursing procedures, and execution of valid doctor’s orders. There are seven specific characteristics of a professional nurse.

Accountability

The nurse is liable for any resulting act or misconduct based on the professional decisions implemented, committed, or performed. A negligent nurse may be administratively, criminally, and civilly liable based on prevailing laws.

  1. Administrative Liabilities
    • Section 23, R.A. 9173 (Revocation and Suspension of Certificate of Registration/Professional License and Cancellation of Special/Temporary Permit): the Board shall have the power to revoke or suspend the certificate of registration/professional license or cancel the special/temporary permit of a nurse upon any of the following grounds:
      • For any causes mentioned in Section 22, R.A. 9173; for unprofessional and unethical conduct; for gross incompetence or serious ignorance; for malpractice or negligence in the practice of nursing; for the use of fraud, deceit, or false statements in obtaining a certificate of registration/professional license or a temporary/special permit; 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 temporary/special permit; or for practicing his/her profession during his/her suspension from such practice;
      • Provided that the suspension shall be for a period not to exceed four (4) years.
      • Such a suspension demands due process before an investigating authority. (Omitted the PRC administrative hearing and investigation procedure.)
    • Section 35, Article VIII of R.A. 9173 (Prohibitions in the Practice of Nursing): A fine of not less than Fifty thousand pesos (₱50,000.00) nor more than One hundred thousand pesos (₱100,000.00) 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:
      • Any person practicing nursing in the Philippines within the meaning of this Act: without proper certification (without, stolen, expired, invalid, falsely attained); who falsely poses or advertises as a registered and licensed nurse or falsely appends B.S.N./R.N. to their name; or who, as a registered and licensed nurse, abets or assists the illegal practice of a person who is not lawfully qualified to practice nursing.
      • 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
      • Any persons or employer of nurses who violates the minimum base pay of nurses and the incentives and benefits that should be accorded them as specified in Sections 32 and 34; or
      • Any person or the chief executive officer of a juridical entity violating any provision of this Act and its rules and regulations.
  2. Criminal Liabilities
    • Art. 365. of the Revised Penal Code (Imprudence and Negligence): Reckless imprudence consists in voluntary, but without malice, doing or failing to do an act. Simply imprudence consists in the lack of precaution displayed in those cases in which the damage to be caused is not immediate nor clearly manifest.
      • If the reckless action would have been a grave felony, arresto mayor in its maximum period to prision correccional in its medium period;
      • If the reckless action would have been a less grave felony, arresto mayor in its minimum and medium periods shall be imposed;
      • If the reckless action would have been a light felony, arresto menor in its maximum periodical shall be imposed.
      • If the simple action would have been a grave felony, arresto mayor in its medium and maximum periods shall be imposed.
      • If the simple action would have been a less grave felony, arresto mayor in its minimum period shall be imposed.
      • If the action only results in damage to the property of another, a fine equal to or up to three times such value (but not less than ₱25.00) is imposed.
      • If the simple action causes some wrong, which if done maliciously, would have constituted a light felony, a fine not exceeding two-hundred pesos (₱200.00) and censure shall be imposed.
      • A penalty next higher in degree is imposed upon offenders who fail to lend on the spot to the injured parties such help as may be in their hands to give.
  3. Civil Liabilities
    • Art. 2176 of the New Civil Code: whoever by act or omission causes damage to another, there being fault or negligence, is obliged to pay for the damage done. Such fault or negligence, if there is no pre-existing contractual relation between the parties, is called a quasi-delict and is governed by the provisions of this Chapter.
    • Art. 2177 of the New Civil Code: responsibility for fault or negligence under the preceding article is entirely separate and distinct from the civil liability arising from negligence under the Penal Code. But the plaintiff cannot recover damages twice for the same act or omission of the defendant.

EXAMPLE

Nurse Lolita who failed to digilently compute the right dose of a drug as ordered by the doctor to her patient named Esmeralda. As a result, the patient’s condition deteriorated over the week due to drug overdose, and later on, Esmeralda died as a consequence. Nurse Lolita, as a licensed nurse practitioner, shall be accountable for the death of her patient because of failure to exercise due diligence in providing care. The surviving relatives of Esmeralda can file necessary legal actions in court and the Professional Regulation Commission to hold Nurse Lolita accountable for the resulting death. As part of her administrative liabilities, the Board of Nursing may suspend or revoke Lolita’s license and certificate of registration to practice, based on the outcome of their administrative hearings and investigations conducted by an appointed committee. The basis of accountability of Nurse Lolita for a penalty of suspension or revocation is contemplated under the provisions of R.A. 9173 or the Nursing Act of 2002. On the other hand, since the death of patient Esmeralda is an outcome of a criminal act, the trial court may also render a decision for imprisonment under Article 365 of the Revised Penal Code and/or the imposition of award of damages, Article 2176 and 2177 of the New Civil Code, as her civil liabilities.

Professional Autonomy

The nurse is able to think independently and take actions related to patient care within their scope of practice, as is defined by the existing nursing laws, Code of Ethics, and other various policies or guidelines affecting nurses. Failure of the nurse to perform their duties within limits set by law would possible expose them to various professional accountabilities as discussed in the preceding number. It is also the duty of the nurse to be ever mindful of the conduct of their colleagues that may be detrimental to the patient and profession. Section 28 of R.A. 9173 (Scope of Nursing) states the tasks included in the scope of nursing practice in which the nurse is allowed to perform as part of professional autonomy:

  1. Altruism: the nurse is selfless and services others without regard for compensation or reward.
  2. Caring Attitude: the nurse puts in diligent efforts to care for any client, sick or well, and regardless of the patient’s economic or social status.
  3. Competency: the nurse is competent in all of their duties, and continues professional training to keep up with changes in patient care. The nurse should be able to recognize when they are not qualified for their duties and act accordingly.
    • R.A. 10912, The Continuing Professional Development (CPD) Act of 2017 for nursing mandates 15 credit units for professional license renewal, in this case every 3 years. These are obtained from formal learning, non-formal learning, informal learning, self-directed learning, online learning activities, and professional work experience.
  4. Ethical: the nurse follows the nursing code of ethics and is equipped with the morality of human conduct, values, and standards.
  5. Service-Oriented: the nurse is dedicated to service, in that they are able to anticipate, recognize, and meet the patients’ needs.
  6. Specialized: the nursing profession requires a specialized body of knowledge and well-defined skills.

Scope of Nursing Practice

The scope of nursing practice is defined under Section 28, Article VI of the Philippine Nursing Act of 2002. A person is said to practice nursing when they render nursing services to other individuals or groups from womb to tomb. Nursing services include but are not limited to:

  1. Provision of care through the nursing process
  2. Collaborate with communal resources and health teams
  3. Provide health education
  4. Take student nurses as apprentices
  5. Undertake nursing and health human resource development, training, and research.

Roles of a Professional Nurse

  1. Caregiver: to provide care and comfort, show concern for client welfare and safety, and utilize scientific knowledge in activities to do so.
  2. Change Agent: to initiate or assist in changing the patient’s condition or lifestyle, or the systems of care via Kurt Lewis’ Unfreeze, Change, Refreeze theory
  3. Counselor: helping the client recognize and cope with psychologic or social problems, develop an improved interpersonal relationship, promote personal growth, develop new or alternate attitudes, feelings, and behaviors, recognizing health choices, and developing a sense of control.
  4. Teacher: provide information regarding health, help the client learn or acquire new knowledge and skills, and encourage adherence to treatment and healthy lifestyles.
  5. Researcher: participate in identifying significant researchable problems and using the research process for investigation.
  6. Advocate: promote for what is best for the client, ensuring that their needs are met and rights are not violated; support the client’s decisions.
  7. Manager: makes decisions and coordinates the activities of others, delegating and allocating resources appropriately. Managers plan, direct, develop, monitor, and evaluate the quality of care and personnel. They represent the staff and administration as needed.

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