Midwife Licensure Exam Bioethics & Professional Conduct — Philippine Nursing Law & Legal AccountabilityRevision Notes

Exam Tips

• NLE questions often use RA 7164 as a distractor — always choose RA 9173 as the CURRENT governing law.
• Remember the key phrase in the declared policy: 'high standard of nursing practice' and 'quality nursing care to the Filipino people.'
• Questions may ask what RA 9173 repealed — the answer is RA 7164 (Philippine Nursing Act of 1991).

Key Points

• RA 9173 is the PRIMARY governing law for nursing practice in the Philippines, enacted in 2002.
• It REPEALED the previous Philippine Nursing Act of 1991 (RA 7164) — this is a common NLE distractor.
• The declared policy is to promote and maintain HIGH STANDARDS of nursing practice, uphold the dignity of the profession, and ensure delivery of QUALITY NURSING CARE to Filipinos.
• RA 9173 covers: creation and functions of the Board of Nursing (BON), examination and licensure requirements, scope of nursing practice, grounds for suspension/revocation of license, nursing education, salaries, and professional development.
• The law recognizes nursing as both a science and an art requiring professional competence and moral accountability.
• Subsequent issuances (IRRs, BON resolutions) supplement RA 9173 but it remains the PRIMARY reference for the NLE.

Definitions

Section Title

Republic Act No. 9173: The Philippine Nursing Act of 2002

Common Mistakes

• Confusing RA 9173 (current, 2002) with RA 7164 (old, 1991) — always associate 9173 with 2002.
• Thinking the BON alone administers all professional regulation — it is the PRC that is the overarching government agency; the BON operates under the PRC.
• Forgetting that RA 9173 covers not just examination but also education, salaries, and professional development.

Exam Tips

• Remember the passing standard as '75/60 rule': 75% general average, no subject below 60%.
• The BON's most significant power for NLE purposes is the authority to ISSUE, SUSPEND, or REVOKE the certificate of registration.
• Questions about who appoints BON members: THE PRESIDENT OF THE PHILIPPINES.
• CPD compliance is required for license RENEWAL — a nurse who does not complete CPD units cannot renew the PRC license.

Key Points

• The PROFESSIONAL REGULATION COMMISSION (PRC) is the government agency that administers, implements, and enforces regulatory laws for ALL licensed professions, including nursing.
• The PRC administers the licensure examination, issues and renews PRC ID cards, maintains the registry of professionals, and provides administrative support to the BON.
• The BOARD OF NURSING (BON) is the professional regulatory board for nursing, operating UNDER the PRC.
• The BON Chairperson and members are APPOINTED BY THE PRESIDENT OF THE PHILIPPINES from a list of nominees.
• KEY BON FUNCTIONS: (1) Conduct the nurse licensure examination; (2) Issue, suspend, and revoke certificates of registration/professional licenses; (3) Monitor and enforce standards of nursing practice and education; (4) Promulgate the Code of Ethics (with the accredited professional organization); (5) Recommend measures to upgrade nursing education and practice.
• EXAM ELIGIBILITY REQUIREMENTS: (1) Philippine citizen (or citizen of a country with reciprocity); (2) Good moral character; (3) Holder of a BSN degree from a recognized institution.
• PASSING STANDARD: General average of AT LEAST 75%, with NO RATING BELOW 60% in any subject area.
• After passing: Takes professional oath, entered in the roster, receives certificate of registration and PRC license.
• LICENSE RENEWAL now requires compliance with CONTINUING PROFESSIONAL DEVELOPMENT (CPD) requirements.
• The ACCREDITED PROFESSIONAL ORGANIZATION (APO) for nurses is the PHILIPPINE NURSES ASSOCIATION (PNA).

Definitions

Section Title

The PRC and the Board of Nursing (BON): Structure and Functions

Common Mistakes

• Saying the BON is independent — it operates UNDER the PRC.
• Thinking a 74% general average with all subjects above 60% is passing — NO, the general average must be AT LEAST 75%.
• Confusing the PNA (accredited professional organization) with the BON — the PNA is a private professional association; the BON is a government regulatory body.
• Forgetting that BON members are appointed by the PRESIDENT, not elected.

Exam Tips

• Section 28 = Scope of Nursing Practice — memorize this section number.
• Key NLE scenario: A physician orders a medication the nurse knows is incorrect dose. The nurse's duty is to CLARIFY the order, not blindly carry it out. Sound nursing judgment prevails.
• The scope includes working 'for compensation' — voluntary/charity work by nurses is also governed by standards but the legal definition of 'practice' involves compensation.

Key Points

• Section 28 of RA 9173 defines WHEN a person is considered to be practicing nursing: when, FOR COMPENSATION, he/she performs professional nursing functions.
• CORE OF NURSING PRACTICE = THE NURSING PROCESS: Assessment → Nursing Diagnosis → Planning → Implementation → Evaluation (ADPIE).
• The nursing process is applied to INDIVIDUALS, FAMILIES, AND COMMUNITIES in ANY health-care setting.
• Scope includes: (1) Health education, counseling, and promotion; (2) Collaboration with other health team members; (3) Administering treatments and medications as PRESCRIBED by authorized prescribers (physicians, dentists, etc.); (4) Safe and quality nursing care including emergencies; (5) Supervision and teaching of nursing/midwifery students and training of nursing aides; (6) Nursing administration, education, and research.
• CRITICAL LEGAL PRINCIPLE: Implementation of a physician's legal order must be done with SOUND NURSING JUDGMENT — the nurse is NOT relieved of accountability merely because an order was given.
• The nurse has a DUTY TO QUESTION orders that are unclear, incorrect, or potentially harmful before carrying them out.
• Performing acts BEYOND the defined scope of practice constitutes illegal practice and exposes the nurse to liability.

Definitions

Section Title

Scope of Nursing Practice (RA 9173, Section 28)

Common Mistakes

• Thinking a nurse can perform ANY act a physician orders without question — nurses must use sound nursing judgment and are accountable for their actions.
• Believing scope of practice only applies in hospitals — RA 9173 says 'any health-care setting,' including community, home, schools, etc.
• Forgetting that nursing administration, education, and research are part of the scope — not just bedside care.

Exam Tips

• Remember the '3-liability rule': One act can trigger ADMINISTRATIVE + CIVIL + CRIMINAL liability.
• For NLE scenarios about license revocation: always think ADMINISTRATIVE liability before the BON.
• For NLE scenarios about a patient suing for damages: always think CIVIL liability.
• Reckless imprudence = CRIMINAL liability under the Revised Penal Code.

Key Points

• A nurse can face THREE TYPES OF LIABILITY simultaneously from a SINGLE negligent act.
• ADMINISTRATIVE LIABILITY: Before the BON/PRC. Consequences include SUSPENSION or REVOCATION of the professional license. Grounds include: unprofessional/unethical conduct, incompetence, negligence, conviction of a crime involving moral turpitude, practicing while impaired.
• CIVIL LIABILITY: A private action for DAMAGES brought by the injured patient. The goal is MONETARY COMPENSATION for harm. Most commonly arises from negligence (tort law).
• CRIMINAL LIABILITY: Prosecution by the STATE when the act constitutes a crime. Examples: reckless imprudence resulting in injury or death, illegal practice of nursing. Criminal cases carry penalties of fines and/or imprisonment.
• Example: A nurse gives the wrong medication that causes patient death. The nurse may face: (1) BON proceedings for revocation of license (administrative); (2) Civil suit by the family for damages (civil); (3) Criminal case for reckless imprudence resulting in homicide (criminal).
• The principle of CONCURRENT LIABILITY means all three can proceed simultaneously and independently.
• Acquittal in a criminal case does NOT automatically mean no civil or administrative liability.

Definitions

Section Title

Legal Accountability: Types of Liability

Common Mistakes

• Thinking that only one type of liability can arise from one incident — all three can arise simultaneously.
• Believing that criminal acquittal automatically dismisses civil and administrative cases — they are independent proceedings.
• Confusing who files each type of case: Administrative = BON/PRC; Civil = Patient/family; Criminal = State/government.

Exam Tips

• For NLE scenarios, first identify: is there DUTY? BREACH? CAUSATION? DAMAGE? If any element is missing, there is NO negligence.
• Res ipsa loquitur classic scenario: 'Patient underwent appendectomy and postoperative X-ray shows a surgical clamp inside the abdomen.' = The instrument speaks for itself.
• Respondeat superior: Hospital is sued because nurse is negligent → hospital may pay, but nurse is still accountable.
• Battery scenario: 'Nurse administers chemotherapy to a patient who signed consent for a different procedure.' = Battery (unauthorized contact).
• Documentation: The golden rule is 'Not documented = not done.' In legal proceedings, courts rely on the written record.
• Incident reports: Complete them promptly after adverse events but NEVER reference them in the patient's chart.

Key Points

• NEGLIGENCE = failure to do what a reasonably prudent nurse would do (or doing what a prudent nurse would not do) under similar circumstances, resulting in harm.
• THE FOUR ELEMENTS OF NEGLIGENCE (all four must be present to establish liability): (1) DUTY — nurse-patient relationship existed; (2) BREACH — nurse failed to meet the standard of care; (3) CAUSATION — the breach directly/proximately caused the harm; (4) DAMAGES — patient suffered actual harm.
• Memory aid: D-B-C-D (Duty, Breach, Causation, Damages) or 'Did Barbara Cause Damage?'
• MALPRACTICE = professional negligence; negligence by a professional judged against the standard of the profession. All malpractice is negligence, but NOT all negligence is malpractice.
• COMMON NEGLIGENT ACTS IN NURSING: Medication errors, patient falls, failure to monitor/report changes in condition, burns, wrong-site/wrong-patient procedures, failure to follow up on orders, defective equipment, inadequate or falsified documentation.
• KEY LEGAL DOCTRINES: (1) Res ipsa loquitur; (2) Respondeat superior; (3) Force majeure; (4) Last clear chance.
• INTENTIONAL TORTS (different from negligence — these are deliberate acts): Assault, Battery, False imprisonment, Defamation (libel/slander), Invasion of privacy/breach of confidentiality.
• DOCUMENTATION RULE: 'If it was not documented, it was not done.' Clinical records are legal documents. Never alter, backdate, or falsify. Incident reports are NOT placed in the patient's chart.

Definitions

Section Title

Negligence, Malpractice, and Legal Doctrines

Common Mistakes

• Forgetting that ALL FOUR elements of negligence must be present — if any one element is absent, there is no negligence.
• Confusing assault (threat) with battery (actual contact). Battery requires actual physical contact without consent.
• Thinking respondeat superior removes the nurse's personal liability — the nurse REMAINS personally liable even if the employer is also sued.
• Placing incident reports in the patient's chart — incident reports are SEPARATE administrative documents and should NOT be referenced in the medical record.
• Confusing res ipsa loquitur with negligence per se — res ipsa is about inferring negligence from the obvious nature of the injury.

Exam Tips

• Anti-Hospital Deposit Law = RA 8344, strengthened by RA 10932. Key principle: 'No deposit shall be required before emergency treatment is given.'
• NLE scenario about a patient refusing a life-saving blood transfusion due to religious beliefs: The NURSE must RESPECT the decision, document it, and notify the physician. Proceeding against the patient's wishes = battery.
• Informed consent = DISCLOSURE + COMPREHENSION + VOLUNTARINESS + COMPETENCE. If any element is absent, consent is not truly 'informed.'

Key Points

• Filipino patients are entitled to recognized rights that nurses are legally and ethically obligated to uphold.
• KEY PATIENT RIGHTS: (1) Considerate, respectful, non-discriminatory care consistent with human dignity; (2) Information about diagnosis, treatment, and prognosis in understandable terms; (3) INFORMED CONSENT — right to agree to or REFUSE treatment; (4) Privacy and confidentiality of medical information; (5) Access to medical records; (6) Choice of physician and facility, including right to a second opinion; (7) Religious and cultural beliefs to be respected; (8) Right to refuse participation in research; (9) Be informed of hospital rules and costs of care.
• INFORMED CONSENT requires: (1) DISCLOSURE of sufficient information; (2) COMPREHENSION by the patient; (3) VOLUNTARINESS — free from coercion; (4) COMPETENCE — the patient has decision-making capacity.
• RA 8344 (as amended by RA 10932) = ANTI-HOSPITAL DEPOSIT LAW: Prohibits demanding a deposit before administering emergency or serious-case treatment. A patient cannot be refused emergency care due to inability to pay.
• Nurses also have mandatory reporting duties under law: certain communicable diseases must be reported to public health authorities; child/elder/disabled person abuse must be reported.
• VULNERABLE GROUPS with special legal protection in Philippine law: Children, elderly persons, persons with disabilities, women.

Definitions

Section Title

Patient Rights in the Philippine Setting

Common Mistakes

• Thinking that a patient who is seriously ill cannot refuse treatment — competent adults can always refuse, regardless of severity of condition.
• Confusing RA 8344 with RA 10932 — RA 10932 is the amendment that strengthened RA 8344 (Anti-Hospital Deposit Law). For NLE, know both numbers but the key principle is the same.
• Thinking informed consent is only the physician's responsibility — nurses verify that consent is properly obtained before proceeding with procedures.

Exam Tips

• RA 10173 = Data Privacy Act of 2012. Enforced by: National Privacy Commission (NPC). Health data = SENSITIVE personal information.
• Remember the 3 principles: TRANSPARENCY, LEGITIMATE PURPOSE, PROPORTIONALITY — these may appear as answer choices in NLE questions.
• Scenario: Nurse posts a photo of a patient's wound on social media to ask for clinical advice = VIOLATION of RA 10173 (and also ethical confidentiality).
• The Data Privacy Act does NOT prevent disclosure when another law REQUIRES it (e.g., mandatory reporting of tuberculosis or COVID-19 to the DOH).

Key Points

• RA 10173 = DATA PRIVACY ACT OF 2012. It protects ALL personal information, with HEIGHTENED protection for SENSITIVE PERSONAL INFORMATION.
• HEALTH DATA is expressly classified as SENSITIVE PERSONAL INFORMATION under RA 10173 — this gives patient health information the highest level of legal protection.
• Processing of health information requires a LAWFUL BASIS — typically: (1) patient's consent, or (2) necessity of providing medical treatment/care.
• THREE PRINCIPLES of data processing under RA 10173: (1) TRANSPARENCY — the data subject must know how their data is used; (2) LEGITIMATE PURPOSE — data must be collected for a valid, specific purpose; (3) PROPORTIONALITY — only the minimum data necessary should be collected.
• The NATIONAL PRIVACY COMMISSION (NPC) enforces RA 10173. Violations carry both administrative penalties and criminal sanctions.
• In practice: Patient information is shared ONLY on a NEED-TO-KNOW basis for care purposes, with valid consent, or where another law requires disclosure (e.g., mandatory disease reporting).
• The Data Privacy Act REINFORCES the nurse's existing ethical duty of confidentiality with a LEGAL obligation.
• Posting patient information on social media, discussing patient details in public areas, or sharing records without consent = violation of RA 10173.

Definitions

Section Title

The Data Privacy Act (RA 10173) and Patient Confidentiality

Common Mistakes

• Thinking that sharing patient information with a family member is always allowed — it requires the patient's consent or a valid legal exception.
• Confusing RA 10173 (Data Privacy Act, 2012) with other RAs — remember: 10173 = 2012 = data privacy = health information protection.
• Believing that posting a patient photo without identifying information is safe — even de-identified information may still violate data privacy if the patient can be identified from context.

Exam Tips

• BON Resolution No. 220, s. 2004 = Code of Ethics. BON + PNA = partnership in promulgating the Code.
• The five areas of the Code: People/Patients, Practice, Co-workers, Society/Environment, Profession — remember with 'PPCSP' or 'People Practice Co-workers Society Profession.'
• NLE questions may ask who promulgated the Code: BON (in coordination with PNA). Never say PNA alone promulgated it — it was the BON, in coordination with PNA.

Key Points

• The Code of Ethics for Registered Nurses in the Philippines was promulgated by the BON through BOARD RESOLUTION NO. 220, SERIES OF 2004.
• It was developed in COORDINATION WITH THE PHILIPPINE NURSES ASSOCIATION (PNA), the accredited professional organization.
• The Code is promulgated pursuant to RA 9173 — it is the ethical framework that complements the legal framework of the Nursing Act.
• The Code organizes the nurse's ethical obligations into FIVE AREAS OF RELATIONSHIP/DUTY: (1) Duty to People/Patients served; (2) Duty to Practice (nursing practice); (3) Duty to Co-workers; (4) Duty to Society and the Environment; (5) Duty to the Profession.
• KEY OBLIGATIONS under the Code: Respect for dignity and rights of every person; safe and competent practice; honesty and integrity; protection of confidentiality; advancement of the profession.
• VIOLATION OF THE CODE can be a GROUND FOR ADMINISTRATIVE SANCTION by the BON — it is not just a moral guideline but a legally enforceable professional standard.
• The Code is the BRIDGE between ethical principles and legal accountability in nursing.

Definitions

Section Title

The Code of Ethics for Registered Nurses in the Philippines

Common Mistakes

• Thinking the Code of Ethics has no legal effect — violations CAN lead to BON administrative sanctions including license revocation.
• Confusing the body that promulgated the Code (BON) with the body it was coordinated with (PNA).
• Forgetting the year of the Code of Ethics resolution: 2004 (BON Resolution No. 220, s. 2004).