Nursing 105's Topic legal aspects and problems in nursing evolution of nursing law in the philippines by Jhonee F. Balmeo RN

1. Nursing 105-
Legal Aspects
And Problems
In Nursing
THE EVOLUTION OF
PHILIPPINE NURSING LAWS

2. THE EVOLUTION OF
PHILIPPINE NURSING
LAWS
Submitted To:
Mrs. Erlinda E. Domingo RN,MPH,CESO IV
Submitted By:
Jhonee F. Balmeo RN

3. Brief history of nursing in the
Philippines
– The history of nursing in the Philippines stems from the caregiving provided
by women, priests, and herb doctors during precolonial Philippines. This trend
continued during the Spanish colonial era, although women did not have much
opportunity to be formally educated in schools because only a limited number
of Filipino women received primary education in charitable institutions
established by Spaniards.

4. – During the Philippine revolution, Filipino women also became the providers of
care for wounded revolutionaries. During the American period in the
Philippines, Filipino women were given the chance to become educated as
nurses, guided by their American nurse and missionary mentors, until nursing
became a full-pledged profession in the Philippines, a professional career not
only for modern-day women in the country but also for men in the Philippines.

5. – The advance of nursing in the Philippines as a career was pioneered by a culture
of care which was intrinsic in the Filipino people.
– From that time onwards the way the health system was delivered also evolved.

6. Early Philippines
– Early beliefs of health and illness in the Philippines were in conjunction with
beliefs of mysticism and superstitions. The cause of a disease was believed to be
either another person, who was an enemy, or a witch, or evil spirits.
– Filipinos were careful not to upset other people or the evil spirits for the good
of their health. These evil spirits could be driven away by people with the power
to banish demons: priests or herb doctors. Filipinos who became sick were
usually cared for by their female family members or friends in the home.

7. – People thought health was directly related to many superstitions and legends.
Back then, there were no medical professionals but men known to practice
magic and the supernatural. These herb men were known as “herbicheros.”
Victims who suffered from unidentified illnesses were thought to be cursed by
witches and wizards known as “mangkukulam/mangagaway.”
– Dangerous birthing and “pamao” were thought to come from “nunos”. While in
labor, the “mabuting hilot” (good midwife) was usually present. If the birth
became too dangerous, bad omens and evil sorcerers were thought to be the
cause. Exploding gunpowder from a bamboo cane near the head of the person
going through the suffering would usually get rid of the bad omen

8. Spanish colonial rule
– During Spain's colonial rule (1521-1898) the Philippine education system
offered distinct and unequal opportunities for Filipinos based on gender. An
example of this sexism was allowing only limited numbers of women to receive
primary education in Spanish charitable institutions.
– Without an education women were unable to gain much knowledge or power.
The knowledge of caring for others came from family members and personal
experience with the sick. Nursing other individuals was seen as a task, not a job
or a profession. During the Spanish regime many specialized hospitals were
established to care for the Spanish king’s soldiers and civilians.

9. Philippine Revolution
– At the time of the Philippine Revolution many women transformed their homes
into quarters to nurse Filipino soldiers and revolutionaries. One of these women
was Melchora Aquino, also known as the "mother of the Philippine Revolution".
In her old age of about 80, Aquino was a supporter of the revolution by
providing food and shelter to the revolutionists. She provided care for those
who became sick or wounded. However, a few days after the revolution began,
she was arrested by the Spaniards for providing care to the rebels.
– Aquino’s work caring for the ill and the wounded during the revolution has
brought comparisons to the British Florence Nightingale. Both these women
cared for soldiers during war and paved the way for nursing practice.

10. American colonial rule
– Although the Philippines had gained independence from Spain, the United
States began to instill their power upon the islands, and a conflict broke out
between the Filipinos and the Americans. This was the start of the Philippine–
American War. The presence of Americans played a vital role in influencing the
development of nursing into a profession.
– Nurses and missionaries from the United States came to act as nurse mentors
for the Filipina women. Nursing education, like teaching and missionary work in
the Philippines, provided white American women with a sense of purpose in the
colony. This influence then continued with the building of many hospitals where
American nurses took charge and Filipino women began to learn under careful
eyes.

11. – An example of this was the development of the Iloilo Mission Hospital. In 1901,
through the efforts of Dr. and Mrs. Andrew J. Hall, missionaries of
the Presbyterian Foreign Mission Board from the United States, a temporary
bamboo clinic was erected at Calle Amparo (now Ledesma Street), Iloilo City, to
serve as a venue for the treatment of health care to the very poor. This was
made possible because Andrew Hall was a doctor and his wife was a nurse.

12. – This system laid the foundation upon which the Union Mission Hospital Training
School for Nurses (now Central Philippine University College of Nursing and
Allied Health Sciences) was built in 1906. Between the time that this school was
built and the time that the Philippines gained their independence from US
colonial rule in 1946, the nursing profession continued to grow with the
development of more nursing schools and more Filipina women seeking to
become nurses

13. – While taking advantage of these learning opportunities Filipinos began to learn
more about the United States and the opportunities that the country could hold
for them, such as extending their education and increased pay. This began the
migration of nurses to the US. As individuals began travelling to and from the
US, the stories they brought home began to spark the interest of others to
follow.

14. Post-colonial Philippines
– After World War II, when Manuel Roxas assumed the presidency of the Republic
of the Philippines on July 4, 1946, it officially marked the end of the colonialism
between the US and the Philippines. Like much of the rest of the world, the
Philippine islands were in ruins and Roxas was determined to rebuild his
country. He made it clear to his constituents that the new government was still
going to rely heavily on US financial support in order to rehabilitate its national
economy.
– Roxas’ first attempts to balance the Philippines' budget included collecting
unpaid taxes, reducing expenses and promoting foreign trade, which would
include the exportation of Filipino nurses. Already trained by Americans, Filipino
nurses were the perfect candidates to assist the US and other countries
experiencing post-World War II shortages.

15. – At the time in the Philippines there were also rumors of a nursing shortage;
however, this was questionable, due to the expanding health programs,
inefficient use of nurses' time and skills, and loss of qualified nurses to other
countries. By the mid-1960s, Filipino nurses were entering the US by the
thousands. The benefit to the travelling nurses was that they were able to make
nearly 20 times as much as they had earned back home.

16. – A negative effect of the high exportation rate was that the nurses were adding
to their own country's nursing shortage problem. The Philippines also faced
losing one of its greatest sources of social capital: educated workers. The
negative effects were also seen in the US, as American salaries decreased
because Philippine nurses who newly arrive would work the same job at a lower
wage.

17. Early 1900s
– Many US states passed reforms in licensure for nurses. Decreased training
mandates were created, as well as stricter adequacies for getting into a nursing
institution. For instance, one prerequisite was at least one year of high school
education. The idea of having students work in a more active role prior to
seeing patients was a new idea that was beginning to pay off.
– In the Philippines, it was also the early 1900s when the first school for nursing
was established. The program of study was still shattered and unclear. Only a
few students were enrolled informally in this kind of education. A legislation or
law was needed at the time, contributing to the establishment of the "First True
Nursing Law" in 1919.

18. 1915
– Actually, the first law that had to do with the practice of
nursing was contained in RA 2493 (1915) which amends
Medical Law (Act No. 310)
-Regulated the practice of medicine
-Provided for the examinations and registration of nurses in
the Philippine Islands
-Applicants needed to be
– Only 20 years old

19. – of good physical health
– with good moral character
-Graduates of intermediate courses of public schools could enter the school of nursing
Called first-class nurses
-Second-class nurses filed an application with the district health officer in the district
where they resided

20. 1919
– Act 2808 approved on March 1, 1919 is considered as the first true nursing Law.
– Under this law,
– -the first Board of Examiners for nurses was created composed of 3 members
appointed by the Secretary of Interior, one of whom is a doctor of medicine and the
two others are RN’s.
– -It also provided the holding of exam for the practice of nursing on the 2nd Monday
of June and December of each year
– -This Law also specifically prohibits the practice of nursing without having been
conferred or obtained the proper certificate of registration from the board of
examiners for Nurses

21. 1920
– – 1st board examination for nurses was conducted by the Board of Examiners, 93
candidates took the exam, 68 passed with the highest rating of 93.5%-Anna
Dahlgren
– theoretical exam was held at the UP Amphitheater of the College of Medicine
and Surgery. Practical exam at the PGH Library.

22. 1921
– Filipino Nurses Association was established (now PNA) as the National
Organization of Filipino Nurses
– PNA: 1st President ± Rosario Delgado
– Founder ± Anastacia Giron-Tupas

23. 1922
– Act No. 3025 (1922)
– -Amplification of the definition of the nursing profession
– -Change the date of exam: 2nd Monday of April and October

24. 1932
– Act No. 4007 (1932)
– Reorganization law of 1932
– -Conduct of examination was placed under the direct supervision of Bureau of
Civil Service
– -Change of jurisdiction over the Board of Examiner under the Department of
Public Instruction

25. 1942
– Executive Order No. 317 (1942)
– -Pursuant to Commonwealth Act 430, transfer of jurisdiction of the board to the
Department of Health and Public Welfare

26. 1950
– (June 17)
– Republic Act No. 546 (1950)
– - Republic Act No. 546 was enacted placing the Board under the Office of the
President.
–

27. 1953
– (June 19)
– RA 877 (1953) also known as The Philippine Nursing Law was approved (This act
regulated the practice of nursing in the Philippines.)
– -Organization of the Board of Examiners of nurses (the Board was composed of
three (3) nurses, a Chairman and two Members with additional powers and
duties.)
– -Provisions regarding nursing schools and colleges, examinations, registration of
nurses including sundry provisions relative to the practice of nursing

28. – -Two important sections pertained to the need for registration as nurse before
anyone could practice nursing in the country
– 1. No person shall practice or offer to practice nursing in the Philippines as defined in
the Act, without holding a valid certificate of registration as nurse issued by the
Board of Examiners for Nurses
– 2. Not only prohibit the practice of nursing without a certificate of registration issued
by the Board of Nursing but also provides the penalty for doing so

29. 1958
– (October 17)
– Proclamation No. 539
– 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.

30. 1966
– (June 18)
– -Republic Act 4704 (1966)
– -Board of Examiners increases from three to five members
– -Members of the Board – appointed by the President of the Philippines
– -Members of the Board – Master’s Degree, instead of a Baccalaureate Degree
– -No age disqualification
– -Board of Examiners for Nurses could receive P12,000.00-P18,000.00 yearly
– -Academic qualification – from the level of Baccalaureate Degree to that of a
Master’s Degree in Nursing
– -Amended sub-paragraph 7 of Section 17 of RA 877

31. – -Legal orders in writing of physicians concerning treatments and medications
including the application of hypodermic and intramuscular injection
– -Intravenous and other injections may be administered under the direction and
in the presence of the said physician
– -“This section shall not apply to students in schools and colleges of nursing who
perform nursing services under supervision of their instructors and professors
of nursing and to exchange professors of nursing”
– -(No longer “upon recommendation of the Commission of Civil Service”)

32. – -Entrance to colleges, include courses in physical, biological, social and
behavioral sciences, as well as humanities, chemistry, psychology and zoology
– -Scope of nursing practice was broadened, whole management of the care of
patients
– -Date of holding of nurse’s examination was no longer fixed
– -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 years

33. 1970
– (August 31)
– Republic Act 6136 (1970)
– -The application and execution of legal orders in writing of physicians
concerning treatments and medications including the application of hypodermic
and intramuscular injection; provided that intravenous and other injection may
be administered under the direction and in the presence of the said physician

34. 1991
– Republic Act 7164 or the "Philippine Nursing Act of 1991 Introduced by Senator
Heherson Alvarez
– -Redefinition of the scope of nursing practice to emphasize:
– The use of nursing process as a scientific discipline in arriving at an appropriate
nursing action and care
– The teaching, management, leadership and decision making roles of the nurse
– The undertaking of and participation in studies and research by nurses

35. – -Requiring a faculty member who was appointed to the Board of Nursing to
resign from his/her teaching position at the time of appointment and not one
year preceding his/her appointment as provided in Republic Act 877
– -Updating a faculty's educational qualification by requiring a Master's Degree in
Nursing or related fields or its equivalent in terms of experience and
specification as pre-requisite to teaching
– -Specification of qualifications of administrators of nursing services
– -Inclusion of the phrase "unethical conduct" as one of the reasons for
revocation and suspension of certificate of registration

36. 2002
– RA 9173
– Known as the Nursing Act of 2002 was signed into law by Pres. Gloria M. Arroyo

37. The following are some changes they added
and some rectifications in the previous one:
– The composition of the Board of Nursing under RA 7164 otherwise known as the Philippine
Nursing Act of 1991 is 5. Under Article III section 3 of RA 7164, the Board of Nursing shall be
composed of a chairman and four members who shall be appointed by the President of the
Philippines from a list of twelve nominees who are registered nurses of recognized standing
and must possess prescribed qualification. However, this was already deleted in the latest
Nursing Law or The Philippine Nursing Act of 2002. The Members were increased from 5 to 7.
Article III Section 3 of RA 9173 states that there shall be created a Professional Regulatory
Board of Nursing, hereinafter referred to as the Board to be composed of a chairperson and
six members. They shall be appointed by the President of the Republic of the Philippines from
among two recommendees, per vacancy, of the Professional Regulation Commission, chosen
and ranked from a list of three nominees, per vacancy, of the accredited professional
organization of nurses in the Philippines who possess the qualifications prescribed.

38. – The nursing areas covered and mentioned under Section 4 of RA 9173 are the
following: Nursing Education, Nursing Service and Community Health Nursing.
These are the areas which the members of the Board of Nursing must
represent. Nursing Research is deemed covered under the Nursing Education.

39. – Article 3 Section 6 of the RA 9173 states that the term of office of the chairperson and the
members of the board shall be for a term of 3 years and until their successors shall have been
appointed and qualified provided that they may be reappointed for another term. Any
Vacancy in the Board occurring within the term of a member shall be filled for the unexpired
portion of the term only. Each member of the board shall take the proper oath of office prior
to the performance of his or her duties. The incumbent Chairperson and the members of the
board shall continue to serve for the remainder of their term under RA 7164 until their
replacements have been appointed by the President of the Philippines and shall have been
duly qualified. The Hold-over doctrine applies in the situation where the term of office of the
incumbent officers have already expired but there are no replacements yet. They must
continue to hold office until their successors shall been APPOINTED and QUALIFIED.

40. – Article IV Section 15 of RA 9173 provides: In order to pass the examination, an
examinee must obtain a rating of not below sixty percent in any subject. An
examinee who obtains an average rating of seventy-five percent or higher but
gets a rating below sixty percent in any subject where he/she is rated below
60%. In order to pass the succeeding examination, an examinee must obtain a
rating of at least 75% in the subject or subjects repeated. Section 16 of the RA
7164 was already deleted in the new Nursing Law of 2002, it requires
examinees who fail the nurse licensure examination for the third time to take a
refresher course consisting in enrollment and passing in the regular fourth year
subjects in a recognized nursing school. The removal examination shall be taken
within two years after the last failed exam.

41. – Article III Section 11 provides: The President of the Republic of the Philippines
may remove or suspend any member of the Board of Nursing after having been
given the opportunity to defend himself/herself in a proper administrative
investigation, on the following grounds:
a. Continued neglect of duty or incompetence
b. Commission or toleration of irregularities in the licensure examination
c. Unprofessional, immoral or dishonorable conduct

42. – The PNA established in 1922 was responsible in lobbying our government for
the adoption of the recommendations made by the international labor
organization in 1977 with regard the status of the economic and social welfare
of our nursing personnel. The Professional Regulation Commission of the
Philippines duly recognizes the PNA as well as in the Section 3 (j) of the
Implementing Rules and Regulation of RA 9173 issued by BON Board resolution
number 425.

43. – Article V section 26 of RA 9173 provides: Nurses who have not actively
practiced the profession for five (5) consecutive years are required to undergo
one month didactic training and three months of practicum. The Board shall
accredit Hospitals to conduct the said training program.

44. – Article V section 27 provides: A member of the faculty in a college of nursing teaching
professional courses must:
a. Be a registered nurse in the Philippines
b. Have at least one year of clinical practice in a field of specialization
c. Be a member of good standing in the accredited professional organization; and
d. Be a holder of a master’ degree in nursing, education, or other allied medical and health
sciences conferred by a college or university duly recognized by the Government of the
Republic of the Philippines.
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 5 years of experience in nursing.
The citizenship requirement mentioned under RA 9173 is for those members of the Board of
Nursing.

45. – RA 9173 abolished the previous requirement stated in the previous Nursing Act
RA 7164 sec. 23, requiring applicants desiring to enroll in a nursing course to
belong to the upper 40% of the graduating class of the general secondary
course as certified by the school

46. – RA 9173 deleted the provision of RA 7164 section (4,f) requiring nurses who
graduate from state colleges and universities to render, after being issued the
necessary board licenses, at least 1 year of nursing service in the Philippines
before they are allowed to leave for overseas jobs.

47. Today
– The Philippines is the leader in exporting nurses to meet the demands of the
United States and other developed nations. It has been argued, however, that
the Philippines' persistent production of nurses for the global market is a state
strategy to develop an export industry for economic development. Things such
as immigration services and nursing licensing authorities encourage the
production of nurses for export

48. – The first two years of general education is grounded on liberal arts that strengthen
the values and character of the person as a caregiver. The language of instruction in
all local institutions is English. This prepares the student for licensure both locally
and internationally. This also gives the nurses access to ever-growing literature in
the health sciences. The community skills, competence and confidence in the use of
English certainly contribute to healthcare in any setting. The curriculum also
strengthens the students' capabilities to participate in research in nursing and other
health sciences, provides flexibility in the openness to the use of new teaching
approaches, and encourages active involvement in extension work that reaches out
to the other sectors. All registered nurses in the Philippines are required to have
a bachelor's degree in nursing.

49. – Today, nurses must acquire their degrees through a combination of
competency-based and community-oriented courses. The Philippine curriculum
has several advantages compared with those of other Asia Pacific Economic
Cooperation (APEC) institutions. This kind of education offers much more than a
solely skill-based curriculum can. The four-year requirement to earn a
bachelor's degree in nursing meets the minimum entry requirement for
professional nursing practice.

50. THANK YOU!