lic of the Philippines
HOUSE OF REPRESENTATIVES
Quezon City

EIGHTEENTH CONGRESS
First Regular Session

HOUSE BILL No. _ 3477

Introduced by
BAYAN MUNA Party-List Representatives FERDINAND R. GAITE,
CARLOS ISAGANI T. ZARATE, and EUFEMIA C. CULLAMAT,
ACT TEACHERS Party-List Representative FRANCE L. CASTRO,
GABRIELA Women’s Party Representative ARLENE D. BROSAS,
and KABATAAN Party-List Representative SARAH JANE I. ELAGO

ANACT
PROVIDING FOR A COMPREHENSIVE NURSING LAW TOWARDS SAFE AND
QUALITY HEALTH CARE SYSTEM, REPEALING FOR THIS PURPOSE
REPUBLICT ACT 9173
OTHERWISE KNOWN AS THE PHILIPPINE NURSING ACT OF 2002, AND,
APPROPRIATING FUNDS THEREFOR

EXPLANATORY NOTE

‘This Bill aims to address the issues and concems of nurses and the nursing profession, with
the end goal of contributing to the development of a comprehensive, safe, quality, free and
accessible health services especially for the poor Filipinos.

President Rodrigo Duterte’s partner, Ms. Honeylet Avancena, herself a nurse, said during the
August 1, 2019 Breastfeeding Summit that it is high time that nursing law is polished.

Polishing, updating and making relevant the Nursing law have long been the call of many
concerned health professionals, considering the profession’s important role in the delivery of
health services and, considering, too, that the poor health of our people remains a serious
concer. However, nurses, who are the most numerous health professionals in the clinical
setting, are plagued with problems preventing them from fully and effectively performing
their functions towards improving people’s health.

Six (6) out of 10 (ten) Filipinos die without seeing a health professional. Only 17,489
barangays out of 42,000 total barangays have health centers.

While the Philippines is one of the top exporters of nurses in the world, many barangays are
without a nurse. Overcrowded public hospitals are understaffed with 1 nurse taking care of as
much as 40-80 patients, greatly compromising the quality of health care and the safety of the
patients.

Nurses, like most health workers, are overworked and underpaid. Inadequate salaries and
benefits, lack of jobs and security of tenure, and inhumane working conditions pushing them
to seek better job opportunities abroad or change careers.



In 2016, according to PNA, there were some 500,000 registered nurses who are working both
in the government and private hospitals. Some 200,000 registered nurses are working
different jobs far from health work, while over 200,000 registered nurses are jobless.'
Contractual, on-the-job-training nurses and trainees who are paid below the minimum or even
not paid at all are made to perform the tasks of staff nurses. The Department of Budget and
Management and Department of Health, despite protests and recommendations from health
and nurses groups, failed to increase the plantilla positions for nurses and enforce a healthy
nnurse-patient ratio of 1:4? for general, medical, surgical wards, based on recommendations of
‘many nursing associations in the world.

Instead of providing additional plantilla positions, the government embarked on programs
that hire contractual nurses to fill the gaps in understaffed hospitals and health units. These
programs, formerly called Nurses Assigned to Rural Services (NARS) program, renamed to
Registered Nurses for Health Enhancement and Local Service (RNHEALS), and was
changed to Nurse Deployment Program? hired nurses under “contract of services” for six
‘months to two years. Recently due to the pressure and clamor of nurses, the DOH increased
the monthly salary equivalent to that of Nurse 2 and provided benefits to the nurses. Yet the
nurses remained as contractuals.

‘The government failed to ensure adequate pay and benefits for nurses. The provision in the
Nursing Act of 2002 prescribing salary grade 15 as entry salary grade for nurses in public
health facilities was never implemented at all. Worse, in 2009 with the passage into law of
Salary Standardization Law III or Joint Resolution No 4, the entry salary grade for nurses in
public sector was set at salary grade 11 denying the nurses of the rightful salary due them
since 2002. Even Executive Order No. 201 signed by former President Benigno Aquino III on
February 19, 2016 failed to reinstate the entry Salary Grade 15 for nurses. EO 201 pegged the
Nurse 1 position at Salary Grade 11 and provided an increase of P2,205 spread out in four
years, or additional additional P528-575 per year, or P17.60-19.17 basic salary increase per
day. Former President Aquino vetoed the Comprehensive Nursing Bill in 2016 due to the
salary upgrading provision.

“Off in lieu" implemented for those who work for 16-24 hour duties circumvent existing
labor and civil service laws and unjustly deny nurses of the mandated benefits including
overtime pay, nightshift differential, and on- call pay.

Nurses in the private sector are in worse situation, with no security of tenure, no hazard pay,
with some receiving a pitiful monthly salary of P6,000, an amount which is way below the
‘mandated minimum wage in National Capital Region at P 537/dayor P 11,814/month.

‘The nursing education which is run like a business enterprise, is generally expensive,
repressive, of substandard quality and produces graduates who are inclined to work abroad.
Addressing the issues and concems of the nurses and. the nursing profession become more
urgent and imperative as we face emerging and re-emerging health threats like dengue,
measles, HIV/AIDS, and others. Unless we act with urgency, we will face the renewed
onslaught of massive brain drain and further exploitation of nurses that will negatively affect
health care provision and the health of our people.

By passing a nursing law that considers the above reality, and putting in place clear
provisions for the salary, benefits, rights and general well-being of nurses and for the

‘eaters i
2 http:/Awww.national ted. orp
> Department of Health Circular No 2013-0403 dated September 20, 2013

V


improvement of the nursing. profession towards more relevant care, we can get closer to our
vision of a comprehensive quality, pro-people health care and a healthy citizenry.

In this light, the passage of this bill is earnestly sought.

Approved,

'
_— +
REP, INA. GAITE REP. MRSA,

BAYAN MUNA Partylist BAYAN MUNA Partylist

REP. EUFEMIA C. CULLAMAT REP. CASTRO
BAYAN MUNA Partylist ACT, Party-List

~
REY ARLENE D. BROSAS REP. S,

d JANE L ELAGO
/ABRIEBA Women's Party

IN Party-List


Republic of the Philippines
HOUSE OF REPRESENTATIVES
Quezon City

EIGHTEENTH CONGRESS
First Regular Session

House BILLNo, 3477

Introduced by
BAYAN MUNA Party-List Representatives FERDINAND R. GAITE,
CARLOS ISAGANI T. ZARATE, and EUFEMIA C. CULLAMAT,
ACT TEACHERS Party-List Representative FRANCE L. CASTRO,
GABRIELA Women’s Party Representative ARLENE D. BROSAS,
and KABATAAN Party-List Representative SARAH JANE I. ELAGO

AN ACT
PROVIDING FOR A COMPREHENSIVE NURSING LAW TOWARDS SAFE AND
QUALITY HEALTH CARE SYSTEM, REPEALING FOR THIS PURPOSE
REPUBLICT ACT 9173
OTHERWISE KNOWN AS THE PHILIPPINE NURSING ACT OF 2002, AND
APPROPRIATING FUNDS THEREFOR

Be it enacted by the Senate and the House of Representatives of the Republic of the
Philippines in Congress assembled:

ARTICLE I
‘General Provisions

Section 1. Title. - This Act shall be known as the "Comprehensive Nursing Law of 2019."

Section 2. Declaration of Policy. - \t is hereby declared the policy of the state to uphold the
dignity of the nurses and assume responsibility for the protection, respect, and improvement
of the nursing profession by instituting measures towards competent and relevant nursing
practice for health and safety of the public, just and humane conditions of work, and
promotion of professional growth. Thus, the State recognizes nurses as prime movers of
national development and contributors to international cooperation and understanding.

‘The State further guarantees the delivery of accessible, affordable, and available quality
health care to all the people through implementation of adequate and competent Nursing
Personnel System (NPS) throughout the country.

Section 3. Definition of Terms. - The following terms when used in this act shall mean:

(a) Accredited Professional Organization (APO), refers to a professional organization of
nurses duly accredited by the Professional Regulation Commission as per RA No. 8981.

4


(b) Advanced Practice Nurse (APN), refers to a nurse who acquired substantial theoretical
knowledge, decision making skills in the specialty area of nursing practice and proficient
clinical utilization of this knowledge in implementing independent and inter-dependent
nursing interventions. Specialties can be differentiated in categories, according to function,
disease, pathology, systems, age, sex, acuity, setting, technology, and therapies. They must be
given credentialing certification by the specialty association.

(c) Bachelor of Science in Nursing (BSN), refers to the basic program for nursing education.
(d) Certification/Credentialing refers to the process undertaken by an individual nurse to be
recognized to practice in a specifically defined professional tract, i.e. General Nursing,
Nursing Specialty Advanced Practice, Nursing Education, and Leadership and Governance.
‘The Board confers the certification or credential after a validation process based on
promulgated guidelines and mechanisms.

(e) Commission on Higher Education (CHED), refers to the body created by law to
promulgate policies, standards and guidelines in the implementation of basic and graduate
program for nursing education.

(®) Health Facility refers to an institution, establishment, clinic that offers health services and
nursing care, such as hospitals, barangay health centers, and clinics.
(g) Nurse, as provided for in this Act, refers to a person who passed the Philippine Nurse
Licensure Exams (PNLE) and whose license has not been revoked by the law. Thus, it
pertains to a Registered Nurse (RN). A nurse may append before his/ her name the title
"Nurse", "Nars", or "Nrs." or after his/ her name the title R. N.

() Nursing Personnel System (NPS), refers to a system of human resource management in an
institution that classifies the structure, organization, and coordination within the workforce
both in private and public health care facilities and nursing educational institutions to
advance the welfare and protect the rights of the nurses and to ensure the employer-employee
relationship, security of tenure, just compensation, humane conditions of work, and
professional growth.
(@ Philippine Nurse Licensure Exams (PNLE), refers to a written examination given by the
Board in order to obtain license to practice nursing.

() Precarious Work is the term used to described substandard employment conditions, such
as under-payment, absence of salary, no security of tenure, lack of employer - employee
relationship, no benefits, poor working conditions; and, deviation from the standard
‘employment relationships, such as contractual, false volunteerism, job orders thru agencies,
part time, self-employment, fixed term work, temporary, on call, home workers, call center
jobs, few benefits, lack of collective bargaining representation, and no job security.
(k) Professional Regulation Commission (PRC), refers to the government agency pursuant to
Republic Act No. 8981 or as may hereafter be amended or repealed. It shall be referred to in
this law as the Commission.

() Professional Regulatory Board of Nursing (BON), refers to the administrative body
created by law to supervise and regulate the practice of the nursing profession in the
Philippines. As such, the Board shall be the ultimate authority in the practice of the
profession in the Philippines. It shall be referred to in this law as the Board.

(m) Public Health Institution (PHI), refers to any government-led, owned or controlled
institutions which pursues and realizes the lofty goals and objectives of providing and

5



managing safe, efficient, effective and quality public health programs and services and
advocacies for health, in all levels of the Health Care Delivery System (HCDS - national to
local) which include among others: Rural Health Units (RHUs/ Barangay Health Centers);
Research Facilities e.g. Research Institute for Tropical Medicine, etc.; Training Resource
Facilities e.g. the U.P. College of Public Health and State or Local Colleges or Univers
offering Health-Related Programs; the Department of Health and all retained health facilities,
and the like.

(n) Special Permit refers to the permit to practice nursing in the Philippines issued by the
Board to licensed nurses of foreign nationalities.

(0) Temporary Permit refers to the permit to practice nursing in the Philippines issued by the
Board to Filipino nurses, who does not have a professional license from the Philippines or
have not renewed their license for five (5) years, but are licensed from foreign countries.

ARTICLE Il
Board of Nursing

Section 4. Creation and Composition of the Board. - There shall be created a Professional
Regulatory Board of Nursing composed of seven (7) members who shall elect among
themselves a Chairperson to serve for one (1) term, without re-election. The President of the
Republic of the Philippines shall appoint the members of the Board from among those
recommended by the Commission and ranked from a list of three (3) nominees, per vacancy,
of the accredited professional organization of nurses in the Philippines and who possess the
qualifications in this Act. Provided, that the membership of the Board shall come from the
different areas of nursing, including education, service, and community.

Section 5. Qualifications of the Members of the Board. - The members of the Board must
possess the following qualifications:

(a) Must be a natural born citizen and resident of the Philippines for the past five (5)
consecutive years;

(b) Must be a Nurse in the Philippines and a holder of a valid and updated certificate of
registration and a current professional identification card;

(©) Must be a holder of a master's degree in nursing or other health-related masteral
program and, preferably, with a doctorate degree conferred by a university duly
recognized and accredited by the government;

(@) Must have at least ten (10) years of continuous practice of the nursing profession prior
to appointment. Provided, however, that the last five (5) years of which must be in the
Philippines; and

(€) Must be of good moral character and has not been convicted of any offense involving
‘moral turpitude.

Section 6. Prohibition as Member of the Board. - A member of the Board shall not hold a
position nor have pecuniary interest in any educational institution offering BSN, any review
or training center for PNLE, training hospitals and health facilities with nursing affiliates.


Section 7. Term of Office. - The members of the Board shall hold office for a term of three
(3) years. Any member of the Board may serve for two (2) terms or a maximum of six (6)
years.

Section 8. Vacancy. - Any vacancy in the Board must be filled in the manner prescribed in
this Act and only for the unexpired portion of the term. Each member of the Board shall take
the proper oath of office prior to the performance of duties.

Section 9. Compensation. - The members of the Board shall receive compensation and
allowances comparable to the compensation and allowances received by the members of
other regulatory boards.

Section 10. Administrative Supervision of the Board, Custodian of its Records, Secretariat
and Support Services. - The Board shall be under the administrative supervision of the
Commission. All records of the Board, including applications for examinations,
administrative and other investigative cases conducted by the Board must be under the
custody of the Commission. The Commission shall designate the Secretary of the Board and
shall provide the secretariat and other support services to implement the provisions of this
Act.

Section 11. Powers and Duties of the Board. - ‘The Board shall supervise and regulate the
practice of the nursing profession and shall have the following powers, duties and functions:

(a) Ensure the proper conduct of the PNLE, which includes the application, test
development, examination, correction and release of results. The use of appropriate
technologies and modalities during the conduct of the PNLE is encouraged to enhance
efficiency while upholding integrity;

(b) Issue, suspend, revoke or reissue certificates of registration for the practice of nursing
and ensure the widest publication through electronic and written media;

(©) Enforce and monitor safe and quality standards of nursing practice, study the
conditions affecting the nursing practice in the Philippines, and exercise the powers
necessary to ensure the maintenance of efficient, ethico-moral, technical and
professional standards in the practice of nursing towards the optimal health and
common good of the nation;

(4) Ensure quality nursing education by examining and monitoring higher educational
institutions offering and seeking permission to open nursing education programs and
to ensure that standards of nursing education are properly complied with and
maintained at all times. Provided, that the Board and the CHED shall have joint
authority to open and close nursing education programs offered by higher educational
institutions;

(©) Create policies to govern nursing review programs, monitor and regulate
implementation of such, and close institutions and centers that violate said policies;

(f) Conduct hearings and investigations to resolve complaints against actively practicing
nurses for unethical and unprofessional conduct and violations of this Act, or its rules
and regulations and in connection therewith, issue subpoena duces tecum and


subpoena ad testificandum to require the appearance of respondents and witnesses
and the production of documents and penalize with contempt persons obstructing,
impeding or otherwise interfering with the conduct of such proceedings, upon
application with the Board of Nursing;

(g) Promulgate a Code of Ethics that is responsive to the needs of the nursing profession
in coordination with the APO of nurses within a year from the effectivity of this Act;

(h) Prescribe and operationalize, via necessary infrastructures, a National Nursing Career
Progression Program to ensure continuing professional development of Filipino
nurses, create the Council for Nursing Advancement, Recognition, and Specialization
as well as the various Nursing Specialty Boards to assist the Board for this purpose;

(i) Ensure performance of mandated duties and functions with the provision of
operational resources including human, financial and spatial resources to ensure the
confidentiality and sanctity of their functions as provided through the annual budget
of the Commission as promulgated in the General Appropriations Act;

i) Source and utilize funds earmarked for national nursing development;

() Prescribe, adopt, issue and promulgate guidelines, regulations, measures and
influence authorities and agencies on decision-making as may be necessary for the
improvement of nursing practice, advancement of the profession, and for the proper
and full enforcement of this Act, subject to review and approval by Commission.

() Create a council for nursing recognition, accreditation and certification that will assist
the Board in:

a. Recognizing organized nursing groups;

b. Setting standards for advanced nursing practice, education, research, and
management;

c. Accrediting specialty and advanced nursing programs based on
established mechanisms;

d. Approving criteria for credentialing individual registered nurse to be
implemented by specialty associations; the Department of Health, or the
University of the Philippines through its Health Sciences Center and the
Philippine General Hospital, as the case maybe, for pioneering nursing
specialization; and,

e. Monitoring and evaluating specialty and advanced nursing practice,
education, research and management.

Section 12. Annual Report. - The Board shall, at the close of its calendar year, submit an
annual report to the President and Congress of the Philippines through the Commission
giving a detailed account of its proceedings and the accomplishments during the year and
making recommendations for the adoption of measures that will upgrade and improve the
conditions affecting the practice of the nursing profession

Section 13. Removal or Suspension of Board Members. - The President may remove or
suspend any member of the Board, after due process, on the following grounds:

(a) Continued neglect of duty or incompetence;
(b) Commission or toleration of irregularities in the PNLE; and,


(c) Unprofessional, immoral or dishonorable conduct.

ARTICLE III
Examination and Registration

Section 14. Philippine Nurse Licensure Examination (PNLE). - \n order to obtain a
certificate of registration, professional license, and professional identification card, all
nursing graduates must take and pass the PNLE. The Board shall administer the PNLE in
such place and date as designated by the Commission: Provided, that no nursing educational
institution may withhold any requirement or documents, or both, of any nursing graduate for
the purpose of preventing them to apply for the PNLE. All nursing educational institution
must ensure that their nursing graduates will take the nearest scheduled PNLE after
graduation. Any delay in taking the PNLE must be accordingly justified by the President,
Registrar or Dean of the educational institution through a public instrument.

Section 15. Scope of Examination. - The Board shall determine the scope of the PNLE by
taking into consideration the nursing core competencies, the nursing curriculum, the scope
and areas of nursing practice, and other related disciplines.

Section 16. Qualifications for Admission to the PNLE. -In order to be admitted to the
PNLE, an applicant:

(a) Must be a holder of a Bachelor of Science in Nursing degree from a recognized
educational institution that complies with the standards of nursing education duly
recognized by CHED;

(b) Must be of good moral character and have not been convicted, by final judgment,
of any criminal offense involving moral turpitude or guilty of immoral or
dishonorable conduct, or any person declared by the court to be of unsound mind;
and,

(©) Must be a citizen of the Philippines, or a citizen or subject of a country which
permits Filipino nurses to practice within its territorial limits on the same basis as
the subject or citizen of such country; Provided, that the requirements for the
registration or licensing of nurses in said countries are substantially the same as
those prescribed in this Act.

Section 17. Fees for Examination and Registration. - Applicants for licensure and for
registration must pay the prescribed fees set by the Commission.

Section 18. Ratings. - In order to pass the PNLE, an examinee must obtain at least seventy-
five percent (75%) of tested areas of all competencies.

Section 19, Issuance of Certificate of Registration, Professional License and Professional
Identification Card. - A certificate of registration and professional license shall be issued to
all successful examinees, subject to Section 14 of this Article. A certificate of registration and
professional license shall show the full name of the registrant, the signature of the
Chairperson of the Commission, and the members of the Board, The certificate shall bear the
ogo of the Board and the official seal of the Commission.


‘The Commission shall likewise issue the professional identification card. The card must bear
the following: full name of the registrant nurse, the serial number, the date of issuance and
expiration, the Signature of the Chairperson of the Commission; date of registration.

Section 20. Oath of Profession. - All successful examinees must take an oath of profession
before the Board or any government official authorized to administer oaths prior to entering

upon the nursing practice.
Section 21. Roster of Nurses. - The Commission shall maintain a roster of nurses pursuant to
the PRC Automated System, The Roster of Nurses shall serve as the centralized database for
nursing professionals for purposes of documentation, verification of registrants, statistics,
research, and development.

Section 22. Registration by Reciprocity. - The Board may issue a certificate of registration/
professional license, without examination, to a nurse registered under the laws of a foreign
state or country: Provided, That the requirements for registration or licensing of nurse in said
country are substantially the same as those prescribed under this Act: Provided further, that
the laws of such state or country grants the same privileges to Professional Registered Nurse
of the Philippines on the same basis as the subjects or citizens of such foreign state or
country.

Section 23. Practice Through Special or Temporary Permit. - The Board may issue a
special or temporary permit for specific period and purposes, to the following persons based
‘on qualifications, and professional standards; Provided, that a completion report shall be
submitted to the Board at the end of the specified period, either by those issued with the
special permit or its local counterpart or sponsor, to wit:

(a) Licensed nurses from foreign countries whose services are either for a fee or free if
they are internationally well-known specialists or outstanding experts in any branch or
specialty of nursing;

(b) Licensed nurses from foreign countries who are engaged by colleges/universities
offering the nursing program as exchange professors in a branch or specialty of
nursing; and

(©) Licensed nurses from foreign countries who are in community or institutional
integration, or international health advocacy work, or similar activities in the country,
in coordination with a local people’s or government organization, or advocacy group.

Provided, that no permit is required for foreign or licensed nurses from foreign countries on
medical mission or those who come to aid during declared disasters and calamities whose
services shall be free in a particular hospital, center, clinic or community. This is only for the
duration of the project or medical mission.

Section 24. Non-registration and Non-issuance of Certificate of Registration, Professional
License, Professional Identification Card, ‘Special Permit’ —or
Temporary Permit. - No person convicted by final judgment of any criminal offense
involving moral turpitude or any person guilty of immoral or dishonorable conduct or any

10


person declared by the court to be of unsound mind may be registered and issued a certificate
of registration, professional license, professional identification card, or a special or temporary
permit.

‘The Board shall furnish the applicant a written statement setting forth the reasons for the
actions, which shall be incorporated in the records of the Board.

Section 25. Revocation and Suspension of Certificate of Registration, Professional
License, and Professional Identification Card and Cancellation of Special or Temporary
Permit. - The Board shall have the power to revoke or suspend the certificate of registration,
professional license, professional identification card, or cancel the special or temporary
permit of a nurse upon any of the following grounds:

(a) Conviction, by final judgment, of any criminal offense involving moral turpitude or
guilty of immoral or dishonorable conduct or any person declared by the court to be
of unsound mind;

(b) Violation of this Act, its policies, rules and regulations, and of the Philippine Code of
Ethics for Nurses;

(©) Gross negligence, grave misconduct, ignorance, and incompetence in the nursing

practice;
(@) Fraud, concealment, misrepresentation, or false statements in obtaining a certificate of
registration, professional license, professional identification card, special permit or
temporary permit;
(©) Practice of the nursing profession pending suspension of license.
‘The suspension of the certificate of registration, professional license, and professional
identification card, shall be for a period not to exceed four (4) years.

Section 26. Reinstatement and Re-Issuance of Revoked Certificates of Registration,
Professional License, and Professional Identification Card. ~ The Board may, after the
expiration of a maximum of four (4) years from the date of revocation of a certificate of
registration, professional license, and professional identification card, for reasons of equity
and justice, and when the cause for revocation has disappeared or has been cured and
corrected, upon proper application thereof and the payment of the required fees, reinstate and
re-issue the certificate of registration, professional license, and professional identification
card.

ARTICLE IV
Nursing Practice

Section 27. Nursing Practice. - The administration of nursing care through the utilization of
the nursing process: assessment, nursing diagnosis, planning, implementation, and evaluation.
Nursing practice encompasses various stages of human growth and development towards the
promotion of health, prevention of illness, health care techniques and procedures, restoration
of health, alleviation of suffering, and end-of life care, may it be performed independently or
collaboratively.

u


Section 28. Scope of Nursing Practice. - The following are the scope of nursing practice: (1)
nursing education; (2) nursing service; (3) nursing research and informatics; (4) nursing
leadership and governance; and (5) community health nursing.

Section 29. Nursing Care. - includes, but is not limited to: the provision of physiological,
psychological, spiritual, social and emotional care; essential health care, safety and comfort
measures, health teachings; executing health care techniques and procedures; and, traditional
and innovative approaches to individuals, families, population groups and communities from
conception to death.

‘A nurse shall be deemed to be practicing nursing when he or she, for a fee, salary or
compensation, singly or collaboratively, performs nursing care to individuals, families,
population groups, and communities.

Section 30. Roles, Responsibilities, and Competencies of a Nurse. - A nurse shall possess
and exercise the core competencies in the performance of the roles and responsibilities, in
accordance with the standards set by the Board.

Section 31. Continuing Professional Development (CPD). — Nurses shall be encouraged to
undertake Continuing Professional Programs (CPD). The Board shall provide a mechanism to.
continuously improve and enhance the nurses’ competence by updating them on the latest
scientific, technological, ethical and other applicable trends in the local and global practice of
nursing.

It shall be the duty of the APO, the accredited specialty organizations, the Department of
Health, the University of the Philippines through its Health Sciences Center and the
Philippine General Hospital, public and private hospitals and health facilities to provide free
continuing professional development program to its employees and members. Other than
those aforementioned, only authorized providers accredited by the Board shall be allowed to
offer CPD programs. Such accredited programs however, shall be offered free to its
constituents.

Section 32. Requirement for Inactive Nurses Returning to Practice. - Nurses are deemed to
be inactive when:
(a) They are not utilizing nursing competencies as defined in the scope of nursing
practice for five (5) consecutive years;
(b) They have not renewed their professional identification card for five (5) years; and
(c) They do not have proof of five (5) years of continuous nursing practice.

Inactive nurses are required to undergo one (1) month didactic training and three (3) months
practicum in hospitals accredited by the Board.

ARTICLE V
Nursing Education

2


Section 33. Nursing Education. - Refers to the formal learning and training in the science
and art of nursing provided by higher educational institutions duly recognized and accredited
by the CHED.

‘There shall be a standard Basic and Graduate Program for Nursing Education which must be
pursuant to the CHED Law (RA 7722).

Provided, that higher educational institutions offering Nursing education shall be required to
maintain a passing rate of least 40% in the PNLE among its graduates. Failure to do so in
three consecutive years shall be a cause for the closure of the nursing program in accordance
with Section 11 (4) of this Act.

Section 34. Basic Program for Nursing Education. - Refers to the nursing education
program primarily designed based on the health care needs of the Filipino people, imbues
graduate nurses with service orientation, love of country and fellow Filipinos, and equips
them with the necessary knowledge, skills and attitudes for safe, relevant and quality nursing
practice.

‘The curriculum and the Related Learning Experiences (RLE) must be in accordance with the
National Nursing Core Competency Standards promulgated by the Board and implemented
through the Policies, Standards, and Guidelines of the CHED. The curriculum and RLE
should include community integration and immersion to encourage more graduates to work in
community setting.

Section 35. Graduate Program for Nursing Education. - Refers to the post baccalaureate
nursing program, which builds on the experiences and skills of a nurse towards mastery,
expertise, and leadership in practice, research, and education. It includes a master’s degree
and doctorate degree in nursing founded on the philosophies, and the scientific body of
knowledge and practice.

Graduate Program for Nursing Education shall be offered only in higher educational
institutions as prescribed by the prevailing CHED Policies, Standards and Guidelines (PSG)
for Graduate Education.

Section 36, Qualifications of the Dean. - The Dean of the College of Nursing (Dean) shall
formulate policies, plans in collaboration with the administration/ school officials and
stakeholders. The Dean must adhere to the prescribed curriculum for the advancement of
nursing education.
‘The Dean:
(a) Must be a holder of a certificate of registration and a current professional
identification card issued by the Commission;
(b) Must have the appropriate certificate of nursing proficiency, or its equivalent, to be
issued by the BON;
13


(©) Must be a holder of a master’s degree in nursing, conferred by a university duly
recognized and accredited by the Government of the Republic of the Philippines;

(@) Must have at least five (5) years of experience in teaching and supervision in Nursing
Education; and

(e) Must have at least three (3) years clinical experience in a general nursing service.

Section 37. Qualifications of the Faculty. ~

(1) Basic Program for Nursing Education. - A member of the faculty in a College of Nursing
teaching professional courses:
(a) Must be a registered nurse in the Philippines and holder of a certificate of registration
and a current professional identification card issued by the Commission;
(b) Must have at least three (3) years of nursing practice;
(c) Must be a holder of any masteral degree, conferred by a university duly recognized
and accredited by the Government of the Republic of the Philippines; and
(4) Must have the appropriate certificate of nursing proficiency, or its equivalent, to be
issued by the BON.
(2) Graduate Program for Nursing Education. - A member of the faculty teaching graduate
professional courses:
(a) Must follow prescriptions 1 and 2 of basic nursing education; and
(b) Must be a holder of must be a holder of any doctoral degree conferred by a
university duly recognized and accredited by the Government of the Republic of the
Philippines.

Section 38. Faculty - Student Ratio. - There must be a faculty to student ratio to be
determined by the CHED and BON.

ARTICLE VI
Nursing Service

Section 39. Nursing Service. - Is the promotion of health and prevention of illness which
includes, but not limited to, nursing care provided by a nurse, either independently or
collaboratively, to any individual, family or group in various health care settings.

Nursing Service shall include the following functions: (1) Provide health education to
individuals, families and communities; (2) Ensure that information on healthy lifestyle are
incorporated in his or her health teachings; (3) Seek opportunities to promote a healthy
lifestyle within his or her influence; (4) Accept that he or she is a role model for a healthy
lifestyle; (5) Enable people to increase control over their health and to improve health; (6)
Build healthy public policy; (7) Create supportive environment; (8) Strengthen community
action for health; and, (9) Establish linkages with community resources and coordination of
services with the health team.

Section 40. Nursing Interventions. - In accordance with Sec. 27 and 29, nursing
interventions include, but is not limited to: any or combination of essential primary health
care, the application of traditional and innovative approaches, health counseling, and

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administration of written prescription for treatment, therapies, oral, topical, and parenteral
medications, perform peripartal care covering pre-intra- postpartum care including the
performance of internal examination during labor in the absence of antenatal bleeding, attend
to normal delivery and suturing of perineal laceration and immediate care of the newborn;
perform perioperative care covering pre-intra-post-surgical care interventions; care during
emergency and disaster.

Section 41. Health Interventions in Collaboration with Other Members of the Health
Team. - From promotion of health to end-of-life care, nurses collaborate with other members
of the health team.

Section 42. Advanced Practice Nursing. - \s a specialized and expanded nursing care
pursuant to Sec. 45 hereof. Advanced Practice Nursing is specialty training, through an
‘Advanced Practice Nursing Program formulated by the concerned agencies with certification
to be issued by the accredited specialty association after passing the qualifying examination.

Provided, that in the interest of national need, public service, and advances in health care, and
notwithstanding any contrary provision in this Act, the Department of Health, or the
University of the Philippines through its Health Sciences Center and the Philippine General
Hospital, as the case maybe, may also create and develop additional and pioneering
‘Advanced Practice Nursing specialty or specialties, that shall automatically be recognized by
the Board. Certified nurses under said pioneering nursing specialty, may create its own
specialty organization that shall be registered with the Board; and, develop the certifying or
qualifying examination for future entrants.

ARTICLE Vil
Nursing Research, Policy Development, and Planning

Section 43. Nursing Research and Policy Development. - Shall involve study and pursuit of
nurse related issues encompassing the following areas:

(a) Professional nursing practice such as advancing nursing knowledge to ensure quality
nursing care for all and advocacy for sound health policies globally.

(b) Nursing regulation on credentialing, code of ethics, standards and competencies.

(©) Socio-economic welfare for nurses like occupational health and safety, human
resources planning and policy, remuneration, career development.

Section 44. Studies and Implementation of Nursing Human Resource Needs, Production,
Utilization and Development. - The Board, in coordination with the accredited professional
organization and appropriate government or private agencies shall initiate, undertake and
conduct studies on healthcare human resources production, utilization and development and
take the lead in the implementation of a comprehensive nursing human resource development
from nursing education to nurses deployment.
Section 45. Advanced Practice Nursing Program. - Within ninety (90) days from the
effectivity of this Act, the Board in coordination with the accredited professional
organization, recognized specialty organizations, the Department of Health, and the
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University of the Philippines through the UP College of Nursing and the Nursing Service of
the Philippine General Hospital, is hereby mandated to formulate and develop an Advanced
Practice Nursing Program that would upgrade the level of skill and competence of specialty
nurse clinicians in the country, such as, but not limited to, the areas of critical care, oncology,
renal, and such other areas as may be determined by the Board: Provided, that the
beneficiaries of this program are obliged to serve in any Philippine hospital for a period of at
least two (2) years continuous service

Section 46. Funding for the Advanced Practice Nursing Program. - ‘The annual financial
requirement needed to train at least ten percent (10%) of the nursing staff of the participating
government health facility shall be chargeable against the funds of the said facility.

Provided, that the Department of Health, in coordination with the accredited professional
organization, recognized specialty organizations, shall set the criteria for the availment of this
Program.

Section 47. Salary. - The minimum base pay of nurses working in the governmental health
institutions, upon entry, shall not be lower than P30,000 or equivalent to salary grade (SG)
"1S" of the latest Salary Standardization Law. This is to enhance the general welfare,
commitment to service, and professionalism of nurses. In non - governmental and/or private
health institutions, the minimum base pay for the nurses upon entry shall be equivalent to that
of SG "15" in the public health facilities.

Section 48. Incentives and Benefits. — Nurses in public and private sectors shall be provided
with all applicable benefits prescribed under Magna Carta of Public Health Workers or
Republic Act No. 7305, including overtime pay, night-shift differential, on-call pay; hazard
pay subsistence allowance, housing facility or housing allowance and free annual physical
examination.

In addition, the Board, in coordination with the DOH, other concerned government and non-
government institutions, association of hospitals and the APO, shall establish an incentive
and benefit system in the form of free hospital care for nurses and their dependents,
scholarship grants and other non-cash benefits.

Section 49. Protection from Ilegal Dismissal and Unjust Termination of Employment. ~
No nurse shall be unjustly dismissed or illegally terminated from service pursuant to Articles
279-286, Book VI of Labor Code.

ARTICLE VII
Nursing Leadership and Governance

Section 50. Nursing Leadership. - Nursing is a dynamic field that requires leaders who will
20 through the changing aspects of the health sector as they are part of the workforce that will
toil and labor for the improvement of the health of the citizenry. Nurses adapt specific roles
in organizational structure, from being the policy makers in health facilities and giving
guidance to senior management on best practices in nursing and patient care. They work with

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healthcare leaders to establish compensation and benefit programs and are involved in nurse
recruitment, training and retention. Thus, nurses in the management positions shall develop
patient-care programs, manage nursing budgets, plan new patient services, establish nursing
policies and procedures, participate in cross-lepartmental decision making, conduct
performance improvement activities and represents the scope of nursing practices at Board of
director meetings and other stakeholder.

Section 51. Nursing Governance. - Governance in nursing practice is shifting from the
traditional view that nurses are subordinate and passive employees towards having more
proactive involvement of taking charge of the organization to be the antecedent in decision
making and implementation of plans and policies for the patients and communities.
Governance in the practice of nursing shall empower each nurse in decision-making over
their professional practice while extending their power and control over the administrative
aspect of their practice.

ARTICLE IX
Nursing Personnel System

Section 52. Nursing Personnel System. - The nursing personnel system covers the following
fields: nursing service administration in the hospital setting, community health practice, and
the academe. There shall be a nursing service office in every health institution, may it be
administrative or clinical, with at least ten nurses. The nursing service office must be under
the control and management of a chief nursing officer.

Section 53. Ratio. - The ratio of staff nurse to patient in a hospital setting shall be based on
patient acuity, the complexity of patient health status, and the environment by which care is
delivered. Staffing ratio shall also consider the presence or absence of significant others
responsible in the care of the patient such as patient immediate relative and other licensed or
unlicensed personnel. Based on the foregoing assumption, the prescribed patient load for a
nurse shall be the following:

General Ward:
Low or minimal Care - 1:8
Moderate Care - 1:4

Emergency Room — 1:4
‘Trauma/ICU patients in the ER ~ 1:2

‘Neonatal Intensive Care ~ 1

Operating Room (not including the circulating support stafY) — 1:1
Post Anesthesia Care —
Intensive/Critical/Special Care ~ 1:2

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‘The ratios are the maximum number of patients assigned to a nurse at any time during a shift.
A non-registered nurse or attendant shall not be allowed to substitute for the duties and
responsibilities for a full time registered nurse.

There shall have one nurse for a barangay with at least 5,000 population; one nurse for a
school or school district, high school or college with at least 2,000 pupils or students; one
nurse for every business/industrial establishment with at least 400 employees.

‘The Department of Health, in coordination with the officials of public hospitals and health
facilities, APO, and accredited specialty organizations, shall review and update the existing
standard staffing pattern for public hospitals and other public health facilities, and make
proposals for additional plantilla items for nurses to reflect the nurse-patient ratio.

Section 54. Nursing Service Management. - Refers to the Management and Administration
of Nursing Services by Nurses equipped with the necessary competencies on govemance and
leadership characterized to wit:

(1) First Level Manager or Head Nurse

(2) Second Level Manager or Nurse Supervisor

(3) Third Level Manager, Chief Nursing Officer or Chief Nurse Executive

Section 55. First Level Manager or Head Nurse — is in-charge of the planning, organizing,
directing and controlling of a particular ward, nursing unit or section of a hospital or health
facility. He/She must have at least 12 units of post graduate studies leading to any masteral
degree.

Section 56. Second Level Manager or Nurse Supervisor — is in charge of the planning,
directing and controlling of a specific nursing specialty or nursing unit or geographical
aggrupation of a hospital, health facility, healthcare institution, or health care company. It
may range from a loosely- aggregated nursing units, shift (e.g. afternoon or night shift
supervisor) or up to chief of an organizational division of the healthcare institution. The
person holding this position shall have at least 24 units of post-graduate studies or at least
with any masteral degree or equivalent, for chief of a division and must have at least three (3)
years of related experience as first level manager or head nurse.

Section 57. Third Level Manager, Chief Nursing Officer (CNO) or Chief Nurse
Executive — otherwise called as Chief Nurse, Nursing Director or Nurse Executive, or
‘equivalent, as recognized by the Civil Service Commission. The nursing service and delivery
of healthcare in a hospital, community set-up or any health care institution or company must
be under the control and management of the CNO. The CNO shall carry full administrative
responsibility and shall have the authority on planning, organizing, directing, and controlling
of nurses. A CNO must have at least five (5) years experience in relevant nursing practice
setting. In addition, the CNO must be a master's degree holder in relevant nursing practice
setting, conferred by an educational institution duly recognized and accredited by the
Government of the Philippines.


‘The CNO is responsible for the formulation of policies, strategic and operational planning,
financial plan and resource allocation, policies and procedure development, professional and
organizational involvement to address epidemiologic problems and provide statistical data,
and shall exercise good governance and accountability of the nursing personnel. The CNO
shall also act as the advocate for the rights and welfare of nurses.

To ensure full professional autonomy, the CNO shall be at the executive level reporting
directly to the Chief Executive of the hospital, public health or community set-up, or any
health care institution or company. In an institution where the nurse or nursing personnel is
only part of a smalll health service unit, the Chief Executive of such agency or company shall
censure that the nurses are afforded professional autonomy in the performance of their duty as
nurses.

Section 58. Public Health Practice. - Nursing service shall be organized and operationalized
in every local health agencies in order to ensure the nursing component of public health
programs, Thus, an ideal nurse in every barangay shall be the thrust of public health in order
to provide accessible, available, and affordable quality health care to all. More so, a nurse in
every school, may it be private or public, shall be prioritized in every primary, secondary and
tertiary educational institutions in order to instill health awareness at an early stage and to
improve the health status of the students.

Section 59. The Public Health Nurse (PHN). - The PHN shall perform the functions and
activities of health promotion, such as the prevention and treatment of various diseases and
illnesses in a particular public setting. The PHN shall exercise a supervisory role to the
midwives and barangay health workers within her catchment area. The PHN shall initiate and
participate in developing policies and guidelines to promote basic nursing services.

ARTICLE X
Prohibited Acts and Penal

Section 60. Prohibited Acts. - Any of the following shall constitute unlawful and illegal acts:

(a) Any person who is practicing the nursing profession in the Philippines:

(1) Without a certificate of registration, professional license, professional
identification card, special permit or temporary permit or without having been
declared exempt from examination in accordance with the provision of this Act;

(2) Who uses a certificate of registration, professional license, professional
identification card, special permit or temporary permit of another;

(3) Who uses an invalid certificate of registration, professional license, a suspended
or revoked certificate of registration, professional license, or an expired or
cancelled special or temporary permits;

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(4) Who, by any means of misrepresentation, false evidence, or concealment,
obtained a certificate of registration, professional license, professional
identification card, special permit or temporary permit;

(5) Who falsely poses or advertises as a registered and licensed nurse or uses any
other means that tend to convey the impression that he/she is a registered and
licensed nurse;

(6) Who appends "Nurse", "Nars", or "Nrs." before his or her name or B.S.N/R.N.
(Bachelor of Science in Nursing/Registered Nurse) after his or her name without
having been conferred said degree or registration; or

(7) Who, as a registered and licensed nurse, abets or assists to the illegal practice of a
person who is not lawfillly qualified to practice nursi

(b) Any natural or juridical person, educational institutions offering BSN without full
compliance with the requirements prescribed by law, conducts review classes for
both local and foreign examination without permit/clearance from the Board and the
Commission, or conducts Continuing Professional Development for nurses without
accreditation from the Board; Or any natural or juridical person or health facility
who undertakes or offers in-service training programs, for a fee and without
permit/clearance from the Board and the Commission;

(©) Any natural or juridical person or health facility who subscribes to sub-standard
quality of nursing care and/or nursing practice , such as non-compliance with the
nurse-patient ratio;

(@ Any natural or juridical person, health facility who exercises and promotes
precarious working conditions to nurses, such as, but not limited to, the following:
1. Contracting or availing of the services of a nurse either without salary, for
allowance, for salary below the applicable wage prescribed under this Act, whether
or not under the pretext of a training, development program, certification course

and/or seminar,
2. Depriving or denying a nurse of the incentives and benefits as provided for by the
existing laws;

3. Collecting any fees from a nurse or from any person or agent in his or her behalf
in exchange for a nurse's voluntary services in a health facility;

4. Requiring or obliging a volunteer nurse to perform the regular work functions
and/or regular work load expected from a regular staff nurse employed by the health
facility without proper compensation, to render full-time service as a condition for
the continued availment of his/her volunteer services, and/or to be the sole nurse on
duty, except during disasters, calamities, and war;

5. Contracting or availing of the services of a volunteer nurse, under the pretext of
OST, contract of service, and/or job orders, in order to fill-up a vacant position that
requires the hiring of a full-time regular employed nurse, or for free in exchange for
any type of certification to be issued by the health facility for purposes of the nurse's
‘employment application;


6. Contracting or availing of the services of a nurse, under the pretext of training or
certification course, but requires the nurse to render the tasks and responsibilities
expected of a regular staff or public health nurse, in violation of Section 47 hereof; or

(e) Any violation of the provisions of this Act.

Section 61. Sanctions. - A fine of not less than one hundred thousand pesos (P100,000,000)
nor more than three hundred thousand pesos (P300,000,000) 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 violation of any prohibited acts enumerated in Section 58 (a) hereof,

A fine of not less than three hundred thousand pesos (P500,000,000) and/or imprisonment of
not less than one (1) year nor more than six (6) years shall be imposed upon violation of any
prohibited acts enumerated in Section 58 (b), (c), (d), and (e) hereof. In addition, suspension
or revocation of license to operate may be granted upon the discretion of the court.

Section 62. Refund and Compensation. - Any nurse found to have been a victim of Section
58 (d) hereof shall be entitled to a full refuund of all fees illegally collected and payment of
unpaid salary, which should not be less than the applicable wage for services rendered.

Section 63. Liability of the Agency. — In cases of violations committed by government
agencies, juridical persons, including local government units or any other entity, and for any
untoward incident that may result from violations of Section 58 (b), (c), (d), and (e), the head
of the agency and Board of Directors or executive officials of the agency shall assume full
responsibility.

Provided, that in no case shall the individual nurse be held liable for untoward incidents that
‘may result from the violations of the juridical persons/agency.

ARTICLE XI
Miscellaneous

Section 64. Implementing Agencies. - The Department of Health is hereby designated as the
agency tasked with monitoring the compliance with and implementation of the provisions of
this Act by public health facilities. The Department of Labor and Employment is designated
as the agency tasked with monitoring the compliance with and implementations of the
provisions of this Act by private health s. The Commission and the Board is
designated as the agency tasked with monitoring the compliance with and implementations of
the provisions of this Act by educational institutions, CPD providers and health facilities. The
CHED is similarly designated as the agency tasked with monitoring the compliance with and
implementations of the provisions of this Act by educational institutions with regard to
nursing education programs and its curriculum.

Section 65. Appropriations. - The amount necessary to carry out the provisions of this Act
shall be charged to the General Appropriations Act immediately upon effectivity hereof.

a


Section 66. Implementing Rules and Regulations. - Within ninety (90) days after the
effectivity of this Act, the Board of Nursing and the Department of Health shall jointly take
the lead in the formulation of the Implementing Rules and Regulations. Representatives from
the Civil Service Commission, the Department of Budget and Management, the Department
of Labor and Employment, the Department of Interior and Local Government, the
Commission on Higher Education, the Professional Regulation Commission, the UP College
of Nursing and the Nursing Service of the Philippine General Hospital, the Department of
Education, the accredited professional organization, the nursing unions and nursing specialty
organizations, the Union of Local Authorities of the Philippines, and all other concerned
nursing organizations and government agencies, shall be part of the body that shall formulate
the implementing rules and regulations of this Act.

Provided, that the full implementation of the provisions contained in this Act pertaining to
the Nursing Board, Examination and Registration, Practice, Education, Service, Research,
Policy Development, and Planning, Leadership and Governance, and Personnel System, shall
be within five (5) years from the passage of this Act.

Provided further, that the Implementing Rules and Regulations shall become effective fifteen
(15) days after publication in the Official Gazette or in a newspaper of national circulation.

Section 67. Separability Clause. - Should any provision of this Act be declared
unconstitutional, the remaining parts not affected thereby shall remain valid and operational.

Section 68. Repealing Clause. - Republic Act No. 9173, otherwise known as the "Philippine
Nursing Act of 2002" is hereby repealed. All other laws, decrees, orders, circulars, issuances,
rules and regulations and parts thereof which are inconsistent with this Act are hereby
repealed, amended or modified accordingly.

Section 69. Effectivity. - This Act shall take effect fifteen (15) days after its publication in the
Official Gazette or in any newspaper of general circulation.

Approved,

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