Regulating Nursing Practice in Philippines

State policy and guarantees

The State assumes responsibility for the protection and improvement of the nursing profession through measures that produce relevant nursing education and humane working conditions, and that improve better career prospects and a dignified existence for nurses (Section 2).
The State guarantees the delivery of basic health services through an adequate nursing personnel throughout the country (Section 2).

Board of Nursing: creation and powers

A Board of Nursing is created to be composed of a Chairman and four (4) members, appointed by the President from a list of twelve (12) nominees who are registered nurses of recognized standing in the Philippines (Section 3).
Nominees must possess the qualifications prescribed in Section 5, certified by the accredited national nurses’ association to the Professional Regulation Commission (Section 3).
The Board supervises and regulates the nursing profession (Section 4).
The Board determines licensure examination subjects and syllabi, determines relative weight, constructs test questions, and scores and rates examination papers (Section 4).
Within one hundred twenty (120) days after the examination, the Board submits an examination-result report containing the weighted average rating of each examinee to the Office of the President for release and publication (Section 4).
The Board issues, suspends, or revokes certificates of registration for the practice of nursing (Section 4).
The Board studies conditions affecting nursing practice and exercises powers necessary to ensure maintenance of efficient, ethical, technical, moral and professional standards, taking into account the health needs of the nation (Section 4).
The Board examines the prescribed facilities of universities or colleges seeking permission to open new nursing colleges or departments to ensure standards and essential requirements for a qualified dean and faculty and an adequate budget are properly complied with and maintained at all times (Section 4).
Permission to open colleges of nursing is based on the favorable written recommendation of both the Board and the Department of Education, Culture and Sports (Section 4).
The Board requires nurses who graduate from state colleges and universities to render at least one (1) year of nursing service in the Philippines after receiving the necessary board licenses before they may leave for overseas jobs (Section 4).
The Board investigates violations of the Act and, through its Chairman with Board approval, may issue summons, subpoena, or subpoena duces tecum, and compel attendance through the power of contempt (Section 4).
The Board promulgates decisions or adopts measures necessary for the improvement of nursing practice, advancement of the profession, and full enforcement of the Act (Section 4).
The Board promulgates rules and regulations necessary to carry out the provisions of the Act (Section 10).

Board membership qualifications, conflicts, term

Board members must be citizens and residents of the Philippines and be members in good standing of the accredited national nurses’ association (Section 5).
A Board member must be a registered nurse and hold a master’s degree in nursing conferred by a college or university duly recognized by the Government (Section 5).
A Board member must have at least ten (10) years of continuous practice of the profession prior to appointment (Section 5).
A Board member must not be a holder of a green card or its equivalent (Section 5).
A Board member must not have been convicted of any offense involving moral turpitude, even if previously extended pardon by the President of the Philippines (Section 5).
Any person who qualifies as Chairman or member must automatically resign from any teaching position in any school, college, university, and/or review program for local nursing board examinations, or from any government employment and any government subdivision, agency, or instrumentality (including government-owned or controlled corporations and their subsidiaries) (Section 6).
The person must not have any pecuniary interest in or administrative supervision over any institution offering basic nursing education programs, including review classes (Section 6).
The Chairman and members hold office for a term of three (3) years and continue until their successors have qualified (Section 7).
A Board member may be reappointed for another term not exceeding three (3) years (Section 7).
If only one (1) member is reappointed, that member becomes the new Chairman automatically by virtue of seniority (Section 7).
If two (2) or more members are reappointed, the best qualified among them becomes the new Chairman, determined by all members of the new Board (Section 7).
If all members of the old Board are reappointed or all members are new, the members of the new Board determine the best qualified who is recommended to the President as Chairman (Section 7).
Any vacancy within a term is filled only for the unexpired portion of the term (Section 7).
Each Board member must take the proper oath of office prior to performing duties (Section 7).
Board members receive compensation equal to that given to the Chairman and members of other government boards situated under analogous circumstances (Section 8).
The President may remove any Board member on grounds of continued neglect of duty or incompetence, commission or toleration of irregularities in the examination conducted by the Board, or unprofessional or dishonorable conduct, after giving opportunity to defend in a proper administrative investigation supervised and controlled by the Department of Justice upon instruction of the President (Section 9).

Board records, custody, and examination mechanics

Board records, including examination papers, minutes of deliberations, records of administrative cases and investigations, and examination results, are kept by the Professional Regulation Commission under the direct custody of the person designated by the Chairman of the Commission (Section 11).
No record may be removed, altered, or examined without prior authorization of the Board (Section 11).
All applicants for license to practice nursing must pass written examinations by the Board of Nursing (Section 12).
The Board holds the licensure examination not earlier than one (1) month but not later than two (2) months after the closing of the semester prescribed by the Department of Education, Culture and Sports (Section 14).
The examination is held in the City of Manila or in places decided by the Board subject to approval of the Professional Regulation Commission (Section 14).
The Board determines the scope of the examination, taking into consideration objectives of the nursing curriculum, broad areas of nursing, and other related disciplines and competencies (Section 15).
To pass the examination, an examinee must obtain a general average rating of at least seventy-five percent (75%) with a rating of not below sixty percent (60%) in any subject (Section 16).
If an examinee’s general average is at least seventy-five percent (75%) but any subject is below sixty percent (60%), the examinee must retake the examination only in the subject(s) where the rating is below sixty percent (60%) (Section 16).
To pass a succeeding examination, the examinee must obtain at least seventy-five percent (75%) in the subject(s) repeated (Section 16).
If an examinee fails to obtain at least seventy-five percent (75%) in the subject(s) repeated despite the third examination, the examinee is no longer allowed to take the examination unless the examinee proves to the Board that the examinee has undergone a refresher course consisting in enrollment and passing in the regular fourth year subjects in a recognized nursing school (Section 16).

Qualifications for applicants and licensing

An applicant for admission to the nursing licensure examination must establish to the satisfaction of the Board that the applicant is a citizen of the Philippines, or a citizen or subject of a country that permits Filipino nurses to practice within its territorial limits on the same basis as its citizens, provided that registration/licensing requirements in that country are substantially the same as this Act’s requirements (Section 13).
An applicant must be at least eighteen (18) years of age (Section 13).
Any underage applicant who successfully passes the examination is not permitted or licensed to practice nursing until the applicant reaches the age of majority (Section 13).
An applicant must be in good health and of good moral character (Section 13).
An applicant must hold a bachelor’s degree in nursing from a college or university duly recognized by the proper government agency (Section 13).
A certificate of registration as nurse is issued to any applicant who passes the examination upon payment of the prescribed fees (Section 17).
Every certificate of registration must show the registrant’s full name, serial number, signatures of the Board members, and the official seal of the Board (Section 17).
Applicants for licensure examination and for registration must pay the prescribed fees set by the Professional Regulation Commission (Section 18).
Certificates of registration may be issued without examination to nurses registered under the laws of any foreign state or country, provided that the requirements for registration/licensing are substantially the same as this Act and that the foreign state/country grants the same privileges to registered nurses of the Philippines on the same basis (Section 19).

Disqualification, revocation, and replacement rules

No person convicted by final judgment of any criminal offense involving moral turpitude, or any person guilty of immoral or dishonorable conduct, shall be issued a certificate of registration (Section 20).
The Board must furnish the applicant a written statement setting forth the reasons for its action, and those reasons are incorporated in the Board records (Section 20).
The Board may revoke or suspend a nurse’s certificate of registration on grounds including:
- causes mentioned in Section 20;
- unprofessional and unethical conduct;
- gross incompetence and serious ignorance;
- malpractice or negligence in the practice of nursing; and
- use of fraud, deceit, or false statements in obtaining a certificate of registration (Section 21).
The Board may, for reasons of equity and justice or when the cause for revocation has disappeared or has been cured and corrected, issue another copy of a revoked certificate upon proper application and payment of required fees (Section 22).

Nursing education requirements

Applicants enrolling in a nursing course must belong to the upper forty percent (40%) of the graduating class in general secondary education, as certified by the school (Section 23).
The nursing education program must provide a sound academic and professional foundation for the practice of nursing (Section 24).
Learning experiences in classroom, hospital, home, community, or other health/welfare agencies must strictly adhere to requirements embodied in the prescribed curriculum and to the rules, policies, and standards of nursing education (Section 25).
Learning experiences must not be less than six (6) units or its equivalent (Section 25).
Faculty members in a college or school of nursing must be:
- Filipino citizens;
- registered nurses in the Philippines;
- have at least three (3) years of clinical practice in a field of specialization;
- members in good standing in the accredited national nurses’ association; and
- holders of a master’s degree in nursing or related fields conferred by a government-recognized college or university (Section 26).
Faculty already considered qualified and actually occupying positions before the Act’s effectivity are not disqualified by this Act (Section 26).
Those occupying faculty positions before effectivity must qualify under the master’s degree requirement within a period of five (5) years from the Act’s effectivity (Section 26).
By the year 2000, all colleges of nursing must only employ faculty members with a master’s degree in nursing or other related fields (Section 26).
In addition, the dean of a college or school of nursing must have at least three (3) years of experience in teaching and supervision in nursing education, and preferably a master’s degree in administration and supervision of nursing education programs (Section 26).

What constitutes nursing practice

A person practices nursing when, for a fee, salary, or other reward or compensation, singly or in collaboration with another, initiates and performs nursing services to individuals, families, and communities in various stages of development toward:
- promotion of health;
- prevention of illness;
- restoration of health; and
- alleviation of suffering (Section 27).
Nursing services must involve utilization of the nursing process, including assessment, planning, implementation and evaluation of nursing care, including traditional and innovative approaches in self-executing nursing techniques and procedures, comfort measures, health teaching, and administration of legal and written prescription for treatment therapies and medication, including hypodermic intramuscular or intravenous injections (Section 27).
Special training is required according to protocol established for the administration of intravenous injections (Section 27).
Nursing practice includes establishing linkages with community resources and coordinating the health team, motivating individuals/families/communities, resources and coordination of services with other team members, participation in teaching and guidance and supervision of nursing education students (including administering nursing services in hospitals, homes, communities, and similar settings), undertaking consultation services, and engaging in other activities requiring utilization of registered nurse knowledge and decision-making skills (Section 27).
Nursing practice includes undertaking nursing and health manpower development training and research and soliciting finances for those activities in cooperation with appropriate government or private agency (Section 27).

Nursing service administrators: qualifications

Persons occupying supervisory or managerial positions requiring knowledge of nursing must be:
- Filipino citizens or former Filipino citizens who have officially declared intent to reacquire Filipino citizenship;
- registered nurses in the Philippines;
- members in good standing of the accredited national organization of nurses;
- have at least two (2) years experience in general nursing service administration; and
- possess a Bachelor of Science in Nursing degree with at least nine (9) units in management courses at the graduate level (Section 28).
Persons occupying chief nurse or director of nursing service positions must additionally have:
- at least five (5) years experience in a supervisory or managerial position in nursing; and
- a master’s degree major in nursing service administration or its equivalent (Section 28).
Those occupying such chief nurse/director positions before the Act’s effectivity have five (5) years from the Act’s effectivity to qualify under the chief nurse/director requirements (Section 28).
By the year 2000, only holders of a master’s degree major in nursing administration shall be appointed to such positions (Section 28).
For hospitals with bed capacity of fifty (50) and below, the minimum academic qualifications and experiences for chief nurse must follow the requirements stated in subsections (c), (d) and (e) of Section 28 (Section 28).

Health human resource development roles

The Nursing Board must undertake studies and initiate and/or cooperate with appropriate government or private agencies to conduct studies for health human resource production, utilization and development (Section 29).

Prohibitions and criminal penalties

A fine of not less than PHP 10,000.00 nor more than PHP 40,000.00, or imprisonment of not less than one (1) year nor more than six (6) years, or both, is imposed at the discretion of the court upon any person:
- practicing nursing in the Philippines within the meaning of the Act:
  - without a certificate of registration or without having been declared exempt from examination under the Act;
- using as one’s own the certificate of registration of another;
- using an expired, suspended or revoked certificate of registration;
- giving false evidence to the Board of Nursing to obtain a certificate of registration;
- falsely posing or advertising as a registered nurse or using any other means that tend to convey the impression that the person is a registered nurse;
- appending B.S.N./R.N. to the name without having been conferred said degree or registration (Section 30).
The same penalty framework also applies to any person who undertakes in-service educational programs or who conducts review classes for both local and foreign examinations without permit/clearance from the Philippine Nursing Association, the Board of Nursing, and the appropriate office or officer of the Department of Labor and Employment (Section 30).
The same penalty framework applies to any person violating any provision of the Act (Section 30).

Pay standard, enforcement, and remedies

The proper government office or agency fixes a standard pay for all nurses working in either public or private health agencies, based on current National Economic and Development Authority (NEDA) figures (Section 31).
The standard basic pay must be increased periodically to cope with the increase in cost of living (Section 31).
Law-enforcement agencies and officers of national, provincial, city, and municipal governments must enforce the Act and prosecute any person violating it (Section 32).

Repeals, separability, and effectivity rule

All laws, decrees, orders, circulars, rules and regulations, and other issuances inconsistent with the Act are repealed, amended, or modified accordingly (Section 33).
If any part of the Act is declared unconstitutional, the remaining parts not affected continue to be valid and operational (Section 34).
Effectivity occurs one (1) month after publication in a newspaper of general circulation in the Philippines (Section 35).