THE IMMENSE POWER OF THE PHILIPPINE LAWS AND OTHER MANDATES

AFFECTING THE NURSING PROFESSION

By

Dennis N. Muñoz, RN, RM, LPT

Master of Nursing, Ateneo de Davao University

Nursing is a fulfilling career; it allows an opportunity to help others and make a difference in the day-to-
day lives of real people. Becoming a nurse is perhaps the noblest in the house of medicine. As an
individual professional, nurses are neither superhumans, nor it does have special powers to control the
inevitable but willing to help in promoting well-being, prevent and retard degradation of human flesh, cure
dishearten spirit and more importantly willing to help people to make able again.

Nurses are human mortals, sentient beings, prone to commit mistakes and believe nothing is above the
law and must be involved in "Law and Order". Therefore, nurses are expected to function within the
legislation, legal policies, statutes relevant to the profession and practice setting, and professional
standards.

The Philippine congress in 2002, ratified and repeal a certain provision of the old Nursing Law of 1991
under Republic Act 7164 to meet the demands and needs of the time, thus the Republic Act 9173 also
known as the Philippine Nursing Act of 2002 was created in full implementation and are in effect even up
to present.

This comprehensive legislation is design to regulate various aspects of the nursing profession, particularly
designed to provide for protection and improvement of the nursing profession by instituting measures that
will result in relevant nursing education, nursing research, effective nursing leadership, humane working
conditions of the Registered Nurses, better career prospects and decorous existence for nurses in the
Philippines medical community.

One of the darkest moments ever encounter by the Nursing Law in the Philippine nursing practice
happened in the year 2006. The challenges were immense to this law since it was tested for its resilience
and power. The culprit of the supposed vanguards in upholding the law are among those who violated
the provisions that were articulated in the law. The Philippine Board of Nursing (BON) was created from
the nursing law. It became part of the administrative body under the executive control of the Professional
Regulation Commission (PRC) that regulates the practice of nursing in the Philippines islands under the
PRC Modernization act of 2000.

One of the roles of the members is:

1. To provide regulatory standards in the practice of Nursing by implementing the Nurse Practice
Act and by lobbying Congress for any proposed amendment to any laws with a direct relationship
to the practice of nursing.
2. To ensure public safety by administering the Philippine Nursing Licensure Exam (PNLE) to
graduates of nursing schools before the practice of Registered Nursing in the Philippines.
3. To maintain high standards of nursing education by auditing the performance of Philippine
Nursing
From the above-stated provisions, let us analyzed those three roles of BON under the PRC Modernization
act of 2000 and parallel its implication to the Nursing Practice Act of 2002.

LEGAL BASIS IN THE REGULATORY STANDARDS IN THE PRACTICE OF NURSING

The title Registered Nurse is given to a Filipino graduate who satisfactorily complied with the minimum
requirements set by the Commission on Higher Education for a degree in Bachelor of Science in Nursing.
After graduation, the aspiring nursing is eligible to take the Comprehensive Philippine Nurse Licensure
Examination and must pass the 500-item paper-and-pencil test. After paying the prescribed fees and
have taken the Professional Nursing Oath, the Registered Nurse has the privilege to practice the nursing
profession anywhere in the Philippines and other countries covered by its scope and reciprocity.

The Standard of the Nursing practice and Nursing education is patterned from American Nursing
Education System. The Philippines is currently the world exporter of nurses to meet demand in various
western, middle eastern, and other developed nations in terms of health care services. Arguably, the
country's persistent production of nurses for the global market is a state strategy to develop an export
industry for economic development (Brush, 2010).

This Global marketing strategy of the Philippines has developed explicit internal policies and practices
that encourage the production of nurses for export and operate in tandem with state-influenced policies in
receiving countries (i.e., immigration services, nursing licensing authorities) to ease the process of
emigration (Brush, 2010).

According to RA 9173, Article III, Section 9, paragraph c states: The Board shall supervise and regulate
the practice of the nursing profession and shall have the following powers, duties, and functions: Monitor
and enforce quality standards of nursing practice in the Philippines and exercise the powers necessary to
ensure the maintenance of efficient, ethical and technical, moral and professional standards in the
practice of nursing taking into account the health needs of the nation.

Why promote Nursing Standard?

All standards of practice provide a guide to the knowledge, skills, judgment & attitudes that are needed to
practice safely. They reflect a desired and achievable level of performance against which actual
performance can be compared. Their main purpose is to promote, guide, and direct professional nursing
practice (Registered Nurses Association of BC (2003) & the College of Nurses of Ontario (2002).

Why are standards important?

• Outlines what the profession expects of its members.

• Promotes guides and directs professional nursing practice – important for self-assessment and
evaluation of practice by employers, clients, and other stakeholders.
• Provides nurses with a framework for developing competencies
• Aids in developing a better understanding & respect for the various & complementary roles that
nurses have. ( Registered Nurses Association of BC (2003) & the College of Nurses of Ontario
(2002)

Significant advances in the nursing profession made it imperative to define the competencies,
performance indicators, and standards for beginning nurses in their different roles. The promulgation of
the Philippine Regulation Commission-Board of Nursing (PRC-BON)’s National Nursing Core
Competency Standards (NNCCS) is a response to this situation (Licuanan, 2012).
The implementation of the National Nursing Core Competency Standards (NNCCS) imbued with the
vision of improving, updating, and standardizing Nursing education and practice in 2012 especially the
three roles of the nurse:

1. Beginning Nurses’ Role on Client Care

2. Beginning Nurses’ Role on Management and Leadership

3. Beginning Nurses’ Role in Research.

As mandated, the Professional Regulatory Board of Nursing ensured, through monitoring and evaluation
scheme, that the core competency standards were implemented and utilized effectively innursing
education, in the development of test questions for the Nurse Licensure Examination (NLE), and in
nursing service as a basis for orientation, training, and performance appraisal (NNCCS, 2012)

Competency Standards of Nursing Practice in the Philippines include:

1. Safe and Quality Nursing Care

2. Management of Resources and Environment
3. Health Education
4. Legal Responsibility
5. Ethico-Moral Responsibility
6. Personal and Professional Development
7. Quality Improvement8.Research
8. Record Management
9. Communication
10. Collaboration and Teamwork

As mandated, the Professional Regulatory Board of Nursing ensured The 2012 National Nursing Core
Competency Standards (2012 NNCCS) will serve as a guide for the development of the following:

1. Basic Nursing Education Program in the Philippines through the Commission on Higher
Education (CHED).
2. Competency-based NLE Test Framework as the basis for the development of course syllabi and
3. test questions for “entry-level” nursing practice in the Philippine Nurse Licensure Examination.
4. Standards of the Professional Nursing Practice in various settings in the Philippines.
5. National Career Progression Program (NCPP) for nursing practice in the Philippines.
6. Related evaluation tools in various practice settings in the Philippines.

In 2017, The PRC Board Resolution number the primary purpose of nursing Standards is to promote,
guide, and direct professional nursing practice. PRC Board of Nursing Resolution no. 22, Series of 2017
made a Promulgation of the Philippine Professional; Nursing Practice Standard. The professional
Regulation commission Board of Nursing and its Technical Working Group (TWG) continually worked on
the competent standards by refining the set of competencies and the indicators of performance under the
four domains:

1. Value based nursing practice

2. knowledge-driven nursing practice
3. outcome-oriented professional relationships
4. Leadership and governance.
These domains were identified by the TWG in its process of benchmarking the Philippine nursing
Standard with those of other countries.

In the 2017 Standard of Nursing Practice, it was designed to promote, guide, and direct professional
nursing practice. Specifically, the standards will be useful to the following:

Professional Nurse:

1. to have a better understanding of their professional obligations

2. use the same as the basis for their own continuing competence and professional development
3. advocate for enhancing changes in policies and practice
4. define and resolve professional practice issues and concerns

Employers

1. to be able to develop a system that supports surges to meet prescribed standards of practice focusing
on:

a. developing job description

b. development orientation and in-service programs
c. defines and resolve professional practice issues and concerns.

Nursing Education Leaders: to serve as a guide in the development

Public: can be assured of competent, safe, quality nursing care and ethical practice

PRCBON

1. to be able to use the same as the basis in regulating the nursing practice by:

a. using it as a framework for the NLE

b. recognizing the entry-level education program
c. providing guidance to nurses of their professional obligations
d. providing a foundation for the assessment of their professional performance
e. clarifying to the public and other health care professionals what the profession expects of its
members
f. serving as a basis in addressing incompetent and unethical nursing practice

Philippine Nursing Licensure Exam (PNLE) Scandal in 2006

ARTICLE IV of the RA 9173 States a specific mandate that pertains to the Nurse Licensure Examination.

It states: All applicants for a license to practice nursing shall be required to pass a written examination,
which shall be given by the Board in such places and dates as may be designated by the Commission. It
also states the consideration of the objectives of the nursing curriculum, the broad areas of nursing, and
other related disciplines and competencies in determining the subjects of examinations. The rating of the
board exam states to pass the examination, an examinee must obtain a general average of at least
seventy-five percent (75%) with a rating of not below sixty percent (60%) in any subject. And, all
successful candidates in the examination shall be required to take an oath of the profession before the
Board or any government official authorized to administer oaths before entering upon the nursing
practice.
REPUBLIC ACT NO. 8981 also known as An Act Modernizing the Professional Regulation Commission of
2002 states in Section 5: The Commission shall establish and maintain a high standard of admission to
the practice of all professions and at all times ensure and safeguard the integrity of all licensure
examinations.

One of the Greatest challenges that hit the nursing Profession was the unexpected, unprecedented,
leakage in the Nurse Licensure Examination in 2006. The controversy began with the discovery of a
“leakage” of exam questions disseminated by two nurses review centers to their examinees in Baguio City
and perhaps other locales. The examinees were provided with a list of 500 questions and answers in two
of the exam’s five subjects (Tests III and V) (Rodis, 2007).

According to the Court of Appeals Special Fourteenth Division, 2010 by Associate Justice Jose Reyes Jr.
and concurred in by Associate Justices Apolinario Bruselas Jr. and Ricardo Rosario: The June 2006 NLE
leakage scandal did not only impose an undue burden on the affected examinees who had to take the
exams again but also “tainted the integrity and cast doubt on the fitness and competency of the entire
Philippine nursing industry, which for years has sought to prove to the world that our country can produce
competent, reliable and trustworthy health care professionals.

Anesia Buenafe Dionisio has been sentenced to six years imprisonment with perpetual disqualification
from holding any public office for being negligent in her custody of the test materials, according to a
decision promulgated by the Sandiganbayan Fourth Division on Nov. 14, 2013. The court faulted Dionisio
for allowing one Evelyn O. Asinas, a PRC employee, to encode and print hard copies of the questions for
her. In convicting Dionisio for negligence, the Sandiganbayan dismissed her protestation that she has
been involved in the Nursing Board examinations since 1991 but had never been implicated in any
irregularity until the 2006 controversy. But the Sandiganbayan said Dionisio should have been more
mindful of her sworn duty under the “security declaration” required from all members of PRC’s
professional regulatory boards that they are personally responsible for “preserving the confidentiality of all
classified information.” The Sandiganbayan convicted an examiner of the Professional Regulation
Commission (PRC) for leaking the questions of the 2006 nursing exams (GMA News, 2013).

Another former member of the Board of Nursing of the Philippine Regulation Commission was found
guilty of a violation of the PRC Modernization Act and the Anti-Graft Law for manipulating and leaking
nursing licensure test questions in 2006. In a 107-page decision, the anti-graft court Sandiganbayan’s
Special Fifth Division sentenced Virginia Diolola-Madeja to six to seven years’ imprisonment and
perpetually disqualified her from holding public office for violation of the Anti-Graft Law. She was also
fined P100,000 for violation of the PRC Law. Her bail bond for provisional liberty was also canceled.
Madeja was designated as the examiner in the 2006 Nursing Licensure Examinations (NLE) in the subject
Medical-Surgical Nursing (Test III) and prepared 500 questions composed of 100 situations with five
questions each. The court said Madeja’s defense that she left the manuscripts in her bag has no merit
because she did not even report the incident. The said manuscript was also returned to the commission
afterward.“The pieces of evidence presented by the prosecution lead to no other conclusion than the
accused leaked or divulged her prepared test questions to unauthorized persons before the June 11 and
12 (licensure exams),” according to the decision of the Special Fifth Division composed of Presiding
Justice Amparo Cabotaje-Tang and Associate Justices Roland Jurado and Alex Gesmundo. “Her act of
divulging her test questions before the said dates unquestionably caused damage not only to the
licensure examinations for nurses but also for all professional licensure examinations,” it added. The
decision came out on January 12, 2015 (Inquirer, 2015).

OTHER ISSUES RELATED TO THE NURSE LICENSURE EXAMINATION

In the Research Study conducted by Palaganas et al. (2014) about the PNLE, She concluded that those
who took the examination for the first time (first timers) performed better, had a higher passing
percentage, and significantly higher average rating than repeaters in all the NLEs. Among the repeaters,
those who took the examination for at most two times showed a higher passing percentage and the
average rating.

Palaganas also concluded that: Examinees from accredited schools also had higher passing percentage
and average rating than examinees from non-accredited schools. Those from government-owned schools
showed a higher passing percentage in all NLEs and significantly higher average ratings in six (6) out of
the eight (8) NLEs than examinees from non-government-owned schools.

The study found that the accredited and government-owned schools had higher passing percentage
average rating compared to non-accredited and non-government owned schools. Significant differences
were found in the passing percentage and average rating of the examinees across regions and testing
centers.

In the research study conducted by Bautista et al. in 2018, he stated that there was a downward trend
among those taking and passing the NLE between 2010 and 2016. He stated further that, HEIs should
consider decreasing their student-faculty ratio to improve NLE performance. Relevant government
agencies should take measures to improve most HEIs’ NLE performance in the Philippines.

The 2019 research study by Oducado et al, states that: The use of students’ pre-admission qualification,
academic performance in nursing school, and terminal test scores may assist nursing schools in
identifying the performance of nursing graduates in the NLE that may be useful in the development of
admission and retention policy in the nursing program. On top of the known factors affecting NLE
performance, nursing schools may also benefit from developing and conducting an institutional
standardized competency assessment administered at the end of the nursing program to aid them in
assessing students’ likelihood of success in the NLE.

THE CHALLENGES OF THEW NURSING CURRICULUM WITH OTHER NATION.

In the comparative curriculum study conducted by Cornejo (2018), The nursing curriculum of the National
University of Singapore has no General Education being offered due to the Singapore educational
system. Additionally, they need to take and pass the English skills language as part of the requirement
can be admitted in the program and they offer two types of the curriculum which are a 3-year BS Nursing
and a 4-year BS Nursing – Honour and they have only had 120 modular units and 160 modular units
respectively. While the CMO No. 14 series 2009 and CMO No.15 series 2017 both offering the 4 years
baccalaureate nursing curricular program with a total unit of 202 for CMO No.14 s2009 and 192 units for
CMO No.15 s2017. The difference between the two CMO was the units being offered in General
Education in CMO 15 s2017 are 36 units the reason will be the implementation of the K-12 Program that
some General subjects were removed.

Despite there are differences in domestic regulation in showing each idea they are still sharing common
goals on how the Nursing curriculum will implement, these are the program outcomes, standard
competencies, and frameworks for the nurse to demonstrate the required basic competence upon the
completion of the programs and in connection to the national licensure examination to ensure that the
required basic clinical competence of a beginning nurse practitioner has been met and these are:
Knowledge, Ethical and legal competencies, Professional nursing practice, leadership and management
competencies, education and research competency, and personal and professional quality competency.

The Philippines needs to strengthen the collaboration on a network in nursing education with the other
country to gain opportunities provided in connection with core competencies stated between the
countries, so in this opportunity, the Philippine nursing curriculum will be recognized internationally and
might be given the equivalency. Other challenges are the crediting the courses of the student’s own
country that taken from an outside school or universities, this should be addressed properly by adopting
any of the available credit transfer systems which mostly applicable to the Student Exchange Program,
among agree parties of universities and facilitated when the accreditor/ evaluator knows the quality of the
nursing program. If giving the nursing students, the opportunity to study and experience professional
nursing in other countries will broaden the students’ perspective and may allow the greater trade in
services between the country wherein the student completes the nursing program or its equivalency. But
there is a need to standardize the regulatory frameworks and properly benchmark the curriculum that
aligns with the learning outcomes and competencies of their own country’s nursing curriculum with the
partner country and creation of a joint body to ensure that the nursing graduates will have the necessary
competencies to allow to practice and employed globally. In a comparative curriculum study conducted by
Reblando in 2018, the author delineated the strength and weakness of our curriculum against other nation
offering a baccalaureate degree in nursing

STRENGTHS OF COMPLIANCE WITH INTERNATIONAL STANDARDS

The Philippine BSN curriculum is compliant with international standards of core competencies in the
delivery of the program and the assessment methods. The core competencies identified in these areas
are in line with the international standards for a nursing curriculum, which are used to identify the eligibility
of a nurse for practice. The current curriculum provides the nurses with the essential skills required for a
successful nurse and provides them with adequate training to make them better qualified for their careers
(Lazarte, 2016). The program successfully provides nurses with adequate communication and leadership
skills, which make them very capable of their jobs despite difficult circumstances in the health care
system in the country (Reblando 2018).

Weaknesses:

The main areas of weakness within the program are health education and research (Lazarte, 2016). The
curriculum does not incorporate lessons on how nurses should educate the community on different
aspects of healthcare. The curriculum does not also include training practicum on research, to provide
students with the skills they need to carry out evidence-based research and promote the nursing practice.
Nurses graduating from the program have problems identifying research gaps in the nursing practice and
building new research on them to create better health practices in a community setting (Reblando 2018).

References

1. Bautista, J. R., Ducanes, G., & David, C. C. (2019). Quality of nursing schools in the Philippines:
Trends and evidence from the 2010–2016 nurse licensure examination results. Nursing Outlook,
67(3), 259-269. https://doi.org/10.1016/j.outlook.2018.12.012
2. Cayabyab, M. J. (2015, January 12). PRC examiner found guilty of leaking nursing test questions.
INQUIRER.net. https://newsinfo.inquirer.net/664069/prc-examiner-found-guilty-of-leaking-nursing-
test-questions
3. CORNEJO, L. T. (2018, October 8). (PDF) The comparative analysis of the Philippines nursing
curriculum of the CMO No. 14 series 2009 and CMO No. 15 series 2017 with the selected
international curriculum concerning equivalency or recognition. ResearchGate.
https://www.researchgate.net/publication/331210463_The_Comparative_Analysis_of_Philippines_Nu
rsing_Curriculum_of_the_CMO_No_14_series_2009_and_CMO_No_15_series_2017_with_the_Sele
cted_International_Curriculum_in_Relation_to_Equivalency_or_Recognition
4. National Nursing Core Competency Standards. (2012). Professional Regulation Commission.
5. Oducado, R. F., Cendaña, D. P., & Belo-Delariarte, R. G. (2019). Institutional Competency
Assessment And Other Factors Influencing The Nurse Licensure Examination. INTERNATIONAL
JOURNAL OF SCIENTIFIC & TECHNOLOGY RESEARCH, 8(12), 268-270.
6. Performance in the licensure examination for teachers among the graduates of Isabela State
University, echague, isabela, Philippines. (2020). Journal of critical reviews, 7(11).
https://doi.org/10.31838/jcr.07.11.11
7. PRC Board of Nursing Resolution no. 22, Series of 2017. (2017).
8. PRC exec in 2006 nursing board exam leak convicted of Graft. (n.d.). GMA News Online.
https://www.gmanetwork.com/news/news/nation/337356/prc-exec-in-2006-nursing-board-exam-leak-
convicted-of-graft/story/
9. Reblando, J. (2018). A comparative analysis of the Philippine nursing curriculum from other countries.
International Journal of Advanced Research, 6(7), 526-532. https://doi.org/10.21474/ijar01/7393
10. Republic Act No. 9173 AN ACT PROVIDING FOR A MORE RESPONSIVE NURSING
PROFESSION, REPEALING FOR THE PURPOSE REPUBLIC ACT NO. 7164, OTHERWISE
KNOWN AS "THE PHILIPPINE NURSING ACT OF 1991" AND FOR OTHER PURPOSES. (2002).
The Lawphil Project - Arellano Law Foundation, Inc.
https://www.lawphil.net/statutes/repacts/ra2002/ra_9173_2002.html
11. Rodis, R. E. (2007). The nursing scandal. Telltale Signs.
https://rodel50.blogspot.com/2007/04/nursing-scandal.html