Professional Adjustment Mr. Hermie G.

Siroy, RN MN

Professional Adjustment Philippine nursing practice

Course Content I. II. III. IV. V. VI. Nursing as a Profession Core Competency Standards for Nursing Practice the Philippines Nursing Ethics Choosing a Field of Nursing Applying, Retaining, Resigning and Dismissal from a Position Contracts

Quizzes 45% Term Exam 40% Requirements 10% Class Participation 5% Assignments Nightingale Pledge (memorize) List of Accredited Nursing Organizations o Date organized o Founder/Organizer Copy of CCS and prospectus (2009) New PNA Hymn (memorize)

Historical Influences in the Development of Nursing as a Profession - Knowledge of the past can help us understand how nursing developed. A. Religious Influence - Early Christian Church practiced the Acts of Charity o Deacons/Deaconesses servants for the sick, caring for people is service to God - Monastic Orders (4th and 5th Century A.D.) o Augustinian Sisters first nursing order o Did nursing, housekeeping, cooking, laundering at the same time ran the hospital o Protestant Reformation (16th century) By Martin Luther (Spread to England and developed their) Nursing plunged into its own Dark Age o Revival of the Deaconess Order Pastor Theodore Fliedner of Kaiserwerth, Germany and his first wife (1836) saw deaconess in Holland Kaiserwerth place were Nightingale Trained o More nursing school opened under the secular organization and churches B. Military Influence - Military nursing orders were established during the crusades - FN served in the Crimean was in 1854-1856

Professional Adjustment Mr. Hermie G. Siroy, RN MN

C. Secular Influence - St. Francis of Assisi believed that men and women can participate in nursing and social welfare work under the religious control - Sisters of Charity (1600) - Establishment of nurses organization, enactment of laws and development of nursing journals D. Educational Influences - Early nursing trial and error/apprenticeship - Daughters of St. Vincent de Paul formal education took place Florence Nightingale 90 died August 13, 1910 Nursing in the Philippines Nursing education pioneered by Dr. Mrs. Andrew Hall - Presbyterian o Evolved from the apprenticeship system Union Mission Hospital Training School, Iloilo City became the training institution for Filipino nursing students Iloilo Mission Hospital School of Nursing in Iznart St. set the stage for nursing as a profession

Fist Nursing Graduates Felipa de la Pena of Panit-an, Capiz Nicasia Cada of Oton, Iloilo Dorotea Caldito of Leon, Iloilo

1919 the 1st Nurses Law (Public Act #2808) was enacted regulating the practice of the nursing profession in the Philippines. It also provided the holding of exam for the practice of nursing ion teh 2 nd Monday of June and December of each year Traditions in the Nursing Profession The Nurses Cap o Purpose of the cap to keep the nurses hair neatly in place and present a modest appearance o FN in the 1800s caps were hood shaped and had a ruffle o Black band on the nurses cap worn at the time of graduation The Nursing Pin o The 8 Pointed Cross (aka the Maltese Cross) The Maltese Cross originated in the Maritime Republic of Amalfi in Italy. Amalfi was the birthplace of some pious merchants who founded the first hospital of the Order of St. John in Jerusalem, in 1048. The emblem of the knights Hospitaliers 8 Beatitudes of Jesus Christ o Baron Bassiliev a 19th century Knight Commander of the Knights Hospitaliers o Wearing of the pin extended to schools to symbolize wisdom, strength, courage and faith o Pinning Ceremony The Nurses Uniform o Has always been significant because it provides a strong nonverbal message about ones images. o Communicated an impression of confidence, competence, professionalism, authority, role, identity, and accountability o 1900s hemline was raised and uniform became more functional

Professional Adjustment Mr. Hermie G. Siroy, RN MN

o o

Mid-1960s pantsuits became accepted 1970 scrubsuits & athletic shoes became acceptable

The Nightingale Pledge Embodies the principles of sacrifice, service and obedience Written by Lystra E. Gretter of Harper Hospital School in Detroit

Some Situations That Have Caused Internal Changes in the Nursing Profession 1. 2. 3. 4. More men entering the nursing profession There has been less acceptance of the passive behaviors associated with the historical handmaiden role. The average age of working registered nurses has increased The practice of nursing has shifted from acute care in the hospital to a more community-and-primary care focus.

Development of Nursing as Profession Is nursing a Profession? Perhaps you have heard many people say that nursing is a vocation, while some say that it is a profession Websters Dictionary defines a profession as an occupation or calling requiring advanced training and experience in one specific or specialized body of knowledge which provides service to society in that special fields Nursing is an occupation requiring a unique body of knowledge and skills and which serves society

Criteria of a Profession 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. Public service and altruistic activities Autonomy and independence of practice Specialized body of knowledge (ability to do special things, authority) Evidenced based practice results of research studies High level of individual responsibility and accountability accountable for what you are doing Code of Ethics Code of Nursing Ethics Self-regulation self monitored profession Competency and professional license High intellectual level of functioning Well-organized and strong representation Lifetime commitment Public acceptance

Profession Prestigious occupation with a high degrees of identification among members that requires lengthy and rigorous education in the intellectually demanding and theoretically based course of study; engages in rigorous self-regulation and control; that holds authority over clients; and that puts service to society above simple self-interest.

Professional Adjustment Mr. Hermie G. Siroy, RN MN

Professional Nursing An art and a science in which certain principles are applied in the skillful care of the sick in appropriate relationship with the client and the physician and with others who have related responsibilities. It is concerned equally with the prevention of illness and conservation of health

Professional Nurse A person who has completed a basic nursing education program and is licensed in his/her country to practice nursing

Professionalism Demonstration of high level personal, ethical, and skill characteristics of a member of a profession

Qualifications of a Professional Nurse A. Professional Preparation 1. Must have a Bachelor of Science degree in Nursing 2. Must have a license to practice nursing in the country 3. Must be physically and mentally fit B. Personal Qualities and Professional Proficiencies 1. Has interest and willingness to work and learn with individuals/groups in a variety of settings 2. Has a warm personality, a well-balanced emotional condition and concern for people 3. Is resourceful and creative 4. Has the capacity and ability to work cooperatively with others 5. Has the initiative to improve self and service 6. Has competence in performing work through the use of the nursing process 7. Has the skill in decision-making, communicating, and relating to others 8. Must be research-oriented 9. Does active participation in issues confronting nurses and the nursing profession What you call nursing is much less important than what you make it. caring for a client wholeheartedly and practicing what you have learned Professional Adjustment Growth of the whole person in the development of his capabilities to make him fit to assume his position Preparation of an SN for the responsibilities of prof and social life (Participate in the community), by developing capabilities in a way that would make her fir for the practice in nursing

Educational Preparation for Nursing Baccalaureate Nursing 3-year hospital-based program leading to Graduate in Nursing (Phased out) 1983 4-year collegiate degree program leading to BSN 1998 2-year education and basic nursing procedures leading to AHSE (Associate in Health Science Education) o Additional 2 years of major nursing component leading to BSN

Professional Adjustment Mr. Hermie G. Siroy, RN MN

2006 4 year degree program (CHED 30)

Graduate Education in Nursing Major purposeprepare nurses in improving nursing care through advancement of nursing theory and science. Prepare nursing leaders by generating higher levels of competence and by teaching, administering and investigating professional practice.

Masters Degree Program Generally takes 1 to 2 years Masters in Arts, Master in Nursing, Master in Science in Nursing, and Master of Science Pursue an area of clinical specialization and elect an area of role and development

Doctoral Degree Program Titles awarded are Doctor of Philosophy (PhD), Doctor of Nursing Science (DNS), Nursing Doctorate (ND) Preparation for various positions such as administrators of nursing colleges, nursing research specialists, consultants of nursing services, nursing education programs or hospital services

Continuing Education for Nurses Continuing education refers to formalized experiences designed to enlarge the knowledge and skills of professional nurses Forms of Continuing Education 1. 2. 3. 4. 5. 6. 7. Graduate school Seminars-workshops/lectures Conventions-gathering of professionals Distance learning/self directed learning package-school of Correspondence On teh job training for specialization/4 weeks Authorship-ownership of intellectual property In-service education planned program for staff nurses by the employer

CPE (Continuing Professional Education) Credit Units Requires 60 CPE credit units every 3 years

BON Resolution No. 01 Series of 2008 Created the CPE Council for nursing

Objective of Continuing Education 1. To provide and ensure the continuous education of a registered profession with the latest trends in the profession. 2. To raise and maintain the highest standard and quality of the practice for the profession. 3. To make the nurse globally competitive.

Professional Adjustment Mr. Hermie G. Siroy, RN MN

4. To promote the general welfare of the public. Factors in Society that Promote Need of Nurses to Continue Education 1. 2. 3. 4. 5. An aging population results in older clients with more complex health problem Skilled nursing care is needed with the advent of home care nursing. Nurses need to be knowledgeable about the cultural and social influences on health. Newer technology and scientific discoveries. New diseases related to social and environmental problems.

Core Competency Standards for Nursing Practice Committee Members 1. BON 2. CHED Technical Committee on Nursing Education 3. PNA Project was conceptualized April 2001 Initial draft presented June 2003 Refinement done January 18, 2005 Date of Effectivity August 2005 May 2009 Revised CCS Legal basis RA 9173, Art.3, Sec.9 (c) The Board shall monitor and enforce quality of standards of nursing practice in the Philippines and exercise the powers of 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. Rationale 1. Effects of globalization Globalization free enterprise and no monopoly of business New technology comes in to our country 2. New expectations for contemporary nursing practice Nurse Anesthetist First Assistant to the surgeon Nurse entrepreneur 3. Changes in dynamics of health science and information technology 4. Demographic changes Study of population of a certain place o Increase demand of food o Overcrowding o Increase demand for health care o Migration 5. Changes in the health care program

Professional Adjustment Mr. Hermie G. Siroy, RN MN

6. Increasing and more exacting (strict) demands from the consumers of health care. 7. Surge of overseas employment opportunities for Filipino nurses. Nursing Relief Act - only Filipinos can be employed; abolished in 1995 Significance 1. 2. 3. 4. 5. 6. Guide in developing the curriculum in nursing Framework for developing test syllabus for entrants into the nursing profession Tool performance evaluation among nurses Basis for advance practice and specialization Framework for developing a training curriculum for nurses Yardstick for unethical and unprofessional practice of nursing.

Key Areas of Responsibilities Patient Care Competencies (70%) 1. Safe and quality nursing care 2. Communication 3. Collaboration and teamwork 4. Health education II. Empowering Competencies (10%) 5. Legal responsibilities 6. Ethico-moral responsibilities 7. Personal and professional responsibilities III. Enhancing Competencies 8. Records management 9. Management of resources and environment IV. Enabling Competencies 10. Quality Improvement 11. Research Revised May 2009 I.

Nursing Ethics Values are ideals or concepts that give meaning to the individual life Form as a basis for behavior

Personal Values Values that a person may internalize by how he perceives them from the society in which he lives Professional Values Values that are acquired from the code of ethics, nursing experiences, teachers and peers ***Nurses hold values that relate to both competence and compassion

Professional Adjustment Mr. Hermie G. Siroy, RN MN

Nurses are expected to value: 1. 2. 3. 4. 5. 6. 7. Virtues learned The ability to provide safe, competent and ethical care Health promotion and well-being of clients Respect and promotion of autonomy of clients Dignity and worth of each person Justice and fairness in the care of clients Confidentiality of information gathered

Morals or Morality Fundamental standards of what is right or wrong that the individual learns and internalizes, usually in the early stages of childhood development

Ethics Science that guides our judgement concerning the morality of human acts. Various ways of understanding and examining the moral life of a person

Study of ethics may be said to have 2 aspects: a. Related to how people should behave as to what is good, right and just b. Related to what people actually do and the pressures which influence their action Professional Ethics Embraces basis principles of right action or norms of conduct which is exemplary and honourable in teh practice of a profession

Nursing Ethics Is concerned with the principles of right conduct as they apply to the nursing profession Aspect of oral philosophy which serves as guide in ones judgement or appraisal of the goodness or badness of acts relative to the practice of nursing

Nursing Professional Ethics Division of ethics which treats of the moral principles, duties or behavior of the members of the nursing profession toward their patients, their co-workers, and to their profession.

Bioethics Specific domain of ethics that focuses on moral issues in the field of health care

Ban Reusselaer Potter published the book entitled Bioethics: Bridge to the Future Ethic Committees in Hospitals A. Act an advisory body to medical and nursing staff as well as families struggling with difficult situations B. Help institution establish policies regarding ethical concerns that ten to recur in that setting C. They are consulted when issues about life-and-death decision-making arise.

Professional Adjustment Mr. Hermie G. Siroy, RN MN

Basic Ethical Concepts Commonly Applied in Health Care 1. Rights and Obligations Rights justified legal or moral entitlements which may be based on particular agreements Types of Rights a. Legal rights Rights guaranteed by law Enforceable though civil or criminal courts E.g. right to treatment, right to freedom from assault b. Ethical rights Privileges allotted to certain individuals or groups that do not have the power of law to enforce the claim E.g. right to know the truth, right to life c. Option rights give individuals the freedom of choice and the right to live their lives as they choose as long as they stay within a set of prescribed boundaries E.g. Basic human rights, Civil and political rights, Right to life and liberty freedom from expression, equality before the law Economic, social, and cultural rights Respect and dignity, right to food, to work and to education Obligations fulfilling ones contractual commitment to clients or his employee 2. Autonomy o Right to independence and personal freedom, which leads to the primacy of self-determination o To govern oneself, one must have these capacities a. To understand the issue and what the situation is all about b. To reason out and give ones own opinion c. To deliberate by weighing the pros and the cons of the issue and make an independent choice o From this principle, client has the right to informed consent; if unsigned waiver o Autonomy is not an absolute right 3. Beneficence o Means to promote and do good o Sometimes referred to as the constitutive principle of reciprocity (Golden Rule) o Elements of beneficence a. One ought to prevent evil or harm b. One ought to remove evil or harm c. One ought to do or promote good 4. Nonmaleficence opposite side of the coin of beneficence since the admonition is stated in the negative one ought not to inflict evil or harm 5. Justice is the professional obligation to be fair and equal to all people 6. Fidelity refers to the obligation to be faithful to the agreements, commitments, and responsibilities that once has made to ones self and others 7. Veracity refers to the telling the truth or not intentionally deceiving or misleading patients. Some argue that there is a limit to veracity such as when truth would harm patients prognosis for recovery-referred to as benevolent deception. possible harm to patients autonomous and loss of nurse credibility.

Professional Adjustment Mr. Hermie G. Siroy, RN MN

8. Standard of Best Interest when a person cannot make informed decision, the health care providers or family make the decision based on what they believe to be in his/her best interest. 9. Confidentiality keeping privileged information private. Moral Principles Standard of conduct that individuals have constructed for themselves Body of obligations and duties that a particular society requires of its citizens or members

Conscience Place within us where we feel a sense of joy and contentment when we act rightly; a sense of disquiet and guilt if we act wrongly

Moral Principles that Help Guide Nurses in Making Moral Decisions 1. The Golden Rule 2. The Two Fold Effect/Principle of Double Effect Intervention is based on the following effects: a. That the action chosen must be in itself morally good or at least morally indifferent b. That the harm must never be intended but merely tolerated as casually connected with the good intended c. That the good must not follow as a consequence of the secondary harmful effects d. That the good effect must outweigh the bad effect E.g. the act of self defense by Thomas Aquinas 3. The Principle of Totality o The whole is greater than any of its parts o E.g. Hysterectomy due to cancerous growth in the uterus at the time the woman wants to get pregnant. 4. Epikia o Exception to the general rule. o E.g. Refusal of JW patient to blood transfusion despite of massive blood loss 5. No one is obliged to betray himself o No one can force any person to answer a question if such will incriminate him/her 6. The end does not justify the means o Contraception facilitates the exploitation of women by men who seek to gratify the sexual desire without commitment 7. Defects of nature may be corrected o Everyone has the right to be normal 8. A little more or less does not change the substance of an act 9. The greatest good for the greatest number o Similar to the Principle of Finality A healthy man may voluntarily donate any part of his body not essential to his life, without contradicting nature for the benefit of his sick neighbour. Done out of generosity, his gesture is not only justified but is meritorious as well. o Organ donation and transplantation referred by Pope JP2 as a manifestation of love for ones neighbour. o A nurse refuses to admit a disturbed agitated and violent client due to understaffing and with 10 disturbed patients in the psychiatric ward

Professional Adjustment Mr. Hermie G. Siroy, RN MN

10. No one is held to the impossible o A nurse who is told to care for an unreasonable number of patients and who becomes worried that she is neglecting her duty because she is physically incapable of carrying out all details commanded, she should remember this principle in setting her conscience. 11. Principle of material and formal cooperation. o The one who cooperates somehow assist in the carrying out of an immoral act by giving advice, providing necessary information, doing or facilitating anything which is one way or another, makes the immoral act possible. 12. Principle relating to the origin and destruction of life o God gave us life, therefore, He has the right to take away that life. ***Good Samaritan Law NEN (Nursing Ethics Network) Affiliated with Boston College School of Nursing Began in 1995 Composed of 20 nursing professionals with expertise in end-of-life issues, nursing ethics, and palliative care

Spiritual Care Involves extending the worshipping community to the people in difficult circumstances. Mark 12:30-31 Proverbs 17:22 John 13:34 Galatians 6:9 Matthew 25:40

Code of Ethics Formal statement of ethical principles and rules which gives the members of profession a frame of reference for judgments in complex nursing situations

Code of Nursing Ethics Serves as a guide for nurses in the observance of the ethical principles that should govern their nursing practice, conduct and professional relationship

Purposes of the Code of Nursing Ethics 1. It provides a basis for regulating the relationship between the nurse, the client, co-workers, society and the profession. 2. It provides a standard basis for excluding the unscrupulous nursing practitioner and for defending a nurse who is unjustly accused. 3. It serves as a basis for professional curricula and for orienting the new graduate to professional nursing practice. 4. It assists the public in understanding professional nursing conduct.

Professional Adjustment Mr. Hermie G. Siroy, RN MN

History of the Code of Ethics for Filipino Nurses 1922 it was initially under the name of Filipino Nurses Association (CCS and Ethics are copied form ICN) 1941 a tentative code of ethics for nurses already existed 1982 PNA Special Committee was organized with Emiritus Julita V. Sotejo as chairperson. The committee initiated the movement to develop a Code of Ethics for Filipino nurses. February 25-26, 1982 proposal for the code of ethics emanated from the seminar-workshop entitled Ethics and Morals of health Care, conducted by nurses September 1982 circulation of the proposed Code. October 27, 1982 final presentation of the document; unanimously approved but not implemented March 21, 1984 addition of teh promotion of spiritual environment; code was approved through BON resolution No. 633 October 18, 1989 code was approved by the BON in its Resolution No. 1955 October 23, 2003 new Code of Ethics was presented at the Assembly of Nursing Representatives, during its 81 st Foundation Anniversary, 46th Nurses Week Celebration and the Annual National Convention of Nurses in Iloilo City. July 14, 2004 finally adopted under RA 9173 and promulgated by the BON under Resolution N. 220 series of 2004.

Code of Ethics for Filipino Nurses Refer to pp. 284-290 Professional Nursing in the Philippines 10th edition by Lydia and Ronald Venzon Responsibilities of Nurses to the Public 1. Nurses are advised to become familiar with teh patients Bill of Right and observe its provisions 2. The patient and his/her family are entitled to know information or facts within the limits determined by the physician In cases where the patient is definitely dying, a well-known authority suggested these views: a. The decision of whether to inform the client or not should be left to the discretion of the attending physician or the nurse. b. Under no circumstance must the client be told he is dying. c. Patient has the right to know exactly what his condition is. d. N should accord much weight to the opinion or feeling of the clients family, who know the client better than anybody else. e. The desire to know of his real condition will be determined by the client himself. 3. Any information gathered by the nurse during the course of caring for the patient shall always be treated confidential. This duty extends even after the patients death 4. When a nurse is engaged by a patient or any agency, he shall complete said service on the length of time stipulated in the contract.

Professional Adjustment Mr. Hermie G. Siroy, RN MN

Responsibilities of the Nurse to the Physician 1. Nurses will not only carry out doctors orders but help plan and implement patient care as well. 2. If any of the medical orders were not carried out for some reason, such shall not only be brought to the attention of the physician but also noted properly in the patients chart. 3. Nurses shall familiarize themselves with the various routines, methods, or idiosyncrasies of physician, so that smooth relationships can be maintained 4. Any case of illegal, incompetent or unethical practice by any member of the health team shall be brought to the attention of the appropriate authority through channels within the institutional or agency setting 5. Nurses shall remember that any medical act relegated to them is illegal because it is specified in the Medical Law that any licensed nurse who does this, even if supervised can be held for illegal practice of medicine. Responsibilities of Nurses to Their Colleagues 1. Nurses are expected to be able to get along smoothly with their colleagues. o A mature person easily blends in any situation 2. Nurses shall adjust themselves to the organization and know its policies and procedures. The shall establish good working relations with co-workers 3. It is important that nurses know their place in the total organization so that they may cooperate, coordinate and maximize their work. 4. Situations, such as when nurses see their colleagues neglect their duties or are incompetent shall be brought to the attention of the immediate supervisor or appropriate authority within the agency setting before any life could be endangered. Responsibilities of Nurses to Themselves 1. Maintain competence by continuous learning and endeavor t find possible means to utilize it to develop their skills. 2. They shall endeavor to live a life that will uphold their self respect. 3. Especially when on duty, nurses shall try to look neat and attractive o Female nurses are advised to use moderate make-up and a neat hair style o Male nurses are advised to be clean shaven with hair clipped close to the nape o Wear uniforms that are neither too short nor tight-fitting nor expose unnecessarily any part of the body while giving care to the patients. o Uniforms shall be worn only when on duty. Dining in public, shopping or going to market in uniform is discouraged. o Use of anti-perspirant is advised most especially during hot summer months o Jewelry such as earrings, necklaces or bracelets is not worn while on duty. However, wedding rings, school rings, or school pins may be worn. 4. They must act in a sincere and compassionate manner which is worth emulating. 5. Nurses must not put in too much overtime to allow themselves to be placed in a position far beyond their abilities and knowledge. They must always function in a highly stressed state. Advance Medical Directive A written document signed by a competent person giving direction to health care providers about treatment choices in certain circumstances.

Professional Adjustment Mr. Hermie G. Siroy, RN MN

May be self-written or prepared by someone else as instructed by the patient.

Types of Advance Directives 1. Living Will formal legal document that can be general or specific. Signed by patient and witnessed by 2 persons. 2. Durable power of Attorney for Health Care legal written directive. o Allows the chosen person to make bank transactions, sign Social Security checks or write check. 3. Health Care Proxy or Surrogate this is a legal document in which an individual designates another person to make health care decisions. o Same rights to request or refuse treatments for the clients sake Advantages of the Medical Directives 1. 2. 3. 4. Enhance communication between patients and providers about life-sustaining technology Assist in reducing litigation in healthcare Preserve patients autonomy Could lower health care costs

Ethical Dilemma A situation that requires an individual to make a choice between 2 equally unfavourable alternatives

Ethical Violation Act of neglecting fundamental nursing obligations in a situation where the nurse knows that the action or lack of action is NOT appropriate.

Ethical Distress Situation in which the nurse cannot fulfil his ethical obligations and commitments Nurse fails to pursue what he believes to be the right course of action

Goal of the Ethical Decision-making Process To determine right from wrong in situations where clear demarcations do not exist.

Decision Making Process in Ethics 1. 2. 3. 4. Collect, analyze, and interpret data State the dilemma Consider the choices of action Analyze the choices of action individually o Consider the following questions a. What are values are at stake? b. What principles are at stake? c. What personal issues are at stake? 5. Make the decision o Consider the advantages and disadvantages of your final decision 6. Act on your decision and assess the outcomes of the decision o Includes an on-going assessment of the prevailing circumstances\

Professional Adjustment Mr. Hermie G. Siroy, RN MN

Judge whether circumstances are better or worse than hoped for and whether the long term effects will be successful.

Case Analysis Ethical Cases Members of teh Group: ___ Case # ___ I. Data Gathered o Must be bulleted in form o Must be taken from the given situation Statement of the Dilemma o Follow the format ___vs.___ Actions to be taken o Choose which side of teh dilemma the group would like to support o As you list down the possible interventions, indicate ethical and moral principles involved or values at stake. Make an appropriate decision o Support your decision with information taken from journals, books and magazines. o Consult the following: a. Of what advantage does your chosen action have over the other choices? b. What would be the possible long-term effect of such decision?

II. III.

IV.

Criteria of Evaluation Group Participation 10% Ability to draw out data from the given situation 20% Ability to correctly state ethical dilemma 15% Clarity of justification taken 35% Ability to arrive at an acceptable decision 25% Fields of Nursing Institutional Nursing Positions/Qualifications 1. Staff Nurse o BSN graduate o Pass the nursing licensure exam 2. Head Nurse o BSN Graduate/RN o Has at least 2 years of experience in general nursing administration o Has 9 units in management and administration courses at the graduate level

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o Be a member of good standing of the APO of nurses 3. Nurse Supervisor o MN 4. Clinical Specialist Must have: o High level of knowledge and skill in a special are of practice o The ability to evaluate research in her specialty and to assist staff in implementing findings of research 5. Assistant Nurse Director/Assistant Chief Nurse 6. Nurse Director/Chief Nurse o Masters Degree holder in nursing o Has at least 5 years of experience in a supervisory or managerial position in nursing Nurses in In-Service Education Qualifications Must have at least 2 years experience in basic nursing practice Must have understanding of skills in teaching, supervision, consultation, administration and research Has the ability to plan and implement programs for different kinds of nursing personnel

Classification of In Service Educators 1. Quality Assurance Coordinator o Must have an experience in clinical nursing and research 2. Nurse Instructor for In-Service Training Program o Must has 2 years of experience in clinical practice and research o Must be a masters degree holder in Nursing preferably with clinical specialization 3. Nursing Coordinator for Staff Development Community Health Nursing Definition A. COMMUNITY HEALTH NURSING DEFINITION: 1. Public Health Nursing 2. Community Health Nursing POSITIONS/ QUALIFICATIONS: 1. Public Health Nurse 2. Supervising PHN/ Nurse Supervisor at the Provincial or City level o Masters Degree in Nursing or Public Health o At least 5 years of experience as PHN 3. Nursing Instructor II 4. Regional Training Nurse o Master in Nursing or Public Health o 6 years nursing experience 5. Regional Nurse Supervisor/ Regional PHN

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6. Nursing Program Supervisor o Masters degree in Public Health or MN major in CH Nursing Administration 7. Assistant Chief Nurse in selected City Health Departments 8. Chief Nurse in Selected City Health Department and Health Offices B. NURSING EDUCATION POSITIONS/ QUALIFICATIONS: 1. Faculty/ Clinical Instructors o BSN/ RN o Masters in Nursing or Education o One year of clinical practice in the field of specialization o Be a member of good standing in the APO of nurses 2. Level Chairpersons 3. Clinical Supervisor 4. Administrative Officer 5. Dean o At least 5 years of experience in teaching and supervision 6. Faculty at the Graduate Program for nurses o Masters Degree or Doctoral degree in Nursing C. SCHOOL HEALTH NURSING A specialized practice of professional nursing that advances the well-being, academic success, and life-long achievement of students. QUALIFICATIONS: 1. BSN graduate 2. Passed the nursing licensure exam D. PRIVATE DUTY NURSING QUALIFICATIONS: 1. BSN/ RN 2. 2 years bedside nursing experience a s a professional nurse in a general hospital immediately prior to application 3. Be a full time PDN 4. Be acceptable to the Director of Nursing Service as suitable for orientation to do private duty nursing 5. Be a certified IV nurse therapist by the ANSAP CATEGORIES: 1. General Private Duty Nurse o Provides basic nursing care 2. Private Duty Nurse Specialist REQUIREMENTS: 1. Required documents o Professional Tax Receipt o PRC Card or license o Residence Certificate or cedula 2. Undergo orientation in the hospital as conducted by the Nursing /service office 3. Wear full white nurses uniform with blazer 4. Has a medical certificate after undergoing needed laboratory examination 5. Give 2 character references 6. Show certification as an IV therapist

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E. MILITARY NURSING POSITIONS/ QUALIFICATIONS: 1. Air Force Nursing o Flight Nurse/ Aero-space nurse o Nurse responsible for patients, military or otherwise, who have been evacuated from battle areas to the nearest installation for treatment 2. Army Nursing 3. Navy Nursing o Provides high- quality nursing care for sailors, marines and service members and their families wherever duty calls Brig. Gen. Elvegia R. Mendoza first woman General in the AFP; Dec. 26, 1990 QUALIFICATIONS FOR COMMISSION IN THE RESERVE FORCE NURSE CORPS: 1. BSN degree/ RN 2. Natural born Filipino citizen 3. Be mentally and physically fit for military service and cleared by appropriate security agencies 4. Has a pleasing personality and good moral character 5. Skillful in using the nursing process and making sound/ rational judgment 6. Be interested and willing to work in both peaceful and wartime conditions 7. Not more than 32 years of age at the time of commission 8. Satisfy the height requirement: male 62 inches; female 60 inches 9. Be single or has never been married for both male and female candidates QUALIFICATIONS FOR COMMISSION IN THE REGULAR FORCE, NURSE CORPS: In addition to the requirements of the Reserve Force: 1. Successfully pass the rigid screening and battery test for the purpose 2. Height requirement: males 64 inches; females 62 inches 3. Not be more than 26 years of age at the time of regular commission QUALIFICATIONS FOR CALL TO ACTIVE DUTY (CAD): 1. Must be commissioned 2. Must have at least 1 year nursing experience in a reputable health agency 3. Must have been cleared by appropriate security agency QUALIFICATIONS FOR GENERAL DUTY NURSE: 1. Have the rank of 2nd lieutenant 2. Have adequate knowledge of general nursing theory and practice 3. Have knowledge of new developments in the nursing field

F. OCCUPATIONAL HEALTH NURSING A specialty practice that provides for and delivers health and safety programs and services to workers, worker populations and community groups QUALIFICATIONS: 1. BSN/ RN 2. At least 1 year of experience in emergency care 3. Knowledgeable of legal responsibilities 4. Has the ability to take and read ECGs, lab tests, x-rays ROLES: 1. Clinician

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2. Manager 3. Coordinator 4. Adviser/ counselor G. CLINIC NURSING Nurse acts as receptionist, assists in physical examinations, performs laboratory examinations, do dressings, give injections, do referrals as well as give health teachings Must possess good assessment skills and excellent teaching and communication skills, exhibit organizational and leadership ability

H. INDEPENDENT NURSING PRACTICE Self-employed and provides professional nursing services to clients and their families. Reach out and offer their services rather than expect clients to seek their help Make referrals and collaborate with physicians and other disciplines as needed by the client or family I. ADVANCED PRACTICE NURSING It is an umbrella term for nurses who have specialized education and experience beyond the basic nursing program 1. Entrepreneurial Nursing o Characteristics: a. Independent b. Flexible c. Assertive d. Accountable e. Creative f. Has the drive to achieve g. Has an appetite for hard work h. Disciplined i. Self-confident j. Excellent communication skills k. Ability to handle stress l. Ability to market oneself

GUIDELINES IN CHOOSING A FIELD OF NURSING: 1. Qualifications 2. Years of experience and the amount, the type and the quality of education needed 3. Age 4. Aptitude, physical condition and emotional stability 5. Personal career goals 6. Conditions in nursing and occupational trends FACTORS IN THE SELECTION OF A FIELD OF NURSING: 1. Socioeconomic factors 2. Enhancement of ones ability in a certain field 3. Altruistic or humanitarian motives 4. Availability of work 5. Qualifications 6. Method of entering Applying, Retaining, Resigning and Dismissal From a Position

Professional Adjustment Mr. Hermie G. Siroy, RN MN

A. Applying for a Job Identifying Potential Employers o To begin your job search effectively, you need to identify potential employers. You might begin to review with those familiar to you and gradually move outward in an ever widening circle to identify others. Letter of Application Personal Interview B. Retaining a Position Once you have obtained a position, strive to retain it and be successful in that chosen field. This will lead to self-satisfaction and building a career in nursing. Suggestions for a Successful Career in Nursing 1. Have adequate knowledge and preparation for the job. o Reading profession literature and attending clinical conferences 2. Have a well developed personality. Cultivate a pleasing appearance o Dress Code 3. Develop a good interpersonal relationship with your co-workers by; a. Being enthusiastic in and dedicated to your work and being sincere and considerate to others. b. Being tactful and dependable. Be patient and have self-control. c. Develop the ability to adhere to social amenities and socially compatible. d. Be cheerful and have self-confidence e. Offer help when needed. 4. Develop proficiency in communication, both in oral and in written forms. 5. Be able to adjust to working conditions and to life patterns characteristics of particular occupations and communities. The ability to pakikipagkapwa tao o pakikisama. Causes of Failure Incompetence or lack of the required ability and knowledge for the particular job. Poor IPR, lack of cooperation with co-workers, dishonesty, boastful. Personality defects conceited sarcastic, tactless, envious, discourteous, too sensitive. Inadequate knowledge in social conduct, too little time for relaxation and recreation. Indifference to need for professional growth. o Always finding reason for not attending professional meetings and joining the professional organization. C. Resignation There are many reasons why nurses resign from their jobs. 1. To seek better positions whether in the Philippines or abroad. 2. Unfair labor practice 3. Due to marriage and/or children. 4. Transfer of family to others place. 1. 2. 3. 4. 5.

Professional Adjustment Mr. Hermie G. Siroy, RN MN

Pointers When Planning to Resign from a Position 1. Allow a 15 day or a months notice before resignation takes effect. Provide the employer with enough time to seek replacement. 2. Leave your job with a clean record. Finish your delegated assignments, if there are any. 3. Take it over with your employer first. Leave a friendly feeling towards superiors and co-workers 4. Write a letter of resignation. State your reasons for resigning and indicate the exact date when it will be effective. If you are leaving due to an unpleasant experience, inform your supervisor about it and do so with tact and politeness. - this can affect your future recommendations in other agencies. 5. It is but proper to express your gratitude for the kindness and consideration shown to you during your stay. 6. The copy of the certification of clearance should be attached to your resignation letter Reasons for Dismissal from a Position Negligence patient fell down the table and broken his legs Incompetence Malpractice Unprofessional Behavior Breach of Contract Contracts Contract Law Law that governs all legal actions related to the making, keeping, or breaking of legal contracts of any type.

Contract An agreement that creates an obligation Legally binding exchange of promises

Kinds of Contracts 1. Formal Contract o Agreement between or among parties that requires to be in writing by some special laws. o It is signed under seal by contracting parties. 2. Informal contract o One that results from a written document or oral discussion where it is not required to be in writing. o Seal not require 3. Express contract o Agreement in which the terms and conditions are clearly stated either or in writing. 4. Implied contract o Agreement that is presumed or inferred as the result of acts or conduct of parties 5. Void or inexistent contract

Professional Adjustment Mr. Hermie G. Siroy, RN MN

o One that is not from the beginning and therefore may not be enforced 6. Illegal or unfair contract Requisites of a Contract 1. 2. 3. 4. 5. 2 or more persons must participate Parties involved must give consent to the contract Object which is the subject matter of the contract must specified Cause of obligation is established. Contracting parties must have the legal capacity to enter into contract