Monday, May 16, 2011

ANSAP on the Certification Process for Safe & Quality Nursing Practice


Released on April 27, 2011 during
ANSAP's Special General Assembly
Manila Hotel

The Association of Nursing Service Administrators of the Philippines, Inc., or ANSAP for short, has brought the standards of certification process in the country to the highest level of recognition both locally and globally.  ANSAP has grown as a premiere certification body recognized by all hospitals and healthcare institutions here and abroad.

            Latest issues on certification process of ANSAP provides erroneous opinions/advisories on (1) intravenous therapy (I.V.) training, and (2) special training for suturing of perineal lacerations.  Also, the removal of Chief Nurse as a signatory to OR/DR Cases of nursing students, disregarding the command responsibility and accountability. ANSAP thus registers its vehement opposition/objection on all these.

            First, truth to tell, ANSAP was given specific authority or mandate to provide specific training program in the administration of intravenous injection for nurses pursuant to PRC-BON Resolution No. 08, s. 1994. The said resolution was promulgated in accordance with Sec. 27 (1) of Republic Act (R.A.) No. 7164, also known as the Philippine Nursing Act of 1991. It is also true that R.A. No. 7164 was repealed by R.A. No. 9173, otherwise known as the Philippine Nursing Act of 2002.

            However, R.A. No. 9173 has neither set aside nor removed the administration of intravenous injections within the scope of nursing practice. It does not invalidate/nullify  PRC-BON Resolution No. 08, s. 1994, in fact, it expanded the scope of nursing practice insofar as intravenous therapy is concerned, to wit:

Section 28. Scope of Nursing. - A person shall be deemed to be practicing nursing within the meaning of this Act when he/she singly or in collaboration with another, initiates and performs nursing services to individuals, families and communities in any health care setting. It includes, but not limited to, nursing care during conception, labor, delivery, infancy, childhood, toddler, preschool, school age, adolescence, adulthood, and old age. As independent practitioners, nurses are primarily responsible for the promotion of health and prevention of illness. As members of the health team, nurses shall collaborate with other health care providers for the curative, preventive, and rehabilitative aspects of care, restoration of health, alleviation of suffering, and when recovery is not possible, towards a peaceful death. It shall be the duty of the nurse to:

(a) Provide nursing care through the utilization of the nursing process. Nursing care includes, but not limited to, traditional and innovative approaches, therapeutic use of self, executing health care techniques and procedures, essential primary health care, comfort measures, health teachings, and administration of written prescription for treatment, therapies, oral topical and parenteral medications, internal examination during labor in the absence of antenatal bleeding and delivery. In case of suturing of perineal lacerationspecial training shall be provided according to protocol established; (Emphasis/underscoring supplied).

            However, 2011 Advisories has either confused nursing leaders or misunderstood the scope of nursing practice when it stated that “no specific carry over proviso in R.A. No. 9173, particularly of IV training.” Contrary to its developmental position when the BON mentioned in the advisory that the “IV Training started under R.A. No. 7164 (BON Resolution No. 08, s. 1994) has in the last 15 years generated a competent pool of I.V. nurses” (thanks to ANSAP for its unwavering commitment and hard work), it has contradicted itself when it said that “this policy for all legal purposes and intent is rendered null in keeping with Art. IX, Sec. 40 of R.A. No. 9173.”

            For emphasis, intravenous therapy is well within the scope of nursing practice under Section 28, R.A. No. 9173. It falls within the phrase “parenteral medications.”  It has not been removed from the present nursing law.  IV therapy is within the meaning or scope of parenteral medication for it means the giving of substances directly into a vein. Whereas, parenteral drug administration of any medication involves injecting a drug either directly into a skin (intradermal), muscle (intramascular), vein (intravenous), artery (intra-arterial), abdominal cavity (intraperitoneal ), heart (intracardiac) or into the fatty tissue beneath the skin (subcutaneous). With this, parenteral medication needs even more special training. ANSAP institutionally provides this special training for safe and quality nursing practice.

            Second ANSAP has institutionalized the IVT training and certification in the country resulting to the development of competent role of IVT nurses and making Filipino nurses acceptable and employable here and abroad. This is because standards, trainings and protocols in the IVT Certification have been developed by ANSAP through years of research, actual conduct of training and hands-on experience. Thus, any effort to set aside all these accomplishment will be counterproductive and relax the progress of nursing practice in the country.

            Third, all the more, suturing of perineal laceration requires special training as specifically stated in R.A. No, 9173. Sec. 28 hereof states that “In case of suturing of perineal laceration, special training shall be provided according to protocol established.” Like intravenous therapy, maternal child care and suturing of normal laceration entail extensive training comparable to that of the competency requirements of BLS and ACLS. Thus, ANSAP upholds this provision, ensures standards of safe nursing practice and strictly observes the Code of Ethics for Nurses.

            Fourth, the unceremonious and improper removal of the name of the Chief Nurse in the OR/DR Cases of nursing students is very alarming. The BON has apparently overlooked the serious responsibility and accountability of the chief nurses over staff nurses and nursing students. Under the principle of command responsibility, the Chief Nurse has direct authority and responsibility for the work of a unit. Ultimately, the safety of the patients is the responsibility of the chief nurse. Hence, its removal as signatory to the OR/DR Cases is legally improper.

            Notably, the process for the completion of OR/DR cases starts with the coordination of the Dean with the Chief Nurse. It is true that the student is supervised by the clinical instructor and the staff nurse assigned in the area. However, it is legally wrong to divest chief nurses of their authority and responsibility by allowing only the staff nurses to sign on the OR/DR cases of students.  It will certainly set bad precedent for the healthcare delivery safety, particularly in ensuring the provision of safe and quality patient care. Thus, ANSAP demands that the Chief Nurse sign in the OR/DR cases of students.

            Finally, ANSAP is supporting all the actions and policies in relation to the manner of completing the task of meeting our Millennium Development Goals (MDGs). But it will resist all moves and attempts to thwart its noble effort to advance nursing practice in the country and ensure safe and quality patient care.  In fact, it has partnered with several specialty nursing organizations, government and non-government agencies to achieve this goal. 


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