Nurse as an Employee

THE NURSE AS IN EMPLOYEE

• The Concept of a Professional Employer and Employee Relationship • The Test for Determining the Existence of an EmployerEmployee Relationship • Rights and Responsibilities of a Nurse • Rights of Nurse-Practioners vis-a-vis Rights of Clients/Patients

The Constitution of the Philippines provides that the State shall afford full protection to labor, local and overseas, organized and unorganized, and promote full employment and equality of employment opportunities for all. It shall guarantee the rights of all workers to selforganization, collective bargaining and negotiations, and peaceful concerted activities, including the right to strike in accordance with law.

They shall be entitled to security of tenure, humane conditions of work, and a living wage. They shall also participate in policy and decision-making processes affecting their rights and benefits as may be provided by law.

There must be an employer-employee relationship in order for the provisions of the Labor Code on the Labor Standards to apply. It follows that an individual who renders service outside of the ambit of an employer-employee relationship is not within the coverage of the statutory benefits or labor standards of the Philippine Labor Code; hence, commercial transactions (such as partnership, independent contracts, co-ownership, self-employment, etc.) are beyond the scope of the Labor Code.

EMPLOYER A legal entity that controls and directs a servant or worker under an express or implied contract of employment and pays(or is obligated to pay) him or her salary or wages in compensation.

EMPLOYEE A person who is hired to provide services to a company on a regular basis in exchange for compensation and who does not provide these services as part of an independent business.

When an employer hires a new employee, he is not just bringing a new member of the workforce aboard, he is also starting a new relationship. Because employers and employees often work in close quarters, they necessarily develop relationships. Managing these relationships is vital to business success, as strong relationships can lead to greater employee happiness and even increased productivity. To reap these benefits, keep the dynamics of your employer-employee relationship in mind.

Relationship Basics Generally, employer and employee relationships should be mutually respectful. The degree of closeness in these relationships will depend on both the employer and the employee. Some employers opt to keep their employees at a distance and, in doing so, ensure that there is no confusion as to the hierarchy that exists between them.

Others elect to become friendlier with their employees, seeing this as a way to amp up employee happiness. While neither option is entirely right or wrong, it is wise to avoid getting too close to employees, as doing so can cause the line between employer and employee to become blurred

Mutual Reliance The employer-employee relationship should be one of mutual reliance. The employer is relying upon the employee to perform her job and, in doing so, keep the business running smoothly. Conversely, the employee is relying upon the employer to pay her and enable her to support herself, and potentially her family, financially.

Relationship Building Just as with all relationships, the employer and employee relationship is one that must develop over time. Employers can promote the building of relationships by speaking candidly with their employees about their lives, asking them about their families and learning about their interests. Similarly, employees can promote the building of this relationship by being open with their employer and sharing information about themselves and their lives.

Boundaries Though the type of employee and employer relationship that is considered appropriate varies from company to company, boundaries exist at almost all companies. Generally, it is unwise for employers to develop romantic relationships with their employees. Similarly, employers should exercise care to ensure that the relationship they develop with one employee isn't notably closer than the relationships they develop with others, as this can lead to concerns regarding favoritism or similar issues of unfairness within the workplace.

When can we say that an individual is considered as an employee?

How can he prove that he is working for a certain employer?

Tests to Determine the Existence of an Employer – Employee Relationship

FOUR FOLD TEST This test determines the existence of an employer - employee relationship 1. Whether the alleged employer has the power of selection and engagement of the employee (Power to Hire) Engagement means a contract within the business and affiliations; Which means if there is a problem within the vicinity of the employee it will be engaged to the employer, the same if there is a problem with the employer, changes will be engaged to the employees.

2. Whether the employee is being paid wages (Power to pay wages)

Changes with the salary made by the employer must be distributed well to all the employees; All employees means the employer cant disregard any employee within his company.

3. Whether he has the power to dismiss (Power to Discipline)

The employer has to power to dismiss, punish or reprimand any employee, only if the employer has full accountability and knowledge of the misconduct or unprofessionalism of the employee.

4. Whether he has control of the employee with respect to the means and methods by which work is to be accomplished (Power of Control)

The employer has the power to control his or her employees by any means and methods he wants to accomplish the companies goal, even if the way he wants it is time consuming, it is the employer’s right.

Economic Reality Test In Sevilla v. Court of Appeals, the Court observed the need to consider the existing economic conditions prevailing between the parties, in addition to the standard of right-of-control, to give a clearer picture in determining the existence of an employeremployee relationship based on an analysis of the totality of economic circumstances of the worker.

Under economic reality test, the benchmark in analyzing whether employment relation exists between the parties is the economic dependence of the worker on his employer. That is, whether the worker is dependent on the alleged employer for his continued employment in the latter’s line of business.

Applying this test, if the putative employee is economically dependent on putative employer for his continued employment in the latter’s line of business, there is employer-employee relationship between them. Otherwise, there is none.

Two-tiered test (or Multi-factor test) The economic reality test is not meant to replace the right of control test. Rather, these two test are often use in conjunction with each other to determine the existence of employment relation between the parties. This is known as the two-tiered test, or multi-factor test. This two-tiered test involves the following tests: The putative employer’s power to control the employee with respect to the means and methods by which the work is to be accomplished; and The underlying economic realities of the activity or relationship.

The determination of the existence of employeremployee relation must be tilted in favor of the employee since any doubt in the interpretation of the provision of the Labor Code shall be construed in favor of labor.

The determination of the existence of an employer-employee must follow, not only because of the statutory provision but by humanitarian reason as the employee is almost or most of the time at the disadvantage situation and the law must protect the disadvantaged.

Nurse A person educated and trained to care for the sick or disabled. A woman employed to take care of a child; a nursemaid. A woman employed to suckle children other than her own; a wet nurse. One that serves as a nurturing or fostering influence or means:

The American Heritage® Dictionary of the English Language, Fourth Edition copyright ©2000 by Houghton Mifflin Company. Updated in 2009. Published by Houghton Mifflin Company. All rights reserved.

Nursing encompasses autonomous and collaborative care of individuals of all ages, families, groups and communities, sick or well and in all settings. It includes the promotion of health, the prevention of illness, and the care of ill, disabled and dying people. World Health Organization

ROLES AND RESPONSIBILITIES OF A NURSE

1. Caregiver/ Care provider The traditional and most essential role functions as nurturer, comforter, provider “mothering actions” of the nurse, it also provides direct care and promotes comfort of client, provide activities involves knowledge and sensitivity to what matters and what is important to clients and shows concern for client welfare and acceptance of the client as a person

2. Teacher Provides information and helps the client to learn or acquire new knowledge and technical skills, the nurse also encourages compliance with prescribed therapy, promotes healthy lifestyle and interprets information to the client

3. Counselor Helps client to recognize and cope with stressful psychologic or social problems; to develop an improve interpersonal relationships and to promote personal growth provides emotional, intellectual to and psychologic support. It focuses on helping a client to develop new attitudes, feelings and behaviors rather than promoting intellectual growth. Encourages the client to look at alternative behaviors recognize the choices and develop a sense of control.

4. Client advocate Involves concern for and actions in behalf of the client to bring about a change. Promotes what is best for the client, ensuring that the client’s needs are met and protecting the client’s right. Provides explanation in clients language and support clients decisions.

5. Manager Makes decisions, coordinates activities of others, allocate resources, evaluate care and personnel plans, give direction, develop staff, monitors operations, give the rewards fairly and represents both staff and administrations as needed .

6. Researcher Participates in identifying significant researchable problems, in scientific investigation and must be a consumer of research findings Researcher must be aware of the research process, language of research, a sensitive to issues related to protecting the rights of human subjects.

7. Change agent Initiate changes or assist clients to make modifications in themselves or in the system of care.

8. Clinical Specialists Is a nurse who has completed a master’s degree in specialty and has considerable clinical expertise in that specialty. She provides expert care to individuals, participates in educating health care professionals and ancillary, acts as a clinical consultant and participates in research.

9. Nurse Practitioner Is a nurse who has completed either as certificate program or a master’s degree in a specialty and is also certified by the appropriate specialty organization. She is skilled at making nursing assessments, performing P. E., counseling, teaching and treating minor and self- limiting illness

10. Nurse-midwife A nurse who has completed a program in midwifery; provides prenatal and postnatal care and delivers babies to woman with uncomplicated pregnancies.

11. Nurse Educator A nurse usually with advanced degree, who beaches in clinical or educational settings, teaches theoretical knowledge, clinical skills and conduct research.

12. Nurse Entrepreneur A nurse who has an advanced degree, and manages health-related business.

13. Nurse administrator A nurse who functions at various levels of management in health settings; responsible for the management and administration of resources and personnel involved in giving patient care.

NURSES RIGHTS Venzon, Lydia M. RN, MAN, PhD, FPCHA; Venzon, Ronald M., RN, MAN Professional Nursing in the Philippines(2010) 11 The edition chapter 8 page 108

1. Nurses have the right to practice in a manner that fulfills their obligations to society and to those who receive nursing care.

2. Nurses have the right to practice in environment that allow them to act in accordance with professional standards and legally authorized scopes of practice.

3. Nurses have the right to a work environment that supports and facilitates ethical practice, in accordance with the Code of Ethics for Nurses and its interpretive statements.

4. Nurses have the right to freely and openly advocate for themselves and their patients, without fear or retribution. 5. Nurses have the right to fair compensation for their work consistent with their knowledge, experience, and professional responsibilities.

6. Nurses have the right to a work environment that is sale for themselves and their patients.

7. Nurse have the right to negotiate the conditions of their employment, either as individuals or collectively, in all practice settings

Rights of Patients Philippine Patient’s Bill of Rights

1. Right to Appropriate Medical Care and Humane Treatment. Every person has a right to health and medical care corresponding to his state of health, without any discrimination and within the limits of the resources, manpower and competence available for health and medical care at the relevant time. The patient has the right to appropriate health and medical care of good quality.

In the course of such care, his human dignity, convictions, integrity, individual needs and culture shall be respected. If any person cannot immediately be given treatment that is medically necessary he shall, depending on his state of health, either be directed to wait for care, or be referred or sent for treatment elsewhere, where the appropriate care can be provided.

If the patient has to wait for care, he shall be informed of the reason for the delay.

Patients in emergency shall be extended immediate medical care and treatment without any deposit, pledge, mortgage or any form of advance payment for treatment

2. Right to Informed Consent. The patient has a right to a clear, truthful and substantial explanation, in a manner and language understandable to the patient, of all proposed procedures, whether diagnostic, preventive, curative, rehabilitative or therapeutic, wherein the person who will perform the said procedure shall provide his name and credentials to the patient, possibilities of any risk of mortality or serious side effects, problems related to recuperation, and probability of success and reasonable risks involved:

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The patient will not be subjected to any procedure without his written informed consent, except in the following cases A. Emergency cases where death is a big risk in the situation. B. When controlling an epidemic that may pose risk to community. C. When a law make is compulsory for everyone D. When a patient is a minor or legally incompetent; third party is required

E. When disclosure of material information to patient will jeopardize the success of treatment, in which case, third party disclosure and consent shall be in order. F. When the patient waives his right in writing.

Informed consent shall be obtained from a patient concerned if he is of legal age and of sound mind. In case the patient is Incapable of giving consent and a third party consent is required, the following persons, in the order of priority stated here under, may give consent: 1. 2. 3. 4. 5.

Spouse Son or daughter of legal age Either parent Brother or sister of legal age Guardian

3. Right To Privacy and Confidentiality. The privacy of the patients must be assured at all stages of his treatment. The patient has the right to be free from unwarranted public exposure, except in the following cases: 1. When his mental or physical condition is in controversy and the appropriate court, in its discretion, orders him to submit to a physical or mental examination by a physician. 2. When the public health and safety so demand 3. When the patient waives this right

The patient has the right to demand that all information, communication and records pertaining to his care be treated as confidential. Any health care provider or practitioner involved in the treatment of a patient and all those who have legitimate access to the patient's record is not authorized to divulge any information to a third party who has no concern with the care and welfare of the patient without his consent, except:

a) when such disclosure will benefit public health and safety; b) when it is in the interest of justice and upon the order of a competent court; and c) when the patients waives in writing the confidential nature of such information;

d) when it is needed for continued medical treatment or advancement of medical science subject to de-identification of patient and shared medical confidentiality for those who have access to the information.

Informing the spouse or the family to the first degree of the patient’s medical condition may be allowed; Provided, That the patient of legal age shall have the right to choose on whom to inform. In case the patient is not of legal age or is mentally incapacitated, such information shall be given to the parents, legal guardian or his next of kin.

4. Right to Information. In the course of his/her treatment and hospital care, the patient or his/her legal guardian has a right to be informed of the result of the evaluation of the nature and extent of his/her disease, any other additional or further contemplated medical treatment on surgical procedure or procedures, including any other additional medicines to be administered and their generic counterpart including the possible complications and other pertinent facts, statistics or studies, regarding his/her illness, any change in the plan of care before the change is made, the person’s participation in the plan of care and necessary changes before its implementation, the extent to which payment maybe expected from Philhealth or any pay or and any charges for which the patient maybe liable, the disciplines of health care practitioners who will furnish the care and the frequency of services that are proposed to be furnished

5. The Right To Choose Health Care Provider and Facility. The patient is free to choose the health care provider to serve him as well as the facility except when he is under the care of a service facility or when public health and safety so demands or when the patient expressly or impliedly waives this right. The patient has the right to discuss his condition with a consultant specialist, at the patient’s request and expense. He also has the right to seek for a second opinion and subsequent opinions, if appropriate, from another health care provider/practitioner.

6. Right to Self-Determination. The patient has the right to avail himself/herself of any recommended diagnostic and treatment procedures. Any person of legal age and of sound mind may make an advance written directive for physicians to administer terminal care when he/she suffers from the terminal phase of a terminal illness: Provided, That a)He is informed of the medical consequences of his choice; b)He releases those involved in his care from any obligation relative to the consequences of his decision; c)His decision will not prejudice public health and safety.

7. Right to Religious Belief. The patient has the right to refuse medical treatment or procedures which may be contrary to his religious beliefs, subject to the limitations described in the preceding subsection: Provided, That such a right shall not be imposed by parents upon their children who have not reached the legal age in a life threatening situation as determined by the attending physician or the medical director of the facility

8. Right to Medical Records. The patient is entitled to a summary of his medical history and condition, He has the right to view the contents of his medical records, except psychiatric notes and other incriminatory information obtained a bout third parties, with the attending physician explaining contents thereof. At his expense and upon discharge of the patient, he may obtain from the health care institution a reproduction of the same record whether or not he has fully settled his financial obligation with the physician or institution concerned.

The health care institution shall issue a medical certificate to the patient upon request. Any other document that the patient may require for insurance claims shall also be made available to him within a reasonable period of time.

9. Right to Leave The patient has the right to leave a hospital or any other health care institution regardless of his physical condition: Provided, That a) he/she is informed of the medical consequences of his/her decision; b) he/she releases those involved in his/her care from any obligation relative to the consequences of his decision; c) his/her decision will not prejudice public health and safety.

No patient shall be detained against his/her will in any health care institution on the sole basis of his failure to fully settle is financial obligations.

However, he/she shall only be allowed to leave the hospital provided appropriate arrangements have been made to settle the unpaid bills: Provided, farther, that unpaid bills of patients shall be considered as lost income by the hospital and health care provider/practitioner and shall be deducted from gross income as income loss for that particular year

10. Right to Refuse Participation in Medical Research. The patient has the right to be advised if the health care provider plans to involve him in medical research, including but not limited to human experimentation which may be performed only with the written informed consent of the patient.

11. Right to Correspondence and to Receive Visitors The patient has the right to communicate with relatives and other persons and to receive visitors subject to reasonable limits prescribed by the rules and regulations of the health care institution

12. Right to Express Grievances. The patient has the right to express complaints and grievances about the care and services received without fear of discrimination or reprisal and to know about the disposition of such complaints. The Secretary of Health, in consultation with health care providers, consumer groups and other concerned agencies shall establish a grievance system wherein patients may seek redress of their grievances.

Such a system shall afford all parties concerned with the opportunity to settle amicably all grievances

13. Right to be Informed of His Rights and Obligations as a Patient. Every person has the right to be informed of his rights and obligations as a patient. The Department of Health, in coordination with health care providers, professional and civic groups, the media, health insurance corporations, people’s organizations, local government organizations, shall launch and sustain a nationwide information and education campaign to make known to people their rights as patients, as declared in this Act. Such rights & obligations of patients shall be posted in a bulletin board conspicuously placed in a health care institution.

http://smallbusiness.chron.com/employeremployeerelationship-16737.html Francisco vs. NLRC, G.R. No. 170087 August 31, 2006 Religious of the Virgin Mary vs. NLRC, G.R. No. 103606, October 13, 1999 Viaña vs. Al-Lagadan and Piga, 99 Phil. 408 (1956). Sevilla v. Court of Appeals, G.R. Nos. L-41182-3, April 15, 1988.