• Liability — legal responsibility for one's acts or omissions, and the obligation to answer for harm caused.
• Negligence — failure to use the degree of care that a reasonably prudent person would use in the same situation. It can be committed by anyone.
• Malpractice — professional negligence: failure of a professional to meet the standard of care of the profession (what a reasonably prudent nurse with similar training would do in similar circumstances), causing injury.
• Standard of care — set by the Philippine Nursing Act (RA 9173) scope of practice, the Code of Ethics, hospital policies and procedures, professional standards, and expert testimony.
• Intentional torts — deliberate wrongful acts, e.g., assault (threat of harmful contact), battery (touching without consent, including treatment without consent), false imprisonment (unjustified restraint or detention), defamation (slander if spoken, libel if written), and invasion of privacy.
• Documentation — the legal record of care. The Code of Ethics for Registered Nurses states that accurate documentation of actions and outcomes of delivered care is the hallmark of nursing accountability.

Four elements of negligence or malpractice — all must be proven by the injured party:

The first element the client must establish is duty — without a nurse–client relationship there is no negligence claim.

Three kinds of legal liability in the Philippines

One act can produce all three at once (e.g., a fatal medication error can lead to a criminal case, a damages suit, and a Board case).

Doctrines often tested

• Respondeat superior (vicarious liability) — the employer may be held liable for negligent acts of employees in the course of their work. The nurse remains personally liable for her own negligence.
• Res ipsa loquitur ("the thing speaks for itself") — negligence may be inferred when the injury would not ordinarily occur without negligence, the instrument was under the defendant's control, and the client did not contribute (e.g., a retained sponge after surgery, a burn from a hot water bag on an anesthetized client).
• Borrowed servant / captain of the ship — a nurse working under a surgeon's direct control in the operating room; both may share liability. Following a physician's order does not excuse a clearly wrong act.
• Personal liability rule — every person is liable for their own negligent conduct; "I was told to" is not a defense for an obviously harmful order.
• Good Samaritan principle — emergency help given in good faith outside work, within one's competence, is ethically expected; the nurse is still expected to act as a prudent nurse and not beyond competence.

Common causes of nursing negligence

• Medication errors (wrong drug, dose, route, time, client; not verifying unclear or verbal orders)
• Failure to identify the client (e.g., blood transfusion, specimens)
• Falls from failure to assess risk, use side rails per policy, or supervise transfers
• Burns, pressure injuries, and injuries from equipment the nurse was not trained to use
• Failure to monitor and failure to report deterioration to the physician in time
• Improper technique (e.g., intramuscular injection into the sciatic nerve area)
• Failure to follow policies and standards (e.g., infection control, central line care)
• Abandonment — leaving an assigned client without proper endorsement, or sleeping on duty
• Failure to document or improper documentation

Documentation principles

• Record promptly, in chronological order, with date and time; never document in advance
• Factual and objective: what you saw, heard, measured, did; quote the client when relevant
• Complete: assessments, interventions, client responses, notifications (whom you told, when, and what was ordered)
• Legible, using approved abbreviations only
• Errors: draw a single line, write "error" per policy, initial and date; never erase, use correction fluid, or remove pages; in electronic records follow the amendment procedure
• Never chart for someone else or let anyone use your login
• Late entries are labeled as such with the current date and time
• Incident reports are completed per policy but not mentioned in the chart; they are quality tools, not part of the medical record

"Not documented = not done" is how courts often view gaps in the record.

Risk-reduction habits

• Verify every order that is unclear, incomplete, or unsafe; read back verbal and telephone orders
• Use two identifiers and double checks for high-alert drugs and blood
• Ask for supervision or training before performing an unfamiliar procedure
• Communicate changes in condition through the proper chain of command, and document each attempt
• Protect passwords, ID cards, and access badges — lending them makes you responsible for what happens

• Know and practice within the scope of RA 9173 and hospital policy
• Maintain competence through continuing professional development
• Assess, monitor, and report changes promptly; escalate if the response is inadequate
• Follow procedures precisely; refuse to perform tasks beyond competence until trained
• Document accurately and honestly
• Report errors and near misses — disclosure and reporting are ethical duties and support learning
• Supervise assistive personnel and students; the nurse is accountable for tasks assigned

• Board action: malpractice or negligence, gross incompetence, and unethical conduct are grounds to suspend or revoke registration (RA 9173 Sec. 23).
• Treatment without consent may be battery; however, in a true emergency when a client cannot consent and no surrogate is available, implied consent allows necessary life-saving care.
• Confidentiality breaches (e.g., posting client records on social media) can bring criminal liability under the Data Privacy Act (RA 10173) — e.g., unauthorized disclosure of sensitive personal information: 3 to 5 years and ₱500,000 to ₱2,000,000; unauthorized processing: 3 to 6 years and ₱500,000 to ₱4,000,000 — plus civil and administrative liability.
• Restraints without an order or clear emergency justification may be false imprisonment.
• Honesty after an error: concealing or falsifying records turns a mistake into dishonesty and adds liability.

Case 1. A nurse gives an IM injection in the wrong gluteal site and injures the sciatic nerve.

Analysis: duty (assigned nurse), breach (incorrect technique below the standard of care), causation (injection caused the nerve injury), damage (foot drop). This is malpractice, with possible civil, criminal, and administrative liability. Prevention: use the ventrogluteal site or correct landmarks.

Case 2. A nurse on night duty falls asleep with a severe headache, without informing anyone, and a client falls and fractures a hip.

Correct principle: failing to arrange cover before becoming unable to work breaches the duty of care. The nurse should have informed the charge nurse and endorsed the clients. Illness is not a defense if no handover was made.

Case 3. A nurse skips the bedside blood identification check, and the client has an acute hemolytic reaction.

Analysis: the clearest breach is failure to follow the identification procedure; all four elements are present. Correct actions now: stop the transfusion, keep the IV line open with normal saline via new tubing, notify the physician and blood bank, monitor, document, and file an incident report.

Case 4. A client falls while being moved by wheelchair because the nurse did not lock the wheels. The client sues.

The client must first establish that the nurse owed a duty of care, then breach, causation, and damage.

• Thinking negligence requires intent — it does not; carelessness is enough.
• Believing a physician's order removes nurse liability.
• Forgetting that damage must be proven: a breach with no injury is not actionable negligence (though it may still be an administrative issue).
• Writing "incident report filed" in the chart.
• Correcting records by erasing or rewriting — this destroys credibility.
• Assuming the hospital alone is liable — the employer's liability does not remove the nurse's personal liability.

• Negligence elements: duty, breach, causation, damage — duty is proven first
• Malpractice = professional negligence measured against the standard of a reasonably prudent nurse
• Liability types: criminal (punishment), civil (compensation), administrative (license)
• RA 9173 Sec. 23: malpractice or negligence → suspension or revocation
• Respondeat superior: employer liable too, but the nurse stays personally liable
• Res ipsa loquitur: injury that would not occur without negligence (retained sponge, burns under anesthesia)
• Battery = treatment without consent; emergency = implied consent
• Documentation: timely, factual, complete; errors corrected with a single line; never erase; incident reports stay out of the chart
• Most common negligence causes: medication errors, falls, failure to monitor/report, failure to identify clients
• Data Privacy Act penalties for sensitive information: up to 6 years and ₱4,000,000; a social media leak is unauthorized disclosure (3–5 years, ₱500,000–₱2,000,000)