Evolution

Act No. 2493 (1915) - regulating the practice of medicine in the Philippines during American time

- sections 7 & 8 contain provisions related to nursing as an adjunct to medicine

Act No. 2808 (1919) - first true Philippine nursing law - created the board of examiners for nurses (Board of Nursing). The 2 members are

nurses. The chairperson is a physician.RA 877 (1953) – Comprehensive Nursing Law of 1953

- BON was composed of 3 members & 1 chairperson; and 2 additional members with other powers and duties.

RA 4704 (1966) - increased the composition of the BON into 5- age limit of 65 years old

RA 7164 (1991) - Philippine nursing act of 1991 -same composition for the BON but removed the age limit

~It is the law that governs the practice of the nursing profession in the Philippines.

Principal authors: Sen. Juan Flavier (Senate Bill No. 2293) Cong. Carlos Padilla (House Bill No. 1084)

Dates to remember: October 08, 2002 – Approval of the House of Senate (Senate

Bill No. 2293) October 15, 2002 – Passed by Congress (House Bill No. 1084)

…the Bicameral Conference Committee consolidated the 2 bills October 21, 2002 – The consolidated version was signed into

law by President Gloria Arroyo

Scope of nursing practice: IIAA

Initiate and perform nursing services to individuals, families and communities in any health care setting

Includes, but not limited to, nursing care throughout the lifespan (conception, labor, delivery, infancy, childhood, toddler, preschool, school age, adolescence, adulthood, & old age)

As independent practitioners, nurses are primarily responsible for promotion of health & 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… PEPUT

Provide nursing care through the utilization of the nursing process.

Establish linkages with community resources andcoordination with the health team

Provide health education to individuals, families and communities

Undertake nursing and health human resource development training and research

Teach, guide and supervise students in nursing education programs including the administration of nursing services in varied settings such as hospitals and clinics; undertake consultation services; engage in such activities that require the utilization of knowledge and decision making skills of a registered nurse

Registration~ The recording of names of persons who have qualified under the law to practice their respective professions

Modes of Registration… REST: Reciprocity, Examination, and Special or Temporary Permit

Registration by Reciprocity: SS~A certificate of registration/professional license may be issued without examination to nurses registered under the laws of a foreign state or country provided:

Same requirements for registration or licensing of nurses as those prescribed under the RA 9173

Same privileges granted to registered nurses of the Philippines given in that country

RA 9173The Philippine Nursing Act of

2002

Goal: A more responsive nursing law and nursing profession to balance national health needs and global demands

Salient Points of the RA 9173

Nursing care includes, but is 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 prescriptions 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 laceration, special training shall be provided according to protocol es-tablished.

License~ A legal document given by the government that permits a person to offer to the public his or her skills and knowledge in a particular jurisdiction, where such practice would otherwise be unlawful without a license

S.S. Ocean

Requirements for applicants: BRRRBSN curriculum of applicant (copy), RN’s in their country, Residents of the Philippine for 3 years, Reciprocal foreign law (copy)

Practice through Special/Temporary Permit: MIX

Medical missions for free Internationally recognized experts or

specialists (free or for a fee) Xchange professors in schools/colleges of nursing

Registration by Examination

Qualifications: BCG BSN graduate Citizen of the Philippines,

or a citizen or subject of a country which permits Filipino nurses to practice on the same basis as the citizen of such country (reciprocity)

Good moral character

Board Rating Prescribed by Law General average of at least 75% No subject with a rating below 60% Should an applicant obtain an average of 75% or

higher but gets a rating below 60% in any subject, he/she has to retake the exam but only on the subject/s which is rated below 60%. To pass, he/she has to get at least 75% in the subject/s repeated

Grounds for Non-Issuance of License/Non-Registration: C3 Conviction by final judgment of any crime involving

moral turpitude Conduct, immoral and dishonorable Court declared him/her as having unsound mind

Grounds for Suspension/Revocation of Registration: MUD COW PIC

…picture a cow stuck in the mud

Malpractice or negligence Unsound mind Deceit, fraud, or false statements in obtaining

certificate of registration

Conviction by final judgment Offense against Nursing Law

and Code of Ethics Wrong and unethical conduct

Practicing during suspension Incompetence gross Conduct unprofessional

Reissuance of revoked certificatesof registrations / replacement of lost certificates: ProCaRe

Proper application and payment Cause of revocation has been corrected Reasons of equity and justice, maximum of 4 years

Requirements for nurses returning to practice: ROT Retrain in a accredited

institution One month didactics (lecture) Three months practicum

The Board of Nursing~ The government agency which regulates the practice of nursing in the Philippines~ Composed of a Chairman & 6 members~ Each one has a 3-year term, and can be reappointed once for another 3 years~ If a BON member is unable to complete his/her term period, his/her replacementshall fill in and serve the unexpired portion of the term only.

Members of the BON may be appointed by:1. Regular appointment. – The Philippine Nurses Association certifies for the Appointment to the Board of Nursing from the three (3) nominees per vacancy and the Board shall endorse two (2) nominees per vacancy to the President2. Ad interim Appointment – A board member is appointed in the meantime to fill in a vacancy or perform the duties of an office during the absence of the regular incumbent. There is no definite term of appointment

Qualifications: RN MAMA

Registered nurse Natural born Filipino citizen and resident of the

Philippines

Master’s degree in nursing, education and related fields (Chairperson and majority of members should be masters in nursing)

At least 10 years of practice of the nursing profession; the last 5 years should be in the Philippines

Moral turpitude crimes- not convicted of any Accredited professional organization member

BRRR!

~Suspension should not exceed four years~Revoked certificate of registration may be issued after the maximum duration of 4 years upon application and payment of appropriate fees, provided that the cause for revocation has been corrected or disappeared

Current composition of the BON (until mid-2011):Chairperson: Hon. Carmencita AbaquinMembers: Hon. Perla Po, Hon. Betty Meritt, Hon.Marco Antonio Sto. Tomas, Hon. Leonila Faire, Hon. Yolanda Arugay, and Hon. Amelia Rosales

Hold-over doctrine – simply requires those who have been appointed to continue serving or holding their position even if their terms has already lapsed, until such time that their replacement shall be appointed. Jus Sanguines Doctrine – nationality is determined by parental descentJus Soli Doctrine – nationality is determined by place of birthNatural-born citizen – citizens of the Philippines by birth who need not perform any act of acquire or perfect his/her citizenshipCitizen - A person owing loyalty to and entitled by birth or naturalization to the protection of a state or nationMoral Turpitude -acts contrary to justice, honesty, modesty, or good morals

☭

Powers and Functions of the Board

Regulatory Function: CRIME Conduct nurses licensure exam Recognize nursing specialty organizations in coordination with the accredited professional organization (APO) Issue, suspend or revoke certificates of registration in

the practice of nursing Monitor and enforce quality standards of nursing

practice Ensure quality nursing education

Quasi-Judicial Function: CPP (Mnemonics includes Quasi-Legislative)

Conduct hearings and investigations to resolve complaints against nurse practitioners: with powers to issue subpoena and cite contempt

Quasi-Legislative Function: Promulgate a Code of Ethics in coordination and

consultation with the APO Prescribe, adopt, issue and promulgate guidelines,

regulations and decisions for the improvement of the nursing practice, advancement of the profession and enforcement of Nursing Act subject to review and approval of the PRC

Removal and Suspension of Board Members: ICU Incompetence Commission/toleration of irregularities in the NLE,

continued neglect of duty Unprofessional, immoral, dishonorable conduct

Nursing Specialty Certification Program

Certification~Mechanism that is used to validate achievement of a level of clinical specialty or functional expertise and competence that goes beyond the level of basic licensure. By passing specifically prepared written examinations, nurses are able to qualify for certification in most nursing practice areas.

Legal Basis - R. A. 7164 - Philippine Nursing Act of 1991, Board of Nursing Resolution No. 14, S. 1999; R. A. 9173 Sec. 32

1. Creation of a Nursing Specialty Certification Council (NSSC) to oversee the administration of the program by the Specialty Certification Board

NSSC shall be composed of 5 officers Chairman - member of BON Vice-Chair, Secretary, Treasurer - appointed by

the Chairman of the PRC from the recommendees of the BON

Business manager - consumer representative

2. Specialty Certification Board in Each of the Four Major Nursing Specialties… CM3

Community Health Medical - Surgical Maternal and Child Health Mental Health and Psychiatric

Certification shall be given in three (3) levels Level I - Nurse Clinician I Level II -Nurse Clinician II Level III - Clinical Nurse Specialist (fields: critical care,

oncology , renal and other areas as may be determined by the board)

Qualifications for Certain Fields of Nursing

Nursing Service Administrators (Hospital/Institutional Nursing): NARA

Nine units in management and administration graduate level

At least 2 years of experience in general nursing administration

Registered nurse in Philippines, BSN graduate Accredited professional organization member

in good standing

Those occupying the position of chief nurse or director of nursing service: FM

Five years of experience in a supervisory or managerial position in nursing

Master's degree in Nursing

Clinical Instructor (Nursing Education) Master's degree in nursing, education,

or other allied medical & health sciences At least 1 year of clinical practice in the

field of specialization Registered nurse in the Philippines APO member in good standing

Those occupying the position of dean of the college of nursing

Five years of experience in nursing education Master's degree in Nursing

Fields of Nursing/Areas of Special ization: In CAMP PINIS

Independent Nursing Practice~Means that the nurse is self-employed and provides

professional nursing services to patients & their families e.g.EntrepreNurse

Nursing Specialty Certification Program aims to train at least 10% of all public nurses per year and its funding shall come from the Philippine Charity Sweepstakes Office (PCSO)

Clinic Nursing~ Nurses work with a doctor and serves as the receptionist,

data gatherer and organizer. Scheduling of appointments andorganizing the patient’s files are the major activities in this field. Simple procedures such as immunizations or suturing ofwounds are assisted by clinic nurses.

Advanced Practice Nursing~Synonymous with specialization; an umbrella term for nurses who have specialized education & experience beyond the basic nursing program e.g. clinical nurse specialists.

Military Nursing ~ Nurses here are specially trained for medical services during

war or peace. They are responsible on the health of both civilians (mostly in delivering services as part of community relations) and military men as well as people considered as enemies. This kind of field demands endurance of the rapid activity and action on the unpredictable field of work.

Private Duty or Special Duty Nursing~Nurse renders comprehensive nursing care to any type of

patient on a one-to-one ratio. A private duty nurse is an independent contractor.

Public Health or Community Health Nursing~ Nurses are exposed to the community set-up wherein their

clients are individuals, families or groups. Emphasis is on promotion of health and prevention of diseases.

Institutional or Hospital Nursing~ Nurses work with a health team and the setting is most likely

hospitals, hospices, clinics and nursing homes. Nursing Education~ Nurses here are also teachers and molders of the future of

nursing. They equip young minds in order to be competent nurses later on.

Industrial or Occupational Health Nursing~Specialty practice that provides and delivers health care

services to workers. The focus is on promotion, protection, and supervision of workers' health within the context of a safe and healthy work environment.

School Nursing~ Nurses are responsible primarily in the welfare of students as

well as the faculty. They responsible in health care activities by the school in the areas of health service, health education and environmental health and safety.

Penalties for violations of RA 9173: FIB Fine (not less than P50,000 and not more than P100,000) Imprisonment (not less than 1 year and not more than 6 yrs) Both, depending on the court

RA 9173 and RA 7164: What has changed?

1. Creation and composition of the BON RA 7164: 5 Members, 1 Chairperson. The Chairperson and

members of the BON are appointed by the President from a list of 12, nominated by the PNA & duly certified by the PRC.

RA 9173: 6 Members, 1 Chairperson. (1) The PNA recommends 3 nominees per vacancy. (2) The PRC will recommend 2. (3) The President appoints 1. To illustrate, if there are 2 vacancies, there will be 6 nominees from the PNA, 4 recommendees by the PRC, and 2 appointees by the President.

2. Qualifications of the Chairperson and Members of the BON

RA 7164: 6 qualifications RA 9173: 5 qualifications – removed the provision from RA

7164 prohibiting the appointment to the BON of holders of green card (US permanent residence status) and the like.

3. New Provisions Rules on licensure exam with the exclusion of a

requirement of the refresher course.In R.A. 7164, if the exam was taken for 3 times without passing, a refresher course is required. While in R.A. 9173, the taker could have the exam countless times without a refresher course.

Addition of a section: Requirements for nurses who have not actively practiced for 5 consecutive years1 month didactic program and 3 months practicum in any hospital accredited to conduct continuing education units

Provision of time frame within which a nurse with a revoked Certificate of Regulation (COR) may seek re-issuance of another Certificate of Regulation/ID card not exceeding 4 years.

Revision on the qualifications of the faculty and dean of the College of Nursing.

Simplification but comprehensiveness in the scope of nursing practice.

Refocusing on continuing professional education with trainings and seminar.

Enrichment on the qualifications of nursing service administrators by giving priority to those with Master’s degree in Nursing and general staff course.In R.A. 7164, A Master of Arts in Nursing Major in Nursing Service Administration and 9 units of Management courses is required.

Supplementing the article on Health Human Resources, Product Utilization and Development.With sections on salary (sets salary grade 15, as described in RA 6758, as the minimum base pay for all public health nurses; PNA calculates salary grade 15 at around P24,000 today), comprehensive nursing specialty program, funding on incentives and benefits

Increase of the minimum and maximum fine for those in violation of any of the provision of this actFine for violations of RA 9173 have been raised to not less than P50,000 pesos to not more than P100,000. In RA 7164 it used to be not less that P10,000 to not more than P50,000.

An article on final provisions covering the mechanism on the enforcement of this act.

Applicants to nursing schools are no longer required to be on the top 40% of his/her high school graduating class

Minimum age of 18 years old qualify in applying for the NLE has been removed.

BSN graduates from state colleges and universities are no longer required to render 1 year of nursing service in the Philippines after issuance of license

IV Therapy training is no longer a requirement of the nursing law but only that of the ANSAP (Association of Nursing Service Administrators of the Philippines). Latest BON guidelines indicate that it should already be incorporated in the BSN curriculum.

RA 9173 repealed and superceded RA 7164 (Philippine Nursing Act of 1991) as the special law governing the nursing profession…

The End-all, Be-all Reference Guide to Other Related Laws

REPUBLIC ACT – an act passed by the Congress of the Philippines in a Republican form of government.

Republic Act 349 – Use of human organs for surgical, medical and scientific purposes.

Republic Act 546 – The BON was transferred under the authority of the President

Replublic Act 649 – Government Nurse Salary Act Republic Act 997 – Abolished the Division of Nursing and

established the 3 main divisions of nursing – service, education, communication, and community health.

Republic Act 1054 – Requires the owner, lessee or operator of any commercial, industrial or agricultural establishment to furnish free emergency, medical and dental assistance to his employees and laborers.

Republic Act 1080 – Civil Service Eligibility (NLE passers are automatically civil service eligible)

Republic Act 1082 – Rural Health Unit Act Republic Act 1136 – Act recognizing the Division of Tuberculosis

in the DOH Republic Act 1612 – Privilege Tax/Professional tax/omnibus tax

should be paid January 31 of each year Republic Act 1891 – Act strengthening Health and Dental

services in the rural areas Republic Act 2382 – Philippine Medical Act which regulates the

practice of medicine in the PhilippinesNurses may perform acts of physicians in case of national emergencies and if the DOH secretary gives a permit

Republic Act 2644 – Philippine Midwifery Act Republic Act 3573 – Reporting of Communicable Diseases

Report within 24 hours: Polio, MeaslesReport within 1 week: Neonatal teatanus, HIV/AIDS, severe

acute diarrhea Republic Act 4073 – Domicillary (home) treatment of Leprosy Republic Act 4226 – Hospital Licensure Act Republic Act 5181 – Reciprocity law Republic Act 5821 – The Pharmacy Act Republic Act 5901 – 40 hours work for hospital workers Republic Act 6111 – Medicare Act Republic Act 6365 – Established a National Policy on Population

and created the Commission on population Republic Act 6425 – Dangerous Drug Act of 1992 Republic Act 6511 – Act to standardize the examination and

registration fees charged by the National Boards Republic Act 6675 – Generics Act of 1988 Republic Act 6713 – Code of Conduct and Ethical Standards for

Public Officials and Employees (reference for BON Res. 220) Republic Act 6725 – Act strengthening the prohibition on

discrimination against women with respect to terms and condition of employment

Republic Act 6727 – Wage Rationalization Act Republic Act 6758 – Standardized the salaries Republic Act 6809 – Majority age is 18 years old Republic Act 7164 – Philippine Nursing Act of 1991 Republic Act 7170 – Law that governs organ donation Republic Act 7277 – Magna Carta of Disabled Persons Republic Act 7305 – The Magna Carta of Public Health Workers

Republic Act 7392 – Philippine Midwifery Act of 1992Nurses may take midwifery exam without a midwifery degree

Republic Act 7432 – Senior Citizen Act (20% discount) Republic Act 7600 – Rooming In and Breastfeeding Act of 1992

Breastfeeding: Early (first 30 mins) Exclusive (first 6 months)Extended (up to years and beyond)

Republic Act 7610 – Special protection of children against abuse, exploitation and discrimination act

Republic Act 7624 – Drug Education Law Republic Act 7658 – An act prohibiting the employment of

children below 15 years of age Republic Act 7719 – National Blood Services Act of 1994

Requirements: Weight 45 kg for 250 cc blood 50 kg for 450 cc bloodAge 18-65 (16-17 yrs old need parental consent)BP 90/60 - 160/100 mmHgHgb 12.5 g/dLGeneral good health

Republic Act 7875 – National Health Insurance Act of 1995 Republic Act 7877 – Anti-sexual harassment Act of 1995 Republic Act 7883 – Barangay Health workers Benefits and

Incentives Act of 1992 Republic Act 8042 – Migrant Workers and Overseas Filipino Act

of 1995 Republic Act 8172 – Asin Law Republic Act 8187 – Paternity Leave Act of 1995 Republic Act 8203 – Special Law on Counterfeit Drugs Republic Act 8282 – Social Security Law of 1997 (amended RA

1161) Republic Act 8291 – Government Service Insurance System Act

of 1997 (amended PD 1146) Republic Act 8344 – Hospital Doctors to treat emergency cases

referred for treatment Republic Act 8423 – Philippine Institute of Traditional and

Alternative Medicine Republic Act 8504 – AIDS Prevention and Control Act of 1998 Republic Act 8749 – The Philippine Clean Air Act of 1999 Republic Act 8981 – PRC Modernization Act of 2000 Republic Act 9165 – Comprehensive Dangerous Drugs Act 2002 Republic Act 9173 – Philippine Nursing Act of 2002 Republic Act 9226 – Hospital Licensure Act Republic Act 9288 – Newborn Screening Act

Time: 24 hours to 2 weeks after birth (ideal 48-72 hours)Heel prick, then blood is dried for 4 hoursTransport within 24 hours to newborn screening facilityResults are released in 7 days (within 24 hours if positive)Diseases: congenital hypothyroidism, congenital adrenal hyperplasia, galactosemia, phenylketunuria, G6PD deficiency

Republic Act 9439 – Anti-Hospital Detention ActHospitals may not hold patients for inability to pay. Patients need only to sign a promissory note.

Republic Act 9442 – 20% discount for persons with disabilities Republic Act 9502 – Cheaper Medicines Law (includes a

provision that medical professionals should prescribe using the generic names only)

Republic Act 10028 – Expanded Breastfeeding Promotion Act 2010 – requires lactation stations and lactations breaks in workplaces

PRESIDENTIAL DECREE – An order of the president by virtue of possessing the powers of law-making and execution. Such was the case during the Martial Law period (1972-1986).

Presidential Decree 46 – An act making it punishable for any public official or employee, whether of the national or local government, to receive directly or indirectly any gifts or valuable things

Presidential Decree 48 – Limits benefits of paid maternity leave privileges to four children

Presidential Decree 69 – Limits the number of children to four (4) for tax exemption purposes

Presidential Decree 79 – Population Commission Presidential Decree 147 – Declares April and May as National

Immunization Months Presidential Decree 148 –Woman and Child Labor Law

Employable age is 16 years old Presidential Decree 166 – Strengthened Family Planning

program by promoting participation of private sector in the formulation and implementation of program planning policies.

Presidential Decree 169 – Requiring Attending Physician and/or persons treating injuries resulting from any form of violence.

Presidential Decree 223 – Professional Regulation Commission Presidential Decree 442 – Labor Code regulates employees’

unionization and collective bargaining rights. Provision for a 10% night differential pay for hospital workers.

Presidential Decree 491 – Nutrition Program Presidential Decree 539 – Declaring last week of October every

as Nurse’s Week. October 17, 1958 Presidential Decree 541 – Allowing balikbayan Filipino

professionals to practice their respective professions in the Philippines so they can provide the latent and expertise urgently needed by the homeland

Presidential Decree 568 – Role of Public Health midwives has been expanded after the implementation of the Restructed Health Care Delivery System (RHCDS)

Presidential Decree 603 – Child and Youth Welfare Act / Provision on Child Adoption

Presidential Decree 626 – Employee Compensation and State Insurance Fund. Provide benefits to person covered by SSS and GSIS for immediate injury, illness and disability.

Presidential Decree 651 – All births and deaths must be registered 30 days after delivery.

Presidential Decree 791 – Empowered nurses, midwives, and other health professionals to promote acceptable methods of contraception (mostly artificial)

Presidential Decree 825 – Providing penalty for improper disposal garbage and other forms of uncleanliness ~(garbage is collected from 8 2 5)

Presidential Decree 851 – 13th Month pay Presidential Decree 856 – Code of Sanitation Presidential Decree 965 – Requiring applicants for Marriage

License to receive instruction on family planning and responsible parenthood.

Presidential Decree 996 – Provides for compulsory basic immunization for children and infants below 8 years of age.

Presidential Decree 1359 – A law allowing applicants for Philippine citizenship to take Board Examination pending their naturalization.

Presidential Decree 1519 – Gives medicare benefits to all government employees regardless of status of appointment.

Presidential Decree 1636 – requires compulsory membership in the SSS and self-employed

PROCLAMATION – an official declaration by the Chief Executive / Office of the President of the Philippines on certain programs / projects / situations

Proclamation No.6 – UN’s goal of Universal Child Immunization; involved NGO’s in the immunization program

Proclamation No. 118 – Professional regulation Week is June 16 to 22

Proclamation No. 499 – National AIDS Awareness Day Proclamation No. 539 – Nurse’s Week every third week of

October Proclamation No. 1275 – Declaring the third week of October

every year as “Midwifery Week”

LETTER OF INSTRUCTION – An order issued by the President or department secretary to concerned public officials/government bodies which serve as a guide to his/her previous decree or order.

LOI 47 – Directs all school of medicine, nursing, midwifery and allied medical professions and social work to prepare, plan and implement integration of family planning in their curriculum

LOI 949 – legal basis for Primary Health Care (10-19-79) LOI 1000 – Government agencies should be given preference to

members of the accredited professional organization when hiring

EXECUTIVE ORDER – an order issued by the executive branch of the government in order to implement a constructional mandate or a statutory provision.

Executive Order 51 – The Milk Code, banning of ads of milk formulas for less than 2 year olds.

Executive Order 174 – National Drug Policy on Availability, Affordability, Safe, Effective and Good Quality drugs to all

Executive Order 180 – Government Workers Collective Bargaining Rights Guidelines on the right to Organize of government employee.

Executive Order 203 – List of regular holidays and special holidays

Executive Order 209 – The Family Code (amended by RA 6809) Executive Order 226 – Command responsibility Executive Order 503 – Provides for the rules and regulations

implementing the transfer of personnel, assets, liabilities and records of national agencies whose functions are to be devoted to the local government units.

Executive Order 857 – Compulsory Dollar Remittance Law

OTHERS: Act 1931- establishment of nursing schools under the Bureau of

Education in 1909 Act 1975 – authority over nursing schools transferred from

Bureau of Education to Bureau of Health Administrative Order 114 – Revised/updated the roles and

functions of the Municipal Health Officers, Public Health Nurses and Rural Midwives

Administrative Order 2009-0025 - New Emergency Newborn Care Protocol

BON Resolution 220 – Code of Ethics for Nurses (drafted by the PNA, based on RA 6713)

ILO Convention 149 – Provides the improvement of life and work conditions of nursing personnel.

PRC Resolution 2004-179 – reimplementing continuing professional education (60 units per 3 years, 1 hour=1 unit)