定位不明的照護者-論專科護理師之執業範圍與資格標準

Abstract

近年來，我國醫療健康保險給付制度改變醫師選擇執業科別的意願，有限醫療資源左右了醫療行為與醫院的經營方式，台灣醫療生態丕變，為維持醫療生態平衡與兼 顧公眾健康及醫療需求，各醫院在考量成本效益下，以成本較低且熟悉醫療作業的護理專業人員，取代原本高成本的醫師人力，執行部分醫療工作，專科護理師的角色逐漸由傳統的護理照護，擴展成協助醫師執行醫療行為的轉型醫療照護者，其實際執行之業務與住院醫師工作範圍多有重疊，而法源僅依據護理人員法第24條第2項之概括規定與主管機關相關函釋，容許專科護理師在醫師指示下執行醫療輔助行為，在法規層面上並沒有完整妥善的討論與規劃，由於專科護理師執業範圍法源位階不足，法規界定不明確， 使專科護理師執行醫療行為忐忑恐有違法之虞，也引起公眾對其健康照護安全的疑慮。若能重新審視修訂法律，提升專科護理師訓練與健全認證程序，釐清專科護理師的執業範圍與法律定位，讓其專業能力獲得公眾認同，增進專科護理師在醫療照護的獨立性，定能在有限的醫療資源下提供最佳的醫療照護。

Recently, insufficient reimbursement of health insurance and the shortage of medical resource have caused the shortage of physicians and difficulty to hospital management. To maintain the balance between quality and cost of health care, hospitals often substitute nurses for physicians in many occasions due to their lower salary. The role of nurse practitioners is therefore transformed from traditional nursing care to collaboration with physicians. The scope of nurse practitioners’ practice partly overlaps with the scope of practice for physicians. However, the unclear regulations defining the scope of nurse practitioners’ practice increases the risk of malpractice litigations to nurse practitioners and creates danger on the safety of public health. Therefore, it is essential to revise the current regulations, including clarifying the scope of practice, raising the standards of training and certification, and enhancing the independence of nurse practitioners’ practice, for improvement of health care quality under the limited medical resource.