篇名

專科護理師:醫師的最佳輔助人力   免費試閱

並列篇名

Nurse Practitioners: The Best Auxiliary Manpower for Physicians

作者
中文摘要

近年來,由於醫師過勞問題層出不窮,受僱醫師納入勞動基準法規範範圍內已是社會的共識,但恐將因此出現住院醫師或主治醫師的人力缺口!然而,若以醫療資源的使用分配作為基準點(以人均國家醫療費用校正後),當前臺灣醫師的數目是足夠的。醫師人力主要缺口集中在夜間及假日值班。對此之因應計畫乃是以推動一般醫療主治醫師照護制度及一般醫學醫師補充住院醫師值班工時。此外,衛生福利部擬推動醫療法修法,增加專科護理師的培訓以及建立醫師臨床助理制度,作為醫師人力輔助的來源。醫療法第58條明定:「醫療機構不得置臨床助理執行醫療業務。」
若為了因應醫師人力之需求而修改醫療法第58條並制定「臨床助理」制度,勢必將挹注大量之人力、物力、時間與金錢於立法、教育、考試、訓練及認證等制度之上,不僅耗時費力、緩不濟急,亦極可能淪為急就章,擬出一個不完善的制度。工作時間方面,專科護理師尚符合臨床需要。然而,在專科護理師的業務範圍方面,於醫師監督下得執行較低危險程度之醫療業務範圍及項目,尚未符合臨床上的需求,本文認為,未來宜適度開放中度危險程度之醫療業務範圍及項目以為因應。觀察專科護理師過去12年來的發展,涉及專科護理師的相關訴訟共有7件,當中4件係刑事訴訟、3件係民事訴訟。在刑事訴訟的部分,專科護理師有3件敗訴,敗訴率高達75%,從判決內容可知當醫師不承認知情時,專科護理師敗訴機率極高。本文主張醫師應當信賴受有適當訓練及經驗之合格專科護理師,並於指示執行醫療業務時,仍須親自核對,或透過口頭詢問專科護理師,確認專科護理師執行的醫療業務無誤,以避免危險發生、確保病人安全;若非專科護理師有重大過失,醫師尚不得因不承認知情而主張未處於監督地位。綜觀臺灣當前醫療體系發展之現況,本文認為醫師與專科護理師的聯合照顧模式可使病人享有更優質的醫療照護,適當地開放中度危險程度之醫療業務範圍及項目,並確立醫師與專科護理師的法律責任關係,將使得專科護理師成為醫師的最佳輔助人力。

英文摘要

In recent years, reducing the working hours of physicians become the consensus of the society, but will appear the manpower indentation of resident doctor or doctor in charge! However, if taking medical resource as the basis of comparison, corrected with national health expenditure per capita, the number of Taiwanese doctor per 10,000 of population is enough. The main indentation of Doctor’s manpower is during the nighttime and the holiday which will be resolved partially by promotion of hospitalis care system and also using postgraduate year resident as the duty resident. In addition, the Health Welfare Department intends to increase nurse practitioner (NP) and also set up clinical assistant as the auxiliary manpower for the physicians. According to the Labor Standard Act, the working hours of NP can fulfill the clinical demand. NP can only performed low risk medical procedures under the supervision of doctor. It needs to be extended to median risk procedures to meet the clinical need. In the past 12 years, there are 7 lawsuits against NP, 4 criminal suits and 3 civil suits. NP lost three criminal trials (75%) because physicians deny awareness of the patient’s conditions. We suggest that, for patient safety, while physicians choose competent NP to care the patients, doctors still need to inspect the performance of NP to avoid medical error. Unless there are gross negligence of NP, physicians should not declare that they were unaware of the conditions of the patients. At present time in Taiwan, combined care of patients with physicians and NP may be the best medical caring system. It is necessary to be extended the NP activities to median risk procedures and to reestablishment of physicians-NP legal relationship to make NP the best auxiliary manpower for physicians.

起訖頁

009-024

出版單位
DOI

10.3966/241553062017050007002  複製DOI  DOI查詢

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