台灣護理專業對教考用失衡議題之省思

A Taiwan Nursing Perspective on Current Imbalances in Educating, Licensing and Hiring New Nurses

護理專業發展之良窳攸關健康照護品質與就醫安全。台灣在21世紀全球化、資訊化、自由化與企業化的衝擊下，於金融風暴、健保政策與社會環境快速變遷中導致護理職場呈現諸多困境，如：醫療機構護理編制縮減與工作條件惡化，衍生護理人員高工作負荷、高流失率、延聘困難與人際衝突案例日增的窘境，嚴重影響專業發展、照護品質、就醫安全與工作士氣。以教、考兩端觀之，因應教改政策，護理技職教育規模快速膨脹，學生數激增，在有限資源下，教學品質與成果未如預期；國考及格率偏低與職場高流失率，已影響臨床人力供給與穩定；教考用失衡問題對專業發展、社會需求與教育資源浪費影響甚鉅。本文目的在探討近年醫療職場、國家考試與護理教育之現況與困境，剖析教考用失衡之因，提出改善建議：（一）強化人力資源保護與職能開發，由用人端觀點整合產學、考用兩端，以提升專業職能與穩定人力。（二）以職能標準為培育主軸，修正國家考試考題內涵與考試方式，解決考用不一之問題。（三）以職能標準設計課程與採行實務導向的教學法，各校對學生畢業前推動會考制度，解決產學脫節或教育成果標準不一之問題。（四）護理專業配合政府發展國際醫療趨勢，儘早培育國際人才，本文可做為政策面與專業發展之參考。

Level of development in the nursing profession affects healthcare quality and safety. The nursing profession in Taiwan today faces myriad external pressures such as the global financial crisis and rapidly changing national health insurance policies and social issues. For example, cutbacks in nursing manpower at medical institutions and increasingly difficult healthcare working conditions are increasing nurse workloads and turnover, conflict in the workplace, and difficulties in recruiting new nursing staff. Such negative developments directly and negatively impact professional development, healthcare quality, healthcare safety, and workplace morale. In terms of maintaining and enhancing the quality of new nurses entering the profession, rapid growth in numbers of technology schools and nursing students have severely strained insufficient resources and resulted in teaching quality and education outcomes below expectations. Poor passing rates on the national nursing license examination and increasingly high new nurse turnover are now significant negative factors influencing clinical manpower availability. Imbalances among education, licensing, and hiring clearly and negatively impact nursing professional development and social needs and cause the inefficient allocation of limited education resources. This article discusses and analyzes the causes underlying current imbalances in nurse hiring, licensing, and education. We provide the following suggestions: (1) Integrate education and licensing activities based on professional recruitment considerations to promote nursing competent and manpower stability; (2) revise the focus and content of the national license examination to resolve the current disconnect between license examination and hiring needs; (3) redesign curricula, update teaching material, and adjust teaching methods based on professional competencies in order to resolve key education and recruitment problems. All nursing schools should prepare their students well to pass the license examination in order to resolve the current state of inconsistent educational standards, and (4) train international nursing talent to address and reflect international medical care trends and policies in Taiwan. This paper is intended to serve as reference for both policymakers and professionals in the nursing and healthcare fields.