專科護理師執行醫療業務辦法之臨床衝擊與展望

The Clinical Impacts and Prospects from the New Regulation regarding Nurse Practitioners Practicing Medicine

由於醫療政策的演變，醫師人力不足的情形日益嚴重，使得專科護理師在醫療的角色日顯重要。為使專科護理師的獨特角色功能及執業範疇更為明確，2014年8月立法院通過「護理人員法第24條修正條文」，並於同年由衛生褔利部訂定及公告實施「專科護理師於醫師監督下執行醫療業務辦法」，專科護理師除了護理師業務外並於醫師監督下得執行醫療業務，自此專科護理師的執業範疇更為明確，不再處於模綾兩可的灰色地帶。然而，由於考量醫療業務之風險程度，該辦法中規範專科護理師可執行之醫療項目未能全然反應臨床實際現況與需求，易使專科護理師在職場上陷入情、理、法膠著的困境。因此，筆者分別就專科護理師的發展、專科護理師的角色功能、專科護理師執業範疇之立法進展、「專科護理師於醫師監督下執行醫療業務辦法」對臨床工作的衝擊與後立法時期專科護理師執業之展望進行剖析，期能藉由本文提升讀者對專科護理師執業範疇立法過程、衝擊與展望的了解與共識，進而繼續推動與調整專科護理師執業範疇使其更為合理合法且貼近臨床實務現況；並使此一進階護理角色功能更為明確與執業更有保障。

Because of the complexity of modern healthcare and severe shortage of clinicians, roles of nurse practitioners have become more important in today's clinical practice. To clarify the unique role of a nurse practitioner and its practice scopes, Legislative Yuan of Taiwan passed the Nurses Law Amendment Act provisions of Article 24 in August 2014. Health and Welfare Decree announced and implemented a supervision rule that “nurse practitioner must perform medical practices under the supervision of a physician” in the same year. Thereafter, the scopes of practice for nurse practitioners have clearly defined that in addition to nursing practice, nurse practitioners may perform medical practice under a physician's supervision without ambivalence and confusion. However, considering clinical medical practice's high risk, the medical practices that nurse practitioners were allowed to perform do not fully reflect real clinical situations and needs. Moreover, it may put nurse practitioners in a problematic position while facing the challenges of judgement, temperament, and reasoning. This article aims to analyze these acts to make readers better understand and have consensus on the legislative process, impacts, and prospects of the scope of practice for nurse practitioners. Then, the scope of practice for nurse practitioners can be further developed for legitimate and reasonable practice in real clinical situations. Therefore, the role and function of nurse practitioners can be more distinct, and supervised medical practice can be competent and protected.