臺灣專科護理師制度發展及待解課題之評析

The Development and Analysis of Taiwan's Nurse Practitioner System

近十年來，臺灣醫療環境的變化導致醫護人員之配置無法滿足現實所需，進而在維護照護品質並兼顧醫療成本之考量下，培訓資深或專業護理人員執行醫療業務遂成為可行的發展方向。由於護理人員與病患接觸時間長，最了解其個別狀況，若能培訓其具備醫事專業並於醫師監督下執行醫療業務，將有助於紓解現行醫護臨床上人力不足的現況，此也促成了「專科護理師」的發展。臺灣於2000年透過修正護理人員法確立起「專科護理師」的名稱，賦予其與醫師共同提供連續性及整合性醫療照護之任務，然而在制度實施初期，因法令規範及銜接制度未臻完備而致影響其實施進程，嗣歷經數次修法後，目前專科護理師整體制度已漸趨完備。為俾利整體制度之發展，本文以專科護理師制度作為觀察，分析其制度發展及相關待解之課題，冀望能對此提供若干建議供各界參考。

Over the past decade, the changes of Taiwan medical environment have led to the shortage of medical staff. Therefore, the authorities tend to train experienced nurses with additional nursing and medical profession in order to perform certain medical care services. Such solution, which is based on the American nurse practitioner (NP) system, may help alleviate the current shortage of medical staff; consequently the authority promoted the nurse specialist system. For the purpose continuity and integrated medical cares within the system of physicians and nurse specialists, Taiwan established “nurse practitioner” and amended the Nursing Personnel Act in 2000. However, the lack of clinical nurse specialist (CNS) experience made nurse practitioner can only perform medical assistance and low risk medical procedures under the supervision. Thus, the Authorities revised the Nursing Personnel Act in 2015 and allowed nurse practitioner to practice normal medical procedures under supervision of physicians. After several amendments, the system development of nurse practitioner has been improved, but it still can be better. In order to enhance the quality of the legal system, this paper describes the development of nurse practitioner and analyzes the current defects. This paper also provides some suggestions to contribute the development of legal system.