回顧臺灣建立專科護理師制度初期之決策過程

A Historical Review on the Policy Making Process of Establishing Nurse-Practitioner System in Taiwan, Between 1981-2006

本文從文獻記載、重要會議記錄及親身參與制定 政策的經歷資料，進行回顧性的整理，將臺灣從 1981年至2006年之間，衛生署、中華民國護理 學會及財團法人國家衛生研究院等機構，為發展 「專科護理師」制度而進行政策決擇事件，依據 Young和Quinn提出的六階段政策循環過程架構， 進行描述性分析。結果發現，在這段約25年期 間，臺灣在推展「專科護理師」制度而進行的重 要政策決擇，恰好落在Young和Quinn政策循環 論的第一階段至第四階段。在這四個階段，臺灣 也正經歷整體衛生及醫療系統上的大變革，如頒 布及修訂第一部《護理人員法》、實施《全民健保 法》；加上一股要求醫護品質再提升的專家群及 社會力量，使得醫院需要接受評鑑的概念，也因 勢而生。可見，一個政策的釐定及實施，可說是 在天時、人和、地利三個互相影響的條件下， 逐漸匯集而成的。

 

Based on literature review, meeting records and observation data from author’s personal participation in the process of policy making, a descriptive analysis of policy- making process in relation to establishing nurse practitioner (NP) system in Taiwan was conducted. The time period of this historical review covers from 1981 to 2006. Data indicate that the process covering a quarter of a century, can be divided into four stages of the interactive, inter-related 6-stage-Policy-Making Cycles described by Young and Quinn in 2002. Since a move of reforming Taiwan’s health care system was concomitantly going on during this period of time, important health related bills such as 《Nurse’s Act》and《National Health Insurance Law》were implemented or amended. Beside, hospital accreditation and hospital structural re-engineering were demanded and implemented. The whole society seemed to become readier and readier to have NP system established. It is concluded that in order to succeed in planning and implementing a policy, three key components must have come together. The three key components are being in the right environment, by the right persons and at the right time.