偏鄉醫院專科護理師之執業困境

Practice Barriers for Nurse Practitioners in Rural Hospitals

背景：由於醫師困難招聘，專科護理師被視為解決偏鄉醫事人力資源危機的重要一環，惟國內針對偏鄉醫院專科護理師臨床執業困境之研究較為有限。
目的：探討偏鄉醫院專科護理師臨床執業困境。
方法：以質性研究內容分析法，採立意取樣，進行面對面半結構式訪談。
結果：共10位偏鄉醫院專科護理師參與，其執業困境主要來自三方面：擔心無法保障病人安全；醫療軟硬體不足，專科護理師負荷大；醫療健保給付與病人權益難取得平衡點。
結論／實務應用：為解決偏鄉專科護理師面臨之困境，建議政府應強化專科護理師的臨床教育訓練，醫院管理者可運用網路及社群媒體行銷偏鄉醫院，並結合募資平台以募集足夠資源，才能強化人力及軟硬體設備；最後應該有足夠法規和機制以保障具有專科護理師道德勇氣者，對涉及醫療之詐欺意圖或行為，能予以勸導或勇敢檢舉，避免健保資源之浪費。

Background: Nurse practitioners (NPs) are regarded as part of the primary healthcare professional team in rural hospitals, which often faced difficulties in hiring doctors. Only a few studies have been conducted that assess the barriers to practice for NPs in rural hospitals in Taiwan.
Purpose: This study was designed to explore the barriers of practice for NPs working in rural hospitals.
Methods: A qualitative research approach was used in this study, and participants were recruited using purposive sampling. Data on barriers to clinical practice were collected using face-to-face, in-depth interviews.
Results: A total of 10 NPs participated in this study. The three barriers identified were patient safety concerns, the impact of limited medical resources and the demands and heavy workload on NPs, and the difficulties of balancing the interests of profit-oriented hospitals and patients’personal medical insurance rights.
Conclusions/ Implications for Practice: To reduce barriers to practice, NPs require additional training from the government to strengthen their clinical knowledge and skills. In addition, when facing insufficient support from the Department of Health, these NPs may leverage online hospital marketing and crowdfunding platforms to obtain necessary software/hardware resources for their rural hospitals. If universal health insurance and personal medical insurance are misused within a hospital, NPs should have the moral courage to speak up and should be provided with adequate protection under rules and regulations that allow them to report cheating, illegal behaviors, and other activities that waste / misdirect healthcare resources.