專科護理師之執業困境與未來修法建議

Practicing Difficulties of Nurse Practitioners and Suggestions for Future Law Amendment

專科護理師執業範圍於103年8月立法後，專科護理師執業範圍較為明確，但專科護理師於臨床實務中仍面臨若干執業困境，執業困境一為專科護理師依預立醫療流程可開立醫囑，其法源依據為「專科護理師於醫師監督下執行醫療業務辦法」，但專科護理師於醫師指示下開立醫囑，於臨床實務上，亦屬常見，但卻欠缺法源依據。衛生福利部於112年2月公告「專科護理師於醫師監督下執行醫療業務辦法」之修正草案，此修正草案規範預立醫療流程適用於社區居家情境，執業困境二為預立醫療流程適用於社區居家情境， 是否有牴觸醫師法第11條規定之虞？再者，修正草案對預立醫療流程制定程序之規範，亦非清楚，可能造成預立醫療流程於社區居家情境之適用，窒礙難行。本文針對此等困境與問題提出建議，希冀健全專科護理師執業範圍之法制，避免專科護理師觸法，確保其執業安全，並提升病人之照護安全與品質。

 

Since the Nursing Personnel Act was amended in August 2014, the scope of practice of nurse practi­tioners is relatively clear, but nurse practitioners still face some difficulties in clinical practice. The first difficulty is that based on the “ Regulations Governing Nurse Practitioners Carrying out Medical Activities under the Supervision of a Physician “ nurse practitioners can prescribe medical orders ac­cording to the pre-established medical procedures. However, it is common for nurse practitioners to prescribe medical orders under the oral instructions of physicians in clinical practice without prescribe medical orders, and the action lacks any legal foundation. In February 2023, the Ministry of Health and Welfare announced the amendments to the “ The Practice of Nurse Practitioners Performing Medical Services Under the Supervision of Physicians “. This amendment regulates that the pre-estab­lished medical procedure is applicable to the community home care situation. Thus, the second prac­tice difficulty is as followed: Is there any risk of violating the provisions of Article 11 of the Physician Law? Furthermore, the amendments are not clear about the formulating process of the pre-established medical procedures, which may hinder the application of the pre-established medical procedures in the community home care situation. This paper puts forward suggestions for these dilemmas and prob­lems, hoping to complete the legal perspectives of nurse practitioners’ scope of practice, to prevent nurse practitioners from breaking the law, to ensure the safety of their practice, and to improve the safety and quality of care for patients.