Medical Community "No Hospital Will Follow Government Guidelines"
Government Cannot Guarantee Civil and Criminal Immunity for Nurses
Concerns Over Renewed Medical Sector Conflict Surrounding Nursing Act
The government’s key measure to address the medical service gap, the ‘Expansion of the Pilot Project for Physician Assistant (PA) Nurses,’ has not been properly implemented in medical settings. The government has not announced the implementation status, and both the medical and nursing communities have stated that they will not even attempt to ascertain the current situation. Concerns have also been raised that the PA nurse pilot project could reignite conflicts across the entire medical community surrounding the enactment of the Nursing Act.
On the 11th, as collective actions by doctors, centered around residents, continue, a nurse is busy moving around at a secondary general hospital in Seoul. Photo by Jinhyung Kang aymsdream@
The Ministry of Health and Welfare launched a pilot project last month on the 27th to expand the scope of medical acts performed by PA nurses, and on the 8th of this month, it announced supplementary guidelines broadly permitting a total of 98 medical acts for PA nurses. Each hospital must adjust, manage, and operate the scope of PA nurses’ duties under the final responsibility of the hospital director.
However, as of the 13th, five days after the announcement of the PA nurse pilot project expansion, the government has not compiled or announced the progress status from the medical community. Among the major measures implemented by the government following the medical service gap caused by the resignation of residents on the 20th of last month, the PA nurse pilot project is the only one for which no status compilation has been conducted.
Both the Korean Medical Association and the Korean Nurses Association are also not tracking the implementation status. The Medical Association stated, “It is difficult to survey all 248 training hospitals, and hospitals are not obligated to respond to the Medical Association’s survey, so it is impossible to ascertain the PA nurses’ medical practice situation.” The Nurses Association also said, “Even when requesting related data from hospitals, they do not submit it, so we cannot grasp the situation,” adding, “It is the Ministry of Health and Welfare’s responsibility to understand the situation.”
Meanwhile, as of the 13th, it was confirmed through Asia Economy’s investigation that the ‘Big 5’ hospitals (Seoul National University, Asan Medical Center, Severance Hospital, Samsung Medical Center, and Seoul St. Mary’s Hospital) have not implemented the expansion of PA nurses’ medical practice. Asan Medical Center is currently discussing whether the government guidelines can actually be applied in clinical settings at the Nursing Work Scope Adjustment Committee. Seoul National University Hospital, Severance Hospital, and Samsung Medical Center are also reviewing and discussing the matter overall. Seoul St. Mary’s Hospital is still considering how to form the Nursing Work Scope Adjustment Committee itself.
The Medical Association believes that most hospitals will maintain the limited scope of medical assistance traditionally handled by PA nurses rather than applying the expanded PA nurse medical practice guidelines. Joo Suho, the Medical Association’s Emergency Response Committee Media Relations Officer, said at a briefing, “Given that doctors themselves face criminal penalties and damage compensation rulings over minor issues arising during medical practice, no hospital would entrust medical acts to nurses.” The Ministry of Health and Welfare stated that the hospital director bears legal responsibility for accidents caused by insufficient management and supervision of PA nurses, and that the adjustment and setting of PA nurses’ work scope participating in the pilot project are legally protected. The Ministry also said it would fully support PA nurses in court, including submitting opinions, even if they face lawsuits from patients related to medical acts.
Senior nurses capable of handling PA duties generally earn higher salaries and work shorter hours than residents, which poses a financial burden on hospital management. Nurses are regular employees under the Labor Standards Act, whereas residents are one-year contract workers under the ‘Resident Act (Act on Improvement of Training Environment and Status of Residents)’ and can work up to 80 hours per week. A Big 5 hospital official explained that the government has not introduced a new health insurance fee for PA nurses’ delegated medical tasks, so related allowances must be paid by hospitals themselves, adding an extra burden to training hospitals already recording large deficits due to the medical service gap.
The nursing community initially opposed the PA nurse pilot project but shifted to support after Prime Minister Han Duck-soo stated on the 8th that “the opinions of nurses will be listened to and reflected in the newly promoted Nursing Act and medical reform.” The nursing community has demanded the re-enactment of the Nursing Act, which President Yoon Suk-yeol vetoed last year. On the 8th, the Korean Nurses Association issued a statement asserting, “The PA nurse pilot project laid the foundation for legal protection of nurses’ duties, and based on this, a Nursing Act should be enacted to clearly define the scope of nurses’ duties and provide legal protection.”
The enactment of the Nursing Act is opposed by 13 medical professional organizations except for the Korean Nurses Association. The government plans to legalize PA nurses, who have been tolerated in an illegal status until now, as a response to the medical service gap caused by residents’ resignation. Accordingly, if the Nursing Act is re-promoted, it is expected to reignite conflicts across the entire medical community.
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