Advanced Nursing Practice Development in Taiwan

Transcription

1 Advanced Nursing Practice Development in Taiwan Yueh-chih Chen, RN, Ph.D. School and Graduate Institute of Nursing National Taiwan University 1

2 Advanced Practice Nurse In US Nurse Practitioner, NP Clinical Nurse Specialist, CNS Nurse Anesthetist, NA Nurse Midwifery, NM 2

3 The Development of NP System in Taiwan The Differences between US and Taiwan US From Primary Health Care System to Acute Care System Taiwan From Acute Care System to Primary Health Care System **The level of difficulty and complexity is relatively higher 3

4 The Major Factors for Developing NP in Taiwan A change in Residents Training in Medical System Residents will no longer be used as the core workforce in hospitals Upgrading Nursing Education since 1990 s From 1994 Junior College Senior College From 1996 Vocational High School Junior College From 2004 No more Vocational High School 4

5 The Major Factors for Developing NP in Taiwan Implementing the National Health Insurance (NHI) in 1995 Promulgation of a revision of Nurses Act on 8 Nov Adding new sentences to Clause VII that after completing training and passing the national test, a Registered Professional Nurse ( ) be certified as Specialized Professional Nurse ( ) 5

6 Stages in Development of NP System in Taiwan Three Stages I. Pre-National Policy Planning Stage (1990--June 2001) Initiating Organization Taiwan Nurses Association (TWNA) Difficult to continue II. National Policy Planning Stage (June ) Initiating Organization Center of Health Policy Research and Development, National Health Research Institute ( NHRI) A Policy Proposal on Designing NP Practice Model and Training Program III. Executing Stage ( ) 6

7 Stage I (1990 June 2001) Pre-National Policy Planning Stage Phase 1: Late 90 Prevalence of Physician Assistant (PA) Phase 2: 1991~June 2001 Promoting Advanced Nursing Practice via Clinical Ladder System by Taiwan Nurse Association (TWNA) N1 N2 N3 N4 The Clinical Ladder Closer to CNS Not NP In Terms of Clinical Ladders: Terms used within nursing profession No standard of training No written scope of practices No credentialing status No remunerative system to compensate achieved advance competence 7

8 Stage I (1990 June 2001) Pre-National Policy Planning Stage Phase 3: Chaotic Period What is Specialized Professional Nurse ( )? What do we need in an Acute Care Setting? PA? CNS? NP? Do we need to collaborate with Physicians? 8

9 Stage II (June ) National Policy Planning Stage 9

10 Stage II (June ) National Policy Planning Stage Phase 1: June 2001 A Policy Proposal on Designing NP Practice Model and Training Program Initiating Organization: Center of Health Policy Research and Development, (NHRI) Taskforce Team: 4 Nurses & 3 physicians Logistic supports: A full-time project manager and meeting costs for the taskforce members 10

11 Stage II (June ) National Policy Planning Stage A Policy Proposal On Designing Nurse Practitioner Training Program and Practice Model in Taiwan (Published by NHRI Forum/ Center on Health Policy Research and Development in July 2003) 11

12 The Definition of Specialized Professional Nurse ( ) SPN is a Nurse Practitioner who is an advanced nurse practitioner employed in an institution. Her/his major role is to provide a continuous and integrated medical and nursing care collaboratively with physicians. 12

13 The Purposes of Developing NP System in Taiwan To upgrade the quality of medical services and prevent and reduce medical errors To improve collaboration in medical-nurse team To readjust patient care tasks shared between physician and nurse so that physician be To improve physician-patient and nurse-patient relation To establish a national standard for Training Programs and Licensure System for NP to ensure the high level of NP competencies 13

14 NP System for Operation Department of Health: National NP Council NHRI: Center for Health Policy Research and Development NP Taskforce Committee Program Review & Accreditation Workforce Resource Management Competence Review & Credentialing 14

15 Proposed NP Scope of Practices Independent Role Functions Physical assessment, Basic Nursing Care, Discharged Planning, Patient Teaching, Nursing Consultation, Charting and Others recommended by Hospital NP Supervisory Committee Assigned Role Functions Recommended by hospital Department of Medical Affairs and the Visiting Staffs. NP be assigned to prescribe lab tests, X-ray and delegated standing medications. After completion special training, Artery Puncture, N-G tubing, Pap smear, EKG etc. 15

16 Stage II (June ) National Policy Planning Stage Phase 3 : December 2002 December 2004 The NP proposal sails from National Health Research Institutes to the Department of Health Back and Forth!! 16

17 Stage II Phase 4 DOH From Passive to Active 10/27/ 04 Promulgation of Rules on NP Specialty Category and Accreditations 12/07/ 04 Meeting held on Issues related to NP Scope of Practices 01/06/ 05 1 st Meeting of DOH NP Advisory Committee was called 17

18 Stage II Phase 4 DOH From Passive to Active Rules on Deciding NP areas of Specialty and Accreditation approved in DOH Training of NP be in hospitals accredited by DOH and beginning from Medical and Surgical specialties. The standards of Accreditation be pronounced by DOH NP Training Courses in hospital should meet the criteria required by DOH The principles of receiving criteria of NP competence be pronounced by DOH 18

19 Issues Related to NP Scope of Practice Discussed in DOH NP practices should be performed collaboratively with physicians based on all existing Medical and related Health Laws/Acts in Taiwan 19

20 The 1st meeting of DOH NP Advisory Committee Members: 10 Nurses, 6 physicians, 1 Lawyer Principles accepted on qualifications for NP Credentialing A certification system for the first generation preceptors suggested NP Training hospitals must set up a NP Supervisory Committee chaired by the Deputy Superintendent 20

21 Stage III ( ) Executing Stage 21

22 Stage III ( ) Executing Stage Training Program for the trainer March to June 2006: 4-month 33 Physicians and 66 Nurses August Hospitals will be selected to provide one-year training program for NPs Sun Set Clause and Trainer in 2006 August 19 Written Test October 14~15 Oral Test If all passed, the first group of National Certified NPs will be born 22

23 Conclusion 1. SPN (NP) in Taiwan is Defined as Advanced Nurse Practitioner Employed in an Institution. 2. SPN System (NP) in Taiwan Start from Acute Setting 3. Development of SPN System (NP) is Supported by the Government. 4. SPN in Taiwan is Certified by DOH is the milestone of Developing SPN System (NP) in Taiwan. 23

24 What We Have to Do in the Future? 1. The concept of transformation from PA to NP need certain period of time. 2. The Practice Scope of NP need to be expanded. 3. How to maintain the National Level? 4. How NP can be accepted by the Public? 5. Education Level of NP need to be elevated to B.S. or even Master Degree. 24

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28 Thank You Very Much for Your Attention!! 28