간호업무 관련 의료법 개정의 의의와 향후 과제

이유리,최성경,김인숙 한국의료법학회 2017 한국의료법학회지 Vol.25 No.2

On 29 December 2015, the Medical Service Act regarding nursing services was amended and enforced from 30 December 2016. Provision on nurse's task was vague under previous Medical Service Act, which had a gap with actual nursing field. Nurses' roles may be replaced by nurse assistants so that boundaries between two professions were blurred. Also, nurse assistants were in the blind spot of supervision and audit which needs to quality control mechanism. In this regard, this study examined the revision of nursing services related Medical Services Act and reviewed significance and policy implication on revision. Firstly, nurse's mission and duties were specified. It recognized nurses role on health management professional which implies improved professionalism. Secondly, qualification management for nurse assistant was enforced. Nurse assistants are obtained accreditation of qualifications from the Minister of Health and Welfare after completing the curricula prescribed and passing the national examination. An education and training institutes for nurse assistants are assessed and accredited. Registered nurse assistants should declare their qualification as well as get refresher training. Thirdly, nurses give guidance on the assistance performed by nurse assistants which leads to division of mission and duties among nursing staffs. Future tasks of revised Medical Service Act are accumulating cases after amendment, developing supporting policy for management of nurse assistants, managing supply and demand on nursing staffs, and discussion of whole nursing professions including midwife, nurse practitioner, physician assistant, and others. 2015년 12월 29일 간호사 및 간호조무사와 관련된 의료법 일부 개정안이 국회 본회의를 통과하여 최종공포 되었다. 기존의 의료법에는 간호사의 업무가 추상적으로 명시되어 있어 실제 간호현장에 부합하지 않다는 것이 문제점으로 지적되어 왔고 간호사 수급불균형에 대한 대책으로 간호사의 역할을 간호조무사가 대체할 수 있도록 함으로써 간호사-간호조무사간의 업무 경계가 모호해진 상황이었다. 또한 간호조무사의 질 관리 및 감독이 사각지대에 있어 질적 수준의 제고가 필요하였다. 본 연구에서는 간호업무와 관련된 의료법 개정의 주요내용을 살펴보고 법 개정의 의의와 정책적 시사점을 도출하였다. 주요한 내용으로는 첫째, 간호사에 대한 업무는 의료법 제정 이후 64년 만의 첫 개정으로 개정된 의료법에서 간호의 전문성을 살리고 건강관리전문가로서의 간호사의 역할을 인정하는 방향으로 간호사의 업무규정이 구체화되었다. 둘째, 간호조무사에 대한 자격관리가 강화되었다. 간호조무사에게 보건복지부 장관 자격을 부여하였으며, 간호조무사 교육훈련기관의 지정·평가제도, 간호조무사의 자격신고 및 보수교육제도가 도입되었다. 셋째, 간호조무사의 업무에 대한 지도권이 간호사에게 있음을 법률에 명시함으로써 간호인력 별 역할분담 및 적정 간호인력 공급의 틀을 마련하였다. 간호업무와 관련된 의료법 개정의 향후 과제로서 간호인력 간 업무범위 구분에 따른 사례축적, 간호조무사 관리체계 세부지침 마련, 간호인력 수급관리 등이 이루어져야 할 것으로 보인다.

Work competence of nurse aides" in a skill-mixed model hospital: the perspectives from both nurse aides and nurses

Hsiang-Wen Kung,Hui-Chen Hsu,Bih-O Lee 한국간호과학회 2021 한국간호과학회 학술대회 Vol.2021 No.10

Aim(s): Nurse aides provide a major support for long-term care services. However, research findings regarding the various aspects of nurse aides’ work competence that may facilitate or impede their work performance remain inconsistent. To compare th-e differences between the nurse aides’ and registered nurses’ perceptions of the nurse aides’ work competence. Method(s): This study was designed as a cross-sectional study, and convenience sampling w-as employed to recruit a sample that comprised 220 nurse aides and registered nurs-es who had served for more than three months at a regional teaching hospitalin southern Taiwan. The instruments consisted of the demographic data and the 36-it-em Nurse Aides’ Work Competence Scale. Result(s): There are no significant differences between the self-perceived and the nurse-s’ reported overall work competence of nurse aides. The results showed that th-e nurse aides had room for improving their work competence in terms of “pro-blem solving” and “activity design”. The nurse aides and resisted nurses differe-d significantly in terms of “activity design” because the nurse aides’ perception of their work competence in “activity design” was more positive than that repo-rted by the registered nurses. Conclusion(s): Nurse aides should be incorporated into cross-disciplinary teams. Activity design could be handled by other healthcare providers such as physical therapists or senior social workers.

간호사의 의료인 간 의사소통에 대한 조사연구

조용애,김미경,조명숙,남은영 병원간호사회 2013 임상간호연구 Vol.19 No.1

Purpose: To present necessary data for improvement in communications between health professionals in as characterized by nurses' communications. Methods: This study was a descriptive survey research design with a survey of 1,510 registered nurses working in general hospitals (of at least 1,900 beds) in Seoul. A questionnaire on communication in the ICU, nurse-physician and nurse-nurse, was used. Data were collected from January 9 to 20, 2012, and the response rate was 85.0%. Results: Cronbach α values ranged from.75 to .89, except for .59 for accuracy (nurse-physician), with .89 overall. The highest mean score was for perception for timeliness [3.83±.57], followed by shift communication (nurse-nurse) [3.64±.66], openness (nurse-nurse) [3.64±.65], accuracy (nurse-nurse) [3.14±.61], openness (nurse-physician) [2.90±.75], understanding (nurse-physician) [2.82±.65], and accuracy (nurse-physician) [2.70±.59]. Subscales of openness, understanding, and shift communication were strongly associated with communication satisfaction. The general characteristics of nurses with different perceptions of communications included age, clinical experience, work pattern, and department. Conclusion: Proactive activities to improve accuracy, openness and mutual understanding between physicians and nurses are required for patient safety. Further studies are also needed to reassess communications and evaluate the relationship between patient outcomes and nurses' job satisfaction after application of strategies to improve communications.

Factors Related to Nurse Staffing Levels in Tertiary and General Hospitals

Kim Yun Mi,June Kyung Ja,Cho Sung-Hyun Korean Society of Nursing Science 2005 Journal of Korean Academy of Nursing Vol.35 No.8

Background. Adequate staffing is necessary to meet patient care needs and provide safe, quality nursing care. In November 1999, the Korean government implemented a new staffing policy that differentiates nursing fees for inpatients based on nurse-to-bed ratios. The purpose was to prevent hospitals from delegating nursing care to family members of patients or paid caregivers, and ultimately deteriorating the quality of nursing care services. Purpose. To examine nurse staffing levels and related factors including hospital, nursing and medical staff, and financial characteristics. Methods. A cross-sectional design was employed using two administrative databases, Medical Care Institution Database and Medical Claims Data for May 1-31, 2002. Nurse staffing was graded from 1 to 6, based on grading criteria of nurse-to-bed ratios provided by the policy. The study sample consisted of 42 tertiary and 186 general acute care hospitals. Results. None of tertiary or general hospitals gained the highest nurse staffing of Grade 1 (i.e., less than 2 beds per nurse in tertiary hospitals; less than 2.5 beds per nurse in general hospitals). Two thirds of the general hospitals had the lowest staffing of Grade 6 (i.e., 4 or more beds per nurse in tertiary hospitals; 4.5 or more beds per nurse in general hospitals). Tertiary hospitals were better staffed than general hospitals, and private hospitals had higher staffing levels compared to public hospitals. Large-sized general hospitals located in metropolitan areas had higher staffing than other general hospitals. Occupancy rate was positively related to nurse staffing. A negative relationship between nursing assistant and nurse staffing was found in general hospitals. A greater number of physician specialists were associated with better nurse staffing. Conclusions. The staffing policy needs to be evaluated and modified to make it more effective in leading hospitals to increase nurse staffing.

병원간호사의 재직의도

이은희,조경숙,손행미 병원간호사회 2014 임상간호연구 Vol.20 No.1

Purpose: The purpose of this study was to identify nurse's intention to keep current job in the hospital. Methods: Data were collected from 1,143 nurse's working in over 300 beds hospital. The questionnaire with 47 items was developed by researchers to measure nurse's intention to keep his/her current nursing job in hospital. The questionnaire was developed through a focus group interview asking nurse's about their work experiences and literature review, and validated by researchers. Using descriptive statistics, data were analyzed in frequency and severity of nurse's intention to keep nursing job. The Cronbach's α of the questionnaire was .906. Results: The mean score of nurse's intention to keep current nursing job was 2.66. The highest mean scores of item of nurse's intention to keep nursing job was “as a nurse it is my duty to help others” (3.19±0.45), and the lowest was “the rotating shift helps me doing housework and raise for my kids” (1.77±0.64). And there are significant differences between period of working (F=9.71, p<.001), current position (F=5.91, p<.001), educational level (F=13.44, p<.001), and impulse experience of changing a job (F=71.20, p<.001). Conclusion: The findings of this study showed possibilities to develop programs for heightening the pride of professional nurse and increasing nurse's intention to keep nursing job in order to increase nurse's professional satisfaction and achievement.

간호사-간호사 및 간호사-의사 협력 정도와 의료 오류 발생 간의 관계

이영주,황지인 간호행정학회 2019 간호행정학회지 Vol.25 No.2

Purpose: The aim of this study was to examine degrees of nurse-nurse collaboration and nurse-physician collaboration,and investigate their relationships to the occurrence of medical errors. Methods: A cross-sectionalquestionnaire survey was conducted with 264 nurses in a university hospital. The questionnaire included fivecomponentnurse-nurse collaboration and three-component nurse-physician collaboration scales. Data wereanalyzed using independent t-tests, ANOVA, x2 tests, and multiple logistic regression. Results: Mean score fornurse-nurse collaboration was 2.8 out of 4.0, and for nurse-physician collaboration, 3.4 out of 5.0. There weresignificant differences in the nurse-nurse and nurse-physician collaboration scores by nurses’ preference toworkplace and work unit. A significant difference was found in the nurse-nurse collaboration scores by job position. Fifty-seven (21.60%) nurses responded that they had experienced a medical error in the last six months. Logisticregression analysis revealed that nurse-physician collaboration was a significant factor associated with nurses’ errorexperience. Nurses with higher scores for the nurse-physician relationship component were less likely to experiencemedical errors. Conclusion: Findings from this study show that nurse-nurse and nurse-physician collaboration weremoderate. Negative relationship between nurse-physician collaboration and the occurrence of medical errorindicates that enhancing nurse-physician collaboration would contribute to improving patient safety. 목적: 본 연구의 목적은 간호사-간호사 협력 및 간호사-의사 협력의 정도를 조사하고, 간호사-간호사 협력 및 간호사-의사 협력과 의료 오류 발생과의 관계를 조사하는 것이었다. 방법: 횡단적 설문 조사 연구로서, 대학 병원에 근무하는 간호사 264명을 대상으로 하였다. 설문지는 5개 하위 영역의 간호사-간호사 협력과 3개 하위영역의 간호사-의사 협력 척도를 포함하였다. 수집된 자료는 t-test, ANOVA, Chi-square test, 다중 로지스틱 회귀분석으로 분석하였다. 결과: 간호사-간호사간 협력의 평균 점수는 4.0점 만점 2.8점이었고 간호사-의사 협력의 평균 점수는 5.0점 만점 3.4점이었다. 간호사-간호사 및 간호사-의사 협력의 점수는 간호사의 근무부서와 희망부서에 근무하는지에 따라 유의한 차이가 있었다. 간호사-간호사 협력 점수는 직위에 따라 유의한 차이가 있었다. 57명(21.60%)의 간호사가 최근 6개월 동안 의료 오류를 경험한 적이 있다고 응답하였다. 로지스틱 회귀분석 결과, 간호사들의 의료 오류 경험은 간호사-의사 협력 점수와 유의한 관계가 있었으며, 간호사-의사간 협력 관계 하위 영역 점수가 높을수록 의료 오류를 덜 경험하는 것으로 나타났다. 결론: 간호사-간호사 및 간호사-의사 협력 수준은 보통 이상으로 양호하였다. 또한 간호사-의사 협력과 의료 오류 발생간의 부적인 관계는 간호사-의사 협력 강화시킴으로써 환자 안전을 향상시키는 데 기여할 수 있음을 보여주었다.

조산원(助産院)의 분만간호서비스에 대한 건강보험수가 산출방법과 적용방안

김진현,정유미 한국간호과학회 2009 Journal of Korean Academy of Nursing Vol.39 No.4

services in the national health insurance and estimated the optimal reimbursement level for the services. Methods: A cost accounting model and Sustainable Growth Rate (SGR) model were developed to estimate the conversion factor of Resource- Based Relative Value Scale (RBRVS) for nurse-midwife’s services, depending on the scope of revenue considered in financial analysis. The data and sources from the government and the financial statements from nurse-midwife clinics were used in analysis. Results: The cost accounting model and SGR model showed a 17.6-37.9% increase and 19.0-23.6% increase, respectively, in nurse-midwife fee for delivery services in the national health insurance. The SGR model measured an overall trend of medical expenditures rather than an individual financial status of nurse-midwife clinics, and the cost analysis properly estimated the level of reimbursement for nurse-midwife’s services. Conclusion: Normal vaginal delivery in nurse-midwife clinics is considered cost-effective in terms of insurance financing. Upon a declining share of health expenditures on midwife clinics, designing a reimbursement strategy for midwife’s services could be an opportunity as well as a challenge when it comes to efficient resource allocation. services in the national health insurance and estimated the optimal reimbursement level for the services. Methods: A cost accounting model and Sustainable Growth Rate (SGR) model were developed to estimate the conversion factor of Resource- Based Relative Value Scale (RBRVS) for nurse-midwife’s services, depending on the scope of revenue considered in financial analysis. The data and sources from the government and the financial statements from nurse-midwife clinics were used in analysis. Results: The cost accounting model and SGR model showed a 17.6-37.9% increase and 19.0-23.6% increase, respectively, in nurse-midwife fee for delivery services in the national health insurance. The SGR model measured an overall trend of medical expenditures rather than an individual financial status of nurse-midwife clinics, and the cost analysis properly estimated the level of reimbursement for nurse-midwife’s services. Conclusion: Normal vaginal delivery in nurse-midwife clinics is considered cost-effective in terms of insurance financing. Upon a declining share of health expenditures on midwife clinics, designing a reimbursement strategy for midwife’s services could be an opportunity as well as a challenge when it comes to efficient resource allocation.

Effects of Nurse Staffing on Surgical Patient-Outcomes with Cerebrovascular Disease

Sunyoung Jang 보안공학연구지원센터 2016 International Journal of Bio-Science and Bio-Techn Vol.8 No.2

The purpose of this study was to examine the relationships between nurse staffing and patient outcomes including inpatient mortality and length of hospital stay. Data were obtained from the '2008 Korea National Patients Survey' conducted by the Korea Institute for Health and Social Affairs. The study sample consisted of inpatients with surgical cerebrovascular diseases (n= 728). Nurse staffing was measured using 2 indicators: number of beds per nurse and number of inpatient days per nurse. Hospital characteristics included size, location, ownership, and physician staffing. Patient characteristics were age, gender, primary diagnosis, admission route, type of surgery, and primary payer. Patient outcomes were mortality during hospitalization and length of hospital stay. After controlling for hospital and patient characteristics, the relationships of nurse staffing to inpatient mortality and length of hospital stay were analyzed by multilevel analysis. Nurse staffing was not significantly associated with inpatient mortality. Higher nurse staffing was related to a decrease in length of hospital stay. The study findings suggested that higher nurse staffing might decrease length of hospital stay, which could increase efficiency and profits in providing hospital services. Government and nursing policies are required to ensure adequate nurse staffing in hospitals.

간호법 단독입법을 통한간호인력의 합리적 재편 방안

김종호 ( Jongho Kim ) 건국대학교 법학연구소 2015 一鑑法學 Vol.0 No.32

평균수명의 연장으로 인한 건강보험 진료비 증가, 의료기관 증가, 의료기관의 적정한 간호 인력확보의 필요성 증가와 같은 급격한 보건의료환경의 변화로 간호인력 수요가 증가하고 있다. 인구의 고령화로 인한 노인의료비 증가, 만성질환자 관리의 필요성 증가에 비용효과적인 대응을 위한 간호인력 수요도 커지고 있다. 또한 노인장기요양보험제도의 도입· 확대 등으로 간호서비스 제공영역이 의료기관에서 지역사회로 변화하면서 간호의 역할범위도 보다 확장되고 있다. 중동호흡기증후군(MERS) 사태에서 보는 바와 같이 포괄간호서비스 수요도 반드시 충족되어야 할 상황이다. 그러나 현재 우리나라 간호사는 다른 의료인력과 함께 의료법에 포괄적으로 규정되어 있어 명확한 법적 지위와 규제 내용이 부재하며 간호인력 간 업무와 책임한계가 불명확한 상황이다. 이는 급변하는 간호 관련 보건의료 환경변화에 간호서비스가 적절히 대응하지 못하게 할 뿐만 아니라 간호서비스의 질 저하를 초래할 우려가 있다. 특히, 진료보조업무에 있어서 간호사와 간호조무사간의 업무중복과역할혼란의 문제가 발생하고 있어 명확한 업무규정이 요구된다. 대부분의 국가들이 간호관련 단독법에 기반하여 간호인력 양성을 위한 교육과정과 업무를 명확히 규정함으로써 간호서비스의 책임성을 담보하고 있으며, 간호사가 간호보조인력에 대한 지도·감독의 권한을 부여함으로써 간호인력 간 업무중복의 문제를 피하고있다. 우리나라도 간호행위 관련 서비스의 책임강화와 간호인력 관련 문제발생 가능성을 최소화하고 간호인력 양성을 활성화함과 동시에 보건의료 환경변화에 적절히 대응할 수있는 인력수급 시스템을 구축할 수 있는 간호사 관련 단독입법이 필요하다. 이를 위하여 간호업무의 개념정의와 구체적인 행위구분, 면허·자격 응시기준, 교육기관 및 교육기간, 간호사중앙회, 보수교육 및 면허·자격신고제, 간호정책의 심의·의결을 위한 간호정책심 의위원회, 인력처우개선 및 복지증진, 인력확보와 취업촉진을 위한 간호인력개발센터 설치 등을 주요내용으로 하는 간호법 제정이 필요하다. More than 65 years ago, governments enacted laws which protect the public’s health and doctors assistant by overseeing and ensuring the safe practice of nursing. It is not uncommon to find various complementary therapies available at hospitals, either as part of nursing care, or as an extended health care service. Currently many hospitals and other healthcare facilities, such as long-term care facilities are being constructed to replace those at the end of their life and to meet the demand as the baby boomer population grows older in Korea. Many of these are designed according to a new understanding of the healing environment and the research behind evidence-based design. Small sized clinics are also beginning to change, not least because the Korean healthcare system can no longer afford a system that focuses on disease-based care. Healthcare is beginning to recognize the central place that wellbeing of mind, body, and spirit plays in health. In this rapidly changed medical environment, the nursing resources are most crucial factor to meet the broadly varied conditions. The nurse workforce generally consists of licensed nurses and nurses-aides. The physical setting is the patient’s first impression of a healthcare facility and one of the most important factors in the patient’s perceptions of the quality of care and their overall satisfaction. One of the key factors driving changes in healthcare is the concept of patient-centered care. Each of the items are necessary to satisfy patients by appropriate nursing care service. Nursing-sensitive outcomes are one indicator of quality of care and may be defined as variable patient or family caregiver state, condition, or perception responsive to nursing intervention. However, Korea has no Nurse Act separated from the Medical Service Act since 1951. This study discussed the necessity of single Nurse Act enactment independent from the Medical Act by arguing and comparing foreign jurisprudence and legislative connection between lower levels of nurse staffing and higher rates of adverse events. Complementing this study is a providing number of other research agendas addressing the growing nurse workload and rising rates of burnout and job dissatisfaction. Many stakeholders within the health care system, especially governments, hospitals and hospital organizations, doctor and nurse associations, nurse-aides foundations, and accreditation organizations, are aware of the lack of qualified nursing staff and related problems and are actively seeking solutions. High level general hospitals may cut spending for other personnel, such as unlicensed caregivers, housekeepers, and other support staff to enhancing their medical reputations. On the other hand, local clinic and small sized medical firms are insist that revise or enactment of new law may increasing cost of health care and they against preparing new bill. If no renovation is made in the medical law, the amount of nursing work performed by non-licensed nurse-aides in inpatient units could increase, and investments in medical technology and facilities to improve the quality of care could be deferred. Accordingly, researching a reasonable nursing resources reorganization plan through enactment of Nurse Act is summons in our time.

간호사-간호사, 간호사-의사 협력 및 전문직 자아개념 간의 관계: 임상실습 경험이 있는 간호대학생을 대상으로

전소자,전미경 대한산업경영학회 2024 산업융합연구 Vol.22 No.4

본 연구는 임상실습 경험이 있는 간호대학생을 대상으로 간호대학생이 지각한 간호사-간호사 협력 및 간호사-의사협력, 전문직 자아개념 간의 관계를 파악하기 위한 서술적 조사연구이다. 연구대상은 간호대학생 140명이며 수집된 자료는기술통계 및 Pearson’s 상관계수, 전문직 자아개념 영향요인은 회귀분석 하였다. 연구결과 전문직 자아개념은 간호사–간호사 협력 및 간호사–의사협력과 양의 상관관계가 있으며, 전문직 자아개념 영향 요인은 간호사-간호사 협력으로 설명력은48.0%로 나타났다. 따라서 간호대학생의 간호전문직 자아개념 향상을 위해서는 간호사-간호사 협력관계 증진을 위한 전문직간 협력 향상 교육 프로그램 개발과 임상현장 사례를 바탕으로 전문직 간 협력 시뮬레이션 시나리오 개발 및 적용의 교육과정개발도 필요 할 것으로 생각된다. This study is a descriptive survey study to identify the relationship between nurse-nurse cooperation, nurse-doctor cooperation, and professional self-concept perceived by nursing students among nursing students with clinical practice experience. The subjects of the study were 140 nursing students, and the collected data were descriptive statistics, Pearson's correlation coefficient, and regression analysis of the factors influencing professional self-concept. As a result of the study, professional self-concept was positively correlated with nurse-nurse cooperation and nurse-doctor cooperation, and the influencing factor of professional self-concept was nurse-nurse cooperation, with explanatory power of 48.0%. Therefore, in order to improve the nursing professional self-concept of nursing students, it is necessary to develop an educational program to enhance cooperation between professionals to promote the cooperative relationship between nurses and nurses, and to develop a curriculum for the development and application of simulation scenarios for cooperation between professionals based on clinical field cases.