Advanced Nursing Practice Development in Taiwan

(1)

Advanced Nursing Practice

Development in Taiwan

Yueh

-

_-

chih

_chih

Chen,

_Chen,

RN, Ph.D.

School and Graduate Institute

of Nursing

National Taiwan University

(2)

Advanced Practice Nurse

• In US

–

Nurse Practitioner, NP

–

Clinical Nurse Specialist, CNS

–

Nurse Anesthetist, NA

(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

(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

(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. 2000

– Adding new sentences to Clause VII that “after completing training and passing the national

test, a “Registered Professional Nurse”(護理師) be certified as “Specialized Professional

(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 2001-- )

★ Initiating Organization

•Center of Health Policy Research and Development , National Health Research Institute ( NHRI)

(7)

Stage I

(1990—June 2001)

Pre

-

_-

National Policy Planning Stage

_{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

(8)

Stage I

(1990—June 2001)

Pre

-

_-

National Policy Planning Stage

_{National Policy Planning Stage}

Phase 3: Chaotic Period

What is Specialized Professional Nurse

(專科護理師)?

What do we need in an Acute Care Setting? PA? CNS? NP?

(9)

Stage II

(June 2001-- )

National Policy Planning Stage

(10)

Stage II

(June 2001-- )

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

(11)

Stage II

(June 2001-- )

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)

(12)

The Definition of Specialized

Professional Nurse

(

₍

專科護理師

)

₎

• 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.

(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

(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

(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….

(16)

Stage II

(June 2001-- )

National Policy Planning Stage

Phase 3

:

December 2002—December 2004

The NP proposal

sails

from National Health Research Institutes

to the Department of Health

(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

• 1st Meeting of DOH NP Advisory Committee was called

(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

(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

(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

(21)

Stage III

(2006--

)

(22)

Stage III

(2006--

)

Executing Stage

★

Training Program for the “trainer”

•_{March to June 2006}: 4-month

33 Physicians and 66 Nurses

•_{August 2006}

-17 Hospitals will be selected to provide one-year training program for NPs