Earticle

의료분쟁이 증가함에 따라, 간호사와 관련된 의료분쟁의 건수도 상대적으로 증가하고 있어 연구가 필요한 분야로 대두되고 있다. 하지만 여전히 간호사와 환자간의 법률관계에 대해서는 연구가 미진한 것이 사실이다. 하지만 최근 간호학의 발달로 간호사들의 역할과 기능이 다양하게 확대됨에 따라 간호사들의 활동과 책임한계도 넓어졌다. 이에 따라 간호사들의 의료분쟁 발생빈도도 증가하고 있다. 하지만 아직도 간호사의 업무는 의사의 역할에 대한 보조적인 행위를 하는 것으로 인식될 뿐이어서 의사의 총괄책임에 포함되어 넘어가는 경우가 대부분이다. 또한 간호사의 업무는 의료행위 중 일부를 구성하는 것이지, 의사의 역할에 보조적인 행위를 하는 것이 아니다. 물론 업무의 성격은 의사의 행위에 대한 보조적인 업무도 많으나, 이것은 어디까지나 간호사의 업무 중 일부에 지나지 않는다고 보아야 한다. 또한 간호사도 의료인이므로 의료행위에 관한 일반사항은 의사와 다를 것이 없다. 이러한 간호사의 특성 및 현재 우리의 의료상황에 비추어 보건대 간호사의 업무가 고도화・전문화 되어 가고 있는 것이 사실이며, 간호사의 독자적인 영역도 확고히 굳혀가고 있다 할 것이다. 이러한 시대 흐름 속에서 환자 안전과 국민 건강증진을 위한 간호사에 관한 독립법률 즉 간호법 제정을 위한 목소리도 커지고 있다. 이에 비추어보건대 간호사의 책임도 그 만큼 커질 것이 명확하다. 즉 간호사가 의사의 지시에 따라 간호를 수행하고 그 결과의 책임 또한 의사에게 돌리던 시대는 지나간 것이다. 따라서 본 논문에서는 간호행위의 성질 및 법적 책임에 대해 설명하고, 향후 간호사와 환자간의 법적분쟁 발생 시 효과적으로 대처하기 위한 제도적 장치에 대해 논의해보고자 한다. 이를 통해 향후 간호사와 환자간의 분쟁 발생 시 판단에 있어 단초를 제공하는 것이 이 논문의 목적이라 할 것이다.

As the number of medical disputes regarding nurses has increased after medical disputes have increase, there is a need for a study on it. However, the legal relationship between nurses and patients has not yet been analyzed. Recently, the role and function of nurses are expanded according to the development of the science of nursing; moreover their activity and limitation of responsibility are also expanded. For this reason, the medical disputes regarding nurses have been increasing. However, the majority of these kind of dispute are just passed over because their practice is usually considered to be a mere action to assist doctor’s role. In addition, nurse practice is not a secondary action of doctor’s role, but forms part of a medical treatment. Of course, nurses handle many secondary tasks after doctors finish their medical treatment. But this is only part of the whole tasks of nurses. Furthermore, the general details of their medical treatment are not different from those of doctors because they also belong to the medical service personnel. Considering these features of nurse and the medical condition in South Korea, their task is becoming increasingly developed and specialized and they are also establishing their own field. With this stream of times, there is a growing interest in enacting a Nursing Practice Act, in other words, the independent law on nurse for the sake of patient safety and national health promotion. Then, their responsibility will distinctly be expanded as much more. That is, the time that nurses practice their medical care by following doctors’ order and also pass over their responsibility to doctors is closed. Thus, this study examines the features and responsibilities of nursing practice, and discusses an institutional framework to efficiently cope with the legal disputes between nurses and patients. It aims to throw light on the decision making on nurse-patient disputes in future.

There is a system in Korea named “Advanced Practice Nurse System” qualified by the Minister of Health, Welfare and Family Affairs for Advanced Practice Nurse besides nurse licence. Medical practice is, in today's medical law, understood as a general concept colligating medical practice, nursing practice and midwife practice and so on, for it is defined as a deed of medical technique practiced by medical personnel. Referring to the fact that the Supreme Court recognizes medical personnel as people who have medical expert knowledge, nursing practice can be recognized as a region of medical business and therefore it is not necessary to prescribe nursing practice separately from the definition of medical practice on a precedent, because nurse belongs to medical personnel. According to the precedent regarding ‘Unlicensed Medical Practice of Advanced Practice Nurse for Anesthesia’ recently sentenced by the Supreme Court, the medical practice is only allowed a doctor because it is ‘in need of special knowledge and experience because of high danger on human body' and it is judged to be an unlicensed medical practice prohibited in medical law if it is to be done by a nurse. When considering the actual situation that System for Advanced Practice Nurse for Anesthesia is established under the circumstance that an anesthetist is in want and therefore the operation has not been performed on time, and that it is being expected an anesthetist to be in need, it is necessary to legislate for the range of medical practice of Advanced Practice Nurse so that Advanced Practice Nurse System can be practically legalized, for the role of Advanced Practice Nurse has the great possibility of shrinking because the precedent has considered Advanced Practice Nurse for Anesthesia doing anesthetic operation in clinic today as a potential wrongdoer.

Purpose: The purpose of this study were to classify and define critical care and to develop the core competencies of advanced practice nurses. Method: From an extensive literature review, a draft of a classification system in critical care and the core competencies of advanced nurse was developed. A focus group, consisted of the representatives from related areas in medicine and nursing, was used to draw a consensus on the draft presented. Result: A final classification system for critical care contained cardio/pulmonary system, gastrointestinal system, neuromuscular system, genitourinary system, endocrine system, oncology/hematology/immunology system, and pediatrics. The core competences for advanced practice nurse contained advanced clinical practice, education and counseling, consulting and collaboration, research, leadership. Conclusion: Increased complexity of care and clinical decision making need advanced practice nurse to be prepared as a competent professional. Based on the study result, a standard for education, practice and credentialing can be refined.

Purpose : The purpose of this study was to understand and describe the experiences of the advanced nurse practitioner (APN) system used by healthcare providers including APNs, doctors who worked with APNs, and APN master's course professors at a graduate school. Methods : Qualitative data were collected via snowball sampling. The participants were nine APNs, six doctors, and three professors. They were divided into three focus groups, each of which consisted of all three types of healthcare providers. Data were collected via interviews with the three focus groups conducted from September to October 2019. All interviews were audiotaped and transcribed verbatim. The transcribed data then underwent qualitative content analysis. Results : Based on the data, we extracted four themes and 14 categories. The themes were "Role and system of APNs started according to healthcare environment changes", "Optimal healthcare provider to ensure quality of care", "Confused role and system of APNs due to incomplete medical law", and "Tasks for the stable operation of the APN system." Conclusion : For quality treatment and safety of patients, a legal basis must be established for the APN system. For its stable operation, social consensus regarding legislation about APNs' scope of practice is required. Finally, a discussion is necessary about the integration of APNs' 13 fields.