As residents who had left training hospitals amid the doctor-government conflict returned, hospitals began reassigning PA (physician assistant) nurses who had filled the care gaps, and fissures are emerging in succession.
According to the medical community on the 12th, Seoul National University Hospital and Samsung Medical Center recently returned some PA nurses to the nursing department. Asan Medical Center plans to reassign PA staff after internal discussions by the end of next month.
PA nurses are nurses who assist doctors and take on part of physicians' work, from surgical preparation to assisting in surgery and suturing surgical sites. Amid the doctor-government conflict, major hospitals have operated with more than double the previous number of PA nurses since last year.
◇ "Thrown away after use when residents return" General strike forecast
As residents returned and major hospitals moved to adjust PA nurse staffing one after another, nurses' dissatisfaction has also grown. They said hospitals used them when needed and, once circumstances changed, unilaterally forced department reassignments.
The labor union at Seoul National University Hospital, which has announced a general strike for the 17th, also cited this issue as one of the main reasons for the walkout. The SNUH union is demanding that the hospital hire essential staff and revamp the pay system.
Kwon Ji-eun, chief negotiator of the Seoul National University Hospital labor union (a nurse), said, "PA nurses who filled the residents' gap for 1 year and 6 months are being 'thrown away after use,'" adding, "Without gathering opinions from those affected or providing explanations and without talks with the union, the hospital is pushing through unilateral department reassignments."
In response, Seoul National University Hospital explained, "In September, we adjusted by returning some PA nurses to the nursing department and having some remain with the clinical support team."
A hospital official who requested anonymity said, "In order to minimize the care vacuum caused by the earlier mass departure of residents, the hospital conducted a pilot program for PA nurses by accepting applications, in line with Ministry of Health and Welfare guidance to temporarily expand PA nurse operations."
But circumstances differ by hospital. Some regional university hospitals with small resident quotas or low return rates are retaining their existing PA staffing.
Among professors, there is also a mood favoring retention because collaboration with PA nurses is more stable and efficient than with residents. An Asan Medical Center official said, "The scale of personnel changes has not yet been set," adding, "We will decide our future operating direction after collecting opinions by department."
◇ Scope of practice remains unclear, conflict over who trains them
The fact that the system is not yet fully in place is another reason the medical field is facing confusion. The Ministry of Health and Welfare plans to announce the enforcement decree and rules of the Nursing Act at the end of this month. The ministry is reportedly reviewing a plan to adjust the medical acts PA nurses can perform into 43 items across seven categories, including procedures, treatments, and surgical support.
Because the criteria for the scope of practice have been unclear, conflicts have erupted among professions such as residents and nurses over boundaries of work, and concerns about medical accidents have also been raised. The medical and nursing communities are also in a tug-of-war over designating professional institutions to train PA nurses.
The Korean Nursing Association (KNA), a nurses' organization, says the association should handle education and evaluation and issue certifications to reduce variations in training across medical institutions. In contrast, the Korea Hospital Association argues that because techniques differ by specialty, hospitals should provide PA nurse training.
On the 3rd, Minister Jeong Eun-kyeong of the Ministry of Health and Welfare held a first roundtable with leaders from the Korea Hospital Association, the Korean Medical Association Organization, the Korean Dental Association, the Association of Korean Medicine (AKOM), the Korean Pharmaceutical Association, and the Korean Nursing Association (KNA). At the meeting, Hospital Association President Lee Seong-gyu and Nursing Association President Shin Kyung-rim also clashed over who should control PA nurse training, showing differences in position.
A professor at a university hospital in Seoul said, "Although residents have returned to training sites, it will be difficult to revert to the system before the doctor-government conflict," adding, "I think it will take five years for the new system to take hold and for hospitals to return to normal."