Nurses can now draft medical certificates that doctors used to write and perform punctures to harvest bone marrow, as well as handle extracorporeal circulation tasks that revive patients whose hearts have stopped. While residents left hospitals amid doctor-government conflict, nurses took on these duties, sparking debate over whether they were legal. Now, with relevant laws and rules in place, a path has opened for official recognition of the work.
The Ministry of Health and Welfare said on the 1st that it will implement in Nov.–Dec. the draft rule titled "Rules on the performance of nurses' patient care assistance (PA) tasks" after a notice-and-comment period. It also issued an administrative notice that day listing the acts involved in nurses' patient care assistance.
A bone marrow puncture involves inserting a needle into the marrow to collect marrow tissue. Extracorporeal circulation uses a heart-lung machine to circulate blood and supply oxygen when a patient's heart briefly stops during cardiac surgery. With about 17,000 PAs in Korea, they have been substituting for these tasks after residents left hospitals for 1 year and 7 months due to the doctor-government conflict.
PA nurses have long operated on the fine line between legal and illegal because there was no relevant law. The Nursing Act that legalized PAs was enacted in Sep. last year. A ministry official said, "The rules on the performance of PA nurses' tasks, which are of high interest on the ground, were put out for legislative notice after additional discussions."
Going forward, PA nurses can draft preliminary versions of medical certificates and treatment, surgery, and anesthesia records. They can also perform skin suturing and knot tying, subcutaneous tissue incision, peripheral arterial catheter insertion, and bone marrow puncture. In relation to extracorporeal circulation, they can operate heart-lung machines and auxiliary equipment. A ministry official said, "PA nurses can perform 43 detailed acts across three categories: patient assessment and documentation/prescription support, procedure and treatment support, and surgical support and extracorporeal circulation."
However, chest tube insertion is not included in the scope of PA nurses' duties. Chest tube insertion is a procedure to insert a tube into the pleural cavity, the space between the lung and the chest wall, to drain air, fluid, or blood. A ministry official explained, "Chest tube insertion is a highly advanced medical act and was therefore not included," adding, "Assistance with chest tube insertion could be added, but field feedback noted that general nurses—not only PAs—can do it, so it was excluded."
Beyond the 43 detailed acts, there may be tasks that PAs have been performing in the field. In such cases, if a hospital reports them within three months of the effective date of the notice, PA nurses may perform those tasks for 1 year and 3 months.
PA nurses must have at least three years of clinical experience at a hospital, general hospital, or military hospital. They also must meet training completion requirements. Even with less than three years of clinical experience, continuous performance of patient care assistance for 1 year and 6 months will be deemed to satisfy the experience requirement.
Only hospitals and higher-level institutions that have obtained medical institution accreditation under the Medical Service Act may employ PA nurses. Dental hospitals, Korean medicine hospitals, and psychiatric hospitals are excluded. PA nurse education can be provided by medical organizations such as the Korean Nursing Association (KNA), the Korean Medical Association Organization, and the Korean Hospital Association, as well as general hospitals with 300 or more beds and advanced practice nurse training institutions. Programs will include theoretical and practical training and on-site practice, and the hours and content will be further discussed.