The Dissonance Over the Enactment of Nursing Law

기사승인 2022.08.10  19:46:10

The Nurses of Inha University Hospital

On 12th May 2022, the world celebrated the 51st International Nurses Day in recognition of the professionalism and dedication of nurses. During the past two years of COVID-19, nurses have contributed a lot; therefore, they were expected to take a break and enjoy International Nurses Day. However, instead of taking a rest, many nurses held a rally in Seoul city. The nurses who attended the rally claimed the establishment of "Nursing Law," independent from the Medical Service Act to clarify the scope of their work and improve their working conditions. Society respects the nurses' devotion to social well-being; however, the nurses generally do not receive adequate investment from the government and the Ministry of Health and Welfare. Of course, there are some counterclaims to the nurses' point of view. We will find out about what the Nursing Law is, and the opinions of each party about this law.


What is “Nursing Law”?

The Nursing Law is an independent law enacted by transferring nursing-related matters from the category of medical practices that are comprehensively regulated by the current medical law. It is a law that systematically regulates matters related to the scope of nursing work, training and supply of nursing professionals, and improvement of their working conditions. The establishment of this law reflects the nurses' diversified, segmented, and specialized roles in a rapidly-changing healthcare system. At this point, the aging population is rapidly aging and chronic diseases are spreading, which leads to a growing demand for professional nursing services. Contemporary nursing services are expanding to long-term care institutions, senior welfare centers, as well as families. However, there is a need for a new management system because the current medical law is focused on occupations with higher qualifications, such as doctors, dentists, and oriental doctors. In particular, as COVID-19 becomes a long-term pandemic, the poor working conditions and treatments of nursing personnel— which the public has not been aware of— have come to the surface. Therefore, in addition to the existing medical law, the demand for establishing a legal device that can solve the practical problems of nursing personnel became stronger. The number of nurses in Korea is also less than the OECD average. According to the 2018 OECD worldwide statistics, there are generally 9.5 nurses per 1,000 population. However, in Korea, the number of nurses is 6.9 per 1,000 population, which is 2.6 less than the OECD average. Thus, in many other countries, one nurse generally takes care of 4-5 patients; however, in Korea, one nurse takes care of 20-30 patients.



This heavy workload has come about because only half of the licensed nurses in Korea are currently working; the other half decided to devote themselves to other careers due to the poor work conditions of nurses in Korea.

The most crucial reason that nurses have argued for their Nursing Law is the "scope" of the nursing duty. The current medical law does not particularly specify the role and authority of nurses. According to the role of nurses mentioned in Article 2, Paragraph 2, No. 5 of the Medical Act, the scope of the nurses' duties is to assist in medical treatment conducted under the guidance of doctors, dentists, or oriental doctors. Professional nurses currently work in a wide range of fields, including home care, infection control, geriatrics, anesthesia, and healthcare; however, the law only gives them the title of "assistants."


Issues in the Nursing Law Controversy

As mentioned previously, the current medical law does not specify the duties of the nurses, so the nurses' expertise is not recognized by law. Therefore, it is difficult for the nurse's capability to be used to the maximum. In addition, since the scope of their duties is not specified, each institution of authority interprets the role of nurses differently. For example, according to the Ministry of Health and Welfare, a nurse's medical assistance activities include simple questionnaires, blood sugar level measurement, injections, blood collection, surgery assistance, and treatment assistance (such as securing blood vessels and urinary ducts). However, judicial institutions such as the Supreme Court and district courts claim that nurses' work is performed only under the guidance of a doctor. As such, the scope of responsibilities for nursing duties is not clearly defined, which could be problematic if medical malpractice occurs. In addition, according to the expansion of nursing services, the locations of nurses' workplace has expanded from medical institutions to schools, daycare centers, rehabilitation facilities, and welfare facilities for the elderly. Despite their dedication, the National Medical Act does not recognize the professionalism of nurses.

Main Contents of the Nursing Law

Some of the main contents of the law include clarification of the scope of nurses' work, the establishment of a comprehensive nursing plan every five years, a thorough survey of the work condition every three years, and an arrangement of appropriate and qualified nurses for patient safety.  To list some of the other major items, the law includes the establishment of basic guidelines for treatment improvement, provision of adequate financial resources, investigation of human rights violations for nurses, and imposition of education obligations.

If nurses were not limited to nursing work in the medical institution but were allowed to perform expanded roles in various fields, it would be possible to reduce the number of nurses leaving the medical field. In this way, nurses would be able to pursue their careers and further demonstrate their expertise without leaving the field.

The nursing law, which would become a standard for the nurses' duties, has been developed by reflecting on the role of nurses in the modern healthcare environment.

Therefore, if this law is enacted, the scope of nurses' work would be clearer and nurses would provide safer and higher-quality services.


The General Public Reaction to the Nursing Law

In March 2022, when the Korea Consumer Federation conducted a survey of 1,500 citizens in their 20s along with 301 nationwide healthcare workers, 83.0% of the respondents agreed with the need to enact the independent nursing law.

Among them, 42% cited the most crucial reason for needing the nursing law is because the current medical law does not stipulate the role of job contents of nurses.

In addition, 23.0% answered that independent law is needed to specify all of the currently expanding roles of the nurses. 21.0% answered that the law is necessary to clearly define the scope of nursing responsibility. 13.6% answered that the enactment of this law would stimulate a stable supply of professional nurses based on licenses and qualifications. However, although the general public agrees with the necessity of enacting the law, they only had a mere interest in the revision movement. This situation shows that active publicity is required. When the same survey institution asked whether the citizens knew that the enactment of this law is currently being debated in the National Assembly, 81.5% of the respondents answered that they do not know. Thus, 83.3% of the respondents answered that they do not know about the details of the nursing law currently proposed in the National Assembly. In summary, citizens in their twenties generally agree on the necessity of the independent nursing law. However, their awareness of movements and details is very low; therefore, active advertising efforts are required.


Parties Against the Nursing Law and Their Point of View

Despite the benefits and necessity of the Nursing Law, many medical personnel parties are against the approval of this law. These parties include doctors, nurses' aides, and emergency medical technicians (EMTs).

Doctors Holding an Assembly Against the Enactment of Nursing Law

When a nurse's duty changes from "assistance of medical care under the guidance of a doctor" to "work necessary for patient care under a doctor's prescription," the nurse's sole medical practice may not adequately respond to the patient's emergency claim. In addition, the doctors point out that medical practice is originally meant for all medical staff to work together to produce the best results. They suggested that enacting a law exclusively for nurses could lead to inequality in the treatment of other medical staff. Pil-soo Lee, the president of the Korean Medical Association, claimed that the Nursing Law ignores and excludes the voices of other healthcare professionals but only prioritizes nurses. Dr. Lee contends that the best medical service can be implemented through the collaboration of various professional workers in the current medical system.

However, if the Nursing Law is enacted separately from the Medical Act, the existing medical order would collapse. Eventually, the medical systems protecting public health would fall through. Although the doctors agree that the treatment of nurses is poor and requires improvement, the enactment of the Nursing Law may cause professionals to infringe on each other's domain and cause confusion in the healthcare sector. In the case of nurses, the current medical law clearly defines the business supervision relationship of "assistance of treatment under the guidance of a doctor" to distinguish the nurses' tasks from the medical practice of doctors. However, the proposed Nursing Law allows nurses to independently perform treatment tasks by the change in the working of "assistance of treatment" to "work necessary for patient care." Therefore, many doctors are concerned that in the not-too-distant future, a nurse would be able to open and run an independent clinic.

To briefly describe the difference between a nurse's aide and a nurse, the nurse's aide performs auxiliary processing under the guidance of a nurse. In addition, becoming a nurse's aide does not require a degree but a certificate; becoming a nurse requires a Bachelor's degree and a license. The Nurse's Aide Association is one of the internal organizations in the nursing profession. The members of the Nurse's Aide Association are dissatisfied that they are to be excluded from the nursing law associated with the Nurses Association, therefore the content of the law did not elicit the aides' agreement or empathy. The nurse's aides do not disagree that the role of nurses will expand along with the paradigm shift in healthcare, especially in this aging society. Instead, the nurse's aides argue that the problems of current nurses can be solved by revising the existing Medical Act. As nurse's aides are also a party to poor treatment, the association claims that the Nursing Law should contain articles that would also address the nurse's aides. In the worst case, if the Nursing Law were enacted, the nurse's aides could lose their jobs or become criminals by practicing unlicensed nursing. However, the Nurses Association does not agree with the arguments of the Nurses Aides Association. Since the establishment of the Nurses Association, nurse's aides have been "human resources" to assist nurses in their tasks. The Nurses Association contends that if the law were enacted, the value of nurses would be properly evaluated and the wages would rise, which would eventually lead to an increase in the wage of the nurses' aides as well.

Similar to the difference between a nurse's aide and a nurse described previously, paramedics also require a license. Paramedics are people who majored in emergency rescue from a 3/4-year university and obtained a certificate by taking the national exam. The role of the paramedics is to perform emergency tasks such as consultation, rescue, transfer, and first-aid in case of an emergency. The paramedics pointed out that if the nursing law were enacted, the nursing practices of paramedics such as the 911 paramedics and the marine police could all be considered "unlicensed nursing." They also argue that the Nursing Law infringes on the work of the paramedics. According to the law, the work of emergency professional nurses includes emergency classification, consultation, management, and treatment of patients, which overlaps with the work area of paramedics as well as that of Emergency Medicine (ED) doctors. All in all, the Paramedics Association opposes the Nursing Law, arguing that the enactment could lead to a complete loss of the necessity and the professionalism of the paramedics.

Most of the members of the medical field are ready to end the conflict; it has been dragging on for a long time. The conflict between each occupation, including the scope of work of medical personnel, can be viewed as a turf war by the public. Accordingly, criticizing each other and raising their voices could only cause tiredness in the general public. An official from the medical field pointed out, "If medical personnel, who should be collaborating to show their utmost capability, are arguing for their own benefits, who would be able to trust us and receive treatment?"

Therefore, many medical professionals claim that it is now the time to reach an agreement; the medical field and the nursing field should now find a solution to satisfy both parties.


Cases in Other Developed Countries

As many as 90 OECD countries have independent Nurse laws, which helped to improve awareness and treatment of nurses. In many countries, nurses are legally recognized as professional medical personnel. They even play a role in primary care in addition to prescribing and managing medications for chronic disease, diabetes, respiratory disease, and obesity.

Nurses' prescriptions are practiced in some European countries, the United States, New Zealand, and Australia. Of course, nurses' prescriptions for medicines are somewhat limited; however, these countries evaluate nurses' prescriptions positively because it helps to improve patient health. In some countries such as the United States, nurses do not only prescribe medicine— they can also open individual clinics. In a clinic that provides primary care, the first medical professional a patient encounters is a nurse. The nurses treat patients and send them to higher-level institutions if needed. Howard Kent, UN Secretary-General, explained the merits of enacting the Nursing Law by saying "Nurses first meet and select patients who need to see a doctor in person, thereby increasing efficiency and reducing medical costs nationwide."

Admittedly, many advanced countries have independent nursing laws; however, these countries also have separate laws for other medical professionals such as doctors and dentists. Therefore, the opponents of this law claim that the situations of these advanced countries and that of Korea are completely different. In addition, according to the Medical Association's survey, only 11 countries in the OECD have a single law about nursing without laws regarding other medical professionals. This accounts for only 30% of the total number of OECD countries.

The Medical Association asserts that the poor working condition of nurses is not due to the lack of a Nursing Law, but rather due to low medical fees. Thus, the Medical Association puts forth the analysis that it is necessary to adjust medical fees to induce reasonable compensation for nurses and appropriate staffing.

Medical Staffs

If the Nurses Law is enacted, nurses would have an improved sense of identity as independent nurses. Thus, they would obtain guaranteed legal status, and experience an improvement in the social perception of nurses. This may serve as an opportunity to provide higher quality and safer medical services to the public. However, the medical field is a place where numerous medical professionals such as doctors, dentists, nurses, nurse aides, and paramedics work together to ensure the health of the people. Hopefully, the treatment of all medical staff who have always been by our side for our well-being, and who have struggled at the forefront in the past two years due to the spread of COVID-19, would be improved as a whole.


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