Development of Clinical Nurse Specialist in Taiwan: Issues and Suggestions

近年來，由於疾病型態的改變，健保制度的實施，我國的醫療體系生熊亦隨之改變。 為了維持醫療生態的平衡，為了配合民眾健康需求，更為了在成本-效益之間維持平 衝點，各醫療機構引進醫師助理(PA)，以接替住院醫師部分的工作。而護理界近年來 由於教育的提昇，則比較希望積極的推動專科護理師(CNS)的制度，以接替住院醫師 部分的工作。因此，未來的醫療團隊成員如何來重新定位角色與功能，成為醫護人員 一直關切的議題。本文謹就這些議題把美國的進階護理發展過程加以說明，並與台灣 的狀況加以比較，再提出未來台灣要發展專科護理師的建議。希望本文能夠澄清醫護 界的疑惑，使得發展專科護理師的過程能夠順利些。終久，專科護理師制度的建立， 受惠最大的是需要醫療服務的對象──民眾。 In recent years, many changes have occurred in Taiwan’s Health Care Delivery System, including the predominant types of disease, the inauguration of National Health Insurance, and concepts of cost-effective hospital management. In order to maintain a balance between public needs in health care and cost- effective hospital management, a new health care team member , the physician assistant (PA), was introduced by physicians to take over aspects of the role originally played by resident physicians. The nursing profession, however, have a preference for the development of a Clinical Nurse Specialist (CNS) for taking over aspects of the traditional resident physician’s role. Accordingly, the roles of the PA and CNS are important issues for discussion between physicians and nurses. This article discusses the development of advanced practice nurse in the U.S.A and compares the issues in the U.S.A and Taiwan. Finally, suggestions are made for developing a CNS system in Taiwan. It is believed that the beneficiaries of a CNS system will be the health care system utilizing public.