In recent months headlines have been screaming about “sweatshop hospitals.” Registered nurses, resident doctors and interns from various medical facilities have been complaining about the conditions they are expected to work under. Some have even taken their stories to US-based news network CNN.
Taiwan’s apparently wonderful national health insurance system, it would seem, is based on the work performed by medical staff in these “sweatshop hospitals.” How these hospitals are run has a direct impact on the quality of treatment and in the end it is the patients who are most affected. However, medical staff have worked under these conditions for many years now and a high level of medical treatment has still been maintained.
Apart from the way these “sweatshop hospitals” have managed to keep going, advanced practice registered nurses (APRNs) have played an integral role in the maintenance of a high standard of medical treatment in Taiwan.
The practice of having APRNs started in the US. The continuous and comprehensive nursing and medical care that they provide, side by side with doctors, is especially important to critically ill patients. Due to a lack of resources, critical-care doctors have to struggle to divide their time between the operating theater, the emergency room and the examination room. Also, as residents are not always very decisive when it comes to treating critically ill patients, it is often APRNs who provide the best support for critical-care physicians. APRNs also care for critically ill patients in intensive care units (ICUs), under the supervision of the critical-care physicians.
When the condition of patients in the ICUs change, APRNs can draw on their wealth of clinical experience to diagnose the nature of this change. When critical-care physicians are unable to be at the scene to see a patient, APRNs can communicate the details of the situation to them. In this way, they can help make up for the lack of critical-care residents.
Taiwan is losing a lot of its registered nurses, especially those in their first year and their fifth to 10th year of service. APRNs start out as senior nurses and get their positions after they go through strict training and pass national examinations. They are therefore paid slightly more than other nurses and, as a result, the position of APRN offers nurses a way in which they can advance their careers, giving them a chance to move on from the normal nursing system.
This chance for career advancement is an attractive option to less senior nurses and this can also help stem the flow of nurses away from the sector. In addition, the clinical experience that APRNs have means they can act as mentors to less senior nurses, as well as being able to assist in the care of critically ill patients. This mitigates, to an extent, the lack of nurses we have to care for the critically ill.
Many hospitals in the US have APRNs and they are starting to become more common in Japan, where the initial emphasis was on having them for the critically ill. After two decades of development here, there are now many APRNs in Taiwan. Apart from helping compensate for the lack of critical-care physicians as well as nurses for the critically ill within Taiwan’s medical system, APRNs have become an important part of the maintenance and improvement of the quality of critical medical care in regional hospitals and medical centers all around the country. Establishing a proper system for APRNs would effectively ease the burdens of Taiwan’s “sweatshop hospitals.”
Lin Pyng-jing is a professor of surgery at Chang Gung Memorial Hospital.
Translated by Drew Cameron.
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