Enactment of the Nursing Act: Why is It Controversial?

Enactment of the Nursing Act: Why is It Controversial?

I. Abstract

Nurse as a profession around the world first emerged as a means to cope with the shortage of doctors. In more recent years, however, nurses have begun to be recognized as the central workforce in healthcare and since then nursing regulations have developed to better reflect such change. Yet as of July, 2022, South Korea does not have an independent law that prescribes the duties and rights of a registered nurse. The COVID-19 pandemic brought attention to the inherent problems of Korea’s      nursing system, thereby promoting discussions on the legislation of the Nursing Act. This paper introduces some of the most controversial Articles of the Nursing Act bill proposed by Rep. Kim Min-seok (Democratic Party of Korea) and how the alternative draft constructed after the discussions at the Review Subcommittee of the Health and Welfare Committee differs from its original version. Following that, the dynamic of the debate on the Nursing Act will be studied. Finally the paper suggests what it deems as fundamental solutions to the problems addressed earlier and shares a brief outlook on the Nursing Act.

II. Introduction

The issue of legislation of a new law called the Nursing Act has sparked fierce controversy in Korea since its proposition in the 21st National Assembly on March 25, 2021. In particular, the Korea Medical Association (KMA) which represents about two-thirds of the nation’s doctors and the Korean Nurses Association (KNA) have clashing opinions on the issue, with the former opposing and the latter demanding legislation.

Although the bills may differ in detail, the Nursing Act aims to designate the roles and duties of nurses by law and to establish a legal basis to improve their working conditions including salaries and working environment.

On May 17, 2022, the Health and Welfare Committee at the National Assembly approved the bill on the Nursing Act proposed by Rep. Kim Min-seok of the main opposition Democratic Party of Korea. However, it then was not approved by the Legislative and Judiciary Committee, closing down further discussion on the bill in the Assembly’s first half term of the year.

It is predicted that the Nursing Act again will be a contentious issue in the second half term for it being the center of conflicts between different types of health professionals and experts, and in politics and in society. This paper examines the details of the aforementioned bill and the dynamics of the debate surrounding the enactment of the Act. Subsequently, it goes on to suggest a direction in which the debate should be headed towards for the matter of the common good as well as the interests of both nurses and doctors.

III. Legislation of the Medical Service Act and Calls for the Nursing Act

Enacted in 1951, Nation’s Medical Service Act (NMSA) was the first medical law to be legislated since the establishment of the Republic of Korea.[1] Article 2 of the NMSA stipulated three types of healthcare personnel: (1) doctors and dentists, (2) oriental medicine doctors, and (3) public health nurses, midwives, and nurses. According to Article 1, the scope of nursing service was limited to care of injured or sick people and assisting with medical treatment. This remained the same in the newly named Medical Service Act of 1962. However, the 1982 iteration expanded its scope to the present form, including the care of postnatal women and conducting of health activities prescribed by the Presidential Decree in nursing activities. In 1973, different nursing specialties were determined for the first time via a ministerial decree: public health nurse, nurse anesthesiology, and mental health nurse.[2] In 1990, two more specialties, nursing assistants and homecare nurses, were added. Currently in Korea there are a total of thirteen nursing specialty areas legalized by different enforcement decrees. The increase in the number of nursing specialties is generally viewed as a development that properly reflects the aging society Korea is becoming and the various chronic illnesses that come with the phenomenon.

Since 1977, the Korean Nurses Association has begun to make voice toward the enactment of the Nursing Act which designates the rights and duties of nurses solely. After a series of bills proposed in the Assembly was scrapped without hardly any thorough deliberations on, the Nursing Act for the first time was put on the table for discussion on the Health and Welfare Committee in March, 2021.[3] The bill was proposed by Rep. Kim Min-seok of the main opposition Democratic Party of Korea along with two other similar bills written by Rep. Seo Jeong-seok and Rep. Choi Yeon-seok of the ruling People Power Party. The problem of health workforce shortage and overwork during the COVID-19 pandemic served as an impetus to the action.

On May 17, 2022, the Health and Welfare Committee approved the bill. However, it did not get approved by the Legislative and Judiciary Committee during the general meeting held on May 26, stopping it from being put to vote.[4] Nevertheless, the disputes surrounding the Nursing Act are still ongoing for the reason that it is likely to be a re-emerging issue in the following terms of the 21st National Assembly.

IV. Article 16 and Article 12 of the Nursing Act and the Alternative Bill

On a more specific level, Article 16 is the main component of Rep. Kim Min-seok’s bill that has aroused antagonism among non-nurse groups.[5] Article 16 (Prohibition against unlicensed nursing services) prescribes as follows: 1Anyone that is not a registered nurse shall not perform nursing services according to Article 12; and even nurses shall not perform any nursing services other than those licensed. (the rest omitted)

Article 16 simply changed the terms “medical personnel” and “medical practices” in Article 26 of Medical Service Act currently in force to “registered nurse” and “nursing services” respectively. This alteration legally prohibits all types of healthcare providers except nurses from practicing nursing tasks. Article 12 below lists the range of “nursing services”. Items 1 through 4 are identical to Items 가 through 라 in Article 2 of the Medical Service Act, and Item 5 was newly added.

Article 12 (Nurse’s duties) A nurse has the mission to perform the following duties:

  1. Observation of a patient at his/her request for nursing, collection of data, making judgment on nursing, and nursing for convalescence;
  2. Provision of assistance in medical treatment under the guidance of a physician, dentist, or oriental medical doctor;
  3. Provision of education and consultation to a person in need of nursing, planning of health promotion activities and implementation thereof, and other health services prescribed by Presidential Decree;
  4. Guidance on the assistance in the duties referred to in items 1 through 3 performed by an assistant nurse;
  5. Guidance on the assistance in the duties referred to in Article 15 performed by a care worker.

Afterwards, the alternative bill made major changes to the original amendment. Rep. Kim’s bill initially stipulated that nurses should perform their duties “in accordance with the patients’ needs” in Item 2 of Article 12; this in particular was the hot button for it could be interpreted as having eliminated the need for “guidance of a physician, dentist, or oriental medical doctor.”[6] However, in response to the requests of the Ministry of Health and Welfare and the Health and Welfare Committee, it was later changed to accord with the scope of nursing defined in the current Medical Service Act.[7] Also, the alternative bill removed Article 16 of the original bill entirely. Article 30 (Prohibition of Infringement on Rights of Nurses) was newly added to prevent anyone from causing physical or mental harm to a nurse; it clarifies the obligations of institutions’ superintendents to prevent any violation of nurses’ rights and the obligations of the Minister of Health and Welfare to plan and implement relevant training programs and investigation for the same purpose.

V. Contrasting Opinions on the Nursing Act

Although the Act re-stipulated that nurses can carry out medical treatments to patients only by assisting doctors, the Nursing Act’s disputes are still ongoing for various reasons. It should be noted that the following are more relevant to Rep. Kim’s original bill than the alternative one.

  1. Support for the Act

The Korean Nurses Association is the representative group that has been urging lawmakers to pass the bill. Members claim that the comprehensiveness and ambiguities of the Medical Service Act fail to protect nurses from frequently working overtime and doing work that is outside their job descriptions, ultimately resulting in lower quality care for patients.[8] The association explains that in Korea each nurse takes care of 11 to 18 patients while the OECD average is six to eight. In a rally held on November 23, 2021 in front of the National Assembly, Shin Kyung-rim, head of the KNA, explained that at present 90 countries including the United States, China, Japan, Canada, the United Kingdom, and Taiwan have Nursing Acts and that Korea’s 460,000 nurses and 120,000 nursing students will continue to fight for the enactment. Another point the KNA emphasizes is that, by providing a legal basis for nurses to practice medical care based on their professionalism and utilize their expertise to the fullest, people’s rights to health will be more effectively guaranteed.

  1. Opposition to the Act

On the opposite side of the KNA are other medical groups such as the Korea Medical Association, Korean Dental Association, Korea Care Association, and the Korean Licensed Practical Nurses Association.[9] Lee Pil-Soo, head of the Korea Medical Association, expressed concern that some of the bills’ clauses—such as Article 16 and 12 before the changes—would only benefit nurses while unjustly compromising the interests of doctors and other health practitioners. Specifically, he said that the Act may allow nurses to run their own medical clinics as well as not allow doctors to engage in activities mentioned in Article 12 such as “observation of a patient at his/her request for nursing,” “collection of data,” and “provision of education and consultation to a person in need of nursing.” Furthermore, the medical world fears that once the Nursing Act is enacted provisions might continue to be added, and if an independent law is made for each kind of medical personnel, Korea’s health care system may collapse.

VI. Conclusion

The outbreak of COVID-19 helped raise awareness of the concentration of population in large cities’ hospitals, nurses’ experiences of heavy workloads, and shortages of staff and equipment. Regarding the shortages in the nursing workforce, merely raising the quota of nursing students in universities has been proven very ineffective. The number of universities across the country that has a nursing department increased from 127 to 203 over the ten years between 2006 and 2015. License holders dramatically grew in number as well from 10137 in 2006 to 17505 in 2016.[10] What must be noted instead is that 45.5% of the approximately 20,000 new graduate nurses leave their jobs within one year (Hospital Nurses Association 2020). Therefore, policy implementations that reflect the relatively low level of nurses’ job satisfaction and the numerous instances of turnover/leaving the job are urgently called for. Operation of a flexible working hours scheme, devising ways for small and medium-sized hospitals to make more profit so nurses working there can be paid what they deserve, and deploying professional counselors to hospitals to help nurses better cope with mental stress are just a few.

Meanwhile, the legislation of the Nursing Act is bound to remain a polarizing issue. The Articles accountable for most disagreements, Articles 16 and 12, have been deleted, but it seems insufficient to assuage concerns for potential similar bills and amendments. The necessity and the contents of the Nursing Act is a topic that would continue to require active sharing of opinion to the point where an optimal balance is reached between the division of responsibilities among medical personnel and the betterment of nurses’ working conditions. Once a consensus is built, either an independent law for nurses or at least some changes to the existing Medical Service Act could be made and benefit as many as possible.

 

Works Cited

Ha Kyung-Dae, 간호법 원안 대비 수정 대안에 간호사 권리 추가, 논란 부분은 대폭 삭제, Mediagate News, https://www.mediagatenews.com/news/4020355718 (July 10, 2022)

Ha Kyung-Dae, 간호사 단독법 무엇이 문제인가의사가 간호 업무하면 위법?, Medigate News, https://medigatenews.com/news/1291943726, (July 9, 2022).

Heo Nam-seol, Min, Seo-young, 의사들은 간호법에 반대하나, The Kyunghyang Shinmun, https://ww.khan.co.kr/national/health-welfare/article/202205111728011

Kang, Sun-Joo and Kim, In-sook, Development Of The Korean Nursing Profession With Changes In Its Legal Basis, International Journal Of Nursing & Clinical Practices, Graphyonline Publications PVT, Ltd., Vol. 3, No. 1, 1, 2, (2016).

Lee Hyo-jin, Nurses And Other Medical Workers Clash Over Nursing Act, The Korea Times, https://www.koreatimes.co.kr/www/nation/2021/11/113_319487.html (July 8, 2022).

Lee Hyo-Jin, Why Doctors Oppose Nursing Act Legislation, The Korea Times, https://www.koreatimes.co.kr/www/nation/2021/11/113_319487.html, (July 9, 2022).

Medical Service Act, Enforcement date 17 Aug, 1973, Act No.2533

Park Sun-jae, 간호사 인력 부족, 해결 안되는 이유는?, Medical Observer, http://www.monews.co.kr/news/articleView.html?idxno=94693

 

 

[1]  Kang, Sun-Joo and Kim, In-sook, Development Of The Korean Nursing Profession With   Changes In Its Legal Basis, International Journal Of Nursing & Clinical Practices, Graphyonline Publications PVT, Ltd., Vol. 3, No. 1, 1, 2, (2016).

[2] Medical Service Act, Enforcement date 17 Aug, 1973, Act No.2533

[3] Lee Hyo-Jin, Why Doctors Oppose Nursing Act Legislation, The Korea Times, https://www.koreatimes.co.kr/www/nation/2022/05/119_329380.html, (July 9, 2022).

[4] Ha Kyung-dae, 간호법 원안 대비 수정 대안에 간호사 권리 추가, 논란 부분은 대폭 삭제, Mediagate News, https://www.mediagatenews.com/news/4020355718 (July 10, 2022)

[5] Ha Kyung-dae, 간호사 단독법 무엇이 문제인가의사가 간호 업무하면 위법?, Medigate News, https://medigatenews.com/news/1291943726, (July 9, 2022).

[6] Op. cit

[7] Heo Nam-seol, Min Seo-young, 의사들은 간호법에 반대하나, The Kyunghyang Shinmun, https://ww.khan.co.kr/national/health-welfare/article/202205111728011

[8] Lee Hyo-jin, Nurses And Other Medical Workers Clash Over Nursing Act, The Korea Times, https://www.koreatimes.co.kr/www/nation/2021/11/113_319487.html (July 8, 2022).

[9] ibid.

[10] Park Sun-jae, 간호사 인력 부족, 해결 안되는 이유는?, Medical Observer, http://www.monews.co.kr/news/articleView.html?idxno=94693

 

cinnacha@naver.com

Posted in Autumn 2022.