The government says it will consider using physician assistant (PA) nurses to fill the healthcare gap caused by the mass resignation of junior doctors, but most hospitals do not see it as a realistic option.

That’s because PAs are already working in hospitals, but the legality of their practice is ambiguous. Moreover, medical sources said there are currently no legal safeguards if problems occur due to delegating some of the doctor's duties to these nurses.

Last Thursday, Second Vice Minister of Health and Welfare Park Min-soo appeared on MBC Radio's talk show, saying the government would take measures to allow PAs to take a more active role in the event of a hospital strike by interns and residents.

However, hospitals are not considering using PAs as they are operating an emergency care system centering on specialists by, for instance, reducing scheduled tests and surgeries and accelerating the discharge of inpatients since the strike began on Tuesday.

"Most hospitals have reduced the number of patients. They are not considering PA nurses as replacements to fill the medical gap caused by the mass resignation of specialists," said a surgeon at a university hospital in the Seoul metro region in a telephone interview with Korea Biomedical Review.

It is no secret that PA nurses are already working in the clinic. Still, the professor said there are no deviations from the existing range of their duty or additional tasks, adding that if the situation is prolonged and difficult to handle, his hospital will also have to “drastically reduce outpatient treatment.”

An official from a university hospital in South Jeolla Province said, "We have already reduced hospitalizations and surgeries by 30 percent. Depending on the situation of each department, we plan to recommend discharge for stable patients. The situation is not urgent enough, at least for now, to use PA nurses to replace doctors.”

The official said that the hospital has no PAs to do any additional work beyond what they were already doing, adding that they were discussing (expanding Pas’ duties) in case the prolonged strike saturates the faculty’s capacities.

Reporting centers for ‘illegal orders’ reflect growing anxiety among nurses

Nurses are feeling increasingly anxious. Some hospital unions have issued "emergency protective measures" to respond to illegal medical orders following the mass resignation of junior doctors and are preparing "self-safety devices" by setting up reporting centers.

"In the case of SMG-SNU Boramae Medical Center, some intern tasks, such as dressing and culture, are being delegated to nurses," said Park Na-rae, secretary-general of the Seoul National University Hospital Branch of the Medical Solidarity Headquarters. "In the intensive care unit, there are nurses exclusively responsible for treatment in place of interns, and I heard their work domain is expanding."

Park acknowledged that as a nurse, it's hard to say “no” because the patient is right in front of them.

"You can't say it's not your job and leave the patient unattended. When there is an emergency or CPR, how many nursing staff can say, 'I can't do it because it's a doctor's job?'” Park said. “If nurses are forced to do something illegal although they refuse to do it, they will have no choice but to take a hardline stance, such as protesting the hospital authorities."

A union official at Asan Medical Center said, "Yesterday, we set up a report board, but we haven't received any reports nor found any illegal orders. There is an atmosphere of concern that nurses might be assigned to doctors’ work. We visited the nursing department and asked them not to replace other workers."

A Korea University Ansan Hospital nurse said, "I feel that nurses and patients could be harmed, like shrimps getting hurt as whales fight. The government says it will use PA nurses as substitutes, but it is difficult for nurses to agree to it when legal protection is difficult."

There is no condition or standard that only professional nurses with more than a few years of experience can become PA nurses, and even new nurses can also become PA nurses, the nurse said, adding that if there are unfair work instructions to nurses, the union will monitor them.

The Korea Nurses Association also said that more than 100 cases have been reported to the central center receiving reports of unfair work orders since the mass resignation of medical residents, adding that its task force is analyzing the reports and will discuss and announce a response plan.

"Before issuing illegal medical orders to PA nurses, the scope of nurses' duties should be delineated legally, and a legal protection system should be put in place," the association said.