'To enhance primary care, Korea should strengthen nursing assistants' capabilities'

As Korea has become a super-aged society, the scope of community healthcare institutions is expanding beyond hospitals to include patients' homes.

With the upcoming implementation of the “Act on Integrated Support for Regional Care, including Medical and Long-Term Care (Care Integration Support Act),” preparations are also in full swing in the medical field. Interest in home healthcare and care services among medical professionals is at an all-time high.

The problem is that the legal framework does not reflect reality. Currently, over 80 percent of the nursing workforce at medical clinics is nursing assistants. In the vast majority of “neighborhood clinics,” which are single-physician practices, these nursing assistants are indispensable for at-home care. However, they are excluded from various personnel standards, including the fee system for home visits.

“Nurses and nursing assistants must be treated as a single unit of nursing personnel in both integrated care and related legal systems,” said Professor Lee Ju-yul of the Department of Health Administration at Namseoul University, who met with journalists last week.

Noting that the recently implemented Nursing Act is a “nursing workforce law” rather than a “nurse law,” Profess Lee emphasized the need to redesign the roles of nursing personnel based on this law and to “strengthen the capabilities of nursing assistants as part of efforts to enhance primary care capacity.”

"The role of doctors is becoming more specialized and sophisticated. The same applies to nurses. However, they cannot continue to perform their current duties and roles as they are,” Lee said. “Some of the doctors' duties should be taken over by nurses, and some of the nurses' duties should be taken over by nursing assistants to fill the ‘gaps’ that arise in the process of specialization and sophistication."

To this end, Professor Lee stressed that the training and education of nursing assistants must be systematized. Currently, the primary training program for nursing assistants is a one-year vocational school course. There are no standardized textbooks or educational standards in place.

“Under the current system, it is difficult to expect nursing assistants to have the capabilities to replace nurses in primary care settings,” Lee pointed out. “The training program should be systematized and standardized, and existing personnel should be provided with practical, job-focused education.”

Lee also proposed establishing a two-year training program and categorizing nursing assistants into two levels — Level 1 and Level 2 — to enhance their job capabilities. While acknowledging that “not all nursing assistants can perform roles equivalent to nurses,” he emphasized that if nursing assistants meet certain qualification requirements, they should be able to participate in various community care activities, and this should be explicitly stipulated in the institutional framework.

“If the Ministry of Health and Welfare pays a little more attention, it will be possible to strengthen the professionalism of nursing personnel and secure an efficient personnel structure appropriate for the era of care,” Lee said, proposing the formation of a cooperative task force between the ministry, the National Assembly, the Korean Nursing Association (KNA), and the Korean Licensed Practical Nurses Association (KLPNA).

In addition, he said that the KLPNA should establish a mid- to long-term plan and take strategic action to improve the education system, career development, role definitions, and public perception.

He also emphasized the role of the medical community. “Just as the education of physician assistants (PAs) being discussed in the process of implementing the Nursing Act should be centered on the medical community, the participation of the medical community is essential in standardizing and systematizing the education of nursing assistants.”

Improving the treatment of nursing assistants is also an indispensable task. Lee predicted that if skilled personnel do not stay in local communities, the burden on medical institutions will increase when home healthcare services are expanded, and it will be difficult to prevent a decline in efficiency and quality. He claimed that this should be viewed as an investment in the sustainability of primary healthcare that transcends professional boundaries.

The government must also take proactive steps to strengthen compensation for medical institutions to enhance the quality of care provided by nursing assistants and establish support systems.

“If this is left solely to the discretion of individual medical institutions, it will only increase their burden. To ensure that communities can access high-quality medical and care services, there must be a social consensus that we must be willing to pay for them accordingly,” Lee emphasized, expressing hope that the Lee Jae Myung administration will adopt this as a new agenda for the healthcare sector and proceed with public discussion.