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Advocating for Implementing a Nurse Practitioner System in Korea

In April 2023, David (Hyunmin) Yu, MSN, RN, AGACNP-BC, CCRN, TCRN, Nurse Practitioner in the PPMC Medical Intensive Care Unit, was invited to Seoul, South Korea, to speak at the largest national critical care medicine conference in South Korea, organized by the Korean Society of Critical Care Medicine.

By Sara Rubins and Bridget McQuate, Penn Presbyterian Medical Center 5 Things to Know Newsletter

As Korean hospitals are now facing significant staffing challenges and show an interest in a Nurse Practitioner system like the one in the United States, David is in a perfect position to discuss the role of ICU NPs in the U.S., and within UPHS specifically. At the conference, David shared his concern for how the unstable staffing system in Korean hospitals could negatively affect not only patient care, but nursing professionals and medical providers as well.

David is originally from South Korea and spent three years as a Surgical Intensive Care nurse at a hospital in Seoul. In 2014, he moved to the U.S. and joined the PPMC family in 2016 as a Trauma / Surgical ICU nurse. In 2018, he received his master’s in Nursing at Penn, became an Acute Care Nurse Practitioner, and is now pursuing a PhD in Nursing, also at Penn.

The challenges David addressed in his presentation begin with the 80-hour residency law. Long after the U.S. changed its laws in the 1990s to limit resident physicians to an 80-hour work week, Korea adopted an 80-hour guideline in 2016.

Because resident physicians can no longer provide care for an unlimited amount of hours, hospitals in Korea are suffering from a lack of providers.

To fill the gap, nurses and physician assistants (PAs) who are also registered nurses (unlike their counterparts in the U.S.) are being asked to step up and take on medical tasks like placing orders and performing procedures that they’re not officially qualified to undertake.

This situation has the potential to put not only nurses and PAs at risk, but also patients.

In Korea, formal degree programs for PAs are not available. Unlike their counterparts in the U.S., PAs employed in Korean hospitals often practice without receiving formal and systematic education and training specifically tailored to the PA role. While Korea has a curriculum for advanced practice nurses, their scope of practice differs from that of NPs in the United States.

Advanced practice nurses in Korea are not permitted to place medical diagnoses, prescribe medication or perform procedures. In contrast, nurses in the U.S. have the opportunity to pursue additional education that enables them to legally prescribe medication and provide comprehensive medical care to patients in both outpatient and inpatient settings. This expanded curriculum and related laws in the U.S. allow nurses to address any moral, ethical and legal concerns that may arise.

From a political lens, the Korean Medical Association has shown resistance to changing the requirements and adopting the Nurse Practitioner system. Physicians who work in outpatient environments are not seeing the problem as clearly as inpatient physicians who are facing the real shortage of providers and the ethical dilemma of healthcare workers who are pushed into performing care that goes beyond the scope of their qualifications.

David feels strongly that adopting a Nurse Practitioner role in Korea would go a long way toward addressing Korea’s current challenges.

He also emphasized the importance of implementing systematic NP training, laws and policies in Korea along with the adoption of the NP role. Such measures would not only protect healthcare workers but enable them to provide enhanced assistance to patients while remaining aligned with their ethical and moral values.