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The health ministry has launched a new model project to nurture “special nurses” who can provide a wider range of medical services than ordinary nurses. The primary purpose of the project, which began with the new fiscal year, is to have nurses take on some of the duties that would otherwise be done by doctors, allowing doctors to spend more time with patients who need advanced medical care. However, some crucial legal matters require action from the ministry.

To qualify as a special nurse, one must have been a licensed nurse for a set period of time, have a master’s degree from a graduate school recognized by a third-party body (to be established) and be certified by that body.

Special nurses will be able to, following doctors’ orders, conduct ultrasound tests, order chest X-rays, assist with the insertion of catheters, assess and determine triage categories, insert breathing-support tubes, stitch minor wounds, treat fevers and dehydration and decide to discontinue patients’ medication, among other duties.

The health ministry says that if done under the instruction of a doctor, these practices constitute “assistance for medical treatment” under the Public-Health Nurse, Midwife and Nurse Law. Ordinary nurses already perform a range of procedures, such as intravenous injections, that would seem logically to fall under the same category. However, because the ministry has not specificied the actions that can be called “assistance for medical treatment,” nurses are working in a legal gray zone.

Now that a ministry project is encouraging the expansion of nurses’ duties, a legal definition is essential. Without one, special nurses will be worried about the legality of their work, and patients may also feel anxiety.

Until the ministry defines in specific terms what activities special nurses can perform, and which of those they can perform without a doctor’s instruction, special nurses will be unable to fully utilize their knowledge and skills.

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