中美护士管理法律制度的比较研究
摘要
目的对中美两国护士管理法律制度进行比较研究,获得中美两国护士管理法律制度的差异,结合护理学科发展的规律和我国国情现状进行分析,为完善和发展我国护士管理法律制度提供参考和建议。
方法以比较法学为理论基础,在文献研究、专家访谈和现场调研的基础上,收集整理中美两国护士管理法律制度的相关资料,确定比较要素。采用比较研究的方法,即运用布雷迪(Bereday. G)的“四步比较法”,对中美两国护士管理法律制度进行描述、解释、并列和比较。描述：包括中美两国护士的注册及准入制度、护士执业范围的法律规定、护士权利和义务的法律规定、护士管理机构的法律规定、护士及医疗机构违规和处罚的相关法律规定；解释：在描述的基础上,归纳两国护士相关法律制度的特点；并列：以表格的形式对两国同质信息进行并列对比,发现其共同点和差异；比较：结合两国护理学科发展水平以及经济社会发展现状对上述异同点进行分析。
结果中美两国在护士管理法律制度方面的存在相同点：都设立了专门针对护士管理的法律制度、都建立了比较严格的护士准入及注册制度、都对护士的权利和义务、护士管理机构的职责、护士及医疗机构的违规与处罚做出一定的规定。中美两国在护士管理法律制度方面的存在差异主要包括：1)护士注册与准入制度方面：美国对护士实行分层次注册制度、并对高级注册护士的注册和准入做出法律规定、对护士的延续注册强调要有规定时间以上的从业记录；中国实行单一的护士注册制度、开展专科护士计划但没有相应的法律规定、一定时间的从业记录并未列入申请延续注册的条件。2)护士执业范围法律规定方面：美国《护士执业法》对不同注册层次的护士执业范围做出区别规定,从法律角度明确和规范护士特别是高级注册护士的定位和使用；我国《护士条例》中没有护士执业范围的相关规定,仅在部门规章中根据技术职称和工作岗位做出职责规定。3)护士管理机构的法律规定方面：美国对护士管理机构的人员组成、日常运作、管理职责做出法律规定,州护士管理局全权负责护士的准入、注册、执业、监督、处罚等管理工作；中国仅对护士管理机构即各级卫生主管部门的管理职责做出规定,同时存在各级卫生主管部门之间权限和责任不对等,实际操作有困难的现象。同时中美两国还在护士权利和义务的规定方面各有侧重、对医院护士编制的立法层次和法律规定有所差异。
结论根据上述中美两国在护士注册与准入制度、护士执业范围法律规定、护士管理机构的法律规定、医院护士编制的法律规定等方面的差异,结合两国护理实践发展水平、护理教育发展水平、法律制度、社会观念等因素分析,提出完善和发展我国护士管理法律制度的建议和构想：立法建立护士分层次注册制度、立法建立专科护士准入及管理制度、完善护士延续注册的法律规定、完善护士执业范围的法律规定、规范助理护士的使用、规范各级卫生主管部门在护士管理方面的职责,立法完善护士编制规定。
Objective The purpose of this study was to obtain the difference in legal system of nurse administration between China and US with the method of comparative study. We sought to give some suggestion to the development of legal system of nurse administration in China by analysis of the differences along with nursing development order and the country reality.
Methods With the rationale of comparative study of law, on the basis of literature study, field research and expert interview, this study planned to collect and arrange relevant information on the legal system of nurse administration between the two countries to determine comparative essentials. By applying the Bereday. G four-step comparative method, we described, interpreted, arranged in parallel and compared the legal system of nurse administration between two counties.Description included regulation on nurse's registration and admission, nursing practice scope, nurse right and obligation, nurse authority as well as violation and penalties of nurses and organization. Interpretation was to inducing the characteristics of the legal system between these two countries. Arrangement was made in list form to compare the legal system in order to find the differences. Comparison was to analysis the same point and the differences between China and US by considering nursing development levels and social-economic condition.
Results China and the US legal system of nurse administration maintain common point in the following areas:they both have set up specifically legal system for nurse administration and established stringent admission and registration system for nurses. The regulation of nurse rights and obligations, responsibilities of nurse administration organization as well as violation and penalties for nurses and relevant organization had also been made. The differences between china and US on legal system of nurse administration include:1)Registration and admission of nurse:The US implement different registration levels of nurses, regulate the registration and admission of APRN and require a certain nursing practice time for license renewal.In China, there is only one registration level of nurse and no legal rules has been made although we planed to initial nurse specialist.,there is no nursing practice time limit for license renewal.2) In the regulation of nursing practice scope, US "Nurse Practice Act" determined different scopes for different nurse levels and also clearly standardize the employment of APRN.In our country, there is no regulation of nursing practice scope can be found in Nurse Rules, only in departmental rules and regulations the provisions of different responsibility was made in accordance with job titles and post.3) In the legal regulation of nurse organizations, US have rules about the staff, the daily work and the responsibility of the nurse board, which is the authority of nursing administration. In China, for different organizations in charge of nurse administration, the right and responsibility of these organizations are not issued clearly enough for practice. Meanwhile, differences can be found in the definition of right and obligation of nurse between two countries. The legislation level and content of regulations in the aspect of nurse-patient ratio are also different.
Conclusion According to the differences between China and US on the nurse registration and admission system, the regulation of the scope of nursing practice, the authorities of nurse administration and the nurse-patient ratio, with analyzing the development levels of nursing practice, nursing education, the legal system, social concepts and other relevant elements, we suggest that the Chinese legal system of nurse administration should: legislation to establish a hierarchical system of nurse registration as well as nurse specialist admission and registration system.To improve the legal regulation on the scope of nursing practice, standardize assistant nurses employment and the responsibilities of nurse administration authorities. To improve the regulation for nurse patient ratio.
方法以比较法学为理论基础,在文献研究、专家访谈和现场调研的基础上,收集整理中美两国护士管理法律制度的相关资料,确定比较要素。采用比较研究的方法,即运用布雷迪(Bereday. G)的“四步比较法”,对中美两国护士管理法律制度进行描述、解释、并列和比较。描述：包括中美两国护士的注册及准入制度、护士执业范围的法律规定、护士权利和义务的法律规定、护士管理机构的法律规定、护士及医疗机构违规和处罚的相关法律规定；解释：在描述的基础上,归纳两国护士相关法律制度的特点；并列：以表格的形式对两国同质信息进行并列对比,发现其共同点和差异；比较：结合两国护理学科发展水平以及经济社会发展现状对上述异同点进行分析。
结果中美两国在护士管理法律制度方面的存在相同点：都设立了专门针对护士管理的法律制度、都建立了比较严格的护士准入及注册制度、都对护士的权利和义务、护士管理机构的职责、护士及医疗机构的违规与处罚做出一定的规定。中美两国在护士管理法律制度方面的存在差异主要包括：1)护士注册与准入制度方面：美国对护士实行分层次注册制度、并对高级注册护士的注册和准入做出法律规定、对护士的延续注册强调要有规定时间以上的从业记录；中国实行单一的护士注册制度、开展专科护士计划但没有相应的法律规定、一定时间的从业记录并未列入申请延续注册的条件。2)护士执业范围法律规定方面：美国《护士执业法》对不同注册层次的护士执业范围做出区别规定,从法律角度明确和规范护士特别是高级注册护士的定位和使用；我国《护士条例》中没有护士执业范围的相关规定,仅在部门规章中根据技术职称和工作岗位做出职责规定。3)护士管理机构的法律规定方面：美国对护士管理机构的人员组成、日常运作、管理职责做出法律规定,州护士管理局全权负责护士的准入、注册、执业、监督、处罚等管理工作；中国仅对护士管理机构即各级卫生主管部门的管理职责做出规定,同时存在各级卫生主管部门之间权限和责任不对等,实际操作有困难的现象。同时中美两国还在护士权利和义务的规定方面各有侧重、对医院护士编制的立法层次和法律规定有所差异。
结论根据上述中美两国在护士注册与准入制度、护士执业范围法律规定、护士管理机构的法律规定、医院护士编制的法律规定等方面的差异,结合两国护理实践发展水平、护理教育发展水平、法律制度、社会观念等因素分析,提出完善和发展我国护士管理法律制度的建议和构想：立法建立护士分层次注册制度、立法建立专科护士准入及管理制度、完善护士延续注册的法律规定、完善护士执业范围的法律规定、规范助理护士的使用、规范各级卫生主管部门在护士管理方面的职责,立法完善护士编制规定。
Objective The purpose of this study was to obtain the difference in legal system of nurse administration between China and US with the method of comparative study. We sought to give some suggestion to the development of legal system of nurse administration in China by analysis of the differences along with nursing development order and the country reality.
Methods With the rationale of comparative study of law, on the basis of literature study, field research and expert interview, this study planned to collect and arrange relevant information on the legal system of nurse administration between the two countries to determine comparative essentials. By applying the Bereday. G four-step comparative method, we described, interpreted, arranged in parallel and compared the legal system of nurse administration between two counties.Description included regulation on nurse's registration and admission, nursing practice scope, nurse right and obligation, nurse authority as well as violation and penalties of nurses and organization. Interpretation was to inducing the characteristics of the legal system between these two countries. Arrangement was made in list form to compare the legal system in order to find the differences. Comparison was to analysis the same point and the differences between China and US by considering nursing development levels and social-economic condition.
Results China and the US legal system of nurse administration maintain common point in the following areas:they both have set up specifically legal system for nurse administration and established stringent admission and registration system for nurses. The regulation of nurse rights and obligations, responsibilities of nurse administration organization as well as violation and penalties for nurses and relevant organization had also been made. The differences between china and US on legal system of nurse administration include:1)Registration and admission of nurse:The US implement different registration levels of nurses, regulate the registration and admission of APRN and require a certain nursing practice time for license renewal.In China, there is only one registration level of nurse and no legal rules has been made although we planed to initial nurse specialist.,there is no nursing practice time limit for license renewal.2) In the regulation of nursing practice scope, US "Nurse Practice Act" determined different scopes for different nurse levels and also clearly standardize the employment of APRN.In our country, there is no regulation of nursing practice scope can be found in Nurse Rules, only in departmental rules and regulations the provisions of different responsibility was made in accordance with job titles and post.3) In the legal regulation of nurse organizations, US have rules about the staff, the daily work and the responsibility of the nurse board, which is the authority of nursing administration. In China, for different organizations in charge of nurse administration, the right and responsibility of these organizations are not issued clearly enough for practice. Meanwhile, differences can be found in the definition of right and obligation of nurse between two countries. The legislation level and content of regulations in the aspect of nurse-patient ratio are also different.
Conclusion According to the differences between China and US on the nurse registration and admission system, the regulation of the scope of nursing practice, the authorities of nurse administration and the nurse-patient ratio, with analyzing the development levels of nursing practice, nursing education, the legal system, social concepts and other relevant elements, we suggest that the Chinese legal system of nurse administration should: legislation to establish a hierarchical system of nurse registration as well as nurse specialist admission and registration system.To improve the legal regulation on the scope of nursing practice, standardize assistant nurses employment and the responsibilities of nurse administration authorities. To improve the regulation for nurse patient ratio.
引文
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