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Suggestion of System Reforms for Assistant Nurses at the Dental Hospital or Dental Clinic
Int J Clin Prev Dent 2020;16(4):154-158
Published online December 31, 2020;  https://doi.org/10.15236/ijcpd.2020.16.4.154
© 2020 International Journal of Clinical Preventive Dentistry.

Ok-Nyeo Hong1, Kyu-Hwan Lee2

1Korean Licensed Practical Nurses Association, Seoul, 2Department of Preventive Dentistry, Seoul National University Bundang Hospital, Seongnam, Korea
Correspondence to: Kyu-Hwan Lee
E-mail: khlee@snubh.org
https://orcid.org/0000-0002-0918-8711
Received December 10, 2020; Revised December 14, 2020; Accepted December 17, 2020.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
The dental assistant system has not been established in Korea, and the assistant nurse workforce at the dental clinics has instead taken the role of the dental assistant. Therefore, for some time now, there have been some arguments between dental hygienists because of the limitation of their tasks by the law. The assistant nurse system should be reformed for dental works. The main theme would be considered from the reference for study, for supply, and the task of the dental assistant workforce compared with dental hygienists. From the study, the ideas for system reform for assistant nurses who have worked at the dental clinics would be suggested with the consideration of present dental situations. The co-operation of the workers at dental clinics should be required between dental hygienists and assistant nurses together by changing relative regulations. The dental expert or professional assistant nurse system should be established in the future.
Keywords : licensed practical nurses
Introduction

1. Assistant nurse workforces at present

The assistant nurse is defined as one of the medical and health care workers who is working with the role of the medical/dental assisting works at the medical or dental hospital/clinics, social health care center, or nursing home, to promote the health level of the members of the community.

The assistant nurse system has been established since July 25th. In 1966, according to the regulation of the medical assistant rule, act 1st as deciding the name of a nurse assistant and change the name as an assistant nurse in 1967 on the medical law [1].

The number of certified assistant nurses was 763,127 in the latter part of 2019; among them, 213,005 (26%) were working at present days, and 19,425 (9%) of the total number of workers has worked at the dental hospital as 371 and clinics as 19,054 at present days (Table 1).

Table 1 . Working activities for the assistant nurse in 2019 (unit: persons)

Certified (A)Working (B)Working at dental part

Subtotal (C)Dental hospital (D)Dental clinic (E)
763,127 (100%)213,005(A/B) (26%)19,425(B/C) (9%)371(C/D) (2%)19,054(C/E) (98%)

Values are presented as number (%).



An increasing tendency to work at the dental clinics was revealed from 2015 to 2019 as 25% in consideration that 15,191 were working at dental clinics in 2015, but 19,054 in 2019, according to the data of the working place for the assistant nurse by the annual survey for working.

Of course, it also showed an increasing tendency to work at the medical clinics (20%) or oriental medicine clinics (61%). Of all the assistant nurses at the primary medical/dental care facilities, 16% worked at the dental clinics, as shown in Table 2.

Table 2 . Working venue for assistant nurse for primary medical/dental clinics in Korea (unit: persons)

YearTotalDentalMedicalOriental medicine
201591,230 (100%)15,191 (17%)62,737 (69%)13,302 (14%)
2016105,194 (100%)18,052 (17%)70,692 (67%)16,450 (16%)
2017104,708 (100%)17,785 (17%)70,720 (68%)16,203 (15%)
2018107,862 (100%)17,569 (16%)74,146 (69%)16,147 (15%)
2019116,043 (100%)19,054 (16%)75,593 (65%)21,396 (18%)
2015/201924,813 (27%)3,863 (25%)12,856 (20%)8,094 (61%)

Values are presented as number (%).



It revealed the average pass rate of the certification for the assistant nurse was about 74.9% for last 5 years as 62.2% in 2015, 71.4% in 2016, 78.6% in 2018, 82.1% in 2018 and 83.4% in 2019, as shown in Table 3 [2].

Table 3 . Average pass rate for national board certification

YearAverage20152016201720182019
Apply48,47353,44955,25046,01045,14542,513
Testing45,82350,27352,03543,32042,88940,598
Pass34,32231,30337,16934,03335,22933,874
Pass rate74.9%62.2%71.4%78.6%82.1%83.4%


2. The education system for assistant nurse

The nursing assistant shall pass the national qualification examination after completing 740 hours of theoretical education and 780 hours of practical training courses conducted by a nursing assistant education and training institution designated by the Minister of Health and Welfare. The contents for the test would be composed several items which has been suggested on the medical law and decided from the National Board Evaluation Institute for working ability, certified by the Ministry of Health and Welfare. The standardization of the contents for the evaluation would be shown in Table 4 as followings [3].

Table 4 . The education contents and the evaluation for assistant nurse task guide from the Korea Institute for the Evaluation of the work ability

ContentItemTheoryPractice
Basic nursingNursing care25
Basic nursing8036
Adults nursing703
Matternal nursing501
Child nursing501
Eldery nursing301
Emergency nursing308
Basic anatomy and physiology80
Basic pharmacology20
Basic nutrition20
Basic dentistry25
Basic oriental medicine20

Health nursingHealth education15
Health administration20
Health environment30
Industreal health20

Public healthDisease control program30
Population and delivery10
Maternal health10
Community health25
Medical law30


3. Assistant nurse at the dental clinic/hospital

Acceding to the medical law, assistant nurse can do the medical or dental assisting task with helping the nurse at the hospital and with helping the doctor/dentist at the medical/ oriental medicine or dental clinics, without the registered nurse, but under the supervision of the doctor, dentist or oriental medicine doctor. The main roles of the assistant nurse would be as such following works as treatment assisting, diagnostic assisting, injection, pharmacy assisting, nursing charting record, and so on.

On the other hands, dental hygienist in Korea has been permitted with such activities as orthodontic bracket setting or removal, fluoride topical application, intra-oral X-ray taking, temporary filling, temporary crown setting or removal, calculus or tooth deposit removal, impression taking, and the others for prevention of oral disease and oral hygiene works, according to the para medical workforce's law.

The Problems and Suggestion for the Assistant Nurse System at Dental Clinic

1. Inadequate system for assistant nurse at dental clinic

Even though it has been about 9% of the assistant nurse in numbers, working at the dental part among the total assistant nurse, in the year 2019, they have not been recognized as a special profession as a limited special profession because the assistant nurse had been educated and oriented for the medical working mainly.

During the training for assistant nurse, only 25 hours have been supplied for dental profession among 740 hours trains in lecture time. Moreover, most of them have trained the practical course at hospital or medical clinics instead of dental hospital or dental clinics for 780 hours. It would be unreasonable that only 1 or 2 questions for dentistry related contents could be shared in the national board exam among 100 questions.

2. Discussion about the reform for the training system

The results for the supply of the dental assistant workforce published by Dasan Institute of Economic Research referred the research from the Ministry of Health and Welfare, have been shown the followings in Table 5. It revealed that only 9.6% of assistant nurse answered as enough educated about the dental works on the training course of assistant nurse education, 21.6% for nothing particular, and 68.3% of them answered as deficient.

Table 5 . The evaluation for assistant nurse about dental training (unit: %)

DegreeDeficientNothing particularEnough
Education levelHigh school66.822.0
College71.322.1
University72.020.0
Post graduated school100.00.0
Working career Under 5 years73.415.2
5-10 years69.525.3
10-15 years61.130.0
Over 15 years70.118.1
Total68.321.69.6


16.5% of them answered no necessary for the continuing education, but 24.5% of them answered as nothing particular and 56.7% forrequired. 76.7% of them answered that there has been not so many opportunities to get the more and new dental education, at the working venue, as shown in Table 6, 7 [4].

Table 6 . The need of the continuing education for dental assistant nurse (unit: %)

ItemNo needNothing particularNeed
Education levelHigh school16.124.0
College14.032.2
University23.511.8
Post graduated school0.00.0
Working careerUnder 5 years21.526.6
5-10 years14.728.4
10-15 years15.620.0
Over 15 years15.324.4
Total16.524.556.7


Table 7 . The more opportunities for dental education at the present working place (unit: %)

ItemNot suppliedSupplied
Education levelHigh school73.9
College62.8
University70.6
Post graduate school0.0
Working careerUnder 5 years70.3
5-10 years75.6
10-15 years68.4
Over 15 years67.0
Total76.7


The summary of the questionnaire research from the Dasan Institute of Economic Research, it revealed as severe deficiency of the dental education for the assistant nurse who working at the dental clinic or dental hospital, and it needed for the continuing education but not enough for supplying the dental education opportunity from present working clinics.

3. Illegal situation on the dental works both for the assistant nurse and the dental hygienist according to the present regulation

By the data from Dasan Institute of Economic Research, 53.6% of dental clinics in Korea have employed both workforce as dental hygienist and assistant nurse together, otherwise 24.5% of there for only dental hygienist and 21.9% for assistant nurse only, as shown in Table 8.

Table 8 . The comparison of the tasks for the dental workforce (unit: %)

ItemDental hygienistAssistant nurseTotal
Both workforce52.055.353.6
Dental hygienist only48.0-24.5
Assistant nurse only -44.721.9
Total100.0100.0100.0


They answered that sometimes they worked with over the limited roles as 40% of dental hygienists answered as working for assistant nurse's work, and 35.4% of works were really assistant nurse's work, among their roles. As the same situations, 64.5% of assistant nurse worked the dental hygienists works and among their works, 64.8% of the works would be a dental hygienists works. It means that they have worked sometimes without limitation of roles, shown in Table 9 [4].

Table 9 . The over limited role activities between the dental hygienist and assistant nurse at present working situations (unit: %)

Dental hygienistAssistant nurse
Assistant nurse's roleOver limited work rate from whole their worksDental hygienist's roleOver limited work rate from whole their works
40.035.464.564.8


It should be different the role from the dental hygienist and assistant nurse with the different regulations, but they couldn't help working with over limitation of their own roles and working other's roles partially under the special situation at present dental clinics. Of course it might be an illigal from the medical law and the paramedical workforce law, but it should be reformed consideration with the present situations, with consideration of their real works and tasks at present dental situations, shown in Table 10 [4].

Table 10 . The relative working rate of dental workforce (unit: %)

ItemDental hygienistAssistant nurse


Every time doingSometimes doingNot doingEvery time doingSometimes doingNot doing
Calculus remove80.612.76.846.018.835.1
Fluoride topical application48.726.924.530.717.551.8
Temporary filling60.321.218.638.618.942.5
Temporary crown setting63.920.116.046.419.234.4
Removal of tooth deposit60.021.218.845.120.034.9
Impression taking75.113.511.453.122.024.9
Bracket, wire remove35.716.447.924.310.964.9
Preventive cares76.516.37.255.022.922.2
Intra oral X-ray taking81.413.15.559.218.622.2
Injection7.09.683.428.03.668.4
Prescription guide6.38.585.224.93.271.9
Vital sign check15.330.354.437.914.148.1
Assisting for diagnosis6.513.380.229.97.362.8
Treatment assisting / sterilization73.517.39.282.89.18.2
Operation preparation/ assisting for anesthesia69.417.513.179.810.99.3
Assisting for operation68.816.414.875.712.012.2
Post operative care/ dressing for operative legion/post operative instruction53.329.317.548.220.631.2

Conclusion

The dental expert or professional assistant nurse system should be established and expansion to whole dental clinics or dental hospitals in consideration of the present system, such as visiting assistant nurse system, special nurse system, special professional social care personnel or part physical therapist system, after certified assistant nurses and finish 800 hours special dental education, in order to get the professional task for the dentistry.

It was suggested that the dental expert or professional assistant nurse system should be applied with the present assistant nurse from the training after establishing the reform of the relative law, in consideration of the concept that it has been managed in medically oriented assistant nurse system at present and otherwise; it should be reformed with the dental oriented training regulation more, for dental expert or professional assistant nurse system in the future, in order to adapt for the dental profession without an argument with the dental hygienist.

1. Establishing the standard curriculum for dental experts or professional assistant nurses and national board examination

The standardization of the curriculum contained with the professional lectures and dental hospital or clinics practical training should be needed for the education of dental expert or professional assistant nurse system, at the establishing stage through several discussions with the dental or medical professionals together, in order to be certified with the professional degree for dental assistant works.

Moreover, in order to expand the dental task roles, increasing the numbers or rate of questions for dentistry from 1 or 2 questions at present to more should be considered, even though the increasing total numbers of questions are more.

2. Discussion for the reform of the task of the dental workforce

It has been apt to against the law under the present law, for both of the dental workforce as a dental hygienist and assistant nurse who has worked at a dental clinic, because it has been established without the consideration of the present dental situations. Therefore, it should be discussed again with dental professionals; both with the dentist, dental hygienist, assistant nurse, and professional legal profession together, in order to reestablish the dental assisting law related to the present situation and in a reasonable dental environment in Korea.

There might be some difficulties in discussing, but a co-operative mind would be important instead of standing each right for the task because it should be important for reasonable dental treatment, and both workforces would contribute this concept for reasonable dental care through the enough dental assisting or helping the dentist together.

The Korean Licensed Practical Nurses Association has suggested that co-operation should be required, as some tasks assigned to dental hygienists at present would be given to dental experts or professional assistant nurses together; on the contrary, some tasks assigned to assistant nurses at present should be assigned to dental hygienists together, under the conception for the co-operation and reasonable dental cares.

Conflict of Interest

No potential conflict of interest relevant to this article was reported.

References
  1. Korea Institute for Health and Social Affairs. Workshop report on health manpower planning-dental health and oriental medicine manpower, medical technicians and nurse aides. Sejong : Korea Institute for Health and Social Affairs. 1989.
  2. Korean Licensed Practical Nurses Association. The development of the standard education course for assistant nurse training. Seoul : Korean Licensed Practical Nurses Association. 2019.
  3. Korea Institute for Health and Social Affairs. A study on the program development for assistant nurse's task. Sejong : Korea Institute for Health and Social Affairs. 2019.
  4. Dasan Institute of Economic Research. Survey on supply and demand and working environment of dental assisting personnel. Seongnam : Ministry of Health and Welfare. 2018.


December 2020, 16 (4)