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The Suggestion of the Reform of the Assistant Nurse System at Dental Field in Korea
Int J Clin Prev Dent 2021;17(2):31-35
Published online June 30, 2021;  https://doi.org/10.15236/ijcpd.2021.17.2.31
© 2021 International Journal of Clinical Preventive Dentistry.

Ok-Nyeo Hong

Korean Licensed Practical Nurses Association, Seoul, Korea
Correspondence to: Ok-Nyeo Hong
E-mail: smail427@hanmail.net
https://orcid.org/0000-0001-7061-5041
Received May 29, 2021; Accepted June 20, 2021.
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
Assistant nurse is the one of the health workforce who work for medical or dental assistant or nurse assistant works at the medical centers, social security centers or community health centers, in order to promoting the health level for the people. The certified numbers of the assistant nurse are about 763 thousands and 28% of them have been working. Among them, 19,425 have been working in dental fields as 371 for dental hospitals and 19,054 for dental clinics. Assistant nurse can do such roles as dental assisting, assist for dental diagnosis, intra muscular or intra venous injection, assisting for prescription of medication and nurse records, at the dental fields, according to the regulation by the Ministry of Health and Welfare, Korean government. So, the reform of the educational system and the training course for assistant nurse in dental fields should be needed in order to adjust the Korean dental environment, because it has been adapted for the medical oriented system at present in Korea.
Keywords : dental assistant, dental workforce
Introduction

1.The workforce of the assistant nurse at present

Assistant nurse is the one of the health workforce who work for medical or dental assistant or nurse assistant works at the medical centers, social security centers or community health centers, in order to promoting the health level for the people [1].

Assistant nurse system in Korea was established through the regulation for medical assistant law in 1966 and correct it named as an assistant nurse with the medical law in 1987.

763,127 of assistant nurse have been cerified untill in 2019 and among them, 28% of them as 213,005 was working at the medical or dental field. 9% of their workforce of assistant nurses as 19,425 were work at dental field as 371 for dental hospital and 19,425 for dental clinics [2] (Table 1).

Table 1 . Work places at dental field for assistant nurse in Korea, 2019 (Unit: persons)

Certificated numbers (A)Working numbers(B)Dental field

Subtotal(C)D.Hospital(D)D.Clinics(E)
763,127 (100%)213,005 (A/B) (28%)19,425 (B/C) (9%)371 (C/D) (2%)19,054 (C/E) (98%)


It revealed that a little bit increasing tendency of the numbers who worked in dental or oriental clinics and it showed as from 15,191 in the year 2015 to 19,054 in 2019 as 2.5% of increasement at dental clinics.

It was the similar situations as medical and oriental clinics to increasement of a little numbers of assistant nurses as from 62,737 in 2015 at medical clinics to 75,593 in 2019 as 2.0% of increasement of the working numbers and from 13,302 in the year 2015 to 21,396 in 2019 as 6.1% of increasement at oriental clinics. The distribution of their work places in the year 2019 were showed as 16% for dental clinics, 65% for medical clinics and 18% of them for oriental clinics (Table 2).

Table 2 . The distribution of assistant nurse for primary clinics in Korea (Unit: persons)

Working place201520162017201820192015 vs 2019
Total91,230 (100%)105,194 (100%)104,708 (100%)107,862 (100%)116,043 (100%)24,813 (27%)
Dental Clinic15,191 (17%)18,052 (17%)17,785 (17%)17,569 (16%)19,054 (16%)3,863 (25%)
Medical Clinic62,737 (69%)70,692 (67%)70,720 (68%)74,146 (69%)75,593 (65%)12,856 (20%)
Oriental Clinic13,302 (14%)16,450 (16%)16,203 (15%)16,147 (15%)21,396 (18%)8,094 (61%)


As the mention about the education and training for assistant nurse, 34,322 were passed for the certification test for assistant nurse from 50,273 appliances, in the year 2015, 37,169 from 52,035 in 2016, 34,033 from 43,320 in 2017, 35,229 from 42,889 in 2018 and 34,322 from 45,823 in 2019 as average 74.8% of pass rate for 5 years as 34,322 of passed persons from 45,823 of appliances for total numbers of 5 years (Table 3).

Table 3 . The training numbers for the assistant nurse for recent 5 years (Unit: persons)

YearApplied numbersTested numbersPassed numbersPass rate
Average for 548,47345,82334,32274.9%
201553,44950,27331,30362.2%
201655,25052,03537,16971.4%
201746,01043,32034,03378.6%
201845,14542,88935,22982.1%
201942,51340,59833,87483.4%


2.Educational system for assistant nurse

More than 1,520 hours of training course as 740 hours for lecture and 780 hours for practical training were required at the nurse training private institute and written test would be done from the Korean Medical Workforce Examination Institute. The final passed one can be certified the assistant nurse certification from the Minister of Health and Welfare in Korean government [3].

The suggested curriculum and the regulation about the assistant nurse from the National Occupation Evaluation Institute would be shown in Table 4.

Table 4 . The guide-line for the educational evaluation by National Occupation Evaluation Institute

CurriculumUnitLecturePractice
Basic nursingNursing care25
Basic nursing8036
Adult nursing703
Maternal nursing501
Child nursing501
Senior nursing301
Emergency nursing308
Basic anatomy and physiology80
Basic pharmacology20
Basic nutrition20
Basic dental science25
Basic oriental medicine20
Nursing health scienceHealth education15
Health administration20
Evironmental health30
Industrial health20
Public health scienceDisease control program30
Population and delivery10
Maternal health10
Community health25
Medical law30


3.The role of the assistant nurse

Assistant nurse is a workforce for assisting the nurses at the hospital levels but can take roles with the nurses without the helps of nurses at the clinic levels as medical, dental or oriental clinics, under the control of the doctors, dentists and oriental doctors, even though they are not the main workforce for medical field, according to the medical law in Korea. The main roles of assistant nurse are such as assisting for diagnosis, injection shotting, medical or dental treatment assisting, and nurse chart recording, according to the interpretation of the medical law from the ministryof Health and Welfare in Korea.

As the mention about the dental hygienists, as one of the dental workforce, they can do apply the orthodontic wire, scaling, fluoride topical application, intral-oral X-ray taking, temporary filling, temporary setting stain removal, impression taking and the others as prevention works at the teeth and around the teeth tissue, according to the para-medical law.

Body

1.Unadaptable system for dental cares on the assistant nurse system

The most of the activities and education contents for assistant nurse has been forcused for medical cares and not for dental cares, in spite of 9& of total assistant nurses as 19,425 of assistant nurses have worked at the dental hospitals and dental clinics. So assistant nurse is hard for recognized as a professional workforce under this system.

Only 25 hours were distributed among 740 hours of lecture time in assistant education system and the most of the students were practical training for 780 hours, at the medical hospitals and not for dental hospitals. Moreover, only one or two questions for dental field, among 100 questions for test, can be suggested on the national board examination. So it would be estimated that the present assistant nurse education system is hard for adjusted for the workforce training on dental field.

2.Survey for the reform of the education system

Dasan Economic Research Institute has announced that only 9.3% of assistant nurses answered “enough” 21.3% of them answered as “moderate” but 68.3% answered as “defficient” for the dental field contents in the assistant nurse education curriculum through the questionnaire survey for assistant nurses. from the trust research for the Ministry of Health and Welfare in Korean government (Table 5).

Table 5 . The evaluation about the dental field part contents from the curriculum for assistant nurse education (Unit: %)

ItemDefficientMediumEnough
Educational levelHigh school66.822.011.2
College71.322.16.6
University72.020.08.0
Post graduate school100.00.00.0
CareerUnder 5 years73.415.211.4
5-10 years69.525.35.3
10-15 years61.130.08.9
Over 15 years70.118.111.9
Total 68.521.89.8


About the continuing education, 16.5 % of them answered as “No need” but 24.6% of them answered as “Medium” and 53.7% of them answered as “Need”, in order to promotion of their roles continuously. But majority as 76.7% of them answered that they have not received the continuing education or training from their present work place (Table 6).

Table 6 . The survey for the need about the continuing education (Unit: %)

ItemNo needMediumNeed
Educational levelHigh school16.124.059.9
College14.032.253.7
University23.511.864.7
Post graduate school0.00.0100.0
CareerUnder 5 years21.526.651.9
5-10 years14.728.456.8
10-15 years15.620.064.4
Over 15 years15.324.460.2
Total 16.524.858.7


It revealed that there was much deficient for dental contents for the assistant nurse education, according to the questionnaire survey from Dasan Economic Research Institute. And needed so much for training about the dental field contents, but there has not enough opportunities to receive the dental education at the present work places (Table 7).

Table 7 . Receiving the eligible education for the assistant nurse from the present work place (Unit: %)

ItemNot suppliedSupplied
Educational levelHigh school73.926.1
College62.837.2
University70.629.4
Post graduate school0.0100.0
CareerUnder 5 years70.329.7
5-10 Years75.624.4
10-15 Years68.431.6
Over 15 Years67.033.0
Total 76.723.3


3.Illegal roles for dental hygienist and assistant nurse

It revealed that there have been worked the dental hygienists and assistant nurse together at 53.6% of the dental clinics and only dental hygienists worked at 24.5% of the dental clinics and only assistant nurse worked at 21.9% of dental clinics, according to the survey from Dasan Economy Research Institute (Table 8).

Table 8 . Workforces for dental hygienists and assistant nurse at the dental clinics (Unit: %)

ItemDental hygienist Assistant nurse total
D.H. and A.N. together48.0-24.5
Only dental hygienist52.055.353.6
Only assistant nurse-44.721.9
Total100.0100.0100.0


The relative weight for invasion to the others roles between the dental hygienist and assistant nurse at the dental clinics were revealed as 40.0% of dental hygienists have done the assistant nurses roles and answered that 35.4% of them though their works as assistant nurse's work. Otherwise, 64.5% of the assistant nurse at dental clinics have thought their works as the dental hygienist's works and 64.8% of their works might be a dental hygienist's works (Table 9).

Table 9 . Invasion rate for each role at dental clinics between the dental hygienist and assistant nurse (Unit: %)

Dental hygienistAssistant nurse


Role for assistant nurseWeight among their own worksRoles for dental hygienistWeight among their own works
40.035.464.564.8


It has been known as different the roles of the dental hygienist and assistant nurse at the dental clinis. But there was not so remarkable boarders between their roles of works at the dental clinics at present situation, according to the analysis from the Dasan Economic Research Institute. They sometimes invasion to other's roles by situations and sometimes do the other's works, in spite of the illegal from the medical law and para-medical law. So it needed to re-establish the role of both workforces or reform of thr medical and paramedical law in the future (Table 10).

Table 10 . The performance rate for the roles at the dental clinics (Unit: %)

Item of the workDental hgienistAssistant nurse


Always doOften doNot doAlways doOften doNot do
Eliminate calculus80.612.76.8 46.018.835.1
Fluoride topical application48.726.924.530.717.551.8
Temporary filling60.321.218.638.618.942.5
Removal of temporary crown63.920.116.046.419.234.4
Deposit removal60.021.218.845.120.034.9
Impression taking75.113.511.453.122.024.9
Orthodontic wire bending/setting/removal35.716.447.924.310.964.9
Prevention at teeth/oral cavity76.516.37.255.022.922.2
Intra oral X-ray taking81.413.15.559.218.622.2
Injection7.09.683.428.03.668.4
Phamacological work6.38.585.224.93.271.9
Vital sign check15.330.354.437.914.148.1
Assist for diagnosis/blood6.513.380.229.97.362.8
Assist for treatment, washing, disinfection73.517.39.282.89.18.2
Operation preparation, assisting for anesthesia69.417.513.179.810.99.3
Assisting for operation68.816.414.875.712.012.2
Pdst operative treatment/instruction, antiseptic treatment for dressing, suture removal53.329.317.548.220.631.2

Conclusion

It would be considered the following answers to solve the above problems.

1.Establishment of dental assistant system

Dental assistant should be belong to one of the assistant nurse system like the special assistant nurse establishing with the consideration of the home visiting assistant nurse after finishing with 700 hours training or specialized social workers and physical trainer who are certified with their abilities from the ministry of Health and Welfare in Korean government, in order to recognized with the special assistant workforce in the dental field.

It was suggested to be a dental assistants by applying from the assistant nurses, as one of the certifying the dental assistants from the assistant nurses. This idea should be needed to reform of the medical laws in order to make the basic back grounds. Dental assistant should be grown up for dental works mainly, on the contrary as the assistant nurse at present should be work for medical works.

Under this plan for the suggestion, some careered assistant nurse can be applied to be a dental assistant, after finishing the dental education which has suggested curriculum from the ministry of Health and Welfare, and then, would be referd the certification. In case of considering the dental assistant system from the education, it should consider for 1,520 hours of the dental training, as the same training hours with the assistant nurse education.

2.Preparation of the curriculum for dental assstant and national board exam

In case of educating the assistant nurse forcusing as dental works to utilize at the dental field, assistant nurses worked at the dental field with several careers, would be certified after educated certain periods prepared with the standard curriculum and practical traing at the dental clinics or dental hospitals, without consideration of establishing the dental assistant system.

It should be needed to reform the national board examination in consideration with the assistant nurse manpower according to the level of the medical organization, and the activities or the roles for them, for the relative weight of the quantity of the questions It was suggested as 200 questions from 100 at present for the assistant nurse national board examination, in order to increase the numbers of the questions for the dental field.

3.Re adjustment of the roles for dental assistant and dental hygienist

It can be hard to keep the regulation about each role for dental workforces as dental hygienist and assistant nurse at dental clinic under the present dental situations, without employing the both workforces as dental hygienist and assistant nurse together at all dental clinics. But there are some difficulties to do that because of the business or management difficulties.

It can be suggested with the ideal idea to establish their roles independently in consideration of the co-operation with each works, because it is the defferent workforce between the dental hygienist and assistant nurse at the dental clinic. So it was suggested to reform the system with the idea for performing the works for both of them.

It means that some works which could be done by dental hygienist only can be extended the role for permitting all or some part to dental assistant who had got the certification by training and on the contrary, some works for permitted only for assistant nurse at present, would be permitted to dental hygienist, withcase by case, in consideration of dental situations at present in Korea.

Conflict of Interest

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

References
  1. Dasan Economy Research Institute, Ministry of Health and Welfare, A study for the demend and supply for the dental assisting workforce 2018.11.30.
  2. Korean Assistant Nurse Association, The development of the standard curriculrum for the assistant nurse education. 2019.12
  3. Korean Health and Social Research Institute, A study on the program development of the works for assistant nurse 2020.10.3


June 2021, 17 (2)