進階護理人員(進階護理師)是指有執照的護理人員,再接受訓練或敎育後,從事更廣更複雜的進階護理業務之人員。目前美國最常見的進階護理師包括專科護理師,開業護理師,助產護理師,以及麻醉護理師。其衍生主要源自兩種不同的理由;一是護理專業的發展和學識敎育的提升而產生,一是醫師人力不足或醫師人力費太貴、爲因應健康照顧體系的需求所產生的。我國自1902年起已有助產士之養成,但至1995年只剩842人執業。1958年起因麻醉醫師人力不足,各大敎學醫院陸續訓練麻醉護士,至今已有1600多名麻醉護理人員。專科護理師也在我國逐漸發展。目前國内進階護理人員面臨的主要問題包括:角色定位問題,正式認證和專業能力確定之問題,以及在人事體系中缺乏正式職稱和升遷管道。
Advanced practice nurses (APN) are registered nurses who receive further education and training and have expanded roles in the health care system. The current roles of advanced practice nurses include: clinical nurse specialist, nurse practitioner, nurse midwife, and nurse anesthetist. Two forces have resulted in the creation of APN roles: 1) the advancement of the nursing profession; and 2) the shortage and expense of physician manpower. In Taiwan, midwifery training was begun in 1902. However, all formal midwifery education programs have been closed and midwives are losing their practice. The first training program for nurse anesthetists started in 1958 due to a shortage of anesthesiologists. Currently, 1,600 nurse anesthetists are in practice. The role of clinical nurse specialist is developing. Several graduate schools of nursing provide master-leveled program for clinical nurse specialist. No nurse practitioner program has been established. Major barriers to the development of APN in Taiwan include, poor role identification, lack of certification for APN, and lack of formal position and promotion tracks. In order to develop an advanced practice nurse system, government support is needed.