Fase 2: Establecimiento del enfoque metodológico y desarrollo del plan

In this section, a brief history of Japanese nursing and nurse education are discussed to provide a background for key issues related to the Japanese nursing workforce.

History of Japanese Nursing System and its History

The foundation of the Tokyo Voluntary Hospital Nursing School in 1885 was the beginning of the Japanese nursing system (JNA, 2006). After this first Japanese nursing school, several nursing schools were founded with American and English nurses. In 1915, the promulgation of ‘Registered Nurse Ordinance’ ensured the national standard of nursing qualification. After the Second World War, the new act ‘ Public Health Nurses, Midwives and Nurses Act’ was introduced in 1948 and established the foundation of the modern nursing education in Japan (MHLW, 1948). This law changed the status of the nursing profession and all candidates for the nursing profession were required to pass the national exam board for the formal licensed qualifications (JNA, 2006). The jurisdiction of nursing education was given to the MHLW. Thus, most of early nursing education was outside of higher education institutes. Currently, there are three recognised, nationally authorised nursing professions; ‘registered nurse (RN)’, ‘public health nurse (PHN)’, ‘midwife (RM)’(JNA, 2006).

In addition there are locally authorised ‘assistant nurses’ (AN) in Japan. The assistant nurse system was introduced in 1951 due to the shortage caused from the increased number of hospital beds. In 1964, a new nurse education system for assistant nurses was introduced.

26

In 1952, the first four-year university nursing course was introduced and the Ministry of Education took the jurisdiction over university nursing education. In the early 1990s, there were only nine universities that provided nursing education. However, this increased dramatically during the 1990s to 91 universities within a decade.

There are several explanations for this significant increase. Firstly, in 1992 there were legislative changes in the Medical Care Act originally passed in 1948 (MHLW, 1948; Yoshikawa, 2003). These changes resulted in a shortage of nursing staff. Secondly, as a response to increasing demands for nursing staff caused by legislative change, the ageing population and developed medical technologies, legislation on encouragement to maintain the nursing workforce was introduced by way of the Nurse Provision Act (Yoshikawa, 2003). In addition, the report of the consensus conference about the current nursing system stated that there was a need to expand nursing education in higher education including undergraduate and postgraduate levels and organising the nursing training system and standardising of the nursing education (MHLW, 1987; JNA, 2006). In 1992, the Ministry of Home Affairs (now the Ministry Home Affairs and Communications) announced that they would provide financial support to establish nursing in universities (Yoshikawa, 2003) as a response to the Nurse Provision Act. This announcement triggered a dramatic increase in the number of universities providing nursing education. The latest statistics show in 2009 there were 183 universities in Japan that produced 14, 322 new nurse graduates (MHLW, 2010a). The following Table 2-9 outlines a brief history of Japanese nursing.

Table 2-9: Brief History of Japanese Nursing27

Year Principle Legislation Other Important Event

1876

Meiji Restoration

The Japanese term for nurse is used for the first time

1885 The first nursing training institute, the Tokyo

Voluntary Hospital Nursing School. 1915 Passed the Registered Nurse Ordinance

1945 The Second World War ends

1948

Medical Care Act

Public Health Nurses, Midwives and Nurses Act

1951 Assistant nurse introduced into practice

1952 First four-year university nursing course

1987

The MHLW reports the need for establishing more undergraduate and postgraduate nursing course and organising the nursing education.

1992 The Nurse Provision Act

27

Becoming a Registered Nurse in Japan

The Japanese nursing pre-registration system is rather more complicated than the UK system. There are six pathways to be a RN in Japan. After nine years of compulsory education, with or without an additional three years of high school, there are two main streams to enter the nursing education system (JNA, 2006). Currently, the most common pathway is nursing education following a high school diploma.

Nursing students go to a university (4-year bachelor’s degree course combined with public health nurse and midwifery), or to a junior nursing college (3-year course, diploma or junior colleague degree course), or to a nursing training school (3-year course diploma course). Another way to become a RN is to gain the assistant nurse qualification first and then a shortened RN qualification course (two-year course, diploma course). All nursing students are required to take the national board examination for registration. The pass rate has ranged from 84 %& to 91% over the past ten years. Once you are qualified, the qualification is valid forever as there is no registration renewal system in Japan unlike the UK (JNA, 2006).

The result of the above systems is that there are two qualifications for nursing; that is a RN qualified by the MHLW and an assistant nurse (AN) qualified by the local prefectural government. In the‘ Public Health Nurses, Midwives and Nurses Act’ (1948), it states that the assistant nurse provides nursing care under instructions from medical doctors, dentists and RNs (MHLW, 1948). However, there is no difference between the nursing care provided by RNs and assistant nurses and they end up doing the same job under a different salary and social status (JNA, 2006). Some comment indicate that the assistant nurse system is a possible cause of the low value of nursing in Japan and worsens the quality of nursing care (MHLW, 1996; Yoshikawa, 2003). In 1996, the report of the ‘Consensus Conference for issues regarding the assistant nurse system’ suggested that there was a need for the integration of the two nursing education systems including the abolition of the assistant nurse system in the 21st century(MHLW, 1996). However, this has not happened yet due to conflict between health professional organisations (Japan Medical Association, 1996).

Table 2-10 shows the educational background of new graduates. A total of 32,258 new graduates, of which 68% of all new graduates had high school diploma (MHLW, 2010a) and 22% of all graduates had bachelor’s degree.

Table 2-10: Educational Background of New Graduates and Their Pathway 2009 University (4 years) Nursing Junior College (3years) Nursing Training School (3 years) Nursing Junior College (2 years) Nursing High School (5 years) Nursing Training School (2 years) Total Newly graduate 10,560 1,740 19,958 364 2,754 11,592 46,96 8 Employed as nurses (includes PHN/RM) 9,529 1,348 1,8191 326 2,582 10,392 42,36 8 Employed outside nursing 197 250 247 0 40 97 831 Further Study 496 12 917 9 78 98 1,610 Others 338 130 603 29 54 1,005 2,159 Total of graduates outside nursing 1,031 392 1,767 38 172 1,200 4,600

Source: Reproduced with modification from MHLW (MHLW, 2010a)