Overview of Japanese Nursing System

History and system

Although nursing has a long history in Japan, modern nursing rapidly developed with the switchover from traditional Chinese medicine to Western medicine after the Meiji Restoration. The beginning of nursing education system in Japan provided midwifery education, licensing and training in accordance with the Medical Regulation enacted in 1874. Modern nursing education started in 1885. Modernized nursing professional qualifications were established by Midwives Rules of 1899, Nurses Rules of 1915, and Public Health Nurses Rules of 1941, respectively. The National Healthcare Act enacted in 1942 regulated public health nurses, midwives and nurses as healthcare professionals along with medical doctors and dentists.

After the World War II, under the GHQ (General Headquarters of the Supreme Commander for the Allied Powers), placed during the allied powers' occupation, the existing three rules for nursing professionals were unified into the Act on Public Health Nurses, Midwives and Nurses in 1948, based on the philosophy of integrated nursing. The purpose of this law was defined as "to enhance the quality of public health nurses, midwives and nurses, and thus to promote and improve healthcare and public health."

Today, nursing personnel in Japan can be divided into public health nurses, midwives, nurses and assistant nurses. The Act above specifies their qualification and practice in Article 2-6.
Japanese nursing system was reorganized under the command of GHQ so that a nursing division was installed in the then Ministry of Health and Welfare in 1948 to start nursing administration by nursing personnel. However, with the subsequent changes in the healthcare provision system and the increase in hospitals, the shortage of nurses became serious, and issues about nurses' work conditions including workloads and working hours surfaced. To address them, the Ministry took measures to improve the nursing system, establish a higher nursing education, and enhance the nursing education.

In these years, enhancement of nursing services has been required to meet the advanced and diversified healthcare, the aging society with fewer children, and the diversified citizens' needs. In 2009, amendment bills for the Act on Public Health Nurses, Midwives and Nurses and other laws by lawmaker-initiated legislation gained approval for the first time in 60 years. The main amendments are specifying graduation from a 4-year college in the opening of the provision on the eligibility to take the nurse's examination, revising the course terms of public health nurse and midwife education, and making the endeavor to provide newly-graduated nursing personnel training obligatory. In order to further improve quality and services of nursing, efforts are in progress to enhance the education, expand the nursing fields and introduce new frameworks.

To become a public health nurse, midwife or nurse in Japan, it is essential to complete a required curriculum at an educational institution set forth by law, pass a national examination that can be taken once a year, and obtain a license granted by the Minister of Health, Labour and Welfare. To become a nurse, basic academic background for twelve years and three years' basic nursing education are required. To become a public health nurse or midwife, training for nurses plus one or more years of education are required. Foreign nursing personnel who wish to work in Japan are required to take Japan's national nursing examination to obtain a Japanese license because nursing licenses obtained overseas are not accepted.

Licenses for assistant nurses are not issued by the Minister but by prefectural governors. However, licensed assistant nurses need not only work within the prefecture but anywhere in Japan. The term of training for assistant nurses is two years. Nursing services by them require the orders of a physician, dentist or nurse.

Japanese nursing qualification doesn't have any renewal system, and lasts for the rest of their lives. However, dispositions including the rescission of a license may be rendered as grounds for disqualification set forth by the law or in case of acts that compromise dignity.

Chronology
1868	Meiji Restoration
1874	Medical regulation is established
1885	The first nurse-training institute was established.
1899	Enactment of the Midwifes Ordinance
1900	The first nurse regulation was established (Tokyo only, subsequently expanded nationwide)
1915	Enactment of the Registered Nurses Ordinance
1929	The Association of Nurses was established.
1933	The 7th ICN Congress approves membership of Japan's Imperial Nurses Association.
1937	Promulgation of Public Health Center Act （The term of Public Health Nurse is used for the first time in law）
1941	Enactment of the Public Health Nurse Ordinance
1942	Enactment of the National Health Act
1945	The WWII ends. Japan was placed under GHQ control
1946	A new nurse education system was launched under GHQ guidance. The Japanese Association of Midwives, Registered Nurses and Public Health Nurses is established today's JNA).
1948	Enactment of the Act on Public Health Nurse, Midwife and Nurse. The law changes the status of these nursing professions into formal licensed qualifications granted upon passing examinations.
1949	Enactment of the ordinance for designating training schools for public health nurses, midwives and nurses
1951	Introduction of the assistant nurse system
1952	Introduction of the first four-year university course on nursing
1955	JNA joins ICM.
1957	Introduction of a two-year nursing education course (for assistant nurses preparing for the government examination for nurse qualification)
1959	The Japan Nursing Federation is established as a political lobbying organization.
1965	National Personnel Authority ruling on the regulation regarding night shifts of nurses (up to 8 days a month, ban on single-person night shift)
1967	Establishment of the Japan Nursing Society
1977	The 16th ICN Congress was held in Tokyo.
1987	Ministry of Health and Welfare reports the need to establish training institutes for nursing education, organize forums / training sessions, step up the standard of nursing education and create more undergraduate / postgraduate courses on nursing.
1990	May 12, the birthday of Florence Nightingale, was officially declared the Nursing Day.
1992	A prefecture nursing association opens the first visiting nurse station. Enactment of the Act on Assurance of Work Force of Nurses and Other Medical Experts.
1994	The first male public health nurse receives an official license.
1995	Great Hanshin & Awaji Earthquakes Initiatives for disaster nursing gather momentum.
1996	The first group of Certified Nurse Specialists receive certification.
1997	The first group of Certified Experts Nurses receive certification.
2007	ICN Conference was held in Yokohama.
2010	Enforcement of partial revision of the Act on Public Health Nurses, Midwives and Nurses Introduction of novice nurses' clinical training project

Public health nurses

A public health nurse is a person who engages in health guidance using the title of public health nurse under the license of the Minister of Health, Labour and Welfare (Article 2 of the Act on Public Health Nurses, Midwives and Nurses) .

The workplace of public health nurses are public health centers, public administration including those of municipalities, cities or villages, as well as in industry or a hospital. Among these, those working for municipalities, cities or villages have been increasing year after year. The ratios of workplaces in 2007 showed that health centers and municipalities, cities and villages accounted for 64.2%, hospitals and clinics for 22.2% and other establishments for 5.5%.

Public health nurses, being the leaders of public health nursing operations, are professionals who have conducted such operations as community activities or methods of getting into communities. Through the activities, the professionals find common health problems within a community and seek solutions valuing partnership and collaboration with residents. To solve diversified and complicated health problems, there are great expectations of public health nurses. Particularly in these years, their roles in urgent and troublesome issues including measures against lifestyle-related diseases and suicide are critical.

Classes to prevent life-style related diseases instructed by Public health nurse

Midwives

A midwife is a woman who engages in midwifery or health education to pregnant and postpartum women or newborn under the license of the Minister of Health, Labour and Welfare (Article 3 of the Act on Public Health Nurses, Midwives and Nurses). This license can only be obtained by women. Midwives are granted the right to establish a midwifery home, but have to notify the prefectural governor that has jurisdiction over the home's location within ten days of the establishment (Article 8 of the Medical Service Law).

The location of birth in Japan has switched from home births to births at facilities (hospitals or clinics) during the past 50 years. Accordingly, midwives working in hospitals or clinics account for approximately 87%, forming the majority, while those who work at midwifery homes account for approximately 5% as of 2007. The recent healthcare provision system is intended to be more intensive due to a decrease in facilities for birth, as well as obstetrics and gynecology specialist doctors. The Ministry of Health, Labour and Welfare grants subsidies to promote coordination and role sharing between medical doctors and midwives. Facilities providing "in-hospital midwifery clinics" or "in-hospital midwifery care" where midwives offer independent care in a hospital or clinic have also been increasing.

Nurses

A nurse is a person who engages in providing care to person with injuries and/ or illnesses or postpartum women, or to assist medical treatment under the license of the Minister of Health, Labour and Welfare (Article 5 of the Act on Public Health Nurses, Midwives and Nurses).

Sophistication and advancement of healthcare as well as the emergence of an aging society with fewer children have triggered changes in the healthcare provision system and disease structure. Consequently, citizens' needs are diversified so that it is required to meet such needs. Currently, there have been moves to expand nurses' roles. Under these circumstances, the government has held review meeting to establish "specific practice nurses" (tentative name) to provide more invasive medical practice, as a new framework.