Nursing in Japan

Basic nursing education

There are several courses of basic nursing education in Japan. In the main courses, basic nursing education is provided at 4-year colleges/universities, 3-year junior colleges or 3-year training schools after graduation from high school to take a national examination to obtain the national license. The educational institutions offering these three courses are under different regulating authority; colleges/universities and junior colleges are under the jurisdiction of Ministry of Education, Culture, Sports, Science and Technology (MEXT) while most training schools are under the jurisdiction of Ministry of Health, Labour and Welfare (MHLW)

Education for public health nurses and midwives is provided at colleges/universities, one-year colleges or training schools, and master's programs at graduate school. If a 4-year college/universities education includes a training program for public health nurses and/or midwives, graduates can qualify to take the national examination, not only for nurses, but also for public health nurses and/or midwives.

Figure 8: Main basic nursing education courses

*1:Nursing University/ College provided Public Health Nursing Course and/ or Midwifery Course in 4-year education, those graduates could get qualification to sit for national examination for Public Health Nurse and /or Midwife in addition to Nurse.
*2:To obtain Public Health Nursing /Midwifery License, it is required to hold Nursing License.

*Assistant nurse courses are omitted

Curriculum of education

The education contents required to be eligible to take the national examination are prescribed jointly by the MHLW and MEXT. Although there are several courses of basic nursing education in Japan as mentioned above, standard of education are equally appropriated to irrespective of the type of educational institution, or whether it is a 4-year college/university, a 3-year junior college or a 3-year training school. For other educational institutions than those offering the main courses, there are different standards.

Figure 9: Education curriculum of nursing schools

Content		Credits
Foundation studies	Basics of scientific thinking	13
	Understanding of humans, living and society
Specialized Basic studies	Human body structure and functions	15
	Diseases mechanism and recovery promotion
	Health support and social security system	6
Specializations I	Basic nursing	10
	Clinical training	3
	Basic nursing	3
Specializations II	Adult health nursing	6
	Gerontological nursing	4
	Child health nursing	4
	Maternal nursing	4
	Mental health and psychiatric nursing	4
	Clinical training	16
	Adult health nursing	6
	Gerontological nursing	4
	Child health nursing	2
	Maternal nursing	2
	Mental health and psychiatric nursing	2
Integration	Home care nursing	4
	Nursing integration and practice	4
	Clinical training	4
	Home care nursing theory	2
	Nursing integration and practice	2
Total		97

(Appendix 3 of Designated rule for Public Health Nursing, Midwifery and Nursing School and Training school)

Development of university nursing education

The first nursing university was inaugurated in 1952. There used to be just eleven nursing colleges/universities, but they sharply increased since 1992 with flexible curriculum organization in accordance with the university establishment standards outlined in 1991, and basic principles concerning nursing college/university establishment prescribed in Act on Assurance of Work Forces of Nurses and Other Medical Experts, enacted in 1992. In addition, lower birthrates and increasing rates of students advancing to college or university encourage schools to launch the training for nursing personnel in high social demand from the perspective of ensuring students. As a result, nursing colleges/universities numbered 193 as of 2010 while master's programs are provided at 121 graduate schools and doctoral programs at 61 graduate schools.

While such incorporation into colleges/universities has contributed to higher social evaluation of nursing personnel, the steep increase in colleges/universities has resulted in disparity between schools and questionable quality of faculties.

Figure 10: Transition of colleges/universities, master's programs and doctoral programs

Figure 11: Change in the number of applicants

[Source] Statistical Data on Nursing Service in Japan 2004~2009

[Reference]
Ministry of Education, Culture, Sports, Science and Technology (Figure 10)
Japanese Nursing Association Publishing Company ed. (2010) Statistical Data on Nursing Service in JAPAN 2009, Japanese Nursing Association Publishing Company. (Figure 10, 11)

Clinical training for newly-graduated nursing personnel

The amendments of Act on Public Health Nurses, Midwives and Nurses and Act on Assurance of Work Forces of Nurses and Other Medical Experts made it obligatory to endeavor to give postgraduate clinical training to newly-graduated nursing personnel from April 2010. The government formulated guidelines aiming to provide the training at all healthcare institutions and launched partial subsidization of training costs.

It is expected to improve the quality of nursing, secure medical safety and prevent early turnover of newly-graduated nursing personnel.

Continuing education

The qualification of nursing personnel in Japan lacks any renewal system so that continuing education after obtaining a license is not compulsory. However, it is essential for nursing personnel to continue to improve their expertise to meet advanced healthcare and diversified citizens' needs. Therefore, opportunities for continuing learning are offered, including on the job training at the workplace, training and workshops provided by Japanese Nursing Association (JNA) or prefectural nursing associations, and various scientific meetings.

Credentialing system

In Japan, the qualification of public health nurses, midwives, nurses and assistant nurses is stipulated by law, while the certification of specialized nurses is not specified by law. Although many organizations and societies certify such personnel, credentialing system by JNA is socially recognized and appreciated.

This credentialing system by JNA, intended to offer quality healthcare to citizens, certificates the following three; certified nurse specialists, certified nurses and certified nurse administrators.

Certified nurse specialists

Certified nurse specialist (CNS) system is designed to contribute to the development of healthcare and welfare as well as to improve nursing science by forwarding CNSs with specific advanced nursing knowledge and skills into society to provide high-level nursing care efficiently for individuals, families and groups having complex and intractable nursing problems.

The roles of CNSs are excellent nursing practice, consultation with care providers including nurses, coordination among the concerned parties, ethical coordination to protect the rights of individuals, etc., education of nursing personnel, and research activities at clinical settings. A nurse is certified as a CNS by completing a master's program at a graduate school after obtaining a national license for nurses, and then passing the credentialing examination given by JNA after accumulating a certain amount of experience. It is required to renew the certification every five years.

Certified nurses

Certified nurse (CN) system is designed to diffuse quality nursing care at nursing sites by forwarding CNs who can provide high-level nursing practice, using skilled nursing expertise in specific nursing fields, into society.
The roles of CNs are nursing practice at high level, instruction of nurses, and consultation with nurses.
A nurse is certified as a CN by accumulating a certain amount of experience after obtaining a national license for nurses, and then passing the credentialing examination given by JNA after completing the required education program for certification. It is required to renew the certification every five years.

Certified nurse administrators

Certified nurse administrator (CNA) system is designed to provide quality organizational nursing services to individuals, families and local residents with diversified healthcare needs, establish frameworks for training of CNAs meeting certain standards, help to maintain and improve the quality of CNAs and the standard of nursing, and thereby contribute to the development of healthcare and welfare.

A nurse is certified as a CNA by accumulating a certain amount of experience after obtaining a national qualification for nurses, and then passing the credentialing examination given by JNA after completing a master's program at a graduate school or an education program for certification. It is also required to renew the certification every five years. As of January 2012, 1,307 nurses are certified as CNA.

Table 3: Number of certified nurse specialists by field (as of January, 2013)

Field	Registered number
Cancer Nursing	432
Psychiatric Mental Health Nursing	144
Community Health Nursing	26
Gerontological Nursing	55
Child Health Nursing	96
Women's Health Nursing	44
Chronic Care Nursing	84
Critical Care Nursing	114
Infection Control Nursing	22
Family Health Nursing	21
Home Care Nursing	6
Total	1,044

Table 4: Number of certified nurses by field (as of January, 2012)

Field	Registered number
Emergency Nursing	739
Wound, Ostomy and Continence Nursing	1,778
Intensive Care	750
Palliative Care	1,295
Cancer Chemotherapy Nursing	1,007
Cancer Pain Management Nursing	638
Visiting Nursing	333
Infection Control	1,611
Diabetes Nursing	438
Infertility Nursing	121
Neonatal Intensive Care	287
Dialysis Nursing	151
Perioperative Nursing	235
Breast Cancer Nursing	188
Dysphagia Nursing	373
Pediatric Emergency Nursing	159
Dementia Nursing	262
Stroke Rehabilitation Nursing	290
Radiation Therapy Nursing	103
Chronic Respiratory Nursing	57
Chronic Heart Failure Nursing	60
Total	10,875