NURSING
IN JAPAN

Japanese Nursing Association

Table of Contents
Preface ����������������������������� 2
Ⅰ. Overview of Social Security System in Japan
1. Universal Health Coverage in Japan ���������� 3
2. Social Security System and Reform Efforts������� 3
Ⅱ. Health Care Delivery System
1. M
 edical Care Delivery System�������������� 7
2. Medical Insurance System ��������������� 9
3. Long-term Care Delivery System ������������ 11
4. Long-term Care Insurance System ����������� 13
Ⅲ. Nursing System
1. D
 evelopment of Modern Nursing ������������ 16
2. Regulations and Current Challenges in Nursing
Qualifications ���������������������� 16
3. O
 ccupations Involved in the Provision of Nursing Care �� 17
Ⅳ. Nursing Education
1. Basic Nursing Education ���������������� 19
2. C
 ontents of Basic Nursing Education���������� 19
3. Development of University Education for Basic
Nursing Education and Graduate School Education �� 20
Ⅴ. Improvements in Credentials
1. Current System��������������������� 22
2. A
 ssistance for Improvements in Credentials of Nursing
Professionals (Professional Organization’s Initiatives) ��� 23
Ⅵ. Situation of Nursing Professionals in Japan
1. S
 tatus of Employed Nursing Professionals ������� 25
2. Impact of COVID-19 Pandemic on Working Conditionsof Nursing Professionals ����������������� 26
3. E
 fforts for Nursing Professionals Who Have Left
the Profession or Who Are Not Currently Working���� 26
Ⅶ. Foreign Nurses Working in Japan
1. F
 oreign Nurses Working in Japan������������ 29
2. Acceptance of Foreign Nurses ������������� 29
Ⅷ. Response to Disasters and Pandemics
1. R esponse to Disasters (Disaster Relief Nurses)����� 31
2. Response to Pandemic ����������������� 32
3. R
 estructuring of Dispatch System of Relief Nursing
Professionals in Natural Disasters and Pandemics ��� 33
References

Nursing in Japan 2023 01

Preface
In Japan, the population is aging faster than in other countries and the birthrate is declining. This is causing concerns about social infrastructure becoming
weaker and inequality spreading at many levels. Additionally, there are challenges
related to health and medical care because the groups of people who need them
are getting larger and more diverse. This makes it harder to meet the increasing
demand and also harder to maintain quality.
As Japan’s demographics change, society is also changing gradually. A key
target for current policies is the year 2025, when the challenge of an aging
population is expected to shift rapidly from being about the speed of aging to thehigh percentage of elderly people. To prepare for this, the Japanese governmentis promoting the Community-based Integrated Care System that supports homebased care for mainly the elderly by 2025.
Under these circumstances, the Japanese Nursing Association (JNA) developed
and published the “Future Vision of Nursing” in June 2015. Considering the natureof nursing that takes perspectives of both medical care and living, the vision
reiterates the value of “Nursing that Supports and Sustains Human Life, Living
and Dignity”. To support this vision, the JNA shared a 10-year action plan thatruns until 2025 to promote nursing in various community settings and has beenworking on projects to achieve this goal.
Five years have passed since the announcement of the vision, and discussions
have already begun on what lies ahead beyond 2025. There is an urgent need toestablish a social security system for all generations, including not only theelderly, but also people with disabilities, children, those living in poverty, andeven healthy individuals with latent needs.
We have already reached the point where we must consider the next vision for
nursing, looking ahead to 2025 and beyond. The rise of non-communicable diseases(NCDs) and the progress of diversity are affecting the concept of “health”. Physical,
mental, and social well-being have become increasingly important following the
COVID-19 pandemic. As such, we hope to present a vision of nursing that canmake a significant contribution to sustaining universal health coverage (UHC) wellinto the future.
“Nursing in Japan” has been published by the JNA since 2005. It introduces theinstitutional framework in Japan for nursing professional qualifications, the nursing
delivery system, and more. This edition is the first update in six years, since the2016 edition, and the first after the COVID-19 pandemic. It summarizes thecurrent framework of nursing, its historical development, and current challenges
in a compact manner. Japan is recognized in international comparisons as acountry that achieved UHC early on. Needless to say that discussions on reforming
the system to sustain and enhance UHC in Japan are a valuable experience. Given
this context, we hope that this booklet will deepen understanding of Japanesenursing among many countries and people involved in global health and provide
an opportunity to discuss common issues related to achieving and sustaining UHC.
02 Nursing in Japan 2023

Ⅰ．Overview of Social Security System in Japan
1. Universal Health Coverage in Japan
In Japan, the provision of health careservices to all people, one of the threecomponents of universal health coverage(UHC), was achieved with the introduction ofuniversal health insurance in 1961 (Figure1-1). Subsequently, efforts were made to
expand the services covered and reduce copayments, and UHC was largely achieved by
1973. As a result, Japan has been recognizedfor extending life expectancy to the highest
level in the world, reducing health disparities,
and achieving a high standard of health care.
However, in recent years, it has been
pointed out that disparities in health careaccessibility exist within the universal health
Figure 1-1

Achievement and development of universal health insurance(Comparison of pre-1961, 1961, and 1973)

1973
Reduce patientco-payments
1961

insurance system, based on socioeconomic
factors such as income and occupation.1)2)
There have also been concerns about regional
disparities in medical care due to an uneven
distribution of doctors and nurses. Despite thesignificant social changes expected due to adecreasing working-age population as thebirth rate declines, extreme population aging,and the concentration of the population in
urban areas, the challenge is to build a highquality health care delivery system thatmakes efficient use of limited health careresources while maintaining the social
security and health care insurance systems.

Expandingthe population
coveredPre-1961 condition

Expandservicecoverage(3) Z-axis: What isthe percentage ofco-payments?

(2) Y-axis: Which services
are covered?

(1) X-axis: Who is covered?
Source: Kenji Shimazaki: Essence of Japan’s Universal Health Coverage: What and how should
be conveyed of Japan’s experience, FY 2014 International Medical Research andDevelopment Fund (Issue No. 26, Directive 1) Research Report Symposium, “Health
Security System: How to apply Japan’s experience to UHC in developing countries,”
Report on July 16, 2015

2. Social Security System and Reform Efforts
1) Overview of the social security system
In Japan, the social security system serves
as a safety net to support the security andstability of people’s lives. The system consistsof four pillars: social insurance, social welfare,public assistance, and health care and publichealth. It plays a crucial role in supporting
people’s lives throughout their lifetime.
Among these, the system for supporting
healthy lifestyles and medical services in caseof illness is stipulated in “Health Care andPublic Health”, and the system for providing
medical and long-term care services isstipulated and enhanced in “Social Insurance”.
Efforts are being made to enhance both
systems.

The latter system includes a health careinsurance system, which allows anyone who
falls ill or gets injured to receive medical carewith peace of mind, and a long-term careinsurance system that supports, by society as
a whole, those who require long-term care as
they age. This is a compulsory insurance
system that provides in-kind benefits(provision of services) to ensure a healthy
lifestyle and has income redistribution as its
foundation. According to a 2017 survey, theincome gap has narrowed, with a Gini
coefficient of 0 . 3721 after redistribution,compared with 0.5594 for initial income.3)
The universal health insurance system,
established in 1961 based on the National
Nursing in Japan 2023 03

areas.4)5)
With the aging of society and other factors,
expenditures on social security benefits for
public services such as health care, pensions,
welfare, and long-term care continue toincrease year by year, reaching 1.296 million
yen (23.2% of GDP) in 2021 (Figure 1-3). ThisGDP ratio exceeds the OECD average of
21.4% in 2017 (Figure 1-4). As a result,spending is regularly higher than social
insurance premium income, and this differenceis financed by a large amount of public funds.
To make the social security system
sustainable, the government strengthened
financial resources through a consumption tax
hike (raised from 5% to 10% in 2019) under
the policy of Comprehensive Reform of Social
Security and Tax. The government is now
making strong efforts (as described in thenext section) to address the aging of the babyboom generation (those born during the first
postwar baby boom from 1947 to 1949), with akey target being the year 2025, when 8.06
million baby boomers will be 75 or older.

Health Insurance Act, introduced the healthcare insurance system. The long-term careinsurance system, established in 2000, wasbased on the Long-Term Care Insurance Act
to address the progress of aging, changes inthe social background, and changing demand
for services, providing a mechanism forsociety as a whole to support the elderly inneed of care.

2) P opulation and social
expenses forecasts

security

As the aging of the population combinedwith a dwindling birth rate continues toprogress, the total population has shifted froman increasing to a decreasing trend since2010. The total fertility rate in 2021 was 1.30,
indicating that the declining trend is expected
to continue. Therefore, even if the elderly
population begins to gradually decrease after
2040, the aging rate in the total population is
expected to remain flat (Figure 1-2). There
are regional differences in these demographic
changes, which are expected to progress
more rapidly in rural areas than in urban
Figure 1-2

Japan’s Population Trends and Outlook

The elderly population is expected to increase slightly, and working-age population is expected to decrease slowly from2025 to 2040. The intergenerational imbalance becomes more serious. (Working-age population: Elderly population =1.5:1.0) After 2040, the elderly population will begin to decline, but the aging rate will remain unchanged.
(10,000 people)
14,00012,00010,000

(%)
70.0

2025
2040

Population aged 65+
Percentage of working-age population (aged 15-64)

3,677

8,000
30.0％

Population aged 15-64

6,000

7,170

Aging rate (Percentage of age 65+)

4,000

3,921
35.3%

5,978

60.0

Elderly population notmuch changed
3,381
Working-age
population declines

2,000
0

1960

1970

1980

1990

2000

40.0
30.0
20.0

4,529 10.0

Population aged 0-14
1950

50.0

2010

2020

2030

2040

2050

0.0
2060(year)

Note: Actual data from the National Census conducted by the Statistics Bureau of the Ministry of Internal Affairs and Communications until
2015, and estimates based on Population Projections for Japan (2017 estimates) (assuming a medium birth rate (medium death rate))
conducted by the National Institute of Population and Social Security Research from 2020 onward.
Source: Ministry of Health, Labour and Welfare, Environment Surrounding Social Security around 2040 (Hearing materials for the Special
Subcommittee of the Local System Research Committee, September 12, 2018, Ministry of Health, Labour and Welfare), https://www.
soumu.go.jp/main_content/000573859.pdf

04 Nursing in Japan 2023

Figure 1-3(trillion yen)
130
120
110
100

1970

GDP (trillion yen) A
Total social security beneﬁt
expenditures (trillion yen) B(Breakdown) Pension
Medical careWelfare and others
Ｂ/Ａ

Trends in Social Security Benefits

1980

1990

2000

75.3

248.4

451.7

3.5 (100.0％)

24.9 (100.0％)

0.9 (24.3％)

10.3 (41.4％)

2.1 (58.9％)
0.6 (16.8％)
4.7％

2021

2010

537.6

(10,000yen)
129.6
100

(Budget basis)

504.9

559.5

47.4 (100.0％)

78.4 (100.0％) 105.4 (100.0％)

129.6 (100.0％)

23.8 (50.1％)

40.5 (51.7％)

52.2 (49.6％)

58.5 (45.1％)

10.8 (43.2％)

18.6 (39.3％)

26.6 (33.9％)

33.6 (31.9％)

40.7 (31.4％)

3.8 (15.4％)

5.0 (10.6％)

11.3 (14.4％)

19.5 (18.5％)

30.5 (23.5％)

10.0％

10.5％

14.6％

20.9％

23.2％

90

90

105.4

80
70

78.4

80

Pension
Medical careWelfare and others
Social security beneﬁts per capita

70

60
Pension60

47.4

Social security beneﬁts per capita (Right scale)

50

50
40

40

30
24.9

30

Medical care

20

20
10

10

3.5

0.7

0.1
0
1950

1960

Welfare and others

1970

1990

1980

2000

0
2021
(Budget basis)

2010

Data: “The Financial Statistics of Social Security in Japan FY 2019” by the National Institute of Population and Social Security Research; theestimates are those of the Ministry of Health, Labour and Welfare for FY 2020 to 2021 (budget basis), and the gross domestic product for FY
2021 is based on the “Fiscal 2021 Economic Outlook and Basic Stance for Economic and Fiscal Management (decided by the Cabinet on
January 18, 2021)”
Note: T he values in the figure are social security benefit expenditures (trillion yen) for FY1950, 1960, 1970, 1980, 1990, 2000, 2010, and 2021 (budget basis).
Source: Ministry of Finance, Social Security (reference data, April 13, 2022), https://www.mof.go.jp/about_mof/councils/fiscal_system_council/
sub-of_fiscal_system/proceedings/material/zaiseia20220413/03.pdf

Figure 1-4

(%)
35.0

32.2

29.7
8.2
12.3

28.7 28.6

10.7 9.0

6.6

28.0 27.8 27.8

26.5 26.4

8.1 8.0 8.5

7.8

14.6 6.3

9.0

10.0
15.6
11.8

12.0

8.5

6.5

10.3 9.4

4.4

8.2

5.2

OECD average
21.4%
20.8

6.9 5.4

6.1 5.9

19.7

19.0 18.6

6.1 4.8

18.0 17.6

7.8

17.2

4.5

7.7

4.7 5.9

7.7

5.4

4.9

13.8
6.8

10.0 9.4 9.7 10.4 10.1

10.8
6.8

16.4

5.9 5.1 4.0
4.7

7.1 7.5
12.0

8.1

7.5 5.3 5.5

7.6

16.5
13.4

5.0

21.8 21.5 21.3

15.9 15.6

15.0

5.0 4.5 3.3

3.4 4.3 5.3
4.8

8.9 8.4

5.6 5.4

8.2 7.7
3.9

7.5 6.8
6.4

14.5 14.2
4.1 4.6

5.5

12.1 11.9

1.6 1.6 10.9
3.3

5.2

4.9 4.5

7.3

5.5

3.8
4.2

4.9

7.5
1.9
2.8

2.9 2.7

FranceDenmark
Finland
Belgium
Italy
Austria
Switzerland
Germany
NorwaySwedenGreeceUnited States
Spain
Netherlands
Portugal
Japan
Luxembourg
Iceland
Australia
Slovenia
United Kingdom
PolandHungary
Czech Republic
New Zealand
CanadaSlovak Republic
Estonia
IsraelLatviaLithuania
Colombia
Chile
Ireland
Türkiye
Costa Rica
Korea
Mexico

5.0

12.0

13.3

3.3

22.7 22.4 22.4

5.7
6.5

14.5

23.2 22.9

8.2

4.8
6.6

5.7 7.9

23.9
5.6

11.9

6.4
7.1

25.2 24.8
3.9 2.3

10.7

20.0 9.5
15.0

Welfare and others
Medical care
Pension

31.3

30.0
25.0

International comparison of social security benefits by sector (% of GDP)

Note: Based on the OECD Social Expenditure Database and calculated by the Counsellor Office for Policy Management of the
Director-General for Policy Planning and Evaluation, Ministry of Health, Labour and Welfare (2017 figures). Social expenditure
data based on the OECD Social Expenditure Standards is included a wider range of costs (e.g.,facility maintenance costs)
than social security benefits.
Source: Ministry of Health, Labour and Welfare, Composition and Overview of Japan’s Social Security System, https://www.mhlw.
go.jp/content/12600000/000984355.pdf

Nursing in Japan 2023 05

3) Reforms toward 2025

such as doctors and nurses, who are the key tohealth care delivery, differentiating andcoordinating the medical functions of medical
institutions, and enhancing home-based care.
The government’s aim is to achieve theCommunity-based Integrated Care System inwhich health care, long-term care, prevention,
housing, and livelihood support are provided in
an integrated manner, focusing on thecommunity as the key to the daily lives of theelderly and allowing them to live in theirfamiliar environment as long as possible (Figure
1-5).

By 2025, the baby boomer generation will be
75 years old or older, and there are concernsthat social security benefit expenditures will
increase due to the growing latter-stageelderly. To sustain the social security system
despite demographic changes and regional
differences, it is necessary to establish a healthcare delivery system that meets the healthcare needs of each region. Therefore, thegovernment is promoting efforts in each region
to build a more efficient and higher-quality
health care delivery system toward 2025. This
includes securing professional human resources
Figure 1-5

Community-based Integrated Care System

Long-termcare
Medicalcare

Delivery of home
based care

Visits/Moving inHome
Outpatient/Inpatient

Visiting long-term care/Visiting nursing

Community
general support
centerCare manager

Livelihood
supportLong-term
care
prevention*A community-based integrated care system is generally
assumed to be a junior high school district unit.

NPOs/Senior clubs/Volunteers

Source: Partially modified by the Japanese Nursing Association based on Toyama Community-based Integrated Care System, what is a communitybased integrated care system?, http://toyama-chiikihoukatsu.net/about/4) Considerations for 2040

The “2040 problem” is predicted to be thenext major social issue after 2025. By around
2040, Japan’s population will continue to be in
decline, exacerbating the aging society withfewer children and resulting in an evensmaller working population to support society.
At the same time, the elderly population thatis supported by society is expected to age
even further, with nearly 30% of the elderly
being 85 years old or older. The imbalance
between those who support and those whoare supported will therefore become a major
issue. Furthermore, economically, it is said
that economic disparities and impoverishment
06 Nursing in Japan 2023

between and within generations will continue
to deepen as a generation in which many
work under precarious employment or
without a job because their job hunting
coincided with a difficult employment
environment reaches old age in 2040.
The government aims to increase the total
number of workers and to realize health careand welfare services that can run with fewer
people as the workforce continues to decrease.
Specifically, the government will work topromote diverse employment and social
participation, extend healthy life expectancy,
and improve productivity through health careand welfare service reforms.

Ⅱ．Health Care Delivery System
1. Medical Care Delivery System
1) Situation of medical institutions

those with less than 200 beds accounted for
70.0% of the total (Table 2-2). The total
number of hospital beds is 1,583,783 (Table2-3), which is about 13 beds per thousandpeople, ranking Japan first in the world (Table
2-4).

Table 2-1 shows the total number of medical
institutions in Japan as of October 1, 2021. In
terms of hospitals by the number of their beds,
those with 50 to 99 beds accounted for thelargest number (2,048 facilities, 25.0%), andTable 2-1

Number of medical institutions by institution type
Falicities

Total
Hospitals
Psychiatric hospitals
General hospitals(Regrouped)Hospitals with beds
for long-term care
Medical clinics
With beds(Regrouped)Medical clinics with beds
for long-term care

As of October 1 of each year

Change over the year

Percentage distribution (%)

2021

2020

Number

Percentage
(%)

2021

2020

180,396

178,724

1,672

0.9

…

…

8,205
1,053
7,152

8,238
1,059
7,179

△    33△     6△    27

△
△
△

0.4
0.6
0.4

100.0
12.8
87.2

100.0
12.9
87.1

3,515

3,554

△    39

△

1.1

42.8

43.1

104,292
6,169

102,612
6,303

1,680
△  134

△

1.6
2.1

100.0
5.9

100.0
6.1

642

699

△    57

△

8.2

0.6

0.7

Without bed

98,12396,309

1,814

1.9

94.1

93.9

Dental clinics
With beds
Without bed

67,89921
67,87867,87421
67,853

25
25

0.0
0.0

100.0
0.0
100.0

100
0.0
100.0

Source: Ministry of Health, Labour and Welfare, Outline of Results, Ⅰ. Survey of Medical Institutions, Summary of Dynamic Survey of Medical
Institutions and Hospital Report 2021, https://www.mhlw.go.jp/toukei/saikin/hw/iryosd/21/dl/02sisetu03.pdf

Table 2-2

Number of medical institutions by number of beds
Falicities

Hospitals
20- 49 beds
50- 99100-149
150-199200-299300-399
400-499500-599600-699700-799
800-899900 +Me d i c a l c l i n i c s(with beds)
1- 9 beds
10-19

As of October 1 of each year

Change over the year

Percentage distribution (%)

2021

2020

Number

Percentage
(%)

2021

2020

8,205

8,238

△

33

△

0.4

100.0

100.0

908
2,048
1,421
1,365
1,032
674
366

909
2,061
1,424
1,368
1,036
677
369

△
△
△
△
△
△
△

   1
13
   3
   3
   4
   3
   3

△
△
△
△
△
△
△

0.1
0.6
0.2
0.2
0.4
0.4
0.8

11.1
25.0
17.3
16.6
12.6
8.2
4.5

11.0
25.0
17.3
16.6
12.6
8.2
4.5

162
110
38
29
52

161
111
42
28
52

0.6
0.9
9.5
3.6
-

2.0
1.3
0.5
0.4
0.6

2.0
1.3
0.5
0.3
0.6

6,169

6,303

△

134

△

2.1

100.0

100.0

1,774
4,395

1,787
4,516

△
△

13
121

△
△

0.7
2.7

28.8
71.2

28.4
71.6

1
△    1△    41-△△

Source: Ministry of Health, Labour and Welfare, Outline of Results, Ⅰ. Survey of Medical Institutions, Summary of Dynamic Survey of Medical
Institutions and Hospital Report 2021, https://www.mhlw.go.jp/toukei/saikin/hw/iryosd/21/dl/02sisetu03.pdf

Nursing in Japan 2023 07

Table 2-3

Number of beds by bed type

As of October 1 of each year

Number of beds
2021

Change over the year

2020

Percentage distribution (%)

Percentage

Number

2021

(%)

2020

Total

1,583,783

1,593,633

△

9,850

△

0.6

…

…

Hospitals

1,500,057

1,507,526

△

7,469

△

0.5

100.0

100.0

Psychiatric beds

323,502324,481

△

  979

△

0.3

21.6

21.5

Psychiatric hospitals

244,422

246,006

△

1,584

△

0.6

16.3

16.3

General hospitals

79,08078,475

0.8

5.3

5.2

1,893

1,904

△

    11

△

0.6

0.1

0.1

3,944

4,107

△

  163

△

4.0

0.3

0.3

284,662

289,114

△

4,452

△

1.5

19.0

19.2

886,056

887,920

△

1,864

△

0.2

59.1

58.9

83,66886,046

△

2,378

△

2.8

100.0

100.0

6,310

6,936

△

  626

△

9.0

7.5

8.1

58

61

△

     3

△

4.9

…

…

290,972

296,050

△

5,078

△

1.7

…

…

Infectious diseases
beds
Tuberculosis beds
Beds for longterm care (A)General beds
Medical clinics(Regrouped)Beds for longterm care (B)Dental clinics
Beds for long-termcare (total) (A)+(B)  605

Source: Ministry of Health, Labour and Welfare, Outline of Results, Ⅰ. Survey of Medical Institutions, Summary of Dynamic Survey of Medical
Institutions and Hospital Report 2021, https://www.mhlw.go.jp/toukei/saikin/hw/iryosd/21/dl/02sisetu03.pdf

Table 2-4

International comparison of health care delivery system in 2019

Country

Average length ofstay in hospitals

Hospital beds per
1,000 people

Japan

―
（16.0）

12.8

Germany

8.9＊（＊7.5）

France

  8.8
（5.4）

UnitedKingdom

＊
6.6
（6.2）

UnitedStates―（＊5.5）

Medicalpractitioners per
100 hospital beds
19.2＊

Medicalpractitioners per
1,000 people
2.5

＊

90.6

176.2

＊

7.9

55.5

4.4

5.8

54.3

3.2

E

2.5

120.1

3.0

2.8

＊

92.2

2.6

＊

Nurses per 100
hospital beds

189.6

＃

Nurses per 1,000
people
11.8

＊

14.0
11.1

＃

334.2
420.2

＃＊

8.2
12.0

＃

OECD. Stat (as of September 1, 2021)
Note1 [#] includes staff working in research institutes, etc., in addition to staff engaged in clinical work.
Note2 [*] indicates data for 2018.
Note3 [E] is the estimated value.
Note4 The number of medical practitioners and clinical nurses per 100 beds is simply the total number of clinical doctors, etc. divided by the numberof beds and multiplied by 100.
Note5 The bracketed average length of stay in hospitals is the average length of stay in acute care beds (general hospital beds in Japan).
Source: Ministry of Health, Labour and Welfare, Estimates of number of hospitals, Current status of health care delivery system, https://www.mhlw.
go.jp/content/10800000/001029753.pdf

2) Situation of health care professionals

In Japan, in addition to nurses, health care
professionals including physicians, dentists,
pharmacists, and others are also engaged inhealth care. The number of health care
professionals in each profession is shown in
Table 2-5. Of these, approximately 1.68 million
are engaged in the nursing profession (as of2019), with the number increasing by about
08 Nursing in Japan 2023

30,000 each year. Compared to other countries,
Japan’s number of nursing professionals per
1,000 people (11.8) is not significantly different
from Western countries. However, the numberof nursing professionals per 100 hospital beds
(90.6) is very low, less than half of that inFrance and Germany, and one-fifth of that in
the United States (Table 2-4). Currently, thefunctional differentiation of hospital beds (i.e.,the optimization of the roles of hospital beds
and personnel allocation according to thoseroles) is underway. In conjunction with this
discussion, it is necessary to optimize nurse
staffing according to the functions of thehospital.
As for the current challenges related tosecuring nursing professionals, uneven
distribution by field (by place of employment)
and shortages in some regions in relation to
Table 2-5

demand (uneven distribution by region) are
more serious than the issue of quantitative
maintenance. If the uneven distribution by
field and region continue to progress, evenunder a universal health insurance system, it
will lead to differences in accessibility to andthe content of health care services dependingon the nature of the medical and nursing careneeded and the area of residence, which maylead to an expansion of health disparities.

Number of health care professionals

・Physicians	  323,700
・Dentists	  104,118
・Pharmacists	  250,585
Source: H ealth Statistics Office of Director-General for Statistics and Information Policy, Ministry of Health, Labour and Welfare,Statistics of Physicians, Dentists and Pharmacists 2021
※ Physicians and Dentists employed in medical institutions, pharmacists employed in pharmacies and medical institutions.
・Public health nurses	    64,819
・Midwives	    40,632
・Nurses
1,272,024
・Assistant nurses	  305,820
Source: According to a survey by Health Policy Bureau, Ministry of Health, Labour and Welfare 2019
Source: Ministry of Health, Labour and Welfare, Number of health care professionals, Overview of the system and the basic statistics, Annual Health,Labour and Welfare Report (2019), https://www.mhlw.go.jp/wp/hakusyo/kousei/21-2/kousei-data/siryou/sh0202.html#sec02

2. Medical Insurance System
1) Overview of the system

The universal health insurance systemprovides medical care to all citizens. It has fourmain characteristics: [1] universal coverage forall citizens under public health insurance, [2]freedom to choose medical institutions (freeaccess), [3] access to advanced medical care at
low cost, and [4] a social insurance system as
the basis, supplemented by public funds.6)
Citizens are obligated to enroll in public
insurance and pay premiums. However, they
Figure 2-1
Insured person (patient)②Medical care service(provision of medical
beneﬁt)can receive medical care with a partial costburden (co-payment) when they visit medical
institutions (Figure 2-1). The co-payment is 30%of the medical costs, but the co-payment ratio
varies depending on age and economic status(Figure 2-2). Citizens are generally free tochoose their medical institutions. The operationof these mechanisms is broadly divided into
two types: employee’s health insurance, inwhich employed individuals and their family
members enroll through their place ofFlow of insured medical treatment④Sending approvedclaim②Co-payment

Medical care facility providing insured
services, etc(hospital, clinic, pharmacy, etc)

Insurer①Payment of premium③Medical fee claim⑥Payment of medical fee⑤Payment of billedamountExamination and payment organization(Health Insurance Claims Review andReimbursement Services Federation of National
Health Insurance Associations)

Source: All Japan Hospital Association，Medical Fee System, https://www.ajha.or.jp/guide/1.html

Nursing in Japan 2023 09

employment, and national health insurance, inwhich self-employed and unemployedindividuals and their family members enroll
based on their place of residence (municipality).
Through the payment of insurance
Figure 2-2

premiums according to ability to pay, amutual assistance system was establishedearly on, whereby anyone can receive medical
services anytime and anywhere without aheavy financial burden.

Patient’s co-payment of medical costs【Patient’s co-payment ratio of medical costs】
general andlow-income persons

co-payment of 10%
75 y/o70 y/oco-payment of 20%*

persons with a
pre-retirementlevel income

co-paymentof30%

A system that provides reimbursement for the amountexceeding the monthly maximum co-payment in order
to avoid co-payments for medical costs becoming too
expensive for family budgets.

〈Example: Case of an employee with co-payment of 30%〉
Medical costs ¥1,000,000

co-payment of 30%

6 y/o(before compulsory
education)*High-cost Medical Care Beneﬁt System

Co-payment
at reception¥300,000

High-cost medical care beneﬁts:¥300,000 － ¥87,430 = ¥212,570

co-payment of 20%

Maximum co-payment:¥80,100 + (¥1,000,000 － ¥267,000) × 1% ＝ ¥87,430*Since April 2008, the co-payment for those aged 70 to 74 had remained unchanged at 10%, but was gradually increased to
20% for insured persons who turned to 70 from 2014 onwards.
(Note) T he maximum co-payment is divided into general, high-income, and low-income categories according to the income of
the insured.
Source: Ministry of Health, Labour and Welfare, Characteristics of the Universal Health Insurance System, https://www.mhlw.
go.jp/content/12400000/000377686.pdf

2) Payment mechanism for medical costs
The payment of medical costs is based on afee-for-service system, where a fixed numberof points are assigned to each medical
procedure, including examinations, tests,
treatments, hospitalizations, surgeries, andmedications. As of 2022, the unit price for one
point is set at 10 yen. The total number ofpoints for the medical procedures provided ismultiplied by 10 yen to calculate the medical
costs, and the patient pays a certain
percentage of this amount as a co-payment(see above). Under the current fee-for-service
system, medical practitioners are incentivized
to perform more medical procedures because
their compensation increases with eachprocedure. Therefore, there is less incentive
to control costs. As a result, a comprehensive
payment system has been adopted for some
hospitalizations and outpatient services toaddress this issue.

10 Nursing in Japan 2023

3) Trends in medical care expenditure

Under the universal health insurance
system, national medical care expenditure has
been increasing steadily due to the aging of
the population, changes in disease structureleading to increased use of health care(including an increase in the number of users
and longer usage periods), and medical
advancements (Figure 2-3). The national
medical care expenditure for fiscal 2019, justbefore the outbreak of the COVID-19, were
44.3895 trillion yen (up by 994.6 billion yen or
2.3% year-over-year (YoY)), with 351,800 yen
per capita (up by 8,600 yen or 2.5% YoY). Thisaccounts for 7.93% of GDP, gross domestic
product (up by 0.02% YoY) and 11.06% of GNI,
gross national income (up by 0.33% YoY).7) (Forreference, national medical care expenditure
for fiscal 2020 were 42.9665 trillion yen (downby 1.423 trillion yen or 3.2% YoY8)), and it isbelieved that impacts affecting this decrease
included a reluctance to visit medical
institutions due to the COVID-19 pandemic.)

(trillion yen)
45

Figure 2-3

Annual changes in national medical care expenditure and its ratio to GDP

9.0
8.0

35

7.0

30

6.0

25

5.0

Ratio to GDP

20

4.0

15

3.0

National medical care expenditure

10

Ratio to GDP

National medical care expenditure

40

2.0

5
0
1955

(%)
10.0

1.0
1960

1965

1970

1975

1980

1985

1990

1995

2000

2005

2010

2015

0.0
2020 (FY)

Source: M inistry of Health, Labour and Welfare, Overview of the national medical care expenditure 2020, https://www.mhlw.go.jp/toukei/saikin/hw/k-iryohi/20/dl/data.pdf

3. Long-term Care Delivery System
1) Types and number of long-term carefacilities

The current situation of long-term careservice providers nationwide as of October 1,
2021, is shown in Table 2-6. There are
currently four types of long-term careinsurance facilities available for long-term careinsurance services: welfare facilities for theelderly requiring long-term care, health carefacilities for the elderly requiring long-termcare, integrated facilities for medical and longterm care, and sanatorium-type medical carefacilities for the elderly requiring long-termcare. Facility standards for each type areregulated by law according to their different
functions.
Long-term care service establishments arebroadly categorized into five categories:
preventive long-term care service
establishments, community-based preventive
long-term care service establishments, in-homeservice establishments, community-based
service establishments, and in-home long-termcare support establishments. Among these,
visiting nursing stations, which provide nursing
care by visiting nurses for people recuperating
at home, were first established in 1992, and thenumber of these stations has increased to13,554 (up by 1,161 stations YoY). In terms of
the establishing entities of these stations, thehighest percentages are for-profit corporations(companies), accounting for 59.2%, followed byhealth care corporations (21.9%).9) Additionally,
combined multiple services (nurse-led
comprehensive community care) were
established in 2012 as a system in which asingle establishment provides four services(visiting nursing, home-visit long-term care,
day service, and overnight service) so thatpeople can continue to live out their lives intheir familiar communities even if they need
medical treatment or long-term care. The
number of these facilities has been increasing
year by year and has reached 817 in 2021 (upby 106 facilities YoY).

Nursing in Japan 2023 11

Table 2-6

Results of Survey of Institutions and Establishments for Long-term Care for 2021

As of October 1 of each year

YoY

Long-term care insurance facilities
Welfare facilities for the elderly requiring long-term careHealth care facilities for the elderly requiringlong-term care
Integrated facilities for medical and long-term careSanatorium-type medical care facilities for theelderly requiring long-term care
Preventive long-term care service establishments
Home-visit bathing service for preventive long-term care
Visiting nursing stations for preventive long-term careOutpatient rehabilitation service for preventive
long-term careShort-term admission for daily preventive long-term careShort-term admission for recuperation forpreventive careDaily preventive long-term care admitted to
specified facilities
Lending preventive long-term care welfare instruments
Sales of specific preventive long-term carewelfare instrumentsCommunity-based preventive long-term care service
establishmentsOutpatient care service for preventive long-termcare for dementia patientsMultifunctional preventive long-term care in a small
group homeDaily life care service for preventive long-termcare in communal living for dementia patientsPreventive long-term care support establishments(community general support centers)
In-home service establishments
Home-visit long-term careHome-visit bathing long-term care
Visiting nursing stations
Outpatient day long-term care
Outpatient rehabilitation
Short-term admission for daily life long-term care
Short-term admission for recuperation
Daily life long-term care admitted to specified facilities
Rental service of equipment for long-term carecovered by public aid
Sales of specified equipment covered by public aid
Community-based service establishments
Regular visiting/on-demand home-visit longterm/nursing careHome visit at night for long-term careCommunity-based outpatient day long-term care
Outpatient long-term care of dementia patients
Multifunctional long-term care in a small group home
Communal daily long-term care for dementia patientsDaily life long-term care for people admitted to
a community-based specified facilityCo mbined multiple services (nurse-led
comprehensive community care)Community-based welfare facilities for theelderly requiring long-term care
In-home long-term care support establishments

2021

2020

8,414

8,306

4,279

4,304

617

536

81

15.1

421

556

△ 135

△ 24.3

1,483
13,221

1,561
12,115

△ 78
1,106

△

5.0
9.1

△

△

0.6

Change in number

Percentagechange (%)

108
△

25

△

0.6

8,225

8,274

11,256

11,134

122

4,966

5,098

△ 132

5,174

5,033

141

2.8

7,648

7,463

185

2.5

7,636

7,506

130

1.7

3,445

3,536

5,145

5,076

69

1.4

13,703

13,612

91

0.7

5,280

5,249

31

0.6

35,612
1,705
13,554
24,428
8,308
11,7905,068
5,610

35,075
1,708
12,39324,087
8,349
11,668
5,220
5,454

537
△    3
1,161
341
△ 41
122
△ 152
156

△

49

1.3

91

1.1
△

△

△

△
△

2,6

2.6

1.5
0.2
9.4
1.4
0.5
1.0
2.9
2.9

7,770

7,545

225

3.0

7,657

7,529

128

1.7

1,178

1,099

79

7.2

221
19,5783,753
5,614
14,085220
19,667
3,868
5,556
13,977

1
△ 89
△ 115
58
108

365

354

11

3.1

817

711

106

14.9

2,474

2,413

61

2.5

39,04739,284

△ 237

△
△

△

0.5
0.5
3.0
1.0
0.8

0.6

Note: Establishments that provide more than one service are accounted for in each item.
Source: Ministry of Health, Labour and Welfare, Results of Survey of Institutions and Establishments for Long-term Care for 2021, https://www.mhlw.
go.jp/toukei/saikin/hw/kaigo/service21/dl/kekka-gaiyou_1.pdf

12 Nursing in Japan 2023

2) Situation of long-term care workers

Various health care professionals work
alongside care staff and certified care workers
in providing long-term care services. The
largest number of nurses is engaged in visiting
nursing stations (92,139), followed by day-careservice for long-term care (38,225), health carefacilities for the elderly requiring long-termcare (29,732), and welfare facilities for theelderly requiring long-term care (27,418) in
2021.9)

4. Long-term Care Insurance System
1) Overview of the system

The long-term care insurance system is amechanism by which society as a whole
supports the care of the elderly, and its key
provisions are stipulated by the Long-TermCare Insurance Act. As the population ages,
the number of people requiring long-term careincreases, and the duration of long-term care
lengthens, family structures that provide longterm care are also changing, with the shift tonuclear families and the aging of caregivers.
In response to these changes, the long-termcare insurance system was established in 2000,
with municipal governments as the insurers
responsible for its operation. All citizens over
40 years old, including the insured persons
mentioned above, have an obligation to pay
insurance premiums, and benefits are provided
to primary insured persons aged 65 and older
as well as secondary insured persons aged 4064 (Figure 2-4). However, in order to use thissystem, it is essential to receive a certificationof needed long-term care to classify the levelof long-term care needed according to thedegree severity. The basic mechanism issimilar to that of health insurance, providing
in-kind benefits (long-term care and preventive
care benefits) under partial co-payment, but
the financial structure is more complex. The
amount of partial co-payment is 10% of thecost of services used but varies depending on
income (Figure 2-5).

2) Payment mechanism for long-termcare costs

The payment of long-term care costs is
calculated by adding regional and labor

supplements based on the location of theservice provider to the basic remuneration set
for each service. The monthly upper limit for
using long-term care services is determinedaccording to the level of care needed, based on
the certification of needed long-term care. Whileusers mainly choose the services they want touse, for in-home long-term care services suchas visiting nursing, care managers interveneand create a care plan that combines services
according to individual needs. Users pay acertain percentage (as described above) as copayment, but they are responsible for paying
the full amount exceeding the upper limit. With
the promotion of community-based integrated
care and the shift from medical institutions tothe community, the number of users with highmedical needs is increasing, and the assessmentof medical needs is also increasing in caremanagement.

3) Trends in long-term care expenditure

As society rapidly ages, the number ofpeople with the certification of needed longterm care has been increasing every year
(Figure 2-6), resulting in an increase in the
total expenditure of long-term care insurance.
When the long-term care insurance system
was established in 2000, the total expenditurewas 3.6 trillion yen. However, in 2018, it had
nearly tripled to 11.0 trillion yen (up by 400
billion yen YoY). Under this system, theinsurance premiums paid by primary insured
individuals aged 65 and over are also
increasing. This trend is expected to continue
in the future.

Nursing in Japan 2023 13

Figure 2-4

Insured individuals in the long-term care insurance system〇 The long-term care insurance system covers (1) individuals aged 65 and older (primary insured persons) and(2) individuals aged 40 to 64 with health insurance (secondary insured persons).
〇 Long-term care insurance services are available to those aged 65 or older when they require support or care regardlessof the cause, and to those aged 40 to 64 if they require support or long-term care due to aging-related diseases such as
terminal cancer and rheumatoid arthritis.

Primary insured persons

Secondary insured persons

Individuals aged 65+

Individuals aged 40-64 with health insurance

Covered persons
Number of people

35.25 million
・In need of long-term care(condition requiring long-term care due tobeing bedridden, dementia, etc.)
・In need of support(condition requiring support in daily living)

Requirements

41.92 million(aged 65-74: 17.3 million, aged 75+: 17.96 million)

6.45 million (18.3%)
aged 65-74: 730,000 (4.2%)
aged 75+: 5.72 million (31.8%)

130,000 (0.3%)

Collected by municipality(generally, deducted from one’s pension)

Collected together with health insurance
premiums by health insurers/support and theirpercentage of theinsuredInsurance premium
burden⎩⎜⎧⎩⎜⎧Number of persons
certified as requiringlong-term care

Limited to cases where the condition requiringlong-term care or support is due to age-relateddiseases (specified diseases) such as terminal
cancer and rheumatoid arthritis(Note) T he number of primary insured persons and persons certified as requiring long-term care/support is based on the “Status Report on
the Long-term Care Insurance System” and reflects the figures as of the end of fiscal 2018.
	The number of secondary insured persons is based on reports from health insurers for the Health Insurance Claims Review &Reimbursement Services to determine the amount of long-term care benefit payments, and reflects the monthly average for fiscal 2018.
Source: Ministry of Health, Labour and Welfare, Overview of the Long-Term Care Insurance System (May 2021), https://www.mhlw.go.jp/
content/000801559.pdf

Figure 2-5

Mechanism of the long-term care insurance system

Municipalities (insurers)
Tax50%

Premiums
50%

Municipalities
12.5%

Prefectures National government
12.5%*
25%*

Payment of 90% (80%or 70%) of expenses*

Service Provider○ In-home services* For institutional beneﬁts, 20% by the national
government and 17.5% by the prefectures
23%

27%

Billing• Regular visiting/on-demand home-visit
long-term/nursing care
• Communal daily long-term care fordementia patients etc.

○ Facility services• Welfare facilities for the elderly• Health care facilities for the elderly, etc.

Based on population ratio(FY2018‒2020)

Fiscal stability fundIndividualmunicipalities
Premiums
Generally deducted from pension• Home-visit long-term care
• Outpatient day long-term care, etc.

○ Community-based long-term care services

Co-payment of 10% (20% or 30%)*

Nationwide pool Housing and food expenses
National health insurance & healthinsurance associations, etc.

Use of services

Certiﬁcation of needed long-term care
Insured persons

Primary insured persons• Individuals aged 65+

Secondary insured persons• Individuals aged 40 to 64(35.25 million)(41.92 million)(Note) The number of primary insured persons is based on the “Status Report on the Long-term Care Insurance System” and reflects the figures
as of the end of FY2018.
	The number of secondary insured persons is based on reports from health insurers for the Health Insurance Claims Review &Reimbursement Services to determine the amount of long-term care benefit payments, and reflects the monthly average for fiscal 2018.
* For those with incomes above a certain level, 20% of the expenses (effective August 2015) or 30% of the expenses (effective August 2018).
Source: Ministry of Health, Labour and Welfare, Overview of the Long-Term Care Insurance System (May 2021), https://www.mhlw.go.jp/
content/000801559.pdf

14 Nursing in Japan 2023

Figure 2-6

 rends in the number of persons certified asTrequiring long-term care/support

The number of persons certiﬁed as requiring long-term care/support
has increased by about tripled over the 20 years from 2000 to 2020
(nearly doubling its ratio of the total elderly population). The increasein the number of persons certiﬁed as requiring long-term care level 1 orless is particularly large.
(10,000 people)
800

18.6

700

(％)
20

669

600

Long-term care level 5Long-term care level 4Long-term care level 3Long-term care level 2
Long-term care level 1
Requiring support 2
Requiring support 1
Requiring support
Percentage of persons
with certiﬁcation ofneeded long-term care

15

500
400
300
200

10

9.9
218

5

100
0

2000 2005 2010 2015 2020
(FY)

Requiring support
1

2
3.83 times0Long-term care
1

2

3

4

5

Total

2.94 times 2.78 times 2.42 times 2.07 times 3.06 times* Percentage of persons certiﬁed as requiring long-term care/support isthe percentage in the population aged 65 and over
Source: Compiled by the Japanese Nursing Association based on the results ofbasic complete tabulation on population and households, Population
census 2020 , Statistics Bureau, Ministry of Internal Affairs andCommunications, https://www.stat.go.jp/data/kokusei/2020/kekka.html

Nursing in Japan 2023 15

Ⅲ．Nursing System
1. Development of Modern Nursing
In Japan, modern nursing developed rapidly
with the introduction of Western medicine in1868 . The beginning of Japan’s nursing
education system dates back to 1874 and theestablishment of the “Isei” medical regulation,

which provided for the education and licensingof midwives, and marked the start of theirtraining. In 1885, Japan’s first nurse-training
institute was established, and modern nursing
education began.

2. Regulations and Current Challenges in Nursing Qualifications
In Japan, regulations governing nursing
qualifications were established through the
Midwives Ordinance of 1899, the Nurses
Ordinance of 1915, and the Public Health
Nurses Ordinance of 1941. The National Medical
Care Act of 1942 designated public healthnurses, midwives, and nursesNote 1 as medical
professionals alongside physicians and dentists.
Following World War II, the Allied Forces
established the General Headquarters of theSupreme Commander for the Allied Powers(GHQ) to oversee the occupation of Japan.
Under GHQ, the laws governing public healthnurses, midwives, and nurses wereconsolidated into the Act on Public Health
Nurses, Midwives, and Nurses of 1948. Thislaw mandated nursing education for thoseseeking to become public health nurses or
midwives and made nursing licenses anational qualification. Its purpose was “toimprove the qualities of Public Health Nurses,
Midwives, and Nurses, and to thereby
promote medical care and public health.”
Additionally, the nursing system wasreorganized under GHQ’s direction, and in
1948, the then-Ministry of Health and Welfare
established the Nursing Division, which began
nursing administration by nurses.
As the medical system changed after the
war and hospitals increased in terms of size
and number of beds, a shortage of nurses
emerged and issues with working conditions
such as the workload and working hours ofnurses surfaced. In response, the Ministry of
Health and Welfare revised the nursing
system by eliminating the classification ofnurses into Class A and Class B according tojob content, creating an assistant nurse
system in 1951, introducing nursing education
at four-year universities in 1952 , and16 Nursing in Japan 2023

improving treatment.
Nowadays, as the birth rate continues todecline and Japan becomes a super-aging
society, and as social needs change andmedical care becomes increasingly advanced,
nurses are required to provide comprehensive
nursing care that addresses complexity anddiversity. The Act on Public Health Nurses,
Midwives, and Nurses has been amended 21
times since its enactment. The revisions madein 2009 included specifying “university” as thefirst qualification for taking the national
nursing exam, changing the educational
period for public health nurses and midwives
from “six months or more” to “one year or
more,” and requiring employers to “make asincere effort” to provide training for new
nursing personnel.Note 2 Furthermore, a 2015
revision initiated a new system that allows
nurses who have completed the stipulated
training to perform certain medical
interventions, such as intravenous drips fordehydration, according to procedure manuals
without waiting for the judgment of aphysician or equivalent professional, in orderto promote home-based care and other goals.
Today, as treatment and recuperation
settings spread throughout the communityand become more diverse, and as work-stylereforms are implemented across society andtask shifting and sharing are introduced inhealth care professions, discussions regarding
the role of nurses are becoming increasingly
important.
Note 1: In 2001, the Act on Public Health Nurses, Midwives, andNurses was amended to change the Japanese terms for
public health nurses, midwives, and nurses from words
specifying them as women to gender-neutral words. The
Japanese version of this document uses the gender-neutral
terms throughout.
Note 2: T he clinical training for newly-graduated nursing personnel
is stipulated by the Act on Public Health Nurses, Midwives,
and Nurses and the Act on Assurance of Work Forces of
Nurses and Other Medical Experts.

3. Occupations Involved in the Provision of Nursing Care
Public Health Nurse

Therefore, the target for their work is diverseand multi-layered, including all people livingin the community, from infants to the elderly,
from healthy people to those with illnesses ordisabilities, and both individuals and groups
within the community. They are also involved
in local government policies related to health.
At companies, public health nurses provide
health counseling, health guidance based on
the health check results, and environmental
adjustment. In recent years, their roles have
expanded to include supporting the continued
employment of people with illnesses andmental health support in the workplace.
Public health nurses are mainly employedby health centers, municipal governments andother administrative bodies, as well as industry(e.g., corporations), hospitals, and other healthcare facilities (Table 3-1).

A public health nurse is a person who has
acquired a public health nurse license (national
qualification) from the Minister of Health,Labour and Welfare (MHLW) to use the titleof public health nurse and provides healthguidance as a profession (Article 2 of the Act
on Public Health Nurses, Midwives, andNurses).
The role of public health nurses is toconduct health activities so that people canlead healthy lives. Many public health nurses
work for local government health and hygiene
administrative organizations such as healthcenters. They provide support to individuals
with health problems in the community andwork to identify local health issues and takemeasures to address them in an effort toimprove the overall health of the community.
Table 3-1

Status of employment

Public Health Nurses

Grand total
Year
2017

Healthcenters

Prefectures

Municipal

Hospitals

Healthfacilities
for theelderly

Clinics

Visiting
nursing
stations

Socialwelfarefacilities

Welfarefacilities forthe elderlyHome
services
etc.

Industries

Nursingschools,
Institutes

OthersGrand total

Increase overprevious year

Index

63,022904

116.1(12.4)
7,798

（2.3）
1,450

（45.9）
28,908

（9.3）
5,887

（16.3）
10,303

（0.1）
57

（0.6）
356

（0.8）
507

（0.1）
75

（1.6）
1,020

（4.7）
2,967

（1.9）
1,224

（3.9）
2,470

（2.1）
1,351

（46.4）
29,666

（9.3）
5,947

（16.2）
10,377

（0.1）
40

（0.4）
259

（0.7）
421

（0.1）
39

（2.0）
1,257

（5.2）
3,349

（1.8）
1,148

（3.1）
2,015

（0.1）
42

（0.4）
274

（0.7）
424

（0.1）
44

（2.2）
1,429

（4.6）
2,974

（1.8）
1,142

（2.9）
1,906

Home visit
onlySocialwelfarefacilities

Industries

Nursingschools,
institutes

Others

（0.2）
70

（0.2）
94

（3.9）
1,557

（0.5）
204

2018

63,969947

117.8（12.7）
8,100

2019

64,819850

119.4（12.9）
8,357

（2.2）
1,395

（46.7）
30,299

（9.9）
6,427

（15.6）
10,106Grand total

Increase overprevious year

Healthcenters

Prefectures

Municipal

Hospitals

Clinics

（0.1）
21

（2.8）
1,106

（60.8）
24,164（25.5）
10,124

（5.2）
2,057

1,004

428

625

1,144

396

563

（0.1）
24

（0.1）
23

（3.8）
1,533

（0.6）
222

605

（0.1）
27

（0.1）
26

（3.8）
1,531

（0.6）
243

Midwives
Year

Grand total
Index

Maternity homes
Total

Establishers Employees

2017

39,720

107

122.3

（0.8）
323

2018

40,272

552

124.0

（0.9）
368

（0.0）
18

（3.2）
1,273

（60.7）
24,451（25.5）
10,257

（5.2）
2,103

125.1

（0.9）
384

（0.1）
25

（3.5）
1,409

（60.9）
24,738（24.5）
9,968

（5.6）
2,281

2019

40,632

360

1,246

430

Nurses and Assistant Nurses
Grand total
Classification（Grandtotal）（Nurses）（AssistantNurses）

Year

Healthcenters

Hospitals

Clinics

Healthfacilities
for theelderly

Visiting
nursing
stations

Socialwelfarefacilities

Welfarefacilities
for theelderlyHome
services
etc.

Industries

Nursingschools,
institutes

Others

（0.5）
8,292

（62.7）
975,672（19.7）
307,082（2.9）
45,432（3.2）
50,093（1.7）
26,715（2.6）
41,127（4.3）
66,886

（0.4）
5,792

（1.1）
16,635

（0.6）
9,503

（0.5）
8,144

（62.3）
984,075（19.4）
305,578（3.1）
48,717（3.6）
56,806（1.8）
28,872（2.7）
41,947（4.4）
69,210

（0.4）
5,832

（1.1）
16,913（0.7）
10,366Prefectures Municipal

Grand total

Increase overprevious year

Index

2017

1.555,181△3,159

112.4

（0.1）
1,193

（0.0）
  759

2018

1,578,782

23,601

114.1

（0.1）
1,286

（0.1）
1,036

2019

1,577,844  △938

114.0

（0.1）
1,336

（0.1）
1,231

（0.5）
8,195

（62.6）
987,247（18.8）
296,073（3.1）
48,993（3.8）
60,375（1.9）
29,331（2.7）
42,950（4.4）
69,806

（0.3）
5,156

（1.1）
17,199

（0.6）
9,952

（0.1）
1,121

（0.1）
740

（0.6）
7,217

（69.4）
849,341（15.5）
189,891（2.0）
24,403（3.7）
45,328（1.4）
17,176（1.9）
23,227（3.0）
36,142

（0.4）
4,599

（1.4）
16,553

（0.6）
7,584

2017

1,223,322

12,657

123.0

2018

1,256,970

33,648

126.4

（0.1）
1,237

（0.1）
1,003

（0.6）
7,139

（68.8）
865,090（15.3）
192,662（2.1）
26,430（4.1）
51,740（1.5）
18,897（2.0）
24,579（3.0）
38,261

（0.4）
4,784

（1.3）
16,867

（0.7）
8,281

（0.1）
1,182

（0.6）
7,249

（68.9）
876,227（15.0）
190,343（2.1）
27,092（4.3）
54,951（1.5）
19,533（2.0）
25,624（3.1）
39,126

（0.3）
4,174

（1.3）
17,148

（0.6）
8,097

（0.0）
    19

（0.3）
1,075

（38.1）
126,331（35.3）
117,191（6.3）
21,029

（1.4）
4,765

（2.9）
9,539

（5.4）
17,900（9.3）
30,744

（0.4）
1,193

（0.0）
     82

（0.6）
1,919

2019

1,272,024

15,054

127.9

（0.1）
1,278

2017

  331,859△15,816

85.3

（0.0）
  72

2018

  321,812△10,047

82.7

（0.0）
  49

（0.0）
    33

（0.3）
1,005

（37.0）
118,985（35.1）
112,916（6.9）
22,287

（1.6）
5,066

（3.1）
9,975

（5.4）
17,368（9.6）
30,949

（0.3）
1,048

（0.0）
     46

（0.6）
2,085

78.6

（0.0）
  58

（0.0）
    49

（0.3）
  946

（36.3）
111,020（34.6）
105,730（7.2）
21,901

（1.8）
5,424

（3.2）
9,798

（5.7）
17,326（10.0）
30,680

（0.3）
  982

（0.0）
     51

（0.6）
1,855

2019

  305,820△15,992

Note (1): “ Hospitals” are recorded according to the Hospital Report (2010-2016), the Medical Facilities Survey and Special Tabulation (2017) and estimates (2018, 2019).
Note (2): “ Clinics” are based on the Medical Facilities Survey (2011, 2017) and estimates (2010, 2012-16, 2018,2019). The figures for 2011 exclude the Ishinomaki and
Kesennuma medical zones in Miyagi Prefecture and the whole of Fukushima Prefecture.
Note (3): A ll categories other than hospitals and clinics are based on the Health Administration Report (2010, 2012, 2014, 2016 and 2018) and estimates (2011, 2013, 2015,2017 and 2019).
Note (4): B rackets are percentages of the total number.
Researched by Nursing Division, Health Service Bureau, Ministry of Health, Labour and Welfare
Source：Japanese Nursing Association Publishing Company, Statistical data on nursing service in Japan 2020, https://www.nurse.or.jp/home/statistics/index.html

Nursing in Japan 2023 17

Midwife

A midwife is a woman who has acquired a
midwife license (national qualification) from
the MHLW to practice midwifery or provides
health guidance for pregnant women,
puerperal women, or newborn babies as aprofession (Article 3 of the Act on Public
Health Nurses, Midwives, and Nurses).
The role of midwives is to assist in childbirth,
provide health guidance and advice to pregnant
and parturient women leading up to childbirth,and provide care for mothers and babies afterchildbirth. They also deal with sexual andreproductive health issues throughout women’s
lives, including providing parenting guidance,
counseling for couples undergoing infertility
treatment, and sexual health counseling duringpuberty and menopause. In addition to working
in hospitals and clinics, they can also establish
their own midwifery homes.
As the location of childbirth has shiftedfrom the home to medical institutions, such as
hospitals and clinics, have become the primaryplaces of employment for midwives (Table
3-1).

Nurse

A nurse is a person who has acquired anursing license (national qualification) from
the MHLW to provide medical treatment orassist in medical care for injured and ill
persons or puerperal women as a profession(Article 5 of the Act on Public Health Nurses,
Midwives, and Nurses).
The roles of nurses are to provide care for
injured or sick persons or puerperal womenand to assist in their medical treatment. From
the unique perspective of nurses, they
comprehensively assess information, looking
at the individual from various aspects such as
physical, mental, social, and cultural factors to

18 Nursing in Japan 2023

accurately determine the necessary nursing
care. As professionals who support people’s
lives and livelihoods, nurses work in a wide
range of settings and roles, from medical
institutions such as hospitals and clinics tohome-visit nursing and long-term carefacilities, as well as in schools and other places
where people work.
Hospitals and clinics are the primary placesof employment for nurses, although thepercentage of nurses working at visiting
nursing stations, which have been establishedsince 1992, is increasing (Table 3-1).

Assistant Nurse

An assistant nurse is a person who has
acquired a nursing assistant license from theprefectural governor to provide medical
treatment or assist in medical care for injured
and ill persons or puerperal women under the
direction of a physician, dentist, or nurse, as aprofession (Article 6 of the Act on Public
Health Nurses, Midwives, and Nurses). Licenses
for assistant nurses are granted by prefectural
governors, but the license allows assistantnurses to work anywhere in Japan, not justthe prefecture where the license was issued.
The difference between a nurse and an
assistant nurse is the need for instructions
when performing their work. Assistant nurses
are required to receive instructions from aphysician, dentist, or nurse to perform theirduties (Article 6 of the Act on Public Health
Nurses, Midwives, and Nurses). While thebasic education for nurses requires at least
three years after graduation from high school,
the basic education for assistant nurses
requires at least two years after graduationfrom junior high school, thus differing interms of admission requirements and lengthof education.

Ⅳ．Nursing Education
In order to become a nursing professional in
Japan, it is necessary to complete basic nursing
education, pass the national public healthnursing, midwifery, or nursing examinations,then obtain a license (national qualification)from the Minister of Health, Labour andWelfare (MHLW). In the case of assistantnurses, it is necessary to pass a prefectural
examination and obtain a license from theprefectural governor. Nursing profession
licenses in Japan do not have a requirement foressential ongoing education—they are a lifetime
license without a renewal system.

1. Basic Nursing Education
For basic nursing education, which is theeducation required prior to obtaining anursing license, the pathway for high school
graduates includes studying at university/
college (four years), junior college (three
years), or nursing school, such as vocational
school (three yearsNote 1). The jurisdictional
government agencies differ between
educational institutions, so while universities/
colleges and junior colleges are under the
Ministry of Education, Culture, Sports, Scienceand Technology (MEXT), nursing schools arelargely the jurisdiction of the MHLW.
In order to become a public health nurse ora midwife, individuals must undergo basic
nursing education and pass the national nurse
examination. Education for public healthnurses and midwives is conducted at colleges/
Figure 4-1

universities, one-year junior colleges, nursing
schools, and master’s programs at graduate
schools. As part of four-year nursing programs
at colleges/universities, if there is a publichealth nurse or midwifery education program,
it is possible to become eligible to sit thenational examination for not only the nurse
qualification, but also for the public healthnurse and midwife qualifications. However,with the increase in credits for education inrecent years, there are significant time
constraints in terms of completing concurrent
education for multiple qualifications over four
years, so public health nurse and midwife
education is gradually transitioning to graduate
schools (Figure 4-1).
Note 1: There are also nursing schools with four-year programs.

Basic nursing education

Nursing
University/
College, 4-year

Graduate fromHigh School

Nursing JuniorCollege, 3-year

National
NursingExamination

NursesNursing School,
3-year
Source: Prepared by the Japanese Nursing Association

2. Contents of Basic Nursing Education
The content of basic nursing education isbased on the Act on Public Health Nurses,
Midwives, and Nurses and set out in the joint
ministerial (MEXT and MHLW) “Ordinancefor Designating Training Schools for Public
Health Nurses, Midwives and Nurses” andvarious revisions have been made inaccordance with social nursing needs. In the2020 revision of the ordinance, consideration
was given to the competencies of future
nurses that should be strengthened, and theassociated educational content. As a result,the number of credits for Community Health/Home Care Nursing and more increased,
Nursing in Japan 2023 19

meaning that the total number of credits also
increased (Table 4-1).
At the main institutions offering courses forstudents wishing to become nurses, includingcolleges/universities (four years), junior
Table 4-1

colleges (three years), and nursing schools(three years), the educational content was set
down using the same criteria, regardless ofthe educational institution type.

Appendix 3 of Ordinance for Designating Training Schools for
Public Health Nurses, Midwives and Nurses
Education contents

Credits

Specialized basic studies

Human body structure and functions
Disease mechanism and recovery promotion
Health support and social security system

Specialized studies

Basic nursing
Community health/Home care nursing
Adult health nursing
Gerontological nursingChild health nursing
Maternal nursing
Mental health and psychiatric nursing
Nursing integration and practiceClinical training
Basic nursing
Community health/Home care nursing
Adult health nursing
Gerontological nursingChild health nursing
Maternal nursing
Mental health and psychiatric nursing
Nursing integration and practice
Total

⎩⎨⎧

Basics of scientific thinking
Understanding of humans, living and society⎩⎨⎧ ⎩⎨⎧

Foundational studies

14
16
6
11
6（4）
6
4
4
4
4
4
23
3
2
4
2
2
2
2
102（100）

Source：Ministry of Health, Labour and Welfare, Appendix 3 of Ordinance for Designating Training
Schools for Public Health Nurses, Midwives and Nurses, https://elaws.e-gov.go.jp/
document?lawid=326M50000180001

3. D evelopment of University Education for Basic Nursing Education and Graduate School Education
Since the introduction of basic nursing
education in four-year universities in 1952, thedevelopment of university education for basic
nursing education has progressed over a shorttime, with flexible curriculum organization inaccordance with the university establishment
standards outlined in 1991 and basic principles
concerning nursing college/university
establishment prescribed in the Act on
Assurance of Work Forces of Nurses andOther Medical Experts enacted in 1992. In
1991, there were only 11 colleges/universities,
with a capacity for enrollment of only 558
students, but since then there has been a

20 Nursing in Japan 2023

sharp increase in numbers. In recent years,
with increasingly low birth rates andincreasing rates of students moving on to
university, there have been moves to establish
nursing faculties in universities in order tosecure student enrollments. As of 2022, thenumbers have reached 280 colleges/
universities and 25,673 students (Figure 4-2).
Combined with the transition to graduate
schools offering midwifery programs and publichealth nurse programs, similar increases havealso been observed with regard to graduate
school education (Figure 4-3).

Figure 4-2

Changes in the number of nursing universities/colleges and admission capacity
Number of nursing programs in 2022: 280 universities/colleges, 296 programs(some universities have more than one program in one university)(Schools)
300

25,673 people

Number of universities/colleges
Admission capacity

250
200
150
100
50
11 14

0

21

30

40

46

63

52

74

84 89

96

104

119

127

143

156

166

178

188

194

203

210

226

241 246255

263

272 274276 280(People)30,00025,00020,00015,00010,0005,000

01991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 (FY)(Researched by Medical Education Division, Higher Education Bureau, Ministry of Education, Culture, Sports, Science and Technology)
Source：Ministry of Education, Culture, Sports, Science and Technology, Draft budget for nursing in 2023, Reference material of SubCommittee on Nursing Issues, Health and Labour Sub-Committee（14 February, 2023）(Schools)
250

Figure 4-3

Changes in the number of graduate nursing programs and admission capacity
2,894 people

Master's programs
Doctoral programs

200

150
101

100

50

0

5
2

5
2

7
3

7
3

7
5

8
5

14
6

22
7

31
9

36
11

44
15

53
16

63

19

74

25

81

31

109

119

127 131

140 144

87

36

43

46

54

61

62

69

71

149

74

156

161 165(People)
3,500
3,000

175

180

186

193 197

2,500
2,000

76

85

88

94

99

105 106 105

1,500
1,000
500

0
1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 (FY)(Researched by Medical Education Division, Higher Education Bureau, Ministry of Education, Culture, Sports, Science and Technology)
Note：Master’s programs after 2004 include one professional graduate school (admission capacity of 40 students).
Source：Ministry of Education, Culture, Sports, Science and Technology, Draft budget for nursing in 2023, Reference material of SubCommittee on Nursing Issues, Health and Labour Sub-Committee（14 February, 2023）

Nursing in Japan 2023 21

Ⅴ．Improvements in Credentials
1. Current System
Given that nursing is a profession that isdeeply connected with human life and thelives of people, that medical and nursing
techniques and knowledge systems are
Figure 5-1

constantly progressing, and that societal needs
are always changing, it is stipulated in law as
a pursuit that requires life-long diligence(Figure 5-1).

Nursing-related legal descriptions of professionalism in the nursing profession■ Medical Care Act
 Article 1-2 (1) Medical care is to be provided in accordance with the physical and mental state of the medical care recipient,
based on a relationship of trust between the physician, dentist, pharmacist, nurse, or other medical care professional and the
medical care recipient, in a way which respects life and ensures the dignity of the individual, and not only the medical
treatment, but including measures to prevent illness and rehabilitation measures must also be of high quality and well-suited.
 Article 1-4 (1) Physicians, dentists, pharmacists, nurses, and other medical care professionals must endeavor to deliver highquality and well-suited medical care to medical care recipients, based on the concepts provided for in Article 1-2.
■ Act on Public Health Nurses, Midwives, and Nurses
 Chapter IV Nursing Practice Article 28-2 Public health nurses, midwives, nurses, and nursing assistants must undergo clinicaltraining and other training (excluding refresher training for public health nurses, and refresher training for nursing assistants),
must strive to improve their professional quality, even after having acquired the license.
■ Act on Assurance of Work Forces of Nurses and Other Medical Experts
 Article 6 Nurses and other medical care professionals shall strive to develop and improve their abilities on their own initiative,
such as by receiving training, and demonstrate confidence and pride in their nursing duties in an effort to respond to theincreasingly sophisticated and diverse demands of the public for health care services with the realization that they are the key
providers of health care.

1) Clinical Training for Newly GraduatedNursing Personnel10)

From 2010, it was made obligatory for
hospitals, etc. to endeavor to provide ClinicalTraining for Newly Graduated Nursing
Personnel, which is undertaken to acquire thebasic practical clinical skills required for work.
It improves the quality of nurses and prevents
early departure of nurses. As of 2020, training
in accordance with the government’s
Guidelines on Clinical Training for Newly
Graduated Nursing Personnel is provided at
almost all hospitals where newly graduatednursing professionals work. Hospitals can alsoutilize the general fund for community healthcare and long-term care.

2) Training System for nurses performing
specific interventions

With the advance of the aging society inJapan, there has been an increase in thenumber of people in the community living withchronic diseases or with multiple conditions. A
reform of the health care provision system (a22 Nursing in Japan 2023

shift in the location of some treatment frommedical institutions to communities) iscurrently underway, given that in 2025, theentire baby boom generation will be aged 75
or over. As part of this, in 2014 the “Training
System for Nurses Performing SpecificInterventions” was established to upskill
nurses to be able to work in any situation
including home-based care and to encourage
the use of advanced clinical practical skills.
Nurses who have completed the designatedtraining are now able to perform specificinterventions that have been established inadvance based on a procedure manual
prepared by doctors (in the form of one
physician instruction) (Figure 5-2). Specificinterventions are supplementary medical
treatments, and include 38 interventions that,when performed by nurses according to theprocedure manual, particularly require
practical comprehension, thinking, anddecision-making skills as well as advanced andspecialist knowledge and skills11).

Figure 5-2

Flow of supplementary medical treatment in the case of system applicability
OUTSIDE thescope of the medical
conditions

The doctor or dentist
identiﬁes the patient andinstructs the nurse to
carry out a specificintervention according to
the procedure manual

Conﬁrm the patient's'scope of medical
conditions of thepatient'

Instructions are requested fromthe physician or dentist

WITHIN thescope of the
medicalconditions

The nurse performs the'supplementary medical
assistance' as speciﬁedin the procedure manual

The nurse
reports results
to the doctor
or dentist

Source: Ministry of Health, Labour and Welfare (MHLW), Overview of Training System for Nurses Performing Specific Interventions,
https://www.mhlw.go.jp/stf/seisakunitsuite/bunya/0000070423.html

Table 5-1

Clinical Ladders
Name

Publication Year

URL

Clinical Ladder of Competencies for Midwifery Practice：
CLoCMiP2012https://www.nurse.or.jp/nursing/josan/renowned/clocmip/
index.html?utm_source=whats_new&utm_campaign=20220627

Clinical Ladder for Nurses（JNA Ladder）

2016

https://www.nurse.or.jp/nursing/education/jissen/index.
html#ladderManagement Ladder for Hospital Nursing Managers

2019

https://www.nurse.or.jp/nursing/practice/management_
ladder/index.html

Source: Prepared by the Japanese Nursing Association

2. Assistance for Improvements in Credentials of Nursing Professionals (Professional Organization’s Initiatives)
1) Continuing education

The Japanese Nursing Association (JNA)
states in its Code of Ethics for Nurses (2021
revised edition)12) that “Nurses always endeavor
to develop, maintain, and improve their abilities
through continuous learning as part of theirindividual responsibilities” and as a nursing
professional organization, it has supported
nurses in ongoing learning and skill
development. In 2000, it designed and publishedthe “Continuing Education Standards” andprovided support for education provided byvarious organizations targeting the wider
nursing professional population in terms of
maintaining/improving the quality andsystematization of education. The JNA also
conducts continuing education appropriate to
the various careers of nursing professionals.
In addition, the JNA also designed a ladder
to be used as a framework for improving incredentials, and it has standardized the index
for the practical skills required by nursing
professionals and has supported nurses inacquiring these skills. (Table 5-1). In 2016, the
MHLW examined the skills required bymunicipal public health nurses to form astandard career ladder, and the JNA assisted
in its design.

2) Establishment of a system supporting
lifelong learning

Given the changes in society and working
styles since 2020, the current system of ongoingtraining has been reviewed, and the JNA isworking on a shift toward a new system (thesystem supporting lifelong learning) to support
independent learning by nursing professionals
and the practical utilization of learning andexperience. Currently, the JNA is working on
the base of this system, through clarification ofnursing competencies and designing a new‘ladder’ to guide nurses through step-by-stepacquisition of these competencies. In addition to
the practical skills in the current ladder, skills,
competencies required from an ethical andlegal perspective, leadership and management,
etc. have been added (scheduled to be
published in June 2023).

3) T raining of highly specialized nurses(Table 5-2, Table 5-3)

The JNA runs the Certified Nurse Specialist
System, Certified Nurse System, and Certified
Nurse Administrator System. Thesecredentialing systems are intended to provide
high-quality health care to people in Japan. In
order to establish the systems, investigations
were carried out so that the consensus of the
Nursing in Japan 2023 23

nursing community would be reflected. As aresult, there are currently a number oforganizations and societies that provide
certification systems in their field, but thecredentialing systems by the JNA are sociallyrecognized and highly respected.
In order to guarantee quality, theTable 5-2

credentialing system for each qualification
involves certification of the educational
institution, stipulation of the eligibility to takethe examination, and performing thecredentialing examination according tovarious criteria and a five-yearly renewal
process13)14).

Role of credentialed professionals

Certifications

Roles

Certified Nurse Specialist

Play a role in practice, consultation with care providers, coordination between health and social
care professionals, ethical coordination, education and research, through excellence in nursing
practice.

Certified Nurse

Play a role in high standards of nursing practice, instruction and consultation with the nursing
professionals and others with high level of clinical reasoning and judgement of pathologicalconditions.

Certified Nurse Administrator Play a role in the development of a creative organization with excellent managerial qualities.
Source: Prepared by the Japanese Nursing Association

Table 5-3

Overview of the credentialing systems

Certifications

Certified Nurse Specialist

Year ofinauguration

Year ofissuing firstcertification

Number offieldsNumber of
programs

Duration of
education

Number ofcertificatedpersonnels＊1

1994

1996

14

112 Graduate
Schools
319 Courses＊2

2 years
38 credits

2,901(13 fields)

1997

21

24 institutions
35 courses

6 months・
600+ hours

20,660(21 fields)

2021

19

26 institutions
42 courses

Within 1 year・
Around 800
hours

1,495
(19 fields)

1999

―

First: 69
Second: 59
Third: 32

105 hours
180 hours
180 hours

4,468

A course＊3
Certified
Nurse

1995
B course＊3

Certified Nurse Administrator

1998＊ 1：As of April, 2022
＊ 2：Accredited by the Japan Association of Nursing Programs in Universities＊ 3：A Course=Does not Incorporating Training System for nurses performing specific interventions・B Course=Incorporating Training System for nurses performing specificinterventions
Source: Prepared by the Japanese Nursing Association

24 Nursing in Japan 2023

Ⅵ．Situation of Nursing Professionals in Japan
1. Status of Employed Nursing Professionals
In order to respond to increasing healthcare and nursing needs, the number of
employed nursing professionals has increased
year by year as a result of initiatives tosecure health care personnel. The number of
employed nurses is about 12.1 per 1,000
people (2020), the fifth highest among OECD
countries (Figure 6-1).
The total number of employed nursing
professionals was 1,683,295 in 2019, about fivetimes the figure of 349,251 in 1970 (Figure6-2). The number of assistant nurses has beenon the decline since 2003 (Table3-1). For thatreason, the total number has only been an
increase of 272 workers compared with theprevious year. The number of employednursing professionals who are male has beenslowly increasing, and is around 8% of all
nursing professionals15).
The main workplace for nursing
professionals in 2019 was hospitals for morethan 60% of nurses and midwives, and aroundthe same amount (35%) each at hospitals andclinics for assistant nurses (Table 3-1). For
public health nurses, the highest proportion
was in government agencies (public healthcenters, prefectural/municipal offices) at
approximately 60%. Furthermore, in recent
years, there has been a gradual increase innursing professionals working in global
health/nursing fields, such as at U.N. agencies,
JICA, international NGOs.
Looking at employed workers according toage bracket, most nurses and public healthnurses are in their 30s or 40s, but mostmidwives are in their late 20s.16) In all
professions, after the peak in worker numbers,
the decrease from age 45 onward is particularly
significant.
By contrast, the number of nursing
professionals aged 60 or older who continue towork after the official retirement age or who
are reemployed is increasing year to year. In
2002, they accounted for 3.4% of all workers,
but in 2020 they totaled approximately 360,000,
or 11.8%; in other words, about 1 in every 9
working nursing professionals was aged atleast 60.17)
In November 2019, it was estimated by the
Ministry of Health, Labour and Welfare(MHLW) that the demand for nursing
professionals18) would be 1.88 to 2.02 million
workers, in contrast to the national supply of
nursing professionals of approximately 1.75 to
1.82 million in 2025, which is expected to be ashortfall of at least 60 , 000 workers.
Furthermore, in addition to the lack of
numbers, amid expanding nursing needs in

Figure 6-1 Employed nurses per 1,000 people among OECD countries (2020)
18

Figure 6-2 T rends in the number of employednursing professionals（1970～2019）（People）
1,300,000

16
14

12.1

12

1,200,000
1,100,000

10

1,000,000

8

900,000

6

800,000

4

700,000
600,0000

500,000

ut

h

Af
ric
In Bra a
do z
eo
ne il
pl
e’
Tü sias
Re M rkiy
pu e ebu xiclic o
SlLa of)
ovtv
akia
Re Isra
pu el
b
S lic
Es pain
t
H on
un ia
ga
ry
Po Italy
Li rtug
th a
U
ua l
ni
C ted K nia
ze K orch in ea
Re gdo
pu m
C bli
a c
Sl nadov aeNew Au nia
Ze strial a
U
ni F and
te ra
d nc
S e
G tat
er es
m
a
J ny
Au apast nr
Ic aliaela
Sw No nditz rwa
er y
la
nd

2

C

hi
na
(P

So

Nurses1,272,024

Note 1: Some countries (France, Ireland, Italy, the Netherlands, Portugal, Slovakia, Türkiye, and theUnited States) include nurses who are not in clinical practice such as managers, educatorsand researchers.
Note 2: Austria and Greece include only hospital-employed nurses.
Note 3: Midwives and nursing assistants (not qualified as nurses) are usually excluded, althoughsome countries include midwives who are considered professional nurses.
Source：OECD Data, Nurses, https://data.oecd.org/healthres/nurses.htm

Assistant nurses
305,820400,000
300,000
200,000
100,000

Public health nurses
64,819Midwives
40,63201970 1975 1980 1985 1990 1995 2000 2005 2010 2015 2019（Year）
Source: J apanese Nursing Association Publishing Company,
Statistical Data on Nursing Service in Japan 2021

Nursing in Japan 2023 25

regions, including remote areas, as well as an
uneven distribution of nursing professionals
by area (by place of employment), such as
shortages in visiting nursing and long-termcare facilities, while medical institutions havesufficient numbers of nurses.

various areas such as home-based care(associated with diversification in treatment
settings and the promotion of communitybased integrated care) and long-term careinsurance services, it has been identified that
overall, there is a shortage of nurses in some

2. Impact of COVID-19 Pandemic on Working Conditions of Nursing Professionals
overtime had increased.19) Other impacts
observed were “fear/anxiety of infection,”“deterioration of working environments,” and“discrimination/prejudice/insensitive
comments from others”.

Since 2020, the COVID-19 pandemic has
impacted both the working environments andthe work of nursing professionals. In a factfinding survey of staff working in jobs related
to COVID-19, 55.3% of respondents said that

3. Efforts for Nursing Professionals Who Have Left the Profession or Who Are Not Currently Working1) Status of nursing professionals who
have left or who are not currently
working in the profession

workers are women, and that shift work is
required including night shifts when working
at a medical institution (Figure 6-4).
It is estimated that those not currently
working as nursing professionals (not working
in the nursing profession after leaving) total
approximately 700,000 under age 65, which is
31.1% of those who hold a nursing license(2018). For nurses, the proportion of those notworking as nurses is high in the 35–39 age
group (34.15%) and the 55 and over age group(28.48%-65.65%).20) By contrast, 36.1% of nursing
professionals who are not working in theprofession say, “I want to work as a nursing
professional,” but this ratio decreases thelonger they are away from the profession.21)

While the number of employed nursing
professionals in Japan is increasing, there arealso nursing professionals who are leaving or
who are not currently working in theprofession. In a JNA survey from FY2020, it
was estimated that the proportion of
permanent employees (hospital nursing
professionals) leaving the profession was
10.6% and that of newly graduated employees
was 8.2% (Figure 6-3). Factors leading tonurses leaving the profession vary dependingon the area, it is thought that in nursing thisis due to the fact that more than 90% of
(%)
25
20
15
10
5
0

Figure 6-3 Trends in turnover of hospital-employed nursing professionals
19.7

20.8

12.3

11.9

9.3

8.9

2005

2008

20.1

18.7

16.9

17.7

16.4

10.9

10.8

10.9

10.7

11.5

7.5

7.5

7.5

7.8

8.6

2011

2014

2017

2018

2019

14.9
10.6
8.2

Previous graduates
Permanent employees
New graduates2020 (FY)

Source: The Japanese Nursing Association, Survey on the Actual Situation of Nursing in Hospital and Outpatient Nursing 2021,
https://www.nurse.or.jp/home/up_pdf/20220401121744_f.pdf

26 Nursing in Japan 2023

Figure 6-4 Reasons for wanting to leave nursing (2019/2018)■Reasons for wanting to leave nursing for job seekers (currently employed) (All age groups and those 24 and younger) ‒ 2019 and 2018
0

5

10

15

8.0
8.1

Long work hours/a lot of overtime

25 (%)
20.8

12.3

7.7
8.0

Moving house
Parenting

20

13.5
12.9

Interest in work outside nursing

22.7

16.6

11.1

9.0
7.2
6.7

0.1
0.7

6.7
6.7
6.2
5.5

Marriage
One’s own health (mainly physical reasons)

5.3

6.2
7.1

9.7

6.1
5.5

Anxiety about one’s ﬁtness/skills

16.7

5.8
5.8

The signiﬁcant burden of night shifts
Dissatisfaction over promotions/pay increases/salary

5.6
5.3

Relationship with superiors (nursing managers)

5.5
5.1

Cannot take holidays

5.4
4.9

9.9

12.8

7.6
7.1

11.8

Cannot combine work with housework

1.1
1.1

Health or nursing care of family members

1.2
1.0

19.6

7.3

13.2

10.2

4.5
4.4
4.5
3.8

Weight of responsibility/anxiety about malpractice

4.4
4.2

One’s own health (mainly psychological reasons)

4.1
4.1

9.3

10.1
14.9

19.7

FY2019 ‒ all age groups (n=24,710)

FY2018 ‒ all age groups (n=23,844)

FY2019 ‒ 24 years and younger (n=893)

FY2018 ‒ 24 years and younger (n=904)

Source: Compiled by the Japanese Nursing Association based on FY2019 and FY2020 the Japanese Nursing Association Report of Analysis of job
seekers, job vacancies, and employment for nursing professionals based on Nurse Center Registration Data

2) Initiatives for continuing employment
and being reemployed

In order to ensure the nursing service
delivery system and to promote the work ofnurses as professionals, assistance forcontinuing employment and returning towork is important.
Since the Act on Assurance of Work Forcesof Nurses and Other Medical Experts wasenacted in 1992, there have been various
initiatives, mainly at hospitals, to introduce a
range of work options. Initiatives include
alleviating the burden on workers in terms ofmaking night shift work more decent andremedying long working hours, and creating
systems for regular workers to be able towork short shifts. In recent years, the issue ofharassment has emerged, either between staff
at workplaces or from patients (users) or theirfamilies, which has resulted in initiatives
being launched to ensure healthy and safe
workplaces. Regarding assistance for
returning to work, prefectural nurse centers
have been set up, where initiatives have been
introduced for securing nursing professionals
in these prefectures. As part of reemployment
support for nursing professionals who are notcurrently working, there is a free service forwork referrals, and support in the form of
training for returning to work. The JapaneseNursing Association (JNA) has links withgovernmental projects, moves forward withinitiatives to secure nursing professionals,
such as improving working environments, andruns the Central Nurse Center designated by
the MHLW.
Furthermore, a new nursing personnel
utilization system is set to start in 2024, whichuses the Individual Number (personal ID
number) system. It is expected to provide amore comprehensive structure for ongoingcareer support based on work experience andtraining courses undertaken, the promotion of
more effective continuing education, andsupport for returning to work for nursing
professionals currently not working in theprofession.
In addition, there are also moves to improve
the working conditions of nursing
professionals, specifically in terms of wages.
Led by the government, from February 2022,
efforts were made to increase the wages ofnursing professionals using government
subsidies and medical reimbursement fees, andNursing in Japan 2023 27

measures were put in place so that the wagesof nursing professionals were increased byabout 3% (12,000 yen per month) at hospitals
providing COVID- 19 -related treatment.
Furthermore, in November 2022, the salaryschedule for national public servant healthcare workers, which influences Japan’s nursing
wage system, was revised, and in December,

28 Nursing in Japan 2023

the MHLW notified health care facilities
around Japan to promote consideration of
improved working conditions of nursing
professionals associated with career
enhancement. Various policies to raise thewages of nursing professionals have beenpromoted.

Ⅶ．Foreign Nurses Working in Japan
1. Foreign Nurses Working in Japan
Mutual recognition of nursing qualifications
by other countries is not carried out in Japan.
As a result, foreign nurses who wish to workin Japan need to pass the Japan national nurse
examination and to obtain a license, but if theygain a position in nursing after that, they canwork in Japan without any restrictions on the
period of employment. Their visa status will be“medical services” but because it is the same
category as doctors and other related
occupations, the number of workers with only
a nursing-related qualification is unknown. For
reference, according to the Ministry of Justice’s
published statistics on foreign nationals living
in Japan, there were 2,534 foreign nationals asof June 2022 who were residents (working) inJapan with the visa status of “medical services.”
The main countries of origin were China (1,821
people), Indonesia (176 people), Vietnam (145people), South Korea (140 people), Taiwan (105people), and Philippines (95 people).22) In the casethat international students study at nursing
schools, etc. in Japan and take the national
exam, they are not classified as international
students at the point of passing the exam, so it
is not possible to gain an understanding of thenumber of people gaining nursing qualifications
through the international student route.
However, if they are later employed as nurses,
their visa status changes to “medical services”
and they are included in the above statistics. It
should be noted that among foreign nationals,
for people with no work restrictions (visa statusbased on position/relationship) including
spouses of Japanese nationals, permanent
residents, special permanent residents, andspouses of permanent residents, it is notpossible to obtain information on the number of
those with nursing qualifications or the numberof those working as nurses.
Obtaining qualifications is divided into those
who have graduated from an MHLW-accredited
nursing school just like Japanese nationals, andthose who have graduated from an overseas
nursing school and gained an overseas nurse’s
license and then received certification ofeligibility to sit an exam in Japan. In reference
to the latter, the following section sets out
information on the acceptance of foreign nurses
based on Economic Partnership Agreements(EPAs) as an outline and official framework for
obtaining qualifications.

2. Acceptance of Foreign Nurses1) O verview of methods for obtaining
qualifications

For someone with an overseas nursing
license to take the Japan national nurse exam,
it is necessary for them to gain eligibility to
sit the exam via “certification of eligibility to
sit the exam.” The requirements for eligibility
include being a graduate of an overseas
nursing education institution, having anursing qualification, and having achieved theN1 level of the Japanese Language Proficiency
Test. The review for certification of eligibility
is carried out by the Ministry of Health,Labour and Welfare (MHLW) in accordancewith the certification criteria based on the
Act on Public Health Nurses, Midwives, andNurses (Act No. 203 of 1948) Article 21 (5).
Those who are certified are issued acertification from the MHLW, and they canthen start the procedures for taking thenational exam. The certification of eligibility

to sit the national exam for public healthnurses and midwives is the same. For theprocesses and review methods for certificationof eligibility to sit the exam (public healthnurses, midwives, nurses), see the MHLW
website.23)2) O utline of the framework and thetrack record of accepting foreign
nurse candidates under EPAs

(1) Framework for acceptance of foreign
nurse candidates under EPAs
The acceptance of foreign nurse candidates
based on EPAs is carried out with an official
framework and with special provisions fromthe perspective of stronger economic ties
between Japan and another specific country.
In line with this framework, a nurse
candidate who has entered Japan has aduration of stay set out as part of theagreement (three years), and during this time,
Nursing in Japan 2023 29

they work at a hospital while undergoingtraining to prepare for the national exam. If thecandidate obtains a national qualification either
during their stay or after returning home, they
are permitted to work in Japan as a nurse.
Currently, agreements have been signedwith Indonesia, Philippines, and Vietnam, andacceptance of nurses based on these
agreements has been carried out since 2008,2009, and 2014 respectively.
The Japan International Corporation of
Welfare Services (JICWELS) is a coordination
institution for the support and acceptance of
those working and training toward acquisitionof a national qualification. From the perspectiveof properly accepting candidates, it is the only
coordination institution for acceptance. The
MHLW acts to supervise JICWELS’ services,such as work referrals, along with closely
liaising and operating with the Ministry ofForeign Affairs, the Ministry of Justice, and theMinistry of Economy, Trade and Industry24).
For the latest information on this framework,
see the MHLW website.25)

nurse candidates, the government provides
support for the costs required to holdinformation sessions within Japan, to holdbasic training in the nursing field, and to
conduct on-site visits by nursing specialists
at facilities accepting candidates.
② Project to support the learning of foreign
nurse candidates
 For enhanced Japanese study and training
focusing on specialist nursing fields forforeign nurse candidates, the government
has set up and operates an e-learning support
system, and provides support for the costs
required to hold regular group training forcandidates and to assist training planning fortrainers at institutions accepting candidates.
・Project to support the work-related trainingof foreign nurse candidates
 For the foreign nurse candidates to achieve
the level of Japanese language ability required
to work, the government supports theacceptance institution for the costs required toappoint a Japanese language teacher and forthe costs for trainers and the training location.

(2) Japan’s EPA-related projects
In order to carry out the smooth andappropriate acceptance of foreign nurse
candidates entering Japan based on an EPA,
and toward increasing the number accepted,
the government is conducting the following
projects including induction training fornurses, on-site instruction and assistance withlearning environments for the facility accepting
candidates, and support for candidates forlearning Japanese and acquiring specialist
knowledge.
・Project to support the acceptance of foreign
nurses/Project to support the learning of
foreign nurse candidates① Project to support the acceptance of
foreign nurses
 For the smooth acceptance of foreign(3) Track record of acceptance via EPAs
Of the nurse candidates accepted via EPAs,
the number of people who have passed thenational exam by the end of their stay is asshown in Table 7-1 (up until 2018). The systemallows for multiple attempts at the exam
during their stay, or, after the end of their stay,another entry into Japan to take the exam.
The pass rate for the national exam is low,which is associated with the insufficientJapanese language ability of the nurse
candidates, so the government is working on anumber of improvements to the framework,
including more comprehensive learning support
for the national nurse exam, and thecompilation of national exam questions using
wording that is easier to understand for nurse
candidates whose first language is not Japanese.

Table 7-1 Track record of acceptance and the number of successful national nurse exam candidates (up until 2018)

Track record of acceptancesuccessful national nurse exam candidates(% of Track record of acceptance)

Indonesia(2008~)

Philippines(2009~)

Vietnam(2014~)

Total

653

546

101

1421

193
(29.6％)

199(36.4％)

91(90.1％)

516(37.2％)

Source: C ompiled by the Japanese Nursing Association based on the Japan International Corporation of Welfare Services（JICWELS）, Booklet for Acceptance of Foreign
Nurse and Care Worker Candidates under EPA in FY2023, https://jicwels.or.jp/wp-content/uploads/2022/03/2023%E5%B9%B4%E5%BA%A6%E7%89%88%E5%
8F%97%E5%85%A5%E3%82%8C%E3%83%91%E3%83%B3%E3%83%95%E3%83%AC%E3%83%83%E3%83%88.pdf

30 Nursing in Japan 2023

Ⅷ．Response to Disasters and Pandemics
1. Response to Disasters (Disaster Relief Nurses)
1) Disaster relief nurses

In response to the Great Hanshin-Awaji
Earthquake (Kobe Earthquake) of 1995, theJapanese Nursing Association (JNA) set up theDisaster Relief Network System so that intimes of large-scale natural disasters, disaster
relief nurses could be sent to affected areas.
Disaster relief nurses, as members ofprofessional nursing associations, are nursing
professionals who take on the role of providing
Table 8-1⃝⃝⃝⃝

appropriate health care/nursing in disasteraffected areas, working to support nursing
professionals in affected areas to alleviate
physical and mental stress, and to maintainthe health of disaster victims. They are
registered with prefecture nursing associations（Table 8-1). As of the end of March 2021, thenumber of registered disaster relief nurses
was 10,251.26)

Registration requirements for a disaster relief nurse

Currently a member of prefecture nursing associations
At least 5 years of work experience
Approval of the head of the facility upon registration if working at healthcare facilities
Completed the disaster nursing training course

Source: Japanese Nursing Association, How to become a disaster relief nurse, https://www.nurse.or.jp/nursing/practice/saigai/
index.html

2) Framework for dispatching disaster
relief nurses27)28)

In terms of dispatching disaster relief
nurses, the JNA or the nursing association in
the prefecture where a disaster has occurred
coordinates the dispatch of disaster relief
nurses according to the disaster responseclassification (Level 1, 2, 3) set out based on
disaster scale levels. The priority for disaster
relief nurses is generally to work at medical
institutions/social welfare facilities andemergency shelters (including emergency
shelters for the vulnerable). The target periodof work in affected areas is from the third day
to one month after the disaster, and the period
for disaster relief nurses to be individuallydispatched is, as a rule, three nights and fourdays, including travel. Nursing support workby disaster relief nurses is carried out on thebasis of self-sufficiency. In case of Levels 2 and3 in which the JNA coordinates dispatch ofnurses, the JNA provides disaster relief nurses
with travel accident insurance, travel expenses,
accommodation expenses, and daily allowances.

3) Track record of activities: 2011 Great
East Japan Earthquake (Tohoku
earthquake and tsunami)29)

March 11, 2011 was the largest earthquake
since national records began, at magnitude 9.0
with a maximum intensity of 7 on theJapanese seismic intensity scale.30) On the dayof the earthquake, the JNA set up theDisaster Management Headquarters. Due topoor transport connections in the aftermath ofthe earthquake, the JNA hired large buses
and transported 20–30 disaster relief nurses
to the affected areas each day. The nurses
were available 24 hours a day at emergency
shelters and medical institutions in theaffected areas. They cared for evacuees who
required medical or nursing assistance,
managed infection assessments andenvironmental hygiene, dealt with infection
control measures, cared for those in isolation,
and assisted with getting people to medical
institutions and emergency shelters for thevulnerable depending on the health status of
the evacuee in question. From March 21 to
May 17, 2011, 938 disaster relief nurses(cumulative total of 3 , 770 nurses) weredispatched to 49 emergency shelters andmedical institutions affected by the disaster,
to carry out support work.31)

The Great East Japan Earthquake on

Nursing in Japan 2023 31

2. Response to Pandemic1) R esponse to the COVID-19 pandemic32)

COVID-19 was first confirmed in Wuhan
City, China, in December 2019, after which it
spread around the world. It was declared by
the World Health Organization on January 30,
2020, as a Public Health Emergency ofInternational Concern. The first person to be
infected in Japan was confirmed on January
15, 2020. On February 1, the Japanese
government designated it as a “designatedinfectious disease,” which made compulsory
hospitalizations possible and the relevant care
to be at the government’s expense. The Novel
Coronavirus Response Headquarters was alsoestablished. After that, there were repeatedwaves of infection, and up until February 17,
2021, when COVID-19 vaccinations started inJapan, the total number of positive cases had
reached 416,812, with 6,487 deaths (231 deaths
under the age of 60, 6,244 deaths over 60, and
12 unknown).33)
As COVID-19 spread around the country,
nursing professionals treated patients in avariety of settings including health care, longterm care, government, community, in-home,and educational facilities. Certified Nurse
Specialists (CNS) in Infection Control Nursing
and Certified Nurses (CN) in Infection Control(certified by the JNA) used their expertise andexperience, moving out of their own facilities
and into other health care facilities, publichealth centers, and elderly care facilities toprovide support for infection control.34) With ashortage of nurses to respond to the pandemic,
Table 8-2

6,745 nursing professionals who had not beenworking answered the call of the Nurse Center
to return to work in COVID-19 accommodation
facilities for mild cases and at vaccination sites(as of June 20, 2021).35) While there was greaterpublic concern for health care workers
working on the front lines of the pandemic,
these health care workers who were treating
positive cases were also on the receiving endof prejudice and mental abuse. In the resultsof a survey conducted in September 2020, it
was found that one in five nurses had
experienced prejudice or discrimination as aresult of the spread of COVID-19.36)

2) T reatment support from public healthcenters37)38)

As a base for public health administrationin the community, infection control is part ofnormal public health center operations. Whenan infection occurs, they take outbreak
responses to prevent further spread of
infection, as well as preventive measures for
future recurrences. Public health centerswere responsible for confirming and reporting
total numbers of positive COVID-19 cases totheir respective prefectural offices as well as
arranging hospitalizations for positive cases(excluding hospitalizations where they weretransported by ambulance). Public healthnurses at the centers provided a range of
support for the treatment of positive cases (asof February 2021, Table 8-2).

Main treatment support for positive cases provided by public health nurses at public health centers

1. Treatment for people with symptoms (not tested)⃝ Telephone consultations at the fever consultation center⃝ Taking specimens⃝ Arranging and supporting physician visits, transport
2. Treatment for positive cases following receipt of a “COVID-19 Case Notification”⃝ Active epidemiological investigation (for positive case/facility)⃝ Arrangements for the receiving hospital/support for transport⃝ Hospital Admission Admonishment and work restriction notification for the positive case⃝ Transfers from hospitals assisting with infectious diseases to designated medical institutions for infectious diseases⃝ Grants for medical fees during admission⃝ Treatment support and consultation for those recuperation at home
⃝ Communication at the time of discharge
Source: C ompiled by the Japanese Nursing Association based on Nursing White Paper (2021): The Work of Nurses during the Spread of COVID-19, JNA (Ed)

32 Nursing in Japan 2023

3) O verseas comparison of mortality rates
in elderly care facilities39)40)41)
In the early stage of the pandemic, deathsof elderly people with a high risk of severe
disease were significant. As of the end of
April 2020, approximately 14% of the national
deaths from COVID-19 in Japan were thoseusing elderly care facilities. By contrast, in
Europe and the U.S. at the same time, people
in elderly care facilities made up nearly halfof the national death. The reason for the low
mortality rate in Japan’s elderly care facilities
is not clear, but some news reports point to
the efficacy of measures such as the following:in the early stage of the pandemic, thegovernment called for infection control
measures in elderly care facilities around thecountry (e.g. visiting restrictions), and there
was thorough infection control in thesefacilities. Furthermore, it is thought that the
support of CNSs and CNs specialized in
infection control was effective.

4) T reatment of foreign nationals living inJapanWith the global spread of COVID-19, fromFebruary 1 , 2020 , Japan began entry
restrictions on visitors from some countries andregions. By contrast, the number of foreign
nationals living in Japan at that time wasapproximately 2.93 million42), and the number of
positive cases of foreign nationals increased at
the same time as positive cases among
Japanese nationals increased. In the early stageof the pandemic, issues emerged such as intreating foreign patients and those withsymptoms as well as lack of availability of
information in other languages. Subsequently,
there was a gradual increase in COVID-19 callcenters and support centers for those
recuperating at home, operated by local
authorities with multi-language support
available. A multi-language COVID-19 website
was set up by the Ministry of Health, Labourand Welfare, and a 24-hour free telephoneinterpretation service for public health centers,
health care facilities, and accommodation
facilities for mild cases was started.43)44)

3. R estructuring of Dispatch System of Relief Nursing Professionals in Natural Disasters and Pandemics
National frameworks will be set up, in which
health care personnel can be widely dispatchedin times of infectious disease outbreaks/
pandemics, trained and registered in normal
times. In December 2022, with the revision of
the Act on the Prevention of Infectious

Diseases and Medical Care for Patients with
Infectious Diseases and the Medical Care Act,disaster relief nurses and nurses who havecompleted the current “COVID-19 Response
Training” can be trained and utilized in a newframework under government policy.

Nursing in Japan 2023 33

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34 Nursing in Japan 2023

25 M
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Nursing in Japan 2023 35

Japanese Nursing Association
5-8-2 Jingu-mae, Shibuya-ku, Tokyo, 150-0001 JAPANURL: h ttps://www.nurse.or.jp/（in Japanese）
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E-mail: inquiry@nurse.or.jp（Department of International Affairs）

Publication year: 2023
©2023 Japanese Nursing Association
36 Nursing in Japan 2023

Japanese Nursing Association