社会医学研究．第 32 巻 2 号．Bulletin of Social Medicine, Vol.32（2）2015

原著

Promoting occupational health services in small-scale enterprises in Japan:
Employment conditions and activities of nurses
at regional occupational health centers
小規模事業場への産業保健サービス提供の推進―地域産業保健センターにおける看護職の雇用と活動の実態―
Junko NAKATANI 1），Akinori NAKATA 1），Hisako IZUMI 2）
中谷淳子 1）2）、中田光紀 1）、和泉比佐子 3）1）School of Health Sciences, University of Occupational and Environmental Health, kitakyushu, Japan
2）Doctoral course, Sapporo Medical University Graduate School of Health Sciences, Sapporo Medical
University, Sapporo, Japan
3）School of Health Sciences, Sapporo Medical University, Sapporo, Japan
1）産業医科大学産業保健学部看護学科
2）札幌医科大学保健医療学研究科博士課程後期
3）札幌医科大学保健医療学部看護学科

抄録
地域産業保健センターに所属する保健師や看護師の雇用および業務の実態を明らかにするために、全国の地域産

業保健センターに所属する看護職 195 人を対象とした質問紙調査を実施した。地域産業保健センターに所属する看護職は 65.6％が非常勤雇用であり、週に１回以上活動する看護職は 33.7％であった。業務内容は、保健指導や健康相談など労働者個人に対する活動を主とする一方、作業環境の改善や作業の改善はほとんど実施されていなかった。
また、衛生管理者免許の非保持者は、保持者と比較して「作業の改善（0.0% vs.14.0%）」、「各種調査の立案実施（0.0%
vs.14.0%）」、「メンタルヘルス相談（48.6% vs. 79.1%）」、「健康づくり事業の企画・立案（8.8% vs.28.6%）」を実施
している割合が有意に低かった。これらの結果より、地域産業保健センターに所属する看護職は、非常勤雇用であることや衛生管理者の免許を持たないことなどから、活動内容に限りがあることが推察された。地域産業保健セン
ターにおいて、看護職を雇用するための政府による財政的な補助に加え、産業保健活動に関する専門的な教育の必要性が示唆された。
Abstract
To understand the current status and tasks performed by nurses working at regional occupational healthcenters (ROHs), we conducted a questionnaire survey. Among 195 participants, two-thirds (65.6%) of nurses at
ROHs were working under part-time condition, and only 33.7% of them engaged in ocupational health nursing
services more than once a week. They engaged in supporting health of individual employees through healthguidance and health consultations rather than performing work environment improvement and operation
improvement. Compared to non-licensed health supervisor nurses, licensed health supervisor nurses had  
受付期日：2015/04/30

受理期日：2015/05/09

連絡先アドレス：horikawa@health.uoeh-u.ac.jp― 79 ―

社会医学研究．第 32 巻 2 号．Bulletin of Social Medicine, Vol.32（2）2015

increased experiences in conducting“operations improvement (0.0% vs.14.0%),“drafting and implementing
various surveys (0.0% vs.14.0%)”,“mental health consultations (48.6% vs. 79.1%)”, and“planning and drafting
health promotion initiatives (8.8% vs.28.6%)”. Results suggest that activities among nurses at ROHs are limited
attributable to the fact that they work under part-time condition without holding health supervisor license. In
conclusion, nurses at ROHs need additional funding/support by the government as well as more formal training
to promote occupational health activities at such centers.
キーワード：小規模事業場、地域産業保健センター、産業保健、産業看護、産業看護活動
Key words： Small-scale enterprises, Regional Occupational Health Centers, Occupational Health, Occupational
Health Nursing, Activities of occupational health nurses.

Introduction

in small-scale enterprises (SSE) 2）.

During the past ten years, health among Japanese

According to the “Comprehensive survey ofworking population had worsened gradually. Based

Economic Census 2009”4）, enterprises with fewer

on the nationwide surveys conducted by thethan 50 employees (so-called SSE) accounted for 97%

Ministry of Health, Labor and Welfare, basic indicesof all enterprises and their employees accounted forof worker health in Japan had declined; for example,

61% of all Japanese employees. A national survey by

the rate of abnormal findings in periodical healththe Ministry of Health, Labor and Welfare indicatedexaminations was 47.3% in 2003 compared to 53.0%

that measures such as 1) appointing an occupational1）

in 2013 . Similarly, the proportion of workers who

physician/health supervisor, 2) establishing a healthreported feeling severe anxiety and stress in theirand safety committee, 3) carrying out periodic

working life was 58.0% in 2007 but reached 60.9% in

general health examinations, and 4) taking action

2）2012 . Correspondingly, a number of serious healthfollowing health examinations, were implemented inissues including deaths and suicides from overwork,large-scale enterprises but not so much in SSEs 5）.

so called Karoshi/Karojisatsu, had increased, and theAccording to a report by Ministry of Health, Labor

number and rate of employees who were approved

and Welfare, enterprises with 300+ employees

3）.

provided mental health care up to 90%, whereas

It is reasonable to imagine that exposure to poor

figures for enterprises with 30 to 49 employees

working environment can reduce employees’quality

were 56%, and enterprises with 10 to 29 employees

of working life (QOWL) as well as qualitative anddropped to 39% 3）. These figures clearly indicate thatquantitative productivity; therefore, prevention

occupational health measures had been imbalancedof disorders and injuries through promotion of

between the large-scale enterprises and the SSEs 6）.

by the workers’compensation followed this trend

occupational health activities needs to be reinforced.

This imbalance may be attributable to a lack of

As a national health strategy, Japan’s Ministry ofunderstanding of the aim and content of occupational

Health, Labor and Welfare has established a variety

health activities by employers 7） leading to limitedof policies to improve employees’ health status

governmental support and poor human resources 8）.

including 1) introducing specific health checkups and

To address occupational health needs of SSEs,

counseling guidance to prevent metabolic syndrome,

the Japanese government founded 347 regional

2) formulating guidelines for mental health measures,

occupational health centers (ROHs) in every region

and 3) mandating employer to consult employeesof the country. Each center has a coordinatorwith excessive working hours through occupational

who will contact occupational health specialists

health professionals. Although such strategies haveand these specialists will provide actual services.

been promoted, prevention measures did not prevail

Although a number of ROHs exist, these centers― 80 ―

社会医学研究．第 32 巻 2 号．Bulletin of Social Medicine, Vol.32（2）2015

are often underutilized 9）. Major reasons for suchoccupation, whether the subject was a licensed

underutilization are 1) a lack of awareness of thehealth supervisor or not, number of years

ROHs by business owners, and 2) the occupational

worked at the current regional occupational

physicians at these centers work under part-time

health center, work experience other than at thecondition leading to limited time spent on theseregional occupational center, number of years

activities. To reinforce such activities, ROHs decided

worked as a nurse and current employment

to recruit nurses who can help occupational healthstatus, whether subjects also worked as a

activities developed at these centers. Although

coordinator or not, frequency of performing

activities at these centers have been graduallyactivities at the regional occupational healthfacilitated, there are a number of problems whichcenter, number of workplaces visited in theneeds to be solved to meet SSEs’needs. According

past year, and number of visiting healthto our survey of ROHs, only 73 out of 347 centersconsultations performed in the past year.
2）Tasks: From the 20 task items (Table 2),

10）

had nurses working at these centers . A survey
targeting coordinators investigated that there areresponse options were as follows: a) Had

still in short in number of nurses to support theexperienced regularly, b) Had experienced

services in a standard manner. In addition, thesometimes, c) Had experienced a little, and d)survey targeting nurses claimed that they did not

Never experienced in such activities.

have enough opportunities to train their skills and3）Tasks that subjects wanted to engage in: From

therefore facing difficulties to become licensed healththe 20 task items in Table 2, the subjects weresupervisors or occupational health specialists.

asked to provide the tasks that they wished toemphasize (multi selection answers).

In accordance with the above context, the4）If they wish to participate in training opportunities

objective of this questionnaire survey was toor not if they had such opportunities?

understand the current status and tasks performed

5）If such opportunities are given, please selectby nurses working at ROHs and the problems

five activities from the list in Table 5.

encountered when performing their tasks during

5. Analysis method

their occupational health activities.

Responses were obtained from 98 individuals
Subjects and methods(response rate, 50.1%), and the responses of the  1. Subjects

89 individuals who met the study inclusion criteria

The subjects were public health nurses andwere analyzed. In addition to descriptive statistics,
each task subjects were divided into a group that

nurses at ROHs throughout Japan.

performed the task (consisting of subjects whose

2. Survey method
1）Anonymous, self-administered questionnaire

response was“Had experienced regularly”,“Hadwas delivered by postal mail and asked toexperienced sometimes”, or“Had experienced a

respond within 3 months.

little”and a group that did not perform the task,

2）Among 347 ROHs, 100 centers agreed tosubjects whose response was“Never experienced

participate in the current survey and thesuch activities”. A chi-square test was thenquestionnaire was distributed to 195 public

performed to examine the relationship between

health nurses and nurses in such centers.

task performance and whether the individual wasa licensed health supervisor or not. Fisher's exact

3. Survey period

test was performed if any cells had less than 5.

During August to November 2009.

The significance level for all statistical analyses

4. Survey content

was p<.05%. Data were analyzed using SPSS

The survey questions were as follows.
1）Basic attributes and work status: sex, age,― 81 ―

Statistics 22.0 software.

社会医学研究．第 32 巻 2 号．Bulletin of Social Medicine, Vol.32（2）2015

Ethical considerations

drafting health promotion initiatives”(3.3),“workWhen a request was submitted to the center

environment improvement”(4.4%), and“drafting andcoordinators, subjects were asked to respond to theimplementing various surveys”(4.4%) were activities

questionnaire on voluntary basis. Informed consent

that were not focused by the subjects.

information was provided in the front sheet of thequestionnaire and if they returned the questionnaire,

3. Tasks that subjects wished to emphasize (Table 3)
Of the 20 task items, subjects wished to emphasize

it was considered as consent to participate.

“providing health guidance after health examinations”
Results(33.7%), followed by“health consultations”(28.1%)

1. Subject attributes and work status (Table 1)

and“mental health consultations”(21.3%) compared

Overall, 96.7% of subjects were women and age

to other task items.

group with 60 years or older accounted for 38.9%
followed by 40 to 49 years old (27.8%), 50 to 59 years

4. Differences in the rate of implementation inold (15.6%), 30 to 39 years old (10.0%), and 20 to 29

various tasks according to health supervisor

years old (6.7%).

license status (Table 4)With regard to nursing professional type, 74.4%

Compared to non-licensed health supervisors,

were public health nurses, 16.7% were RNs, andlicensed health supervisors carried out“operations

2.2% were nursing assistance; 5.6% had missing

improvement” more often than non-licensed

value on this question. The proportion of those withsupervisors (licensed vs. non-licensed: 14.0% vs. 0.0%,

licensed health supervisors was 53.3%, and 17.8% of

p=0.021). Similarly, activities such as“drafting andthe subjects also worked as coordinators. The mostimplementing various surveys”(licensed vs. non-common work experience other than employment

licensed: 14.0% vs. 0.0%, p=0.023),“mental healthat a regional occupational health center (multiple

consultations”(licensed vs. non-licensed: 79.1% vs.

responses) was working at public health (51 cases),

48.6%, p=0.005), and“planning and drafting healthfollowed by clinical (41 cases) and occupational healthpromotion initiatives” (licensed vs. non-licensed:(32 cases). Forty-six percent of subjects claimed that

28.6% vs. 8.8%, p=0.031) were more often carried

they had worked at the regional occupational healthout by licensed health supervisors than non-licensed

center for 2 to 4 years.

supervisors.

The most common employment status was parttime temporary employee (65.6%), followed by

5. Availability of training opportunities and skills

regular staff member (23.3%) and full-time temporary

and topics wish to learn (Table 5)

employee (2.2%). Forty-six percent of subjects

Sixty-eight percent of subjects answered thatanswered that they work at the ROC one to five

they can receive training if they wish, while 29.2%

times per month, and 23.6% of subjects answered

responded that they don't have such opportunities.
As shown in Table 5, forty-eight percent ofthat they work one to three times per week.

subjects claimed that they wish to learn about“health interview skills (48.3%)”followed by“health

2. Tasks (Table 2)
As shown in Table 2,“providing health guidancein person after health examinations (57.3%),”management (44.9%)”, and“communication skills(42.7%)”.

“health consultations (58.4%)”and“mental healthconsultations (24.7%)”were three major activities

Discussion
Major findings in this study are as follows. First,

focused by the subjects. In contrast, subjects
answered that“showing up at the client workplaces”

according to our survey, two-thirds (65.6%) of nurses(1.1),“operation improvement”(3.3%),“planning andat ROCs were working under part-time condition,― 82 ―

社会医学研究．第 32 巻 2 号．Bulletin of Social Medicine, Vol.32（2）2015

Table 1. Subject attributes and work status (n = 89)― 83 ―

社会医学研究．第 32 巻 2 号．Bulletin of Social Medicine, Vol.32（2）2015

Table 2. Task and performance conducted by nurses (n = 89)

Table 3. Tasks that subjects wished to emphasize (n = 89)― 84 ―

社会医学研究．第 32 巻 2 号．Bulletin of Social Medicine, Vol.32（2）2015

Table 4. Differences in percentage of implementing various tasks depending on health supervisor license status― 85 ―

社会医学研究．第 32 巻 2 号．Bulletin of Social Medicine, Vol.32（2）2015

Table 5. Skills and topics that nurses wish to cover further (multiple responses possible) (n = 89)

and because of this condition only 33.7% of themThis is common among nurses as well as doctors

engaged in occupational health nursing services moreworking at ROCs. Because ROCs are supported bythan once a week. Second, nurses at ROCs could

limited government support, and services provided

not sufficiently perform operations improvement,by these centers are basically free of charge, it iswork environment improvement, and drafting anddifficult to employ full-time healthcare professionals.

implementing various surveys. Third, compared

To promote occupational health activities at theseto non-licensed health supervisors, licensed healthcenters, it is essential to increase funding/support bysupervisors had significantly increased experiences

the government and establish employment status ofin conducting“operations management (0.0% vs.

health care workers at these centers.

14.0%),“drafting and implementing various surveys

With regard to employment status within(0.0% vs. 14.0%)”,“mental health consultations

occupational health nurses, Igarashi et al. (2008) 11）(48.6% vs. 79.1%)”, and“planning and drafting healthreported that only 2.7% (10 out of 404) were part-promotion initiatives (8.8% vs. 28.6%).” Results

time employees. In our previous survey targeting

revealed that activities among nurses at ROHs arenurses employed at industrial health organizations,limited attributable to the fact that they work under

the proportion of part-time employment was

part-time condition without holding health supervisor

20.7% (200 out of 968) 12）. As stated previously, thelicense. In conclusion, nurses at ROCs need more

proportion of part-time employment in this study

formal training to promote occupational healthwas 65.6%. A large difference in the proportion

activities when working at such centers.

has been observed between these three studies.

In this study, the most common employment status

Several plausible explanations are as follows. First,of nurses is part-time temporary condition (65.6%).

when recruiting employees at these centers, limited― 86 ―

社会医学研究．第 32 巻 2 号．Bulletin of Social Medicine, Vol.32（2）2015

monetary support may only allow them to employ

the organization itself. Through health promotion

under part-time condition, and therefore mostactivities aimed at the workplaces, the occupational

applicants could be nurses who are already retired

health nurse tends to contribute to an approach offrom their former occupation. Second, because of

establishing a person-to-person relationship with thelimited funding, salaries provided by these centers

employee and improving their lifestyle, while theare not comparable to their former jobs. ROCs arehealth supervisor tends to contribute to improve theconfronting such difficulties and are at stake towork environment and operations13）. Nurses at ROCs

maintain their existence.

are often the only specialists engaged in occupational

Major duties of occupational health nurses

health in small-scale enterprises, and obtaining a

are consisted of “health management,”“workhealth supervisor license appears to be an effective

environment management,” and “operationmeans of expanding their activities.

management.”Among them, our survey revealed

Approximately 30% of the subjects responded

that nurses at ROCs are focusing on“providingthat they had no opportunities to participate inhealth guidance in person after health examinations

occupational health training such as attending(57.3%),”“health consultations (58.4%),”and“mental

academic conferences and seminars in the past year.

health consultations (24.7%)” which is classified

This figure is much lower than the survey conductedas“health management”activities, while“workby Igarashi et al.11） showing that less than 10% had

environment improvement (4.4%),”and“operationno such opportunities. Occupational health nurses

improvement (3.3%)”which is classified as“workmust constantly respond to emerging occupational

environment management” and “operation

health problems because employees and companies

management”are not the main activities of nurses atare subject to dynamic changes in social conditions

ROCs. Such differences may be speculated as follows.

and social environment. Therefore, all occupational

First, nurses at ROCs do not have rich experiences

health nurses need to obtain up to date information,in occupational health itself (only 64.8% in our survey

knowledge and skills through continuous educational

had past experience in occupational health nursing).

training.

Second, only 56.7% of nurses at ROCs had‘health

Regarding skills and knowledge that nurses atsupervisor license’which means that those who

ROCs wanted to obtain were“work physiology”,

had such license are treated as occupational health“occupation/work-related health effects”,“operations

professional.

management”,“work environment management”,

Our study also revealed that licensed healthand“industrial health education.”Although suchsupervisors had experiences in conducting

activities are not frequently conducted on the daily“operations improvement (14.0%)”,“drafting andbasis, nurses at ROCs are aware of the importance

implementing various surveys (14.0%)”,“mentalof such activities.

health consultations (79.1%)”, and“planning andSeveral limitations with regard to this study aredrafting health promotion initiatives (28.6%).”

as follows. This survey only assessed the activities

In contrast, non-licensed health supervisors had

and problems among nurses at ROCs. It is necessary

only 2.9%, 0.0%, 49.6%, and 8.8%, respectively,

to uncover why some activities are frequently

for corresponding activities. This indicates that

conducted and some are not. It is also importantpossessing health supervisor license improved

how to promote activities that are not frequently

both knowledge and awareness of the healthconducted. Furthermore, we need to know whatsupervisor as a professional responsibility to conduct

is expected from business owners and employees

occupational health activities and may have affected

and how they can utilize ROCs. It is also importantthe implementation of nursing so that it was not

to grasp opinions of coordinators and occupational

limited to supporting individual workers but also

physicians regarding the effectiveness and merits of― 87 ―

社会医学研究．第 32 巻 2 号．Bulletin of Social Medicine, Vol.32（2）2015

small-scale enterprises. Occupational Medicine

nurses working at regional occupational centers.

2007 ; 6(57) : 126-130
In conclusion, nurses at ROCs need additional

7） Toshiaki Higashi. General report of the researchsupport by the government as well as more formal

related to future occupational health, Healthtraining to promote occupational health activities

Labour Sciences Research Grant, Research on

at such centers. Such action will certainly promote

Occupational Safety and Health, General report

occupational safety and health of SSEs’consequentlyof the research related to future occupational

leading to enhance productivity of employers andhealth ; 2004
8） Mamoru Hirata, Shinji Kumagai, Takeo Tabuchi

welfare of employees.

et al. Acutual Conditions og Occupational Health,
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