JNA News Release2015.February Vol.16

JNA News Release
Japanese Nursing Association
5-8-2 Jingu-mae, Shibuya-ku, Tokyo 150-0001 JAPAN

Tel: +81-3-5778-8559

Fax: +81-3-5778-8478

http://www.nurse.or.jp/jna/english/

ICN Asia Workforce Forum and Alliance of Asia Nurses Association (AANA)
Meeting Held in Tokyo
The 15th ICN Asia Workforce Forum(AWFF) and the 11th Alliance of Asia Nurses
Association (AANA) Meeting were held inTokyo from November 17th to 19th, 2014. In
the ICN AWFF, National Nurses’ Associations(NNAs) from eleven countries and regions in
Asia reported and exchanged views on labour
issues among nurses in these countries. Also,
JNA board members and experts from Japan
presented on “Occupational health and safety:thescienceoflabour in

nursing”

and“Post-quake health hazard and long-term
support activities in Fukushima after the Great
East Japan Earthquake.” In the AANA meeting,
NNAs from ten countries and regions in Asia

Delegates participated in ICN AWFF・AANA Meeting(Suga Sakamoto, JNA President, is the 2nd person from the right in the front row.)presented and shared information on “Agingand nursing: the role of nurses in the elderly care, issues and preparedness for the future” and “NNAs efforts
and issues in building and strengthening the competency of nurses on general practice.”
The 16th ICN AWFF and the 12th AANA Meeting will be held in Singapore in November 2015.

A Nationwide Hospital Survey on “Guidelines on Night Shift and Shift Work for
Nurses” Conducted
JNA developed and released a “Guidelines on

implementation status of 11 items in the Standards

Night Shift and Shift Work for Nurses” (hereinafter,

for Organizing Shift Schedules (hereinafter, thethe guidelines) in 2013. A nationwide hospital survey

standards) of the guidelines. The collected data onon the guidelines was conducted in January andthe 11 items in the standards were aggregated by

February of 2014. The survey was to collect data on

shift system, 2-shift and 3-shift systems. This survey

the recognition rate of the guidelines and therevealed the following characteristic findings.

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JNA News Release2015 Vol.16
The recognition rate of the guidelines was 95.8% andStandards for Organizing Shift Schedulesof the “Guidelines on Night Shift and Shift Workfor Nurses”

the rate increased up to 100% in hospitals with more thanStandard①Time between shifts

relatively higher percentages of hospitals which either

Provide 11 hours or longer time between shifts.

②Total hours spent at work
Total hours spent at work are up to 13 hours.

③Number of night shifts
Night shifts should basically be within 8 times a monthin a system of 3 shifts per day. If using another shiftsystems, the number should adjust to the work hours.

④Number of consecutive night shifts
Up to 2 consecutive night shifts.

⑤Number of consecutive working days
Up to 5 days.

⑥Time allocated for breaks
Provide 1 hour or more in the middle of a night shift,
and a period according to the length and load of theshift during a day shift.

⑦Naps during night shifts
Provide an uninterrupted nap time in the middle of thenight shift.

⑧Rest following a night shift (including days off)
Provide a rest period of 48 hours or more after 2
consecutive night shifts. A rest period of 24 hours ormore is desirable after 1 night shift.

⑨Consecutive days off on weekends
Consecutive days off over Saturday and Sunday
without preceding following night shift should beensured at least once a month.

⑩Direction of rotation
The roster to be forward rotating.

⑪Start of the morning shift
Avoid starting the morning shift before 7 AM.

500 beds. Among the 11 items in the standards, items withhave implemented after the release of the guidelines orare currently considering with a plan to work on were thefollowing: in hospitals with a 3-shift system, Item① Timebetween shifts (24.5%), Item⑨ Consecutive days off on
weekends (19.4%), Item⑧ Rest period of 48 hours ormore after 2 consecutive night shifts (19.2%), and Item⑩
Direction of rotation (19.2%); in hospitals with a 2-shiftsystem, Item ⑨ Consecutive days off on weekends(17.8%), Item⑧ Rest period of 48 hours or more after 2
consecutive night shifts (14.0%), and Item② Total hours
spent at work (12.7%).
This survey was conducted in a short period of timeafter the release of the guidelines. However, the results
revealed that on-site efforts to comply with the guidelines
have already been initiated and undertaken. In thehospitals making these efforts, significant effects, such as
an improvement in the retention of employed nurses andan increase in nurses seeking to be employed, have been
observed. For nurses to continue to work and practicetheir profession, it is absolutely essential to improve theirworking environment, particularly in night shifts. JNA willcontinue to actively provide and strengthen support for
nurses.

Item⑩ Direction of Rotation:
A forward shift rotation, recommended in Item
⑩ Direction of rotation, means to schedule shifts
in a clockwise direction and to provide enoughtime between each shift.
Example)Day shift → Evening shift →(Off duty)→ Midnight
shift

Irregular sleep patterns, caused by working
night shifts, is considered to have an impact on 3
aspects, health, safety and life of individuals. The
forward rotation of shifts in a 3-shift system helps
the individuals to physically adapt to the new shiftschedule.
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Please refer to JNA News Release Vol. 11 for more
information on the “Guidelines on Night Shift and Shift
Work for Nurses.”
http://www.nurse.or.jp/jna/english/news/pdf/2013nr_11.pdf

JNA News Release2015 Vol.16
Comparison of 2-shift and 3-shift Systems:

Shift Hours for Nurses Generally Adopted in Japan:
2-shift and 3-shift systems

Accordingtotheresultsofthesurvey,approximately 60% of hospital wards adopt a 2-shiftsystem and approximately 30% adopt a 3-shiftsystem. The 2-shift system is more commonly used in

2-shiftsystemhospitals with fewer beds.

Day shiftNight shift

8：30～17：00
8.5hour

16：30～9：00
16.5hours

Items in the standards of the guidelines werecompared between 2-shift and 3-shift systems.

3-shiftsystemDay shift

Evening shift

Midnight shift

Percentages of hospitals which implemented each

8：30～17：00
8.5hours

16：30～1：00
8.5hours

0：30～9：00
8.5hours

item before the release of the guidelines were
examined. Items with major differences between

9:00AM

8:30AMthese shifts were the following: Item① Time betweenNote) Slight differences in shift hours among hospitals exist.

shifts (86.5% in hospitals with the 2-shift system and29.7% in hospitals with the 3-shift system), Item②
Total hours spent at work (13.2% and 65.6%
respectively), and Item⑧ Rest period of 48 hours ormore after 2 consecutive night shifts (54.1% and18.6% respectively).

Survey Results by Shift System:
Implementation status in percentage of each Standard for Organizing Shift Schedules in the “Guideline on
Night Shift and Shift Work for Nurses”
Standard 1 Time between shifts
12-shift

86.5

3-shift

29.7

3.1

1.7 2.5

18.1

21.3

22.4

3 2.2
2.1

2.3 4.1

Standard 2 Total hours spent at work
0.5 1.1

2-shift

13.2

11.1

22.3

3-shift

46.9

65.6

4.8

7.9

11.5

9.4

10.3

13.7

3

0.5 2.1

Standard 8 Rest following a night shift：a rest period of 48 hours or more after 2 consecutive night shifts
2-shift54.1

3-shift

18.6

2 2

15.8

10.1

7.9

22.2

34.5

5.5

0.7 2.8

Standard 9 Consecutive days off on weekends
2-shift

57.6

3-shift

2.52.354.1

3.2 2.3

13
14

10.4

10.6

3.6

13.5

11

2

Standard 10 Direction of rotation
3-shift

13.6

0%

10%

1.1 4

14.1

20%

18

30%

40%

27.3

50%

60%

21.8

70%

Note）For Standard 10, only hospitals with the 3-shift system are subject to the data collection.
Only the survey results relevant to this article are presented in this graph.

Implemented before release of the guidelines
Implemented in all wards after release of the gudelines
Implemented in some wards after release of the guidelines
Planning to work on and currently considering
Planning to work on but have't started to consider
Currently not planning
Not answered

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80%

90%

100%

JNA News Release2015 Vol.16

Information on Nursing for the People with Lifestyle-related Diseases in Japan
Posted on JNA website
Prevention and control of Non-communicable diseases (NCDs) are the issues
to be addressed globally. In Japan, NCDs relating to lifestyles and behaviors arecalled “lifestyle-related diseases.” JNA has started posting detailed informationof nursing for the people with lifestyle-related diseases in Japan on our official
English website.
The posted information provided with facts and figures introduces the current
situations, risk factors as well as nursing and JNA’s efforts, being divided into thefollowing 3 topic areas: 1. Current State of Lifestyle-related Diseases/NCDs inJapan and Actions Taken; 2. Nursing for the People with Lifestyle-relatedDiseases: Health Promotion, Prevention and Living with the Diseases; 3. JNA in
Action.
http://www.nurse.or.jp/jna/english/

A Level III Certification in “Clinical Ladder of Competencies for Midwifery
Practice” will be Commenced
in the “Clinical Ladder of Competencies for Midwifery

Background of the Development of the “Clinical
Ladder of Competencies for Midwifery Practice”:

Practice” (hereinafter, the clinical ladder) will be commenced.

Midwives in Japan have been surrounded

In August 2015, an application for a Level III certification

This certification system was developed and establishedcollaboratively by five organizations in total, including JNA
and other midwifery organizations. This is designed to certify

by and confronted with numerous issues,
such as closure of labour and delivery
facilities and integration of maternity wards
into other hospital wards due to declining birth

midwives with practical competencies equivalent to a Level

rates and a shortage of obstetricians, an

III of the clinical ladder. An authorized organization to issue

uneven distribution of healthcare facilities

this certification is the Japan Institute of Midwifery

where midwives work, and the inadequacy of

Evaluation.

systematicOnce the Level III certification is granted through thissystem by applying the clinical ladder that JNA developed
and released nationwide in 2012, midwives will be deemed
to be capable of practicing midwifery care responsibly andindependently

duringnormalpregnancy,

andstructured

educational

programs for working midwives. These issues
have made it difficult and challenging to fully
utilize the expertise of midwives and todevelopandstrengthen

theirpractical

competencies.

delivery,

As a tool that is available and can bepostpartum and neonatal periods. As requirements toutilized nationwide, JNA developed andachieve the Level III of the clinical ladder, learning contents

released the “clinical ladder” in 2012, along

and numbers of performed cases, such as physicalwith “Career Pathways for Midwives” andcheckups during pregnancy and delivery assistance, will be“Training Guidelines for Newly Graduatedspecified and also practical skills will be assessed andevaluated on a regular basis.
This will make it possible to improve practical competency
levels of midwives and to assure the quality of midwiferycare. This will also help midwives to build confidence, and4|

Midwives.” An application of the clinicalladder will make it possible to evaluate andassure practical competencies of midwives
and to facilitate and further advance theircareers.

JNA News Release2015 Vol.16

moreover this will encourage other healthcare professionals to acknowledge practical competencies of
midwives, consequently leading to role sharing.
Please refer to Midwifery in Japan and JNA News Release Vol. 8 for more information on the “Clinical Ladderof Competencies for Midwifery Practice” and the “Training Guidelines for Newly Graduated Midwives.”
http://www.nurse.or.jp/jna/english/midwifery/pdf/mij2014.pdf
http://www.nurse.or.jp/jna/english/news/pdf/2012nr_8.pdf

Nursing in JapanQ Where do midwives in Japan work?
In Japan, the number of working midwives in 2012 was 35 thousand1). The percentages of working
midwives in 2012, as shown in the table 1, were as follows; 62.4% at hospitals, 25.1% at clinics, and 5.0% at
midwifery homes. More than half of working midwives have been employed at hospitals, and many newly
graduated midwives have been employed at hospitals as well.
In Japan, midwives are licensed to manage normal pregnancies and deliveries independently with theirown responsibility and judgment, while cooperating with physicians as needed. Also, midwives can open andrun midwifery homes, which are defined as one of healthcare institutions by the Medical Care Act. However,the number of midwives who run midwifery homes or who are employed at midwifery homes is certainly
small.
Working midwives are unevenly distributed among facilities in such a way that many of them have been
employed at hospitals, as described above. However, estimated proportions of deliveries Note1) at hospitals
and at clinics are almost the same. As indicated on the table 1, the percentages of live births in 2012 were as
follows; 52.7% at hospitals, 46.3% at clinics, and 0.8% at midwifery homes. Despite the fact of slightly lessthan half of live births taking place at clinics, the proportion of working midwives employed at clinics is lessthan one third. In other words, the number of working midwives employed at clinics is not proportional to theestimated number of deliveries at clinics. This uneven distribution of working midwives is caused by a factthat appropriate placement of midwives at each facility is not specified by the existing Medical Care Act andthe discretion is left to each facility. Furthermore, such uneven distribution is evident not only between
hospitals and clinics but also among hospitals. Many working midwives have been employed at perinatal
maternal and child medical centers, which provide advanced perinatal care and interventions.
At facilities with fewer working midwives, it has been challenging to provide sufficient continuing education
for midwives and to accept midwifery students for clinical experiences within their facilities. Also, at theperinatal maternal and child medical centers, where many working midwives are employed and where manyhigh-risk pregnancies and deliveries are handled, midwives have limited opportunities to be involved invarious types of midwifery care, particularly low-risk cases, during pregnancy, delivery, postpartum andneonatal periods.
JNA has been working toward the creation and provision of safe and secure environment for childbirth withhigh-quality midwifery care provided by midwives, including to address the issues presented above, namely
the uneven distribution of working midwives among facilities.

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JNA News Release2015 Vol.16

Table 1：Number and Percentage of Working Midwives and Live Births 1)
Statistics by Facility Type in 2012
Working midwives

Live births

Hospitals

21,957 (62.4%)

546,793 (52.7%)

Clinics

8,840 (25.1%)

480,262 (46.3%)

Midwifery homes
OthersNote2)

1,742(5.0%)

8,282 (0.8%)

2,646(7.5%)

1,894 (0.2%)

Note1) It is to be assumed that proportions of deliveries by facility type are relatively similar to the proportions of live
births by facility type in table 1. Statistical data on numbers of deliveries by facility type is not available.
Note2) Facilities corresponding to “others for working midwives” and “others for live births” do not necessarily match.

Reference:
1) Data obtained from Statistical Data on Nursing Service in Japan 2013, Japanese Nursing Association
Publishing Company

News Topics in Japan
Healthy Life Expectancy for 2013
On October 1, 2014, the Ministry of Health, Labour and Welfare announced the healthy life
expectancy for 2013. The data for 2013, in comparison with that accounted last time in 2010, is 71.19
years for men with a 0.78 year increase and 74.21 years for women with a 0.59 year increase. The
gap between the life expectancy at birth and healthy life expectancy in 2013, comparing with the data
in 2010, is 9.02 years for men with a 0.20 year reduction and 12.4 years for women with a 0.37 year
reduction.
Training System for Nurses to Perform Specific Medical Interventions
On December 24, 2014: The Amendatory Law to the Related Acts for Securing Comprehensive
Medical and Long-Term Care in the Community was enacted in June 2014 and the Training System
for Nurses to Perform Specific Medical Interventions was consequently legislated. Under the training
system, medical interventions involving highly skilled decisions and practice will be defined and thecontents of training required for nurses to perform such medical interventions will be standardized.
In preparation for an introduction of the training system in October 2015, the Ministry of Health,Labour and Welfare established a council for the training system. Detailed contents of specificinterventions and training were discussed in the council and, eventually expressed suggestions andviews were compiled and summarized on December 24th. Based on this, the Ordinance of the
Ministry of Health, Labour and Welfare and other related enforcement notices will be issued.
Estimated Number of People with Dementia in 2025
On January 7, 2015, the Ministry of Health, Labour and Welfare announced a revised estimate ofpeople with dementia. By 2025, when the baby-boomers will reach 75 years old or older, the numberof people with dementia is estimated to be approximately 7 million, which will represent one in every
five persons aged 65 or older.

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