JNA News Release2018 October Vol.26

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

Tel: +81-3-5778-8559

Fax: +81-3-5778-5602

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

I. 2017 Survey on the Actual Situation of Hospital Nursing
The Japanese Nursing Association (the JNA) conducted the 2017 Survey on the Actual Situation of Hospital (theSurvey). The Survey is conducted once a year on hospitals across Japan, aiming to identify the supply/demand
and recruiting statuses of nurses at hospitals as materials for the JNA projects and policy proposals. The Survey
conducted in 2017, shows the turnover rate of nurses and other data in FY 2016. This article shares the three key
results of the Survey.

1. Roles of hospitals in local communities
In 2025, the so-called "baby boomers" born between 1946 and 1964 enter the latter stage of elderly(75 years or older) in Japan. Based on the expected rapid increase in demand for healthcare and long-termcare, reform in healthcare system is being promoted. In this reform, measures are being taken for the differentiationof bed functions, collaboration of healthcare institutions, and home health care in individual local communities.
Hospitals that have focused on acute-phase care are also required to incorporate their roles in the local
communities into their management. In the Survey, questions were asked to hospitals concerning the roles thatthey are playing at present in the local communities, and those that they plan to play in the future (2025). The
results showed that the shares were the highest both at present and in the future at nearly 30% for "Have multiple
functions including acute-phase care, recovery-phase care, chronic-phase care, etc., and satisfy local needs in a
broad range." The share of "Provide home-visit medical and home-visit nursing, thereby taking care of patients athome" increased from 0.5% at present to 4.7% in the future (Figure 1). The Survey suggested that individual
hospitals were seeking to play their roles by collaborating with local communities.

2. Utilization of nursing human resources in local communities
Recently, the idea has been highlighted in Japan to utilize hospital nurses as human resources in local
communities. This includes, dispatching nurses working at hospitals as lecturers to seminars/lectures targeted at
local healthcare and long term care workers and residents, as well as the accompaniment to home-visit nursing
by hospital nurses with high expertise (e.g. Certified Nurse Specialists, Certified Nurses).
Approx. 80% of the responding hospitals reported that they were implementing certain initiatives to utilize theirnurses in the local communities. The share of such initiatives was the highest for "Education and promotion
activities for local residents" at 47.9%, followed by "Education and promotion activities for local professionals" at
40.2% (Figure 2). This suggested elevated awareness for utilizing nurses working at hospitals to make further
contribution in local communities.

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JNA News Release2018 October Vol.26

3. Turnover rate of nurses
The average turnover rate of hospital nurses in Japan stood at 10.9% for permanently employed nurses, including
7.6% for newly graduated nurses. The turnover rate has remained at the same level over the past few years.
Among the 47 prefectures in Japan, the turnover rate of regular employed hospital nurses was the highest in
Kanagawa, Tokyo and Osaka, indicating higher turnovers in large cities, just as in usual years.

Present
roles

Roles
for 2025

A.

Mainly provide advanced/specialized inpatient care, and handle severe acute-phase diseases

B.

Mainly take care of patients who require inpatient care for acute-phase diseases, as well as acutephase patients in relatively mild condition

C.

Have multiple functions including acute-phase care, recovery-phase care, chronic-phase care, etc.,
and satisfy local needs in a broad range

D.

Have functions to provide buck-up for acute-phase hospitals as well as rehabilitation, thereby taking
care of patients who aim at returning home

E.

Take care of patients with diseases/disabilities who require long-term treatment

F. Provide home-visit medical treatment and home-visit nursing, thereby handling patients who receive
F.
medical care at homeF
G. Take care of relatively mild acute-phase diseases and health management as “primary care facilities”
F.
for local residents
H.

OthersI.

Do not know

J. No response / Unknown

Figure 1

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Roles of hospital in local communities (present roles vs. Roles for 2025)

JNA News Release2018 October Vol.26

Education and promotion activities for local residents
Education and promotion activities for local professionals
Visiting guidance at patient’s home before discharge
Visiting guidance at patient’s home after discharge
Support/guidance and consultation service concerning nursing skills
at other local institutions by hospital nurses
Nothing particularSame-day or accompanied visits by high experties nurses
with home-visit nurses of other institutions.
Dispatch of hospital nurses to other local institutions
OthersNo response / unknown

n = 4,134 Multiple choice

Figure 2 Initiatives to utilize nursing human resources at hospitals for local communities(multiple choice)
The Survey overview
Targets

8,396 hospitals in Japan

Survey period

October 1-16, 2017

Survey method

Sent and returned self-reporting survey sheets by post

Response status

Effective responses: 4,134 (effective response rate: 49.2%)

II. Publication and dissemination of the "Occupational Health and Safety
Guidelines for Nurses towards Healthy Workplace(healthy and safe
workplace)"
As the work styles and workplaces of nurses become increasingly diversified, it is urgently required to establish
sustainable workplace environment that enables nurses to continue working in a healthy and safe manner. Under
the basic recognition that "the health and safety of nurses protect the health of patients," the Japanese Nursing
Association (the JNA) published the " "Occupational Health and Safety Guidelines for Nurses towards Healthy
Workplace (healthy and safe workplace) " (the Guidelines).
The existing "Occupational Safety and Health Guidelines" (published by the JNA in 2004) mainly consisted of theidentification of various occupational safety and health risks to which nurses are exposed on their job, and therelevant organizational preventive measures. For nurses to continue working in a healthy manner throughout theirlives, the Guidelines indicate that it is important for nurses to combine two perspectives: (1) the understanding andhandling of work-related risks, and (2) the promotion of own health to practice nursing in a mentally and physically
healthy status. The Guidelines also suggest initiatives based on these two perspectives.
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JNA News Release2018 October Vol.26

Contents of the Guidelines
Chapter

Description

1

Persons who create healthy and safe workplaces and actual initiatives (the five steps)

2

Work-related risks and how to handle them
1. Biological factors; 2. Physical factors; 3. Chemical factors; 4. Ergonomic factors;
5. Traffic traveling factors; 6. Work shift/hour factors; 7. Mental/social factors, 1) Violence bypatients/users, colleagues and/or third parties; 2) Harassment; 3) Mental stress3

Health promotion
1. Adaptation to occupational life;
2. Harmonization with life events;
3. Health promotion to continue working throughout one's life;
1) Changes in occupational life; 2) Changes in family/personal life; 3) Physical/mental andhealth changes

4

Reference information and Annex

Persons who create healthy and safe workplaces
Realization of healthy and safe workplaces
Healthy and safe workplaces that respect basic human rights
・Workplaces where nurses can provide high-quality nursing practice in an environment where they can fully
exercise their abilities and continue developing their skills in a healthy manner.
Organization-wide initiatives
Protect staff from work-related risks, and support the health promotion of each individual・Declaration of healthy and safe workplace by the head of the facility; from human resource management tohuman asset management.
Initiatives by nurse administrators
Create environment and culture for healthy and safe workplace.
Promotion of work-life balance in a planned manner; promotion of actions for securing human resources
and cross-organizational actions.
Initiatives by individual nurses
Health promotion throughout working life in order to continue one’s professional development while working ina style that matches oneself.
・Achievement of work-life balance that matches oneself; development of one's own career plan, etc.
Possible collaboration with local communities, society and patients/ service users
Understanding and expectation that healthy nurses can provide better nursing in a continuous manner
・Facility operation involving local communities, promotion of participation by patients/residents, etc.

To promote and disseminate the Guidelines, the JNA conducts on-demand online seminars targeted at nurse
administrators, in addition to opening a special website in Japanese
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JNA News Release2018 October Vol.26(http://www.nurse.or.jp/nursing/shuroanzen/healthy_work_place/index.html) concerning the occupational safety
and health of nurses, implementing seminars, and making campaign posters, as part of its nationwide campaign
in concurrence with the National Industrial Health Week slated for October 2018.

III. Publication of the "Guidelines for In-hospital midwife-led care and Inhospital midwifery clinics 2018"
The Japanese Nursing Association (the JNA) prepared and published the "Guidelines for In-hospital midwife-led
care and In-hospital midwifery clinics 2018" (The Guidelines 2018) in March 2018. The Guidelines 2018 is aimed
at enhancing the functions of midwifery care systems, subsidized by the Ministry of Health, Labour and Welfare.
Based on the "Guidelines for In-hospital midwife-led care: Division of Roles and Collaboration between Physiciansand Midwives" (the Former Guidelines), which was formulated in 2008, the following points were added to the
Guidelines 2018, in order to satisfy the diverse needs of pregnant, postpartum and puerperal women and theirfamilies, taking into account the environment that surrounds perinatal medical care, and the characteristics of therelevant healthcare institutions.


Selection standard for targeted persons were establishedStandards for consultation and reporting to obstetricians and neonatologists in each phase (pregnancy,
delivery, puerperium, and neonatal phases)

In-hospital midwife-led care and In-hospital midwifery clinics refer to systems where midwives undertake healthchecks and delivery assistance for themselves from the pregnancy to puerperal phases of targeted persons, incollaboration with physicians. The Guidelines 2018 strongly recommend that midwives should be engaged in all
pregnant and postpartum women, and work together with obstetricians in support for high-risk pregnant andpostpartum women.
At present, not a few healthcare institutions have systems that divide roles based on risk levels (i.e. high-risk
pregnant and postpartum women taken care of by obstetricians, and low-risk by midwives). It is required toestablish efficient healthcare service systems that address the present status and issues of perinatal care, andmatch the local needs and the functions of individual healthcare institutions. Through the Guidelines 2018, the
JNA aims at the promotion of team care and the expansion of in-hospital midwife-led care and in-hospital midwifery
clinics.

Contents of the Guidelines
Chapter

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Description

1

Necessity of in-hospital midwife-led care and in-hospital midwifery clinics

2

Present status and issues of in-hospital midwife-led care and in-hospital midwifery clinics

3

In-hospital midwife-led care and In-hospital midwifery clinics

4

Processes and management of in-hospital midwife-led care and in-hospital midwifery clinics

5

Establishment of systems required for in-hospital midwife-led care and in-hospital midwifery clinics

JNA News Release2018 October Vol.26

Present status and issues in perinatal care
Ten years have passed since the Former Guidelines were formulated in 2008. Although an increased
number of facilities have opened in-hospital midwifery clinics, the number of in-hospital midwife-led carethat have been opened remain at the same level, and are not regarded as sufficient.


Situation of pregnant, postpartum and puerperal women
While the number of live births is generally declining in Japan, the share of deliveries by women aged
35 years or older has been increasing year after year (27.5% in 2014, approx. 170% compared to 16.4%
in 2005). Among complications during pregnancy or among pregnant women, gestational diabetes takes
up a higher share than other diseases. In particular, the frequency of pregnancy-induced hypertension
syndrome rapidly increases after the mother's age exceeds 40 years. It is required to enhance care forpregnant, postpartum and puerperal women who have such risks.



Situation of healthcare professionals
The work hours are long and loads are high among obstetricians/gynecologists. In Japan, “work stylereform” is being promoted, and the long work hours of physicians is indicated as one of the problems. By
profession, the share of employees who work for more than 60 hours per week is the highest among
physicians at 41.8%. In particular, the share of full-time physicians employed by hospitals who work for
60 hours or longer per week is higher at 53.3% in Obstetrics/Gynecology than in other clinicaldepartments, calling for the promotion of team care and the division of roles with midwives.

To promote the assurance of quality of care provided at in-hospital midwife-led care and in-hospital midwifery
clinics, The Guidelines 2018 strongly recommend that midwives assigned to in-hospital midwife-led care and inhospital midwifery clinics should have practical midwifery competency that equals Level III of the Clinical Ladderof Competencies for Midwifery Practice.*

Definition of “in-hospital midwife-led care”
A system where midwives provide midwifery care to pregnant and puerperal women, respecting theirand their family’s preference, while making decisions of normality and abnormality from pregnancy
through to around first puerperal month, in a healthcare institution capable of emergency response
Definition of “in-hospital midwifery clinic”
A system where midwives divide roles with obstetricians, and undertake health checks and healthcare
guidance for pregnant and puerperal women, respecting their and their family’s desire, in a healthcare
institution capable of emergency response. This excludes where obstetricians undertake healthchecks, while midwives only undertake healthcare guidance and breastfeeding outpatient care.

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JNA News Release2018 October Vol.26
CLoCMiP® (Clinical Ladder of Competencies for Midwifery Practice)
Level III certification system and advanced midwives

The CLoCMiP® Level III certification system objectively evaluates that midwives have a specified
level of midwifery competencies, and reviews and certifies that the CLoCMiP® Level III
requirements are satisfied. This system was established by five associations related to midwifery inJapan (Japanese Nursing Association, Japan Midwives Association, Japan Academy of Midwifery,Japan Society of Midwifery Education, and Japan Institute of Midwifery Evaluation), and certificationis performed by the Japan Institute of Midwifery Evaluation. Midwives who have been certified are
titled "advanced midwives." More than 10,000 advanced midwives were certified in 2015 and 2016(certification was suspended in 2017and resumed in 2018).



CLoCMiP® consists of five levels (Novice, I, II, III and IV). The "Level III" competency certified bythis system refers to ability to perform midwifery care in an independent manner. To apply forcertification, midwives should satisfy the specified requirements (e.g. having assisted 100 or moredeliveries), and should also be approved by the facility that their education and management levels
are equivalent to Level III.

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