JNA News Release2021.March Vol.34

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

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

Survey Results on the Actual Status of Nurses’ Responses to COVID-19
Survey Outline

In September 2020, the Japanese Nursing Association (JNA)
implemented a “Survey on the Actual Status of Nurses’ Responses toCOVID-19.” The purpose of this survey was to link the frontline situationand nurses’ opinions to policy recommendations to the Governmentand support for the clinical settings, by grasping the actual status ofnurses, including the working environment during the first wave of theCOVID-19 pandemic (roughly January – May 2020). Survey contents
include the actual status of “Nursing system and workforce,” “Workingconditions, and health and safety,” “Securing nursing humanresources,” “Cooperation among government, prefectural nursing
associations, and frontlines,” “Prejudice and discrimination against
nurses,” “Activities of Certified Nurses and Certified Nurse Specialists,”and “Support expected by JNA and appropriate provision ofinformation.”
The survey results revealed a severe situation at the frontlines after the[Survey period]
Sep. 8 – 28, 2020
[Survey method]Web-based survey[Survey targets]
1) Hospital nurse administrators, 2)
Facility covered by long-term careinsurance nurse administrators, 3)
Visiting nursing station nurse
administrators, 4) Certified Nurses ininfection control/Certified Nurse
Specialists in infection control
nursing, 5) Certified Nurses otherthan 4), 6) Presidents of prefecturalnursing associations, 7) Nurses who
have returned to practice due toCOVID-19, and 8) Individual nurses[Number of respondents (responserate)]
1) 2,765 (33.5%), 2) 1,865 (15.5%),
3) 2,664 (22.1%), 4) 803 (27.4%),
5) 2,679 (13.2%), 6) 47 (100%),
7) 689 (67.3%), 8) 38,479 (-%)

spread of COVID-19. Among the actual status clarified through thesurvey, this News Release reports the actual status of “Nursing system and work style,” “Securing nursing
human resources,” “Prejudice and discrimination against nurses,” and “Activities of specialized nurses”.

Survey Result 1 ： Nursing system and work style◆Situation regarding accepting COVID-19 patients [hospitals]
Roughly 60% of responding hospitals accepted COVID-19 patients or treated/examined individuals withsuspected COVID-19, while 7.1% admitted patients with severe conditions.

◆Impact on the nursing system due to COVID-19 [hospitals]
A total of 46.0% of hospitals that accepted COVID-19 patients made changes to nurse staffing. Amonghospitals that changed nurse staffing, 46.1% closed some wards in response to COVID-19, while 37.9%
reduced nurse staffing for hospital wards/outpatient services, without closing wards. Among those hospitals
which changed nurse staffing, 47.6% answered that, “Due to the high demand for nurses at the section battlingwith COVID-19, nurses became scarcer in other sections”. This suggests that hospitals faced difficulties in
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balancing COVID-19-related care with usual healthcare services.
◆Working environment and nurse leaving job
In the survey, 15.4% of hospitals answered that “Some nurses left jobs due to COVID-19-related reasons suchas changes in the working environment and the risk of infection.” In particular, hospitals that were designatedto accept COVID-19 patients, such as designated medical institutions for infectious diseases exhibited a highrate, at 21.3% (Figure 1). Reasons stated for leaving jobs included: changes in overtime hours, change inease of taking paid leaves, changes in the working environment, such as changes in the night shift number,
hours or evenness, shortages of personal protective equipment, inadequate infection prevention measures at
the workplace, and inadequate measures for promoting understanding among staff to prevent discriminationand prejudice.

Total (n = 2,765)

15.4

Designated medical institutions for infectious diseases (n = 1,138)

84.6

21.3

Not fitting in the above category (n = 1,627)

78.7

11.3
0%

Existed

10%

88.7
20%

30%

40%

50%

60%

70%

80%

90% 100%

Did not exist

Figure 1. Existence/non-existence of nurse leaving job due to working environment changes, risk ofinfection, etc. in response to COVID-19 [hospital nurse administrators](Cross tabulation by infection disease response).

Survey Result 2： Actual status of securing nursing human resources◆Attendance situation of nurses
Regardless of the acceptance/non-acceptance of COVID-19 patients, 42.4% of hospitals, 16.9% of healthcare
facilities for the elderly requiring long-term care, 9.9% of welfare facilities for the elderly requiring long-term care,and 32.0% of vising nursing stations answered that there was a change in the work attendance of nurses.
Among institutions that indicated that there was a change in nurses’ attendance, 80-90% answered that somenurses were unable to attend work. As for the reasons for non-attendance, the most common answers were:
temporary closures of schools and nursery for children due to the Declaration of a State of Emergency by theGovernment, followed by close contact with COVID-19 patients or persons with suspected COVID-19 (Figure2).

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2.16.3
0.8

Infection of the nurse her/himself

14.5
20.6

10.2
3.1 9.5

Infection of the nurse’s family member/relative
Close contact with COVID-19 patients or persons withsuspected COVID-1924.2

35.4
27.9

55.3
76.638.9 46.5 55.3

Temporary closure of schools/nursery

22.9
7.911.6
12.2
8.5
3.1 7.4
4.5
4.8
7.1
4.2 5.3

Psychological instability, such as fear of infection
The nurse her/himself has underlying medical condition
A family member has underlying medical condition

3.9 2.1
2.9
0.9 0
0.1 0
15.8

The nurse is pregnant
A family member is pregnant
Others

24.5

33.9
34.7

23.4
020

40

60

80

100

Hospitals (n = 1,131)

Healthcare facilities for the elderly requiring long-term care (n = 127)

Welfare facilities for the elderly requiring long-term care (n = 95)

Visiting nursing stations (n = 781)

Figure 2. Reasons for non-attendance by nurses (multiple answers)[Nurse administrators of hospital/facility covered by long-term care insurance/visiting nursing station]

Survey Result 3： Actual status of prejudice and discrimination against nurses
Among all individual nurse respondents, 20.5% answered that
“Prejudice and discrimination existed.” (Figure 3)
The details of the prejudice/discrimination were as follows:

20.5%“Nurses’ families or relatives received verbal abuse fromsurrounding persons” (27.6%), “Nurses themselves received

79.5%

verbal abuse from patients” (19.8%), followed by “Nurses
themselves received verbal abuse from persons in theircommunity” (19.2%) (Figure 4).

ExistedDid not exist

Figure 3. Existence/non-existence of
prejudice/discrimination [individual nurses]

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JNA News Release2021.March Vol.34(n=7,904)

Nurses’ families or relatives received verbal abuse fromsurrounding persons

27.6%

Nurses themselves received verbal abuse from patients

19.8%

Nurses themselves received verbal abuse from persons intheir community

19.2%

Nurses themselves received verbal abuse from workcolleagues

16.5%

Nurses’ family members or relatives were suspended fromwork by employers

7.9%

Parents (nurses) were refused to enter the facilities theirchildren attend

4.4%

Nurses themselves were refused to enter shops/facilities intheir communities

4.1%

Nurses' children were refused attendance at the facilities
they attend

2.4%
33.3%

Others
0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

Figure 4. Details of discrimination and prejudice [individual nurses] (among 7,904 persons who
responded that “discrimination and prejudice existed”)

Survey Result 4：Activities of specialized nurses *1◆Activities of Certified Nurses in infection control and Certified Nurse Specialists in infection control nursing
・76.3% of respondents answered that they “played an important role” in their workplace in response toCOVID-19.
・ The specific measures taken were broadly divided into three categories. The first measure was thedevelopment of an infection control system. A wide range of specific actions were implemented, including:“Consultation responses to staff related to COVID-19” (90.3%), followed by “Development and disseminationof zoning” (89.7%), “Review and revision of manuals for infectious disease control” (88.3%), “Inventory
checks, selection, and purchases of personal protective equipment” (85.4%), and “Holding and planning ofresponse meetings in workplace” (81.4%). The second measure was responses to patients and families.
Specifically, “Guidance and education for inpatients/outpatients/facility users concerning measures for
infectious disease control” was the most common answer (56.7%), followed by “Consultation responses toinpatients/outpatients/facility users concerning COVID-19” (46.9%). The third measure was guidance andeducation for staff, including “Holding training workshops related to COVID-19 (wearing and removing
personal protective equipment and sampling methods)” (92.2%), followed by “Mental health support” (35.7%).
・Collaborations/support provided outside workplace
Among the Certified Nurses in infection control and Certified Nurse Specialists in infection control nursing
who answered that collaboration for COVID-19 was requested from facilities outside their workplace (552nurses), more than 50% answered “Collaboration/support was actually provided” to medical institutions,
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public health centers, and residential long-term care facilities.
◆ Activities of specialized nurses other than in infection control field・ For Certified Nurses, respondent specialties were “Wound, ostomy and continence nursing” (18.0%),“Palliative care” (13.2%), “Cancer chemotherapy nursing” (8.8%), “Emergency nursing” (6.2%), “Intensivecare nursing” (5.5%), while for Certified Nurse Specialists, respondent specialties were “Cancer nursing”(31.2%), “Psychiatric mental health nursing” (16.2%), “Gerontological nursing” (11.7%), and “Critical carenursing” (8.4%).
・Specifically, as for the arrangement of infection control measures, Certified Nurses in emergency nursing
implemented “Development and dissemination of zoning” (63.6%), and Certified Nurses of intensive carenursing implemented “Simulation of the occurrence of a suspected COVID-19 case” (54.3%). As forresponses to patients/families, “Direct care for COVID-19 patients” was implemented by Certified Nurses inemergency nursing (37.9%), by Certified Nurses of intensive care nursing (37.2%), and by Certified Nurse
Specialists in critical care nursing (36.0%).
・As for guidance and education for staff, 81.0% of Certified Nurse Specialists in psychiatric mental healthnursing implemented “mental health support.”*1 Specialized nurses in JapanThe credentialing system by JNA certifies specialized nurses in specific nursing fields as Certified Nurses and Certified
Nurse Specialists. Certified Nurses are those who are certified by JNA as nurses with advanced nursing skills andknowledge in specific nursing fields. As of December 2020, a total of 21,847 Certified Nurses are working throughout
the country. Among these, 2,977 nurses are working as Certified Nurses in infection control. Certified Nurse
Specialists are those who pass the credentialing examination given by JNA, and are recognized as having excellent
nursing practice competencies in specific nursing fields. As of December 2020, a total of 2,733 Certified Nurse
Specialists are working throughout the country, in 13 fields. Among these, 90 nurses are working as Certified Nurse
Specialists in infection control nursing.

JNA President, Toshiko Fukui held a press conference concerning theresults of “Survey on the Actual Status of Nurses’ Responses to COVID19” on December 22, 2020. Based on the survey results, she emphasized
the necessity of developing working environments in which nurses cancontinue to work, as well as the necessity of securing nursing humanresources for overwhelmed hospitals, and appealed for support for nurses
Dr. Toshiko Fukui, JNA President

who were infected with COVID-19.

The results of this survey were covered widely by media including TV and newspapers. In particular, the factthat 15% of all hospitals, and more than 20% of hospitals designated to accept COVID-19 patients responded
that “Some nurses left jobs due to changes in the working environment in response to COVID-19 and the riskof infection,” was introduced as a serious problem in many special feature articles and TV programs, which
attracted considerable public attention.

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