JNA News Release2020.December Vol.32

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/

1. JNA’s latest efforts regarding Coronavirus disease (COVID -19)
JNA News Release Vol. 31 (https://www.nurse.or.jp/jna/english/news/pdf/2020nr_31.pdf) described JNA’s
efforts in response to COVID-19 during the first wave through to June, centering around the Declaration of aState of Emergency issued by the Government on April 7.
This volume provides updates on our subsequent initiatives in preparation for the second and third waves.

1) Development of support tools for infection prevention and control at small and medium-sized
hospitals and elderly facilities
JNA is taking initiatives to thoroughly implement measures for infection prevention and control acrossorganizations. As one of these initiatives, we developed support tools for infection prevention and control at
small and medium-sized hospitals and elderly facilities.
The purpose of this tool is to facilitate the dispatch of certified nurses in infection control and nursing
administrators from prefectural nursing associations to small and medium-sized hospitals and elderly facilities.
This tool was developed because the consultation service on infection control set up by JNA received anumber of inquiries from small-sized hospitals and elderly facilities during the first wave. This clarified thatfacilities without infection control specialists had problems in COVID-19 control.
To establish an infection prevention and control system, this support tool is divided into four periods; a"localized epidemic period" in which there are no COVID-19 infected persons in the hospital or facility, an "outbreak of infected person period" in which COVID-19 infected persons occur and/or close contact in thehospital or facility; a "spread of infection period" in which the number of COVID-19 infected persons in thehospital or facility is high and increasing; and a "convergence and preparedness for recurrence period" in which
the number of COVID-19 infected persons in the hospital or facility is decreasing and preparations are being
made for reconstruction. It also provides check items lists and key points for checking in three aspects;
management, infection control, and collaboration.

2) Conducting a survey of nurses response to COVID-19
JNA conducted a survey on response of nurses to COVID-19.
The purpose of this survey was to identify the actual working environment of nurses in various fields, tomake policy proposals to the Japanese government, provide support for clinical settings, and to gather
information to explore desirable nursing system for emergency response.
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In response to COVID-19, there have been situations that the nursing community had never experienced inrecent years, such as shortage of hygiene and other materials, deteriorated working environment, anddiscrimination and prejudice. It is important to establish a system for nurses to work safely and securely inhealthcare settings.
The survey results will be presented in JNA News Release soon.

JNA newly post on COVID-19 updates on the JNA English Website
The pages share our initiatives regarding COVID-19 and key activities by nurses in Japan.
https://www.nurse.or.jp/jna/english/

2. Nursing status survey at hospitals and medical clinics with beds in 2019
~ Actual status of and measures against violence and harassment ~In September 2019, JNA conducted facility survey and employee survey among hospitals and medical clinics
with beds nationwide. The purposes of this survey were 1) to understand the actual working environment ofnurses, including supply-demand trends such as securing and retention of nurses, and responses towardnursing related systemic reform related to nursing; 2) to examine the past nursing labor policies, and 3) to obtainmaterials and data for preparing proposals to establish workplaces and sustainable work style that will enable
nurses to continue working safely and securely in a future.
The results of this survey clarified that factors related to the sustainable work styles of individual nurses werenight shift burden, overtime work, self-discretion such as task orders and work pace, as well as
violence/harassment from employees, patients and families.
In recent years, various types of harassment including abusive language from patients and families to nurses
and other healthcare workers have been considered a problem in Japan. This threats the safety and securityof healthcare workers in workplaces. JNA considers harassment as an important issue affecting the retentionof nurses, and has been engaged in activities such as making requests to the Government and holding seminars
at healthcare facilities in order to promote organizational measures against harassment.
In view of this background, this news release focuses on violence and harassment among thesurvey results, and describes the actual status of violence/harassment and measures against harassment at
hospitals

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JNA News Release2020.December Vol.32

Overview of the survey<For Hospitals>[Survey on hospitals]
Target: All 8,300 hospitals nationwide (response requested to the nursing director)
Period: September 2 to October 11, 2019
Method: Sent and recovered self-reporting questionnaires by mail
Effective responses: 3,385 (effective recovery rate: 40.8%)[Survey on employees]
Target: Nurses working at all 8,300 hospitals nationwide (≤ 10 per site)
Period: Same as the above
Method: Online
Effective responses: 15,026 (effective recovery rate: 18.1%)<For medical clinics with beds>[Survey on clinics]
Target: 2,500 sites randomly extracted from medical clinics with beds nationwide
Period: September 2 to October 11, 2019
Method: Sent and recovered self-reporting questionnaires by mail
Effective responses: 320 (effective recovery rate: 12.8%)[Survey on employees]
Target: Nurses working at the 320 clinics that cooperated in the survey above (≤ 5 per site)
Period: Same as the above
Method: Online
Effective responses: 528 (effective recovery rate: 4.2%)

Q What are "medical clinics with beds"?
Medical clinics with beds are those that have a facility to hospitalize up to 19 patients.
Source: Medical Care Act

1)

Actual status of violence/harassment from patients, families, and employees at workplace(1) Actual status of violence and harassment at hospitals
In the employee survey, the most common type of harassment in the workplace over the past year
was "Mental abuse" (24.9%), followed by "Physical abuse" (21.7%) and "Segregation from personal
relationships" (14.6%). Mental abuse was the most frequently received from employees at the same
workplace (52.3%), followed by that from patients (44.4%). In the meantime, physical abuse was themost frequently received from patients (93.4%) (See fugure1).

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2020.December Vol.32

Actual status of violence and harassment at medical clinics with beds
In the employee survey, the most common type of harassment in the workplace was “Mental abuse”(13.8%), followed by “Unwanted sexual behavior” (11.0%) and “Segregation from personal
relationships” (9.7%). Mental abuse was the most frequently received from employees at the same
workplace (60.3%), more than double the mental abuse received from patients (24.7%). In themeantime, unwanted sexual behavior was the most frequently received from patients (55.2%) (Seefigure 2).

* The data shows the results of non-managerial staff.

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JNA News Release2020.December Vol.32

2) Measures against violence and harassment
Hospitals and medical clinics with beds were questioned about the status of organizational measures(e.g. establishment of work rules, implementation of employee training, consultation service, prompt andappropriate responsive measures) against violence/harassment from patients/families and among
employees. In Japan, harassment prevention measures in the workplace have been mandated for theemployer since June 1, 2020 (see TOPICS, p. 6, for details).

(1) Measures taken by hospitals
The rate of organizational measures taken against violence and harassment from patients and families
to employees and against violence and harassment among employees was approx. 70% for each item.
①

Measures concerning patients and families
Among measures against violence and harassment from patients and families, the highest rate was
77.5% for “Consultation service on violence and harassment”, followed by 74.8% for“Implementation of prompt and appropriate responsive measures against violence and harassment”
and 72.2% for “Clarification of basic policy on violence and harassment as a hospital” (See Table1).

Table 1. Measures against violence and harassment from patients and families (n=3,385)
Implemented

In preparation

No plan to
examineNo response/ Unknown

Clarification of basic policy on violence andharassment as a hospital

2,443

565

284

93

72.2

16.7

8.4

2.7

Stipulation of disciplinary policy and action in case ofconfirmed violence or harassment in the work rules

2,216

660

366

143

65.5

19.5

10.8

4.2

Dissemination and enlightenment among employees
about basic policy, disciplinary policy and action on
violence and harassment

2,344

619

281

141

69.2

18.3

8.3

4.2

2,624

445

191

125

77.5

13.1

5.6

3.7

Implementation of prompt and appropriate
responsive measures against violence andharassment

2,533

513

171

168

74.8

15.2

5.1

5.0

Efforts to improve the workplace environment toeliminate factors causing violence and harassment

2,178

757

268

182

64.3

22.4

7.9

5.4

Consultation service on violence and harassment

Upper row: number of sites; Lower row: percentage②

Measures concerning employees
Among measures against violence and harassment among employees, the highest rate was 78.6%
for "Consultation service on violence and harassment", followed by 74.0% for "Implementation ofprompt and appropriate responsive measures against violence and harassment" and 73.1% for"Clarification of basic policy on violence and harassment as a hospital" (See Table2).

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JNA News Release2020.December Vol.32

Table 2. Measures against violence and harassment among employees (n=3,385)
Implemented

In
preparation

Clarification of basic policy on violence andharassment as a hospital

2,476

521

299

89

73.1

15.4

8.8

2.6

Stipulation of disciplinary policy and action in case ofconfirmed violence or harassment in the work rules

2351

581

322

131

69.5

17.2

9.5

3.9

Dissemination and enlightenment among employees
about basic policy, disciplinary policy and action on
violence and harassment

2,379

596

281

129

70.3

17.6

8.3

3.8

2,659

419

196

111

78.6

12.4

5.8

3.3

Implementation of prompt and appropriate
responsive measures against violence andharassment

2,504

529

195

157

74.0

15.6

5.8

4.6

Efforts to improve the workplace environment toeliminate factors causing violence and harassment

2,225

725

270

165

65.7

21.4

8.0

4.9

Consultation service on violence and harassment

No plan to
examineNo response/ Unknown

Upper row: number of sites; Lower row: percentage(2)

Measures taken at medical clinics with beds
The rate of organizational measures taken at medical clinics with beds against violence andharassment from patients and families to employees and against violence and harassment among
employees was lower than 40% for each item, indicating the necessity for establishing suchmeasures.
①

Measures against violence and harassment from patients and families
The rate of medical clinics with beds reporting that each type of action was taken did not reach
40%. The percentage of "In preparation" was about 20 to 30%, and "No plan to examine" alsoreached 20 to 30% (See Table3).

②

Measures against violence and harassment among employees
The rate of medical clinics with beds that reported "Action is taken" was the highest for"Implementation of prompt and appropriate responsive measures against violence andharassment" at 41.3% (132 sites). The rate did not reach 40% for the other types of measuresagainst violence and harassment among employees (See Table4).

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JNA News Release2020.December Vol.32

Table 3. Measures against violence and harassment from patients and families (n=320)

Clarification of basic policy on violence andharassment as a hospital
Stipulation of disciplinary policy and action in case ofconfirmed violence or harassment in the work rules
Dissemination and enlightenment among employees
about basic policy, disciplinary policy and action on
violence and harassment
Consultation service on violence and harassment
Implementation of prompt and appropriate
responsive measures against violence andharassment
Efforts to improve the workplace environment toeliminate factors causing violence and harassment

Implemented

In
preparation

No plan to
examineNo response/ Unknown

94

80

104

42

29.4

25.0

32.5

13.1

85

91

93

51

26.6

28.4

29.1

15.9

113

75

78

54

35.3

23.4

24.4

16.9

117

65

100

38

36.6

20.3

31.3

11.9

100

78

95

47

31.3

24.4

29.7

14.7

124

66

82

48

38.8

20.6

25.6

15.0

69
21.6
120
37.5
88

In
preparation
93
29.1
72
22.5
93

No plan to
examine
105
32.8
81
25.3
87

No response/ Unknown
53
16.6
47
14.7
52

27.5

29.1

27.2

16.3

99
30.9
132

73
22.8
63

99
30.9
84

49
15.3
41

41.3

19.7

26.3

12.8

103
32.2

82
25.6

88
27.5

47
14.7

Upper row: number of sites; Lower row: percentage

Table 4. Measures against violence and harassment among employees (n=320)
Implemented
Clarification of basic policy on violence andharassment as a hospital
Stipulation of disciplinary policy and action in case ofconfirmed violence or harassment in the work rules
Dissemination and enlightenment among employees
about basic policy, disciplinary policy and action on
violence and harassment
Consultation service on violence and harassment
Implementation of prompt and appropriate
responsive measures against violence andharassment
Efforts to improve the workplace environment toeliminate factors causing violence and harassment
Upper row: number of sites; Lower row: percentage

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JNA News Release2020.December Vol.32

NEWS TOPICS
Legislation that mandates measures against workplace harassment
In Japan, Employers are mandated to take preventive measures against sexual harassment and maternity
harassment. In addition, with respect to power harassment, the "Law Partially Revising the Act on the
Promotion of Female Participation and Career Advancement in the Workplace" was revised in May 2019 to
mandate employers to take preventive measures against power harassment in the workplace. This act was
enforced in June 2020. However, Small and Medium Enterprises; SME employers* are mandated to takesuch measures starting April 1, 2022, until which time they are obliged to make the relevant efforts.
On the other hand, there is no law for measures to prevent harassment from customers to employees.
* In the case of medical/welfare services, the term refers to (1) employers whose capital or total investment
is 50 million yen or less, or (2) employers whose number of full-time employees is 100 or less.

<Measures to be taken by the employer management>
The following measures must be taken by the employer (mandatory): Clarification, dissemination and enlightenment of the policy of the employer
 Establishment of systems necessary to provide consultation service including the handling ofcomplaints and respond appropriately
 Prompt and appropriate responsive measures against harassment at workplace Any other measures to be taken such as privacy protection, prohibition of disadvantageous
treatment, etc.
* In addition, measures against harassment related to pregnancy, childbirth, child care leave andothers at workplace include those for eliminating the causes and background factors.
Source: Ministry of Health, Labour and Welfare. To Prevent Harassment at Workplace (Sexual

Harassment / Harassment Related to Pregnancy, Childbirth, Child Care Leave and others / Power
Harassment).
https://www.mhlw.go.jp/stf/seisakunitsuite/bunya/koyou_roudou/koyoukintou/seisaku06/index.ht
ml (in Japanese) (accessed on October 26, 2020)8|