Oita University of Nursing and Health Sciences

Development of the First Nurse Practitioner Graduate Program in Japan

Because of the coming aging society and a shortage of medical doctors in local areas, our faculty believed that it was necessary to stress practice-oriented education at the graduate level in order to establish a healthcare system that can provide patients in Japan with safe and timely opportunities to maintain their health. Therefore, the Graduate School of our university established a course to educate and train nurse practitioners (NPs) in its Master’s program in 2008. This was the first such course in Japan and the March 2011 graduates of the Master’s program at our school became Japan’s first nurse practitioners to be fully trained in specified medical practice. There are two NP majors in the fields of primary care with separate curricula in our Graduate School: the Geriatrics major, established in 2008, and the Pediatrics major, established in 2009. The objectives of the new majors are to train highly qualified nurse practitioners with higher levels of expertise and competence in practice who can contribute to clinical care in medical long-term care facilities in remote areas and work autonomously in collaboration with physicians.

 

Our faculty believes that nurse practitioners will be indispensable in medical practice in Japan in the future as they use their knowledge and skills to organize and promote effective cooperation among a variety of medical staff members resulting in an improvement of healthcare services. It is our expectation that nurses who obtain higher levels of knowledge and skills through systematic education and training in Master’s degree programs will be able to enhance patient quality of life as nurse practitioners by participating directly in medical practice, which is typically restricted to medical doctors. We believe that other institutions will follow our lead and nurse practitioner education at the graduate level will be a future trend in Japanese nursing education.

 

In order to establish a nurse practitioner graduate level program, the faculty of our graduate school organized the Nurse Practitioner Development Project in 2005 in order to develop educational curricula for new NP majors in its Master’s program. Since 2005 the NP Project has held a series of biannual meetings in Oita with faculty from institutions such as the Case Western Reserve University Frances Payne Bolton School of Nursing, the Pace University Lienhard School of Nursing, the Seoul National University College of Nursing, and the Korea University College of Nursing in order to develop an original NP education and training program for the development of nurse practitioners in Japan. Through the information and advice received during these biannual meetings and through numerous visits our faculty made to nurse practitioner graduate programs in foreign countries, our NP Project developed education and training curricula in the fields of primary care for our new Geriatrics and Pediatrics NP majors.

 

The curricula for the two-year Nurse Practitioner Master’s courses that we developed mainly comprise basic medical subjects, such as physical assessment, clinical pharmacology and pathophysiology, with the aim of developing students’ ability to perform safe and reliable medical interferences. The course curricula for the Geriatrics and Pediatrics majors are constructed organically with lectures, exercises and clinical practicums instructed and guided by our faculty, with strong support from medical doctors as part-time teachers and instructors. The focus of the two curricula in our NP majors is the treatment of patients with chronic diseases.

 

The Nurse Practitioner Development Project has worked with local hospitals in Oita since November 2008 in order to realize the institutionalization of the nurse practitioner in Japan. Along with these local hospitals we have proposed several times to the Japanese Government that a special zone for structural reform be set up, which would enable Japanese nurse practitioners to provide clinical care for patients with chronic diseases such as diabetes and hypertension autonomously under the comprehensive instruction of medical doctors.

 

These proposals, the initiation of our nurse practitioner educational program, and the subsequent establishment of nurse practitioner educational programs at other institutions have stimulated the government to implement a new administrative movement for the expansion of the scope of practice of nurses in Japan. Since August 2009, the Ministry of Health, Labour and Welfare has actively engaged in discussions on how to effectively organize and facilitate cooperation among various medical workers. In March 2010, the Ministry also suggested that the temporary new title “designated nurse” be adopted and it has proposed that nurses with this title be allowed to perform some specific medical practices under the comprehensive instruction of medical doctors. At present the Ministry is discussing the scope of this designated medical practice and the prerequisite conditions and requirements for training and educating nurses with this new title.

 

Even with these new developments, it is expected that it will take time to establish an NP system in Japan in which nurse practitioners are able to perform designated medical practice autonomously in cooperation with medical doctors. However, the proposal of the title of “designated nurse” is a significant development in the recognition and legalization of nurse practitioners in Japan, and once the issues of scope of practice and conditions and requirements of education and training have been determined it is expected that this new position will be institutionalized with a national occupational license in the near future.

 

In order to support and enhance the current movement towards the establishment of a nurse practitioner system in Japan, the Japanese Nurse Practitioner Association was established in 2008 with our Nurse Practitioner Development Project as its administrative bureau. The aims of the association are to standardize educational programs for nurse practitioners, to guarantee the quality of their performance, and to work for social understanding of the title of “NP” in Japan.

 

 

The Nurse Practitioner (NP) Project

 

On June 18, 2014, seven years after our university established the first NP graduate course in our country, the Act on Public Health Nurses, Midwives and Nurses (Nursing Act) was revised and a Training System for Nurses to Perform Specific Medical Interventions (the training system) was established by the Japanese Diet. The Nursing Act has been revised several times since its passage in 1948, but this was the first revision concerning nursing practice itself. It resulted in expansion of the scope of nurse interventions that allows the provision of timely care to people on site. Nurses can now offer such services as the adjustment of medicine and the performance of infusions to treat dehydration under the comprehensive instructions of a physician. 

 

This revision results from the serious problem of our aging society in Japan. In particular, the first generation of baby boomers will all be latter-stage elderly by 2025. An elderly society also has a high mortality rate, so in the future significant demands will be made on our medical, health and welfare system by the rapidly increasing number of end-of-life care cases, dementia cases, elderly households and elderly living alone, and by the expected soaring medical and healthcare expenses these problems will generate. An expansion of the scope of nursing practice and a steady increase in the number of nurses able to provide proper primary care in local areas and day care centers are valid steps to address these issues.

 

Our NP Project received a variety of assistance and advice from abroad as we worked to establish our NP Master’s course. Since 2005, we have held a series of biannual international meetings in Oita with faculty from Case Western Reserve University, Pace University, and Seoul National University, and we have dispatched our faculty members to overseas institutions to develop our NP Program. After starting our NP course in 2008, we continued to work towards the establishment of the role of the nurse practitioner in Japan, and we actively participated in the National government’s model project and was able to provide actual evidence on the effectiveness of nurse practitioner activities. We therefore believe that our NP education program was a turning point for the nursing and medical fields in Japan.

 

At present, the Japanese Organization of Nurse Practitioner Faculties (JONPF), which is currently comprised of seven universities with NP Master’s courses, is working to realize the future role of the NP in Japan and is establishing standard curricula for NP education in the two fields of primary care and critical care. JONPF was established as an incorporated association after the new training system was enacted in 2014. The president of JONPF is our university’s former president, the vice-president is our current president, and our university is in charge of the secretariat. The goal of our NP Project and of JONPF is to further expand and promote NP activities in Japan, and to continue educating and training nurse practitioners who can cooperate and collaborate with physicians. JONPF also conducts NP certification every March when five third-party evaluators from Japan and abroad conduct a strict examination that ensures quality of practice. As of March, 2014, nearly 150 nurses have passed the examination and are playing an active role in healthcare in Japan. 

 

NP Master’s course graduates in Japan have acquired medical knowledge and have been trained to possess improved clinical skills, reasoning ability and judgment. They are striving to provide high-quality medical services in site through collaboration and cooperation with physicians. As an institution entrusted with NP education in Japan, we believe it is essential for us to conduct extensive research on the activities of our graduates in order to produce evidence of their effectiveness in the workplace. 

 

The two papers referenced below were published in the International Nursing Review and are our most recent research efforts about our NP Master’s course and our graduates’ activities:

 

H. Fukuda et al. (2014). The first nurse practitioner graduate programme in Japan. International Nursing Review.

 

M. Ono et al (2014). Japanese nurse practitioner practice and outcomes in a nursing home. International Nursing Review.

 
updated: 01/10/2016