First Foreign Nurses Pass State Examination

[Mulboyne]

The Nikkei reports (Japanese) that three nurses brought to Japan under a trade programme have passed the state examination. 277 nurses from Indonesia and 59 from the Philippines took the test so the pass rate is only 1% compared with the national average of 89.5%. It's a slight improvement on last year when 82 Indonesians took exam and no-one passed. Unsuccessful candidates have 3 chances to pass the exam so. If they cannot achieve a pass grade, they will have to leave Japan. Health Minister Akira Nagatsuma announced at a press conference that the three successes were cause for celebration but there remains a strong debate about the issue. Some argue that the foreign nurses and caregivers are not being given sufficient training and opportunity to pass the exam while others have even called for a different certification programme. There is obvious concern at the suggestion that standards should be lowered in anyway and some will point to these first successes as evidence that foreign nurses can meet local requirements. However, if the aim is to attract foreign nurses to Japan, then the current pass rate will not achieve that result in anything like significant numbers. Next year will be crucial. For some of the Indonesians who also failed the test last year, 2011 will be their final chance. If the pass rate doesn't rise dramatically, then many will be going home which may discourage other nurses from taking part in the programme.

[Greji]

Next year will be crucial. For some of the Indonesians who also failed the test last year, 2011 will be their final chance. If the pass rate doesn't rise dramatically, then many will be going home which may discourage other nurses from taking part in the programme.

Naah.... They'll just get all the failures jobs as hostesses and they'll be good to go...

[Kanchou]

If the pass rate doesn't rise dramatically, then many will be going home which may discourage other nurses from taking part in the programme.

I would have thought that was the reason it was so low

[Behan]

That kind of pass rate has to be really discouraging. They need a longer study time before taking the test or should be allowed to try again. Failing 98% and then shipping them home is a big waste of everyone's time and money.

[Yokohammer]

That kind of pass rate has to be really discouraging. They need a longer study time before taking the test or should be allowed to try again. Failing 98% and then shipping them home is a big waste of everyone's time and money.

Yup.

Just another way of appearing to be open and welcoming while actually erecting almost insurmountable obstacles.

They have to take the test in Japanese, right? A subject that the locals already have a good grounding in, but is probably the main reason for the low pass rate. That just doesn't make sense if the goal is to increase health care quality and capacity in this country. Communication skills are obviously important, but those skills naturally improve the longer people are here (normally).So it would seem logical to focus on medical/care skills and give the language a little more time.

Under the circumstances I'm guessing that the 1% of the foreign nurses (three nurses) who did pass the test are a whole heckuva lot smarter than the 98% of the locals who passed. They had so much more to learn in a very limited time.

[Mulboyne]

Mainichi:

...Yuko Hirano, an associate professor at Kyushu University, points out that Japanese language support for candidates is insufficient, with the task generally being left up to hospitals or other facilities that accept them. In January this year, Indonesian Foreign Minister Marty Natalegawa told Japanese Foreign Minister Katsuya Okada during talks that he wanted the exam to be revised, saying the kanji was difficult.

From last year, the government has been developing Japanese language learning materials and translating past exams, and the fiscal 2010 budget for the program has risen to about 900 million yen -- roughly 10 times more than the figure recorded this fiscal year. However, it has only just begun to consider revising difficult vocabulary in the tests, such as the rarely used term "jokuso" (bedsores), more often described in Japanese as "tokozure."

"If a large number of people are returning home without qualifications because they failed the exam despite having acquired a degree of skills in their own countries, then the EPA system itself is likely to be brought into question," said Wako Asato, an associate professor of Kyoto University.

[Ganma]

Yup.

Just another way of appearing to be open and welcoming while actually erecting almost insurmountable obstacles.

Another cunning plan from the land of the rising bullshit.

[Behan]

A bit off subject, but I have heard stories of university, junior college, and nursing school teachers being told NOT to fail failing students. They were told to lower their standards or to give the students another chance.

[Level3]

Japan is fucking insane.

Aren't these nurses ALREADY licensed in their own countries?
Is Japanese medicine really so advanced that those licenses mean nothing?
lol
Especially since we know that the Japanese staff are probably just using the gaijin for the more entertaining duties like changing diapers and cleaning up puke.

Add in that at least in some hospitals, there is most likely resistance from the Japanese staff, thinking if these imports succeed, then Japanese nureses will lose their jobs. (Even though that's fucking insane with the nurse shortage)

Where's the incentive to J nurses to help the gaijin co-workers improve their Japanese? Nowhere.

Dammit, I want hot Filipina nurses in EVERY hospital! Especially since they already speak English, too! Tri-lingual nurses getting booted out of Japan because they don't know the kanji that nobody uses for "bedsore"?! I want my shakai hoken payments back!

[Behan]

by Level3
Dammit, I want hot Filipina nurses in EVERY hospital! Especially since they already speak English, too! Tri-lingual nurses getting booted out of Japan because they don't know the kanji that nobody uses for "bedsore"?! I want my shakai hoken payments back!

Are you obeying the hospital rules, Level3?

[Behan]

Are you obeying the hospital rules, Level3?

[FG Lurker]

Are you obeying the hospital rules, Level3?

I think I'd obey just about anything coming from a nurse who looked like that!

[Mulboyne]

As discussed on the other threads about the establishment of these EPA nurse and caregiver programmes, Japan was initially reluctant to admit overseas workers when the idea was raised by the Philippines. (The Philippines was supposed to be the first to send people under the programme but delayed passing the trade bill so it was Indonesia which ended up supplying the first wave").

However, it has become increasingly evident that these workers are a good idea. The problem is that many Japanese believe that Japan is an El Dorado for foreigners, especially those from other parts of Asia, and believe that any slight opening of the doors runs the risk of inviting hordes of the great unwashed to flood the country. It seemed quite natural to expect anyone who wanted to work in Japan to meet local standards on local terms.

Those might be legitimate concerns if you were bringing in unskilled labour but it is becoming increasingly evident that Japan does not have such obvious pulling power when it comes to skilled or experienced labour. It's one thing to set up demanding conditions, it's another to realize that they are actively working as a barrier to entry.

I don't think anyone can legitimately argue that foreign nurses and caregivers ought to be held to different standards but the Japanese exams, like most such vocational qualifications, are basically memory tests. You can train for memory tests: after all, a large part of the Japanese education system is given over to the practice. There needs to be greater priority on helping these foreign nurses and caregivers learn enough practical Japanese to be genuinely useful in their daily work but also be drilled in the right exam technique to pass the state test.

[Ganma]

However, it has become increasingly evident that these workers are a good idea. The problem is that many Japanese believe that Japan is an El Dorado for foreigners, especially those from other parts of Asia, and believe that any slight opening of the doors runs the risk of inviting hordes of the great unwashed to flood the country. It seemed quite natural to expect anyone who wanted to work in Japan to meet local standards on local terms.

These old fart politicians are living in a dream world. They don't seem to realise that the bubble is over. The irony is that the way foreign workers are treated in the end the only people Japan will be able to get will be the great unwashed. Kind of like the way Korea is now.

[Mulboyne]

Yomiuri: High language barrier for nurses

Masugi Sato, the director of Sato Hospital in Hirakata, Osaka Prefecture, was deeply disappointed by the results of this year's national nurses examination. Two foreign nurses are working at his hospital under a project tied to an economic partnership agreement (EPA), aiming to pass the nurses exam after acquiring work experience in Japan, but both failed the test. Only three, or 1.2 percent, of the non-Japanese applicants for the latest test were successful. "I was correct in worrying that the Japanese-language proficiency [of the two foreign nurses] might be insufficient," Sato said. The government announced the exam results March 26. It was the second chance to achieve qualification for the first group of foreign nurses who came to Japan under the economic partnership program. In the first opportunity in 2009, 82 foreign nurses took the exam, and all failed. This year, 254 such nurses applied, and three passed. The news was a relief for the different parties involved, but there were still 251 unsuccessful applicants. If any of the 98 Indonesian nurses in the first group fail the test next year, they will have to return home.

Japan has agreed to accept nurses and nursing caregivers from Indonesia and the Philippines under its EPAs with those nations. Currently, 840 foreign nurses and caregivers work in Japan under the program. If they pass the qualifying exam within their designated periods--three years for nurses and four years for nursing caregivers--they can continue to work in Japan beyond those periods. The government is in talks to accept nurses and caregivers from Vietnam and caregivers from Thailand. Sato Hospital hosts two Indonesians, and it is the hospital's responsibility to prepare them for the test, although there are no established methods or textbooks translated into Indonesian. It takes the Indonesian staff one week to learn a single page in a textbook written in Japanese, looking up the technical terms in dictionaries as they go.

Indonesia does not have public health insurance or nursing care insurance systems. "The test covers three kinds of insurance programs, including national health insurance," said Junichi Itaoka, 58, a volunteer who teaches Japanese to the nurses. "I taught them about it, but they don't seem to grasp the differences." One of the two Indonesians, Ida Ayu Made Juliantari, had a good education in Indonesia and four years of work experience at a hospital there before coming to Japan. But her experience often is not applicable in Japan. "In Indonesia, many patients [I dealt with] had infectious diseases or appendicitis. I rarely saw elderly people with dementia," she said in Japanese. Tomomi Yoshino, the chief nurse who is her supervisor, said: "She has only one more chance. We must do our best."

Morina Melina Ross Tambunan, 23, is a nursing care worker at Arcadia, a health care facility for the elderly in Musashi-Murayama, Tokyo. She continues to help patients eat even when it is time for her break, and is well liked among them. Chief care worker Manami Komatsu, 31, says: "She's our role model for polite language. She inspires us." Overall, however, medical institutions are seeking far fewer foreign nurses and caregivers this fiscal year. In total, they have requested 139 nurses and 189 caregivers, 60 percent fewer than the previous fiscal year. The reason is believed to be the educational burden involved in taking on foreign workers. Also, an increasing number of Japanese are seeking jobs in the nursing and caregiver fields amid the ongoing recession.

Morina plans to take the national qualification exam for nursing caregivers two years from now. The pass rate among Japanese applicants is 50 percent. Morina takes a two-hour Japanese lesson three to four times a week, but is still far from the level needed to pass. "Under the current exam, all [foreign] applicants may fail, and the program itself may fail," said facility head Tsuneto Kimura. "Even if they don't pass the same exam as Japanese applicants, they can work well."

Numerous experts and observers are calling for the program to be reviewed. Four hospital groups, including the Japan Hospital Association, submitted a set of proposals to the government last month. The proposals included:

- Foreign nurses and caregivers should be provided with sufficient Japanese-language education before coming to Japan.

- Candidates should be allowed to stay in Japan for an extended period and given more opportunities to take the exam.

A civic group named Garuda Supporters called for "special measures in consideration of the Japanese-language handicap," such as extending the time applicants have to complete the exam. The tests use terms so technical that few native Japanese speakers can read them. For example, "jokuso" is a synonym of "tokozure" (bedsore), and "goen" is a term for aspiration. "I'll ask the exam committee [that creates the questions] to consider whether difficult terms can be replaced with easy words," Health, Labor and Welfare Minister Akira Nagatsuma has said,

Still, it is unclear whether word changes would boost the number of foreigners passing the exam. To increase the number of successful applicants under the current framework, the government has begun supporting medical institutions in their efforts to help foreign employees improve their Japanese skills. Starting this fiscal year, the government is granting subsidies to medical facilities to hire Japanese-language teachers. The Japan International Corporation of Welfare Services, which acts as an intermediary between foreign nurses and Japanese medical institutions, distributed three kinds of textbooks for the exams. "Hospitals are having a harder time and are more frustrated than we expected. We want to support them," an official of the organization said.

[Bucky]

[nottu]

[omae mona]

Do you work in healthcare? Are you comfortable with nurses reading your medical record and making life-pertinent decisions in a language they don't understand? Please clarify your position regarding this.
Now, on the other hand, I agree with the poster that a whole heap of hot, Filipina nurses would do me a world of good - yes, yes, yes, kill me with that misread of the meds - but don't stop doing that thing.

nottu, my gut feeling is to agree with you (especially about the hot Filipina nurses of course). But actually an acquaintance of mine is married to the head of a hospital, who mentioned he thinks the language requirement is silly. He says he couldn't care less if his nurses (native Japanese or otherwise) are literate, as reading/writing ability has basically no impact on their ability to carry out their duties. Surprised me, but there you have it from an actual hospital administrator. Still, personally I don't think I would feel very comfortable.

[Yokohammer]

Do you work in healthcare? Are you comfortable with nurses reading your medical record and making life-pertinent decisions in a language they don't understand? Please clarify your position regarding this.

You really ought to read carefully and at least make an effort to understand before attacking.

The part of my post (from 5 months ago) you obviously missed, or chose to ignore, is:

So it would seem logical to focus on medical/care skills and give the language a little more time.

The language skills will be acquired eventually. Until that time the foreign healthcare folk can be useful as assistants or apprentices, or however they can put their skills to work without endangering patients. How long do you think it'd take? The problem is that the ostensibly open but in reality booby-trapped Japanese system doesn't give then enough time. Its primary purpose is to reduce pressure on the government for not being open to foreign workers, while actually making it almost impossible for foreign workers to get a foot in the door.

That's my position. I thought I had already made it clear.

[nottu]

[Coligny]

Do you work in healthcare? Are you comfortable with nurses reading your medical record and making life-pertinent decisions in a language they don't understand? Please clarify your position regarding this.
Now, on the other hand, I agree with the poster that a whole heap of hot, Filipina nurses would do me a world of good - yes, yes, yes, kill me with that misread of the meds - but don't stop doing that thing.

Nurse don't make decisions... They carry on orders or repetitve tasks. If at first they can do the more basic tasks and free litterate nurse to do more complex one it's already a big fracking win.

Usually, smart people don't do if they are unsure. So a -smart- nurse will not be a threat, only if the jnurse act like deepshit bad stuff might happen...

Unfortunately, the reckless behaviour of "don t know but do anyway as they are the god choosen people" is quite common among japanese... So it's going to be easy to use fureign nurses as scapegoats...

[nottu]

[Yokohammer]

What do you regard as an "attack" in those simple questions? You know me well enough by now - if I was "attacking" it would be up front - I'm really just a kind and thankful teddy bear at heart - just ask those Filipina nurses at those outpatient clinics in Pontocho.

That's "attack" as in "attack a straw man." I got the impression that you were misrepresenting my position for the sake of argument, for the following reasons:

1) Nurses don't make life-pertinent decisions. Doctors do.
In an emergency they might apply CPR and even use an AED machine (heck, so would I ... they teach you how in driving school, fer chrissake).
There are a gazillion non-life-threatening but vital tasks newbie health workers can take care of, thus lightening the load on veteran nurses who are overworked and prone to making mistakes as it is. I honestly thought this was obvious, and that your response was distorting reality (in much the same way that the Japanese government does) for the sake of argument.

2) The whole point of my argument was, as described in my response to what I perceived as your straw-man attack, that the Japanese government habitually takes superficial measures to reduce pressure on themselves while going out of their way to not make any real or meaningful changes. I'm prepared to bet the same sort of thing is going to happen with the Hague convention treaty on child custody issue. If they were sincere about allowing foreign health workers into the country, or had any sense of urgency, they'd allow more time for language proficiency. That's all it takes.

[Mulboyne]

A family member has spent a lot of time recently in British hospitals. He said that, aside from his doctors, he only encountered one British member of staff. He has some mild communication problems with the accents but received a standard of care which would have been impossible if they didn't fill out the ranks of the health service.

That's the debate Japan needs to have. The original plan to allow a quota of Philippine and Indonesian nationals over was part of negotiated trade agreements. The Japan side saw it in the same terms as old 80s treaties which allowed limited market access but no guarantee of any take-up. From this perspective, there was never a reason to think that overseas nurses & caregivers should do anything other than pass the same tests given to their Japanese counterparts.

This has now changed. There's a growing realization that Japan may need qualified staff from overseas and a system which turns away 99% of applicants isn't going to achieve that goal. The question now is what kind of trade-off is acceptable. It's also worth emphasizing we are talking about caregivers as well as nurses. That's a low-paid, fairly low-status job in Japan and the staff shortage is likely become acute.

[dimwit]

I guess being involved in the training of nurses over here I best wade into this debate. Nottu, I can tell you right now the quality of Japanese nurses is scrapping the bottom of the barrel. While they may have the requisit language skills, they seem to have sacrificed any higher cognitive functioning in the deal. While I have never encountered any of the foreign nurses, I would suppose that these are some of the best and most ambitious students you are likely to find given the screening process they have to go through just to enter the program, and are unlikely to, for example, to mistake distilled water for saline solution, or to be administer uncorrect dosages because they lack basic thinking skills. The reality is that there is such a shortage of nurses that they are accepting anyone/ thing with a heartbeat into the the nursing school program. When I started out I would guess that I would be scared to be treated by maybe 2-5% of my students. Nowadays, I would put the figure at about 25%.

[nottu]

[Mulboyne]

...The question I asked is what role does language deficiency in nursing, and the provider side in general, play in medical errors...

It's a fair issue to look at. However, I don't think anyone here has argued that adequate communication skills are inessential. Surely that's taken for granted. The question is whether the current entrance requirements are the best way to assess them. There are plenty of medical professionals in Japan who believe they aren't.

If it were simply a a free trade issue then there would be no particular incentive to raise the success rate over 1%. Since it's becoming clear that Japan faces a general recruitment problem the solutions will need to address how to get higher quality staff domestically through better training and working conditions or else how to incorporate overseas-qualified staff into the workforce. Some combination of both policies would seem to be the best option but the second would be faster to implement.

[nottu]

[Mulboyne]

...With a study on Japanese as a second language health care providers and the statistically insignificant effect on medical errors, the rest of the political persuasion should be a slam dunk.

Who are these Japanese as a second language health care providers you're proposing to study?

[nottu]