Exploring the Competencies of Japanese Expert Nurse Practitioners: A Thematic Analysis

Abstract

Nurse practitioners (NPs) provide medical care equivalent to that of physicians and facilitate access to healthcare. Although Japan’s first NP graduated in 2010, how Japanese expert NPs work effectively in clinical contexts is yet to be investigated. We aimed to identify the competencies that make expert NPs in Japan effective. Twelve Japanese expert NPs were purposely selected. The average age of the participants was 44.8 years, average NP experience was 7.5 years, and eight participants were women. Semi-structured interviews were conducted online from March to May 2021. Interviews were recorded, transcribed verbatim, and analyzed using thematic analysis. Thematic analysis revealed five themes: working in physicians’ contexts, interprofessional collaboration, involvement in nurses’ work, contribution to healthcare, and personal qualities for effective working. Japanese expert NPs can function effectively in clinical settings by flexibly and humbly collaborating with other medical professionals who have autonomous positions. They can improve the quality of healthcare by proposing practical solutions to problems faced by patients and medical organizations. These explored competencies can be applied to other aging and more complex societal contexts, and in updating the required competencies of Japanese NPs.

Applying Advanced Practice Nurses in Rural Japan: A Mixed-Methods Perspective

“…This finding aligns with existing literature emphasizing the burden of acute conditions in rural areas, where limited access to specialized care and delayed presentations are standard [17,18]. The significant presence of conditions like bacterial pneumonia, dehydration, and acute respiratory failure in our study highlights the crucial roles APNs can play in improving patient outcomes, which can be achieved through early detection, management, and timely referral to specialized care for these conditions [19,20].…”

Perspectives on Collaboration between Physicians and Nurse Practitioners in Japan: A Cross-Sectional Study

“…On the other hand, however, it is puzzling that NPs are less likely than physicians to believe that they themselves are contributing to improving the quality of medical care. Japan has the virtue of “modesty” and Japanese NPs believe in modesty [ 16 ]. This is a phenomenon that is difficult for Westerners to understand, often likened to a “bamboo ceiling”, and understood as a negative in career development in the international community, especially in the West.…”

Reconsidering the Role of Nurse Practitioners in Japan: What Direction Should Japanese Nurse Practitioners Aim for?

“…This necessitates promoting effective and efficient team-based medical care, including task shifting and sharing among various professions [1]. In nursing, roles are expected to be expanded through specific actions and task shifting/sharing, and multiple qualification systems have emerged [2]. In 2008, in response to social issues, such as regional disparities in medical care provision, three-minute outpatient consultations, and the shuffling of emergency patients, Japan began training nurse practitioners as one measure to provide fair, effective, and timely medical care to those in need [2].…”

“…In nursing, roles are expected to be expanded through specific actions and task shifting/sharing, and multiple qualification systems have emerged [2]. In 2008, in response to social issues, such as regional disparities in medical care provision, three-minute outpatient consultations, and the shuffling of emergency patients, Japan began training nurse practitioners as one measure to provide fair, effective, and timely medical care to those in need [2]. This was followed by the establishment in 2014 of a training system for nurses involved in specific actions, which started in 2015 [2].…”

“…Nurse practitioners have a foundation as nurses and should establish a new role or take on part of the doctor's work based on this foundation. They can view patients from medical and nursing perspectives, have a broad view of patient information, and thus have a high capacity for coordination [2]. As such, they are expected to act as "key persons in team medicine" and "gatekeepers of community medicine."…”