Challenges of Care in the Era of Super-Aging Society: Focusing on Changes in Certification and Discretionary Authority of Nurses in Japan

Japan is simultaneously facing a super-aging society and a declining birthrate, leading to a labor shortage and lower tax revenues. Increasing healthcare costs and the increasing burden of medical and nursing care are also becoming an issue. In response to these issues, long-term care insurance has been introduced, and a shift from institutional care to home care has been made to curb healthcare costs. At the same time, the government is expanding the autonomy of existing healthcare professionals and creating new certifications. We will discuss the transition in response to these social issues in Japan, particularly for nurses, from the 1990s to the present, clarifying the process from a neo-Weberian perspective. Nurses in Japan were created in 1948, after WWII, as a national certification with a modern, Western-style education. Since then, nurses have moved in the direction of enhancing both quality and quantity by increasing professionalism and securing the number to respond to social changes such as the advancement of medical care and the aging of society. Since 1995, certified nurses and specialized nurses have been established by the Japan Nurses Association, and since 2015, the specific nurses, who are similar to nurse practitioners, has been created. On the other hand, in addition to nationally licensed nurses, there are also licensed practical nurses appointed by prefectural governors, and unlicensed nursing assistants and attendants. In addition, home helpers and nursing support workers with certain qualifications have also been providing nursing care. In this situation, several problems can be pointed out in terms of the boundaries between the various qualifications related to nursing care and the collaboration between nursing and other professions (e.g., physicians, pharmacists, clinical technicians, etc.). We hope that this conference will provide an opportunity to discuss these issues and compare them with those in other countries.