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  • Asahi: Foreign nursing trainees face unfair hurdles

    Posted by Dr. ARUDOU, Debito on May 28th, 2009

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    Hi Blog.  Here’s a good article (with excellent commentary from the place I first read it, at Mutantfrog; link here) on the hurdles even people that qualify as “skilled labor”.  Japan doesn’t want unskilled (tanjun roudousha), yet imported over a million factory workers over the past two decades (and is now even bribing them to go home).  Now here it is making it more difficult for people who have a skill to qualify to stay.  

    What does the GOJ want?  Easy.  Revolving-door cheap foreign labor, which won’t stay and get expensive or start demanding its own rights.  Unfortunately, that’s not how immigration works, even though with its aging society, immigration is what Japan needs.  We’ve said this umpteen times before, but lemme just repeat it for the noobs, sorry.  What the GOJ wants and what it needs are working against each other.  Its unforgiving and inflexible policies such as these that are hurting Japan’s future.  Arudou Debito in Sapporo


    POINT OF VIEW/ Atsushi Takahara: Foreign nursing trainees face unfair hurdles

    THE ASAHI SHIMBUN 2009/5/13

    Courtesy of Mutantfrog, with excellent commentary

    At hospitals and nursing homes for the elderly across the nation, 208 Indonesians have commenced work. They are trainees who came to Japan hoping to become nurses and certified care workers under the economic partnership agreement (EPA) signed between Japan and Indonesia. Having finished a six-month Japanese-language study program, they started working in January and February. All of them are qualified to work as nurses in their home country and many of them have a lot of nursing experience. But most of those I met expressed anxiety and frustration.

    This is because of the system that requires them to pass Japanese state exams within specified periods. If they fail, they must return to their home country. Would-be nurses have three chances to sit for the exams in three years of their stay. Conditions are tougher for aspiring care workers. Since foreign trainees are required to have actual working experience in Japan for at least three years before they can take the exam, they only have a single chance to pass in four years.

    The language barrier weighs heavily on them. In particular, learning kanji characters is very difficult. For example, they must struggle with such technical terms as jokuso (bedsores) and senkotsubu (sacral region) that are difficult to read and understand, even for the average Japanese. Holding a Japanese-Indonesian dictionary, one trainee lamented: “I feel as though my head is about to burst.”

    Hospitals and nursing homes that accepted the trainees hoping they can serve as a new source of labor are also supporting them on a trial-and-error basis. Some of the facilities have the trainees write diaries in Japanese and correct them while others encourage them to speak in Japanese about what they did and saw during the day at the end of their shift. One hospital required the trainees to study hard for two hours every day using mock state exams and kanji tests. It reminded me of a cram school.

    All the Japanese government did to help was to provide them with six-month Japanese-language training. After that, it practically left almost everything, including the contents of on-the-job training and preparations for state exams, to the hospitals and nursing homes that accepted them. Accepting facilities are disappointed by the wide gap between their expectations and the reality of using trainees to cover a labor shortage.

    Under the comprehensive EPA, Japan accepts the trainees from Indonesia in exchange for the economic benefits, including abolition or reduction of tariffs on its exports of cars and electronic equipment. The government stands by the traditional policy of refusing to accept unskilled foreign laborers. Therefore, the government’s stance is that the acceptance of nursing trainees this time is a form of personnel exchange and is not meant as a measure to address a labor shortage. The government’s cold attitude seems to be a reflection of such a position.

    In Indonesia, showing anger in public is considered disgraceful. When I studied in Indonesia, I came in contact with such Indonesian national traits. I had the impression that while Indonesians tend to be kind and amicable, even when they are inwardly unhappy, many of them keep their discontent bottled up.

    Having sent young members of their workforce to Japan, the people of Indonesia are closely watching whether they can adequately reap the benefits of their investment. If the trainees go home feeling angry with Japan’s “cold policy” and such a reputation spreads, it could cause a deterioration in Indonesian public sentiment toward Japan.

    The United States and countries in Europe and the Middle East are adopting policies to complement their shortage of labor in nursing and nursing care with workers from Asian countries. They are providing such incentives as granting them permanent resident status in a bid to secure competent personnel.

    An operator of a facility I met during a reporting assignment told me: “Unless Japan accepts foreign workers, the nation’s welfare system is destined to eventually fail.” The fact is that Japan is lagging far behind other countries in this regard.

    The first thing Japan should do to encourage highly motivated, competent trainees to stay on is to lower the hurdles that stand in their way and make their stay more comfortable.

    Specifically, I urge the government to extend the period of stay and give them more chances to pass the required exams that would allow them to qualify as nurses and care workers. It should also embark on providing more detailed care and take advantage of the opportunity as a test case to advance harmonious coexistence with foreign workers.

    * * *

    The author is a staff writer at the News Center of The Asahi Shimbun Fukuoka Office.(IHT/Asahi: May 13,2009)


    23 Responses to “Asahi: Foreign nursing trainees face unfair hurdles”

    1. Peter Says:

      When has immigration ever hurt a country? Countries like Canada and America were built by immigrants and can boast an immensely diverse population albeit with different beliefs and tradations but with an influx of ideas and different ways of thinking.

      If Japan will ever ‘wake up and smell the coffee’ remains to be seen about this issue. I think they are more than happy to accept “skilled” labour for a year then ship them out and get in another fresh load. I’m guessing people want to come over and work but the GOJ just keeps putting up walls against them. Is this an effort to keep Japan strictly Japanese, clean and pure?

      — Just to play Devil’s Advocate with your opening question, I’m sure Fiji can make a cogent argument against immigration, FWIW. But I agree that’s a bit rare, and Fiji’s assimilation policy was pretty flawed. As is Japan’s.

    2. Mumei Says:

      I think the problem is that while Japan grudgingly accepts foreign labor, they do not view this as immigration or even a road towards that end. They expect foreign labor to one day “go home”. In my opinion, Immigrations seems to consider real immigrations to begin at the point of either marrying a Japanese citizen and/or getting PR. Right or wrong, until then anyone is expendable.

    3. Jeffrey Says:

      It may be a bit harsh, but given the choice between a Japanese nurse or a foreign one, who do you think the average Japanese person would prefer? This system is quite unfair and it seems that the government only wants to accept foreign labor that can pass off as Japanese. It would also free them from potential criticism if a Japanese patient were to die under a foreign nurse’s care.

    4. James Says:

      Several things

      Why the hell is Japan doing such a good job at turning out people competent enough to be convenience store clerks and not being able to train nurses? Where and why is Japan failing in its science training that it can’t find enough nurses? Why do people choose working as office workers over being health care Professionals? What does Japan have in place that will help persons who left these professions to marry and raise families 20 or 30 years ago upgrade/relearn their skills so they can re-enter these professions?
      Wouldn’t a good place to start be ‘TV dramas that honor these professions? Career days that let young people see nurses in action before they have fallen so far behind in science that they can’t become nurses?

      Secondly What are these exams like? To me they smell a little like the exams designed to keep black Americans off the voters lists.

    5. yang Yan Zhao Says:

      I think the way the Japanese government is going about letting foreign nurses is pretty bad.

      That having been said, they’re absolutely right to require a high level of Japanese from these nurses. I’m in China in med school and let me tell you it’s extremely difficult to see any patients here even though I speak Chinese very well. Not only do you need to know common and medical terms for body parts and diseases you also need to know all the regional slang.

    6. Jcek Says:

      I don’t really think this has a lot to do with race, but more to do with labor standards. As suggests the GOJ chose Indonesian nurses because:

      “In Indonesia, showing anger in public is considered disgraceful. When I studied in Indonesia, I came in contact with such Indonesian national traits. I had the impression that while Indonesians tend to be kind and amicable, even when they are inwardly unhappy, many of them keep their discontent bottled up.”

      I don’t think the average J nurse is under as much pressure to become a nurse nor to stay one as these Indonesian nurses are. I wouldn’t even be surprised if wages had huge discrepancies, even if they give the NJ nurses special titles to designate them as “less-skilled”. Why do they keep referring to their programs as “training” when they are hiring experienced people?

      As the article pointed out, Japan is lagging behind the rest of the world. The GOJ’s feet-dragging is doing nobody any good, and welfare won’t be the only system failing.

    7. carl Says:

      This might sound bad, but I’m gonna have to disagree that the hurdles are too high. We’re talking nurses and care-givers for the elderly. It many cases it might literally be a “life-or-death situation” if your nurse doesn’t understand what you’re saying. In that case, would it really be so unfair to be so stringent with the language skills your nurses have?

      — Yes, I’m sure the robots they’re proposing to take over health care will be all the more attentive. Clank.

    8. darridge Says:

      There are a couple of good points raised above:

      * with so many freeters and out of work Japanese, why aren’t they being encouraged to take up nursing and other health related jobs? These are well paid and – with the increasing age demographics – secure jobs. Scholarships etc could attract people and it would then be a boost for ailing japanese universities. Then language issues wouldn’t exist.

      * Language skills are very important in these fields. That isn’t the issue. How people are going to obtain these skills is. Japanese instruction could take place in the home countries, or there could be an introductory course as candidates enter Japan – a 6 month intensive kind of thing.

      This to me is the real issue – Japan needs these people, as its own people apparently don’t want to work, but yet again has put no thought or system into place to ensure they get people with the correct skills. If you need people with japanese skills, then TEACH THEM JAPANESE. They aren’t born with it innately!

      — Right. And I’m sure these policymakers know this.

      But lookit. I doubt that’s really part of the plan. It’s become increasingly clear to me (what with what happened to the Nikkei Brazilians and Chinese Trainees) that the GOJ would rather squeeze out whatever work is possible from NJ for three years, declare them unfit for stay, and bring in a new batch. We’re not talking about competency. We’re talking about cheap labor. And the perpetually revolving door is one way for that to happen.

      Looks like I’m getting more cynical as I age.

    9. Mark in Yayoi Says:

      It should be noted that the shoe has been on the other foot in the past.

      I remember reading about the problems that mainland nurses had when communicating with monolingual Okinawan speakers a few decades ago, when there were still many Okinawans who couldn’t speak Common Japanese. Dictionaries were produced, and the medical personnel spent time trying to learn basic phrases in Okinawan, but they certainly weren’t kicked out of their jobs and sent back to the mainland if they couldn’t master Okinawan.

      I agree with the idea that the nurses should be responsible for learning the language of their patients, but while that’s the government’s position now, it wasn’t always like that. It’s only like that now because the language of the patients happens to be the language of the government.

    10. nadrew Says:

      wow. 6 months of japanese, the standard course for students who want to enter university is something like 2 years/ 600 hours.

      this is a site from malaysia referencing jasso.

      debito nailed it. our racially pure overlords have thought this all through. nothing to see here. move along.

    11. Intricate Says:

      I Agree with Carl. I’d rather have a robot nurse that understands me even though I have to try out a dozen synonyms (i.e. Zork, that text based adventure game) instead of a nurse who will, occasionally, not understand me correctly whatever I say.

      So I say that they should just keep the hurdles that high, but maybe it would be good if they got more help getting over them. Like provide more Japanese language teachers or something like that. It’s not impossible to pass these tests, and it might even be easy to pass them within the time frame they are set. But they do need the proper education.

      — I think the statement that a human cannot understand anything you say no matter what, just because that human is a foreigner, is a sentiment reserved for the most xenophobic. There is such as thing as non-verbal cues, and common human decency and empathy. There is always a way to communicate.

      Kindly desist in saying this sort of thing again on

    12. betty boop Says:

      it is just horrible that this trickle of nurses and caregivers from other shores is causing such a stir. it should be business as usual. think of all the japanese doctors, nurses, caregivers practicing in countries around the world. they practice in other countries because they are allowed to take a test and if they pass they can get a license. what truly boggles my mind is why they don`t allow the same kind of thing here on a much wider basis.

    13. carl Says:

      Ok, ok, cut me some slack. I missed the “robot workers” article but, now that I’ve read it, it just sounds ridiculous. I guess I could understand robotic workers in an industrial setting (assembly lines or whatever), but not in something like health care.

      But let’s be honest: would any of us want to be attended by someone we couldn’t totally communicate with? Or want our elderly relatives or young children to be attended by someone who might not understand them? It’s not an ethnic or language issue, I don’t think, but a safety one. Of course, though, the Japanese government should undertake the burden of teaching these nurses the proper language and how to use it and give them a longer period of time. Sending them back to their countries if they don’t learn Japanese well enough is pretty useless. Still, anyone can call me a xenophobe if they want, but I’d rather have a nurse, J or NJ, who could totally understand what I was saying. Just my two cents.

      “There is such as thing as non-verbal cues”

      Not always useful in emergency situations or if the patient is paralyzed.

      — You’re assuming these people are not properly trained to do their job just because they’re foreign? Cut THEM some slack.

    14. Mumei Says:

      I assume that the state exam is the 看護師国家試験. Various details here:

      Even though I have been doing software development for almost 15 years now, I previously had to pass one of the 情報処理技術者試験 state exams before immigrations would give me the proper visa to do that kind of work. While there is certainly a lot of material, the hardest part was doing it in Japanese, even though I have a BA in Japanese and linguistics, graduated from a Japanese university, and have JLPT level 1.

      However, while challenging, if anything similar, then I do think that passing the nurse exam should be possible within the three years given. Perhaps offering the test at least twice a year would improve the odds.

    15. carl Says:

      “You’re assuming these people are not properly trained to do their job just because they’re foreign?”

      The whole issue here for me (aside from the economic and labor importation angle) is about nurses who can’t speak Japanese and, thus, might have trouble communicating with their patients in times of emergency. If that’s the case then, yes, I’d say they’re not qualified to work in Japan or any country where they can’t speak the language at the level required for them to give the utmost care to their patients or deal with emergency situations. Again, call me a “xenophobe” if you want, but I wouldn’t want my epileptic child taken care of by someone who couldn’t communicate with them or has to rely only “non-verbal cues.” Would you? Also, if they can’t communicate with the patient, what’s to say they could even communicate with doctors or EMTs or other medical personnel? “Non-verbal cues” wouldn’t be very useful when trying to explain to a paramedic over the phone what’s wrong with a bedridden patient and why you need their assistance immdediately.

      However, if the nurse and patient can communicate in Japanese, or another language they both share, I see no problem. I support high language standards in this case only because we’re talking about people’s lives. In other fields where you can learn to do your job with mimnimal interaction with others, well, language isn’t that big a problem, I don’t think.

      Again, just my two cents. Anyone is free to disagree.

      — The issue for me here is that this issue of communication (“can’t speak Japanese”, whatever that means, and however you judge it) is a fait accompli. The ability to communicate in Japanese is a part of the job description, of course, I agree. The problem is, many people who are in a position to judge this (particularly the GOJ) are requiring what seems to be akin to perfection from non-natives in native and technical Japanese. Which you are simply not going to get from anyone but the very small numbers of talented people with a knack for language, not necessarily a knack for nursing.

      I’m sure we’ve all been in a situation where we’ve been told by Japanese speakers that any infraction, accidental grammatical mistake, or even accent is “not Japanese”, and had that used against non-natives as a way to say they aren’t qualified to say or do something. It’s like saying to Carl that I won’t approve his comment above because of its spelling mistakes. “It’s not English!” Absurd.

      By insinuating that by default non-natives “can’t speak Japanese” (as opposed to, “can’t do their jobs”, but this becomes the same thing), this is a dangerous attitude. One that will enable anyone to say, “she or he is not qualified because her or his Japanese is not perfect”. You’re putting non-natives at an incredible disadvantage in the workplace all over again. Don’t fall into that trap.

      Train people to do their jobs. Give them language training and tests and whatever to make sure they get up to speed and are capable. Of course. We all agree on that. Just be careful not to set the bar too high for minimum standards. Which is what the Asahi article is arguing. Language acquisition and understanding and communication has a lot of grey. Don’t talk in such black-and-white linguistic absolutes, Carl.

    16. James Annan Says:

      A point that many of the cynics are missing is that the “incompetent” nurses are ALREADY here and ALREADY working. It’s not like they suddenly lose whatever use they have the moment they fail a kanji test. Perhaps a reasonable policy would be to restrict their promotion and progression opportunities according to their language skills (eg I guess they will struggle with bureaucracy and paperwork for some time). I don’t see how the patients benefit from sacking this cohort and bringing over others to start from scratch.

    17. carl Says:

      “many people who are in a position to judge this (particularly the GOJ) are requiring what seems to be akin to perfection from non-natives in native and technical Japanese”

      That may very well be, Debito-san. I don’t have much info about this beyond this article. Do you know anyone who can find out what kind of test is being given? It might be interesting to see where the threshold is. If you do find out, please post an update. Either way, when it comes to nursing and whatnot wouldn’t you rather err on the side of caution?

      “It’s like saying to Carl that I won’t approve his comment above because if its spelling mistakes”

      With all due respect, that’s a pretty misleading comparison, one that doesn’t take into the potentially serious nature of the health care profession. No one’s going to die if I make spelling errors on your blog. On the other hand, people who don’t have a good enough working knowledge of a language, especially when it comes to nursing or care giving (which might include numerous technical terms or other obscure jargon), could make potentially lethal mistakes. Anyway, we’re going off on a limb, here. Or I am.

      “Just be careful not to set the bar too high for minimum standards”

      Wouldn’t you agree, though, that in the nursing profession, or any profession where you might have someone’s life in your hands, that the requirements should be higher than others? That’s why doctors need MDs and ditch diggers just need muscles.

      Anyway, good article, though. I always liked reading Asahi back in my Japan days.

    18. john k Says:

      Well, as for the language barrier of nurses versus robots etc.

      Just would like to point out a basic point about being “unweell”…what happens when a patient becomes unconscious?
      1)What would the robot do?
      2)How does the nurse communicate with the patient?

      It comes down to qualified nurses and their experience. A good nurse can work in “any language”, but obviously speaking “the same”does help, but ain’t the be all and end all of it.

      To diagnose a problem, for a nurse who is properly trained/qualified, is easy. Finding the correct word to use may take longer, but at least said nurse can identify a problem and raise the ‘alarm’…The only real barrier is the administration. Medicine is like mathematics, a universal languge.

    19. adamw Says:

      the funny thing is – that there is no shortage of japanese nurses here.problem is that as the work is so hard and indequately compensated,licensed japanese nurses soon drop out ,thus causing the shortage..
      the language requirements/3 year thing was not something the j government orign requested.
      it was a demand from the japanese nurses union who dont want to see their salaries going down..

      regarding the carl/debito debate – i think both are right.
      it is basically just a cynically ploy to get cheap labour in then remove after 3 yrs..
      however as carl says,you cant have people in these professions who cant speak the language properly-onelinguistical mistake could lead to a death…

      personally,i feel that common sense will prevail and that after 3yrs ,these nurses will have become indispensable and there will be some extension/amnesty on the test-but you never know in japan..

    20. James Annan Says:

      I think people are getting a bit melodramatic about the critical dangers of supposedly unqualified healthcare workers. While I wouldn’t want to denigrate the important work they do, they are basically working in care homes feeding and cleaning old people, not performing life-saving surgery or even prescribing medicine. If they don’t know the kanji for bedsores they only have to ask someone who does.

    21. Bendrix Says:

      I know working at McDonald’s is not as serious as nursing, and making a mistake there is likely not going to cost lives … but, I had the language thing used against me when I applied for work there. I asked isn’t there any job where I don’t need to have perfect Japanese, like flipping burgers? And the manager said every worker has to interact with customers. That I was able to have a conversation like that in Japanese, I guess, wasn’t enough to work at a McDonald’s in Japan, even in a toilet cleaning capacity.

      This whole language thing often crops up in Japan as a convenient excuse for barring foreign workers. In that Tackle show with Beat Takeshi, the Japanese ballbuster with the glasses kept talking about language ability when it came to Nikkei finding work outside the factories in this recession; funny, though, how it didn’t matter in the factories when the machines were humming. I guess perfect Japanese language ability is essential, but in good times as long as one can get his or her point across, e.g., turn the burger at such a point, that’s sufficient.

      I return to the United States on Monday. Can’t say I’ve had a good experience trying to find work in Japan. It didn’t matter that I was here on a spouse visa, which made it lawful for me to work. Funny thing, my Japanese wife, whose English is nowhere near perfect, is able to return to her old job in America, a retail job requiring customer service.

    22. level3 Says:

      Can I just end the debate right now?

      People are using the hypothetical death or two caused by a tragic language mistake as justification for making these nurses pass the license test in Japanese within 3 years.

      Please compare this to the much more REAL thousands of deaths that will result from a nurse labor shortfall causing a reduction in the quality and availability of care, even though they may be able to apologize for deaths in their perfect Japanese.

      “We are so sorry, the nursing home is full, please look after your seriously ill grandmother yourself.”
      “We are so sorry, there are only 2 nurses in the wing, they were too busy with other patients to notice that your daughter was choking to death.”
      “We are so sorry, the rookie Japanese nurse had worked 16 hours straight, was tired and stressed, and gave your O- wife some A- blood by misatake. She died, but at least not at the hands of some gaijin. Gaijin have trouble reading Japanese, so such errors would be more common! …. What do you mean ‘Japanese skill doesn’t matter noticing O vs. A’?”

      Debate over.

      It’s just as silly as the debate over actually making people pay a bit for ambulance service as a means to reduce the abuse of this free service.

      The socio-utopian-whiners who demand ambulance service must remain free forever, because hypothetically some people in need of emergency care might not call for an ambulance because they would be afraid they can’t afford the fee. (Pretty lame, since if they can’t cough up an ambulance fee, they surely can’t come up with the 30% payment for treatment when they arrive. Point moot.)


      People actually dying RIGHT NOW because the ambulance that could have saved them is being used as a free taxi, and an emergency room doctor is occupied examining some jerk.

      Hypothetical future deaths in the single digits VS. actual real deaths in the hundreds or thousands right now and growing into the future if nothing is done.

      But I guess arguments comparing inarguably different death tolls just aren’t that persuasive to many people these these days…

    23. Manule Says:

      I think the whole truth about this matter is to keep the nurses in some condition that they won’t progress and ascend to the top of their possibilities while here, because let’s be sincere, they are not being hired to diagnose or prescribe anything but just to clean and walk the impaired -and if any emergency just push the big red button and the “real” doctors or nurses will come,- just the plain hard, dirty, and dull jobs of the health care universe, jobs that no J will take. But if putted that way no one will ever come right? so let’s invent the test thing and keep them wishing and willing untill is time to sayonara. (not even thanks)

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