Description

Despite the significant number of Indonesian nurses joining the Japanese National Nursing Licensure Examination (JNNLE), only a few of those were successful. Indonesian nurses as one of active migration player to Japan’s market remain a critical support in supporting human resources for health in Japan. However, the successful nurses’ perspectives have yet to be understood entirely.

Nursing Licensure

This study used a descriptive qualitative approach. The participants were twenty Indonesian nurses who have passed the licensure examination. This study was carried out by semi-structured interviews conducted virtually. The data were analyzed using thematic content analysis.

Language ability as the key to succeeding in the exam, strategies to passing the exam, supports resources as factors to increase the passing rate, understanding the nature of nursing exam, and internal motivation to be recognized as a professional nurse in a foreign country.

Indonesian nurses who passed the Japanese national nursing licensure examination tend to deploy planned strategies. Honing the language skills while working and living in Japan is very important, while structured support systems in the hospital, government, and social network are imperative to learning the new knowledge in the area of nursing care in Japan.

Most countries worldwide currently experience a shortage of skilled health workers, especially nurses. Recruiting immigrant nurses becomes an attractive option for developed countries, including Japan, to fulfill their nursing personnel’s needs. Japan needs a significant number of nurses because the country currently encounters a shortage of human resources of productive age, given that the birth rate in Japan decreases while the number of elderly increases. The fertility rate in Japan declined from around 1.8 in 1980s to less than 1.3 in 2005. Also, the mean age of childbearing for Japanese women increased from 28 years in 1980 to 31 years in 2010.

Economic Partnership Agreements

Meanwhile, the percentage of older adults was estimated to increase from around 11% in 2010 to around 19% and 27% in 2030 and 2060, respectively. Consequently, the dependency ratio was predicted to rise significantly from 36% in 2010 to around 54% in 2030 and 78% in 2060. To overcome this problem, Japan has established partnerships with countries with a nursing workforce surplus, like Indonesia and the Philippines, to recruit immigrant nurses through Economic Partnership Agreements (EPA). By the end of 2018, 2445 people consisting of 653 nurses and 1792 caregivers had been placed in Japanese hospitals and nursing homes. Recent data showed that 3638 health workforces have been deployed to Japan for both job positions. However, from that number, the passage rate for the national exam was only 27%.

Along with Indonesia, Japan established the Indonesia-Japan Economic Partnership Agreement (IJEPA), a government-to-government partnership scheme under the auspices of the two countries’ representatives, namely the national agency for placement and protection of Indonesian workers, currently known as the Indonesian migrant workers protection agency, and japan International Corporation of welfare service.

Despite the partnerships, Indonesian nurses who want to pursue a career in Japan still have to pass the Japanese National Nursing Licensure Examination (JNNLE) to obtain a Japanese nursing license. As such, the IJEPA mandates the Japanese government to equip the Indonesian nurses with training and preparation programs before and while working in Japan, including preparing their exams. In Indonesia, a nursing student has to pass similar competence examination to become a nurse; this examination is conducted in Bahasa Indonesia, their national language, so it is easier for them to get the pass. However, to get equal recognition as a nurse practicing in Japan, the foreign candidates must face an exam with the same standard as the Japanese candidates, including using complex Chinese (kanji) and Japanese characters (hiragana and katakana) as the writing system. Overcoming this standard is not an easy task for Indonesian nurses who are newcomers to Japan.14 This obstacle can explain why the pass rate of foreign candidates in the JNNLE is low. In 2011, only 9.6% of Indonesian and Filipino nurses passed the exam. While in 2022, the passage rate of Indonesian nurses for exam was only 22%.

The experience of foreign nurses participating in the JNNLE is not much explored. There was a phenomenology study that discussed the Indonesian nurses’ challenge for passing the exam. This study found that mastering the Japanese language was the main obstacle experienced by the Indonesian candidates. Also, the difference in Japanese dialects could be problem and brought misunderstanding among them. Another study explored learning problems experienced by Filipino nurse candidates using an exam simulation conducted in English. This study found that, besides language barrier, the difference in nursing education curriculum and basic nursing policies are also pivotal in determining the exam success.

 The authors’ previous study concluded that language barriers and passing the examination were among the two most challenging aspects of working as a nurse in Japan. This study, however, did not capture the struggle of the Indonesian nurses in passing the JNNLE. There is no study that specifically explores the topic and their experiences in getting the pass and how they overcame the struggle were still unexplored. Therefore, this study aimed to explore the experiences of Indonesian nurses who passed the national nursing licensure examination in Japan. The study results are expected to be the basis for improving and enhancing the preparation programs for Indonesian nurses. Thus, they can compete with nurses from other countries who have entered the Japanese job market. Hence, the pass rate number of Indonesian nurses can rise significantly.