SunText Reviews

Commentary Article

Japan is an aging society, and this has been a major issue for many years. One of the suggested solutions is the revision of the law 10 years ago, and the novel profession of ‘Nurse practitioner (NP)’ has been established [1]. The significance of NP has been gradually evaluated in various clinical situation. Until 2024, approximately 9,000 nurses have completed specialized practice training, which has cooperation with Japanese Nursing Association (JNA) [2]. For decade, their main areas of activity are acute care, home care, and community care. The general history and progress of NP system in Japan is briefly summarized [3-5] (Table 1).

For community care and medicine, appropriate post-acute care (PAC) and subacute care (SAC) for elderly patients and those with lifestyle-related diseases have become important [6,7]. We have been working in the Heisei Medical Welfare (HMW) medical group for years, and continue to provide medical care, welfare, and research [8,9]. HMW headquarters and Eto Hospital are located in Tokushima, Shikoku Island in Southern Japan (Figure 1a,b). HMW medical group has more than 100 hospitals and welfare facilities, about 9,000 beds, and more than 14,000 staff members in Japan, and has a rehabilitation center in Indonesia, associated with many staff members working from overseas. HMW's goal has been PAC and SAC for long, but in recent years, we have set a new mission as "Living your life for everyone" [10].

The term "Nurse practitioner" has been gradually prevalent so far. The official long term was "special practice training-completed nurse". During the actual medical care in our daily work, the most frequent task where a practical nurse is useful is replacing a tracheal cannula [11] (Figure 2). Formerly, this was a medical procedure that only doctors could perform. Therefore, the replacement had to be adjusted within the doctor's limited schedule. If there were simultaneously many patients with necessary replacement of cannulas, it was sometimes impossible to perform it due to the doctor's circumstances on the day.

On the other hand, it becomes possible for nurse practitioner team to replace cannulas on certain scheduled date and time. For additional benefit, the team can prepare and change cannula together, where some nurses can learn changing cannula for nurse colleagues with advices and lectures.

Several benefits can be observed for the intervention of nurse practitioners. For example, they understand the ordinary situation of the patients, and then they can make fine adjustments for ideal timing.

They can share information together while actually performing the work as a team. Furthermore, they actually observe, show, and teach each other in the team mates. In this way, there are three aspects: consideration, work, and education [12]. For comparison, the previous situation for replacing a tracheal cannula would be described.

A busy doctor usually quickly changed the cannula, where the nurse around just looked at the instant procedure without explanation or advice. On the other hand, when a nurse practitioners are involved, every person around can understand, remember slowly and share a valuable learning opportunity and experience. In this way, our hospital has many nurse practitioners who have completed training in specific procedures, and thus they can learn, teach, consult, and improve their skills during ordinary working days. This is the strength and advantage of nurse practitioners, and it will be expected to develop more in the future. Always easy situation to consult with someone would be one of the strength points, where nurse practitioners are working together.

Recent overview of the activities and current status of nurse practitioners has been described. The number of them who has already completed the training course until 2024 would be approximately 9000, nationwide. They are active in a wide range of medical settings, including acute care hospitals, chronic care facilities, visiting nursing, emergency medical care, and home medical care.

Several discussion, trends and perspectives related to nurse practitioners have been reported over the past few years. There are four significant aspects, which are described in detail as follows:

From task sharing to task shifting

Nurse practitioners have been evaluated as "assistants to doctors until now. However, more autonomous judgment and action will be necessary for responding immediately to acute situations in clinical opportunities. In other words, there has been various discussion about shifting from "task sharing" to "task shifting" [13]. This also includes a legal review of the system with some complex perspectives.

Establishment of responsibility system

The responsibility system would be prepared against the possible medical accident occasion. It has been called for re-examination from the perspective of medical safety. Currently, the Ministry of Health, Labor and Welfare has considered the issue of clarifying the legal framework.

Building a career path for nurses

Certain discussion has been observed for transitioning and reconstructing a career system centered on nurse practitioners. Among them, the crucial issue would be whether “nurse practitioners (NPs)" are nationally qualified or not. It is expected that these matters will lead to even clearer roles and treatment in the future [14].

Promoting the activities in home and community

Nurse practitioners are active in not only hospitals, but also a wide range of fields such as home medical care, community medical care and others. Among them, particular expectations have exist that they will play a central role in "family doctors" and "community comprehensive care systems." In this way, the government is also promoting the advantages of nurse practitioners into various fields who had completed specific practice training in the home medical care field.

Some limitation may be present in our practice with nurse practitioners and national system. Certain issues can be found for clarifying responsibilities, compensation systems, and regional disparities in recent years.

In summary, the system of nurse practitioners was launched in 2015. Its role has recently expanded significantly as an important system for responding to the diversification and complexity of the medical field. The role of nurse practitioners will become increasingly indispensable in the future.

Conflict of interest

The authors declare no conflict of interest.

Funding

There was no funding received for this paper.