Japan Press Weekly

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2014 April 16 - 22 [LABOR]

Gov’t plans to shift some of doctors’ responsibilities to nurses to enable cuts in medical expenditure

The government intends to reduce medical spending by shifting part of doctors’ jobs to nurses, criticized Japan Medical Workers’ Unions (Iroren) Chair Yamada Mamiko.

A set of bills to reform medical and nursing-care programs that the government submitted to the current Diet session includes a bill to revise the Act on Public Health Nurses, Midwives, and Nurses.

With the revision of the law, the government plans to establish a system which permits nurses to conduct “certain types of medical procedures” which are currently allowed only to be performed by doctors and dentists because those procedures require advanced techniques and are at times performed in a life-threatening situation.

Under the system, trained nurses will perform those procedures by following the directions given in a doctors’ manual. The bill, however, provides no concrete information regarding the system such as contents of the training for nurses, the scope of “certain medical procedures”, and definition of terms used in the manual.

Furthermore, the number of procedures increased to 41, including endotracheal intubation, from 29 presented during discussions on the revision in March last year.

The Japanese Society of Anesthesiologists pointed out that performance of intubation by nurses would jeopardize medical safety regardless of how well they practice the procedure because intubation could pose a threat to patients’ lives when the person performing the procedure makes a wrong judgment or has an insufficient level of technique. The organization calls on the government to remove the procedure from the revision bill.

Recalling her 36-year career as nurse, Iroren Chair Yamada said, “Recently nurses are forced to carry out more of doctors’ functions than before.” She expressed her concern that the government will increase the number of medical procedure categories without limit.

Yamada cited the fact that in the United States, the reimbursement rate for medical services by trained nurses is set lower than that by physicians in order to cut medical costs. She said that what the Japanese government aims is to keep medical costs low by imposing doctors’ functions onto nurses under the pretext of a doctor shortage.

“Who takes the blame in case of accident? I definitely oppose the revision in order to protect medical safety,” said Yamada.