Anglia Ruskin University
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Exploring decisions as to whether to remain or to leave made by Indonesian, Filipino and Vietnamese registered nurses relocating to Japan under the Economic Partnership Agreement (EPA)

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posted on 2023-09-11, 14:09 authored by Yoshiyuki Nagaya

Aim: Since 2008, Japan has accepted foreign nurses in accordance with the Economic Partnership Agreement (EPA). The nurses’ experiences prior to registration in Japan have been investigated previously; however, the part played by experiences at work and in everyday life in their decisions to remain or leave has not been explored. The present study sought:

1) to explore the decisions taken by EPA nurses to remain in or leave Japan; and

2) to generate a theory to explain those decisions.

Method: The study adopted an inductive qualitative approach to generate a new theory, adopting the methodology of Charmaz’s (2014) Constructivist Grounded Theory (CGT) as its philosophical underpinning. The participants (n=20) were EPA nurses from Indonesia, the Philippines and Vietnam. All had passed the Japanese National Nursing Examination (NNE) and were currently or formerly working in Japan. Both online and in-person interviews were offered. The interview schedule covered both work-related and non-work-related topics, such as aspirations prior to arrival, expectations while living and working in Japan, and plans after departure from Japan.

Findings: The analysis identified four main difficulties for the EPA nurses choosing to stay in Japan in order to work: mastery of the Japanese language; cultural adaptation; interpersonal relationships; and adjustment to changed circumstances. In the Japanese health-care demographic, EPA nurses face difficulties in attaining competency in the Japanese language and adapting to a different culture in the workplace and in everyday life. Together with developing relationships with others, these are tasks that begin before nursing registration. While working as nurses, some participants encountered changes in their circumstances, which involved additional challenges prompting them to consider leaving Japan. EPA nurses found it more difficult to continue to work and live in Japan without attaining a higher level of Japanese language proficiency or adapting to cultural differences. Otherwise, they experienced difficulties in their interpersonal relationships, although not all of the EPA nurses who experienced such difficulties encountered similar problems.

Conclusion: The findings have implications for the EPA programme, which should mandate hospitals and care homes to give comprehensive and unified support to nurse candidates. To optimise the effectiveness of its health-care system, Japan should enhance working conditions for foreign staff and give them further training. In addition, cultural coexistence is important for the future of Japanese society.



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Faculty of Health, Education, Medicine and Social Care


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