Japan's nurses lift delicate voices to demand better work conditions


TOKYO -- After years of working and living at one of the tightening pressure points of social change amid postwar prosperity, Japan's nurses are on the march for the first time in a decade.

Brought up on a Japanese standard of femininity that demands a falsetto voice and a delicately tentative body language, they often look uncomfortable as they line up in white-clad ranks behind banners and raise their fists in the traditional gesture of Asian demonstrators and strikers.

But for seven months they have been organizing demonstrations, petition campaigns, lobbying drives and -- for the first time in 11 years -- strikes, in a society seldom known for labor militancy. They want relief from working conditions that have changed little despite decades of improvements in the lives of other workers.

In the process, they are demonstrating that even in a well-ordered society, rapidly rising prosperity can produce social problems that no one could foresee and for which solutions aren't easy.

"Working conditions drive most nurses out of their jobs after only a few years, and that makes the shortage worse, and that makes the working conditions worse, and that drives more nurses out of the profession," Hisako Ejiri, president of the Japan Federation of Medical Workers' Unions, said recently.

"It's rare to see a nurse over 50 years old in Japan, and almost none stay long enough to retire."

At first blush, the problems of Japanese nurses -- among whom there are practically no men -- sound like the familiar refrains of many U.S. nursing organizations: too many night shifts, and too many clerical and other non-nursing details.

But differences between working conditions for nurses in the two countries can be measured in orders of magnitude, not degrees.

They begin with patient loads.

Japan's rapidly rising prosperity radically increased the number of hospital beds over the past two decades, but the number of working nurses scarcely changed.

World Health Organization statistics show that this country's 778,000 nurses now have to cover 1,634,000 hospital beds, about 300,000 more than there are in the United States, which has about twice Japan's population.

That is a ratio of 2.10 beds per nurse, compared with a ratio of 0.68 for each of the 1,943,000 nurses working in the United States.

The situation promises to get much worse before it gets better, because:

* As prosperity and higher education levels reduce birthrates, Japan's population is rapidly aging. From about 11.6 percent of the population today, the over-65 segment is forecast to reach 25 percent in about 30 years.

Since people over 65 use medical services at a rate about four times that of the population at large, the workload for nurses is certain to rise in the future.

The Ministry of Health has estimated that, given declining birthrates and the average nine-year nursing career, 30 years from now Japan might have to give nursing training to one girl in every 10.

* Prosperity also has brought a steadily tightening labor shortage and constantly increasing education of women, which interact to create work opportunities that female Japanese never before could contemplate.

Those opportunities draw still more nurses out of the profession.

* With medical costs rising and everyone wanting bigger and bigger chunks of tax revenues, the government has steadily trimmed its contribution to health insurance.

The result has been mounting pressure from employers and patients to get a grip on medical costs, and one place to squeeze is the nursing staff, one of a hospital's biggest budget items.

"Our surveys show that nurses find satisfaction in helping the sick and want to stay in their jobs after marriage and even after having babies," Ms. Ejiri said.

"But the situation will only get worse and worse if we can't drastically increase pay, reduce the night duty any one nurse has to take, guarantee holidays and vacations that most nurses are now pressured out of ever taking, give maternity leave and provide day care for babies."

The nurses' campaign has brought many expressions of JTC support, including a petition signed by 126 members of the Diet.

In this spring's annual labor negotiations, it also brought a 6 percent increase in nurses' starting pay, one of the highest in any union job category in the country.

But the government's responses so far have consisted of modest funding increases for existing programs.

"The government is willing to pour money into educating more nurses," Ms. Ejiri said, "but that money would produce more nurses if we would invest it in the things that would attract the people we've already trained back into the profession."

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