XIV International Economic History Congress, Helsinki Session 50

Transcription

1 XIV International Economic History Congress, Helsinki 2006 Session 50 The Determinants of the Registered Nurse s and the Practical Nurse s First Job: the cases of some attached nursing schools in Japan, 1960s-70s Mai Yamashita mayama@cc.kyoto-su.ac.jp Faculty of Management Kyoto Sangyo University Uekamo-Motoyama,Kita-ku,Kyoto,Japan 1

2 Introduction The Ministry of Health and Welfare in Japan officially announced the Public Health Nurse, Midwife, Nurse Law in This law defined details of the nurse qualification. The law was revised in The point was clearly to describe the definition of the registered nurse and the practical nurse. Table 1 shows the difference between two training systems. Why did the qualification of the practical nurse come into existence in 1951? The number of hospitals increased after World War in Japan and it did remarkably high. One of the reasons was that the national health care system was introduced in So there was a great demand for the nurse. But it was difficult to fill the lack of the registered nurse. At that time Japanese girls could not take an entrance exam for the registered nurse easily, for that the percentage of girls who advanced to high schools was low of the 1950 s. So the practical nurse took an important role to avoid the nursing shortage in Japan. But the members of JNA and many nursing researchers began to criticize about the practical nurse around 1960 s as follows. 1. The specialized knowledge of the practical nurse is insufficient. Therefore, the qualification of the practical nurse should be abolished. 2. The registered nurse and the practical nurse do the same work at the medical faculty though their specialties are different. Therefore, this problem needs to be resolved. I agree with these points of view. But, there is room for more to be done. We have to analyze more the supply-demand situation and the annual transition about Japanese nurse especially of the 1960s to 1970s. The reason was that the medical situation had changed remarkably during the period. For example, medical technical innovation was spurred upgrades. It is necessary for us to demonstrate the link between the change of the medical situation and that of the nursing labor market. Currently, there is not that much research showing the difference of the job market between the nurse and the practical nurse using the concrete date. I think one of the important topics is the first job. The reason why I notice about the first job is that I am sure it has much influence on her career option. Therefore, my purpose of this paper is as follows: First, I compare the curriculum between the registered nurse and the practical nurse and consider the features that differentiate the former from 2

3 the latter. Second, I focused on the nurse s first job for now and survey the difference between the first job of the registered nurse and the practical nurse and specify the determinants and the annual transition. I. The transition of number of nursing schools and students Table 2 The table 2 shows the annual transitions in the number of nursing schools and students from 1956 to The following facts were clarified from this table. First, a lot of practical nursing schools were established in the 1960 s. Second, a lot of registered nursing schools (2 years) were established in the 1970 s. This fact means that the graduates from the practical nurse went on to the registered nursing school (2 years) as soon as they got the practical nurse license. Third, the number of the registered nursing schools (3 years) gradually increased between the 1960 s and the 1970 s. Table 3 It can be confirmed that the registered nurse was more than the practical nurse in the 1970 s by Table 2. Then, to materialize this transition more, give the example of Kumamoto Prefecture in Table 3. It was clarified from Table 3. First, the attached school of Kumamoto University (3 years) had changed into Junior College in 1978 and The Faculty of nursing was established in Kumamoto University in Three schools were secondarily changed from the practical nursing school into the registered nursing school (2 years) in the 1970's. Thirdly, the practical nursing school established by the doctor association increased from 1952 to The following points became clearer in case of Kumamoto Prefecture. The registered nurses were highly educated, On the other hand, in case of the practical nurse, the educational development was limited in the 1970 s. From this fact, I expected that the practical nurse faced some inconvenient situations in the nurse labor market in the 1970 s. To clarify the inconvenience, in the next chapter, I consider what education had the registered nurse and the practical nurse received in the 1960 s and in the 1970 s..the curriculum of the registered nurse and the practical nurse Table 4 Table 4 shows the curriculum of the practical nursing school in The following points can be confirmed from this table. The practical nurse studied the scientific aspects of nursing in the first 3

4 grade and went to the hospital to practice in the second grade. However, there was not an agreement as to how many hours the students of practical nursing school worked at the hospital per day. One of researchers criticized this situation by saying, We only learned of the lack of sufficient knowledge when we were the students of the practical nursing school. The aim of the practical nursing education was only to acquire nursing techniques. The doctor didn t need nurses to diagnose patients. Table 5 Table 5 shows the curriculum of the registered nursing school in 1959 and in The curriculum of the registered nursing school was revised in 1967 in Japan. The following points were derived from Table 5. First, the subjects of the registered nursing school were divided into special and basic in the new curriculum. Second, much time was spent on the scientific aspects of nursing in the curriculum (1968). Thirdly, the number of basic subjects increased in the curriculum (1968). The reason for this change was because the new curriculum was applied by the curriculum of the university. Here one of the nurses remember the teacher of their registered nursing school emphasizing that, "The nurse had to be able to diagnose patients based on initial consultation", "Look at the patient as a whole", and "Take partnership with the doctor". In brief, it s understood that the education of the nursing school developed into one of higher education. Table 6 Table 6 shows the scientific areas of study that the registered nurse and the practical nurse learned. The following points became clear. First, the difference of the subject was that in 1968 was divided into three different types of nursing: Adult, Child and Maternity. These classifications were according to the characteristics of the patients and it differed from that of the medical science. Secondarily, the doctor didn t have to teach the students for fixed hours in the new curriculum in That is, the teacher who had the registered nurse s qualification came to teach the students mainly. Thirdly, the practice time was shortened from its original length. Fourth, the school hour of the nurse was much longer than the practical nurse. In summary, the curriculum of the registered nurse changed remarkably, but that of the practical nurse didn t. Therefore, the difference in specialty was deeply divided between the nurse and the practical nurse after Which raises the question, did the registered nurse and the practical 4

5 nurse work at different medical institutions because of the difference in specialty? In the next chapter, I will analyze their first job more specifically..the workplace of the registered nurse and the practical nurse Figure 1 Figure 1 shows the percentage in the number of the registered nurse and the practical nurse who worked at the hospital or the clinic from 1960 to From this figure, we can observe the following: Many of registered nurses worked at the hospital, and after 1966, the tendency became strong more. On the other hand, the practical nurse worked at the clinic more than nurses. Table 7 Table 7 shows the percentage in the number of the registered nurse and the practical nurse who worked at the different scale of hospitals. It is understood that the registered nurse worked at the larger scale hospital and the practical nurse worked at either the large- scale hospital or the small-scale hospital..the first job of the registered nurse Before continuing this chapter, it should be pointed out the type of the nursing schools in Japan, especially about the institutor. In 1974, about 30% of the registered nursing school was national. As for the practical nursing school, about 40% was established by the doctor association. In short, the institutor of the registered nursing school was different from the practical nursing school. Since this chapter, it analyzes the first job of the registered nurse. Many of registered nursing schools (3years) were attached by the hospital. Therefore, the registered nurses had been assumed to find their job in the attached hospital after graduating. Then, to confirm the truth, I examine their first job of the graduates at the following schools: the attached registered nursing school of National Sanatorium Fukuoka-East Hospital(Fukuoka-East), that of National Sanatorium Toneyama Hospital (Toneyama), and that of Kumamoto University. Figure 2 Figure 2 shows the percentage in the number of graduates who worked at the hospital or went on to school. The following points were shown from this figure. About 80% worked at the hospital, and 20% went on to school about three different schools. Figure 3 Figure 3 shows the percentage in the number of graduates who found their job in the attached 5

6 hospital from 1956 to It is difficult to show the common feature of the three schools. I dare to say the percentage decreased for the three schools, and that the percentage of Fukuoka-East was the lowest. In short, the graduates of the nursing school (3 years) didn t necessarily find their first job at the attached hospital. Figure 4 Figure 4 shows the percentage in the number of graduates from Fukuoka-East who found their job at four different types of hospitals. First, the percentage of the national hospital was remarkably high from 1968 to 1970 because many graduates found their first job at Fukuoka-Chuo Hospital. The reason is that many of students went to Fukuoka-Chuo Hospital for the practice and that they were able to receive much information beforehand. Second, the percentage of the university attached school was remarkably high. From 1966 to 1968, the number of graduates who found their first job at Kyusyu University Hospital increased. From 1973 to 1974, some graduates found their first job at Fukuoka University Hospital. Since 1979, some graduates found their first job at the University of Occupational and Environmental Health Hospital. To summarize, many students wanted to find their job at the university attached hospitals if once they established near the registered nursing school in the 1970 s. For example, here we have, one graduates looking back the choices of the first job in the memorial book of Fukuoka-East. After I graduated from the nursing school, I decided finding my first job at Kyusyu University Hospital. And, I reported directly to my teacher, Ms Sakaue. Then she complained to me as follows: You might become a nurse. Do you think that you can provide the enough care for the patients? I don t think so. I was not able to answer, and muttered so in the chest: I want to study and work at another hospital. The following points can be guessed from this quote. The students of the registered nursing school thought that they could get the special knowledge if they found their first job at the university attached hospital. The medical technical innovation had made rapid progress at that time so it was important for students to study cutting-edge medical technology. In addition, they found their first job at their own free will contrary to our expectations. Table 8 6

7 Table 8 shows the percentage in the number of graduates who went on to three different types of schools. It has been understood from Table 8 is that there were a lot of graduates who went on to the public health nursing school. It examines more in detail in the following. First, a lot of graduates went on to Fukuoka Nursing Training School (the public health nursing school). The reason was that the students at this school were able to acquire not only the public health nurse license but also the nurse-teacher license only in one year after graduating. Secondly, after 1975, the number of graduates who went on to the nurse-teacher course of Kumamoto University increased. It was very popular among registered nurses, for they would like to graduate from the university.. The first job of the practical nurse Table 9 Table 9 shows that the percentage in the number of graduated who worked at the hospital or the clinic about Gunma prefecture in From this table, we can observe the graduates who found their first job at the clinic was numerous. Then, why was the percentage so high? One of the members in the doctor association of Minamata City and Ashikita-gun gave the useful suggestion as follows. Nurse shortage was very serious in Minamata City. Therefore, it was necessary to train a lot of nurses. (omission) We have to cooperate with the doctor association and the school board of Minamata City. And, we would like to establish the practical nurse school of Minamata City at all costs. It is possible to conclude it from the case above as follows. The doctor association was positive in the establishment of the practical nursing school. The reason is in first it was more difficult for the medical practitioners to employ the nurses because they would like to work at the hospital. Second the medical practitioner didn t want to employ the registered nurses because of their high wages. Third, most of medical practitioners in Japan belong to the doctor association. So, the manager at the school established by the doctor association recommended the graduates of the practical nursing school to the medical practitioners. So the medical practitioner was able to employ quite a few graduates. 7

8 Table 10 Table 10 shows the percentage in the number of graduates from Matsudo, who got their first job at the different types of hospitals from 1955 to The following points can be derived from this table. None of graduates in first found their first job at the clinic. They found their first job in the National Sanatorium Matsudo Hospital and other National Hospitals, secondarily. A lot of graduates went on to the registered nursing school (2 years) thirdly after the latter half of the 1970's. One of the staffs at this hospital was describing such a situation at that time as follows. The management of the practical nursing school was hard. However, we have continued to manage this school because we expected that the students worked at our hospital. In the course of time, all the students became high school graduates not junior high school. So it was possible for students to try to take an examination of the registered nursing school (2 years) as soon as graduating. Some doctors complained about this situation. "None of the students worked at this hospital after graduating. There was no sense in managing the practical nursing school. Then, why did a lot of students in the practical nursing school try to go on to the registered nursing school (2 years)? The reason is the rise in the percentage of the number of students who had finished high school. In detail, this percentage of them was 38.6% in 1971 and 78.6% in They were able to take the entrance exam of the registered nursing school (2 years) right after graduating from the practical nursing school. In this connection, before in the 1960 s, the situation was different. It was a recollection of one of the graduates in 1958 as follows: I was from Chichibu. After the students in Chichibu graduated from junior high school, they have few choices for their future course: First, they went on to a high school at night time. Secondly, they helped to work at the firm where their family managed. Third, they found their job in other prefecture. In those days, I also tried to get any jobs that I could earn my living. In brief, some of the students had entered the practical nursing school unwillingly because they have difficulty in making a living in the 1960 s.however, such a situation changed in 1970 s.i suppose the family income of the students went up and the number of the students who had to enter the practical nursing school had been decreasing. 8

9 Concluding Remarks I present the following concluding remarks. 1 The registered nurse was able to choose their first job at their own free will,1960s-1970s. On the other hand, the practical nurse had few choices of the first job. 2) The practical nurse found their job in the clinic after graduating from the school established by the doctor association. In Japanese, this phenomenon is called "Orei Boukou". In addition, the practical nurse found their jobs in an attached hospital or the practice hospital after graduating from the training school of the attached hospital. In summary, the first job is different between the registered nurse and the practical nurse. And Around in the 1970's, more and more practical nurse became unsatisfied with such situations and tried to enter the registered nursing school (2 years) after graduating. 3) The attached hospital managed the registered nursing school(3 years). The first purpose of managing the school was to increase registered nurses at the attached hospital. However, the registered nurses didn t necessarily find their first job in it. Usually, they tended to find their first jobs in university s attached hospitals or national hospitals within the same region of the school. This tendency had become strong more since the 1970's. The reason why they hoped to find their first job in their hospitals was to make use of the knowledge they learned their specifics in the hospital. That is to say, they wanted to use their knowledge in the large-scale hospital setting. 4) It was easy for registered nurses to take public health nurse, midwife, and nurse-teacher's qualifications. Therefore, the nurse could gain much of knowledge about nursing easily. This situation was obviously different from the practical nurse. 5) In the end, the determinant of the first job is as follows. First, the case of registered nurses: 1. the same region as the nursing school 2. putting to use of the nursing knowledge 3. the scale of hospitals 4. the attached hospital 5. the practice hospital 6. the personal preference. Second, the case of the practical nurse: 1. the same region as the practical nursing school 2. the doctor association 3. the attached hospital 4. the practice hospital. Medical technical innovation had occurred of the 1960s to the 1970s in Japan. A lot of university-attached hospitals were built at that time and they have taken the central role in the advanced medical technology. It has also a great impact on Japanese nursing labor market. Statistic 9

10 shows that the registered nurse tended to work at the large-scale hospital (including the university-attached hospital) and the practical nurse did at the clinic, 1960s-1970s. I analyzed more in this paper why was there a major difference between the two, paying attention to the first job. The registered nurses could choice their first job. And more, they didn t necessarily work at the attached hospital. They worked at the hospital they could make use of their talent. This fact shows as follows: First, medical workers began to estimated the registered nurse s specialty. Second, the registered nurse began to recognize their responsibility as the specialist and utilize their unique capacity at the medical institution. However, the practical nurses faced with the different situation. There were many restrictions on them to the first job. And their career as the nurse became increasingly more complex. Finally, some points under discussion remains to be solved. Generally, the nurses change the workplace several times, it is insufficient only the analysis of the first job. We have to analyze how to pursue their career in the concrete. 10

11 Reference Fukuoka kenritsu kango senmon gakko Fukuoka Nursing Training School 2005 Mizuki no kaze fukuoka kango senmon gakko heiko kinenshi The Wind of Mizuki The Memorial Book of Fukuoka Nursing Training School Fukuoka kenritu kango senmon gakko Fukuoka Nursing Training School, pp Kaneko Hikari Shimizu Kayoko 1994 Rekishi kara mita kijyun kango seido to sono genjyou(taidan) The history of the system and the present condition of the basic nursing system(the interview) Byoin The Journal of Hospital, 53-4,pp.314. kango Kyoiku Hensyusitsu Hen 1997 Jyunkango Mondai Tyosha Kento Hokoku (shiryo to kaisetsu) The report about the problem of the practical nurse The Date and The Explanation Igaku Syoin,pp.2,pp Kusakari Jyunko Kendo Takako, Kodama Kazuko nen ni kango wo kataru isoide shikashi tyakujitsuni sekimu wo hatasu toki ga kita The Discussion about nursing in 2000:Time,that The Nurse has to perform an important rule, has finally come Nihon kango kyokai syuppan kai Nursing Association Press pp.38,pp Omori Ayako 2003 Kango wo kangaeru sensyu15 Omori Ayako ga kenbun shita kango no rekishi The Nursing History that Omori Ayako experienced.(the selection of Japanese Nursing 15) Nihon kango kyokai syuppan kai Nihon Nursing Association Press,pp.153,pp

12 Kokuritsu Ryoyojyo Fukuoka Higashi byoin kaiko 30 syunen kinenshi The attached nursing school of National Sanatorium Fukuoka-East Hospital 1983 Kokuritu Ryoyojyo Fukuoka Higashi Byoin Fuzoku Kango gakko kaigaku 30 syu nen kinen shi The book on 30th birthday of the nursing school of National Sanatorium Fukuoka-East Hospital Kokuritu Ryoyojyo Fukuoka Higashi Byoin Fuzoku Kango gakko The attached nursing school of National Sanatorium Fukuoka-East Hospital,pp.315. Kokuritu Ryoyojyo Matsudo byoin fuzoku kango gakko The attached nursing school of National Sanatorium Matsudo Hospital 1974 Kokuritu Matsudo byoin fuzoku kango gakko kinen shi The memorial book The attached nursing school of National Sanatorium Matsudo Hospital Kokuritu Matsudo byoin fuzoku kango gakko The attached nursing school of National Sanatorium Matsudo Hospital pp.9, pp.62 Kumamoto shi ishikai shi hensyu iinkai The desk of the history of the doctor association in Kumamoto City 1977 Kumamoto shi ishikai shi The history of the doctor association in Kumamoto City Kumamoto shi ishikai the doctor association in Kumamoto City, pp.218. Minamata si and Asikita gun isikai si hensyu iinkai The desk of the history of the doctor association in Minamata City and Asikita County 1977 Minamata shi and Asikita gun isikai shi The history of the doctor association in Minamata City and Asikita County Minamata shi and Asikita gun isikai the doctor association in Minamata City and Asikita County, pp.218-pp.219. Kumamoto daigaku iryou gijyutu tanki daigakubu 20 syunen kinensi kai The desk of the 20 years memorial book in Kumamoto Medical Techincal Junior College 1997 Soritsu 20 syunen kinen shi The book on the 20th birthday of Kumamoto Medical Technical Junior College Kumamoto daigaku iryou gijyutu tanki daigakubu 20syunen kinenshi kai The desk of the 20 years memorial book in Kumamoto Medical Technical Junior College, pp

13 Nihon kango rekisi gakkai hen The institution of Japanese nursing history 1998 Kensyo: Sengo kango no 50 nen The view The nursing after WW for fifty years Medikaru furendo sya Medical Friend Press,pp.195-pp.220, Kousei syo Imukyoku Kangoka Kansyu The Nurse section of The Minister of Health and Welfare 1980 Kango kankei tokei siryou syu syowa 55 nendo The data book about nursing in 1980 Nihon kango kyokai syuppan kai Nursing Association Press,pp.42. Yamashita Mai 2001 Meijiki ikou ni okeru kango shikaku seido no hensen The transition of the license of nurse after Meiji Era Osaka daigaku keizaigaku The Journal of Economics of Osaka University,50-4, pp.100-pp.114. Yamashita Mai 2001 Sengo iryou gijyutu kakushin ka ni okeru kango gyomu no hensen katei The changing of nursing after WW in the medical technological changing from 1960 to 1970 Osaka daigaku keizaigaku Journal of Economics of Osaka University,51-3, pp.114-pp.130. interview 1. The chief of nursing worked at a corporate hospital in Akashi City, Hyogo (2000/7/20) 2. The chief of nursing worked at a corporate hospital (382 beds) in Osaka City (2000/8/1) 3. The chief of nursing worked at a corporate hospital (171 beds) in Osaka City (2000/8/4) 4. The chief of nursing worked at a corporate hospital in Osaka City (2000/8/7) 5. The chief of nursing worked at a corporate hospital (350 beds) in Osaka City (2000/8/1) website Website about Fukuoka University (referenced 2006/02/07) gide/fkus/univ hitory.html 13

14 Website about Kurume University (referenced 2006/02/07) Website about The University of occupational Environmental Health (referenced 2006/02/07) Website about the educational Faculty of Kumamoto University (referenced 2006/02/07) Website about Kumamoto University (referenced 2006/02/07) 14

15 Table 1 Training System of Nursing in Japan Qualification law investment designate school admission period Registered Nurse The Pubilic Health Nurse, Midwife, and Nurse Law Minister of Health, Labour and Welfare Minister of Education Minister of Health, Labour and Welfare College Junior 3years College 2years High School (Major) Traning School 3years 2years 3years 2years graduate from high school graduate from high school Practical Nurse who graduated from high school Practical Nurse who graduated from high school graduate from high school Practical Nurse working more than three years,or who graduated from high school graduate from high school Practical Nurse working more than three years, or who graduated from high school 4years 3years 2years 2years 3years 2years 3years 2years Practical Nurse Governor Minister of Education Governor High School Traning School graduate from junior high school 3years 2years Source; Sugita Kido,Keito kangogaku Kouza Bekkan9 Kanngoshi, Igaku Shoin, 1998, pp190. Table 2 Transition of the number of schools and students of nursing in Japan Registered Nurse(3 years) Registered Nurse(2 years) Practical Nurse year schools examninees enrollment schools examninees enrollment schools examninees enrollment Source; Nihon Kango kyo-kai Hen, Syowa 50 nendo Kango Hakusyo Kokumin no Kenko to Kango 1975,pp336- pp338,nihon kango Kyo-kai Hen,Syowa54 nendo Kango Hakusyo Henkakuheno Chajengi 1979,pp

16 Table 3 Transition of Nursing School (Kumamoto Prefecture, ) Registered Nurse Practical Nurse year College 3years 2years Trainig School High School Major Kumamoto University 1950 Hospital and National Kumamoto Hospital National sanatorium Saisyunso Sanatorium (Kikuchi-Keihuen) 53 Hospital medical association (Kumamoto-City,Amakusa-Gun) 54 Private Hospital (Seibo-Jikei),medical association(yasiro-city) 1955 medical association(hitoyosi-city) 56 munital hospital(kikusui) medical association(kikuti-gun and City),medical brotherhood(aso-gun) medical association (Sikamoto-Gun and City),municipal hospital(usibuka) 64 medical association(minamata-city and Ashikita-Gun) 1965 munital hospital(ryu-gatake,ueamakusa) 66 Ariake Shin-ai Jyogakuin 67 public hospital(taraki) Tyuou-Jyoshi 68 Kumamoto-Kango medical association (Uto-City and Gun,Simomasuki,Kamimashuki) 69 Kumamoto-Univ for nursing 1970 education 71 munital hospital(ryu-gatake,ueamakusa) Tamana-Jyoshi private hospital(seibo-jikei) medical association (Kumamoto) Kumamoto medical munital hospital(ryugatake,ueamakusa) Sanatorium(Kikuchi-Keihuen) 78 technology Junior College munital hospital(ryu-gatake,ueamakusa),disuse Note; I modified sources. Sourse; Kumamoto-ken Eisei-Bu Kango Gyosei No Ayumi,1978,pp14. 16

17 Table 4 Thecurriculum of the attached practical nursing school of National Sanatorium Matsudo Hospital (1964) subject anatomy and physiology bacteriology and sterilization hygiene and public health regimen pharmacology social examination about deseases and health first grade hours first term second term second grade first term second term nursing nursing history and ethics 10 nursing theory and practice 100 internal 80 surgery 50 peditrics 40 obstetrics and gynecology 30 mental illness 25 dermatology,urlogy 10 opthalmology,dentisry,otolarymgology 15 tuberculosis 40 law about public health 10 physiotherapy 10 housekeeping and domestic science 30 the practice cultural study language music gym Note; shows terms that students study Source; Kokuritu Ryoyojyo Matudo Byouin Huzoku Kango Gakko, Kinenshi 1984,pp

18 Table 5 The curriculm of the attached registered nursing school of Kumamoto University (1959,1968) subject hours special hours introduction of medical science 15 introduction of medical science 15 pathology 30 pathology 45 anatomy and physiology 90 anatomy 45 physiology 45 dieteics 45 biochemistry(contain dieteics) 45 bacteriology 45 bacteriology 45 social welfare 20 social welfare 15 individual hygiene and public health 20 public health 30 public health 30 law about public health 15 pharmacology 30 pharmacology 30 nursing 725 nursing(generality) 360 adult nursing 1665 child nursing 300 maternity nursing 330 total 2655 basic chemistry 60 chemistry 30 education 30 education 30 psychology 30 psychology 30 statistics 15 statistics 30 sociology 30 sociology 30 mental health 15 physics 30 foreign language,music,gym biology 30 foreign language 30 gym 30 philosophy 30 ethics 30 constution 30 music 30 Source; Kumamoto Daigaku Igakubu Fuzoku Kango Jyosannpu Gakko, Soritu 80nen-shi, 1997,pp29-pp30,pp36-pp37. 18

19 Table 6 The scietific study of nursing: The Practical Nurse(1964), The Registered Nurse(1959) The Registered Nurse 1968 Practical Nurse 1964 Registered Nurse(1959) Registered Nurse(1968 subject hours subject hours subject hours subject hours history and ethics(nursing) 10 history(nursing) 20 nursing nursing theory and practice 135 introduction cont 60 Adult nursing nursing theory and practice 100 adjustment 30 ain history and introduction 30 nursing skill 10 internal medicine 80 internal medicine 90 internal (doctor) 30 (doctor) 60 medicine(contain 50community health(contains psychiatric 60 and mental disease 410 (nurse) 50 (nurse) 30 epidemic) details surgery 50 surgery 80 surgery contains orthopedics) surgery (doctor) 40 (doctor) 15 surgery(nurse) 10 (nurse) 35 orthopedics(doctor) 25 orthopedics orthopedics(nurse) 15 (contain epidemic 80 physiotherapy (doctor) 50 (nurse) 30 pediatrics 40 pediatrics 60 Child nursing (doctor) 20 (doctor) 40 introduction 15 (nurse) 20 (nurse) 20 community health 30 obstetrics and gynecology 30 obstetrics and gynecology 70 gynecology 35 disease 75 (doctor) 15 (doctor) 50 (nurse) 15 (nurse) 20 Maternity Nursing mental illness 25 mental illness 25 mental illness 30 introduction 15 opthalmology,dentisry,otolaryn gology public health and nursing introduction (doctor) 15 community health 75 (nurse) 10 disease opthalmology,dentisry,otolaryng 40 opthalmology 15 ology otolaryngology dentisry 15 dermatology,urlogy 10 dermatology,urlogy 30 dermatology 15 urlogy 15 physiotherapy 10 physiotherapy 15 tuberculosis 40 laws about public health housekeeping and domestic science Note; I changed the turn of the subjects of the three different curriculum. Source; Kokuritu Ryoyojyo Matsudo Byoin Fuzoku Kango Gakko, Kinenshi,1984, p131,kumamoto Daigaku Igakubu Fuzoku Kango Jyosanpu Gakko,Soritu 80nen-shi, 1997, pp30 and pp37. Table 7 The persentage in the number of the registered nurse and the practical nurse who worked at the different scale of hosopitals (%) year the qualification R P R P R P R P R P from 20 to 99beds 19,9 25,8 15,7 25,0 11,2 26,9 10,4 28,1 10,0 29,2 from 100 to 199beds 18,5 22,2 16,3 20,3 13,9 20,6 13,2 21,2 13,7 22,8 from 200 to 299beds 61,5 52,0 68,0 54,7 14,2 16,0 14,5 16,5 14,9 16,6 more than 300 beds 60,7 36,4 61,9 34,2 61,4 31,4 Note; R means the Registered Nurse, P means the Practical Nurse. Source: Koushei-syo, Iryou Sisetu Tyosha. 19

20 Table 8 The percentage of graduates from Fukuoka-East, who went on to three different types of school, school midwife public health nurse school nurse Total(Graduate) year Number % Number % Number % Number % ,0 0 0,0 0 0, , ,0 1 5,0 0 0, , ,0 2 10,0 0 0, , ,0 5 25,0 0 0, , ,8 1 5,3 0 0, , ,8 3 11,5 0 0, , ,0 2 10,0 0 0, , ,0 3 15,0 0 0, , ,9 1 5,9 0 0, , ,0 1 4,8 1 4, , ,0 4 18,2 0 0, , ,0 2 10,0 1 5, , ,4 4 14,8 0 0, , ,5 3 13,6 0 0, , ,0 3 11,5 0 0, , ,6 3 8,6 1 2, , ,0 1 4,2 0 0, , ,0 2 6,9 0 0, , ,1 6 12,5 0 0, , ,7 1 2,2 4 8, , ,0 6 11,8 1 2, , ,0 0 0,0 3 6, , ,1 2 4,1 1 2, , ,0 6 12,0 2 4, , ,2 3 6,3 3 6, , ,5 5 10,9 2 4, , ,5 5 12,5 4 10, , ,3 4 9,1 1 2, ,0 Source; Kokuritu-Ryoyojyo Fukuoka-Higashi Byoin Fuzoku Kango Gakko Kaigaku 30 Syunenshi,1983,pp126-pp127. Table 9 The percentage in the number of graduated who worked at the hopsital or the clinic about Gunma Prefecture in 1963 school graduate clinic hospital(practice) hospital(other) Number % Number % Number % Number % Isezaki ,0 0 0,0 5 12, ,2 Takasaki , ,0 0 0,0 0 0,0 Kiryu , ,0 3 8,6 2 5,7 Doctor Association National Sanatorium Shibukawa , ,7 0 0,0 5 29,4 Usui ,0 7 58,3 5 41,7 0 0,0 Maebashi , ,4 5 8, ,6 numata , ,6 2 15,4 0 0,0 Fujioka , ,7 0 0,0 1 6,7 Tomioka ,0 3 27,3 4 36,4 4 36,4 Ohinata ,0 1 6, ,0 2 13,3 Awahu-Rakuseninn ,0 0 0, ,7 5 26,3 Corporation Maebashi-Sekizennkai ,0 0 0,0 3 30,0 6 60,0 Prefecture Gunma , ,9 7 36,8 1 5,3 Source; Takasaki-shi Ishi-kai Huzoku Takasaki Jun-kango Gakko 40 nen-shi,1996,pp

21 Table 10 The Percentage in the number of graduates from Matsudo, who got their first job at the different types of hospitals, Sanatorium Matsudo Sanatorium other kokufudai-national other-national and public corporation school other total number % number % number % number % number % number % number % number % ,1 3 15,8 0 0,0 5 26,3 5 26,3 1 5,3 1 5, , ,8 0 0,0 0 0,0 0 0,0 0 0,0 0 0,0 0 0, , ,8 2 0,0 1 5,6 2 11,1 7 38,9 1 5,6 0 0, , ,0 0 0,0 2 10,0 2 10,0 4 20,0 0 0,0 0 0, , ,0 0 0,0 3 15,0 5 25,0 5 25,0 3 15,0 0 0, , , ,3 1 6,7 0 0,0 3 20,0 0 0,0 0 0, , ,3 3 20,0 0 0,0 3 20,0 2 13,3 2 13,3 0 0, , ,1 2 14,3 0 0,0 4 28,6 0 0,0 0 0,0 0 0, , ,7 2 16,7 0 0,0 2 16,7 0 0,0 0 0,0 0 0, , ,0 3 18,8 1 6,3 4 25,0 0 0,0 0 0,0 0 0, , ,8 0 0,0 4 22,2 6 33,3 0 0,0 0 0,0 3 16, , ,9 0 0,0 2 11,1 0 0,0 0 0,0 0 0,0 0 0, , ,6 3 15,8 0 0,0 3 15,8 3 15,8 0 0,0 0 0, , ,9 0 0,0 1 5,3 7 36,8 0 0,0 0 0,0 0 0, , ,9 0 0,0 2 11,1 7 38,9 0 0,0 1 5,6 1 5, , ,2 0 0,0 2 10,5 5 26,3 0 0,0 0 0,0 0 0, , ,0 0 0,0 0 0,0 0 0,0 0 0,0 0 0,0 0 0, , ,7 0 0,0 2 11,8 3 17,6 1 5,9 0 0,0 0 0, , ,3 0 0,0 0 0,0 1 4,8 0 0, ,0 0 0, , ,5 0 0,0 0 0,0 2 9,1 0 0,0 8 36,4 2 9, , ,0 0 0,0 0 0,0 0 0,0 0 0, ,5 1 4, ,0 Source; Kokuritu Ryoyojyo Matudo Byouin Fuzoku Kango Gakko Kinenshi,1984,pp

22 Table.1 The Number of employees (Nurse,Practical Nurse) The Registered Nurse The Practical Nurse (H) (C) (H) (C) ,2 20,4 74,6 25, ,2 19,6 73,4 26, ,3 19,4 71,5 28, ,6 18,9 70,7 28, ,1 18,3 68,6 30, ,7 17,6 65,6 33, ,9 15,8 65,6 33, ,2 20,4 74,6 25,2 71,2 19,6 73,4 26,3 72,3 19,4 71,5 28,2 76,6 18,9 70,7 28,9 77,1 18,3 68,6 30,9 77,7 17,6 65,6 33,7 79,9 15,8 65,6 33,7 22

23 Fukuoka-East(H) Fukuoka-East(S) Toneyama(H) Toneyama(S) Kumamoto(H) Kumamoto(S) ,0 0,0 73,7 26,3 85,7 11, ,0 5,0 100,0 0,0 80,6 11, ,0 15,0 100,0 0,0 89,7 0, ,0 30,0 100,0 0,0 86,4 4, ,9 21,1 83,3 16,7 77,5 10, ,6 15,4 77,8 22,2 80,9 6, ,0 10,0 85,0 15,0 81,0 2, ,0 15,0 75,0 25,0 76,6 17, ,2 11,8 73,7 26,3 83,0 15, ,5 9,5 70,8 29,2 84,0 16, ,8 18,2 73,7 26,3 78,0 19, ,0 15,0 75,0 25,0 84,6 12, ,8 22,2 87,5 12,5 60,5 39, ,8 18,2 76,9 23,1 79,6 20, ,5 11,5 96,0 4,0 82,9 17, ,0 20,0 84,0 16,0 87,5 12, ,8 4,2 100,0 0,0 74,4 25, ,1 6,9 82,8 17,2 77,1 22, ,4 14,6 81,0 19,0 81,6 18, ,2 17,8 86,8 13,2 46,8 53, ,3 15,7 86,4 13,6 52,6 47, ,0 12,0 85,7 14,3 58,1 41, ,8 10,2 100,0 0,0 55,6 40, ,0 20,0 94,9 5, ,3 16,7 100,0 0, ,3 21,7 96,2 3, ,0 30,0 81,3 18,8 23

24 Fukuoka-EastOther Sanatorium National Univ ,0 5,0 15,0 0, ,0 10,0 0,0 10, ,0 5,0 0,0 0, ,0 5,0 0,0 15, ,6 21,1 5,3 5, ,4 15,4 3,8 11, ,0 0,0 10,0 10, ,0 0,0 5,0 10, ,8 0,0 11,8 11, ,6 0,0 23,8 14, ,9 0,0 13,6 4, ,0 5,0 10,0 10, ,6 0,0 0,0 18, ,4 9,1 4,8 9, ,9 3,8 26,9 11, ,0 2,9 17,1 17, ,3 4,2 20,8 8, ,1 3,4 13,8 6, ,6 8,3 20,8 22, ,0 0,0 11,1 22, ,5 2,0 13,7 15, ,0 12,0 4,0 10, ,4 0,0 8,2 16, ,0 6,0 8,0 20, ,3 4,2 10,4 27, ,9 0,0 4,3 13, ,5 0,0 2,5 17, ,2 6,8 6,8 29,5 24

25 Fukuoka-East toneyama kumamoto fukuoka-higashi univ national Fukuoka-East Toneyama Kumamoto ,0 68,4 57, , ,0 68,4 57, ,0 88,9 41, , ,0 88,9 41, ,0 75,0 59, , ,0 75,0 59, ,0 82,4 36, , ,0 82,4 36, ,6 77,8 47, , , , ,6 77,8 47, ,4 44,4 29, , , , ,4 44,4 29, ,0 30,0 40, , ,0 30,0 40, ,0 18,8 25, , ,0 18,8 25, ,8 36,8 41, , , , ,8 36,8 41, ,6 45,8 44, , , , ,6 45,8 44, ,9 52,6 46, , , , ,9 52,6 46, ,0 56,3 38, , ,0 56,3 38, ,6 50,0 23, , , , ,6 50,0 23, ,4 30,8 30, , , , ,4 30,8 30, ,9 48,0 36, , , , ,9 48,0 36, ,0 28,0 22, , , ,0 28,0 22, ,3 27,3 37, , , , ,3 27,3 37, ,1 41,4 41, , , , ,1 41,4 41, ,6 31,0 42, , , , ,6 31,0 42, ,0 13,2 23, , , ,0 13,2 23, ,5 65,9 13, , , , ,5 65,9 13, ,0 40,5 25, , ,0 40,5 25, ,4 36,8 40, , , , ,4 36,8 40, ,0 38, , ,3 35, ,25 27, , ,9 53, , , , ,5 53, ,5 17,5 2, , , , ,8 25

26 90,0 Figure 1 The percentage in the number of the registered nurse and the practical nurse who worked at the hospital or the clinic ,0 70,0 60,0 % 50,0 40,0 30,0 20,0 The Registered Nurse (H) The Registered Nurse (C) The Practical Nurse (H) The Practical Nurse (C) 10, Year Note; (H) means the hospital and (C) means the clinic. 26

27 Figure 2 The percentage of the number of graduates who worked at the hospital or went on to school, ,0 90,0 80,0 70,0 % 60,0 50,0 40,0 30,0 20,0 10,0 0,0 Fukuoka-East(H) Fukuoka-East(S) Toneyama(H) Toneyama(S) Kumamoto(H) Kumamoto(S) Year means the hospital and (S) means the school. Note; (H) 27

28 100,0 Figure 3 The percentage of the number of graduates who found their job in the attached hospita, ,0 80,0 70,0 % 60,0 50,0 Fukuoka-East Toneyama Kumamoto 40,0 30,0 20,0 10, Year 28

29 Figure 4 The percentage in the number of graduates fom Fukuoka-East who found their first job at four different types of hospitals, ,0 50,0 % 40,0 30,0 20,0 Fukuoka-East Other Sanatorium National Univ 10,0 0, Year 29