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The Uni-Files

A candid look at EFL life and lessons from a university teacher's perspective.

April 05, 2010

Classroom Nurse/Doctor discrmination? You bet! PLUS comments on the Foreign Nurses' EPA Trainee Program in Japan

Two sections today.

The first section is an outline of an interesting discussion I had with a ranking Faculty of Nursing member at our university regarding the controversial EPA agreement completed between Japan and the Philippines/Indonesia, in whichnurses from those countries are able to come to Japan to 'work' as trainees- but with a three-year time limit, unless they are able to pass the standardized Japanese nursing examination in Japanese. This program has been criticized by several pundits in the Western media plus many web-based Japan-oriented sites but there may be more to it than meets the eye, or at least the usual uninformed knee-jerk polemic that tends to surround public debate on such issues. (Those wishing to look at some survey stats on how Japanese hospital officials actually feel about the issue might want to peruse this.

The second section (with that eye-catching title) elaborates on why I discrminate in my classroom between doctors (or at least medical students) and nursing students.
But let's start with the Foreign Trainee Nursing Program EPA discussion.

Part one- The Nursing EPA Foreign Trainee Program

I had a chance to discuss the program's merits/demerits and surrounding details the highest-ranking individual in terms of introducing and administering the program at our university hospital. So far, they haven't introduced it here- and probably won't under the present circumstances. Here's the lowdown:

Me: Some commentators see the 'three years only' rule as unfairly limiting and ultimately leading to a de facto revolving door, use-'em-and-discard-'em, disposable nurse program where only Japan benefits from cheap labour.

Response: That's just nonsense, although I too have heard some foreign reports saying this. First it is a bilateral program. The terms of the program were hammered out in conjunction with the Ministries of Health in the Philippines and Indonesia. And they all agreed on the time limitation. Do you know why? Because they trained these skilled nurses for service in their own country, at their own expense. They don't want a brain drain, to lose them to richer countries. They want them to learn abroad, and of course it is expected that foreign currency will be remitted home, but officials in those countries most certainly do NOT want to see the fruits of their labour disappear abroad.

Me: Some commentators see it as a way of limiting immigration or assimilation into allegedly xenophobic Japanese society.

Response: The Ministry of Health worked out this agreement, not the Department of Immigration. They are worlds apart. It's strange that some people would confuse the two. But foreigners often see Japan as one big unit, like Japan Inc. It's a kind of prejudice or misunderstanding I think.

Me: But wouldn't a longer program provide an answer to Japan's nurse shortage? And wouldn't it therefore ease the burden on Japanese nurses?

Response: Not really. In fact, the program creates more work for Japanwese nurses.

Me: How so?

Response: The foreign trainees have limited Japanese or no Japanese language skills at all at first. That's just a fact. Now, a nurse's job is typically made up of four parts. First, housekeeping. Second, physical treatment and therapeutic administration. Third, personal care ('wellness') and fourth, paperwork. Paperwork is a huge part, especially nowadays with electronic charts. But unless a foregn trainee is fluent in Kanji they could not possibly do the paperwork. Treatment and administration also have huge liability issues so the foreign traineees are unable to carry out those duties. A mistake based upon a communication misunderstanding could have enormous repercussions so they'd be excluded from that role until they have a full Japanese license.

That leaves personal care and housekeeping, less than half a regular nurses' responsibilities, that they can carry out- and even the personal care issue can be dodgy if their Japanese verbal skills are limited. Now, the problem is, if these trainee nurses are registered as being on-staff the hospital administrators are allowed to increase the patient load accordingly, because the number of nurses has officially 'increased'. But because the foreign trainees can't do the same job it simply increases the workload for the regular nursing staff. In addition, they have to train the trainees too and sometimes even have to help them learn the Japanese language. So where are the benefits for the Japanese nurses in all this?

Me: Would the foreign trainees get the same wage as a Japanese nurse?

Response: As a Japanese trainee nurse yes, but there are other factors in the agreement that may make it slightly lower. The specific hospital administration does not decide the wage. But I can tell you that the nurses' unions are creating opposition to the program since they believe that by paying a lower wage to foreign nurses that they'll be priced out of the market and replaced by cheaper foreign nurses.

Me: Is that a real possibility?

Response: They could just pay them the exact same wage but in the end that would actually turn out to cost more because the hospital has to pay for some aspects of training, housing etc. and liability issues. And hospitals are expected to avoid being in the red these days. Even with program funding fiscal perfomance is very strictly monitored. Why operate at a loss with both increased liability and tougher working conditions for the Japanese nurses?

Me: Isn't it a bit much to expect people with little experience in Japanese to pass a professional exam after only three years?

Response: It's certainly tough but that will at least weed out the less than serious candidates. But understand also that if it takes any longer to prepare for the license it means that the extra work for the Japanese nurses involved also goes on longer. And, as I said, the governments of the participating countries are very worried about a skill and brain drain.

Me: Thanks for your time.

(As you probably realize, the above exchange is both paraphrased and translated, although I can say in good conscience that I have not deviated from the original responses in any substantial manner. I also hesitate to name the person I spoke to- I'm not a reporter and this is not reporting per se. Let's just call the person a ranking university official with knowledge of the program. Finally, I encourage knowledgeable readers who feel that the information contained above is inaccurate to comment)

Part two: Why I discriminate between nursing and medical students in my classroom

Sometimes discrimination, in the purest sense of the word, makes perfect sense. It does in this case too.

No, I do not treat the nursing and med students the same. I use different content, have different expectations and employ different evaluation criteria. Here's why:

1. The medical students are academically more proficient.
95% of Med student Center Shiken scores are higher than corresponding Nursing scores. And even if you discount the academic viability of the Center Shiken you might trust me when I tell you that the quality of school, juku and related records for med students is also substantially higher.

2. Med students generally are more proficient in English.
Our university has English as one of the two core subjects on its entrance exam, hence Med students partial to Eigo will tend to choose our entrance exam. On the other hand, English is not a subject on the Nursing entrance exam.

3. Med students are on average older and more worldly.
This is just a statistically verifiable fact. Almost all the nursing students are 18 and come from Kyushu. Many, if not most, have never worked or been abroad. The med students come from all over Japan and many are in their early 20's as freshmen, having worked or travelled (or having studied other subjects post HS).

4. Doctors will almost certainly use English in specific ways while in service, nurses much less so.
Doctors will certainly come across English in both reading and writing research, conferring with peers internationally, or attending conferences. Doctors will probably give a presentation or do an English poster session at some time. They are also more likely (by far) to be assigned abroad for research. The only category in which nurses might use English as much as a doctor is with the occasional NJ patient who doesn't speak Japanese (although here in Miyazaki that usually means only Korean or Chinese monolinguals, not English speakers). The chance that a medical professional out in these parts will meet a non-J speaking foreigner are not high or consistent enough to warrant it being a foundation of university curriculum design.

What then is the point of teaching nursing students English?
First, learning a foreign language, or at least engaging a 2nd language with a cognitive, content-based focus is part of a good academic grounding for any university graduate. Second, it could inspire those who do want to become bilingual, international medical professionals to go further (and we do have courses that allow for such students to expand their English skills and international horizons).

How does all this manifest itself in the English nursing classroom?
There is less of an emphasis on developing professional discourse and academic literacy skills than there is with medical students although in no way are these neglected. Rather, the content is less rigorous both in terms of expected English proficiency and content/tasks. The teaching moves at a slower pace BUT neither is it what we might call remedial or Eikaiwa-based. Evaluation is also more gentle.

Does this mean that med classes are more engaging, fulfilling, and easier to teach from the Prof's perspective?
Hell, no. The nursing classes are generally great fun. They are less intense, take themselves less seriously, and hold a somewhat refreshingly cavalier approach to the classroom and English that lightens the teacher's pedagogical load. In short, nurses classes seem to have fewer classroom 'issues'.

Does anybody else out there teach both medical and nursing students? What are your feelings on this?



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