Trends in the geographic distribution of nursing staff before and after the Great East Japan Earthquake: a longitudinal study

Human Resources for Health

Yasuki Kobayashi¹  Toshikazu Seto²  Jun Tomio¹  Noriko Morioka¹ 

[1] Department of Public Health, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku 113-0033, Tokyo, Japan;Center for Spatial Information Science, The University of Tokyo, 4-6-1 Komaba, Meguro-ku 153-8505, Tokyo, Japan

关键词: Nurse;    Geographic distribution;    Nuclear disaster;    Great East Japan Earthquake;   

Others  :  1225545
DOI  :  10.1186/s12960-015-0067-6

 received in 2015-01-01, accepted in 2015-08-10,  发布年份 2015

【 摘 要 】

Background

Medical care systems in Iwate, Miyagi and Fukushima prefectures were greatly damaged by the Great East Japan Earthquake (GEJE), which struck on 11 March 2011. The shortage of nurses in this area was concerning; however, temporal trends have not been investigated. This study aimed to investigate the trends in the geographic distribution of total nursing staff per population in the secondary medical areas (SMAs) of these prefectures before and after the GEJE. We also aimed to qualify the above trends.

Methods

We conducted a longitudinal study at four time points (July 2007, 2010, 2011 and 2013) over 6 years using reports of basic hospitalization charges from all hospitals within Iwate, Miyagi and Fukushima prefectures that experienced severe damage from the GEJE. We calculated the number of total nursing staff per population in the SMAs and compiled descriptive statistics. Changes from 2010 to 2013 were qualified and mapped.

Results

In coastal SMAs, the ratios of total nursing staff per population decreased immediately after the GEJE. In most SMAs in 2013, the ratios increased and exceeded the pre-GEJE level. However, the changes in total nursing staff per population from 2010 to 2013 were negative in Ryouban (−4.0%), Ishinomaki–Tome–Kesennuma (−1.9%), Sousou (−47.7%) and Iwaki (−1.9%). In Sousou, which is closest to the Fukushima Daiichi Nuclear Power Plant, the changes in total nursing staff per population qualified by job role were −33.7% for nurses, −57.7% for associate nurses and −63.2% for nursing aides.

Conclusions

Our study indicated that the temporal trends in the number of total nursing staff per population due to the GEJE differed between the physically damaged areas and those affected by radiation. We also found the difference in the trend by qualifications: the reduction in total nursing staff per population was larger in Sousou, the area most affected by radiation, than in any other SMAs. Moreover, the number of nursing aides was most affected among the three types of staff. To promote the post-GEJE reconstruction of medical care systems, it might be necessary to develop policies to secure both nurses and nursing aides after nuclear disasters.

【 授权许可】

   
2015 Morioka et al.

【 图 表 】

Figure 1.

Figure 2.

Figure 3.

【 参考文献 】

• [1]Cabinet Office, Government of Japan: White paper on disaster management 2013. 2013. http://www.bousai.go.jp/kaigirep/hakusho/pdf/H25_honbun_1-4bu.pdf. Accessed 1 Sept 2014.
• [2]Miura N, Yasuhara K, Kawagoe S, Yokoki H, Kazama S. Damage from the Great East Japan Earthquake and Tsunami - a quick report. Mitig Adapt Strateg Glob Chang. 2011; 16:803-18.
• [3]Ochi S, Nakagawa A, Lewis J, Hodgson S, Murray V. The Great East Japan earthquake disaster: distribution of hospital damage in Miyagi Prefecture. Prehosp Disaster Med. 2014; 29:245-53.
• [4]Tominaga T, Hachiya M, Tatsuzaki H, Akashi M. The accident at the Fukushima Daiichi Nuclear Power Plant in 2011. Health Phys. 2014; 106:630-7.
• [5]Matsumoto M, Inoue K. Earthquake, tsunami, radiation leak, and crisis in rural health in Japan. Rural Remote Health. 2011; 11:1759.
• [6]Chaffee M. Willingness of health care personnel to work in a disaster: an integrative review of the literature. Disaster Med Public Health Prep. 2009; 3:42-56.
• [7]Ministry of Health and Welfare, Fukushima prefectural government: Fukushima Prefecture total nursing staff supply and demand planning 2013. 2013. https://www.pref.fukushima.lg.jp/sec/21045d/kansenkangokango07.html. Accessed 9 Sept, 2014. (in Japanese)
• [8]Aiken LH, Sloane DM, Bruyneel L, Van den Heede K, Griffiths P, Busse R et al.. Nurse staffing and education and hospital mortality in nine European countries: a retrospective observational study. Lancet. 2014.
• [9]World Health Organization (WHO): Nursing midwifery services strategic directions 2011–2015. (2010). http://www.who.int/hrh/resources/nmsd/en/. Accessed 22 April 2015.
• [10]World Health Organization (WHO): The 2014 update, Global Health Workforce Statistics. http://apps.who.int/gho/data/node.main.A1444?lang=en. Accessed 20 April 2015.
• [11]Izutsu M, Suzuki E, Izutsu Y, Doi H. Trends in geographic distribution of total nursing staff in Japan from 2000 to 2010: a multilevel analysis. Acta Med Okayama. 2014; 68:101-10.
• [12]Medical Care Act, 1948. Article 30–4. http://www.japaneselawtranslation.go.jp/law/detail/?id=2199&vm=04&re=01. Accessed 1 May 2014.
• [13]Ministry of Health and Welfare, Iwate prefectural government: Iwate Prefecture regional health care plan 2013–2017. 2013. http://www.pref.iwate.jp/iryou/seido/keikaku/002229.html. Accessed 1 May 2014. (in Japanese)
• [14]Medical Maintenance Division, Miyagi prefectural government: sixth Miyagi Prefecture community medical program 2013–2017. 2013. http://www.pref.miyagi.jp/soshiki/iryou/rmpindex.html. Accessed 1 May 2014. (in Japanese)
• [15]Regional Medical Division, Fukushima prefectural government: sixth Fukushima Prefecture medical plan 2013–2017. 2013. https://www.pref.fukushima.lg.jp/sec/21045c/iryou-keikaku6.html. Accessed 1 May 2014. (in Japanese)
• [16]Act on Public Health Nurses, Midwives, and Nurses, 1948. Article 5–12. http://www.japaneselawtranslation.go.jp/law/detail/?id=2075&vm=04&re=01. Accessed 1 May 2014.
• [17]Japanese Nursing Association: Overview of Japanese nursing system. http://www.nurse.or.jp/jna/english/nursing/system.html#nurses. Accessed 7 Dec 2014.
• [18]Affairs Department Disaster Prevention Office, Iwate prefectural government: list human casualties and building damage situation of the Tohoku region Pacific Ocean Earthquake (March 31st, 2014). http://www2.pref.iwate.jp/~bousai/taioujoukyou/201403311700jinntekihigai.pdf. Accessed 14 Apr 2014. (in Japanese)
• [19]Crisis measures division, Miyagi prefectural government: damage such as the situation in the Great East Japan Earthquake (Feb 28th, 2014). http://www.pref.miyagi.jp/uploaded/attachment/247174.pdf. Accessed 10 Apr 2014.
• [20]2011 damage situation immediately report by the Tohoku region Pacific Ocean earthquake ver. 1160 (April 4th, 2014). Fukushima prefectural government, Fukushima; 2014. (in Japanese)
• [21]Estimate population by municipalities. Iwate prefectural government, Morioka; 2013.
• [22]Estimate population by municipalities. Miyagi prefectural government, Sendai; 2013.
• [23]Estimate population by municipalities. Fukushima prefectural government, Fukushima; 2013.
• [24]Garber M, Unger L, White J, Wohlford L: Hurricane Katrina’s effects on industry employment and wages. http://www.bls.gov/opub/mlr/2006/08/art3full.pdf. Accessed 1 August 2015.
• [25]United Nations: UNISDR Terminology on Disaster Rsk Reduction. http://www.unisdr.org/files/7817_UNISDRTerminologyEnglish.pdf. Accessed 3 August 2015.
• [26]Forestry Agency, Japanese Government: http://www.rinya.maff.go.jp/j/routai/anzen/pdf/kijun.pdf. Accessed 2 March 2015. (in Japanese)
• [27]Ministry of the Environment, Japanese Government: Decontamination Guidelines. . Accessed 19 August 2015. . Accessed 2 March 2015. http://www. [http://josen.env.go.jp/en/framework/pdf/decontamination_guidelines_2nd.pdf] webcitemeti.go.jp/english/press/2011/0826_03.html webcite
• [28]Extension Site of the Distribution Map for Radiation Dose. http://ramap.jmc.or.jp/map/eng/. Accessed 2 March 2015.
• [29]Tohoku Regional Bureau of Health and Welfare: about the annual reports. http://kouseikyoku.mhlw.go.jp/tohoku/shinsei/shido_kansa/shisetsu_kijun_teirei/index.html. Accessed 15 Oct 2013. (in Japanese)
• [30]Hospital report. http://www.mhlw.go.jp/toukei/list/80-1.html. Accessed 10 July 2014.
• [31]Population estimate. http://www.stat.go.jp/english/data/jinsui/index.htm. Accessed 10 July 2014.
• [32]National Land Numerical Information download service. http://nlftp.mlit.go.jp/ksj-e/index.html. Accessed 11 May 2014.
• [33]Regional Medical Support Center, Fukushima prefectural government: current status of Fukushima Prefecture of medical. https://www.pref.fukushima.lg.jp/sec/21045g/iryougenjyou.html. Accessed 11 Nov 2014.
• [34]Ministry of Economy, Trade, and Industry, Japanese Government: For accelerating the reconstruction of Fukushima from the nuclear disaster -major points-Cabinet Decision on December 20, 2013. http://www.meti.go.jp/english/earthquake/nuclear/roadmap/pdf/20140605_01.pdf. Accessed 1 May 2015.
• [35]Areas to which evacuation orders have been issued (December, 2013). http://www.meti.go.jp/earthquake/nuclear/pdf/131231a.pdf. Accessed 10 Oct 2014. (in Japanese)
• [36]Sato Y, Hayashida N, Orita M, Urata H, Shinkawa T, Fukushima Y et al.. Factors associated with nurses’ intention to leave their jobs after the Fukushima Daiichi Nuclear Power Plant accident. PLoS One. 2015.
• [37]Qureshi K, Gershon RR, Sherman MF, Straub T, Gebbie E, McCollum M et al.. Health care workers’ ability and willingness to report to duty during catastrophic disasters. J Urban Health. 2005; 82:378-88.
• [38]Barnett DJ, Thompson CB, Errett NA, Semon NL, Anderson MK, Ferrell JL et al.. Determinants of emergency response willingness in the local public health workforce by jurisdictional and scenario patterns: a cross-sectional survey. BMC Public Health. 2012; 12:164. BioMed Central Full Text
• [39]Cone DC, Cummings BA. Hospital disaster staffing: if you call, will they come? Am J Disaster Med. 2006; 1:28-36.
• [40]Lanzilotti SS, Galanis D, Leoni N, Craig B. Hawaii medical professionals assessment. Hawaii Med J. 2002; 61:162-73.
• [41]Buchan J, Dal Poz MR: Skill mix in the health care workforce: reviewing the evidence. Bull World Health Organ. 2002; doi:S0042-96862002000700010.
• [42]Ministry of Health, Labour and Welfare, Japanese government: FY 2008 Revision of Medical Fee [Heisei 22 nendo sinryouhousyu kaitei]. http://www.mhlw.go.jp/stf/seisakunitsuite/bunya/kenkou_iryou/iryouhoken/iryouhoken12/index.html. Accessed 29 April 2015.
• [43]Kudo Y, Kido S, Shahzad MT, Yoshimura E, Shibuya A, Aizawa Y: Work motivation for Japanese nursing assistants in small- to medium-sized hospitals. Tohoku J Exp Med. 2011;. JST. JSTAGE/tjem/225.293 webcite
• [44]Van Dyke ME, McCormick LC, Bolus NE, 3rd Pevear J, Kazzi ZN. Radiological emergency preparedness: a survey of nuclear medicine technologists in the United States. J Nucl Med Technol. 2013.
• [45]Regional Medical Division, Fukushima prefectural government: Fukushima Prefecture Regional Medical revitalization plan (Aizu-Minamiaizu medical area). 2009. http://www.pref.fukushima.lg.jp/uploaded/attachment/37706.pdf. Accessed 20 Sept 2014. (in Japanese)
• [46]Kobayashi Y, Takaki H. Geographic distribution of physicians in Japan. Lancet. 1992; 340:1391-3.
• [47]Tanihara S, Kobayashi Y, Une H, Kawachi I. Urbanization and physician maldistribution: a longitudinal study in Japan. BMC Health Serv Res. 2011; 11:260. BioMed Central Full Text
• [48]Toyabe S. Trend in geographic distribution of physicians in Japan. Int J Equity Health. 2009; 8:5. BioMed Central Full Text