Japan’s aging population and the growing number of young Japanese shunning ‘3D’ jobs (dirty, dangerous and demanding) has resulted in an increasing demand for foreign nurses and eldercare workers. In response, the Japanese government has recently started to recruit nurses and allied professionals from Indonesia and the Philippines under bilateral economic partnership agreements (EPA).

These Indonesian and Filipino nurses and carers are required to attend six months of Japanese language training as well as pass Japan’s national qualifying exams in Japanese within two to four years of their arrival. They will face repatriation if they fail the exam. They must prepare for the difficult exam in Japanese while actually working. In the meantime, they are demoted from qualified nurses to nursing assistants.

According to Yumiuri Shinbun, all 103 foreign nurses who arrived in 2008 failed the first national examination in February 2009. The main hurdle: language, specifically Kanji.

“Nearly all the exam questions include technical terms and difficult kanji that even most Japanese could not read at a glance. For example, the questions include kanji for “jokuso” (bedsore), “gyogai” (lying on one’s back) and “doseki” (push or strain).” (8 January 2010)

To this end, there has been an increasing call for a review of the exams. For example, the Yomiuri Editorial is suggesting that they should be allowed to use a bilingual dictionary or furigana should be written above or next to the kanji in text questions. However, there is mounting opposition to this. The Health, Labor and Welfare Ministry and the Japanese Nursing Association are concerned that foreign nurses’ lack of proficiency in Japanese, particularly Kanji, may cause fatal accidents. JNA’s executive director, Shinobu Ogawa, says a kanji for ‘right’ is very similar to a kanji for ‘left’ and the consequence of confusing them could significantly compromise patient safety.

Indeed, the issue of Kanji is something my family and I experienced with my father’s home-nurse. Growing up in Brazil as a third-generation Japanese, Tokiko had very limited Japanese proficiency. In the beginning, she had difficulty reading the medicine labels and the shopping lists my mother put together. Naturally, this was of great concern. However, a solution to this came rather easy to my mother – she simply started writing shopping lists in hiragana and put furigana to every kanji in the medicine labels. The language problem subsided, Tokiko proved to be the most professional, caring and devoted aide we could ever have.

While the debate about changing the examination system continues, there seems to be less emphasis on finding pragmatic and equitable solutions to communication problems. It is unlikely that Kanji would be the biggest problem in the workplace, but if they are, how can solutions such as those of my mother’s be institutionalised? The first important task, however, is to gain situated knowledge of where, when and with whom they experience the real, actual communication problems. It’s obviously important that their language learning is assisted. But as Ingrid has argued here and elsewhere, putting this responsibility squarely on their shoulders would not work. The way forward, then, is to look into how the communicative burden can be shared among the foreign workers, their Japanese colleagues and management.


Piller, I & Takahashi, K. (2011). Language, Migration, and Human Rights. In Wodak, Ruth, Paul Kerswill and Barbara Johnstone. Eds Handbook of Sociolinguistics.

Author Kimie Takahashi 高橋君江

高橋 君江 is Visiting Associate Professor at International Christian University, Tokyo. Before joining ICU in 2014, she was Lecturer at the Graduate School of English at Assumption University of Thailand (2011 – 2014) and Postdoctoral Research Fellow at Macquarie University, Australia (2007 and 2011). Kimie is an Honorary Associate in the Department of Linguistics, and continues to co-supervise several PhD students with Ingrid Piller at Macquarie University.

More posts by Kimie Takahashi 高橋君江
  • David Marjanović

    It’s of course cheap for me to say this (I’ve never even been to Japan), but, in the long run, I think kanji should be phased out altogether, as has already happened in both Koreas.

  • Emi Otsuji

    This reminds me of the NHK documentary I watched in Sep last year. It was about a philipinna eldercare worker who was made to believe that she couldnot function properly unless she knew enough kanjis… we need to break this mono-kanjual myth! It would be interesting to see what constitutes ‘langauge proficiency’ and ‘competecy’. I just read an interesting article by Kramsch and Whiteside 2008 on that. Did you read Language Ecology in Multilingual settings?

  • Mike

    Is it too cynical to suggest that the Japanese Nurses Association are more interested in protecting their own members’ interests than in solving the problem of nurse shortages? If nurses can’t come in from overseas then hospitals might have to pay more to recruit from the limited supply of Japanese nurses.

  • purpel

    Interesting topic, I thought in America we have difficult exames for nursing but it shows Japanees make things also difficult to forign nurses, they have to be happy that nurses go to japan and want to help . japanese language is not english language that everybody knows or can learn quickly .For short-term problem solving I would say they could use telephone translation what we use also in america for people who don`t speak english, instead of pushing nurses to learn Kanji while they are working.
    And for long term problem solving as Mike mention that, They sould make nursing more interesting that more people could attend nursing school.It is always burden to nurses, they make things difficult and more stressful to nurses.

  • steven

    Even japanese native speakers fail the nurses test so why would a foreigner who also has to learn written, spoken and reading Japanese at the same time pass? Once they fail (as expected), they are replaced by another group who then perform the same menial hospital tasks while ‘studying’ on these training visas.

    While there are ways around the problem, there remains the issue that many japanese do not really like dealing/working with non japanese in japan. Being such a strong mono-culture, there is always going to be the issue of foreigners not conforming to the japanese ways/expectations of doing things. Many japanese like it when foreigners can speak japanese at the ‘cute’ level but many more are literally lost for words when they have to deal with a fluent foreign speaker (unless of course that person happens to be on TV entertaining them!

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  • whats wrong with adding hiragana/furigana? Is it a cost issue?

    adding hiragana/furigana can eventually aid the learning of kanji, they will end up recognising and learning it, thus no longer needing the hiragana/furigana. kanji is a benefit to the japanese language, it can definately help you understand words you may not have already learnt. WIthout learning kanji, every word will look foreign.

    As a Japanese learner, childrens books entirely in hiragana are hard to read. the kanji helps me read more fluently.

  • Alice Sarmiento

    Bilingual hospitals set up for elderly care specific to immigrant medical workers as employees?
    has no one else had this thought?