153 

 

A COMPARATIVE STUDY OF NURSING EDUCATIONAL SYSTEM IN 

INDONESIA AND JAPAN 
 

Susiana Nugraha,* Mika Tanaka,** Ferry Efendi*** 

 
* Member of Indonesian National Nursing Association 

** Faculty of Nursing Fukuoka University, 8-19-1 Nanakuma, Jonan-ku, Fukuoka 814-0180, 

Japan, (Tel) +81-92-871-6631 

***Faculty of Nursing Airlangga University Indonesia, Jl. Mulyorejo Kampus C Unair Surabaya 

60115 Tel/Fax: (031) 5913257 

E-mail: fefendi@gmail.com 

   

ABSTRACT 

 

Introduction: According to the Economic Partnership Agreement (EPA) between the Indonesian 

and Japanese governments, the Japanese government plans to recruit Indonesian nurses and 

caregivers to fulfill the demands of those positions at hospitals and health centres. However, to be 

a qualified worker in Japan, one has to pass a national examination that is conducted by the 

Minister of Health, Labor, and Welfare for a license as a registered nurse within 3 or 4 years of 

working as a nurse or caregiver, respectively. Method: Having considered that matter, a 

comparative study of the background of educational systems in Indonesia and Japan is discussed in 

this paper, with particular reference to the Diploma 3 nursing program. Result: There is no 

specific difference between the Indonesian and Japanese nursing education systems. Discussion: 

However, the current health condition of the countries remains the focus of the curricula where 

Indonesian nursing education is focused on communicable disease and surgery nursing, whereas 

the Japanese system focuses on gerontology and chronic disease nursing. In terms of the 

qualification method, Japanese nurses should undertake a national board examination to be a 

qualified nurse. On the other hand, there is no national board examination for Indonesian nurses. 

 

Keywords: nursing education system, Indonesia, Japan 

 

 

INTRODUCTION 

 

Japan and Indonesia have been 

working towards an Economic Partnership 

Agreement (EPA), a comprehensive bilateral 

economic agreement that will include 

liberalisation of trade in goods and services, 

as well as cooperation in the fields of 

investment, competition policies and people 

movement (Purnama, 2007). As a part of the 

implementation of Article 7 of the EPA 

regarding the “people movement”, the 

Japanese government plans to recruit 

approximately 400 nurses and 600 caregivers 

within a two-year-period (MOFA, 2008).  

On 5
th

 August 2008, the first group 

of Indonesian nurses arrived in Japan 

(BNP2TKI, 2008). Having been trained for 

Japanese language and introduced to 

Japanese nursing systems for the first six 

months after arrival, they had to face a 

national nursing board examination (MOFA, 

2008). The examination was conducted in 

Japanese, using Japanese characters and 

Chinese characters (Kanji). Furthermore, the 

nurses and caregivers have to pass a national 

test within three and four years respectively, 

as a requirement to continue working in 

Japan (MOFA, 2008).  

The agreement has opened up an 

opportunity for Indonesian nurses to find a 

new labour market. Indonesian nursing 

educational institutions graduate 

approximately 15,000 nurses annually 

(Nursalam and Efendi, 2008). However, due 

to inappropriate health care and worker 

distribution systems, the Indonesian labour 

market can only accept a minimum number 

of nurses (Suwandono et al., 2005). This 

agreement also brings some benefits to 



Jurnal Ners Vol. 3 No. 2 Oktober 2008-Maret 2009: 153-159  

154 

 

Indonesian nurses and caregivers i.e. they 

gain new experiences and learn different 

systems in the nursing profession. Therefore, 

these experiences can be applied in Indonesia 

or internationally, and the quality of 

Indonesian nurses will be considered 

consequently. 

According to Okamoto (1992), 

improvement in living standards among 

Japanese people and increases in medical 

care usage have caused a rapidly aging 

population, decreased the death rate caused 

by tuberculosis for all age groups and other 

infectious disease and caused falls in 

mortality among infants, adolescents and 

young adults. Increasing the numbers in an 

aging population means an increase in 

demands on medical care. The demand for 

nursing workers has outpaced the supplies, 

due to the development of medicines, 

increasing the numbers of beds and aging 

patients (Kanai-Pak et al., 2008). 

Additionally, a number of nursing workers 

are required in various areas. Implementation 

of long-term care insurance encourages the 

place for treating and rehabilitating patients 

with chronic illnesses to be shifted from 

hospitals to facilities for long-term care, 

home medical care and visiting nursing 

(Sawada, 1997). Having considered those 

conditions, through the EPA agreement, the 

Japanese government has opened the labour 

market for foreign nurses as stipulated in the 

memorandum of understanding (MOFA, 

2008).  

Success of EPA implementation will 

bring a lot of benefit for both countries and to 

achieve that objective, both Indonesian 

nurses and Japanese nurses need to 

understand each other. Indonesia and Japan 

have different backgrounds in terms of 

language and culture. This is a big challenge 

for both nurses while working in the same 

hospital, although they have the same 

background in nursing. In terms of nursing 

skill, there is no question of the nurse‟s skill. 

This is because the nurse has the same 

background in nursing education. And each 

country has its own caring character. 

This paper describes Indonesian and 

Japanese nursing educational backgrounds in 

order to figure out a general description of 

their educational systems. Having 

comprehended the educational systems, the 

capability of nurses in terms of knowledge 

and skill in nursing would be known. The 

other advantage is to complementing their 

liability and majority while caring the 

patients. Comparison of educational 

background would be the first step to 

knowing their competence and potential in 

the working field. In advance, this 

comparison will figured their majority and 

shortage in nursing knowledge. By 

understanding this condition, Japanese and 

Indonesian nurses will be able to have mutual 

charge on knowledge and experience in the 

working field. Besides this, during the EPA 

agreement for nurse recruitment, Indonesian 

and Japanese nurses will be better prepared 

for future recruitment. 

A comparative descriptive study was 

performed based on databases of published 

materials and electronic journals. This 

comparison focused on a curriculum that was 

stipulated by government law for a Diploma 

3 (D-3) degree of nursing education.  

 

RESULT 

Indonesian Nursing 

 In general, nursing educational 

institutions in Indonesia consist of two kinds 

of educational path, i.e. undergraduate 

program (S-1) and diploma program (D-3), 

after completing a basic educational program 

at Senior High School (Figure 1). These 

nursing schools provide curricula as 

stipulated by the National Education Systems 

No. 20/2003 of the Ministry of Education, 

which adopted the recommendation from the 

Indonesian Nurses‟ National Association. 

The number of nursing educational 

institutions in Indonesia is 427 and 173 for 

D-3 and S-1 levels, respectively, while the 

average number of graduates is 12,810 and 

3,460 for D-3 and S-1 levels, respectively 

(Nursalam and Efendi, 2008). 

 

 

 

 

 

 

 

 

 

 

 

Figure 1. Indonesian nursing educational path 

High school 

University 
level/Bachelo

r 

Pre-employment test 

 

Being a nurse 
 

Nursing 

school/Diploma 



A Comparative Study of Nursing Educational System (Susiana Nugraha, dkk.) 

155 

 

 The curriculum for the S-1 program 

consists of academic and professional phases. 

Having completed the academic phase in 8 

semesters, students are required to conduct 

research that will be examined at the end of 

the academic phase for a bachelor degree. 

Furthermore, they have to continue to the 

professional phase for two semesters in order 

to get a Ners degree. In this phase, students 

have to conduct nursing practices in a 

hospital under supervision in 9 divisions of 

nursing science, i.e. Nursing Management, 

Emergency Nursing, Maternity Nursing, 

Medical Surgical Nursing, Mental Health 

Nursing, Pediatric Nursing, Family Nursing, 

Community Nursing and Geriatric Nursing. 

 On the other hand, the curriculum of 

D-3 also consists of the academic phase and 

the professional phase which can be fulfilled 

in 6 semesters, but in contrast to the S-1 

program, both of the phases are integrated. 

At the end of each semester of academic 

activities, students are required to continue 

directly to nursing practices in hospitals 

under close supervision. The nursing 

practices from semester 1 to 4 are fulfilled by 

simple nursing practices, such as taking 

temperatures or measuring the blood pressure 

of patients. Afterwards, for the whole of 

semesters 5 and 6, students are required to 

conduct comprehensive practices (Nursalam 

and Efendi, 2008).  

These educational institutions 

provide curricula for the applicable 

qualifications as stipulated by law. According 

to Decree of the Ministry of National 

Education No. 139/U/1999, the D-3 program 

has 96 credits and consists of class lectures, 

laboratory practices and clinical training with 

a duration of over 4,800 hours (Table 1) 

(Nursalam and Efendi, 2008). 

 The nursing school curriculum 

guidelines stipulate the range of class hours 

per credit i.e. 18 hours for lectures, 36 hours 

for experiment and skill practices and 72 

hours for clinical training. Instead of the 

above curriculum, each institution has to 

apply some local curricula which are decided 

by each institution for 14–24 credits. Each 

institution determines class hour equivalents 

to a credit (Ministry of Education and 

Culture, 1999). 

 Having graduated from nursing 

school, one is qualified to work as a nurse in 

a hospital as a professional nurse.  

Table 1. Indonesian national curriculum for 

D-3 program 
Group 

lectures  

Subject Credits Total 

General 

lecture 

Religion 

Citizenship 

General ethics 

The five basic 
principal of the 

Republic of Indonesia 

2 

2 

2 

2 

8 

Basic 

skill 

lecture 

Anatomy  

Physiology and 

biochemistry 

Nutrition 
Microbiology and 

paracytology  

Pharmacology 

Pathology 

2 

2 

 

2 
2 

 

2 

2 

12 

Skill 

lecture 
and 

clinical 

training 

Fundamentals of 

nursing 
Basic human needs 

Nursing ethics 

Communication in 

nursing 
Health promotion 

Nursing 

documentation 

Medical surgical 
nursing  

Pediatric nursing  

Maternity nursing  

Mental nursing  
Community nursing  

Emergency family 

nursing 

Emergency nursing 
Geriatric nursing 

Professional nursing 

Management and 

leadership in nursing 
Nursing research 

4 

 
8 

2 

2 

 
2 

2 

 

17 
 

6 

5 

5 
9 

3 

 

3 
2 

2 

2 

 
2 

76 

Total   96  

 

  Nurses who graduate from Bachelor 

of Nursing programs are called professional 

nurses and nurses who graduate from 

Diploma III in nursing are called beginner 

professional nurses. A professional nurse is a 

person who passes the higher level of 

accredited education. The beginner 

professional nurse is a nurse who has good 

knowledge of intellectual, technical, 

interpersonal and moral, responsibilities in 

delivering nursing services based on valid 

regulations. Currently, there is no national 

board examination for nursing qualifications 

in Indonesia. The Indonesian government and 

Indonesian nurse association are working 

towards creating a national standardisation 

for nurses (Hennessy et al., 2006). 

However, the current valid system is 

based on the regulation of Decree of the 

Ferry Efendi 



Jurnal Ners Vol. 3 No. 2 Oktober 2008-Maret 2009: 153-159  

156 

 

Ministry of Health No. 1239/2001 about 

Nurse Registration and Practice. Having 

graduated from nursing school (D-3 and S-1 

programs), a student should apply for a 

nursing permit (Surat Ijin Perawat) to the 

local government at least one month after 

graduation (Ministry of Health, 2001). Since 

they hold the nursing permit, they can apply 

to work in the hospital or other health care 

centres. In addition, each hospital has its own 

standard for accepting a nurse. In general, 

nurses have to pass the hospital pre-

employment examination – a written and 

clinical practice test. Having been accepted 

as an employee of a hospital or health care 

centre, the nurse should apply for a working 

permit (Surat Izin Kerja) which is published 

according to the results of skill and 

knowledge assessments and compliance with 

nursing ethics.  

 

Japanese Nursing 

 

Rapid growth in nursing at university 

level has contributed to the development of a 

nursing profession in Japan (Turale et al., 

2008, Turale et al., 2009). There are several 

educational institutions for becoming 

professional nurses in Japan. For registered 

nurses, the basic route would be to complete 

senior high school, after that, study at a 

nursing university (four-year bachelor degree 

course), junior nursing college (three-year 

associate degree course) or nursing school 

(three-year course) (Figure 2). Besides a 

registered nurse, there is a two-year course 

for a nurse assistant.  

 
Figure 2. Japanese nursing educational path 

 

A nurse assistant is defined as a 

nurse engaged in providing nursing care 

under instruction from medical doctors or 

registered nurses (Turale et al., 2008). 

In addition 6-month (normally one 

year) education is prepared in nursing 

schools and universities for public health 

nurses and midwives. Students who graduate 

from these educational institutions are 

entitled to take the examination to become a 

registered nurse. In 2006, the numbers of 

nursing educational institutions in Japan were 

158 for universities, 37 for junior colleges 

and 512 for nursing schools. 11,906 or 32.7% 

of nurses graduated from universities, 

whereas 1,982 or 5.4% of nurses were from 

junior college and 22,549 or 61.9% were 

from nursing school. 

This part is focused on the 

curriculum for a registered nurse. The 

educational institutions provide curricula for 

the applicable qualifications as stipulated by 

law. The credits required to be entitled to 

take the governmental examination are 97 

units for a registered nurse (in 2009, the 

public health nurse, midwife and nurse 

regulations were revised in credits for the 

enrichment of nursing skills and the ability to 

deal with nursing ethics, nursing 

administration and residential nursing in 

nursing students). The duration of the 

curricula is three years (over 3,000 hours of 

lectures and clinical training). Each 

institution determines class hour equivalent 

to a credit. The nursing school curriculum 

guidelines stipulate the range of class hours 

per credit i.e. 15–30 hours for lectures, 30–45 

hours for experiment and skill practices and 

45 hours for clinical training (Japanese 

Nursing Association, 2008). As shown in 

Table 2, the total credits for the diploma 

three are 97 credits. 

A registered nurse is qualified as a 

professional nurse by government 

examination. Having graduated from an 

educational institution that provides a 

curriculum for the applicable qualifications, 

graduates are entitled to take the 

governmental examination that was 

conducted by The Minister of Health, Labor, 

and Welfare, for a license as a registered 

nurse (Japanese Nursing Association, 2008, 

MHLW, 1984) 

 

 

High school 

Junior 

College 

University/

Bachelor 

Registered Nurse National Board 

Examination 

 

Work as a Registered Nurse 

Nursing 

school/Diploma 



A Comparative Study of Nursing Educational System (Susiana Nugraha, dkk.) 

157 

 

Table 2. Japanese national curriculum for D-

3 program 

 

. 

The national examination for 

registered nurses consists of essential 

questions (30 items), general questions (150 

items) and questions concerning certain 

clinical cases (60 items). Questions 

concerning clinical cases evaluate the ability 

of the nurse to understand and judge the 

situations which nurses would meet in 

hospital. Information about the patient such 

as symptoms, physical and mental condition, 

age, sex and sociological background are 

given to answer the questions. Areas of 

questions are the structure and function of the 

human body (anatomy, physiology, 

biochemistry, nutritional science), disease 

mechanisms and recovery promotion 

(pathology, pharmacology, microbiology), 

social security systems and people‟s health 

(public health, social welfare, related laws), 

fundamental nursing, residential nursing, 

adult nursing, geriatric nursing, pediatric 

health nursing, maternal nursing and mental 

health nursing. All items in the examination 

are multiple-choice (Japanese Nursing 

Association, 2008).  

Students are required to get a score 

over a pass standard. Essential questions 

must be correctly answered in order to pass, 

otherwise in the case of errors in these 

questions the student will fail the 

examination. The examination pass rates 

were 90.6% in 2007 and 90.3% in 2008. 

 

DISCUSSION 

In terms of educational paths, there is 

no specific difference between Indonesian 

and Japanese nursing educational systems, as 

shown on Table 3. The basic difference is in 

the method of qualification for nurses. 

Japanese nurses have to undertake a national 

board examination to become a qualified 

nurse, whereas there is no national board 

examination for Indonesian nurses. In 

addition, current health conditions in the 

countries remains the focus of each 

curriculum. Indonesian nursing education 

focuses on communicable disease and 

surgery nursing, whereas the Japanese 

education focuses on gerontology and 

chronic disease nursing.  

 

 

Table 3. Nursing educational background in 

Japan and Indonesia for D-3 

program 
Aspect Indonesia Japan 

Content of 

curricula 

Majority in 

medical surgical 

nursing 

Majority in 

geriatric nursing 

and adult 

nursing 

Qualificati

on method 
 

 

 

No national board 

examination. The 
capability to work 

selected based on 

hospital pre-

employee 
examination. 

 

Capability to 

work selected by 
the nursing 

national board 

examination. 

Hospitals 
conduct an 

employment test 

to hire registered 

nurses. 

Contents 
of the test  

Written and 
clinical practice 

test 

Written test 

Midwife 

and public 

health 

nurse 
course 

Separately given 

in different 

institution for 

minimum three 
year course. 

Given after 

completing the 

nursing course 

for minimum of 
six months. 

 

Group 

lectures  

Subject Credits Total 

General 

lecture 

Introduction to 

scientific approach 
Understanding 

humans and human 

living society 

13 

 

13 

Basic 

skill 

lecture 
 

Structure and 

functions of the 

human body 
Disease mechanisms 

and recovery 

promotion 

Social security 
systems and people‟s 

health 

15 

 

 
6 

21 

Skill 

lecture 

and 

clinical 
training  

Basic nursing 

Adult health nursing 

Geriatric nursing 

Pediatric health 
nursing 

Maternal nursing 

Mental health nursing  

Home health nursing 
Integrated nursing 

and practice 

Clinical training 

Basic nursing 
Adult health nursing 

Geriatric nursing 

Child health nursing 

Maternal nursing 
Mental health nursing  

Home health nursing  

Integrated nursing 

and practice  

10 

6 

4 

4 
 

4 

4 

4 
4 

 

 

3 
6 

4 

2 

2 
2 

2 

2 

63 

Total  97  



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158 

 

To be qualified as a nurse in Japan, 

Indonesian nurses also have to pass a 

Japanese nursing national board examination, 

which is held once a year at the end of 

February (Japanese Nursing Association, 

2008). Upon arrival nurses and caregivers are 

taught the Japanese language and introduced 

to Japanese nursing systems for six months 

(MOFA, 2008). For the first period of arrival 

in the middle of August, the nurse has three 

chances at the examination and finishes in 

the middle of February (Clinder, 2008). The 

probability of Indonesian nurses passing at 

the first chance of examination would be 

questionable, since they have no special 

preparation in the Japanese language and 

Japanese nursing systems before coming to 

Japan.  

Japanese people very much respect 

the psychological condition of the patients 

and Japanese nurses always pay special 

attention to their psychological condition 

(Japanese Nursing Association, 2008). 

Therefore, intensive learning of the Japanese 

language, culture and Japanese nursing 

systems in the working field would be an 

important point to help Indonesian nurses 

pass the nursing examination and be accepted 

for work as a real nurse. Consequently, a 

regulation from the Japanese government is 

needed for the hospitals which recruit foreign 

nurses to achieve this purpose.  

People believe it is unreasonable to 

insist that Indonesian nurses take exactly the 

same examination that Japanese nurses do 

and such a strict requirement could cause a 

lot of valuable workers to be simply thrown 

away (Clinder, 2008). However, based on the 

long-term experiences of sending nurses 

abroad, most Indonesian nurses have been 

acknowledged by receiving countries to have 

good personalities, such as being kind, 

having sympathetic attitudes for patients and 

being likely to have a good relationship with 

the patients and this, in turn, supports their 

job effectively. These conditions were 

believed to allow Indonesian nurses to 

survive against the language barriers and 

differences in nursing systems.  

 

CONCLUSION 

 

This paper describes insights about 

nursing education and the nursing 

systems of Indonesia and Japan. 

Nevertheless, the illustration is only 

given in general; further research would 

be needed to describe it in detail. 

Comprehension of educational 

backgrounds of nursing and the nursing 

systems of both countries will enhance 

the relationship between nurses from 

Indonesia and Japan
 

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