Slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. La Salle UniversityThe La Salle Doctor of Nursing Practice program (DNP) is in response to the call for health care improvement and innovation. The program is a practice-focused doctorate with a strong clinical component in health care environments, and providing opportunities for expert knowledge and skill development through completion of clinical hours and a clinical capstone project.  The program delivered online, includes immersion experiences three times in the program, once during delivery of the Core, Advanced Core and Residency courses.
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The Clinical Nurse Leader (CNL) Certification Program is managed by the Commission on Nurse Certification (CNC), an autonomous arm of AACN, and governed by the CNC Board of Commissioners. On January 16, 2014 the National Commission for Certifying Agencies (NCCA) granted accreditation to the Commission on Nurse Certification (CNC) and the CNL Certification Program for demonstrating compliance with the NCCA Standards for the Accreditation of Certification Programs. This article will provide an overview of existing career pathways in nursing in Japan, Taiwan, and Thailand.
These three countries share strong economic and political ties and are growing nursing education programs at similarly rapid rates. This section will provide a brief presentation of the development of nursing in Japan, followed by a review of admission requirements for education programs and a description of the career pathways, including the routes and types of licensure available for general and advanced nursing practice.
Japan, which consists of four major islands as well as thousands of smaller islands, has a population of over 127 million. After completing junior high school, students interested in nursing have various options to become a Registered Nurse (RN).
National educational policies allow universities, colleges, junior colleges, nursing schools, and nursing high schools to conduct their own recruitment process. There are several levels of “generalist nursing qualifications” in Japan, including Licensed Practical Nurse (LPN), Registered Nurse (RN), Public Health Nurse (PHN), and Midwife (Ministry of Health, Labor and Welfare [MHLW], 2003). For advanced specialized licensure, certification standards are developed by various nursing organizations and academic societies such as the JNA, since national qualifications have not been standardized by the government for these exams.
This section will provide a brief presentation of the development of nursing in Taiwan, followed by a review of admission requirements for education programs and a description of the career pathways, including the routes and types of licensure available for general and advanced nursing practice. Taiwan is an island in the western Pacific Ocean with a population of approximately 23 million people.
The minimum requirement to practice nursing at a professional level in Taiwan is that of being a registered nurse (RN).
There are two systems of educational programs available to students to become a registered nurse, the Technical and Vocational Education system and the General University Education system (see Figure 2). There are 2 types of licenses recognized in Taiwan to practice nursing: registered nurse (RN) and registered professional nurse (RPN). Generally, students who graduate from the nursing high school program in the TVE system are eligible only for RN licensure, and not for the RPN licensure. In 2000, Taiwan began the development of a nurse practitioner (NP) system to improve collaboration between physicians and nurses and to provide continuous and comprehensive patient care.
Chronic diseases present an important area for career development in Taiwan, where eight out of ten leading causes of death are due to chronic diseases.
This section will provide a brief presentation of the development of nursing in Thailand, followed by a review of admission requirements for education programs and a description of the career pathways, including the routes and types of licensure available for general and advanced nursing practice. The father of the King of Thailand, Prince Mahidol Songkhla, received his medical education as a physician from Harvard University.
To date, a baccalaureate degree in nursing is the entry-level requirement for working as a professional nurse in Thailand (Ministry of Education, 2008).
To obtain a registered nursing license, students who have earned a BSN degree are eligible to take the national licensing examination.
By and large, BSN graduates have been employed by governmental and private healthcare institutions at all levels (primary, secondary, and tertiary care). As in Japan and Taiwan, advanced practice nurses (APNs) are needed due to the demand for increased specialization in patient care and health promotion. In Thailand, due to a lack of physicians, there is a crucial need for advanced practice nurses to work in primary care settings, especially those located in the rural parts of the country. NOTE: Table 3 provides a summary comparison of nursing education in Japan, Taiwan, and Thailand including entry-level admission requirements, types of programs, and licensure. Five issues and challenges that Japan, Taiwan, and Thailand have in common and that impact the career pathways of nursing students and nurses in these countries have been identified. Attaining a more established professional identity separate from physicians and unique to nursing is a goal toward which nurses in all three countries continue to strive.Although the role of nurses in the healthcare systems in Japan, Taiwan, and Thailand has unmistakably advanced in recent years, physicians continue to have a direct impact on the clinical practice and professional development of nursing. Working in an academic position, such as that of a nursing faculty member, is associated with elevated status in most Asian countries, including Japan, Taiwan, and Thailand. Additionally, nursing programs in these countries depend too heavily on the use of non-nursing clinical faculty who teach nursing content from a non-nursing perspective.
Language barriers that may lead to errors may hinder the delivery of appropriate healthcare services and even result in life-threatening consequences for patients.
Increased migration of nurses to other countries, increased international travel, and the increased mobility of global epidemics have made competency in English a necessity. Another issue related to language barriers concerns the use of textbooks translated from English. The continuation of nursing programs under the baccalaureate level delays the transition of nursing education into the university system and hinders a clear set of standards for examination and licensure. Although there has been much progress in responding to these changes in healthcare delivery, disparate routes for entry-level nursing programs persist; and widely varying levels of licensing for general practice are common, as described above.
The nursing profiles for Japan, Taiwan, and Thailand point to a number of similarities in career pathways, issues, and concerns.
Differentiation in nursing practice based upon levels of education, experience, and competency helps to define the structure and roles of professional nurses (AACN, 1995).
It may be helpful to consider that the word "crisis" in the Chinese language is derived by merging the characters "danger" and "opportunity." The future of healthcare will show that change, which is constant, brings tremendous opportunities for new growth and advancement. American Association of College of Nursing, American Organization for Nurse Executive, & National Organization for Associate Degree Nursing. AACN is governed by an 11-member Board of Directors, each of whom represents a member institution. This post-Master’s program is designed in accord with the American Association of Colleges of Nursing (AACN) Position Statement on Doctoral Education and The DNP Essentials.
This progress is due, at least in part, to the higher levels of education nurses are receiving today. For each country, a brief presentation of the development of nursing will be followed by a review of admission requirements for education programs and a description of available career pathways, including the routes and types of licensure for general and advanced nursing practice. Although distinct cultural differences exist among the three countries, the focus of this article is not on cultural differences between these countries, but rather on identifying common issues and challenges related to the preparation and development of nurses.
The use of the term “Kangofu,” meaning nurse, was first used in 1876 (Japanese Nurses Association, 2006).
They can attend a “Nursing High School” (5 year program), or attend a traditional senior high school and upon graduation, attend (a) a four-year nursing college or university, (b) a three-year junior nursing college, or c) a three-year hospital or medical affiliated training school for nurses (see Figure 1). Nursing graduates from universities are qualified to take the PHN National Board Examination.
There are three types of advanced specialized licensure: Certified Nurse (CN), Certified Nurse Specialist (CNS), and Certified Nurse Administrator (CNA). Nurses must have at least five years of clinical practice (three years in the specialty area) to be eligible to enter a CN-regulated curriculum. Nurses must have at least five years of clinical practice (three years are in the specialty area of which one year is practice after graduation) and graduate with a master’s degree to be eligible to take the CNS examination offered by JNA. Nurses who have over five years of clinical practice and management experience, as well as a master’s degree with a major in nursing management, are eligible to take the CNA examination offered by JNA. A specific career advancement opportunity for nurses in Japan is that of specializing in the area of gerontology. It was influenced during the 16th and 17th centuries by European settlers, such as the Portuguese, Spanish, and Dutch, and more recently by the Japanese who controlled the island for a period of 50 years ending in 1945 (Chiang-Hanisko, 2003). Hospitals and other healthcare institutions offer various programs to train nursing assistants.
The Technical and Vocational Education (TVE) system includes two types of entry-level nursing programs. Before the development of this system, nurses in many hospitals and some clinics who were acting in advanced roles were often viewed as "physician assistants." In recognition of the expanding role of nurses in the healthcare system, the Department of Health established national standards for training and licensure for NPs to ensure a high level of competency as advanced practice nurses.
To be qualified as an NP, nurses must have an RPN license, at least five years of clinical practice in a specialty area, and the endorsement of their hospital management (Department of Health, 2008). Chronic diseases present an important area for career development in Taiwan, where eight out of ten leading causes of death are due to chronic diseases (Taiwan Government Information Office, 2008).
Thailand, formerly known as Siam, is located in Southeast Asia and has a population of over 65 million people (Ministry of Public Health, 2007). In 1926, he initiated a relationship with and received help from the Rockefeller foundation to improve medical and nursing education in Thailand (Anders & Kunavikikul, 1999). There are different educational systems that students may attend after high school to become a professional nurse. Students who may have attended a two-year technical nursing program, popular in the 1980s, and received an associate degree in nursing (ADN), are eligible to pursue two additional years of nursing education to obtain a BSN (see Figure 3).
All new BSN graduates are employed immediately upon graduation due to an increasing demand for nurses in Thailand. The Thailand Nursing Council has established national standards for licensure and examination of all APN programs. They include identity of the nursing profession, limited faculty resources, English language barriers, transitions of nursing education, and the provision of culturally competent care. Traditionally, physicians regarded nurses as their "assistants" and closely controlled their scope of practice. This makes it relatively easier to attract nurses into academic positions in these countries than in some other countries. Faculty who entered academia in the 1970s and 1980s, and who have often been promoted based on seniority and not merit, are still actively teaching in all three countries.

Students may be taught, both in the classroom and in the clinical setting, from a biomedical standpoint, rather than from a nursing perspective.
Mastering English for medical and nursing purposes has become essential for career advancement in many Asian counties, including Japan, Taiwan, and Thailand. In addition, nurses enrolled in CNS, NP, master’s, or doctoral programs rely mainly on English language textbooks and research databases to keep abreast of the growing international body of nursing knowledge. The selection of translated textbooks is often arbitrary, and some translations do not capture the contextual meaning of the medical and nursing terminology used.
The healthcare systems in Japan, Taiwan, and Thailand are experiencing ongoing changes to increase healthcare accessibility and specialization, with an emphasis on multidisciplinary collaboration and accountability. While multiple entry points may attract more students into various nursing programs, the quality of care provided by graduates below the baccalaureate level is questionable and may be inadequate for today’s and tomorrow’s professional healthcare environment (Ozawa et al., 2006). The nursing curriculums in each of these counties provides only limited, if any, culturally specific content to guide nurses in caring for patients from cultures different from their own. Each country is faced with nursing challenges including workforce shortages, overly complex curriculum paths, a struggle for professional status, a scarcity of qualified faculty, English language barriers, a changing healthcare environment, and the demands of operating in a multicultural world. Such programs benefit the nursing profession by increasing the supply of advanced nursing specialists and faculty, generating research-related activity, and equipping nurses with higher levels of clinical expertise and leadership skills. Differentiation criteria will continue to be established as the healthcare system demands higher levels of abilities and competencies from nurses. Ratchneewan Ross is an Associate Professor at the Kent State University College of Nursing.
Puangrat Boonyanurak is an Associate Professor, Vice Rector for Special Projects, and Director of the Graduate Program in Nursing Administration at Saint Louis College, Bangkok, Thailand. Mieko Ozawa is a Professor of Nursing Administration and Informatics, and Assistant Dean of the Graduate School of Nursing at the National College of Nursing, Japan. Ling-Chun Chiang is a lecturer at Hung Kuang University, Department of Nursing, in Taichung, Taiwan.
Advanced Practice Nurses (CNS, CRNA, NP and Nurse Midwives), as well as other Master’s prepared nurses may apply. However, the goal of developing a stable nursing workforce remains elusive worldwide, due to career progression challenges related to nurse recruitment, education, retention, and promotion.
The article will conclude with a discussion of issues and challenges common to all three countries, specifically the identity of the nursing profession, limited faculty resources, English language barriers, transitioning of nursing education, and culturally competent care.
Providing a synopsis of the career patterns in each of these countries may help to identify our global workforce problems and challenges in nursing as well as provide insight into the unique approaches taken in the individual country to cultivate nursing as a national resource.
This test examines students in the areas of mathematics, science, Japanese language, foreign language, geography, history, and civics (NCUEE, 2008). Junior high school students who seek to become an LPN usually attend a high school nursing program or an assistant nursing school and are required to pass a prefectural (state) assistant nursing examination. The basic route is to study at a university in a four-year nursing program to obtain a bachelor’s degree.
Nursing graduates from junior colleges or specialized nursing schools are required to complete an additional year of public health nurse training in order to take the national PHN exam. Nursing graduates of four-year universities are qualified to sit for the Midwifery National Board Examination.
Certified Nurse Specialists are advanced practice nurses with expertise in one of ten specialized areas including: cancer, psychiatric mental health, community health, gerontology, child health, women’s health, chronic care, critical care, and infection control nursing. Certified nurse administrators are involved in issues of nurse management, organizational development, and cost-effectiveness programs. Japan will have the world’s oldest population by 2020 with over 31% of the population over 60 years of age (Ogawa & Matsukura, 2005).
Historically, the first nurse-training program in Taiwan was initiated by the Japanese government in 1897 during the Japanese occupation. However, nursing assistants are not licensed as professional nurses and usually work under the guidance of RNs performing basic nursing tasks. After completing junior high school, students can select a program of study for three to four years in a nursing high school or enter a five-year junior college nursing program. Both exams are comprehensive in scope and cover subjects in basic medicine, pathophysiology, pharmacology, medical-surgical nursing, pediatric nursing, maternal-child nursing, and psychosocial nursing. Generally, those nurses recommended by the hospital for the NP examination are functioning at an advanced level as advanced clinical specialists. For patients with chronic diseases and their family the provision, by healthcare professionals, of terminal care support to deal with death and dying has been insufficient. The country has never been colonized which is a point of great pride for the people of Thailand. The first four-year program leading to a Bachelor of Nursing Science degree was established in 1956. The first route is to attend an established, four-year nursing program at a university that is within the Ministry of Education system. The majority of nurses with ADN degrees have furthered their education towards a BSN degree since this is now the entry level degree needed to practice nursing in Thailand (Ministry of Public Health, Bureau of Policy and Strategy, 2006).
The Thailand Nursing Council has implemented programs for relicensing and continuing education to ensure nurses stay current with clinical and practice information. Candidates pursuing licensure as an APN, whether CNS or NP, must complete a master’s degree in nursing through the university-based system. More recently, nurse-physician relations have been improving, perhaps driven by serious nursing shortages and escalating healthcare costs. The use of physicians to teach undergraduate and graduate nursing courses is still common today, especially in Japan and Taiwan. Patient documentation, doctor’s orders, medications, and progress notes are often written in English. The need to be proficient in English is also necessary to participate in international nursing activities, such as international collaborative research and conferences (Chiang-Hanisko, Ross, Ludwick & Martsolf, 2006). Some nursing programs will therefore avoid the use of translated textbooks and attempt to use the original English language textbook.
Nursing education in the three countries is responding by restructuring and upgrading curricula, clinical competencies, and specialization to raise the professionalism of nursing practice. Nurses’ overlooking of cultural implications of care can result in patients experiencing misunderstanding, mistreatment, or marginalization, all of which can impede their recovery. Although the goal of a stable nursing workforce remains elusive in Japan, Taiwan, and Thailand, the enormity of change already taking place in nursing in these countries, and indeed in all of Asia, should not go unnoticed.
Future career pathways for nurses will occur as nurses more clearly define their identity, increase their skills, and adapt to new work environments.
Her research areas include immigrant health, with a focus on older adult populations, and transcultural nursing. She received her PhD from the Frances Payne Bolton School of Nursing, Case Western Reserve University. She completed her MSc and PhD degrees in health sciences at the Graduate School of Medicine, University of Tokyo.
She is a member of the Curriculum Advisory Committee and Chairperson of the Student Affairs Committees providing guidance to nursing students on course selection and careers. A trial calculation of how many newly graduated nurses can be trained at National Hospital Organization facilities that satisfy provisional standards on desirable educational systems. Challenges, strategies, and priority areas for nursing and midwifery research: Report of the preconference on nursing and midwifery research. This article provides an overview of existing career pathways in nursing in three Asian countries: Japan, Taiwan, and Thailand.
A formal licensing system for nursing professionals was created in 1899 with the enactment of the “Midwifes Ordinance,” followed by the Registered Nurses Ordinance in 1915, and the Public Health Nurse Ordinance in 1941.
Universities, colleges, and junior colleges can use these test results as well as their own admission criteria to evaluate an examinees’ capabilities (Lambert, Lambert, & Petrini, 2004). LPNs are permitted by law to carry out many of the same duties as an RN under the direction of a doctor, dentist, or RN.
Students can also attend a junior college nursing program for three years or a specialized nursing school for three years. After passing the examination, nurses with the PHN license can provide public health guidance in community, school, and workplace settings.
Nursing graduates from junior colleges or specialized nursing schools are required to complete an additional year of midwifery training to become eligible to take the national Midwifery examination. CNSs can positively influence care by providing advanced patient assessment and expert consultation to patients in their area of specialty. Nurses with specialized knowledge and training will increasingly be needed in order to plan and deliver quality care to meet the needs of older adult populations. Nurses were called “Kan-Hu-Fu,” which means “the woman who looks after the sick people” (Chen & Tsai, 2001). Upon completion of either entry-level program, students can continue their nursing education by attending a two-year nursing college or a four-year institute of technology. The RPN examination is considered more difficult since it tests more theoretical and conceptual nursing knowledge as well as advanced medical knowledge. Once identified as a qualified candidate, they are eligible to take the NP examination which is both written and oral. This history and spirit of independence led to a change in the name of the country from Siam to Thailand, meaning the land of the free (Ross & Ross, 2008). The first master’s program was started in 1973, and the first doctoral program in 1984 (Anders & Kunavikikul). To enter these programs, high school graduates must take a rigorous national entrance examination that includes subjects such as biology, chemistry, English, Thai language, social studies, and mathematics. The Thailand Nursing Council is responsible for the licensure examination for BSN graduates to become registered nurses.
CNS specialization areas include medical and surgical, pediatric, mental health and psychiatric, geriatric, and maternity nursing. To meet this need, the Nursing Council of Thailand, along with government assistance, must continue innovative initiatives to entice advanced practice nurses into the area of rural healthcare.

Many physicians have begun to realize that collaboration with nurses may result in improving nurse retention, reducing overall healthcare costs, and ultimately reaching more positive patient outcomes. Newer, doctorally prepared faculty members, too, often have limited clinical exposure and do not understand the realities of nursing practice. Many teaching hospitals and universities prefer that physicians teach nursing courses due to their perceived greater technical and clinical expertise. Yet, this can often be a burden to nursing students and faculty with limited English-language-proficiency skills. Also, the complexity of the nursing education system and licensure process can be confusing to the public and negatively impact the image of nursing. Greater emphasis on providing culturally competent care is needed to ensure that nurses are prepared to work in a multicultural world.
For example, as the debate continues whether multiple entry points for nursing education and licensing is compatible with today’s healthcare needs, more employers are showing a preference for BSN-prepared nurses. Developing new career pathways during times of nursing shortages and workforce instability is challenging. She is currently Chair of the Research Awards Committee for the Transcultural Nursing Society and member of the University Research Council at Kent State University.
Her research areas include depression and self-esteem (among HIV-positive perinatal women and nursing students), sexual violence, and adolescents’ risk behavior and health promotion. She is a World Health Organization scholar and visiting professor at the National College of Nursing, Tokyo, Japan. Her research interests are organizational commitment, leadership, and continuing education in nursing with a focus on work outcomes, such as improved job performance and high quality care. She obtained her master’s degree in nursing from Emory University, and is currently enrolled in the doctoral program at the Frances Payne Bolton School of Nursing, Case Western Reserve University. Paper presented at the International Network for Doctoral Education in Nursing (INDEN) conference: A Global Agenda for Nursing Doctoral Education, Taipei, Taiwan. For each country, a brief presentation of the development of nursing is followed by a review of admission requirements for education programs, and a description of available career pathways, including the routes and types of licensure for general and advanced nursing practice.
Despite this progress, the goal of developing a stable nursing workforce remains elusive worldwide. In 1946, after World War II, the Japanese Association of Midwives, Registered Nurses, and Public Health Nurses was established and became the Japanese Nursing Association (JNA). For master and doctoral programs, each university has established its own set of criteria for admittance. Students who complete any of these programs are entitled to take the national examination to become a registered nurse. With Midwifery licensure, nurses can enter into their own practice or work in cooperation with a doctor at a maternity clinic.
Certified nurses provide advanced nursing practice, leadership, and consultation in 19 specific areas. They may also take on a higher level of clinical and professional leadership as well as participate in research activity. This continues be a critical nursing workforce issue considering the current shortage of nurses as well as the lack of advanced practice nurses trained in gerontological nursing. During the occupation, nurses were trained and educated both by the Japanese and by missionaries from western countries such as Belgium, Canada, Switzerland, and the United States.
The second system, the General University Education (GUE) system, accepts students from traditional senior high schools and provides four years of nursing education at a university level (Yu et al., 2005). Presently, the Taiwanese government is in the process of raising the educational requirement for RPN licensure to a bachelor’s degree.
Upon successful completion of the examination, they enter into a concentrated, hospital-based training program lasting for at least six months. Co-Shi Chao (known as the “Mother of Hospice Care”) has been promoting the need for hospice and palliative care since 1993 (Chao, 2005), cultural acceptance of the hospice concept, the living will and the DNR directive has faced some resistance in general society. The first school of nursing and midwifery in Thailand was established at Siriraj Hospital in 1896 in Bangkok.
During the past ten years, the number of nursing schools has increased significantly under the leadership of governmental and private institutions. A high grade point average from high school and acceptable performance on an additional entrance examination administered by the particular institution may also be required. This trend towards greater nurse-physician collaboration is encouraging; yet the traditional attitudes of “nurse as an assistant” and physician as “principal authority” in patient care decisions persist today.
This lack of current clinical experience brings about a disconnect between education and clinical practice (Chou et al., 2005). A shortage of qualified nursing faculty results in this continued reliance on physicians to teach in nursing programs.
For example, when a diabetic patient’s diet order has been written as “sugar free,” a non-English speaking nurse may interpret this to mean the “free use of sugar.” Such an interpretation could result in the patient experiencing a dangerously high level of sugar in the blood. Opportunities for career growth may be restricted for nurses with limited English-language proficiency. Discontinuing nursing programs under the baccalaureate level can help to move the profession of nursing forward. As universities expand nursing programs and increase the number and quality of nursing graduates, the BSN degree as a standard for entry-level nursing positions is gaining wider acceptance. Her research areas include nursing care quality, nursing management, caring, HIV, and maternal-child health. East meets west: A comparison between undergraduate nursing education in Japan and in the United States.
The article concludes with a discussion of issues and challenges common to all three countries, specifically the identity of the nursing profession, limited faculty resources, English language barriers, transitioning of nursing education, and the provision of culturally competent care. The JNA is a professional nursing organization that represents public health nurses, midwives, professional nurses, and assistant nurses (JNA, 2006).
LPNs who desire to become an RN are required to attend a junior college or specialized nursing school for two additional years before taking the national examination. Acceptance into either system is based upon scores on a national exam, high school grade point average, and participation in school activities.
The training is largely guided by physicians and includes 160 hours of coursework in advanced pharmacology, advanced pathophysiology, advanced health assessment, clinical judgment, health promotion and disease prevention, and medical law and ethics. Recently, with the support of government, religious, and medical leaders, the need for hospice and palliative care services have become more widely accepted in Taiwanese society.
At present, there are at least 60 undergraduate, 45 master, and 12 doctoral programs in Thailand. In most circumstances, available seats for nursing students are very limited at the university level compared to those in the United States. Pharmacology and pathophysiology are not separated from but incorporated into these nursing subject areas.
Candidates must complete a clinical practicum under the supervision of a physician or an APN (one APN per two students). Qualified nursing faculty are needed to develop and guide nursing students to fulfill their role as professional nurses, thereby empowering nurses with greater autonomy and control over nursing practice. The Public Health Nurse, Midwife and Nurse Law introduced in 1948 was designed to raise the standards of professionalism for nurses through regulation of practice, education, and examination.
As the demand for nurses increased, academic programs in nursing were established at the vocational level in high schools, as well as in institutes, colleges, and universities. Entrance to both systems is highly competitive and high scores on the national exam are a prerequisite to acceptance. In addition, candidates must complete a clinical practicum under a physician’s supervision with at least 30 medical or surgical patients and at least 10 acute and critical patients. To address these needs, even more nurses need to be prepared at the advanced practice level to offer palliative treatment and support in acute care hospitals, home care settings, and hospice centers. In 1985 the Nursing Council of Thailand was established to promote education and research and monitor the professional conduct of nurses and midwives. The second route is to enroll in a nursing program sponsored by the Ministry of Public Health, the military, a police department, a metropolitan school, the Red Cross, or a private university (Anders & Kunavikikul, 1999). The first graduate nursing program offering a master’s degree was started in 1979, and the first doctoral program began in 1997 (Department of Health, 2000).
Mathematics, general science, biology, social sciences, English, and Chinese literature are subjects generally tested on the national exam.
After successful completion of the practicum, candidates are awarded an NP license which is renewable every six years. As with Japanese and Taiwanese nurses associations, the Thailand Nursing Council is expanding its interest and activities beyond the national level (Thailand Nursing Council, n.d.
An entrance examination is also required by each institution for admission into master’s and doctoral programs and available seats are very limited.
As of April, 2006, Japan had 146 universities and colleges offering the bachelor’s degree in nursing with 87 of these programs providing postgraduate nursing education, 37 of which offer doctorate level courses (JNA, 2008a). By 2008, educational programs to meet the demands for nursing professionals had expanded to 39 schools, including 14 associate, 25 undergraduate, 16 master’s, and 11 doctoral programs (Department of Statistics, 2008).
For master’s and doctoral programs, entrance criteria and requirements are set by each individual university. The Nurses Association of the Republic of China was first founded in 1914 and later renamed the Taiwan Nurses Association (TWNA) in 1999. The TWNA works to promote the standards for professional nursing practice, education, and research on both the national and international levels (TNA, 2008).

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