A Comparative Study of the Lived Experiences of Indonesian Caregivers in Japan and the Returnees in Indonesia

citation : Nugraha, S., Tanaka, M., & Efendi, F. (2008). A Comparative Study of Nursing Educational System in Indonesia and Japan. Jurnal Ners3(2), 1-11.

Based on the effective implementation of Economic Partnership Agreement (EPA) between Indonesia and Japan the mobility of caregivers from Indonesia to Japan has started since 2008. From Indonesian perspective, this is the first time for the country to send out nurses to work as caregivers under a bilateral agreement. However, the notion of ‘caregiver’ is often associated with domestic work without professional training which invites debates on the issue of nurse deskilling. The latest data from the National Board for the Placement and Protection (BNP2TKI) in 2014 showed that 167 Indonesian nurses worked as qualified caregivers in Japan. In addition, 295 caregivers have returned home due to some circumstances. Despite the original intention of the EPA that foreign caregivers are expected to pass the examination in order to continue working in Japan, the high proportion of Indonesian caregivers returning to Indonesia challenges the underlying assumption and the sustainability of the EPA.


In term of educational path, there is no specific difference between Indonesian and Japanese nursing educational systems, as shown on Table 3. The basic difference is on the method of qualification for the nurses. Japanese nurses should undertake national board examination to be a qualified nurse, whereas there is no national board examination for Indonesian nurses. In addition, current health condition of the countries remains the majority of the curriculums. Indonesian nursing education is focusing on communicable disease and surgery nursing, whereas Japanese is focusing on gerontology and chronic disease nursing. To be qualified as a nurse in Japan, Indonesian nurse also have to pass Japan nursing national board examination, which is held once a year at the end of February. Upon arrival nurses and caregivers will be taught Japanese language and introduced Japanese nursing systems for six months. For the first period of the arrival in the middle of August, the nurse will have 3 chances of examination, and will finish in the middle of February. The probability of Indonesian nurses to pass the first chance of examinations would be questionable, since there is no special preparation on Japanese language and Japanese nursing systems before coming to Japan. Japanese people are very respect on psychological condition of the patients, and Japanese nurse thought to always pay special attention on their psychological condition. Therefore, intensive learning on Japanese language, culture and Japanese nursing systems in the working field would be an important point to help Indonesian nurses to pass the nursing examination and be accepted to work as a real nurse. Consequently, a regulation from Japanese government is needed for the hospitals which recruit foreign nurses to reach this purpose. People believe it is unreasonable to insist that the Indonesian nurses take exactly same examination that Japanese nurses do, and such a strict requirement could cause a lot of valuable workers to be simply thrown away (www.japanprobe.com). However, based on the long term experiences on sending the nurses abroad, most of Indonesian nurses have been acknowledged by the receiving countries as having good personalities, such as kind, sympathetic attitudes for patients, and are likely to have a good relationship with the patients, and this in turn supports their job effectively. These conditions were believed those Indonesian nurses are able to survive against the language and difference nursing system.

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Nursalam and F. Efendi, PENDIDIKAN DALAM KEPERAWATAN . Jakarta: Salemba Medika, 2008.

Salah satu aspek penting dalam pendidikan saat ini yang perlu mendapat perhatian adalah mengenai konsep pendidikan untuk orang dewasa. Tidak selamanya kita berbicara dan mengulas seputar peserta didik yang berusia muda (andragogi). Kenyataan di lapangan, bahwa tidak sedikit orang dewasa yang harus mendapat pendidikan baik pendidikan informal maupun nonformal, misalnya pendidikan dalam bentuk keterampilan, kursus-kursus, penataran dan sebagainya. Dalam pendidikan keperawatan sendiri, kita memiliki dua jalur yaitu program A dari SMA dan B atau khusus dari Diploma 3. Kelas upgrade atau program B mayoritas didominasi peserta didik dengan kategori usia dewasa. Masalah yang sering muncul adalah bagaimana kiat dan strategi membelajarkan orang dewasa yang tentunya memiliki keunikan tersendiri. Dalam hal ini, orang dewasa sebagai peserta didik dalam kegiatan belajar tidak dapat diperlakukan seperti peserta didik biasa yang sedang duduk di bangku sekolah tradisional. Oleh sebab itu harus dipahami bahwa orang dewasa yang tumbuh sebagai pribadi
dan memiliki kematangan konsep diri bergerak dari ketergantungan seperti yang terjadi pada masa anak-anak menuju ke arah kemandirian atau pengarahan diri sendiri.

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A deskilling and challenging journey: the lived experience of Indonesian nurse returnees

Kurniati, A., Chen, C. M., Efendi, F., & Ogawa, R. (2017). A deskilling and challenging journey: the lived experience of Indonesian nurse returnees. International Nursing Review, n/a-n/a. https://doi.org/10.1111/inr.12352

Aim: To illuminate the lived experiences of Indonesian nurses who previously worked as caregivers in Japanese residential care facilities, by exploring the journey of becoming returnees.
Background: The creation of bilateral agreements between Indonesia and Japan has facilitated the
movement of Indonesian nurses to work as caregivers in Japan since 2008. While this decision raised concerns with regard to the degradation of nursing skills, little is known about this issue from the perspective of nurse returnees and how the experience affects their life.
Method: A hermeneutic phenomenological method was employed for this study. A purposive sample of 15 Indonesian nurse returnees participated in this study. Semi-structured interviews were conducted in four of Indonesia’s provinces between August and October 2015. Data were analyzed thematically, supported by QSR NVIVO 10 software.
Findings: Four key themes emerged from the data analysis: (i) returning home; (ii) going back to zero; (iii) walking through a difficult journey; (iv) overcoming barriers. These findings described the lived experiences of nurse returnees when they got back to the country of origin.
Conclusion: Indonesian nurse returnees experienced deskilling and struggled to re-enter the nursing profession or to find other non-nursing jobs. The significant impact of this migration on individual nurses with regard to maximizing the benefits of return migration deserves further investigation. Implication for nursing and health policy: The Indonesian government, jointly with other stakeholders, should develop a brain gain strategy to align returnees’ expertise with the needs of the national labor market. The public-private partnership should be strengthened to utilize returnees in healthcare services


For returnees in this study, their homecoming was driven by contract termination as a result of failing the examination, family consideration and the feeling of being under pressure in Japan. This ?nding is in line with other return migration studies. Expired contracts have been among reasons compelling the return of Filipino nurses to their home country (Lorenzo et al. 2007). Cassarino (2008) reported that 12.6% of North African migrants were forced to return home due to losing their job. Family was among the strong motives for returning home considered by Ghanaian health professionals (Adzei & Sakyi 2014) and Indonesian nurses (Hirano et al. 2012). In our study, returnees who were both certi?ed and  non-certi?ed caregivers claimed their stressful work experience in Japan contributed to their decision to return. Feeling distressed has also been reported by internationally educated nurses working in Iceland (Magnusdottir 2005) and the USA (Jose 2011). Language and communication barriers, discrimination and different working environment are among common stressors experienced by foreign educated nurses (Moyce et al. 2015). Brain waste occurs when overseas educated health professionals are unable to apply their professional skills in the destination countries (Alam et al. 2015), and this is referred to by Kingma (2006) as a gradual deskilling process. Deskilling has been experienced by migrant nurses who worked as professional nurses (Alexis & Shillingford 2015; Pung & Goh 2016) or as lower-skilled health workers (Salami et al. 2014). For the returnees examined in this study, inability to perform nursing interventions had decreased their skills. Deskilling was unforeseen, because Indonesian nurses were unfamiliar with the caregiver job description (Nugraha & Hirano 2016) and they expected to improve their nursing career and learn advanced technology in Japan (Hirano et al. 2012). The migration policy of Indonesian nurses emphasizes on the expansion of work opportunities and acquisition of new knowledge, skills and work experience (MoH 2012). The dispatch of Indonesian nurses to Japan as caregivers, therefore, is mainly a way to overcome the saturated domestic labour market, but has not yet fully addressed the issue of deskilling and reintegration of returned professionals. Retaining nurses within the nursing profession has remained a global concern in maintaining a robust health system (International Council of Nurses 2013). The dif?culties faced by returnees are particularly related to their return to nursing or their career path. In this study, only three of the 15 returnees (20%) were employed in nursing areas, which is in contrast to a previous study on the return migration of Jamaican nurses by Brown (1996), which found that 76% of these returned to nursing practice. Sadly, Efendi et al. (2013) also found that Indonesian returnees who previously worked as nurses in Japan under the EPA also had a problem in ?nding jobs. Although there are no clear data on nursing unemployment, Indonesia’s labour market is reported to have low capacity to absorb new nursing graduates (Suwandono et al. 2005). The overall unemployment rate in Indonesia is quite high, at 6.18% in 2015, or approximately 7.56 million people of productive age unemployed (BPS 2015). As noted by the returnees in this study, supports from the Indonesian government and the Indonesian National Nursing Association are strongly required in facilitating their return. Having refresher training is crucial to enable them to go back
to the nursing profession. Constructing a returnees’ database and the placement in public hospitals in underserved areas would be a signi?cant contribution in strengthening the health workforce. Haour-Knipe & Davies (2008) emphasized the important role of government in developing such a mechanism. In general, returned Indonesian migrants lack support and urge the government to intervene (International Labour Organization 2015). Both the Japanese and Indonesian governments regularly run job fairs once a year to link between prospective employers and returnees (Efendi et al. 2013). This collaborative effort should be strengthened further by aligning returnees’ competency into the national ageing policy. The caregiving background of nurse returnees would be bene?cial for leveraging the quality of care in the elderly long-term care industry in Indonesia. Returnees who were unable or unwilling to join the nursing workforce utilized the ?nancial and human capital gained in Japan to support their living in their home country. This is parallel with the global pattern of nurse migration in which returnees bring back ?nancial, human and social capitals (Haour-Knipe & Davies 2008). This ?nancial capital is often used to improve the economic status of the family or to start businesses. A migration study of doctors and nurses carried out by Brown & Connel (2004) found that returnees chose self-employment or establishing their own businesses using capital collected from savings and remittances which might compensate their skill drain. The human capital, as expressed by the study participants, is manifested in the acquisition of Japanese language pro?ciency and positive work attitude. Pro?ciency in the Japanese language helped some of the participants to be employed at Japanese companies or health facilities. Returnees’ positive in?uences from their work experience were also con?rmed in a previous study by Efendi et al. (2016), which found that Indonesian migrant nurses in Japan adopted discipline as a work ethic and way of life.
Limitations This study is not without limitations. First, although coming from the same cultural background, the interviewers were not known by most returnees. The participants might be cautious or hesitant about speaking more openly. Second, only participants from Java Island were recruited, thus ignoring disparities among regions in Indonesia.

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