Part of our Nursing Councils of the World series. Last checked: November 2026.
Japan has one of the oldest populations in the world and more than a million nurses, yet hospitals and care homes still struggle to fill posts. For foreign nurses, Japan offers respected work, good conditions and a fascinating culture, but the route is unusually demanding: you must pass Japan’s national nursing examination in Japanese. In 2026, 88.3% of all candidates passed, but only 24.4% of candidates in the category that includes Economic Partnership Agreement (EPA) nurses and other foreign-qualified applicants did.
This guide explains how nursing is regulated in Japan, the types of nurses, the national examination, the Japanese Nursing Association, the EPA route for nurses from Indonesia, the Philippines and Vietnam, and what foreign nurses need to know before applying.
Imagine you are an experienced ICU nurse from Manila working as a nursing assistant in a hospital in Osaka. By day you help patients bathe and eat; by night you study kanji for words like “respiratory failure” and “anticoagulant”. Your Japanese colleagues are kind, but the national exam is in two months, and you know that most candidates like you do not pass. This is the reality of the EPA route: rewarding, respected and very hard.
Who regulates nursing in Japan?
Nursing in Japan is governed by the Act on Public Health Nurses, Midwives and Nurses, and licences are issued under the authority of the Ministry of Health, Labour and Welfare (MHLW). Unlike many countries, Japan does not have an independent nursing council. The MHLW sets the national examinations, maintains the national register for registered nurses, public health nurses and midwives, and handles disciplinary measures. Prefectural governors license assistant nurses.
Types of nurses in Japan
| Title (Japanese) | Role | Licensed by |
|---|---|---|
| Kangoshi (看護師), registered nurse | Full nursing practice in hospitals, clinics and community | Minister of Health, Labour and Welfare, after the national exam |
| Junkangoshi (准看護師), assistant nurse | Works under the direction of a registered nurse or physician | Prefectural governor, after a prefectural exam |
| Hokenshi (保健師), public health nurse | Community and public health | Minister, after a separate national exam (requires RN qualification) |
| Josanshi (助産師), midwife | Midwifery; open only to women under current law | Minister, after a separate national exam (requires RN qualification) |
The national nursing examination
The national examination for registered nurses (看護師国家試験) is held once a year, usually in February, with results in March. Key facts from the 115th examination in 2026:
- Exam date: 15 February 2026.
- Results: 24 March 2026.
- Candidates: 59,614; passers: 52,666.
- Overall pass rate: 88.3%; new graduates 94.1%; new university graduates 96.3%.
- EPA and other foreign-qualified candidates: 696 candidates, 170 passers, a pass rate of 24.4%.
The exam is entirely in Japanese and covers fundamentals, adult, geriatric, paediatric, maternal and psychiatric nursing, home care, health support and social security systems, and integrated nursing practice, with required questions that must meet a separate pass standard. Questions are written for Japanese readers, and foreign candidates must handle medical kanji under time pressure, which is why pass rates for foreign candidates are much lower.
How foreign nurses can become licensed
1. Qualification recognition route
Nurses trained abroad can apply to the MHLW to have their education assessed for eligibility to sit the national examination. Requirements typically include:
- Graduation from a recognised nursing programme with education equivalent to Japanese standards.
- A nursing licence from the country of education.
- High-level Japanese proficiency, usually the Japanese-Language Proficiency Test (JLPT) at N1 level.
- Document submission and a review by the ministry, sometimes with further assessment.
If approved, you sit the same national examination as Japanese candidates.
2. The Economic Partnership Agreement (EPA) programme
Japan’s EPAs with Indonesia (from 2008), the Philippines (from 2009) and Vietnam (from 2014) allow qualified nurses from these countries to come to Japan as nurse candidates. They:
- Receive Japanese language training before and after arrival.
- Work in Japanese hospitals as nursing assistants under contract while preparing for the exam.
- Have a limited period, typically three years with possible extension, to pass the national exam.
- Can stay and work as registered nurses in Japan if they pass, with options to renew their status.
Candidates are recruited through official channels in each country, such as the Philippine Overseas Employment Administration functions (now the Department of Migrant Workers), Indonesia’s BP2MI and Vietnam’s labour ministry, with placement coordinated in Japan by the Japan International Corporation of Welfare Services (JICWELS).
3. Care worker routes
Japan also recruits foreign care workers (kaigo) through EPAs and the Specified Skilled Worker scheme. These are care worker roles, not registered nurse roles, but some nurses use them to build language skills and work experience in Japan.
The Japanese Nursing Association (JNA)
The Japanese Nursing Association (Nihon Kango Kyokai) is Japan’s national professional association for registered nurses, public health nurses, midwives and assistant nurses, and is a member of the International Council of Nurses. With hundreds of thousands of members, it is one of the largest nursing organisations in the world. The JNA:
- Advocates on nursing policy, staffing, pay and working conditions.
- Runs certification for Certified Nurse Specialists and Certified Nurses in specialty areas, along with continuing education.
- Supports nurses returning to work through prefectural nursing centres.
- Publishes ethical guidance and nursing practice standards.
Membership is through prefectural nursing associations.
Working conditions and pay
- Pay varies by region, hospital type and experience. Registered nurses typically receive a monthly salary plus allowances for night shifts, and bonuses paid twice a year, which can add significantly to annual income.
- Shift patterns include two-shift (long day and night) or three-shift systems.
- Japan places strong emphasis on teamwork, punctuality, detailed documentation, hierarchy and politeness (keigo) in communication with patients and colleagues.
- Demand is especially high in elderly care, home-visit nursing and rural areas.
Challenges for foreign nurses
- Language: clinical Japanese, including reading kanji in charts and on the exam, is the biggest barrier.
- Exam pass rates: much lower for foreign-qualified candidates.
- Working as an assistant first: EPA candidates work below their qualification level while preparing.
- Cultural adjustment: communication styles, hierarchy and expectations differ from many countries.
- Family: bringing family depends on your visa status.
Tips for success
- Start Japanese study early and aim for JLPT N2 or N1 before arrival if possible.
- Learn medical vocabulary in kanji, not only romanised Japanese.
- Use past national exam questions published in Japan for practice.
- Join study groups with other foreign candidates and ask Japanese colleagues for help.
- Protect your wellbeing; balancing work and study is demanding.
Nursing education in Japan
Japanese nurses qualify through several routes:
- Four-year university programmes, now the most common route for new registered nurses, often combined with eligibility for the public health nurse or midwife examinations.
- Three-year nursing schools and junior colleges, traditionally attached to hospitals and still important outside major cities.
- Assistant nurse programmes (junkangoshi), with routes to upgrade later to registered nurse.
- Graduate programmes preparing Certified Nurse Specialists, educators and researchers.
Clinical placements emphasise teamwork, careful documentation and patient safety. Students also learn the long-term care insurance system, which shapes community nursing for older people.
Certified nurses and specialist practice
Through the Japanese Nursing Association, experienced nurses can become Certified Nurses in fields such as emergency nursing, intensive care, infection control, dementia care, palliative care, wound, ostomy and continence nursing, and diabetes nursing, after specialist training and an examination. Certified Nurse Specialists complete master’s-level education in areas such as oncology, psychiatric, community, gerontological and critical care nursing. Japan has also introduced a system of specified acts training, which allows trained nurses to perform certain medical procedures under protocols, supporting care in hospitals and home settings.
Home-visit nursing and an ageing society
With more than a quarter of the population aged 65 or over, Japan relies heavily on home-visit nursing stations (houmon kango), which support older people, people with chronic illness and those receiving end-of-life care at home. Nurses in these stations work with a high degree of independence, coordinate with care managers and families, and are a growing part of the workforce. For foreign nurses who pass the national exam, home and community nursing can be a rewarding path, but requires strong Japanese communication skills.
Daily life for foreign nurses in Japan
- Housing: many hospitals provide or subsidise accommodation for EPA candidates and new staff.
- Cost of living: lower in regional cities than in Tokyo or Osaka.
- Community: Filipino, Indonesian and Vietnamese communities, churches and mosques provide support and friendship.
- Etiquette: punctuality, politeness, bowing, removing shoes in certain areas and clear apologies are important in workplace culture.
- Natural disasters: learn your hospital’s earthquake and typhoon procedures early.
Frequently asked questions
Can foreign nurses work in Japan?
Yes, but they must pass the national nursing examination in Japanese, through the qualification recognition route or the EPA programme.
What is the pass rate of Japan’s nursing exam?
88.3% overall in 2026; 24.4% for the category including EPA and foreign-qualified candidates.
Is there an English version of the exam?
No. The exam is in Japanese.
Which countries are part of the EPA nurse programme?
Indonesia, the Philippines and Vietnam.
But is Japan worth it for a foreign nurse?
For nurses who love the language and culture and are ready for several years of intense study, Japan can be deeply rewarding, with excellent clinical standards and respect for nurses. For those who want a quick, high-paying move, English-speaking countries or the Gulf are usually faster. Choose Japan for the right reasons, and plan for the long haul.
Your next step: If Japan interests you, take a free online JLPT practice test this week to see your current level, and set a realistic target date for N2.
Related: The hardest nursing exams in the world · Nursing councils of the world
Sources: Ministry of Health, Labour and Welfare (Japan); 115th national nursing examination results, as compiled by Obunsha Educational Information Center (April 2026); Japanese Nursing Association; JICWELS (EPA programme). Rules change; check official sources.
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