Pharmaceutical universities have changed their program from four to six years to produce better pharmacists. With the establishment of new Pharmacy schools, we may end up with an overabundance of pharmacists in the near future. On the other hand, the shortage of nurses is still an issue. If pharmacists can operate in-patient pharmaceutical services, nurses will be able to concentrate on their main duties. In order for this to come into effect, it is necessary to enable pharmacists to give shots to patients and to charge them for their operation.
To grasp the current situation, a survey was carried out concerning the amount of pharmaceutical work done by nurses. The results show that approximately 30% of nurses' daily work pertains to pharmaceuticals and that nurses are hoping to have pharmacists in hospital wards. 65% of the nurses with pharmacists in hospital wards agree that pharmacists should be able to give shots to patients, whereas 49% of nurses without in-ward pharmacists agree.
Therefore, if pharmacists can give injections and charge patients accordingly, the quality of medical care and safety will improve as well as the possibility of solving the issue of the shortage of nurses and excessive number of pharmacists.

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To investigate useful measures for nursing staff development, this study clarified the association between the nursing staff's perception of their relationship with their nurse managers and their cognitive levels (sense of competence, sense of growth, meaningfulness, etc.) and learning behavior.
A self-administered questionnaire survey was conducted among nursing staff working at teaching hospitals. The factor structure of “the relationship with nurse managers” was analyzed, and 5 factors, namely, consideration for individuals, work innovation, management and instruction, interpersonal adjustment, and intellectual activation, were extracted. There were differences in the association between the nursing staff's relationship with their nurse managers and their cognitive level and learning behavior depending on the number of years of experience (young, experienced, and veteran nurses), and it was suggested that the sense of competence, etc., may be affected by intellectual activation, management and instruction, consideration for individuals, and work innovation in young nurses. It was suggested in experienced nurses that the sense of growth, etc., may be affected by consideration for individuals and that the sense of competence may be related to an increase in learning behavior. It was suggested in veteran nurses that the sense of competence, etc., may be affected by consideration for individuals, work innovation, and interpersonal adjustments and that learning behavior may be improved by working on the sense of competence.

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Objective:The objective of this study is (1) to reveal hospital factors associated with the strength of a local healthcare network, and (2) to assess whether the implementation of a liaison critical pathway promotes differentiated functionality of the hospitals.
Methods:This study utilized a questionnaire to collect patient volume, average length of stay, details of the pathways used, and characteristics of the regions from all 625 hospitals that implemented a liaison critical pathway. The data was analyzed using linear regression modeling.
Results:Of the 625 hospitals surveyed, 232 (37.1%) hospitals participated in the study. In terms of hip fracture, hospitals with high patient volume (p=0.002) and short average length of stay (p=0.005) were related to high applicability of a liaison critical pathway. The average length of stay was significantly shorter by 12.8% in hospitals implementing the liaison critical pathway with specific criteria for discharge from acute hospital (p=0.036) when compared to hospitals without specific discharge criteria.
Conclusions:This study suggested an importance of discharge criteria in the liaison critical pathway.

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Quantitative measure of the quality of medical care using clinical indicators has been actively implemented in Western countries to assure the quality of medical care. Similar attempts have also recently begun to be implemented in Japan, for example at the National Hospital Organization where efforts have been made to facilitate evaluation of the quality of care through utilization of “clinical evaluation indicators” (a term used at the National Hospital Organization equivalent to the clinical indicators mentioned above) for visualization of the current status. In fiscal 2010, the National Hospital Organization participated in the “Quality of Care Evaluation/Publication Promotion Program” under the initiative of the Health Policy Bureau of the Ministry of Health, Labour and Welfare. Within the framework of this program, the Organization attempted to make public the results from the 45 member hospitals, together with the name of each hospital. The organization also made public the manual for measurement (including the formulae for calculation) that would allow measure of the clinical evaluation indicators in other hospitals covered by the DPC (Diagnosis Procedure Combination) system or planned to be covered by the system. Clinical evaluation indicators are useful to detect potential issues through presenting inter-hospital variations in data, and so on. From now on, the validity of these indicators should also be tested to confirm, for example, that they appropriately reflect the quality of care during routine clinical practice.

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