The purpose of this study was to identify the factors contributing to depression and to the intention among nurses to resign or transfer to another position.　A mail-based survey was conducted in 536 nurses providing care to patients with intractable neurological diseases （response rate, 66.2%;valid response rate, 62.3%）.　The path coefficients were statistically significant at less than 5%.　Among the nurses who responded to the survey 62.3% and 62.9% had depression and expressed their intention to resign, respectively.　A covariance structure analysis revealed that the factors contributing to depression were “conflict with superiors” and “imbalance between care and outcome” among nurses with less than 3 years’ experience in providing nursing care to patients with intractable neurological diseases, and “conflict with colleagues” among nurses with 3 years or longer experience in providing nursing care to patients with intractable neurological diseases.　In both groups, “difficulty of involvement” and workplace support were found to contribute to depression through their impact on self-efficacy.　In addition, in both groups, depression was found to contribute to the intention to resign, and “quantitative workload” contributed to the intention to resign or transfer to another position.　For nurses with 3 years or longer experience in providing nursing care to patients with intractable neurological diseases, “verbal abuse by patients” was also found to contribute to the intention to resign.　These results suggest the necessity of measures, such as measures to improve the workplace human relations, not only for all nurses, but also for groups of nurses defined by years of experience in providing nursing care for patients with intractable diseases.

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As a prerequisite to guarantee and improve the quality of care through multi-institutional comparisons using clinical indicators, it is necessary to undertake evaluations aimed at the standardization of definitions of clinical indicator and of the data calculation methods.　In this analysis, in which indicator values obtained in accordance with the manual for measurement of the National Hospital Organization clinical indicators were compared with the indicator values obtained using the formulae included in the “List of Healthcare Quality Indicator Definitions” posted in the portal site of Healthcare Quality Indicators, issues to be examined for improving the usefulness of clinical indicators were identified by analysis of the impact of the differences between the denominator and numerator definitions on the calculated values.　　Significant differences were observed in the values of six analyzed indicators of similar diagnoses/clinical concepts.　The indicator values were found to be affected by the diagnosis coding, indication criteria and exclusion criteria, all of which are defined as denominators in the calculation.　Clinical indicators to evaluate the consultation process are used to extract a representative patient population and to assess whether the standard medical care available to the extracted population is properly provided.　Therefore, it is important to establish definitions that allow an approximate patient population to be properly extracted.

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Employer contributions to employee retirement benefits represent the financial resource for payment of employee retirement benefits.　However, for public hospitals which outsource the paperwork for employee retirement benefits to partial cooperatives, along with the local government that established the hospital and other local government agencies, there is the possibility of an imbalance occurring between the hospital contributions to retirement benefits and the retirement benefits received by the employees.　In the case of Asahi General Hospital, for which the paperwork related to employee retirement benefits is carried out by partial cooperatives, as one organization of Asahi City, the reserve for employee retirement benefits required as of April 1, 2014, when the Revised Local Public Enterprise Act was implemented, was 9,179 million yen.　However, the accumulated balance as of March 31, 2013, which is the difference between the employer contributions and the amount of employee retirement benefits, was 10,996 million yen.　This means an excess of employer contributions by an amount of 1,817 million yen.　Since a part of the employer contributions is used for the personnel expenses and construction costs, etc., of the governing body, the full amount of the accumulated contributed surplus does not belong to the hospital.　However, to stabilize the management of public hospitals and to improve the quality of medical care to be provided in the region, imbalances in the employer’s retirement benefit contribution plan, if any, should be resolved urgently.

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