• Wakako Eklund.
• Pediatrix Medical Group, Nashville, Tennessee 37203, USA. eklundthree@gmail.com
• J Perinat Neonatal Nurs. 2010 Apr 1; 24 (2): 155-66.

AbstractChallenge has the potential to create opportunities for innovation. This applies to new developments aimed at enhancing existing systems of healthcare delivery. The development of the neonatal nurse practitioner's role in the United States is undoubtedly 1 such example of an innovation that was made in response to the challenge in neonatal healthcare delivery. This challenge and concomitant change was generated by a significant increase in neonatal patient needs, survival of smaller and sicker neonates, a rising acuity level, and the accompanying need to elevate the standard of healthcare for neonates. Nursing has faced such challenges more than once and been called upon to change the scope of practice not only in the United States but also globally. Japanese nursing is at a new historic moment since the end of World War II. There is an increased interest in expanding the role of nursing in collaboration with physicians to meet the complex needs of a growing neonatal intensive care population. However, for a nation where traditionally physician-led medicine was believed to maintain patient safety, nursing role advancement is met with significant opposition. This article will first describe the differences between neonatal intensive care unit workforce in Japan and in the United States and then introduce recent neonatal healthcare issues and the nation's response including an exploration of the neonatal nurse practitioner's (NNP's) role. Various barriers against nurse practitioner's role development are explained to better describe the context of NNP. This article focuses on the current status and direction of the NNP movement and efforts that are being made in Japan.

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