Mizutani Mayumi, Nishide Ritsuko, Nishitani Naoko, Bando Harumi, Nishimura Junko, Tanimura Susumu
Department of Integrated Health Sciences, Nagoya University Graduate School of Medicine, Aichi, Japan.
Department of Nursing, Nagoya University of Arts and Sciences, Aichi, Japan.
BMC Nurs. 2025 Jul 18;24(1):944. doi: 10.1186/s12912-025-03299-z.
Ensuring an adequate density of public health nurses (PHNs) is vital for effectively addressing community health needs. This study aimed to (1) map the geographic distribution of PHN density across all 47 prefectures in Japan from 2019 to 2024, (2) investigate regional factors associated with PHN density at the prefectural level, and (3) analyze these associations at different quantile levels of PHN density.
An ecological study was conducted using available public data from 47 prefectures in Japan, focusing on variables related to PHN density such as school density, educational capacity, percentage of graduates selecting PHN careers, percentage of graduates remaining within the prefecture, recruitment rate, and turnover rate. Choropleth maps were created to visually represent geographic distributions. Ordinary least squares (OLS) regression and quantile regression (QR) models were used to analyze the identified regional factors associated with PHN density.
The mean prefectural-level PHN density was 378.0 per million population, with a 3.6-fold difference (range, 172.7-618.4). The results of OLS regression indicated positive associations between PHN density and educational capacity (regression coefficient B = 0.71, standardized regression coefficient β = 0.40, p = 0.016), the percentage of graduates selecting their first career as a PHN (B = 3.29, β = 0.34, p = 0.013), and those selecting their first PHN career within the prefecture (B = 2.15, β = 0.24, p = 0.032). The QR analysis showed that these associations varied across different quantiles. Education capacity was significant in lower (30th percentile) and higher quantiles (90th percentile). The proportion of graduates who started their career as PHNs and those who remained in the prefecture were significant across several quantiles.
Fostering pathways that encourage graduates to pursue public health nursing as their first career choice and remain in their prefectures is essential to enhance prefectural-level PHN density. A balanced approach that addresses both the quantity and quality of PHNs is necessary to advance public health nursing in Japan.
确保公共卫生护士（PHN）有足够的密度对于有效满足社区卫生需求至关重要。本研究旨在：（1）绘制2019年至2024年日本47个都道府县公共卫生护士密度的地理分布图；（2）调查都道府县层面与公共卫生护士密度相关的区域因素；（3）在公共卫生护士密度的不同分位数水平上分析这些关联。
利用日本47个都道府县的公开可用数据进行了一项生态研究，重点关注与公共卫生护士密度相关的变量，如学校密度、教育能力、选择公共卫生护士职业的毕业生百分比、留在都道府县内的毕业生百分比、招聘率和离职率。创建了分级统计图以直观呈现地理分布。使用普通最小二乘法（OLS）回归和分位数回归（QR）模型来分析确定的与公共卫生护士密度相关的区域因素。
都道府县层面公共卫生护士的平均密度为每百万人口378.0人，相差3.6倍（范围为172.7 - 618.4）。OLS回归结果表明，公共卫生护士密度与教育能力（回归系数B = 0.71，标准化回归系数β = 0.40，p = 0.016）、选择公共卫生护士作为第一职业的毕业生百分比（B = 3.29，β = 0.34，p = 0.013）以及在都道府县内选择公共卫生护士作为第一职业的毕业生百分比（B = 2.15，β = 0.24，p = 0.032）之间存在正相关。QR分析表明，这些关联在不同分位数上有所不同。教育能力在较低分位数（第30百分位数）和较高分位数（第90百分位数）上具有显著性。在几个分位数上，以公共卫生护士身份开始职业生涯的毕业生比例和留在都道府县内的毕业生比例具有显著性。
建立鼓励毕业生将公共卫生护理作为第一职业选择并留在都道府县的途径对于提高都道府县层面的公共卫生护士密度至关重要。在日本，采取兼顾公共卫生护士数量和质量的平衡方法对于推进公共卫生护理工作是必要的。
