Jo Lewis, Nurse Practitioner, Angle Vale Medical Centre and Hyde & Partners Medical Centre
Jo Lewis is a nurse practitioner (NP) with more than three decades of nursing experience. A registered nurse since 1991 and working in primary health care since 2007, she became an endorsed NP in 2018. Jo is currently part of the South Australian NP Pilot Program at Angle Vale Medical Centre and also practises as a tenant NP at Hyde & Partners Medical Centre in Gawler, South Australia.
From neon-lit Tokyo to the calm efficiency of Sapporo, my first trip to Japan was unforgettable. But what struck me most wasn’t the temples or the bullet trains – it was standing at the 16th Japanese Primary Care Association Conference presenting my talk, ‘Strengthening Primary Healthcare in Australia: A Journey Beyond Hospital Walls,’ and realising that the everyday work of Australian primary health care nurses matters on the global stage.
If you’ve ever wondered, ‘Does what I do in my clinic really make a difference?’ – the answer is yes. The health checks, care coordination, patient education, and quiet persistence you deliver every day are exactly the things health systems around the world want to learn from.
At the conference, I presented the Four Pillars of nurse practitioner (NP) practice – clinical care, leadership, education and research. While these might sound lofty, they simply describe what primary health care nurses already do. Every time you manage a complex patient, mentor a colleague, share knowledge, or contribute to quality improvement, you are strengthening those pillars.
Japanese colleagues were eager to hear this. With the world's most rapidly ageing population and longest life expectancy, they are already grappling with the challenges Australia is preparing for. They saw real value in the way Australian nurses and NPs are shaping primary health care.
Japan’s NP role is still developing. Oita University of Nursing and Health Sciences launched the country’s first graduate-level NP program in 2008, offering advanced coursework in physical assessment, pharmacology, and pathophysiology, alongside significant supervised clinical hours. The first graduates completed the program in 2011.
However, unlike Australia, Japan does not yet have a national NP certification system or consistent legislative framework. Many Japanese NPs continue to practise under comprehensive physician orders, limiting their independence.
This is precisely why I was invited to present at the conference, along with other professionals from countries with established NP systems. Leaders such as Professor Mayumi Kako, Chihiro Kimura, and Kazuya Honda are at the forefront of developing advanced nursing practice in Japan. Their interest in Australia’s Four Pillars model, and in initiatives like the South Australian NP Pilot, reflects their determination to strengthen the role of nursing in primary health care in Japan.
Both Australia and Japan face ageing populations – but at different stages. In Australia, about 17% of people are aged 65 and over, and we are preparing for the health care challenges that will emerge as this number increases. In Japan, nearly 29.3% of the population is already 65+, making it the most rapidly ageing nation in the world. Life expectancy there is around 81 years for men and 87 years for women – the highest globally.
For primary health care nurses, this reality highlights the importance of what might feel like ordinary work: medication reviews, frailty checks, chronic disease management and health education. These are not small things. They are the interventions that enable ageing populations to live not only longer, but better.
The Japanese Primary Care Association (JPCA) Conference, held on 20–22 June 2025 in Sapporo, carried the theme ‘Appropriate Primary Healthcare: Adapting to communities and providers.’ Led by Dr Kengo Kisa and the JPCA Hokkaido Block Chapter, the program blended on-site sessions with live-streaming and on-demand access.
I spoke on preventative, person-centred NP care. In return, I listened to presentations on migrant health, collaborative care models, and the urgent need to decarbonise health care. The content was rich, but what stayed with me most was the generosity of colleagues: thoughtful conversations, warm hospitality, and a shared commitment to improving health care for all.
This journey began when Lisa Collision, APNA’s General Manager of Research and Innovation, introduced me to Professor Mayumi Kako, an academic leader at Hiroshima University with a long-standing interest in community and primary health care nursing. Through Mayumi, I was connected with Chihiro Kimura, Symposium Director at Unnan City Hospital and Chief of JPCA’s Nursing International Division. Trained in both Japan and the United States, Chihiro is an NP specialising in geriatrics and leading the development of transitional care services.
I was also welcomed by Mr Kazuya Honda, Chair of Junshin Gakuen University, NP, educator, and Vice President of the Japan Society of NPs. With over a decade of NP experience in neurosurgery and rural island practice, and now a PhD candidate in Health Sciences and Nursing, Kazuya represents the next generation of NP leadership in Japan.
It was a privilege to present alongside Mr Takehiro Itou, lecturer and founder of Well-being LLC, who draws on 18 years of NP experience in general medicine and neurosurgery, including remote island hospitals. He now leads a home-visit nursing service – an innovative model of community-based NP care.
I also had the opportunity to learn from Professor Michiko Moriyama, a distinguished scholar at Hiroshima University with extensive research in chronic disease management and health policy; Dr Takahiro Yasaka, a gastrointestinal surgeon and primary care physician who has dedicated nearly 30 years to health care on remote islands in Nagasaki Prefecture; and Professor Suga Sakamoto, former President of the Japan Nursing Association and now Vice President at Tokyo Healthcare University, where she leads NP education nationally.
Together, these leaders extended the invitation for me to present in Sapporo. Their collegiality reinforced how much stronger nursing becomes when we share knowledge and build connections across borders.
Travelling to Japan gave me fresh clarity about home. In Australia, scope of practice is steadily expanding – from primary health care nurses driving prevention to NPs leading services in chronic disease, mental health and rural care.
The South Australian NP Pilot, which embeds salaried NPs in general practice, is testing what sustainable models could look like. APNA’s advocacy continues to shine a light on the critical role of primary health care nurses in delivering better outcomes.
But here’s the truth: None of this progress is possible without you. Every health assessment, every patient you educate, every referral you coordinate builds the case for greater visibility and recognition of nursing. Together, these everyday actions drive reform.
My Sapporo visit reminded me that our work is not small or isolated. It connects to a bigger, global story. International engagement creates opportunities for collaborative research, cross-country policy dialogue and educational exchanges. But perhaps most importantly, it shows that when you sit down with a patient in your consulting room – whether in rural South Australia, suburban Sydney, or regional WA – you are practising in ways the world is watching and learning from.
Several reflections stayed with me:
Precision builds trust. Reliability, whether in trains or care plans, makes the difference.
Respect is embedded. In Japan, courtesy is cultural, not optional, and it reminded me of how much our workplaces could gain from the same.
Longevity is visible. Japan shows us what it really looks like when populations live longer lives, and why prevention and continuity of care are vital.
Curiosity fuels growth. My Japanese colleagues’ eagerness to learn about NPs matched my eagerness to learn from them. That openness is where true progress begins.
Coming home, I felt energised. Yes, barriers remain – workforce shortages, outdated funding models, policy inertia. But we are part of a global nursing movement. Nurses everywhere are expanding scope, proving impact, and demanding recognition.
So, if you ever doubt your worth, remember this: Our colleagues in Japan and around the world are eager to learn from us. They see value in the everyday work we do in primary health care.
Health care, like travel, is about connection. From Sapporo back to South Australia, I was reminded that when nurses share knowledge and stand tall in our role, we create something bigger than ourselves – healthier communities at home, and stronger primary health care across the globe.
The world is watching what we do in primary health care – and learning from it. What feels routine to us is exactly what health systems need most.
APNA is pleased to announce that the Australia–Japan Foundation will fund a collaboration between APNA and Hiroshima University to connect primary health care nurses between the two countries. Nurses will have the opportunity to share expertise on workforce development, leadership, gender equity and supporting diverse communities.
You can add APNA-Member Professional Indemnity Insurance to your membership, when you join APNA.
