Background In 2011, EULAR proposed 10 recommendations for nurses' roles in management of chronic inflammatory arthritis. The scope of nursing activities for patients with rheumatoid arthritis (RA) in Japan is narrower than that of nurses in Western countries because of the differences in roles and responsibilities between nurses in Japan and the West. In Japan, nurses' roles are not well evaluated.

Objectives We assess the opinions of nurses and doctors in Japan regarding EULAR recommendations for nurses' roles in the management of RA.

Methods This is a cross-sectional survey among Japan. Nurses and doctors in Japan consulting patients with RA were selected randomly for this study between October and December, 2014. Levels of agreement and application for each of the 10 recommendations were assessed utilizing a 0-10 scale (0=none, 10=full agreement/ application). Nurses and doctors were also asked to explain the reasons for their disagreement or belief in lack of application, using free format comments. Data analyses were performed utilizing Paired t-test and Wilcoxon rank sum test.

Results 431 nurses (male/ female, 9/422) and 128 doctors (male/female, 106/22) were included in this study. The average ages were 42.2 and 43.9 years old, and the average clinical experiences in RA was 5.6 and 13.0 years, for nurses and doctors respectively. For nurses, the highest and lowest levels of agreement were for recommendations No.8 (9.3) (nurse education and skills maintenance) and No.3 (7.2) (patient access to telephone nursing services), and those of application were also for No.8 (7.4) and No.3 (4.7), respectively. Similarly, for doctors, the highest and lowest levels of agreement were for recommendations No.8 (9.4) and No.3 (7.4), and those of application levels were also for No.8 (8.0) and No.3 (5.6), respectively.

We evaluated the differences between agreement and application for the 10 recommendations both in nurses and doctors. For both nurses and doctors, levels of application were statistically lower than those of agreement for all items (p<0.0001, for each of the 10 recommendations in both groups). Furthermore, with regards to agreement, results for nurses and doctors showed no statistically significant differences in any of the 10 items. However, with regards to application, nurses' answers were statistically lower than those of doctors for all 10 recommendations (p<0.05, for each of the 10 recommendations).

The reasons for discrepancies between agreement and application given by nurses included lack of knowledge and confidence regarding education of RA, insufficient staff and time, and lack of educational support. In addition to nurses' comments, doctors cited lack of specialization or protocols regarding RA treatment for nurses, ineffectiveness of the nurses' reassignment and rotation system in Japan, and possible disagreement between nurses and doctors.

Conclusions This study is a preliminary investigation into the role of nurses in the treatment of patients with RA in Japan. Our results demonstrate potential significant shortcomings in the nurses system in Japan when it comes to RA treatment. Further research is necessary in order to analyze and address these issues. We believe this situation must be investigated further, not only to improve the situation in Japan, but also to benefit other countries which may experience similar difficulties.

Disclosure of Interest None declared