The steps being taken to address Germany's nursing crisis

Louise Baker, Senior Project Manager at the Robert Bosch Stiftung, discusses how the Robert Bosch Stiftung is helping to improve recognition for nursing profession

Germany is in the midst of a nursing crisis. This is nothing new. In fact, the Robert Bosch Stiftung has been facing this challenge head head-on for over 25 years.

More than 1.6 million people work in the nursing profession in Germany, making it the largest professional group in Germany’s health care system. Traditionally, nursing in Germany has been a vocational profession. However, over the past couple of decades, there has been a shift from vocational training to the academic qualification of nurses. This shift was politically underpinned in 2012 when the German Scientific Council (Wissenschaftsrat) recommended that 10 – 20% of all nurses should be academically qualified. And although there have been some advances since that decision was taken, Germany still has a long way to go in reaching that target.

As in many other European countries, Germany is facing a shortage in its nursing staff. There are not enough people entering the nursing profession, and many of those who have chosen nursing, are leaving due to unsatisfactory working conditions and/or difficulty in finding an acceptable work-life balance. This also means that while Germany is facing a demographic shift in its population, which in turn is putting complex pressures on its health system, there is also a demographic shift in its nursing staff: Germany’s nurses are getting older, and there are not enough new, young recruits to make up the workforce. Nursing in Germany needs to move with the times and be recognized as the attractive profession it is, with career development opportunities for all, regardless of the level of entry or age.

There is a huge spectrum of training programmes, academic qualifications and career choices for those entering or already in nursing. However, the sheer number of courses on offer often leads to confusion and misunderstanding, not only when selecting a career path, but also when selecting suitable staff for a specific nursing environment. As the academic qualification of nurses is a relatively new concept in Germany, there is also a lot of uncertainty surrounding the introduction into and the managing of academic professions in nursing teams. This often raises questions about who is needed and what role each person should play in the team. One of the biggest challenges is finding the optimal skills mix for the health care setting in question. There are also lots of discussions on how to manage a nursing team, so that the academically qualified staff and the vocationally trained staff are utilizing their different skills and competencies to the optimum and in the best interests of the patient.

So what is being undertaken to help redress these challenges? Organisations such as the Robert Bosch Stiftung and the Deutscher Berufsverband für Pflegeberufe (DBfK, The German Nurses Association) have been lobbying for the academic qualification of nursing staff for decades. They argue that it would bring more attractive career opportunities and recognition for the nursing profession as a whole. In addition to this, and in fact, more importantly, they are convinced that academically qualified nurses are essential for counteracting the growing complexity of healthcare in Germany, whilst while ensuring a positive impact on patient care and the German healthcare system. It must also be stressed though, that both organisations recognize and are adamant that in order to provide the best patient care possible, a wide range of academically and vocationally qualified nursing staff is needed. Through projects such as 360° Pflege - Qualifikationsmix für den Patienten (360° Nursing – Skills mix for the patient) the Robert Bosch Stiftung is actively helping to systematically anchor the wide range of nursing qualifications in health care practice. The manifesto “Mit Eliten pflegen” (German version available only) published in March 2018 was a very public demand for a change in the general conditions and regulations in nursing. The main message in the Manifesto being, that academically qualified nurses have a significant role to play in providing optimal and individualized, hands- on patient care and should be placed in positions where they can provide the excellent nursing care they have been trained to give.

The introduction of Community Health Nurses, a completely new concept in Germany, is striving to bring about real change in not only how nurses work in a primary care setting, but their role in the health care system in general. This is especially relevant for regions that are structurally weak or economically underdeveloped and where the number of medical doctors is dropping drastically. Specialised and academically qualified nurses are one way to address this problem. Through the appropriate training, nurses can fill key positions in local primary care centres, as is the case in countries such as Canada, Finland, and the UK.  For this to happen Germany not only needs a change in the way nurses are trained, but also a change in how nurses and their role in the health care system across primary, secondary and tertiary levels are perceived. Fortunately, nursing is a topic, which is continuing to gain political and public momentum in Germany and abroad. Discussions are being started, and action is being taken, with one prominent example being the International Council of Nurses “Nursing Now” campaign launched by HRH The Duchess of Cambridge in February 2018.

These initiatives are definitely steps in the right direction, but change takes time. Therefore, the Robert Bosch Stiftung will continue its work in advocating the need for an academically qualified, interprofessional approach to nursing in order to ensure the highest quality patient care possible, across Germany’s health care system. For more information on the Robert Bosch Stiftung and our work on health and healthcare, please visit www.bosch-stiftung.de