Ways to End the Nursing Crisis
Author: Thorsten Rienth
The German Federal Statistical Office predicts that there will be around 6.78 million people in need of care in 2055 – almost three million more than two years ago. But there is a shortage of nursing staff all over.
Doreen Pappritz was 42 years old when she set her trowel and level aside for good. “The director of a home for the elderly, where I volunteered from time to time, asked me if I might want to start working for him as an unskilled caregiver.” Pappritz, then a skilled construction worker, did – and made the industry switch mid-career. Looking back after a traditional nursing education and many years on the job, she knows it was the right move. “In nursing, I found meaning. I get to feel real gratitude practically every day.” This was not the case on construction sites.
Employment growth in nursing is losing momentum
Retrainees like Doreen Pappritz are a blessing for an industry that can no longer keep up with the work. According to the Hans Böckler Foundation, two out of three men and four out of five women in Germany already have to be cared for in their old age. And baby boomers will soon reach the age where they need care. According to the statistics platform Statista, the number of people in need of care in Germany was around 4.96 million at the end of 2021. For 2055, the Federal Statistical Office forecasts around 6.78 million people in need of care.
There is good news: The number of employees in care, who are subject to social insurance contributions, is also rising – from 1.52 million in June 2021 to 1.68 million in June 2022, according to the employment agency. But there is also bad news: “Since the beginning of 2022, employment growth in care has noticeably lost momentum.” The number of newly concluded training contracts for nursing specialist training has also fallen.
Especially in social professions, money is not the main factor
Financially, corrective action is already being taken. At the beginning of May 2023, the hourly wage for nursing professionals increased from 17.10 euros to 17.65 euros, according to the Verdi trade union. The next increase up to 18,25 euros is already slated for December. That signifies a basic wage of 3,174 euros per month for a 40-hour week, Verdi writes on its website. Nurses in training will receive 13.90 euros per hour starting May 1, 2023, and 14.15 euros starting in December. The union also points to vacation entitlement, which has increased by two days to 29 days for a five-day work week. Yet the truth is that money is not the main factor, especially in social professions. The working conditions are more important. But they are often so bad that employees have been quitting their jobs or reducing their working hours in droves.
More attention, binding shift plans, and simplified documentation
Many of them might return if conditions were to improve, according to the most recent study “I’ll care again if …” conducted by the Bremen Chamber of Employees, the Saarland Chamber of Labor, and the Westphalian University of Applied Sciences in Gelsenkirchen. Around 12,700 former or part-time caregivers took part.
According to the study, around half of part-time employees and as many as 60 percent of the people who left could imagine increasing their working hours or returning to the nursing profession if working conditions were improved. Conditions such as more nurses per patient, reliable shifts, more time for human attention, binding shift plans, and simplified documentation. Even a very cautious estimation results in a calculated potential of 302,000 full-time nurses, and in an optimistic scenario even up to 661,000 full-time nurses, according to the study.
Genuine mental hygiene beats well-intentioned “benefits”
While most aspects of improved working conditions stand or fall with political decisions, the facilities themselves have some leverage, too. In order to make teams feel comfortable, larger facilities in particular offer yoga, resilience classes, back consultations, and sometimes even help with childcare.
However, Doreen Pappritz, now a nursing trainer at the DEKRA Academy, warns against window dressing. “There’s no question that these are nice and certainly well-intentioned benefits. Whether they really help the nursing staff in exercising their profession, however, is another matter.” Pappritz points to supervision offerings that are part of everyday work in fire departments and rescue services. “This goes hand in hand with real mental hygiene, which reduces sick leave in the workforce and counteracts people cutting back hours or looking for jobs in completely different industries.”
Nursing and care staff can choose their employers
At the end of May, the German Parliament passed the Nursing Care Support and Relief Act (PUEG). As of July 1, 2023, the statutory contribution rate for long-term care insurance will increase from the current 3.05 percent to 3.4 percent. The supplemental premium for people without children will rise from 0.35 percent to 0.60 percent, which corresponds to a contribution rate of 4.0 percent. For families with children, the calculation is the opposite. People caring for three children pay 2.9 percent. The additional annual revenue of 6.6 billion euros is also intended to help improve the working conditions of nursing staff.
Will that be enough? Doreen Pappritz has her doubts. “There is simply an incredible amount of catching up to do,” she says. And the nurses’ patience is finite. Recently, she said, she attended the 10th anniversary meeting of her nursing training cohort. “Out of about 35 people, maybe five are still working as nurses.”
But it is also true that some things have changed fundamentally for the better. “Ten years ago, employers would terminate someone’s annual contract if they couldn’t work all shifts,” Pappritz recounts. “Today, nurses can choose their employers.” Do you want to only taking on night shifts or provide care as a floater when there are vacation or sickness gaps to fill somewhere? “That’s no longer a problem,” Pappritz assures. “If an employer doesn’t bring that flexibility today, they’re quickly left without staff.”
“We need people with compassion, not pity.”
Philipp Lutze, Head of HealthCare Training at DEKRA Akademie, on retraining as a nursing assistant
Incomes in the nursing sector are rising significantly, in some cases by more than 11 percent. Does that mean that retrainees are lining up for you now?
The fact that incomes have risen with the new collective wage agreements is true and has been long overdue. But it has not yet triggered a “run” on nursing professions.
Why not?
Compared to other professions, many nurses do not earn bad net wages at all, due to the numerous tax-free allowances. But unlike regular wages, none of the tax-free allowances go into the pension fund. That’s why worries about poverty in old age unfortunately prevent many people from starting a career or wanting to retrain in the nursing field.
DEKRA Akademie offers a retraining program to become a nursing assistant. What type of people show interest – and what have they done professionally before?
Interestingly, there is no clustering pattern whatsoever with regard to former professions. It looks to me like a fairly normal cross-section of the population. However, it is noticeable that the 35 to 40 age group is disproportionately strongly represented. This is often due to drastic experiences in people’s private lives, for example someone being very involved in caring for their parents. On the other hand, other interested parties of the same age have been in the same job for 15 or 20 years and are looking for new fulfillment – because they simply no longer feel good on their way home from work.
What prerequisites or requirements should retrainees bring to the table to become a nursing assistant?
Nothing works in nursing without empathy. It is indispensable in order to be able to assist patients in a caring, sensitive way. Equally indispensable is one clear distinction: We need people with compassion, not pity. Approaching things with pity will break you! Resilience is also important: Nursing professions are physically and psychologically very demanding. It takes strength to position patients correctly. People cannot be deterred by the fact that death and dying are part and parcel of nursing care, either. Organizational talent, communication, and teamwork skills are also essential: It is not only the topics of positioning, wound care, and urine and stool control that are complex. This also applies to work processes on the ward, which need to be coordinated efficiently for the benefit of the patients.