Nursing professions | Nursing: Not everyone is doing everything anymore

Here, there's a shortage of skilled workers, there, a growing number of people in need of care – the nursing sector is currently caught between these two extremes, in outpatient settings, nursing homes, and hospitals. This week, professional perspectives were among the topics discussed at the Nursing Day in Berlin.

Several professions are now active in the various sectors. Furthermore, a shift is underway: Previously, three-year trained and certified nurses formed the core of the workforce, supplemented by support staff. However, according to a project by the German Nursing Council on educational architecture, at least four "roles" are now discussed. These are the nursing assistant, the registered nurse with and without a bachelor's degree, and the specialist with advanced skills (APN with a master's degree) – each with specific responsibilities. Since 2020, registered nurses have also undergone three years of training, but now in a "generalist" format , meaning they can work in hospitals, nursing homes, or home care services.

In practice, however, responsibilities and the division of tasks are not always clear, resulting in the effect of "everyone doing everything." This was also the title of a symposium at the Nursing Conference, which examined the processes of change within the profession. Because clear boundaries are often still lacking, dissatisfaction frequently arises – partly due to being over- or under-challenged.

Personal hygiene seems to be one of the areas of conflict among the professions; within nursing itself, such activities are still sometimes devalued. "But who defines the value of an activity?" asks Judith Hantl-Merget. The nursing director of the Romed clinics in southeastern Bavaria provides the answer herself: "It shouldn't be the nurses, but the patients, the core group in hospitals." Thomas von den Hooven, nursing director at the University Hospital of Münster, sees it very similarly: "This devaluation is wrong." Patients sometimes arrive on the wards sweaty and bloody, for example, after an operation. For them, careful personal hygiene without time pressure is a real blessing.

"Who defines the value of an activity? It shouldn't be the caregivers, but the patients."

Judith Hantl-Merget , Director of Nursing, Romed Clinics

Therefore, for genuine patient-centered care, it is advantageous if all professions are aware of their responsibilities and areas of expertise. This requires structures, but also a strong team culture. Hantl-Merget has observed that clarifying responsibilities suddenly reveals that taking on accountability isn't always so appealing. "If we want to change something here, it can't be done by top-down directives." In her hospital network, some departments have already been restructured using role definitions. "This works in neonatology, acute geriatrics, and cardiology." Up to six different qualifications are involved. The anxieties of employees must also be addressed during this change process.

Positive experiences with a so-called skill mix among employees, meaning a blend of qualifications, have been established in long-term residential care for some time, as Philipp Schuh, one of the managing directors of Alloheim senior residences , reports. Nursing assistants with one to two years of training now make up a larger proportion of the staff, resulting in "more hands at the bedside." As a result of these changes, the traditional "residential unit" structure has been replaced by a focus on professional expertise. The transition process has been underway for two years and will continue for some time. "The clear division of tasks is beneficial for the employees; they now have more time for their work," says the business graduate.

Hantl-Merget confirms that the job profiles definitely contribute to the attractiveness of the institution: "We have many applications for apprenticeships and a turnover rate of seven percent. We receive unsolicited applications; we don't need a recruitment agency. Employee retention is growing." She attributes this to the clarity of individual responsibilities and the associated appreciation.

At the symposium, no one could foresee how long the restructuring process in nursing described here will ultimately take. That it even begins seems vital to ensuring care. This also includes nursing taking on additional tasks, including more patient and family education. We need to get ahead of the curve; we need greater health literacy within the population.

The issue of academic training also belongs in this context. Without it, there would be no new role profiles; with it, responsibility for professional standards would be strengthened. But the percentage of university graduates in nursing is currently only 2.5 percent – ​​despite decades of discussion in Germany. The German Council of Science and Humanities recommends up to 20 percent, and Norway has already reached 100 percent. The panelists agreed that there is no way around the academic training of the nursing profession. The pace of this process is far too slow. Therefore, it is even possible that in the future, certain experienced professionals will be able to obtain a bachelor's degree through a shortcut.