Combating the Nursing Crisis

The quality of our healthcare has come under pressure. Already, the demographic change is clearly noticeable, and this is only the beginning. The “Elite Caregivers” manifesto shows how Germany can provide high-quality healthcare for all going forward.

Robert Bosch Stiftung | March 2018
Patient and nurse
Werner Krüpers

The ongoing demographic change poses an increasing threat to the quality of our healthcare, as the number of older, chronically ill, and multimorbid patients requiring care is rising. And this is only the beginning of a development that will take full effect from the mid-2020s on when the baby boomer generation will require more and more care. But an aging society is not the only challenge: The changes in work processes based on increasing digitalization, the migration from rural regions where mainly older people remain, and the need to provide care for an increasingly diverse population with distinct, individual demands also add to the problem.

What needs to happen to make sure that high-quality healthcare can be offered to all people going forward? Initiated by the Robert Bosch Stiftung, 40 experts discussed this question and have now published a summary of their findings in the form of the “Elite Caregivers” manifesto. One of their core demands is to give nursing staff the level of responsibility that matches their qualifications. Plus, the profession needs to be made more attractive and offer better career development opportunities to ensure a sufficient number of qualified care personnel in the future.

Change society’s image of professional care

“We urgently need more attractive career paths in nursing and care,” commented Franz Wagner, President of the German Nurses Association and a member of the Robert Bosch Stiftung’s expert council. “To make this happen, we will have to change society’s image of professional care. Today, most people think that nursing means to shift and feed infirm people.” Over the past few decades, the world of medical treatment and care provision has become more and more complex. Another important aspect to consider is that the demand for nurses will soar disproportionately in the years to come. This is why the quality of healthcare will primarily depend on staffing, namely the number of professional caregivers and their qualifications. “Germany not only needs more nursing staff in professional care, but also many more nurses with academic degrees in direct care,” according to Mr. Wagner. This is why, back in 2012, the Scientific Council recommended a 10 to 20 percent share of academically trained nurses. Presently, Germany does not even come close to these numbers.

Catching up to international standards

“It’s high time for Germany to catch up to international standards in nursing. Especially in terms of academically trained nurses, we are far behind many other countries,” said Uta-Micaela Dürig, Vice Chair of the Board of Management of the Robert Bosch Stiftung. Even in the UK, whose National Health Service often serves as a textbook example of what not to do, the situation is much better in this respect. Specially trained nurses with the job title of clinical nurse specialists mostly care for their patients without supervision and only call in the doctor if a patient’s condition deteriorates. “The manifesto aims to present the prerequisites for excellent care and the reasons why academically trained nursing staff are urgently needed in all areas of healthcare. We hope our message will be heard and will motivate decision-makers to rethink their positions and act on it.”

The manifesto’s title, “Elite Caregivers”, invokes an older memorandum, “Care Needs Elites”, published by the Robert Bosch Stiftung in 1992. This document was written in response to the nursing crisis of the early 1990s and called for an academicization of nursing to make the profession in Germany more competitive, bring it up to international standards, and help it meet the demands of the impending demographic change. “Care Needs Elites” triggered the introduction of a multitude of academic nursing programs, especially in nursing management and care education.