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Concerted Action for Nursing – Germany’s Strategy to Combat the Shortage of Nursing Professionals

By launching the nationwide campaign, “Make a career as a human being!” (2019–2021), the government aimed to attract young people and adults seeking a career change to nursing.

By Matthias von Schwanenflügel
Head of Directorate-General 3 ‘Demographic Change, Senior Citizens, Non-statutory Welfare’
Federal Ministry for Family Affairs, Senior Citizens, Women and Youth

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The Concerted Action for Nursing initiated a wide-scale process in Germany to win back, retain, and attract nursing professionals at all levels. Training and qualification play a key role in this effort, ensuring not only high quality of care, but also job satisfaction for nursing professionals taking on these demanding jobs.

The demand for nursing personnel is high. One of the most significant demographic changes facing German society is that people are living longer and enjoying a higher quality of life in old age than ever before. While this is a positive development, it requires ensuring access to long-term care for a growing number of people. By the end of 2019, approximately 4.1 million people in Germany needed long-term care.1 By 2050, the number of those with care needs is projected to rise to 6.5 million.2 With more need, the demand for professional caregivers will also grow substantially.

Already a nationwide shortage of nursing professionals exists. In 2020, for every 100 unfilled positions there were only 26 professional caregivers in geriatric care and 47 in nursing care registered as jobseekers.3 Especially in geriatric nursing, demographic and social trends will continue to increase the demand for staff. It is estimated that the inpatient sector alone will need to fill an additional 71,000 full-time positions between now and 2030.4

Securing the staffing base to provide good professional nursing care is clearly one of the key social policy tasks in Germany. The COVID-19 pandemic cemented the importance of meeting the demands for nursing professionals. The frontline work of nurses during the pandemic demonstrated how their efforts save lives and reduce suffering. Nurses are essential not only in crisis response, but also in meeting the everyday needs of an aging society. Improving the structural framework conditions in nursing, achieving the appropriate financial valuation of the nursing professions, and increasing society’s appreciation of professional caregivers are among the most important goals of German long-term care and health policy.

Concerted Action for Nursing

In 2018, the German federal government set up the Concerted Action for Nursing to meet the challenges caused by demographic changes in nursing and long-term care. The initiative is supported by a long list of partners, including government agencies and community organizations. Among those involved are the Federal Ministry of Health; the Federal Ministry for Family Affairs, Senior Citizens, Women and Youth; the Federal Ministry of Labour and Social Affairs; the Federal Laender; nurses’ and nurse training associations; associations of LTC facilities and hospitals; churches; long-term care and health insurance funds; associations of affected persons; the occupational accident insurance funds; the Federal Employment Agency; and social partners.

In June 2019, the stakeholders agreed on binding goals and concrete measures to improve the working conditions of nursing professionals, enhance nursing training, and improve the remuneration of professional caregivers. Five different working groups specified goals and measures on topics such as training; personnel management; occupational health, safety, and health promotion; innovative approaches to care and digitalisation; recruitment of nursing professionals from abroad; and remuneration in nursing.5 

 Change is already underway. The second implementation report by The Concerted Action for Nursing, published in August 2021,6 highlights the creation of more nursing positions in inpatient and outpatient care. Additionally, critical steps are underway towards better payment and overall working conditions for care professionals and companion carers. The first-ever nationwide, uniform minimum wage for care professionals is being implemented (€15.00 per hour since July 2021). Starting in April 2022, the minimum wage for care professionals will rise to €15.40 per hour (increase of 2,67 percent). Also companion carers benefit from the new minimum wage. Since September 2021 the new minimum wage is €12.00 per hour. Starting in April 2022 the minimum wage for companion carers will rise to a nationwide minimum wage of €12.55 (increase of 4,58 percent). Furthermore, from September 2022 on, a long-term care facility's accreditation will depend on whether the care professionals and companion carers in its employ are paid at least the amount specified in one of the collective wage agreements in the field of care.7

New Nursing Training in Germany

To boost the popularity of the nursing profession and attract new recruits, Germany comprehensively reformed its new training program. The Act on Nursing Professions united previously separate and disjointed professional training programs for geriatric care, nursing care, and pediatric nursing into a uniform generalist nursing training program. Introduced in 2020, training is now for a “qualified caregiver” that seeks to cover comprehensive nursing care for all ages, in all areas of nursing practice. The vocational qualification is automatically recognized Europe-wide. In addition, after completing two-thirds of their program, trainees can opt for a special professional qualification in geriatric or pediatric nursing.

Not only was the framework for training overhauled, but so was the quality of the instruction. This included implementing new parameters for qualifying teachers and improving practical instruction. Finally, access to the program has improved. The nursing training program is free and trainees are entitled to an adequate training allowance. Alongside the professional nursing training programs, a primary qualifying nursing training program is being offered at universities for the first time.

Inspiring Future Nurses

With the goal of increasing both the number of trainees and training institutes by 10 percent by the end of 2023, the Vocational Training Initiative for the Care Sector launched in January 2019 as part of The Concerted Action for Nursing. Its aim is to support the introduction of the new nursing training program with over 100 agreements by the time the first year of training ends in 2023. Under the leadership of the Federal Ministry for Family Affairs, Senior Citizens, Women and Youth, the participants include all of the stakeholders involved in nursing from the federal government, the Laender, and the relevant associations.

By launching the nationwide campaign, “Make a career as a human being!” (2019–2021), the government aimed to attract young people and adults seeking a career change to nursing. The government financially backed this effort with a multi-year funding program of €25 million to the Laender for implementing long-term care reforms. To help transition to the new nursing training program, long-term care facilities and nursing schools are supported with diverse information and counselling opportunities. The website www.pflegeausbildung.net provides comprehensive information on the new nursing training program and the training initiative.

Early Success Despite a Pandemic

The Concerted Action for Nursing training program is already paying off with more people considering a job in nursing. A total of 57,294 trainees commenced the new training program in 2020. This came despite the negative impact the coronavirus pandemic has had on educational programs. Given the disruptions caused by the pandemic, it is possible that as we emerge from it the number of new trainees will continue to grow, outpacing the previous year.

Still, the coronavirus pandemic clearly demonstrated the role increased wages also plays. During the current legislative period of the Bundestag (2018 – 2021), the increase in salaries in geriatric care amounted to 15.6 percent overall and 9.8 percent in nursing (by 2020). In this respect, the measures implemented by Concerted Action for Nursing led to positive developments overall. We now need to continue the successful implementation of the goals and measures specified within the framework of the Concerted Action for Nursing so that they can quickly bear fruit. 

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1 Pflegestatistik - Pflege im Rahmen der Pflegeversicherung - Deutschlandergebnisse – 2019, S.21. (Care statistics - Nursing in the Context of the LTC Insurance – Results for Germany – 2019, p. 21) (in German).

2 Siebter Bericht der Bundesregierung über die Entwicklung der Pflegeversicherung und den Stand der pflegerischen Versorgung in der Bundesrepublik Deutschland, Berichtszeitraum: 2016-2019, S.13. (Seventh Report by the Federal Government on the Development of the LTC Insurance and the State of Nursing Care in the Federal Republic of Germany: 2016–2019, p. 13) (in German).

3 Bundesagentur für Arbeit Statistik/Arbeitsmarktberichterstattung, Arbeitsmarktsituation im Pflegebereich, Mai 2021, S. 17 (Federal Employment Agency Statistics/Labour Market Reporting, Situation in Nursing, May 2021, p. 17) (in German).

4 SOCIUM, IPP, iaw, KKSB (2020): Final report on project development and testing of an evidence-based procedure to uniformly measure the demand for personnel in long-term care institutions, based on the qualitative and quantitative standards stipulated in section 113c of the Social Code – Book XI (staffing requirements), p.369 (in German).

5https://www.bundesgesundheitsministerium.de/fileadmin/Dateien/3_Downloads/K/Konzertierte_Aktion_Pflege/191129_KAP_Gesamttext__Stand_11.2019_3._Auflage.pdf (in German).

6https://www.bundesgesundheitsministerium.de/fileadmin/Dateien/3_Downloads/K/Konzertierte_Aktion_Pflege/KAP_Zweiter_Bericht_zum_Stand_der_Umsetzung_der_Vereinbarungen_der_Arbeitsgruppen_1_bis_5.pdf (Second report - Concerted Action for Nursing) (in German).

7 Second report – Concerted Action for Nursing (Fn.6), p. 103 ff (in German).

 


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