Reforms overdue

Dear readers,

Healthcare and nursing professions are attractive. This is demonstrated by the high levels of transition to the relevant training occupations, especially by young women. It is also, however, revealed by the high proportion of trained persons who remain in their profession. Working conditions are, however, anything but attractive. Remuneration is generally moderate, and the work itself is associated with mental stress and characterised by irregular hours. Better payment, more recognition and an improved work-life balance are all at the top of the wish list for employees in the sector.

Standardised nursing training

At the beginning of 2016, the Federal Cabinet adopted a draft proposal for uniform nursing training. This had been preceded by many years of concentrated debate and pilot projects. The draft law was ambitious. The aim was not only to bring together the professions of general nurse, children’s nurse and geriatric nurse, which had previously been separate occupations, but also to switch to free training for everyone. A further intention was that all learners would receive a training allowance. The idea of merging all nursing professions into a single occupation provoked criticism from the professional associations and stakeholder groups. Although merging into uniform training programmes is eminently sensible, professional tasks vary considerably in practice.

Now the law is on hold for the time being. This is regrettable given the rising demand for nursing staff and in light of the fact that existing training provision is scarcely capable of covering this requirement. In addition, persons from other occupational fields and skilled workers from abroad need to be recruited. A solution which enjoys the consent of the relevant stakeholders should be found as soon as possible. The principle of broad profiling of training could be harmonised with the necessary differentiation with regard to the different fields of occupational activity. Pertinent models already exist within dual vocational education and training, such as main focus profiles, specialisms and areas of deployment.

Academisation

Over recent years, numerous institutes of higher education have begun to develop programmes of study in the healthcare and nursing professions. This represents a reaction to rising requirements and relevant recommendations. It remains unclear, however, which tasks should be taken on by nursing staff who hold a degree. Higher education study may be useful for management tasks or for activities within practical training. This demand could, however, also be met by appropriate advanced training. Degree-level studies are not required for the vast majority of tasks involving direct contact with patients. There are not enough higher-level tasks that need to be performed. Neither does higher education pay off financially, because nursing staff holding a degree often carry out the same activities as colleagues who have not studied.

Academisation would receive a new boost if there was a realignment of the distribution of tasks between academic and non-academic occupations in the healthcare sector. A redelineation of occupational roles would permit ready justification of whether to pursue academic training or an academically-based additional qualification. Other countries show that this is possible without compromising quality of care. In Germany, however, we have not yet reached this point. Those with medical qualifications mainly lay claim to diagnostic tasks and treatment decisions. Maybe the impending shortage of doctors will ensure that this issue is included on the agenda. Nevertheless, pilot projects are now in place to experiment with the idea of transferring individual tasks to nursing and geriatric nursing staff.

REINHOLD WEIß
Prof. Dr., Deputy President of the Federal Institute for Vocational Education and Training (BIBB) and Head of Research

Translation from the German original (published in BWP 1/2017): Martin Kelsey, Global Sprach Team, Berlin