Shortage of skilled workers in nursing – How big is the nursing shortage?

In Germany, the nursing shortage is at the center of social debates given the rising costs of nursing home places and an acute shortage of staff. The problem could even worsen in the coming decades: working conditions are problematic in many facilities, which has a direct impact on care in clinics and nursing homes. In order to meet the growing challenges in the nursing industry, innovative concepts are required that both improve working conditions and make the profession more attractive.

So many nursing staff are currently missing

The shortage of skilled workers in the nursing sector in Germany is more drastic than in many other sectors. Despite the significant increase in the number of employees in recent years – a development that far exceeds other sectors of the economy – the need for qualified nursing staff remains unmet. In 2023 the reported Federal Employment Agencythat there were tens of thousands of positions open for nursing specialists, whereas only around a third of the skilled workers required were registered as job seekers. This shows the large discrepancy between supply and demand in this sector.

especially the Elderly care suffers from an acute shortage of skilled workers, closely followed by health and nursing care. These two professional groups are experiencing the greatest shortages nationwide. Specialized nursing professions, such as operating theater nurses or intensive care nurses, also struggle to find sufficient staff, which leads to significant bottlenecks. After a Survey by the Evangelical Association for Geriatric Care (DEVAP) In 2023, four out of five care facilities were forced to cut back on their offerings because of a lack of specialist staff.

In this context will be Alternatives as the 24-hour care at home increasingly important. Such a form of care offers continuous care from specialists directly in the home of the person in need of care and is therefore an increasingly attractive option – especially when traditional care facilities can no longer provide all services.

The serious understaffing also has a critical impact on care-intensive wards in hospitals. There has been one since 2019 statutory minimum staffing levels for such areas, but international comparisons show that Germany continues to lag behind other countries. For example, in the Netherlands there are only about half as many hospital patients per nurse as in Germany, which underlines the urgency for effective measures to address this shortage.

Looking into the future – the nursing shortage could continue to increase

The challenges in the nursing sector in the Federal Republic could become significantly worse in the coming years. The population is aging and forecasts indicate that the number of people needing care will increase significantly. The Barmer care report for example, indicates that around 6 million people could be in need of care by 2030 – an increase of 1.4 million compared to today.

Although the number of people starting training in nursing has increased, according to the Federal Statistical Office, the need remains unmet. This is, among other things, because: A third of training contracts in nursing are terminated prematurely – a significantly higher rate than in many other professions.

By 2055, the number of people in need of care could even increase by 37 percent to around 6.8 million. This growing need could lead to an additional shortage of around 180,000 nursing staff – in geriatric care alone. According to experts, the future development in the nursing professions depends heavily on how attractive and sustainable the working conditions are. Without major improvements, the nursing shortage will continue to worsen, which will increasingly endanger the health care of people in need of care.

This is how the shortage of skilled workers works

The shortage of nursing staff has far-reaching effects on patients and residents. Affected employees describe that time pressure often means that care cannot be provided as carefully as necessary. Important interpersonal aspects fall by the wayside, and even recommended care measures that can promote healing processes are neglected.

Another important aspect at this point is that Patient safety: It has now been proven that with each additional patient a nurse has to care for, the risk of fatal outcomes following surgical procedures increases. This shows how important adequate staffing is in medical facilities.

Causes of the nursing shortage – that’s what’s behind it

The nursing shortage in Germany has different causes, which are based on various social and economic conditions. The central ones here are: extremely stressful working conditions for nursing staff. Many find the constant time pressure, the high work pace and the often necessary overtime to be a constant burden. Last but not least, this means that nursing staff in clinics and care facilities regularly work at their limits and are increasingly thinking about giving up their job.

Another critical point is this inadequate remuneration in parts of the healthcare system. Loud Data from the Federal Employment Agency The average salary of full-time nursing staff in clinics is around 3,771 euros gross per month, while their colleagues in inpatient and outpatient care facilities have to make do with around 2,885 euros. The German Professional Association for Nursing Professions suggests establishing a starting salary of 4,000 euros in order to make the profession more attractive and increase appreciation for the work done.

The poor work-life balance, stressful shift work and a lack of social and internal appreciation further exacerbate the situation. The working conditions are often so strenuous that nursing staff have a high rate of illness and often leave the profession early.

Added to this is the Demographic change, which further increases the pressure on the care system. Birth rates are falling, while at the same time more and more older people are dependent on professional care. This development will continue to worsen in the coming years, as more nursing professionals are retiring than young people are moving in.

The situation creates a vicious circle: a lack of staff leads to greater stress on the remaining employees, which in turn worsens working conditions and further reduces the attractiveness of the professional field. About the cycle of shortage of skilled workers to break through fundamental changes in the structure and financing of care necessary to both improve working conditions and ensure adequate pay.

Ways out of the shortage of skilled workers in nursing – an overview of possible solutions

The federal government has already taken a number of steps to improve the ever-worsening nursing shortage situation – such as the introduction of minimum staffing levels in care-intensive clinic wards and the collective bargaining agreement, which has led to higher wages in retirement homes. But there are other approaches available that are intended to put an end to the nursing shortage:

• Hospital reforms: Federal Health Minister Karl Lauterbach is planning a two-step reform that, among other things, will increasingly carry out medically justifiable treatments on an outpatient basis. The aim is to reduce the burden on nursing staff and reduce night shifts.
• Collective agreements: After successful strikes by nursing staff at the NRW university hospitals, improved working conditions are being negotiated in the form of collective agreements.
• International recruitment: To counteract the shortage, the federal government is actively recruiting foreign nursing staff. The number of foreign nursing staff has already doubled in recent years.
• Redistribute tasks: Having unskilled workers take on simple tasks could enable skilled workers to concentrate on their core tasks. This is based on research showing that reorganizing the distribution of tasks can be effective.
• Increase contributions to nursing care insurance: In order to ensure the financial sustainability of the care system, the… Contributions to nursing care insurance increase in the future. A possible private pension insurance could also be introduced as an additional pillar.
• Technology and digitalization: Innovative technologies and new devices are intended to help make care more efficient and improve everyday life in care facilities.

Outpatient care services as an alternative

Outpatient care services are becoming increasingly important as a result of the nursing shortage problem. For many relatives, they represent an alternative to caring for people in need of care at home and relieving the burden on the family, who often take on a large part of the care. This development is reflected in the numbers: at the end of 2021, almost 443,000 people were employed in outpatient care facilities, a significant increase of 134 percent compared to the figures from 2001. At that time there were only around 189,600 employees (Destatis).

At the same time, the number of people using outpatient care services has also risen sharply – by 141 percent in the same period. This highlights how essential these services have become to meet the growing need for care. Outpatient care services not only offer a sensible alternative to inpatient care, but also enable many people in need of care to in to stay in their usual surroundings. This helps to improve the quality of life of those affected and strengthen social bonds, which are often put to the test when moving to a care facility.