>> Before answering the question raised by Mr. Höfert, “Care chambers: If not now, then when?”, the question must be answered: “Care chambers - why?” Do we even need nursing chambers? What use do they have? Are they better suited to take on the social tasks that are to be assigned to them than the institutions and authorities that have previously been tasked with doing so?
Those in favor of setting up nursing chambers - including Mr. Höfert - give the following reasons, among others: Chambers serve to protect the population from care errors or from “black sheep” in the industry. They served to ensure quality and the safety of the profession holders. They would guarantee a binding professional code, compliance with professional ethics and serve the self-administration of the profession.
In this article I want to look at the functions intended for the chambers and examine the question of whether they are the appropriate instrument to fulfill the tasks intended for them.
As institutions under public law with compulsory membership, chambers only have access to the professional members who are members of them. You can oblige them to behave in a certain way or encourage them to commit themselves to, for example, adhering to a defined ethical code. Misconduct can be sanctioned. For example, the Bavarian draft law stipulates that the chamber can impose fines. In Germany, nursing care for the elderly, the sick and children is predominantly not carried out by freelance nursing staff who have to be encouraged to behave correctly through a chamber or through a voluntary commitment, but by employed nursing staff. They are subject to the instructions of their employers and have only limited opportunities to influence the quality of their work. The chamber could neither ensure sufficient funding for hospitals and nursing services nor adequate staffing, nor even the correct qualifications of professionals. No matter how good the will of the professionals, good care cannot be guaranteed if the conditions do not allow it.
In such a situation, being punished by your own chamber because mistakes were made does not seem to me to be a very pleasant prospect. However, it should be noted that established chambers, such as the medical associations, have so far neither been noticed by sustainably sanctioning misconduct by so-called “black sheep” among practicing doctors, nor that they are responsible for one in outpatient medical care or even in hospitals would ensure good quality of care. Anyone who wants to get justice as a patient or person in need of care will have to go through the courts. Why should it be any different with the nursing chambers?
We are convinced that quality assurance must take place through improved framework conditions and that responsibility for the quality of services lies primarily with the service providers themselves (homes, nursing services, hospitals), not primarily with their employees. Quality control should be carried out by independent authorities and institutions such as the home supervision or the medical service of the health insurance companies. However, more independence would not hurt the latter. In this case, it makes more sense for benefit recipients to be involved via their interest groups or consumer protection organizations. Quality assurance by the chambers that amounts to sanctioning members of the profession is not the method of choice here.
Professional regulations for nursing professions currently exist in the federal states of Bremen, Hamburg and Saarland. As state regulations, they leave nothing to be desired in terms of commitment. However, it is doubtful whether they contain sensible regulations and contribute to quality assurance. Their objectives are very similar to those of nursing chambers, but how this form of quality assurance should be implemented in practice remains an open question.
The central core of the professional regulations is the regulation on “maintenance of competence and quality assurance”. The professional regulations in Bremen stipulate that “measures to maintain competence of at least ten hours must be carried out by every professional nursing staff in addition to the study of specialist literature”. Such a regulation may make sense for self-employed people and freelancers who can regulate their own working hours to a greater extent; for employed nursing staff, in addition to a personal obligation to undergo further training, it is more important to have a legal right to further training during or being counted as working time with the employer bearing the costs guarantee. Here, employers are just as obliged to promote and maintain the qualifications of their employees as they themselves are. However, it is not the chambers that can regulate this, but rather the legislature or the collective bargaining parties.
Ethical principles are already established by professional associations and the International Council of Nurses (ICN) Code of Ethics and are taught in professional training. However, they thrive on the fact that those who are supposed to comply with them must be convinced of their correctness. This is difficult to regulate through professional regulations or legal regulations.
Professional self-administration may make sense for freelancers and self-employed people who are not otherwise subject to instructions; for employees, professional behavior is very much influenced by the employment relationship and its conditions. Your interests are represented through professional associations, unions and, if necessary, specialist societies. Compulsory membership does not increase professional commitment, but only increases the available financial volume. The diversity of interests and associations is not eliminated by chambers regulated by state law. Their composition will reflect this diversity. At best, the legitimacy of speaking for members of the profession is increased, although the minority factions in the chambers have to live with the fact that they are not heard by the public. The Federal Chamber is a registered association; it can only harmonize the diversity of opinions of the state chambers to a limited extent. So why should the opinion of the President of the Federal Chamber be heard more than that of the President of the German Nursing Council? Even if the latter only represents a portion of the nursing staff?
In my opinion, the benefits attributed to the chambers are disproportionate to the effort involved in setting up a comprehensive chamber structure, staffing it and financing it through compulsory membership from membership fees. <<