DBfK President Prof. Dr. hc Christel Bienstein / Image source: DBfK

Using nursing skills for hospital structural reform

01.08.2023 13:06

Until the key points from the Federal Ministry of Health were published, the hospital structural reform was seen by the German Professional Association for Nursing Professions (DBfK) as an opportunity for better health care and the development of the nursing professions. The DBfK had already argued in a policy brief that the nursing potential should be exploited in the reform and responded to the key points in a press release with sharp criticism. The association is now following up with a position paper in which ten demands for a successful reform are formulated.

“Our call to those responsible for politics is clear: use the nursing potential, otherwise the reform will not succeed,” said DBfK President Christel Bienstein. “We can clearly see that, in addition to the serious shortage of personnel in all health professions, we are confronted with incorrect care. This endangers the secure supply of the population. Compared to the OECD, we spend the most money on health care, but achieve only mediocre results. On the one hand, this is due to a shortage in primary care, which must be addressed in parallel with real structural reform. On the other hand, we know that nursing staffing levels and the proportion of academically trained nurses in hospitals are directly related to complication and mortality rates. An expansion of primary care and higher staffing ratios with more academically trained nurses are urgently needed if health care for the population is to be truly improved.”

In the present one Position paper “Hospital structural reform: Using nursing potential” The DBfK therefore makes the following ten demands:

1. Level II hospitals must be created and designed so that they can provide short-term inpatient treatment and, depending on regional needs, can also be set up as primary care centers.
2. The quality criteria in the service groups must reflect the nursing performance and include a needs-based personnel ratio as well as the necessary mix of qualifications for the nursing professions. A sensible personnel key results, for example, from PPR 2.0 and the associated instruments. In addition, a nursing science-based quota for academically trained nurses is necessary for the respective performance groups.
3. A nursing research program is needed in Germany to provide a scientific basis for quality of care. The discipline formation of nursing science in Germany must be promoted in order to be able to develop scientific excellence in this subject.
4. Nursing career profiles such as Advanced Practice Nurses (APN) with different focuses in hospitals, in inpatient and outpatient long-term care, and Community Health Nurses (CHN) in primary care must be established.
5. Emergency nursing care, as outlined in the government commission's fourth report, must be created and carried out by APNs trained at master's level with the appropriate competence to act.
6. Level Ii hospitals play a central role in regional acute care care. They combine the inpatient and outpatient areas when, for example, they organize the transition to home life. The Level II hospitals therefore have a strong nursing mandate that requires high-level nursing skills. They must therefore also be able to be under the professional supervision of APN.
7. The legal course in healthcare profession and benefit law must be set and the Nursing Professions Act must be adapted to the new requirements. The practice of medicine is to be transferred to nursing professionals in the sense of substitution in a health professions law.
8. Reservation tasks must be taken seriously and given space for execution. First and foremost, this includes the authorization to independently prescribe care and the necessary remedies and aids.
9. Investments in nursing education are necessary - in primary-qualifying bachelor's and specialized master's courses - as well as in the training of the necessary teaching staff. Nursing science and research must be strengthened.
10. Needs-based care in hospitals must be fully refinanced. The nursing services in the sense of primary care in Level II hospitals must be financed through a benefit law. Care evaluation relationships and a care DRG system are to be categorically rejected.

“We can no longer afford to let the skills of nursing professionals go to waste,” says Bienstein. “Anyone who continues to ignore the importance of professional care will exacerbate the problem and endanger the population’s health care.”