Nursing emergency: “Doctors have to call for hours to place the children elsewhere”

The cold season has begun, oncological and neurological patients need to be cared for - but many nurses are ill, work part-time or have even retired.

That is why the situation in the intensive care units for children is currently very tense.

Professor Ursula Felderhoff-Müser, Vice President of the German Society for Child and Adolescent Medicine, on the situation in German children's hospitals.

Is there an acute overload in the children's intensive care area?

When we talk to colleagues, there is hardly a children's intensive care unit that does not regularly have to close beds due to staff shortages.

And we actually have the problem that doctors who are actually needed at the bedside spend hours on the phone with the intensive care units in the entire area in order to accommodate the children elsewhere.

We also have to transfer children to clinics up to 200 kilometers away.

This is of course very difficult for families when the child is in intensive care and is so far away from home.

Can you be more specific how many beds are locked?

This varies from region to region, but it can happen that a third or even half of the beds in a clinic cannot be occupied.

The situation will continue to worsen during the cold season because the infection period begins again.

In summer there wasn't really much relaxation as far as the number of patients was concerned.

Also because of Covid?

No, that has nothing to do with the pandemic, children rarely have to be hospitalized if they are infected.

There are more other infections, respiratory infections - but also children with acute life-threatening diseases such as serious accidents, diseases of the nervous system or oncological diseases.

Although these occur less frequently than in adults, it is important that the children can be adequately cared for.

Clinics that offer maximum intensive care - for example dialysis or neuromonitoring - within pediatrics are particularly in demand.

Could children also be treated in adult intensive care units if necessary?

This is by no means an alternative for every child, it is only possible for older children or young people.

And there has to be a free place in the adult ward, of course the situation there is also tense.

With small children or infants, for example, who have completely different needs, this is not possible anyway.

What's the biggest problem?

A lack of staff in the care sector is the main reason at the moment because we have a very reduced number of children's intensive care beds.

However, we have been observing this trend for years and of course it has not gotten any better during the pandemic, as many nurses have given up their jobs.

Does the aggravated situation also have something to do with the reform of nursing education?

In fact, we fear that pediatric

nursing will no longer be explicitly offered as a specialization subject with the start of general studies (

Nursing is such a beautiful job.

what has to happen

We urgently need to recruit more nursing staff and make the profession more attractive again.

This applies to adult care, but especially to care within paediatrics.

In the course of the pandemic, a bit of the fact that pediatric nursing is a really nice profession has been lost.

And, of course, caregivers need to be valued appropriately and paid reasonably.

This is a step that should have been taken a long time ago.

And on a political level?

We need more financial resources, especially in the field of paediatrics, where we have very high upfront costs, i.e. the costs that are not included in the current case flat rates, i.e. the flat rates used to bill medical services in Germany.

Children's hospitals often do not work economically.

The minimum staffing levels are also not up for discussion, but there are simply not enough staff.

To draw blood from a young child, you need a doctor and two nurses and a certain amount of time to convince them that you can draw blood at all.

With an adult it is of course something completely different.

So the flat rate system itself is not the problem?

We must adequately reimburse the case-based flat rates and include the provision costs.

When the case-based system was introduced, it was not sufficiently taken into account that children have completely different needs.

As already mentioned, many things are significantly more personnel- and technology-intensive than in the field of adult medicine, since children, for example, have to be monitored very closely.

And sometimes it takes a lot of detective work to figure out what's actually wrong with the child.

The case-based flat-rate system simply does not reflect this at the moment.