Mönchengladbach (dpa) - Pediatrician Wolfgang Kölfen and pediatric nurse Sylvia Croonenbroeck are a well-coordinated team. The head of the Center for Pediatric and Adolescent Medicine in Mönchengladbach appreciates the knowledge and experience of his colleague.

"The expertise of these specialists in child health is essential for the quality of care for our young patients," emphasizes the Vice President of the Professional Association of Pediatricians. However, the 63-year-old fears that the traditional profession of pediatric nurse will become an obsolete model as part of the reorganization of nursing professions. Critical voices on the reform, which affects around 140,000 new trainees every year, also come from geriatric care.

Possible degrees in nursing

Since the beginning of this year, the innovation has brought with it the following degrees after three years of training: the nurse, pediatric nurse (previously a pediatric nurse), nurse with a pediatric focus, geriatric nurse and the nurse with a focus on geriatric care. The campaign "Make a career as a human being!" of the Federal Ministry of Family Affairs to focus on attracting more people to the nursing profession.

Kölfen regrets that at least the career as a pediatric nurse may soon be a thing of the past: it is too expensive for nursing schools to offer the qualification. According to a survey by the chief physicians of the children's clinics, 30 to 50 percent of them did not have this specialization in their portfolio. They are supporters of generalist nursing training to become a nurse with the same theoretical proportions for all graduates. Some of them viewed specialization after the three-year training as a potential business area.

The association representative also receives headwind from the federal states. In a letter to the Federal Joint Committee on Health Care, they favor the nurse with a pediatric focus and demand that several years of relevant professional experience are sufficient for use in pediatric and adolescent medicine.

Requirements decreased

"This dilution of the qualifications of the pediatric nurse is a scandal," said Kölfen. As a result, care is losing many committed young women. "Those who come to us have a vision - they want to help children, not adults or the elderly." The 7,000 apprenticeships are in great demand. The innovations thwarted the call for quality. Whether the patient benefits from it depends on coincidences: "If parents bring their child to the children's clinic, they can meet a generalist with a maximum of 120 hours of pediatric training or a pediatric nurse with 2800 hours of pediatric theory and practice in the future." And this value is still below the requirements for the classic pediatric nurses, of which there are 38,000 according to Cologne.

Actually, the care profession law is supposed to make the care activity more attractive, reduce staff shortages and prevent future gaps in care. The federal government's recipe against the need for nursing is generalist training with a wide range of uses: from acute and pediatric nursing to inpatient or outpatient long-term care to psychiatric care. The federal government plans to increase the number of nursing trainees by ten percent by 2023.

Great shortage of nurses

This is urgently needed: According to earlier information from the Institute of German Business, 130,000 to 150,000 nurses will be missing by 2035, depending on the scenario. At the same time, the number of people in need of care is increasing rapidly. This year there are four million older people in need of help - 80 percent more than 20 years ago. According to the Federal Statistical Office, there will be around 5.9 million in 2050. The job-specific unemployment rate of one percent (2018) shows how swept the market is in nursing.

It is not yet clear how many additional young people the reform will bring to nursing, as most nursing schools only start the new courses in April or October. The first signs indicate increased interest.

That wouldn't surprise Stefanie Brase, nursing director of the Darmstadt Clinic. She is very taken with the generalist education. "I am convinced that this will attract more nursing trainees and open up more opportunities than risks for both employees and employers." The nursing manager adds: "For the first time, the training encompasses all situations and forms of care - from children to the elderly." This also corresponds to the changed patient groups in clinics and care facilities. "More and more multimorbid old patients are treated in the hospital and younger, seriously ill patients in long-term care facilities." The reform takes this into account and will prevail, she predicts.

Education in a clinic preferred

The representatives of geriatric care see much more critically. Wolfgang Hahl, head of the Mannheim Academy for Social Professions and chairman of the conference of nursing schools in Baden-Württemberg, does not expect the new nursing professions to bring more trainees to his industry. "Hospitals can meet the new requirements much better than retirement homes or outpatient care services," explains Hahl. Because the trainees have to complete up to five internships. Most of these stations could be easily passed under the roof of a clinic. "A small outpatient service can't do that," says Hahl.

It is unlikely that senior institutions will benefit from the generalistically trained forces, especially in the short term. "The change is usually reversed: the nurses come to us after many years in the clinic." Although there are only 19 unemployed people per 100 vacant specialist positions in geriatric care (2018), the willingness to train in retirement homes is restrained. Apart from all legal regulations, the hospital workplace has a completely different image than the care of the elderly due to the series of clinics, says Hahl.

Information on nursing law

Campaign Make a career as a person

Labor market care report

Professional association of pediatricians

Position of the nursing schools