While the number of people in need of care is continuously rising, concerns are growing as to whether there will still be enough qualified staff available in the coming years. The nursing staff shortage is no longer an abstract future scenario, but is already shaping everyday life in hospitals, nursing homes and outpatient services.
However, the discussion is not only about numbers, but also about finding sustainable solutions. Politicians, associations and institutions are looking for ways to make the profession more attractive, improve working conditions and attract new skilled workers.
What does nursing staff shortage mean?
The term nursing staff shortage describes a situation in which the demand for qualified nursing staff exceeds the supply available on the labour market. This affects hospitals, inpatient care facilities and outpatient care.
In practice, the nursing shortage manifests itself in unfilled positions, high workloads, increased overtime and growing demands on existing staff. According to recent surveys, it can take over 200 days to fill a nursing position in some cases. At the same time, the number of reported vacancies significantly exceeds the number of registered unemployed skilled workers.
Another structural problem is the low potential for substitution: nursing services can only be replaced to a limited extent by technology or other professional groups. This makes the situation even more explosive.
Nursing staff shortage – causes
The causes of the nursing staff shortage are complex. One of the most important factors is demographic change. The population is getting older on average, and with increasing age comes a higher risk of needing care. At the same time, many nursing staff from the baby boomer generation will be retiring in the coming years. This will exacerbate the imbalance between supply and demand.
Added to this are structural problems within the profession. Nursing is considered physically and mentally demanding. Shift work, weekend work and emotional stress lead many skilled workers to reduce their working hours or leave the profession altogether. The high proportion of part-time workers further exacerbates the nursing shortage.
Another aspect concerns social recognition. Despite rising salaries, many nursing staff feel that their professionalism is not sufficiently appreciated. A lack of co-determination, bureaucratic burdens and time pressure affect job satisfaction.
Regional differences also play a role. While some federal states expect a moderate increase in the number of people requiring care, other regions anticipate significant growth. This uneven distribution significantly exacerbates the shortage of nursing staff at the local level.
Nursing staff shortage – current situation
There are currently around 1.7 million nursing staff employed in Germany who are subject to social insurance contributions. After a period of stagnant growth during the coronavirus pandemic, a slight increase has recently been recorded. Nevertheless, the situation remains tense.
The rising proportion of nursing staff with foreign nationality is particularly striking. In recent years, employment growth has been driven almost exclusively by international skilled workers. Without this immigration, the shortage of nursing staff would be much more pronounced.
In addition, the ratio of unemployed to job vacancies illustrates the bottleneck situation: while there are sometimes more unemployed nursing assistants than job vacancies, the number of job vacancies for skilled workers significantly exceeds the number of job seekers.
The number of people in need of care is also rising steadily. More than five million people in Germany are already affected today. At the same time, the financial burden on nursing care insurance is growing, triggering additional debates on reform.
Forecasts for the coming years
Forecasts assume that the demand for care services will continue to rise significantly over the next 15 to 20 years. According to estimates, the number of people in need of care could grow to around six million by 2040.
Depending on the scenario, the demand for care is expected to increase by around a third by 2049. At the same time, forecasts for the number of available care workers vary: while a status quo scenario assumes a decline, a trend variant anticipates moderate growth. Regardless of the scenario, however, one thing remains clear: without effective solutions, the shortage of nursing staff will continue to worsen in the future.
Nursing staff shortage – solutions
The search for solutions is complex, as there is no single measure that could solve the problem on its own. Rather, a bundle of reforms, structural changes and social adjustments is needed.
Digitalisation
Digitalisation offers opportunities to make work processes more efficient and to relieve the burden on nursing staff in a targeted manner. Electronic documentation systems can reduce the time-consuming paperwork that has been necessary up to now and avoid duplicate entries. Modern software solutions also make it possible to record nursing documentation on the go, at the bedside or during home visits, which shortens travel times and increases transparency. Especially in the context of the nursing shortage, every minute saved is valuable, as it directly benefits patient care.
In addition, technical assistance systems are increasingly being used. Sensor-based carpets or bed modules can register falls, while digital monitoring systems continuously record vital signs and provide early warning of critical changes. This allows complications to be identified more quickly and emergencies to be avoided. Telecare approaches are also gaining in importance, especially in rural areas, as they enable remote professional advice and can bridge gaps in care provision.
Despite all the technological advances, however, one thing remains clear: digitalisation can only alleviate the shortage of nursing staff, not completely solve it. This is because important core elements of care, such as empathy and relationship building, cannot be replaced by technology.
Care salaries
Pay in the care sector has risen noticeably in recent years. Collective agreements, minimum wage adjustments and political reforms have led to median wages growing more strongly than in many other occupational groups. This development is an important sign of social recognition.
In addition, adequate remuneration is an important factor in combating the shortage of nursing staff, as financial attractiveness is a decisive factor in choosing a career and remaining in the profession.
However, improving remuneration also brings financial challenges. Care facilities have to bear higher personnel costs, which are refinanced through care rates. This has an impact on co-payments in inpatient facilities and on care insurance. Long-term solutions must therefore also take into account a sustainable financing strategy in order to secure good wages in the long term.
Flexible working hours
Flexible working time models are considered one of the most effective solutions to counteract the shortage of nursing staff. The nursing profession is traditionally characterised by shift work, weekend work and short-term changes to duty rosters. Many skilled workers reduce their working hours in order to better cope with family commitments or personal stress.
Models such as the four-day week, preferred duty rosters or reliable shift systems can significantly improve the work-life balance. The aim is to make working conditions more predictable and attractive.
Nursing staff recruitment
International recruitment is playing an increasingly important role in overcoming the shortage of nursing staff. In recent years, employment growth in the nursing sector has been driven largely by skilled workers with foreign citizenship. Without this immigration, the supply situation would be significantly more strained.
For international recruitment to be successful, structured recognition procedures, intensive language training and sustainable integration concepts are required. In addition to professional qualifications, social integration into teams and society is a key success factor.
At the same time, continuing professional development in the UK is becoming increasingly important. Subsidised retraining programmes for nursing professionals show high integration rates into the labour market. The majority of graduates are in employment subject to social insurance contributions just a few months after completing their training. These programmes therefore represent an important pillar of the solutions to the shortage of nursing staff.
In the long term, it will be important to strengthen national training capacities and retain international skilled workers in the long term in order to secure a stable workforce in the nursing sector.
Nursing Competence Act – opportunities for addressing the shortage of nursing staff
With the Nursing Competence Act, policymakers are pursuing the goal of transferring more responsibility and independent competences to nursing professionals. Expanded areas of responsibility would allow nursing staff to work more independently and better apply their expertise.
A redistribution of activities, such as delegating certain tasks to assistants, can help to deploy skilled workers in a more targeted manner. Studies show that qualified personnel often take on tasks that would not require three years of training. A clearer task structure could make more efficient use of resources and alleviate the shortage of nursing staff.
In addition, upgrading the profession strengthens the overall image of the job. Greater autonomy and responsibility increase the attractiveness of the profession and are part of sustainable solutions in the long term.
Conclusion
The shortage of nursing staff is one of the most significant challenges facing the German health and social care system. Demographic developments, high levels of stress in everyday working life and structural deficits are exacerbating the situation. Forecasts show that the demand for nursing services will continue to increase.
At the same time, there are a variety of approaches to addressing the shortage of nursing staff: better pay, flexible working time models, targeted further training, international recruiting, digitalisation and strengthening nursing skills.
It will be crucial to implement these solutions not in isolation, but as part of a comprehensive reform strategy. Only if politicians, institutions and society act together can the shortage of nursing staff be curbed in the long term and high-quality care be ensured.
Jobs in nursing
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Author: Nicolas Simon / Medi-Karriere
