A human heart is emblazoned on Madeleine Bohm's forearm and delicately engraved flowers grow from it. “The tattoo represents my love for medicine,” says the 30-year-old nurse. It reminds her that working in the clinic is her dream job. She is currently visiting an elderly patient in the intensive care unit who is being artificially ventilated. Injured motorcyclists lie here, farmers and winegrowers after accidents at work, people who have had serious falls. Some can leave the station after hours, others stay for weeks. “Originally I wanted to become a doctor,” says Bohm. She smiles when she thinks back to spending hours at the station with her father as a child. He was in the emergency service. “It’s a meaningful career, nothing else was out of the question for me.”
But during her first internship in a hospital, she was disillusioned to discover “that the doctors had incredibly little time,” she says. “Care, on the other hand, is much closer to the patient. We are the ones who are at the bedside all the time, who look after and accompany people and relatives.” That corresponded much more to what she wanted: “I also like to listen for five minutes, take a moment to comfort myself.” Despite With busy workdays and pressure, she finds herself in the intensive care unit during this time. “Yes, shift work is often tiring. Yes, the job remains underpaid in relation to the work performed and the demands, even if we are paid here according to a comparatively good collective agreement,” she says.
Madeleine Bohm moved from Rhineland-Palatinate to Freiburg im Breisgau for her training. What attracted them wasn't just the lively student city with the Black Forest on the doorstep. It was mainly the university hospital; With more than 15,000 employees, it is the largest employer and training company in southern Baden. A good 4,300 nursing staff care for around 90,000 inpatients and around 900,000 outpatients every year.
There is construction noise on the site, and a new children's clinic is scheduled to open in 2024. A helicopter circles over the landing site. 130 nursing staff work in the medical and anesthesiological intensive care units, each of which has 14 treatment places. In the university hospital's nine intensive care units, one nurse never looks after more than two patients. Silvia Kopp is the nursing manager, a hands-on woman with dark hair. She began her training in Freiburg in 1987 and has stayed at the university hospital ever since. “There were 1,500 applications for every 60 open positions,” she remembers. She has written more than 50 applications herself.
Times have long since changed. Today it is employers who are recruiting staff. The lack of capable nursing staff in Germany means that many beds in numerous clinics have to remain permanently empty, even though they are actually urgently needed. In Freiburg, the management of the clinic reacted in a timely manner; The problem of blocked beds is also known here, but it occurs comparatively rarely. The hospital now not only advertises above-average remuneration, flexible working hours, job tickets, a fitness program and staff accommodation, but above all: development opportunities. This makes the university clinic one of the exemplary employers in nursing, as a study by the MINQ Institute for the stern showed.
In Freiburg, the management of the wards was redesigned in 2017: Now the nursing management takes care of staff management and processes, a nursing management translates scientific findings into bedside measures, and the nursing pedagogical management coordinates the promotion of young talent, training and further education. This means that some can concentrate on nursing care, while others instruct trainees and train new nursing staff. The management jobs are in demand.
Madeleine Bohm is one of the first graduates of a new model that is currently being tested: “3 1”. It makes it possible to follow the three-year training to become a nursing specialist with a one-year further training in intensive care.
She often hears the sentence from friends: “Respect that you do this work, I couldn't do it.” Bohm believes that many people associate care with little-recognized, but hard work that offers hardly any opportunities for development. From their point of view, the reality of work – with all the demanding requirements – is different. “I would like people to see how complex this job is and what we really achieve.”
At the medication counter in the intensive care unit, Bohm's colleague Salome Stange draws sugar solution into a syringe. After graduating from high school, she first began an apprenticeship as a chef, worked in a veterinary practice and in a nursing home, then began studying pharmacy in Freiburg and ended up in the emergency services. Only after these detours did she begin her training as a nursing specialist and study nursing science at the same time. Like Madeleine Bohm, she wants to work close to patients - and at the same time be scientifically active. “During training, I was nervous weeks before my first practical assignment in the intensive care unit,” says the 28-year-old. But the team on site gave her security. “I felt cared for and cared for.” After her exams, she started in the intensive care unit. “The job is exciting, there is hardly any routine here. I learn something new every day,” she says. At the same time, she continues to study and still has two semesters until she completes her master's degree. Your university lessons and exams are taken into account in the roster; In order to meet the workload, she works part-time, 55 percent.
But she doesn't just study for university. She and her colleagues, who also combine studies and training, also supervise their own research projects at the clinic. They use ten percent of their working time for this, and science and everyday life are merging more and more.
For example, 32-year-old Kathrin Spangenberg, who is dosing antibiotics next to Salome Stange at the counter, is responsible for revising standards in her project: for different forms of ventilation and medication management, which are particularly relevant for internal intensive care medicine. Colleague Annalisa Amann, 26, examines nutritional management: she evaluates data on nutritional status in order to detect malnutrition at an early stage and counteract it. And addresses the question: What should be done to make the often disreputable hospital food more nutritious, promote recovery and taste better? In addition to trust and responsibility, the young nursing specialists experience a lot of appreciation. They should grow into experts in an area and contact persons for the medical profession. It is one of the ideas to offer female academics development opportunities - and not to lose them.
In 2021, the clinic asked employees in the intensive care unit what was bothering them. The answers that kept coming were: the emotional strain and the amount of tasks. Salome Stange is now devoting herself to the topic of how she and her colleagues can better deal with all the challenges of everyday working life.
An idea for creating better working conditions can be found hidden behind a partition in the corridor of the intensive care unit: a massage chair with virtual reality glasses and headphones. “In the realm of dreams” is written on a sign hanging on the privacy screen. Here employees can relax during their breaks and immerse themselves in another world. There is professional support to reduce stress and incorrect workload: for example supervision and discussion groups after stressful situations, after deaths or if there are conflicts within the team. On the ward they try to design duty rosters according to everyone's needs and coordinate with each other. Maximum flexible working hours make it possible to study during your training – or years afterwards. In order to be able to combine family and work, there is childcare and the option of not having to take night shifts or work on weekends. Some only work at certain times, adapted to the daycare's opening hours. If there is a lack of staff somewhere, the ward management compensates for this with a flexible pool of jumpers: more than a hundred full-time staff who can move freely between the clinic's wards - as required. And last but not least, nursing staff at university hospitals in Baden-Württemberg earn significantly more than elsewhere - after three years of training, they will start with at least 3,630 euros gross from January 2024, significantly more than under other collective agreements.
The scientific study that Salome Stange is working on is part of a big vision: the Freiburg University Hospital is on the way to becoming one of the first German “magnet hospitals”, modeled on certified American clinics. The guiding principle: Staff should be attracted like a magnet, for the benefit of the employees and patients. The concept developed in the USA when there was a nursing shortage in the 1980s. Some clinics stood out at the time because they found it easier to get staff. Studies have shown that nurses there were happier and more involved in decision-making processes. The patients also benefited from this; there were fewer complications and deaths. Criteria were derived from this. The aim is to improve the well-being and health of employees. Studies show that motivated and competent nursing staff in adequate numbers are associated with good patient outcomes (satisfaction, better care, lower mortality).
The university hospital's partner hospital is the Thomas Jefferson University Hospital in Philadelphia. The people of Freiburg exchange ideas with their American colleagues. Among other things, some visited the so-called simulation center: prospective nurses trained realistically in caring for sick people, some of whom were portrayed by actors. There is now also a “skills lab” in Freiburg. In the USA, future nurses often enter direct patient care later than in this country. There and also in countries like Sweden or Great Britain many people complete their studies. The Science Council demands that ten to twenty percent of nursing staff in Germany should also study in the future. But academization is still getting off to a slow start: only 0.5 percent of nurses have a nursing degree to date. At the Freiburg University Hospital it is currently 3.2 percent - a rate that stands out nationwide.
The fact that the university clinic is at the top here is also thanks to nursing director Helmut Schiffer. “If employees can initiate and implement things in their direct area of activity, this increases satisfaction and connection with their work and our company,” says the 63-year-old. Almost ten years ago he came to the south from the Berlin Charité. The fact that he is on the hospital board as nursing director shows how important nursing is here. Schiffer quickly realized that the nursing shortage is a vicious circle: the greater the staff shortage, the more unbearable the working conditions, which leads to more layoffs. But he believes it is possible to reverse this downward spiral. Schiffer was a nurse himself. “The profession has become more complex and demanding over the last few years due to the specializations that are common in a university clinic,” he says. For him, the consequence is that the profession has to become more professional. He wants to link theory and practice even more closely, advance clinical nursing science and link patient care, teaching and research even more closely. He sees the university clinic as a role model when it comes to implementing knowledge directly in everyday ward life. And he wants to promote motivated nursing staff. This means: higher quality tasks, more responsibility, more development opportunities.
His concept also includes regularly offering open consultation hours. And he has introduced discussion groups in which nurses discuss the issues on their wards with doctors and administration. They should contribute their ideas so that decisions are not made about them, but with them. One of the keys for Schiffer is to attract qualified personnel. And to hold.
Based on the star lists of hospitals and rehabilitation clinics, we have now identified exemplary employers in the care sector. The underlying scientific finding is that good jobs can be found where patients are treated and cared for well. You can find the results of our stern study here.
Further information about our stern studies can be found here.