Which country is hiring more nurses
Systemically relevant - but they don't notice anything : German nurses flee abroad
Visit him? In Luxemburg? That's not going well at the moment, says the nurse Maik Rech a few days ago, he hardly has time and the borders are tight anyway. He could manage a video call, but to be honest, the corona stress in the hospital, in the evening it is often too broken.
But he could report by voice message, answer questions on Whatsapp, whenever he had some air. And here and there send a photo of the country in which he works, not far from home and yet as if on another planet, at least from a nurse's point of view: a land of milk and honey.
Maik Rech, 40 years old, is a trained intensive care nurse and has been in the job for 17 years. He comes from Baumholder in Rhineland-Palatinate, which is between Trier and Kaiserslautern, he is married and has three daughters.
Rech has been working at the Hôpital Robert Schuman on the Kirchberg plateau, a district of Luxembourg City, for four years; he is currently turning corona patients there on their stomachs and monitoring ventilators.
One of the photos he sent of himself shows a man with disheveled hair, a mask print on his face, the sweat of the layer glistening on his forehead. On another, he wears a full body suit, blue gloves up to his elbows, protective goggles, mask, hood, and he holds his arms bent in a bodybuilder gesture. A superhero poses as a superhero.
The clapping sounds like mockery to the nurses
There is currently a lot to read about the systemic importance of carers. Citizens applaud from balconies, parliamentarians even applauded in the Bundestag, but that sounded like mockery to those who applauded - they are demanding an answer to one of the most pressing questions of the past and the coming decade: What can be done about the shortage of care?
The German care system suffers from one grievance: it lacks carers. Four out of five hospitals had not filled positions in the past year, 12,000 were missing in normal wards, and another 4,700 in intensive care units, and that is only the minimum requirement.
In order for nurses to work normally in the hospitals, i.e. without overtime, spontaneous assignments and taking breaks, a further 80,000 jobs would have to be created, according to a survey by the Verdi union.
But the employees often wait in vain for new colleagues, instead many leave their jobs themselves - or flee abroad, to Switzerland, Holland, Denmark, Luxembourg. There are thousands who are leaving. Exact figures, according to both the Federal Health and Labor Ministry, are not available.
However, there are 1,500 nurses and almost 800 auxiliary nurses in Germany's smallest neighboring country, Luxembourg alone, as the local Ministry of Health reports on request. What are German nurses looking for there when they are so urgently needed at home? What can Germany learn from their emigration? And can they be recovered?
"You feel a constant stress"
Maik Rech, he says by voice message, started training as a nurse in 2003 and graduated in 2006. In 2008 he added the additional training to become an anesthetist and intensive care nurse and at the same time worked out a management position as a division manager at the West Palatinate Clinic.
But the higher he rises, the more he dislikes the working conditions. “I was dissatisfied, frustrated, especially because of the lack of staff. You feel a constant stress, you have to step in for others, you cannot achieve your goals. In addition, there is the pressure to save from above. ”He has repeatedly asked the clinic management for an increase in staff. Their answer, according to Rech: "We would hire, but there is no one who wants to do it."
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The shortage of skilled workers has long led to one of the worst care codes in Europe. There are an average of 13 patients for every nurse in Germany, compared to only five in Norway, seven in the Netherlands and eight in Switzerland.
On many nights, nurses report, even the 13 is a utopia, then they are responsible for up to 30 or even 40 people alone.
Soon the nurse had enough of the conduct of the clinic management
Lower staff limits introduced by Health Minister Jens Spahn, devised to protect staff from overload and not to endanger the safety of patients, were collected again at the beginning of the corona pandemic. The shortage of skilled workers leads to immense stress - even before Corona, a third of employees were considered to be at risk of burnout.
"The system was hit against the wall for 15 years," says Michael Isfort, director of the German Institute for Applied Nursing Science. "The corona crisis now acts like a magnifying glass under which all of these problems become visible."
Maik Rech also soon had enough of the refusals from the hospital management. In 2016 he met an old colleague who was meanwhile working in Luxembourg. He raves and tells about an open position. Rech works on a trial basis, writes a list, “Advantages and disadvantages Luxembourg”. Then it is clear: He's leaving.
What he noted under “disadvantages” at the time is quickly dealt with: an hour and a half drive before and after each shift, three hours in the car every day, a tough job. Moving to Luxembourg was out of the question, the Rechs are too deeply rooted in Baumholder, his wife also works in nursing there, the daughters go to school.
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The list of advantages became all the longer. In Luxembourg, Rech earns more than twice as much as he did in Germany, although he reduced his working hours to 85 percent. He now pays less taxes, instead of 30 days of vacation he is entitled to 35, after one year he also acquired the right to a Luxembourg pension. Added to this are amenities such as higher vacation pay, school fees for the children, higher amounts of child benefit and an annual bonus in June, the so-called “surprime”.
Nowhere in Europe do nurses earn more
With his earnings, Rech is on average. For a full-time nurse in Luxembourg, this is 96,500 euros gross in 2018. In no other European country do nurses earn more. If you ask the Luxembourg Ministry of Health why this is so, the answer is succinct: "Because the economic situation currently allows this."
However, part of the truth is that Luxembourg is dependent on foreign carers. 64 percent of employees already come from abroad, 24 percent from Germany. When Germany and France announced at the beginning of March that they would close the borders with Luxembourg, the Grand Duchy negotiated hard to obtain exceptions for the nursing staff. "If the borders are closed, we can also close the hospitals," said Prime Minister Xavier Bettel.
The government quickly offered carers like Rech hotel rooms to keep them in the country. “They were afraid that Germany would have withheld us if the German hospitals were overloaded.” The offer from Luxembourg suited him, it saved him the traffic jam at the border.
"Responsible for cleaning my ass and not much else"
Especially after night shifts, he stayed in a four-star hotel, only five minutes away from the hospital. A photo he sent showed a spacious hotel room, king-size bed, desk. "You can take as much drinks as you want, the food comes from the caterer," he reported. And for breakfast there was croissants.
The hotel room is over now since the borders were reopened. But there are still many other advantages. "At German hospitals you often have the feeling that I'll tell you what it's like to be responsible for cleaning people's asses and not for much else," he says.
In Luxembourg one is more likely to be the doctor's right-hand man than a henchman. The stress is lower, but the willingness to stand in for colleagues is greater. "Because the payment for weekend work is so good, there is an argument about it," says Rech. The high salary - it works beyond the account balance.
In Germany, too, nurses have long been asking for more money. A petition from nurses, now signed by half a million people, sets up a list of demands to Health Minister Jens Spahn. Point five: “An immediate promise of significant wage increases for nursing staff, which must be at a starting salary of 4,000 euros. You can save the refinancing for the time after this crisis. "
"A tentative step in the right direction"
Spahn has not yet commented on this. Most recently, the Minister of Health and Labor Minister Hubertus Heil designed a one-time bonus of 1,000 euros - but only for geriatric nurses. They are often worse off financially than their colleagues in the hospital, but the fact that the nurses on the foremost Corona front are not considered is incomprehensible to many.
The Federal Ministry of Health does not answer specific questions about the petition, the situation in Luxembourg or the carers who are leaving.
Instead, a staff member sends a general paper. It is about making the job more attractive again, he writes and refers to what has been achieved, for example the Nursing Staff Strengthening Act, which has been in force since 2019. It ensures that the hospitals get any additional jobs refinanced by the health insurances. It also outsources the nursing staff costs from the flat-rate case fees, which makes it harder for hospitals to save on nursing costs.
Bernd Riexinger, chairman of the party Die Linke, called the law "a tentative step in the right direction" when it was introduced, but it does not get to the root of the problem. Many nurses don't go far enough either.
Fridays for Future as a role model
If the nursing staff want to gain more influence on politics in the long term, all actors agree that they must act more united. So far, the industry has been highly disorganized. Contact points such as the German Professional Association for Nursing Professions only bring together a fraction of the workforce.
Many also view the newly founded state care chambers in Rhineland-Palatinate, Lower Saxony and Schleswig-Holstein with a critical eye. And even in the Verdi union - and only that is tariff-eligible, i.e. has the license to negotiate higher wages - only around ten percent of the carers are registered. It is said that only very few people hope for anything from Verdi, Verdi negotiates laxly, the wage increases that have been won are marginal, it is said.
Nursing scientist Isfort explains: “This is systemic, the union doesn't just represent the nurses. If they suddenly ask for 4,000 euros, then others want more too. "
How could it be better? The nurse Alexander Jorde just presented an idea in the podcast “Halbzehn.fm”. Jorde became famous when he put Chancellor Merkel in the electoral arena in 2017 with questions about the nursing emergency.
They threatened strikes - and they were successful
"I actually believe that we currently cannot avoid founding our own union or some kind of movement that collects more people," says Jorde. The Marburger Bund is a role model that represents doctors well. But also Fridays for Future. Widespread strikes should become an issue, nurses should understand that they are in a special position because nothing would work without them. "I want a union that hits the table in the negotiating room until the wood splinters."
How to do that is also worth taking a look at Luxembourg. Looking at wages, there is a massive jump between 2016 and 2017.
Pitt Bach can explain the jump. Bach is the central secretary of the Health and Social Affairs Syndicate at the Luxembourg trade union OGBL. Almost 90 percent of the Luxembourg nursing staff are represented in it. Small country, strong union. "In June 2016 we organized a demonstration with 9,000 nurses in Luxembourg City," says Bach, "we also threatened strikes."
Shortly afterwards he was at the negotiating table when the union negotiated the new collective agreement. The result: wage increases of 13 percent. Bach says: “We were 100 percent successful. All of our demands were implemented. "
Maik Rech, the German nurse in Luxembourg, is grateful. Can he still imagine coming back to Germany one day? “Even if Germany would pay 1000 euros more net, I would still have to work in an intensive care unit at 67 - which is almost impossible, it is simply too exhausting. In Luxembourg, on the other hand, I can retire at 57. “Germany lost him.
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