Pursuit of profit underlies German nursing shortage

A new study in open-access journal 4open concludes that profit motives and excessive bureaucracy contribute to Germany's nursing crisis

What is the primary role of healthcare – to make profits or care for patients? This question lies at the heart of a new study, “German nursing shortage in hospitals - Homemade by Profititis?” in the open-access journal 4open, which examines the causes and consequences of a nurse shortage in German hospitals. The authors argue that business culture in healthcare has resulted in untenable staff cuts in the name of savings, and a heavy and largely unnecessary paperwork burden for staff.

“A physician is nothing without a nurse and vice versa,” says Professor Björn Brücher, an author of the recent study and Editor-in-Chief of 4open. Nurses are a vital part of the healthcare system. As anyone who has been a patient in hospital will know, nurses directly interact with patients more than any other healthcare staff and are crucial in delivering effective patient care. In countries with a high standard of patient care, there is typically a high nurse-to-patient ratio, while in those with poorer patient care the ratio is lower. This, as the authors of the new study argue, is no coincidence.

Previous research has linked greater nursing numbers with a decrease in patient mortality and readmission, and an increase in patient satisfaction. Despite these benefits, in many countries a shortage of nurses is an ongoing problem. In Germany, the number of nurses working in hospitals decreased between 1999 and 2009. However, the number of patients requiring treatment increased, and that number is projected to grow substantially in the next ten years, putting a significant strain on nursing staff.

What happens when healthchare is run like a business?

Given the importance of nurses, why the shortage? Healthcare, the study says, is increasingly run as a business, and this business culture has permeated to the very top. Business executives have largely replaced clinicians in leadership positions. For example, a 2009 study reported that 96.4% of US hospitals were led by a CEO who wasn’t a clinician, and that such hospitals ranked significantly worse in terms of their quality scores.

Business culture has had a corrosive effect on healthcare. 'Good' business involves reducing costs and maximizing profits. An easy way to achieve this is to cut staff numbers. This has been implemented among nurses in health services in many countries, including Germany, with consequent reductions in patient care and job satisfaction for overstretched nurses.

Modern business also involves collecting data to assess competitiveness, identify areas where improvements can be made and enhance performance. While this might sound admirable, in a healthcare context it has meant an enormous paperwork burden for frontline healthcare staff. Many nurses complain that rather than documenting their work with patients, paperwork actually forms the bulk of their work.

“There is no evidence that such paperwork actually improves patient care, and it takes healthcare staff away from their patients,” says Brücher. “Moreover, the data generated from such paperwork have been used as a justification for cost-saving measures, such as reducing staff and bed numbers, which have detrimental effects on patient care.”

Putting patients before profits can rectify the shortage in nursing care

Obviously, the resources available to pay for healthcare are limited, and every healthcare system must balance the patient care it provides with the funding available to pay for that care. Moreover, hospitals should strive to be frugal where appropriate. But do they need to be profitable, and are profits more important than patient welfare?

“Creating profits or collecting data is not wrong, but creating profit for profit’s sake and data for data’s sake at the expense of patient care is ethically questionable and shows that our healthcare systems have lost their focus and purpose,” says Dr. Daniela Deufert, a co-author on the study. “We need to take responsibility for this issue, and rectify the nursing shortage as soon as possible,” both authors argue.

This "Key Summaries" article is brought to you in collaboration with SciencePOD.