Health and Healthcare

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Healthcare and nurse at desk work

The health and nurse or registered nurse (in common parlance nurse or nurse , just in the salutation and sister or nurse ) is a regulated health professional in the German health care . The job description includes the professional independent care , observation , care and advice of patients and those in need of care in an inpatient or outpatient environment as well as the documentation and evaluation of nursing measures. The tasks also include the execution of medical orders and assistance with medical measures.

Permission to perform the legally protected professional designations health and nurse , registered nurse , health and children's nurse or health and pediatric nurses is since 2004/2007 after three years of study at an accredited nursing school and successfully passing a state examination at the request granted . Nurse or nurses are still legally protected job titles. The same applies to the designation health and nurse (male / female; in the period 1988–2022). As of January 1, 2020 starting training should, according to §§ 1 and 6 of the nursing profession Act (PflBG) after at least three years of vocational training from 2023 with the new job title as a nurse or care professional finish.

Following the basic nursing training, there are further training opportunities for almost all specialized areas of nursing, which lead to an expanded job title in the context of specialist school-based training ( specialist health and nurse ). Further qualification options are offered in nursing science , education and economics courses, for which a completed training as a health care professional is usually required.

Job title

With the amendment of the law on the professions in nursing ( Nursing Act - KrPflG) from 1985 by resolution of the Bundestag in July 2003, the fourth Nursing Act of the Federal Republic of Germany came into force on January 1, 2004. A new state-protected occupational title of health and nurse was introduced for the nursing staff trained after January 1, 2004 , which replaced the previous designation of nurse (which still comes from the old Christian nuns ) or nurse . The legal protection of the former job titles was not lifted, the nurses, nurses, pediatric nurses and pediatric nurses trained according to the third KrpflG may either continue the previous job title or use the new title.

The designation of health and nurses takes account of the changed professional self-image of nursing, emphasizes the increasing independence and professionalization of nursing and expresses an expanded range of tasks in professional nursing in the direction of health care and advice. At the same time, the “ideological” job title of the nurse is to be replaced. With the gradual amalgamation of nursing training with child nursing and geriatric care to form a generalist nursing profession through the Nursing Professions Act , the job title will partly be changed to nursing specialist from 2020. Primarily qualified university graduates use the new job title in connection with the academic degree ( §§ 37 to 39 PflBG). A planned evaluation of the future career choice should decide on the initially existing continuation of the professional qualifications of health and child nurse and geriatric nurse.

Nursing job titles from other countries such as Switzerland ( Graduate care professional ), France (Infirmier), Sweden (Sjuksköterska) or the Anglo-American ( Nurse ) are usually based on academic training and can be for health and nursing with the German dual education not fully equate. However, the degrees are usually mutually recognized. Within the framework of the EU directive on the mutual recognition of professional qualifications, it is possible for German nursing staff to work within the EU and Switzerland.

However, the term “nurse” has not yet established itself in common parlance. Traditionally, the terms nurse or nurse continue to be used, both by patients and by the bearers of the corresponding professional title.

Professional activity and fields of work

In addition to fire fighters and doctors, health workers and nurses (“nurses”) are consistently among the three most trustworthy professions in Germany. 87% of the population expresses “very high” or “fairly high” trust in them.

Areas of responsibility and activities

Nurses and nurses look after and care independently for patients or those in need of care of all ages in inpatient facilities or as part of outpatient care. These tasks in the field of basic care include supporting the patient in all areas of everyday life, for example with eating, position support or personal hygiene. They accompany the seriously ill and dying, care for the deceased and serve as contact persons for relatives or other affected persons. Nursing staff plan the care as part of the care process , document the implementation and assess the success of the care measures applied. The care service-related billing, organizational and administrative work is done with the help of care assistance programs, material and medicine supplies are monitored and ordered. They give trainees, care assistants , interns and housekeeping staff assistance and guidance.

Nursing specialists are the link between doctors, therapists, relatives and patients, carry out medical orders independently within the framework of treatment care, prepare patients for therapeutic and diagnostic measures or carry out required medical treatments. They assist doctors in carrying out therapeutic measures and take care of the patient's psychological care . You will perform administrative and organizational tasks, coordinate appointments with other specialist departments and the members of the therapeutic team, take part in rounds and meetings. As part of patient observation, they determine and document the data required for therapy, such as blood pressure, pulse and temperature, and assess the patient's sleep behavior, breathing and behavior.

Nurses and nurses advise those in need of care and their relatives about care measures, health promotion and instruct them to help themselves. They help with the procurement of the necessary aids , participate in the communication with health insurances and the determination of the need for care by the medical service of the health insurance (MDK).

This includes in particular:

Nurses in the operating room (1910)
Nursing training in the USA (1942)
  1. Independent areas of activity
  2. Co-responsible areas of activity
    • Implementation of diagnostic and therapeutic measures as directed by a doctor
    • Administration of drugs
    • Preparing injections
    • Administration of subcutaneous and intramuscular injections
    • Preparation and connection of infusions
    • Taking blood from the vein and capillaries
    • Insertion of transurethral urinary catheters
    • Performing intestinal enemas
    • Insertion of feeding tubes
  3. More interdisciplinary areas of activity
    • Participation in measures to prevent illness and accidents
    • Preparing patients and those in need of care for discharge
    • Health advice
    • Advice during and after physical illness


There should be no allergies to these products with regard to the use of allergy-inducing products, especially if they can hardly be replaced by alternatives (e.g. certain hand disinfectants). By shift work extra physical stress can occur with early, late, night shifts and weekend services. Training companies usually require a medical health certificate. Working with sick and dying people is psychologically stressful. Some educational institutions also require a certificate of good conduct .

Places of work

Typical workplaces are the specialist departments in general hospitals, specialist hospitals (e.g. for psychiatry ), sanatoriums and rehabilitation facilities , as well as in dialysis centers , nursing homes , old people's homes and hospices and in general or specialized outpatient care services. Some health and nursing staff work on a self-employed basis as care advisors or are active in advisory or expert functions at the MDK, in advice centers, health authorities , care support points and at health or care insurance companies. In case management, they create assistance plans and, in transitional care, combine medical care, nursing care, social support and domestic help. Some nurses work as NCOs in the medical services of the Bundeswehr , work in shipping as ship nurses or as civil servants in prison hospitals and wards in prisons .


Training requirements

A prerequisite for training as a health care worker is at least a school leaving certificate with secondary school leaving certificate or a secondary school certificate in connection with at least two years of successfully completed vocational training or training as a nursing assistant or at least one year of training as a nurse or geriatric care assistant regulated by state law. A minimum age for starting training is not legally required. However, under 16s are often deferred in the application process.

Duration of training and content

The duration of training and its contents are stipulated nationwide by the KrPflG and the training and examination regulations for professions in nursing (KrPflAPrV). The training lasts three years and ends with a state examination. It is divided into 2100 theory hours in which the theoretical basics for health care and nursing or health and child care are taught and 2500 practical hours. Part of the training is a 1200 hour differentiation phase in the theoretical and practical training, which extends to the skills to be imparted for health care and nursing or health and child care. This is intended to enable joint theoretical and practical training in health and nursing and health and children's nursing in the first two years. The third year is the differentiation period in which the trainees receive the specific theoretical and practical training. This special division between the first two and the third year was introduced with the amendment of the legal framework in 2004 as part of the first reforms.

In Appendix 1 to Section 1, Paragraph 1 of the KrPflAPrV, twelve subject areas are defined in which the students must be taught the relevant training content in theory and practice:

  1. Recognize, record and evaluate care situations in people of all age groups
  2. Select, carry out and evaluate maintenance measures
  3. Provide expert support, advice and guidance on health and care-related issues
  4. Participate in the development and implementation of rehabilitation concepts and integrate them into care activities
  5. Align care activities in a personal manner
  6. Align nursing activities with nursing science findings
  7. Align care activities with quality criteria, legal frameworks and economic and ecological principles
  8. participate in medical diagnostics and therapy
  9. Take immediate life-sustaining measures until the doctor arrives
  10. Develop professional self-image and learn to meet professional requirements
  11. influence the development of the nursing profession in a social context
  12. work together in groups and teams

Theoretical training

Theoretical training is carried out at state-recognized nursing schools by nursing teachers or lecturers from other areas and includes the following knowledge bases:

The lessons are not limited to the pure transfer of knowledge, but include demonstrations and exercises of numerous courses of action from practical care ( basic and treatment care ): personal care of the patient, applying bandages , prophylaxis and care of pressure sores , general wound care, administering medication professionally and serving food are just a few examples.

Practical training

The practical training is divided into a general area and a differentiation area in accordance with Appendix 1 to Section 1 Paragraph 1 B KrPflAPrV. In the general area, the health and nursing care of people of all ages in inpatient care in the fields of surgery , orthopedics , internal medicine , geriatrics , gynecology , neurology , pediatrics , psychiatry , and maternity and newborn care and outpatient care in preventive, curative, rehabilitative and palliative areas are taught. In the differentiation area, appropriate knowledge within health care and nursing or health and children's nursing should be conveyed, which takes place in corresponding specific inpatient facilities, for example in surgery, psychiatry or pediatrics and children's surgery during the third year of training.


The training ends with three written, three oral and one practical exam. If one of these exams is not successfully completed (up to grade 4.0), you have the option of repeating it once. After successfully completing the course, you are granted permission to use the protected professional title of “health and nurse”. In everyday language, for example in job offers, the addition "examiniert" is often used or the state examination is referred to as "exam". This is superfluous because passing the exam is a prerequisite for using the protected job title.

Reforms and developments

The first regulations for nursing training in the Federal Republic existed in 1957. Up until then, nursing training at nursing schools had lasted a year and a half. The now three-year training was divided into a two-year course at a nursing school, which comprised 400 hours of theoretical and practical lessons, and a subsequent one-year practical activity. An amendment to the German Nursing Act came into force in 1965. The course at the nursing school was extended to three years, the practical year was omitted. The theoretical part of the training was now 1200 hours. The next change took place on June 4, 1985. The number of lessons for theoretical and practical lessons was increased to 1,600, and 3,000 hours were provided for practical training.

For some time now, there have been various ideas about reforming training, e. B. to relocate nursing training from nursing schools , which are mostly located in hospitals, to technical colleges or vocational schools . However, so far no proposal has prevailed. With the amendment of the Nursing Act in 2004, there was indeed a small reform intended to make training more practice-oriented, but the discussion about a more far-reaching reform continues.

In March 2012 a federal-state working group proposed further development of the nursing professions cornerstones for the preparation of the draft of a new nursing professions law . Thereafter, the geriatric care training, the health and nursing or child nursing training will be merged into a generalist nursing training and a new academic training will be introduced. In response to a small inquiry in the Bundestag in December 2012, the federal government announced that it was working on a draft law stating that an intermediate educational qualification (10 school years) was sufficient for access to training. Insofar as there are efforts on the part of the EU to require a 12-year general school education as an entry requirement, as is already the case in 24 EU countries, the Federal Government continues to advocate at European level that the previous European regulation that requires 10 years of schooling, stay.

In November 2015, the Federal Ministry of Health specified the plans in a press release. After the law was passed in June 2017, elements of generalist training are to begin with the 2020 training year. Further details of this training are regulated in the Nursing Professions Training and Examination Ordinance (PflAPrV). Nursing studies are also made possible in which the state examination to obtain professional approval is part of the university examination ( Sections 30 to 41 PflAPrV).

Continuing education and career alternatives

Professional adjustment

Colloquially, further training in nursing, which represents supplementary training measures in the vocational or general education area, is often referred to as further training . They are intended to ensure that the qualification is retained by adapting to professional innovations and can span a period of a few hours to several days. As they are partly in the interests of the employers, they are partly financed by them or offered directly at the workplace, even if they are fundamentally in the self-interest and responsibility of the nurse. Typical qualification courses from the field of adaptation training are, for example, Bobath courses, kinesthetics , practical instructions , transcultural care , IT courses, work organization, hygiene, communication and interviewing, palliative care , care planning and documentation, evaluation or validation .

Professional qualification

The advancement courses referred to as advanced training or specialist advanced training in nursing have the goal of an additional qualification, either in order to develop professionally or to advance. The advanced training usually lasts two years while working and, in contrast to adaptive advanced training, always ends with an examination and leads to a new job title or an expanded job title. As a rule, this form of continuing education requires it to be carried out at a school institution with state recognition. In some federal states there is a legal basis for further training. Examples of rise developments are the specialized training in anesthesia and intensive care , geriatric psychiatry , Domestic intensive care, oncology care, palliative care -Pflegefachkraft, operation service , psychiatry or hygiene specialist , qualified to direct a functional unit , as quality healthcare managers , auditors , wound manager , business administrator in the elderly and nursing or specialist in social and health services as well as emergency medicine .

Higher education courses

If they have a technical college or university entrance qualification that meets the admission requirements, nursing staff can also pursue academic training. Universities of applied sciences offer courses in nursing science , nursing management , nursing pedagogy and palliative care, as well as health management and business studies in health care, health or medical informatics . The courses of study end, depending on their characteristics, with the academic degree of qualified nurse, bachelor or master , at universities the doctorate in nursing sciences to "Dr. rer. cur. ”(rerum curae) possible.

Professional alternatives

With or without training and additional qualification measures, nurses can also work in other related professional fields, for example in geriatric care or in health and child care . Qualification measures are required in each case for activities as a stomatotherapist , study nurse , medical assistant , medical-technical assistant for functional diagnostics , surgical assistant , diabetes advisor , health advisor , social medical assistant , occupational medical assistant (plant nurse), telemedical assistant or medical documentary . Switching to self-employment is possible, for example, through training as a naturopath or by setting up a nursing service, a freelance practice or running a nursing home.

A previously completed training in the GuKp or another health profession can shorten the training time in another health (specialist) profession. Easier training requirements enabled, for example, the shortened training to become a paramedic until the end of 2014 - which was replaced by the emergency paramedic .

Earnings / income

In state and municipal institutions, such as state hospitals, university clinics, district hospitals , payment is made according to special parts of the collective agreement for the public service or collective agreement for the public service of the federal states :

  • TVöD, Annex E, special section hospitals
  • TVöD, Annex F, special section care and support facilities, Kr application table
  • TV-L, Kr - Nursing staff in the public service of the federal states

The grouping of nurses and nurses takes place at least in pay group 7a. In 2013, the basic salary was at least 2160 euros per month. The basic salary is supplemented by partially tax-free supplements such as local allowances, shift allowances, collective bargaining allowances, psychiatric allowances, supplements for work on public holidays, Saturdays and night work.

Church employers usually pay a tariff based on TVöD / TVL, e.g. AVR-Caritas , AVR Diakonie.

For private employers such as hospital corporations (. Eg Asklepios - , Helios - or Sana clinics ) there are often floor collective agreements that can differ from TVöD. Often, performance-related salary components are also common here. Most hospitals still pay contributions for a collectively agreed supplementary pension scheme ( company pension ), e.g. B. to the church supplementary pension fund , the supplementary pension fund (ZVK) or the federal and state pension fund (VBL).

For care companies that mainly provide outpatient, partial inpatient or inpatient care services or outpatient nursing care services for those in need of care, the minimum wage is regulated by ordinance. This will increase to 11.35 euros per hour by January 1, 2020 (in the east to 10.85 euros per hour).


Up until 1955, according to the collective agreement in the public sector, nurses received 5% less wages than nurses. This was justified with the physically more difficult work of the nurses, which, however, was not recognizable in practice. The ÖTV union also signed the contract. Nevertheless, the ÖTV district of Hamburg supported a number of nurses in order to rectify this difference through legal action. After the positive court ruling, the City of Hamburg paid all of the nurses employed by it the full wages retrospectively for two years. The difference was eliminated in the next collective agreement.

In Austria, the job for female nurses is considered to be heavy work within the meaning of the Heavy Labor Ordinance and the list of related professions.

Employment structure

In 2007, 638,787 people in Germany were employed as health and nursing staff subject to social security contributions; the proportion of women was 86.3%. 3.5% of the employees are foreigners. While the number of employees under 25 years of age fell from 8.0% to 6.0% between 1999 and 2007 and that of those between 25 and 35 years of age fell by 9 percentage points to 23.4% in the same period meanwhile more than half of the nurses 35 to 50 years old. The group of over 50-year-olds increased from 12.2% to 20.6% between 1999 and 2007.


  • Claudia Bischoff: Women in Nursing . On the development of women's roles and occupations in the 19th and 20th centuries. 4th, updated new edition. Campus, Frankfurt am Main / New York 2008, ISBN 978-3-593-38726-0 .
  • Manfred Engl: Employment Compass Health and Nursing. Employment opportunities and alternatives . Edition Aumann, 2011, ISBN 978-3-942230-01-8 .
  • Nicole Menche: Care Today . Textbook. 4th, completely revised edition. Urban and Fischer, Munich 2007, ISBN 978-3-437-26771-0 / ISBN 978-3-437-28140-2 (small edition).

Web links

Commons : Healthcare Professionals  - Collection of pictures, videos, and audio files
Wiktionary: nurse  - explanations of meanings, word origins, synonyms, translations

Individual evidence

  1. So also the title of a German trade journal, " Die Sister, Der Pfleger ", since 1962
  2. a b c §23 of the Nursing Act
  3. Monika Stöhr, Nicole Trumpetter: Developing professional self-image and learning to cope with professional requirements: Analysis and suggestions for teaching . In: Angelika Warmbrunn (Ed.): Workshop books on care today . tape 10 . Elsevier, Urban & FischerVerlag, 2006, ISBN 3-437-27620-4 , pp. 22 .
  4. ^ The reform of nursing training - the draft of the Nursing Act. (PDF) (No longer available online.) Federal Ministry of Health, archived from the original on December 8, 2015 ; accessed on November 27, 2015 . Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. @1@ 2Template: Webachiv / IABot /
  5. Page of the 2017 lead Federal Ministry of Health on the new law ( Memento of the original from August 3, 2017 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. (including speech by Minister Gröhe on June 22, 2017 in the Bundestag for the third reading) @1@ 2Template: Webachiv / IABot /
  6. Reader's Digest European Trusted Brands Survey 2013 ( Memento of the original from August 17, 2013 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. @1@ 2Template: Webachiv / IABot /
  7. The German ZWP trust these professions , accessed on May 17, 2013.
  8. AOK, Allergies at Work ( Memento of the original from March 28, 2013 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice.  @1@ 2Template: Webachiv / IABot /
  9. ausbildungnet, health and nurse
  10. Nursing Germany, training to become a nurse and nurse ( Memento of the original from June 29, 2013 in the Internet Archive ) Info: The archive link has been inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice.  @1@ 2Template: Webachiv / IABot /
  11. § 3 and § 4 of the Nursing Act
  12. a b Training and Examination Ordinance for Professions in Nursing (KrPflAPrV)
  13. ^ First ordinance on the professional practice of nursing and the establishment of nursing schools of September 28, 1938, Reichsgesetzblatt Part IS 1310.
  14. ^ Nursing Act of July 15, 1957 ( Federal Law Gazette I p. 716 , PDF, 440 kB).
  15. Law amending the Nursing Act of September 20, 1965 ( BGBl. I p. 1438 , PDF, 499 kB).
  16. ^ Nursing Act of June 4, 1985 ( BGBl. I p. 893 , PDF, 999 kB).
  17. ^ Training and Examination Ordinance for Professions in Nursing of October 16, 1985 ( Federal Law Gazette I, p. 1973 , PDF, 1.7 MB).
  18. Report of the Federal and State Working Group on the Further Development of Nursing Professions, Key Points for the Preparation of a New Nursing Act of March 1, 2012 ( Memento of the original of November 18, 2012 in the Internet Archive ) Info: The archive link was inserted automatically and not yet checked. Please check the original and archive link according to the instructions and then remove this notice. (PDF; 388 kB) @1@ 2Template: Webachiv / IABot /
  19. Proposal by the European Commission for a directive of the European Parliament and the Council to amend Directive 2005/36 / EC  ( page no longer available , search in web archivesInfo: The link was automatically marked as defective. Please check the link according to the instructions and then remove this notice. (PDF) on the recognition of professional qualifications and the regulation on administrative cooperation with the aid of the internal market information system of 19 December 2011 (PDF; 263 kB) p. 11.@1@ 2Template: Dead Link /  
  20. Answer of the Federal Government to the small question of the MPs Mechthild Rawert, Petra Crone, Bärbel Bas, other MPs and the parliamentary group of the SPD - printed matter 17/11608 (PDF; 95 kB) - dated December 11, 2012, printed matter 17/11802 (PDF ; 143 kB)
  21. ^ Nursing Professions Training and Examinations Ordinance - PflAPrV , text and reasons
  22. ^ The reform of nursing training - the draft of the Nursing Act. (PDF) (No longer available online.) Federal Ministry of Health, archived from the original on December 8, 2015 ; accessed on November 27, 2015 . Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. @1@ 2Template: Webachiv / IABot /
  23. A good overview of the classifications is provided in Appendix 2 to the Federal Employees' Collective Agreement in the church version (BAT-KF) Remuneration group plan for BAT-KF for employees in the care service (Nursing staff - remuneration group plan for BAT-KF - PEGP.BAT-KF) Appendix 2 to BAT-KF remuneration group plan for BAT-KF for employees in the nursing service.
  24. collective agreement for the public service of the federal states 2013 - nursing staff. , Collective agreement for the public service, special section hospitals. , Collective agreement for the public service, special section care and support facilities.
  25. Second Ordinance on Nursing Work Conditions of November 27, 2014 ( BAnz AT 11/28/2014 V1 ), Third Ordinance on Care Work Conditions of August 1, 2017 ( BAnz AT August 11 , 2017 V1 ).
  26. ^ Annual report 1955 and 1956 of the ÖTV district Hamburg
  27. Heavy Labor Ordinance, Federal Law Gazette II No. 104/2006. RIS , accessed November 12, 2010 .
  28. Heavy work complete list. (Flipbook) Austrian Social Insurance , November 2014, accessed on December 4, 2015 .
  29. Professions in the Spiegel der Statistik 1999–2007. (No longer available online.) Federal Employment Agency , archived from the original on February 5, 2006 ; Retrieved January 14, 2010 . Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. @1@ 2Template: Webachiv / IABot /