Implementation strategies to integrate academically qualified nurses in German innovator hospitals

Abstract Background In Germany, the number of Bachelor and Master programs for nurses has increased significantly over the past 20 years but the recommended target of 10%-20% of academically qualified nurses has not yet been reached. In university hospitals, it was 3% in 2018. Major challenges for hospital managers are to attract and retain academically qualified nurses in clinical practice, with some hospitals doing better than others. Methods In 2020, semi-structured interviews (n = 18) were conducted with chief nursing officers, nurse managers, nurses, and physicians working in five innovator hospitals, characterised by a high willingness to change the work environment, improve quality of care, and increase the number of academically qualified nurses. The interviews were recorded, transcribed, and analysed using Atlas.ti. Mayring's qualitative content analysis method was applied. Results Recruiting, retaining, and integrating academically qualified nurses varied in the five hospitals studied but all provided time and/or financial support for nursing students. Those with a longer tradition of attracting academically qualified nurses were following a hospital-wide strategy. CNOs or other leaders motivated nurses to enrol in a degree program, provided close support for clinical projects (e.g., on the ward) and when starting a career (e.g., coaching), and fostered individual career planning. Specialised tasks for nurses with a master's degree were leadership roles or specialised patient care. Taking over additional clinical or scientific activities according to their qualification was seen as beneficial to integrate the nurses. Barriers were the limited acceptance of graduated nurses by nurses with a vocational training, low staffing levels, and limited political support. Conclusions Recruiting and retaining graduated nurses takes efforts by hospitals in the current situation of a nation-wide nursing shortage. A hospital-wide approach can be a way to overcome this challenge. Speakers/Panelist Inge Rinzema V&VN VS, Dutch Association of Nurse Practitioners, Utrecht, Netherlands Johanna Heikkilä JAMK University, Jyväskylä, Finland Sabine Valenta Department of Nursing Science, University of Basel, Basel, Switzerland


Background:
Many countries in Europe and worldwide have implemented new professional for nurses or are in the process of implementation, yet, an overview of the evidence on skillmix changes has been missing. This study has analysed skillmix innovations in nursing, evidence on outcomes and lessons for implementation.

Methods:
An overview of systematic reviews, following a protocol plus country case studies, as part of an international study. The literature search was performed in six databases, with search terms covering skill-mix whereby the nursing profession played a key role. Screening was performed by three researchers after high interrater reliability rates were achieved. Analyses were performed for the nursing professions, a typology of skill-mix changes (task-shifting and role expansion) and evidence on outcomes.

Results:
A total of 42 systematic reviews were identified on nurses working in new roles. The roles varied considerably, ranging from nurse prescribing to advanced practice nursing and nurse-led clinics. Nurse-led chronic care programmes were frequently identified, with overall positive outcomes on several health outcomes, e.g., for patients with diabetes or cardiovascular diseases. Nurses were also working in advanced roles in health promotion and prevention, e.g., performing screening programmes, showing equivalent quality of care compared with doctors if adequately trained. Several skill-mix models to enhance care coordination and integration were identified, suggesting that when tailored to the needs of specific population groups, particularly for vulnerable groups, may improve health outcomes or access to services.

Conclusions:
The roles of nurses are increasingly diversifying and expanding internationally. Sharing country experiences on how to effectively educate the workforce to be prepared for these new roles and ensure smooth integration is critical.

Background:
In Germany, the number of Bachelor and Master programs for nurses has increased significantly over the past 20 years but the recommended target of 10%-20% of academically qualified nurses has not yet been reached. In university hospitals, it was 3% in 2018. Major challenges for hospital managers are to attract and retain academically qualified nurses in clinical practice, with some hospitals doing better than others.

Methods:
In 2020, semi-structured interviews (n = 18) were conducted with chief nursing officers, nurse managers, nurses, and physicians working in five innovator hospitals, characterised by a high willingness to change the work environment, improve quality of care, and increase the number of academically qualified nurses. The interviews were recorded, transcribed, and analysed using Atlas.ti. Mayring's qualitative content analysis method was applied.

Results:
Recruiting, retaining, and integrating academically qualified nurses varied in the five hospitals studied but all provided time and/or financial support for nursing students. Those with a longer tradition of attracting academically qualified nurses were following a hospital-wide strategy. CNOs or other leaders motivated nurses to enrol in a degree program, provided close support for clinical projects (e.g., on the ward) and when starting a career (e.g., coaching), and fostered individual career planning. Specialised tasks for nurses with a master's degree were leadership roles or specialised patient care. Taking over additional clinical or scientific activities according to their 15th European Public Health Conference 2022 qualification was seen as beneficial to integrate the nurses. Barriers were the limited acceptance of graduated nurses by nurses with a vocational training, low staffing levels, and limited political support.

Conclusions:
Recruiting and retaining graduated nurses takes efforts by hospitals in the current situation of a nation-wide nursing shortage. A hospital-wide approach can be a way to overcome this challenge.

Speakers/Panelist: Inge Rinzema V&VN VS, Dutch Association of Nurse Practitioners, Utrecht, Netherlands
In recent years, there have been increasing instances of crossborder crises, including climate change, terrorism, international trade disputes and global health threats. These emergency situations require large-scale planning for preparedness and response in order for countries to be able to cope with unforeseen challenges. Especially the COVID-19 crisis had a huge impact on European countries and the daily lives of its citizens. The pandemic has proven to be more than a health crisis; it is a human, economic and social crisis, impacting people, societies and economies at their core. The European Commission has recently funded many projects (in the Horizon 2020 program, H2020) to work on different aspects of crisis management, many with a focus on managing pandemics. While each project has distinct aims and challenges, they all work towards a common goal. It is for this reason that thirteen EU-funded H2020 projects, with a combined funding of E72 million, have united to form the PREparedness and resPonse for emergency situAtions in euRopE (PREPARE) cluster. Each of the thirteen projects is tackling challenges specifically looking at the preparedness and response phases of crisis management and working together they aim to achieve stronger results and greater impact for their cause. Together CO-VERSATILE, COVID-X, COVINFORM, EUR3KA, LINKS, NO FEAR, PANDEM-2, PathoCERT, PERISCOPE, PHIRI, RISKPACC, STAMINA and STRATEGY will explore synergies, research opportunities and deliver joint activities to maximise impact. Through mutual support, the cluster will strengthen the response to the ongoing crisis and the aim to be better prepared for future health crises. In a round table discussion, a selection of these H2020 will briefly present their contribution to crisis preparedness and resilience of European countries (25 min). These brief presentations will be followed by a round table discussion (35 min), touching upon topics such as common findings (building trust, health inequalities, training and capacity building, addressing stakeholder diversity); and the dissemination and exploitation of the results to the general public, to researchers, to (public) health professionals and policy makers, Finally, as many of these projects end in 2022/2023, what are the next steps or threats, what should be the highest priority for future Horizon Europe projects? The audience will be able to provide their view on the different topics through an interactive voting poll during the session. Throughout the session, the exchange of knowledge, experiences and opinions with the audience will be facilitated by the chairs. Key messages: The actionable outcomes of the major Horizon 2020 projects provide key-input for political decision-making in preparedness and response scenarios. The PREPARE cluster builds a sustainable structure for large-scale planning for preparedness and response for countries to be able to cope with unforeseen challenges.