Nursing Crisis: A Foreign Solution?

There is a nationwide shortage of over 60,000 nursing personnel in the German healthcare sector – vacancies that do not look likely to be filled by German-based staff any time soon. That’s why nursing homes want to collaborate with the federal government on tackling the shortage with skilled foreign workers. Just recently, Federal Minister for Health Jens Spahn went on a recruitment drive for specialists to Mexico, Kosovo and the Philippines.


Mr. Köksal, can nursing staff from Asia, Eastern Europe and Latin America really reduce the personnel gap in this country?

It’s simply a fact that we have too few staff here in Germany, and if we look at current numbers in vocational schools and training centres, it becomes clear that this situation is not likely to change in the near future. In this respect, I welcome the targeted recruitment of medical professionals from abroad.

The professional care worker from Romania, for example, should therefore represent a potential solution. But is it that simple in practice?

Unfortunately, no. Foreign nursing and medical professionals often find themselves confronted with distrust, prejudice and xenophobia in many parts of Germany.

Why is that?

Medical and nursing facilities expect foreign skilled workers to be fully integrated into their day-to-day operations, without accommodation for language barriers, cultural differences and individual experience levels.

At IUBH, we’ve undertaken our own research in this area. We have found that if the nurse from India or the pharmacist from Iraq does not (yet) have sufficient proficiency in German language and cultural practices, the result can be disillusionment on the part of patients and their families with healthcare institutions, and hostility towards the professional themselves despite the effort that has gone into recruiting them. Patients therefore become less willing to cooperate. Thus, the quality of care along with the perception of the professionalism of the healthcare facility can be adversely  affected.

In that case, what steps can be taken to resolve the problem?

Integration of foreign healthcare professionals in the German healthcare sector often fails due to a) differing qualification standards between Germany and other countries, b) lack of language skills, and c) a lack of willingness on the part of German employers to facilitate that integration. In my view, therefore, mandatory ongoing education, with a view to establishing common standards, is necessary.

You seem to be advocating for additional vocational training that every employee would have to undergo before qualifying for employment in the German market. That sounds rather strenuous. Who would benefit from it?

It would worthwhile for everyone! Not least for the skilled workers themselves: a vocational training programme tailored to the needs of the potential employee would make possible a sustainable integration into the German healthcare system, thereby ensuring them a successful start on the domestic labour market.

But German healthcare institutions would also benefit. With proper investment in integration and further education, we can avoid repeating the mistakes of the first “guest-worker” recruitment programmes of the 1950s and ‘60s, allowing better long-term retention of specialists within Germany. Healthcare facilities could see a reduction of absenteeism and high turnover rates among foreign professionals, and also cut back on staffing and training costs.

In the long view, we could even see a social benefit on the national scale. With regards to so-called “circular migration” – in the sense of long-term prospects for the integration of foreign skilled professionals into the domestic labour market – a culture of further education and training could strengthen healthcare structures in general across Germany.


Prof. Dr. Mümtaz Köksal has been lecturing in Healthcare Management at IUBH, Bad Honnef Campus, since April 2016. He received his Bachelor’s in Medicine before undertaking a Master’s in Healthcare Planning and Financing. Mümtaz Köksal gained practical experience in the healthcare sector, first as a management consultant, then in a senior management role with the MediClin hospital group, a position he held for more than 13 years.

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