Short on ICU nurses, Germany looks abroad

The story of German Health Minister Jens Spahn and Judith Heepe, the nursing director at Berlin's Charite Hospital,  is a little like the tale of the hare and the hedgehog. Heepe, like the wily hedgehog, is somehow always faster.

In September 2019, Spahn was in Mexico signing a contract to speed up the process for Mexican nursing staff to receive work permits in Germany. Heepe had already been there. A month before that, Spahn had sent his state secretary to the Philippines on a recruitment mission. Heepe had been there, too. 

In the Brothers Grimm fairy tale, the hare thinks to itself: That's not possible. Judith Heepe sees the funny side as she recounts her imaginary competition with Spahn. In the race to recruit nursing staff from overseas, you must be highly creative. And sometimes take matters into your own hands. 

For more than five years, Heepe has led the nursing division at Charite, Berlin's oldest hospital and Germany's most famous. She is responsible for 4,600 staff members, and during the second wave of the pandemic they've been working under pressure every day, especially the intensive care nurses in the COVID-19 ward. 

Struggle to recruit nurses in Germany

If the pandemic had broken out four years ago, Charite would probably have had to admit defeat. "At that time we were lacking 400 nurses. Every year we have plugged this gap by 100 workers and expanded our training capacities at the same time," says Heepe.

That's why she has not only flown to Mexico and the Philippines, but has also been to Albania and made approaches in South America. Soon, Charite also wants to bring Brazilian nurses to Germany. "The market in Germany has totally run dry," she says. According to the German Interdisciplinary Association for Intensive and Emergency Medicine (DIVI), the country lacks about 3,500 to 4,000 skilled workers in intensive care.

Politicians are constantly asking Heepe how the situation has come to this. "I can only tell them: this situation is our own fault. In recent years there have simply not been enough people trained and qualified. We now have what was a totally avoidable gap in the next four or five years," she says. It's an emergency that could cost Germany dearly in the next few weeks, with intensive care stations overcrowded due to the pandemic. "It also means that we must pay people better," Heepe says. 

Struggles with officials and bureaucracy

Heepe is someone who gets things done. Her motto: Don't take no for an answer.

"At some point, I was more familiar with the State Office for Health and Social Affairs than I ever wanted to be," she says with a laugh. She was always having to discuss the office's requirements for foreign nurses to supply original documents. Her relationship with the Berlin health authorities has a history: It happened almost three years ago, half a world away in Mexico. And Heepe can still recall every detail. 

"I was in a video conference with 15 Mexicans who were in complete despair because their recruitment company had gone bust," she remembers. "And then I told them: 'Who cares? We can do it! We'll bring you here!'"

For Heepe, that marked the start of a nerve-wracking side job. She took on everything that the agencies would normally sort out, from visas and flights to dealing with officials, bank accounts and health insurance to organizing language courses. And sometimes, when the whole project looked at risk due to German bureaucracy, she took unconventional measures.

A suitcase full of documents

In April 2018, Herbert Perez boarded a plane from Mexico City to Berlin with a suitcase and a backpack. Charite had paid for the flight. In the backpack were two pairs of trousers, three T-shirts and two shirts. In the suitcase: all the original paper documents for the 15 Mexican nurses who wanted to work in Germany. The young Indigenous nurse from the southern state of Oaxaca with the German first name became the vanguard; he had everything in his luggage that officials in Berlin were demanding.

"The scales at the airport showed exactly 22.5 kilograms," Perez remembers. "At the very last second people were still coming to the airport to drop off documents." The nurse can laugh now when he thinks back to his first trip to Germany, but at the time he was a nervous wreck.

"What would have happened if I had forgotten something amidst all the hustle and bustle, or if documents were lost in transit or if the airlines made a mistake and the suitcase went missing?" All these thoughts were running through his head. But everything worked out. Today, following a six-month program to certify his credentials, Perez is a valued colleague. He works on the coronavirus intensive care ward and helps day in, day out to bring Germany through the crisis.

Dramatic situations in intensive care wards

"The current situation is extremely critical, there are only a few intensive care beds," Perez says. "At the moment we are reaching the limits of our capacities." He has himself already tested his limits — like many nurses he contracted the coronavirus and was bedridden with fever for a week. 

Perez wanted to be a nurse since he was a small child. He is the kind of person who needs to be told when to slow down. Even today, he's surprised whenever his colleagues tell him he needs to relax, that he is entitled to a vacation or days off. "I didn't know such things from Mexico, there you have fewer rights as a worker."

Heepe is organizing everything so that Perez's partner, a preschool teacher, can soon join him in Berlin and start work in Charite's kindergarten. 

An international success story, then, with only winners? Not quite. There is growing criticism that Germany is snapping up well-trained personnel from developing nations when they are also urgently needed in their own countries. A recent report in the German newspaper Frankfurter Rundschau spoke of "nursing imperialism."

'Germany needs to solve its nursing problem itself'

The German Interdisciplinary Association for Intensive and Emergency Medicine (DIVI) is familiar with these accusations. The experts agree: Germany's nursing shortage is a problem of the country's own making and in an emergency like the current coronavirus pandemic, other countries should not be further weakened.

"Bringing in qualified staff from abroad always sounds like the big answer to the problem. But the more you investigate it, the less of an answer it seems," says Michael Isfort, deputy board chairman of the German Institute of Applied Nursing Research. The proportion of foreign nursing staff in the hospital sector is currently about 1%. "That is extremely small."

Nurses like Herbert Perez go mainly to large cities like Berlin; according to Isfort 90 to 95% of the international staff are working in the big urban centers. "We've still not yet succeeded in getting care workers from abroad into rural areas," he says.

According to experts, it's clear that recruiting staff from abroad won't be the long-term solution to Germany's nursing emergency. 

This article was translated from German.