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Med Care. 1997 Oct;35(10 Suppl):OS132-42.

Trends in hospital restructuring and impact on the workforce in Germany.

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Agnes Karll Institute for Nursing Research, Eschborn, Germany.



The author describes the impacts of hospital restructuring and reform legislation in Germany on the nursing workforce.


A descriptive analysis using selected literature is presented.


Driven by the increased service needs of an aging population and the imperative to contain health-care costs, the hospital sector is shrinking while increasing its intensity of care delivery. Within this environment, the demand for patient-focused, high-quality nursing care is high, whereas the number of new graduates entering the nursing field is declining. Despite absolute increases in the number of nurses employed by the hospital sector, evidence suggests that hospitals are operating with a nursing workforce deficit. The recent reform law of 1992 mandates several changes with large implications for nursing. These include a linking of the hospital sector with outpatient care; a focus on rigorous, interdisciplinary quality assurance; and a revaluing of the adequacy of hospital nurse staffing.


Hospitals will remain the major employers of nurses, with new outpatient sector opportunities. Adequate nurse staffing methodologies, sound personnel retention strategies, and reform of care delivery models are needed to assure high-quality nursing care in the hospital sector.

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