The fourth past interview with Tom and Patrick, recorded on 15 November 2024. This interview was originally due to be published in November 2024. But then an applicant cancelled shortly before her first shift in December. I decided not to publish the article for the time being to avoid the applicant's cancellation being associated with my blog
In this interview, I speak openly with my friend Tom about the challenges and shortcomings in the care sector as a patient requiring ventilation. The interview addresses the stresses and strains on carers, structural problems in intensive care and the lack of well-trained staff - but also the positive aspects of a committed team.
Tom: Patrick, you met new carers again this week. How did that go?
Patrick: It was... a rollercoaster. I would like to start by saying that I am incredibly happy with my permanent team. They do a great job every day, often under extreme conditions. But if someone is absent - like now due to a long-term illness - the system becomes unstable. We need replacements who often only step in for a short time. And this is where the real problem in the care sector becomes apparent: the lack of familiarisation and excessive demands on care staff.
Tom: What exactly happened?
Patrick: A new carer who had just joined the team only had three hours of induction. In this short time, she was supposed to familiarise herself with my ventilation machine, my cough assistant, stoma care and other details. She then took over the first day and night shift straight away, although no one showed her what to do at night. It is impossible to provide such complex care safely.
I was in situations that were life-threatening. According to the machine's protocol, I was unprepared and without oxygen for more than two minutes. I couldn't write or point out the lack of ventilation with my eyes, because it takes experience to understand my eye language - it was terrible. Mistakes like this happen when carers work under time pressure without sufficient training.
Tom: That sounds scary. Why is this happening?
Patrick: It's not down to the carers themselves. Many are motivated, but are scheduled in such a way that they barely have time to familiarise themselves. That's what happened to me this week. After three hours, the first day was over because the night shift with the next patient was on the schedule. Maybe that's what they wanted, I don't know. Of course, you get paid well for working 12-hour shifts for weeks on end. But that's still a system error. Nursing companies deliberately calculate as if employees are always healthy, have no holiday entitlements and don't have to work overtime1Corinna Emundts, Nursing crisis "Corona crisis makes problems more visible", tagesschau.de, 12 November 2020, https://www.tagesschau.de/inland/interview-rothgang-101.html. Someone will step in for the money.
It's often just about covering services. Companies send inadequately trained staff to seriously ill patients in order to be able to bill the health insurance companies2 Sandra Stalinski, Pflege in Deutschland - Warum das Intensivpflegegesetz umstritten ist, tagesscaau.de, 2 November 2019, https://www.tagesschau.de/inland/intensivpflegestaerkungsgesetz-faq-101.html.
Tom: What does this mean for other people affected?
Patrick: Many experience these "Hell" on a daily basis. There are reports of patients being sent unqualified staff who have never seen a ventilator. These carers work for a few days, leave again and no one checks whether the patients are receiving the care they need.
One example: some temporary employment agencies send nursing staff without specific training in intensive care to patients requiring ventilation - I have experienced this myself in the past. These are human lives that are being put at risk.
Tom: Despite this criticism, you repeatedly emphasise how satisfied you are with your team.
Patrick: Absolutely. My permanent team is great. They are experienced, empathetic and know my needs. Unfortunately, many carers are working at the limit. The profession is often underpaid, the working hours are hard and there are not enough staff to compensate for sickness absences3Nadine Millich, Nursing Thermometer 2022 on intensive care at home - Tense situation for managers and nursing staff, 12 July 2022, https://www.bibliomed-pflege.de/news/angespannte-situation-von-leitungen-und-pflegepersonal.
Whenever a replacement comes in for a few days, I realise how lucky I am with my team. I would like to emphasise that the problems I experience are not due to a lack of commitment on the part of nursing staff, but to a system created by employers and, in some cases, legislators, which overburdens and exploits them4Ann-Kathrin Jeske, Gesundheitssystem am Limit: Die Pläne der Ampel-Koalition für mehr Pflegekräfte, 8.12.2021, https://www.deutschlandfunk.de/gesundheitssystem-am-limit-die-plaene-der-ampel-koalition-fuer-mehr-pflegekraefte-dlf-5defcc8d-100.html. Let me put it bluntly: if someone has worked 60 hours in five days and then gets a call asking if they can fill in at the weekend, what percentage of work do you expect them to do? But care services love care services love such workers who always say yes.
Tom: What needs to change?
Patrick: More care services so that they can say "no" when the insurance company wants to send new patients. Because that's where the problem starts. I was accepted by my nursing service even though it was clear that there weren't enough nurses for me and the labour market was empty. I shouldn't have been accepted. But I'm really glad that Amelie didn't turn me away like everyone else. Otherwise I would have had to live in a shared care home where I wouldn't have been able to live and work independently.
More nursing services require more staff, better pay and, above all, structured induction programmes and specialist training for new nursing staff so that the ones we have don't leave after a few years without any prospects. I am even prepared to cover the costs of a longer induction programme myself. It's absurd how little time is planned for something like this. Nobody should have to work in a profession that deals with human lives without sufficient training5Leon KupperIntroduction to out-of-hospital intensive care - # 5 important topics, 18/08/2023, https://dmaonline.de/die-5-wichtigsten-einarbeitungsthemen-ausserklinische-intensivpflege/.
Tom: How many carers do you think Germany needs?
Patrick: I think - and I am basing this on figures from the Federal Statistical Office6 Press release no. 033 of 24 January 2024, At least 280,000 additional nursing staff are expected to be needed by 2049, 24.1.2024, https://www.destatis.de/DE/Presse/Pressemitteilungen/2024/01/PD24_033_23_12.html 7Florian Zandt, Demographic change - How is the care crisis developing?, statista, https://de.statista.com/infografik/32325/geschaetzte-anzahl-an-fehlenden-pflegekraeften-in-deutschland/ - It is quite likely that we are talking about 150,000 vacant positions, most of which have yet to be created.
Conclusion
The interview with Tom impressively shows how structural deficits in care jeopardise patients and overburden carers. While dedicated carers do a great job every day, they often reach their limits. To improve the system, we need more staff, better working conditions and sustainable reforms8HBS, Working conditions in the care sector, Hans Böckler Foundation, 08/05/2024, https://www.boeckler.de/de/auf-einen-blick-17945-zahlen-und-studien-zum-pflegenotstand-und-wege-hinaus-17962.htm.
Update from 21.11.2024
The subsequent shifts went really well (I thought). Coincidentally, she was on day duty that day when my team leader was on night duty. I took advantage of the opportunity to offer her a permanent place in my really cool team during the handover. My suggestion met with little interest from all sides. She already had five other patients. Too bad. Or better like this.
Names have been changed for data protection reasons.
You can find the background to this article and how the idea came about in this article here: The past interview experiment. Always on Sundays.
