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Nursing the German Economy

In Pflaumheim, a small German village about a marathon’s distance from Frankfurt, revealing that one “has a Polin,” or “Polish woman,” has become tantamount to announcing one’s own slow demise. As in many rural areas in Germany, Pflaumheim confronts an aging population. The nursing and elderly-care industries have become so heavily dominated by Polish women in recent years that local retirees no longer bother to refer to the nurses by title—as Krankenschwestern or Pflegekräfte—but rather employ the nationality of many of its practitioners.

This trend—epitomized by this crass shift in nomenclature among certain older cliques—is unique neither to rural communities nor to Bavaria. The entire Federal Republic of Germany is experiencing a nursing shortage so severe it has its own name: the Pflegekräftemangel. The Pflegekräftemangel has called into question the sustainability of the nation’s unique apprenticeship programs and the future of European integration, as increased demand for qualified caretakers prompts an influx of guest nurses from Eastern Europe to fill empty positions. These caretakers gain the opportunity to earn a living in Europe’s strongest economy while filling a critical gap in the market—a mutually beneficial solution to a difficult problem. Nevertheless, these trends have prompted outrage from conservatives who claim that the ensuing export of German welfare payments to families who reside elsewhere in Europe is an abuse of the system.

However, maintaining the full compensation and welfare payments of intra-European guest workers and their children is not just an opportunity to address Germany’s public health crisis. It is also a chance to invest in the future of Europe while promoting the sustainability of a German economic model that privileges skilled labor and high-quality goods and services.

Germany has long been lauded for its unique education system. German high school students are presented with two paths upon graduation: free university or a trade school education paired with a variety of apprenticeships. Apprenticeships are precursors to careers in everything, from hair-styling to taxi-driving to IT. Upon completing an apprenticeship, workers are considered fully qualified specialists in their field and are compensated as such. Though it has some drawbacks—making drastic career changes difficult, for example—the German model is largely regarded as a path toward equitability through the value it places on all professions and skills.

But such a model only functions if high school graduates pursue a diversity of professions upon entry into the job market. Although there are still more applicants for apprenticeships than spots available—a surplus of 31,500 in the 2016–2017 academic year—more and more graduates are streamlining into a select number of career paths, narrowing the breadth of the German economy while creating a dearth of workers in less desirable professions. Restaurant manager is currently Germany’s most unpopular apprenticeship, with butcher following closely. The field of nursing (Pflege), too, has suffered considerably—creating the Pflegekräftemangel. Not only do the current 137,000 nursing graduates report dissatisfaction and frustration with their apprenticeships, but 30,000 nursing positions across Germany are also presently unoccupied, a number that experts anticipate will reach 50,000 in coming years.

While some might cite the declining popularity of the butchering profession as cultural erosion in the land of bratwursts, the fact of the matter is that most employment vacancies in Germany are not existentially threatening; however, the Pflegekräftemangel represents a direct affront to public health and, quite literally, human survival. The situation is especially grim given Germany’s rapidly aging population and declining birth rate. Next year, the number of Germans aged 60 and older will be greater than the number of those aged 30 and younger, a trend that does not look to abate with the current fertility rate of only 1.5 births per woman.

For these reasons, the Pflegekräftemangel has taken on a pressing political weight in Berlin. Federal Minister of Health Jens Spahn has been tasked with developing a plan of action to attract more workers to the field—a massive PR campaign aimed at “making nursing cool again.” Among other actions, Spahn is mulling a tax-free bonus of €5,000 for those who take up full-time nursing positions.

Spahn is also the first to admit that no end to the German nursing shortage can occur without immigration, particularly from within Europe. Of the roughly 1.6 million nurses and caretakers currently active in Germany, 11 percent are foreigners—a number that is rising rapidly. Most come from Poland, Romania, and Croatia. As part of his initiative, Spahn also seeks to attract more nurses from the Balkans. In total, the Ministry of Health has announced plans to employ around 50,000 more foreign caretakers in Germany in the near future.

Though they fill a crucial gap in the German economy, these foreign nurses and caretakers have recently come under immense political scrutiny for the alleged burden they place on the German welfare state. Every worker who pays taxes in Germany is entitled to state benefits, regardless of nationality. A specific form of welfare payment has borne the brunt of political criticism: Kindergeld, literally “children’s money,” which mandates that all parents in Germany receive a monthly government stipend of €194 for each of their first and second children, €200 for the third child, and €225 for any further children under 18 years of age.

The largely foreign-staffed nursing industry has recently become the target of Kindergeld-related anger. Many Eastern European nurses come to Germany alone, leaving families and children behind. Even though these children may not reside within the German state, their German-employed parents still receive Kindergeld on their behalf. Critics argue that when these payments are shipped to Poland, Romania, or Croatia, where the cost of living is lower, they take on a disproportionately high value compared to their value in wealthy Germany. This is an issue of equity, critics say—these payments privilege the children of foreign Pflegekräfte at the cost of domestic German youth.

Over the past two years, the number of Kindergeld recipients living outside of Germany has risen decisively, from 232,000 in December of 2016 to 268,000 in June 2018. To portray this trend as debilitating to the state is erroneous, however, given that the number of foreign workers contributing to the German economy from other EU countries has also grown proportionally from 1.782 million in 2016 to 1.963 million in 2017. If workers are contributing to the wellbeing of Germans and residing in Germany, they should be fairly compensated. To adjust welfare payments based on a worker’s nationality would be to grant tacit government authorization to their position in a separate, and lesser, social class.

Such an act of nationalistic discrimination would run counter to Germany’s policies of EU inclusion, which includes its support of the accession of five Balkan states into the EU by 2025 through its promotion of a host of economic and state development initiatives. Exported welfare payments are an optimal way to spur Eastern European development because they are transactional: Germany offers a comparatively small export of funds to the youth of Eastern European states in return for the incredible service their parents provide the German economy and its aging population at a precarious moment.

Thankfully, the European Commission firmly refuses to endorse the adjustment of  Kindergeld—and other welfare payments—to the cost of living in Eastern European countries. However, the demand itself demonstrates that growing xenophobia now includes prejudice towards fellow EU citizens at a time when Germany needs immigration most to ensure the long-term sustainability of its welfare state. It’s critical that Germany encourage and properly compensate inter-European workforces like nurses; in doing so, it has the chance to stabilize its own economy while bolstering the entire European Union.

Photo: Old, Elder

About the Author

Allison Meakem '20 is the Campus Editor of the Brown Political Review. Allison can be reached at