Step by Step - The Magnet® Journey at Robert-Bosch-Hospital in Stuttgart, Germany

by Anna Christina Bruns, M.Sc.; Ellen Houston; Eva-Verena Lindenau, M.Sc. (RBK Magnet4Europe Team) ​

Research shows that academically qualified nurses in direct patient care promote high-quality care. The Magnet® Manual therefore specifies a minimum aim of 80 % academically qualified nurses. In Germany, we are still a long way from achieving such rates. The German Science Council (Wissenschaftsrat, 2012) recommends for example a rate of 10 - 20 % of nurses with an academic degree in Germany. 
The main reason for these discrepancies lies in the German training system for nurses. Here, the majority of prospective nurses undergo three years of vocational training, which is completed with a certification. As of the year 2000, the first integrative / dual nursing study models were offered as an alternative. Only with the new Nursing Professions Act (Pflegeberufegesetz) of 2020, primary qualifying nursing study courses were established supplementary to the existing training courses.  Another challenge is that so far only a few graduate nurses are working in direct patient care. The Science Council's HQGplus study (2019) found that only 3.2 % of university nursing students plan to work in direct patient care after graduation. We believe this is primarily due to the lack of career development opportunities and competency-appropriate job profiles. 

TLPs & APNs at RBK

 Academically qualified nurses at the RBK 
In recent years, we at Robert-Bosch-Hospital (RBK) in Stuttgart have implemented a strategy to attract more academically qualified nurses for direct patient care. We have therefore made good progress in attracting and retaining graduate nurses. Since 2013, there has been the opportunity to complete a dual course of study at RBK's Irmgard Bosch Education Center (IBBZ) in cooperation with the Baden-Württemberg Cooperative State University (DHBW). Furthermore, our nurses can obtain further qualifications on a part-time basis with the help of a scholarship from the Robert Bosch Foundation.   

To achieve more transparency and highlight development opportunities at RBK, we created a career development matrix for nurses. It shows the possible career paths in the areas of nursing management, nursing science and nursing pedagogy as well as nursing practice.  In this course, we introduced an advisory program for nursing students and trainee program for graduates in order to integrate them into our hospital at an early stage. In addition, we developed and implemented two job profiles for academically qualified nurses in direct patient care. 

1) The Team Leader for Nursing Process Assurance (TLP) has a bachelor in nursing and at least 1 year of professional experience in nursing practice. They are responsible for professional quality assurance at the unit level. 
2) The Advanced Practice Nurse (APN) has a master's degree and several years of relevant professional experience. They are an expert in a specific nursing specialty area and are active at the department level or across the hospital. Just in the last two years, we have been able to attract over 20 TLPs and 3 APNs to our hospital. 
 
This strategy was a tremendous groundwork for our Magnet® Journey, especially since it was precisely in these two professional groups, that we found important multipliers for the Magnet® concept. The TLPs and APNs act as knowledge drivers on site and, in collaboration with the ward managers, ensure sustainability in the development of the patient care. Through regular exchange between the RBK Magnet® team and the TLPs as well as APNs, initial projects have been established in accordance with the Magnet® criteria. Examples of this are the development of a patient-integrating care handover or the development of a dashboard for nursing sensitive patient outcomes. 

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RBK, Photo by: Tobias Scheuerer

Our initiatives around Magnet®  
To communicate our participation in the Magnet4Europe study and inform about the Magnet® concept throughout the hospital, it was important for us to reach as many employees as possible. To do this, we reported on Magnet® through various communication channels in a targeted manner. 
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We publicized information about Magnet® and the Magnet4Europe study in the hospital through various campaigns and media, for example through a Magnet® exhibition stand on Health Day and on Patient Safety Day. In addition, we sent regular staff information to all employees via the house-wide e-mail distribution list and created posters that were displayed on the wards and in staff areas. A hybrid event series ("Let's Talk about Magnet®") on the status of our Magnet® Journey is beginning this fall.  

Another approach to implementing Magnet® criteria house-wide is to situate the Magnet® concept in the various continuing and professional education courses. In collaboration with our training center, we aligned the curriculum for the continuing education program for all nursing managers, as well as the continuing education program for ward managers and practical supervisors with the five Magnet® principles. 
The focus of the management strategy on the topic of Magnet® is always on the active exchange and discussion of the topics. Our intention is to make Magnet® tangible and understandable for everyone. Ultimately, it is not the concept that makes the difference, but the people who live it.  

​We look forward to the continuation of our Magnet® Journey! 

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