The academization of nursing offers many advantages. It supports the professionalization of nursing staff, thereby enhancing their critical thinking and decision-making skills, and ultimately improving the individualized treatment of patients. In light of demographic change and a shortage of skilled professionals, the nursing sector is in urgent need of leveraging every possible advantage. Nevertheless, Germany is struggling with the academization of nursing.
Only 2.5% of nursing professionals in Germany have completed a university degree. According to the Economic Council, this figure should be 20% to improve the quality of care. Internationally, at least 10% of nurses hold an academic degree in many countries; in Norway, it is even 100%.
Today, a variety of educational models provide different qualification pathways in nursing. These include a three-year generalist training to become a registered nurse, a one-year nursing assistant training program, and bachelor’s or master’s degrees that can also be completed in a dual-study format alongside employment.
As the qualification pathways in nursing become more complex, so do the associated competencies, responsibilities, and areas of expertise. This presents many opportunities, but also challenges that hospitals and care facilities must navigate.
Competency Expansion Through Academization
Through academic study, nurses gain in-depth knowledge in areas such as clinical decision-making, scientific research, communication, ethics, and care coordination. This enables them to analyze complex care situations more thoroughly, act based on evidence, and make autonomous decisions — for example, in wound care, medication administration, or health counseling.
Evidence-based practice (EBP) can thus elevate nursing into a quality-assured and patient-centered profession. Research findings are directly integrated into decision-making and applied in practice. Medi-Karriere outlines six key steps in EBP, including final evaluation. Insights from practice also feed back into research.
Personalization and Quality Enhancement Through Academization
What this competency expansion means for hospitals and care facilities must still be redefined. Since 2016, the Robert Bosch Foundation has initiated efforts to combine these varied qualifications into a balanced mix tailored to each patient. “Given demographic changes, all qualified nursing professionals are needed to ensure care.”
This allows for highly individualized patient care and better management of complex medical issues. For nursing professionals, choosing a training path is also a personal decision. A university degree does not necessarily mean graduates will remain in academia. According to the 2019 VAMOS study, 60% return to direct patient care. Moreover, it is not just theoretical knowledge they gain. The competencies of graduates are diverse — from implementing client-centered interventions to quality assurance and interprofessional collaboration.
New career paths emerge from academization and the resulting expansion of competencies. Advanced Nursing Practice (ANP) roles, for example, involve nurses with university degrees specializing in certain areas. They can lead complex care processes in palliative care or psychiatry, make diagnoses, and administer medications.
Academization clearly improves care quality. A 2019 U.S. study found that patient mortality rates drop when a higher percentage of nurses hold bachelor's degrees.
“The observational study by Harrison et al., involving 36 hospitals across four U.S. states, concluded that cardiac arrest patients in hospitals where 70% of nurses hold bachelor’s degrees — versus only 40% — had a higher likelihood of surviving without neurological deficits.”
Yet, as noted in a nursing podcast, the question remains: why is this the case? The authors call for more research to “advance practice with scientific insights.”
More research is needed on how to better integrate academization into everyday practice. The Robert Bosch Foundation has long been advocating for this. Its 360° Nursing program promotes a qualifications mix in nursing. In the first phase (2016–2018), experts developed concepts tested in pilot facilities. Results, materials, and case studies are well organized on the program’s website. These show that a targeted qualification mix can enhance care quality and improve the profession’s appeal.
Challenges for hospitals and care facilities due to the academization of nursing care
Successfully integrating academized nursing into traditional systems requires structural change. First, job roles for these new profiles must be created. Both bachelor's and master's graduates in nursing science or ANP should have opportunities for practical work. This can lead to new career paths and increase an organization’s attractiveness. Offering ANP roles means allowing them to work with patients while continuing their academic careers.
Job profiles for academically trained nurses must be clearly defined. They should differ from those of non-academic colleagues, yet still include some “classic” nursing duties to avoid frustration on both sides. A mentoring team with role models can help manage this. Any anxieties among staff with different educational backgrounds — essentially, fears of being “no longer” or “not yet” important — should be taken seriously.
This requires open or transformational leadership, especially important during times of uncertainty and shifting norms (VUCA-BANI). This leadership style builds trust within teams. It also proved effective in the 360° projects of the Robert Bosch Foundation, where varied communication methods — written, verbal, digital, and face-to-face — helped ensure that all stakeholders felt respected, according to the program’s final report.
Improved communication is not just needed within nursing teams. In interactions with hierarchical medical staff, mediation may be helpful to prevent undermining their roles. On the flip side, doctors must also take the academization of nursing seriously. The critical and systematic thinking developed during nursing studies enables nurses to engage with physicians as equals and take on responsibilities like diagnosis and medication management. Doctors, too, must adjust to flatter hierarchies, which ultimately reduces their workload. This structural shift elevates the profession and enhances its reputation.
Financing and Non-Monetary Incentives
As nurses gain more competence and recognition, their status and salaries increase. This brings up the challenge of financing both the studies and the new roles. While the German government provides stipends through the Nursing Studies Strengthening Act (PflStudStG), healthcare providers must budget accordingly. Experienced HR consultancies can help — not only with job planning and recruitment but also onboarding and team integration.
Another insight from the Robert Bosch Foundation’s project: monetary compensation isn’t everything. Responsible tasks and continuing education also make positions more attractive.
Hospitals and care facilities can thus significantly boost their appeal by creating the right structures for integrating academically trained personnel.
Conclusion
Academization brings significant competency expansion to nursing professionals. New roles like Advanced Nursing Practice assume responsibilities traditionally held by doctors. To implement this transformation smoothly, hospitals and care facilities must foster dialogue among staff. Mentorship can help.
In any case, companies should seek expert guidance to ensure the change is structurally embedded and culturally accepted. Open leadership and flat hierarchies also improve employee retention. Ideally, the academization of nursing will enhance both care quality and working conditions.
It also supports other critical developments, such as digitalization, and may help recruit urgently needed skilled workers. This includes international professionals accustomed to academic nursing standards and seeking opportunities in Germany. Organizations can benefit greatly from HR consultants — for candidate selection and job profile development — by leveraging their networks and expertise.
