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Introduction:The effective integration of professional nursing staff with university training into care processes is associated internationally with better patient outcomes. In Germany, there is a current lack of reliable figures on graduates and their areas of responsibility. Therefore, the aim of this follow-up survey, designed as a repetition of a previous one, was to ascertain the number of nurses with a Bachelor's or Master's degree involved in direct patient care at university medical centers. Method: In a cross-sectional study, chief nursing officers in university medical centers were asked to quote the number of professional nurses with a university degree (Bachelor, Master, Doctorate). Additional questions focused on their tasks and responsibilities and the measures undertaken to facilitate their integration into the organization. The data were analyzed using descriptive statistics. Results: In total, n = 29 valid questionnaires from 35 university medical centers were included in the analysis, resulting in a response rate of 82.85%. For a total of 18 centers, the number of university-qualified nurses had increased by n = 786 between 2015 (n = 593) and 2018 (n = 1,379). The overall percentage of nurses with a university degree working at a university medical center in the study was 3.16% (SD = 1.66; min -max = 1.09 -6.69; Q1 -Q3 = 1.49 -4.04; 95% CI 2.30 to 3.95). In direct patient care, the quota was 2.11% (SD = 1.40; min -max = 0.47 -5.42; Q1 -Q3 = 0.87 -3.16; 95% CI 1.36 to 2.76). The main focus of their duties was on standard care and patient education (graduates with a Bachelor's degree), evidence-based nursing practice development (Master's degree) and research activities (doctoral degree). Discussion: Compared to 2015, the proportion of professional nursing staff with university training has increased but remains at a very low level. These nurses perform relevant clinical tasks and are involved in the development of good practice. However, there is a need for better competence-based differentiation.

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AbstractBackgroundAlongside midwifery-led care (AMC) was introduced in Germany in 2003. The aim of our study was to collect data about the utilization of AMC within North Rhine-Westfalia (NRW), Germany’s most populous state, and to collect information regarding the approach used for implementation of AMC and providers’ experiences in day-to-day work.MethodsQuantitative data were collected by questionnaire, telephone interview and comparative analysis of documents created for use in AMC. Qualitative data were compiled by questionnaire and workshop.ResultsSeven obstetric departments offer AMC in NRW. On average, 3.4% of women gave birth in these AMC units, corresponding to 0.3% of all births in NRW. For the establishment of AMC, institutional, organizational, professional and formal arrangements were undertaken. An eligibility and transfer checklist was agreed upon between midwives and obstetricians. Both professions were faced with skepticism. Daily work in AMC resulted in improved teamwork between the two professions and increased job satisfaction for midwives. Acquisition of manual skills and time constraints were the major challenges.ConclusionThe low utilization of AMC is not due to the concept of care itself or difficulties with its implementation, nor to a lack of eligible women. Reasons may be insufficient awareness about AMC or a lack of interest in this type of care.