Temporary work in nursing when there is a shortage of staff: “Are we evil?”

When Sascha M. talks about his job, he quickly starts to rave: “Overall, it is very close to a sense of freedom.” For personal reasons, the family man does not want his full name to be published, but he is all the more active in promoting his work.

After school, the 36-year-old from Wismar trained as a state-certified geriatric nurse in Marnitz (Ludwigslust-Parchim) and has never wanted to do anything else since then.

Skilled worker shortage: temporary employment the big winner

Ten years ago, however, he turned his back on the “classic” system. M. works in Hamburg for a temporary employment agency that places nursing staff in homes and outpatient services. “I earn very good money and can write my own schedule. For the last nine years, I’ve only had late shifts,” he says. For most permanent employees, this freedom in the schedule is almost impossible.

His employer, “go fair temporary employment,” can offer M. all of these advantages. People like him are urgently needed in the care homes. And the recruitment agencies charge a lot for this, luring people from the industry with the same freedom and good salaries, only to offer them back to the facilities at a high price. In a way, temporary employment has become the big winner in the shortage of skilled workers in the care sector, and the number of employees has risen steadily.

Home operator Alloheim: 10,000 euros costs for a temporary worker

But at whose expense? “The additional costs for temporary work are borne by the solidarity system,” says Steffen Hehner. In other words: at the expense of the insured, those in need of care, operators and permanent employees.

Hehner is the chairman of “Alloheim Senioren-Residenzen”, one of the largest private care providers in the country. The company has 260 locations nationwide and around 22,000 employees. Nevertheless, even at its peak, Alloheim employed an average of around 500 temporary workers. “We pay around 10,000 euros a month for a temporary worker,” Hehner continues. “We have to change the shift schedules so that the temporary workers can even come to us.”

Dr. Steffen Hehner has been Chairman of the Management Board of Alloheim Senioren-Residenzen SE – one of the largest private care providers in Germany – since 2023
Photo: Alloheim Senioren-Residenzen SE

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How much of the 10,000 euros goes to the recruitment agency and how much to the employees varies. However, temporary employment agencies have long been advertising monthly salaries of 5,000 euros gross and more, while permanent employees now earn 3,300 to 3,500 euros depending on the location, according to the Federal Statistical Office. “Currently, temporary workers dictate the conditions. This means that the system is flawed in the long term,” says Johannes Buß from the board of the Caritas Association for the Diocese of Osnabrück.

Why Sascha M. prefers to work as a temporary worker

In addition, according to Hehner, many temporary employment agencies actively recruit newly trained specialists. Directly or through their employees. With precisely the same advantages that Sascha M. is also happy about. He himself only ended up in permanent temporary employment on his second attempt.

In 2011, he tried it for the first time “out of curiosity,” as he says. But the company put him off. However, his permanent position at an outpatient service was no better. “We had to do a lot of double shifts. The police even stopped me and a colleague in our car once because we looked so worn out,” he remembers.

The shortage of nursing staff will probably continue to increase (24.01.2024)
Photo: dpa graphics

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A friend of M. was already working at “go fair” at the time and recruited him, so to speak. M. did not find it difficult to quit his old job because of the conditions there. In 2014, he was already paid 18 euros per hour. For comparison: the minimum wage for skilled workers in nursing only rose to more than 18 euros at the end of 2023. M. now earns significantly more, without wanting to say exactly how much.

Also interesting: 125 euros per month for care – why this often fails in practice

This is the proportion of temporary workers in nursing

“Funny enough, we temporary workers sometimes stay at a facility longer than some employees. Sometimes we bring back structure that didn’t exist before because the staff was constantly changing. I’ve even trained permanent employees several times,” he says.

It could be easy to lure people into temporary employment, with the result that the shortage of staff in nursing becomes more severe and temporary employment thus becomes self-sustaining in a sense.

However, despite all the excitement of many operators, the proportion of temporary workers is still low; only about two percent of the more than 1.7 million nursing staff in Germany are employed by temporary employment agencies. You might think that this is a fringe group that has realized how to get more out of their job. Sascha M. says: “We temporary workers are highwaymen. But we just can’t get by without us. Does that make us evil?”

Temporary work in nursing: Is more regulation needed?

However, the problem of temporary work is not about good and bad. It is about “regulated and unregulated,” as Alloheim boss Hehner puts it. Like every care provider, whether private or non-profit, Alloheim negotiates rates with the insurance companies. “Everything in care – including prices and salaries – is completely regulated. But the payment of temporary workers is not. And that is being exploited too much.”

Alloheim and other institutions sometimes even have to pay transfer fees to temporary employment agencies if employees want to return to permanent employment. It would be unthinkable the other way around.

There is no refinancing for this, and operators are left with the costs. Hehner stresses that it would not work without temporary workers. “It is a legitimate concept for compensating for temporary absences.” Holidays can be planned, but not flu epidemics. And operations in a nursing home cannot cease if there are no employees. But the way things are going now, temporary workers must be regulated, demands Hehner.

Nursing union Bochumer Bund calls on employers to take action

But this could actually exacerbate the problem of the shortage of skilled workers. The General Association of Personnel Service Providers (GdP), in which many temporary employment agencies are organized, coined the word “Pflexit” to describe the scenario. It means: “Without temporary employment, many nursing staff would no longer be working in their profession.”

The GdP refers to a study by the German Economic Institute that it commissioned itself. According to this study, only around 21 percent of people in the field of inpatient geriatric care would return to permanent employment if the legislature restricted temporary employment. In nursing, the figure is even lower.

The nursing union Bochumer Bund also defends the temporary workers: The possibility of temporary work “has so far offered them a way out of the hamster wheel of inadequate pay, working hours that other employees take for granted and working conditions that often do not allow for humane care.” It is therefore up to the operators to win back employees with attractive working conditions.

Sometimes temporary workers are only there to meet the quota

But it is not that simple, says Steffen Hehner from Alloheim: “We as providers will not be able to offer only the shifts we want, 30 days’ holiday and a company car, especially to newcomers to the job. This is not refinanced by the system.” In addition, temporary workers are even brought in without actually having to work, but only because the workforce required by law is lacking.

Full-time facilities are subject to a skilled worker quota of 50 percent. That sounds like a high quality standard, but it is not necessary. Nevertheless, temporary workers have had to be brought in to meet the requirement. “Sometimes not even to work. Just so that they are there and the quota is right,” says Hehner. At least: The quota is to be made “more flexible” in the future, but care companies are still measured against it.

Nevertheless, although concrete measures are lacking, Health Minister Karl Lauterbach and Labor Minister Hubertus Heil (both SPD) certainly want to limit the activities of temporary employment agencies. The refinancing of “springer pools,” a type of temporary employment within an institution, is already helping large companies like Alloheim.

Gold rush mood subsides

And Steffen Hehner says: “But you can also see that the gold rush mentality is waning. The announcement of regulation of temporary employment alone is causing some providers to get out of the business.”

Without temporary work, he would probably only stay in nursing if the pay was similar to a permanent position. That is the decisive factor: Because despite all Sascha M.’s love for his job, he also says: “I don’t just go to work for good conditions and applause. I go to work for money.”