Intensive care: why one registered nurse is not the same as another

Not every registered nurse (Pflegefachkraft) is allowed or able to provide intensive care. The differences in training and additional qualifications are considerable, and they determine how safely your family member is cared for. If you are currently looking for a care service for a person who needs ventilation or has another condition requiring intensive care, it is worth taking a closer look.

What does "skilled nurse" actually mean in care?

The term "registered nurse (Pflegefachkraft)" is regulated by law. Since the Pflegeberufegesetz (Nursing Professions Act), which came into force in 2020, there has been a generalised three-year training programme. It replaces the former separate training programmes for health and general nurses, geriatric nurses and paediatric nurses. That sounds good at first, but it has an important consequence: the basic training covers many areas, but intensive care is not part of the standard curriculum. So someone who has just completed their training is a qualified nurse, but not yet an intensive care specialist. That is not a criticism, it is simply the reality of the system.

What additional qualifications does an intensive care nurse need?

For out-of-hospital intensive care (außerklinische Intensivpflege), meaning the care of people at home who need ventilation or have severe care needs, there are clear professional requirements. The foundation is the three-year nursing training. In addition, specific further training is required, which can vary depending on the provider and the federal state. The Gemeinsamer Bundesausschuss (G-BA) (Federal Joint Committee) has set out in a binding way in its guideline on out-of-hospital intensive care (AKI-Richtlinie) which qualifications nurses in this field must have. These include, among other things, a recognised further training in intensive care or anaesthesia nursing or a specific specialist further training for out-of-hospital intensive care. Care services working under the AKI guideline must prove that their employees meet these requirements. The long-term care insurance funds (Pflegekassen) check this when granting approval.

What must intensive care nurses be able to do in concrete terms?

It is not only about certificates. It is about skills that make the difference in serious situations. A specialist nurse in intensive care must, for example, be able to handle ventilators safely, change tracheal cannulas, assess vital signs and react correctly to complications. Many patients in out-of-hospital intensive care have several serious illnesses at the same time. Care is complex and sometimes unpredictable.

• Safe handling of ventilators and suctioning
• Tracheostomy care and cannula changes
• Recognising and assessing deteriorations in condition
• Administering medication and monitoring infusions
• Communicating with non-verbal or ventilated patients
• Working together with doctors, therapists and emergency services

None of this is learned in regular nursing training alone. It takes experience on the ward, structured further training and regular courses. A good intensive care service makes sure that its nurses have not just completed further training once, but are trained continuously.

What should you look out for in a care service as a family member?

If you are looking for an intensive care service in the Alpen, Wesel, Xanten or Rheinberg area, you have the right to ask specific questions. That is not distrust, it is your job as a family member. Ask the service directly: What qualifications do your nurses have? How many of them have a recognised further training in intensive care or anaesthesia nursing? How does the induction of new employees work? Are there regular continuing education and training courses? A reputable care service answers these questions openly and without hesitation. If the answers sound evasive or you get the feeling that the qualifications are being played down, that is a warning sign. The long-term care insurance fund (Pflegekasse) and the Medizinischer Dienst (MD) check care services regularly, and the results are partly publicly accessible. That can be another point of reference. In Moers or Kamp-Lintfort, the responsible long-term care insurance funds (Pflegekassen) are the same as everywhere in North Rhine-Westphalia. Your family member's long-term care insurance fund (Pflegekasse) is always the first point of contact if you have questions about the qualification requirement or the approval of a service.

Why the difference matters so much for your family

Imagine your family member is ventilated and lives at home. At night, someone comes on duty who is officially a registered nurse (Pflegefachkraft), but has never worked in intensive care. He or she may be good at general care, but is unsure with the ventilator in an emergency. That is not theory, it happens. Conversely, there are nurses who bring years of intensive care unit experience, have completed specialist further training and are still calm and humane in their approach. That is the difference you want for your family member. The G-BA's AKI guideline was intended for exactly this: to secure a minimum standard and reduce the gap in quality. It applies to all care services that bill out-of-hospital intensive care (außerklinische Intensivpflege) through statutory health insurance. That is real progress, even if implementation in practice sometimes still takes time. If you would like to know more about the costs of intensive care at home, you will find a separate guide here on the blog. And if you are curious how a good intensive care service works internally, our article on the AKI specialist day in Brilon is also worth a look, as it deals with exactly such professional questions.