Abstract
In many countries, the educational pathway into nursing is an academic study program. In Germany, it is also possible to study nursing; however, the vocational path is chosen far more frequently. For this study, 15 first-year apprentices were interviewed on their criteria for choosing this career and their future prospects. The interview results indicate that personal motivation or other individual reasons for entering the nursing profession are the main incentives for pursuing nursing education. Career orientation and internships, as well as biographical experiences and personal environment, also significantly influence their career choice. The apprentices cite various factors that could increase their chances of remaining in the nursing profession in the long term, including financial compensation, opportunities for further education and personal development, and appreciation and recognition for their work by other medical colleagues. Responses to career choice criteria questions are examined and classified using established theories (e.g. Gottfredson 2002; Lent, Brown & Hackett 1994). The results are discussed in terms of possible consequences and implications for VET teachers and instructors to understand the perspectives of recruiters and explore ways to enhance and promote the appeal of nursing education in the German VET system. This could contribute to the professional development of future professionals at an early stage. The concluding considerations offer a framework for exploring broader applications.
Keywords: nursing education, German VET System, career choice process, qualitative research
1 Introduction
1.1 Thematic framework
The demand for skilled nursing staff is currently high and, according to all projections, is expected to continue rising in the coming years. There are several reasons for this: the number of nursing apprentices is not at the desired level, the dropout rate from apprenticeships is too high, and the number of skilled workers remaining in the nursing profession is too low. Demographic developments exacerbate this trend: The increasing number of elderly people in Germany who are suffering from multi-morbidity demands a larger workforce in the professional nursing sector. It is therefore essential to promote and support nursing apprentices at an early stage to ensure their long-term retention in the profession. The successful recruitment of skilled professionals is correspondingly challenging for clinics and hospitals.
To gain insights for recruiting staff and those interested in an apprenticeship, this article will adopt the perspective of young school graduates. A greater understanding of their career choice process and professional decision-making mechanisms, along with further insights into young people’s lives after or while transitioning from school to work in nursing education via the German VET system, is expected to yield new findings that will simplify recruitment in the future.
1.2 The nursing profession in Germany in transition
In 2020, the Nursing Professions Reform Act (Pflegeberufegesetz – PflBG) reorganized nursing vocational education and training in Germany. Nursing apprenticeships, which had previously been regulated separately in Geriatric Nursing Law (Altenpflegegesetz -AltPflG) and Nursing Law (Krankenpflegegesetz – KrPflG), were merged into a generalist nursing apprenticeship. This now includes the care of people of all age groups. The generalist apprenticeship ends with the acquisition of the professional title “Pflegefachfrau” (f) or “Pflegefachmann” (m). The profession can be entered through VET or a primary qualifying course of university study. VET comprises both theoretical and practical components. The theoretical component takes place in nursing schools, which are integrated into various structures within the individual German federal states. The theoretical component of the apprenticeship comprises 2,100 hours and the practical component at least 2,500 hours. In Germany, apprenticeships are divided into alternating theoretical and practical phases. It includes different nursing areas and specializations (inpatient acute and long-term care, outpatient acute and long-term care, psychiatry and paediatrics) (Bundesgesetzblatt 2020).
From the beginning of their apprenticeship, apprentices are confronted with a multitude of professional stresses and challenges, both emotional and psychological in nature. This is largely due to their exposure to diverse locations and activities, as well as to illness, suffering and death. Meeting these demands requires a high level of adaptability and resilience (Coppers & Struck 2024).
However, if these demands are not met effectively, the dropout risk increases. The corresponding risk factors were compiled in a study by Garcia-González and Peters (2021): key issues include a lack of support in practical and theoretical areas, as well as a lack of emotional support combined with an unfriendly atmosphere in daily work life. In addition, stress, inadequate guidance, the feeling of not being taken seriously and a lack of appreciation towards the apprentices are cited as reasons for dropping out of the apprenticeship. These risk factors are highly relevant: when statistics are examined for Germany as a whole, approximately 30 percent of apprenticeship contracts in generalist nursing education are terminated prematurely each year (Garcia-González & Peters 2021).
1.3 The transition from school to work
What are the challenges for young people when making a career decision? For young people, the transition from school to vocational education and training is a crucial step in shaping their future lives. The transition presents a major challenge in deciding between various offers, opportunities, and educational paths. During this phase of choosing a career, school, parents and peers exert varying degrees of influence, depending on the individual. Some young people experience this phase as a stressful situation, as school leavers, in particular, are confronted with various problem areas (e.g., parents’ expectations, final grades and sending applications). Ideally, young people should be able to make their own career choices and actively explore their skills and strengths. The process of seeking an apprenticeship requires individuals to possess a clear understanding and a realistic idea of the career options available to them, thereby facilitating effective planning for their future. Accordingly, vocational orientation should be understood as a process rather than a single event (Struck 2020).
It is also relevant to note that the expectation of career choice as a discrete, adolescent decision, or the notion of having “one profession for life”, has become increasingly obsolete. After all, during the transition from school to work, young people are faced with an initial choice of apprenticeship rather than “one career for life”.
In addition, internships are critical in the career choice process in Germany. For example, there are obligatory internships during school as well as some voluntary internships during school vacations. Furthermore, for young people, parents play a pivotal role in the career selection process. Their insights and counsel are significant in this regard. Accordingly, parents can support exploration behaviour through encouragement and by setting a positive, active example. Exploration refers to a period and activity in which young adults explore their career interests and opportunities and make their first career choices. Vocational tasks are tried out, and their abilities are evaluated, allowing career interests and aspirations to become more concrete and realistic. According to Kracke and Hofer (2002), parents should encourage independent thinking and action in conversations and discuss on an equal basis. In addition, a secure relationship with parents and friends is conducive to young people’s exploratory behaviour (Kracke 2002; Kracke & Hofer 2002; Neuenschwander 2008).
Overall, vocational orientation should be viewed as a long-term process that requires individuals to work it out for themselves. Due to current changes in the labour market and increasingly flexible employment relationships, the demands placed on young, career-choosing subjects are increasing (Struck 2020). Characteristics and skills such as adaptability and resilience are becoming increasingly important when searching for an apprenticeship and during the initial phase of the apprenticeship.
1.4 A brief overview of the research on the nursing profession
To provide a framework for the topic, empirical findings on the choice of an apprenticeship in nursing in Germany will be discussed below. Research on career selection has consistently confirmed that apprentices choose their professions based on various characteristics and motives. As part of the target group considered in this study, nursing apprentices, in particular, exhibit an increased desire for meaningful work, as they aim to help others (Reiber et al. 2021). Identifying with the tasks of the apprenticeship occupation is reinforced by earlier studies (e.g. Rauner 2017), which show that nursing apprentices exhibit a comparatively strong professional identity compared to other apprentices.
This author’s investigations also show that a significant proportion of nursing apprentices have “inherited” the profession, i.e. that a professional role model from their immediate family environment (e.g. mother, aunt) has already worked in this profession or at least in the healthcare sector. Apprentices who have “inherited” the profession have already demonstrated a fundamental or (more) established professional identity compared to other apprentices at the start of their apprenticeship (Struck et al. 2024).
Concerning nursing, Altmeppen (2022) also worked out three process variants (or types) of a biographical decision for nursing apprenticeship: “Nursing vocational education as a phase of time-off”, “Nursing vocational education as a strategic career choice to secure an employment biography” and “Nursing as a profession of choice” (Altmeppen 2022). In a figurative sense, these illustrate the career choice motives and individual justification patterns underlying the decision to pursue a career in nursing.
It should also be noted, as the study by Auffenberg and Heß (2021) shows, that qualified nurses would return to the profession or increase their working hours if working conditions were improved and (work) stress levels were reduced. These aspects include (similar to previous studies) reliable working hours, more time for high-quality and professional care, increased appreciation from superiors and higher financial remuneration (Auffenberg & Heß 2021).
A recent study by Driesel-Lange et al. (2024) shows, on the other hand, that comparatively few parents advise their children to pursue a nursing apprenticeship (6.9%). Among other things, parents rate the aspects of career, work-life balance, earnings and leisure time in the healthcare professions as poor or less good (Driesel-Lange et al. 2024). These findings are particularly relevant in the context of the career choice process, where parents are among the most important contact persons for young adults. The results of Driesel-Lange et al. (2024) demonstrate that such (negative) expectations of professions, in this case in the healthcare sector, on the part of parents can lead to young people being less likely to pursue these occupations.
1.5 Research interests and questions
This article will therefore examine the perspective of young people in the career choice process, or after transitioning from school to work, and their associated entry into nursing VET. To achieve this objective, the study incorporates interviews with apprentices in their first year of apprenticeship. These interviews are analysed through the lens of theoretical considerations on the career choice process and will be classified according to empirical research findings.
Although there are currently two paths to becoming a nursing professional in Germany, via university studies or an apprenticeship, the focus here is on apprenticeship. This is not meant to be critical or disparaging toward university studies. However, apprenticeship has a long tradition, has recently undergone extensive reform in Germany, and is very popular among German school leavers (over 50,000 new apprenticeship contracts per year). In specific terms, the two research questions are examined:
- What are the factors influencing the decision to select an apprenticeship in nursing?
- What do apprentices expect of their future career prospects in nursing?
Initially, the current state of nursing in Germany is examined, followed by a presentation of central theoretical approaches to career choice. Building on this, the empirical state of research is presented in excerpts.
2 Theory on the career choice process
There are numerous theoretical approaches to explaining and understanding the career choice process in international discourse; in this paper, the reference is reduced to two central and internationally frequently cited works.
Rather than providing a comprehensive overview of the various theoretical approaches to the career choice process, this paper deliberately focuses on two theoretical concepts that have been extensively discussed and developed internationally for many years and have also served as a theoretical basis in numerous international research studies.
2.1 The concept of the “Theory of Circumscription, Compromise and Self-Creation”
An internationally frequently cited and empirically verified theoretical approach is the concept of the “Theory of Circumscription, Compromise and Self-Creation” (TCCSC) by Linda Gottfredson (2002). According to this approach, there is a continuous process of circumscription and compromise of an occupational aspiration field based on the assessment of the prestige and gender connotation of different occupations. Career choice occurs through an exclusionary process of occupations: Already in early childhood, assessments of known professions are made regarding whether they are gender-typical or gender-atypical, and whether they can be expected to have high or low prestige. As adolescence progresses, an area of vocational aspiration is formed in which the final, “remaining” career aspirations can be interpreted as an expression of the self-concept.
The self-concept, i.e. the cognitive idea of who you are, is crucial. Actions are interpreted in such a way that they are compatible with the self-concept. In addition to a person’s self-image and identity, people also have individual ideas about various professions. These ideas include the activities associated with a profession, the working conditions and the professional requirements. This creates a cognitively developed image of the personalities of the people working in this profession. In the process, the appropriateness of this professional practice is compared with oneself.
This refers to how well a profession fits in with a person’s self-concept. After all, the higher the compatibility between self-concept and profession is assessed, the greater the likelihood of choosing this profession and pursuing it later. In addition to one’s own professional interests, the professional requirements and tasks in the profession are decisive. In addition, the (perceived) accessibility of an occupation has an influence on the final selection and the compromise in the career choice decision. In their career choice process, people therefore often not only pursue a desired occupation, but also develop a range of acceptable alternatives for themselves. In this way, preferred occupations (which appear potentially difficult to achieve) are relinquished for less compatible occupations that are perceived as more attainable. This results in the formation of a compromise (Gottfredson 2002; Hofmann & Neuenschwander 2023).
For this study, the theoretical considerations are adapted to include the formation of compromises based on perceived availability, one’s self-concept, interests and expected activities as central factors in career choice decisions.
For an apprenticeship in nursing, this could mean that the perceived availability of numerous open and unfilled apprenticeship positions, as well as the media debate about the shortage of skilled workers in the healthcare sector, could heighten the appeal of the apprenticeship and influence the selection of individuals.
Linda Gottfredson also emphasised the importance of aligning one’s expected activity with one’s professional interests. This could also serve as a guideline for deciding to pursue vocational education and training in nursing.
2.2 The social-cognitive career theory (SCCT)
As a second theoretical point of reference, the considerations of the Social Cognitive Career Theory (SCCT) by Lent et al. (1994) should be taken into account for this study. SCCT postulates that behaviour in the career choice process is influenced by self-efficacy and outcome expectations. The focus here is on several theoretical models with regard to the development of vocational interests, career choice (decision), vocational performance and vocational satisfaction. The models include environmental factors and learning experiences that influence the level of self-efficacy and outcome expectations. It is expected that people with greater self-efficacy set more realistic goals, perform better, and ultimately be more satisfied with the actions they take.
In an application of the SCCT models, Lent and Brown (2013) extend the model of self-management to adaptive career behaviour across the lifespan, considering exploration as an action of adaptive career behaviour. This model explains outcomes and abilities in relation to goals and actions. Two applications or adapted models were developed for the model, one of which relates to adaptive behaviour in the life stage of exploration. It considers exploration goals and exploration actions as an aspect of adaptive career behaviour to explain outcomes (e.g., level of decisiveness). Lent and Brown (2013) assume that the decision to engage in career exploration and decision-making behaviour applies to people who have favourable beliefs about their exploration and decision-making abilities (self-efficacy) and expect positive outcomes as a result of their efforts (such as that exploring career options will help make a satisfactory choice; outcome expectancy). Adaptive career behaviour, in the form of exploration, is understood as self-regulatory and is directly and indirectly related to self-efficacy and outcome expectancy (Lent & Brown 2013).
For this study, the relevance of self-efficacy and exploratory behaviour as a decisive factor in the career choice process, as well as the decisiveness of the career choice decision, is drawn from theoretical considerations on SCCT, among other factors. One or more internships, for example, could be correspondingly significant. The same applies to confidence in one’s own abilities when deciding on a career. Such a decision can also be reinforced “from the outside” through discussions with other people.
2.3 Intermediate summary and classification
The information compiled shows that nursing apprentices have a particular career aspiration or a special expectation of their profession, in that they are looking for meaningful work in which they want to help others. In addition, young people “listen” to their parents when choosing a career and take their recommendations and advice into account. In the case of nursing, there is also the argument that there is a certain amount of “inheritance” in career aspirations. This means that parents are twice as important in developing a career aspiration in nursing.
The approaches of career choice theories make it clear that young people have a better chance of realising a career aspiration that suits them personally if they have a high level of confidence and, at the same time, actively explore career options, e.g., through an internship. It is also clear that during adolescence, compromises are made when choosing a career, including the extent to which one’s own career aspirations align with one’s self-concept, as well as the activities expected and the perceived availability of an occupation.
All of these aspects provide initial indications of how personnel recruitment for the nursing sector can potentially be optimized. The evaluation of the empirical data should provide further in-depth findings.
3 Methodological approach
A total of 15 interviews were conducted with first-year apprentices for the empirical part of this study. The 15 interviewees were recruited from three different nursing schools. The gender distribution indicates that 12 females and 3 males were interviewed, with an average age of 21. The interviews with generalist nursing apprentices were conducted in person and in a 1:1 format. The duration of the interviews was 15 to 36 minutes. The interviews are taken from an ongoing research project (“Peer-to-Peer Transfer” from the EMPOWER joint project, funded by the German Federal Ministry of Education and Research) and therefore constitute secondary data analysis. As part of the project, a guide for interviews with apprentices was developed, addressing a total of seven content-related themes and introducing them through narrative storytelling prompts. Two of these seven themes are analysed in the current study for first-year apprentices. Most of these interviews were conducted in the first half of 2024. To ensure ethical compliance for the overall project, an ethics application was submitted to the Ethics Commission of the German Society for Nursing Science (Deutsche Gesellschaft für Pflegewissenschaft e.V.) at the start of the project, which received a positive response. Participation in the interviews was voluntary and self-initiated and took place directly on-site at the schools. The interviews were conducted in a quiet atmosphere, with the interviewer and interviewee engaging in direct conversation. The conversations themselves were recorded as audio files and then transcribed, anonymized, and coded in MAXQDA. The guideline concept was based on Witzel’s (2000) problem-centred interview approach, while the evaluation and coding were based on the content-structuring qualitative content analysis method, as outlined by Kuckartz and Rädiker (2022). The category system was developed inductively and deductively, and further developed during the coding process.
I would like to express my sincere thanks to Esther Berkemer, Anna Coppers, Christina Hoffmann, Leoni Gröner, Pia Pütz, and Felix Schnakenburg for their assistance in the process and implementation of data collection, data preparation, and data analysis.
4 Results
4.1 Consideration of career choice motives
The first section of the analysis examines the career choice motives that influenced the apprentices’ decision to enter nursing education.
Table 1: Main category 1: Career choice motives
| Number | Subcategories | Total |
| 1.1 | Private environment | 21 |
| 1.2 | Professional environment | 9 |
| 1.3 | Biographical experiences | 28 |
| 1.4 | Career orientation | 49 |
| 1.5 | Generalist training structure | 9 |
| 1.6 | Personal motivation/individual reasons | 59 |
| 1.7 | Social influence on career development | 1 |
A purely descriptive analysis of the coding reveals that a total of 176 statements made by first-year apprentices were categorised under the heading of “career choice motives”. With 59 codes, most of the statements fell into the category of “personal motivation/individual reasons” (1.6), and the second most frequent category was “career orientation” (1.4). In addition, “Biographical experiences” (1.3) and the “private environment” (1.1) have a particular influence on the choice of career and the decision in favour of an apprenticeship in nursing. This is made clear in the statements made by the young adults surveyed.
In the following, a personal abbreviation, e.g. “B16”, is given after the quotes and statements of the apprentices interviewed. The letter stands for the class assignment and/or the institution and was assigned serially. In the interview transcripts, the statements or positions mentioned were counted serially; therefore, a “Position” is indicated here. Most of the interviews had more than 100 positions. A high position indicates that the statement was made later in the interview.
4.1.1 The consideration of “personal motivation/individual reasons”
To come closer to answering the research question, the statements in the four categories with the most codes will be considered below. As already mentioned, category 1.6 “Personal motivation/individual reasons” accounted for the most codes. Here, like Reiber et al. (2021), among others, it was found that the apprentices are determined to assist and contribute positively to people’s lives: “I decided to do this apprenticeship because I want to help people.” (D17_Position: 4); “…when I think about it, some people don’t have anyone and I might want to help them somehow or cheer them up a bit. And to be there for them so that they’re not all alone.” (B16_Position: 2); or “Simply working with people and supporting them where they need help and have problems” (A11_position: 4).
Some apprentices also want to be able to experience the progress of their patients’ recovery during their apprenticeship, gain positive emotions from it and also experience gratitude, like B15 (position: 4): “I chose this because I absolutely, simply love working with people, also to feel the gratitude. And that you can also see the progress, or unfortunately, sometimes, when things go backwards, I say. But above all, you simply have contact with people and many are grateful.”
Other arguments include “doing it better” than their colleagues: “Some nurses are just so completely focused on their work and somehow so rude, so unfriendly. And I just want to do things a bit differently. […] But also to show that they are in safe hands and that we are there for them because we have also chosen this profession.” (B16_position: 8). Or they want to be “allowed to do more” than “the assistants, they provide support and they’re not allowed to do everything. And I actually wanted to do more and the apprenticeship also offers it.” (A11_Position: 20); others also want to gain new knowledge because they are curious and interested: “I just find it interesting to simply know the body for myself too, how it all works.” (B15_position: 4). For still others, their first orientation and role models came from TV, because “to be honest, I always watched Grey’s Anatomy and so on during my A-levels and so on. And that’s where my first interest started.” (B12_position: 4).
For some, nursing is also a professional alternative or a professional compromise, as mentioned by Gottfredson (2002), as it appears or is available and accessible: “Well, I once considered studying psychology, but that was too difficult. It was too hard to get there because I didn’t quite get my A-levels.” (B14_Position: 4).
4.1.2 The analysis of “career orientation”
A vital option in the career choice process for exploring different professions and comparing one’s interests is the internship. Of the fifteen interviewees, eight had completed an internship and reported, among other things, that this had strengthened their career choice: “Then I did an internship last year in March, two weeks on the children’s ward and that convinced me even more […] And after the internship I really decided to do it.” (B9_Position: 4+8). Some of the apprentices were also able to give specific reasons for this, including “because I really enjoy working with adults. I noticed that during my internship. Dealing with people in general.” (B6_Position: 24). Some interviewees also clearly stated that they had completed several voluntary internships: “That’s why I did a lot of voluntary internships, but somehow always in the social sector at kindergarten, in hospital, in a retirement home.” (B16_Position: 2). Others realized through school content that they were interested in professional topics in care: “I went to a vocational school where there was a specialization in health and care. […] And that’s when I actually realized, I was 17, that I wanted to go into nursing.” (B15_Position: 32).
4.1.3 The perspective on “biographical experiences”
“Biographical experiences” include illnesses or accidents suffered by family members, sometimes including parents, which led to or reinforced the desire to pursue a particular career: “So I think the specific trigger was really that my mother has a chronic pancreatic disease. And that has been with me since I was six. She was hardly ever at home, and that hurt me quite a lot. And then I noticed that she was getting help at the hospital, but sometimes I also noticed that some of the nurses weren’t very nice; let’s say they weren’t very kind.” (B16_Position: 6) and “Because of the care situation, because of my mother, I mean, my mother has a crooked leg. That’s why I’m interested. I also wanted to help people in need of care and help them as best I can.” (A7_Position: 4).
In addition to their own parents, respondents also mentioned contact to nursing through their siblings or grandparents, some of whom even sparked an initial interest in pursuing a career in nursing and specializing in the field: “And when I was, well, when I was eleven, my little sister was born. She was a premature baby. And that just really interested me. The way she was treated in the intensive care unit, and how she received further treatment in the hospital because she also had several febrile seizures. And that just fascinated me. The work of the nurses.“ (B9_Position: 4); ”And my grandmother was ill. She was incontinent. And she couldn’t take care of herself or wash herself. Yes, and at the same time, I was going to school. And sometimes, when my mother wasn’t there, I was there to look after my grandmother. Yes, especially on weekends, I gained some experience with that.” (D17_Position: 4) Or also: “Yes, so mainly it was this year that I had the initial impulse that I wanted to go in this direction. Precisely because my grandfather became quite ill. At the beginning of the year, he had, and still has, a brain tumour, and that was one of my first real encounters with hospitals and patients and so on.” (B12_Position: 4).
4.1.4 The influence of the “private environment”
The private environment takes into account positive and negative feedback and influences from friends and family, as well as potential role models from the private context. For example, the influence of parents is directly addressed by the apprentices: “And then my mom said, ‘Why don’t you go into nursing? I can see you doing that.’” (A5_Position: 4). Others even report that several people in their environment advised them to learn nursing, citing character traits and behaviours as reasons for their recommendation: “Well, my [family and friends] all said it suits me very well because I’m a very open person and also very helpful. Or my aunt is also in outpatient nursing and said it really suits me.” (B9_Position: 6-8).
Some also have friends who have completed apprenticeship in nursing themselves and can therefore offer first-hand tips and recommendations: “And then a friend said to me that she had also qualified as a health care and nursing assistant at the time and that I should give it a try, she could really see me doing it.” (B15_Position: 8).
4.2 Reflection on future career prospects
In this section, the responses regarding the career prospects of the apprentices are analysed.
Table 2: Main category 2: Career prospects
| Number | Subcategories | Total |
| 2.1 | Remaining in the nursing profession | 51 |
| 2.2 | Leaving nursing | 1 |
| 2.3 | Career prospects open | 7 |
| 2.4 | Conditions for remaining in the profession | 11 |
The results of the “Career prospects” section contain a total of 70 codes, 51 of which fall into category 2.1 “Remaining in the nursing profession.” These figures alone indicate a high retention rate and potentially long-term prospects in the profession. Only one person stated that they intended to “leave nursing” (2.2) at the time of the survey, during their first year of their apprenticeship. A further seven codes can be grouped under the category “Career prospects open” (2.3). Here, remaining in the profession is not yet certain, but it is also not ruled out. In addition, 11 codes were assigned that provide statements and indications of the “conditions for remaining in the profession” (2.4) that are required, desired, or needed.
4.2.1 Those who want to stay – or the prospects of remaining in the nursing profession
First, the various statements regarding “remaining in the nursing profession” will be presented. This indicates that there are distinct and sometimes clear ideas and aspirations regarding one’s own professional future. These statements are very differentiated: “If I can advise people at home about care, that’s where I see myself. Driving to people’s homes, assessing the situation. Yes, giving advice on what can be done.” (D15_Position: 172); “So my goal has always been to work in a hospice at some point.” (B15_Position: 16) or “And I had also thought about the emergency room because I just like action.” (B11_Position: 180).
In some cases, apprentices can explain their own wishes at the beginning of their apprenticeship or express expectations (e.g. in the sense of Gottfredson) regarding the specific nature of the work: “I imagine that I will successfully complete my apprenticeship, at least that’s what I hope. And that I will find a specialty. Let’s take children as an example, specializing in paediatrics in a hospital.” (A7_Position: 124).
After the apprenticeship, there are also opportunities for further development, career progression and assuming more responsibility. This could include managing a ward or working as a practical instructor. Some apprentices already have exactly these kinds of ideas and expectations at the beginning of their apprenticeship: “I want to be a practical instructor because I just enjoy explaining things to other young people, whatever it may be. […] Explaining things in a way that is easy to understand and that everyone can really understand.” (B8_Position: 12).
In addition to these specific career aspirations for greater depth and specialization in nursing, six people also expressed an interest in studying nursing education with a view to becoming a nursing VET teacher and inspiring young people for this profession in the future. At this point in time, these considerations are mostly expressed speculatively: “Yes, I would like to continue studying. Maybe education.” (D14_Position: 4) and “Studying might be something I do afterwards. […] And then maybe go into nursing studies. Nursing education, that is.” (B12_Position: 163).
4.2.2 Alternatives to remaining in nursing
This section discusses categories 2.2 and 2.3, i.e., both leaving nursing and (still) remaining in nursing with an open or undecided future.
Only one statement was coded for category 2.2, “Leaving nursing.” This person describes their desire to study medicine and explains this as the reason for wanting to leave nursing: “I always wanted to study medicine and stuff. Now I’m doing the apprenticeship.” (A11_Position: 124). This desire to leave nursing is somewhat surprising, given comparable empirical studies. This can potentially be explained by the early stage of apprenticeship or by the fact that certain experiences that, according to other studies, contribute to leaving nursing have not yet been acquired. It could also be explained by social desirability, whereby such thoughts are not articulated in an interview setting.
In contrast, some respondents made it clear that their career prospects, and thus their decision to remain in nursing, were uncertain. At the time of the interview, they were still uncertain or undecided about how they wanted to shape their professional future: “I don’t necessarily feel that I know exactly what I want to do with my apprenticeship.” (B12_Position: 20). Alternatively, because they want a change or variety from their current job, but do not yet know exactly what the alternative will be: “Yes, let’s see where the journey takes me. That’s just how it is right now. The fact is, I don’t want to spend my whole life in geriatric care. […] So I’m definitely going to leave nursing, geriatric care. But where exactly, I’m not sure. Closed psychiatric wards really interest me, or maybe a hospital.” (A5_Position: 116).
4.2.3 What does it take to stay? Conditions for remaining in the profession
Regardless of the interviewees’ own perspectives on remaining in nursing, the interviews should reveal the conditions necessary to make staying in nursing attractive. These answers could also be of interest to HR managers and hospital administrators when considering how and why staff can be retained. The apprentices mention various aspects here, with financial remuneration for their work being only one argument: “If the salary were to increase, that would of course be very nice.” (D15_Position: 180).
The apprentices are much more interested in opportunities for further apprenticeship and personal development: “And also further apprenticeship in the future, so that you always learn something new.” (B15_Position: 36). They also want recognition and appreciation, preferably to be seen as equals by other medical colleagues: “And to be seen as equals. So, maybe the doctors too. I don’t know how that works in practice, really. I haven’t noticed it that much yet. But that they don’t see you as inferior or anything, but appreciate what you do.” (B6_Position: 60-64).
Future professionals want to feel comfortable on the ward and enjoy their work: “And for the practical side, I would say if I feel comfortable and enjoy it. If I noticed that I didn’t feel comfortable and didn’t enjoy it, and I always went to work in a bad mood, then I would say it’s not for me.” (B7_Position: 48). And for difficult experiences, they suggest that there may also be a need for opportunities to process their own experiences in the profession so that they do not remain alone with them: “But of course, I have to see how I can cope with the suffering, because I also have experiences that have shaped me.” (B16_Position: 80). They also suggest that the image of the profession or job profile should be strengthened and promoted: “So, in general, that in difficult situations, the profession is still appealing, so to speak. […] That you maybe try a little bit more, how should I put it, to present it a little more. This is the nursing profession, and this is what it is. And there’s a lot more to it.” (B16_Position: 16).
4.3 Limitations
When interpreting the results, it should be taken into account that the results are based solely on the statements of 15 interviews with apprentices and that the correlations therefore only apply to a specific (selected), small, regionally concentrated sample. It is not permissible to generalise the results.
The results should be interpreted with caution, not least because they are based on information provided by the apprentices themselves. Consequently, effects and patterns of social desirability in the responses cannot be ruled out.
Furthermore, the aspect of self-motivation to participate in the interviews must also be mentioned, as there is a clear disadvantage of a selective sample (Reinders 2005). Although participation in the interviews was voluntary, there remains a risk that more satisfied apprentices were disproportionately likely to participate.
This could lead to negative or critical arguments about nursing apprenticeships being underrepresented in the dataset. Here, there could be a positive selection bias, which also consists in the fact that the apprentices surveyed are among the (particularly) motivated and committed individuals who (strongly) reflect on their actions and commitment to nursing and have a (comparatively) above-average level of identification and motivation with this particular activity. Consequently, the findings from the data set presented (also for this reason) cannot be generalized.
5 Classifying discussion and recommendations for action
The results provide indications as to why and to what extent the recruitment of skilled workers, using the example of nursing apprenticeship in Germany, poses major challenges for the healthcare system. On the other hand, there are indications, results, and answers to the research questions formulated above.
The theoretical assumptions, particularly those of Gottfredson (2002), Lent et al. (1994), as well as Lent and Brown (2013), have been confirmed. Internships and actively exploring career options are crucial for making decisions and compromises. However, findings from the research literature also appear to be confirmed, with many respondents in the present study indicating that they chose nursing as a career because they wanted to help others, as reported by Reiber et al. (2021). Moreover, they want to be in direct contact with people and experience gratitude. It is also important to note that the results of Auffenberg and Heß (2021) were confirmed, indicating that increased appreciation and higher financial compensation, among other factors, can contribute to retention in nursing.
With regard to career decisions, it can be noted that there is a high level of personal motivation, and that biographical experiences of nursing in the family also influence career choices. Indications of “inheritance” were also confirmed, as was the relevance of internships in the career choice process. For personnel recruitment, this means that some of the decisive factors cannot be directly influenced by the personnel themselves.
The way nursing is discussed and how trained professionals communicate and report on nursing and working conditions at the ward to their family and friends has an influence. This factor has a significant impact on the decision to recommend the nursing profession to one’s children. It is a professional field that exhibits a certain degree of professional inheritance, so the conditions should be correspondingly positive and the employees satisfied, so that they can (with a clear conscience) pass on the profession to their children within their families.
The perspective of the professional future illustrates that most statements were made in favour of remaining in nursing. For recruitment, this is initially good news, as it contributes to retention in nursing. Furthermore, some respondents had clear career goals or activities and positions they would like to achieve.
These options for personal development should be promoted and supported by the human resources department. Furthermore, regarding the aspects that increase the chances of remaining in the profession, various arguments are put forward, with salary being only one of many. Rather, appreciation, recognition, and enjoyment of work are demanded, as well as opportunities for further apprenticeship, a publicly strengthened and promoted professional image, and support in processing and coming to terms with experiences and stressful situations.
Referring to the research questions formulated above, it can be concluded that, in particular for the healthcare sector, other or special aspects play an important (or more important) role as criteria for the occupation than is the case for other occupations. These could include, for example, biographical experiences, personal connections and contact with the healthcare sector, as well as individual reasons and the private environment. It appears that various reasons and factors influence people’s choices of healthcare occupations. The reasons for staying in the healthcare sector and expectations for one’s own future career are also highly individual. As in other occupations, there are, of course, corresponding expectations regarding career development opportunities and prospects.
It is definitely possible to apply the scientific and vocational education findings to regions in Asia. Halik Bassah and Mohd Noor (2023), for example, have already discussed potentially complementary considerations. In their study, they looked at industry in Malaysia and highlighted the difference between the employability skills of young individuals and the skills required by industry in Malaysia. Interestingly, Halik Bassah and Mohd Noor focus firmly on the position of industry and employers, whereas the present study gives the apprentices themselves a voice. The comparison is therefore an interesting read and also provides options for further research (e.g. in Malaysia). Halik Bassah and Mohd Noor (2023) identify, among other things, the importance of social and communication skills, as well as teamwork. These aspects are not only transferable to the healthcare sector but are also important to the apprentices themselves. Accordingly, consideration should be given to how these findings can be utilised to ensure that employers prioritise and promote both perspectives, taking them into account in their decisions. Furthermore, future studies with regional partners on the ground should allow both groups of people to be consulted about their individual expectations and perspectives. These considerations ‘could promote an effective and competitive TVET ecosystem in Malaysia. Subsequently, initiatives such as strategic collaborations between TVET institutions and industries need to be supported by implementing traineeships or workplace-based training programmes to develop TVET graduates’ employability skills.’ (Halik Bassah & Mohd Noor 2023).
Subekti et al. (2019) previously reported similar findings in Indonesia. They also identified the particular importance of communication and teamwork in terms of the employability skills required. The focus on interns is particularly interesting. This allows a connection to the study presented, which, although it focuses on young people entering the labour market, clearly identifies the importance of internships. These considerations should be explored further and taken into account in future research. For pedagogical implementation, Subekti et al. (2019) have developed a learning model (Work Based Learning – Teaching Factory Model) which could also be transferred to the healthcare sector in some respects. The preliminary work by Subekti et al. (2019) is therefore valuable and should be taken into account.
6 Outlook
In the future, longitudinal studies with control groups (e.g., nursing students) and multi-method research approaches should be used to evaluate the effects and changes over the entire duration of the apprenticeship at different locations.
In addition, long-term support for the apprentices in both learning locations is needed, as well as a system that promotes specific requests for personal and content-related development (opportunities) and does not dismiss them. This can help nursing professionals speak positively about their profession because they perceive it as it is, with all its challenges, and this contributes to its increased attractiveness. This could increase demand, but the consequences of demographic change remain. Few arguments were put forward as to how staff retention could directly contribute to recruiting apprentices, but several aspects were identified in which HR managers can contribute to retaining skilled workers who have completed their apprenticeship. This must be accompanied and promoted through educational measures, as well as empirical research.
Acknowledgement
I would like to express my sincere thanks to Esther Berkemer, Anna Coppers, Christina Hoffmann, Caroline Haupt, Leoni Gröner, Pia Pütz and Felix Schnakenburg for their assistance in the process and implementation of data collection, data preparation, and data analysis. I would also like to thank the participating institutions and schools that made these surveys possible, as well as the apprentices surveyed for their cooperation and participation.
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