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Der Weg in die Matrix
(2023)
Woran es hängt
(2023)
Reform als Zumutung
(2023)
Zwar mag ein Reformwille der Verwaltung in Reden und Konzeptpapieren beschworen werden; häufig findet sich jedoch keine Realität, die dieser «Poesie der Reform» (Luhmann, 2000) entspricht. Sicher ist diese Darstellung etwas überspitzt. Verwaltungen von heute unterscheiden sich deutlich von denen vor 20, 40 oder 60 Jahren. Gleichwohl sind Reformen und Innovationen für Verwaltungen eine besondere Herausforderung und Zumutung. In diesem Artikel wollen wir herausarbeiten, worin dieser Zumutungsgehalt besteht: Warum tun sich Verwaltungen mit Innovationen oft schwer? Hierzu werden wir zentrale Besonderheiten herausarbeiten, welche die Verwaltung als Organisationstyp auszeichnen. In einem zweiten Schritt wird es dann möglich sein, danach zu fragen, unter welchen Bedingungen Innovationen gleichwohl gelingen können - oder ihr Gelingen mindestens wahrscheinlicher wird.
Genauer hinsehen
(2023)
Psychologische Sicherheit
(2023)
Durch psychologische Sicherheit am Arbeitsplatz lässt sich vieles erreichen. Sie senkt den Krankenstand, schafft Bindung zum Arbeitgeber, ermöglicht tiefere kollegiale Beziehungen und erleichtert es, voneinander zu lernen. Dabei wird aus der Perspektive des Individuums auf die Organisation geschaut und ihre personellen Vertreter, die Leader. Dieser Beitrag betont hingegen die Bedeutung der Organisation und der Grenzen, welche diese setzt. Führungskräfte können tatsächlich für psychologische Sicherheit sorgen. Allerdings nutzen sie dafür oft die falschen Mittel.
Background:
Like most countries, Germany is currently recruiting international nurses due to staff shortages. While these are mostly academic, the academisation of nursing in Germany has only just begun. This allows for a broader look at the participation of migrant nurses: How do care teams deal with the fact that immigrant colleagues are theoretically more highly qualified than long-established colleagues?
Methods:
Case studies were conducted in four inpatient care teams of two hospitals in 2022. Qualitative data include 26 observation protocols, 4 group discussions and 17 guided interviews. These were analysed using the documentary method and validated intersubjectively.
Results:
Due to current academisation efforts in Germany and the immigration of academised nursing staff from abroad, the areas of activity and responsibility of nursing in Germany are under negotiating pressure. This concerns basic care for example, which in Germany is provided by skilled workers, but in other countries is mostly provided by assistants or relatives. The question of who should provide basic care, whether all nurses or only nursing assistants, documents the struggle between an established and a new understanding of care. In this context, the knowledge and skills of migrant and academicised care workers become a crucial aspect in the struggle for a new professional identity for care in Germany.
Conclusions:
The specific situation in Germany makes it possible to show the potential for change that international care migration can constitute for destination countries. The far-reaching process of change of German nursing is given a further dimension not only by its academization, but by the immigration of international and academically trained nursing staff, where inclusive or exclusive effects can already be observed.
Key messages: The increasing proportion of migrant nurses accelerates the current discussion on nursing in Germany. Conflict areas show up in everyday work of care teams and must be addressed there.
Einleitung
Pflege in Deutschland befindet sich in einem Veränderungsprozess. Die politisch forcierte Zuwanderung von Pflegekräften sowie die Akademisierung führen zu einem enormen Anpassungsdruck bei allen Beteiligten. Wie wirkt sich dies auf den Arbeitsalltag aus?
Methoden
Die qualitative Datenbasis umfasst bisher 36 Tage Teilnehmende Beobachtung, 17 Themenzentrierte Leitfadeninterviews sowie vier Gruppendiskussionen in vier Pflegeteams zweier Krankenhäuser. Die Analyse erfolgt mit der Dokumentarischen Methode.
Ergebnisse
Am Beispiel der Grundpflege (u. A. dem „Waschen“) wird deutlich, wie die Pflegeteams ihren Arbeitsalltag neu aushandeln. Die Teams mit einer hohen migrationsbezogenen Diversität argumentieren eher, dass die Aufgaben der Grund- und Behandlungspflege entsprechend der Qualifikation als Hilfs- oder Fachkraft erledigt werden sollen. Hier treten stereotype (kulturalisierende) Zuschreibungen in den Hintergrund. Demgegenüber berufen sich Pflegeteams mit einer niedrigen migrationsbezogenen Diversität eher darauf, dass die Grundpflege in Deutschland – anders als in anderen Ländern – zu den Aufgaben einer examinierten Pflegefachkraft zählt. Kolleg*innen aus dem Ausland wird die pflegerische Kompetenz daher eher abgesprochen.
Schlussfolgerung
Die Frage nach der Aufteilung von Grund- und Behandlungspflege, ist auf allen Stationen virulent. Die Teams entwickeln jedoch in Abhängigkeit von ihrer spezifischen Heterogenität unterschiedliche Umgangsweisen. Demzufolge sollte sich Personal- und Organisationsentwicklung insbesondere an den Pflegeteams orientieren.
The digitization process has triggered a profound transformation of modern societies. It encompasses a broad spectrum of technical, social, political, cultural and economic developments related to the mass use of computer- and internet-based technologies. It is now becoming increasingly clear that digitization is also changing existing structures of social inequality and that new structures of digital inequality are emerging. This is shown by a growing number of recent individual studies. In this paper, we set ourselves the task of systematizing this new research within the framework of an empirically supported literature review. To do so, we use the PRISMA model for literature reviews and focus on three central dimensions of inequality - ethnicity, gender, and age - and their relevance within the discourse on digitization and inequality. The empirical basis consists of journal articles published between 2000 and 2020 and listed on the Web of Science, as well as an additional Google Scholar search, through which we attempt to include important monographs and contributions to edited volumes in our analyses. Our text corpus thus comprises a total of 281 articles. Empirically, our literature review shows that unequal access to digital resources largely reproduces existing structures of inequality; in some cases, studies report a reduction in social inequalities as a result of the digitization process.
The long term relationship between Medicaid expansion and adult life-threatening chronic conditions
(2023)
We test whether the expansions of children's Medicaid eligibility in the 1980s–1990s resulted in long-term health benefits in terms of severe chronic conditions. Still relatively rare in the field, we use prospective individual-level panel data from the Panel Study of Income Dynamics (PSID) along with the higher quality income measures from the Cross-National Equivalent File (adjusting for taxes, transfers and household size). We observe severe chronic conditions (high blood pressure/heart disease, cancer, diabetes, or lung disease) at ages 30–56 (average age 43.1) for 4670 respondents who were also prospectively observed during childhood (i.e., at ages 0–17). Our analysis exploits within-region temporal variation in childhood Medicaid eligibility and adjusts for state- and individual-level controls. We uniquely concentrate attention on adjusting for childhood income. A standard deviation greater childhood Medicaid eligibility significantly reduces the probability of severe chronic conditions in adulthood by 0.05 to 0.12 (16%–37.5% reduction from mean 0.32). Across the range of observed childhood Medicaid eligibility, the probability is approximately cut in half. Greater childhood Medicaid eligibility also substantially reduces childhood income disparities in severe chronic conditions. At higher levels of childhood Medicaid eligibility, we find no significant childhood income disparities in adult severe chronic conditions.
German and European migration policy operates in permanent crisis mode. Sudden increases in irregular immigration create a sense of loss of control, which is instrumentalised by populist forces. This has generated great interest in quantitative migration predictions. High expectations are placed in the AI-based tools currently under devel­op­ment for forecasting irregular migration. The potential applications of these tools are manifold. They range from managing and strengthening the EU's reception capacity and border protections to configuring humanitarian aid provision and longer-term planning of development programmes. There is a significant gap between the expectations placed in the new instruments and their practical utility. Technical limits exist, medium-term forecasts are methodologically implausible, and channels for feeding the results into political decision-making processes are lacking. The great demand for predictions is driven by the political functions of migration prediction, which include its uses in political communication, funding acquisition and legitimisation of political decisions. Investment in the quality of the underlying data will be more productive than developing a succession of new prediction tools. Funding for applications in emergency relief and development cooperation should be prioritised. Crisis early warning and risk analysis should also be strengthened and their networking improved.