Relevant im falschen System

Wir haben es schon eine ganze Weile geahnt, aber dank der derzeit grassierenden CoVid-19-Pandemie ist es nun amtlich: Pflege ist systemrelevant! Applaus! Applaus! Applaus! Mit dieser wichtigen Erkenntnis wird es für die Pflegenden in Deutschland wohl endlich bergauf gehen.

Oder?

Zunächst einmal ist es ein Trugschluss, dass die Relevanz der (beruflichen) Pflege bislang diskutabel gewesen wäre. Pflege war nie nicht relevant. Es gibt Hinweise, dass schon die Neandertaler ihre Kranken pflegten und versorgten. Man kann davon ausgehen, dass der Mensch und seine Vorfahren Altruismus und Fürsorge entwickelte und kultivierte, um in frühester Zeit das Überleben der eigenen Gruppe und des eigenen Nachwuchses zu sichern. Auch für heutige Gesellschaften ist es undenkbar, Kranke und Hilfsbedürftige sich selbst zu überlassen. Selbst mit der modernen Medizin kann auf eine pflegerische Versorgung nicht verzichtet werden. Um dies zu erkennen brauchte es auch in den letzten hundert Jahren keine Pandemie. Pflege ist relevant, egal in welchem System.

Wäre Pflege nicht relevant, würde man nicht seit einem halben Jahrhundert über Pflegenotstände und seine Auswirkungen berichten. Man würde nicht immer wieder versuchen diese Notstände mit Fachkräften aus dem Ausland oder anderen Personengruppen zu beheben. Es würde keine Kampagne über die neue Pflegeausbildung geben. Man würde sich nicht fragen, wie Pflege digitalisiert und robotisiert werden könne. Gesundheitsminister Jens Spahn hätte das Thema vermutlich nicht auf die Agenda gesetzt, wenn es keine Relevanz hätte.

Nun stellt man dieser Tage fest, dass Pflege (und viele weitere Berufe) trotz ihrer Relevanz für die Bevölkerung schlecht bezahlt wird und ein geringes Ansehen genießt. Und man fragt sich, wie kann das nur sein? Schlecht bezahlt und geringes Ansehen, da will ja kaum jemand diese relevante Aufgabe übernehmen und das kann doch nicht im Sinne unserer Gesellschaft sein. Da muss doch ein Fehler im System liegen…

Nun besteht das Problem der berflichen Pflege (sowie der anderen sogenannten systemrelevanten Berufe) nicht darin, dass ihre Relevanz aufgrund eines Systemfehlers übersehen wurde. Vielmehr ist es unser System, das pflegerische Arbeit unsichtbar und klein hält, solange sie denn gemacht wird.

In unserem Gesundheitssystem gilt Pflegearbeit rein als Kostenfaktor. Effekte professioneller Pflege im Rahmen der Prävention, Rehabilitation aber auch der Therapie werden kaum wahrgenommen. Stattdessen wird Pflege darauf reduziert, Menschen „satt und sauber“ zu halten. Mit diesem Verständnis vom Pflegeberuf konnte er nie ein angesehener geschweige denn gut bezahlter Beruf werden. Tatsächlich muss man noch immer die Notwendigkeit der dreijährigen Pflegeausbildung verteidigen (von einem Studium reden wir in dem Zusammenhang noch nicht einmal), gerade in der häuslichen und stationären Langzeitversorgung.

Hinzu kommt, dass Pflege (und Care-Arbeit sowieso) gesellschaftlich noch immer als weiblicher Liebesdienst verstanden wird, an den einige Erwartungen und Ansprüche herangetragen werden. Aufopferungsbereitschaft ist nur eine davon, aber gerade dieser Tage hochaktuell: aufgrund der Ansteckungsgefahr von Covid-19 und dem bestehenden Mangel an Schutzausrüstung gehen die Pflegenden (wie auch andere Berufsgruppen) in der Patient*innen- bzw. Klient*innenversorgung ein zusätzliches Gesundheitsrisiko ein, neben dem, das aufgrund der körperlich und psychisch belastenden Tätigkeit und der Schichtarbeit ohnehin schon besteht.

Auch besteht eine Erwartungshaltung in puncto Gehalt. Zwar gelten Pflegende gemeinhin als Geringverdiener (wobei es sich um eine sehr undifferenzierte Einschätzung handelt, aber das ist ein anderes Thema), sobald jedoch dauerhaft höhere Gehälter für diese Berufsgruppe gefordert werden, ist die Zustimmung eher verhalten: es folgen Vergleiche mit anderen Berufsgruppen, man stellt nach einem Blick in den TVöD fest, dass Pflege ja doch nicht so schlecht verdient (auch dies eine eher undifferenzierte Einschätzung), es wird auf pflegende Angehörige und ungelernte Hilfskräfte verwiesen und überhaupt soll Geld doch nicht die Hauptmotivation für den Beruf sein.

In einigen Kreisen scheint im Zuge der Pandemie nun allmählich angekommen zu sein, dass die selbstverständliche Erwartung einer selbstlosen Aufopferungsbereitschaft im Pflegeberuf nicht nur jetzt, sondern auch langfristig zu einem Problem für die Gesundheitsversorgung wird, weil sich irgendwann niemand mehr für den Beruf finden wird und aus auch die Pflegenden an ihrer Arbeit hindert. Mal ganz abgesehen davon, dass sie angesichts der fordernden und komplexen Pflegearbeit schlicht und ergreifend ungerecht ist.

Bleibt zu hoffen, dass während der bestehenden Krise ein Umdenken in unserer Gesellschaft einsetzt. Denn solange Pflege nicht als eine notwendige und anspruchsvolle Gesundheitsleistung in unserem System verankert wird, die ihr Geld wert ist, werden langfristig keine Veränderungen zu erwarten sein. Bonuszahlungen für die Kolleg*innen, die während der Pandemie weiterhin Menschen versorgen sowie eine Gehaltsanhebung sind erste wichtige Schritte. Darüber hinaus werden wir aber auch diskutieren müssen, welche grundsätzlichen Änderungen im System notwendig sind, um der Relevanz der beruflichen Pflege Rechnung zu tragen.

Autor: Beatrice

Pflegewissenschaftlerin B.Sc. Gesundheits- und Krankenpflegerin seit 2008 im Intensivbereich

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