Medical workers are broadening their horizons, as Yang Wanli reports in Hamburg and Tang Yue in Beijing.

Song Xi, a 24-year-old nurse, is planning her trip to Germany, but the preparations have been far from easy.

She has only been abroad once before, to Vietnam, and this time her journey will not be a short sightseeing trip, but a working visit for three to five years.

When it comes to hiring nurses, turning to Chinese recruits is nothing new.

As many countries face the problem of an aging society and difficulties in hiring nurses - due to work stress and low wages - employing Chinese workers has become popular in some Asian countries including Singapore, Japan and South Korea.

However, working in Western countries, including Britain and Canada, is an emerging trend. In Germany, the European Union's richest country, such an opportunity for nurses has been allowed only since July.

Song is among the first group of nurses to benefit from the new policy in Germany. Under an agreement signed by China and Germany at the end of 2012, some 150 Chinese nurses will work in the European country from 2013, with the first 25 leaving in October.

Traveling to Europe has been a dream for Song since childhood, as she views the continent as a place of fairy tales, ancient castles and a different culture. However, studying abroad is too expensive for her family of four from Jingzhou, a city in Hubei province.

Although she couldn't afford to study overseas, Song never abandoned her dream. After studying foreign nursing care at Hubei University of Chinese Medicine for five years, she worked as an intern at a local hospital in 2012.

"But it was hard to practice what I learned in college. For example, health education was not highly valued," she said.

During this time, she heard of the nursing program between China and Germany, feeling the time was right to make a move. "I believe this working experience will give me a chance to be a real nurse," she said.

The shortage of nurses has become a problem in Germany, which has had an aging society for decades.

In July, 4,393 nurses in Germany were registered as unemployed, with 6,792 vacancies announced to the German Federal Employment Agency. For nurses caring for the elderly, there were 3,517 registered as unemployed, with 9,080 registered vacancies.

"In Germany, employers are not obliged to announce their vacancies to the Federal Employment Agency, so the latter figure might be even higher," said Marcel Schmutzler, a press official with the agency's International Placement Services Department.

Franz Wagner, chief executive officer of the German Nurses Association, said that in the past 10 years most of the foreign nurses in Germany came from Poland and Romania.

He said there are cultural differences and differences between the roles of nurses from country to country. "A nurse from Europe probably finds it easier to adjust than somebody from Asia or Africa," he said.

Huge population

Although the number of Asian nurses has not risen significantly in the past year, Wagner said Asia has become interesting for German employers, because of its huge population - China and India, in particular.

He said German employers have also found it difficult to find nurses in Europe who want to work in Germany, because working conditions for them there are not competitive when compared with those in Scandinavian countries, Britain or the United States.

"In these countries, nurses find better conditions, such as a lower workload, better recognition and image, less overtime and better salaries," Wagner said. "In addition, German is a difficult language to learn."

Although she has had German-language and culture training since September 2012 and has passed the language test, Song still lacks confidence in her upcoming trip.

"I watched some German TV programs, but felt they were hard to understand because they speak fast and sometimes with dialects," she said. "And also the letter 'r' is very difficult to pronounce."

Other questions about living in Germany are also on her mind. Are all shops and restaurants closed on Sundays? Can you still eat rice in a Western country? And do you have to buy boots in Germany, because of thick snow and extreme cold in winter?

A win-win deal

Compared with the average monthly salary of about 3,320 yuan ($540 or about 400 euros) for a nurse in China, working overseas represents a good deal.

Wang Zhuwen, director of operations at Shandong International Nurse Training Center, which is responsible for training the 150 Chinese nurses who will work in Germany from this year, said: "Most overseas Chinese nurses earn more than they do in China. In Germany, the gross starting salary for nurses in public hospitals ranges from 2,190 to 2,365 euros ($2,957-$3,193) a month."

Many Chinese nurses are passionate about going abroad, not only because of the higher salary, but also because they receive greater respect from patients, he said.

Relations between medical staff and patients have been severely strained in China over the past years. Without competition from privately owned hospitals, public hospitals take almost all the responsibility for patients' medical services. Patients have not been happy with hospital services, while doctors have complained of low salaries.

"In some other countries, nurses enjoy more respect and hospitals place greater value on their services. It is also the dream of many young people to see the outside world," Wang said.

He added that some Chinese nurses have migrated after working overseas for several years, while others found better jobs after returning to China.

The nurses' training center in Shandong province is owned by an overseas personnel-training company, formed in 1989. To date, more than 80,000 Chinese have been trained and sent overseas through the center. Previously, most of the workers were blue-collar employees, such as welders and farm workers. Now, demand has grown overseas for more skilled workers from China, including nurses.

Since the training center was set up in 2005, more than 1,000 Chinese nurses have been sent abroad, mostly to Asian countries, including Singapore and Japan, which have a shortage of nurses along with an aging problem.

"The consequences of this immigration will be mainly positive," said Schmutzler, the press official with the German Federal Employment Agency.

He believes such immigration will increase, because the labor force in Germany will decline in coming decades as the number of elderly people increases.

"Neither immigration from European Union countries, nor from non-EU countries, may be able to fill this gap alone. Only a mixture of both, plus domestic measures to activate hidden potentials in the German labor market, will help to meet this challenge successfully," he said.

Wagner, from the German Nurses Association, said, "In the short term, we will be able to cover vacancies with German nurses if employers create better working conditions."

He said thousands of German nurses have left the profession, unwilling to cope any longer with the workload and other factors. "If more nurses from abroad come to Germany, I assume many will move on to other countries in Europe where they will find better jobs," he added.

Personal choice

Working overseas is a personal choice for Song, of concern only to her family and boyfriend.

"Many single girls might be encouraged to marry Germans, who are known for their good looks as well as an attitude centered on the family," she said. "But I've got a Chinese boyfriend. He will not come with me, but our relationship will be sustained by our trust and love."

She has many images of Germany in her mind, including its dress sense, gentle attitude and numerous types of beer and sausages. Most of her impressions stem from books or TV programs, with Munich being Song's favorite city "because of local people's hospitality".

Song said that with her hometown known for its spicy food, one essential item she must take with her to Germany is a large bottle of local chilies.

Contact the writers at yangwanli@chinadaily.com.cn and tangyue@chinadaily.com.cn

Wu Wencong in Beijing contributed to this story.

Nurse Zhang Yongmei (left), who is on a peace mission in Beirut, shows a medical kit of traditional Chinese medicine to her counterparts from Belgium during an exchange activity. Yang Shengchao / Xinhua

Nurses receive training at a hospital in Handan, Hebei province. Some Chinese nurses have migrated after working overseas. Hao Qunying / for China Daily

A nurse takes care of newborns at No 1 People's Hospital in Xiangyang, Hubei province. Gong Bo / for China Daily

A nurse demonstrates oxygen treatment at a professional skills competition in Neijiang, Sichuan province. Lan Zitang / for China Daily

(China Daily USA 09/25/2013 page6)