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Journal of Psychiatric and Mental Health Nursing, 2025; 0:1–13
https://doi.org/10.1111/jpm.13153
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Journal of Psychiatric and Mental Health Nursing
ORIGINAL ARTICLE OPEN ACCESS
Task Profiles of Academically Qualified Psychiatric Nurses
in Germany: Results of a Cluster Analysis
StefanScheydt1,2,3 | AndréNienaber1,4 | MartinHolzke2,5,6
1Central Institute of Mental Health, Mannheim, Germany | 2German Center for Mental Health (DZPG), Partner Site Mannheim- Heidelberg- Ulm,
Mannheim, Germany | 3Bern University of Applied Sciences, Department of Health, Bern, Switzerland | 4University Psychiatric Clinics Basel, Basel,
Switzerland | 5Center for Psychiatry South Wuerttemberg, Ravensburg- Weissenau, Germany | 6University Ulm, Ulm, Germany
Correspondence: Stefan Scheydt (stefan.scheydt@zi-mannheim.de)
Received: 17 June 2024 | Revised: 9 January 2025 | Accepted: 22 January 2025
Funding: The authors received no specific funding for this work.
Keywords: advanced practice nursing| cluster analysis| cross- sectional study| Germany| mental health nursing| nurses' roles| psychiatry
ABSTRACT
Introduction: As little clarity exists regarding the roles of academically qualified nurses in Germany it is not certain that nurses
who call themselves “nursing experts” actually perform the tasks of a nursing expert or APN. An important aspect of the present
“Study on the situation of academically qualified nurses in psychiatric care contexts in Germany” (AkaPP study) was therefore to
identify profiles or clusters based on the tasks and activities performed by academically qualified psychiatric nurses in Germany.
Aim: To identify possible clusters of academically qualified psychiatric nurses working in direct care practice, nursing develop-
ment or nursing research positions in relation to their self- described tasks and activities.
Method: Data were collected via an online survey between August and November 2020. The target group of the study was aca-
demically qualified nurses in Germany working in a psychiatric- psychosocial healthcare institution. The group of interest for the
analysis was the subgroup of nurses in a “direct care and scientific nursing role” (academically qualified nurses working in direct
patient care, nursing development or nursing research positions; n = 105 valid cases). A hierarchical cluster analysis was carried
out using the Ward method on the basis of the tasks and activities described by the participants in the questionnaire. The identi-
fied clusters were described in terms of descriptive statistics against the background of previously defined content characteristics
and compared for noticeable differences. Reporting was performed according to the STROBE checklist.
Results: Cluster analysis revealed the following seven clusters of academically prepared nurses: (1) Practice Development and
Consultative Expertise, (2) Basic Nursing Practice, (3) Advanced Practice Development and Nursing Research, (4) Specialised
and Expanded Psychiatric Nursing Practice, (5) Basic Psychiatric Nursing Practice, (6) Direct Patient Care and Basic Practice
Development and (7) Advanced Psychiatric Nursing Practice.
Discussion and Implications for Practice: The clusters identified provide a nuanced understanding of the roles of graduate
psychiatric nurses in Germany. This insight helps to tailor staffing structures and training programs to the needs of psychiatric
care settings. By delineating distinct role profiles, healthcare institutions and policymakers can optimise resource allocation,
enhance interdisciplinary collaboration and ultimately improve patient outcomes. This research provides guidance for refining
clinical practice models and promoting professional development in psychiatric nursing contexts.
This is a n open access ar ticle under the terms of t he Creative Commons Attr ibution License, which p ermits use, dis tribution and repro duction in any medium, p rovided the orig inal work is
properly cited.
© 2025 T he Author(s). Journal of Psy chiatric an d Mental Health Nurs ing published by John W iley & Sons Ltd.
2 of 13 Journal of Psychiatric and Mental Health Nursing, 2025
1 | Background
Mental health care is facing major challenges that are associ-
ated with increasing complexity in service delivery. Influencing
factors include, for example, changes in future patient char-
acteristics (e.g., ageing population, migrants with traumatic
experiences) and the corresponding care requirements with
simultaneous changes in mental healthcare structures (e.g.,
urban–rural gap, shortage of physicians and therapists, in-
creasing digitalisation of services) (Giacco et al. 2016; Priebe
etal.2019; Thornicroft etal.2016). These challenges mean that
psychiatric nursing in future care models will have to act in-
creasingly autonomously and take on corre spondingly ex panded
or advanced and highly specialised tasks (Scheydt2024; Wand
etal.2022). To provide such extended or advanced and highly
specialised care, nurses need to be trained to the appropriate
level (Daly and Carnwell2003; Scheydt and Holzke2018b).
However, as recent studies have shown (e.g., Lehmann
et al. 2019), Germany lags far behind international standards
in terms of (university- based) nursing education and training.
This is particularly evident in higher education and in the de-
ployment of academically qualified nurses in nursing practice.
While other countries such as the Netherlands (45%), Canada
(61%), the UK and Sweden (both 100%) have a very high pro-
portion of nurses with a university degree, the proportion of
nurses with a university degree in Germany is only around one
to 2% (Lehmann etal.2019). This is understandable, as nurses in
Germany have traditionally been trained in vocational schools
rather than universities, as is the case in many other countries.
In most countries in Europe and beyond, the nursing profession
requires a university degree (Lehmann etal.2019). In Germany,
there are various options for further education, both vocational
and higher education. However, higher education for nurses in
Germany is still in its infancy. There are many reasons for this,
most of which lie in the historical development of the nursing
profession in Germany. These developments would fill a sepa-
rate article, but are brief ly described in the box below (see Box1).
The fact that the academisation of nursing in Germany is lag-
ging behind international standards is also ref lected in the
research on these issues. In the international context, the as-
pects of academisation of nursing and the integration of ac-
ademically qualified nurses have been the subject of much
research for decades. Several publications have described
cross- sectional studies examining the situation of academi-
cally qualified nurses, mostly in the role of advanced practice
nurses. Some publications focus on the psychiatric care set-
ting (e.g., Allen1998; Campbell etal.1998; Chien and Ip2001;
Delaney et al. 2019; Drew and Delaney 2009; Jones 2018;
Sharrock etal. 2008). More recent findings based on empiri-
cal data on the identification of specific nursing practice roles
and practice profiles are provided by Gardner et al. (2016),
who used cluster analysis to identify the practice patterns of
Australian nurses by job description. However, these findings
do not address the roles of psychiatric nurses. Two reviews by
Scheydt and Hegedüs(2021) and Hurley etal.(2022) described
the clinical roles of psychiatric nurses, but at the level of tasks
and activities rather than differentiating professional role pro-
files between basic and advanced nursing.
In German- speaking countries, too, topics related to the acade-
misation of nursing have attracted attention in both research
and nursing practice. This is ref lected, for example, in the in-
creasing number of studies and corresponding publications in
recent years. While the aspects of role development and role
implementation or the views on the tasks and role understand-
ing of academically qualified nurses are primarily examined
(Baumgartner et al. 2023; von Dach et al. 2023; Doppelfeld
etal.2023; Laimbacher etal.2023; Möcking and Hosters2023;
Scheydt and Holzke 2018b; Scheydt et al. 2020; Schlunegger
et al. 2023; Schönbächler Marcar and Keller 2022; Seismann-
Petersen etal.2023; Weidling eta l.2023; Zúñiga etal.2022), only a
few cross- sectional studies could be identified that examined the
situation of academically qualified nurses (Bergjan etal. 2021;
Mertens etal.2019; Tannen etal.2017; Wissenschaftsrat2022)
and only a miniscule proportion of the identified studies are
from the psychiatric field (Laimbacher etal.2023; Scheydt and
Holzke 2018b; Scheydt et al. 2020; Weidling et al. 2023). The
studies identified so far deal with the topics of role development,
role implementation and role understanding mainly anecdotally
or in the context of (individual) case studies. There is no sys-
tematic cross- sectional study in the German- speaking area that
provides valid statements based on a larger sample.
Against this background, the Research Group “Mental Health
Nursing” (Central Institute of Mental Health, Mannheim,
Germany), together with colleagues from the Center for
Psychiatry South Wuerttemberg, has conducted the “Study on
the situation of academically qualified nurses in psychiatric care
contexts” (AkaPP study) (Scheydt etal.2021). The overall aim of
this study was to generate extended data on the use of academ-
ically qualified nurses, particularly in psychiatric- psychosocial
practice areas in Germany. In particular the roles performed,
concrete areas of deployment, facilitators and barriers to deploy-
ment in direct patient care, as well as other selected structural
Summary
• What is known on the subject?
○ Germany lags far behind international standards in
nursing education and training. This is particularly
evident in higher education and in the deployment
of academically qualified nurses in nursing practice.
○ There is no clarity about the roles of academically
qualified nurses in Germany. It is not certain that
nurses who call themselves “nursing experts” actu-
ally perform the tasks of a nursing expert or APN.
• What the paper adds to existing knowledge?
○ Statistical methods were used to develop role profiles
based on the actual tasks and activities performed
by academically qualified psychiatric nurses.
○ An empirically based model of the role profiles of
academically trained nurses was developed, which
complements existing competency models and clas-
sifies nursing roles into basic and advanced roles.
• What are the implications for practice?
○ The results provide a solid basis for a better under-
standing and clear definition of the role of academic
nurses in psych iatric setting of the German- s peaking
countries.
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3 of 13
data and framework conditions were collected in order to ex-
plore the status of the academisation of psychiatric nursing.
Since there are no legal stipulations or regulations in Germany
regarding the specific role profiles, an important aspect of the
study was the explorative analysis of the roles of academically
qualified psychiatric nurses.
2 | Objectives
The aim of this study was to identify possible clusters of aca-
demically qualified nurses in terms of their tasks and activi-
ties. Against this background, the following research questions
guided our work: (a) Which clusters can be identified in the
subgroup of academic nurses working in direct care practice,
practice development or nursing research positions based on
the tasks and activities performed? (b) What are the underlying
characteristics of these clusters?
3 | Methods
3.1 | Study Design and Background
As part of the AkaPP study (Scheydt etal.2021), a hierarchical
cluster analysis using the Ward method was conducted within
the subgroup “nurses in direct care and scientific nursing roles”
against the background of the objectives described above. The
AkaPP study was conducted as a nationwide cross- sectional
questionnaire study. The study was reported following the
STROBE (Strengthening the Reporting of Observational Studies
in Epidemiologic Studies) guideline for reporting (von Elm
etal.2007).
3.2 | Data Collection and Sampling
Data collection took place between August and November 2020
via an online survey. A self- developed questionnaire was used
for the survey, based on a systematic literature review on regard-
ing the academisation of (psychiatric) nursing. The content of
the questionnaire created in SoSci- Survey (https:// www. sosci
survey. de/ ) was discussed and agreed upon by the authors. This
made it possible to specify the questions, add missing aspects,
make linguistic adjustments and optimise the order of the ques-
tions. The questionnaire was approved on this basis was then
pre- tested by external experts (two nursing scientists with many
years of experience in questionnaire research and a psychiatric
background) to check the validity and comprehensibility of the
content (Häder2015). The specific content of the questionnaire
has been reported elsewhere (Scheydt etal.2021).
The analytical focus of the cluster analysis was the category
“Tasks and activities” (FR06, see Appendix S1), which was
developed on the basis of two systematic literature reviews
(Scheydt and Hegedüs2021; Scheydt and Holzke2018a). The dif-
ferent individual variables in the “Tasks and activities” category
are listed in TableS1. For a clearer presentation of the results,
the individual variables in the category “Tasks and activities”
(FR06) have been grouped into domains (see TableS2).
3.3 | Sample and Description of the Analysed
Subgroup
The target popul ation of the Aka PP study was academically qua l-
ified nurses in Germany working in a psychiatric- psychosocial
healthcare setting. Study participants were recruited through
social networks (e.g., Facebook, Twitter, Instagram) and email
distribution lists of various professional societies and specialist
departments with a focus on psychiatry and mental health. A
total of 185 academically trained nurses participated in the sur-
vey. As there is no obligation to register professional nurses in
Germany no statement can be made about the basic population.
The total sample could be divided into five subgroups based on
the described function designations (FR12): (a) direct care and
scientific nursing role (n = 109), (b) nursing management role
(n = 31), hybrid nursing practice and management role (n = 16),
educational role (n = 7) and other (n = 6). The group of interest
for this analysis was the subgroup “direct care and scientific
nursing role”, i.e., academically qualified nurses working in
direct care practice, nursing development or nursing research
positions. Of the 109 cases in this subgroup, 105 cases were
identified as valid (test criterion: FR06 was fully completed) and
were therefore included in the analysis.
3.4 | Statistical Analysis and Selection
of the Appropriate Number of Clusters
Statistical analysis was performed using hierarchical cluster
analysis (Ward's method, Euclidean squared distance mea-
sure). Prior to the cluster analysis, the data set was randomly
sorted several times to eliminate any bias in the results due
to possible structures within the data set. In addition, the so-
called split- half method was used to check the robustness of
BOX | Why is the academisation of nursing in Germany
lagging behind international developments? An attempt at a brief
summar y of possible (historical) reasons.
Although the first university nursing programme was es-
tablished in Germany as early as 1913, this development
was halted by the Nazi regime and the Second World War.
It would be more than 40 years before another attempt was
made to academise nursing in Germany. It was not until the
1990s that the first degree programmes in nursing manage-
ment and nursing education were offered (Heitmann and
Reuter 2019; Schulz and Sauter 2015). The first bachelor's
degree in nursing with a focus on nursing practice was in-
troduced in 2003. Master's programmes followed in 2006,
and the first doctoral opportunities did not appear until the
2010s. There are several reasons for this late development
of the academisation of nursing in Germany. One main rea-
son is certainly the traditional and rather backward- looking
image of nursing a fter the Nazi era and the Second World War
(Bischoff- Wanner2011; Neumann2009; Steppe2000). Other
reasons lie in the established and funded dual education
system and the perception of nursing as a practice- oriented
profession, as well as in the structural characteristics of the
German nursing system. In addition, there is no national
register for nursing professions. Although there are indi-
vidual professional associations, the degree of organisation
among nurses in Germany is very low.
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4 of 13 Journal of Psychiatric and Mental Health Nursing, 2025
the cluster solution (Backhaus etal.2023). This involved ran-
domly dividing the analysed data into two equal halves and
performing a cluster analysis on each group using the same
procedure. The high level of consistency in the results sug-
gests that the cluster solution has an adequate degree of sta-
bility. In a final step, the identified clusters were described by
descriptive statistics against the background of the previously
defined content characteristics and analysed comparatively
for their striking differences.
Since there are no goodness- of- fit indices for cluster analyses,
the selection of the appropriate number of clusters was deter-
mined by a combination of analysis of the scree plot (analysis
of the change in the measure of heterogeneity over the course
of the fusion process using the so- called elbow test) and visual
analysis of the dendrogram (visual representation of possible
groupings). Finally, the expert opinion of the members of the
research group, based on many years of experience in psychi-
atric practice and nursing research, was considered to agree
on the final number of clusters (Backhaus etal. 2023; Bortz
and Schuster2010). In addition, the strength of the effect of
the cluster variables used on cluster membership was calcu-
lated for the different cluster solutions (from 5 to 10 clusters) in
order to obtain possible indications of the number of clusters
based on the strength of the effect. The Cramer's V correlation
measure was calculated for this purpose. All statistical data
analysis was performed using IBM SPSS statistical software
(version 27).
3.5 | Ethics and Informed Consent
Ethical approval of the study was granted by the Ethics
Committee II of the Ruprecht- Karls- University Heidelberg,
Medical Faculty Mannheim (No. 2024–582). Participation in
the online survey was voluntary and based on informed con-
sent. The data generated by the study were processed, analysed
and stored in anonymised form in accordance with generally
accepted European data protection guidelines. As the lists of
identifying data of the participants are stored separately from
the data of the online survey, it is not possible to draw conclu-
sions about individual persons. Personal data will be stored for
a maximum of 2 years after evaluation and then destroyed in ac-
cordance with data protection guidelines.
4 | Results
The cluster analysis revealed seven clusters of the tasks and ac-
tivities of academically qualified nurses. The seven clusters were
named as follows: (1) Practice Development and Consultative
Expertise, (2) Basic Nursing Practice, (3) Advanced Practice
Development and Nursing Research, (4) Specialised and
Expanded Psychiatric Nursing Practice, (5) Basic Psychiatric
Nursing Practice, (6) Direct Patient Care and Basic Practice
Development and (7) Advanced Psychiatric Nursing Practice.
The specific characteristics of each cluster are summarised
in Table1. The frequency distribution of the items within the
cluster variable “Tasks and Activities” (FR06) is illustrated in
Table2. A summary graphical systematisation and delineation
of the described clusters on the dimensions (a) patient proximity
of activities (“Focus on direct patient care” versus “Focus on
non- patient and system related activities”) and (b) specialisation
and expansion/advancement of practice (“Basic nursing prac-
tice” versus “Specialized and expanded or advanced psychiatric
nursing practice”) is shown in Figure1 below.
4.1 | Cluster 1: Practice Development
and Consultative Expertise
Cluster 1 consists of a total of 10 academically qualified nurses,
which represents a relative fre quency of 9.5% within the a nalysed
subgroup. In this cluster, 70.0% (n = 7) of the nurses have a bach-
elor's degree and 30.0% (n = 3) have a master's degree. All nurses
in this cluster have a professional nursing licence and 70.0%
(n = 7) have a formal specialisation in psychiatry or psychiatric
nursing. The nurses in this cluster have on average 20.3 years
of work experience in nursing overall (SD = 12.104 years),
15 years of professional experience in psychiatric nursing
(SD = 10.759 years) and 3.6 years of professional experience since
their last university degree (SD = 2.722 years). Nurses in this
cluster identified their role as “Practice Development Nurse”
(70.0%, n = 7), “Expert Nurse/Advanced Practice Nurse” (20.0%,
n = 2) and “Registered Nurse” (10.0%, n = 1). Half of the nurses
in this cluster do not work in direct patient care (n = 5). O verall,
70.0% (n = 7) of nurses in this cluster reported that their area of
responsibility had changed since graduation.
As can be seen in Table2, cluster 1 consists of academically qual-
ified and professionally experienced nurses who reported their
main areas of responsibility as “Development, implementation
and evaluation of new concepts” (100.0%) and “Independent
planning and implementation of nursing practice and quality de -
velopment projects” (100.0%). Other frequently mentioned tasks
in this cluster are “Scientific literature research to support pro-
fessional decision- making” (90.0%), “Consultative Expert activ-
ity on specialist topics and complex care situations/with a focus
on professional and collegial advice” (90.0%), and “Networking
outside the institution” (80.0%) and “Participation in further ed-
ucation and training” (80.0%).
4.2 | Cluster 2: Basic (Generalist) Nursing Practice
Cluster 2 comprises 20 academically qualified nurses, which
corresponds to a relative frequency of 19.0% within the ana-
lysed subgroup. Most of the nurses in cluster 2 have a bache-
lor's degree (90.0%, n = 18). In this cluster, 95.0% (n = 19) of the
nurses have a professional nursing licence and 42.1% (n = 8)
have an additional formal specialisation in psychiatr y or psychi-
atric nursing. The nurses in cluster 2 have on average 9.6 years
of professional experience in nursing overall (SD = 7.99 years),
10.25 years of professional experience in psychiatric nursing
(SD = 8.065 years) and 3.6 years of professional experience since
their last university degree (SD = 1.97 years). The nurses in clus-
ter 2 work completely patient- oriented in direct care practice
(100.0%). Their professional title is “registered nurse” (90.0%).
18 nurses in cluster 2 (90.0%) stated that their area of respon-
sibility had not changed since graduation. Most nurses in clus-
ter 2 (85%, n = 17) reported that they had not been involved in
a research project in the 36 months prior to the survey. “Basic
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5 of 13
TABLE | Overview of cluster characteristics.
Characteristics
Cluster
Total1 2 3 4 5 6 7
n = 10 (9.5%) n = 20 (19.0%) n = 13 (12 .4%) n = 13 (12.4%) n = 26 (24.8%) n = 19 (18.1%) n = 4 (3 .8 %) n = 105 (100.0%)
Age
20 to 30 years 10.0% 50.0% 15.4% 46.2% 46.2% 42 .1% 0.0% 37.1%
31 to 40 years 50.0% 20.0% 38.5% 30.8% 30.8% 26.3% 25.0% 30.5%
41 to 50 years 10.0% 20.0% 30.8% 15.4% 11.5% 21.1% 50.0% 19.0%
51 to 60 years 10.0% 10.0% 15.4% 7.7% 11.5% 10.5% 25.0% 11.4%
61 years or older 20.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 1.9%
Gender
Female 50.0% 80.0% 61.5%> 69.2% 76.9% 73.7% 25.0% 69.5%
Male 50.0% 20.0% 38.5% 30.8% 23.1% 26.3% 75.0% 30.5%
Qualification: professional licence and formal specialisation
Professional licence in nursing
(“registered nurse”)
100.0% 95.0% 76.9% 91.7% 92.3% 94.7% 100.0% 91.4%
Formal specialisation in psychiatric
nursing care
70.0% 42 .1% 61.5% 61.5% 50.0% 42.1% 50.0% 51.4%
Qualification: highest academic degree
Bachelor 70.0% 90.0% 46.2% 92.3% 76.9% 78.9% 0.0% 74.3%
Diploma 0.0% 5.0% 7.7% 0.0% 7.7% 0.0% 0.0% 3.8%
Master 30.0% 5.0% 30.8% 7.7% 15.4% 21.1% 100.0% 20.0%
Doctorate 0.0% 0.0% 15.4% 0.0% 0.0% 0.0% 0.0% 1.9%
Functional designation
Registered Nurse 10.0% 90.0% 0.0% 15.4% 65.4% 26.3% 25.0% 42.3%
Specialised Nurse 0.0% 5.0% 0.0% 7.7% 19.2% 5.3% 0.0% 7.7%
Expert Nurse/Advanced Practice
Nurse
20.0% 0.0% 23.1% 76.9% 3.8% 31.6% 50.0% 23.1%
Practice Development Nurse 70.0% 0.0% 46.2% 0.0% 0.0% 10.5% 25.0% 15.4%
(Continues)
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6 of 13 Journal of Psychiatric and Mental Health Nursing, 2025
Characteristics
Cluster
Total1 2 3 4 5 6 7
n = 10 (9.5%) n = 20 (19.0%) n = 13 (12 .4%) n = 13 (12.4%) n = 26 (24.8%) n = 19 (18.1%) n = 4 (3 .8 %) n = 105 (100.0%)
Nursing Scientist 0.0% 0.0% 30.8% 0.0% 0.0% 5.3% 0.0% 4.8%
Quality Management Nurse 0.0% 0.0% 0.0% 0.0% 3.8% 21.1% 0.0% 4.8%
Other 0.0% 5.0% 0.0% 0.0% 3.8% 0.0% 0.0% 1.9%
Patient closeness of the activity
Clinically oriented: close to the patient 50.0% 100.0 % 0.0% 100.0% 10 0.0% 68.4% 75.0% 76.9%
Non- clinically oriented: activity away
from the patient
50.0% 0.0% 100.0% 0.0% 0.0% 31.6% 25.0% 23.1%
Change of role and tasks after graduation
Applies (yes) 70.0% 10.5% 84.6% 92.3% 42.3% 84.2% 100.0% 60.0%
Research activity 36 months before survey
Applies (yes) 60.0% 15.0% 100.0% 38.5% 30.8% 52.6% 10 0.0% 46.7%
Professional experience
… in professional nursing care per se 20.3 year s 9.5 ye ars 17. 2 ye a rs 11.6 yea rs 11.0 yea rs 12.6 years 23.2 years 13.2 year s
… in the field of psychiatric nursing/
psychiatry
15.0 years 10. 2 yea rs 15.5 years 9.9 year s 9.6 ye ars 9.2 ye ars 19.0 y ear s 11. 3 year s
… since last university degree 3.6 years 3.6 years 3.6 years 2.9 yea rs 4.4 years 3.1 years 3.7 y ear s 3.6 years
TABLE | (Continued)
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7 of 13
close- to- patient nursing care”, analogous to vocational training,
was reported as the main task in this cluster (100.0%).
4.3 | Cluster 3: Advanced Practice Development
and Nursing Research
Cluster 3 consists of 13 academically qualified nurses, represent-
ing a relative frequency of 12.4% of the analysed subgroup. In
this cluster, 53.8% of the nurses have a bachelor's degree (n = 6) or
diploma (n = 1), 30.8% (n = 4) a master's degree and 15.4% (n = 2)
a doctorate. Ten nurses in this cluster (76.9%) have a professional
nursing licence and n = 8 (61.5%) have an additional formal spe-
cialisation in psychiatry or psychiatric nursing. Nurses in clus-
ter 3 have on average 17.2 years of professional experience in
nursing overall (SD = 9.985 years), 15.5 years of professional ex-
perience in psychiatric nursing (SD = 7.763 years) and 3.6 years
of professional experience since their last university degree
(SD = 2.730 years). Nurses in cluster 3 work mainly in roles that
do not involve direct patient care (100.0%) in research and de-
velopment. Regarding their role function, the nurses use the fol-
lowing titles: “Expert Nurse/Advanced Practice Nurse” (23.1%,
n = 3), “Practice Development Nurse” (46.2%, n = 6) or “Nursing
Scientist” (30.8%, n = 4). Most nurses in cluster 3 (84.6%, n = 11)
reported that their area of responsibility had changed since
graduation. All nurses in cluster 3 reported that they had been
involved in a research project within the last 36 months prior to
the start of the survey.
As can be seen in Table 2, cluster 3 consists of academically
qualified nurses whose main tasks are in the following areas:
“Participation in or independent planning and implementation
of nursing practice and quality development projects” (92.3%),
“Development, implementation and evaluation of new con-
cepts” (92.3%), “Scientific research activities to support profes-
sional decision- making” (92.3%) and “Dissemination of nursing
knowledge” (84.6%). Cluster 3 therefore has a high proportion
of scientific activities in addition to the focus on practice and
quality development.
4.4 | Cluster 4: Specialised and Expanded
Psychiatric/Mental Health Nursing Practice
Cluster 4 consists of 13 academically qualified nurses giving
rise to a relative frequency of 12.4% of the analysed subgroup.
With 92.3% (n = 12), the majority of the cluster has a bachelor's
degree; one person (7.7%) states that they have a master's degree.
In this cluster, 91.7% (n = 11) of the nurses have a professional
nursing licence and 61.5% (n = 8) have an additional formal spe-
cialisation in psychiatry or psychiatric nursing. The nurses in
cluster 4 have on average 11.6 years of professional experience
in nursing overall (SD = 7.901 years), 9.9 years of professional ex-
perience in psychiatric nursing (SD = 4.038 years) and 2.9 years
of professional experience since their last university degree
(SD = 1.564 years). All nurses in cluster 4 work in direct patient
care. Nurses in cluster 4 report the following job titles: “Expert
Nurse/Advanced Practice Nurse” (76.9%, n = 10), “Registere d
Nurse” (15.4%, n = 2) and “Specialist Nurse” (7.7%, n = 1). Most
nurses in cluster 4 (92.3%, n = 12) reported that their area of
practice changed after graduation. In addition, 38.5% (n = 5)
reported that they had been involved in research projects in the
36 months prior to the survey.
As can be seen in Table 2, cluster 4 consists of academically
qualified nurses whose main tasks are in the areas of “Basic
close- to- patient nursing care”, analogous to vocational training
(100.0%), “Specialized and expanded/advanced close- to- patient
care” (92.3%) and “Development, implementation and evalua-
tion of new concepts” (92.3%). Other main areas of activity are
“Patient and family counselling” (76.9%), “Case management
at micro level, e.g., primary nursing” (76.9%) or “Consultative
expert activity on specialist topics and complex care situations”
(76.9%).
4.5 | Cluster 5: Basic Psychiatric/Mental Health
Nursing Practice
Cluster 5 consists of 26 academically qualified nurses, repre-
senting just under a quarter (24.8%) of the subgroup analysed. In
this cluster, 76.9% (n = 20) of the nurses have a bachelor's degree,
15.4% (n = 4) have a master's degree and two (7.7%) have a di-
ploma. Furthermore, 92.3% (n = 24) of the nurses in this cluster
have a professional nursing licence and 50.0% (n = 13) have addi-
tional formal specialisation in psychiatry or psychiatric nursing.
The nurses in cluster 5 have on average 11 years of professional
experience in nursing overall (SD = 9.208 years), 9.6 years of pro-
fessional experience in psychiatric nursing (SD = 7.926 years)
and 4.4 years of professional experience since their last univer-
sity degree (SD = 4.934 years). The nurses in cluster 5 all work
in a direct care practice role proximal to the patient (100.0%).
Most of the nurses in cluster 5 work in the role of “Registered
Nurse” (68.0%; n = 17) or “Specialist Nurse” (19.2%; n = 5). Ab out
half (47.8%; n = 11) of the nurses in cluster 5 reported that their
tasks had changed since graduation. In addition, 30.8% (n = 8)
reported that they had been involved in research projects in the
36 months prior to the survey.
Cluster 5 consists of academically trained nurses whose main
tasks are in the areas “Basic close- to- patient nursing care”, anal-
ogous to vocational training (80.8%) and “Patient education” or
“Patient and family counselling” (76.9% in total).
4.6 | Cluster 6: Direct Patient Care and Basic
Practice Development
Cluster 6 consists of 19 academically qualified nurses, repre-
senting a relative frequency of 18.1% within the analysed sub-
group. The majority (78.9%, n = 15) of nurses in cluster 6 have
a bachelor's degree and 21.1% (n = 4) have a master's degree.
94.7% (n = 18) of the nurses in this cluster have a professional
nursing licence and 42.1% (n = 8) have additional formal spe-
cialisation in psychiatry or psychiatric nursing. The nurses
in cluster 6 have on average 12.6 years of professional expe-
rience in nursing (SD = 7.456 years), 9.2 years of professional
experience in psychiatric nursing (SD = 7.926 years) and
3 years of professional experience since their last university
degree (SD = 2.677 years). Most nurses in cluster 6 work in
direct patient care (68.4%, n = 13), but also in “research and
development” or “quality management”. Nurses in cluster 6
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8 of 13 Journal of Psychiatric and Mental Health Nursing, 2025
TABLE | Frequency distribution and significance level of the items within the cluster variable “tasks and activities” (FR06).
Characteristics
Cluster
Total1 2 3 4 5 6 7
10
(9.5%)
20
(19.0%)
13
(12 .4%)
13
(12 .4%)
26
(24 .8%)
19
(18 .1%)
4
(3.8%)
105
(100.0%)
Tasks and activities (FR06): Main variables of the cluster analysis
Basic close- to- patient nursing care
(analogous to vocational training)
20.0% 100.0% 0.0% 92.3% 80.8% 63.2% 75.0% 66.7%
Specialised and expanded/advanced
close- to- patient care
30.0% 0.0% 0.0% 92.3% 46.2% 5.3% 100.0% 30.5%
Expanded medical- diagnostic tasks
(e.g., assessment, screening, …)
20.0% 0.0% 0.0% 23.1% 30.8% 10.5% 75.0% 17.1%
Specific tasks in health promotion
and disease prevention
10.0% 0.0% 0.0% 53.8% 26.9% 5.3% 100.0% 19.0%
Patient and family counselling 50.0% 0.0% 30.8% 53.8% 65.4% 26.3% 75.0% 39.0%
Patient education 10.0% 0.0% 7.7 % 76.9% 53.8% 21.1% 100.0% 32.4%
Performing nursing consultations 30.0% 0.0% 0.0% 30.8% 3.8% 0.0% 0.0% 7.6%
Case management at the micro level
(e.g., primary nursing)
10.0% 0.0% 0.0% 76.9% 46.2% 15.8% 75.0% 27. 6%
Independent professional
responsibility for the treatment
process
10.0% 0.0% 0.0% 53.8% 34.6% 15.8% 75.0% 21.9%
Care coordination/case
management (including interface
management)
20.0% 0.0% 7.7% 15.4% 15.4% 5.3% 50.0% 11.4%
Leadership and management tasks
(formal management)
10.0% 0.0% 7.7 % 15.4% 0.0% 10.5% 75.0% 8.6%
Leadership and management tasks
(professional leadership)
50.0% 0.0% 30.8% 38,5% 3.8% 42.1% 25.0% 22.9%
Development, implementation and
evaluation of new concepts
100.0% 0.0% 92.3% 92.3% 34.6% 84.2% 100.0% 60.0%
Consultative expert activity 90.0% 0.0% 30.8% 76.9% 0.0% 10.5% 25.0% 24.8%
Participation in practical training
(e.g., practical guidance)
20.0% 5.0% 7.7 % 53.8% 11,5% 36.8% 0.0% 20.0%
Independent planning and
implementation of research projects
0.0% 0.0% 53.8% 0.0% 3.8% 0.0% 50.0% 9.5%
Independent planning and
implementation of PD/QD projects
100.0% 0.0% 84.6% 15.4% 0.0% 36.8% 75.0% 31.4%
Participation/collaboration in
research projects
0.0% 0.0% 61.5% 0.0% 11.5% 5.3% 75.0% 14.3%
Participation/collaboration in
practice/quality development
80.0% 0.0% 69.2% 38.5% 7.7% 42 .1% 75.0% 33.3%
Scientific literature research
to support professional
decision- making
90.0% 0.0% 92.3% 46.2% 0.0% 57.9% 100.0% 40.0%
(Continues)
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9 of 13
give the following job titles: “Registered Nurse” (25.3%, n = 5),
“Specialist Nurse” (5.3%, n = 1) and “Expert Nurse/Advanced
Practice Nurse” (31.6%, n = 6). Other job titles include
“Quality Management Officer/Nurse” (21.1%, n = 4), “Practice
Development Nurse” (10.5%, n = 2) and “Nursing Scientist”
(5.3%, n = 1). Overall, 84.2% (n = 16) of nurses in cluster 6 re-
ported that their tasks or roles had changed since graduation.
Approximately half of the nurses in this cluster (52.6%, n = 10)
reported that they had been involved in research projects in
the 36 months prior to the survey.
Cluster 6 consists of academically qualified nurses whose main
tasks are in the area of “Development, implementation and eval-
uation of new concepts” (84.2%), but also in the area of “Basic
close- to- patient nursing care”, analogous to vocational training
(63.2%). The other domains appear to play a rather secondary
role within this cluster.
4.7 | Cluster 7: Advanced Psychiatric/Mental
Health Nursing Practice
Cluster 7 consists of 4 academically qualified nurses, repre-
senting a relative frequency of 3.8% within the analysed sub-
group. All nurses in cluster 7 have a master's degree. All nurses
in this cluster have a professional nursing licence and half of
them have a formal specialisation in psychiatry or psychiat-
ric nursing. Nurses in cluster 7 have on average 23.25 years
of professional experience in nursing (SD = 6.602 years),
19 years of professional experience in psychiatric nursing
(SD = 13.115 years) and 3.7 years of professional experience
since their last university degree (SD = 3.005 years). In this
cluster, 75.0% (n = 3) of the nurses work in direct patient care.
Nurses in cluster 7 report the following job titles: “Nursing
Expert/APN” (50.0%, n = 2), “Registered Nurse” (25.0%, n = 1)
and “Staff Position Nursing Development” (25.0%, n = 1). A ll
nurses in this cluster reported that their scope of practice had
changed since graduation. All nurses in this cluster were also
involved in a research project in the 36 months prior to the
survey. As can be seen in Figure 1, the scope of practice of
cluster 7 extends across all domains. However, there appears
to be less activity in the domains “care management and sys-
tems support” and “education and teaching” than in the other
domains.
5 | Discussion
This study uses empirical data to describe the practice profile of
academic psychiatric nursing or advanced psychiatric nursing
practice in Germany. Cluster analysis of the tasks and activities,
described by the participants, was used to identify seven clusters
of academically qualified nurses. These different clusters describe
different academic role profiles in psychiatric nursing, some of
which differ significantly from each other in terms of practice pat-
terns. The clusters can be grouped into two main areas: “special-
ized patient care” or “research and development”, on a continuum
from “basic” to “specialised” to “advanced” practice (see Figure1).
This task and activity profile provides a realistic and representa-
tive picture of the academic role profiles of psychiatric nurses in
Germany. It can likely be generalised to the healthcare systems in
Austria and Switzerland.
The results provide a first insight into the academic landscape
of psychiatric nursing in Germany. For the first time, the aca-
demisation of psychiatric nursing in Germany can be compared
internationally. Similar to the study by Gardner et al. (2017),
a cluster analysis is used to identify task profiles and nursing
role types. In our case, however, this is done on the basis of
self- described tasks and activities and not on the basis of self-
described job titles. Similar to previous studies (e.g., Carryer
etal.2018; Duffield etal. 2021; Gardner etal. 2016; Jokiniemi
Characteristics
Cluster
Total1 2 3 4 5 6 7
10
(9.5%)
20
(19.0%)
13
(12 .4%)
13
(12 .4%)
26
(24 .8%)
19
(18 .1%)
4
(3.8%)
105
(100.0%)
Participation in further education
and training
80.0% 0.0% 69.2% 61.5% 7.7% 36.8% 75.0% 35.2%
Teaching (e.g., in specialist training
or as a lecturer at a university)
40.0% 0.0% 46.2% 15.4% 3.8% 15.8% 75.0% 20.0%
Public relations/anti- stigma work 30.0% 0.0% 38.5% 7.7% 0.0% 0.0% 100.0% 12.4%
Networking outside the institution 90.0% 5.0% 92.3% 61.5% 11.5% 21.1% 100.0% 39.0%
Networking within the institution 40.0% 0,0% 92.3% 61.5% 7.7% 10.5% 50.0% 29.5%
Dissemination of nursing
knowledge (e.g., specialist articles or
lectur es)
10.0% 0.0% 84.6% 23.1% 11.5% 10.5% 75.0% 21.9%
Note: Colour Scale and consensus definition: > 50% to 74.9% =
majority agreement
; 75.0% to 89.9% =
low consensus
; 90% or more =
strong consensus
.
Abbreviations: PD, practice development; QD, quality development.
TABLE | (Continued)
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10 of 13 Journal of Psychiatric and Mental Health Nursing, 2025
etal.2022), this study aims to practice profiles and to differenti-
ate the different (academic) role profiles based on the underlying
tasks or practice patterns.
The study results make a significant contribution to the under-
standing of roles in psychiatric nursing, providing an empirical
approach different from most theoretical or normative prescrip-
tions and describing roles from basic to advanced psychiatric
nursing, adding to the international literature and contributing
to theory building in psychiatric nursing. The clusters identi-
fied are consistent with contemporary competency models or
guidelines for psychiatric/mental health nursing, such as those
developed by the International Council of Nurses (2008, 2020,
2024) and Scheydt and Holzke(2018b). However, to fully capture
the breadth of the field of role profiles of academically prepared
nurses in mental health settings, these models need to be ex-
panded to include research and development, management and
leadership, and education and training. This can be achieved by
validating the content, for example through the Delphi method.
Clear delineation of nursing roles in psychiatry promotes profes-
sional development enables optimal use and evaluation of roles
at different career stages, and supports their formalisation. The
prevailing approach to workforce planning focuses mainly on
the number of nurses needed in relation to the number of pa-
tients, rarely considering the level of expertise and skill mix. A
proper synthesis of existing knowledge can facilitate the (fur-
ther) development of (existing) tools that promote appropriate
role delineation and skill- based staffing. It could be important
for service providers and managers to recognise the uniqueness
of each role and develop strategies for effective collaboration in
order to maximise the benefits of each role.
In addition, the results can help policymakers better under-
stand the needs and requirements of mental health care and to
implement appropriate measures to promote practice, research
and education. This could improve the quality of care and
strengthen (mental) health care as a whole. In view of planned
changes in legislation that will expand the responsibilities
of qualified nursing staff (e.g., the Nursing Competence Act
planned for 2025 in Germany, see German Federal Ministry of
Health2023), it is crucial to establish clear role models and com-
petence levels. In addition, the regulatory authorised instance
should regulate and monitor continuing education. It would
then be necessary to be registered as a specialised or extended
nurse in order to take on such (extended or advanced) nursing
care tasks.
5.1 | Limitations
Due to the specific objective and research question, only ac-
ademically qualified nurses were considered in this study.
However, due to the predominantly vocational training struc-
ture in Germany, they account for only about one to 2% of all
professional nurses (Lehmann etal.2019). Therefore, this study
only describes the role profiles and practice patterns at the aca-
demic level, but not psychiatric nursing in general. Future stud-
ies should also include non- academic nurses for comparison.
Participants for the study were recruited through German
professional associations with a focus on psychiatric nursing.
However, this may have introduced a bias due to an overrep-
resentation of nurses from inpatient settings. It is important to
note that nurses working in outpatient and community settings
were underrepresented, which may limit the interpretation of
the results. It is also important to note that there is no manda-
tory registration for nurses in Germany. Therefore, it is not pos-
sible to draw conclusions about the total number of academically
qualified nurses and the corresponding response rate.
FIGUR E | Graphical classification and delineation of clusters on the dimensions. EbP, Evidence- based Practice; PMH, Psychiatric and Mental
Health; PR, Public Relations; PR , public relations.
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11 of 13
Another limitation is the method of cluster analysis itself. Due
to its exploratory nature, cluster analysis is used only to con-
struct knowledge from the empirical data and not for inferential
statistical verification. The selection of cluster solutions and in-
terpretation of cluster content is also somewhat subjective and
highly dependent on the researchers. To reduce complexity, only
nurses working in direct care practice, nursing development or
nursing research positions were analysed. Subsequent analysis
and theory development will need to include the other nursing
groups (management and education).
In addition, cluster 7 is relatively small compared to the other
clusters (n = 4). Even if we assume that the size of cluster 7 re-
flects the reality of APN in Germany, the small sample size
within the cluster could still lead to various limitations regard-
ing the quality and transferability of aspects such as robustness,
interpretability or susceptibility to bias. This must be taken into
account when interpreting the results.
From the vantage point of the development of nursing practice,
this paper does in no way solve the fundamental problem of
“prescriptionism” (theoretical contemplation of the ideal roles
of academically prepared mental health nurses) versus “em-
piricism” (actually examining the role profiles in real practice).
However, this paper may serve as a impetus for the development
of such a discussion.
Furthermore, no existing instrument was used to delineate ad-
vanced roles, but a specially developed item battery based on
previous work on the (advanced) tasks and activities of psychiat-
ric nursing (Scheydt and Hegedüs2021; Scheydt etal.2019). For
future studies, an internationally established instrument such
as the Advanced Practice Role Delineation Tool (e.g., Gardner
etal.2016) should be considered.
6 | Conclusion
The AkaPP study was the first to develop an empirically derived
model of the role profiles of psychiatric nurses in Germany,
which complements existing competency models and classifies
nursing roles between basic and advanced psychiatric nurs-
ing. Further analyses, e.g., taking into account aspects of role
development, can provide in- depth insights into the situation
of academically qualified nurses in psychiatry (in Germany).
Recommendations for management, practice development, ed-
ucation, policy development and research can be derived. For
example, future- oriented role models can be derived from the
empirically generated task clusters, which can serve as a basis
for further research projects on necessary competencies. These
can also be used to develop curricula at the university level, such
as Psychiatric/Mental Health Nurse Practitioner (PMH- NP) and
Community Mental Health Nurse (CMHN). In addition, the re-
sults can help nurses to define their role more clearly and im-
prove their competencies to better meet the needs of patients.
Nurse managers could develop a better understanding of the
different role profiles and organise and structure their teams ac-
cordingly, which could lead to a more efficient division of labour
and better use of resources. Identifying the different role pro-
files also enables healthcare professionals to better understand
their roles and responsibilities and develop their professional
competencies. In particular, young nurses in the early stages of
their careers can benefit from the results in order to plan their
individual career based on their aspirations and goals.
7 | Implications for Practice
The clusters identified provide a nuanced understanding of the
diverse roles of graduate psychiatric nurses. This comprehensive
insight helps to tailor staffing structures and training programs
to the specific needs of psychiatric care settings. By delineating
distinct role profiles, healthcare institutions and policymakers
can optimise resource allocation, enhance interdisciplinary
collaboration and ultimately improve patient outcomes. This re-
search serves as a valuable guide for refining clinical practice
models and promoting professional development in psychiatric
nursing contexts.
Acknowledgements
We would like to thank Alexandra Vogt, Center for Psychiatry South
Wuerttemberg, for her support in carrying out the AkaPP study. She
made a valuable contribution to the preparation of the study, partic-
ularly in relation to the development of the questionnaire and data
collection. The AkaPP study is endorsed by the German Center for
Mental Health (DZPG).
Ethics Statement
Ethical appro val of the study was gra nted by the Ethics Comm ittee II of the
Ruprecht- Karls- University Heidelberg, Medical Faculty Mannheim (No.
2024–582). Participation in the online survey was voluntary and based on
informed consent. The data generated by the study were processed, an-
alysed and stored in anonymised form in accordance with generally ac-
cepted European data protection guidelines. The lists of identifying data
of the participants are stored separately from the data of the online survey.
It is not possible to draw conclusions about individual persons. Personal
data will be stored for a maximum of 2 years after evaluation and then
destroyed in accordance with data protection guidelines. As the data pro-
tection officer of the AkaPP study, the corresponding author assumes full
responsibility for the ethically correct conduct of the examination.
Conflicts of Interest
The authors declare no conflicts of interest.
Data Availability Statement
Research data are not shared.
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