A nurse scientist with a passion for evidence-based practice

During this time, Kottner received his first funding from Stiftung Charité, in the form of the 2013 Max Rubner Award for his project, ‘Evidence-Based Skincare at Charité.’ It was thanks to the prize money that he was able to carry out the project, which had three steps: First, an overview was gained of the skincare products and strategies being used outside the field of dermatology at the Charité. Next, these were compared with existing skincare guidelines, particularly with regard to promoting the skin’s barrier function. Finally, a best-practice proposal for patient skincare at Charité was developed. Almost 15 years later, Kottner still remembers the variety of products and procedures that he and his team encountered. He recalls: “We went from ward to ward and opened the cupboards to see which products were being used. Then we interviewed the staff about how they were applied. It quickly became clear that everyone had different approaches, even within the same department, simply because they were working on different wards. This heterogeneity was essentially the opposite of evidence-based practice. Following a literature review, we developed a skincare algorithm for the Charité, matching it with a defined set of products. We found that no more than 20 products were really needed. We presented our findings in numerous management meetings.” 

It will still take some time before a comprehensive skincare standard is implemented across all areas of clinical care at the Charité. However, Kottner’s early Max Rubner project has, at the very least, provided an important impetus. It highlights his ambition to align science and practice closely, both to benefit patients in clinics and in terms of resource efficiency.

Kottner speculates that he probably would have stayed in dermatology – his personal “study paradise” – had it not been for a joint decision by the Berlin Senate and the Charité to launch a primary qualifying bachelor’s degree program in nursing. Under the rubric ‘Expanding Health Professions,’ the key passage in the higher education agreement between the State of Berlin and the Charité for the years 2018 to 2022 reads as follows: “The Charité contributes to the training of nursing experts who come to understand the growing significance of integrated care systems and help shape these, while collaborating across disciplines with other health professions. Following the implementation of the new Act on the Nursing Professions, which will, however, not take place before the 2019/20 winter semester, Charité will establish a primary qualifying, training-integrated nursing degree program with an annual intake capacity of 60 students.”

The Charité began working at full speed to lay the groundwork, advertising two professorships. Kottner was initially hesitant to apply, in part because internal appointments still carry a certain stigma in academic circles. But he eventually applied. The application process, appointment and the establishment of the Institute for Clinical Nursing Science all happened quickly. A shared vision helped, and: “The pressure was on, the teaching program was launched.” Kottner explains that the founding of the institute was a pioneering step in early 2021. Other university hospitals in Germany have since followed suit. He says that the development as a whole makes complete sense: “The German Science and Humanities Council – among others – have said it many times: If you’re going to set up a nursing degree program, then please do it at a medical faculty to ensure proximity to clinical practice. We can wholeheartedly confirm the value of that.”

Kottner’s comment does not intend to disparage the nursing training programs offered by medical teaching institutions. However, he does want to highlight the advantages of the academic education offered at the Charité: “We have a different profile. There’s a special university culture here. Even though our students are training for practical nursing work, research plays a fundamental role. Students are expected to act on the basis of evidence and provide high-quality care. While most of them won’t pursue research careers themselves, their entire degree is shaped by the level of expertise we have here at the Charité. The nursing degree program is supported by a network of over 30 clinics and institutes. When students are studying orthopedics, colleagues from the department come in to teach them. When they are studying the foundations of science, Volker Hess, the head of the Institute for the History and Ethics of Medicine, may pay them a visit. They also participate in inter-professional teaching formats, such as our emergency care course. This has an impact on the students. It’s a form of socialization. They share the campus with students from other disciplines, ranging from medicine and health sciences to midwifery. During their lunch breaks, they sit together and ask each other, ‘So, what are you studying?’ They meet each other at an early stage in their careers, rather than just after they have finished their training and are already working in their respective fields.”

We talk about the great responsibilities that nurses carry. No other medical profession is as close to the patients, Kottner stresses. “Nurses make many clinical decisions, even if they’re not always aware of it. They do it every single day.” Evidence-based practice means that nurses take scientific findings on a given issue into account and incorporate them into their decision-making process. It does not mean that nurses are expected to act solely on the basis of study results or alleged research directives. This is a common misconception that Kottner often encounters. An introductory video on the e-COMPAS intranet platform explains this clearly. Evidence-based nursing is represented graphically as a puzzle made up of four pieces – first, the preferences of the patients; second, internal evidence, meaning the personal clinical expertise and experience of the nurse; third, the surrounding conditions that must be taken into account (such as legal requirements or available resources); and finally, external evidence stemming from scientific research. The four strands create the basis on which nursing decisions should be made. The development of e-COMPAS is the key result of the project ‘Nursing based on Science – Science based on Nursing. A platform for knowledge exchange in nursing,’ which Kottner and his colleague Antje Tannen successfully submitted for the Max Rubner Award in 2022. The concept of an internal, structured communication platform at the Charité to promote an improved transfer of ideas, questions and knowledge between nursing practice and nursing research convinced both the jury and the steering group – and it has been realized.

During the interview, Kottner demonstrates the platform’s features on his computer. In just a few clicks, nurses can access the input form that allows them to record care-related issues and ask questions. These are either answered directly, for all platform users to read, by Julia Will, research associate at the Institute of Clinical Nursing Science, or transferred to a pool of open research questions. This pool is available to anyone at Charité planning to write a thesis and seeking a research topic related to nursing practice. Once the theses are finished, the findings are in turn made available on the platform so that practitioners can benefit from them as well. Win-win! 

Jan Kottner identifies the “structural problem” that e-COMPAS aims, at least in part, to address. The reason why evidence-based nursing practice is still so underdeveloped today? “There simply isn’t standard access to easily digestible evidence. In my view, it’s the job of the faculty to change that. But since we’re not working directly in clinical practice, we don’t have as much insight into the problems faced by nurses on the ground. The platform brings together the challenges faced by nurses with knowledge gained from research.” He praises the work of Julia Will, who answers questions concisely without compromising on quality. On the contrary: her answers are always based on high-quality sources such as Cochrane reviews and clinical guidelines.

This increased integration – the direct exchange between nursing practice and nursing science – is part of Kottner’s vision for a future-proof healthcare system. Like many others at the Charité, he is working within his remit to meet this goal. The way things are currently going can’t realistically continue for much longer. Costs are rising exponentially, and it’s hard to imagine the consequences if nothing changes. On the topic of the nursing staff shortages, Kottner says: “It's a global trend.” However, he draws distinctions between the situation in Germany and that in other countries. In comparison, Germany still has a clear over-supply of hospital beds. But this is no longer sustainable. And the country still has – for now – a high density of nursing staff. In Kottner’s view, the German healthcare system urgently needs to innovate, with more differentiated healthcare professions and up-to-date training programs for each field. Developments such as the Nursing Education Reinforcement Act and the Act on the Nursing Professions make him cautiously optimistic. But, he adds: “We need to be much braver, and go much further!”

The demographic shifts will be so dramatic that the doctor as a “resource” will have to be managed very differently. Inevitably, this will also lead to further changes in the role and scope of the responsibility of nurses. They need to be properly equipped for that. As nursing research repeatedly demonstrates: “Having nursing staff as the first point of contact works very well!” But putting that into practice is also a question of mindset. There is still resistance in Germany: Sectoral boundaries are pointed out; objections citing legal arguments and the like are made. But despite these concerns, restructuring the healthcare system is ultimately a matter of necessity. Kottner also envisions the possibility of one day adding a Clinical Master’s program at the Charité for ‘his’ students. “We’re working on making that happen!”

Kottner’s most recent funding from Stiftung Charité is the joint science x media Tandem 2024, with photojournalist Patricia Kühfuss. Their project goes under the short title ‘Nursing science goes visual,’ and aims to challenge dominant, stereotypical photographic representations of the nursing profession, as well as to counter the relative invisibility of nursing science as an academic discipline. In interdisciplinary, cross-professional exchange involving people from nursing science, nursing staff and the media world, Kottner and Kühfuss are currently developing alternative and constructive visual narratives. Kottner says: “It’s funny when a hardcore scientist like me and an artist like Patricia try to communicate. I think we partly live in different worlds. But as I understand it, this conversation across professional boundaries is exactly what the Tandem funding is all about!" 

He goes on to describe how they involved many Charité staff members right from the start – their professional self-image is an integral part of the project. For him, it is important that the collaboration creates a realistic image of the profession. Nurses don’t just wipe bottoms and dress wounds, and they’re not heroes either. At least not any more or less than other healthcare professionals. For Kottner, public perceptions of nursing tend to oscillate between these extremes, often accompanied by an unspoken, “I could never do that!” As is so often the case, the truth lies somewhere in between. And – at least in a hospital context – one of the core tasks of a nurse is actually communication: with relatives and patients, and in coordinating between the different professional groups.

Kottner and Kühfuss recently pored over the hundreds of photos that have been taken so far as part of their science x media Tandem project. For the artist, the photos they’ve taken so far are not enough, Kottner says with a laugh, even though they already have a great deal of strong material: “These photos definitely break with the usual narrative, that’s for sure! We have photos – approved for use by everyone involved – about which I think, Wow, these are scenes that just haven’t been seen before.” He admires his tandem partner, how she dons Charité scrubs, grabs her camera, and accompanies the nursing staff through full night shifts. 

The project results will later be exhibited, but beyond that, they will also be accessible to editorial offices nationwide through the laif photo agency. Publication by publication, their photos will shape a new image of the nursing profession.

Dr. Nina Schmidt
July/August 2025