Germany faces a large shortage of nursing staff as its population ages, and it has opened new routes for internationally educated nurses. Government-backed programmes and bilateral agreements have recruited nurses from countries including the Philippines, India, Mexico, Brazil, Tunisia and, increasingly, sub-Saharan Africa, with Ghana among countries announcing nurse deployments to Germany. Unlike English-speaking destinations, the biggest hurdle is language. This guide explains the main steps. Rules can change, so always confirm with official German sources.
The job title: Pflegefachfrau / Pflegefachmann
Since 2020, Germany has had a generalist nursing qualification called Pflegefachfrau or Pflegefachmann (registered nurse). To work under this protected title, foreign-trained nurses need state recognition (Anerkennung) of their qualification and a licence to use the title. Until then, you may be able to work as a nursing assistant.
Step 1: Learn German
- For professional recognition, nurses typically need German at B2 level (Common European Framework of Reference), often with a nursing-specific language exam.
- Many visa routes allow entry with B1, with B2 completed in Germany.
- Accepted exams commonly include Goethe-Institut, telc (including telc Deutsch B1·B2 Pflege) and ÖSD. Check which your federal state accepts.
- Getting from zero to B2 typically takes many months of full-time study, often a year or more. This is a serious commitment.
Step 2: Apply for recognition
- Recognition is handled by the competent authority in the federal state (Bundesland) where you plan to work. The official portal Anerkennung in Deutschland has a “Recognition Finder” to identify the right office.
- Documents usually include: nursing diploma, transcript with hours of theory and practice, licence/registration from your home country, certificate of good standing, CV, ID, and certified German translations.
- The authority compares your training with German training. You’ll receive either full recognition or a “deficit notice” (Defizitbescheid) listing gaps.
Step 3: Compensation measures
If gaps are found, you choose (where offered) between:
- Knowledge test (Kenntnisprüfung): oral and practical exams, often after a preparation course.
- Adaptation period (Anpassungslehrgang): supervised practice, often several months, ending with a final interview.
Many recruits do this while employed as nursing assistants in Germany, with the employer supporting the process.
Step 4: Visa
Germany’s Skilled Immigration Act includes routes for nurses, such as a visa for recognition measures (to complete the knowledge test or adaptation period in Germany) and a skilled worker visa once recognised. A recognition partnership route also allows some nurses to start working in Germany while the recognition process is completed, if they have an employment contract and meet language and other criteria. The official portal Make it in Germany explains current visa options, and applications are made through German embassies or consulates.
Pay and conditions
- Pay depends on employer and collective agreements (for example, the public sector TVöD agreement). Recognised nurses earn more than assistants.
- Deductions for tax and social insurance (health, pension, unemployment, long-term care) are substantial, but give access to healthcare and social protection.
- Living costs vary greatly between cities.
- Family reunification is possible for skilled workers, subject to conditions.
Choosing a recruitment route
- Government and ethical programmes: Germany’s “Triple Win” programme, run by the Federal Employment Agency and GIZ with partner countries, is one well-known example. Some governments, such as Ghana’s labour export programme, also arrange deployments.
- Look for the German “Fair recruitment care Germany” quality seal (Gütesiegel), which identifies agencies committed to ethical recruitment.
- Red flags: agencies charging large fees to nurses, holding your passport, vague contracts, or “bonds” with huge penalties if you leave. WHO’s Code of Practice says recruitment costs shouldn’t be borne by health workers.
- Check the WHO Health Workforce Support and Safeguards List: Germany has committed not to actively recruit from listed countries except under government-to-government agreements.
Is Germany right for you?
Germany offers stable employment, strong worker protections and a path to permanent residence, but requires real commitment to the language and culture. Nursing practice differs too: some basic care tasks done by nurses in Germany may be done by assistants or families elsewhere. Speak to nurses already working there before you decide.
Related: Nurse salaries abroad compared · Nursing CV for jobs abroad · Building community abroad
Based on information from the official portals Anerkennung in Deutschland and Make it in Germany, and the WHO Global Code of Practice. General information, not legal advice. Requirements vary by federal state and change over time.