Last updated on  August 2, 2024

For foreigners looking for a job in Germany health and elderly care is the sector that cannot be overlooked. The German healthcare sector is with seven and a half million employees one of the largest employers in the country and also the one with most job vacancies. Apart from the additional five thousand medical doctors that are currently needed in the sector there is a huge shortage of other healthcare personnel, particularly nurses and caregivers.

As of the end of 2023, 1.69 million nurses and caregivers were employed in German healthcare facilities (62% of that number were nurses, 38% caregivers) while ca 16% of them were foreign workers. However, many more are needed as one nurse in Germany looks after 13 patients in comparison to 6 in the US. At the moment there are nearly 200,000 unadvertised vacancies for nursing jobs that would be impossible to fill and the situation is worsening by day. This is mainly due to aging of the population as the share of elderly patients is increasing while several hundred thousands of nursing employees are going into retirement. As a result, besides replacing retired employees, additional 460,000 of nursing personnel (incl. nurses, caregivers and nursing assistants) would have to be hired by 2049 to prevent staff shortages. But, a vacancy for a nursing staff member today remains unfilled on average for ca 240 days.

1. Where are Most Nursing Job Vacancies?

Geriatric care is the fastest growing segment within the German healthcare sector and thus happens to have most job vacancies for nursing personnel. This situation is a result of population aging and retirement of the “baby-boomer” generation that started only recently and will continue for another two decades. Germany has one of the longest life expectancies in Europe (78.3 years for men and 83.2 years for women, i.e., 80.7 years combined) while 1.5 million Germans are over 90 years old. As of the end of 2023, there were 5.2 million care-dependent Germans, mostly seniors, twice as many as 10 years ago. Demand for long-term geriatric care is expected to continue growing over the next 15-20 years as the baby-boomer generation ages. Approximately 0.63 million people are employed in geriatric care in Germany and many more will be needed in the future. However, for each 100 job openings for geriatric nursing personnel there are only about 35 interested applicants.

2. The German Government’s Support for Recruiting Foreign Nurses

German authorities understand that it is impossible to find enough personnel in Germany to meet the growing demand and are, therefore, interested in recruiting foreign nurses, particularly from countries with high unemployment rate among nursing personnel. The currently active government projects aimed at hiring foreign nursing staff for work in the German health and elderly care sector include:

• Triple Win Project – in 2013, the German government concluded bilateral agreements with the governments of Bosnia and Herzegovina, Philippines and Tunisia known as the “Triple Win Project” to help nurses from these countries find employment in Germany. In the meantime, India, Indonesia, Jordan and Vietnam have joined the programme. For more information on the country specific projects for any of the participating countries visit this page.
• Nursing Professionals for Germany (“Pflegekräfte für Deutschland”) – this is en extension of the abovementioned “Triple Win Project” which is also organized by the Federal Employment Agency but runs as a separate programme focusing on hiring nursing professionals from Brazil and Mexico. Selected candidates will complete the German language courses in their home country and will have their qualifications recognized by German authorities before leaving for Germany.
• Project APAL – recruitment of trainees from Brazil, Columbia, El Salvador, Mexico and Uzbekistan for the German healthcare sector. Participants must be at least 18 years of age, interested either in nursing or in medical technical jobs, they must have full secondary education equivalent to the German ‘Abitur’ and German language skills at level B1. The project APAL started in 2019 and is managed by the Federal Employment Agency. Information about the project in Spanish can be found at this page.

However, Germany is welcoming nursing personnel also from other countries than listed above provided they meet professional qualification requirements and learn German. In addition, the German government encourages foreigners to complete nursing vocational training programmes in Germany to become eligible for jobs in the German health and elderly care sector. At the moment, Spain, Poland, Croatia and some other East European countries supply most nurses to the German healthcare sector.

3. Salaries of the Nursing Personnel in Germany

The salaries in the nursing industry vary significantly even for comparable jobs. They are affected by several major factors such as the federal state where the job is done, the size and type of the employer and the qualification, experience and professional specialization of the employee. Generally speaking, the highest salaries are paid in the southern federal states and the lowest in the north-east, that is, in the former East Germany. The size matters too, so in most cases the larger the employer the higher the salary for the same work. Wages in the public sector are determined by the rates of pay defined in the collective agreement for the public service whereas in the private sector they are individually negotiable. That, however, does not automatically imply that they are higher. Often the opposite is true because of exploitation of (mostly foreign) workers that often occurs in the private sector, particularly in households. But, one major factor that is fully under your control is your qualification and skills.

The staring salary of a registered general nurse in Germany is around EUR 3,250 a month (ca EUR 2,200 netto for a single person with no kids and no church membership) and depending on further qualifications, specialization, professional experience and location it can easily go up to EUR 3,750 a month (ca EUR 2,470 netto). Typically, office nurses have the lowest average salaries (EUR 3,500 a month) as they do not work in shifts. The greatest demand in Germany is for geriatric nursing personnel. The average monthly salary of a geriatric nurse is EUR 4,500 which is well above the national average for a nurse (EUR 3,900 in H1 2024). Similarly, most other specialist nurses (operating room nurses, emergency room nurses, palliative care nurses, etc.) also earn on average EUR 4,500 a month. The biggest earners, however, are senior nurses with specialist qualifications and supervisory responsibility who make on average around EUR 4,750 per month (ca EUR 3,000 netto).

3.1. Median Salaries for Selected Nursing Professions in Germany in H1 2024

Profession	EUR monthly
Office nurse	3,500
Nurse in hospital	4,050
Geriatric nurse	4,500
Paediatric nurse	4,000
Hospital environment hygiene nurse	4,250
Nurse in intensive care	4,500
Palliative care nurse	4,500
Emergency room nurse	4,500
Operating room nurse	4,500
Senior nurse	4,750
Nurse average	3,900
Nursing assistant	3,000
Senior caregiver	3,900
Caregiver assistant	2,650*
* The minimum salary of a caregiver assistant was raised to EUR 2,685 a month as of May 1st, 2024. Source: EntgeltAtlas of the Employment Agency, rounded to the nearest 50 euros.

Foreign nurses with German fluency problems usually do not work with full responsibility in the first year of their employment while receiving intensive language training. Thus they earn less, that is around EUR 2,680 a month (ca EUR 1,870 netto), which happens to be a starting salary of a junior nursing assistant in Germany. Once they obtain a B2 German language certificate and are recognized as a registered general nurse their monthly salary goes up by ca EUR 600.

The starting salary of a senior caregiver is at least EUR 3,380 monthly (since May 1st, 2024 – read the paragraph below) whereas caregivers with ten years of experience make around EUR 3,900 a month. In fact, the average monthly salary of a senior caregiver in Germany was EUR 3,900 in H1 2024. Caregiver assistants earn a minimum of EUR 2,685 a month (since May 1st, 2024). Please note that salary statistics vary, depending on the source used. For more information on salary levels in Germany and calculation of deductions (taxes and social security contributions) as well as on the cost of living in Germany please refer to this article.

The COVID years have exposed the long-neglected weaknesses in the German healthcare sector such as the difficult working conditions of the caregiving staff. To relieve the situation, the government approved measures aimed at making the caregiving jobs more appealing to attract larger numbers of job seekers. For example, there is no unpaid overtime anymore while several hikes of the minimum hourly wages during 2022-24 have made salaries of the caregiving personnel more rewarding. As a result, from May 1st 2024, the minimum hourly wage of a senior caregiver is 19.50 euros per hour, 16.50 euros for a junior caregiver and 15.50 euros for a caregiver assistant. This translates into minimum monthly salaries of 3,380 euros, 2,860 euros and 2,685 euros, respectively based on a 40-hour work week (more information in German is available from the Federal Government). A further increase is planned for July 1st, 2025, i.e., a senior caregiver should then earn a minimum of 20.50 euros per hour, a junior caregiver 17.35 euros per hour and a caregiver assistant 16.10 euros per hour. These minimum wages are binding for all employers in the public sector.

However, the aforementioned minimum wage increase does not apply to caregivers working in private households (most of whom are foreigners from Eastern Europe). At the moment they earn a minimum of 12.41 euros an hour (as of 2024) but even this lower rate only applies to those who work as employees and not as independent contractors. Furthermore, please note that healthcare facilities run by the Church have their own pay rates and are thus not subject to any of the abovementioned pay increases.

4. Regulation of the Nursing Profession in Germany

The official occupational term for a German registered nurse is ‘Gesundheits- und Krankenpfleger’. Hence, an old term ‘Krankenschwester’ is no longer officially used. Most German nurses were educated in three-year vocational programmes in higher nursing schools attached to the hospital, though more recently, nurses also receive education in colleges and graduate with a B.Sc. in nursing. In both cases, they have to pass an official standardized exam at the end of the course to be registered with the health authority of the corresponding federal state as a “general” nurse. There is a one-off charge associated with the registration but no maintenance fees.

Unlike a nurse, a nursing assistant (‘Gesundheits- und Krankenpflegehelfer’) is not a regulated profession in Germany. Nursing assistants, in Germany also known as healthcare assistants, typically attend one-year vocational programmes in the same schools as nurses. They do not need to pass any official standardized exam, but still, they have to demonstrate their fitness for the job to the local health authority of the federal state in order to be allowed to practice their profession.

5. Qualification Requirements for Nursing Personnel in Germany

As it was mentioned above, German nurses obtain their education in a three-year vocational training programme at a higher school or earn a Bachelor’s degree in nursing from the university. Later on, many nurses further their education by taking up specialist courses (e.g. intensive care, palliative care, home care, oncology, anaesthesia, psychiatry, hygiene, etc.). Nursing assistants must have completed a one-year vocational programme at a higher nursing school. Recently, some universities have launched courses for nursing assistants designed for students who have completed secondary education in a non-healthcare related field.

Foreign nurses and nursing assistants wishing to work in Germany must demonstrate that they possess professional qualifications and skills (usually minimum of two years working experience) equivalent to those of their German colleagues. In addition, they need to pass a German language proficiency exam level B2 (read this article for more information on German language proficiency tests), be in a good physical condition and have a clean criminal record. Language proficiency is often the biggest entry barrier for most foreign nurses as they are not only required to communicate with their patients in German but also to do a lot of writing in German to document their work.

6. Recognition of Foreign Nursing Qualifications in Germany

Foreign nurses have to demonstrate to the local health authority of the federal state in which they wish to seek employment that their professional qualifications correspond to German standards for a registered nurse.

6.1. Automatic Recognition of Nursing Diplomas from EU and EFTA

Certified nurses from the European Economic Area countries (the EEA includes the EU and EFTA, that is the EU and Iceland, Lichtenstein and Norway) will have their qualifications automatically recognized if these were obtained after their country joined the EU or EFTA. However, applicants who obtained their qualifications before their country joined the EU or EFTA will need to submit a certificate of compliance with the minimum standards set out in the EU Directive 2005/36/EC to receive automatic recognition. This certificate must be issued by the relevant health authority of the EEA country where their education was obtained.

6.2. Assessment of Nursing Qualifications from Third Countries

Citizens from third countries will need to have their professional qualifications assessed by the health authority of the federal state in which they wish to work against the German nursing diploma. This takes up to three months.

Additional required documents include a CV, other professional certificates (e.g. diplomas for geriatric nursing), proof of relevant professional experience, medical certificate and a criminal record certificate. More detailed information on recognition of foreign nursing diplomas can be found at the ‘Recognition in Germany‘. Alternatively, for a quick overview of requirements check out this pdf (download starts automatically!). And, if you are really serious about working in a nursing job in Germany read also this detailed guide.

As mentioned in the above section, foreigners wishing to work in Germany as nursing assistants will also have to submit their diplomas, proof of professional experience and other relevant documents (language certificate, medical certificate and criminal record certificate) to the local health authority of the corresponding federal state. This procedure is state specific and it is not as strictly regulated as that for a nurse. There is no registration, just a permit to practice the profession.

Since March 2024, nurses and nursing assistants from third countries who do not yet have their professional qualifications recognized in Germany can start working in Germany under the so-called recognition partnership while their qualifications are being reviewed by the respective health authority.

7. Options for Those Who Fail to Meet Qualification or Language Requirements

Those applicants who fail to meet the professional qualification requirements for a registered nurse will be given an opportunity to either take a standardized exam or will have to pursue additional training that may last up to three years. Some foreign nurses may be found to lack exposure to clinical care and will need to do internships before they can obtain a title of a registered nurse. Applicants for a registered nurse who fail to meet the German language proficiency requirements (level B2), but achieve at least B1 level, will be allowed to work as a nursing assistant while pursuing an intensive language course. Once they earn a B2 German language certificate they will receive a title of a registered nurse.

In an unlikely event that qualifications of a nursing assistant are found to be inadequate, applicants may be asked to complete a vocational training in Germany or in their home country of up to one year in duration. In case of insufficient language proficiency they may be asked to take up an intensive language course.

8. Visa and Residence Permits for Foreign Healthcare Personnel

Residents of the EU and EFTA countries (commonly known as the EEA) do not need a visa or a residence permit to take up employment in Germany. Citizens of some other countries like the US, Canada or Australia do not need a visa to travel to Germany but they do need a residence permit for gainful employment. However, nationals of most other countries need both, an entry visa and a residence permit. Nonetheless, when it comes to badly needed healthcare personnel, arranging these documents should not pose a major obstacle no matter which country an applicant comes from. You can find detailed information on visa and residence permits in the upper part of the article on immigration to Germany.

9. How to Find and Apply for a Nursing Job in Germany

If you are seriously looking for a nursing job in Germany, you should refer to our Guide for Foreign Jobseekers for additional information on work related topics such as government employment projects for foreigners or instructions on how to apply for a job in Germany as well as for links to public employment agencies and independent job portals.

Many foreign job seekers use international recruitment agencies to find work and arrange the necessary formalities for them. However, if you meet all qualification requirements for a nursing job in Germany (you can take a language proficiency examination in your home country) it should not be too difficult to manage it all by yourself. Remember, Germany needs tens of thousands of foreign nurses and caregivers. So, don’t be shy to apply for a nursing job in Germany through a German-based employment agency or directly with a potential employer. Some employers may even offer you a signing bonus of around 3,000 Euros that you probably won’t get from an employment agency.