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 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. It is estimated that additional 200 thousand nursing personnel (incl. nurses, caregivers and nursing assistants) will be needed by 2030.
Geriatric care is the fastest growing segment within the healthcare sector. This is due to 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 (82 years for men and 85 years for women) while 1.5 million Germans are over 90 years old. At the moment, nearly 2.6 million German seniors require long-term geriatric care and this number is estimated to grow to 3.5 million by 2030. Nearly one million people are employed in geriatric care in Germany today 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.
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. In 2013, the German government concluded bilateral agreements with the governments of Bosnia, Serbia, Philippines and Tunisia known as the “Triple Win Project” to help nurses from these countries find employment in Germany (for more information on the Triple Win Project see this page).
However, Germany is welcoming nursing personnel also from other countries 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.
Salaries of the Nursing Personnel in Germany
The staring salary of a registered general nurse in Germany is EUR 2,300-2,400 a month (ca EUR 1,600 netto) and depending on further qualifications, specialization, professional experience and location it can go up to EUR 3,000 a month (ca EUR 1,900 netto). The greatest demand in Germany is for geriatric nursing personnel. The average monthly salary of a geriatric nurse is EUR 2,450 while emergency room nurses earn on average EUR 2,800 and operating room nurses EUR 3,000 a month. Senior nurses with specialist qualifications can earn up to EUR 3,500 per month (ca EUR 2,200 netto).
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 1,800-1,900 a month (ca EUR 1,300 netto), which happens to be an average 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 500. For more information on salary levels in Germany and calculation of deductions (taxes and social contributions) as well as on the cost of living in Germany please refer to this article.
Regulation of the Nursing Profession
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.
Qualification Requirements for Nursing Personnel in Germany
As it was mentioned above, German nurses obtain their education in a three-year vocational 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.
Recognition of Foreign Qualifications
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.
Certified nurses from the European Economic Area countries (EEA includes the EU, 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.
Citizens from the 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 which 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 here.
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.
Failure to Meet Language Proficiency or Professional Qualification 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 or take up an intensive language course.
Visa and Residence Permits for Foreign Healthcare Personnel
Residents of the EU and EFTA countries (commonly known as 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.
Also, you can 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 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.