Professional Recognition for Foreign Nursing Staff in Germany

Anyone wishing to work as a foreign nursing professional in Germany requires a licence to do so, as this is a regulated profession (see Sections 1 (1), 58 (1) and (2) of the German Nursing Professions Act, PflBG). The basic requirements for this are regulated in Section 2 PflBG: A recognised vocational or higher education qualification, an impeccable police clearance certificate, health suitability and a certain level of German language skills (B2-B1, depending on the federal state). To fulfil the training requirements, nursing staff with non-German professional qualifications usually have to apply for recognition to the responsible authority. This usually involves a considerable amount of administrative work. If the application is incorrect or the documentation is incomplete, these procedures can take a disproportionately long time.

Another point that complicates the initial situation considerably is the substantial number of authorities involved in this procedure. In the worst-case scenario, one must mediate independently between the German embassy, German immigration authorities, the employment agency, the recognition office for professional qualifications and the employer.

In addition, the legal situation is highly complex and multi-layered. The main reason for this is competing legal standards. The PflBG came into force in Germany in 2020. One of the main aims of the law was to merge training, which had previously been divided into nursing, paediatric nursing, and geriatric nursing in Germany, into one general nursing training programme. In this respect, it replaced the previous provisions of the German Nursing Act (KrPflG) and the German Nursing Act for the Elderly (AltPflG). However, the conversion for the recognition process was expected to be particularly complicated and lengthy, so a kind of transitional regulation was explicitly found for the recognition processes in Section 66 (a) PflBG. According to this, the respective previous standards can continue to apply until the end of 2024 if the requirements for the new regulations have not yet been met at the place of application. In addition to the latest introduction of the PflBG, the Skilled Immigration Act (FachKrEG) was enacted simultaneously. This regulates the immigration requirements for (nursing) professionals. This law was then comprehensively revised in 2023 to better counteract Germany’s shortage of skilled workers. This makes determining the relevant standard particularly complicated and often requires analysis by an experienced lawyer.

To be able to work as a nurse in Germany, regardless of the exact job title (nurse, paediatric nurse, or geriatric nurse), the recognition of professional training is required. The recognition centres in Germany, appointed by the respective federal states, are responsible for professional recognition. In North Rhine-Westphalia, for example, the application must be submitted to the central recognition centre for health professions (zentrale Anerkennungsstelle für Gesundheitsberufe ). The exact requirements for the recognition of foreign nursing qualifications depend on the specific constellation. However, a basic distinction can be made between two groups of cases: Recognition of equivalence or the need for an adaptation course.

Section 40 (2) PflBG requires an ‘equivalent qualification’ for nursing staff with a qualification from a third country. According to this complex and confusing legal standard, training in a third country is deemed equivalent if it does not differ significantly from German training. The authorities regularly check this in two steps.

Firstly, the reference occupation is determined to assess the equivalence then. When determining the reference occupation, it is established whether the foreign training sufficiently overlaps with the desired occupation. A paediatric nurse, for example, would not have a significant overlap with the occupational profile of a geriatric nurse. The equivalence of the training is then assessed. Here, the authority decides whether the existing differences between the training programmes in terms of theoretical and practical training or the legal regulation of the nursing profession in the country of origin are to be classified as substantial.

If necessary, Section 40 (2) sentence 2 PflBG allows existing differences to be compensated for by professional experience or skills acquired elsewhere. If the differences are insignificant, the foreign training is recognised as equivalent. If, on the other hand, the differences between the two professions are substantial in the opinion of the authorities, the person concerned has two options for practising the profession of carer based on their previous training. On the one hand, it is possible to complete an adaptation course (Section 40 para. 3 sentence 2 PflBG); on the other hand, it is conceivable to take a knowledge test.

The deadlines in the recognition processes stipulate a processing time of four months, but only from when the collected documents are available (see Section 43 (3) sentences 1 and 2 of the Training and Examination Ordinance for the Nursing Professions, PflAPrV). Legal and advocacy practice shows that several things can be done to keep the expected waiting times as short as possible.

Firstly, it is helpful to collect all the required documents, translate and notarise them if necessary and then submit them in a bundle. This will prevent consultations, and the waiting period will begin as soon as possible. At this point, legal support is particularly recommended. Our lawyers will check which documents are required in total and arrange the respective translations and notarisations for you so that the completeness of your application is guaranteed.

However, the waiting periods can also be shortened in purely legal terms. The newly enacted Section 81 (a) of the German Residence Act (AufenthG) and the accelerated visa procedure it enables play a particular role here. This stipulates that the applicant’s employer leads the application process. An agreement is concluded between the immigration authorities and the employer following Section 81 (a) (2) AufenthG so that it is clear from the outset for all parties involved that the permanent position will follow directly after the work has been authorised. If this accelerated procedure is chosen for nursing staff, the four-month period already mentioned will be reduced to a two-month period (Section 43 (2) sentence 2 PflAPrV). If an employer exists and is involved, the processing time for professional recognition can be significantly reduced.

The German immigration team at Schlun & Elseven Rechtsanwälte utilises all available options to effectively speed up the procedure so that you can start work sooner. Our lawyers will provide you with legal advice on the options available to you for professional recognition. We are also at your side for follow-up questions and will advise you on possible residence permits and other challenges under German immigration law.