How does the nurse recognition process work in Germany? – DE

From a nurse perspective, becoming a registered nurse in Germany can be confusing. From an employer perspective, the amount of work to process the qualification recognition paperwork and the effort to organize training for a candidate to go from a Nurse Assistant to a Registered Nurse can be daunting. 


Foreign nurses and German employers are often left wondering what the best path to becoming a registered nurse is. 


Some of the questions we hear from foreign nurses every day include:

  1. Do I  need to recognize my nurse qualifications in order to work as a nurse in Germany? 
  2. Will I be required to do a qualification recognition measure (“Anpassungsmaßnahme”) in Germany to become a registered nurse?


Some of the questions we hear from German employers are: 

  1. How lengthy is the qualification recognition paperwork process and how can we avoid deployment delays due to bureaucracy? 
  2. What is the best training for nurses so that they are ready to pass their Registered Nurse examination?


One question that we hear overall is: 5) What qualification recognition measure options are there? 


Don´t worry, we are here to help and will break these topics down for you. 


Let´s start with the basics… 


1) Who needs to recognize their nurse qualifications in order to work as a nurse in Germany?

The first answer is very simple: if you have a degree in nursing or a nursing license from a EU country, you do not have to undergo the Qualification Recognition (QR) process. 

However, what happens if you are a foreign nurse that is already in Europe and wants to become a nurse in Germany? Regardless of what visa status you currently have and whether you have already obtained a Qualification Recognition (QR) in your current country, you will have to undergo the German QR process and file your paperwork in order to become a nurse in Germany. 


2) Will I be required to do a Qualification Recognition (QR) Measure to become a Registered Nurse?


The short answer is: if your degree is from outside Europe, most likely yes. 


While you might have obtained a university nursing degree in your home country, which might be considered superior to the 3 year technical German nursing degree, the German authorities want to ensure that you are properly trained to succeed at your new job in Germany. From CWC´s experience of bringing hundreds of foreign nurses to Germany over the past 9 years, 99% of foreign nurses recruited from outside Europe are currently required to undergo a Qualification Recognition Measure (Anpassungsmaßnahme) upon arrival in Germany to become a registered nurse in Germany. One important point to note is that QR decisions might vary across local authorities. Given the German political system, each of the 16 states “Bundesländer” may choose their own processes and decision-making. However, while a few Bundesländer were in the past giving foreign nurses the full recognition, this trend has now subsided and all states have converged towards requiring the QR measure from all nurses with nursing degrees outside of Europe. 


3) How lengthy is the QR process and can it negatively affect deployment timelines?


Every Bundesland in Germany has their own slightly different version of the QR document process and timelines. Our experience since 2012 has shown that processing timelines range anywhere between 6 weeks and 10 months! Therefore, it is important to understand the process of the particular authority that will review each candidate’s documentation in order to avoid unnecessary delays. In March 2020, the “beschleunigtes Fachkräfteverfahren”” was implemented in Germany to expedite the QR decision-making process, which works well across certain Bundesländer. 


To expedite the process, Care With Care works closely with both the candidates and the German employers to have all the required paperwork ready, notarized and translated by the time the candidate receives a job offer. At that point, Care With Care submits the paperwork to the responsible authority: our goal is to receive the QR results by the time the candidate has passed his / her language examination. 


Care With Care believes in keeping all stakeholders informed regarding timelines, next steps and expectations, in order to create maximum transparency and allow both candidates and employers to properly prepare for the deployment to Germany. 


4) How can employers ensure the best training to ensure candidates succeed in becoming a Registered Nurse?


Every employer is set up differently and it is crucial to identify which QR measure will work best at their institution. As you will see below, the options range from offering a “Lehrgang” training at your institution to outsourcing the training to partner nursing schools. At Care With Care, we work closely with employers to identify the resources that they can invest into the QR training and the timelines expectations for the nurses to become fully registered. We can offer different options and always have an open mind to testing alternative models, as long as we do not compromise the quality of the training. If you are interested in exploring QR opportunities, feel free to contact us


5) What Qualification Recognition (QR) Measures exist and how is this path decided?


There are two main QR Measure options: a) the “Lehrgang” and b) the “Kenntnisprüfung”.


  1. Lehrgang- QR Measure: This measure consists of an internship at the employer, during which candidates practice all the deficits that the local authority identified during the QR process. The local authority reviews the nursing curriculum from the candidate’s school and country, and identifies which topics were not covered at all or enough during the studies. Therefore, all nurses from one country – for example the Philippines – should receive the same “partial recognition” result (“Defizitbescheid”). If the candidate has prior work experience, the authority might take this into consideration and reduce your deficit topics. The Lehrgang measure length is determined by the authority and lasts 4-10 months. At the end of the Lehrgang, the candidate will have an oral examination at your employer. One important detail is that many employers cannot offer the Lehrgang- QR option as they might not be set up to offer the proper training. 


  1. Kenntnisprüfung- QR Measure: This measure consists of preparing and taking a theory and a practical exam at a German nursing school. The preparation for these exams may vary: it could take place in the country of origin, virtually while the candidate is working at the employer or on-campus at a nursing school. The preparation timeline ranges from 1-6 months and is not set by the German local authority but instead by a combination of the employer / the recruitment agency / and nursing school that are supervising the QR journey.


Now that you are familiarized with the two QR Measure models, let us share a few “must knows”: 

  • 18 months: This is the time limit for a candidate to successfully pass the QR Measure in Germany. Otherwise, the candidate will have to return to your home country. 
  • Language: Please note that even if a candidate passes the QR Measure, he / she will not become a Registered Nurse unless they have successfully passed the German B2 exam.
  • Decision makers: The QR Measure option is decided by 1) which local authority reviews the case and 2) what training is most applicable to the employer.
  • Getting paid: It is important that you work at least part-time as a Nurse Assistant during your QR Measure, and therefore get paid during that time. 
  • Best & Worse: There are no “better or worse” QR Measures as long as your agency is focused on quality and setting the candidate up for long-term success in Germany.
  • Have a plan: Make sure that candidates have a QR Measure plan before leaving the country of origin. This plan is crucial for to become a registered nurse and integrate in Germany. 


CWC has had almost 10 years of experience developing QR Measures that set foreign nurses up for success upon arriving in Germany. 93% of our nurses have passed the QR Measure on the first try and 99.8% have received their German nurse license (“Urkunde”) upon arriving in Germany. 


Our advice to all foreign nurses is: no matter which agency or employer you decide to work with, make sure that they have experience helping you become a registered nurse once you are in Germany. This might be the most crucial step for your long-term success in your new job. 


Our advice for all employers is: we recommend having a solid QR plan for your candidates upon arriving in Germany as it is crucial to ensure their long-term success in your institution and in this new country. Care With Care can gladly help you design a QR plan that works for you and your candidates. 

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