Germany is undergoing far-reaching demographic change. As people live ever longer lives and the proportion of older people in our society increases, there is a wider need for inpatient and outpatient care services. Hospitals, nursing homes and other care providers are finding it harder and harder to recruit and retain skilled nursing staff. According to the Skills Gap Analysis published by the Federal Employment Agency (BA), there are only 19 candidates for every 100 geriatric nurse vacancies. Recruiting skilled healthcare and nursing staff is therefore a key challenge for Germany.
Working in nursing
Nurses and geriatric nurses are responsible for monitoring, providing advice to and caring for patients, whether in hospitals, care homes or the patients’ homes. Depending on their specialisation and their qualifications, some nursing professionals may also be charged with documenting and evaluating care procedures, following doctors’ orders and assisting doctors in their work. Talking to patients’ families forms another important part of the nursing profession’s work. In light of demographic change, the demand for skilled geriatric nurses is rapidly increasing. It is expected that by 2050, more than twice as many people will be in need of care.
This means that securing an adequate number of skilled nursing staff is an important challenge for Germany. In order to face up to this challenge, a number of different strategies have been devised. These include for example the reform of nursing training which is to be implemented by 2020, as well as the recruitment of nursing professionals from abroad.
Good job opportunities for nursing professionals from abroad
In Germany, anyone wishing to work in nursing requires a licence. In order for your professional qualifications to be recognised, you often need to take an adaptation course to bring your language and professional skills in line with the requirements. Applications for the recognition of professional qualifications need to be submitted to the competent authority of the German Land in which you intend to work. If your application is granted, you are entitled to work across the whole country, irrespective of the Land in which your application has been granted. In order for your application to be successful, the following requirements need to be met:
- You need to have your qualifications recognised in Germany: If you have obtained your nursing qualifications abroad, you need to have these recognised in Germany. The competent authority will verify whether or not the professional qualifications which you have acquired abroad are fully equivalent to the corresponding qualification issued in Germany. If this is not the case, you can sign up for an adaptation course.
- You need to speak German well enough: Depending on the German Land in which you intend to work, you need to prove you have a B1 or B2 German proficiency level under the European Framework of Reference.
- You need to be in good health: You need to present a certificate issued by a German doctor stating that you are physically and mentally fit and able to work in nursing care.
- You need to be trustworthy: In order to prove that you are trustworthy, you need to provide a police-clearance certificate. Depending on your situation, either a police-clearance certificate issued in Germany or issued in your home country will be necessary.
In the recognition procedure, more emphasis is placed on where you obtained your qualification than on which nationality you have:
Professional qualifications acquired in an EU country: If you have acquired your nursing qualifications in a country that is a member of the EU or the European Economic Area, your professional qualifications will usually be recognised automatically. However, anyone wishing to work as a nurse in Germany needs to speak the language. You need to prove that your “level of German is sufficient for practicing your chosen occupation” (as set out in Section 2 (1) no. 4 of the German Nursing Act). This usually corresponds to a B1 or B2 German proficiency level.
Professional qualifications acquired outside the EU: Nursing is included in the list of occupations where Germany is experiencing a skills shortage (whitelist). This means that nursing professionals from outside the EU may be recruited and are allowed to come to Germany to work in nursing in line with the Ordinance on the Employment of Foreigners.
Before you apply for a visa, you need to find out what career paths your professional qualifications will allow you to take in Germany. You need to apply for the recognition of the foreign professional qualifications which you have acquired abroad. The recognition procedure may lead to:
- A full recognition of your professional qualifications: This means that your qualifications have been found to be fully equivalent to the corresponding German qualification and that you have also met all of the other requirements (for example language skills). Once you have obtained a valid job offer, you can apply for a visa from the German mission located in your home country. More information about this can be found in the visa section. Once you are on German soil, you need to apply for a residence permit issued by the foreigners authority to persons for the purpose of working in nursing care (Section 18 (4) Act on the Residence). Please note that in Germany, nursing is a vocational training qualification, and not, like in many other countries, a university course. Consequently, the EU Blue Card does not apply to nurses wishing to work in Germany.
- A partial recognition of your professional qualifications: If the authority scrutinising your application finds that your level of theoretical and practical skills is not sufficient for your qualifications to be fully recognised, you can opt to take an adaptation course in Germany which will bring your qualifications in line with the requirements. If certain criteria are met, you may be granted a visa for the purpose of the recognition of professional qualifications (Section 17a Act on the Residence). This visa gives you 18 months to acquire the missing qualifications by undergoing further training. The training courses you take need to be relevant for the recognition of your professional qualifications. This includes adaptation courses, preparatory courses for examinations, language courses or further training in-house at a company. You are allowed to work part-time and earn money as an auxiliary nurse whilst undergoing adaptation training in Germany. Once you have been granted full recognition, your residence permit may be extended for up to one year, giving you time to find employment as a nursing professional. Detailed information about how you can apply for a visa under Section 17a Act on the Residence can be found in the visa section.
For more information about recognition, examinations, adaptation courses and the German authorities competent for these matters, please go to www.anerkennung-in-deutschland.de.
Becoming a skilled nursing professional
In July 2017, the German government reformed the nursing training system to update the curricula and make the nursing profession more attractive. The reform is to be implemented by 2020. This means that apprentices who start training in nursing before 1 January 2020 will be subject to different rules and regulations than those who start training after 1 January 2020.
Nursing training programme prior to 1 January 2020
Persons wishing to become nursing professionals can choose between three different vocational training programmes. They can train to become ‘nurses’, ‘geriatric nurses’, or ‘paediatric nurses’. All three of these vocational training programmes take three years to complete. The theoretical part of the training takes place at a vocational school or nursing school, whilst the practical part takes place at the workplace. Applicants need to have a school-leaving certificate obtained after 10 years of schooling; if they have completed vocational training in the field of nursing assistance or nursing support, a school-leaving certificate obtained after 9 years is enough. No matter whether they want to train as nurses, geriatric nurses or paediatric nurses, applicants need to bring a number of key skills to the job. They need to be diligent, emphatic, responsible, emotionally stable and in good physical shape in order to meet the wide range of tasks they will be faced with. Potential employers are hospitals and nursing homes, but also, depending on the type of training completed, outpatient care services, residential homes for the elderly, children’s hospitals and many more.
Nursing training programme from 1 January 2020
On 1 January 2020, the new German Nursing Professions Act (Pflegeberufegesetz, PflBG) will enter into force. All applicants starting to train as nursing professionals after this date will undergo two years of general nursing training. In the third year of training, apprentices will either continue general training to become general nurses or specialise to become geriatric or paediatric nurses. Under the new nursing training programme, the theoretical part of the training will continue to take place at a nursing school whilst the practical part will continue to take place at the workplace. Diligence, empathy and responsibility, emotional stability and physical endurance will continue to be crucial personal qualities that apprentices need to have. In addition to this, the wide variety of workplaces that persons training under the new framework can be employed at will remain unchanged. The requirements for starting training in nursing will also remain unchanged. Those who have completed training as general nurses, geriatric nurses or paediatric nurses can also opt to undergo further training to become nursing care specialists. The duration of their initial training will then be factored in. In addition to the vocational training programme for nursing, a new university course for nursing will be introduced. This course will cover all of the skills taught under the vocational training programme and also take into account the ever more complex needs of persons in need of care.
Brief overview of the changes brought about by the reform of nursing training
The reform is transforming some of the fundamental aspects of nursing training and working life. The new reform places a strong focus on general nursing training. This means that everyone training as a nurse will acquire the basic nursing skills needed to care for persons of different ages and with different needs by taking into account new developments in nursing science. Nursing professionals will have better opportunities for finding work, changing jobs, being promoted and for personal development in all areas of nursing care. Persons training under the new programme will also have more flexibility. They can choose the training option that exactly fits their needs; for example, if they want to study, they can opt for the new generalised university degree in nursing. Another plus of this generalised nursing training is that it is recognised across the EU, giving persons working in nursing even more job opportunities. The new nursing training programme will be completely free of charge, and apprentices will receive adequate remuneration.
Click here for an infographic illustrating the reform of the nursing professions in a concise and easy-to-understand manner.
Initiatives / agreements with other countries
The Federal Ministry for Economic Affairs and Energy (BMWi) has launched a pilot project with Vietnam entitled “Recruiting labour from Vietnam to train as nurses in Germany”. Under this programme, young Vietnamese undergo training in Germany to become nursing professionals. The pilot project is being conducted in cooperation with the GIZ.
Its goal is for Germany to build further upon its partnership with Vietnam in the healthcare sector. The Federal Employment Agency is supporting the GIZ in the project. The pilot project has been adapted to the curriculum of the reformed nursing training programme in order to ensure a smooth transition to Germany’s new generalised nursing training system.
Since 2016, two rounds of the project have been launched in Vietnam, preparing young Vietnamese candidates for training as nursing professionals in Germany. The candidates undergo a government-sponsored qualification programme which is conducted in cooperation with the Goethe-Institut in Hanoi. Candidates take a 13-month German language course, in which they also learn technical language. They undergo intercultural training and are given information about the key aspects of working as a nursing care professional in Germany. Once they have passed the language test, the candidates travel to Germany to undergo training there.
Triple Win project
The Triple Win project focuses on both labour market and development policy goals. It also delivers on the promise of establishing a culture that welcomes labour from abroad and recognises their qualifications and skills. The Federal Employment Agency has joined with GIZ to conduct the Triple Win pilot project. The goal of this project is to recruit nursing professionals from abroad to work in Germany. The project is based on agreements that have been struck between the Federal Employment Agency and the employment agencies of the partner countries, namely Bosnia-Herzegovina, Serbia, the Philippines and Tunisia. The employment agencies of the partner countries are responsible for organising the application procedure in their country. They also check the applications for a number of formal criteria. The Federal Employment Agency then organises interviews in which it assesses the personal qualifications, nursing skills and language proficiency of the applicants. Candidates also need to pass a language test as part of the selection procedure. GIZ helps nursing professionals acquire the necessary language skills (level B1 under the European Framework of Reference including the technical language of nursing care), prepares them for working life in Germany and also offers integration courses and supports nursing professionals as they apply for having their professional qualifications recognised in Germany. Up until their professional qualifications have been recognised, the nursing care professionals work as auxiliary nurses. They are required to obtain the recognition of their professional qualifications within the first year of their stay in Germany. Nursing professionals can work in hospitals, outpatient care, and elderly care, but, irrespective of the field in which they work, they are required to undergo the recognition procedure for nursing.