Hiring Nurses from Abroad: Pros and Cons for German Employers

Key takeaways: Nurses from abroad are no longer a niche topic for German hospitals and care providers – since 2022, employment growth in nursing has been carried entirely by immigrant staff [1]. Pros: plannable access to qualified personnel, high retention, legally accelerated procedures. Cons: a lead time of many months, costs under the employer-pays principle, inconsistent recognition practice across the federal states, and genuine integration work. This article lays out both sides – with figures and sources – so you can decide whether and how international recruitment makes sense for your organisation.

Last updated: September 2026. Guidance for employers, not legal advice.

Why the question is being asked at all

According to the Federal Statistical Office's nursing workforce projection of January 2024, Germany will be short of roughly 280,000 to 690,000 nursing professionals by 2049, depending on the scenario [1]. In 2024/2025 about 1.7 million nursing professionals were in employment subject to social insurance; many positions remain unfilled [1]. The Federal Employment Agency's analysis also shows that since 2022 employment growth in nursing has been driven mainly by immigrant nurses [1]. Weighing "pros and cons" today is therefore no longer about whether international nurses work in the system – but whether your organisation takes a structured route or leaves it to others.

Pros: what speaks for nurses from abroad

1. The route is proven and scales

Recognition authorities recognised around 86,600 foreign professional qualifications in 2025, roughly 32,000 of them in nursing – more than in any previous year [2]. The state-run Triple Win programme (GIZ and ZAV) has brought 4,544 nurses and 355 trainees into German facilities over ten years [3]. The process is no longer an experiment but routine with clear responsibilities.

2. High retention when recruitment is fair

For mark-compliant placements, the Gütegemeinschaft Anwerbung und Vermittlung von Pflegekräften aus dem Ausland reports that 90 percent of nurses stay with their first employer for more than a year [4]. Against that, the association cites vacancy costs of up to €70,000 per unfilled position [4]. Both are the association's own figures, not official statistics – but they show the order of magnitude.

3. Legally accelerated procedures with fixed deadlines

Under the fast-track procedure for skilled workers (§ 81a Residence Act), the employer can initiate the entry procedure at the foreigners authority [5]. It bundles recognition, Federal Employment Agency approval and pre-approval of the visa with fixed deadlines: recognition authority generally two months (§ 43 PflAPrV), employment agency one week, visa appointment within three weeks, decision generally three further weeks; fee €411 [5][6][7]. Details in our guide to the fast-track procedure for employers.

4. Plannability instead of competing for the same pool

Recruiting on the local labour market means competing with every other facility nearby for the same applicants. An international pipeline delivers a calculable inflow – with lead time, but without depending on luck. From the perspective of executive and nursing management this is a strategic issue that has to be actively steered [8].

5. Teams become more diverse – and learn from it

The Hessian Institute for Nursing Research describes integration as a reciprocal process in the team from which both sides benefit when it is deliberately shaped [9]. Facilities with several years of experience report that existing staff and newcomers manage the exchange very successfully when colleagues are informed about backgrounds and the recognition process [3].

Cons: what speaks against it – or needs careful planning

1. The lead time is long

Language, recognition, visa: many months lie between selection and the first working day. Language level B2 is generally required to practise nursing [10]. The standard recognition procedure takes up to four months from complete documentation (EU qualifications three months); only in the fast-track procedure two months [6][10]. Start in spring and you will still not have a nurse on the ward by autumn.

2. The employer pays – in full

The employer-pays principle is the core of the state quality seal and of the Triple Win programme: placement, language course, travel and translation are paid by the employer, not the nurse [3][11]. Add the fee for the fast-track procedure (€411) [5] and recognition and examination costs that vary by federal state. An honest total sets these outlays against the cost of the vacancy – our cost calculator does exactly that; the cost blocks are explained in Hire nurses from abroad.

3. Recognition practice differs from state to state

GIZ describes as a persistent systemic challenge that the modalities for adaptation courses leading to recognition still vary greatly between the federal states and that digitalisation of administrative processes is only slowly advancing [3]. Whether a knowledge test or an adaptation course applies, which places are available and how long it takes depends on the location.

4. Integration is work – and needs an owner

Recruitment is the first step, and within an in-house integration management many further steps should follow [11]. Facilities such as Agaplesion Klinikum Hagen have established dedicated integration coordinators who accompany the whole process from application to the German licence [12]. Without that role, support falls to ward managers who have no time for it. It also means recognising and addressing racism and discrimination in everyday nursing [13].

5. The market has bad actors

As demand grows, so does the number of placement providers and models – and the scope of services offered by private providers can look very different from state-regulated programmes [3]. Repayment clauses, hidden fees for candidates or recruitment from WHO-list countries are not only ethically problematic: under § 38 BeschV the Federal Employment Agency may not approve employment from WHO-list states [14]. How to recognise fair providers is explained on the official site of the Faire Anwerbung Pflege Deutschland quality seal.

6. New employer duties

Since 1 January 2026, employers must inform third-country skilled workers about the "Faire Integration" counselling service under § 45c Residence Act [15]. It is a small duty, but it shows that international recruitment carries responsibility beyond the employment contract.

Pros and cons at a glance

When is it worth it – and when not?

It is worth it if your organisation has recurring demand, can build the lead time into workforce planning and is prepared to organise integration as a task with named owners. Then the effort is high once and a process thereafter.

It is not worth it if a single position has to be filled in six weeks, nobody can take on support after arrival, or the budget covers only placement but not language, recognition and onboarding. Then a pro quickly becomes a con – not because of the nurses, but because of the missing structure.

Turning the cons into plannable tasks

1. Choose the procedure: check whether the fast-track procedure fits your cases – it sets fixed deadlines [5].
2. Vet the partner: employer-pays, no repayment clauses, no WHO-list countries, listed by the Gütegemeinschaft [4][14].
3. Demand transparency: you should be able to see at any time where every candidate stands – language level, documents, recognition, visa. On the TalentSure platform that is the default: every step is documented and visible to employers, and contracts are checked for quality-mark compliance before the process starts.
4. Staff the integration: name a responsible person and prepare the team before the first nurse arrives [11][12].
5. Calculate total cost: the benchmark is not the placement fee but the cost of the vacancy [4].

Our page Hire nurses from abroad shows the structured route for hospitals and care providers. For the nurses' own perspective, see our page for international nurses.

Frequently asked questions

How long until a nurse from abroad can start work?

Many months: language level B2, recognition (standard up to four months from complete documentation, two months in the fast-track procedure) and the visa add up [6][10]. The fast-track procedure sets fixed deadlines for authorities and visa [5][7].

What does it cost to hire nurses from abroad?

There is no flat rate. Under the employer-pays principle the employer covers placement, language course, travel and translation [3][11], plus procedural fees such as the €411 for § 81a [5]. The benchmark is the cost of the unfilled position – up to €70,000 according to the Gütegemeinschaft [4].

Do international nurses stay long-term?

For mark-compliant placements the Gütegemeinschaft reports that 90 percent stay with their first employer for more than a year [4]. In-house integration management is decisive [11][12].

Which countries may not be recruited from?

WHO-list states: under § 38 BeschV the Federal Employment Agency may not approve employment in health and nursing professions in those cases [14].

Does the nurse have to pay for the placement?

No. The employer-pays principle is the core of the state quality seal: the employer bears the full cost [11].

Sources

1. Bibliomed Medizinische Verlagsgesellschaft (ed.): e-book "Ausländische Pflegekräfte | 2026 – Pflege international gestalten", Die Schwester | Der Pfleger / f&w, Melsungen, March 2026, p. 4 ("Pflegepersonal in Deutschland – Zahlen und Projekte"; data: Federal Statistical Office nursing workforce projection, January 2024; Federal Employment Agency statistics, May 2025)
2. Federal Statistical Office (Destatis): press release no. 295 of 19 August 2026, "10 % mehr Anerkennungen ausländischer Berufsabschlüsse 2025", https://www.destatis.de/DE/Presse/Pressemitteilungen/2026/08/PD26_295_212.html
3. Bibliomed e-book "Ausländische Pflegekräfte | 2026", op. cit., pp. 20–23 (Björn Gruber, GIZ: "Anwerbeprogramm Triple Win – Nachhaltig und fair")
4. Gütegemeinschaft Anwerbung und Vermittlung von Pflegekräften aus dem Ausland e. V.: "Fragen und Antworten – Welchen Vorteil bietet das RAL Gütezeichen Arbeitgebenden?", https://www.faire-anwerbung-pflege-deutschland.de/haeufige_fragen (accessed 12 Sept 2026)
5. § 81a AufenthG, https://www.gesetze-im-internet.de/aufenthg_2004/__81a.html; IHK Erfurt: "Beschleunigtes Fachkräfteverfahren (§ 81a AufenthG)", https://www.ihk.de/erfurt/fachkraefte/auslaendische-fachkraefte/beschleunigtes-fachkraefteverfahren-6170272 (fee €411; accessed 12 Sept 2026)
6. § 43 Pflegeberufe-Ausbildungs- und -Prüfungsverordnung (PflAPrV), https://www.gesetze-im-internet.de/pflaprv/__43.html
7. § 36 (2) Beschäftigungsverordnung (BeschV), https://www.gesetze-im-internet.de/beschv_2013/__36.html; IHK Frankfurt am Main: "Das beschleunigte Fachkräfteverfahren (§ 81a AufenthG)", https://www.frankfurt-main.ihk.de/hauptnavigation/wirtschaftspolitik/fachkraefte-demografie-und-arbeitsmarkt/auslaendische-fachkraefte/das-beschleunigte-fachkraefteverfahren-81a-aufenthg--6602812
8. Bibliomed e-book "Ausländische Pflegekräfte | 2026", op. cit., pp. 24–26 (Linda König-Balija: "Recruiting ist Chefsache", Celenus/salvea; first published f&w 6/2022)
9. ibid., pp. 8–11 (Christina Gold, Viola Kaets, Ulrike Schulze: "Transkulturelle Pflegeteams – Integration wechselseitig gestalten", Hessian Institute for Nursing Research)
10. Hessisches Landesamt für Gesundheit und Pflege: "Anerkennung internationaler Pflegeabschlüsse – Antrag und Anerkennungsverfahren", https://hlfgp.hessen.de/pflegefachberufe/auslaendische-abschluesse-pflege-antrag-und-anerkennungsverfahren (accessed 12 Sept 2026)
11. Bibliomed e-book "Ausländische Pflegekräfte | 2026", op. cit., pp. 28–29 (Ann-Christin Wedeking: "Transparent und fair anwerben – Gütesiegel Faire Anwerbung Pflege Deutschland")
12. ibid., pp. 32–37 (Robin Keller: "Mein Alltag als Integrationskoordinator", Agaplesion Klinikum Hagen; first published Die Schwester | Der Pfleger 5/2025)
13. ibid., pp. 12–16 (Kai-Philipp Biermann: "Rassismus erkennen und bekämpfen"; first published 1/2024)
14. § 38 Beschäftigungsverordnung (BeschV), https://www.gesetze-im-internet.de/beschv_2013/__38.html
15. IHK Region Stuttgart: "Faire Integration: Neue Pflicht für Arbeitgeber", https://www.ihk.de/stuttgart/fuer-unternehmen/fachkraefte-und-ausbildung/personalgewinnung-und-entwicklung/fachkraefteeinwanderung/neue-pflicht-fuer-arbeitgeber-6845440; BMAS: "Start des Beratungsangebots Faire Integration" (2026), https://www.bmas.de/DE/Service/Presse/Meldungen/2026/start-des-beratungsangebots-faire-integration.html

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For employers: Planning to hire nurses from abroad? Our employer page explains how hospitals and care providers recruit international nurses in a vetted, plannable process with no fees for the candidates.