Knowledge Test for Foreign Nurses in Germany: An Employer's Guide (2026)
Key takeaways: If the recognition authority finds substantial differences between a foreign and the German nursing qualification, the nurse has to complete a compensation measure – an adaptation course or a knowledge test (Kenntnisprüfung) [1]. The knowledge test is a state examination with an oral part (45–60 minutes) and a practical part (two to four care situations, at most 120 minutes each); each part can be retaken once [3]. It should be offered at least twice a year, and the nurse must be able to sit it within six months of the recognition decision [3]. For employers, this is where a nursing assistant becomes a registered nurse – hospitals plan around ten months to a year for preparation [6][7]. This guide explains the format, deadlines, residence rules and how to organise preparation.
Last updated: October 2026. Guidance for employers, not legal advice. The federal states' authorities are responsible; details such as fees and registration vary by state.
When is a knowledge test required?
Nurse (Pflegefachfrau/Pflegefachmann) is a regulated profession. Anyone with a non-EU qualification who wants to work as a registered nurse in Germany needs a licence under the Nursing Professions Act; the competent state authority checks equivalence under § 40 PflBG [1]. That affects many people: in 2025 around 86,600 foreign qualifications were recognised nationwide, about 32,000 of them in nursing [8].
If the authority finds substantial differences, the nurse receives a decision listing them. She or he then chooses: adaptation course or knowledge test (§ 40 (3) PflBG) [1]. Since 16 December 2023 the nurse can also waive the equivalence assessment entirely and go straight to the knowledge test or adaptation course (§ 40 (3a) PflBG) [1]. That saves time where differences are foreseeable anyway.
For the equivalence assessment itself, the authority generally decides within four months of receiving complete documents, and within two months in the fast-track skilled worker procedure (§ 43 PflAPrV) [2]. Our guide to recognising foreign nursing qualifications covers the full recognition procedure.
Format of the knowledge test
The knowledge test is a state examination before a state examination board. It takes place at nursing schools or universities under § 6 PflBG, or at comparable institutions recognised by the authority [3]. It has two parts [3]:
| Oral part | Practical part | |
|---|---|---|
| Content | One complex task covering at least three different competence areas of the training [3] | At least two and at most four care situations in which the nurse demonstrates reserved activities and the nursing process [3] |
| Duration | At least 45, at most 60 minutes [3] | At most 120 minutes per care situation [3] |
| Examiners | Two specialist examiners [3] | Two specialist examiners [3] |
| Passed if | All examiners award at least "sufficient (4)" [3] | All examiners rate the performance as "passed" [3] |
| Retake | Once [3] | Each failed care situation once [3] |
The practical part normally takes place with real patients; with the authority's approval a simulation is also possible [3]. Hesse shows what this looks like in practice: candidates care for up to four people, written care planning is required for one of them, and the oral part covers a complex case plus topics such as the nursing process, communication, interprofessional collaboration, legal and ethical foundations, and evidence-based practice [4].
Deadlines and exam dates
Two rules in § 45 PflAPrV matter for your workforce planning [3]:
- The knowledge test should be offered at least twice a year.
- The nurse must be able to take it within six months of the equivalence decision.
Exam dates are therefore scarce. Missing a date or failing a part can quickly cost half a year. Build the exam date into your plan from the start and align preparation with it.
Language: the licence requires German at B2 level. Hesse, for example, accepts telc B2, Goethe-Zertifikat B2, the nursing language exam (Fachsprachprüfung Pflege) or TestDaF [4]. The language exam is separate from the knowledge test – it should be done by the time of the exam so the licence can be issued straight afterwards.
Residence during preparation
Most nurses prepare for the knowledge test in Germany. The Residence Act offers two routes [5]:
- Residence for recognition measures (§ 16d (1) Residence Act): the permit is issued for up to 24 months and can be extended by at most twelve months to a total of three years. German at A2 level or above is required. Employment unrelated to the measure is permitted for up to 20 hours a week [5].
- Recognition partnership (§ 16d (3) Residence Act): the nurse works for you from day one while recognition is under way. Requirements are a state-recognised qualification from the home country with at least two years of training, a concrete job offer, and a written agreement in which the nurse commits to pursuing recognition and you commit to enabling the compensation measure. The permit is initially valid for at most one year and can be extended to three years [5].
An exam-only visa (§ 16d (5) Residence Act), by contrast, does not permit employment [5] – so it is rarely the right route for employers. Our guide to the Skilled Immigration Act explains the immigration routes in more detail.
Knowledge test or adaptation course?
The nurse makes the choice [1], but your facility shapes what is realistic. The adaptation course compensates for the differences named in the decision through theory and practice and lasts at most three years [1]. The knowledge test assesses the nurse's overall competence instead – it is the faster route when the nurse is professionally strong and your facility can offer structured preparation.
How hospitals do it in practice:
- Agaplesion Klinikum Hagen prefers the knowledge test and prepares nurses in around ten months – two days of online teaching per week, two to three classroom days per month, practical instruction on the wards and several mock exams [6].
- University Hospital Cologne plans around one year for recognition: an induction week, a six-week nursing-language course, then the preparation course for the knowledge test, supported by practice instructors released from ward duty [7].
- UKE Hamburg mostly uses adaptation programmes in its own training academy that combine ward placements with language support [7].
Employer checklist
- Read the decision: which differences does the authority name? They determine what preparation must focus on.
- Choose the route: knowledge test or adaptation course – together with the nurse and in line with your practical instruction capacity. Where differences are foreseeable, consider waiving the equivalence assessment (§ 40 (3a) PflBG) [1].
- Secure an exam date: clarify registration with the state authority early; the exam must be possible within six months of the decision [3].
- Organise preparation: preparation course, nursing language, ward-based instruction and mock exams – as in Hagen and Cologne [6][7].
- Pick the right residence route: § 16d (1) or the recognition partnership under § 16d (3); keep an eye on permit deadlines [5].
- Prove B2 in time: finish the language exam in parallel so the licence can follow the knowledge test directly [4].
- Plan for integration: until the licence is granted the nurse works below their qualification. Our guide to integrating international nurses shows how to support this in the team.
How TalentSure helps
TalentSure is not a traditional recruitment agency but a platform: employers, vetted sourcing partners in the source countries, language schools and the recognition and visa workflows all work in one place. For the knowledge test that means each nurse's decision, language certificate, exam date and residence deadlines are documented and visible to you at any time – so you see early when a date or deadline is at risk. For an overview of cost and process, see Hire international nurses in Germany; to talk about your facility, get in touch.
Frequently asked questions
What is the knowledge test for foreign nurses?
A state examination that lets nurses from non-EU countries compensate for substantial differences from German training. It consists of an oral part (45–60 minutes) and a practical part with two to four care situations [3].
Who decides whether a knowledge test is needed?
The competent state authority determines during recognition whether substantial differences exist. If they do, the nurse chooses between the knowledge test and an adaptation course [1].
How often can the knowledge test be retaken?
The oral part and each failed care situation in the practical part can be retaken once [3].
How long does preparation take?
It depends on the nurse and the facility. Hospitals such as Agaplesion Hagen and University Hospital Cologne plan around ten months to a year [6][7].
Can the nurse work during preparation?
Yes, depending on the residence permit. With the recognition partnership the nurse works for you from day one; with a permit under § 16d (1) Residence Act, unrelated employment of up to 20 hours a week is allowed. An exam-only visa does not permit employment [5].
Sources
- § 40 Nursing Professions Act (PflBG), https://www.gesetze-im-internet.de/pflbg/__40.html (para. 3a inserted by the Pflegestudiumstärkungsgesetz, in force since 16 Dec 2023)
- § 43 Nursing Training and Examination Regulation (PflAPrV), https://www.gesetze-im-internet.de/pflaprv/__43.html
- § 45 Nursing Training and Examination Regulation (PflAPrV) – knowledge test, https://www.gesetze-im-internet.de/pflaprv/__45.html
- Hessisches Landesamt für Gesundheit und Pflege: "Anerkennung internationaler Pflegeabschlüsse – Antrag und Anerkennungsverfahren", https://hlfgp.hessen.de/pflegefachberufe/auslaendische-abschluesse-pflege-antrag-und-anerkennungsverfahren (accessed 2 Oct 2026)
- § 16d Residence Act (AufenthG), https://www.gesetze-im-internet.de/aufenthg_2004/__16d.html
- Bibliomed Medizinische Verlagsgesellschaft (ed.): e-book “Ausländische Pflegekräfte | 2026 – Pflege international gestalten”, Die Schwester | Der Pfleger / f&w, Melsungen, March 2026, pp. 32–37 (Robin Keller: "Mein Alltag als Integrationskoordinator", Agaplesion Klinikum Hagen)
- Bibliomed Medizinische Verlagsgesellschaft (ed.): e-book “Ausländische Pflegekräfte | 2026 – Pflege international gestalten”, Die Schwester | Der Pfleger / f&w, Melsungen, March 2026, pp. 72–74 (Sonja Buske: "Mehr als Rekrutierung – Wie Kliniken internationale Fachkräfte gewinnen"; first published in f&w 3/2026)
- Federal Statistical Office (Destatis): press release no. 295 of 19 August 2026, https://www.destatis.de/DE/Presse/Pressemitteilungen/2026/08/PD26_295_212.html