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Recognition of foreign
nursing training
Information for employers and recruitment agencies on the recognition of foreign nursing qualifications
HERE YOU LEARN ...
... which nursing staff (skilled nursing staff, nursing assistants, unskilled nursing assistants) must have their training acquired abroad recognized in Germany
... the requirements under which foreign nursing training can be recognized in Germany
... how the application process for the application for the deficit notice and the visa works
... which documents you need to submit to the relevant authority
... which labor law peculiarities apply when employing a foreign nurse
Written by: Attorney at Law (Berlin)
Publication date: 15.02.2024
Estimated reading time: 14 min.
1 Which nursing staff need recognition?
3 Employ nursing staff with foreign training
3.1 How does the recognition procedure work?
3.2 What documents are required for the application for recognition?
3.3 What documents are required for the visa application (notice of deficit)?
3.4 Employment of a care assistant
3.5 Employment of unskilled nursing assistants from abroad
3.6 Foreigner already residing in Germany (residence permit)
3.7 EU citizens entitled to freedom of movement and training from the EU
Table of Content
1. Which nursing staff require recognition?
Around 15% of nursing staff in Germany are foreign nationals. Apart from Europe, most of these nurses come from Turkey, Russia and South East Asia. It is to be expected that the proportion of care workers migrating to Germany will increase significantly in the future. In this respect, the German government has recently introduced numerous measures to make it easier for care workers to immigrate. This applies, for example, to the possibility of applying for a visa for nursing assistants (Section 22a BeschV) and the simplification of the recognition procedure (Section 43a PflAPrV). These measures are urgently needed, as the care sector is particularly affected by the shortage of skilled workers due to the ageing population.
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Working as a nurse in Germany
In order to work in the care sector in Germany, foreigners need a residence permit (usually a visa) and recognized training in the care sector. In most cases, training from third countries is not recognized in the respective nursing profession. However, recognition of training is a prerequisite for applying for a visa under the Skilled Immigration Act. In order to have foreign training recognized in Germany, nursing staff must therefore undergo a corresponding recognition procedure. The recognition procedure determines whether the foreign training is qualitatively comparable to training under the German Vocational Training Act. The recognition procedure ends with the issuance of a deficit notice, in which it is determined which compensatory measures are necessary for working as a skilled worker in Germany. A visa can be applied for on the basis of this decision. The visa can be used to complete the recognition training in Germany, after which a professional license is issued in accordance with the Nursing Professions Act (PflBG) (e.g. as a nurse).
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When applying for a visa, a distinction is made between the following levels of training:
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Care worker is to be employed as a care worker in accordance with the PflBG,
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Caregiver is to be employed as a caregiver in accordance with national regulations (e.g. as a nurse),
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Caregiver is to be employed as an unskilled nursing assistant (e.g. with a basic nursing course).
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Depending on the training of the caregiver, different requirements apply for applying for the deficit notice and subsequently
the visa on the basis of the deficit notice. The necessary procedure is explained below.
2. What is a deficite notice?
2.1 What is a deficit notice?
The deficit notice is an administrative act that determines whether and to what extent foreign training is comparable to German training and which compensatory measures (theoretical and practical instruction) are necessary in order to obtain a license to practice
as a nurse. A deficiency notice exists in different versions, depending on which training is to be recognized. The
question of which training is to be recognized always depends on which position has been agreed with the caregiver
in the employment contract or which activities the caregiver is to carry out.
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The starting point for determining the correct procedure is always the position agreed in the employment contract
(care worker or care assistant with or without training) and the place of residence (Germany, European Union, third
Union, third country) of the foreigner. If the employee is already resident in Germany
Germany, a job without recognized training is also possible under certain conditions.
The same applies to European citizens.
What are only care professionals allowed to do?
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Assessing and determining individual care needs
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Organization, design and control of the care process
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Analysis, evaluation, assurance and development of quality
Applying for a visa for unskilled nursing assistants (e.g. with a basic nursing course) is only possible under very specific conditions. In this respect, the employment of unskilled nursing staff does not constitute a "qualified activity", meaning that the Skilled Immigration Act does not apply. The unskilled nursing assistant is therefore excluded from most work visas. Nursing assistants can therefore only apply for a visa if the main purpose of their stay is not to work, but the visa still allows them to work.
The following visas fulfill these criteria:
Employment of certain nationals: certain nationals can obtain a visa without having to prove a specific purpose of stay (so-called "best friends states").
Best friends countries include the following nations: Australia, Israel, Japan, Canada, the Republic of Korea, Monaco, New Zealand, San Marino, the United Kingdom of Great Britain and Northern Ireland within the meaning of Section 1(2)(6) of the Freedom of Movement Act/EU and the United States of America. Due to bilateral and multilateral agreements, there are other countries that can apply for residence in Germany under simplified conditions. You can obtain more detailed advice from a specialist lawyer for migration law.
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Family reunification: Residence for the purpose of family reunification leads to strong privileges with regard to residence opportunities (in particular with regard to further integration). One of these advantages is that the foreigner may pursue any gainful employment to an unlimited extent, regardless of whether it is a qualified or unqualified activity. In order to obtain a visa for family reunification, the foreigner must have a foreign or German family member (spouse or child). If in doubt, you can find out the other requirements for family reunification from a lawyer specializing in immigration law.
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Western Balkans regulation: Finally, care workers from the Balkan region can also benefit from the so-called "Western Balkans regulation". The Western Balkans regulation was reformed with the last reform of the Skilled Immigration Act and is now increasingly being applied. The Western Balkan countries include the following states: Bosnia and Herzegovina, Kosovo, Montenegro, North Macedonia and Serbia.
2.3 Voraussetzungen und Dokumente Defizitbescheid (Anerkennungsantrag)
The deficit notice is an administrative act that determines whether and to what extent foreign training is comparable to German training and which compensatory measures (theoretical and practical instruction) are necessary in order to obtain a license to practice as a nurse. A deficiency notice exists in different versions, depending on which training is to be recognized. The question of which training is to be recognized always depends on which position has been agreed with the caregiver in the employment contract or which activities the caregiver is to carry out.
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The starting point for determining the correct procedure is always the position agreed in the employment contract
(care worker or care assistant with or without training) and the place of residence (Germany, European Union, third
Union, third country) of the foreigner. If the employee is already resident in Germany
Germany, a job without recognized training is also possible under certain conditions.
The same applies to European citizens.
2.4 Requirements and documents Visa application (deficit notice)
The deficit notice is an administrative act that determines whether and to what extent foreign training is comparable to German training and which compensatory measures (theoretical and practical instruction) are necessary in order to obtain a license to practice as a nurse. A deficiency notice exists in different versions, depending on which training is to be recognized. The question of which training is to be recognized always depends on which position has been agreed with the caregiver in the employment contract or which activities the caregiver is to carry out.
​
The starting point for determining the correct procedure is always the position agreed in the employment contract
(care worker or care assistant with or without training) and the place of residence (Germany, European Union, third
Union, third country) of the foreigner. If the employee is already resident in Germany
Germany, a job without recognized training is also possible under certain conditions.
The same applies to European citizens.
2. What is a deficite notice?
The deficit notice is an administrative act that determines whether and to what extent foreign training is comparable to German training and which compensatory measures (theoretical and practical instruction) are necessary in order to obtain a license to practice as a nurse. A deficiency notice exists in different versions, depending on which training is to be recognized. The question of which training is to be recognized always depends on which position has been agreed with the caregiver in the employment contract or which activities the caregiver is to carry out.
​
The starting point for determining the correct procedure is always the position agreed in the employment contract
(care worker or care assistant with or without training) and the place of residence (Germany, European Union, third
Union, third country) of the foreigner. If the employee is already resident in Germany
Germany, a job without recognized training is also possible under certain conditions.
The same applies to European citizens.
2. What is a deficite notice?
The deficit notice is an administrative act that determines whether and to what extent foreign training is comparable to German training and which compensatory measures (theoretical and practical instruction) are necessary in order to obtain a license to practice as a nurse. A deficiency notice exists in different versions, depending on which training is to be recognized. The question of which training is to be recognized always depends on which position has been agreed with the caregiver in the employment contract or which activities the caregiver is to carry out.
​
The starting point for determining the correct procedure is always the position agreed in the employment contract
(care worker or care assistant with or without training) and the place of residence (Germany, European Union, third
Union, third country) of the foreigner. If the employee is already resident in Germany
Germany, a job without recognized training is also possible under certain conditions.
The same applies to European citizens.
2. What is a deficite notice?
The recognition partnership must also fulfil the following requirements:
1. the foreigner has at least two years of state-recognised foreign vocational training,
2. there is a concrete job offer with an employer who is suitable for the training,
3. the foreigner and the employer undertake to start the qualification measures immediately after the foreigner's arrival,
4. the foreigner has at least A2 language skills,
5. the Federal Employment Agency has approved the employment.
Proof of the foreign vocational training must be provided to the foreigners authority or embassy. Recognition abroad is checked by the Central Office for Foreign Education (ZAB). The examination of the recognition of foreign vocational training can be applied for online at the ZAB (from the end of April 2024)
3.5 Employment of unskilled nursing assistants from abroad
4.1 Ausländer hält sich bereits in Deutschland auf (Aufenthaltserlaubnis)
Applying for a visa for unskilled nursing assistants (e.g. with a basic nursing course) is only possible under very specific conditions. In this respect, the employment of unskilled nursing staff does not constitute a "qualified activity", meaning that the Skilled Immigration Act does not apply. The unskilled nursing assistant is therefore excluded from most work visas. Nursing assistants can therefore only apply for a visa if the main purpose of their stay is not to work, but the visa still allows them to work.
The following visas fulfill these criteria:
Employment of certain nationals: certain nationals can obtain a visa without having to prove a specific purpose of stay (so-called "best friends states").
Best friends countries include the following nations: Australia, Israel, Japan, Canada, the Republic of Korea, Monaco, New Zealand, San Marino, the United Kingdom of Great Britain and Northern Ireland within the meaning of Section 1(2)(6) of the Freedom of Movement Act/EU and the United States of America. Due to bilateral and multilateral agreements, there are other countries that can apply for residence in Germany under simplified conditions. You can obtain more detailed advice from a specialist lawyer for migration law.
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Family reunification: Residence for the purpose of family reunification leads to strong privileges with regard to residence opportunities (in particular with regard to further integration). One of these advantages is that the foreigner may pursue any gainful employment to an unlimited extent, regardless of whether it is a qualified or unqualified activity. In order to obtain a visa for family reunification, the foreigner must have a foreign or German family member (spouse or child). If in doubt, you can find out the other requirements for family reunification from a lawyer specializing in immigration law.
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Western Balkans regulation: Finally, care workers from the Balkan region can also benefit from the so-called "Western Balkans regulation". The Western Balkans regulation was reformed with the last reform of the Skilled Immigration Act and is now increasingly being applied. The Western Balkan countries include the following states: Bosnia and Herzegovina, Kosovo, Montenegro, North Macedonia and Serbia.
The activities for which recognition or a license to practice the profession is required can be found in § 4 Para. 2 No. 1 - 3 PflBG.
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Beschäftigung bestimmter Staatsangehöriger: Bestimmte Staatsangehörige können ein Visum erhalten, ohne dass sie einen bestimmten Aufenthaltszweck nachweisen müssen (sog. “Best-Friends-Staaten”).
Zu den Best-Friends-Staaten gehören die folgenden Nationen: Australien, Israel, Japan, Kanada, der Republik Korea, von Monaco, Neuseeland, San Marino, des Vereinigten Königreichs Großbritannien und Nordirland im Sinne des § 1 Absatz 2 Nummer 6 des Freizügigkeitsgesetzes/EU sowie der Vereinigten Staaten von Amerika. Aufgrund von bi- und multilateralen Abkommen gibt es weitere Staaten, die unter erleichterten Bedingungen einen Aufenthalt in Deutschland beantragen können. Vertiefende Beratung erhalten Sie bei einem Fachanwalt für Migrationsrecht.
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Familiennachzug: Der Aufenthalt zum Zwecke des Familiennachzugs führt zu einer starken Privilegierung hinsichtlich der Aufenthaltsmöglichkeiten (insb. bzgl. der weiteren Integration). Einer dieser Vorteile ist, dass der Ausländer in unbeschränktem Umfang jeder Erwerbstätigkeit nachgehen darf, unabhängig davon, ob es sich um eine qualifizierte oder eine unqualifizierte Tätigkeit handelt.
Um ein Visum zum Familiennachzug zu erhalten, muss der Ausländer einen ausländischen oder deutschen Familienangehörigen haben (Ehegatte oder Kind). Die weiteren Voraussetzungen des Familiennachzugs erfahren Sie im Zweifel bei einem Rechtsanwalt für Immigrationsrecht.
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Westbalkanregelung: Zuletzt können auch Pflegekräfte aus der Balkanregion von der sog. “Westbalkanregelung” profitieren. Die Westbalkanregelung wurde mit der letzten Reform des Fachkräfteeinwanderungsgesetzes reformiert und wird nun vermehrt angewendet. Zu den Westbalkanländern gehören die folgenden Staaten: Bosnien und Herzegowina, Kosovo, Montenegro, Nordmazedonien und Serbien.
3.6 Foreigner already residing in Germany (residence permit)
If the foreigner is already in Germany, the employment options are extended, at least with regard to unskilled nursing assistants. In this respect, the same applies to the employment of skilled nursing staff as to the visa process (see above).
Unskilled nursing assistants who are in Germany can be employed here if they are permitted to work according to their residence status. This is generally the case for the following residence titles:
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The care worker comes from the best-friends states, from the Western Balkans or can apply for residence for family reunification (see above).
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The caregiver already has a settlement permit or has even been naturalized.
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The caregiver is a foreigner with a residence permit or tolerated stay and has an employment permit (Federal Employment Agency).
3.7 EU citizens entitled to freedom of movement and training from the EU
Numerous simplifications apply to the recognition of European vocational training. This applies both under residence law (European freedom of movement) and with regard to the recognition of vocational training. In principle, recognition of training acquired in Europe is possible if the respective certificates of equivalence can be issued. If in doubt, a lawyer specializing in migration law can advise you on this.
4. Labor law for foreign nursing staff
How does the employment contract of foreign carers differ?
For compliance reasons, the employment contract for carers should be adapted to the respective professional practice permit and the residence status of the carer. In this respect, the Federal Employment Agency will not approve the employment if, for example, the job description includes activities for which a professional licence is required. The residence status is also relevant, as it should be avoided that the employment relationship formally begins before the carer has received the employment permit (condition precedent).
What happens if the training schedule cannot be adhered to (e.g. pregnancy)?
If it is not possible to complete the training within the planned period (e.g. due to pregnancy or prolonged illness), an extension of the residence permit for recognition must be applied for. However, it should be noted that the residence permit cannot be extended indefinitely. If the training has effectively failed, the foreigners authority can no longer extend the residence permit.
Can the employer reclaim the costs from the carer if the training is cancelled?
Employers take a financial risk when they assume the administrative costs for the carer's immigration in accordance with the Employer Pays Principle. Employers understandably try to secure repayment of these costs by means of various binding clauses in the employment contract. However, there is very detailed case law from the Federal Labour Court on the effectiveness of repayment and commitment clauses in employment contracts, which is why very high requirements regularly apply to such clauses.
Can recruitment agencies pass on the placement costs to the carers?
Placement clauses can only be passed on to the placed person under strict conditions. In this respect, recruitment agencies are brokerage contracts with a social law element. In the case of brokerage contracts, the legislator generally assumes that administrative costs are already covered by the brokerage fee. Brokerage costs can therefore not be passed on to employees.
5. FAQ Employment of foreign nursing staff
With regard to the required language skills, a distinction must be made between the individual administrative procedures. In principle, A2 language skills are required to carry out the visa procedure with the decision on deficits. B2 language skills are required for the issue of the professional license. However, no language skills at all are required to apply for the deficiency certificate itself. The examination of language skills is not the responsibility of the recognition authorities. Insofar as the information sheets of the recognition authorities provide otherwise in some cases, this information relates to the requirements of employers and training providers. However, if language skills are already available, corresponding proof must be submitted.
Yes, the recognition procedure can also be carried out as part of the accelerated skilled worker procedure. The foreigners authority then takes over the recognition procedure for nursing training from third countries.
After completing the adaptation measure, the foreigner is a skilled worker within the meaning of the Skilled Immigration Act and can therefore apply for a settlement permit after four years instead of five. As the skilled worker also has B2 language skills, he or she is also considered to be "particularly well integrated". This reduces the residence time required for naturalization.
