Nurse in Germany: requirements and how to qualify, step by step

To work as a nurse in Germany, you need:

• a nursing qualification recognised in Germany
• upper-intermediate German, level B2
• the state office's licence, called the Erlaubnis, to use the protected title Pflegefachfrau or Pflegefachmann (registered nurse)

If you are not an EU, EEA or Swiss citizen, you also need a residence permit for recognition and then work.

Before paying for translations or certified copies, check the document list from the office in your chosen state. You usually need:

• your nursing qualification
• your training curriculum
• a record of placement hours in acute care, long-term care and care at home (outpatient care)
• any professional licence or registration from your home country
• identity documents
• proof of your German level

You usually need certified copies and translations.

Apply to the office in the German state where you want to work, rather than a federal office.

Some general-care nursing qualifications fall under EU automatic-recognition rules and can be recognised without an individual comparison. For other qualifications, including most from outside the EU, the office compares your training with German nursing training individually.

The nurses hub explains the procedure, documents and decision times in detail.

You apply to the office in the state where you want to work, not to a federal office.

If the office finds important differences between your training and German training, it sends a Defizitbescheid (deficit notice). This letter lists what is missing. You can usually choose between two ways to close the gaps:

• Anpassungslehrgang (adaptation course): further training focused on the gaps in your notice. You study theory at a nursing school and practise under supervision in a suitable hospital or care facility.
• Kenntnisprüfung (knowledge test): an exam instead of a course, with an oral part, usually about a patient case, and a practical part with an employer.

Pass either one and you get a decision saying your training counts as equal to German training. You use it to apply for the Erlaubnis.

Check which proof your state office accepts before booking an exam. In practice, states and the GMK, the conference of state health ministers, usually ask for B2 German for the licence. No federal law names this level. Your office decides whether a general B2 certificate is enough or you also need a medical German exam.

Check which German certificate your state office accepts before you book an exam.

Which residence permit you need depends on how far along you are with recognition. Most applicants from outside the EU, EEA and Switzerland apply before travelling. US citizens and others covered by the entry rule in Sources can enter without a visa for a long stay and apply in Germany within 90 days. They still need employment authorisation and the nursing licence before starting work.

• Recognition visa (to close your gaps in Germany): If your deficit notice says you can close the gaps through a course in Germany, you can come on that basis. This could be an adaptation course or job-related German classes. You usually have a set time to finish: up to 24 months, extendable to 3 years at most.
• Recognition partnership (with an employer): An employer must agree to go through recognition with you. You can then come to Germany and do qualified work in your field while completing recognition; reserved nursing tasks need the Erlaubnis. The first permit covers the Federal Employment Agency’s approval period, up to one year, and can be extended to three years' total stay. Before licensing, suitable helper work may also be allowed under the employer and employment conditions in § 16d(3) (see Sources).
• Skilled-worker visa (after full recognition): You need completed recognition, the Erlaubnis and a concrete nursing job offer to start work on this visa.
• EU Blue Card: You can also apply if you have a nursing bachelor's degree, such as a BSN, and meet the lower salary threshold for shortage jobs. Nursing professionals, ISCO group 222, are on that list; the Federal Employment Agency must agree. See Germany vs the UK, USA and Gulf for the 2026 thresholds.

Once the office confirms your training, reliability, health and German meet the requirements, it issues the Erlaubnis and Berufsurkunde. The Berufsurkunde is the certificate proving your right to use the title Pflegefachfrau or Pflegefachmann and do reserved nursing tasks.

At this final step, the office often asks for:

• your exam certificate or equivalence decision
• a police clearance certificate no older than three months
• a medical certificate confirming you are fit to work

The exact documents and fees vary by state.

Yes. You follow the same route as other applicants from outside the EU:

• recognition of your Indian nursing qualification by the state office
• B2 German
• a visa for your stage: recognition visa, recognition partnership with an employer, or skilled-worker visa after recognition

We found no India-specific shortcut in the sources checked. If your country has an agreement with Germany that changes this, ask the German embassy or consulate there.

Yes, you can apply for recognition straight after qualifying; German law sets no minimum years of work after qualification. The office first compares your training with German training. If it finds substantial differences, relevant work experience or other proven knowledge and skills can make up for some or all of them (see Sources). Employers may still prefer experience for a particular job.

Yes, the same recognition rules apply to US citizens with non-EU qualifications. A special entry rule lets them enter without a visa for a long stay and apply for a residence permit within 90 days of arrival (see Sources). Before starting nursing work, you still need the nursing licence and a residence permit allowing that employment.

Your documents, office and timeline depend on your country, qualification and chosen state. Our free personalised roadmap on the nurses hub sets these out for your situation. For earnings once you start work, see our nurse salary in Germany guide.