Germany: Recognition (“Anerkennung”) for Foreign‐Trained Nurses — Steps, Timelines & Costs (2025)

Germany is facing a significant shortage of qualified nursing professionals, and many nurses trained abroad look to continue their career here. However, the nursing profession (now consolidated under Pflegefachfrau / Pflegefachmann) is a regulated profession in Germany: you cannot legally practise as a fully recognised nurse without the formal recognition of your foreign qualification. (tern-group.com)

This article offers a comprehensive guide (2025 version) to the recognition process: what it is, why it matters, the step-by-step path, typical timelines, costs, the different routes (knowledge exam vs adaptation course), and useful check-lists and diagrams you can use to plan your journey to working as a nurse in Germany.

Why recognition (“Anerkennung”) is required for nurses

• The nursing profession is regulated by the Pflegeberufegesetz (PflBG) in Germany. (Schlun & Elseven)
• A foreign-trained nurse must obtain state authorisation to use the professional title “Pflegefachfrau” or “Pflegefachmann” (i.e., certified general nurse) and enter the regulated labour market. (anerkennung-in-deutschland.de)
• The recognition process ensures that your foreign qualification is equivalent (Gleichwertigkeit) to the German reference qualification. If not, you may need a compensatory measure (knowledge test or adaptation period). (anerkennung-in-deutschland.de)
• Without recognition you may still work in non-regulated roles (e.g., nursing assistant) but not as a fully qualified nurse using the protected professional title. (Bayerisches Landesamt für Pflege)
• For EU/EEA trained nurses the process may be somewhat easier; for “third country” (non-EU) qualifications the full procedure applies. (service.berlin.de)

Below is a high-level flow-chart of the path:

Start → Choose federal state & competent authority 

      ↓

Collect and translate documents + obtain German language certificate (at least B2) 

     ↓

Submit application for recognition (“Erlaubnis zum Führen der Berufsbezeichnung”) 

      ↓

Competent authority checks equivalence (usually 3–4 months) 

      ↓

Either: Full recognition → Get job as nurse Or: Deficit notice → Compensation measure (Knowledge test OR Adaptation course/practice) 

      ↓

Complete measure → Full recognition → Job as nurse

This diagram is adapted from the official “Recognition procedure” graphic on Make it in Germany. (make-it-in-germany.com)

Step-by-Step Guide (2025 Edition)

1. Select the federal state (Land) and find competent authority

Since Germany is federal, each Land has its own authority that handles recognition of foreign nursing qualifications. Use the official “Recognition Finder” on the Anerkennung in Deutschland portal to determine which authority is responsible for your profession and location. (anerkennung-in-deutschland.de)

Tip: If you plan to live and work in a specific Land (say Bavaria, North Rhine-Westphalia, Berlin etc.), you should apply to that Land’s authority.

2. Collect required documents

Typical required documents include:

• Passport/ID
• Birth certificate/marriage certificate (if name change) + German translation
• Certificate/diploma of your nursing qualification + transcript/record of subjects & hours + German translation (anerkennung-in-deutschland.de)
• Proof you are authorised to practise in your country of training
• Curriculum vitae (German version recommended)
• Proof of relevant work experience
• German language certificate (usually minimum B2) or plan to obtain it
• Medical fitness certificate & certificate of good conduct (no older than 3 months) (anerkennung-in-deutschland.de)
• If documents are not in German: notarized translation or certified translation (requirements vary by Land)

3. Submit the application

You may apply from abroad or once in Germany. Some Länder allow online submission. Once the competent authority receives your full application they will confirm receipt (within ~1 month) and then begin the equivalence check. (anerkennung-in-deutschland.de)

4. Equivalence assessment (Gleichwertigkeitsprüfung)

The authority will compare your training, its content and duration, your experience, with the German reference qualification. The standard processing guideline is 3-4 months after complete file submission. (make-it-in-germany.com)

Possible outcomes:

• Full equivalence: you receive the recognition notice and can practise as fully qualified nurse.
• Significant differences: you receive a deficit notice (Defizitbescheid) outlining what gaps exist; you must then complete a compensatory measure. (anerkennung-in-deutschland.de)
• No recognition (rare): if substantial differences cannot be remedied, you cannot proceed to the full professional title.

5. Compensation measure (if needed)

If deficits are determined, you generally follow one of the routes:

• Knowledge test (Kenntnisprüfung): exam plus practical assessment to test whether you now meet the German standard.
• Adaptation qualification/practice period (Anpassungsqualifizierung): structured practice/learning period under supervision in Germany. Some Länder allow temporary permit (Berufserlaubnis) during this period. (service.berlin.de)
  Upon successful completion, you receive the full recognition notice.

6. Final stage & employment

Once recognized, you have the full right to work as a nurse in Germany under the professional title. At the same time you may need to address other employment/immigration steps (work permit/visa if non-EU). Many hospitals & care facilities actively recruit internationally recognized nurses. (make-it-in-germany.com)

Timelines – what to realistically expect in 2025

Although the guideline is ~3–4 months for the equivalence check, many applicants experience longer due to missing documents, waiting lists for tests/practice, and translation delays. (Schlun & Elseven)

Costs & Financial Considerations (2025)

Recognition and related measures incur costs. Here are typical ranges:

• Application/administrative fee: ~€150–€600 depending on the Land. For example, one Land charges €164 for the application for third-country trained nursing staff. (service.berlin.de)
• Translation & notarisation of documents: can range €150–€600+ depending on number of pages and translator rates.
• German language certificate (B2) & specialist language course: ~€300–€500+ depending on provider.
• Preparation course for knowledge test (Kenntnisprüfung): many providers quote ~€2,000–€3,000 (including materials and exam fee) for the entire course.
• Adaptation period costs: may involve living expenses if relocation to Germany, sometimes partial cost is borne by employer or subsidised.

Support & subsidies:
Applicants might qualify for recognition grant (Anerkennungszuschuss) which can cover part of the cost of your recognition procedure (e.g., up to €600) and also subsidies for the analysis of your qualification. (anerkennung-in-deutschland.de)
Also counselling is available free of charge via the IQ Network and regional centres.

Check-List for Applicants

Before you apply:

• Choose the Land (state) you plan to work in and find the competent authority.
• Confirm your qualification is eligible (state-recognised in your country of training) and gather your diploma/transcripts.
• Start German language training if needed — target B2 and nursing-specific vocabulary.
• Prepare translations if your documents are not in German.
• Verify your professional practice eligibility (allowed to practise in your home country)
• Consider relocation logistics (moving to Germany, cost of living, employer arrangements)

When applying:

• Submit full application with all required documents (possible to apply from abroad).
• Track your application: confirm receipt, check if any documents are missing.
• Be prepared for the possibility of being asked to complete a compensatory measure (knowledge test or adaptation).
• Keep proof of all submitted documents and correspondence.

After decision:

• If recognised: start job search or accept offer as a recognised nurse.
• If deficit notice: plan for route (exam or adaptation), budget time & money, coordinate with employer/training provider.
• Move to Germany (if not already) and complete any required permit/visa formalities.

Check-List for Employers (Hiring Foreign-Trained Nurses)

• Verify the applicant’s recognition status: full recognition or in process (with possible interim permit).
• Ensure language level (German B2 or required standard) and that nurse is ready for past clinical practice in Germany.
• Determine whether employer will support the adaptation process (training, mentorship, integration).
• Understand the Land’s regulations for foreign-trained nurses — slot availability for knowledge test, adaptation periods etc.
• Consider relocation support, integration into workplace, and pay/contract terms aligned with German staffing norms.

Summary

If you are a nurse trained abroad and aiming to practise in Germany as a fully recognised “Pflegefachfrau / Pflegefachmann”, the recognition (Anerkennung) process is essential.

Key points:

• Decide the Land where you will work and identify correct authority.
• Collect complete documentation and translations, and reach German B2 level.
• Submit application and expect at least a few months waiting period (~3–4 months typical for the equivalence decision).
• Be prepared for compensatory measures if deficits are found (knowledge test or adaptation).
• Budget financially and time-wise (translation fees, language exam, training costs, relocation).
• Upon full recognition, you can legally work as a general nurse in Germany, gaining access to the regulated professional title and labour market.

With thorough preparation and realistic expectations, you can successfully navigate the recognition process — and contribute to one of Germany’s most in-demand professions.

Sources & Further Reading

• Recognition Finder – Anerkennung in Deutschland portal (anerkennung-in-deutschland.de)
• Recognition procedure – Make it in Germany portal (make-it-in-germany.com)
• Recognition of nursing staff in Bavaria – Bayerisches Landesamt für Pflege (Bayerisches Landesamt für Pflege)
• Professional recognition for foreign nursing staff – Schlun & Elsven Rechtsanwälte (Schlun & Elseven)