18 versus 16
The Federal Employment Agency reports for June 2024: the share of foreign nationals among employees subject to social insurance in nursing care stands at 18 percent. Across all sectors it is 16 percent.
Nursing care therefore does not lag behind the average, but sits above it. Almost one in five nurses in Germany does not hold a German passport.
For the debate in many facilities this is an uncomfortable figure. It ends the notion that international recruitment is a special route for operations that can no longer manage otherwise. It is the normal case. Anyone not yet taking it is not being cautious, but late.
The second figure confirms this from another direction. Among recognitions of foreign professional qualifications, the nursing professional leads the list of all occupations with 21,699 positive decisions in 2024. Second is the medical profession with 11,000, third the engineer with 4,400. Around 75 percent of all recognition applications concerned health professions.
What this means for your facility
Here comes the awkward conclusion, and it works against a selling point our own industry likes to use.
Access to international nurses is no longer a unique selling point. When 18 percent of employees already come from abroad and the nursing professional is the most-recognised occupation in the country, you are not competing with facilities that do not know this route. You are competing with facilities that have been taking it for years.
With that, the decisive question shifts. It is no longer: how do I get international nurses? But: why should an international nurse come to me and not to the facility two streets away that pays the same salary?
The answer has little to do with recruitment and a great deal to do with what happens afterwards.
Where the competition is actually decided
Three fields in which facilities differ — and none of them is access.
Preparation. How well is the person prepared for Germany before arriving? Language level, expectations of the role, knowledge of the system. The Bertelsmann Foundation survey of 501 companies that have already recruited internationally names, in third place among the problems encountered, false expectations of applicants at 31.1 percent. That is a preparation problem, not a recruitment problem.
Arrival. Housing, registration, bank account, appointments with authorities. Anyone who brings a nurse to Germany and does not organise these steps often loses them not to a competitor, but back to their country of origin. In regions with a tight housing market, accommodation decides success more often than salary.
Recognition support. Of around 66,900 decided procedures in 2024, only 43 percent ended in direct full recognition. 45 percent were decided with a condition, meaning a compensation measure follows. For the nurse concerned this means an additional course or aptitude test alongside work. Facilities that actively support this — with time off, with study time, with a contact person — retain these people. Facilities that treat it as a private problem lose them to those that do not.
Where the recognised professionals come from
A look at origin, because it influences planning.
87 percent of applicants with a positive recognition decision acquired their qualification outside the European Economic Area. At the top of the training countries is Türkiye with 9,200 recognitions across all occupations. Second is Ukraine, which the year before was still in seventh place.
A country that jumps from seventh to second place within a year is a warning sign for any multi-year planning. Regions of origin shift quickly, and for reasons none of us controls — political situation, exchange rates, competition from other destination countries. Anyone basing their entire staffing strategy on a single country of origin is building on a variable that changes every year.
For your facility this does not mean you have to work with five countries at once. It means you should know which country your placement serves and what happens if that channel falls away. This question is easier to ask before the cooperation than after.
The advantage almost no one uses
When competition for finished nursing professionals is at its fiercest, it is worth looking at the field where almost no one competes.
In 2024 the Bertelsmann Foundation, together with Civey, asked 7,501 companies with ten or more employees which instruments they use against skills shortages. Own training is named by 50.8 percent. Recruitment of skilled workers from abroad is named by 18.4 percent. Trainees from abroad are named by 5.3 percent — last place.
Five point three percent. While everyone competes for the same 21,699 recognised nursing professionals, almost no one moves in this field.
The training route under Section 16a of the Residence Act needs no recognition procedure, because the qualification arises in Germany. It takes three years. It costs training capacity. And in the end it delivers a skilled worker who learned the language in the workplace, whose qualification never has to be examined and whose professional network is with you.
If you factor in the retention rate, the calculation looks different than at first glance at the three years.
The figure that sets the urgency
Finally, the order of magnitude in which all of this moves.
The German Economic Institute, together with the Federal Statistical Office, calculates for the baseline scenario of medium immigration: the number of vocationally qualified people in Germany falls from 31.6 million in 2020 to 23.3 million in 2040. The number of academics rises over the same period from 12.0 to 14.8 million. On balance, the supply of skilled workers shrinks from 43.5 to 38.0 million.
The vocationally qualified are precisely the group from which nursing professionals come. It is this group that shrinks by 8.3 million, while the academic group grows.
This is not a forecast of a possible shortage. It is a demographic calculation whose starting figures are already born. The people who will retire in 2040 are working today. The people meant to replace them are in school today — and there are too few of them.
For facilities this means: competition for nurses will not ease. Anyone working today with an 18 percent foreign share will work with a higher one in ten years. The question is not whether international recruitment becomes part of your staffing strategy, but whether you build it up in a phase when you can plan, or in one when you must.
What applicants actually compare
If access is no longer an advantage, a change of perspective is worthwhile: on what basis does a nurse from abroad decide which facility to join?
In our experience, not primarily on salary. The differences between facilities bound by collective agreements matter less to someone coming from a country with a much lower wage level than three other factors.
Housing. Anyone coming from abroad has no landlord who knows them, no credit history and often not three months’ rent as a deposit in the bank. A facility that provides or arranges an apartment has the advantage over one that does not — regardless of salary. In metropolitan areas this counts double.
The prospect on recognition. Anyone entering with a condition wants to know how to complete the compensation measure. A facility that grants study time, gives days off for exams and covers the costs makes the difference between a qualification in one year and one in three.
The first contact person. Not the HR department, but the person on the team who explains in the first weeks how things work. This exists in every facility but is rarely named — and it is precisely the naming that makes the difference.
None of these three points costs significant money. All three cost organisation. That is the real message of these figures: in a market where everyone has access, it is not the one with the larger budget who wins, but the one with the better structure.
What this means for planning
Three practical conclusions.
First: stop selling access as an advantage. Neither internally nor to candidates. In a field with an 18 percent foreign share this is not an argument but a matter of course.
Second: invest where the competition is decided. Preparation, arrival, recognition support. These are not incidental costs of recruitment; they are the recruitment.
Third: examine the training route before dismissing it. Not for every position, but for part of your demand. A field into which 5.3 percent of companies move is rarely overcrowded.
And one point that belongs to an honest answer: international recruitment does not solve the staff shortage in nursing. It gives you access to a larger pool of applicants, no more. If working conditions cause people to leave after two years, a foreign origin changes nothing about that. Turnover follows the same rules.
The information in this article is for orientation and does not replace legal advice.
Free initial consultation — we will call you back, when suits you?
Further reading
- Two paths into nursing, only one needs recognition
- 2024 recognition statistics: 987 chefs, 21,699 nurses
Sources
Federal Employment Agency: Share of foreign nationals among employees subject to social insurance in nursing care, June 2024.
Federal Statistical Office: Recognition of foreign professional qualifications 2024, most frequently recognised qualifications.
Federal Statistical Office: 21% more recognitions of foreign professional qualifications in 2024. Press release No. 321, 2025.
Bertelsmann Foundation / Civey: Instruments against skills shortages, survey 08/06 to 06/09/2024, 7,501 respondents.
Bertelsmann Foundation / Civey: Problems employing foreign skilled workers, 501 respondents.
German Economic Institute (IW) / Federal Statistical Office: Forecast of the supply of skilled workers to 2040, baseline scenario medium immigration.
Federal Ministry of Justice: Section 16a Residence Act. URL: https://www.gesetze-im-internet.de/aufenthg_2004/__16a.html (accessed 12/08/2026).
