You are weighing up whether a nursing training place pays off — and you are probably starting from the wrong baseline. Because you are already contributing to the financing of nursing training, whether you train or not. The only question is whether you also get a future qualified nurse in your own building for that money.
You already pay the levy
The financing of nursing training is governed by the German Nursing Professions Act and works as a levy system: a training fund is formed at state level, into which hospitals, inpatient and outpatient care facilities, the federal state and the long-term care insurance funds pay. One detail is decisive for your calculation, and it is not widely known: all facilities are drawn on for the financing in the same way, those that train and those that do not (Source: Hessian State Office for Health and Care, Training Financing under the Nursing Professions Act).
In Hesse, for example, the financing for 2026 is distributed as follows: hospitals carry 57.24 percent, inpatient and outpatient care facilities 30.22 percent, the federal state 8.94 percent, and the statutory and private long-term care insurance funds 3.6 percent (Source: Hessian State Office for Health and Care, figures for 2026). The exact rates differ from one federal state to the next — the principle does not.
Compensatory payments from the fund, by contrast, only go to facilities that actually train. Anyone who does not fill a training place is therefore paying into a system from which competitors finance their trainees. That is not a judgement, it is how the law is built.
What the training actually costs
Training pay is the largest single item. Under the collective agreement for trainees in the public sector, nursing section, it amounts to 1,490.69 euros per month in the first year from May 2026, 1,552.07 euros in the second and 1,653.38 euros in the third (Source: TVAöD, Special Section Nursing). Over three years that adds up to roughly 56,000 euros — on paper.
The figure in the organisation’s accounts looks different. The Nursing Professions Act defines training costs as the additional costs of training pay plus the costs of the practical training including practical instruction — and precisely these costs are refinanced from the fund through the training budget (Source: Section 27, Nursing Professions Act). On the pay component, the system withholds what is called a value-added share, which the training provider carries itself: 10.526 percent of the pay costs for hospitals and inpatient facilities, 7.143 percent for outpatient services (Source: Hessian State Office for Health and Care). The reasoning behind that deduction is, honestly, in your favour: it reflects the fact that trainees start contributing productively from a certain point onwards.
Refinanced does not mean free, however, and at this point you deserve clarity rather than a flattering calculation. The flat rates cover the calculated costs, not every operational reality. What remains is above all committed time: practical instruction is part of the training under the Nursing Professions Act and ties up experienced staff — precisely the people who are scarce anyway. Add to that organisation, rota planning around school blocks, and the risk that a training relationship ends early. None of these items appear in any fund statement, and anyone who does not plan for them discovers them in the second year of training.
What a trainee brings back during the training
The other side of the calculation does not begin with the final examination. The Nursing Professions Act sets out the extent to which trainees are counted towards staffing: at a ratio of 9.5 to 1 in hospitals and inpatient care facilities, 14 to 1 in outpatient services — with no crediting during the first third of the training (Source: Section 27 (2), Nursing Professions Act). Translated: from the second third onwards, 9.5 trainees notionally deliver the work of one full-time member of staff. That sounds like little at first. But it means the training is not designed as a pure cost block from the outset — it is designed as a ratio of learning time to contribution, and the legislator has already priced that productive contribution into the refinancing.
The real return comes at the end: a fully qualified nurse. What that is worth on the market is shown by the figures from the Federal Employment Agency. For qualified nurses, some 20,000 registered vacancies recently stood against an unemployment rate of 1.1 percent (Source: Federal Employment Agency, Labour Market Situation in Nursing Occupations). Across all occupations, a skilled position stays vacant for an average of 183 days (Source: Federal Employment Agency, April 2025 to March 2026). A qualified nurse who took their examination in your own organisation does not have to be searched for, poached or inducted — they have been there for three years.
And they enlarge the market instead of redistributing it. Every hire of a qualified nurse takes that person away from another employer. Every completed training increases the number of qualified nurses. Why that is the structural difference, and what your organisation needs to bring to it, is set out in our article on nursing trainees from abroad.
The honest additional calculation for international trainees
Anyone recruiting trainees from abroad has further items to add — and they belong on the table before the first contract is signed.
First, language preparation: proof of language skills must be in place before entry, not afterwards. The courses in the country of origin cost money and months, and those months should run in parallel with the procedure so that they are not lost. Second, the procedure itself: a residence title under Section 16a of the Residence Act, approval by the Federal Employment Agency, the visa — with around four months of total lead time from the contract. Third, arrival: accommodation, registration, support during the first weeks. Trainees in nursing are on average 24 years old, and 51 percent are 21 or younger (Source: Federal Statistical Office, press release no. 231 of 2 July 2026). These are young people living alone in a foreign country for the first time — and what decides whether they complete the training is rarely the technical side.
These additional costs are real. They explain why only 5.3 percent of companies bring in trainees from abroad, while 50.8 percent rely on their own training (Source: Bertelsmann Stiftung / Civey, survey 2024). What they do not explain is why the calculation should fail: the training pay — by far the largest item — runs through the same fund for international trainees as for everyone else. What the organisation carries in addition is the preparation. What it gets in return is access to applicant groups for which almost nobody in Germany is competing.
From 2027 a second training route is added
For planning over the coming years, one legislative change deserves attention that has so far received little: on 1 January 2027 the nationally standardised nursing assistance training begins. In full-time form it usually lasts 18 months, replaces 27 different state-level regulations and provides training pay for all trainees (Source: Federal Ministry for Education, Family Affairs, Senior Citizens, Women and Youth, decision of the Bundesrat of 17 October 2025).
For employers this creates an intermediate stage with a clear logic: a nationally uniform, paid qualification below the three-year training for qualified nurses — considerably more than an unskilled assistant, considerably faster than the full examination. Why the route via unskilled helper positions rarely carries, by contrast, is shown by the figures on filling helper roles — and by the difference between the two paths into nursing.
The information in this article is for orientation and does not replace legal advice. Financing rates and responsibilities differ by federal state.
What this means for your decision
Three points from the calculation, without any window dressing.
First: you pay the levy in any case. The decision is not “train or save”, it is “pay in and train” or “pay in and watch”.
Second: the largest cost block is refinanced, and the honest own contribution is time. Anyone who cannot plan for practical instruction and support should not train — anyone who can plan for it gets the only route that creates qualified nurses instead of redistributing them.
Third: three years of lead time are the price, not the counter-argument. The qualified nurse who takes their examination in 2029 begins training in autumn 2026. Structure beats chance — here with plenty of notice.
For the record: we deliberately give no success figures from our own placements in this article. What we describe is the financing system and the legal position, not a result we cannot yet show.
Free initial consultation — we will call you back, when suits you?
Further reading
- Nursing trainees from abroad: what your organisation needs
- Two paths into nursing, only one needs recognition
- Filling helper roles: 156 days is the average
Sources
- Hessian State Office for Health and Care: Training Financing under the Nursing Professions Act. 2026. https://hlfgp.hessen.de/pflegefachberufe/ausbildungsfinanzierung-pflegeberufegesetz (accessed 27 August 2026)
- Nursing Professions Act, Section 27 — Costs of training, crediting. https://www.gesetze-im-internet.de/pflbg/__27.html (accessed 27 August 2026)
- TVAöD, Special Section Nursing, Section 8 Training pay (pay table effective 1 May 2026). https://www.oeffentlichen-dienst.de/auszubildende/92-tvaoed-besonderer-teil-pflege.html (accessed 27 August 2026)
- Federal Ministry for Education, Family Affairs, Senior Citizens, Women and Youth: Bundesrat approves nationally standardised nursing assistance training. 2025. https://www.bmbfsfj.bund.de/bmbfsfj/aktuelles/alle-meldungen/bundesrat-stimmt-bundeseinheitlicher-pflegefachassistenzausbildung-zu-272084 (accessed 27 August 2026)
- Federal Statistical Office: Nursing training 2025 — number of new trainees rises for the third year running. Press release no. 231. 2026. https://www.destatis.de/DE/Presse/Pressemitteilungen/2026/07/PD26_231_212.html (accessed 27 August 2026)
- Federal Employment Agency: Blickpunkt Arbeitsmarkt — Labour Market Situation in Nursing Occupations. 2026. https://statistik.arbeitsagentur.de/DE/Statischer-Content/Statistiken/Themen-im-Fokus/Berufe/Generische-Publikationen/Arbeitsmarktsituation-in-Pflegeberufen.pdf (accessed 27 August 2026)
