You are looking for qualified nurses and finding none. At the same time you may be training your own — and watching the class thin out in the third year. The two are connected, and both have an answer that 94.7 percent of employers are not using.
63,900 start, 35,300 arrive
The number of new nursing trainees is rising for the third year in a row. In 2025 around 63,900 people began nurse training, eight percent more than the 59,400 of the previous year. In total some 157,200 people were in training, seven percent more than in 2024 (Source: Federal Statistical Office, press release no. 231 of 2 July 2026).
That is the good news, and it is usually told on its own. The second figure sits in the same statistic: around 35,300 people successfully completed their training in 2025. A year earlier it was 37,400 (Source: Federal Statistical Office, press release no. 276 of July 2025).
More start, fewer arrive. For an organisation that trains, that is not a statistic but a calculation: every training place standing empty in the third year has cost two years of practical instruction and delivers no qualified nurse.
And one more figure from the same survey that matters for planning: about half of all trainees learn in hospitals, 36 percent in inpatient care facilities, 12 percent in outpatient services. Anyone training in the inpatient or outpatient setting is therefore competing for a smaller slice of an already scarce cohort.
Only 5.3 percent bring trainees in from abroad
Asked which instruments they use against staffing shortages, 50.8 percent of companies name their own training programme. It is by far the most frequently named measure. 18.4 percent recruit abroad. And 5.3 percent bring in trainees from abroad (Source: Bertelsmann Stiftung / Civey, survey 2024).
Read the three figures together. Own training is the most popular instrument. International recruitment is established. The combination of the two — training internationally instead of hiring internationally — is used by practically nobody.
That is neither an accident nor an insider tip, it is a question of effort: the route is longer than a hire and it asks more of the organisation than a signature. But it solves a problem that a hire does not. Anyone hiring a qualified nurse from abroad is competing with everyone else for the same scarce group. Anyone who trains creates the qualified nurse the others are competing for.
Why the route via helper positions does not carry
This is where an uncomfortable figure belongs, because it rules out an obvious shortcut.
In June 2025 around 564,000 people worked as assistants in nursing, which is 32 percent of all nursing staff. At the same time, in the 2025 annual average around 48,000 nursing assistants were unemployed — 79 percent of all unemployed nursing staff. The unemployment rate at assistant level was 8.2 percent. Registered in the same period were around 1,500 assistant positions requiring no formal training. Among qualified nurses the picture is reversed: 20,000 registered vacancies against an unemployment rate of 1.1 percent (Source: Federal Employment Agency, Labour Market Situation in Nursing Occupations, June 2025 and 2025 annual average).
For every registered assistant position there are, arithmetically, around 32 unemployed assistants. Anyone recruiting internationally in this segment is bringing people into a market with a domestic surplus. That is not placement, it is misallocation — and an employer who can do arithmetic will see through it in the first conversation.
One difference does remain, and it matters in practice: assistants with relevant training leave unemployment with a monthly exit rate of 8.5 percent, those without training only 5.2 percent. The market does distinguish clearly between an unskilled helper and a trained nursing assistant. Anyone considering assistant roles should know where that line runs before planning.
What Section 16a of the Residence Act requires
The residence title for in-company vocational training is governed by Section 16a of the Residence Act. Three points determine the procedure.
First: approval by the Federal Employment Agency. The residence permit for qualified vocational training requires the Federal Employment Agency to have given approval under Section 39 — unless an employment regulation or an intergovernmental agreement permits the training without approval.
Second: proof of language skills. For qualified vocational training, proof of sufficient German language skills is required. The provision applies where neither the training institution nor a preparatory language course has already verified those skills.
Third: secondary employment. The title permits employment unrelated to the training purpose of up to 20 hours per week.
The 20-hour rule is not a side note but relevant to your planning: it allows the trainee to work alongside the training — including outside your organisation. Anyone setting training pay so low that a second job becomes arithmetically necessary risks divided attention in exactly the months when practical instruction has to take hold. That is not a legal question but a commercial one.
For nursing there is the additional point that the training itself follows the Nursing Professions Act and the training institution must provide the practical instruction. The residence law side is therefore only one half; the other is your training operation.
The information in this article is for orientation and does not replace legal advice. Responsibilities and requirements differ by federal state.
What your organisation has to bring
In order, the way it runs in practice:
1. Training place and training contract. Without a concrete place there is no procedure. The contract is the basis for everything that follows.
2. Language preparation in the country of origin. Proof of language skills has to be in place before entry, not after. Anyone letting the learning months run in parallel with the procedure does not lose them.
3. Approval by the Federal Employment Agency. Handled via the immigration authority and the diplomatic mission, not by you.
4. Visa procedure. Application at the German diplomatic mission in the country of origin.
5. Practical instruction and arrival. From day one. Accommodation, registration, opening a bank account, the first weeks in the team. That is the point at which training relationships fail — not the technical side.
One item is regularly missing from the effort calculation: practical instruction is not a voluntary extra but part of the training under the Nursing Professions Act. It ties up experienced staff — precisely the people who are scarce anyway. Anyone training internationally plans for that effort on top of the language support. That is the honest reason why only 5.3 percent of employers take this route, and it is not an argument against it. It is an argument for knowing the effort in advance rather than discovering in the second year of training that nobody budgeted for it.
And a second: the trainees we are talking about 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). They are young people living alone in a foreign country for the first time. What decides whether they qualify is rarely the technical side.
Total time to taking up work: around four months from the contract. That is not an optimistic estimate. Anyone wanting to start in autumn begins in early summer.
What this means for your workforce planning
Three consequences that follow from the figures.
The bottleneck sits with qualified nurses, not with assistants. 20,000 registered skilled vacancies at a 1.1 percent unemployment rate against 1,500 assistant positions at 8.2 percent. Anyone wanting to solve their staffing problem in nursing has to work at the qualified level — directly through recognition or indirectly through training.
Training is the only route that creates qualified nurses instead of redistributing them. Every hire of a qualified nurse takes that person from another employer. Every completed training increases the number. That is the difference between a short-term and a structural answer — and the reason why three years of lead time are not too long here but simply the price.
The advantage lies in the preparation, not in the procedure. The procedure takes the same time for everyone. What differs is whether the documents are complete at the first attempt, whether proof of language skills is in place before entry, and whether somebody in the organisation is responsible for the first few weeks. Structure beats chance — particularly here, because chance costs three years.
For the record: we have deliberately given no success figures in this article. What we describe is the method and the legal position, not a result we cannot yet show.
Free initial consultation — we will call you back, when suits you?
Further reading
- Two paths into nursing, only one needs recognition
- International nurses are the norm
- 2024 recognition statistics: 987 chefs, 21,699 nurses
Sources
- 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 Statistical Office: 37,400 people successfully qualified as nurses in 2024. Press release no. 276. 2025. https://www.destatis.de/DE/Presse/Pressemitteilungen/2025/07/PD25_276_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)
- Residence Act, Section 16a — Vocational training; continuing vocational education. https://dejure.org/gesetze/AufenthG/16a.html (accessed 27 August 2026)
- Bertelsmann Stiftung / Civey: Survey of companies on instruments against the shortage of skilled workers in Germany. 2024. (Statista dossier, no freely accessible primary URL verified)
