In short: Nursing is a regulated profession in Germany. International nurses need recognition (an equivalence check by the federal state) and a licence under the Nursing Professions Act; residence routes include § 18a (recognised skilled worker) and § 16d (recognition measures, recognition partnership). Employers can apply for the accelerated skilled worker procedure (§ 81a).
Note: This page provides general information and is not legal advice. The law and the decisions of the competent authorities are decisive; rules can change. As of October 2026.
The steps from a clinic's perspective
- Define the need: ward, number of positions, start window, pay under the applicable collective agreement, onboarding.
- Recruitment and interviews: profile, experience, language level (the federal states set the language requirement for the licence; often around B2).
- Recognition: application to the competent state authority. According to Make it in Germany, the check usually takes three to four months once documents are complete.
- Choose the residence route: full recognition (§ 18a), compensation measure in Germany (§ 16d (1)) or recognition partnership (§ 16d (3)).
- Visa: applied for by the candidate at the German mission abroad, or via the accelerated procedure (§ 81a).
- Arrival and integration: housing, registration, onboarding, knowledge test or adaptation course if required, job-specific language.
§ 18a, § 16d and § 81a at a glance
§ 18a AufenthG covers skilled workers with (recognised) vocational training for qualified employment.
§ 16d (1) allows residence for recognition measures such as an adaptation course: up to 24 months, extendable by up to 12 months to a maximum of three years, with secondary employment up to 20 hours a week.
§ 16d (3), recognition partnership: entry and employment first, recognition afterwards. According to Make it in Germany the permit is first issued for up to one year and can be extended up to three years; with partial equivalence, by up to two further years. Employers must meet conditions (e.g. an approved care facility under § 72 SGB XI) and enable the compensation of deficits.
§ 81a (accelerated procedure): the employer applies with the candidate's power of attorney at the foreigners authority and concludes an agreement. Fee according to Make it in Germany: EUR 411. It speeds up the process but does not guarantee a visa.
How Berlin Tehran helps
We help healthcare professionals prepare their documents in an orderly way and coordinate with employers, following a transparent 8-step process with up to 90 days of support after arrival. We are specialised in Iran and support healthcare professionals from all countries where private recruitment is permitted (see our ethical recruitment rules). We do not provide legal advice; authorities make all decisions.
Apply as a healthcare professional For employers
Related guides
- Accelerated skilled worker procedure (§81a)
- Recognition partnership (§16d)
- Knowledge test or adaptation course?
- Glossary: recognition & residence
Frequently asked questions
Do international nurses need recognition to work in Germany?
Yes. Nursing is regulated; working as Pflegefachfrau/Pflegefachmann requires a licence under the Nursing Professions Act, granted by the state authority after an equivalence check.
What happens if the authority finds differences?
The nurse receives a notice describing the substantial differences (often called Defizitbescheid). They can be compensated by a knowledge test or an adaptation course; under § 40 PflBG the applicant may choose.
What does the accelerated procedure cost?
According to Make it in Germany, EUR 411; it does not guarantee a visa.