Nursing Ausbildung in Germany: the reality agents rarely tell you

A nursing Ausbildung in Germany is a three-year state-regulated training as Pflegefachfrau or Pflegefachmann. It normally requires German at level B2, a school certificate recognised as equivalent to German secondary school and a state exam in three parts. It pays well from the first month, but the language demands, the paperwork and the workload are far higher than in most technical professions.

German name

Pflegefachfrau / Pflegefachmann

Duration

3 years full-time

Legal basis

Nursing Professions Act (PflBG), not the Vocational Training Act

German level

Usually B2

First-year pay

About 1,490 euros gross (public hospitals, from May 2026)

Final exam

State exam: written, oral and practical

What it is called in Germany

Since 2020, the nursing Ausbildung in Germany has been called Pflegefachfrau (female) or Pflegefachmann (male). It lasts three years and combines the care of sick people, elderly people and children in one programme. Theory is taught at a nursing school (Pflegeschule). Practical training takes place in hospitals, care homes and home care services.

One thing we have to admit: the pay is good. In public hospitals with a collective agreement, first-year training pay is about 1,490 euros gross a month (TVAöD-Pflege, from May 2026). Anyone who says nurses in training are badly paid is wrong. The difficulties are elsewhere.

Reality 1: you need B2 German, not B1

For most technical Ausbildungen, B1 is enough. For nursing, most nursing schools and federal states require B2. Some schools even expect B2 with high scores in all four modules. The reason makes sense: you talk to sick and often elderly patients, many of them with a regional dialect, and you write medical documentation in German. A single misunderstanding can be dangerous.

Getting from B1 to B2 usually takes several more months of classes, at additional cost.

Reality 2: your school certificate has to be recognised first

The German Nursing Professions Act (Section 11 PflBG) requires a school certificate equivalent to German secondary school. In practice this means that your certificate usually has to be assessed and recognised by the certificate recognition office (Zeugnisanerkennungsstelle) of the federal state where you will train. The process differs from state to state, takes several weeks and costs a fee in some states.

Compare this with a company-based technical Ausbildung: the Vocational Training Act (Berufsbildungsgesetz) sets no minimum school certificate. The company decides. The visa for vocational training (Section 16a Residence Act) does not require recognition of your school certificate either.

Reality 3: a state exam in three parts

The nursing Ausbildung ends with a state exam. According to the training and examination regulations (PflAPrV), it consists of:

• Written exam: three papers of 120 minutes each, usually on three consecutive working days.
• Oral exam: 30 to 45 minutes in front of examiners.
• Practical exam: with real patients, including a care plan, a case presentation and a reflection discussion, lasting up to 240 minutes.

You have to pass each part separately. Before that, there is an intermediate exam halfway through the training. All of it is in medical German. Technical Ausbildungen also end with an exam, usually at the Chamber of Industry and Commerce (IHK), but the language is much closer to everyday work in a plant.

Reality 4: a heavy workload

Care runs 24 hours a day, seven days a week, including nights, weekends and public holidays. That is not the exception, it is part of the profession. Official data and surveys in Germany show how demanding it is:

• In the German Trade Union Confederation's survey (DGB-Index Gute Arbeit), around 75 percent of care workers said they often work under time pressure. Almost half have to cut back on the quality of their work for lack of time, and only 22 percent believe they can stay in the profession until retirement.
• According to the health insurer Techniker Krankenkasse, nurses were off sick for about 28 working days a year on average, far above the average of about 18 days across all professions (2024).
• According to the Federal Statistical Office (Destatis), 39 percent of hospital nurses and 43 percent of elderly care nurses work part-time, compared with 31 percent of all employees (2023). Many reduce their hours because of the strain.

On top of the physical strain comes the emotional side: patients who die, families in grief, responsibility for people's lives. Not everyone can carry that in a foreign country, far from their own family.

Reality 5: an ageing country means more patients per nurse

Germany is ageing fast. Destatis expects the number of people in need of care to rise from about 5 million (2021) to between 6.8 and 7.6 million by 2055. By 2049, Germany could be short of 280,000 to 690,000 care workers.

Agencies like to sell these numbers as good news: there will always be jobs. That is true. The other side is that a shortage means each nurse has to care for more patients in less time. The time pressure described above is unlikely to ease.

Already a qualified nurse?

Many nurses abroad assume their degree is automatically valid in Germany. It is not. The responsible state authority assesses every qualification individually. If there are substantial differences compared with German training, you have to complete an adaptation course (Anpassungslehrgang), which in some states takes eight to eleven months on average, or pass a knowledge test (Kenntnisprüfung). On top of that you need B2 German, often with a nursing-specific language exam. From application to full recognition, the process can take many months or more than a year.

If you are already a nurse and want to work in Germany, start with the official portal Recognition in Germany and look at government programmes such as Triple Win, run by the Federal Employment Agency and GIZ with selected partner countries. In that case you do not need an Ausbildung at all.

Nursing or a technical Ausbildung?

Nursing is an honourable profession. If you truly want to care for people and are ready for everything above, go for it wholeheartedly. But if you are choosing nursing only because everyone around you does, consider a more direct route:

See the professions with real chances for applicants from abroad, or read what a dairy technologist or an industrial mechanic does all day.

Questions about nursing in Germany

Sources

• Nursing Professions Act (PflBG), Section 11, and the Nursing Training and Examination Regulations (PflAPrV), gesetze-im-internet.de
• Bavarian State Office for Nursing: language requirements; Regional Council Stuttgart: recognition of school certificates and of nursing qualifications (2024)
• DGB-Index Gute Arbeit, special evaluation for care professions (data 2012 to 2017)
• Techniker Krankenkasse (TK): sick days of nurses, 2024
• Destatis: part-time work in care professions 2023; projection of care worker demand (2024) and of people in need of care 2022 to 2070
• TVAöD-Pflege, training pay from May 2026