The 2026 Recognition Reform in Germany: What Changes for Employers of International Nurses?

The short answer

On 1 November 2026, a new federal law came into force that speeds up recognition for doctors, dentists, pharmacists and midwives trained abroad. Nurses aren’t on that list. Their recognition still runs under the Nursing Professions Act (Pflegeberufegesetz).

That doesn’t mean nothing has changed for your nurses. Since December 2023 they’ve had a shortcut of their own, and it’s easy to miss.

What the new law changes

The law to speed up recognition in the health professions was signed on 28 July 2026 and has applied since 1 November 2026 (BMG). Its central idea: for doctors, dentists and pharmacists from third countries (outside the EU, the EEA and Switzerland), the knowledge exam becomes the standard route. The document-based equivalence check (Gleichwertigkeitsprüfung) only happens if the applicant asks for it (BMG press release).

For applicants from third countries, the law also lets federal states test language skills before they assess the qualification, and it gives midwives the option to skip the equivalence check and go straight to a knowledge exam or an adaptation course. Documents can now also be sent electronically.

Why nurses aren’t on the list

Nursing isn’t one of the professions the reform covers. Recognition for nurses continues under the Pflegeberufegesetz and its training and exam regulations (PflAPrV).

So if a nurse or a colleague tells you the new law makes things faster for nurses, it doesn’t. For nurses, though, the biggest change of this kind already happened nearly three years earlier.

What your nurses can already do since December 2023

Since 16 December 2023, nurses can waive the detailed equivalence check and choose the knowledge exam (Kenntnisprüfung) or an adaptation course (Anpassungslehrgang) straight away (§ 40 Abs. 3a PflBG). In other words, nurses already have a direct route to the exam, which is roughly what doctors are getting now.

The waiver is final. If your nurse waives the check, they’ll take the exam or the adaptation course in any case. With the check, the authority could find that their training is equivalent and no further step is needed. That’s why your nurse should get advice before signing, and why it’s worth talking it through together.

Two rules also help with planning. The exam should be offered at least twice a year, and where states hold it on their regular exam dates, they have to make sure your nurse can take it within six months of the authority’s decision (§ 45 PflAPrV).

Three things you might hear, and what’s true

“The new law speeds up recognition for nurses too.” It doesn’t. It covers doctors, dentists, pharmacists and midwives. Nurses aren’t included.

“Nurses always have to go through a full document check first.” Not since 16 December 2023. They can waive it and go straight to the Kenntnisprüfung or an adaptation course (§ 40 Abs. 3a PflBG).

“Waiving the check is always the faster option.” Not always. The waiver is final, and with the check the authority might find the training equivalent. It depends on the individual case.

What to ask your state office

The recognition authority in your federal state is the best place to check your nurse’s situation. Useful questions are whether a decision (Bescheid) has already been issued, whether the waiver is still an option at your nurse’s current stage, when the next exam dates and registration deadlines are, and which German certificates it accepts for the licence.

How CareSteps helps

The CareSteps education centre is an AZAV-approved provider and prepares internationally trained nurses for the knowledge exam. If your nurse chooses the exam route, with or without the waiver, we’ll help you plan the preparation around your rota.

Funding from the Agentur für Arbeit may be possible. Our post on funding the knowledge exam explains how.

Next steps

Not sure which rules apply to your nurses? Email us your federal state and the step your nurse is at, and we’ll help you work out what comes next.