Hiring International Nurses in Germany: A 12-Month Integration and Exam-Prep Plan

A male nurse kneeling to talk with a smiling older woman in a wheelchair in a hospital corridor. Licensed under the Unsplash+ License.

The short answer

An internationally trained nurse usually starts in your hospital before they’re fully recognised. Until then, they can only work in a supporting role, and every month that recognition takes is a month you’re paying for a nurse who can’t yet work at their level.

The private care providers’ association bpa puts the average recognition procedure at 500 days (Deutsches Ärzteblatt, May 2025). You can’t control the authority’s timing, but you can control how ready your nurse is. Here’s a sample plan for the first 12 months.

What you can and can’t control

The authority decides when the decision letter (Bescheid) arrives and which gaps it lists. After that, the rules help you plan. The knowledge 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 decision (§ 45 PflAPrV).

Everything else, from study time to practice on the ward, is in your hands.

A sample 12-month plan

• Month 0: arrival and the decision letter. Your nurse chooses a route, the knowledge exam or an adaptation course. If you want funding, apply before the course starts. Led by HR and the nurse.
• Months 1–2: onboarding on one ward with a named practice instructor (Praxisanleiter), and fixed study days in the rota. Led by the nursing director and practice instructor.
• Months 3–5: exam preparation alongside work, with practice cases on the ward and mock exams. Led by the course provider and the ward team.
• Month 6: registration for the exam. Deadlines differ: in Hesse it’s at least four weeks before the exam, in Hamburg at least six. Led by the nurse and the nursing school.
• Months 6–8: exam month. Time in the exam setting where your state requires or recommends it, and no extra shifts around exam days. Led by the ward manager and HR.
• Months 9–12: licence application with the B2 German certificate, then the move into a registered-nurse role. Led by HR and the nurse.

This is an example, not a promise. The actual dates depend on when the decision arrives, the exam dates in your state and your nurse’s progress.

Month 0: start with the decision letter

Read the authority’s decision together with your nurse. It names the gaps, and those gaps shape everything that follows. If your nurse hasn’t received a decision yet, they can also waive the detailed equivalence check and go straight to the exam or an adaptation course. The waiver is final, so get advice first.

If you want support from the Agentur für Arbeit, timing matters. Funding is generally only paid if it’s applied for before the course starts (§ 324 SGB III).

Months 1 to 5: practice and protected study time

The most useful thing you can give your nurse is time. Put study days into the rota as fixed shifts, not as “if the ward allows it”. Pair your nurse with one practice instructor who can walk them through care planning, documentation and handovers the German way.

Practice on the ward counts as much as the books. The practical exam usually takes place with real patients in a facility approved for nurse training, often your own, so everyday care is exam preparation too.

Photo: Nappy on Unsplash+. Licensed under the Unsplash+ License.

Months 6 to 8: the exam

Register early and check the deadline in your state. Around the exam, keep the rota calm: no night shifts the day before, and time off for the exam days themselves. Two examiners assess the practical part, typically a teacher from the nursing school and a practice instructor.

Months 9 to 12: the licence and beyond

Passing the exam isn’t the last step. For the licence to work as a registered nurse, your nurse usually also needs German at B2 level or higher (Make it in Germany). Plan language support from the start, not after the exam.

Once the licence is in, update the contract and pay group, and talk to your controlling team about how your nurse now counts in your staffing figures. If your nurse came on a recognition-related residence permit, check with the immigration office which permit they need next.

How CareSteps helps

The CareSteps education centre is an AZAV-approved provider and prepares internationally trained nurses for the knowledge exam in a structured three-month course. We coordinate with your ward so preparation fits the rota.

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

Next steps

Bringing several nurses on board this year? Email us and we’ll help you turn this plan into dates for your team.