The interview partners
Prof. Dr. Patrick Da-Cruz is Professor of Business Administration and Health Management at the Faculty of Health Management at Neu-Ulm University of Applied Sciences (HNU) and Academic Director of the MBA programme in Leadership and Management in Healthcare.
Before joining HNU, Mr. Da-Cruz worked for renowned strategy consultancies in the pharmaceutical/healthcare sector and held management positions in healthcare companies in Germany and abroad.
Denise Marie Hradecky LL.M., M.Sc., B.H. is a freelance expert in healthcare, law and reform processes. She lectures on healthcare law and management and advises national and international organisations on reform projects, integration strategies and legal frameworks in the healthcare sector. She studied and obtained further qualifications at the University of Tübingen, Erasmus University Rotterdam, Fontys University of Applied Sciences, Bocconi University Milan, HFH – Hamburger Fern-Hochschule, the University of Cambridge, Harvard University and the Università di Roma La Sapienza. Before becoming a freelancer, she held management positions in clinics and strategic health consulting in Germany and abroad. She is the author of several specialist publications, a regular speaker at conferences and volunteers in political committees and social organisations.
Which legal and bureaucratic hurdles deserve particular attention when recruiting foreign nursing staff – and how can they be successfully overcome?
Denise Hradecky: One key obstacle is the recognition of foreign professional qualifications, which is a matter for the federal states in Germany. Procedures, requirements and processing times vary greatly, which complicates the process. Common reasons for delays are incomplete documents or missing certified translations. Those who compile a complete and verified document folder in their country of origin – including training certificates, timetables, police clearance certificates and translations by sworn specialist translators – are more likely to be successful.
There are two main routes for visas and residence permits: Section 18a or b of the Residence Act (‘skilled worker’) for fully recognised nursing professionals with B2 level, and Section 16d of the Residence Act (‘recognition partnership’) for partial recognition. The latter allows entry before recognition is completed, but requires an adaptation plan, at least B1 language level and close coordination with immigration authorities and embassies.
Language qualifications are regulated uniformly throughout Germany: B2 is required for full professional admission, but some states grant a temporary professional licence from B1 onwards if the upgrade is firmly planned.
Transparency and fairness are also crucial to success: fair contracts with no hidden costs, compliance with WHO ethical guidelines and GDPR-compliant handling of sensitive data. Proactively addressing these issues speeds up procedures and strengthens the trust of nursing professionals.
Is Germany attractive to foreign nursing staff compared to other locations? How can Germany position itself as an attractive location?
Denise Hradecky: Many foreign nursing professionals see Germany as a particularly attractive destination for their professional future. Germany offers international nursing professionals numerous advantages: a stable economic situation, secure jobs with long-term prospects, collectively agreed pay, a high level of medical care and clear legal regulations for immigration and family reunification. A wide range of further training and education opportunities – for example in intensive care, in the operating theatre or in practical instruction – also increase its attractiveness.
Despite these strengths, there are also challenges when compared internationally. Recognition and visa procedures are often lengthy, the bureaucracy is complex, and the cost of living and rents are high in many cities. Countries such as Switzerland and Scandinavia attract people with higher salaries, while English-speaking countries offer lower language barriers.
In order to remain competitive, Germany must significantly speed up procedures and provide better support. One example: in Bavaria, recognition procedures are partly handled digitally, which significantly reduces processing time. In addition to faster processes, high-quality language courses, affordable housing for the initial phase, a structured induction programme and support for family integration are also important.
Last but not least, a culture of appreciation is important: fair contract terms, transparent development opportunities, a say in the team and interculturally trained colleagues. This will make Germany not only an attractive destination, but also a long-term workplace for international nursing professionals.
What mistakes should be avoided when onboarding and integrating foreign nursing staff?
Denise Hradecky: A common problem is insufficiently structured onboarding. If the induction process is too short or unsystematic, there is an increased risk of excessive demands, mistakes and demotivation. Studies show that a multi-stage induction process with clearly defined learning objectives, mentoring and regular feedback loops significantly improves both professional and social integration.
Another mistake is underemployment: qualified nursing staff are sometimes permanently employed as nursing assistants, especially during the recognition process. This often leads to frustration and an increased turnover rate. Transitional arrangements should therefore be clearly communicated and individual development steps planned transparently.
The lack of targeted language support in everyday working life is also critical. Pure language courses without any practical professional relevance are insufficient; subject-specific language training, accompanied documentation exercises and interactive handover formats are required. Interdisciplinary communication, for example with doctors, should be specifically taught in the early stages.
In addition, social integration is often neglected. Without support in dealing with authorities, finding accommodation or establishing social contacts, the risk of migration increases. Equally important is the intercultural awareness of the entire team in order to understand cultural differences and avoid misunderstandings from the outset.
Last but not least, success must be monitored: key figures such as the duration of the recognition process, staff turnover rate and employee satisfaction provide valuable information for optimising integration processes.
What role do agencies and government programmes play in successful recruitment? What should be taken into account?
Denise Hradecky: Agencies and government programmes play a central role in the international recruitment of nursing professionals. Private agencies often take care of the entire process – from searching for candidates and language courses to providing support with visas, recognition and integration. Their advantage lies in their speed and flexibility, as they can recruit specifically in certain countries of origin and take into account the individual requirements of the institutions. However, the quality of the services offered varies greatly. That is why clear selection criteria are crucial: transparent cost structures, compliance with WHO ethical guidelines, verifiable success rates in recognition and language tests, and GDPR-compliant handling of sensitive data.
Government programmes – such as the Federal Employment Agency and its central foreign and specialist placement programme ‘Triple Win’ or bilateral agreements – offer legally secure and ethically verified recruitment channels. They guarantee fair conditions and compliance with international standards, but often work more slowly and less flexibly than private providers. In practice, clinics and care facilities have so far made only limited use of this option.
A hybrid approach is often effective: continuous recruitment through government programmes for predictable needs, combined with carefully selected agency partnerships for short-term bottlenecks. Regardless of the recruitment channel, a structured integration plan, transparent communication and continuous language support remain crucial for sustainable success.
What opportunities and risks do you see in the context of the increasing internationalisation of nursing?
Denise Hradecky: The internationalisation of nursing offers considerable opportunities to alleviate the shortage of nursing staff in Germany and increase the security of care. Targeted recruitment from abroad can close gaps in care, reduce the workload of existing teams and bring in new professional impetus. Culturally diverse teams also promote intercultural competence in institutions and can improve the care of patients with a migrant background. The exchange of knowledge – for example, about different nursing standards and methods – can also enrich the quality of care.
At the same time, there are relevant risks. These include the danger of a brain drain in the countries of origin, ethical challenges in recruitment, and integration problems due to language or cultural barriers. On the positive side, however, the return of nursing professionals to their countries of origin can also offer opportunities: with the knowledge and experience they have acquired in Germany, they can contribute to the further development of the healthcare system there. This creates valuable international networks that benefit both sides.
With fair recruitment practices, targeted language and integration support, and clear development prospects, internationalisation can become a win-win situation – for the institutions, the nursing staff and global healthcare.
Thank you very much for talking to us!
The content and statements presented in the interviews reflect the perspective of the interviewees and do not necessarily correspond to the position of the editorial team.
