Short answer for employers: Nursing professionals from EU countries such as Poland, Romania or Croatia benefit from automatic professional recognition and freedom of movement for workers - no visa, no recognition procedure, start of work within a few weeks. For skilled workers from non-EU Balkan states (Bosnia, Serbia, Albania, Kosovo, North Macedonia, Montenegro), the Western Balkans regulation acts as an entry bridge, but professional recognition must be obtained later. Placement costs for EU skilled workers: €3,000-8,000. For skilled workers from the Western Balkans: €10,000-20,000.
Important first: If you google „caregivers from Poland“, you will land on sites that provide 24-hour care for private households - caregivers without nursing training who live in the homes of senior citizens and help with basic care and housekeeping. This is a completely different topic. This article is aimed at hospitals, nursing homes and outpatient care services that want to recruit qualified nursing staff from Eastern Europe on a permanent basis.
Transparency notice: TalentOrbit International places nursing professionals from the Philippines, India, Kazakhstan and Kyrgyzstan - not from Eastern Europe. This article was written because employers regularly ask us: „Is Eastern Europe still worthwhile, or should we rely on third countries?“ The answer depends on your organization. This guide provides the basis for the decision - based on publicly available data and our experience in advising institutions comparing different regions of origin.
The three strongest EU countries of origin for nurses in Germany are, according to IAB Research Report 22/2024Poland with around 9,700 employees subject to social insurance contributions in the nursing sector, Croatia with 8,700 and Romania with 8,000, followed by Italy, Hungary and a growing number from the Czech Republic, Slovakia and Bulgaria.
But the real news is in the trend: in 2023, for the first time, more foreign nurses from non-EU countries were working in Germany than from the EU. EU recruitment is stagnating. The growth is coming from third countries - Bosnia, the Philippines, India, Tunisia. Over 51,000 nurses from the six Western Balkan states alone are already working in the German healthcare system.
What the figures fail to mention is that they do not differentiate between skilled and unskilled workers. According to the IAB, two thirds of foreign employees in geriatric care work as care assistants, not as skilled workers. In nursing, the ratio is better - two out of three foreign employees work as specialists. This distinction is crucial for employers looking for qualified nursing staff.
Eastern Europe is still an important source. But anyone who relies exclusively on it is planning without reality.
The biggest advantage of recruiting from EU countries can be summarized in one sentence: no visa, no work permit, automatic professional recognition.
The Professional Recognition Directive 2005/36/EC guarantees nursing professionals from EU member states automatic recognition of their qualifications - provided that their training meets the minimum standards (at least three years of training with 4,600 hours, 2,300 of which must be practical). This is the case for specialists from Poland, Croatia, Romania and most other EU member states. Processing by the competent authority usually takes two to four weeks - not months as is the case with third-country recognition.
What this means for your timetable: A Croatian nurse who signs her employment contract today can start working for you once her notice period in her home country has expired (usually one to two months). No visa, no specialist procedure, no knowledge test. Total lead time: one to three months. For a skilled worker from the Philippines or India, it is six to fifteen months. This is a factor that makes all the difference when there is an acute need for personnel.
The catch: just because no B2 language certificate is required for recognition doesn't mean that language doesn't matter. A Romanian specialist who is technically excellent but barely speaks German will have problems on the ward - and so will your team. More on this in a moment.
When people talk about Eastern European nursing staff in Germany, the word „Polish“ is the first thing that comes to mind. There are historical reasons for this: Poland joined the EU in 2004, the geographical proximity is great, German is taught in many Polish schools and the placement infrastructure has been established for two decades. An estimated 400,000 to 700,000 care workers from Eastern Europe work in private households in Germany - the majority of them from Poland.
But for institutional recruitment, the figures tell a more nuanced story.
Poland's own lack of care. The demographic trend in Poland is similar to that in Germany - the population is ageing and demand in Poland is increasing. At the same time, wages have risen significantly in recent years. According to IAB data, the Polish gross median salary for nursing staff is now above the average for all foreign employees in German hospitals. The financial incentive to move to Germany is no longer as great as it was ten years ago. For a qualified nurse in Warsaw or Krakow, Germany is one option among many - and no longer the only one.
International competition. The UK (pre-Brexit), Scandinavia, the Netherlands, Ireland - all have recruited and are recruiting in Poland. The pool of available nursing staff ready to migrate is being divided up.
The childcare market distorts perceptions. The vast majority of Google hits for „care workers from Poland“ relate to 24-hour home care: unskilled or semi-skilled care workers who live in private households, costs from €2,500 per month, secondment model with A1 certificate. This has nothing to do with the recruitment of qualified nursing staff for your hospital or nursing home. Do not confuse the two.
Polish nursing staff for institutional care are available - but you have to search more actively than you did five years ago. The days when a job advertisement on a Polish job portal was enough are over.
What works: Cooperation with Polish nursing schools and universities (universities in Krakow, Warsaw and Wrocław train according to the Bologna standard). Presence at trade fairs such as Medica or specialized recruitment events in Poland. Collaboration with agencies that mediate in EU Eastern Europe and have native-speaking country consultants - for example CuraVita, which specializes in precisely this area.
With Polish specialists, you can expect placement costs of €2,000 to €5,000, no language training in the narrower sense (most bring A2 to B1), and a start of work within four to eight weeks of signing the contract. For facilities in Saxony, Brandenburg or Bavaria, the cross-border commuter model may also be of interest - Polish skilled workers who live near the border and commute on a daily or weekly basis.
What Polish professionals expect: a collectively agreed salary (the minimum wage for care workers will be €20.50 per hour from July 2025), clear roster regulations and the prospect of a permanent position. The willingness to go abroad for poor working conditions has fallen significantly in Poland. If you want to retain Polish nurses, you have to offer the same conditions that would attract German professionals.
With around 8,000 nurses, Romania is the third largest EU country of origin. Nursing training is academic (university, four years) and automatic recognition is generally unproblematic.
The special feature compared to Poland: Romanian is a Romance language. German is not a school subject and the diaspora in Germany is smaller. Expect Romanian professionals to be at A1 level when they enter the country - not B1 like many Polish professionals. This means that you need to organize and budget for language training after they enter the country. Experience shows that Romanian specialists need three to six months of intensive contact with the German language on the ward before they can document independently and communicate in a team. An accompanying specialist language course in the first few months is not an option, but a must.
On the other hand, the market is less competitive than the Polish market. The salary level in Romania is lower and the willingness to migrate is correspondingly higher. And: Romanian nurses usually have a bachelor's degree - their professional qualifications are at least on a par with their German colleagues, often higher.
Croatia (EU since 2013) has become the second strongest EU country of origin in ten years: 8,700 skilled workers in the nursing sector. The training is solid (three-year or academic), and many Croatian professionals have a useful knowledge of German - partly from tourism, partly through family connections to Germany and Austria.
The problem: Croatia has a population of 3.9 million. The pool is limited, and Austria, Switzerland and Scandinavia are also recruiting intensively. Croatia is an excellent source for individual specialists or small groups, but not a country for volume recruitment. If you need ten skilled workers in six months, you won't find them in Croatia.
Together, these four countries supply around 8,000 to 9,000 nursing professionals to Germany. They all benefit from EU freedom of movement and automatic recognition. But the differences are considerable.
Hungary has a strong medical tradition, and knowledge of German is widespread among the older generation. However, the level of German is falling among younger specialists, and the country's own shortage of skilled workers is limiting the willingness to migrate. The Czech Republic and Slovakia are now so economically stable that the incentive to migrate is low - they are particularly relevant for Bavarian and Saxon institutions that can attract cross-border commuters. Bulgaria offers the greatest growth potential: lowest wage levels in the EU, high willingness to leave. But German language skills are almost always zero - nothing works here without language support.
Now things are getting legally more complicated. The six Western Balkan states - Bosnia-Herzegovina, Serbia, Albania, Kosovo, North Macedonia and Montenegro - are not members of the EU. Nevertheless, over 51,000 nursing staff from these countries work in Germany. More than from all EU Eastern states combined.
The key: the Western Balkans regulation (Section 26 (2) BeschV). It allows nationals of these six countries to enter the country to work in any profession - with an employment contract and the approval of the BA, without proof of qualification for the entry itself. 50,000 visas per year are possible.
But - and this is the crucial point that many overlook - the Western Balkans regulation does not replace the obligation to recognize for regulated professions. A Bosnian nurse may enter the country and work, but as a nursing assistant. Unrestricted professional practice is only possible after passing the knowledge test. This takes an additional six to twelve months. More on our page about the legal framework.
What nevertheless makes the Western Balkans attractive to employers is the large diaspora in Germany. Many applicants from Bosnia or Serbia grew up in Germany, speak fluent German and return after completing nursing training in their country of origin. For these candidates, the language barrier is completely eliminated. Others come directly from Sarajevo or Belgrade - for them, the effort involved is comparable to recruiting from a third country. The difference within a single region of origin is greater here than between different countries.
Bosnia-Herzegovina is also part of the Triple Win Program (BA/GIZ) - a state-supervised, ethically certified placement option.
The cost difference between EU and Western Balkan recruitment is considerable - because the most expensive positions are completely eliminated for EU specialists.
| Cost item | EU specialist (PL, RO, HR) | Western Balkans (BA, RS, AL) |
|---|---|---|
| Agency fee | 2.000-6.000 € | 6.000-12.000 € |
| Professional recognition | Automatic (100-300 € fees) | 500-3,000 € (knowledge test + preparation) |
| Language training | 0-2,000 € (optional, after entry) | 1,500-4,000 € (B1/B2 before entry) |
| Visa / skilled worker procedure | Not necessary | 411 € (accelerated procedure) |
| Flight + initial accommodation | 300-800 € | 800-2.000 € |
| TOTAL COSTS | approx. 3.000-8.000 € | approx. 10.000-20.000 € |
EU recruitment is faster and cheaper. But the pool is smaller and competition among European employers is tougher. The Western Balkans offer more available skilled workers - especially from Bosnia and Serbia - but require more time and support.
You can find a complete comparison of placement models - including triple win, private agencies and in-house recruitment - in our guide to the Nursing recruitment from abroad.
The market for recruitment agencies in Eastern Europe is less regulated than the market for third-country recruitment, where the RAL quality seal „Fair Recruitment Care Germany“ serves as a guide. The quality seal only applies to recruitment from third countries - there is no comparable quality seal for EU recruitment.
What you should check when choosing an agency: How long has the agency been active in the Eastern European market? Does it have its own contact persons in the country of origin (ideally native speakers)? How transparent is the cost structure - are there any additional payments on conclusion of the contract? Does the agency offer support with recognition and integration, or does its service end with the placement? And: Can it provide specific references from institutions that have recruited through it?
Beware of agencies that promise „caregivers from Poland“ and actually provide caregivers for private households. Ask explicitly whether they are qualified nursing staff with recognized training or caregivers on a secondment basis. These are two fundamentally different services.
The secondment model dominates the home care market: a company in Poland or Romania sends a caregiver who remains employed and socially insured in their home country (A1 certificate). The German family pays a lump sum.
This model is almost always wrong for hospitals and nursing homes. Three reasons:
Firstly, the posting is limited to 12 to a maximum of 24 months. After that, German social security law applies. This is not suitable for long-term personnel planning.
Secondly, control by the foreign employer creates dependencies. If the sending company withdraws the employee, you are left without staff. You have no direct employment contract.
Thirdly, the PUEG has restricted the refinancing of seconded staff in care rate negotiations. Only directly employed nursing staff paid according to collective wage agreements are fully eligible for refinancing.
The Permanent position (direct placement) is the right way to go. The specialist concludes a permanent employment contract directly with your institution, is paid in accordance with German collective bargaining law and is registered with the social security system. For EU citizens, this can be done without any bureaucratic hurdles. For Western Balkan specialists via the Western Balkans regulation or the Accelerated specialist procedures.
Language does not determine whether a specialist is good at their job. But it does determine how quickly this expertise becomes visible on the ward.
The easiest in terms of language: Poland and Croatia. Polish professionals generally have A2 to B1 - German is a school subject, the large diaspora helps, and many have already gained professional experience with German-speaking patients or colleagues. Croatian professionals are in a similar position: the tourism industry and family connections to Germany and Austria create language contact. In both cases, an accompanying specialist language course after arrival is often sufficient, not intensive language training.
Medium expenditure: Hungary, Western Balkans diaspora, Czech Republic/Slovakia. Hungarian professionals sometimes speak good German - but this varies greatly by generation and region. For candidates from the Western Balkans, it depends on the individual background: Those who grew up in Germany and return speak fluently. Those who come directly from Sarajevo or Pristina need intensive language support. Czech and Slovakian specialists in border regions (Bavaria, Saxony) often bring useful German with them - further inland the situation is different.
Intensive support needs: Romania, Bulgaria, Albania directly from the country of origin. Romanian and Albanian are not Slavic languages - the transfer effect to German is minimal. Bulgarian specialists almost never have any knowledge of German when they arrive. For these groups, you need to plan for language support: three to six months of accompanying specialist language courses, a mentor on the ward, patience in the team.
A tip that we give to every employer, regardless of the country of origin: Conduct the interview in German. Ten minutes of conversation about everyday nursing situations will tell you more than any language certificate.
You can find out more about the recognition of foreign qualifications in our guide to Recognition of foreign qualifications in Germany.
We regularly advise institutions that are faced with precisely this question. The answer is never one-size-fits-all. But there are constellations in which the direction is clear.
Eastern Europe / EU is the better choice if You need staff quickly - start work in one to three months instead of six to fifteen. If your facility is located in southern or eastern Germany, i.e. in geographical proximity to Poland, the Czech Republic or Croatia. If your team has little experience with international integration and you want to keep the support costs low. Or if your budget for language training and recognition support is limited.
Third countries are the better choice if You are planning larger groups - five, ten or more specialists. If the EU market in your catchment area is empty because three other clinics in the district are also recruiting in Croatia. If you are prepared to plan twelve to fifteen months in advance. And if you have the structures in place for systematic integration: Practice supervisors, specialist language courses, accommodation.
The combination is often the smartest approach. In the short term, EU specialists for the most acute gaps and, in parallel, the development of a third-country recruitment project for medium-term personnel planning. Some of the institutions we advise operate precisely this two-pillar model - and it works because the quick EU gains bridge the waiting time for the third-country specialists.
The entire Recruitment process we have documented on our employer page.
For direct placement in a permanent position: € 2,000 to € 5,000 placement fee, no visa costs, no language training abroad. The salary is based on German collective bargaining law - from July 2025 at least € 20.50/hour for skilled workers. Don't confuse this with the €2,500-3,500 per month for home care workers in the secondment model - that's a different market.
In principle, yes - but it is automatic. The EU Professional Recognition Directive guarantees equivalence. Processing takes two to four weeks. Proof of language proficiency is not formally required, but is rightly expected by employers.
The Western Balkans regulation (Section 26 (2) BeschV) allows nationals from Bosnia, Serbia, Albania, Kosovo, North Macedonia and Montenegro to enter the country for employment - with an employment contract and BA approval, without proof of qualification. However, it does not replace the recognition requirement for skilled nursing staff. The specialist can enter the country and work as a care assistant until the knowledge test has been passed.
Check: How long has the agency been active, does it have native-speaking contacts in the country of origin, can it provide references from facilities? Important: Make sure that the agency places qualified professionals for institutional care - not caregivers for private households. There is no quality seal comparable to the „Fair Recruitment Care“ seal of approval for third countries in the EU market, so references and transparency are all the more important.
One to three months after signing the contract. No visa required, automatic recognition in two to four weeks, usual notice period in home country one to two months.
Georgia is not an EU country, but it is close to Europe, with a growing range of German courses and an education system that is oriented towards EU standards. Georgia may be of interest to institutions looking for an interim solution between EU Eastern Europe and the classic third countries (Philippines, India). More in our country comparison on Nursing staff from Georgia.
Are you weighing up whether Eastern Europe, third countries or a combination is the right route for your organization? TalentOrbit International advises healthcare employers on the best country of origin strategy. Our placement services focus on the Philippines, India, Kazakhstan and Kyrgyzstan - but our advice covers the entire comparison.
➡️ Contact: www.talentorbit.de/kontakt | +49 (0) 2173 265 3870 | info@talentorbit.de
This article was written by TalentOrbit International GmbH created. The information is based on the IAB Research Report 22/2024, the Federal Employment Agency's Focus on the Labour Market (2024), the EU Recognition of Professional Qualifications Directive 2005/36/EC and the current regulations of the Western Balkans Regulation (Section 26 (2) BeschV). Status: March 2026.