How clinics and care facilities not only attract international specialists, but also retain them in the long term
You have invested months, spent thousands of euros, collected papers, organized visas - and then the new caregiver quits after four months. What went wrong? In most cases, the answer does not lie in the recruitment process. It lies in what comes afterwards: the integration.
In 2024, more than 300,000 foreign nursing staff in Germany - almost one in five nurses. Since 2022, only immigration has been driving employment growth in the care sector; the number of German care workers is declining. At the same time, according to the Federal Statistical Office, between 280,000 and 690,000 additional nurses will be needed by 2049. The calculation is clear: without international skilled workers, nursing care will collapse.
But recruitment alone is not enough. Anyone who invests 10,000 to 20,000 euros per recruited nurse and loses them again after a short time is burning money. This guide shows what facilities can do to ensure that international nurses arrive, stay and become an integral part of the team.
Note: This article is intended to provide general information for employers in the healthcare sector. It does not replace individual legal or personnel advice. Facility-specific circumstances, collective agreements and national regulations may differ.
Recruiting a care worker from a third country takes an average of 12 to 18 months. The costs - language courses, placement fees, visa, recognition procedure, finding accommodation - add up to between 8,000 and 20,000 euros per person. If integration fails, this money is lost.
But the financial losses are only part of the problem. When an international nurse leaves the facility after a few months, the entire team suffers. The colleagues who were prepared to provide support have to make up the shortfall again. Confidence in international recruitment declines. In the worst case scenario, the existing team develops a negative attitude towards future international employees.
The reasons for early departures are rarely of a professional nature. International nursing staff bring solid qualifications with them - many have an academic nursing degree in their country of origin. What is missing is the arrival: linguistically, culturally, socially and in everyday working life. If you end up in a small town with no connection to a community from your country of origin, sitting alone in a furnished apartment in the evening and feeling like you don't really belong in the team, you start to look around for alternatives.
Studies show: In care teams, origin no longer plays a role until after around three years. This means that the critical phase is long. And it is precisely in this phase that it is decided whether the investment in recruitment will yield a return or become a total loss.
Conclusion: Integration is not a soft issue. It is the point at which an expensive recruitment becomes a long-term appointment - or not.
Successful integration cannot be improvised. It needs structure. In its „Welcome Culture & Integration Toolbox“, the German Competence Center for International Healthcare Professionals (DKF) has defined 15 areas of requirement that institutions should systematically address. We have translated these into five practical pillars:
Familiarization with the actual day-to-day care routine at the facility. This not only includes learning about procedures and documentation systems specific to the facility, but also understanding the distribution of roles in the German nursing system. Many international nursing staff come from countries where nurses act more independently - blood sampling, infusions and diagnostic assessments are naturally part of the job profile there. In Germany, these skills are distributed differently. This can be frustrating if it is not addressed openly.
B2 is the formal standard - but B2 is often not enough for everyday nursing care. Technical terminology, patient dialects, medical documentation, rapid-fire handovers: All of this requires language skills that go beyond the certificate level. More on this in the section „Language support in the workplace“.
Housing, dealing with the authorities, bank accounts, finding a doctor, mobility - everyday things that Germans take for granted are a considerable hurdle for new arrivals. The MEDIAN clinics, for example, rent apartments themselves and rent them out to new employees because landlords are often skeptical of people with little knowledge of German.
Understanding hierarchies, communication styles, dealing with criticism, religious needs - cultural differences are evident in many areas of everyday working life. The decisive factor is that cultural sensitization affects both sides. The existing team needs to be prepared just as much as the new colleagues.
Homesickness, isolation, worries about the family left behind - these are real factors that decide whether to stay or go. Facilities that provide regular opportunities for discussion, facilitate contact with the community from the country of origin and organize leisure activities demonstrably reduce the drop-out rate.
The Charité in Berlän has set up its own „Nursing Integration Unit“. MEDIAN has appointed integration officers at several locations. It is not only large clinics that take this approach: Medium-sized care facilities also benefit when one person is responsible for the overall concept.
The Care Support and Relief Act (PUEG) has provided a legal basis for the pro rata refinancing of recruitment and integration projects since July 2023. In addition, there are training vouchers from the Federal Employment Agency for language courses and adaptation measures. Check with your provider and the relevant employment agency which funding options apply specifically to your institution.
The B2 certificate is the entry ticket - not the goal. Anyone who has to communicate in nursing needs more than grammar and vocabulary. It's about nursing terminology, the ability to formulate a handover precisely, understanding patients with a strong dialect, writing nursing reports that are legally valid.
Important: Promote a culture of error. People who are afraid of making mistakes speak less - and learn more slowly. The team needs to know that linguistic patience is just as much a part of the integration concept as the language course itself.
The most common mistake: the entire integration work is projected onto the new colleagues. They are expected to adapt, learn the language and understand the processes. The existing team is left out in the cold. That goes wrong.
Surveys show that international nursing staff in Germany do experience racism - both from patients and from colleagues. The topic is avoided in many facilities because there is a fear of being associated with racism. But turning a blind eye does not solve the problem.
A mentoring program is the backbone of any successful integration. It gives the new nursing staff a permanent reference person in their day-to-day work - someone who answers questions that you don't want to ask the ward manager, who explains the unwritten rules and who notices when something is wrong.
There are facilities that have been successfully integrating international nursing staff for years. What do they do differently? Common success factors can be derived from the practical examples documented by KOFA and other specialist agencies:
| Success factor | What this means in concrete terms |
| Early contact before arrival | Regular video calls with the future team during the language course phase in the country of origin. Charité begins cultivating relationships months before entry. |
| Housing guarantee | The facility provides a furnished apartment for the initial period. Later, support in the search for private accommodation. No care worker should be without a permanent home on their first day of work. |
| Diversity instead of monoculture | Consciously recruit nursing staff from different countries. Too many employees from one country can lead to group formation and make integration into the overall team more difficult. |
| Long-term perspective | Show clear career paths: Further training, specializations, management positions. Those who see the future, stay. |
| Family involvement | The family's opinion about moving to Germany is a strong predictor for staying. Institutions that also ask about the family situation during the interview make better decisions. |
| Strong corporate culture | Shared values - not as a mission statement on the wall, but lived in everyday life. People are at the center of our work. This applies to patients and employees alike. |
A key point that comes up again and again in the practical examples is that successful facilities do not see the recruitment of international nursing staff as a stopgap solution, but as a strategic pillar of their HR work. They do not invest in integration reluctantly, but because they know that this investment will pay off in the long term.
The first 90 days are crucial. During this phase, the bond with the institution is formed - or it dissolves. A structured plan helps to ensure that nothing is forgotten and provides orientation for everyone involved.
Tip: Create this plan as a physical document that everyone involved signs. This increases commitment and sends a signal: We take your integration seriously.
Expect to pay between 8,000 and 20,000 euros per person, depending on the country of origin and the amount of language training required. This sum includes placement fees, language courses, recognition procedures, visa costs and immigration support. Added to this are the ongoing costs for in-service language training and the working hours of the integration officer. Since July 2023, the PUEG has provided options for pro rata refinancing.
It typically takes 12 to 18 months from the decision to the first day of work for nursing staff from third countries. The biggest time wasters are the recognition procedure and the issuing of visas. The German Agency for Healthcare and Nursing Professions (DeFa) can significantly shorten this process, meaning that entry is sometimes possible after just six months.
B2 is the formal requirement - but it is often not enough in everyday nursing care. Nursing documentation, handover meetings, communication with patients and relatives require specialist language skills that go beyond the general language B2 level. Plan in-service language training for at least six to twelve months after arrival.
The state seal of approval was initiated by the Federal Ministry of Health and is awarded by the DKF at the Kuratorium Deutsche Altershilfe. It recognizes recruitment agencies that recruit ethically, transparently and fairly. For employers, it is a reliable sign of quality when selecting recruitment agencies.
This problem particularly affects facilities in rural areas. As soon as the Professional recognition Some nurses seek to move to larger cities because of better career opportunities, collective bargaining agreements or a larger community from their country of origin. The most effective countermeasure is successful integration on site: a good team, a real sense of belonging, support with family reunification and clear career prospects within their own institution.
Recognize that the problem exists. Studies show that international nursing staff in Germany experience discrimination - from patients, relatives and colleagues. Institutions that keep the issue quiet lose employees. Establish clear points of contact for those affected, train managers in dealing with discrimination and communicate clearly: racist behavior will not be tolerated - by anyone.
Yes, in part. B2 language courses in Germany can be combined with adaptation measures and funded via education vouchers from the Federal Employment Agency. The PUEG also provides a basis for the pro rata refinancing of recruitment projects. Clarify the specific possibilities with your local employment agency and your sponsor.
The most important points of contact are the DKF's „Welcome Culture & Integration Toolbox“ (dkf-kda.de), the KOFA portal with practical examples and recommendations for action (kofa.de), the Care Network Germany (pflegenetzwerk-deutschland.de) and Make it in Germany (make-it-in-germany.com). TalentOrbit also supports you in the entire recruitment and integration of international nursing professionals - from the selection of candidates to their successful arrival at your facility.
The figures are clear: Germany needs international nursing staff. And international nursing staff need more than just an employment contract and a B2 certificate. They need institutions that prepare for them, sensitize their teams, promote the language and create structures in which arrival is possible.
The good news is that there are tried and tested tools, documented examples of success and funding instruments. What is needed is the decision to treat integration not as a secondary task, but as what it is: the prerequisite for the entire investment in international recruitment to make sense.
Are you planning to recruit international nursing staff? TalentOrbit accompanies you through the entire process - from the selection of suitable candidates to the recognition procedure and sustainable integration in your organization. Talk to us.