University hospitals and large hospitals in Germany and Austria have recruited thousands of nursing staff from abroad over the last ten years. Some projects have failed. Others have gone so well that former new arrivals are now running wards themselves. This article looks at the cases where it has worked - and asks why.
One in six nurses in Germany comes from abroad. That's 270,000 people who get up in the morning, speak a foreign language, work in a system that they first had to learn - and still ensure that patients are cared for. This is not a side note. This is a cornerstone of German healthcare.
Despite this, there is strangely little talk about these people. The public debate is mostly about numbers: How many are missing? How many should come? Rarely is it about what happens when they arrive. How does the first day on the ward go? What happens when there is a Bosnian nurse in Berlin-Schöneberg and the patient only speaks Berlin? Who helps when homesickness strikes?
This article does not provide abstract recommendations. It looks at five specific clinics that are internationally Nursing staff from abroad have not only hired, but actually integrated. With programs, with structures, with mistakes and with successes. And he looks across the border to Vienna, where one of the most ambitious recruitment projects in Europe is currently underway.
The figures are well known, but they are so large that they still need to be repeated. According to the Federal Statistical Office, up to 2.15 million nursing staff could be needed in Germany by 2049. The Bertelsmann Foundation has been warning for years: There will be a shortage of at least 150,000 skilled workers by 2030. Berlin alone is expecting a shortfall of 5,800 nurses by the end of the decade. If you want to take a look at the details of the current situation, you can find them in our Analysis of the shortage of skilled nursing staff.
Training alone is not enough. That's not a slogan, it's arithmetic. Vivantes, Berlin's largest municipal hospital group, trains 300 nurses every year. And yet it still has 400 to 600 unfilled positions. The head of the Vivantes recruitment center has put it this way publicly: Training alone would not be enough to cover the demand in the coming years.
The Countries of origin are widely distributed. Poland accounts for the largest share at around 25%, followed by Romania, Croatia, the Philippines and Bosnia-Herzegovina. Serbia has also become much more important as a result of the Western Balkans regulation. 65% now come from third countries - i.e. from outside the EU.
When people talk about international care workers in Germany, sooner or later the name Triple Win comes up. The program has been running since 2013 and is a cooperation between the Federal Employment Agency and the GIZ. It places trained nurses from countries with a surplus of skilled workers in German hospitals and care facilities.
Three sides should benefit - hence the name. The nursing staff get a professional perspective that they don't have at home. Germany gets qualified staff. And the countries of origin benefit from falling unemployment and remittances.
Bosnia-Herzegovina and Serbia were among the partner countries right from the start. Why these countries of all places? The nursing training there is comparable to that in Germany. At the same time, almost 5,000 nurses were unemployed in Bosnia-Herzegovina at times. A nurse there earns 300 to 350 euros a month - if she can find a job at all. More about the Potential of the Western Balkans for German nursing care.
To date, more than 4,500 care workers have been placed through Triple Win. The ILO and the International Organization for Migration have repeatedly recognized the programme as an example of fair recruitment. Employers consistently report a high level of professionalism.
Heidelberg University Hospital is one of the best-known employers in the Triple Win program. Since 2017, the hospital has taken on new international nursing staff four times a year. There are now over 300 of them - mainly from Bosnia-Herzegovina, Serbia, Tunisia and the Philippines.
What sets Heidelberg apart from many other hospitals is a principle that Nursing Director Edgar Reisch likes to repeat: „From care for care.“ Integration is not managed by the administration, but by nursing staff who work on the ward themselves. Nursing educators from the in-house academy organize lessons. Practical instructors prepare for the knowledge test. The people who know best do it themselves.
Then there are Marijana and Snjezana. They come from Serbia and Bosnia-Herzegovina and have been working at the university hospital for almost thirty years. Decades ago, they dared to take exactly the same step that the new arrivals are taking today. They are now part of the integration team - and probably the most valuable part. They speak the language, know the fears, know what the first few weeks feel like. No handbook can replace that.
In September 2023, the UKHD organized a recognition ceremony for the first time: 87 international nursing staff had completed their full nursing Professional recognition received. Some of them are now training new arrivals themselves. Others provide specialist training. This is not marketing. It's measurable.
Since 2023, the hospital has also been cooperating with the Goethe-Institut in Mannheim. The nursing staff there not only learn specialist vocabulary, but also how to ask for the right shelf in a German supermarket or hold a conversation at parents' evening. That sounds like a small thing. But it is not.
Leijla came from Bosnia-Herzegovina in 2019. Two years later, she was a specialist nurse for intensive care and anaesthesia. From an unemployed nurse in a 350-euro country to a specialist in a German intensive care unit - in four years.
Edin, also from Bosnia, has been living in Germany since 2018. After four years in paediatric cardiology, he now works as an integration manager for the recognition of foreign qualifications. He is now helping others to follow the same path.
Vivantes is Berlin's largest municipal hospital group - nine locations, over a thousand beds. The hospital began recruiting abroad back in 2013, when a pilot project run by the Federal Ministry of Economics brought 61 Vietnamese nursing staff to Berlin. Since then, it has expanded massively. Own projects in Mexico, Brazil, Turkey, Kosovo, India and the Philippines followed.
The special thing about Vivantes is not so much the recruitment as the support afterwards. One or two integration assistants work at each location. These are experienced colleagues who not only take care of the professional induction, but also help with visits to the doctor, finding accommodation and finding their way around the Berlin S-Bahn network. And sometimes they simply provide comfort when homesickness strikes. You won't find this in any job advertisement, but in practice it is one of the most important success factors.
In February 2022, Vivantes Hauptstadtpflege was awarded the „Fair Recruitment Nursing Germany“ seal of approval. The seal stands for ethical standards, transparency and the so-called „employer pays“ principle: the nursing staff pay nothing for their placement. No commitment clauses, no repayment demands.
What remains the biggest hurdle? The language - unanimously and without restriction. A colleague at the Auguste-Viktoria-Klinikum tells us that Berlinerisch has little to do with the High German spoken on the language course. And then there are older patients who say they only want to be cared for by German nurses. That's not an opinion. That's discrimination. But the colleagues on the ward help - and that makes all the difference.
With over 23,000 employees from more than 120 nations, Charité is Germany's largest university hospital. International recruitment is a strategic priority there, enshrined in a dedicated agenda for internationalization.
And Charité does something that hardly any other hospital does: it sends its own team to the countries of origin to select nursing staff directly on site. In Mexico and Brazil, recruitment takes place entirely without external agencies. India and Colombia have also been added since 2022.
There is a six-month adaptation program for professional integration - with theoretical and practical components. During the recognition period, the nursing staff work as specialists in recognition, with a reduced area of responsibility but a full salary. Each person is assigned a mentor. Charité bears the full cost of the B2 language course and adaptation qualification.
The recognition process can take up to twelve months. After that, the nursing staff work as fully recognized specialists - with all rights, further training opportunities and promotion prospects. To find out more about the Recognition process We have written down the process step by step.
UKM Münster approaches the topic of integration not only organizationally, but also scientifically. Since 2014, the hospital has recruited over 200 international nursing staff from more than 15 nations. The integration measures are regularly evaluated - not with gut feeling, but with data.
What makes Münster special is the concept of cultural ambassadors. These are international nursing staff who have gone through the entire integration process themselves and now work as bridge builders for new arrivals. A Colombian cultural ambassador on the neonatal ward describes her motivation as follows: 'When she came to Germany, she would have liked to have someone she could ask where to find plantains or arepas ingredients. Today, she is that person for others.
The UKM also provides a practical solution to the housing problem: furnished shared flats for the initial period. People who have just arrived from Colombia or Brazil have no Schufa information and no network on the German housing market. In the first few months, the skilled workers live together. Later, they look for something of their own.
In the first week, there is a city tour and lunch together - accompanied by a local association that supports specialists with leisure activities outside the clinic. Münster is a cycling city. So there are also bicycles for hire. Such details sound small. But they are not.
According to the hospital, after one year the internationally recruited specialists work independently on the ward.
The University Medical Center Freiburg has a head start that hardly any other hospital in Germany has: Over 30 years of experience with international recruitment. Under the motto „We overcome borders“, people from 150 nations work there today - with around 4,300 nursing staff in total.
The peer group meetings are a special element: Regular, confidential meetings in which international nursing staff can talk about things that get lost in the normal ward routine. Cultural misunderstandings. Different expectations of hierarchy and communication. What it means when a doctor „Do that“ says and means „Take responsibility“ - while the caregiver has understood: „Carry out this one instruction.“ The content is determined by the participants themselves. There are also free German lessons and a permanent practical instructor for each international specialist.
The challenge is not limited to Germany. Austria is also urgently looking for nursing staff. And Vienna has decided to tackle the problem with one of the most ambitious projects in the German-speaking world.
The Vienna Healthcare Association (WIGEV) - Austria's largest healthcare employer with 30,000 employees, seven clinics and nine care homes - has launched the #Nurses4Vienna initiative in 2024. The aim is to bring up to 600 qualified nurses from third countries to Vienna over the next five years. The first 19 arrived at the end of 2024 and 88 were already in preparation by mid-2025.
What makes the Viennese model special is that it does not rely on placement agencies, but on direct partnerships with universities abroad. Together with the FH Campus Wien, the nursing staff are prepared in a nine-month course - linguistically, professionally and socially. German lessons (up to level A2) begin at the partner universities. This is followed in Vienna by language courses up to B1 and B2, modules on the Austrian healthcare system and social support from social workers.
General Director Evelyn Kölldorfer-Leitgeb emphasizes that this is not purely a recruitment project, but a comprehensive integration project that offers specialists long-term prospects in Vienna. The results of the first year support this: staff turnover at WIGEV fell to 9 percent in 2024, while the occupancy rate in nursing rose to 95 percent.
For German employers, the Vienna approach is interesting in several respects. Firstly, dispensing with agencies saves costs and increases control over quality standards. Secondly, academic preparation in the country of origin significantly shortens the recognition process. Thirdly, the combination of language training, specialist preparation and social support reduces the risk of emigration - the biggest problem for many German clinics.
From the experiences described, five hurdles can be identified that occur everywhere - and five ways of dealing with them.
B1 is enough for the flight. Not for everyday life on the ward. Naming medications, handover protocols, doctors' orders, conversations with frightened patients - all this requires B2, and not the B2 from the textbook, but real, lived German. And then there are the dialects: Berlinerisch, Swabian, Hessian. No language school in the world can prepare you for this. The successful hospitals combine B2 courses during working hours with specialist language training on the ward and everyday language programs such as Heidelberg's cooperation with the Goethe-Institut.
In Germany, the recognition of foreign nursing qualifications is a matter for the federal states. Depending on the region, the process takes between three months and almost three years. The head of nursing at Frankfurt Hospital has publicly criticized the fact that hospitals submit applications and receive no feedback for months. Anyone recruiting today does not know when the person will actually be on the ward as a recognized specialist. The successful clinics have learned to actively manage this process internally - with their own integration officers who coordinate the paperwork. A detailed guide to the Recognition procedure have been published separately.
When you leave your country, you also leave your network. Friends, family, familiar places - all gone. For many, the first few months are a period of loneliness. Successful hospitals invest in social structures: shared flats instead of isolated rooms (Münster), integration assistants for personal problems (Vivantes), cultural ambassadors with their own migration experience (Münster, Heidelberg), city tours and peer groups (Freiburg). This costs time and money. If you don't do it, you lose people.
A survey conducted in 2022 among foreign nursing staff at German university hospitals revealed that 55 percent experienced discrimination based on language, nationality or origin. That's not an anecdote. That's half. If older patients say they only want to be cared for by German nurses, the hospital is responsible. Hospitals that recognize this, provide training and work against it structurally keep their international specialists for longer.
There is a pattern that is particularly familiar to rural homes. The clinic invests in language courses, accommodation and training. And as soon as the recognition is obtained, the nurse moves to a large city clinic with a collective agreement, better salary or a larger community from their country of origin. That is understandable. But it means that integration is not a one-off project. If you want to retain staff in the long term, you have to offer prospects - further training, career paths, family reunification. The examples from Heidelberg and Bosnia show what is possible when Real career opportunities are created.
| Clinic | Start | Specialists | Origin (focus) | Special approach | Result |
| UKHD Heidelberg | 2017 | Over 300 | Bosnia, Serbia, Tunisia, Philippines | Serbian mentors, Goethe-Institut cooperation | 87 recognitions in 2022/23 |
| Vivantes Berlin | 2013 | Ongoing, several hundred | Vietnam, Mexico, Kosovo, Turkey, etc. | Integration guides at every location | Fair recruitment seal of approval |
| Charité Berlin | ~2018 | Ongoing | 120+ nations | Own team travels to countries of origin | 6-month adjustment program |
| UKM Münster | 2014 | Over 200 | 15+ nations | Cultural ambassadors, furnished shared flats | After 1 year of personal responsibility. |
| UK Freiburg | For 30+ yrs. | Ongoing | 150 nations | Peer group meeting, 30 yrs. experience | Long-standing model |
| WIGEV Vienna | 2024 | 88 (target: 600) | Jordan, Indonesia | University partnerships, not agencies | Fluctuation down to 9% |
No clinic has to reinvent the wheel. The cases described provide a clear pattern:
The examples from Heidelberg, Berlin, Münster, Freiburg and Vienna show that it is possible: It works. But they also show where things get stuck.
Recognition takes too long and is not uniform between the federal states. The entire process from the recruitment decision to the first day of work takes around 500 days on average. Digitization and nationwide standards would change this.
The housing market in major German cities is practically closed to people with no credit rating and no network. Clinics that don't offer a solution lose applicants to those that do.
And: recruitment alone will not solve the problem. As long as working conditions in the care sector do not fundamentally improve, the gaps will grow faster than they can be filled. International recruitment is necessary. But it is not enough.
For clinics and care facilities that want to go down this path, it is worth taking a look at the models described. Not to copy. But as a starting point for their own structures that suit their own organization. Anyone who needs support with the Recruitment and integration of international nursing staff is looking for, please feel free to contact us.
Source reference: This article is based on publicly accessible press releases, career pages and annual reports of the clinics mentioned, on publications of the GIZ and the Federal Employment Agency, on specialist publications (bibliomed-pflege.de, pflegenetzwerk-deutschland.de) and on the official communications of the Vienna Healthcare Association. The individual examples mentioned are publicly documented. Nothing has been invented.