Nursing recognition in Germany with a non-EU degree: Kenntnisprüfung or Anpassungslehrgang

🇩🇪 DE · jobs · 2026-10-30

Translating to German. Showing the English original for now.

A nursing degree from a country outside the EU, the EEA and Switzerland, such as Türkiye, counts in Germany only once it is found equivalent to the German training. That is the rule in section 40(1) of the Nursing Professions Act (Pflegeberufegesetz, PflBG). If the authority finds substantial differences, or if you waive the detailed check, you must prove an equivalent level of knowledge, and you then choose between two routes: a knowledge test (Kenntnisprüfung) or an adaptation course (Anpassungslehrgang) of at most three years that ends with an exam. Section 40(3) gives that choice to the applicant, not to the authority. This is general information about the law, not legal advice.

What you need to work as a nurse in Germany

Section 1 PflBG says that anyone who wants to use the title "Pflegefachfrau" or "Pflegefachmann" needs a permit (Erlaubnis). Section 2 lists four conditions for that permit:

the training required by the act, with the state final exam passed;
no conduct showing that you are unreliable for the profession;
health fitness for the profession;
the knowledge of German needed to work in the profession.

A foreign degree is how you meet condition 1; conditions 2 to 4 apply to everyone. Section 2 names no German level. Under section 43 of the Nursing Training and Examination Regulation (PflAPrV), a person trained abroad applies to the competent authority for this same permit.

Degrees from the EU, the EEA and Switzerland go through section 41 PflBG instead. A degree from Türkiye falls under section 40.

How the equivalence check works

Section 40(2) PflBG says your training is equivalent if it shows no substantial differences ("keine wesentlichen Unterschiede") from the German training. Differences are substantial when subject areas or areas of practical training differ substantially from what German law requires.

Gaps can be closed by skills from actual, lawful work as a nurse or by formally recognised lifelong learning. For a graduate who never worked as a nurse, the first way does not exist yet: placements during the degree are part of the training being compared, not work experience.

If the authority finds substantial differences, section 43(4) PflAPrV says it must issue a decision you can appeal (rechtsmittelfähiger Bescheid) that names the subject areas where it found them. For third-country training it may skip the detailed reasons. Section 43(3) sets the deadline: at the latest four months after the complete documents are in.

Option one: the detailed assessment

This is the standard path in section 40(2) and (3). The result is either full equivalence, with no further step, or substantial differences, which you then close through the test or the course. Section 40(3) says the authority should use existing information, in particular sample assessments (Mustergutachten) from the Gutachtenstelle für Gesundheitsberufe.

What the assessment gives you, even when it ends in differences, is the list of gaps in the decision. That list is what an adaptation course can be built around.

Option two: waiving the assessment

Section 40(3a) PflBG covers exactly this. If you waive the equivalence check finally ("endgültig"), you must prove an equivalent level of knowledge. Sentences 2 and 3 of paragraph 3 apply, so you still choose between the knowledge test and an adaptation course of at most three years. The authority must inform you about the legal consequences of the waiver and about that choice.

The waiver keeps your choice and removes the comparison. Without a check there is no list of substantial differences, so the course is not tied to documented gaps in your degree. The word "endgültig" also matters: the law describes the waiver as final.

The adaptation course: who sets its length

Section 44(1) PflAPrV says the competent authority sets the length and content of the course so that its goal can be reached: showing that you have the skills the profession needs. Under section 44(1a), the authority can set a time frame in its decision, and within it the course can be shortened or extended. The institution running the course applies, with reasons from someone who supervised you; if the authority does not refuse within two weeks, the change counts as approved.

The course runs at nursing schools or comparable institutions (section 44(2)) and ends with a final interview (Abschlussgespräch) on what was taught (section 44(3)). If you do not pass, the course can be extended once and followed by a second interview; if that also fails, you may repeat the whole course once (section 44(4)).

The law sets only the upper limit of three years. It gives no typical length for a given country or degree, and none for Bremen.

The knowledge test: what it covers

Under section 40(3) PflBG the test covers the content of the German state final exam, whatever your degree looked like. Section 45 PflAPrV fills this in. The test has an oral and a practical part, and you pass only if you pass both. The oral part is a complex case from at least three competence areas and should last 45 to 60 minutes. In the practical part you show in two to four care situations, of up to 120 minutes each, that you can run the care process yourself.

Section 45(7) says the test should be offered at least twice a year, and the oral part and each failed care situation may be repeated once. Section 45(8) says the states must make sure applicants can take the test within six months of the decision under section 43(4).

Which route fits a recent graduate

The law shows the trade-off. The knowledge test covers the full state exam either way, so a detailed assessment adds little if you already know you will take the test. The adaptation course is where the assessment matters: with a decision that lists your gaps, the authority has a basis to set a course aimed at them, and section 44(1a) leaves room to shorten it. Before you sign a waiver, ask the authority in writing how it would set the course length with and without the assessment.

After recognition

Recognition is about the profession, not your residence permit. If your permit is ever tied to a specific job rather than to family reunification, the rules in changing jobs in Germany on a residence permit apply. For the longer term, the conditions of a settlement permit are explained in our article on the Niederlassungserlaubnis and fixed-term contracts.

FAQ

Who chooses between the Kenntnisprüfung and the Anpassungslehrgang?

You do. Section 40(3) PflBG says the applicant has the right to choose between the knowledge test and the adaptation course.

Can the adaptation course really last three years?

Three years is the legal maximum in section 40(3) PflBG. The authority sets the actual length under section 44(1) PflAPrV.

If I waive the assessment, do I lose the choice?

No. Section 40(3a) PflBG applies the same choice to a waiver, and the authority must explain the consequences to you first.

Does clinical training during my degree count as work experience?

Section 40(2) PflBG counts actual, lawful work in the profession. Placements during the degree are part of the training that is compared.

How many times can I retake the knowledge test?

Under section 45(7) PflAPrV, the oral part and each failed care situation may be repeated once.

How long does the authority have to decide?

Section 43(3) PflAPrV says at the latest four months after the complete documents are in.

Do I need German for the permit?

Yes. Section 2 no. 4 PflBG requires the German needed to work in the profession; it names no level.

How Jobsy fits

We build Jobsy, a job search service for Europe that searches for you: you say what work you want, and Jobsy finds employers and recruitment and staffing agencies in Germany, from a base of more than 2.6 million, and prepares personal messages in the recipient's language. It does not take part in recognition and cannot shorten it. Once you can apply for nursing jobs, or want a job alongside an adaptation course, the first result is free, and Jobsy Active, which keeps the search going, costs 6.70 euros a month.

Sources

Sources: Gesetze im Internet: § 40 PflBG, Gleichwertigkeit und Anerkennung von Ausbildungen · Gesetze im Internet: § 41 PflBG, Gleichwertigkeit entsprechender Ausbildungen · Gesetze im Internet: § 2 PflBG, Voraussetzungen für die Erteilung der Erlaubnis · Gesetze im Internet: § 1 PflBG, Führen der Berufsbezeichnung · Gesetze im Internet: § 43 PflAPrV, Allgemeines Verfahren, Bescheide, Fristen · Gesetze im Internet: § 44 PflAPrV, Inhalt und Durchführung des Anpassungslehrgangs · Gesetze im Internet: § 45 PflAPrV, Inhalt und Durchführung der Kenntnisprüfung