In German hospitals, the proportion of international nursing staff is growing steadily – as a reaction
to the shortage of skilled workers, with the hope of new perspectives and diversity in the team. Language is
far more than just a means of communication: it is central to safety, quality, team culture
and integration. For hospital employees, this means that language skills and
structures for language promotion are not a minor matter, but essential.
In the following, we look at why language is so important, where exactly the pitfalls lie, what
experiences and examples there are, and how hospitals can take concrete action to overcome
language barriers.
Why language is so important
Patient safety and quality of care
Misunderstandings in communication can cause medical errors – for example due to
incorrect dosage instructions, unclear care handovers or incorrect documentation.
Compliance with hygiene, safety and procedural instructions also depends on everyone involved
being able to understand and use the language.
Workflows & efficiency
If international colleagues are unsure, this delays tasks, especially in shifts, at
handovers or in emergencies.
Comprehensible routines and clear language standards help to reduce frictional losses.
Teamwork & intercultural understanding
Colleagues who speak German as a second language bring other cultural
forms of communication with them – which can be enriching, but can also create friction if
is not reflected upon.
Respectful interaction is crucial, being receptive to misunderstandings and having patience
is also part of a good team culture.
Integration & employee satisfaction
Language is also a key to participation – not only in the patient care process, but also in
social interactions: Breaks, conversations with colleagues, opportunities for further training.
If someone feels that they are constantly “lagging behind” in terms of language, this can lead to frustration,
isolation or even migration – in other words, staff retention is strongly linked to successful
language provision.
Legal and institutional framework conditions
A certain level of German is often required for the recognition of foreign nursing qualifications
(e.g. B2 in the Common European Framework of Reference for Languages).
Language examinations, technical language requirements, documentation obligations – all this makes not
only everyday language necessary, but also technical language.
Just ask yourself once:
How often does a nurse speak during a single shift?
Who are the different communication partners?
What occasions require communication on duty?
What is done orally and what is done in writing? What are the consequences if all these
communication situations do not occur or fail in the workplace?¹
“In addition to linguistic arrival at the workplace, another goal is of course to integrate socially in Germany
. In both cases, language is a decisive
factor.”²
Challenges and typical pitfalls
In order for language to have a positive impact, a number of hurdles need to be actively addressed. Here are typical
stumbling blocks:
Formal language level vs. actual communicative competence
Someone has a B2 certificate, but feels linguistically overwhelmed, e.g. with acute patient inquiries or in emergencies. Or someone only arrives in Germany after a long wait. While the B2 language level has deteriorated again.
Subject-specific language and German peculiarities
Medical terms, care standards, documentation style, legal formulations,
abbreviations, etc. Internationally trained nursing staff often do not know these or know them differently and
need a targeted introduction.
Dialect / colloquial language / fast-talking colleagues
Slippage occurs when a lot of dialect or heavily accented German is spoken in the team
, which can be difficult for non-native speakers to understand.
Written communication
Nursing reports, handover protocols, doctors’ orders – there are high demands on
clarity, completeness and technical precision.
Emotional strain
Linguistic uncertainty creates stress because colleagues are afraid of making mistakes,
being misunderstood or even being held liable
.
Time pressure
In hectic shifts, there is often little time to clarify linguistic uncertainties or ask
.
What hospitals can do – recommendations for action
For hospital management, nursing service managers and all those who work in teams with international professionals.
The following strategies are available:
Anchoring language support structurally
Regular specialist language training or modules that specifically train nursing German under real
conditions.
Onboarding & Mentoring
Introduction to the language of the company: e.g. an appointment in which procedures, important terms, standards
(e.g. hygiene, documentation) are gone through together.
A mentor from the team who provides support with language issues and also explains
cultural particularities.
Promoting communication in everyday life
Clearer, simpler language in handovers or meetings, as comprehensible as possible – speak more slowly if necessary
, ask open questions (“What have you understood?”).
Design written instructions in such a way that technical terms are explained (glossary etc.).
Team sensitization and intercultural training
Training courses in which the team learns how to deal with language diversity: What helps, what can frustrate
?
Raise awareness of the fact that not everyone can communicate equally quickly according to German standards
– and that this does not equal a lack of expertise.
Legal & bureaucratic framework conditions support
Promotion of language courses tailored to nursing professions.
Clarity about what is expected in terms of recognition, language examinations, etc., so that international
colleagues know what they can expect.
Feedback & evaluation
Regular surveys of international employees: Where are language barriers? Where
would they need more support?
Feedback from the team to make it clear where communication problems arise in everyday life
and how they can be solved.
Current status and prospects
The proportion of international nursing staff is now just under 18% of the 1.7 million
employees in the nursing professions. This means that almost one in five nurses comes from abroad.
There is increasing government and civil society attention for fair
recruitment and sustainable integration – including binding standards, e.g. through
funding programs, quality labels, initiatives such as “Fair Recruitment Care Germany”.⁴
At the same time, there are critical voices, e.g. that in some cases language support or
specialist language training is not sufficiently tailored – or that the real
workload and time pressure are too high to systematically address language deficits. The
following questions are intended to help you reflect on and scrutinize the situation in your company.
Questions for your hospital:
How high do you currently estimate the linguistic confidence of your international colleagues in
critical situations (e.g. emergency, handover, documentation)?
Does your institution already offer special courses in specialist languages or mentoring, and how
have these been evaluated?
How open is the team to linguistic diversity – for example, is it made clear that mistakes
and questions are welcome and part of the learning process?
What “small” changes could be implemented in the short term – e.g. glossaries, slower
speaking in meetings, photos or visualization of important processes?
What does the cost-benefit analysis look like – what resources (time, personnel, money, training)
are you currently investing in language support, and what effect do these measures have on quality,
employee retention, etc.?
Conclusion
Language is a central key factor for safety, quality, team culture and integration – and it
is particularly relevant for international nursing staff to successfully enter and work in
German hospitals. It is not enough to demand language tests; what is needed is
systematic, sustainable support, structures and an environment that offers understanding and
support.
When hospitals see language as a development task – not just as a
“prerequisite”, but as an ongoing process – everyone benefits: the patients, the
entire team and the international specialists that Germany trains and brings to
hospitals.
Sources:
“Internationale Pflegefachkräfte ein Praxisleitfaden für Gesundheitseinrichtungen”, 1st edition,
medhochzwei online library
“Concept for a special course “Healthcare professions”. “, Federal Office for Migration and
Refugees, Scheffler/Snippe 2021, p. 23
“More than 300,000 foreign nursing staff” from 29.04.2025, Mediendienst Integration, figures
and facts, https://mediendienst-integration.de/artikel/mehr-als-300000-auslaendischepflegekraefte
“Center for the Integration of Migrants” of July 10, 2025, European Commission, Migration
and Home Affairs, https://home-affairs.ec.europa.eu/policies/migration-and-asylum/migrantintegration/migrant-integration-hub_en