Recruiting international nursing staff is a crucial step for many
healthcare facilities to overcome the shortage of skilled workers.
providers invest heavily in recruitment, language courses and integration. The hope: a sustainable
solution to the staff shortage.
But the reality often paints a different picture. The path from recruitment and recognition to
successful integration is rarely a sure-fire success. Instead of a “happy ending”, many facilities
experience an organizational stress test – for teams, managers and also for patients and
patients.
In addition, nursing facilities and clinics are in direct competition with each other,
when it comes to recruiting nursing staff.
This makes employee-oriented onboarding and targeted integration measures all the more important.
They form the basis for successful employee retention and ensure long-term quality
in the care sector.¹
Integration of international care workers: Between stress and support
For many, the step of working as a care worker in Germany is a profound change –
associated with emotional stress, language barriers and administrative challenges such as
recognition checks, dealing with authorities and finding accommodation.
International nursing staff therefore expect clear contact persons, binding
guidelines and a structured induction. A lack of support quickly leads to
uncertainty, misunderstandings and conflicts within the team.
A professional onboarding and integration concept is therefore crucial – not only for employee retention
but also for the quality of care
.
International nursing staff: expectations and potential for conflict
Many nursing staff from abroad have a degree and bring with them qualifications that
often exceed the tasks offered in inpatient care. If they are predominantly entrusted with
what they see as “underqualified tasks”, dissatisfaction increases – and with it the
willingness to switch to the hospital.
In addition to a fair distribution of tasks, good working conditions and appropriate
remuneration also play a key role. For many international nursing staff, their stay in Germany
is limited in time in order to build up capital for their home country. This makes it all the more important for employers to create clear
career prospects and attractive framework conditions.
I didn’t know if I had done anything wrong”
Whether from the Philippines, India, Eastern Europe or Latin America – the motivation and
expertise are there. Nevertheless, many feel left alone, misunderstood and not really accepted in the team
.
I didn’t know if I had done anything wrong“
Maria* comes from Spain. She was an experienced nurse in her home country. In
Germany, she started full of enthusiasm, but she felt insecure in the first few weeks. She
tells us:
“I tried to help a colleague move a patient. But she just looked at me briefly
and said: ‘That’s not how we do it here. She just left. I didn’t know whether
I had done something wrong – or whether it was just the language that made me stumble.”
Such experiences are no exception. Many international nursing staff report situations,
in which they feel excluded or not taken seriously at all.
Typical challenges in everyday life
Language barriers: Ahmed* from Syria can understand German well, but he is always confused by the technical terms or
dialects of his colleagues. For him, “Lift up” doesn’t sound like
clear work instructions, but rather like a riddle.
Different understanding of care: In India, it is common for relatives to be heavily involved in care
. In Germany, it sometimes causes irritation when caregivers trust
that the family “does more than we do”.
Lack of social connection: Many international care workers go home after work –
alone.
Consequences for the team and quality of care
When international nursing staff gain this experience, it has a knock-on effect:
They doubt themselves and their competence.
Teams appear divided because there is a subliminal distinction between “us” and “them”.
Conflicts arise – often out of misunderstandings and not out of bad intentions.
Patients feel insecure, and this affects the quality of care.
How integration can succeed – concrete approaches
Language promotion as an ongoing task:
A one-off language course is not enough. Nursing staff need continuous support – for
example, language mentorships within the team, where someone consciously explains technical language.
Mentoring instead of being left alone:
New nursing staff should have a permanent contact person right from the start. An experienced colleague,
who not only provides professional support, but also helps with day-to-day tasks: with questions such as “Where is the kitchen?”
or “How does the documentation work here?”
Intercultural training for both sides
It’s not just international nursing staff who need to learn to adapt. German teams
also need to be sensitized. For example, that in some cultures a direct “no” is impolite –
and that silence does not automatically mean consent.
Creating spaces for encounters
A breakfast together as a team, an international buffet where everyone brings something from their home country
or small leisure activities: These moments are worth their weight in gold when it comes to breaking down barriers.
Show appreciation
A “thank you for being there” sounds banal – but it makes a big difference when
care workers feel that their work and their courage to start afresh in a foreign country are seen
.
Recognize conflicts at an early stage and resolve them together
Those who do not suppress conflicts in the team, but resolve them together, strengthen cooperation,
employee loyalty and quality of care. Care facilities thus benefit from harmonious
cooperation and satisfied international nursing staff.
Open communication, clear rules and intercultural competence help to avoid misunderstandings at
. It is crucial to actively
recognize differences in language, working style and communication and to respond to them respectfully.
Onboarding international nursing staff: more than just training
Successful onboarding in nursing means much more than just professional training. It is the
key to integrating international nursing staff into the German care system.
The process comprises three phases: Preparation, familiarization and integration. Social
and cultural integration in particular is a major challenge – even more important than
professional integration. Creating clear structures here lays the foundation for long-term
employee loyalty and team stability.
A structured and appreciative start increases the willingness to integrate, performance
and employee loyalty. Chaotic processes, on the other hand, quickly lead to disappointment and increase the willingness to change
.¹
Intercultural competence as the key to successful integration
The most important success factor in the integration of international nursing staff is the level of
intercultural competence of managers.² Only those who are aware of cultural differences and understand possible
potential conflicts can successfully manage the integration process.
Managers are not only supervisors, but also coaches and companions: they manage
onboarding, task distribution and team integration.³ Cultural diversity influences the entire
organization and requires constant adaptation of processes, communication and standards.⁴
The conscious
use of intercultural communication is essential to ensure that neither international nor local employees feel disadvantaged.⁵
Conclusion
International nursing staff not only bring much-needed expertise, but also new
perspectives and experience. But without targeted support, they often remain on the sidelines of the team
. Integration is not a sure-fire success – it takes time, empathy and structures.
Because one thing is clear: only when international nursing staff feel truly welcome and integrated
can they fully contribute their knowledge and energy. In the end, it is not only
the teams that benefit, but above all the people who are cared for.
*Names changed
Sources:
¹ “Internationale Pflegefachkräfte ein Praxisleitfaden für Gesundheitseinrichtungen”, 1st edition,
Match (ed.), medhochzwei, online library
² “30 Minuten Interkulturelles Onboarding”, 2022, 1st edition, Müller E., Offenbach.
³ “Onboarding. Successfully onboarding and integrating new employees as a manager”, 2nd
edition, Brenner D., Berlin.
⁴ “Organizations”, A very brief introduction. 2nd, revised and expanded edition, Kühl p.,
2020, Wiesbaden, Heidelberg.
⁵ “Am I crazy or are they crazy?”, Kollermann N., In: Dagmar Kumbier (ed.): “Interkulturelle
Kommunikation. Methods, models, examples”, original edition, 2006, Reinbek bei Hamburg, pp. 73-90.