- 2017Legislative process
- 2018Implementation
- 2019Implementation
- 2020Implementation
- 2021Implementation
- 2022Implementation
- 2023Implementation
- 2024Implementation
Background
Alongside dual training, school-based vocational training is a second option for vocational training in Germany. By far the largest proportion of students in this approach are trained in the health, education and social services sectors. These are vocational programmes outside of the BBiG and HwO that are regulated by federal or Federal State law. They are carried out at full-time vocational schools, health care schools and technical schools.
Societal, demographic and epidemiological developments (rising life expectancy; increase in multi-morbidity and dementia), have led to changing demands on nursing care and nursing staff, with increased need for skilled nursing staff. The demand for educators has also grown, not least as a result of the legal entitlement to a childcare place from the age of one introduced in 2013.
Objectives
The law on the nursing and care occupations aims to:
- increase the attractiveness of care and nursing occupations and training by improving occupational conditions for nursing and care personnel;
- retain staff in these fields in the long term.
A policy target of the Care and nursing training offensive is to increase the number of trainees in the nursing occupations by 10% by 2023.
Description
The Law to reform the care and nursing occupations (Pflegeberufsgesetz) was published on 24 July 2017. The initiative 'Concerted Action on Care' (Konzertierten Aktion Pflege - KAP) was launched on 3 July 2018, including the 'Care and nursing training offensive' (Ausbildungsoffensive Pflege) targeted at ensuring the successful implementation of the law (2019-23). Training in healthcare and nursing care occupations, which used to be separated in three areas (general, elderly and paediatrics), have merged into uniform nursing training with a generalist orientation. For the trainees, this expands their employment and development opportunities. In parallel, there is also the possibility of obtaining degrees in health care, paediatric nursing and geriatric care.
The law abolished school fees. Hospitals, nursing homes and outpatient nursing services shall pay trainees an appropriate remuneration. The training costs will be financed in future by compensation funds to be set up in the Federal States. More training places will be created, including 5 000 provided by associations of nursing facilities for the training of nursing assistants. The initiative involves several stakeholder organisations including nursing occupation and nursing occupation training associations, associations of nursing facilities and hospitals, churches, nursing and health insurance funds, patient associations, the Employers' Liability Insurance Association,...
The Law to reform the care and nursing occupations (Pflegeberufsgesetz) was published on 24 July 2017. The initiative 'Concerted Action on Care' (Konzertierten Aktion Pflege - KAP) was launched on 3 July 2018, including the 'Care and nursing training offensive' (Ausbildungsoffensive Pflege) targeted at ensuring the successful implementation of the law (2019-23). Training in healthcare and nursing care occupations, which used to be separated in three areas (general, elderly and paediatrics), have merged into uniform nursing training with a generalist orientation. For the trainees, this expands their employment and development opportunities. In parallel, there is also the possibility of obtaining degrees in health care, paediatric nursing and geriatric care.
The law abolished school fees. Hospitals, nursing homes and outpatient nursing services shall pay trainees an appropriate remuneration. The training costs will be financed in future by compensation funds to be set up in the Federal States. More training places will be created, including 5 000 provided by associations of nursing facilities for the training of nursing assistants. The initiative involves several stakeholder organisations including nursing occupation and nursing occupation training associations, associations of nursing facilities and hospitals, churches, nursing and health insurance funds, patient associations, the Employers' Liability Insurance Association, social partners, cost bearers and the Federal Employment Agency.
The Federal Institute for Vocational Education and Training (BIBB) assumes the task of research on vocational training and higher education institutions and the nursing profession in accordance with Section 60 (4) of the Nursing Professions Training and Examination Ordinance (PflAPrV). The research is approved by the Federal Ministry for Family Affairs, Senior Citizens, Women and Youth (BMFSFJ) and the Federal Ministry of Health (BMG). The BIBB awards and supports various research projects at the interface between policy, research and practice. These projects have different thematic focusses within vocational and higher education institutions and BIBB prepares an annual research programme.
A first part of the law to reform the care and nursing occupations came into force on 1 January 2019.
In 2019, the partners of the 'Care and nursing training offensive started to implement the agreed 111 individual measures in three fields of action, including an information campaign, a new portal and support measures in nursing training to help increase the number of trainees.
A second part of the law to reform the care and nursing occupations came into force on 1 January 2020.
In 2020, the new care and nursing VET programmes (at secondary and tertiary levels) under the law to reform the care and nursing occupations (Pflegeberufsgesetz) began. A first implementation report on the Care and nursing training offensive and the 111 supporting measures was published in November 2020.
The information and advertising campaign Mach Karriere als Mensch (Make a career as a human being) provides information about the opportunities offered by the new nursing training. High access numbers to the portal's further information offers speak for great interest in the training among young people as well as persons who want to retrain.
Within the framework of the new generalist nursing training, closer cooperation between the various training institutions is necessary. In order to support the Länder in the implementation of the nursing training, the BMFSFJ and the BMG have launched a funding programme of up to EUR 19 million.
In many Länder, the funding provided by the DigitalPakt Schule and the subsequent Immediate equipment programme have led to better equipment for nursing schools with digital technology.
In 2021, the Concerted action on care (Konzertierten Aktion Pflege, KAP), which was launched on 3 July 2018 with the Care and nursing training offensive (Ausbildungsoffensive Pflege), continued.
BIBB supported the reform of the nursing professions under the Act of the Nursing Professions. In 2021, it developed the Handreichung für die Pflegeausbildung am Lernort Pflegeschule (Handbook for nursing education at the nursing school earning site) to support teachers at nursing schools and those who are responsible for the school's internal curriculum. Further, it published recommendations for the trainers and instructors of the practical part of the programme, organised several conferences and meetings and reported on the progress of the related research projects.
BIBB was responsible to develop and introduce a monitoring system for the implementation of vocational and higher education nursing training. This also included the establishment of a Nursing Panel consisting of training institutions, nursing schools and higher education institutions. The BIBB Nursing Panel started its work on International Nursing Day on 12 May 2021.
Second implementation report on the Care and nursing training offensive and the 111 supporting measures was published in November 2022. A total of 61 329 people took up training to become nurses in 2021. This is 7% more than in the previous year and makes it the largest training occupation in Germany.
The interim report on the training situation in nursing by the Working Group on Statistics was published in 2022.
The establishment of the BIBB nursing panel has been completed in 2022 and since then continuously collects data on development of nursing education in Germany. The first survey wave on the development of training activities started in October 2022. A special survey of the BIBB Nursing Panel provides an up-to-date overview of nursing degree programmes at higher education institutions that lead to professional qualifications, which started in April 2022.
First research-based recommendations on generalist nursing training were published and other research projects are awarded. On 8 November, the nationwide information and publicity campaign Pflege kann was (Care can do something) was launched. Until 2025, the campaign informs about career and employment opportunities and aims to break down clichés and prejudices against working in care.
The nursing training campaign Ausbildungsoffensive Pflege (2019-23) accompanied the introduction of the new nursing training courses, which started on 1 January 2020. The federal government, federal states and associations agreed on numerous measures in three fields of action with the aim of supporting those involved in nursing training, creating attractive training conditions and further increasing the number of trainees and training institutions. Recommendations from the working group on the job profiles of academically qualified nurses were published in August 2023. The initiative funded by the BMFSFJ expired at the end of 2023.
In 2023, the number of new nursing trainees rose by 6.4% to 60 312 (compared to 2022) and the first class of the new generalist training programme completed their training. To honour the graduates, the BMFSFJ awarded the Nursing Training Prize 2023 for the best graduates of training in November 2023.
The BIBB research congress 'Shaping education and care provision in nursing together' took place on 25 and 26 May 2023 in Bonn with around 500 participants.
The reform of nursing training also requires new qualification measures for future trainees to prepare them for vocational nursing training. In-company introductory qualification (EQ) is one of the qualification measures. BIBB published a handout in 2023, which provides recommendations for qualification modules for EQ.
Leaders in care management bear great responsibility for ensuring high-quality care in care facilities and managing the associated processes. In 2023, BIBB published a study which examines the current and future requirements and qualification programmes for managers in the care sector. In addition to researching existing further training programmes, it also includes an analysis of current and expected future qualification requirements and the development of a framework concept for further training based on these findings.
The results of the study on the workplace situation in acute and long-term care were published in May 2023. They confirm the agreements of the Concerted Action on Care, which adopted a comprehensive package of measures to improve working and training conditions in the care sector in 2019 and has already largely implemented them. They also provide more detailed information than previously available on what professional carers want and which measures could be useful in the future - at a political level, but also in operational practice - to further improve working conditions in the care sector.
The Act to strengthen higher education nursing training, to facilitate the recognition of foreign qualifications in nursing and to amend other regulations was promulgated on 15 December 2023 (comes mainly into force on 1 January 2024). In particular, the aim is to strengthen higher education nursing training by introducing a training allowance for students and improving the financing of the practical part of the degree programmes for training institutions. In addition, recognition procedures for foreign nursing professionals will be standardised and simplified.
The BIBB Nursing Panel in cooperation with the Bonn Survey Centre, surveys more than 6000 people responsible for nursing training from training institutions (e.g. hospitals, nursing homes), nursing schools and universities every year. The aim is to systematically monitor the qualification process in nursing over the long term. The report published in March 2024 summarises the key findings of the survey, which took place between October 2022 and May 2023. The second survey wave started in January 2024.
The published survey shows that many training places in vocational and higher education nursing training remain unfilled indicating an obvious problem on the demand side. Other key challenges: finding suitable applicants, different educational backgrounds of learners and acquisition of teaching staff. Further, in autumn 2024, a special survey is conducted among facilities that do not (currently) offer their own training places in nursing to find out more about the decision in favour of or against having their own trainees. The results will be used to derive support requirements and recommendations for action.
BIBB coordinates 26 research projects on nursing training and occupations. In 2024, BIBB published a report covering the period July 2023 to June 2024 on this research programme with various focal points: improving educational architecture, transparency and permeability of educational pathways, shaping digital change, shaping sustainable migration, ensuring the quality of education and improving the quality of care.
The occupational profile of 'nursing specialist' brings together the professions of geriatric nursing, nursing and paediatric nursing in a generalist training programme. Trainees are qualified to care for people of all ages. The BIBB flyer Pflegeausbildung aktuell (current nursing training) is a brief guide for those interested in training. It explains the nursing training programme and the entry requirements. The second edition published in August 2024 contains revisions and the new licensing system as well as the current collectively agreed training allowances in nursing. The flyer is available in 9 languages.
The final report of the nursing training campaign Ausbildungsoffensive Pflege (nursing training offensive; 2019-23) was published in September 2024. The report documents the implementation of the agreed measures and analyses in depth the development of the first three years of the new nursing training programme. According to the report, the training programme introduced in 2020 has established itself as the largest training occupation in Germany.
BMFSFJ awards the nursing study prize: ten graduates from the first year will be honoured for their academic achievements and their commitment to nursing. The award ceremony will take place on 18 November 2024 in Berlin.
Bodies responsible
- Federal Ministry of Family Affairs, Senior Citizens, Women and Youth (BMFSFJ)
- Federal Ministry of Health (BMG)
- Federal States (Länder)
- Federal Institute for Vocational Education and Training (BIBB)
Target groups
Learners
- Learners in upper secondary, including apprentices
- Young people (15-29 years old)
- Adult learners
Education professionals
- Teachers
- Trainers
Thematic categories
Governance of VET and lifelong learning
This thematic category looks at existing legal frameworks providing for strategic, operational – including quality assurance – and financing arrangements for VET and lifelong learning (LLL). It examines how VET and LLL-related policies are placed in broad national socioeconomic contexts and coordinate with other strategies and policies, such as economic, social and employment, growth and innovation, recovery and resilience.
This thematic category covers partnerships and collaboration networks of VET stakeholders – especially the social partners – to shape and implement VET in a country, including looking at how their roles and responsibilities for VET at national, regional and local levels are shared and distributed, ensuring an appropriate degree of autonomy for VET providers to adapt their offer.
The thematic category also includes efforts to create national, regional and sectoral skills intelligence systems (skills anticipation and graduate tracking) and using skills intelligence for making decisions about VET and LLL on quality, inclusiveness and flexibility.
This thematic sub-category refers to the integration of VET into economic, industrial, innovation, social and employment strategies, including those linked to recovery, green and digital transitions, and where VET is seen as a driver for innovation and growth. It includes national, regional, sectoral strategic documents or initiatives that make VET an integral part of broader policies, or applying a mix of policies to address an issue VET is part of, e.g. in addressing youth unemployment measures through VET, social and active labour market policies that are implemented in combination. National skill strategies aiming at quality and inclusive lifelong learning also fall into this sub-category.
This thematic sub-category refers both to formal mechanisms of stakeholder engagement in VET governance and to informal cooperation among stakeholders, which motivate shared responsibility for quality VET. Formal engagement is usually based on legally established institutional procedures that clearly define the role and responsibilities for relevant stakeholders in designing, implementing and improving VET. It also refers to establishing and increasing the degree of autonomy of VET providers for agile and flexible VET provision.
In terms of informal cooperation, the sub-category covers targeted actions by different stakeholders to promote or implement VET. This cooperation often leads to creating sustainable partnerships and making commitments for targeted actions, in line with the national context and regulation, e.g. national alliances for apprenticeships, pacts for youth or partnerships between schools and employers. It can also include initiatives and projects run by the social partners or sectoral organisations or networks of voluntary experts and executives, retired or on sabbatical, to support their peers in the fields of VET and apprenticeships, as part of the EAfA.
Modernising VET infrastructure
This thematic category looks at how VET schools and companies providing VET are supported to update and upgrade their physical infrastructure for teaching and learning, including digital and green technologies, so that learners in all VET programmes and specialities have access to state-of-the-art equipment and are able to acquire relevant and up-to-date vocational and technical skills and competences. Modernising infrastructure in remote and rural areas increases the inclusiveness of VET and LLL.
This thematic sub-category refers to measures for modernising physical infrastructure, equipment and technology needed to acquire vocational skills in VET schools and institutions that provide CVET or adult learning, including VET school workshops and labs.
This thematic sub-category focuses on establishing and upgrading to state-of-the-art digital infrastructure, equipment and technology, such as computers, hardware, connectivity and good broadband speed that should ensure quality and inclusive VET provision, especially in blended and virtual modes. It also includes specific measures to remove the digital divide, e.g. supporting geographically remote or rural areas to ensure social inclusion through access to such infrastructure for learning and teaching. It also includes support measures for learners from socially disadvantaged backgrounds to acquire the necessary equipment.
Modernising VET offer and delivery
This thematic category looks at what and how individuals learn, how learning content and learning outcomes in initial and continuing VET are defined, adapted and updated. First and foremost, it examines how VET standards, curricula, programmes and training courses are updated and modernised or new ones created. Updated and renewed VET content ensures that learners acquire a balanced mix of competences that address modern demands, and are more closely aligned with the realities of the labour market, including key competences, digital competences and skills for green transition and sustainability, both sector-specific and across sectors. Using learning outcomes as a basis is important to facilitate this modernisation, including modularisation of VET programmes. Updating and developing teaching and learning materials to support the above is also part of the category.
The thematic category continues to focus on strengthening high-quality and inclusive apprenticeships and work-based learning in real-life work environments and in line with the European framework for quality and effective apprenticeships. It looks at expanding apprenticeship to continuing vocational training and at developing VET programmes at EQF levels 5-8 for better permeability and lifelong learning and to support the need for higher vocational skills.
This thematic category also focuses on VET delivery through a mix of open, digital and participative learning environments, including workplaces conducive to learning, which are flexible, more adaptable to the ways individuals learn, and provide more access and outreach to various groups of learners, diversifying modes of learning and exploiting the potential of digital learning solutions and blended learning to complement face-to-face learning.
Centres of vocational excellence that connect VET to innovation and skill ecosystems and facilitate stronger cooperation with business and research also fall into this category.
VET standards and curricula define the content and outcomes of learning, most often at national or sectoral levels. VET programmes are based on standards and curricula and refer to specific vocations/occupations. They all need to be regularly reviewed, updated and aligned with the needs of the labour market and society. They need to include a balanced mix of vocational and technical skills corresponding to economic cycles, evolving jobs and working methods, and key competences, providing for resilience, lifelong learning, employability, social inclusion, active citizenship, sustainable awareness and personal development (Council of the European Union, 2020). The thematic sub-category also refers to establishing new VET programmes, reducing their number or discontinuing some. It also includes design of CVET programmes and training courses to adapt to labour market, sectoral or individual up- and re-skilling needs.
This thematic sub-category refers to expanding VET to higher levels and developing VET programmes leading to qualifications at EQF levels 5-8.
This thematic sub-category covers all developments related to work-based learning (WBL) elements in VET programmes and apprenticeships which continue to be important in the policy agenda. It includes measures to stabilise the offer of apprenticeships, the implementation of the European framework for quality and effective apprenticeships, and using the EU on-demand support services and policy learning initiatives among the Member States. It also covers further expansion of apprenticeships and WBL to continuing VET (CVET), for transition to work and inclusion of vulnerable groups, and for improving citizens’ qualification levels.
Supporting lifelong learning culture and increasing participation
Lifelong learning refers to all learning (formal, non-formal or informal) taking place at all stages in life and resulting in an improvement or update in knowledge, skills, competences and attitudes or in participation in society from a personal, civic, cultural, social or employment-related perspective (Erasmus+, Glossary of terms, https://erasmus-plus.ec.europa.eu/programme-guide/part-d/glossary-common-terms). A systemic approach to CVET is crucial to ensure adaptability to evolving demands.
This broad thematic category looks at ways of creating opportunities and ensuring access to re-skilling and upskilling pathways, allowing individuals to progress smoothly in their learning throughout their lives with better permeability between general and vocational education and training, and better integration and compatibility between initial and continuing VET and with higher education. Individuals should be supported in acquiring and updating their skills and competences and navigating easily through education and training systems. Strategies and campaigns that promote VET and LLL as an attractive and high-quality pathway, providing quality lifelong guidance and tailored support to design learning and career paths, and various incentives (financial and non-financial) to attract and support participation in VET and LLL fall into this thematic category as well.
This thematic category also includes many initiatives on making VET inclusive and ensuring equal education and training opportunities for various groups of learners, regardless of their personal and economic background and place of residence – especially those at risk of disadvantage or exclusion, such as persons with disabilities, the low-skilled and low-qualified, minorities, migrants, refugees and others.
This thematic sub-category refers to initiatives that promote VET and lifelong learning implemented at any level and by any stakeholder. It also covers measures to ensure and broaden access to information about VET to various target groups, including targeted information and promotional campaigns (e.g. for parents, adult learners, vulnerable groups). Among others, it includes national skill competitions and fairs organised to attract learners to VET.
This thematic sub-category refers to ensuring smooth transitions (permeability) of learners within the entire education and training system, horizontally and vertically. It includes measures and policies allowing learners easily or by meeting certain conditions to move from general education programmes to VET and vice versa; to increase qualification levels in their vocation through the possibility of attending vocational programmes at higher levels, including professional degrees in higher education. It also covers opening up learning progression by introducing flexible pathways that are based on the validation and recognition of the outcomes of non-formal and informal learning.
This thematic sub-category refers to all kinds of incentives that encourage learners to take part in VET and lifelong learning; VET providers to improve, broaden and update their offer; companies to provide places for apprenticeship and work-based learning, and to stimulate and support learning of their employees. It also includes measures addressing specific challenges of small and medium-sized enterprises (SMEs) willing to create work-based learning opportunities in different sectors. Incentives can be financial (e.g. grants, allowances, tax incentives, levy/grant mechanisms, vouchers, training credits, individual learning accounts) and non-financial (e.g. information/advice on funding opportunities, technical support, mentoring).
Subsystem
Further reading
Country
Type of development
Cedefop, & ReferNet. (2025). Reforming the care and nursing occupations and training: Germany. In Cedefop, & ReferNet. (2025). Timeline of VET policies in Europe (2024 update) [Online tool].
https://www.cedefop.europa.eu/en/tools/timeline-vet-policies-europe/search/28130