Brazilian nurses in Germany: The hidden costs of the search for a better life

By Anastácia Sena de Arruda  | OMC 2026

Photo by Markus Winkler on Unsplash

What is the psychosocial cost of the dream of a better life? Faced with a persistent shortage of healthcare workers, Germany has increasingly relied on recruiting foreign nurses through government partnerships, bilateral agreements, and private recruitment agencies. Hospitals enter into agreements with these agencies to secure a steady supply of nursing staff, while recruiters travel to Brazil to visit universities, deliver presentations, and use social media influencers to promote a version of the "German dream": better salaries, improved working conditions, opportunities for career development, and a better work–life balance. The strategy has proven successful. Today, Brazilian nurses can be found working in hospitals, care homes, and clinics across Germany. Yet these recruitments rarely emphasize the contractual obligations, lengthy recognition procedures, language requirements, and financial commitments that often accompany the migration process. While the discourse surrounding labour shortages frames foreign health professionals as a possible solution to Germany's healthcare workforce crisis, it tends to overlook the personal and psychosocial costs that many nurses experience after arrival.

These professionals face a set of barriers that begins with the recognition of their professional skills and Brazilian qualifications. As in many Latin American countries, nursing in Brazil is a university-based profession with competencies that differ substantially from the German nursing qualification. In Brazil, the nursing degree typically takes five to six years to complete and extends far beyond bedside patient care. The curriculum emphasizes public health, health education, community outreach, research, and academic training, as well as healthcare management and leadership. In contrast, the German nursing qualification (Ausbildung) generally lasts two to three years and focuses primarily on direct patient care and bedside nursing. Compared to Brazilian nurses, German-trained nurses traditionally have less professional autonomy in areas such as procedures, nursing diagnosis, health promotion, community outreach, and academic or research activities. Although some newer educational pathways are beginning to expand these competencies, they remain limited in comparison with Brazilian university-based nursing education. Although the recognition process has become more straightforward in some federal states, it remains bureaucratic and often does not result in full equivalence in terms of daily responsibilities and scope of practice.

The recruitment arrangements that facilitate nurses' migration also create a framework of obligations that extends well beyond employment itself. Language requirements, contractual commitments, and financial liabilities become interconnected conditions that nurses must fulfil in order to remain and work in Germany. Among these, achieving B1 or B2 (on a scale of A1-C2) proficiency in German within approximately six months is often one of the first and most demanding requirements, frequently under considerable pressure from recruitment agencies that have financed part of the migration process. These agencies frequently advertise comprehensive support packages, including accommodation, German language courses, and employment in hospitals. However, they do not always clearly emphasize that these costs are typically provided as loans that must later be repaid. One nurse I interviewed described this experience as: ‘It happened this way. It was a process I wouldn't call dishonest, but it wasn't entirely transparent. You don't know what to expect and how to prepare yourself, you know? Financially and emotionally.’ As a result, nurses face an additional pressure to pass both the required German language examinations and the professional recognition or qualification exams within the expected timeframe. According to Brazilian nurses that I interviewed, at this stage many are already in Germany, navigating the migration process without an established support network. Some of them receive only limited financial assistance, usually between €200 and €400 per month to cover their basic living expenses. Failure to do so may not only jeopardize their ability to remain in Germany but can also leave them with substantial debts owed to the recruitment agency. Even when the process is successful and nurses begin working, a significant portion of their salaries may be deducted over an extended period to repay these costs. Such arrangements can create financial dependence and, in some cases, raise concerns about exploitative recruitment practices.

In the workplace, the barriers do not disappear. Brazilian nurses often encounter informal hierarchies and unspoken workplace norms that are not always explained to newcomers. These dynamics influence the tasks they are assigned, the level of trust they receive from colleagues, and the extent to which they are genuinely included within the team or remain at the margins. Especially during the initial period of employment, many nurses report feelings of isolation during their shifts. Some describe having their professional competencies questioned by colleagues or being perceived as inexperienced, despite having years of clinical practice and professional experience in Brazil. The transition to the German healthcare environment can therefore involve not only learning language skills but also negotiating professional recognition and belonging within a new workplace culture. Research on migrant healthcare professionals, together with my fieldwork (including interviews with nurses) and observations from my professional network, indicates that experiences of xenophobia, racism, and sexism from both colleagues and patients remain recurring concerns in these settings. Some nurses interviewed recalled colleagues referring to groups of Brazilian staff as a “mafia” because of the increasing number of Brazilian nurses arriving in Germany. Such expressions contribute to the construction of migrant workers as outsiders and reveal persistent barriers to workplace inclusion.

As a researcher, I recognise that academia still observes this phenomenon only partially. Although the migration of nurses from the Global South to the Global North is not new, qualitative literature remains limited, particularly regarding the experiences of Latin American nurses in Germany. Policy debates and workforce planning often reduce these professionals to recruitment targets and labour-shortage figures. But these are people who came in search of a better life, and whose experiences do not fit into spreadsheets. They are stories of joy and grief, of longing, anxiety, and uncertainty. They are also stories of professionals whose physical and mental health deteriorates while they continue caring for others. People who migrated with the promise of a better future only to encounter a reality full of fine print that no one had read aloud to them. In the meantime, they care for patients and families while worried about their own.

I do not write from a distance. I write as a researcher, a healthcare professional, and an immigrant in Germany. I know what it is to migrate, even if my experience differs from theirs. I know the bitterness and the sweetness of building and dismantling dreams in another country. And that is why I write: to amplify the voices of those who are systematically silenced, not only by language barriers or cultural difference, but by fear. Fear of speaking out and losing what the process has already offered: employment and a hope for a better life. Fear of asserting their rights and not being believed. Fear of wanting to return home and feeling ashamed, because the cost of staying is something no one sees.

More groups of nurses are likely to follow. This process will continue even in the absence of official incentives or recruitment programmes. But they are not commodities. They are qualified professionals who deserve recruitment and integration processes that are fair, transparent, and supported by concrete institutional safeguards. To reach this, recruitment agencies should clearly disclose all costs, contractual obligations, and recognition requirements before departure. Employers should provide adequately funded language training with realistic timelines, structured mentorship, and effective measures to prevent workplace discrimination. Public authorities should ensure access to independent legal advice, that nurses can change employers without losing their residence status or becoming trapped by recruitment-related debts, and provide confidential psychological support that is not controlled by recruiters or employers. 

Nurses deserve to have the truth told before the plane ticket is bought. They deserve to arrive with open hearts, but with enough knowledge of how things truly work to protect themselves. They deserve to have their wellbeing treated as a priority, not left to chance. The question is whether they will arrive in the dark, or whether recruiters, employers, authorities, and researchers will tell the full story before they leave home.

Anastácia Sena de Arruda 

Anastácia is a Brazilian medical doctor, researcher and doctoral candidate at the Institute of the History, Theory and Ethics of Medicine at Justus Liebig University Giessen, Germany, supported by a DAAD scholarship. Her research sits at the intersection of migration, human rights, and health systems, with a focus on the lived experiences of Latin American health professionals in Germany. As a migrant herself, her scholarship is inseparable from her commitment to making visible the voices that institutional and academic spaces have yet to hear. Contact: anastaciasenadearruda@gmail.com and LinkedIn.