the major differences are that in Germany you also do personal care (which I haven't done here) and less physical assessment and you have mostly RN's on the ward and only maybe a couple of CNA's per shift. I have also been on wards with no CNA's. So you don't have that much responsibility or rather, you share it with more people. In the States I have worked only Home Health Care which was stressful but I liked it. Right now I'm staying at home with my almost 2 1/2 year old son and I am getting majorly concerned about not finding a job when I want to go back to work, which would be after 3 1/2 of not working. But anyway, as far as working in Germany for you, I think the place to find out what you need to do, is the "Regierungspraesidium". They would be the ones to certify you. There is one in each "state". But once you have your Certificate you can work anywhere in Germany and it does not become inactive. The pay is not as good, that's true. I hope this is of any help to you. Write again if you have more questions.