The man, identified in court only as Niels H, has been on trial in Oldenburg, northern Germany, since September accused of three murders and two attempted murders.
But on Thursday a court-appointed expert said he had confessed to up to 30 killings during a psychiatric assessment.
The expert told the court the 38-year-old gave the seriously-ill patients an overdose of heart medicine so he could then revive them.
Sixty others survived the attacks, which happened between 2003 and 2005.
Investigators believe the former nurse was motivated by a desire to demonstrate his ability to resuscitate patients.
Oldenburg's district court had already sentenced him to seven-and-a-half years in jail in 2008 for attempted murder.
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