He was deputy director of the Sonnenstein Clinic from 1913 to 1918 and director of the institution 1928 to 1939. In 1940 he became deputy director of the Action T4 Medical Office (German: Medizinische Abteilung) under Werner Heyde, which had a front organization called the Reich Cooperative for State Hospitals and Nursing Homes (German: Reichsarbeitsgemeinschaft Heil- und Pflegeanstalten) that handled the registration, evaluation, and selection of patients for adult euthanasia. As the T4 program's chief physician, Nitsche was responsible for corresponding with mental health institutions about registering and transferring patients to be euthanized.
