No C 20/10 Official Journal of the European Communities 26. 1. 88 
Proposal for a Council Directive amending Directive 77/452/EEC concerning the mutual 
recognition of diplomas, certificates and other evidence of the formal qualifications of nurses 
responsible for general care, including measures to facilitate the effective exercise of the right of 
establishment and freedom to provide services, and Directive 77/453/EEC concerning the 
coordination of provisions laid down by law, regulation or administrative action in respect of the 
activities of nurses responsible for general care 
COM(87) 649 final 
(Submitted by the Commission to the Council on 28 December 1987) 
(88/C 20/08) 
THE COUNCIL OF THE EUROPEAN COMMUNITIES, 
Having regard to the Treaty establishing the European 
Economic Community, and in particular Articles 49, 57 
and 66 thereof, 
Having regard to the proposal from the Commission, 
Having regard to cooperation with the European Par­
liament, 
Having regard to the opinion of the Economic and 
Social Committee, 
Whereas the second subparagraph of Article 1 (3) of 
Council Directive 77/453/EEC (') sets out the principle 
that theoretical and technical training shall be 
coordinated and balanced with clinical training, although 
no specific ratio is laid down; whereas Article 1 (4) states 
that the Council, acting on a proposal from the 
Commission, shall decide whether these provisions 
should be retained or amended; 
Whereas, in the light of this review and given in 
particular the increased demands as regards the level of 
knowledge of nurses responsible for general care, it is 
appropriate to amend Article 1 (4) of Directive 
77/453/EEC in such a way as to set the length of the 
theoretical instruction at at least one third, and that of 
the clinical instruction at at least one half, of the 
minimum length of the training referred to in Article 1 
(2) (b) of that Directive; whereas that ratio makes it 
necessary to define more precisely theoretical instruction 
and clinical instruction; 
Whereas it is also necessary to specify, as in the case of 
similar provisions in other directives relating to the 
health professions, that the list of subjects in the Annex 
to Directive 77/453/EEC is not restrictive and to use as 
standard terms 'theoretical instruction' and 'clinical in­
struction' in Directive 77/453/EEC and in the headings 
in its Annex; whereas it is likewise necessary to align the 
wording of certain provisions of Council Directive 
(') OJNoL 176, 15.7. 1977, p. 8. 77/452/EEC (2), as last amended by the Act of 
Accession of Spain and Portugal, with that of similar 
provisions of Council Directive 75/362/EEC of 16 June 
1975 concerning the mutual recognition of diplomas, 
certificates and other evidence of formal qualifications in 
medicine, including measures to facilitate the effective 
exercise of the right of establishment and freedom to 
provide services (3), as amended by Directive 82/76/ 
EEC (4), 
HAS ADOPTED THIS DIRECTIVE: 
Article 1 
Directive 77/452/EEC is hereby amended as follows: 
1. Article 6 (3) is replaced by the following: 
'3. If the host Member State has detailed 
knowledge of a serious matter which has occurred, 
prior to the establishment of the person concerned in 
that State, outside its territory and which is likely to 
affect the taking up within its territory of the activity 
concerned in that State, it may inform the Member 
State of origin or the Member State from which the 
foreign national comes. 
The Member State of origin or the Member State 
from which the foreign national comes shall verify the 
accuracy of the facts. Its authorities shall decide on 
the nature and extent of the investigation to be made 
and shall inform the host Member State of any 
consequential action which they take with regard to 
the certificates or documents they have issued. 
Member States shall ensure the confidentiality of the 
information made available.' 
2. Article 7 (2) is replaced by the following: 
'2. If the host Member State has detailed 
knowledge of a serious matter which has occurred, 
prior to the establishment of the person concerned in 
that State, outside its territory and which is likely to 
affect the pursuit within its territory of the activity 
concerned, it may inform the Member State of origin 
or the Member State from which the foreign national 
comes. 
(2) OJNo L 176, 15. 7. 1977, p. 1. 
(3) OJNoL 167, 30.6. 1975, p. 1. 
(4) OJNoL 43, 15.2. 1982, p. 21. 
26.1.88 Official Journal of the European Communities No C 20/11 
The Member State of origin or the Member State 
from which the foreign national comes shall verify the 
accuracy of the facts. Its authorities shall decide on 
the nature and extent of the investigation to be made 
and shall inform the host Member State of any 
consequential action which they take with regard to 
the information they have forwarded in accordance 
with paragraph 1'. 
3. The following Article 10a is inserted: 
'Article 10a 
Where a host Member State requires its own nationals 
wishing to take up or pursue one of the activities 
referred to in Article 1 to take an oath or make a 
solemn declaration and where the form of such an 
oath or declaration cannot be used by nationals of 
other Member States, the host Member State shall 
ensure that an appropriate and equivalent form of 
oath or declaration is offered to the persons 
concerned'. 
4. The following is inserted after the second subpara­
graph of Article 11 (1): 
'For this purpose and in addition to the declaration 
provided for in paragraph 2 relating to the services to 
be provided, Member States may, so as to permit the 
implementation of the provisions relating to pro­
fessional conduct in force in their territory, require 
either automatic temporary registration or pro forma 
membership of a professional organization or body 
or, as an alternative, registration, provided that such 
registration or membership does not delay or in any 
way complicate the provision of services or impose 
any additional costs on the person providing the 
services'. 
5. Article 14 is deleted. 
Article 2 
Directive 77/453/EEC is hereby amended as follows: 
1. Paragraphs 2 (b), 3 and 4 of Article 1 are replaced by 
the following: 
'2 (b) full-time training, of a specifically vocational 
nature, which must cover the subjects of the 
programme set out in the Annex to this 
Directive and comprise a three-year course or 
4 600 hours of theoretical and clinical in­
struction. 
3. Member States shall ensure that the institution 
training nurses is responsible for the coordination of 
theoretical and clinical instruction throughout the 
training. "Theoretical instruction"shall be defined as: 
that part of nursing training whereby student nurses 
acquire the knowledge, understanding and pro­
fessional skills needed to plan, provide and assess total 
nursing care. This teaching is provided in nursing 
schools and other teaching environments chosen by 
the educational institution, and is given by a staff of 
nursing teachers and other competent persons. 
"Clinical instruction"shall be defined as: 
that part of nursing training whereby student nurses 
as part of a team and in direct contact with a healthy 
or sick individual and/or a community learn to plan, 
provide and assess the required total nursing care on 
the basis of their acquired knowledge and skills. The 
student nurse learns not only to be a member of the 
team, but to be a team leader organizing total nursing 
care, including health education, for individuals and 
small groups in the health institution or the 
community. 
This instruction takes place in hospitals and other 
health institutions and in the community, under the 
responsibility of teachers who are nurses and with the 
cooperation and assistance of other qualified nurses. 
Other qualified personnel may be involved in this 
teaching process. 
Student nurses shall participate in the activities of the 
departments concerned in so far as those activities 
contribute to their training, enabling them to learn to 
undertake the responsibilities inherent in nursing care. 
4. The theoretical instruction referred to in part A 
of the Annex shall be balanced and coordinated with 
the clinical instruction of nurses referred to in part B 
of the same Annex in such a way that the knowledge 
and experience listed in paragraph 1 may be acquired 
in an adequate manner. The length of the theoretical 
instruction shall amount to no less than one third and 
that of the clinical instruction to no less than one half 
of the minimum length of training referred to in 
paragraph 2 (b).' 
2. The Annex is amended as follows: 
(a) The introductory sentence is replaced by the 
following: 
'The training programme leading to the award of 
a diploma, certificate or other evidence of formal 
qualifications as nurses responsible for general 
care shall consist of the two parts and at least the 
subjects listed below. Instruction in one or more 
of these subjects may be given as part of, or in 
association with, other courses:' 
No C 20/12 Official Journal of the European Communities 26. 1. 88 
(b) The headings of parts A and B are amended as 
follows: 
— English version: the heading 'A. Theoretical 
and technical instruction' is replaced by 'A. 
Theoretical instruction'; 
— Danish version: the heading 'A. Teoretisk og 
teknisk undervisning' is replaced by CA. 
Teoretisk undervisning'; 
— German version: the heading 'A. Theo-
retischer und technischer Unterricht' is re­
placed by 'A. Theoretischer Unterricht' and 
the heading 'B. Klinisch-praktische Kranken-
pflege-Ausbildung' is replaced by 'B. Klinische 
Unterweisung'; 
— Greek version: the heading A. '0EO)pr|TiK:f| Kai 
7tpaKTiKf) 5i5aaKcdta' is replaced by 'A. 
3£CopT)TiKf] 8i5aaKaAia' and the heading 'B. 
K-JIIVIKT] 5i5aoKaXia tou VOOOKUUOI)' is replaced 
by 'B. KXIVIKT] 5i5aoKa>ia'. 
— Spanish version: the heading 'A. Ensenanza 
teorica y tecnica' is replaced by 'A. Ensenanza 
teorica' and the heading 'B. Ensenanzas de 
enfermeria clinica' is replaced by 'B. 
Ensenanza clinica'; 
— French version: the heading 'A. Enseignement 
theorique et technique' is replaced by 'A. 
Enseignement theorique' and the heading 'B. 
Enseignement infirmier clinique' is replaced by 
'B. Enseignement clinique'; — Italian version: the heading 'A. Insegnamento 
teorico e tecnico' is replaced by 'A. 
Insegnamento teorico' and the heading 'B. 
Insegnamento infermieristico clinico' is 
replaced by 'B. Insegnamento clinico'. 
— Dutch version: the heading 'A. Theoretisch en 
technisch onderwijs' is replaced by 'A. 
Theoretisch onderwijs'; 
— Portuguese version: the heading 'A. Ensino 
teorico e tecnico' is replaced by 'A. Ensino 
teorico' and the heading 'B. Ensino clinico da 
enfermagem' is replaced by 'B. Ensino clinico'. 
Article 3 
Training courses for nurses responsible for general care 
commenced before 1 March 1991 pursuant to Article 1 
of Directive 77/453/EEC may be concluded in 
accordance with that Article. 
Article 4 
Member States shall bring into force the measures 
necessary to comply with this Directive no later than 
1 March 1991. They shall forthwith inform the 
Commission thereof. 
Article ") 
This Directive is addressed to the Member States.