CELEX: 51987PC0649
Language: en
Date: 1987-12-17
Title: 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 (submitted by the Commission)

ARCHIVES HISTORIQUES
DE LA COMMISSION
COLLECTION RELIEE DES
DOCUMENTS "COM"
COM (87) 649
Vol. 1987/0306
 ---pagebreak--- Disclaimer
Conformément au règlement (CEE, Euratom) n° 354/83 du Conseil du 1er février 1983 concernant
l'ouverture au public des archives historiques de la Communauté économique européenne et de
la Communauté européenne de l'énergie atomique (JO L 43 du 15.2.1983, p. 1) modifié en dernier
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In accordance with Council Regulation (EEC, Euratom) No 354/83 of 1 February 1983 concerning
the opening to the public of the historical archives of the European Economic Community and the
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In Übereinstimmung mit der Verordnung (EWG, Euratom) Nr. 354/83 des Rates vom 1. Februar
1983 über die Freigabe der historischen Archive der Europäischen Wirtschaftsgemeinschaft und
der Europäischen Atomgemeinschaft (ABI. L 43 vom 15.2.1983, S. 1), zuletzt geändert durch die
Verordnung (EU) Nr. 2015/496 vom 17. März 2015 (ABI. L 79 vom 25.3.2015, S. 1), ist dieser Akt
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 ---pagebreak--- COMM ISSION CF THE EUROPEAN COMMUNITIES
                                                 COM(87 ) 649 final
                                                 Brussels , 17 December 1987
                                      Proposai for a
                                     COUNCIL DIRECTIVE
          mending 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
          7 / 453 / EEC concerning the coordination of provisions laid down
          by law , regulation or administrative action in respect of the
                    activit es cf nurses responsible for general, care
                              ( submitted by the Commission )
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 COMCS ' ■ 649 final                                  9n I ço
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                                         - 2 -
                                EXPLANATORY MEMORANDUM
1 . Background , aims and legal bases of the proposal
1.1 The proposal concerns the following two Council Directives :
        - Council Directive 77/ 452 / EEC of 27 June 1977 concerning the mutual
          recognition of diplomas , certificates and other evidence of 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;(1 )
        - Council Directive 77/ 453/ EEC of 27 June 1977 concerning the coordi ¬
          nation of provisions laid down by law, regulation or administrative
          action in respect of the activities of nurses responsible for general
          care . ( 1 )
1.2 The aim of this proposal is to amend the two aforementioned Directives .
       The main amendment proposed concerns Directive 77/ 453/ EEC and deals with
       a minimum balance between theoretical       and clinical instruction , the
       ratios being set at one third and one half respectively of the minimum
       training of three years or 4 600 hours referred to in Article 1 C 2 ) ( b ) of
       that Directive . This part of the proposal derives from Article 1C4) of
       Directive 77/ 453/ EEC , which provides for a review of the Directive 's
       original provisions in respect of this matter five years after its
       notification . In addition , it is proposed that the headings of the Annex
       to Directive 77 / 453/ EEC be amended and that certain provisions of
       Directive 77/ 452/ EEC be brought into line with similar provisions in the
       other directives relating to mutual recognition of diplomas .
1.3 The legal bases for this proposal for a Directive are the Treaty
       establishing the European Economic Community, and particularly Articles
       49, 57 and 66 thereof .
       Moreover , the Commission considers that when the Council adopts this
       proposal for a Directive the qualified majority rule should be applied,
       in accordance with the new wording of Article 57(2 ) of the EEC Treaty
       pursuant to Article 16(2 ) of the Single Act . The Commission takes the
       view that none of the provisions of this proposal for a Directive involve
       in a Member State " amendment of the existing principles laid down by law
       governing the professions with respect to training and conditions of
       access for natural persons ".
 ( 1 ) 0J L 176, 15.7.1977 .
 ---pagebreak---                                                   - 3 -
2 . Amendments to Directive 77 / 452 / EEC
     Article 1 of the proposai
     The purpose of this article is to amend certain provisions of Directive
     77/ 452 / EEC , so as to make them similar to provisions of the same kind to
     be found in Directive 75 / 362 / EEC on doctors , ( 1 ) as amended by Directive
     82 / 76/ EEC ( 2 ). The aim is to ensure harmonization of provisions with the
     same purpose in the various directives relating to freedom of movement for
     the health professions .
3 . Amendments relating to the training of nurses responsible for general care
     Articles 2 and 3 of the proposai
3.1 Article 1 of Directive 77/ 453 / EEC requires the Member States to make the
      award of certificates , diplomas and other evidence of the formal
      qualifications of nurses responsible for general care subject to passing
      an examination which guarantees the acquisition during the training
      period of the knowledge and skills listed in that article and in the
      Annex to the said Directive . Paragraph 3 of this article states that the
      theoretical part of the instruction must be balanced and coordinated with
      the clinical part , although no specific ratio is Laid down .
      Paragraph 4 lays down that five years after notification of the Directive
      the Council shall , in the light of a review of the situation , decide
      " whether the provisions of paragraph 3 on the balance between theoretical
      and technical training on the one hand and clinical training of nurses on
      the other hand should be retained or amended ". Because of a variety of
      priority measures undertaken in the field of freedom of movement and the
      mutual recognition of diplomas for the health professions , the Commission
      has been unable to observe this deadline .
3.2 The question of the balancing of these two parts of the training was
      examined , at the Commission 's request , by the Advisory Committee on
      Training in Nursing ( 3 ) and was the subject of a " report on the training
      of nurses responsible for general care , in particular on the balance to
      be found between theoretical and clinical instruction for this category
      of nurse " ( doc . III / D / 76 / 6/ 80 ) . This report was adopted by the Committee
      on 28 and 29 April 1981 by a unanimous vote of the 27 members present ,
      including those representing the competent authorities of the Member
      States . The various language versions were approved by the Committee at
      its meeting held on 20 and 21 October 1981 and were sent to the Member
      States on 13 January 1982 .
( 1 ) 0J L 167 , 30.6.1977 .
( 2 ) 0J L 43 , 15.2.1982 .
( 3 ) Set up by Council Decision 77/ 454/ EEC of 27 June 1977, published in 0J
      L 176, 15.7.1977 .
 ---pagebreak---                                      - 4 -
3.3 With a view to adapting training more closely to the new requirements
    resulting from the development of the profession, the Committee
    recommends in its report that the number of hours devoted to theoretical
    instruction should amount to no less than one third and the number of
    hours devoted to clinical instruction to no less than one half of the
    total of hours of instruction given in the complete training programme .
    As the report explains , the development of scientific and technical
    progress in the field of health care , the need for close cooperation with
    the other health professions , in particular with doctors , and the new
    guidelines on health have increased the demands made on the professional
    skills of nurses , which makes it necessary to establish an exact balance
    between the theoretical and clinical parts of training .
    The growing complexity of the surroundings in which nurses are required
    to provide care and the advances made in the social , medical and other
    related sciences demand that greater emphasis be placed on the
    theoretical part of their training . This is why the report proposes that
    the theoretical part of this training be set at no less than one third
    and the clinical part , which by its nature demands a longer period of
    assimilation on the part of the students , be set at no less than one half
    of the total length of the training programme .
3.4 The Commission agrees with the balance proposed , which corresponds ,
    moreover, to the figures which were put forward when the Directives on
    nurses were being discussed by the Council . This is the purpose of
    Article 2(1 ) of the proposal , which includes , in essence , the text
    suggested by the Committee .
    However , it will be noted that it is suggested in the Committee 's report
    that the proposed ratios should be applied to "the total of hours of
    instruction given in the complete training programme", which may be
    interpreted as meaning the length of the training actually given in the
    Member State concerned , including that part of the training exceeding the
    minimum three years or 4 600 hours laid down by the Directive . Having
    acquired information on the various national circumstances , the Commis¬
    sion felt that it was advisable to apply these ratios , at least for an
    initial period , only to the minimum training . Application of the proposed
    ratios to the entire length of the training might well raise problems in
    some Member States as regards the organization of the instruction and the
    financial burden . As the proportion set aside for theoretical instruction
    is at least one third , or two sixths , and the proportion set aside for
    clinical instruction at least one half , or three sixths , of the total
    length of three years or 4 600 hours , the remainder , or one sixth , is so
    short that it seems pointless to provide for a breakdown as between
    theoretical and clinical instruction for that proportion .
 ---pagebreak---                                            - 5 -
3.5 Furthermore , the Commission did not deem it appropriate to adopt another
      suggestion     by the Committee to the effect that the responsibility for and
      management      of establishments providing training in nursing should be in
      the hands      of nurses . The Commission takes the view that , as with the
      directives     relating to other health professions , this is a matter for the
      national authorities .
      However , the Commission does consider it advisable , as the Committee
      suggests , to provide for clinical instruction to be given under the
      responsibility of nurses . In fact , instruction in the technique of
      nursing care is , on account of its particular nature , most usefully given
      by nurses , rather than by members of other health professions who are not
      nurses .
3.6 In the interests of clarity , the Commission has likewise adopted another
      suggestion made by the Committee , namely that the terms " theoretical and
      technical training " and " clinical training" be replaced by the terms
      " theoretical instruction " and " clinical instruction ".
      The amendments to the wording of Article 1 of Directive 77 / 453 / EEC set
      out in Article 2(1 ) of the proposal take account of this change in
      terminology . It is also necessary , to amend as required in the various
      language versions , the headings of parts A and B of the training
      programme set out in the Annex to Directive 77/ 453 / EEC .
      In addition , it should be specified , as in the other directives on the
      health professions , that the programme set out in the Annex to Directive
      77 / 453 / EEC is not restrictive . That is the purpose of Article 2(2 ) of the
      proposal .
3.7 Article 3 of the proposal provides that nurses in the process of being
      trained in accordance with Directive 77 / 453 / EEC as it now stands , at the
      time when the proposed Directive comes into force , are entitled to
      continue and conclude their training in accordance with that Directive . -
      The        proposed text is derived from the wording of Article 14 of
      Directive 82 / 76/ EEC ( 1 ) which dealt with a similar question in respect of
      doctors . This measure avoids the disorganization of studies which an
      abrupt transition to the new system would entail for persons already
      undergoing training . Furthermore , it ensures that diplomas awarded to
      such persons under the present system will also qualify for the mutual
      recognition of diplomas .
( 1 ) OJ L 43 , 15.2.1982 .
 ---pagebreak---                                        - 6 -
  4 . Final provisions
#     Articles 4 and 5 of the proposai
      The provisions relating to the date when the Directive comes into force
      and  to the authorities   to which  it  is addressed are to be found    in
      Articles 4 and 5 of the proposal . As regards the date when the Directive
      comes into force, it is proposed that the Member States take the necessary
      measures to incorporate the proposed Directive in their national law
      within two years . This period of time would seem necessary to enable the
      Member States to adapt to the new rules their systems for training nurses
      responsible for general care .
  *
     As a consequence, the date of 1 March 1991 has been chosen .
 ---pagebreak---                                                7
                                        Proposai 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
 w ., ;        establishment and freedom to provide services, and
               Directive 77 / 453 / EEC concerning the coordination of
               provisions laid down by law , regulation or admi ¬
               nistrative action in respect of the activities of
               nurses responsible for general care
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 ( 1 ),
Having regard to cooperation with the European Parliament ( 2 ),
Having regard to the Opinion of the Economic and Social Committee ( 3 ),
Whereas the second subparagraph of Article 1(3 ) of Council Directive 77/453/EE (4)
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   instruction "    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
77/452/EEC (5), 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^^xercise of the
 right of establishment and            freedom   to   provide     services ,   as  amended    by
 Directive 82 / 76 / EEC ( 7 ),
HAS ADOPTED THIS DIRECTIVE :
 ( 1 ) OJ No C ...
 ( 2 ) OJ No C ...
 ( 3 ) OJ No C ...
 ( 4 ) OJ No L 176 , 15 . 7.1977, p. 8
 ( 5 ) OJ No L 176 , 15.7.1977 , p. 1
 ( 6 ) OJ No L 167 , 30.6.1975 , p. 1
 ( 7 ) OJ No L 43, 15.2.1982 , p. 21
 ---pagebreak---                                           Artide 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 .
          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".
 ---pagebreak--- 4 . The following is inserted after the second subparagraph 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 professional
     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 instruction .
       3.        Member States shall ensure that the institution training nurses is
                 responsible for the coordination of theoretical and clinical instruc ¬
                 tion throughout the training .
                "Theoretical instructiorf' shal l be defined as :
                 that part of nursing training whereby student nurses acquire the
                 knowledge , understanding and professional 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 .
 ---pagebreak---              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 nurse 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 : w
 ---pagebreak---                                                                                          ίο
                                              -u -
 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 " A. Teoretisk undervisning";
T- . • -
       - German Version : the heading " A. Theoretischer und technischer
             Unterricht " is replaced by " A. Theoretischer Unterricht " and the
             heading " B. Klinisch-praktische Krankenpflege-Ausbildung" is
             replaced by " B. Klinische Unterweisung";
         - ετββΚ νβτδίοη : Ιήβ Ιιββάΐηβ Α . Ν Θεωρητική καί κρακτιιτή διδασκαλία:"
                  15 ΓβρΙβΰβό      "Α θεωρητική διδασκαλία "
            βηά ίΗβ 1ιβ3(ϋη9 "Β . Κλινική διδασκαλία τοΟ νοσοκόμου: ·■
                  1 5 ΓβρΙβοβδ "Β ^ κλ,ν,κή διδασκαλία".
         - Spanish version : the heading "A. Ensenanza teorica y tecnica "
            replaced by "A. Ensenanza teorica " and the heading "B. Ensenanzas de
            enfermeria clinica "     is -   replaced by MB. Ensenanza clinica ";
         - French version : the heading " A. Enseignement théorique et technique "
                   is    replaced by "A. Enseignement theorique " and the heading
            "B. Enseignement infirmier clinique"        is     replaced by "B. Enseigne¬
            ment clinique";
         - Italian version : the heading " A. Insegnamento teorico e tecnico"
            is replaced by "A. Insegnamento teorico" and the heading "B. Insegnamen¬
            to   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 .
 ---pagebreak---                                    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 .
Done at Brussels,                                      For the Council
 ---pagebreak---                            WNAL. aüSiütss-iûEacxjiQiE
1 . ADMINISTRATIVE OBLIGATIONS ON RTr*KS RESULTING FROM
    APPLICATION OF THE LEGISLATION                      not applicable
I   ADVANTAGES TO FIRMS                                 not applicable
    -  VES NO
    -  SPECIFY
    DISADVANTAGES TO FIRMS                               not applicable
    ( additional costs )
    - YES / NO
    - CONSEQUENCES
A.  EFFECTS ON EMPLOYMENT                               not applicable
5.  WERE BOTH SIDES OF INDUSTRY CONSULTED ?             not applicable
    - YES / NO
    - OPINION OF BOTH SIDES OF INDUSTRY
1 . IS THERE AN ALTERNATIVE APPROACH WHICH ENTAILS
    FEWER CONSTRAINTS ?                                 not applicable