Council of Europe Treaty Series

The member States of tChe Council of Europe, signatory hereto,

Considering that the aim of the Council of Europe is to achieve a greater unity between its members for the purpose, among others, of facilitating their social progress and promoting the social well-being of their populations by means of appropriate action;

Having regard to the Conventions furthering this purpose already concluded within the framework of the Council, in particular the European Social Charter, signed on 18th October 1961, and the European Convention on Establishment, signed on 13th December 1955;

Being convinced that the conclusion of a regional Agreement on the harmonisation of the instruction and education of nurses will promote social progress and guarantee the standard of the nurses required for their establishment in the territory of other Contracting Parties on an equal footing with those countries' nationals;

Considering it necessary to lay down minimal standards,

Have agreed as follows:

Article 1

1. Each Contracting Party shall apply or, if the education of nurses is not under its direct control, recommend the competent authority to apply the provisions governing the instruction and education of nurses set out in Annex I to this Agreement.
2. For the purpose of this Agreement, nurses shall be intended to include only "general trained nurses", male or female. Those nurses whose training is solely within the field of public health, infants' and sick children's nursing, obstetrics or mental health are excluded.

Article 2

Each Contracting Party shall communicate to the Secretary General of the Council of Europe a list of its authorities or other bodies authorised to certify the accomplishment of a nurse's instruction and education satisfying at least the standards laid down in Annex I to this Agreement.

Article 3

1. After the entry into force of this Agreement in accordance with Article 5, the Committee of Ministers of the Council of Europe sitting with its membership limited to the representatives of the Contracting Parties, shall be responsible for the further elaboration of the regulations contained in Annex I to this Agreement in accordance with the current developments in this field.
2. Any modification or extension of the regulations contained in Annex I unanimously approved by the Committee of Ministers referred to in the preceding paragraph shall be communicated by the Secretary General of the Council of Europe to the Contracting Parties and shall enter into force three months after the date on which the Secretary General is notified by the Contracting Parties of their approval of the modification or extension.

Article 3

1. This Agreement shall be open to signature by the member States of the Council of Europe, who may become Parties to it either by:
1. signature without reservation in respect of ratification or acceptance, or
2. signature with reservation in respect of ratification or acceptance, followed by ratification or acceptance.
2. Instruments of ratification or acceptance shall be deposited with the Secretary General of the Council of Europe.

Article 4

1. This Agreement shall enter into force three months after the date on which three member States of the Council shall have become Parties to the Agreement, in accordance with the provisions of Article 4.
2. As regards any member States who shall subsequently sign the Agreement without reservation in respect of ratification or acceptance or who shall ratify or accept it, the Agreement shall enter into force three months after the date of such signature or after the date of deposit of the instrument of ratification or acceptance.

Article 5

1. After the entry into force of this Agreement, the Committee of Ministers of the Council of Europe may invite any non-member State to accede thereto.
2. Such accession shall be effected by depositing with the Secretary General of the Council of Europe an instrument of accession which shall take effect three months after the date of its deposit.

Article 6

1. Any Contracting Party may, at the time of signature or when depositing its instrument of ratification, acceptance or accession, declare that it avails itself of one or more of the reservations provided for in Annex II to this Agreement.
2. Any Contracting Party may wholly or partly withdraw a reservation it has made in accordance with the foregoing paragraph by means of a declaration addressed to the Secretary General of the Council of Europe, which shall become effective as from the date of its receipt.

Article 7

The annexes shall be an integral part of this Agreement.

Article 8

1. Any Contracting Party may at the time of signature or when depositing its instrument of ratification, acceptance or accession, specify the territory or territories to which this Agreement shall apply.
2. Any Contracting Party may, when depositing its instrument of ratification, acceptance or accession or at any later date by declaration addressed to the Secretary General of the Council of Europe, extend this agreement to any other territory or territories specified in the declaration and for whose international relations it is responsible or on whose behalf it is authorised to give undertakings.
3. Any declaration made in pursuance of the preceding paragraph may, in respect of any territory mentioned in such declaration, be withdrawn according to the procedure laid down in Article 10 of this Agreement.

Article 9

1. This Agreement shall remain in force indefinitely.
2. Any Contracting Party may, in so far as it is concerned, denounce this Agreement by means of a notification addressed to the Secretary General of the Council of Europe.
3. Such denunciation shall take effect six months after the date of receipt by the Secretary General of such notification.

Article 10

The Secretary General of the Council of Europe shall notify the member States of the Council and any State which has acceded to this Agreement of:

1. any signature without reservation in respect of ratification or acceptance;
2. any signature with reservation in respect of ratification or acceptance;
3. the deposit of any instrument of ratification, acceptance or accession;
4. any date of entry into force of the modifications or extensions referred to in Article 3.2;
5. any date of entry into force of this Agreement in accordance with Article 5;
6. any communication received in pursuance of the provisions of Article 2;
7. any notification received in pursuance of the provisions of Article 7;
8. any declaration received in pursuance of the provisions of Article 9;
9. any notification received in pursuance of the provisions of Article 10 and the date on which denunciation takes effect.

In witness whereof the undersigned, being duly authorised thereto, have signed this Agreement.

Done at Strasbourg, this 25th day of October 1967, in English and French, both texts being equally authoritative, in a single copy which shall remain deposited in the archives of the Council of Europe. The Secretary General of the Council of Europe shall transmit certified copies to each of the signatory and acceding States.

Annex I – Minimal standards for the instruction and education of nurses

1. The general trained nurse exercises in conformity with the national legislation the following essential functions:
1. giving skilled nursing care to persons as required in accordance with the physical, emotional and spiritual needs of the patient, whether that care is given in health institutions, homes, schools, places of work;
2. observing physical and emotional situations and conditions which have significant bearing on health and communicating those observations to other members of the health team;
3. training and giving guidance to auxiliary personnel who are required to fulfil the nursing service needs of all health agencies.
2. This also involves an evaluation of the nursing needs of a particular patient and assigning personnel in accordance with the needs of that patient at a particular time.

Candidates for admission to schools of nursing shall normally have reached a cultural and intellectual standard equivalent to at least that of the 10th year of general education. They shall therefore either possess a recognised school certificate signifying the completion of such general education, or must have passed an official entrance examination of an equivalent standard.

Nurses shall have a minimum of 4 600 hours basic nursing education. At least half the total time shall be devoted to clinical instruction (practical experience) (see B below). However, the number of hours of theoretical and formal instruction (see A below) shall not be less than one third of the total educational programme.

A – Theoretical and formal instruction

Instruction shall include all aspects of nursing, as well as the prevention of sickness, health education, rehabilitation, drug action and administration of drugs and problems of nutrition and dietetics, and also first aid, resuscitation and the theory of blood transfusion.

Theory and practice shall be co-ordinated and integrated throughout the programme.

The subjects to be included in the curriculum may be grouped under two headings:

1   Nursing

2   Fundamental sciences

B – Clinical instruction (practical experience)

Practical experience shall cover all aspects of the nurse's role, including the prevention of sickness, health education, first aid, resuscitation and blood transfusion.
It shall include:

The following factors shall be taken into account in choosing such fields:

1. The experience gained shall be of educational value. It is therefore necessary to have:
–   sufficient trained staff to ensure that the nursing care is satisfactory;
–   adequate and satisfactory physical facilities, equipment and supplies for the nursing care of patients.
2. In all departments or units to which student nurses are assigned during the practical experience there shall be at all times at least one qualified nurse to provide supervision, and sufficient additional staff to ensure that the student does not undertake tasks which have no nursing educational value.
3. Qualified nurses in departments or units approved as fields of practical experience shall assist in the supervision and instruction of the students for whom the tutorial staff is responsible.

In order that the proposed schemes of nursing education may be adequately carried out, the organisation and operation of the school has to meet the following requirements:

A – Administration of the school of nursing

The administration of the school shall be placed under the direction of a medical practitioner or a nurse who is competent in teaching and administration.

B – Teaching staff

The instruction shall be given by qualified teachers: doctors, nurses and specialists in various disciplines. Each school should have on its staff at least one qualified nurse who has received training of at least one year's duration which qualified her in the teaching of nursing.

C – School finances

The sum of money available to meet expenditure directly attributable to nurse training, e.g. salaries of tutors and cost of teaching equipment, should be clearly identifiable.

A

A school record shall be kept for each student, the authenticity of which would be guaranteed by the competent authority stating:

–   details of courses attended
–   test and examination results
–   an appreciation of the personal and professional aptitudes revealed by the student in the course of the studies.

B

The final examination shall comprise written, practical and oral tests, and its successful result should be certificated.

Annex II

Any Contracting Party may declare that it reserves the right:

1. to derogate from the provisions of Chapter II of Annex I by providing that candidates may have reached a cultural and intellectual standard equivalent to eight years of general education;
2. to derogate from the provisions of Chapter II of Annex I by providing that candidates need not possess a recognised school certificate;
3. to derogate from the provisions of Chapter III of Annex I by providing a number of hours of theoretical and formal instruction other than that referred to in that chapter;
4. to derogate from the provisions of Chapter III of Annex I:
1. by retaining as optional subjects in the curriculum and in practical training, maternity care, mental health and psychiatry and care of the aged and geriatrics, or
2. by providing that clinical instruction shall not cover mental health and psychiatry.

I – Minimum age required for admission to schools of nursing

No hard and fast minimum age for admission to a school of nursing should be laid down. In countries where general education is included in the programme, the age of entry may be considerably lower than when such general education is regarded as a prerequisite. Maturity also depends on social and climatic conditions.
In general, students should not come in contact with patients and with the hospital atmosphere until an age varying from 17 to 19 according to the country.

II – Educational standard required of candidates for admission to schools of nursing (cf. Agreement, Annex I, Chapter II)

The duration of 10 years of general education is not obligatory if the educational standard reached after a shorter duration has an equivalent cultural and intellectual level.

III – Duration and content of educational programme (cf. Agreement, Annex I, Chapter III, first paragraph)

If the total number of hours of education are more than 4,600 the proportions indicated need only be respected in relation to the minimum number of hours.

IV – Practical experience (cf. Agreement, Annex I, Chapter III, B)

1. Fields of practical experience should be proposed by the director of the school and approved by the competent authority of each country.
2. Practical experience should be organised by the director of the school and placed under the supervision of the tutorial staff of the school.
3. The provision No. 2, which requires the existence of "sufficient additional staff to ensure that the student does not undertake tasks which have no nursing educational value", has the purpose of guaranteeing that the nursing students are not given work which does not enter into their field of education and which should be carried out by other personnel.
4. As far as possible the nurses mentioned under No. 3 should have received education in teaching nursing and administration.
5. The following factors should also be taken into consideration:
–   number of patients in the department or unit,
–   variety of clinical conditions presented by the patients,
–   efficiency of administration of the department or unit,
–   existence of programmes of in-service education for the nursing staff of the department or unit,
–   the maximum desirable number of students in the department or unit,
–   the teaching methods employed.

V – Requirements for the organisation of the school of nursing (cf. Agreement, Annex I, Chapter IV)

1. Administration of the school of nursing
   Administration of the school of nursing should normally have the support and advice of a body composed of nurses trained to give instruction and representatives of other disciplines such as medicine, general education, administration and the social sciences.
2. Teaching staff
   There should be tutors responsible for the application of the co-ordination of theoretical and practical instruction. Tutors should be nurses prepared to give theoretical and practical instruction and supervise practical experience. They should contribute to the students' education and professional training. The number of tutors should be related to the number of students in order to ensure proper instruction and supervision. A proportion of 15 students to each tutor is proposed.
3. Facilities for the school of nursing
   Adequate space should be available for the number of students in the school. The following teaching facilities should be provided: class and demonstration rooms, small rooms for group work, library and laboratory. Individual office space should be available according to the number of full-time administrative and teaching staff.
4. Teaching equipment
   Adequate equipment to enable modern methods of teaching to be used extensively should be provided. Particular emphasis should be placed on the availability of audio-visual aids.

VI – Documents to be produced by the nurse

1. A certificate (diploma or other document) authenticated by the government of the country of issue or by the designated authority in that country.
2. An extract of the school record
–   his extract should comprise:
–   the nurse's civil status,
–   courses attended,
–   results obtained.
3. Evidence of linguistic ability