Nursing Levels in the Netherlands

Are you considering working in the Netherlands as a nurse? Then this article is of your interest because Holland has distinct levels of nursing and study possibilities compared to other European countries.

In the Netherlands, there are several routes to become a nurse. The most common way is to enroll in either the MBO nursing or HBO nursing study courses. The difference between the two is in the course level in which you graduate, and you can work in. In this article, we will explain the difference between the nursing levels from level 1 to level 8 in the Netherlands.


What is MBO and HBO?

MBO (Middelbaar Beroeps Onderwijs) translates to “secondary vocational education,” and it prepares students for a wide range of occupations, from franchise manager to mechanic or nursing assistant. MBO cover levels 1 to 4 of nursing.

HBO (Hoger beroeponderwijs) translates to “higher professional education” and is the equivalent of college education and has a professional orientation. HBO is taught at vocational universities (hogescholen), also known as universities of applied sciences. HBO covers level 5 of nursing.

Level 1: Care Assistant I – (Zorghulp)

This is the lowest level of nursing in the Netherlands. As a “zorghulp” you will work in home care, elderly care, or care for the disabled. Your role is to support clients in need of care in the household activities and perform light caring tasks. You will also assist clients in teaching them how to do things independently as much as possible.

This MBO level 1 training lasts one year.

Level 2: Care Assistant II –  (Helpende)

As a helpende you can provide care to a broad group of clients, including the elderly, the disabled, addicts, or people with psychiatric problems. You can work in places like home care, childcare, hospitals, in care for the disabled, care for the elderly. In addition to the duties from level 1 some activities as a helpende are, but not limited to:

  • Provide help with personal care: washing, brushing teeth, dressing, combing hair, etc.
  • Provide help with household chores: cooking, making bed, vacuuming, tidying up, etc.
  • Offer a listening ear, give positive attention, and offer emotional help where necessary.
  • Assist with recreational activities such as a walk, board game or outing.
  • Being alert to the well-being and health of the care recipient.
  • Reporting on the patient’s condition and development.

In this level you will have less independence in the professional actions. However, if desired, you can jump from level 2 to level 3 by fulfilling some requirements. This MBO level 2 training lasts two years.


Level 3: Nurse Assistant- (Verzorgende)

This is a level in high demand and with quite a few responsibilities as the group of clients is more diverse. As a verzorgende you do not only provide basic care, but also perform nursing activities such as:

  • Washing, drying, and dressing clients.
  • Providing and/or administering medicines.
  • Taking care of wounds.
  • Injecting or inserting a catheter.
  • Emotional counseling of clients.
  • Supervising social and recreational activities.
  • Contribute to a positive living environment.
  • Reporting on client development.

You are in contact with family and general practitioners and in some cases with a social worker, nurse (verpleegkundige), or physiotherapist. MBO level 3 requires 3 years of studies.

Level 4: MBO Registered Nurse – (MBO- verpleegkundige)

As one of the highest levels of nursing, reaching level 4 will open a wider range of workplace and target group possibilities, including a specialization.  As an MBO-verpleegkundige you are allowed to independently perform nursing procedures such as pricking, caring for wounds, changing catheters, suppling oxygen, and determining blood sugar. You are also allowed to perform reserved actions. Furthermore, you provide complex care to clients and guide them in daily life.

To become an MBO registered nurse in the Netherlands, you must be enrolled at the Dutch nurse registration (BIG-register). This level training last 4 years.

Level 6: HBO Registered Nurse – (HBO – verpleegkundige)

Since the 2016 – 2017 school year, level 5 was the highest level at HBO, however now nurses who complete the HBO educational course have become classified at level 6, according to the NLQF program classification system.

As an HBO- verpleegkundige your tasks consist of diagnosing and treating acute, episodic, or chronic diseases. You care for patients as an independent nurse or as part of a care team. This can be in a hospital, but also, for example, in district nursing or a care institution. The specific activities can vary a lot and depend on your tasks, specialization, and workplace. Some activities in this level can include prescribing, performing, or interpreting diagnostic tests, such as laboratory and X-ray examinations. Sometimes you also prescribe medication. An HBO- verpleegkundige is less practice-oriented and has greater theoretical knowledge than an MBO-verpleegkundige.

To become an HBO registered nurse in the Netherlands, you must be enrolled at the Dutch nurse registration (BIG-register). This level training last 4 years.

Difference Between Dutch Nursing Levels 4 and 6

According to V&VN, the largest association for nurses and carers in the Netherlands, in practice, MBO and HBO registered nurses often still perform the same duties. However, an HBO registered nurse will take on more directory tasks and will carry out complex and unpredictable care. The difference between MBO and HBO registered nurses is particularly visible in the transcending tasks, such as indicating and organizing care across the work fields, Evidence Based Practice (including the implementation), clinical reasoning, coaching, conducting practice-oriented research and clinical leadership (not hierarchical).

Level 7: Nurse Specialist – (verpleegkundig specialist)

Nurses from higher levels with relevant experience can become nurse specialists. At this level, a nurse is qualified to treat specific groups of patients independently, such as those individuals who are chronically ill.  In this position you expand your thinking about the quality of care into innovation, backed up by research. As a nurse at this level, you need to possess highly specialized advanced knowledge. You also have to have a critical understanding of a range of theories, principles, and concepts. Nurse specialists play an important role in carrying out tasks that have historically been performed by physicians.

Specialist nurses work in a variety of acute and community settings, specializing areas of practice such as general practice, mental health, children’s nursing, learning disability nursing and district nursing. Specialist nurses can work in isolation or as part of a multidisciplinary team to provide high quality, patient-centered, timely and cost-effective care.

In order to become a nurse specialist in the Netherlands, it is necessary to possess a diploma from a recognized master’s level course or a specialization course. On many occasions, the specialization courses are provided at no cost by the workplace.

Did you know there are over 50 nurse specializations in the Netherlands?

Level 8: Management – (Doctoraat en medisch specialist)

In this level, nurses have the possibility to work in senior positions in healthcare. For example, within health policy, education, budgeting, human resources departments, etc.

To achieve this level, there are two routes: follow a part-time training and several short courses or obtain a master’s degree with a specialization in areas such as policy, management and or health or health sciences is required.


We can say that level 1 (zorghulp) and level 2 (helpende) are the lowest MBO levels of nursing and have limited duties as they are mainly related to home and personal care. Level 3 (verzorgende) can be considered as an assistant nurse/or auxiliary nurse in some countries and it is a position with a big demand in the Netherlands. Nursing levels 4 (MBO verpleegkundige) and level 6 (HBO verpleegkundige) have higher independency and responsibilities and enrollment in the Dutch nurse registration (BIG-Register) in required. Level 7 is dedicated to nurses who have obtained a specialization while level 8 is more managerial oriented positions within the healthcare.

Remember that work to work in the Netherlands in one of the above levels, it is mandatory to have a B1 Dutch language level. Do not let this discourage you as over 500 nurses have already joined the EMTG program and learned Dutch within 3 to 4-months. Check out the job possibilities here.