After intense negotiations, the decree establishing advanced practice nurses (IPA) has just been published. It is the birth of a new profession, halfway between nurses and doctors.
The event made little noise, but it is significant. The decree establishing the creation of “advanced practice nurses” (IPA) was published Thursday July 19 to Official newspaper. Behind this term hides nothing less than the creation of a new profession: “super” nurses capable of carrying out consultations, carrying out examinations, renewing prescriptions – all in semi-autonomy.
It is therefore a new level of care that is emerging, halfway between nurses and doctors. The idea is not new: the Health Law, promulgated in 2016 at the initiative of Marisol Touraine, provided for the creation of advanced practice. But the prerogatives and the level of autonomy of IPAs have been the subject of intense negotiations, between a nursing profession determined to assert its skills and liberal doctors not really enthusiastic.
Cancer, renal failure, the elderly …
The decree seems to strike a balance. The IPAs will be in charge of monitoring patients with stabilized illnesses, once a doctor has received a diagnosis and decided on treatment. The scope retained includes oncology (where the practice is common), chronic renal disease (dialysis, renal transplantation), and “stabilized chronic pathologies” in city care, the list of which will be specified. Mental health, initially considered, has not yet been retained.
Within the framework of a protocol signed by a doctor, the RPNs will be able to follow the patients, carry out clinical examinations and technical acts, renew prescriptions and prescribe additional examinations. “The nurses will readdress their patients to the doctor when the limits of their fields of competence are reached”, specify the ministries of health and higher education, in a joint press release. The patient will of course have a say.
5,000 advanced practice nurses by 2022
While regretting the restricted level of autonomy entrusted to IPAs, Patrick Chamboredon, president of the National Order of Nurses, hailed in a press release “a real advance for the profession (…) but above all for improving access taking care”. Faced with the aging of the population and the declining medical demography, IPAs offer hope for better care, especially in areas under stress.
The diploma, at master’s level, will be open to nurses with three years of experience. An experiment is already in progress in Île-de-France and several universities (Paris, Toulouse, Caen, Rouen, Limoges-Bordeaux…) already offer a training offer, so that IPAs should start to become widespread in 2020. The government has committed to train 5,000 IPAs by now the end of the five-year term.
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