How to scuttle the great idea of ​​advanced practice nurses

The concept of advanced practice nurse (APN) was born across the Atlantic several decades ago. It is based on the possibility for a nurse, specifically trained and within a well-defined framework, to prescribe treatments.

→ CHRONICLE. Who will take care of you if no one is taking care of the caregivers?

Timidly implemented in France in certain fields (in oncology for example), this development makes it possible in particular to make up for the lack of availability of physicians and offers patients the possibility of using these professionals with extended clinical skills. Unfortunately, this promising innovation faces major obstacles both from the doctors and the technocrats who run our health system.

The urgency of pain management

Medical corporatism is doing everything to block the development of this file, as with all similar innovations allowing direct access to the paramedical professions without prior prescription. The end-of-life field is however a perfect example of what the intervention of palliative care IPA could bring to patients to fight the evil dying. An approach favoring “taking care” (to care) is preferable to the too simplistic and perfectly illusory at the end of life “cure at all costs” (to cure). And without generalizing in a caricatured way, the first is more a nurse, while the second more medical.

The right care is the result of a true interprofessional collaboration based on mutual respect and not of a hierarchical relationship which is sometimes contemptuous. These are two complementary areas of expertise. Admittedly, the status of IPA with a right limited to its field of prescription requires training to ensure the quality of interventions, but we know that medical skills in the field of relief at the end of life are also largely perfectible, as evidenced by daily experience.

If only one example were needed, that of pain management would be sufficient to justify the urgency of creating the status of IPA in palliative care. The evaluation, the use of appropriate analgesics could effectively be ensured by such nurses. Between a conservative vision of medical power and the interests of patients, it is astonishing to note that questions still arise and that the ministry is slowing down to create this new mention.

IPA, a status that is not valued enough

But the real scandal is not to provide any real salary increase for those who try to become IPA in the few open fields. The training is a master’s degree (common core and specialized training in the future field of skills). The financing by the employer of this full-time university course remains an obstacle course. On his return to the establishment, the IPA almost regains his previous salary.

→ MAINTENANCE. Public hospital: “The caregivers are tired of fighting”

For the record, it was one of the weakest in Europe and remains well below the European average after the Ségur de la santé. We therefore ask a nurse to train for two more years, to return to her post at the same unworthy salary but with new responsibilities. Who are we laughing at ? “Neither nuns, nor assholes”, said our colleagues twenty years ago. Nothing changes !


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