Above all, do not call them ” super nurses “, and even “nursing-medics” : the future of nursing in advanced practice association (IPA), including the first trainings started in the month of October, will have a place in the teams of care. Without shedding a few or too encroaching on the prerogatives of the other.
Established by the law health, Marisol Touraine 2016, these new health professionals, mid-way between the doctors and the nursing graduates of state, will be able to realize acts up here devoted to only physicians. A dozen of training grade master are already accredited or are going to be this year to prepare. Among the main objectives of this revolution : unleashing the medical time doctors, to fight against the medical deserts, and improve the care of patients with chronic pathologies, many more.
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missing Link
If the training of advanced practice have long existed in anglo-saxon countries, they have developed more recently in the countries of northern Europe. But “advanced practice nurse, was a missing link in the chain of the health professions in French,” says Sébastien Colson, senior lecturer in nursing, and responsible for the new formation of the IPA at Aix-Marseille university (AMU). “In a care team, the IPA is there to perform part of the clinical follow-up of some patients through acts delegated to it by the doctor “, he explains. The decrees and orders published in July indicated that the IPA has the right to carry out some exams (blood tests, electrocardiograms, etc), but also to renew or adapt prescriptions for patients whose follow up.
The department of nursing science of the faculty of medicine of Aix-Marseille was a pioneer : his State diploma of advanced practice launched a few days ago is directly from a master of experimental sciences clinical nurses started in… 2009. “With “the universitarisation” of the curriculum in nursing [grade license since 2012], and the growing needs in health professionals, intermediaries, provide opportunities for further training of level bac + 5 was going to be. The AMU was a little bit ahead of the legislation… “, commented Sébastien Colson.
Three areas of intervention, three years of seniority
Still, the training had to be modified to match the new texts, in particular concerning the specializations of last year. As the law provides, for the moment, only three “areas of intervention” for these new nurses : “chronic conditions stabilized and the polypathologies common in primary care “, ” oncology and hemato-oncology “, ” chronic kidney disease, dialysis, renal transplantation “. Will be added shortly psychiatry, according to the health plan of the government announced at the end of September.
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The program of two years of study, that can be done full-time or alternating depending on the universities, a succession of courses, directed research, and of theoretical courses dealing with semiology, medical imaging, pharmacology, pathophysiology, clinical case studies, and even English.
This training is open to holders of a diploma as nurse, level bac + 3, and is therefore, in theory, directly accessible in initial training and once a graduate of an IFSI (training institutes in nursing care). But it is the training which seems to have been prioritized because a professional experience of three years is also required. What regrets the national association of nursing students (Fnesi), which welcomes very favourably on this new business : “A student who did his training with IPA immediately after the IFSI will have to wait three years to exercise advanced practice ! And yet : only if a position of IPA is opened in its institution. This can be discouraging, ” said and Lucy Leon, a third year student and vice-president of the Fnesi.
to Find his place in the team of care
The union, like the national order of nurses, believes that the texts do not go far enough in terms of autonomy and competencies of these new professionals. The scope of practice of APNS is particularly bordered. First by the official texts, which describe by the menu every act that they can perform. But also because during the negotiations which resulted in the writing of these texts, the doctors fought to keep the upper hand on the care of the patient in the course of care. They are the ones who will offer to patients with chronic conditions to be followed by a IPA.
they are also the ones who will make the first requirements. The nurse only able to renew them if necessary, after having carried out an “interview with the patient” and not a ” consultation “… The words have been weighed. “The doctor must provide the leadership diagnostic and therapeutic” of the care team, said in June the doctor François Simon, in the bulletin of the national order of physicians of which he chaired the section on professional practice.
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Despite a strong framework of their prerogatives, the future IPA ” have their place within the teams, and without stepping on the feet of the other “, wants to reassure Lucie Léon, Fnesi. “Expert in its field of intervention and in the care, the IPA will be complementary to the doctors, but also other nurses who are more generalists,” she explains. It will not be there to do the team management, because it is the role of the health framework. “Team care is still often pressured by the pace of the inferno, the lack of arms and the budgetary restrictions. The students entered the first year of IPA in this autumn 2018, will integrate their team in 2020.
