Advanced Practice Nursing (APN) in French Primary Care: the Difficult Implementation of a Fragile Profession

Luan L. and Fournier C. (IRDES). In collaboration with Afrite A. (IRDES)

Questions d'économie de la santé (Issues in Health Economics) n° 277 - April 2023

QES n° 277

After completing an additional two years of training, advanced practice nurses (APNs) acquire an expanded range of competencies, including clinical examination skills and prescribing additional examinations and medication. Previous research have revealed the difficulties faced in France by the first graduating APNs in developing their activity in the hospital setting as well as the private sector.
This qualitative sociological research, based on interviews, studied the practices of these primary healthcare professionals, in a context of considerable tension with regard to the redefinition of the division of care work between healthcare professionals, particularly in private practice. Despite the interest the first APNs expressed in their new role, they all spoke about major difficulties in developing their clinical activities, and had to supplement their work by implementing care coordination activities within multidisciplinary teams, or by continuing, in parallel with their APN work, to practise as general nurses. The study of the first nurses to qualify as APNs, including a few ones who succeeded in building up a substantial patient base, shed light on the components of their work, and made it possible to analyse the conditions for its development.
Apart from the role played by medical demography in France, the diversity of the situations encountered depended, in particular, on general practitioners' willingness to develop - or not to develop - interprofessional collaboration, on the social proximity between the general practitioners and nurses concerned, and on the type of autonomy sought by the nurses.

See also Questions d'économie de la santé n° 277 in French: Infirmière en pratique avancée (IPA) en soins primaires : la construction difficile d'une profession à l'exercice fragile.