Advanced practice nursing: representations of actors in this new model

Abstract

Advanced practice nursing (APN) became legally established in France in 2018. Acquiring competences in the medical domain, an advanced practice nurse (APN) will follow willing patients referred by a physician. An assessment of this innovation's impact in the organization of French health care will be submitted to the French parliament in 2021. This research study was carried out to collect data with the intention of supporting the implementation of this model and constituting the starting point for the model's monitoring over time. To explore different actors' representations of the advanced practice nursing model pertaining to stabilized chronic diseases' management in primary health care, in the PACA (Provence-Alpes-Côte d'Azur region). Actors involved include patients, general practitioners, nurses and advanced practice nursing students. In this prospective qualitative study based on grounded theory, 58 semi-structured individual interviews were conducted. Participants showed heterogeneous representations of the APN's role. They expressed vagueness about the model and pointed out the need for better communication to facilitate its integration. The monitoring of care plans, the home health care, the therapeutic education and prevention were identified as needs in which the APN could participate. Under-medicalized areas were suggested as suitable to its implementation. The main fear was the changes of the distribution of professional tasks with the risk of competition with other established positions. The APN's integration was perceived as easier in healthcare establishments as the roles seems well-defined there with less identity confusion between the various actors, unlike in the private ambulatory care sector. Collaboration among health actors was mentioned as a condition for the success of the APN model. A cautious attitude was noted and a need for a run-in period emerged, first APN being considered as precursors. Mobilization of health actors is a criterion for successful integration of APN, therefore an awareness policy seems necessary. Training of health professionals in their curricula or in continuing education would make it possible to develop collaborative skills necessary for APN's integration.