Advanced practice nursing implementation in France: A mixed-method study

• Published in: Journal of advanced nursing Vol. 80; no. 12; pp. 5076 - 5089
• Main Authors: Toniolo, Jean, Berger, Valérie, Deplanque, Amélie, Langlois, Margaux, Pelletier, Inès, Ngoungou, Edgard Brice, Preux, Pierre-Marie, Beloni, Pascale
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01.12.2024; Wiley
• Subjects: Acceptance; Advanced practice nurses; Autonomy; Challenges; Clinical skills; Data; Health care industry; Implementation; Interdisciplinary aspects; Intervention; Interviews; Life Sciences; Medical personnel; Mixed methods research; Patient satisfaction; Patients; Physicians; Professional development; Professional practice; Professionals; Questionnaires; Resistance; Role ambiguity; Santé publique et épidémiologie; Work skills; France; health policy; France; advanced practice nursing; implementation; implémentation
• DOI: 10.1111/jan.16303
• ISSN: 0309-2402; 1365-2648

To describe advanced practice nursing (APN) in the French healthcare landscape and to provide insights on how the role is defined and implemented and how the role is perceived by physicians. A mixed-method approach incorporating qualitative and quantitative data to offer a global understanding of APN implementation in France was used. Data were collected through questionnaires and interviews with APNs and physicians in diverse healthcare settings in France. The questionnaire assessed the roles, relationships with physicians and patients and the perceived implementation success of APNs. In-depth interviews explored experiences, definitions, challenges and perspectives of APNs. A thematic analysis was applied to the qualitative data to complete the quantitative exploration. Descriptive analyses were performed for quantitative data. A total of 41 APNs and 12 physicians were involved in this study between December 2022 and March 2023. The findings underscore APN as a pivotal, independent profession integrating advanced clinical expertise and interprofessional skills. The challenges encountered by APNs include role ambiguity, ongoing resistance and the need to address institutional barriers. Despite the fact that 73.2% of APNs reported that their role was well implemented, only 17.1% had clearly defined roles at the outset. This study revealed the dynamic and evolving nature of APN in France, highlighting its challenges and opportunities. Despite facing role ambiguity and resistance, APNs play a crucial role in the healthcare system. The results highlight the need for specific interventions to tackle challenges and facilitate successful integration of APN. These insights lay a foundation for future research and interventions aimed at boosting the impact and acceptance of APN in France, potentially influencing policy modifications and professional development. Problem Addressed: The study aimed to enhance comprehension of the implementation and role of advanced practice nursing (APN) in France. It focused on defining APN in the French context, identifying barriers and facilitators to its implementation and evaluating its impact. The study revealed that APN in France is evolving with expanded competencies and clinical autonomy, but faces challenges like role ambiguity and professional resistance. Key findings include the successful integration of APNs in healthcare settings, positive relationships with medical doctors and patient satisfaction. However, the study also highlighted the necessity to resolve role ambiguity and to improve the understanding and acceptance of APN roles among healthcare professionals for successful APN integration. Impact of the research: This research will primarily impact healthcare systems and policy-making in France, guiding the future development and integration of APN roles. It is also relevant for healthcare professionals, particularly nurses and physicians, by providing information about the evolving nature of APN and its benefits in patient care. Globally, the study contributes to the broader discourse on APN, offering insights that could inform APN implementation strategies in other countries facing similar healthcare challenges. COREQ-STROBE. No patient or public contribution.