The growing challenge of optimizing care pathways and ensuring better coordination between town and hospital has promoted the diversification of the nurse’s role, whose place in patient care is becoming predominant. Considering the emergence of specialized nurses coming from dedicated training programs, and the expansion of the nurses activities, the French healthcare ecosystem must adapt in order to generate maximum value for patients. In this article, Alcimed explores the new role of nurses and the impact of such evolution on healthcare actors, especially on pharmaceutical companies.
A medical context encouraging the specialization of registered nurses
In the global context of increasing population health needs, four key challenges shape public health issues in France today:
- The aging of the population and the increase in the number of patients with chronic diseases and polypathologies,
- The central positioning of the healthcare pathway allowing the decompartmentalization of the fields of prevention, care and medico-social support,
- The deep challenge of medical demographics which, given the distribution of healthcare providers across the territory, makes access to care unequal,
- The shift to ambulatory care and the development of the town-hospital network aiming to better coordinate care, as well as to guide and supervise patients in choosing the independant staff in charge of supporting their home care.
Taken together, these four health challenges point out the need for the organization of care to evolve. An evolution that has also been highlighted by the successive Social Security Financing Bills (“PLFSS”) which suggested several adaptations. In line with previous plans, the 2021 PLFSS further strengthens the place of nurses as key players in the evolution of care organization and recognizes the need to try out “an evolution of the skills of health nurses within the framework of organizational protocols and cooperation between healthcare providers”.
Hence, the place for nurses is becoming preponderant in the care pathway and their scope of practice is extending to tasks initially limited to doctors. The ambition of such evolution is to ensure greater coordination of care between town and hospital, as well as better continuity in care pathways, especially for chronic pathologies.
In this changing context, the major question now is to understand how this specialization of nurses will influence the healthcare ecosystem in France.
The growing role of specialized nurses in chronic disease management
Between 2014 and 2019, Cancer Plans 1 and 2 resulted in the creation of new nursing positions in order to improve conditions for the disease diagnosis announcement and to better coordinate the patient care pathway. These nurses are known as announcement registered nurses (announcement IDEs) and care coordinator nurses (IDECs). Who are these specialized nurses and how do their roles differ from “classic” registered nurses (IDEs)?
- The announcement nurses take part, among other things, in the process of reporting pathologies to patients and ensure a dedicated time to care management of patients, without doctors being present.
- The IDECs operate on a broader scope of practice. For example, they plan the organization of care between multidisciplinary teams, monitor patient treatment and carry out in-house training activities in partnership with the coordinating physician. IDECs have become pivotal to the care pathway by ensuring optimal and simplified coordination of the care pathway between town and hospital. By doing so, they foster compliance, manage adverse events, assess their severity, and thus become a privileged contact for patients and local caregivers.
Alongside announcement registered nurses and IDECs, the so-called Advanced Practice Nurses (IPAs) positions were created in 2018 and launched their practices in 2020. The creation of IPA status aims to extend the scope of practice of “classic” IDEs in order to improve the access to care and the quality of patient care pathways while reducing the workload of physicians. Indeed, IPAs can renew prescriptions, adapt or prescribe treatments or tests and provide clinical monitoring. They operate in outpatient or hospital settings, and their current field of intervention includes oncology and stabilized chronic pathologies such as type 1 and 2 diabetes, chronic respiratory deficiency and Parkinson’s disease.
Keen on preparing nurses for these new roles and to ensure an optimal transition, dedicated training and diploma courses have been created. IPAs are notably trained for two years in order to be recognized at the master’s degree level and the training requires a minimum of three years of practice.
A gradual integration of specialized nurses that is hampered by several obstacles
Despite the ambition declared in the 2021 PLFSS and the creation of announcement registered nurses positions in 52 health facilities, IDECs in 35 facilities during the Cancer Plans, as well as the training of 400 IPAs, hospital organizations still need to evolve in order to fully embrace these new positions.
The role of specialized nurses within existing protocols and in relation to other healthcare providers sometimes remains unclear and requires specific definition. It is notably the case for IPAs whose training has been designed without a specific economic model or reporting line within their intake center.
Moreover, the lack of hindsight from healthcare institutions regarding the role of specialized nurses due to the novelty of such positions and their current implementation, has prompted the launch of dedicated studies at the local level in order to clarify nurses’ activities, particularly with regard to physicians. This is for example the case of the CHUs (French University Hospitals) of Angers, Rennes and Limoges, which have analyzed announcement registered nurses and IDECs’ timetables in order to enhance their activities and encourage their inclusion into existing healthcare organizations.
Specialized nurses: a player of growing importance to include in the strategy of pharmaceutical companies
In the context of the emergence of specialized nurses, including particularly the arrival of the first practicing IPAs in 2020, nurses are playing an increasingly important role in patient care pathways. It thus becomes clear that projects aimed at optimizing patient care pathways cannot be carried out without them. The question of their influence on patient care practices, but also on the prescription of medical proceedures for which they would be responsible is then raised. Such a question is to be elucidated by pharmaceutical companies.
Thus, it becomes key for pharmaceutical companies to rethink the involvement of nurses in their strategies. First and foremost, it will be necessary to gain, even more than now, an in-depth understanding of the role, needs and obstacles encountered by these nurses specialized in the care of their patients. Such comprehension is essential to continue improving patient care, optimizing care pathways, developing innovative solutions that go beyond medication, or positioning themselves as reference partners in the French healthcare ecosystem.
About the author
Cécile, Consultant in Alcimed’s Healthcare team in France
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