Clinical Trial Details
— Status: Recruiting
Administrative data
NCT number |
NCT06355505 |
Other study ID # |
PREPS-21-0098 |
Secondary ID |
|
Status |
Recruiting |
Phase |
|
First received |
|
Last updated |
|
Start date |
March 1, 2024 |
Est. completion date |
March 1, 2028 |
Study information
Verified date |
April 2024 |
Source |
Assistance Publique - Hôpitaux de Paris |
Contact |
Julie Devictor, PhD |
Phone |
06 64 71 26 75 |
Email |
julie.devictor[@]aphp.fr |
Is FDA regulated |
No |
Health authority |
|
Study type |
Observational
|
Clinical Trial Summary
Longitudinal, observational research with a mixed quantitative (by questionnaires) and
qualitative (by interviews and observations) approach, multidisciplinary, among Advanced
Practice Nurses (APNs) already graduated and 3 consecutive classes of advanced practice
students who will be followed annually during their implementation as APN until the last year
of the study. The questionnaires will focus on APN scope of practice evolution, economical
analysis and geographical distribution of APN. The ethnographical approach will assess APN
settlements and relation with healthcare colleagues and patients.
Description:
For 40 years, France has faced an increase in demand for care. At the same time, it faces
problems of scarcity and unequal geographical distribution of human resources in health.
Recent projections by the Ministry of Health predict a decline in French medical density over
the next few years, which would more particularly concern the provision of care in private
general practice. According to the Organisation for Economic Co-operation and Development
(OECD), this development raises fears that the already significant spatial inequalities in
staffing will be exacerbated. Another key player are nurses (state registered nurses), who
remain insufficiently numerous and unevenly distributed, although their density is increasing
in France as in most OECD countries. The WHO (World Health Organization) recommends
strengthening the attractiveness of their profession and rethinking professional boundaries
in order to foster cooperation with the medical professions.
In France, the framework of practice of some state registered nurses has evolved within the
framework of programs aimed at developing the delegation of tasks (cooperation protocols,
e.g. Asalé device) and coordinated practice (health homes, health centers). In addition, in
2018, the regulatory framework for advanced practice nursing was created with a dual
objective: to improve access to care and the quality of patient pathways. A specific 2-year
master's degree course is currently provided by 24 universities. To date, there are 2400 APNs
and 700 graduate each year.
Amendment 9 relating to the APN exercise (2023) sets the financial valuation of the advanced
practice nursing activity (PAI packages). A pilot study conducted by Julie Devictor et al
from 2019 to 2021 showed that among the APNs of the two 1st cohorts, 20% work in primary care
(mixed activity APN/state registered nurses majority), 50% in health facilities and 30% do
not practice as APNs. Obstacles and levers to the implementation of advanced practice are
identified in the international literature. The study hypothesize that there are also some in
France, which it is necessary to identify in the context of the health system.