Health: who are these “super nurses” who irritate some doctors?

Doctor Laure Cescon sticks her head out of the water. For a year, this general practitioner has entrusted her patients to Dalila Hemaidi, an advanced practice nurse (IPA) who collaborates with the doctors of a multi-professional health center in the 18th arrondissement of Paris. “I am less and less behind on my consultations, and even a few slots that are freed up”, enthuses the general practitioner, who is facing the increase in demand for care in Île-de-France.

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IPA… Far from the hopped drinks served in bars, this acronym corresponds to a new profession that is jostling to find its place in a breathless health system. With two additional years of training in medical school (master’s level), these nurses are in a way “super nurses”. With expanded skills.

Dalila Hemaidi is particularly comfortable with elderly patients. “I trained for five months with a geriatrician. I know how to assess the fragilities of patients, whether they are rather dependent or robust”, says the one who has accumulated 20 years of experience at the bedside of patients since her first diploma as a state-certified nurse (level bac+3). So Dr. Laure Cescon does not hesitate to refer her patients to her when she deems it necessary. Especially those with chronic illnesses. “When I summon a patient to check their blood pressure following a change in treatment, I can ask Dalila to take care of it,” explains the general practitioner.

A formal organization

This fluidity in the management of support is made possible by a well-crafted protocol. Every week, on Monday, Dalida Hemaidi, Laure Cescon and the other doctors and carers of the nursing home meet to take stock of the files of the patients followed. And to stay informed of warning signs. “With the retirement of doctors in the 18th arrondissement, we are facing an increase in requests for home visits, says Dr Laure Cescon. We therefore ask Dalida to go there to assess medical needs and resources. Then, it presents us with a report specifying the context of the requests for support”.

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In his hepatology department at the Beaujon hospital in Clichy (Hauts-de-Seine), Dr. Mohamed Bouattour can no longer imagine working without Julie Devictor. IPA from the first promotion released in 2019, after 18 years of experience as a state-certified nurse, it is like the doctor’s second pair of glasses. “I am focused on certain aspects of the disease and the treatment of side effects. Rather, Julie provides comprehensive and cross-cutting patient care”, describes this specialist in primary liver tumours.

Patient follow-up relies on communication between the two professionals. “Our offices are side by side and we keep our doors open, which simplifies exchanges,” says Julie Devictor, who works independently without cutting the link with Dr Bouattour. “I had a patient with bone metastases which are very painful while he is being treated with painkillers and chemotherapy, says the IPA. I questioned him to understand his pain which had been well controlled so far. Together with other nurses on the team and a psychologist, we decided to increase the dose of morphine. I then re-educated the patient on how to take his analgesics”. After all these steps, Julie Devictor informs the medical specialist. “Each time I see a patient, I write a report that I send to the doctor and all the correspondents involved in his treatment process”. It details the patient’s history, his lifestyle and specifies the stage of his treatment.

Towards the generalization of direct access

Soon, perhaps, Julie Devictor and Dalila Hemaidi will be even more independent in their work. A bill, brought by Renaissance MP and rheumatologist Stéphanie Rist, generalizes direct access to IPAs provided that they work in homes or health centers, or even in a territorial professional health community (CPTS). But the third structure bothers some doctors.

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“Joining a CPTS would be enough when these structures bring together health professionals who do not know each other”, thunders the vice-president of the Order of Physicians, Dr. Jean-Marcel Mourgues. “It is more relevant to authorize direct access at the scale of a nursing home in terms of communication. We risk getting lost in the volume of the CPTS”, abounds Dr. Laure Cescon, the general practitioner rather satisfied with her collaboration with her IPA, Dalila Hemaidi. In view of the reluctance of doctors, the senators removed from the text the possibility of direct access to IPAs at the CPTS level. Unlike health centres, CPTS are not structures bringing together health professionals in the same place.

Stéphanie Rist is also paving the way for first-time prescription. What Julie Devictor appreciates. “Today, I am not authorized to prescribe doliprane to patients with cancer when it can be given in nurseries or schools. So I disturb the doctor so that he signs a prescription”, points out this advanced practice nurse. “It is no longer possible for a patient not to have easy access to comfort care, in particular level 1 pain treatments,” adds Dr. Mohamed Bouattour, who works with her in his hepatology department. .

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For her part, Dr. Laure Cescon has some reservations. “That IPAs can directly prescribe physiotherapy, orthopedic insoles, yes thoroughly, considers this general practitioner. But for the treatments, I’m not sure that Dalila is comfortable with the first prescription. I think she prefers to call me at the same time she sees the patient. It’s common sense”.

The version of the text adopted by the Senate on February 15 provides for the classification of prescription drugs into three categories, “according to the health risks they present (adverse effects, risk in the event of misuse by the patient …)”. All this, by consulting the competent health orders to determine the list of drugs concerned. It remains to be seen whether the deputies and senators will agree at the beginning of March in a joint joint committee, the last step to validate, or not, the bill.

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