liberal caregivers awaiting recognition

In the rainy dawn, the gray Toyota speeds along the roads tormented by the Breton wind, deserted at the end of the night. Already behind the wheel at 6:30 a.m., Pauline Le Franc, 34, works shifts with two colleagues, which allows her to work 7 days a week. About fifteen kilometers from Rennes (Ille-et-Vilaine), the The town of Saint-Gilles, which houses their office, brings together rural hamlets gradually swallowed up by suburban residences. Pauline has no time to waste, she has to visit around fifteen patients today. “Here we go!” » she says, throwing a warm jacket over her garnet blouse embroidered with her name.

The day will be long and varied: you will have to adapt a treatment, make a decision in the face of an unforeseen event, plan to readjust a treatment… Skills that are little recognized among the 640,000 nurses working in establishments and the 135,000 working in private practice. Mr. S*., for example, slept badly last night. Amputated in the lower part of his leg following the infection of a bad wound, this man in his sixties has just been re-operated. This morning, he complained of new, unknown pains. Pauline, precise and lively, helps him characterize them. His questions will then allow the patient to give more detailed instructions to the specialist he must consult that afternoon. Because the nurse does not have the right to prescribe painkillers, even the most common ones. She therefore cannot advise her patients to take paracetamol! According to a 2012 decree, little modified since, she is authorized to write a prescription only for “items for dressings” and a few other devices.

Another pitfall: Mr. S.’s doctor’s prescription does not mention that it is a complex dressing. The young nurse is angry. Like many of her liberal colleagues, she risks an “undue”: if her primary health insurance fund considers that the act she carried out does not comply with that ordered by the doctor, she will have to reimburse the organization audience. And if the caregiver discovered another wound on her patient’s legs, not provided for by the practitioner’s prescription, she would not have the right to treat it. “Today there is a big gap between our skills and what we have the right to do,” summarizes Thierry Amouroux, of the National Union of Nursing Professionals.

Extensive skills

The text establishing the framework for nursing practice dates… from 1962. And it was only revised in 2004! After Covid, a law recognizing the expertise of these professionals was indeed initiated, then relaunched under the ministry of François Braun (2022-2023). It was to be examined by the National Assembly on June 10, 2024. But a stroke of bad luck: the dissolution decided by Emmanuel Macron stopped the discussions dead in their tracks. Arriving in Matignon, Michel Barnier announces a law in his general policy speech in October 2024 to give “an expanded role” to nurses. On November 19, 2024, two deputies – Nicole Dubré-Chirat (Renaissance) and Frédéric Valletoux (Horizons) – tabled a text incorporating the previous bill. New setback: the government was overthrown a few days later.

However, this text broadens the skills of nurses and introduces two notions: that of nursing consultation and that of prescription, by recognizing the possibility of drafting health products and medical examinations, the list of which must be determined by a ministerial decree. It also defines the “missions” of the profession by recognizing “a work of coordination, contribution to the permanence of care, prevention, evaluation of care”, welcomes Sylvaine Mazière-Tauran, president of the National Council of Order of Nurses.

An urgent reform

All is not lost. This bill could be presented during a next parliamentary session at the start of the year. The decree and the order supplementing it will serve as a basis for conventional negotiations setting the prices of the acts. “The profession urgently needs this text so as not to become discouraged and become attractive again,” summarizes John Pinte, president of Sniil, the main union of liberal nurses.

“We don’t do this job by chance,” says Pauline Le Franc, ringing the doorbell of a 90-year-old patient. The old lady often forgot her medicine. Pauline had to ask her GP to prescribe a daily home visit. Without this, she would never have been able to check that the nonagenarian was taking her tablets correctly.

*The person did not wish to publish their name