Advanced practice: a new form of care

To practice this, advanced practice requires a deepening of knowledge and therefore of nurses’ skills so that they have the ability to respond to issues identified in our healthcare system. Explained Brigitte Feuillebois, Head of Health, Adviser on the Practice of Paramedics at the Directorate-General for the Supply of Care (DGOS). In France, the problems are many: access to care, demographic tensions in the medical field, the desire to diversify practices in the paramedical professions and to develop their career opportunities. All these goals, combined with the development and increase of the population’s health needs, have highlighted the need to develop a new form of health services, advanced practices whose state aid has been confirmed in various plans: strengthening territorial access to care, the National Health Strategy 2018-2022 and the transformation strategy of the health system.

Training and teamwork

The approach requires a high level of mastery, with advanced clinical expertise from the nurse, an additional margin of autonomy to hold full responsibility for this exercise, and an ability to guide the patient. So many skills that require a diploma, obtained at the end of a two-year training course, and prior practice of the profession as a “general” nurse for three years. But the skills acquired by APNs do not replace teamwork. Although this element is currently being questioned, the physician to date must refer the patient to the IPA so that it participates in his or her overall care.

In France, more than 30 accredited universities make it possible to offer more than 800 study places. Financial support is provided by the Regional Health Agencies (ARS) through the Regional Intervention Fund (FIR) to professionals completing this training, especially Liberals; employees who can benefit from financial support through their structure. Today, the liberal economic model is being questioned because of the difficulties for liberal APNs to live off a full-time activity. Treaty negotiations are under way to resolve the issue.

Laura Martin


Julie Devictor, IPA, spoke at the conference to share a typical example of oncology treatment.

Mr. T., 65 years old, has hepatocellular carcinoma of cirrhosis associated with excessive alcohol consumption and a metabolic syndrome. He is treated with immunotherapy and monoclonal antibodies. The patient was referred by the oncology pathologist for alternative follow-up. The standard consultation of IPA lasts between 45 and 60 minutes with a clinical conversation about lifestyle and the patient’s history, a clinical study with in particular interpretation of the biological results, detection of the complications of the pathologies. ” During the consultation, the IPA will be interested in the patient’s diet, his risk of malnutrition, his caregivers, his lifestyle, accessibility to his accommodation, his prescriptions, comorbidities. , ”Listed Julie Devictor. The IPA then implements preventive measures. ” Our clinical reasoning has been strengthened to respond to clinical findings, she clarified. We redirect when it goes beyond our expertise. Our practice is evidence-based. »


– Martin L., “IPA: we are far from the mark”,, 19/04/2022.

– Renaud A., “Liberal IPAs suspended over new conventional negotiations”,, 25/02/2022.

– Martin L., “Advanced practice must be maintained for model readability”,, 01/10/2022.

– Martin L., “Necessary development to make viable and clarify advanced practices”, The nurses. e, No. 17, February 2022.

– Laborde T., “What is the name of IPA?»,, 18/11/2021.

– Martin L., “IPA: first prescription open on an experimental basis”,, 27/10/2021.

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