Nursing in France. Nursing in France. Titles Registration. Take up and pursuit of the training for the profession

Transcription

1 Nursing in France Nursing in France Introduction Titles Registration Training Take up and pursuit of the training for the profession Specialisation The take up and pursuit of the training for specialisation courses Nurse managers and nurse teachers EC Law Diplôme d Etat d infirmier anesthésiste Diplôme d Etat d infirmier de bloc operative Diplôme d Etat d infirmier anesthésiste

2 Introduction In the early party of the 20 th century nurses began to have their function and status regulated. A Brevet de Capacité Professionnel was created 1. Two years later the national nurse association was established. In 1943 the use of the title of nurse was first protected. This law came into force on 8 th April The shortage of nurses effectively meant that the title was not strongly protected. Authorisations for practice and the appointment of people to nursing posts who did not hold the required diploma were common 2. The current legislation is based on the new definition of nurse which recognised the nurses role but also stressed her auxiliary nature with regard to doctors. 3 The state diplomas were introduced by decree in and this training programme made the French training of nurses accord with the new EC sectoral nurses directives. 5 A decree of 17 July 1984 defines the nurse s role and sets out the list of acts which were within the nurse competence to carry out. Approximately 86% of roughly 360,000 in France are employed in the hospital sectors (whether public or private). 1 Paquier France in Quinn and Russell Nursing in the European Dimension (Scutari Press, 1993) p Op. cit. p Law no. 78/615 of 31 May 1978 (J ). 4 Decree 79/ April Id p. 80.

3 Titles The title of infirmier 6 is protected by criminal sanctions. 7 The policing of this is also open to nursing organisations themselves. 8 The illegal practice of nursing is also prohibited by article L 483 of the Code de la santé publique. 9 The specialised nurses have equivalent protection by decree but only the anaesthetic nurses have specialised functions/activities reserved to them. 10 Registration Nurses must register with a Departmental Prefect. 11 Such registration is valid across France but the nurse must re-register with the local prefect if s/he 6 Article L 474 Code de la santé publique: Sous reserve des dispositions des articles L et L , nul ne peut exercer la profession d' infirmier ou d'infirmière s'il n'est muni d'un diplôme, certificat ou autre titre mentionné à l'article L Art. L Un diplôme d'etat d infirmier de secteur psychiatrique est attribue de droit aux infirmiers titulaires du diplôme de secteur psychiatrique. Le diplôme d'etat d infirmier est délivré par l'autorité administrative, sur proposition d'une commission composée en nombre égal de médecins, d infirmiers diplômés d'etat et d infirmiers de secteur psychiatrique titulaires d'un diplôme de cadre de santé, aux candidats qui ont suivi un complément de formation. Un décret fixe les modalités d'application du présent article. (In force Jan 2000) 7 Article L 483 du code de la santé publique. Article L L'exercice illégal de la profession d'infirmier ou d'infirmière est passible d'une amende de francs et, en cas de récidive, d'une amende de francs, une peine d'emprisonnement de cinq mois pouvant en outre être prononcée dans ce cas. L'usage du titre d'infirmier ou d'infirmière par des personnes qui n'en sont pas régulièrement investies et le port illégal de l'insigne sont punis des peines prévues aux articles et du code pénal. 8 Article L 484 op.cit. 9 Article L. 483 L'interdiction temporaire ou définitive d'exercer la profession d'infirmière ou d'infirmier peut être prononcée par les cours ou tribunaux accessoirement à toute peine soit criminelle, soit correctionnelle, à l'exception toutefois, dans ce dernier cas, des peines ne comportant qu'une amende. Les personnes contre lesquelles a été prononcée l'interdiction temporaire ou définitive d'exercer tombent sous le coup des peines prévues au premier alinéa de l'article L cidessous lorsqu'elles continuent à exercer leur profession. 10 Decree of 15 March 1993 (JORF), article Article L 478

4 moves professional residence. 12 There is a language requirement, 13 as well as an entry exam and medical condition requirements. The nurses are on the register and their mode of practice is noted as Article L 478 of the Code of Public Health indicates: L'inscription mentionne la ou les catégories professionnelles dans lesquelles l'infirmier ou l'infirmière exerce (infirmiers exerçant à titre libéral, infirmiers salariés du secteur public, infirmiers salariés du secteur privé, infirmiers de secteur psychiatrique). The Arrêté du 16 décembre 1998 relatif aux lieux d'exercice des infirmiers de secteur psychiatrique 14 indicated where the ex-psychiatric nurses may work. 15 Un infirmier ou une infirmière ne peut être inscrit que sur une seule liste départementale. Cette inscription ne limite pas géographiquement les possibilités d'exercice 12 Article L 478 L'infirmier ou l'infirmière qui est inscrit ou enregistre dans un Etat étranger pour l'exercice de sa profession ne peut être inscrit sur une liste départementale. 13 Article L L'infirmier ou l'infirmière quid demande son inscription sur la liste départementale doit faire la preuve d'une connaissance suffisante de la langue française et des systèmes de poids et mesures utilises en France. Lorsque cette preuve ne résulte pas du dossier accompagnant la demande d'inscription, la vérification est faite par l'inspecteur départemental de la santé; une nouvelle vérification peut être faite, a la demande de l'intéresse, par l'inspecteur régional de la santé. 14 J.O. 292 of Op. cit. p. 82. In the past in France the psychiatric nurse was not a post basic specialisation. Training was carried out in psychiatric centres and lead to a psychiatric diploma. This entitled the nurse to practice psychiatric and geriatric services only. Code de la santé public Art. L Les infirmiers titulaires du diplôme d'etat d' infirmier de secteur psychiatrique peuvent exercer la profession d' infirmier dans les établissements publics de santé, dans les syndicats inter hospitaliers, dans les établissements de santé prives participant au service public hospitalier, dans les établissements de santé privés recevant des patients souffrant de maladies mentales, ou dispensant des soins de longue durée, dans les établissements et services sociaux et médico-sociaux mentionnés a l'article 3 de la loi n# du 30 juin 1975 relative aux institutions sociales et médico-sociales, dans les établissements et services mentionnés a l'article 46 de la loi n# du 30 juin 1975 d'orientation en faveur des personnes handicapées, dans les centres spécialises de soins aux toxicomanes, dans les établissements de santé des armées, a l'institution nationale des Invalides, dans les services et les établissements relevant du ministère chargé de l'éducation nationale, dans les services de médecine du travail et dans les services de la protection judiciaire de la jeunesse.

5 Training Take up and pursuit of the training for the profession Admission to schools of nursing is subject to possession of the baccalaureate or final secondary school diploma. This is the same requirement as for entrance to university. Candidates without a baccalaureate can present themselves to Commission on Validation. If they have least three to five years experience in the medical sector their cases will be evaluated and they may be permitted to enter the School of Nursing. All candidates have to take an entrance exam organised by the School s of Nursing. 16 Numbers are controlled. 17 Candidates must be at least 17 in the year that they apply to take their selection test. The training level is considered to be higher secondary level. Specialisation France recognises three specialist types of nurse, the paediatric nurse (puéricultrice), 18 the anaesthetic nurse (infirmier anesthésiste) 19 and the operating theatre nurse (infirmier de bloc opératoire). 20 The full detail of the training for these nurses is set out in appendix one below. The training is regulated by law and once the certificate and diploma has been achieved they are nationally recognised. The take up and pursuit of the training for specialisation courses 16 This includes tests of admissibility and an interview. 17 See e.g. Arrêté du 26 mars 1999 fixant le nombre d'étudiants admis en première année d'études préparatoires au diplôme d'etat d'infirmier JO 75 of 30 March Décret no de 12 décembre 1990; Arrêté du 12 décembre 1990 amended by Arrêté du 21 janvier 1993; arrêté du 16 juin 1995; arrêté du 21 octobre Arrête du 13 juillet Arrêté du 30 août 1988 amended by Arrêté du 20 janvier 1993, JO 4 février 1993, p Arrêté de 13 septembre 1988.

6 Puéricultrice I. Be either a nurse of midwife; II. Pass admission test to training establishment infirmier anesthésiste and infirmier de bloc opératoire as for paediatric nurse and additionally have two years of experience as a nurse or midwife. There is no reserved area of activity for the specialised nurse except in the case of the anaesthetic nurse as indicated above. 21 The employment market regulates this. There is no legal protection of the specialist titles which are not in fact registered. 22 Nurse managers and nurse teachers A nurse with at least five years professional experience can undertake training to become a nurse manager or teacher. The training lasts nine months at the School of Nursing. EC Law The profession is France is a single profession with no direct entry branch nurses. The recognised specialist nurse practitioners are an evolution from the general care nurse. The mode of access to a French specialised nurse would thus be via the sectoral nurses directives, followed by an application of the Treaty case - law of the EC. 21 See footnote Error! Bookmark not defined. and accompanying text above. 22 There is a draft decree under discussion that deals with the role and exercise of nursing acts, but there is no definitive proposal as yet.

7 The French law 23 in principle permits all those with diplomas mentioned in Article L 474 (which includes EEA recognised qualifications) 24 to access the training in equal chance with French candidates. How well this operates in practice might be open to question. 25 The law used to allow nurses with 5 years relevant experience to be grand-fathered in to the specialisation. 26 Community law could demand a similar process in appropriate cases. 23 Arrêté du 13 septembre JO 20 septembre 1988 article Article L 474 code de la santé publique. 25 Cf C-252/98 Commission v France (pending). 26 Arrêté du 20 janvier 1993 (JO 4 février 1993) Article 1 allowed this for the anaesthetic nurses for example until 1994.

8 Appendix 1 POST- REGISTRATION NURSE TRAINING WITHIN THE EU COUNTRY - France NURSE QUALIFICATION/SPECIALITY Anaesthetic nurse LEVEL DURATION 2 years ENTRY QUALIFICATIONS Nurse/Midwife diplôme d Etat ENTRY REQUIREMENTS & ENTRY EXPERIENCE Health Certificate/vaccinations References/knowledge of French language 2 years clinical experience AGE MINIMUM - MAXIMUM - MANDATORY COMPONENTS (HOURS) FOR QUALIFICATION CLINICAL THEORETICAL - TECHNICAL TITLE OF THE AWARD Diplôme d Etat d infirmier anesthésiste e.g. Certificate/Diploma etc. TITLE AWARDED BY Ministry of Health STATUS OF THE TRAINEE STUDENT APPRENTICE EMPLOYEE * Theory 505 hours (total) 1 Year 3 terms Anatomy physiology Pharmacology Anesthetic techniques Anesthetic selons les terrains 167 hours Transfusion Travaux practiques Year 2-3 terms Anesthesiology and techniques Emergency resuscitation Post operative complications Travaux practiques (1 week) (100 Hours) 138 hours Technical Clinical Training total 77 weeks General surgery orthopedics 30 weeks Transfusion 20 hours Stomatology 8 weeks Resuscitation 9 weeks Emergencies 4 weeks Gynecology 8 weeks Haemodialysis 19 hours Options 9 weeks

9 POST-BASIC/POST-REGISTRATION NURSE TRAINING WITHIN THE EU COUNTRY - France NURSE QUALIFICATION/SPECIALITY LEVEL DURATION ENTRY QUALIFICATIONS Bloc Opératoire (Theatre nurse) 9 months Nurse/Midwife diplôme d Etat ENTRY REQUIREMENTS & ENTRY EXPERIENCE Health Certificate/vaccinations no physical handicap References/knowledge of French language 2 years clinical experience AGE MINIMUM - MAXIMUM - MANDATORY COMPONENTS (HOURS) FOR QUALIFICATION TITLE OF THE AWARD e.g. Certificate/Diploma etc. TITLE AWARDED BY CLINICAL THEORETICAL - TECHNICAL - Diplôme d Etat d infirmier de bloc operative Ministry of Health STATUS OF THE TRAINEE STUDENT * APPRENTICE 1500 hours EMPLOYEE * (normally) Theory 500 hours Hospital hygiene 100 hours Administration-legislation 30 hours Anaesthetic resuscitation 15 hours Surgical techniques 260 hours Surgical techniques 90 hours New technology 5 hours Clinical-technical 1000 hours Surgery-orthopaedic trauma Gastro-enterology Cardio-thoracic Urology Neurosurgery Options 6 weeks 6 weeks 3 weeks 3 weeks 3 weeks 3 weeks (Arrêté du 13 septembre 1988 (JO du ))

10 POST-BASIC/POST-REGISTRATION NURSE TRAINING WITHIN THE EU COUNTRY - France NURSE QUALIFICATION/SPECIALITY Paediatric nurse LEVEL Post-basic DURATION 2 years ENTRY QUALIFICATIONS Nurse/Midwife diplôme d Etat ENTRY REQUIREMENTS & ENTRY EXPERIENCE Health Certificate/vaccinations References/knowledge of French language 2 years clinical experience AGE MINIMUM - MAXIMUM - MANDATORY COMPONENTS (HOURS) FOR QUALIFICATION TITLE OF THE AWARD e.g. Certificate/Diploma etc. TITLE AWARDED BY CLINICAL THEORETICAL - TECHNICAL Diplôme d Etat d infirmier anesthésiste Ministry of Health STATUS OF THE TRAINEE STUDENT * APPRENTICE EMPLOYEE * 1500 hours in total Theory 790 hours Health policy 140 hours Law 20 Educational training 70 The profession 25 Sociology 55 Physiology 23 Pathology 117 Dietetics 60 Psychology 50 Educational psychology 40 Administration and organization 50 Technical-clinical 710 hours 25-35% Hospital sector (Maternity, neonatal, surgery, paediatric) 180 hours 25 30% Community sector Receiving children at home, nutritional guidance home care 180 hours 40 50% Child development and school related projects 350 hours