2024: what results for the nursing profession?

The year 2024 opened with promises of evolution in the nursing profession. That driven by the overhaul of the profession, of course, announced in May 2023 by François Braun, then Minister of Health. Also that of the publication, long awaited several years after the opening of the first discussions on direct access and first prescription for nurses in advanced practice (IPA), of the texts of the Rist law. Finally, those of these new missions that we intended to entrust to nurses to free up medical time, in a context of increasing shortage of doctors: drafting death certificates, and creating the status of referent nurse. As the year comes to a close, it is time to take stock of what has shaped the profession over the last 12 months. And to see to what extent these promises have been kept, and those which are looming for 2025.

The developments that have been noted

• Strengthening the role of nurses in emergency medicine : The year 2024 opened in January with the reform of authorizations in emergency medicine. This marks the creation of emergency branches in the city, but also offers greater responsibility to nurses, pre-hospital and, for liberals (IDEL), by integrating them into Samu correspondents. Reform of emergency medicine: increased use of nurses
• Writing death certificates : In April, it was the turn of the decree governing the experiment authorizing nurses to write death certificates. First imagined in 6 regions (Ile-de-France, Auvergne-Rhône Alpes, Occitanie, Hauts-de-France, Centre-Val de Loire and Réunion), it was seen with this text extended to the entire territory. The 2025 Social Security financing bill (PLFSS 2025), stillborn following the vote on the motion of censure, proposed to have the examinations necessary for the drafting of these certificates financed by Health Insurance or the autonomy branch. Nurses officially authorized to sign death certificates
• The new training system for caregivers : The prospect made representatives of the nursing profession jump: facilitating access for caregivers, conditionally, to training to become nurses by authorizing them to enter directly into the second year. Appeal to the Council of State did not make it possible to prove them right, the latter validating the implementation of the system. Nursing assistants: the system of access to nursing training is maintained
• The creation of the status of referent nurse : Supported by Frédéric Valletoux in the law to improve access to care, the creation of the status of referent nurse for IDELs was enacted at the end of June 2024. It allows any insured person aged 16 and over suffering from a long-term condition (ALD) to appoint a nurse responsible for ensuring paramedical monitoring and coordination of care, in conjunction with the attending physician. Referent nurse: the text finally published
• The IBODEs facing the decree of transitional measures : More than three years after the appearance of the first discussions around transitional measures, in 2021, a decree came at the end of October 2024 to frame the system. A text that does not please operating room nurses (IBODE), who see it as a risk of sacrificing their skills and, ultimately, their specialty. IBODEs between anger and distrust in the face of the decree on transitional measures

Pay increases

• The increase in night hours and public holidays : Announced by Elisabeth Borne in September 2023, this increase in remuneration for caregivers working at night and on public holidays came into force from January 1, 2024. It concerns non-medical professionals, caregivers and nurses. The increase in night hours, weekends and public holidays applied since January 1
• The price of HPV vaccination : In July 2024, a decree sets the flat rate for independent nurses (IDEL) participating in vaccination against human papillomavirus at 37 euros per hour. HPV vaccination: the hourly rate for IDELs is specified
• New regulations around invoicing : This was a strong request from the IDEL unions: to simplify and clarify the regulations governing the invoicing of nursing procedures. At the end of November 2024, a circular was unveiled resulting from consultations between the National Federation of Nurses (FNI), the Union of Liberal Nurses (Sniil), Convergence Infirmière and Health Insurance. It intends to harmonize practices and reduce the number of avoidable billing rejections. Prescription, billing: a circular clarifies the regulations

Construction sites still on hold

• The evolution of childcare nurses : Childcare nurses (IPDE) are awaiting an overhaul of their standards. There is something; it has not evolved since 1983. The Pediatric Conference, postponed for a long time, made it possible to outline the main lines of development for the specialty, including the integration of advanced practice into training. Pediatrics conference: what developments for nurses?
• The pricing framework for temporary work : In order to contain expenses linked to the use of paramedical temporary work, the government intends to apply the regulatory system that it has set for medical temporary work. If the salary ceiling must still be determined by decree, the application of the measure is already planned for contracts signed from July 1, 2025. The tariff framework for temporary work should extend to mid-2025 to paramedics
• Patient/caregiver ratio : Long-demanded by professionals, will the establishment of patient/caregiver ratios soon be effective? Submitted and voted on by the Senate, a bill along these lines should soon be examined by MPs, following its adoption by the Social Affairs Committee, for effective implementation envisaged at the end of 2027. Patient/caregiver ratio: what does the new bill say?
• Indexing of nursing rates to inflation : This is one of the collateral damage of the Barnier government’s censorship. The PLFSS 2025 included an amendment relating to the automatic indexation of nursing care prices to inflation, without requiring conventional negotiations. It remains to be seen whether this text will be reinstated when discussions around the PLFSS resume. PLFSS 2025: proposal to index nursing rates to inflation
• Primo-prescription and direct access : The wait is particularly long for IPAs. While the first announcements of an experiment on the opening of direct access and first-time prescription date from PLFSS 2022, the decree governing them was to be published in the Official Journal at the end of 2024. First-time prescription: the revised decree expected by the end of the year
• The overhaul of the nursing profession : The big part of this year is of course the work carried out on the overhaul of the profession. The discussions ended in June, resulting in a proposed text to redefine the missions and broaden the skills of nurses. The bill has been submitted to the National Assembly, where it will have to be discussed and then voted on, before orders and decrees are published which will list acts and fields of intervention which will now be authorized to them. Overhaul of the nursing profession: what does the proposed law contain?