Since the beginning of 2025, French nurses can perform tasks that recently fell under the physician’s domain. Prescribing certain tests, renewing chronic treatments, issuing death certificates: these transfers of skills are reshaping the care pathway. However, on the ground, the implementation does not always keep pace with the legislator’s rhythm.
Direct access to advanced practice nurses: what changes in 2025-2026
Until recently, consulting an advanced practice nurse (APN) required first visiting a physician. This barrier has been removed. Patients can now directly access an APN for certain clinical situations, without prior referral.
This legal shift goes beyond mere delegation of tasks. It establishes a framework for autonomous practice for APNs, with a scope defined by law. APNs can also make initial prescriptions within their area of expertise, including in medical-social establishments that accommodate people with disabilities.
Why does this change matter so much? Because millions of French people do not have a primary care physician. In underserved areas, direct access to an APN shortens the time before care is provided. Organizations like Convergence Infirmière advocate for this revaluation of the nursing role on a daily basis, promoting a more autonomous and better-recognized practice.
The generalization of issuing death certificates by volunteer nurses illustrates this evolution well. After a pilot phase launched in 2023 in several regions, this competency was extended in 2025. It is a symbolic act: it shows that the transfer of tasks goes beyond care to touch on the administrative continuity of the pathway.
Practical barriers on the ground despite nursing reform
The law opens doors, but practical barriers remain numerous. The first barrier is regulatory. In September 2026, a final legal adjustment was still necessary to align the implementing texts with the passed law. Without these decrees, certain acts remain theoretically possible but impractical.
The second barrier concerns training. Nursing training institutes (IFSI) are preparing a reform of their curriculum for the 2026 academic year, with enhanced university integration. The goal is to adapt teachings to the new responsibilities. In the meantime, professionals already in practice do not all have access to the continuing education necessary to exercise these expanded competencies.
You may have noticed that a law does not immediately change what happens in a practice or a nursing home? This is exactly the gap observed here. Volunteer nurses for issuing death certificates, for example, must have undergone specific training. However, the availability of training remains uneven across regions.
Three concrete barriers identified by professionals
- The lack of operational implementing decrees, which creates ambiguity about the acts authorized on a daily basis
- Insufficient access to continuing education, particularly for liberal nurses practicing in rural areas
- The still fragile coordination with physicians, some general practitioners perceiving direct access to APNs as a loss of control over the patient pathway
Nursing education reform: university integration and new content
The nursing diploma reform planned for 2026 is not just a change of label. University integration means that the curriculum will be more closely aligned with the bachelor-master-doctorate system. Students will benefit from more advanced teaching in clinical sciences, pharmacology, and diagnostic reasoning.
This academic strengthening responds to a logical necessity. If a nurse can prescribe a blood test or renew a chronic treatment, their initial training must cover the basics of medical reasoning. Without this, the legal competency exists, but the clinical competency does not follow.
IFSI are also working on integrating modules related to violence, mental health, and complex pathways. The profession is evolving towards a first-line role, which involves knowing how to identify situations that go beyond technical care.
Liberal nurses and care coordination in underserved areas
Liberal nurses represent a territorial network that few other health professionals can offer. Present in communities where the last physician left years ago, they often provide the first contact with the healthcare system.
The law gradually entrusts them with a coordination role. Monitoring chronic patients, therapeutic education, end-of-life support: these missions already existed in practice, but without a clear legal framework or appropriate remuneration.
- Personalized follow-up for patients with chronic diseases (diabetes, rheumatoid arthritis, heart failure) is becoming a recognized field of practice
- Therapeutic education for patients, long confined to hospital structures, is now opening up to trained liberal nurses
- End-of-life support at home increasingly relies on nurses trained in palliative care
This legal recognition changes the game for funding. An act included in the nomenclature is a reimbursable act, thus accessible to the patient without additional out-of-pocket costs. The shift from disguised volunteer work to paid competency remains the most concrete lever to improve access to care.
The nursing profession is not undergoing a simple regulatory update. It is changing its legal and clinical nature, with a scope of autonomy that has never been so broad in France. The barriers – training, decrees, interprofessional coordination – remain tangible. But the legal framework established in 2025-2026 makes these evolutions irreversible, provided that the resources follow.
