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Canada v. France: Rethinking Role Of Nurses To Meet Healthcare Needs

To meet its current healthcare needs, France looks to the Canadian provinces of Ontario and Quebec which are giving more autonomy to nurses rather than boost the number of doctors.

Nurses will save France's healthcare system
Nurses will save France's healthcare system
Guy Vallancien*


PARIS — After Ontario, the Canadian province of Quebec has also moved to give specialized nurse practitioners the authority to make autonomous diagnoses and practice certain kinds of therapeutic, even high-risk interventions.

This recognition of nursing's key role and responsibilities is the solution that France must adopt to ensure continuous and smooth healthcare coverage throughout the nation.

Canada"s specialized nurses receive additional training that allows them to do a number of things —​ from diagnosing illnesses, to prescribing medications and performing therapeutic interventions —​ that are normally reserved for doctors alone. The illnesses that such nurses are allowed to treat directly include diabetes, hypertension, asthma and chronic bronchiolitis, among others.

This is a far cry from the baby steps that have been taken in France —​ and tightly restricted always by most healthcare workers unions — to give more autonomy to so-called advanced practice nurses. That's why, without further delay, we need to follow Canada's lead and start offering one- or two-year master's degree programs to train our own specialized nurse practitioners to care for adults, children and seniors, and to work in collaboration with midwives on low-risk pregnancies.

In France, some nurses have taken an additional, year-long course to specialize in prostate care. And in the decade that this option has existed, the results have been wholly positive. Patients don't complain any more than expected when nurses take the lead role in treating them. And it's been good for doctors too, freeing them up to focus on more complex kinds of treatment.

France should focus on training nurses to provide more complex care — Photo: Xu Jinquan/ZUMA

This kind of win-win situation for both nurses and doctors directly calls into question France's plan to increase the total number of doctors by 20%. For one thing, those additional doctors wouldn't arrive on the scene for another 10 years, at the earliest. By then, artificial intelligence and robotics would have already taken up much of the work in various specialties.

In other words, if the 20% plan goes forward, we'll essentially be guaranteeing an abundance of unemployed people without resolving the problem at hand, which are the so-called "medical deserts' in France: areas where there aren't enough qualified people to meet the healthcare needs of residents.

And so here's the other option: Starting next year we begin training several thousand specialized nurse practitioners to go meet those healthcare needs not a decade from now, but in one or two years.

And it's been good for doctors too, freeing them up to focus on more complex kinds of treatment.

There's no time to waste. We need to go further than extending a few discreet privileges to advanced practice nurses and instead embrace real and open professional collaboration between doctors and nurses. The same should go for pharmacists too.

Doctors who oppose this are only shooting themselves in the foot. Canada is already showing us that a rapid transfer of medical responsibilities from doctors to nurses can work. Why wouldn't we at least try to follow the example?

*The author is a member of the National Academy of Medicine and president of the Convention on Health Analysis and Management.

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The Colonial Spirit And "Soft Racism" Of White Savior Syndrome

Tracing back to Christian colonialism, which was supposed to somehow "civilize" and save the souls of native people, White Savior Syndrome lives on in modern times: from Mother Teresa to Princess Diana and the current First Lady of Colombia, Verónica Alcocer.

photo of a child patient holding hand of an adult

Good intentions are part of the formula

Ton Koene / Vwpics/ZUMA
Sher Herrera


CARTAGENA — The White Savior Syndrome is a social practice that exploits or economically, politically, symbolically takes advantage of individuals or communities they've racialized, perceiving them as in need of being saved and thus forever indebted and grateful to the white savior.

Although this racist phenomenon has gained more visibility and sparked public debate with the rise of social media, it is actually as old as European colonization itself. It's important to remember that one of Europe's main justifications for subjugating, pillaging and enslaving African and American territories was to bring "civilization and save their souls" through "missions."

Even today, many white supremacists hold onto these ideas. In other words, they believe that we still owe them something.

This white savior phenomenon is a legacy of Christian colonialism, and among its notable figures, we can highlight Saint Peter Claver, known as "the slave of the slaves," Bartolomé de Las Casas, Mother Teresa of Calcutta, Princess Diana herself, and even the First Lady of Colombia, Verónica Alcocer.

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