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LES ECHOS

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*

-OpEd-

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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Geopolitics

Smaller Allies Matter: Afghanistan Offers Hard Lessons For Ukraine's Future

Despite controversies at home, Nordic countries were heavily involved in the NATO-led war in Afghanistan. As the Ukraine war grinds on, lessons from that conflict are more relevant than ever.

Photo of Finnish Defence Forces in Afghanistan

Finnish Defence Forces in Afghanistan

Johannes Jauhiainen

-Analysis-

HELSINKI — In May 2021, the Taliban took back power in Afghanistan after 20 years of international presence, astronomical sums of development aid and casualties on all warring sides.

As Kabul fell, a chaotic evacuation prompted comparisons to the fall of Saigon — and most of the attention was on the U.S., which had led the original war to unseat the Taliban after 9/11 and remained by far the largest foreign force on the ground. Yet, the fall of Kabul was also a tumultuous and troubling experience for a number of other smaller foreign countries who had been presented for years in Afghanistan.

In an interview at the time, Antti Kaikkonen, the Finnish Minister of Defense, tried to explain what went wrong during the evacuation.

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“Originally we anticipated that the smaller countries would withdraw before the Americans. Then it became clear that getting people to the airport had become more difficult," Kaikkonen said. "So we decided last night to bring home our last soldiers who were helping with the evacuation.”

During the 20-year-long Afghan war, the foreign troop presence included many countries:Finland committed around 2,500 soldiers,Sweden 8,000,Denmark 12,000 and Norway 9,000. And in the nearly two years since the end of the war, Finland,Belgium and theNetherlands have commissioned investigations into their engagements in Afghanistan.

As the number of fragile or failed states around the world increases, it’s important to understand how to best organize international development aid and the security of such countries. Twenty years of international engagement in Afghanistan offers valuable lessons.

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