Although the High Authority for Health (HAS) has just issued a favorable opinion on the draft decree relating to nursing prescriptions, it nevertheless expresses reservations and proposes adjustments which risk, depending on the National Union of Nursing Professionals SNPI, to distort the very spirit of the reform…
The law of June 27, 2025 on the nursing profession provides that the state-certified nurse « prescribes health products and additional examinations necessary for the exercise of his profession. The list of these products
health and these additional examinations is established by an order of the ministers responsible for health and social security taken after advice of the High Authority of Health and the National Academy of Medicine. (…). »
The General Directorate for Healthcare Supply (DGOS) therefore contacted the High Authority for Health on March 16, 2026 so that it could issue an opinion on this draft decree which aims to clarify and harmonize the list of health products and additional examinations covered by nursing prescriptions. It brings together all the acts which were until now scattered in different texts relating to the professionsuch as vaccinations, oral contraceptives, medical devices or even nicotine substitutes, in order to provide greater clarity to the regulatory framework.
The project also provides for an expansion of nursing skillsparticularly in the areas of prevention, wound care, sexual health, smoking cessation and pain management. In addition, this development opens up the possibility for nurses to prescribe certain biological and radiological examinations, as well as certain medications.
The HAS opinion is favorable but “subject to taking into account adjustments” :
If the extension of nursing skills can improve access and responsiveness of care, the HAS specifies that “Indirect monitoring (biological results, reports, letters) cannot replace face-to-face clinical evaluation. Quality monitoring is based on direct and shared clinical knowledge of the patient.
The writing of prescriptions requires a prior medical diagnosis, which is not specified in the draft order and the IDE does not have the training enabling it to make an etiological diagnosis or to eliminate differential diagnoses which could be the cause of a loss of opportunity for the patient. These elements fall within the competence of the doctor.
Consequently, an essential condition for this development is the existence of regular, close face-to-face work between general practitioners and prescribing nurses. This cooperation must be real and effective. It is recommended to establish an organizational framework to promote this coordination, which may include geographic proximity and registration in coordinated care teams. Collaboration with IDEs is essential and must be framed by a protocol (independently of its prescribing role which provides for a prescription or a protocol) which makes it possible to guarantee the safety and relevance of the care and examinations prescribed.
It is necessary to maintain coordinated care by the attending physician as this is a guarantee for the patient of quality care and safety in the care provided. This is all the more so if the IDE prescribes imaging or medical biology procedures, and in the event of positive or doubtful results, the continuation of the treatment must be the subject of a medical opinion. It is important to guarantee the clinical stability of the patient before any renewal of prescription
The prescriptions must also be renewed identically and only once, in compliance with the monitoring protocol and subject to the agreement of the referring doctor in order to ensure the continuity and safety of the care pathway.
HAS emphasizes that these developments can only be considered on the condition of guaranteeing a secure framework based on appropriate training for professionals and systematic traceability of the actions carried out. The reform must be accompanied by an initial and continuing training plan, interoperable digital prescription tools and effective access to the patient file. National monitoring of implementation and regular updating of the text based on feedback from professionals must be provided.
For the National Union of Nursing Professionals SNPI » The problem arises when coordination tends to become a form of implicit authorization. On several occasions, the opinion takes up requests made for a long time by certain medical organizations: coordinated care by the attending physician, close cooperation with doctors, rapid medical referral in many situations, questions about the absence of prior medical diagnosis. These concerns may be understandable when dealing with certain complex or risky situations. But they must not lead to distorting the very spirit of the reform:
– Informing the attending physician is not dependent on the attending physician.
– Coordinating the process does not mean subjecting each nursing intervention to prior medical validation.
– Referring when the situation requires it does not mean transforming the doctor into the obligatory entry point for all care procedures.
The patient would have gained neither time, simplicity, nor access to care. We must avoid rebuilding, through regulation, the barriers that the law specifically sought to remove. The goal is not to turn nurses into doctors. The objective is to avoid unnecessary delays in the care pathway (SNIP).
Are HAS’s reservations justified?
The answer is nuanced. Some comments are perfectly relevant. Others deserve to be placed in the reality on the ground and in the objectives pursued by the reform.
Even if nurses already have great skills in wounds, and many have expertise from university degrees in “wounds and healing”, the need to define alert criteria, situations requiring rapid medical referral or even specialist referral methods can be justified.
Same logic regarding certain risky products, local antimicrobials or even the rules for using silver nitrate.
But it is especially on biology and imaging that the debate deserves to be deepened. The opinion expresses strong reservations regarding the nursing prescription of certain biological or radiological examinations.
The main argument is known: nurses are not trained to make a medical diagnosis or to interpret all of these results on their own. This observation is correct. But it doesn’t answer the right question.
The goal is not to turn nurses into doctors. The aim is to avoid unnecessary delays in the care pathway. What does the reform propose?
– Allow the examination to be prescribed when it is necessary for the practice of the nursing profession.
– The patient then arrives at the doctor with the results already available.
– The doctor naturally retains his role of diagnostic interpretation, clinical synthesis and therapeutic decision.
In a context marked by difficulties in accessing community medicine, overcrowding of emergency rooms and the lengthening of treatment times, the answer seems just as obvious. However, the HAS seems hesitant to draw all the consequences.
A reform serving patients
The evolution of skills in health professions must never be analyzed from a corporatist angle. It’s not about pleasing this or that profession. This is about meeting the health needs of the population.
Every year, patients forgo care, delay treatment or see their condition worsen because they cannot obtain a sufficiently rapid response.
Every year, emergencies receive situations that could have been handled earlier in the course.
Every year, caregivers see the consequences of these delays.
Nursing prescription is not an end in itself. It’s a tool. A tool designed to streamline pathways, reduce unnecessary delays, improve access to care and limit loss of opportunity.
HAS recalls the security conditions necessary for its implementation. The government will now have to find the right balance:
– Secure without blocking.
– Coordinate without subordinating.
– Supervise without neutralizing.
The law has opened an ambitious path. The upcoming decree should make it truly practicable. For nurses. But especially for the patients.
See also:
– https://toute-la.veille-acteurs-sante.fr/243893/prescription-infirmiere-reconnaitre-de-nouvelles-competences-pour-mieux-les-limiter-communique/
– https://www.linkedin.com/feed/update/urn:li:activity:7471944238855958528/
