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Experiencing Nursing in France

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By Wynette Morris, RN, NurseZone contributor

Have you ever wondered what it would be like to work as a nurse in France?

On a recent trip to Paris, I interviewed a French nurse working in L’Hộpital Avicenne, in Bobigny, France, (located northeast of Paris). Travel to Paris was part of a study abroad course entitled "Culture and Healthcare in France" offered by the University of North Florida. Our study group was comprised of 20 undergraduate and graduate nursing students, one faculty member and a faculty assistant

Our class enjoyed an insightful tour of the public hospital, L’Hộpital Avicenne. This hospital was built in 1935 as a hospital for French Muslims. In 1971, the hospital was renamed Avicenne after a Persian philosopher to symbolize universal thought and religious and medical intent. This hospital is currently a teaching hospital with an emergency department, intensive care unit, oncology, medical/surgical, infectious diseases and adolescent psychiatry units.

L’Hộpital Avicenne averages 30,000 admissions per year and operates on a budget of $115 million.

After an overview presentation of the main facility, we actually got to visit a wing in the hospital and speak to the doctors and nurses via a translator.

So what does it take to be a French nurse? According to Danielle Cosquer, Cadre Infirmer, an employee of L’Hộpital Avicenne, nursing in France is very similar to the United States but with some notable differences. French nursing school consists of 10 months of didactic training, which prepares the students to be nursing assistants. The students must then work for three years in a hospital environment and take an entrance test. Nursing coursework through a university or institute combined with clinicals for two years is then required. If all classes and standardized tests are passed, students get certified as a nurse, similar to our BSN.

French nurses do not have state licensure and no continuing education hours required by the state. Education for nursing certification is free and after students are certified they may work at any hospital, public or private, in any area of France and in other countries in Europe. If promotion within the hospital system is desired, the nurse must work for a year or two to gain experience and enroll in additional training for specialty nurse. A specialty nurse may then advance in training to a nurse manager, or a high level nurse manager. The high level nurse manager position is similar to our director of nursing position. There are fewer privately employed nurses than publically employed nurses in France.

Nursing is held in high esteem in France, even though it is a civil service job. A beginning nurse’s salary ranges from approximately $1,300 to $1,400 per month, after taxes. The standard work week for nurses is 35 hours and they earn five weeks of vacation per year. To cope with the nursing shortage, many nurses work more than 35 hours per week, but get compensatory time off. Shifts are 7am to 3pm, 2pm to 9pm and 9pm to 7am and all employees must work shifts as needed on a rotational basis. There are no set shifts in this hospital, however, shifts may vary from one hospital to another.

New nurse orientation lasts one month long. However Cosquer admitted that this time period is often cut short, due to the staffing shortage. French nurses are being recruited by other countries and the nursing shortage is affecting France, just as it has in the rest of the world.

Staffing is accomplished similar to team nursing in the United States. In France, a nurse and one or two assistants are responsible for approximately fourteen patients, with staffing adjustments made according to the acuity of the patients. On a typical medical-surgical floor of L’Hộpital Avicenne, thirty-seven patients are managed by three nurses and two aides. In the cardiac unit or intensive care unit, staffing will consist of two nurses and one or two nurse’s assistants for seventeen beds.

Similar to a nurse in the United States, French nurses are responsible for assessing patients, giving medications, training and supervising nursing assistants and employee education. Shift report on the patients is given verbally and their daily routine resembles that of an American nurse.

One of the major differences in the physical facility of the hospital was that

there were many windows, allowing sunshine and bright light into the patient’s rooms. Since it is usually cool in Paris, air conditioning is used minimally. Windows were open on the infectious diseases wing and it appeared immaculate and very bright.

L’Hộpital Avicenne has strict isolation protocols, similar to ours here in the United States, with signs and pictures indicating what type of isolation to observe, i.e. contact, respiratory, etc. Patients, families and visitors are educated in the observance of isolation precautions, in an attempt to reduce the spread of infection.

The top five diagnoses on the infectious disease floor are very similar to the top five here in the United States: HIV, TB (with HIV), pneumonia, meningitis and sepsis.

One of the striking differences noted in this hospital, was that smoking is allowed, everywhere except, of course, around oxygen or other flammable substances. Cosquer reported that patients are allowed to smoke if approved by their physician and the majority of people in France smoke cigarettes or cigars.

A most interesting twist to our tour of this public hospital was when Cosquer led us to a building site that now has become an archeological dig. L’Hộpital Avicenne was preparing to build on their property when the builders discovered ancient graves. All building efforts were halted and archeologists from a local university in Paris were called out to investigate.

Apparently, an as yet to be identified culture had lived on the property thousands of years ago. Skeletons were intact and the shallow graves were located very close to one another. About four graves have been uncovered so far and progress is very slow, due to the delicate nature of the skeletons.

L’Hộpital Avicenne employees are mystified by what civilization occupied their property in years past. According to the archeological expert, when all of the graves are uncovered and the skeletons removed, they will be reassembled at a museum in Paris.

Our class thoroughly enjoyed visiting L’Hộpital Avicenne and talking to the staff. We gained knowledge about how French nurses conduct their daily routines and also felt very fortunate that we live and work in the United States. The greatest commonality among nurses we discovered is that we do what we do because we love it!

Wynette Morris, RN, BSN, is a critical care nurse at Memorial Hospital in Jacksonville, Florida. She is pursuing her master’s degree in nursing at the University of North Florida and plans to become a Nurse Practitioner. This trip was taken as part of a graduate course through the University of North Florida, entitled Culture and Healthcare in France.

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