French Union of Nurse Anesthetists

Nurse Anesthetist in France

 French Union of Nurse Anesthetists

 

There are about 7000 Nurse Anesthetists in France. Most of them are working for Public Institutions.

The French nurse anesthetist is called : Infirmier Anesthésiste Diplômé d’Etat (IADE), meaning Certified (National Diploma) Registered Nurse Anesthetist.

The IADE is a state registered nurse with a specific national diploma in nurse anesthesia. The role is defined within the National Law (93-345 March, 15th. 1993) defining nursing skills , and especially within Article 7 :

" The certified registered nurse anesthetist and the student nurse anesthetist are the only one authorized, in condition that a physician can intervene at any moment, to participate to the application of following techniques, after the physician has examined the patient and has decided the anesthesia :

-general anesthesia ;
-regional anesthesia and reinjections when the device has been settled by a physician ;
-perioperative resuscitation. ".

Actually nurse anesthetists administrate and/or participate to the administration of anesthesia , maintain and control anesthesia until the recovery period. The responsible physician is an anesthesiologist supervising 2 or 3 operating rooms with a nurse anesthetist in each room.

Nurse anesthetists are also participating to Emergency Mobile Units (SAMU, SMUR) and are recognized as resource persons for cardio-respiratory resuscitation procedures.

They are recommended for supervising Recovery Rooms, Surgical Intensive Care Units and Emergency Units.

Education :

After a basic nursing education (3 years post baccalaureate), a 2 years experience of care near the patient (including preferably at least 1 year in intensive or critical care units the student shall succeed to an admission examination to start a nurse anesthesia program of education. The studies are 2 years long with theoretical and clinical curses. At the end of the program the student shall pass and succeed to a national final examination to obtained the National Diploma of Nurse Anesthetist.

There are 27 civil programs and 3 military programs. The nurse anesthesia program of education is a national one. (See below details)

OFFICIAL NURSE ANESTHESIA PROGRAM

[Program agreement] [Conditions for admission] [Program] [Diploma] [School organization]

 

Article I

Conditions for Ministry of Health agreement for a Nurse Anesthesia Program:

A- Dossier containing:

.Conditions of operating of the school, such as accommodation facilities, number and qualification of the faculty.
.Traineeship location, quality of the traineeship faculty and report about activity of traineeship sites.
. School rooms plan and list of equipment.
. Estimated budget for the program;
. Analysis of the regional needs of nurse anesthetists for the 5 years coming;
. Motivated opinion of the local Health Affairs Director.(Official representative of the Ministry of Health).

B- The Director of the school shall be a Certified Head Nurse-Anesthetist;

C- The Scientific Director shall be a University Anesthesiologist Teacher. He will be accountable of the quality of the program and the qualification of the teachers.

 

Article II

General Conditions for Admission:

A- To be allowed to begin a nurse anesthesia program, the candidate shall:

-Be a certified registered nurse.
 
-Justify of two (2) years of practice as nurse.
 
-Present a dossier containing a curriculum vitae and the employer's appreciation
 
-Pass the examination of admittance to the nurse anesthesia program.

 

B- The examining board is appointed by the Representative of Governmental Authority of the Region, based on the nominations made by the Director of Nurse Anesthesia program. It is composed of:

-The Official Representative of the Ministry of Health ( a physician);
-The Nurse Anesthesia Program Director ( certified head nurse anesthetist))
-The Scientific Director ( university teacher anesthesiologist);
-Two (2) anesthesiologists, one is teaching at school;
-One (1) nurse anesthetist teaching at school;
-One (1) nurse anesthetist of hospital trainee site.

 

C- The admittance examination shall evaluate the professional competencies and knowledge, and the ability to follow a nurse anesthesia program. It consists of:

-A written anonymous test of 1h 30. This test, evaluated out of 40 marks, is composed of Twenty (20) short questions about basic nursing learning. A minimum mark of 20/40 is required to be admitted.
 
-An oral test on a professional item linked to clinical learning, for evaluating the candidate's ability for a nurse anesthesia education. The question , chosen just before the evaluation by the examining jury, shall be the same for the entire session. This test consists of a five (5) minutes exposé with a ten (10) minutes discussion with the jury. The candidate has fifteen (15) minutes to prepare the question. A minimum mark of 10/20 is required.
 
-An examination of the dossier , evaluated out of 10 marks.

Are admitted, candidates rated first until the number of seats agreed for the nurse anesthesia program. A minimum mark of 35/70 is required.

 

Article III:

PROGRAM:

A-The program is two (2) years long and full time. It is composed of theoretical, clinical and practical studies and training periods.

For every year there is a vacation period of thirty (30) days and twelve (12) days off, determined by the director of the program.

B-Theoretical, practical and clinical education is divided on three (3) sequences per year. Every sequence shall be validated with a minimum mark of 10 /20.

C-The clinical training period is composed of compulsory and optional traineeship. The sites are approved by the regional official representative of the Ministry of Health, based on the selection made by the program director and the scientific director.

The traineeship evaluation is made by the anesthesia department head anesthesiologist, the department head nurse anesthetist and the nurse anesthetist in charge of the student.

A minimum mark of 10/20 is required.

D-In case of failure on the validations , the student could be authorized to extend by one (1) year the studies.

 

Article IV

Nurse Anesthetist Diploma.

A-Are authorized to sit for the final examination, the students with a complete validation of the sequences and traineeship.

B-The examination is organized by the regional official representative of the Ministry of Health.

C-The final examination consists of:

(These tests are anonymous and have a double correction by 2 members of the jury: an anesthesiologist and a nurse anesthetist.)

 

D-To graduate, the student shall have a final minimum mark of 40/80. A mark lower than 7/20 to one of the written tests or the clinical evaluation is disqualifying.

E-In case of failure, the student shall pass the next examination the year after. The program faculty will decide of the needs for a complement of education or not.

F-In case of mark lower than 40/80 without any disqualifying mark, the student has the opportunity to pass an oral examination, during the two weeks following the announcement of the results.

This examination last 20 minutes and is marked out of 40. The student has 10 minutes for preparing the questions. The mark obtained will replace the mark for the written examination. If the total mark is at minimum 40/80, the student graduates.

G-The examining board is composed as following:

-The regional representative of the Ministry of Health;
-Two (2) Anesthesiologists, one is the department head anesthesiologist of the hospital where the school is settled;
-A Nurse Anesthesia Program Director or teacher of an other school.
-A Scientific Director of a nurse anesthesia program of an other school;
-Two (2) Nurse Anesthetists, one is a Head Nurse Anesthetist on a traineeship site.

H-The regional Representative of the Government issues to the graduates the National Diploma of Nurse Anesthetist.

 

Article V

School organization

Advisory (or technical ) Committee:

A-For every Nurse Anesthesia program, the Director is assisted by an Advisory Committee for all the items concerning the education. The committee advice are required for:

-Application of the official curriculum, objectives of the program, pedagogical project, organization of the program, practical, clinical studies and pedagogical research;
-Traineeship sites agreement, traineeship and sequences evaluation process;
-Dates of holidays and vacation periods;
-Use of the rooms and pedagogical equipment;
-Faculty number, the type and the time of their participation;
-Estimated budget;
-Costs of the studies for the students and the registration fees for the admittance examination;
-School regulations;
-Examination of the dossier presented by students requesting a delay for their studies for exceptional events;

The Director notify to the Committee:

-The pedagogical results of the past year;
-Approved budgets and the final accounts;
-The list of the students .

B- The Director announces, as per advice from the Committee , either the necessity to repeat the year for a student or the stop of the education in case of failure for one or more traineeship or one or more theoretical sequence. The Director notify every meeting to the Committee at least 2 weeks before. He gives to every committee member and to the concerning students a motivated report and the student education dossier. Students receive their dossier on the same date than the Committee.

C-The Committee is appointed and chaired by the representative of the Government. It consists of:

-Director of the program;
-Scientific Director;
-One representative of the Management Board of the School location;
-The Nursing Director of the Hospital receiving students for traineeship;
-One Anesthesiologist teaching at school elected by colleagues;
-One Nurse Anesthetist teaching at school elected by colleagues;
-Two (2) students (one per year) elected fellows;

The students are elected for one year. The other members are elected for the length of the program. Every member has a proxy elected on the same conditions.

The chairman of the Committee by his own or on the request of the majority of the members of the committee can invite any expert for advice for the Committee.

The Committee is meeting at least twice a year.

Disciplinary Board:

A-On every Nurse Anesthesia program the Director is assisted by a Disciplinary Board (DB) The DB is giving advice concerning disciplinary items and the students acts when the safety of the patients is not guarantied and involving the student responsibility.

The DB can propose the following sanctions:

-notice,
-admonition,
-temporary expulsion,
-definitive expulsion.

B-The Disciplinary Board is chaired by the Representative of the Government. It consists of:

-One representative of the Managing Board of the School location;
-One of the two teachers member of the Advisory Committee drawn;
-One of the two students member of the Advisory Committee drawn.

 

The Director informs the involved student of the Disciplinary process. The student can be assisted by any kind of people. Witnesses can be heard. The quorum is required for any decisions. The sanction is voted by a majority of the members.

 

PROGRAM CURRICULUM:

 

Preamble:

The goal of the Nurse Anesthesia program is the acquisition of theoretical and clinical knowledge required for the nurse anesthesia practice of different general and regional anesthesia, management of the recovery period , resuscitation and emergency care, management of severe patients transportation.

This program shall require 24 months or 4056 hours, including 505 hours of theoretical studies and 77 weeks of training.

 

Prerequisites:

The prerequisites imply a good knowledge of the basic nursing education program. The candidates shall actualize the containing of this program.

I- Basic nursing topics:

II- Anatomy and physiology of different functions:

III- Pharmacology:

IV- Nursing practice and regulation.

Global objectives of the program:

At the end of the program the student shall be able to:

-Participate, in presence of a responsible physician able to intervene at any moment, to the application of the following procedures:
general and regional anesthesia, the first injection for the regional anesthesia made by a physician and the following by nurse anesthetists;
 
-participate, in presence of a responsible physician able to intervene at any moment, to the application of the following procedures:
management of patients for peri operative periods and resuscitation procedures;
 
-to come up to any emergency situations and to realize, under physician prescription, the management and cares for patient in case of emergency transportation;
 
-To join with a care system, considering the knowledge for ethic, regulation, management and epidemiology.
 
For this purpose, the program is divided by six sequences as it is described below:

 

First year of Education:

Objectives:

The student shall be able to:

-participate to general and regional anesthesia for visceral and trauma surgery;
-explain the resuscitation acts linked with this type of anesthesia,

i.e.:

1) to identify and to use the equipment :

-to proceed to the right setting;
-to detect the failures;
-to justify the choice;
-to participate to the maintenance and to the managing of the equipment;

2) To explain the use of the anesthesia drugs;

3) To proceed under the supervision of the responsible physician:

-to the management of the patient during the pre anesthesia period and the O.R admittance;
-to the following procedures:
-placement of intravenous catheter .
-ventilation with a mask;
-intubation;
-extubation;
-assisted and controlled ventilation during perioperative period;
-management of the anesthesia and recovery periods;
-to the detection of main complications.

Second year of Education

Objectives

The student shall be able to:

-Participate to general anesthesia and regional anesthesia to any kind of patient and surgery;
-Realize different types of resuscitation cares;
-Participate to the management of acute emergencies and acute patient transportation .

 

Curriculum containing:

I-Theoretical education:

The theoretical education consists of three (3) annual sequences. The education is composed of theoretical lectures, practical courses and workshops. Practical and workshops shall be done by nurse Anesthetists and the length can't be less than 200 hours for the six sequences.

    HOURS  
  Theoretical Practical and workshops Total
1st Year      
I-Sequence 56    
II-Sequence 66    
III-Sequence 45    
Total 1st. Year 167    
2nd Year      
I-Sequence 44    
II-Sequence 49    
III-Sequence 45    
Total 2nd. Year 138    
Total 305 200 505

Three (3) practical sessions of 6 hours each, shall be devoted to blood transfusion, Hemodialysis and Extra-Corporeal Circulation, during the 2 years of education.

II-Clinical Education:

The student shall have clinical education for the following specialties:

1st Year  
Compulsory traineeship  
General surgery, visceral and digestive, orthopedic and traumatological 30 weeks
Stomatology, oropharyngeal and ear surgery and ophthalmology 8 weeks
Blood transfusion 20 hours
2nd year  
Compulsory traineeship  
Pediatric 8 weeks
Gynecology and obstetric 8 weeks
Surgical and medical intensive care 9 weeks
Emergency, acute ambulatory care 4 weeks
Hemodialysis 19 hours
Optional traineeship  
General surgery, intra abdominal, orthopedic and trauma surgery 4 weeks
Emergency, Neuro surgery, cardiac surgery 5 weeks
Total 77 weeks

 

Containing of theoretical and practice education:

First year- 1st sequence

Objectives:

At the end of the sequence the student shall be able to:

-identify and use the usual equipment;
-prepare an OR for an anesthesia;
-participate to the positioning of the patient on the table;
-identify the different periods of a general anesthesia;
-describe 2 anesthesia procedures:
-one by inhalation;
-one intravenous.

Academic:

1-Anatomy and physiology

Remains of respiratory anatomy and physiology;
Remains of cardiovascular anatomy and physiology;
Normal EKG.
Organization and physiology of nervous system.
Role and composition of blood.
Blood groups.

2- Pharmacology

Effects of anesthetics on nervous system.
Signs and stages of anesthesia.
Physical laws of gazes and vaporization.
Pharmacodynamic, pharmacocinetic and use of thiopental, nitrous oxide and halothane.

3- Techniques

Normobar oxygenotherapy.
Arterial and venous routes.
Induction and maintenance of general anesthesia.
Tracheal intubation.
Effects of positioning and changement in positioning of the patient during operation.
Events and accidents during anesthesia.
Cardio respiratory resuscitation procedures.

 

Practical courses

Preparation of the OR, equipment, agents and drugs.
Implementation and maintenance of anesthesia record.
Drugs and agents dilution.
Intubation: material and techniques.
Cardiac monitoring.
Gazes conditioning, pressure reducer, flow control and safety mixer.
Setting of open and close gas machine tubes.
Use of inhalation machines.
Monitoring.
Capnography, and other gazes elimination monitoring.
Vascular catheters placement , types of catheters.
Fluids for anesthesia and resuscitation.
Cardiorespiratory resuscitation procedures.

 

First year- Second sequence

Objectives

At the end of the second sequence, the student shall be able to:

- take care of a general anesthesia;
-detect complications;
-participate to the anesthesia management of fluids and resuscitation procedures,

i.e.:

- maintain anesthesia level,
- take care of the patient ventilation:
- intubated or not;
- with spontaneous ventilation, assisted or controlled ventilation;
- take care of the cardiovascular status with or without specific monitoring;
- take care, evaluate and manage blood losses, fluid therapy.

 

Academic courses

 

I-Physiology and pathophysiology

Cardiovascular system:
Physiology (end)
EKG monitoring and rhythm troubles.
Techniques for collecting data from hemodynamic invasive and non invasive monitoring.
Shock status: hypovolemia, collapses , anaphylactic, septic.
Blood and hemostats:
Blood transfusion: regulation, problems and accidents.
Blood by-products.
Auto transfusion, hemodilution.
Hemostats, physiology remains and drugs interaction.

 

Physiology:

Renal physiology.
Hydra-electrolytic balance.
Acid-base balance.

 

II- Pharmacology and utilization techniques

Pharmacology and utilization techniques of inhalation and intravenous anesthetics (end).
Physiology of neuromuscular system, management and complications of muscle relaxation, pharmacology of muscle relaxants and antagonists.
Reminders of pain sensibility routes and endorphins, pharmacology of morphinics and antagonists, management and complications of administration of morphinics.
Neuroleptics, benzodiazepines: pharmacology and techniques of utilization for preanesthesia, neuroleptanalgesia and diasanalgesia.

 

III-Anesthesia techniques:

Emergence, physiopathology and management.
Problems and accidents during recovery period.
Physiopathology of artificial ventilation.
Starting, management and weaning of short period artificial ventilation.

 

Practical courses:

Utilization of different cardiovascular monitoring.
Setting and utilization of equipment for a massive blood transfusion.
Principles and working of anesthesia machines. Oxymeter.
Monitoring of neuromuscular relaxation.

 

First year. Third sequence:

 

Objectives

At the end of the third sequence, the student shall be able to:

-participate to a general and regional anesthesia;
-identify different anesthesia techniques depending of patient category, surgery , intrabdominal and orthopedic, and the grade of emergency.

 

Academic courses:

 

I- Anesthesia techniques

Thermoregulation, hypothermia and hyperthermia peri-operative.
Regional anesthesia:
-reminders of anatomy and physiology;
-reminders of pharmacology of regional anesthetics;
-methods, problems and accidents of following techniques:
- spinal anesthesia;
- epidural anesthesia;
- blocks;
- regional intravenous anesthesia.

 

II- anesthesia for different categories of patients, surgery types and emergency grade.

Anesthesia for intra-abdominal surgery.
Anesthesia for orthopedic surgery.
Anesthesia for geriatric;
Anesthesia for obese.
Anesthesia for chronic bronchitis and respiratory insufficient.
Anesthesia for cardiac insufficient, coronarian insufficient.
Anesthesia for renal insufficient.
Anesthesia for cirrhotic and lever insufficient;
Anesthesia for diabetic.
Anesthesia for emergency, full stomach.
Anesthesia for schocked patient and Polytrauma.
Anesthesia for burned patient.
Evaluation of the risks of anesthesia and surgery.
Preanesthetic interview.
Position of the Nurse Anesthetist in the care system.
Legislation and responsibilities.

 

Practice:

 

Utilization of different warming system.Monitoring. Preparation of equipment for a regional anesthesia.

Second year. First sequence:

 

Objectives

At the end of the first sequence, the student shall be able to participate to any kind of anesthesia.

Academic courses

I- Anesthesia for pregnancy women.
General and regional anesthesia for obstetric.
Neonate physiology.
Neonate resuscitation.
Anesthesia for pediatric.

 

II- Anesthesia for neurosurgery.
Anesthesia for thyroid surgery.
Anesthesia for ophthalmology, ear ,oropharyngeal surgery, face surgery.
Hypotensive techniques .
Anesthesia for X-ray, scan investigation, endoscopy and central catheters.
Anesthesia for ambulatory and day surgery patient;
III- Anesthesia for urology surgery..
Anesthesia for vascular surgery.
Anesthesia for cardiac surgery. Extra-corporeal circulation.
Anesthesia for thoracic surgery.
Anesthesia for surrenal surgery.
Iatrogenic problems and accidents.

 

Practice for neonate:

Venous catheter placement.
Infusion, transfusion.
Ventilation.
Machines.
Incubators.
Warming table.

 

Second year- Second sequence:

 

Objectives

At the end of the second sequence, the student shall be able to practice specific cares for intensive care patients.

Academic courses:

I- Post operative cardiorespiratory complications.
Acute Respiratory Distress Syndrome.
Tracheotomy and cares for tracheotomised patient.
Management for long period artificial ventilation.
Central and spinal neurological syndrome. Porpheria. Myasthenia.
Polytrauma, thoracic fractures, fat embolism.
 
II- Acute renal insufficiency: prevention, management and care.
Chronic renal insufficiency.
Hemodialysis and peritoneal dialysis, extra-renal purification.
Severe lever insufficiency.
Digestive hemorrhage.
Enteral and parenteral nutrition.
Hydroelectrolytic and acid base balance failure.
Anaphylaxis.
 
III- Nosocomial infection.
Antibiotherapy and antibiotics generalities.
Peritonitis.
Septicemia.
Gangrene.
Burns.
Coagulation troubles, complications of anticoagulant.

 

Guided workshop

 

Hospital hygienic principles adapted to anesthesia.
Hydroelectric and acid -base balance management.
Ethics and human relationship with the patient on anesthesia.

 

Practice:

Methods and machines for ventilation for anesthesia and resuscitation.
Methods for sterilizing anesthesia equipment and machines.
Enteral and parenteral nutrition.
 

Second year- Third sequence

objectives

At the end of the sequence the student shall be able to:

-participate to emergencies management.
-manage appropriate cares for acute patient during transportation.

 

 

Academic courses

 

I- Organization of Emergency Medical Aid. Catastrophes official health organization.

Distress situation:

-management of cardio-respiratory distress;
-management of neuron distress.
-analgesia and sedation.

 

II- Trauma and other aggressions. Evaluation, management , transportation and hospitalization.

Skull and brain trauma.
Spinal trauma.
Thoracic trauma.
Abdominal trauma.
Limb trauma
Polytrauma.
Incarceration, crush syndrome, breakdown.
Hanging, drowning, electrocution, burns, frozen.
Shooting injuries, knife injuries.
Haphazard hypothermia.
Aid on particular circumstances: sea, mountains...

 

III- Medical emergencies. Evaluation, management and hospitalization.

Respiratory emergencies.
Cardiovascular emergencies.
Toxic , metabolic and vascular coma.
Convulsive status. Jactitation status.
Intoxication.
Immediate delivery.

 

Guided workshop

Regional organization of Emergencies.
Collecting, organization, utilization and transmission of information. Computerized systems for anesthesia.
Principles and tools for management of anesthesia equipment.

 

Practice:

Techniques and equipment for cares outside of hospital.
-picking up and positioning of patient for transportation;
- Emergency aid case;
- Aid cars and equipment;
Emergency and deschocked ward: equipment , organization.
 
 
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