Vers une pratique avancée infirmière aux soins intensifs: perception infirmière de son introduction au CHU de Liège

Abstract

Introduction In Belgium, the recent introduction of the advanced practice nurse (APN) role comes in a context of workforce shortage and increasing care complexity. In intensive care units (ICUs), this role remains poorly known and is sometimes viewed as unclear.

Method Exploratory qualitative study using grounded theory. Sixteen semi-structured interviews were conducted with nurses from five adult ICUs at the University Hospital of Liège (CHU de Liège). The interview guide evolved iteratively during data collection and analysis. The thematic analysis (open, axial, and selective coding) was based on the Diffusion of Innovation model.

Results The APN role remains largely unknown, but participants identified several benefits when it is implemented as a complementary function: enhanced clinical coordination, support for decision-making, supervision of new staff, and updating of protocols. Acceptability depends on: (1) clearly defined missions and boundaries; (2) progressive and visible integration at patient’s bedside; (3) structured interprofessional communication; and (4) institutional support. Persistent barriers include professional identity and hierarchy issues, staffing shortages, and organizational constraints. Some tasks are seen as acceptable (simple adjustments, protocols, training), while others are considered more sensitive without a clear framework.

Conclusion Implementing the APN role in ICUs is pertinent if done pragmatically and co-constructed, with a targeted educational strategy, written collaboration agreements, and a local pilot to measure effects and foster the teams buy-in.