A new era for the nursing profession: what the decree of December 24, 2025 changes

By Nathalie Boudet-Gizardin, Partner and Noor Hill

A context of crisis in healthcare pathways

In a context marked by the worsening of medical deserts, longer healthcare journeys, and the increasing prevalence of chronic diseases, the traditional legal framework for nursing practice appeared increasingly ill-suited to the contemporary realities of the healthcare system. The scarcity of medical services in many areas, combined with the growing need for care, necessitated a redefinition of the balance between healthcare professions in order to ensure the continuity, accessibility, and quality of care.

It is within this perspective that the Law No. 2025-581 of June 27, 2025, including Decree No. 2025-1306 of December 24, 2025 ensures regulatory implementation. This text, which is scheduled to come into force no later than June 30, 2026, marks a profound shift in the legal framework for nursing practice by redefining the balance between healthcare professions in order to address the structural tensions affecting the healthcare system. By thoroughly rewriting the articles Articles R. 4311-1 to R. 4311-7 of the Public Health CodeThe text replaces a historically focused approach centered on enumerating the acts within the nurse's role with one based on skills, clinical reasoning, and autonomous professional responsibility. It establishes as legal categories notions previously derived primarily from practice: nursing diagnosis, nursing consultation, direct patient access, and regulated prescriptive authority.

A substantial redefinition of nursing practice

The new article R. 4311-1 defines nursing practice as encompassing "the initiation, analysis, implementation, organization, and evaluation" of nursing acts and care, whether preventive, educational, curative, palliative, relational, or clinical monitoring. This wording establishes a comprehensive and dynamic approach to care, breaking with a strictly executive conception of the profession.

The nurse is involved in a logic of coordination with all actors in the health care pathway and is recognized as having a role in the development and updating of the personalized life and care plan, while the traceability of care is established as a normative requirement.

Article R. 4311-2 represents a major conceptual shift by establishing nursing diagnosis as a distinct competency. Nurses are authorized to identify healthcare needs within their scope of practice and to define appropriate interventions, in accordance with evidence-based practices and ethical guidelines. The Public Health Code thus recognizes the existence of autonomous clinical reasoning by nurses, distinct from, but complementary to, medical reasoning.

The consecration of the nursing consultation

For the first time, nursing consultations are recognized by law (art. R. 4311-3). They include:

"1° During the clinical interview, the observation, collection and analysis of all clinical information and data necessary for the assessment of the person's state of health;

2° The development and determination of nursing care actions and objectives;

3° The provision, evaluation or adaptation of nursing care, including if necessary the establishment of nursing prescriptions for health products and additional examinations which appear on the list mentioned in I of Article L. 4311-1;

4. Within the framework of multidisciplinary collaboration, the organization and coordination of interventions within the healthcare pathway. 

It becomes a structured clinical act, based on a preventive or therapeutic approach falling within the scope of nursing practice, bringing about a change in status: the nurse is no longer simply the executor of prescriptions, but an autonomous clinical actor, who can be directly consulted by the patient. This recognition, however, remains contingent upon the issuance of an implementing decree specifying the conditions of practice.

The evolution of the specific role and the opening of a regulated prescriptive power

Article R. 4311-4 establishes the principle of direct patient access to nurses. Nurses are also authorized to provide care without a prior prescription, by initiating, performing, and evaluating the treatments listed in a ministerial decree. The nurse's independent role is thus no longer fixed in the Public Health Code but becomes an evolving scope, adjustable by regulation.

In parallel, Article R. 4311-2, 6°, allows nurses to prescribe certain health products and additional tests, according to lists and conditions defined by decree. This is not a general prescribing power, but a functional competence intended to streamline patient pathways and ensure the safety of care.

The continued role of the nurse in prescribing or following a medical protocol is reaffirmed in Article R. 4311-6, which strictly defines the conditions for the validity of prescriptions. The decree thus maintains a dual structure, reconciling enhanced autonomy within the nurse's own scope of practice with continued coordination with medical authority for acts exceeding this scope.

Legal issues and perspectives

The reform implemented by the decree of December 24, 2025, follows the developments initiated by the so-called "Valletoux" law of December 27, 2023. This latter law paved the way for a restructuring of care pathways, notably by establishing the status of lead nurse, designed to strengthen the coordination of care for patients with long-term illnesses. The decree of June 27, 2024, ensured its regulatory implementation, enshrining for the first time in law the key role of nurses within the healthcare system.

However, the Council of State's decision of July 22, 2025, concerning the decree of June 27, 2024, relating to the designated nurse, highlighted the legal and institutional sensitivity of these restructurings. Without ruling on the substance of the assigned responsibilities, the highest court, at the request of the National Council of the Order of Physicians (CNOM), sanctioned a procedural flaw related to the failure to consult the High Council of Paramedical Professions. It thus reiterated that any expansion of professional prerogatives must be carried out in strict compliance with the procedural safeguards provided for by the Public Health Code. This legal episode sheds light on the scope of the decree of December 24, 2025: the regulatory overhaul of nursing practice cannot be reduced to a simple technical adjustment, but entails a profound rebalancing of the relationships between healthcare professions, the sustainability of which depends closely on its institutional and interprofessional acceptance.

While the decree of December 24, 2025 represents a major normative advance, its effectiveness remains, moreover, closely conditional upon the publication of the implementing orders, expected no later than June 30, 2026. As long as these texts have not specified the lists of acts, the products and examinations that can be prescribed, as well as the operational procedures for the nursing consultation, the recognized autonomy will remain partly theoretical.

The expansion of nurses' responsibilities also raises the delicate issue of the distribution of civil, criminal, and disciplinary liability. The recognition of nurse diagnosis and consultation, combined with direct patient access, implies a redefinition of the boundaries of responsibility between healthcare professionals, within a legal framework historically structured around medical preeminence. Furthermore, ensuring the legal security of these new prerogatives requires rigorous coordination with the obligations of referral, referral, and traceability, in order to prevent the risks of disruptions in care pathways, redundancy of interventions, or litigation arising from an incorrect classification of the scope of practice.

Finally, this normative overhaul raises a structural issue of training and standardizing practices. The legal recognition of clinical nursing reasoning cannot be fully effective without its pedagogical and professional formalization; otherwise, the newly acquired autonomy risks being undermined by disparities in practice and increased legal uncertainty.

Conclusion

The decree of December 24, 2025, represents a major milestone in the evolution of the regulatory framework for the nursing profession. By replacing a logic of procedures with a logic of competencies, by enshrining nursing diagnosis and consultation, and by paving the way for supervised prescribing, it establishes the nurse as a fully-fledged clinical actor within the healthcare system. This regulatory overhaul outlines a new legal horizon, the concrete implementation of which remains to be developed within a framework that guarantees the safety of patient care.