Nicolas Besnault was one of the first two nurses in advanced practice of the Poitiers University Hospital. He shares his journey and his missions to us in the establishment’s cardiology department.
Evolution towards the profession of nurse in advanced practice
A graduate in 2015, Nicolas Besnault began his nursing career in the general emergency room of the Poitiers University Hospital until 2021. In 2019, he decided to evolve as a infirmier in advanced practice (IPA). “At this stage of my career, I was trying to occupy a central place in the care of the patient. My goal was to combine expertise in a specialty with the opportunity to be a reference person for both patients and for the medical and paramedical team. Proximity to patients is one of my priorities ”. It was during his IPA training at the University of Nice, that he discovered the specialty of cardiology. “Rhythmology is an exciting specialty that requires many knowledge and rigor. It corresponds perfectly to what I was looking for ”.
During his training, the medical and supervisory team created the center of atrial fibrillation. This is the first device in France dedicated to patients benefiting from an ablation of atrial fibrillation integrating a nurse in advanced practice at the heart of the monitoring of these patients. He then joined the project.
IPA activities: expertise for overall patient monitoring
Nicolas Besnault follows patients with atrial fibrillation at each stage of the care path: before, during and after the removal procedure.
Radling throughout Poitou-Charentes, the center of atrial fibrillation receives more than six hundred requests for removal per year via city cardiologists or hospital. Upon medical validation by rhythmologists, Nicolas Besnault contacts patients for in -depth telephone interview. He collects information necessary for the consultation: history, history of the disease, symptoms, risk factors. He has the possibility of prescribing additional examinations such as blood assessments. “This first contact is essential. He reassures the patient enormously, who feels listened to and privileged. It also helps define the fear that some patients can have on removal. It is a time saving the day of consultation ”.
Then, Nicolas Besnault meets the patient with the rhythmologist in pre-Ablation consultation. This time allows us to come back to this information, answer questions and explain the procedure. During the consultation, it raises awareness of patients on risk factors for recurrence of atrial fibrillation such as obesity, sedentary lifestyle, hypertension, diabetes, sleep apnea, tobacco, alcohol, etc. These risk factors influence the patient’s quality of life and the success of removal (between 70 and 80 % success if risk factors are controlled). Nicolas Besnault asks as necessary his network made up of hospital and non -hospital professionals: dieticians, life health, pulmonologists, sports educators, etc. “The objective is to build a personalized care course, adapted to the patient’s objectives and his motivations to reduce his risk factors”.
Nicolas Besnault also participates in the organization of ablation thanks to close collaboration with the secretaries. He ensures that all the required exams have been carried out and coordinate the different stages of the route. As soon as all the conditions are met, it requests the doctor’s validation for the proposed date. During hospitalization for the removal of atrial fibrillation, he visits the patient and exchanges with him around the exit instructions.
Three months later, Nicolas Besnault saw the patient in consultation or teleconsultation independently. This last meeting has several objectives: to take stock of the follow-up of removal, to assess the possibility of stopping certain treatments (anticoagulants, antiarrhythms, beta-blockers) and again return to risk factors.
“Before my presence, this consultation was not systematically carried out. Since I have been there, all patients have benefited from a follow -up consultation. It is strengthening follow -up for the patient and it is a time saving for the doctor ”.
Close collaboration with doctors
Due to his function as a nurse in advanced practice, Nicolas Besnault has autonomy thanks to the post -removal consultations which he performs in autonomy and the confidence of rhythmologists. It has the possibility of reducing or stopping certain treatments during consultations. Despite everything, he makes it a point of honor to maintain close collaboration with rhythmologists: doctors Bruno Degand and François Le Gal and Professor Rodrigue Garcia. He keeps them informed of the journeys of all patients. He insists on the importance of excellent communication and a relationship of trust with doctors, which he deems essential.
The center of atrial fibrillation: an increasing activity
The activity of the center of atrial fibrillation is important: more than 450 ablations of atrial fibrillation in 2024. For three years, Nicolas Besnault notes that his activity is growing from year to year: “I made more than 900 consultations in 2024 against 350 in my first year of exercise”. Nicolas Besnault is delighted with this evolution. He appreciates his post by the central place he occupies with patients and the confidence that doctors give him. He notes that this new nursing profession in advanced practice was very quickly adopted by patients. They quickly seized the interest of having a referent nurse expert in pathology, capable of ensuring a relay and complementarity with the doctor in various situations. “My follow -up makes it possible to streamline the patient’s care path. Being reachable by phone, patients appreciate this proximity to unravel certain complex situations and avoid any unpretentious hospitalization. »»
For Nicolas Besnault, the development of advanced practice is one of the essential solutions to the current challenges of public health.
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