Advanced nursing practice is the subject of a growing number of studies. To date, however, few of them have analyzed the local processes used to implement the functions of advanced practice nurses (APNs). The research presented in this article concerns a pilot project on the precursors of APNs (pre-APNs) in the French healthcare system.

This article analyzes the major obstacles to and levers for the development of pre-APNs’ functions in the light of their active role in the implementation process.

The obstacles include confusion of the function of pre-APN with other nursing functions on the part of their colleagues and superiors, partial assimilation to the medical profession, restriction of the practice of pre-APN under the control of physicians in highly ambivalent interprofessional relationships. Physicians also played a leveraging role in interprofessional mentoring to promote the introduction of pre-APN. They adopted strategies for negotiating their competencies, providing information and raising awareness about their function while asserting a professional identity based on their competence as nurses expert in nursing care in their field of practice (the elderly, mental health and psychiatry, support for chronic or cancer patients, primary care).

The development of advanced nursing practice can only partially derive from formal structures and regulatory frameworks. The various initiatives to publicize, build and install these functions are illustrative of a process of co-construction in practice settings.