Consensus-based indicators of advanced practice nursing outcomes: Results of a Delphi study in France

Despite one of the world's most advanced health systems, advanced practice nursing (APN) roles in France are less than a decade old. Globally, APNs strengthen access, quality, and efficiency of care, but sustaining these roles requires demonstrating outcomes meaningful to patients, providers, and policymakers.

To describe consensus among French stakeholders on patient- and system-level indicators for evaluating APN contributions.

A two-round Delphi process, followed by a nominal group discussion, was conducted. Participants included APNs, nurse managers, physicians, and academics. Candidate indicators, classified using Hamric's framework, were rated on nine-point Likert scales; indicators with ≥75% agreement were validated.

Forty indicators were retained across seven domains, reflecting outcomes such as patient access, continuity, quality of care, collaboration, and leadership.

Consensus indicators show how APN practice is viewed in France-focused on expertise, coordination, and integration. This aligns with global APN competencies but contrasts with physician-substitution models elsewhere.

These validated indicators provide a foundational framework for evaluating APN contributions in France. They offer a strategic tool to support integration, and to inform policy.