Theoretical and experimental study of shared responsibility between the physician and the advanced practice nurse.

Summary The French health care system raises many issues in primary care, both in terms of the territorial distribution of the supply of care and in terms of spending and the management of certain diseases. The development of advanced practice nursing - which allows an advanced practice nurse to perform certain medical tasks, complementary or substitutable to those of the physician, in the first or second line of care - is a response to these challenges. The objective of this thesis is to study the framework for regulating the quality of care delivered by a physician and an advanced practice nurse. It is composed of four chapters. The first chapter highlights the challenges of the French healthcare system to which advanced practice nursing responds and the obstacles posed by current French regulation to the development of the practice. The second chapter discusses, based on the literature, the liability regime that is effective in dissuading physicians and nurses from being imprudent. The third chapter is a theoretical study of the optimal liability rule to be applied to advanced nursing practice depending on the nurse's mode of practice. The final chapter reports on a laboratory experiment that analyzes the effect of collaboration between health care professionals on quality of care as a function of the accountability regime. The thesis demonstrates that advanced nursing practice should be regulated by a fault-based liability regime that allocates reparations for harm according to the interdependence of the behaviors of each of the two practitioners. In addition, the control exercised by the physician when the nurse practices in a salaried capacity leads to a better quality of care. Finally, the laboratory experiment shows, in the presence of a rule of responsibility, a decrease in the quality of care linked to interprofessional collaboration. This result should lead to the development of collaboration between health professionals with caution.