Author: Laure Priolet Vera, Senior Foreign Credentials Evaluator, Josef Silny & Associates (JSA)
Introduction
Nursing education in France has seen significant changes over the last few decades. Historically, nursing was primarily taught as a trade outside of the university education system. However, in recent times, the pressure for standardization from the European Union prompted the French government to reconsider nursing education into an academic discipline. A major reform was implemented in 2009 aligning French nursing education with the European LMD (Licence-Master-Doctorat) framework and integrating nursing into the higher education system. This reform modernized nursing education, strengthened the status of nurses and significantly improved the international comparability of French nursing qualifications.
Nursing Education in France: Before the 2009 Reform
Prior to the reform, French nursing education was primarily a vocational post-secondary qualification.
To become nurses, students completed their training in the Instituts de Formation en Soins Infirmiers/IFSIs (Nursing Care Training Institutes). These hospital-based institutes operated entirely independently from universities and the curriculum was largely focused on preparing them for clinical practice through a combination of classroom instruction and supervised clinical experience. At the time, the primary objective of these hospital-based institutions was to produce qualified health personnel capable of executing the tasks delegated to them by physicians while also following hospital rules and regulations. Admission to the IFSIs generally required successful completion of secondary education, and passing of the French Baccalaureate (Baccalauréat) national examinations.
Upon graduation from the IFSIs, students were awarded the Diplôme d’État d’Infirmier/DEI (State Diploma of Nurse) issued by the French Ministry of Health. This diploma was recognized as a professional qualification outside of the traditional university structure and it granted legal authorization to practice as a registered nurse in France by the Ordre National des Infirmiers (French National Order of Nurses). Holders of this diploma generally did not get access to higher education at French universities.
Reasons for the 2009 Reform
Two primary reasons prompted the comprehensive reform of France’s nursing education in 2009.
The first one was the Bologna Process and the European Union’s initiative to standardize higher education systems across its member states. As a result, France sought to align its nursing program with the European Higher Education Area (EHEA), adopting the LMD framework to make it more comparable internationally.
The second one was the evolving role of nurses within the French healthcare system. The existing educational model did not match that of the rest of Europe and did not adequately reflect the level of knowledge and professional responsibility modern nurses engaged in. Nurses advocated to upgrade their qualifications and receive higher academic recognition of their profession as a nursing science.
The 2009 Reform
The reform of nursing education in France was formalized through the Arrêté du 31 juillet 2009 relatif au Diplôme d’État d’Infirmier (Order of July 31, 2009, relative to the State Diploma of Nurse). It introduced two fundamental changes: a structural integration into the higher education system and a comprehensive curriculum revision.
Structural Integration
The reform integrated the three-year nursing program into the European LMD (Licence-Master-Doctorat) higher education framework by organizing it into six academic semesters worth a total of 180 ECTS (European Credit Transfer System) credits. As a result, the State Diploma of Nurse became recognized at the undergraduate level as a Bachelor’s degree. Additionally, to bridge the gap, the reform required each IFSI to establish a formal partnership with a university, requiring professors from these partnered universities to teach approximately 27% of the nursing courses. Beginning with 2009, graduates were awarded the State Diploma of Nurse by the Ministry of Health of France, as well as the degree of Licentiate (Grade de Licence) by the partner university and the Ministry of Higher Education.
Curriculum Revision
The curriculum had to be redesigned to support the transition into the French university system and to better reflect the changing roles of nurses in healthcare. The focus moved away from a content-based model toward a competency-based approach and strengthened nursing as a scientific discipline. Greater emphasis was placed on clinical reasoning, research, evidence-based practice, ethical decision-making, and collaboration with other healthcare professionals. The revised program also created a stronger connection between classroom learning and clinical experience, encouraging students to apply scientific knowledge to real patient situations, reflect on their practice, and develop the skills needed to make informed clinical decisions. This shift helped bring French nursing education closer to international standards and reinforced the recognition of nursing as an independent and evolving scientific profession.
Benefits and Challenges of the 2009 Reform
The reform produced numerous benefits for nursing education and the nursing profession.
The most significant benefit was the academic recognition of nursing as a university-level discipline. Graduates were now able to gain access to master’s and doctoral programs both in France and throughout Europe, creating new opportunities in nursing education, research, advanced clinical practice, and healthcare leadership.
The adoption of the Licentiate degree (Grade de Licence), awarded together with the State Diploma of Nurse, also improved the international mobility of French nurses. Because the degree follows the Bologna framework and utilizes the ECTS credit system, universities and employers throughout Europe could finally understand and recognize the educational preparation of French nurses. The standardization of French nursing education opened cross-border opportunities and facilitated participation in international exchange and continuing education programs within Europe. The reform also enhanced the professional identity of nurses by recognizing the intellectual and scientific dimensions of nursing practice.
However, the implementation of the reform also brought some challenges. For the first time, IFSIs had to establish new partnerships with universities and adapt to a more academically oriented structure. Faculty members were required to transition from traditional teaching methods to a competency-based approach emphasizing clinical reasoning, critical thinking, and evidence-based practice. Students also faced increased academic demands, including research assignments and new evaluation methods, while continuing to complete extensive clinical training. Additionally, the expanded role of nurses required adjustments within healthcare settings as the profession moved toward greater recognition of autonomy and clinical responsibility.
The Implication of the Reform on Foreign Credential Evaluations
For foreign credential evaluators, the 2009 reform fundamentally changed how French nursing education should be interpreted. The date of graduation and credentials submitted are therefore an important consideration when determining the U.S. equivalency of a French nurse’s education.
Prior to 2009, the State Diploma of Nurse was a post-secondary diploma of vocational qualification issued by the French Ministry of Health through hospital-based nursing care training institutes. The program existed outside of the traditional French university system and did not confer a university degree. This diploma is widely considered to be the equivalent of graduation from a program for registered nurses at an accredited hospital school of nursing in the United States.
Following the 2009 reform, the nursing program became integrated into French higher education, organized into six semesters worth 180 ECTS credits and recognized at the undergraduate level. Graduates are awarded the State Diploma of Nurse as well as the Licentiate degree (Grade de Licence) by a university and the Ministry of Higher Education. Consequently, after 2009, French nurses possess both a professional qualification and a university credential. This degree is considered to be the equivalent of the U.S. degree of Bachelor of Science in Nursing earned at a regionally accredited institution of higher education in the United States.
There is no national licensing examination in France comparable to the NCLEX-RN in the United States. In both the pre- and post-reform systems, graduates who earn the State Diploma of Nurse are eligible to register with the French National Order of Nurses to obtain legal authorization to practice as registered nurses. Registration is mandatory for all French nurses, regardless of whether they work in public or private hospitals, community healthcare settings, or private practice.
Conclusion
The 2009 reform marked a significant milestone in the history of nursing education in France. By turning its Diplôme d’État d’Infirmier (State Diploma of Nurse) from a solely professional qualification into a credential accompanied by the university-awarded Grade de Licence, France successfully aligned its nursing education system with European higher education standards.
The reform increased opportunities for academic advancement, strengthened the professional status of nurses, promoted research and evidence-based practice, and facilitated educational and professional mobility throughout Europe and internationally. Furthermore, the adoption of the 180 ECTS credit system and the university degree framework has greatly improved the international comparability of French nursing qualifications.
Although foreign credential evaluations continue to require careful assessment of academic content, clinical education, and licensure requirements, the reform has made French nursing credentials more transparent and easier to evaluate within international higher education and professional licensing systems, ensuring that French nurses are recognized worldwide as both skilled clinicians and university-educated scholars.
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