The decree of June 26, 2026, redraws the scope of practice for nursing assistants in France. This text establishes a closed list of transferable acts and imposes a strict framework: a non-listed act cannot be delegated locally, even if different practices existed in certain establishments. For professionals in position as well as for students in training, the consequences are direct on daily work and on skills development pathways.
Closed list of transferable acts: what the regulatory framework locks in
Before the publication of the decree of June 26, 2026, several establishments had developed local practices for delegating technical gestures. Some nursing assistants performed acts that theoretically fell within the nursing field, with tacit agreement from the medical hierarchy.
The new text puts an end to this gray area. The list of authorized acts is now restrictive. Specifically, if a gesture does not appear on this list, no internal protocol can make it lawful for a nursing assistant. This rigidity has a clear objective: to secure practices and harmonize the level of practice across the territory.
To better understand the new features of the nursing assistant reference framework 2026, one must start from this regulatory constraint that conditions everything else: training, organization of care, legal responsibility of teams.
Architecture of the nursing assistant reference framework: five maintained competency blocks
Despite the adjustments introduced between 2025 and 2026, the reference framework remains structured around five competency blocks and eleven key competencies. The architecture of the DEAS has not been disrupted. The modifications concern the content of certain blocks, not their number or their logical articulation.
This choice of structural stability deserves to be highlighted. It means that training organizations do not have to rebuild their educational models from scratch. However, the competency sheets within each block incorporate the new acts and additional responsibilities in clinical care.
What changes within the blocks
The extension of authorized technical gestures comes with increased evaluation requirements. The validation tests for the state diploma include situational assessments related to the newly added acts. For students taking the DEAS starting in the 2026 academic year, the level of practical requirement is significantly higher than that of previous cohorts.
Field feedback diverges on one point: is the current training duration sufficient to cover all the new acts with the necessary depth? Educational institutions have the same time allocation but must integrate an expanded scope of competencies.
Obligation for updating for already graduated nursing assistants
Nursing assistants graduated under the old reference framework must undergo targeted updating to perform the new acts. The transition does not happen automatically. A nursing assistant holding a DEAS obtained before the June 2021 reform cannot, in theory, perform the newly authorized gestures without having validated a supplementary module.
This obligation raises several practical questions:
- The funding for these updating trainings remains unclear for professionals in the non-profit private sector, where training budgets are already under pressure.
- The deadlines for compliance are not explicitly set by the decree, creating a period of legal uncertainty for employers.
- The availability of training slots represents a bottleneck, as IFAS must accommodate both new cohorts and practicing professionals.
For health facility management, the risk is twofold: to keep in position professionals who are not formally authorized for the new acts, or to disrupt schedules to free up training time.
Digital health: an underestimated transversal training foundation
Digital health is now integrated as a training foundation for nursing assistants, through a program led by the Health Digital Agency (ANS). A decree from June 9, 2023, laid the groundwork for a specific transversal reference framework applicable to all paramedical training.
In practice, this means that future nursing assistants must master digital tools for care traceability, transmission of clinical information, and coordination with the nursing team via dedicated platforms. This aspect is still little visible in the debates on the reform, even though it concretely changes how nursing assistants document their daily activities.
A gap between the reference framework and the equipment of establishments
The available data do not allow for conclusions about the actual level of digital equipment in nursing homes and hospital services. Some establishments still operate with paper supports for care traceability. Training nursing assistants in digital skills without ensuring access to tools poses a coherence problem between the reference framework and the field.
This gap could create frustration among new graduates, trained in digital practices that they do not find in their first job. Conversely, establishments already equipped see it as an opportunity to streamline coordination between nursing assistants and nurses.
Nursing assistant reference framework 2026: the limits of a text-based reform
The reform of the nursing assistant reference framework is based on a postulate: to broaden the scope of competencies to respond to demographic pressure and recruitment difficulties in the health sector. The intention is consistent with the aging population and the shortage of healthcare personnel.
The limits become apparent as soon as we look at the conditions for implementation. Without targeted funding for continuing education and without a binding timeline, the risk is that of a two-speed reform: well-equipped establishments that quickly train their teams, and others that lag behind.
The 2026 reference framework clarifies the legal framework and raises the level of requirement for the profession. The concrete translation of these advances will largely depend on the resources that employers and public funders will allocate to supporting professionals, both in position and in initial training.
