Abstract Background and aims Since 2018, Advanced Practice Nurses (APNs) have become new contributors to stroke care in France. They work in many clinical settings, and most are not part of neurovascular units. Yet they frequently support patients at risk of stroke or with a previous stroke. To practice safely and autonomously, APNs must develop a clear and structured clinical reasoning framework during their two-year university training. This need is even stronger as their role expands across the entire care pathway. Methods At Université Paris-Cité, a multidisciplinary team of physicians and APNs teaches stroke-related content in the second-year APN curriculum. Between October 2022 and January 2023, five APNs participated in monthly workshops. Their goal was to design a simple, accessible, and reproducible clinical reasoning model for APNs without neurovascular expertise. Feedback from a pilot cohort allowed the team to refine, clarify, and strengthen the model. Results The group developed a three-step framework: “Alert, Assess, Accompany.” It integrates biomedical knowledge with nursing sciences. Step 1 focuses on ruling out a neurovascular emergency (Alert). Step 2 examines control of stroke risk factors and, when relevant, the cause of the stroke (Assess). Step 3 evaluates functional autonomy and its impact on daily life, then guides APN-level interventions (Accompany). The model aims to support consistent and safe decision-making. Conclusions APN practice is expanding within a rapidly changing healthcare system. A shared and structured clinical reasoning model is essential. It supports this emerging profession and helps evaluate its contribution to stroke care pathways. Conflict of interest Boursin: nothing to disclose. Coutier: nothing to disclose. Da Silva Mendes: nothing to disclose. Pires Oliveira: nothing to disclose. Setnikar: nothing to disclose. Mazighi: nothing to disclose.
Boursin et al. (Fri,) studied this question.