Reforms Nothing

The law governing general care nurses in Luxembourg is more than 30 years old. A reform has been planned. Anne-Marie Hanff, president of the National Association of Nurses and Nurse Practitioners (ANIL), has a name for it: "a reform that reforms nothing."[1]

The core problem is simple. Nurses in Luxembourg spend 40% of their working time on paperwork and administrative tasks, not at the patient's bedside. This figure comes from the 2021 Letz'Care study. It is not a complaint about workload. It is a measurement of waste: trained medical professionals doing clerical work because the law will not let them do their actual jobs without a doctor's sign-off.[2]

Cold sore cream

Hanff's example is deliberately small and deliberately devastating. A nurse trained at higher education level cannot provide antiviral cream for cold sores without a doctor's prescription. Providing it would be considered the illegal practice of medicine. This is a routine, low-risk intervention. Nurses are trained to do it. In France, nurses can already prescribe certain materials and care supplies they need in their daily work. In Luxembourg, doing so is a crime.

The gap between what nurses do and what the law allows them to do is the entire story. ANIL is not asking for new powers. They are asking for legal recognition of the work they already perform. The reform, as planned, does not close that gap. It updates a 30-year-old law without changing the fundamental constraint: a nurse cannot act within the scope of their training without a doctor's authorisation, even when that authorisation is a formality that delays care and adds nothing to patient safety.

The fragile system

Hanff described Luxembourg's healthcare system as fragile, facing staff shortages, recently through a pandemic, and now contending with the hantavirus scare. The European Commission's goal after Covid was to make healthcare systems more resilient. "That opportunity has now been missed," Hanff said.

Resilience in healthcare means, among other things, the ability to redistribute work when the system is under pressure. If a pandemic or an outbreak hits, you need every trained professional working at the top of their scope. You cannot afford to have 40% of nursing time consumed by administrative tasks that exist solely because the law has not caught up with reality.

The care home situation is where this hurts most directly. Residents need routine care: creams, dressings, basic prescriptions. Without a doctor available to sign off, that care waits. In a care home, a waiting patient is a suffering patient. The suffering is unnecessary. It exists because a law written more than three decades ago has not been updated to reflect what nurses are already doing every day.

What a real reform would look like

The model already exists across the border. France allows nurses to prescribe within a defined scope. Other European countries have similar frameworks. The principle is straightforward: identify the interventions that nurses are trained to perform and that carry minimal risk, and authorise nurses to perform them without requiring a doctor's involvement for each case.

This does not replace doctors. It frees them to do the work that actually requires their expertise. When a nurse can prescribe cold sore cream, the doctor is not less important. The doctor is more available for the patients who need a doctor. The system gains capacity without adding staff. Given Luxembourg's staff shortages, that gain is not trivial.

Hanff put it plainly: "We are simply asking for things nurses are already doing in practice to be made legally possible, so that nurses can work within a clear legal framework." That sentence should not be controversial. The fact that it is tells you most of what you need to know about how healthcare reform works in practice. The people closest to the problem have the clearest diagnosis and the most practical solution. The system's response is a reform that reforms nothing. The reform has a name now. It is accurate.