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Professional guides

Nurse in private clinic and care home for the elderly: collective agreements, duties and on-call arrangements

· Guide drawn up on the basis of the official sources cited.

In short

In a for-profit private clinic, nurses are generally covered by the national collective agreement for private hospitalisation of 18 April 2002 (IDCC 2264). In non-profit private establishments that are members of FEHAP, the agreement of 31 October 1951 applies (IDCC 29). The applicable agreement is shown on your payslip.

Clinic, non-profit private establishment, care home for the elderly: a large proportion of salaried nurses work outside the public sector. The profession remains the same, but the employment framework changes: private law employment contract, collective agreement, organisation specific to each establishment. This guide helps you identify which agreement applies to you, understand what remains unchanged in your duties, and learn about the specific aspects of working in a care home for the elderly, from the role of coordinating nurse to night on-call arrangements.

What is the difference between a private clinic, a non-profit establishment and a public hospital?

The difference lies in who manages the establishment and therefore in your employment status:

  • Public hospital: you are a civil servant or public law contract worker. This framework is covered in our guide on the nurse in the public hospital sector.
  • For-profit private clinic: you are a private law employee of a commercial company.
  • Non-profit private establishment (association, foundation, mutual): you are also a private law employee.

In the private sector, your rights derive from the Labour Code, the applicable collective agreement, company agreements and your employment contract. There are no competitive examinations, no probationary period leading to permanent status, and no public sector pay scales.

Which collective agreement applies in a private clinic?

Most for-profit private clinics apply the national collective agreement for private hospitalisation of 18 April 2002, identified by the number IDCC 2264. The texts attached to this agreement cover the private hospitalisation sector and the commercial social and healthcare sector, which also includes care homes for the elderly run by commercial companies.

Conventional pay rates and point values are revised by successive amendments: always consult the up-to-date text on Légifrance or on the Digital Labour Code.

Which collective agreement applies in the non-profit private sector?

Non-profit private establishments providing hospitalisation, care, treatment and residential services that are members of FEHAP apply the national collective agreement of 31 October 1951, often called 'CCN 51', identified by the number IDCC 29.

Other non-profit establishments are covered by other agreements or have their own specific arrangements. Do not rely solely on your employer's status as an association: check the agreement stated in your documents.

How do I find out which collective agreement applies to my contract?

  1. Check your payslip: article R3243-1 of the Labour Code requires it to show the name of the applicable sectoral collective agreement.
  2. Re-read your employment contract, which may also mention it.
  3. Search for the text on the Digital Labour Code, using its name or IDCC number, to check the rules on probationary period, leave, notice period or pay.
Good to know: the collective agreement supplements the Labour Code. If you are unsure about a specific point (seniority, bonus, public holidays), check the text in force rather than relying on what your department usually does.

Do a nurse's duties change in the private sector?

No. Your professional skills and obligations are set out in the Public Health Code, regardless of your employer: independent practice, acts on prescription, professional confidentiality, code of ethics. No employment contract can authorise you to carry out an act that falls outside your scope of practice.

The requirement to be registered with the professional body applies in the same way to private sector employees. For details of your competencies, see our guide on the role and competencies of the nurse.

What is a care home for the elderly?

A care home for the elderly (EHPAD) is a medicalised residential home that welcomes, generally from the age of 60, people who need daily help and care, including many residents with Alzheimer's disease. Establishments typically accommodate between 50 and 120 residents.

The resident pays an accommodation fee and a dependency fee. Care is covered by health insurance and is not charged to the resident.

A care home for the elderly may be run by a local authority or public establishment, by an association or foundation, or by a commercial company. Your employment status and collective agreement depend on this.

What does a nurse do in a care home for the elderly?

In a care home for the elderly, the team organises daily care and supports residents with essential daily living activities. The nurse carries out independent practice and prescribed care, with particular challenges:

  • daily technical care, such as wound dressing and medication distribution;
  • monitoring of elderly and dependent residents, to identify early any deterioration in their condition;
  • continuity of care, particularly at night and at end of life, to avoid unnecessary emergency department visits;
  • working with the coordinating doctor and coordinating nurse of the establishment.

What is a coordinating nurse in a care home for the elderly?

The coordinator nurse, often called IDEC, is jointly responsible with the medical coordinator for organising daily care. The Senate, which describes it as an essential link in the functioning of care homes for the elderly (EHPAD), estimates the number of IDECs at between 6,000 and 8,000.

Key point: the role has no regulatory definition, and care homes are not required to employ one. Its responsibilities, hierarchical position and remuneration therefore depend on your contract, job description and collective agreement. A Senate report has proposed recognising and regulating this status, on the model of the medical coordinator.

Important note: before accepting an IDEC post, ask your employer to clarify in writing your responsibilities, your line of reporting, your collective agreement classification and any involvement in on-call duties. The Senate also notes that IDECs do not systematically receive training in management or geriatrics: negotiate this at recruitment.

How do night on-call duties for nurses work in care homes for the elderly?

At night, many care homes do not have a nurse on site. An evaluation by the National Agency for Healthcare and Social Care Performance (Anap), conducted in 2023, showed that one third of the 7,700 establishments had night nursing support, and that this presence reduces residents' visits to accident and emergency departments.

The social security financing law for 2022 provided for the generalisation of night nursing on-call duties in care homes, and decree no. 2021-1570 of 3 December 2021 set out the arrangements for compensation. According to the specifications of the regional health agencies (ARS):

  • on-call duty is often shared between several care homes;
  • it is primarily by telephone, with on-site attendance if necessary;
  • it may be provided by nurses from partner care homes, independent nurses, or nurses from home care services, nursing care centres or home care assistance services;
  • each nurse remains employed by their original organisation;
  • recourse to the emergency call centre remains possible depending on the resident's condition.

The practical arrangements (remuneration, scope, response time) vary from one region to another: check with your regional health agency or your employer.

What does employment law say about on-call duties?

For a private sector employee, on-call duty is a period during which, without being at their workplace, they must be able to intervene if their employer requests it. Time spent intervening is actual working time and must be paid as such. The on-call period itself gives rise to compensation, financial or in the form of rest: its form and amount are set out in your collective agreement and in your establishment's agreements.

Independent nurses wishing to take part in these schemes will find in our guide onsetting up in independent practicethe basics of this mode of practice.

Official sources

Frequently asked questions

What is the IDCC number for the private hospital care collective agreement?
IDCC number 2264. This is the national collective agreement for private hospital care of 18 April 2002.
What is the CCN 51?
It is the national collective agreement of 31 October 1951 (IDCC 29), applied by private non-profit hospitals, care facilities and nursing homes that are members of FEHAP.
Where can I find my collective agreement?
Its title must appear on your payslip. You can then consult the text on the Digital Labour Code or on Légifrance.
Must a nurse in a private clinic be registered with the Order?
Yes. Registration with the Order is mandatory for any nurse in practice, including those employed in the private sector.
Is a coordinator nurse in a care home mandatory?
No. The role has no regulatory definition and care homes are not required to employ one.
Can a self-employed nurse provide on-call cover at night in a care home?
Yes. Shared on-call arrangements can involve self-employed nurses, alongside nurses from care homes, home care services, hospital at home services or nursing care centres.
Is time spent on an intervention during on-call cover considered working time?
Yes. For an employee, time spent on an intervention during on-call cover is actual working time and must be paid as such.

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