Why nurses abroad should pay attention to what’s happening in Portugal?

There are many reasons why I think we should be paying attention to what is happening with nurses in Portugal and it’s not only because the International Council of Nurses and Howard Catton have acknowledge it too. It’s because we can relate to them.

The current situation in Portugal is not the result of a few days of dissatisfaction. The problems have started a long time ago and we are at a breaking-point now. The nursing workforce is in unison demanding that patient safety is at center of the Portuguese government policies and budgets, in a national health system that has been underfunded for many years. It’s a health system that is not fit for purpose, under-resourced and understaffed, with data from OCDE showing the medium number of nurses per 1000 habitants much lower than other countries. In the same data we can look at the UK (https://read.oecd-ilibrary.org/social-issues-migration-health/health-at-a-glance-2017/practising-nurses-per-1-000-population-2000-and-2015-or-nearest-year_health_glance-2017-graph139-en#page1) and understand why we should be paying attention.

Secondly, Portuguese Nurses are demanding that the profession is recognised and valued. And whilst the Portuguese public values the role of the nurse, at present, a Portuguese nurse, irrespectively if they hold a degree, masters or Doctorate earns the same – a starting salary of around €1200 (£1000) before taxes. In Portugal, if you compare the salary of Portuguese nurses with other professions with the same qualifications (for example psychologists) their salary starts at €1600 (£1300) before taxes. Portuguese Nurses want this pay gap to be closed but the situation gets even worse when we know that in Portugal, whether you are a newly qualified nurse or a nurse with 5, 10 or 30 years of experience you will earn exactly the same! The salary and career progression for nurses was frozen around 10 years ago. The added competencies and skills of specialist nurses were only recognised recently but an increase in salary to reflect those added competencies hasn’t happened yet.

There’s also another important reason why we should pay attention to this movement. It shows that nurses have the power when they come together and that we are a force to be reckoned with. When we combine this power with the influence of social media it reaches unprecedented levels. What a group of nurses managed to do was to disturb the status quo and institute a new way to strike, in which neither the government or trade unions could control. Specifically with the Surgical strike, a crowdfund not linked to the Trade Unions, was set up by nurses and managed by nurses to support those that were on strike and not being paid, raising around €400 000 in the last run. This revolution has challenged the traditional ways in which industrial actions could only last a few days, to actually lasting 5 weeks before Christmas, and a few more weeks recently too.

Portuguese nurses have become a threat to the government. They have continued to hold the government accountable and call for action. They are not afraid of speaking out because their agenda has a higher purpose – the safety of those cared in the national health system. On the other side of the coin, we are seeing the government take measures that one can argue are only taken when you feel threatened. You don’t need to take much time to understand that there seemed to be one clear motive: to stop the strike whatever it takes; and to ensure that the portuguese public turned its back against the profession. A civil requisition was ordered by the government to force nurses back into work on the basis that nurses failed to ensure the minimum number of staff during the strike. However, Ordem dos Enfermeiros has publicly stated that they have never received a complaint or formal request for investigation from Nursing Directors in relation to this. In addition, the use of the crowdfunding to support the nurses on strike was questioned and it triggered an investigation to understand who was donating money. The Prime Minister has used derogatory remarks in the media stating that the strike was “savage and putting the portuguese public at risk”, when in fact data has showed that last year response times for cancer patients waiting for a surgery (and even other types of surgeries) were by far met in the majority of portuguese hospitals. Prosecutors have also declared the strike “unlawful”.

Ultimately, I think every single government with a National Health System that doesn’t put patient safety at the center of its policies and budgets, who doesn’t recognise nursing as a “safety critical profession” (in the words of Alison Leary), who doesn’t invest in this workforce should be afraid if this movement spreads across the globe.