For years, nurses in Portugal’s private healthcare sector have mostly taken a backseat in conversations concerning working conditions. This does not come as a surprise, as the participation of the private sector in the provision of care has been somewhat limited. However, nurse organizers caution that the private sector has experienced significant growth over the past 10 years – about one in four nurses now works in the private sector on a full-time basis.
As health workers in the private sector represented a minority in the overall health workforce, their perspective was less represented in professional organizations. However, as the number of nurses in the private sector continues to rise, reaching approximately 15,000 according to local activists, their role in advancing nurses’ rights should be fostered.
Mário Macedo, a pediatric nurse and activist of the platform Enfermeiros Unidos (Nurses United), who is running for the presidency of the Ordem dos Enfermeiros—the Portuguese Nurses’ Association—states that nurses working in the private sector and social services should have a say in the priorities advocated by the association. In fact, he told the People’s Health Dispatch that the path to improving the working and living conditions of nurses lies in involving as many of its members as possible, representing different personal and professional histories. “We really need to build a broad movement, with a lot of different people,” says Macedo.
Enfermeiros Unidos has already started bringing together such a diverse group of nurses and encouraging them to take on governance roles in the Portuguese Nurses’ Association. Their efforts are more than timely, as health workers in both public and private hospitals have been engaged in industrial action since at least November 2022. Most recently, at the end of July, nurses working in private hospitals held a strike to raise awareness about the problems they face at work, following previous industrial action earlier this year in both the private and public sectors. Among the reasons behind their strike, nurses cited salaries that lag behind those in the public sector and longer work schedules compared to their counterparts in public hospitals.
Differences in the rights of nurses in the public and private sectors are already pronounced. Contracts in the private sector extend to a 40-hour work week, compared to the 35-hour week in the public sector, as highlighted by some of the local activists. Payments for working on weekends and public holidays in the private sector don’t match those in public hospitals. Yet, it would be wrong to assume that the position of nurses in the National Health Service in Portugal is enviable. Macedo sees the actions of nurses in the private sector as an expression of long-standing problems burdening nurses in Portugal, similarly to the industrial action in public institutions.
Read more: Shared systemic issues inspire solidarity between Portuguese and British nurses
The objectives of Enfermeiros Unidos include making the profession’s regulatory body more inclusive and participatory for its members, including those in the private sector and social services. According to Macedo, all nurses in Portugal lack recognition within the healthcare system. Although there are approximately 80,000 registered nurses in Portugal, their voices are not taken into account when health policies are shaped.
“It’s always about the money, it’s always about the management, and it’s always about the doctors. The nurses are always excluded from places where the health policies are being thought out and decided upon,” Macedo points out.
In contrast to the model that is being implemented in policy making, it is the nurses who share the most direct link with patients and can provide guidance on how care should be shaped in order to respond to their needs. “I honestly believe that nurses are the strongest group of our health system, because of the way that we are trained, and the way that we take care of people. We know that people’s health must be at the center of every policy,” says Macedo.
Before running for the presidency of the Portuguese Nurses’ Association, Macedo gained experience as a trade union representative. This role helped him learn about organizing, industrial action, and the broader issues nurses face daily. While he distinguishes between the fields where trade unions and professional associations fight for nurses’ rights, Macedo emphasizes the importance of both types of organizations working towards complementary goals.
For example, if the association becomes strong enough to secure formal improvements to nursing education and recognition in the workplace, this would reinforce trade unions’ standing in negotiations. In the longer term, Macedo hopes that working on both fronts could bring concrete improvements to pressing problems: the overall low salaries, the limited scope of work foreseen for nursing professionals, and the general healthcare system financing model.
Expanding workers’ organizations and platforms will be crucial in addressing nurses’ rights at the European level as well. Macedo emphasizes that the daily challenges faced by nurses in Portugal align closely with those experienced by nurses in other European Union countries. He concludes: “Something that I learned from my small European experience is that most of our problems are shared with our European colleagues. And we really should do more European wide action and not only national action.”
People’s Health Dispatch is a fortnightly bulletin published by the People’s Health Movement and Peoples Dispatch. For more articles and to subscribe to People’s Health Dispatch, click here.
