Private sector stalls implementation of nurses’ minimum wage in Brazil

Nurses employed in Brazil’s private health sector are still not being paid salaries defined by law, as employers continue to delay implementation

November 14, 2023 by Outra Saude
ursing professionals hold a demonstration in defense of the implementation of the minimum salary for nursing. (Photo: Marcelo Camargo/Agência Brasil)

Two years ago, in November 2021, the Brazilian Senate approved a bill stipulating the minimum salary for nurses. In May of the following year, the Chamber of Deputies granted approval, and in August 2022, the presidency passed Law No. 14.434/2022, establishing the national minimum wage for nurses.

Amid various developments, the Supreme Federal Court temporarily halted the enactment of the law. However, Congress facilitated the payment of the anticipated amounts by introducing two constitutional amendments and an additional law.

In June 2023, the anticipated conclusive decision came: the Supreme Court declared the laws constitutional and mandated that following a 60-day negotiation period, nurses, technicians, and assistants in the private sector should receive their payments corresponding to the national minimum wage. 

Despite all these decisions, which have passed through all three branches of government, many nursing professionals are still not receiving the pay they have earned after years of struggle. The reason for this is that in most States, private health providers persistently obstruct the implementation of the minimum wage. They claim financial problems and repeatedly request conciliation meetings with workers’ representatives through the courts, in a clear attempt to delay the process.  

On November 7, the National Confederation of Health (Confederação Nacional de Saúde, CNSaúde), which represents the major economic players in the supplementary private health sector, presented a salary proposal to the Superior Labor Court.

The proposal was significantly lower than the defined minimum wage, to the extent that the court did not even forward it to the nurses’ representatives. CNSaúde’s plan also involved salaries being paid in installments for another 2-3 years. “It’s an indecent proposal because, by the time the workers would receive the full amounts, they would have been eroded by inflation,” said up Solange Caetano, president of the National Federation of Nurses. 

“What they don’t want is to reduce their profits. If we were talking about the philanthropic sector, which depends on government transfers, that would be fine, but supplementary healthcare is highly profitable. A report came out showing that the sector’s profit was R$2 billion [406 million USD] in the first half of 2023,” said Caetano, who gave Outra Saúde an overview of the current state of the struggle to implement the nurses’ minimum wage. 

Businessmen’s tricks

After the Supreme Court ruling was published on July 12, not much concrete dialogue was seen during the 60-day timeline given for negotiations between nurses and employers. Once the deadline had passed, instead of receiving their full minimum wage, nurses were surprised by yet another request from CNSaúde for the courts to hold conciliation hearings, this time mediated by the Superior Labor Court. “It was yet another way of delaying payment,” says Caetano. 

The apparent eagerness of the private health sector for more negotiations doesn’t mean that they are willing to engage in honest dialogue. On the contrary, there are indications that their participation in these meetings is not entirely in good faith.

Their tactic can be described as follows: repeatedly propose completely outrageous ideas, causing the nurses’ movements to reject them immediately. Then, blame the workers for hindering dialogue and further delaying the implementation of the minimum wage mechanism. 

One of the clearest examples of this maneuver comes from Paraíba. Milca Rêgo, president of the Paraíba Nurses’ Union (Sindep-PB), says that in her state, health entrepreneurs have presented a proposal to scale up to the minimum wage in installments over up to 5 years — a period even longer than the proposal CNSaúde made on the national level.

“Nurses don’t want an installment plan; they want the minimum wage,” she points out. Therefore, negotiations in Paraíba have not progressed. 

Sindep-PB has sent letters to most of the state’s main hospitals offering to negotiate. “Very few came back to us, always with proposals below the minimum wage,” she says. The union then went to court and won injunctions forcing several establishments to pay their employees the minimum wage immediately.

However, with new requests for mediation made by the private providers, the injunctions were suspended while the negotiations were in progress — once again denying nurses, technicians, and assistants decent pay. 

The differences between public and private healthcare

The beginning of the implementation of the nurses’ minimum wage in the public Unified Health System (SUS) has increased the pressure on private health providers to pay their workers adequately. When nurses see their colleagues who work in state-owned institutions or the philanthropic sector already receiving the minimum wage, it generates “a huge expectation and even grief,” says Rêgo. 

Because of the nurses’ struggle, she says, Paraíba became the first state to implement the minimum wage — and the state government pays it based on a 30-hour workweek, which is closer to real working hours, rather than the 44-hour workweek proposed by the federal government.

On the national level, Rêgo says that “the majority of nurses who work in institutions owned by local governments are already receiving the minimum wage; the complaints that come to us have decreased a lot.” That is because the funds promised by the Ministry of Health to guarantee the nurses’ minimum wage are already being transferred to local administrations. 

A guidance note from the federal Attorney General’s Office, considered “erroneous” by the unions, is still being challenged. The note foresees that the full amount of the minimum wage can be reached through the payment of supplements, bonuses, and allowances — not necessarily by increasing salaries themselves. However, the National Federation of Nurses says it is still in talks with the Attorney General’s Office to amend this understanding. 

A new mediation meeting coordinated by the Superior Labor Court is scheduled for Friday, November 17, and the nursing leaders intend to remain firm in their negotiations with the employers.

“We’re waiting for the proposal to be presented and, at the same time, listening to the unions. We’re going to discuss with the nurses whether we make a counter-proposal, whether we call for mobilizations, or we call for a strike. Nothing is excluded,” concluded Solange Caetano.

The article was written by Guilherme Arruda , and originally published in Portuguese on Outra Saúde.

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.