Silences, omissions and promises to be fulfilled

It is often said that a country is measured by the way it treats those who care for its citizens. And yet, the reality of those who ensure the functioning of the health system, the cohesion of territories and the dignity of care in contexts of greater vulnerability continues to be met with disconcerting silence in structural governance documents. The recent Programme of the 25th Constitutional Government repeats the usual ritual of intentions: to value work, review careers, combat precariousness and attract qualified young people. But between the announcement and the practice, between the promise and the effective commitment, a dangerous gap has been created. The lack of concrete references to Nursing – the largest professional group in the National Health Service – is no minor oversight. It reflects the way in which, structurally, a profession whose relevance goes far beyond its technical dimension continues to be disregarded .

This symbolic absence has material consequences. Just look at nursing careers: structurally outdated, with no effective appreciation of specialization, no fair progression and an evaluation system that drags on with criteria that are not always appropriate to the specificity of the professional hierarchy and the contexts in which they work. Some people talk about merit, but there are no transparent mechanisms to recognize it. Some people proclaim modernization, but ignore the dynamics of stagnation that dominate the sector. The result is clear: unmotivated professionals, increasing turnover, the loss of qualified talent to foreign health systems and, above all, a population that, day after day, faces longer waiting times and loses continuity of care. In short, a system that seems to function more through inertia than through strategic vision.

And it is no coincidence that this situation has been worsening. The inability to guarantee regular competitions, establish mobility processes that respond to nurses’ development expectations or personal and family needs, or even to ensure minimally predictable progression mechanisms, deprives the profession of any horizon for progress. When excellence is demanded without offering dignity, the future of the profession and the security of those who depend on it are jeopardized.

And while devaluation is structural, precariousness is transversal . The proliferation of temporary contracts, often used to meet permanent needs, profoundly affects the stability of teams and the predictability of healthcare responses. Job instability is not just a problem for professionals: it undermines people’s trust in the system, fragments responses and exacerbates territorial inequalities. In many communities, the presence of a permanent nurse can mean the difference between timely care and the lack of continuity in care, with consequences for health outcomes and gains. The phenomenon is transversal to the entire country, affecting not only large urban hospitals, but especially rural, island or urban periphery contexts, where local care becomes even more essential. The logic of precariousness is thus revealed to be doubly unfair: it penalizes professionals and weakens territories, perpetuating cycles of inequality in access to healthcare.

At the same time, there is still a lack of serious commitment to the valorization of knowledge . There is, of course, talk of lifelong qualification, but the educational and scientific requirements that define Nursing are ignored. Specialized training is not a technical whim: it is a practical and social necessity. To give little or no recognition to this differentiation, neither from a remunerative nor functional point of view, is to waste critical, advanced and specialized skills. It is important to emphasize that these areas, often undervalued in public policies, correspond to rapidly growing needs. Portuguese society is aging, chronic disease is increasingly prevalent and responses continue to fall short of what is necessary. Ignoring this evidence is not only failing professionals, but also the people who need them. In short , it is perpetuating a care model focused on acute response, to the detriment of a preventive, community and integrated vision .

Furthermore, the discourse of attractiveness, so often repeated, clashes with the real experience of those who enter the system. Young nurses, far from finding a welcoming and valued structure, are faced with low salaries, no prospects for advancement, lack of institutional recognition, difficult working conditions – with unregulated hours and false overtime, persecutory environments with insecure staffing and permanent exposure to ethical suffering. The flight of recent graduates to abroad, or to areas outside the health sector, is not the result of a lack of desire to remain in Portugal, but of the lack of concrete policies that guarantee minimum conditions of professional dignity. And this silent and persistent flight weakens the system at its foundation, directly affecting the people who depend on it. This reality cannot be resolved with patriotic appeals or vague promises. It requires concrete measures, sustained investment and a long-term vision that sees professionals not as mere executors, but as critical agents of the health system.

This is why the discussion about work cannot continue to be conducted in the abstract . Talking about labor dignity requires naming realities, assuming responsibilities and committing to structural changes. Valuing public service involves recognizing the professions that support it. And in the case of Nursing, this recognition is far from being a reality. What is required is not only the resumption of serious institutional dialogue with the representatives of the profession. It is the political courage to integrate Nursing into a public strategy of professional valorization, correction of inequalities and qualification of services . Not as an exception, but as an expression of a policy that truly recognizes those who, every day, guarantee the health of democracy.

Without justice in public work, the population cannot be guaranteed access to care that guarantees dignity, equity and trust in a State that claims to be at the service of all.