Abstract

TEMIDO, Marta  and  DUSSAULT, Gilles. Skill mix between physicians and nurses in Portugal: Legal barriers to change. Rev. Port. Sau. Pub. [online]. 2014, vol.32, n.1, pp.45-54. ISSN 0870-9025.

Introduction: The healthcare workforce composition in Portugal indicates an inefficient combination of doctors’ and nurses’ roles. One of the possible answers to this problem could be the expansion of nursing staff responsibilities. Evidence shows that this option can improve the performance of healthcare systems, in terms of efficiency and access. Knowing that the legal framework that regulates each of these professions can hinder the review of their respective scope of practice, we assessed the need to change the Portuguese law in order to allow adjustments in nursing staff tasks’ boundaries. Methods: Review of publish and non-published literature and document analysis. Results: We found that in the Portuguese law there is no definition of the medical act. There is, however, a regulatory protection on the exercise of medical diagnosis acts, drugs prescription and autonomous management of patients. We also observed that other actions considered unique to the medical profession, and many are so considered merely because of social conventions, can be delegated. Conclusions: The intent of attributing to the nursing staff tasks previously held solely by medical doctors will need prior legal changes. There is still normative framework for a more effective use of nursing staff skills in order to attain a better performance by the Portuguese health care system. But the success or failure of a political strategy does not depend only on its legal feasibility; social acceptability also must be considered and some Portuguese stakeholders expressed reservations in supporting a nurse's scope of practice enhancement.

Keywords : Skill mix; Physicians; Nurses; Legal and regulatory barriers; Change; Practice.

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