1 Nursing in Portugal Introduction National Nurse Career Structure Types of nurse in Portugal Regulation Registration Title Field of Activity Entry to Nurse Education Education Type of Specialist nurse (specialised courses) EC Law Appendix 1 Post Basic Nurse training Introduction Most nursing in Portugal is in the public sector. Only a very small percentage work in the private sector or as independent workers.
2 The civil service career structure applies to nurses working in the public sector. This divides nurses into two areas of activity as care or management functions. In the care sector they are nurses, graduate nurses 1 and clinical nurse specialists. In the management structure there are head nurses, nurse supervisors and nurse directors. There are also some nursing technical advisors in some central departments of the Ministry of Health. Also certain nurses can act as nurse advisors at different levels of the National Health Service, as well as in central departments Nurses enter into the public civil service according to their basic or post-basic qualifications as nurses or clinical nurse specialists. For clinical specialists a post-basic specialist course is necessary. Promotion is through curriculum evaluation and having the necessary experience and/or qualifications. The diagram on the next page illustrates the structure of this career. 1 There is now promotion to nurse graduate after 6 years of service. Decree law 412/98 of 30 December 1998.
3 National Nurse Career Structure Grades Postbasic courses Area of Activity Technical Advice Management Care Nurse Director 3 Nurse Adviser Nurse supervisor Basic course 2 1 Head Nurse Clinical Nurse Specialist Graduate Nurse Admissi on to the career (post basic course) Basic Nurse Admission to the career (basic course) Automatic promotion Competitive exams (Curriculum evaluation) Temporary Appointments
4 Types of nurse in Portugal There is one basic level of nursing in Portugal that is the general care nurse (enfermeiro). These nurses can take post basic nursing training courses (outlined below at page Error! Bookmark not defined. et seq.) and become clinical nurse specialists (enfermeiro especialista). 2 Nurse training and organisation is in the midst of alteration. The old system has been replaced by a new system. 3 Regulation The new Ordem dos Enfermeiros (Nursing Council) has been established by the Decree Law 104/98 of 21 April Article 1 Nature 1. The Council of Nurses, hereafter to be designated by the abbreviation Council (Ordem), is the public association that represents those people with a diploma in Nursing that, in conformity with the legal provisions that are applicable, practise the profession of nurse. 2. The Council enjoys legal status and is independent of the organs of the State, being free and autonomous in the scope of its prerogatives. Article 3 sets out the prerogatives of the new Council. 5 2 Portaria No. 239/94. 3 Decree law 353/99 of 3 September Diario da Republica 1 a Serie A, 21 April 1998 p.1739 et seq.. 5 Prerogatives 1. The Council has as its fundamental aim to promote the defence of the quality of nursing care delivered to the population, as well as the development, regulation and auditing of the practice of the profession of nurse, ensuring the observance of the rules of ethics and professional deontology. 2. The prerogatives of the Council are: a) To watch over the social function, dignity and prestige of the profession of nurse, promoting the professional and scientific value of its members; b) To ensure adherence to the rules of professional deontology; c) To contribute, by drawing up studies and formulating proposals, for the definition of health care policy;
5 Registration The same Decree law establishes the Statute of the Nursing Council 6 with registration powers. Article 6 of the Statute indicates: Article 6 Registration 1. The awarding of the professional title, its use, and the practice of the profession of nurse depend on registration as an effective member of the Council. 2. Registration in the Council is done in the regional section of the candidate s professional address. 3. Portuguese nationals and foreigners with a diploma in Nursing from a Portuguese or foreign School as long as, in this latter case, they have obtained equivalence for the courses delivered in Portugal, or within the terms of applicable international provisions. d) To define the level of professional qualification of the nurses and to regulate professional practice; e) To award the professional title of nurse; f) To effect the registration of nurses; g) To protect the title and profession of nurse; h) To exercise disciplinary jurisdiction over nurses; i) To promote solidarity among its members; j) To foster the development of training and research into nursing, to pronounce on models of training and the general structure of nursing courses; l) To be heard in legal processes that pertain to the prosecution of their duties; m) To offer the scientific and technical collaboration requested by any national or foreign body, public or private, when there is public interest; n) To promote the exchange of ideas, experiences and scientific knowledge among its members and congenerous organisations, national and foreign, that are dedicated to problems of health and nursing; o) To collaborate with the organisations of class that represent nurses in matters of common interest, on their own initiative or at the behest of those organisations. 3. It is further incumbent on the Council to represent nurses before the organs of sovereignty and to collaborate with the State and other public entitities as long as there are involved matters related to the prosection of the duties of the Council, namely in the actions leading to the access of citizens to health care and nursing care. 6 Article 1 of the Statute of the Nursing Council (estatuto da ordem dos enfermeiros) Nature The Council of Nurses, hereafter to be designated by the abbreviation Council, is the public association that represents those people with a diploma in Nursing that, in conformity with the legal provisions that are applicable, practise the profession of nurse.
6 4. In order to practise the profession of Nurse in Portugal, nationals of other Member States of the European Union may register in the Council when they possess the academic and professional qualifications legally required to practise the profession of Nurse in the respective state of origin. 5. Registration in the Council may only be denied on the basis of lack of legal qualification to practise the profession, or when prohibited by a legal judgment that has become an executory sentence. Presently a temporary document is being delivered to the 35,000 effective members admitted to the new Nursing Council. This document will soon be replaced by the cédula profissional. 7 Title Article 7 deals with nurse qualifications in a general way, and permits that specialist titles will be available to those who already have the general care nurse title. 8 The Nursing Council will protect the titles and promote legal action against those who illegally use the title or illegally practise the profession. 9 The titles of nurse and specialist nurse are thus protected by law. 10 Field of Activity Decree law No 437/91 regulates the field of activity of nurses, in the public sector. 11 This established the legal regime for the nursing career and has been amended recently by Decree Law 412/98 of 30 December Mandated by article 6 of the Decree law 191/96 as amended by article 5 of decree law 104/98 of 21 April This came into force on 31 May 1999 (in accordance with Article 7 of decree law 104/98). 8 Article 7(2) of the Statute of the Council of Nurses. Article 30 sets up the institutional machinery to establish specialities. 9 Power based on Article 3(2)g of the Statute of the Council of Nurses. 10 Article 7 of the Statute of the Council of Nurses. 11 Decree law No 437/91 of 8 November 1991.
7 Article 76 of the Statute of the Council of Nurses sets out the general obligations of nurses and Article 77 various incompatible activities. The Code of deontology includes in Article 83 (b) the obligation To direct the individual to another health care professional in a better position to respond to the problem, when the request is outwith his competence; The Regulation on the professional exercise of Nursing 12 confirms the role of the nurse, and specialist nurse in general terms. Article 4 indicates: Conceitos 1- Enfermagem é a profissã que, na ãrea da saúde, tem como objectivo prestar cuidados de enfermagem ao ser humano, são ou doente, ao longo do ciclo vital, e aos grupos sociais em que ele está integrado, de forma que mantenham, melhorem e recuperem a saúde, ajudando-os a atingir a sua máxima capacidade funcional tão rapidamente quanto possivel. 2- Enfermeiro é o profissional habilitado com um curso de enfermagem legalmente reconhecido, a quem foi atribuido um titulo profissional que lhe reconhece competéncia cientifica, técnica e humana para a prestação de cuidados de enfermagem gerais ao individuo, familia, grupos e communidade, aos niveis da prevenção primária, secundária e terciária. The Nurse is a qualified professional with a legally recognised diploma, to whom the professional title has been granted, which accredits his or her scientific, technical, and human competence to give general nursing care to the individual, family, groups and the community, at the first second and third level of prevention. 3- Enfermeiro especialista é o enfermeiro habilitado com um curso de especialização em enfermagem ou com um curso de estudos superiores especializados em enfermagem, a quem foi atribuido um titulo profissional que lhe reconhece competéncia cientifica, técnica e humana para prestar, além de cuidados de enfermagem gerais, cuidados de enfermagem especializados na área da sua especialidade. The clinical nurse specialist is a qualified nurse who has taken a clinical specialist course or an advanced clinical nurse specialist course, to whom the professional title has been granted, which accredits his or her scientific, technical, and human competence to give specialised nursing care in a particular clinical area, besides general nursing care. 4- Cuidados de enfermagem são as intervençóes autónomas ou interdependentes a realizar pelo enfermeiro no âmbito das suas qualificaçóes profissionals. 12 Set out in decree law 161/96 Diário 205 ( ), Article 4.
8 The principle in Portugal is that the nurse himself or herself must understand the limits of their own competence and act accordingly. There is no list of procedures available to particular types of nurse. Entry to Nurse Education Entry to the polytechnic nurse school is from secondary school with additional requirements being fit (suitable) for nursing and also medically fit. Their entry requirements are similar to those of universities. Entry to the advanced (specialised) courses requires a prior (polytechnic) diploma and at least two years nursing practical experience. 13 Each school may set up other requirements of its own in addition. Education The former basic nursing course taught in polytechnics was called curso de bacharelato em Enfermagem. 14 The Decree law number 480/88 of 23 December 1988 established the system of nursing at polytechnics in the high schools of nursing. These have autonomy and administrative technical scientific and educational matters. They are independent higher education schools and they awarded a bachelor academic degree (grau de bacharel). The new training and regulatory system approved by decree law no 353/99 of 3 September 1999 is due to commence for this (1999) academic year. The new curricula from 1999 onwards is not yet published, but will be soon. Essentially the basic general care nurse course is to become a four year course (instead of the current three year course), and the graduates of this course will have a licentiate university degree (grau de licenciado). Nurses with the bachelor degree will be allowed to continue their studies (whilst working at the same time) in order to obtain the licentiate degree. 13 The new requirements are in compliance with decree law 353/99 of 3 September 1999, article 11.
9 There are 25 public higher education nursing schools (Escolas superiores de enfermagem públicas) in Portugal and 10 private ones. They can all devise their own training (both general care and specialist) presently, subject to Ministry of Education approval. Type of Specialist nurse (specialised courses) The former post-basic courses (Cursos de Estudos Superiores Especializados em Enfermagem) are being replaced by post-licentiate specialised nursing courses (Cursos de pós-licenciatura de especialização em enfermagen), not awarding any academic degree, since the new (general care) nursing courses will award the grau de licenciado. Nurses who intend to proceed with university studies may also access master and doctoral degrees. 15 Before the establishment of the new nursing educational system by Decree law 353/99 the post-basic advanced courses included: Maternal health/obstetric nurse Public health/community nurse 16 Child health/paediatric nurse 17 Mental health/psychiatric nurse 18 Medical surgical nurse 14 It is now called Curso de Licenciatura em enfermagem. 15 Higher education in Portugal may award four academic degrees: I. Bacharelato/grau de bacharel (only at Polytechnics); II. Licenciatura/grau de licenciado (at both polytechnics and universities); III. Mestrado/grau de mestre (only at universities); IV. Doutoramento/grau de doutor (only at universities). V. 16 Sample approvals: Portaria No 130/95 (1995) for the Escola Superior de Enfermagem de Artur Ravara: Annex 1 Specialised course in Infant and paediatric nursing; Portaria 1144/95 (specialist course in Community nursing). 17 See note Error! Bookmark not defined. above 18 The direct entry psychiatric courses ended in 1976.
10 Rehabilitation nurse Elderly health and geriatric nurse 19 Adult and elderly with chronic sickness care nurse 20 Nursing Administration. 21 Post licentiate specialised nursing courses will replace these post-basic advanced courses. 22 The replacement courses have not yet been regulated. The new specialist courses will most likely cover the same specialised areas (listed above in the section starting on page Error! Bookmark not defined.) although other areas may also be implemented / created. 19 These courses began in See note Error! Bookmark not defined. above. 21 See note Error! Bookmark not defined. above. 22 Chapter 3 of the Decree law 353/99 of 3 September 1999.
11 EC Law There are no direct entry branch nurses. The legislation which approved the new general framework for nursing education was published on 3 September The specific regulations for each new course are not yet available. Nurses with either the old or new training courses (in general and specialised care) will access the titles of enfermeiro and enfermeiro especialista mentioned in the Statute of the Nursing Council. The old style nurse will convert to the new style of nurse via a training course undertaken part-time. The level of training is at the Diploma 89/48/EEC level for the Portuguese nurse. As there are currently no formally recognised titles under the new regime nor any specifically recognised roles for the specialised nurses there is no regulation in the sense of EC law the activities being open to the migrant specialist nurse. However the old style specialist can maintain their specialist title until the new regime comes into force.
12 Appendix 1 Post Basic Nurse training There are no post basic courses yet designated under the new legislation. The table below gives the pattern likely to emerge. COUNTRY - Portugal NURSE nurse specialist QUALIFICATION/SPECIALITY LEVEL Post -basic DURATION 2 4 semesters ENTRY QUALIFICATIONS Licenciatura em enfermagem ENTRY REQUIREMENTS & ENTRY 2 years experience as a nurse EXPERIENCE AGE MINIMUM - MAXIMUM De facto minimum age around 24 years old. MANDATORY COMPONENTS (HOURS) FOR QUALIFICATION CLINICAL Unknown as yet TITLE OF THE AWARD Not yet known e.g. Certificate/Diploma etc. TITLE AWARDED BY Polytechnics STATUS OF THE TRAINEE Student
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