Facilidades e dificuldades do trabalho de enfermeiros na Atenção Primária à Saúde na Região Sul do Brasil: percepções à luz da Política Nacional de Atenção Básica e da Política Nacional de Humanização

Abstract

Primary Health Care (PHC) is the main organizing component of the Unified Health System (SUS), assigning nurses a strategic role in care coordination, with the National Primary Care Policy (PNAB) and the National Humanization Policy (PNH) serving as central normative frameworks guiding this practice. However, little is known about the extent to which these guidelines translate in the nurses' own perceptions into the facilitators and challenges experienced in daily clinical and managerial practice. In this context, this study aims to analyze the perceptions of PHC nurses in Southern Brazil regarding the facilitators and challenges encountered in their daily nursing practice specifically concerning professional valuation, professional recognition, and working conditions in light of the PNAB and PNH. This is an analytical qualitative study based on a subset of data from a national multicenter study, involving 174 nurses working in municipalities across the states of Paraná, Santa Catarina, and Rio Grande do Sul. Data were collected through individual audio-recorded interviews and analyzed using the Collective Subject Discourse method. The socio-occupational profile revealed a predominance of women, with a mean age of 39 years and an average of ten years of experience in PHC; the majority were linked to the Family Health Strategy in urban settings. Four categories of facilitators were identified: professional autonomy and institutional protocols; management support and resource availability; teamwork and interprofessional collaboration; and bonds with the community and territory. Four categories of challenges were also identified: care workload and insufficient human resources; leadership and conflict mediation challenges; structural weaknesses and professional devaluation; and weak interdisciplinary cooperation. In daily practice, the facilitators reflected principles advocated by the PNAB and PNH, whereas the challenges highlighted a persistent gap between the normative model and actual working conditions. It is concluded that the implementation of the PNAB and PNH within Primary Health Care (PHC) depends less on the lack of formal recognition of nurses' roles and more on the existence of material, organizational, and relational conditions that sustain the principles advocated by these policies in daily practice; thus, it is necessary to invest in professional recognition, adequate human resource staffing, and the strengthening of participatory management to improve the quality of care provided in the Brazilian PHC system.