Facilitators and Barriers to Investment in the Brazilian Nursing Workforce: A Qualitative Study

To understand the factors influencing investment in nursing from the perspective of relevant interest holders in nursing.

Brazil's healthcare system faces significant inequities in healthcare access, leading to health disparities. There is a strong link between healthcare access and health outcomes, highlighting the importance of nursing roles and regulatory policies.

A qualitative descriptive analysis was conducted using purposive and snowball sampling to recruit and interview 15 participants from various nursing, education, and leadership roles in Brazil. Data were thematically analyzed in Dedoose, ensuring rigor via triangulation, reflexivity, and an audit trail.

Three major themes emerged. First, prioritizing health facilitates investment in nursing. Second, intrinsic challenges include barriers within the profession, such as educational issues and fragmented professional structures. Third, extrinsic barriers, including health system fractures and institutional issues, hinder investment in nursing.

Effective policy reform requires overcoming barriers in nursing education, leadership, employment, and service delivery. In Brazil, priority areas include clarifying scopes of practice, updating regulatory frameworks, and expanding regional access to nursing education.

Investing in nursing across education, employment, leadership, and service delivery is worthwhile for a country's health and economy. Educational opportunities translate to job opportunities only if governments invest in all levels of nursing and if a country can absorb well-trained and qualified nurses into the healthcare system.

This study revealed obstacles and enabling factors related to an investment in nursing by Brazil, offering insights applicable to countries with similar health systems. Recommendations include removing intrinsic restraints, endeavoring to empower nurses, and eliminating extrinsic barriers, all of which could support investment in nursing, ultimately an investment in population health.