Two events which marked clearly the disciplinary and professional development of nurses have coincided in time, almost simultaneously. Nursing studies were included in the University 40 years ago last 2017; and on the other hand, 2018 also marked the 40th anniversary of the Declaration of Alma-Ata, which represented a turning point in health approach and a turning point for what was called the new Primary Care model in Spain. Nursing studies being included in the University meant an obvious advance for disciplinary development; and even though it did not meet all initial expectations, it allowed optimism. It was not easy, and only the effort, commitment, involvement and confidence of a group of nurses made it possible to overcome the resistance generated around that decision.

These 40 years have been useful for nurses to take control of University Education, and to consolidate a training approach that radically changed the syllabus, adapting it to the nursing paradigm, and including new social, professional and organizational realities that, for example, the new Primary Care model, derived from the Declaration of Alma-Ata, demanded.

However, our position at university prevented the maximum disciplinary development. Many nurses had to access through other degrees in order to complete their doctorate; but this did not lead them to abandon Nursing, and this is a clear indicator of loyalty. Nurses were not able to break the glass ceiling that prevented them from growing, until the implementation of the European Higher Education Area. After 40 years of permanence at University, we can say that Nursing is positioned at the same level as any other university discipline, even though there are many who continue trying that this is not so.

Another event occurred almost simultaneously, which changed the role of nurses in healthcare institutions. The organizational changes derived of the Declaration of Alma-Ata led to the proclamation of the Spanish General Health Law of 1986, which established the basis for the development of Primary Health Care; this contributed to nurses acquiring new roles and leadership in said level of care. Nursing consultations, community participation, health promotion, Health Education, etc., represented an opportunity for independent professional growth never known so far; nurses knew how to take advantage of this, and place themselves as examples of the new model and its development. When this year is about to end, it is necessary to reflect about our current situation, both at the University and at Primary Health Care, and about the role that nurses play and can play in the future in both settings.

University has become a hostile setting for professors/researchers, particularly for nurses. The criteria of university excellence prioritize research as an almost exclusive achievement for development, according to the indicators by the National Agency for Quality Assessment and Accreditation of Spain (ANECA), imposing demands very difficult to achieve by nurses, by placing them at the same level as biomedical sciences, and having to compete in a completely commercialized editorial world, very difficult to access in order to reach the indicators demanded. These difficulties, together with the low salaries received by the Teaching and Research Staff, represent a repellent for nurses to approach University, what generates niches of occupation for other disciplines with the following colonization of the faculties and departments of Nursing, that see reduced the squares occupied by these professionals.

Meantime, the Primary Health Care, the ideal setting for the professional development of Nursing, progressively was losting its differentiating characteristics, in which the nursing paradigm fitted perfectly, to be more and more assistentialist, biologist, medicalized, technologically and focused on the disease, what clearly displaces the nursing model, which has to play a more technical role every day.  

The opportunity represented by Primary Care for nurses has gradually faded away as a consequence of the strong medical pressure, lack of planning in professional organization, no political will to create specific positions for specialists in Family and Community Nursing, regardless of having trained specialists for over eight years, the healthcare drift towards an almost exclusive focus on demand, the discontinuation of health promotion, low community participation, and the progressive disappointment of nurses at the disintegration of the Project where so much work had been invested.

However, this is not the time for discouragement or desertion. Despite everything, nurses can reverse this situation through their specific contribution, generation of evidence, and leadership in nursing care, by creating strategies for intervention and adapting, as they can do so well, to current circumstances. Now more than ever, we nurses must show that our contribution is exclusive and essential, at University as well as in Primary Health Care, for achieving the desired GOALS (“METAS”).