During the last decades, there have been countless changes at international level regarding the different social determinants of health (socioeconomic, behavioural and cultural). Technological evolution, the ageing of the active population, sustainable development and the new organizational models, with impact also on the world of work, are the expression of new occupational risks, challenges and opportunities for the safety and health of workers

Within the extensive History of Portugal in the 20th century, including the Carnation Revolution (April, 25th, 1974) and the accession to the European Economic Community (1986), deep changes have occurred in society, such as population access to education and health. However, currently it is possible to see many asymmetries regarding the health and education sectors, in a country with a geographical area of 92,212 km2 and a resident population (in 2019) of 10,295,909 inhabitants.

Regarding healthcare, since 1979 the Portuguese population has access to the National Health Service (NHS); and according to the Constitution of the Portuguese Republic, all citizens are entitled to health protection, and also have the duty to defend and promote it.

Different amendments have been made over the years, both at the hospital setting and at Primary Care, with new organizational models, among other matters. In the health settings, nurses represent a significant number within different professionals, with an obvious increase in their visibility due to the training routes developed.

In this setting, there has been a higher training offer over time in public and private educational institutions, which must be taken into account. This goes back to 1881, when the first Nursing School was created in Portugal, integrated in the hospitals of the Universidad de Coimbra. However, it was in 1988 when the different levels of academic Nursing education were formally acknowledged (1). Among the changes that have occurred over the years, there are currently three training and research courses: the degree in Nursing (240 credits, ECTS), the master and the doctorate (1,2).

The degree allows to obtain the Nursing Degree by the Council of Nurses (Orden de Enfermeras), formally established in 1998; this is a requirement for professional practice, and in compliance with the Regulations for Professional Practice of Nursing (2). Due to the changes that have been occurring in the degree, it is currently structured into three categories: Nurse, Specialized Nurse, and Nurse Manager.

According to the statistical yearbook of the Orden de Enfermeras, 75,928 nurses were registered as active members by December, 31st, 2019; 56,046 of them were General Care Nurses, and 20,003 were Specialized Nurses.

Two hundred years after the birth of Florence Nightingale, who is considered the founder of modern Nursing, there has been an acknowledgement of the importance of nurses in the National Health Service. However, there are multiple factors determining their performance, with levels of professional dissatisfaction that in some cases lead to leaving the profession. Some studies point at the following factors responsible for this reality: poor work conditions, lack of human and material resources, ambiguity of roles, low salaries, overload of physical and emotional work, multitasking, conflicts, violence, and the work-family interaction. Regardless of this, the essence of care associated with Nursing leads these professionals to overcome many barriers and face many challenges in adversity, showing high levels of commitment in many settings, basically associated with commitment to work.

Based on the European Strategic Directions for Strengthening Nursing and Midwifery towards Health 2020 goals (WHO), the following were considered priority action areas: development and transformation of the educational programs, workforce planning and optimizing skill mix, ensuring positive work environments, and promoting evidence-based practice and innovation (3). The Nursing Now campaign, launched in 2018 as a result of the joint action of the World Health Organization (WHO) and the International Council of Nurses (ICN), ends up in 2020: the International Year of Nurses and Midwives and the bicentennial of Florence Nightingale; its objective is to improve and offer higher visibility to nurses, highlighting their essential role in the improvement of population health, gender equality, and economic Growth.

In Portugal, the Orden de Enfermeras joined the Nursing Now campaign with the statement of its Vice-President, nurse Luís Barreira: “This is the time for nurses to reaffirm their leadership. We are the profession with the highest number of professionals within the health sector. Nursing has major potential and value, and therefore we want to give a voice to everybody. We will help nurses to lead the processes of change in order to build a movement that will improve global health” (4).

Through mass media (television and newspapers), websites and scientific events, among others, Nursing Now has had a voice and spread its objectives.

Currently, the COVID-19 pandemic has also brought significant changes for nurses. The search for knowledge, work reorganization and team work are essential cornerstones in order to overcome the obstacles and adversities they are facing. During this period, the population has had the opportunity to acknowledge the role of nurses in different settings, from hospital services to Primary Care. Taking into account that new challenges will open new opportunities, this pandemic is also, undoubtedly, a contribution to Nursing Now.

Nursing has excellent foundations, with high-level academic training, associated to an increasing interest among nurses in clinical practice for academic training continuity, that is to say, master and doctorate degrees; but also with their integration in multidisciplinary research projects led by nurses, such as the research group with the objective of improving Nursing research (NursID, Innovation & Development in Nursing), with the goal to contribute to a multidisciplinary and holistic approach to health. The leadership shown by Nurse Managers has also shown higher reaffirmation in our context, with the acknowledgement by organizations, as well as higher protection for the population, promoting a critical attitude in their health decisions.

The fact that new challenges contribute to nurse empowerment, that they offer training opportunities in such different areas as clinical-surgical, community health, child and pediatric health, maternal and obstetric care, mental and psychiatric health, and rehabilitation in areas of advanced practice such as management or distinct competences such as Occupational Nursing, will be useful for the development of evidence-based practice.

May the Nursing Now campaign be the beginning of Nursing reaffirmation. May nurses achieve the visibility they deserve.