After the COVID-19 pandemic, we can state that Spain has experienced a unique devastation with an unprecedented crisis in the sociosanitary system. A crisis of huge dimensions which has hit in its morphology and structure an already wounded and declining health system; a system which has not yet accepted not only the changes but the “determination” required to implement models already proposed and management models adapted to current demands and uncertainties. The only observed and more significant changes for this context are the result of answers by development and technological innovation (1), but none represent an answer to the analysis considering causal factors such as demographic movements, epidemiological patterns and the specific culture and behaviour of the population regarding health.

From another approach, the healthcare pressure experienced and its thorough restructuring have guaranteed safety and fluidity. We have adapted the specialized spaces and assistance, we have set up models of response for those vulnerable patients who required follow-up in continuity of care, and sometimes we have not arrived in time. We have accompanied intensely in the absence of relatives and the professionals required; we have tested and traced, wearing masks and coveralls; we have organized vaccination and we have vaccinated, managing doubts, questions and indications. And inthese demanding and exhausting circumstances in the healthcare space, we have overcome in order to take up the fragile care, the “lack of consultations” during the pandemic period, and our routine and structured activity (2).

This reorientation of services with goals adapted to new situations has represented a major overload for all professionals. Taking immediate measures within a setting of uncertainty and insecurity, the lack of control in decision making at different levels, the initial lack of protection in its wider sense and in all aspects, the professional and also personal involvement and dedication, are only some of the matters which have illustrated this pandemic period (2). Undoubtedly, we have brought into play our skills for resistance and personal management, leaving aside our self-care, so necessary for caregivers and those who watch the health of others.

After two years of pandemic, and without entering into epidemiological approaches, analysis of prevalence, curves, waves, or mortality figures, but considering the impact on the health of our population and our communities, and taking references about the socioeconomic impact and the exacerbation of inequality and social determinants, we must accept as professionals the responsibility and firm determination of active participation in modelling our system. There are no alternatives if we want equity and access, and to be permanently positioned in the scope of the 2030 Agenda for Sustainable Development Goals (3).

The future demands measures which cannot be delayed, and one of them, and maybe the most urgent, it to redirect the course of our system. There is an imperative need to refocus towards the challenges still unsolved, which have been revealed by the pandemic, and those of our volatile future (1). Currently we are mortgageda biomedical model, and health responses do not contemplate any interaction with other vital factors or those changes designed by causal agents and factors. On the other hand, the bias in systematization by what for, how much and how, both in the design, organization and decision making and in resource management, is oriented and distributed by said model and has not changed for decades. This model does not contemplate promotion and prevention as key settings for investment in health and first line of intervention, or the need to systematize the integral and holistic approach. Likewise, it does not contemplate the integration of the full development of responsibilities and autonomy of nurses, with the maximum skills development that they can reach without the barriers and obstacles supported by said model. And in the same way, their perspective is neither incorporated nor present in strategy design or decision making (4). This is a constant situation supported by decisions which are misguided or relegated to a second plane, or by tortuous bureaucratic processes, regulations or extemporaneous legislations which have generated an involution in our professional development and growth, as well as lack of positioning and consolidation of spaces and roles. Undoubtedly, this context and other interdisciplinary circumstances have facilitated to a greater extent other additional situations against the progress of our profession. This is the case, for example, of the opportunistic emergence of degree qualifications which are disconnected and not integrated into the discipline “core”. We ca no longer stand by and watch asunmet needs and deficiencies based on lack of investment and resources and support for the development of the professional community are being palliated with intermediate options, without the expertise of the care professionals, nurses, for their management, assessment and provision.

This same historical undercapitalization, which ultimately represents lack of investment in health, together with its direct relationship with the necessary resources, is the cause on one hand of the lack of care opportunities and the impact associated with patient morbidity and mortality, sustained by scientific evidence, and on the other hand, of the “normalization” and consolidation of job insecurity, through deficient staff, precarious contracting in all its forms, questionable ways to manage resources and talent, certain forms of work and organization, and also the flight of professionals to other countries as a consequence. Better informed political decisions are required, as for any other setting, which are based on data and results and on the population needs; otherwise, if the policy makers implement general reductions in expenses, they will run the risk to cause more damage than good.

The severity of this set of circumstances sustained over time consists in its serious impact on the profession and nurses, as well as its high impact and consequences on our citizens, patients, and the overall population. Precisely, some matters to measure and lay on the table are the deprivation of full, integral and universal CARE in any of its dimensions, promotion, prevention, assistance or recovery of the disease, and accompaniment in life and in good dying.

From this perspective of care and assistance, those patients who need more support from the system will require a wide range of professional care, both general and specific, and integral care for their health problems. They will also need help, collaboration, continuous support and problem solving through management and organization forms which are less bureaucratic and more professional. For this reason, the model must change: power, responsibility and participation must be distributed so that care and service organization are redesigned around patients, their needs, and the needs of the overall population. Allowing nurses to develop their skills and their autonomy by reducing or eliminating the barriers and resistance by one another would already be a change in the model (4).

So far from a constant radical discourse, this is about the timely unification of a common narrative regarding our position as the agents for change necessary for access and maintenance of health and economies. Our position within the system and our special relationship with patients and citizens in all areas of life and circumstances will determine the dimension of our perspective; and therefore, we must be involved in the analysis, change of model and discussion about the future: consistency, adaptation, relevance and sustainability. New scenarios which are more real, dynamic, decisive, with autonomy for patients and for nurses as the main healthcare providers in the universe of health-disease-dignified death. And also, in order to give response through coordinated structures, common strategies and multidisciplinary plans of collaboration from disciplinary autonomy (5).

The current healthcare crisis, which is also political, social and economic in Spain, could even become deeper if the quality and safety of patients continues to be compromised, as well as an adequate care for the overall population. This crisis has undoubtedly revealed that states and governments are responsible for and affected by health; and therefore, also for the situation of nurses. The lack of response to the call for action , which at the time was worked out with our interlocutors and politicians, , still does not give nurses a chance or space Let’s hope that the Strategy and Coordination in Care anticipated by the Minister of Health last June, 1st will give an answer to the challenges in the future, the needs and required strengthening of the profession. Otherwise, if this was not addressed regardless of the commitment made, the profession would feel once again the intentional oblivion and contempt in an already chronic disaffection for nurses; and finally we will not know where we are going.