Shared practice between nurses and physicians in Primary Health Care: An analysis of care protocols

Abstract

Primary Health Care is a pillar of the Unified Health System and is characterized by team-based work in the areas
of prevention, health promotion, treatment, and rehabilitation. This study aimed to analyze, within established care protocols, the extent of shared work between physicians and nurses in Primary Health Care. This was a qualitative documentary study conducted
through a comparative analysis of 19 national, state, and municipal clinical protocols published between 2014 and 2024. Data collection took place between January and July 2024, and the documents were subjected to inductive thematic analysis. Three themes emerged: different conceptions of shared work in Primary Health Care protocols; the clinical autonomy of nurses as an element
of shared work; and protocols as organizers of the interprofessional work process. The Ministry of Health’s protocols recognize multiprofessional practice but provide less detail regarding shared responsibilities. State and municipal protocols explicitly address shared consultations, ordering of tests, prescribing in accordance with institutional protocols, and inter-professional consultations,
thereby expanding nurses’ clinical autonomy. It is concluded that care protocols strengthen shared work, improve the organization of care, and highlight the need to harmonize guidelines related to clinical responsibilities.