First Level of Health Care: The Autonomous Role of Nurses

Abstract

Introduction: Although nursing autonomy is advancing with national legislation towards a competency-based approach, a positivist vision centered on biomedical aspects persists, limiting comprehensive care. Despite training and experience, role conflicts and oppression by the medical team persist, impeding freedom of decision and leading to job dissatisfaction.Objective: To analyze the professional autonomy of nurses in type A, B and C health centers at the first level of care in Health District 09D04 - Febres Cordero.Method: Qualitative, descriptive, and dialectical approach, based on the perceptions of nursing professionals about their autonomy in Health District 09D04.Results: The perception of autonomy in the first level of health care is limited, under pressure and subject to demanding schedules. There are restrictions imposed by parameters and regulations, although benefits such as quality care and educational responsibility are recognized. Legal limitations, lack of support and restrictions affecting nurses' autonomy are also identified.Conclusions: To empower nurses, a series of measures are required at both the practical and educational levels. These include the implementation of laws that support their autonomy, ongoing training, the promotion of a favorable work environment, and the strengthening of their educational background with a focus on leadership and solution-finding skills.