Planned Invisibility – Nursing and Public Power

A few days ago, the study "Continuity and Change in Public Policies in Portugal," by the Francisco Manuel dos Santos Foundation, revealed one of the faces of the "cronycracy" that reigns in Portuguese politics, commonly used by rulers to control the direction of public policies: administrative reorganizations, budget allocations, and appointments to leadership positions, guaranteeing the means and content, but only rarely the competence and merit.

It is the traditional “bank of favors”, as described by Paulo Coelho in his work “The Zahir” , where this metaphor is used, powerful in the networks of power, in the guarantee of support and its reciprocity, where instead of money the “deposits” are gestures, help, connections, from which it is expected that these favors will be reciprocated, not necessarily by the same person, but by the social universe that has been constructed.

In a country where nurses are the backbone of healthcare, the silence about their role in official documents is deafening. Proof of this "genetically modified" culture is the annual report of the National Vaccination Program, where, in its 65 meticulously and expertly written pages, the word "nurses" or "nursing" is not mentioned once. This is not an omission or inattention; it reflects an institutional culture that continues to marginalize those on the front lines.

This erasure gains another interpretation when we analyze the study mentioned at the beginning of this article, which reveals the culture of "cronyocracy." This is where invisibility becomes a political consequence: choices that silence, decisions that exclude, merit and competencies that are discarded.

The connection, which we must precisely make, between this study and this report highlights the political effect of invisibility. When a fundamental group like nurses is not mentioned in strategic reports, this is not just a lack of recognition; it is potentially a calculated consequence of the intricacies of power.

The absence of nursing knowledge in the structuring discourses of health is not accidental; it is conscious, intentional, and permeates the entire system and its entire structure. As such, it demands an urgent response. Recognizing this pattern is the first step toward breaking it. Because a system that fails to identify also fails to protect. And without protection, there is no progress.

It is urgent to make the essential role of nursing in Portuguese public health visible; we must push for recognition of the important role of nursing in strategic documents, health policies, and government decisions.

As the saying goes, "those who don't show up, forget" and the persistent neglect and invisibility of nursing in the discourses and structuring documents of health in Portugal must end because nursing is too important for health and cannot be forgotten.