Nurse autonomy in conducting consultations in primary care: evidence of advanced nursing practice

Abstract

Objective  To identify the scope and impacts of nursing in primary health care (PHC) in the Brazilian context, based on consultations performed by nurses and their alignment with advanced practice.

Methods  Ecological study, outlined based on data extracted from the Health Reports/Production platform of the Health Information System for Primary Care. The broad and expanded autonomy of nurses in scheduled consultations in PHC was analyzed in the five macro-regions of the country in 2023.

Results  The analyzed data reveal the significant role of nurses in PHC services in different regions of Brazil, particularly in consultations performed by these professionals regarding the monitoring of chronic diseases, women’s health, and disease screening. Nursing consultations stood out in the Northeast and Southeast regions, with a higher concentration related to hypertension, diabetes, and care during pregnancy and the postpartum period.

Conclusion  The findings demonstrate advanced practice competencies by revealing that PHC nurses perform a significant volume of clinical consultations, often associated with complex diagnostic, prescriptive, and therapeutic decisions, even in the absence of formal credentialing or legal recognition, reiterating the urgency of national ethical and legal regulations that align Brazilian practical reality with international guidelines for strengthening the nursing workforce.

Descriptors:
Professional autonomy; Office nursing; Chronic disease; Advanced practice nursing; Health policy

Resumo

Objetivo  Identificar o panorama sobre a abrangência e impactos da Enfermagem na Atenção Primária à Saúde (APS), no contexto brasileiro, a partir de consultas realizadas por enfermeiros e seus alinhamentos com a prática avançada.

Métodos  Estudo ecológico, delineado a partir de dados extraídos da plataforma de Relatórios de Saúde/Produção do Sistema de Informação em Saúde para a Atenção Básica. Foi analisada a competência de autonomia ampla e expandida do Enfermeiro em consultas programadas na APS, nas cinco macrorregiões do país em 2023.

Resultados  Os dados analisados revelam expressiva atuação do Enfermeiro nos serviços de APS nas diferentes regiões do Brasil, de modo particular nas consultas realizadas por este profissional no que tange o acompanhamento de doenças crônicas, saúde da mulher e rastreamento de agravos. Destacaram-se consultas de enfermagem nas regiões Nordeste e Sudeste, com maior concentração relacionadas à hipertensão, diabetes e cuidados no ciclo gravídico-puerperal.

Conclusão  Os achados evidenciam a demonstração de competências de práticas avançadas ao revelar que enfermeiros da APS realizam um volume expressivo de consultas clínicas, frequentemente associadas à decisões diagnósticas, prescritivas e terapêuticas complexas, mesmo na ausência de titulação ou reconhecimento legal formal, reiterando a urgência de uma regulamentação ético legal nacional que alinhe a realidade prática brasileira às diretrizes internacionais de fortalecimento da força de trabalho em Enfermagem.

Descritores:
Autonomia profissional; Enfermagem ambulatorial; Doença crônica; Prática avançada de enfermagem; Política de saúde

Resumen

Objetivo  Identificar el panorama sobre el alcance y los impactos de la enfermería en la Atención Primaria de Salud (APS) en el contexto brasileño, a partir de las consultas realizadas por enfermeros y su alineación con la práctica avanzada.

Métodos  Estudio ecológico, diseñado a partir de datos extraídos de la plataforma de Informes de Salud/Producción del Sistema de Información en Salud para la Atención Básica. Se analizó la frecuencia de consultas que reflejan la competencia de autonomía amplia y expandida del enfermero en consultas programadas en la APS, en las cinco macrorregiones del país en 2023.

Resultados  Los datos analizados revelan una actuación significativa de los enfermeros en los servicios de APS en las diferentes regiones de Brasil, en particular en las consultas realizadas por estos profesionales en lo que respecta al seguimiento de enfermedades crónicas, la salud de la mujer y la detección de afecciones. Destacan las consultas de enfermería en las regiones Noreste y Sudeste, con mayor concentración en relación con la hipertensión, la diabetes y los cuidados en el ciclo gestacional y puerperal.

Conclusión  Los resultados evidencian la demostración de competencias de prácticas avanzadas al revelar que los enfermeros de APS realizan un volumen significativo de consultas clínicas, a menudo asociadas a decisiones diagnósticas, prescriptivas y terapéuticas complejas, incluso en ausencia de titulación o reconocimiento legal formal, lo que reitera la urgencia de una regulación ética y legal nacional que alinee la realidad práctica brasileña con las directrices internacionales para el fortalecimiento de la fuerza de trabajo en enfermería.

Descriptores:
Autonomía profesional; Enfermería ambulatoria; Enfermedad crónica; Enfermería de práctica avanzada; Política de salud

Résumé

Objectif  Identifier le panorama de la portée et des impacts des soins infirmiers dans les soins de santé primaires (SSP) dans le contexte brésilien, à partir des consultations effectuées par les infirmiers et de leur alignement sur les pratiques avancées.

Méthodes  Étude écologique, conçue à partir de données extraites de la plateforme de rapports sur la santé/production du système d›information sur la santé pour les Soins de Santé Primaires. La compétence d’autonomie étendue et élargie des infirmiers dans les consultations programmées dans les SSP a été analysée dans les cinq macro-régions du pays en 2023.

Résultats  Les données analysées révèlent une action significative des infirmiers dans les services de soins primaires dans différentes régions du Brésil, en particulier dans les consultations réalisées par ces professionnels en matière de suivi des maladies chroniques, de santé des femmes et de dépistage des affections. Les consultations infirmières se sont particulièrement distinguées dans les régions du Nord-Est et du Sud-Est, avec une concentration plus importante liée à l’hypertension, au diabète et aux soins pendant la grossesse et l’accouchement.

Conclusion  Les résultats démontrent les compétences avancées des infirmiers de soins primaires, qui réalisent un nombre important de consultations cliniques, souvent associées à des décisions diagnostiques, prescriptives et thérapeutiques complexes, même en l’absence de qualification ou de reconnaissance légale formelle, réitérant l’urgence d’une réglementation éthique et légale nationale qui aligne la réalité pratique brésilienne sur les directives internationales visant à renforcer la main-d’œuvre infirmière.

Descripteurs:
Autonomie professionnelle; Soins infirmiers en cabinet; Maladies chroniques; Pratiques infirmières avancées; Police de la santé

Introduction

Advanced Nursing Practice (ANP) is a modality of professional praxis that expands the scope of nurses’ competencies, providing greater autonomy in clinical decision-making, care management, and the implementation of practices based on the best scientific evidence. This approach aims to improve the efficiency of health services, meet the growing demands of society, and improve patient care. It is defined by the International Council of Nurses (ICN) as a level of practice characterized by specialized clinical competencies, theoretical depth, and advanced professional decision-making skills.(¹-³)

The trajectory of Advanced Practice Nurses (APNs) dates back to the 1960s in the United States, in response to a shortage of physicians, when nurses began to perform functions that intersect with those related to the medical profession, especially in Primary Health Care (PHC).(⁴)

Since then, the development of this line of action by nurses, in different contexts and related to local realities, in the aforementioned specialty, based on specialized knowledge, has occurred in diverse and sometimes fragmented ways among countries, resulting in multiple names, and scopes of practice. Such diversity, although reflecting adaptation to internal realities, has also generated overlapping functions and conceptual ambiguity.

This practice has gradually become more specialized, keeping pace with changes in the health demands of the population, technological advances, and expanded educational opportunities for the profession. This process culminated in the international recognition of the advanced clinical skills exercised by many nurses, consolidating the emergence of ANP as a strategic model of health care, recommended by international organizations, governments, and professional associations.

In light of international advances in the regulation and institutionalization of ANP, there is a clear need for regulations that are sensitive to public health policy guidelines, the emerging needs of the population, and the principles of quality, safety, and professional recognition. In Latin American countries, including Brazil, the consolidation of ANP is still in its infancy, characterized by the absence of clear legal frameworks, training and certification processes, and a precise definition of the scope of practice of these professionals.(¹²,¹³)

The experience accumulated by countries in the northern hemisphere has shown that the implementation of standardized national criteria, the requirement for minimum academic training at the master’s level, and the legal and organizational recognition of ANP functions are essential pillars for strengthening the profession and advancing toward Universal Health Coverage (UHC). In this context, it is understood that the construction of this path requires interinstitutional coordination involving regulatory bodies, health system managers, and training institutions, in addition to the development of a regulatory framework that, while attentive to regional specificities, moves toward conceptual uniformity, legal legitimacy, and social recognition of nursing for the development and effectiveness of ANP.(¹⁴)

The most recent World Health Organization report(¹⁵) on the global nursing landscape, published in 2025, reveals a significant increase in the recognition of advanced practice, since in 2020, only 53% of countries had reported ANP functions, a proportion that grew to 62% in subsequent years. Such evidence indicates that nurses with advanced clinical skills contribute to expanding access to health services and improving the quality of care provided. To this end, it is necessary to consider the factors and contexts that imply the development of APNs, among which is the nursing consultation.

In Brazil, nursing consultations are regulated by Law No. 7,498/1986,(¹⁶) which establishes that this is an activity exclusive to nurses, configured as a systematic care process that involves a scientific approach based on data collection, nursing diagnoses, planning, execution, and evaluation of nursing care. It is through nursing consultations that nurses initiate and develop care management, a process that combines attitudes, skills, and clinical and administrative knowledge to better meet patients’ health needs, in accordance with the legal and deontological precepts of the profession.

Furthermore, it should be noted that nursing is the largest category in the health sector in all countries, and Brazil is no different. However, its implications for advanced practice, in order to meet the health needs of such a heterogeneous socioeconomic population, are not limited to the number of these professionals in the SUS, but above all to their skills, which position nurses in all health settings for the effectiveness of public health policies and the quality of life of the population. Therefore, thinking of the nursing consultation as a context of autonomy for the development of ANP seems to be a condition for implementing what global scientific evidence points to regarding the importance of ANP for caring for people and strengthening health systems, especially in PHC.

Therefore, in view of the above, it is necessary to ask: how do nursing consultations carried out in Brazil, in the context of PHC, express competencies related to ANP? Although there is still a need for regulation of ANP in Brazil, notably through standards that allow new formats of regulation for nursing specialties; and normative requirements for the valorization of these professionals, among other factors, it is understood that nurses, especially in PHC, have successful experiences, regulated by the Nursing Professional Practice Law, which are in line with what is expected for Advanced Practice Nursing. In this context, the objective of this study was to identify the scope and impacts of nursing in PHC in the Brazilian context, based on consultations carried out by nurses and their alignment with advanced practice.

Methods

This study adopted an ecological design,(¹⁷) based on aggregate data, considering the Brazilian territory and its subdivision into macro-regions in the year 2023.

This study is exempt from submission to the CEP/Conep system, since it is based exclusively on the analysis of secondary data, freely accessible to researchers and the general population, and therefore does not imply risks related to privacy, security, or control of access to information.

The data were extracted from the Health Reports/Production Platform of the Health Information System for Primary Care(¹⁸) and CNES Profissionais(¹⁹). To organize the data, a previous study matrix was used, operationalized by a comparative analysis between the Advanced Nursing Practice reference recommended by the ICN(¹) and those competencies established by the PNAB(²⁰) and according to the guidelines for the organization of Primary Care within the SUS.

Digital maps and respective geodetic coordinates were extracted from the website of the Brazilian Institute of Geography and Statistics – IBGE(²¹). The compilation of information related to the 2023 fiscal year took place from June 23 to 27, 2024, following the sequence and search process recommended in a previous study.¹⁴)

This study comprised two phases of analysis:

1. distribution of relative frequencies of ANP Nurse interventions regarding broad and expanded autonomy in scheduled consultations in PHC, in the five macro-regions of the country in 2023, corresponding to Characteristic 7 of the matrix(¹³) for analyzing the competencies and interventions of Advanced Nursing Practices in PHC, located in position seven of the domain Nature of Practice and Exercise of Advanced Nursing Practice, a matrix anchored in the guidelines of the ICN, PNAB, and Brazilian Ministry of Health(¹⁴,¹,²⁰)

2. georeferencing of information from the Matrix for analyzing competencies and interventions of Advanced Nursing Practices in PHC(¹⁴), highlighting the autonomy of nurses in scheduled consultations in PHC.

Phase 1 – Compilation of SISAB information

According to the formulated matrix, the information was grouped and organized in Excel spreadsheets, in line with the codes mapped in the SISAB reporting platform (Chart 1). Thus, indicator 7 was selected from the aforementioned matrix (Almeida, 2025)¹⁴).

Chart 1
Filters used for data extraction

Geographic unit	Brazil
Competence	JAN/23 to DEC/23
Type of production	Individual Care
Professional Category	Nurse
Place of Service	Basic Health Unit (UBS), Mobile Unit, Street, Home, School/daycare center, Hub, Institution/shelter, Prison or similar facility, Socio-educational facility, Others
Type of Team	Primary Health Care
Type of care	Scheduled appointment/continuous care; Scheduled appointment; Spontaneous demand with initial assessment/guidance; Walk-in appointment on the same day; Walk-in appointment with emergency care
Problem/Condition Assessed	Diabetes; Hypertension; Prenatal care; Sexual and reproductive health; Mental health; Communicable diseases; Cancer screening; Tuberculosis; Leprosy; Gestational syphilis - ICPC/ICD: ICD (O981) Syphilis Complicating Pregnancy, Childbirth, and the Puerperium, ICPC (X70) Female Syphilis.

The activities were added up by macro-region (Chart 2), generating national stratification.

Chart 2
Regional distribution of consultation activities conducted by nurses with broad and expanded autonomy in Primary Health Care in Brazil

ICN 2022 - 7. Broad and expanded autonomy (varies according to the country’s context and clinical scenario). PNAB 2017 - III - Perform and/or supervise reception with qualified listening and risk classification, according to established protocols; (differs from ICN; it is restricted because it is dependent on protocols)
SISAB 2023	North	Northeast	Southeast	South	Central-West
Diabetes	639,425	3,816,274	3,273,698	1,582,836	622,396
High blood pressure	1,311,895	7,840,041	6,353,573	3,147,622	1,283,332
Cardiovascular risk screening	10,830	120,032	105,932	95,368	3,862
Prenatal care; well-child care; Postpartum care (up to 42 days)	3,313,670	12,287,828	11,406,077	6,122,632	3,114,607
Sexual and reproductive health	686,974	2,594,749	25,260,088	932,351	244,685
Communicable diseases (Dengue, STDs, Leprosy, and Tuberculosis)	101,471	200,805	511,218	285,896	106,190
Breast and cervical cancer screening	153,248	971,686	2,116,514	1,482,732	217,400
Syphilis	11,089	19,396	33,506	17,587	12,201
Total Region	6,228,602	27,837,964	26,326,606	13,667,024	5,604,673
Grand Total 79,664,869

Phase 2 – Calculation of indicators and georeferencing of information

Based on the information compiled in Chart 1, stored and used in an Excel spreadsheet (total general REGION.xls), two indicators were constructed:

1. proportion, adjusted for the nurse population of each Brazilian macro-region

2. rate standardized by the direct standardization method. (¹⁷)

Adjusted proportion

Based on the total information, according to indicator 7 in Chart 1, the expected frequency (expected N) was obtained through multiple linear regression(¹⁷). The linear regression model considered the size of the nurse population as an adjustment variable (covariate), aiming to minimize the confounding effect of this variable on the frequencies of each item. After calculating the expected frequency for each item, the indicator (adjusted proportion) was calculated according to the formula below.

$\begin{array}{c}\text{Adjusted}\\ \text{proportion}\end{array}=\frac{\begin{array}{c}\text{N expected for the}\\ \text{item from chart}1\end{array}}{\text{total for the item}}\ast 100$

Standardized rate

Based on the total information, according to the indicator in the Chart, the “crude” frequencies [(N observed for the item/total for the item)] were calculated. The size of the Brazilian population (census year) was adopted as the standard population, and the indicators were estimated using the direct standardization method, according to the formula below

$\text{Standardized rate}=\frac{\begin{array}{c}\text{"raw" frequency of the item}\end{array}}{\begin{array}{c}\text{standard population}\end{array}}\ast {10}^{\text{n}}$

With the standardization technique applied and this indicator, it was possible to establish comparisons in two directions (intra and inter) macro-regions.

This indicator was subsequently classified into “quartiles,” using the quartiles of the distribution as cut-off points.

To calculate the indicator and plot the standardized rates on a thematic map,(²²) highlighting indicator 7, Stata software, version 13, was used, applying the ‘spmap’ command family.(²³)

Results

The data analyzed in this study highlight the significant role of nurses in PHC services in different regions of Brazil, particularly in consultations carried out by these professionals regarding the monitoring of chronic diseases, women’s health, and screening for health problems. The survey of consultations recorded in SISAB (2023) highlights the volume of these consultations in the Northeast and Southeast regions, with a higher concentration of consultations for hypertension, diabetes, and care during pregnancy and the postpartum period, as shown in Chart 2.

Chart 3 shows the proportion of consultations, adjusted to the number of nursing professionals linked to PHC, based on CNES records. The data indicate that the Southeast macro-region has the highest adjusted proportion (31.6%), followed by the Northeast (17.4%) and South (5.6%) regions. The North and Central-West regions show a lower relative participation, with 2.2% and 2.9%, respectively. This disparity may reflect inequalities in the size of the workforce and in the implementation of practices with expanded autonomy by nursing professionals.

Chart 3
Adjusted proportions, according to items in Chart 1 for Brazilian macro-regions

Macro-regions	Adjusted proportions*
	7
North	2.2
Northeast	17.4
Southeast	31.6
South	5.6
Central-West	2.9
* Adjustment for the size of the nurse population

Chart 4 shows the standardized indicator, which considers the total Brazilian population as the reference standard. The Northeast (16.4%) and Southeast (15.5%) regions stand out in relation to the national average, indicating greater significance in the development of care provided with broad and expanded autonomy. In contrast, the North (3.7%), South (8.0%), and Central-West (3.3%) regions have the lowest standardized indicators.

Chart 4
Standardized indicators, according to items in Chart 1 for Brazilian macro-regions

Macro-regions	Standardized indicators*
	7
North	3.7
Northeast	16.4
Southeast	15.5
South	8.0
Central-West	3.3
* Standardization by the direct method, adopting the total Brazilian population as the standard population.

This regional distribution can also be seen in Figure 1, which shows a concentration of the highest proportions in the states belonging to the Northeast and Southeast regions, reinforcing the strategic role of these locations in the consolidation of advanced nursing practices in primary care. Spatial analysis reveals inequality in the distribution of practices with a higher degree of autonomy, possibly related to local policies, training and/or professional development opportunities, and service organization.

Figure 1
Geographic distribution of the indicator of broad and expanded autonomy in consultation activities performed by nurses in Primary Health Care. Brazil

Discussion

The clinical skills developed by PHC nurses in Brazil reveal an important role in conducting scheduled consultations, spontaneous demand, and/or emergency care.

Considering the legal perspective, it is important to remember that Law No. 7,498/1986(¹⁶) provides for the professional practice of nursing, establishing in its Article 11 that nurses are responsible for performing all nursing activities, including, among others, nursing consultations. This legal provision confers legitimacy on the autonomous clinical practice of nurses, a central element of advanced practice.

Additionally, Ordinance No. 2,436/2017, which establishes the National Primary Care Policy (PNAB),(²⁰) reinforces this regulation by specifying the specific duties of professionals working in PHC teams. Item 4.2.1 states that nurses are responsible for: “conducting nursing consultations, procedures, requesting complementary tests, prescribing medications in accordance with protocols, clinical and therapeutic guidelines, or other technical regulations established by federal, state, municipal, or Federal District managers, in compliance with the legal provisions of the profession.”

Although they do not constitute specific regulations for Advanced Nursing Practice along the lines adopted internationally, these provisions indicate that expanded clinical competencies are already recognized and performed in the daily routine of Brazilian PHC.(²⁰) In this sense, the construction of a specific regulatory framework could consolidate, formalize, and expand already established practices, contributing to the problem-solving capacity and quality of health care in the country.

The recent Technical Note from the Federal Nursing Council (COFEN) reinforces the existence of advanced nursing practices in the context of the Unified Health System (SUS), especially in Primary Health Care (PHC).(²⁴) According to the document, these practices are already part of the healthcare reality in different regions of the country, which highlights the urgency of mapping, analyzing, and qualifying them systematically in order to maximize their impact on health indicators and the effectiveness of care. A notable example of this mobilization is the national survey conducted in partnership between COFEN and the University of Brasília, which identified and characterized the clinical competencies exercised by nurses in PHC, revealing a significant set of actions that align with the attributes of Advanced Nursing Practice, even in the absence of specific regulations.(²⁰,¹⁶,²⁴)

From a legal, political, and academic perspective, the evolution of Advanced Nursing Practice in Brazil has shown more significant advances than setbacks.(²⁵-²⁸) Although the consolidation process has been slow and challenging, there has been a gradual but consistent trajectory toward the recognition and effective implementation of this model in the Brazilian context.

Based on analyses using SISAB data, this study shows that nurses in PHC provide various types of consultations; the investigation focused on care for patients with diabetes, hypertension, prenatal care, sexual and reproductive health, communicable diseases, cancer screening, tuberculosis, leprosy, and syphilis. In extracting data from SISAB, considering the year 2023, a significant volume of 79,664,869 consultations was calculated, distributed in the following order of magnitude by region in the country: Northeast, followed by Southeast, South, North, and Central-West.

Even with the support of the PNAB, which gives nurses the prerogative to conduct consultations with autonomy and authority to make diagnoses, as well as other complex activities, it is essential that each municipality establish protocols in order to expand the scope of practice in serving the population.(²⁰,²⁸)

From the perspective of professional practice, the care highlighted in this study underscores the extent of nursing’s role in consolidating the principles of the SUS. In the Northeast, nurses conducted 27,837,964 consultations, and in the Southeast, 26,326,606, as shown in Chart 2.

In the case of hypertension, it should be noted that its prevalence in adults is approximately one-fifth to one-third of the Brazilian adult population, according to a study that investigated 60,202 people.(²⁹) In this study, it was observed that the Northeast performed a total of 7,840,041 consultations with patients with hypertension, while the Central-West performed a lower number, with 1,283,332 consultations. Undoubtedly, the demand for and access to health services expresses the need for intervention by nurses, as demonstrated in a clinical study with a significant number of hypertensive patients who adhered to treatment after consultation and nursing intervention.(³⁰)

Research conducted under the Family Health Strategy (ESF) in a municipality in the state of Piauí, with the participation of 27 users, detected a high level of satisfaction with nursing consultations.(³¹) Complementarily, another study, conducted using a convergent care research approach in a municipality in Rio Grande do Sul, identified that the nursing consultation offered in the ESF to people diagnosed with diabetes mellitus has been structured by nurses based on components that align with the principles of the Chronic Conditions Care Model (MACC). Among these elements, the following stand out: strengthening the bond with users, shared responsibility for care, continuity of care, and the inclusion of social and family dimensions in the care process.

This study found 12,287,828 nursing consultations in the Northeast region focused on prenatal care, well-child care, and the postpartum period (up to 42 days after delivery). In the Southeast region, there were 25,260,088 consultations related to sexual and reproductive health. These figures reflect a significant expansion in access to health services, reinforcing comprehensive women’s health care as a fundamental strategy for reducing maternal mortality and promoting reproductive health.

In the state of Maranhão, the perception of pregnant women regarding nursing consultations during prenatal care was analyzed. The results revealed a positive reception by pregnant women, who reported feeling welcomed, especially when the nurse was friendly, performed a complete physical examination, listened attentively, spoke clearly and without rushing, and when the consultation was conducted with adequate time. The guidance provided during the consultation was considered relevant, with an emphasis on maternal and child health care, nutrition, and medication use, described as practical and attentive information.(³³)

Another study recorded the role of nurses in promoting women’s reproductive health, identifying interaction in educational nursing care, the conduct of informational groups focused on guidance and awareness, activities aimed at prevention and clarification about sexually transmitted infections, in addition to clinical nursing care with an emphasis on guidance and the provision of contraceptive methods, reinforcing the role of nurses in comprehensive care for women’s sexual and reproductive health.(³⁴)

With regard to cancer screening in women, ESF nurses have been carrying out actions to meet the Ministry of Health’s requests for breast cancer screening.

Our study reveals intense activity by nurses in the Southeast region, with 2,116,514 consultations, followed by the South with 1,482,732. These data corroborate the findings of a multicenter study conducted in 27 states and the Federal District, carried out in Primary Health Care (PHC). In particular, in the state of Rio Grande do Sul, it was found that most nurses perform cervical cancer (CC) and breast cancer (BC) prevention and screening practices in eight municipalities investigated, in accordance with the guidelines of the Ministry of Health. Among these practices, we highlight the performance of clinical breast exams, the request for mammograms, and the collection of cytopathological exams.(³⁶)

Nurses are qualified and legally authorized to diagnose and treat sexually transmitted infections,(³⁷)and their work stands out both during nursing consultations and in actions such as welcoming patients, qualified listening, identifying cases of syphilis, prescribing and administering medications, and implementing educational practices aimed at promoting health. These professionals use clinical protocols for prescribing medication and follow previously established care flows, ensuring comprehensive care for people with syphilis. Thus, nurses exercise their practice autonomously in pharmacotherapeutic management, based on solid technical and scientific training, institutional support, and coordination with the multidisciplinary team, aiming to offer effective responses to the health demands of the population.(³⁸)

In line with policies that place PHC at the top of the global health agenda, the leadership of nurses is crucial, as they are capable of demonstrating competence in transforming policies into practices, shifting the focus from concept to action, promoting change, and combining PHC and APN as the path to achieving universal health coverage.

Conclusion

The results of this study reinforce the demonstration of ANP’s own competencies by showing that nurses working in PHC perform a significant volume of clinical consultations, often linked to more complex diagnostic, prescriptive, and therapeutic decisions. These findings demonstrate the characteristic attributes of ANP, even in the absence of specific qualifications or formal legal recognition, reiterating the urgent need for national ethical and legal regulation. Such regulation should align Brazilian practice with international guidelines aimed at strengthening the nursing workforce.

Acknowledgments

To the Federal Nursing Council (COFEN) and the Coordination for the Improvement of Higher Education Personnel - Brazil (CAPES) - 001.

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• Data availability:
  The authors did not make the data from this article available in repositories prior to submission.

Edited by

• Guest Associate Editor:
  Márcia Barbieri (https://orcid.org/0000-0002-4662-1983) Escola Paulista de Enfermagem, Universidade Federal de São Paulo, São Paulo, SP, Brazil

Data availability

The authors did not make the data from this article available in repositories prior to submission.

Publication Dates

• Publication in this collection
  09 Feb 2026
• Date of issue
  2025

History

• Received
  25 Mar 2025
• Accepted
  8 Sept 2025