Chronic Nurse Shortage Leaves Amadora-Sintra Hospital Overwhelmed

Lisbon’s busiest suburban hospital just lost its top nurse manager, and the warning signs could hardly be clearer: emergency rooms overflowing, beds closed for lack of staff, and a Ministry of Health still searching for an answer. What follows unpacks how the resignation of Luísa Ximenes at Hospital Amadora-Sintra has become a case study in Portugal’s chronic shortage of nurses—and why the outcome matters far beyond the ring-road of the capital.

Why should Lisbon care?

• 80 extra beds opened in half a year—yet still not enough

• Region needs 7 000+ additional nurses, the unions say

• Emergency teams filing formal “escusa de responsabilidade” protests

• Government floats public-private partnerships as a fix, starting with this very hospital

• A staffing crunch that could reshape waiting times from Sintra to Setúbal

A resignation that broke the dam

When Luísa Ximenes walked out of the chief-nurse office in early January, she left behind a handwritten note accusing the Health Ministry of “zero support.” Within hours, corridors buzzed with talk of a second board dismissal in less than a year. Colleagues say the departure crystallised months of double-shifts, emergency room bottlenecks, and mounting burnout.

Hospital Amadora-Sintra is no small provincial unit; it covers more than 550 000 residents across western Greater Lisbon. By her own tally, Ximenes’s team had created three new intensive-care rooms and kept emergency theatres running on skeleton staffing. “You can’t manage the unmanageable,” she told local radio before switching off her phone.

Inside the corridors: staff stretched to the limit

Nurses describe an atmosphere where every alarm bell seems permanently on. “Triage areas are designed for 20 patients; we often have 50, some waiting on makeshift stretchers,” said an ER nurse with 12 years’ service. She and 70 colleagues have already filed legal disclaimers that transfer liability to the administration if care standards slip.

Surgeons recount postponed procedures because overnight wards lack the ratio of 1 nurse to 6 beds recommended by the Order of Nurses. Farther down the line, physiotherapists and radiographers report similar shortages, turning routine recovery sessions into week-long delays.

Numbers that tell the story

Across Lisbon and Vale do Tejo, the deficit sits at roughly 7 106 nurses, according to the latest union audit. Nationally, Portugal fields 7.6 nurses per 1 000 inhabitants, while the OECD mean hovers near 9.3. Closing that gap would require hiring an entire cohort the size of Évora’s population.

Knock-on effects are already visible:

• Hospital Cascais had 15 surgical beds mothballed last semester.

• São José closed 16 neuro-surgery beds due to short staffing.

• The national cancer institute, IPO Lisboa, flagged a “critical” nurse deficit last spring.

Each cutback feeds a vicious circle: heavier workloads prompt experienced staff to emigrate, which then inflates agency-nurse spending and erodes continuity of care.

What authorities have—and haven’t—done

Facing headlines, the Health Ministry points to a slate of 2026 measures: a centralised wait-list tracker, extra funding for ambulances and VMER units, and a promise to add more medical specialists per 100 000 users. Yet none directly tackles the day-to-day nurse ratio at Amadora-Sintra.

The most controversial move is a plan to reopen competition for public-private partnerships (PPP) in five hospitals, including this one. Officials argue the model can inject quick capital and management expertise. Critics counter that PPPs solved little when first tried in the 2010s and may even accelerate the flight of nurses to the private sector if pay gaps widen.

Voices from the wards and from the unions

The Portuguese Nurses’ Union (SEP) has requested an urgent sit-down with the minister, pressing for career progression, better night-shift bonuses, and the immediate hiring of newly graduated nurses now eyeing jobs abroad. SEP leader José Carlos Martins insists that without a wage package “comparable to Spain’s €2 000 starting salary,” Portugal will bleed talent.

Meanwhile, the Portuguese Association of Nurses (ASPE) flags legal grey areas: a January rule abolishing “virtual” pay steps still lacks implementation guidelines, leaving thousands in limbo over back pay.

Even Lisbon residents with private insurance feel the strain. When public hospitals shut operating rooms, waiting lists migrate to the private sector, driving up co-payment fees and tying general practitioners’ hands when they try to refer urgent cases.

The broader picture for citizens

For families in Benfica, Queluz, or Cacém, the debate is not academic. A child’s high fever at 02:00 can mean a two-hour taxi ride to a functioning paediatric unit; a grandparent’s hip fracture might wait an extra 48 hours for surgery. According to the National School of Public Health, every 10 % increase in nurse workload translates into a 7 % rise in patient mortality within thirty days of admission.

Tourism, a linchpin of Lisbon’s economy, also feels the ripple. Hotels quietly note that travellers increasingly ask about proximity to operational emergency departments before booking.

What comes next

Parliament’s health committee is expected to summon both hospital managers and union leaders later this month. A draft agenda seen by the Observer hints at debate over:

• Mandatory minimum nurse ratios enshrined in law

• An accelerated foreign-credential recognition track to lure Portuguese-speaking nurses from Brazil and Angola

• Monetary incentives for staff who choose to remain in high-pressure urban hospitals rather than migrate to less intense coastal clinics

For now, however, the wards of Amadora-Sintra keep operating under crisis rules—postponing elective work, reallocating staff daily, and hoping the next resignation does not land on an already overfilled desk.