145

ISSN: 2763-5724 / Vol. 06 - n 04 - ano 2026

SUPPLY MANAGEMENT AND NURSING AUTONOMY IN PRIMARY CARE:

CHALLENGES AND THE NEED FOR TRAINING THE NURSING TEAM IN

WOUND CARE AND MEDICATION ADMINISTRATION

Paulo Henrique Dias Trofelli1

Luís Carlos Bueno2

Sara Luciana de Andrade3

Thiago Inocêncio Trofelli4

Alexsandro N. Oliveira5

Marilu de Souza Franco6

Cleber Aparecido Medeiros da Silva7

Abstract: The management of supplies in Primary Health Care (PHC), including ointments,

medications, and materials used in wound care, is essential to ensure continuity of care and patient

safety. In this context, nurses have technical and scientiﬁ c autonomy to make decisions regarding the

selection of products and clinical interventions, according to professional regulations and institutional

protocols. However, in practice, there is often a lack of necessary supplies to properly implement

1 Bacharel em Enfermagem pela Universidade de Mogi das Cruzes – UMC. E-mail: paulot-

dias5@gmail.com - Orcid: https://orcid.org/0009-0006-6733-8235

2 Especialista em urgência e emergência , UTI Adulto , Cardiologia e Hemodinâmica , docência

do ensino Superior Faculminas https://orcid.org/0009-0005-2741-9471

3 Mestranda pela Universidade Ivy Enber Christian University – E-mail: drasaraandrade@

yahoo.com - ORCID iD: https://orcid.org/0009-0004-6094-502X

4 Mestrado em Políticas Públicas pela Universidade de Mogi das Cruzes - UMC. E-mail: thia-

goinocenciotrofelli@gmail.com - Orcid: https://orcid.org/0009-0002-8938-8525

5 Mestrado em gestão de Cuidados da Saúde pela Universidade da Amazônia – UNAMA –

E-mail: ano_alexsandro @yahoo.com – Orcid: https://orcid.org/0009-0001-7023-7092

6 Mestranda em Gestão de Cuidados da Saúde pela Must University. Professora do Curso de

Enfermagem na Universidade de Mogi das Cruzes – UMC.

7 Especialista em Saúde Mental pela FACULESTE– Universidade de Minas Gerais. E-mail: cle-

binhoo79@gmail.com – Orcid: https://orcid.org/0009-0006-0544-1472

146

ISSN: 2763-5724 / Vol. 06 - n 04 - ano 2026

clinical decisions, which compromises the effectiveness of care. This study aims to discuss supply

management in PHC, nursing autonomy, and the importance of training nursing technicians in

wound care and medication administration. This is a literature-based analysis grounded in scientiﬁ c

studies and guidelines from the Brazilian Uniﬁ ed Health System (SUS), highlighting the need for

management plans and continuing education strategies. It is concluded that the integration of resource

management, professional training, and nursing autonomy is essential to improve the quality of care

in Primary Health Care.

Keywords: Continuing Education; Nursing; Primary Health Care; Supplies Management; Wound

Care.

INTRODUCTION

Primary Health Care (PHC) is the main gateway to the Uniﬁ ed Health System (SUS) and

plays a strategic role in the organization of the care network, being responsible for the coordination of

care and the resolution of the population’s health demands. In this scenario, nursing occupies a central

position, especially in the Family Health Strategy (FHS), where nurses work directly in care, service

management and clinical decision-making based on scientiﬁ c evidence.

The work of nurses in PHC is supported by legal provisions that guarantee their technical

and scientiﬁ c autonomy, including Law No. 7,498/1986, which regulates the professional practice of

nursing in Brazil. In practice, this autonomy is expressed in the evaluation of users, in the prescription

of nursing care, in the request for exams according to institutional protocols, and in the choice of

materials for dressings and topical therapies. Recent studies indicate that nurses’ autonomy in PHC is

directly associated with the expansion of care problem-solving, especially when supported by well-

established clinical protocols and efﬁ cient management of available resources (Geremia et al., 2024; ).

However, despite the normative and technical advances of the profession, the literature shows

that nurses’ autonomy is still frequently limited by structural factors related to the management of

147

ISSN: 2763-5724 / Vol. 06 - n 04 - ano 2026

inputs and material resources. The unavailability of medications, ointments, special wound dressings

and other essential materials compromises the proper execution of the prescribed conducts, forcing

the professional to adapt care according to the availability of the unit, which can have a direct impact

on the quality of the care provided.

According to studies on the management of material resources in health, the inadequate

organization of supply and the absence of efﬁ cient planning in Primary Care services represent

important obstacles to the continuity of care and patient safety (Borba et al., 2023). These ﬁ ndings

demonstrate that the management of inputs is not only an administrative activity, but an essential

component of clinical practice in nursing, as it directly interferes in decision-making and in the

effectiveness of care interventions.

In addition, recent literature highlights that nurses play a fundamental role in the management

of health units, being responsible not only for direct care, but also for planning, organizing and

supervising the work process of the nursing team. Studies indicate that the role of nurses in Primary

Care is related to their ability to articulate resources, coordinate teams, and implement strategies that

ensure the continuity and quality of care (Santos et al., 2024).

In this context, the nursing team is composed of nurses, technicians and auxiliaries, the latter

being fundamental in the direct execution of procedures such as dressings, medication administration

and support for care actions. However, it is observed that the training of these professionals still has

weaknesses, especially with regard to the standardization of conducts and the appropriate use of

materials available in Primary Care.

Recent research shows that the fragmentation of the work process and the absence of

structured continuing education contribute to inconsistencies in care practice, in addition to increasing

variability in the quality of care provided (Sousa et al., 2025). Thus, the need to implement continuous

training strategies aimed at the nursing team becomes evident, with a focus on dressings, wound

management and rational use of inputs and medications.

Another relevant aspect identiﬁ ed in the literature is that work overload, associated with

148

ISSN: 2763-5724 / Vol. 06 - n 04 - ano 2026

the scarcity of material and human resources, compromises nurses’ ability to fully exercise their

autonomy in PHC. This reality generates a scenario of constant adaptation, in which clinical decisions

are often inﬂ uenced by the availability of inputs, and not exclusively by the best scientiﬁ c evidence.

In addition, inadequate material management directly impacts patient safety, which can lead

to delays in treatment, inadequate product replacements, and increased risk of wound complications

and infectious processes. Thus, the management of inputs should be understood as a strategic

component of the quality of care, and not just as a logistical activity.

In view of this, it is essential to discuss the need to implement more efﬁ cient management

plans in Primary Health Care, combined with continuing education programs that strengthen the

training of nursing technicians and expand the autonomy of the team. This articulation between

management, training and professional autonomy is essential to ensure safer, more problem-solving

and evidence-based care.

Therefore, this study is justiﬁ ed by the need to understand how the management of inputs

inﬂ uences nursing practice in PHC, as well as by the importance of strengthening the training of the

nursing team as a strategy for qualifying care and improving health outcomes.

OBJECTIVES

General Objective

To analyze the management of inputs in Primary Health Care (PHC) and its relationship

with nurses’ autonomy and the training of nursing technicians in dressing care and medication

administration.

Speciﬁ c Objectives

To describe the role of nurses in the management of inputs, medicines and materials used in

149

ISSN: 2763-5724 / Vol. 06 - n 04 - ano 2026

Primary Health Care;

Identify the main challenges related to the availability and organization of inputs in PHC;

To analyze the autonomy of nurses in clinical decision-making in the face of limited material

resources;

Discuss the importance of continuous training of nursing technicians in dressing and

administering medications;

Reﬂ ect on the impact of the scarcity of supplies on the quality of care and patient safety;

To propose the need for management strategies and continuing education in nursing aimed at

the qualiﬁ cation of care in PHC.

METHODOLOGY

This study is characterized as a qualitative research, exploratory and descriptive in nature,

developed through a narrative literature review, with the objective of analyzing the management of

inputs in Primary Health Care (PHC), the autonomy of nurses and the training of nursing technicians

in dressing care and medication administration.

The qualitative approach, according to Minayo (2014), allows us to understand social and

organizational phenomena in health from their subjective, contextual and structural dimensions, and

is suitable for investigations involving work processes, nursing management and care practices in the

SUS.

The narrative review was chosen because it enables a broad and interpretative analysis of

the existing scientiﬁ c literature, allowing the synthesis of relevant knowledge on material resource

management, professional autonomy and continuing education in nursing. According to Rother

(2007), this type of review is appropriate to describe and discuss the state of the art of a given theme,

contributing to critical reﬂ ection on professional practice.

The data search was carried out in recognized scientiﬁ c databases, including Scientiﬁ c

150

ISSN: 2763-5724 / Vol. 06 - n 04 - ano 2026

Electronic Library Online (SciELO), Latin American and Caribbean Literature on Health Sciences

(LILACS), Virtual Health Library (VHL) and Google Scholar, as well as ofﬁ cial documents from the

Ministry of Health and legislation related to nursing practice in Brazil.

The following inclusion criteria were used: scientiﬁ c articles available in full, published in

Portuguese, with an approximate time frame of the last 15 years, in addition to ofﬁ cial and normative

documents related to Primary Health Care, health management, nursing and continuing education.

Duplicate studies, publications without scientiﬁ c rigor, articles outside the proposed theme or that did

not directly address the management of inputs or the performance of nursing in PHC were excluded.

The descriptors used for the search were selected based on the Health Sciences Descriptors

(DeCS), namely: “Primary Health Care”, “Nursing”, “Resource Management”, “Permanent

Education”, “Dressings” and “Professional Autonomy”, combined through Boolean operators such as

AND and OR, in order to reﬁ ne the results and expand the relevance of the evidence found.

Data analysis was carried out through exploratory, selective, analytical and interpretative

reading, with subsequent organization into thematic categories. This process allowed the identiﬁ cation

of convergences and divergences among the authors, enabling the construction of a critical discussion

about the management of inputs, the autonomy of nurses and the training of the nursing team in PHC.

According to Bardin (2011), content analysis is a technique that enables the systematization

of qualitative data through thematic categorization, allowing consistent inferences about the object

studied. Thus, the ﬁ ndings were interpreted in the light of the scientiﬁ c literature and public health

policies in force in Brazil.

Finally, it should be noted that this study does not involve research with human beings, and

submission to the Research Ethics Committee is waived, according to Resolution No. 510/2016 of the

National Health Council, as it is a literature review.

151

ISSN: 2763-5724 / Vol. 06 - n 04 - ano 2026

RESULTS AND DISCUSSION

Input management and nurse autonomy in Primary Health Care

The ﬁ ndings of the literature show that the management of inputs in Primary Health Care

(PHC) is one of the most determinant components for the quality of nursing care, directly impacting

professional autonomy, continuity of care and patient safety. PHC, as the gateway to the Uniﬁ ed

Health System (SUS), depends on the efﬁ cient organization of material resources to ensure problem-

solving capacity and comprehensiveness of care. In this scenario, nurses occupy a strategic position

both in direct care and in the management of work processes.

The autonomy of nurses in PHC is legally recognized by Law No. 7,498/1986 and reinforced by

institutional protocols and public health policies. This autonomy is expressed in the clinical evaluation

of the user, in the prescription of nursing care, in the request for exams according to protocols and in

the choice of materials for dressing and therapeutic interventions. However, the ﬁ ndings demonstrate

an important contradiction between formally guaranteed autonomy and its practical implementation

in the daily routine of services.

Geremia et al. (2024) highlight that, although nurses have technical and legal support to

practice advanced practice in PHC, the limitation of material resources constitutes a signiﬁ cant

barrier to clinical decision-making. The absence of adequate supplies, such as speciﬁ c wound

dressings, healing ointments, antiseptic solutions, and certain standardized medications, means that

professionals need to adapt their conducts based on local availability, and not necessarily on the best

available scientiﬁ c evidence.

This scenario reveals one of the main ﬁ ndings in the literature: nurses’ autonomy is

conditioned by the organizational structure and resource management of the health unit. In other

words, autonomy is not fully exercised, but rather mediated by structural limitations that directly

interfere with the quality of care.

Another relevant ﬁ nding refers to failures in the process of managing materials and inputs.

152

ISSN: 2763-5724 / Vol. 06 - n 04 - ano 2026

Borba et al. (2023) point out that the absence of adequate planning, inefﬁ cient inventory control, and

lack of integration between administrative and care sectors result in frequent shortages in basic health

units. This reality compromises not only the work of nursing, but the entire ﬂ ow of PHC care.

In addition, the literature shows that the management of inputs is still often understood as

an exclusively administrative activity, when in reality it should be recognized as an integral part

of the health work process. Nurses, as care managers, should actively participate in the deﬁ nition

of acquisition protocols, standardization of materials and consumption planning, since they are the

professionals who are directly involved in patient care.

Santos et al. (2024) reinforce that the role of nurses in the management of family health units

still faces institutional limitations, such as centralization of decisions, bureaucratization of purchasing

processes, and low administrative autonomy. These factors reduce the nurse’s ability to organize care

in an efﬁ cient and evidence-based manner.

Another aspect identiﬁ ed in the studies is the direct impact of the shortage of supplies on

patient safety. The lack of adequate materials for dressings, for example, can lead to the use of less

effective substitutes, increased healing time, a higher risk of infection, and aggravation of injuries.

Thus, the inadequate management of material resources is not only an organizational problem, but

also an important care risk factor.

The ﬁ ndings also demonstrate that units with better organization of the management

of supplies have better indicators of quality of care, greater problem-solving capacity of the cases

attended, and less need for referrals to secondary levels of care. This shows that efﬁ ciency in resource

management directly impacts the effectiveness of PHC.

Another relevant point is that nurses’ autonomy is directly related to the availability of

institutional support. When there is adequate planning, active participation of nursing in management

and well-deﬁ ned ﬂ ows of material replacement, nurses are able to perform their clinical practice in a

safer, more grounded and problem-solving way.

Thus, the results demonstrate that the management of inputs cannot be dissociated from

153

ISSN: 2763-5724 / Vol. 06 - n 04 - ano 2026

clinical practice, being a structuring element of professional autonomy and the quality of nursing care

in PHC.

Training of nursing technicians and impact on the quality of care in dressings and medication

administration

The second axis of analysis shows that the training of nursing technicians is an essential

element for the quality of care in Primary Health Care, especially in practices related to dressings,

medication administration and direct support to nurses’ care activities. Nursing technicians represent

the largest operational workforce in PHC and are directly involved in the execution of daily care for

users.

The ﬁ ndings of the literature demonstrate that, despite its strategic importance, there are still

signiﬁ cant gaps in the continuous training of these professionals. The absence of structured programs

for continuing education in health compromises the standardization of care practices, generating

variations in the execution of procedures and increasing the risk of inconsistencies in care.

Sousa et al. (2025) highlight that the fragmentation of the nursing work process is directly

related to the absence of continuous and systematized training of the technical team. This fragmentation

directly impacts the quality of dressings, the safe administration of medications, and the proper use

of supplies available at the health unit.

Another important ﬁ nding refers to the role of nurses as permanent educators of the nursing

team. The literature indicates that when nurses actively assume the role of supervision, training and

guidance of technicians, there is a signiﬁ cant improvement in the quality of the procedures performed,

greater safety in care and reduction of technical errors.

Continuing education in health is understood as a fundamental institutional strategy for the

transformation of work practices. Unlike one-off training, it must be continuous, integrated into the

daily routine of the services and based on the real needs of the team. In this sense, the ﬁ ndings show

154

ISSN: 2763-5724 / Vol. 06 - n 04 - ano 2026

that units that implement structured training programs have better care results.

In addition, the training of nursing technicians has a direct impact on the management of

inputs. Well-trained professionals tend to use materials more rationally, avoiding waste, reducing

costs, and contributing to the sustainability of the system. This aspect is especially relevant in contexts

of resource scarcity, as often observed in PHC.

Another point identiﬁ ed in the literature is the relationship between training and patient

safety. Improper dressings, for example, can lead to infections, delayed healing, and aggravation of

injuries. Likewise, errors in the administration of medications can generate avoidable adverse events,

compromising the quality of care and increasing the demand for more complex services.

The ﬁ ndings also indicate that the training of the nursing team contributes to the strengthening

of teamwork and to the improvement of communication between nurses and technicians. This

integration is essential to ensure the continuity of care and the standardization of care practices.

Another relevant aspect is that continuing education contributes to the development of

the technical autonomy of mid-level professionals, within the legal limits of their performance.

More qualiﬁ ed nursing technicians are able to perform their activities with greater safety, clinical

understanding and responsibility, which directly reﬂ ects on the quality of the care provided.

Finally, the literature converges in pointing out that the articulation between team training,

efﬁ cient management of inputs and the nurse’s role as a care manager results in a safer, more problem-

solving and efﬁ cient care model. Thus, continuing education in health is conﬁ gured as a structuring

axis for the qualiﬁ cation of Primary Care and for the strengthening of nursing as a professional

category.

CONCLUSION

The present review showed that the management of inputs in Primary Health Care (PHC)

exerts a direct inﬂ uence on the quality of nursing care, especially with regard to nurse autonomy and

155

ISSN: 2763-5724 / Vol. 06 - n 04 - ano 2026

the training of nursing technicians. The ﬁ ndings demonstrate that, although nurses have legal and

technical support for clinical and managerial decision-making, the effectiveness of this autonomy

is still limited by structural weaknesses related to the availability of material resources and the

organization of work processes.

It was found that the scarcity or inadequacy of inputs such as medicines, ointments and

dressing materials compromises the continuity of care, forcing the professional to adapt care conducts

based on the availability of the unit, which can negatively impact the quality and safety of the care

provided. Thus, the management of inputs is conﬁ gured not only as an administrative activity, but as

an essential component of clinical practice in nursing.

In addition, the results indicate that the training of nursing technicians represents a fundamental

element for strengthening PHC. The absence of structured continuing education programs contributes

to the variability of care practices and can compromise the proper execution of procedures such as

dressings and medication administration. In this sense, the nurse’s role as a permanent educator of the

team is indispensable for the qualiﬁ cation of care.

Another relevant point identiﬁ ed is that the integration between resource management,

professional training and nurse autonomy contributes signiﬁ cantly to the improvement of health

indicators, greater patient safety and strengthening of teamwork. When these elements are articulated,

it is possible to observe a more problem-solving, efﬁ cient care that is aligned with the needs of the

population served in Primary Care.

Therefore, it is concluded that it is essential to strengthen institutional strategies aimed at

improving the management of inputs, valuing nurses’ autonomy and implementing effective policies

for continuing education in health. These actions are essential to ensure the qualiﬁ cation of care,

patient safety, and the consolidation of a more integrated, efﬁ cient, and evidence-based care model

within the scope of the Uniﬁ ed Health System (SUS).

156

ISSN: 2763-5724 / Vol. 06 - n 04 - ano 2026

The nurse as a leader and permanent educator in the training of nursing technicians in Primary

Health Care

In the organization of health work in Primary Health Care (PHC), nurses assume a strategic

position not only in direct care to users, but also in the coordination of the nursing team and in the

management of the work process. In this context, their performance as a leader is directly related to

the managerial competencies provided for in the policies of the Uniﬁ ed Health System (SUS) and

in the Primary Care Guidelines, which recognize the nurse as responsible for organizing care and

supervising the actions of the multiprofessional team. According to the Ministry of Health (Brasil,

2017), PHC requires professionals capable of integrating management and care, with nursing being

one of the pillars of this articulation.

Nurses’ leadership in PHC is directly associated with their ability to organize workﬂ ows,

establish care priorities, and ensure continuity of care. According to Santos et al. (2024), the nurse

in the Family Health Strategy plays a fundamental role in coordinating the work process, acting

as a mediator between management and care. This role requires decision-making skills, effective

communication, and technical oversight, ensuring that the team’s actions are carried out safely and

based on scientiﬁ c evidence.

In this scenario, continuing education in health stands out as one of the main tools for the

head nurse in the training of nursing technicians. As recommended by the Ministry of Health (Brasil,

2004), continuing education is a structuring strategy of the SUS, aimed at transforming work practices

based on critical reﬂ ection on the reality of the service. Unlike one-off training, it is a continuous

process, integrated into the daily life of the units, which aims to qualify care and strengthen the

autonomy of professionals.

In the daily routine of PHC, nurses play a fundamental role in the practical guidance of

nursing technicians, especially in procedures that require technical standardization and care safety,

such as dressings, medication administration and wound care. According to Oliveira et al. (2020), the

157

ISSN: 2763-5724 / Vol. 06 - n 04 - ano 2026

nurse’s direct supervision in these procedures signiﬁ cantly reduces care errors and increases patient

safety, since it ensures the correct application of techniques and the appropriate use of available

materials.

In addition, the nurse’s role as an educator contributes to the standardization of care practices

within the health unit. According to Souza et al. (2022), the absence of well-implemented protocols

and continuous team training results in variability in care, which can compromise the quality of

care. Standardization guided by the nurse allows for greater uniformity in conduct, ensuring that

procedures are performed according to scientiﬁ c evidence and institutional guidelines.

Another relevant aspect is that the continuous training of nursing technicians has a direct

impact on the management of inputs and the efﬁ ciency of services. Well-trained professionals tend to

use materials more rationally, better understanding the indication of each product and avoiding waste.

According to Borba et al. (2023), the efﬁ cient management of material resources in health depends

directly on the qualiﬁ cation of the team that uses them, and continuing education is a determining

factor for the sustainability of the system.

However, the literature also points out important challenges for the exercise of this educational

function by nurses. Among them, work overload, high demand for care and insufﬁ cient time for in-

service education activities stand out. According to Figueiredo and Machado (2019), these structural

factors limit the effective implementation of continuing education in basic health units, making it

difﬁ cult to consolidate a culture of continuous learning.

Despite these difﬁ culties, studies show that units where nurses actively play their role as

leaders and educators have better care results. According to Geremia et al. (2024), the practice of

nursing leadership associated with continuing education is related to the improvement of quality

indicators, greater patient safety, and greater integration of the health team. This demonstrates that

continuous training should not be seen as a complementary activity, but as an essential component of

the organization of health work.

Thus, it is concluded that the head nurse plays a central role in the qualiﬁ cation of the nursing

158

ISSN: 2763-5724 / Vol. 06 - n 04 - ano 2026

team in Primary Health Care, being responsible for articulating leadership, continuing education and

care management. Its performance is essential to ensure patient safety, the standardization of care

practices and the rational use of inputs, thus strengthening the quality of care provided within the

scope of the SUS.

REFERENCES

BRAZIL. Ministry of Health. National Policy for Permanent Education in Health. Brasília: Ministry

of Health, 2004.

BRAZIL. Ministry of Health. Primary Care: National Primary Care Policy (PNAB). Brasília: Ministry

of Health, 2017.

BORBA, D. C. et al. Management of material resources in health: challenges for nursing in Primary

Care. Journal of Health Administration, 2023.

FIGUEIREDO, M. F. S.; MACHADO, M. H. Permanent education in health: limits and possibilities

in Primary Care. Ciência & Saúde Coletiva, 2019.

GEREMIA, D. S. et al. Professional autonomy of nurses in Primary Health Care: perspectives for

advanced practice. COFEN – Digital Library, 2024.

OLIVEIRA, A. C. et al. Nurse supervision and patient safety in Primary Care. Brazilian Journal of

Nursing, 2020.

SANTOS, E. P. et al. The role of nurses in the management of family health units: scenarios and

challenges. UFPE Nursing Journal, 2024.

SOUZA, L. M. et al. Standardization of nursing practices and quality of care in PHC. Current Nursing

Journal, 2022.