Challenges and advances of implementing affirmative action policies within graduate nursing programs

Background: Affirmative action (AA) policies are increasingly used in Brazilian graduate programs to address racial inequities. However, implementation is often fraught with institutional tensions, conceptual ambiguities, and uneven adherence. This study investigates the challenges and progress in implementing AA within a Graduate Nursing Program in Brazil. Methods: We conducted a qualitative study with seven academic managers who held positions (coordinators, associate coordinators, and committee members) within the program between 2015 and 2024. Recruitment was guided by purposive sampling, complemented by a snowball strategy. Data were collected through in-depth interviews and analyzed using inductive thematic analysis. Results: Four interconnected thematic axes emerged: (1) diverse interpretations and conceptual dilemmas surrounding AA; (2) institutional facilitators and barriers, including concerns about CAPES evaluation indicators, a lack of binding regulations, and insufficient legal support; (3) the process leading to AA adoption, which was shaped by internal disagreements and external initiatives, such as the Uhayele project; and (4) the limits of access-centered policies, specifically the absence of structured student retention strategies. Although managers recognized AA as crucial for promoting racial equity, implementation was constrained by normative gaps, meritocratic narratives, and the homogeneity of leadership. Conclusion: AA effectiveness in graduate education requires embedding it within broader institutional projects supported by clear guidelines, legal backing, and robust retention strategies. Universities must strengthen mechanisms like scholarships and psychosocial support and establish permanent inclusion committees for consistency. The study provides original insights into AA implementation dynamics in the Global South, contributing to global debates on equity in health.