Precariousness of the work of the nurse: professional militancy from the perspective of the press

Abstract

Objective

To analyze the professional militancy of nurses in the face of the precariousness of the work, presented by the Bahian print media in the 1970s and 1980s.

Methods

Historical-documentary research, with a qualitative approach, whose source was the Bahia newspaper A Tarde. The time continuum includes historical landmarks, such as the: creation of the Federal Nursing Council and its regional sections (1973); creation of the Union of Nurses of the State of Bahia (1981); and the approval of the Professional Exercise Law (1986). The national context was the period of the military dictatorship, which adopted a model of social protection and moved towards a political opening. The search terms “Enfermeira” and “Enfermeiro” were used, resulting in 24 reports. The content analysis in the thematic modality supported the organization.

Results

The professional nurse militancy confronted by the precariousness of work was present in the media through the representative entities, evidenced by the following aspects: devaluation of the workforce, marked by low remuneration and replacement of nurses by personnel without adequate qualification; work overload, evidenced by understaffing and poor qualification; and the search for legal determination of the working day and minimum wage.

Conclusion

Nurses used the media to denounce and make society aware of the determinants of the precariousness of work, but the effective actions of combat were minimally approached. The militant activity was concentrated in the scope of the representative entities, but did not demonstrate a collective movement of the nurses.

Political activism; Politics; Journalism; Employment; Nurses

Resumo

Objetivo

Analisar a militância profissional de enfermeiras frente à precarização do trabalho apresentada pela mídia impressa baiana nas décadas de 1970 e 1980.

Métodos

Pesquisa histórico-documental, com abordagem qualitativa, cuja fonte foi o jornal baiano A Tarde. O recorte temporal abarca marcos históricos como a criação do Conselho Federal de Enfermagem e suas seções regionais (1973); a criação do Sindicato dos Enfermeiros do Estado da Bahia (1981); e a aprovação da Lei do Exercício Profissional (1986). O contexto nacional era o período da ditadura militar, que adotava um modelo de proteção social e caminhava para a abertura política Utilizou-se os termos de busca “Enfermeira” e “Enfermeiro”, resultando em 24 reportagens. A análise de conteúdo na modalidade temática embasou a organização dos dados.

Resultados

A militância profissional de enfermeiras frente à precarização do trabalho se fez presente na mídia por meio das entidades representativas, evidenciada pelos seguintes aspectos: Desvalorização da força de trabalho, marcada pela baixa remuneração e substituição de enfermeiras por pessoal sem qualificação adequada; Sobrecarga de trabalho, evidenciada pelo subdimensionamento e qualificação deficiente; e busca por determinação legal da jornada de trabalho e do piso salarial.

Conclusão

As enfermeiras utilizaram-se da mídia para denunciar e conscientizar a sociedade sobre os determinantes da precarização do trabalho, porém, as ações efetivas de combate foram pouco abordadas. A atuação militante esteve concentrada no âmbito das entidades representativas, não sendo evidenciado um movimento coletivo das enfermeiras.

Ativismo político; Política; Jornalismo; Emprego; Enfermeiras e Enfermeiros

Resumen

Objetivo

Analizar la militancia profesional de enfermeras frente a la precarización del trabajo presentada por los medios de comunicación impresos del estado de Bahía en la década de los setenta y ochenta.

Métodos

Investigación histórica y documental, con enfoque cualitativo, cuya fuente fue el periódico bahiano A Tarde. El recorte temporal abarca marcos históricos como la creación del Consejo Federal de Enfermería y sus secciones regionales (1973), la creación del Sindicato de Enfermeros del Estado de Bahía (1981) y la aprobación de la Ley de Ejercicio Profesional (1986). El contexto nacional era el período de la dictadura militar, que adoptaba un modelo de protección social y caminaba hacia la apertura política. Se utilizaron los términos de búsqueda “enfermera” y “enfermero”, que dio como resultado 24 reportajes. La organización de los datos se basó en el análisis de contenido en la modalidad temática.

Resultados

La militancia profesional de enfermeras frente a la precarización del trabajo se hizo presente en los medios de comunicación a través de las entidades representativas, evidenciada por los siguientes aspectos: desvalorización de la fuerza de trabajo, marcada por la baja remuneración y reemplazo de enfermeras por personal sin la cualificación adecuada; sobrecarga de trabajo, demostrada en el subdimensionamiento y cualificación deficiente; y la búsqueda de determinación legal de la jornada de trabajo y del piso salarial.

Conclusión

Las enfermeras utilizaron los medios de comunicación para denunciar y concientizar a la sociedad sobre los determinantes de la precarización del trabajo, pero las acciones efectivas del combate fueron poco abordadas. La actuación militante estuvo concentrada en el ámbito de las entidades representativas y no se observó un movimiento colectivo de enfermeras.

Activismo político; Política; Periodismo; Empleo; Enfermeros

Introduction

The work, according to Marxist philosophy,¹ is understood as the interaction between man and the natural world, with the aim of transforming nature to achieve a purpose that satisfies their needs. In the health area, the central object lies in meeting individual and collective needs, aiming at the promotion and maintenance of life. Health is produced by ‘living labor in action’, that is, the care for life is obtained at the very moment when human labor is performed.²

The work of the nurse is inserted in the field of health as a producer of service with an exchange value, in a historical process of development of care practices. Nursing was mainly performed by women, and their work was linked to domestic activities, so that, even after integration of this professional into the labor market, the low social and financial value attributed to this profession is related to the depreciation of female work³ With the professional development and qualification of teaching, other characteristics were associated with nursing, such as being friendly, having the ability to make good decisions, and performing multitasking.⁴

Thus, the construction of the professional image is continuous, and depends on the historical context in which it is integrated.⁴ In the time continuum of this study, the context of the last decades of dictatorship, and its path towards political reopening, influenced the creation of representative entities of the profession and greater participation of women in politics and the media.⁵ However, the 1970s were difficult for the health workforce, whose model was undergoing transformation, due to what would become the health reform movement in the 1980s. In the meantime, in the context of professional devaluation and the precarious conditions of nursing work, the political engagement and participation in representative entities can indicate new methods, as well as contribute to the development of strategies that promote valuation and professional recognition.

Studies showed that society has a negative interpretation of the nursing profession, and that nurses do not have the tradition of communicating to society the importance of their work, as well as clarifying information about the profession, which contributes to the maintenance of invisibility, and the lack of knowledge about the profession.⁶ Rethinking the status of the profession permeates the reflection that society has of this professional category, and the image that the professionals maintain of themselves.

In this perspective, the contribution of media to the maintenance of this image is important, considering that the media act as an instrument for forming public opinion. The media has the ability to interconnect the profession and the general public, presenting information that collaborates with the construction of the professional image that society has of the nurse.

Thus, the study aimed to analyze the professional militancy of nurses confronting the precariousness of their work, presented by the Bahian print media in the 1970s and 1980s.

Methods

This was historical research with a qualitative approach, based on social history theory.⁷ The press reports available in the newspaper, A Tarde, the leading print communication in the state of Bahia, during the period delimited by the study, were used as the data source, for the time continuum of the 1970s and 1980s.⁸Articles that approached the professional militancy of nurses in the labor field were selected for this study.

The study focused on the state of Bahia, a federative unit historically recognized by the presence of a militant force, and engaged political action of Bahian nurses.⁹-¹² It is the state with the highest number of nurses in the northeast, and is fourth in the country,¹³ which can demonstrate the expressiveness of the research.

The determinants that motivated the choice of the time continuum were: creation of the Federal Nursing Council (COFEN) and its regional sections (COREN), in 1973, regulating and supervising the profession; creation of the Union of Nurses of the State of Bahia (SEEB), in 1981, the organization with legal responsibility to act in defense of labor rights; and approval of the Law of Professional Exercise, in 1986.

In the national scenario, the political participation of organized civil society in the health reform is highlighted. This was a social movement initiated in the mid-1970s, marked by denunciations of the problems in the health sector, and by proposals of transformation of the health system in force.¹⁴

The 1980s saw the major impetus for the health reform due to the wide mobilization of society in the struggle for the right to health.¹⁴ This historical phase was characterized as a time of reorganization, which reverberated in social policies and in the life of society, marked by social and economic democratization, synchronous to the political democratization.

As it was a documentary study that used public documents with free access, the submission of the research project to the Committee for Ethics in Research with Human Beings (CEPSH) was not necessary, according to norms and guidelines established by Resolution 466/12 of the National Health Council.

The data were collected from September to October of 2017, by means of the collection of articles published in the newspaper, A Tarde, available for access from computers located in the Public Library of the State of Bahia. The entire collection of the periodical is digitized, and so the searches were performed in all the 7,300 editions of the newspaper, published daily, from 01/01/1970 to 12/31/1989, using the terms “Enfermeira” and “Enfermeiro”, totaling 1,666 reports. Among these, 53 addressed the professional militancy of nurses, of which 24 discussed the professional militancy of nurses in the field of work. The other publications presented professional militancy in the education field (16 reports), and within institutions (28 reports), which will not be discussed in the present study.

The analysis and interpretation of the material obtained followed the content analysis proposal, in the thematic modality.¹⁵ After decoding the material, six units of analysis were obtained, which were organized and grouped by themes, resulting in three categories, as demonstrated in figure 1.

Figure 1
Thematic categories and corresponding units of analysis

The use of the term, nurse, as female, occurred according to the personal option of the authors of this study. Based on their understanding, the determinants of the context of the genesis of the profession cover aspects related to gender and the religious and military influences, which evidence the social and sexual division of labor in the field of nursing. Thus, the female figure, along with the assorted issues imbricated with this gender in the course of history, creates elements for understanding the development of the nursing profession, and the manner in which it is recognized at the present time.

Results

The professional militancy of nurses became present in the media in the fight against the precariousness of work, evidenced by the following aspects: devaluation of the work force; work overload; and working day and minimum wage. Chart 1 presents a sample of the findings, newspaper clippings, which exemplify the thematic categories.

Chart 1
Precariousness of the nurse’s work

Newspaper excerpts	Thematic categories
After four years of study [...] the student goes to the job search and the maximum he earns is an average salary of two thousand cruzeiros for eight hours of work. In private hospitals and clinics, the situation is even worse, because they pay less than that [...] there is no lack of professionals in the market, [...] what exists is a policy of low remuneration and the hospitals’ preference for nursing assistants, paying negligible wages. (8.1975)	Devaluation of the work gforce
About 70% of nursing personnel today in Brazil do not have any course, as postulated by legislation, and most of the nurses in the private area earn little more than the minimum wage. (40.1984)
Maria Ivete denounced the insensitivity of organizations that exploit the work in health in the private sector, because they do not consider the patient’s risk when being cared for by a layperson. The only way to reverse this situation, for the new president of ABEN, would be the removal of Law 2,604, which regulates the professionals hiring (41.1984)
According to [...] COREN-Bahia president, the problem found for the performance of the function is reduced to the deficiency of personnel, as much in quality as in quantity. There is no one who can receive administrative tasks in the provision of care, which prevents the nurse from giving care that would be for the patient, family and community. (16.1978)	Work overload
The time in which the nurse class could choose employment, especially in the capital, is far away, “recalls the SEEB president Edelita Araújo, adding that about five years ago, unemployment began to reach the nursing class, reaching proportions that concern the association [...]. But, what is happening is not a lack in the market [...] but a policy of the health institutions, which do not admit enough professionals to guarantee the quality of care.... (31.1982)
The labor market for nurses in the State of Bahia is greater than demand, but the difficulty to obtain employment in the capital with decent remuneration is great [...] This situation is due to lack of stimulation because the nursing class has not yet achieved its ambitions: a professional minimum wage and a defined working day. (16.1978)	Working day and minimum wage.
There are several demands of the category, and, currently, a project is in the National Congress, which claims a professional minimum wage of 10 times the minimum wage for nurses, six for nursing auxiliaries, and four for nursing attendants, as well as two more in which they demand a working week of 30 hours [...]. (31.1982)

Discussion

The evidence presented can be a basis for the nursing category to reflect on the importance of its performance, as well as on the need for greater involvement in the collective spaces of representative organizations. Nurses need to be aware of their role and understand the interests that permeate their professional practice, so they are encouraged to mobilize themselves for the social and financial recognition of the profession.

The results indicate that, during the period under study, Brazilian nursing faced a serious crisis in the work area. The prioritization of market interests, to the detriment of the quality of care provided, non-compliance with existing legislation, and the absence of legal determination that considered the necessary qualification for professional practice, emerged as determinants for the precariousness of work.

The political period was complex and, in the context of health, professionals and the population suffered, with the greatest emphasis on the legal order of health and health policies adopted by military governments, which excluded any social participation.¹⁶

The devaluation of the nursing workforce was evidenced after denunciations of low pay and replacement by mid-level personnel, and even by those without qualification for the performance of such functions, as in the case of nursing assistants.

The predominance of women in the profession, the social and technical division of labor, the lack of legislation on the professional minimum wage, working hours, the existence of a large reserve contingent, and the incipient political organization of nurses contributed to the reduction of the value of the labor force and, consequently, to professional devaluation.³

The work of the nurse originates in domestic work, historically attributed to women, which is socially and economically devalued. Thus, although the professionalization of nursing has given to the nurses a professional status and operated changes in their practice, the labor market has maintained the structure of social domination based on the gender relationships, maintaining the conditions of subordination.¹⁷

Likewise, the qualifications of the feminine, socially understood as related to nursing through domestic tasks, disqualify the work, because they lead to the mistaken understanding that such activities can be realized by the sole application of women’s inherent knowledge.¹⁸ This conception, together with capitalist interests, guided the hiring of labor in the nursing area, which, as described in the results, reached a level of 70% unskilled personnel.

With the expansion of the health services network in Brazil, there was a demand for nursing professionals to compose the new jobs; however, a large number of institutions opted for hiring lower-cost labor, replacing nurses with staff with no university education.¹⁹ Thus, a large reserve contingent of nurses, not included in the labor market was produced. These individuals, when confronted with any hiring opportunity, were subject to the precariousness of the employment relationship and low remuneration, because, in addition to competing with their peers, they faced unfair competition with a heterogeneous and less qualified group.

The large reserve contingent also contributed to reduction in the value of the labor force, because there was no competition among employers in the face of the professional supply. This situation exacerbated the incipient political organization of nurses, especially in relation to union engagement, which made it difficult to mobilize to improve working conditions.²⁰

In this sense, the argument that the technical division of labor in nursing contributes to the devaluation of the work of the nurse is confirmed, but it also cooperates to simplify the work of the nurse and the loss the singularity among the professions.²⁰ Fragmenting the work into simple functions nullifies the difference of attributions between nurses and other professionals, as less qualified individuals perform the same function as others with a higher education.

Another point addressed concerned complaints of work overload due to the low quality of nursing professionals, and the insufficient number of staff to meet the demand. The productive context contributed to the tension, which emerged in the contradiction between the tension between the flow of production and the reduction of labor. The tension-flow paradigm²¹ becomes evident before the disproportionate requirement to meet demand in relation to the offered conditions, generating overload and intensification of work.

Again, the effect of the devaluation of the nurse’s work in the face of the loss of space for other professionals is verified. This practice, in addition to resulting in the poor quality of the services provided, also contributes to the overload of the nurse’s work, which starts to accumulate responsibilities due to the inexistence of other professionals with the same training.

In addition, due to the insufficient quantity of nurses, the nurse suffers from the intensification of the workday, materialized not only by increased production in a shorter work day period, but also by the accumulation of employment bonds to compensate for the low wages, and by the overtime required to compensate for the shortage of professionals.²⁰

It is noteworthy that it was precisely with the purpose of combating this precariousness that the nurses engendered a struggle for regulation of the working day and minimum wage for remuneration. Studies showed that the fight to determine the working day was aimed at preserving the only asset nurses had, and was one of the methods to prevent devaluation of the workforce.²² In this sense, this pretension must be accompanied by better wages, in order to avoid the exhausting accumulation of employments, and avoid other forms of precariousness.

Although the nurses have made progress, the precariousness of work persists, as a problem whose solution still demands great commitment from the category. Nurses continue to experience long working hours, overload of work, and precarious employment relationships, in addition of receiving the most unequal and unfair wages in comparison with other professionals of the health area.²³ This reveals the importance of the involvement of the category in extensive political projects, aimed at the improvement of the quality of nursing work in a global manner, as the precariousness process is a complex and multifactorial. By choosing not to engage with political issues, nurses agree to the established model, and lose their ability to react against the innumerable forms of labor exploitation.

As shown by the results, nurses’ militancy against forms of precariousness was evidenced after complaints and movements made by professional organizations, notably the Association and the Council. The nurses’ union, the organization responsible for acting in defense of labor rights, did not have its activities divulged by the newspaper in a significant manner, revealing the fragility of political organization of this professional category.

It should be noted that the SEEB was created only in 1981,²⁴ during the military government, when there was significant suppression of protest movements. This fact may justify the frivolous representation of the union by the newspaper, although it seems more assertive to conclude that the reduced value attributed to the union was derived from a nursing characteristic,²⁵,²⁶ in this case possibly associated with the fragile political awareness of the category of professional, fear of repression, and the social stigmas that associated trade unionism with subversion.²⁵

The professional entities are extremely important and represent a perspective of change, as they constitute as spaces for aggregation and organization of workers, which can favor the criticality and understanding of the context in which the professional category is integrated.²⁷

The study had as limitation in terms of the use of written material only, as iconographic material was not analyzed. As the images published by the newspaper are intended to illustrate the idea described by the report, the analysis of these could result in complementary findings.

Conclusion

Militancy in the fight against the precariousness of the nurse’s work was expressed in the form of professional devaluation, work overload, and struggle for definition of the working day and professional minimum wage. Work devaluation was also characterized by: low remuneration and replacement of nurses by professionals without adequate qualification, motivated mainly by market interests; the existence of contingent nurse reserves; and, incipient political organization of the category. The devaluation is multifactorial and also involves work overload, as the loss of space for other professional categories resulted in complaints of poor quality of service, overload, and intensification of the workday. Thus, the regulation of the working day and determination of a professional minimum wage were configured as a possibility to protect the workforce of nurses. With regard to the journalistic coverage, it was verified that nurses communicated to society the precarious conditions of work, but little was done to effectively transform this reality. The militancy was concentrated only in the scope of the professional class entities, commanded, in the majority, by the representatives of these organizations, without a collective movement of the nurses.

Acknowledgements

To the Group of Studies and Research in Administration of the Nursing Services - GEPASE for having made the discussions and collective constructions possible.

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Publication Dates

• Publication in this collection
  29 July 2019
• Date of issue
  May-Jun 2019

History

• Received
  9 Nov 2018
• Accepted
  16 Apr 2019