Directors of nursing point of view of the professional capacitating program for nurses working in major teaching medical centers

Abstracts

OBJETIVO: Caracterizar o perfil de capacitação profissional do enfermeiro de um Complexo Hospitalar de Ensino, a partir da percepção das Diretoras de Enfermagem. MÉTODOS: Nesta pesquisa qualitativa utilizou-se o método do Estudo de Caso e adotou-se a técnica da entrevista semi-estruturada realizada com 12 colaboradores. RESULTADOS: Os dados coletados, analisados utilizando-se a Análise de Conteúdo, possibilitaram o resgate das Categorias Política Institucional, Política de Gerenciamento de Recursos Humanos e Elementos Intervenientes no Processo de Capacitação Profissional do Enfermeiro. CONCLUSÕES: Não há uma política institucional formalizada de capacitação do enfermeiro; a questão salarial é elemento dificultador para a capacitação; a contrapartida das instituições de ensino aparece como recurso para capacitação; dois Institutos não possuem Serviço de Educação Continuada e o perfil demandado é de um profissional com postura ética, conhecimento técnico-científico, capacidade de gerenciar sua equipe, assíduo, pontual e comprometido com a Instituição.

Capacitação derecursos humanos em saúde; Recursos humanos de enfermagem; Capacitação profissional; Educação continuada em enfermagem

ORIGINAL ARTICLE

Directors of nursing point of view of the professional capacitating program for nurses working in major teaching medical centers^*

Capacitación profesional del enfermero de un complejo hospitalario de enseñanza en la visión de sus gestores

Juliana Caires de Oliveira Achili Ferreira^I; Paulina Kurcgant^II

^INurse, Master degree in Nursing Services Administration, Nursing School of the University of São Paulo – USP (SP), Brazil

^IIPhD, Full Professor of the Department of Professional Orientation of the Nursing School at the University of São Paulo-USP (SP), Brazil

Corresponding Author

ABSTRACT

OBJECTIVE: To characterize the components of a capacitating program for nurses working in major teaching medical centers.

METHODS: A case study approach was used to conduct this study. Data were collected through semi-structured interviews with 12 directors of nursing. Data were analyzed through content analysis.

RESULTS: The findings consisted of the following themes: Institutional politics, human resources policies, and specific intervening elements of the professional capacitating program for nurses.

CONCLUSIONS: There were no formal institutional policies for professional capacitation of nurses. The nurses' salary level was an element that made the implementation of a professional capacitating program for nurses difficult. Two medical centers did not have a department of continuing education. In addition, there was a need for capacitating nurses to: behave ethically; develop scientific, technical, and management knowledge; and, be assiduous, punctual, and committed to the institution.

Keywords: Health human resource training; Nursing staff/education; Professional training; Education, nursing, continuing

RESUMEN

OBJETIVO: Caracterizar el perfil de capacitación profesional del enfermero de un Complejo Hospitalario de Enseñanza, a partir de la percepción de las Directoras de Enfermería.

MÉTODOS: en esta investigación cualitativa se utilizó el método del Estudio de Caso adoptándose la técnica de la entrevista semi-estructurada realizada con 12 colaboradores.

RESULTADOS: Los datos recolectados, analizados por medio del Análisis de Contenido, posibilitaron el rescate de las Categorías Política Institucional, Política de Gerenciamiento de Recursos Humanos y Elementos Intervinientes en el Proceso de Capacitación Profesional del Enfermero.

CONCLUSIONES: No hay una política institucional formalizada de capacitación del enfermero; la cuestión salarial es el elemento que dificulta la capacitación; la contrapartida de las instituciones de enseñanza aparece como recurso para capacitación; dos Institutos no poseen Servicio de Educación Continua y el perfil demandado es el de un profesional con postura ética, conocimiento técnico-científico, capacidad para gerenciar su equipo, asiduo, puntual y comprometido con la Institución.

Descriptores: Capacitación de recursos humanos en salud; Personal de enfermería/educación; Capacitación profesional; Educación continua en enfermería

INTRODUCTION

The nurse is present in all levels of health services since the basic attention up to the most complex services; additionally, this professional many times acts as an educator giving classes to technical and intermediate levels and in undergraduate and postgraduate nursing courses. This professional also contributes publishing technical-scientific production and collaborates to elucidate the transformation of assistance processes and to build new knowledge on the nursing care⁽¹⁾.

At present, based on the analysis the labor market and the several areas of the nurse acting, it is possible to identify the professional competence as a basic requirement, since we are in a knowledge and information society, searching for patterns of excellence and reaching the best organizational results and increasing competitiveness. The concept of competence allows the nurse to adopt the posture of a thoughtful individual, able to make reflections/critical social actions and to opt for being a person able to construct knowledge in, with and for the nursing professional practice in several areas and social places where it is performed⁽²⁾.

Thus, it is relevant the fact that the nurse must have the initiative and availability to develop his/her competence and that Hospital Complexes of Teaching Hospitals, in general, receive a large number of nurses located in different Institutes. Each Institute has its managerial and assistential technical specificity and, frequently, the development of the professional capacitating program occurs parallel to work, depending upon allowance of the Institution, motivation and personal availability, emphasizing the differences of human behavior in the hospital organization.

On this regards, continuing education is important to increase awareness of the need of a systematic professional formation, designed to reach all levels and offers the opportunity of professional and personal developing. Therefore, the nurse is an educator in any area of acting, either teaching or in the assistance area, being this labor process as much important as that of the research or administration⁽³⁾. Effectiveness of nurse's training for health assistance, inside the hospital, directly depends on the teaching-learning experiences offered by this Institution, whose global program must contain health actions towards its population. It means that it is inherent to the hospital, as any other institution, which produces health goods or services to be responsible by the continuing improvement of the personnel staff⁽⁴⁾.

In the nursing area, the responsibility of training and the capacitating process is directly linked to the service of Continuing Education, which is the co-responsible organ to perform the capacitating program for employees to well perform their attributions. So, a carefully detailed plan with proposals involving knowledge in the technical-scientific, ethic-political and socio-educational dimensions is needed. Furthermore, it is required to involve all human dimensions, emphasizing social, political, religious and philosophic values which might have an influence on perception, reasoning and judgment and decision making of the novice.

Thus, administrators and hospital institutions must invest in human resources capacitating programs, considering the social economic and political contexts and current health too. In this sense, the administrator of the nursing human resources as well as other health managers must create conditions to guarantee the effective contribution of professionals and employees to obtain the institutional objectives, establishing relationships of collaboration among the employees, users and the institution and their respective management offices⁽⁵⁾.

As a result, the general objective of this study was to characterize the profile of the capacitating process of the nurse based on the supervisors' point of view. The supervisors were from the Nursing Division of the Institutes located in the hospital Complex of the Clinicas Hospital at the University of São Paulo, Medical School. The specific objectives were to identify the supervisors' perception of the Nursing Division on the capacitating program profile of the nurses; to know the proposals which orient this capacitating program and, to analyze the institutional elements needed to make this process effective.

METHODS

This is a qualitative descriptive-exploratory research, carried out in the central pole of the Hospital Complex at the Clinicas Hospital of the University of São Paulo, Medical School, after approval of the Ethic Committee in Research of the Nursing School of the University of São Paulo and the Ethic Committee for Analysis of Research Projects of the Clinicas Hospital of the Medical School at the University of São Paulo.

Six supervisors and their six substitutes of the Nursing Division took part of this research, totaling 12 participants who signed The Free Informed Consent.

The adopted method was Case Study and to collect data a semi-structured interview was applied. Characterization of the participants was obtained through questions regarding their position and their institution trajectory. The semi-structured interview had three guiding questions: How do you apprehend our nurse professional capacitating process in this Institution? What do you suggest and consider important in the capacitating program? Which elements do you think are needed to make this process effective?

For analysis of data obtained from the interviews, the Content Analysis technique, defined by Bardin, was used⁽⁶⁾, as a set of communication analysis techniques to detect, by means of describing the messages content, which are the indicators allowing the inference of knowledge regarding conditions of production and reception of these messages. The author signalizes three basic phases for the analysis, denominated as chronologic poles: pre-analysis: phase of organization, systematization of initial ideas, selection of documents, elaboration of hypothesis and objectives and to create indicators that must serve as support for final interpretation; material analysis: fastidious and long phase: consisting of codify operations, transforming gross data of the text to reach a content representation; treatment of the results with inference and interpretation.

RESULTS

Regarding characterization of the collaborators of this study, ages ranged from 28 to 70 years, and the period working in the institution varied from 6 to 38years, revealing a significant difference among them. The year of graduation, period of time in the job and post-graduation courses were different. It called our attention the fact that all collaborators, on their professional trajectories, in the Clinicas Hospital, had worked as assistance nurses before taking over the command of the current position.

Analysis of the content from the interviews allowed the construction of three categories and their respective Units of Meaning:

Institutional Political Category with the Units of Meaning of Institutional Policies, Need of Change, Desired Profile and Responsibilities of the Nursing Manager;

Political Category of Management of Human Resources with the Units of Meaning of Previous Capacitating Program, Current Profile, Criteria for capacitating program, Admission Process, Selective Criteria and Guidelines for Personnel Nursing Capacitating Program;

Category of Intervenient Elements in the professional capacitating process of the nurse with the Units of Meaning Facilitating Factors, Difficulty Factors and Facilitating and Difficulty Factors.

To understand the organizational reality it is needed to capture the elements of the formal and informal structure and to analyze them together, as well as the specific cultural patterns, the processes and power relationships which determine the organization dynamics, being important to emphasize that in the organizations when the employees translate their power into actions, they are doing politics^(7-8).

In this research, although not documented, the institutional policy permeates the whole process of personnel capacitating program. Thus, the interviewers, on their speech, explained the existence of elements of the constitutive and real working process of the organizational policy, showing the need and the importance to legitimate this policy.

In this context, the results of the study showed similarities on the speeches regarding the admittance process, demonstrating that admission of recent graduate nurses by public official examination is a difficulty factor of the professional capacitating process, since many professionals arrive in the Institution without the basic knowledge in nursing, which makes the admission dynamics difficult, as shown in the speech below:

"Many nurses arrive here and are recent graduate, bring no experience, you know... they are not prepared, no ability... (E1D1)

At this point, 11 collaborators brought, on their speech, the need to establish a profile of the desired professional, who even without legitimization is a connecting link in the conception of the collaborators of different Institutes, when demanding an ethic professional nurse with a technical-scientific knowledge, able to manage his/her nursing staff, assiduous, strict and involved in the Institution. Other elements demanded by them regarding professional profile were distinctively considered as the specialization, professional experience, relationships and professional behavior.

Analysis of data also showed that there is a common concern among the collaborators regarding capacitating process. However, in the guidebooks which approach the activities developed by the nurses, there are no references regarding the desirable competences to develop these activities.

It was observed that there is no formal policy to capacitate the nurse into the Hospital complex, as well in the Institutions, alone. Thus, each Institution works the nursing capacitating process in a very particular way and the collaborators of this research have on their hands, the responsibility to legitimate it. This fact is shown on the following sequential speeches:

There is no structured policy, the service supervisors feel the needs of their group and act there. (E1D3)

There is no official policy, so we make plans considering what is important to develop this professional function. (E4D4)

As well as the desired profile, they all revealed to follow similar policies for the capacitating process of the nursing staff, ranging from stimulus for external capacitating programs, due to insufficient resources, up to capacitating programs during work hours. It was also revealed that there is a concern with the following capacitating processes: nurses in command and supervisors; the annual capacitating program for nurses; the opportunities for professionals to improve into their proper Institutions; the capacitating program out of the working hours; the preference to hire ex-employees and with the incentive for this capacitating program.

Among the elements considered essential to perform the professional capacitating program, we have the Continuing Education Service which, so far, it does not occur in all the investigated institutes due to the lack of human resources as a problem resulting from human resources policy, emphasizing that the nurse staff approved by the State Government dates from 1978. The next speech shows:

At present, we have no Continuing Education Service. We have the project but we are trying to establish it. We need a professional, but due to the reduced number of nurses we don't have a professional to be in charge of this position. (E4D5)

Still regarding the elements needed for the capacitating process, the lack of an instruction manual for professional capacitating process and the lack of physical, financial and human resources emerged from the interviews as important factors to make this process occur. The collaborators mentioned that salary appears as an obstacle to maintain the staff capacitated, since it is beneath the salary offered in the current market. This fact makes turnover present in the Institutes, showing a common problem to the whole Hospital Complex and that the Clinicas Hospital (HC) has, among its characteristics, the fact of being an organ responsible for forming professionals for the market. So, besides the hospital school, the HC works with residency, specialization and development, receiving professionals through public official examination, which after one or two years of work acquire experience and leave the hospital receiving better offers in private hospitals, as shown below:

Several professionals who were specialists in this hospital, they are now all working in a hospital that we all know, and we are not able to get them back again due to the low salary , and this issue has a great significance nowadays. (E3D3)

On the other hand, the number of specialist nurses in the Institutes is very important and the search for professionals with master degree and PhD has been increasing. The field to develop researches is vast and we observed in the directors' speech and their substitutes that there is an interest regarding writing, to perform investigations and production that they considered an important step in the trajectory of the capacitating program.

The counterpart of the teaching institutions searching for traineeship in the Hospital Complex is revealed in the collaborators' speeches as a resource to assist the needs of the nurse capacitating process, specially by the fact of being a public hospital, whose budget for this process is small and does attend the demand, mainly of the nursing area. Thus, the counterpart of the teaching institutions can be an element that, at present, incorporates the policy of human resources capacitating process of this Hospital Complex. The speech below reflects this:

This year, to accept the curricular traineeship in this Institution, I have to negotiate a counterpart with the school.

So, they will send some students here and I will verify which courses are important for the nurses to be attending and that they are interest as well. This will be a fact for all the schools; it is a new measure and a new idea of the Superintendence of the Capacitating Center and Development. (E5D3)

At last, another aspect raised by the collaborators of the study refers to the selection process and the nurse's admission process which also differs among the Institutions, emphasizing that one of these Institutes still has not personnel chart approved by the State government. In general, they have the commitment to be a nurse and be legally habilitated to work as well as other attributes described in the editorial of the human resources sector of the Hospital Complex.

DISCUSSION

In health organizations the formal structure establishes the hierarchical level of the services and social agents, indicating, according to the different positions in the organizational design, the power relationships among the positions. There are specific structures keeping similarities among themselves and that belong to the same segment of human work, and that, along with the adopted materials and developed activities establish an adequate organization profile⁽⁷⁾.

Therefore, the professional capacitating process of the nurse inside the hospital environment analyzed in this study is inserted into the context of an intricate organizational structure, in need of a solid structure to be adequately developed.

Serious investigators of the Human Resources Management consider that those persons responsible for personnel recruiting face great difficulties to hire qualified professionals, raising the issue about efficiency of the formation process and qualification of these professionals⁽⁹⁾. The collaborators' speeches are in accordance with this problem. They emphasize the lack of knowledge and experience as factors impairing the professional practice, since the undergraduate courses do not pay much attention to specialties and consequently, we have students that leave the university without the technical-scientific knowledge and the adequate practice for the work.

The profile must be adapted to the job and individual needs. The organization must elaborate criteria for selection, so that it could be able to compare the established profile with the candidate profile, aiming to reach the expected results and integration with the new professional in the work group⁽⁷⁾. Regarding the desired profile of this study, we found the following elements: specialization, technical-scientific knowledge, professional experience, engagement with the Institution and management, plus assiduity, posture, punctuality and ethic.

The fundamental aspects that must be observed to elaborate and operationalize the capacitating programs are: period, content, adopted methods, evaluation of the results and strategies to integrate the recent hired professional with the sector. However, there are a few professionals with continuing education inside the Institutions, making difficulty individual follow-up of the recent graduate student and his/her evaluation, confirming that institutions need to invest in human resources to have an efficient and qualified nursing staff, but emphasizing that these professionals must be able to make a decision making and that they have to look for their own qualification^(10-11).

Labor market requires increasingly from the professionals to be able to domain techniques and get more knowledge, encouraging the students for postgraduation in order to develop their competence, that is, the graduation course is not sufficient for them to meet the demand for the professional profile asked by this market⁽⁹⁾.

A study carried out in 1996⁽¹²⁾ already reported some considerations on this issue, showing the need to construct a partnership between the graduation courses and the hospital institutions. The authors consider that this fact favors development of assistance and consequently, the career, emphasizing the managerial knowledge through a permanent program of human resources formation in the hospital. They also emphasized the need to approach issues regarding the decision making process of the nurse in the undergraduate courses. These issues must favor the management as a determinant factor to access the patient and the organizational objectives by means of planning, coordination and evaluation of the given assistance.

CONCLUSION

At the present time, it is unquestionable for most of the organizations the need to have professionals under a capacitating program through a reflexive and participative education, stimulated by social pressures such as increasing schooling, the individual's crescent development of information level and technological innovation as well as motivation and professional's expectation to participate in the decision of the results and future of the institution. With the growth of hospitals and medical clinics and incorporation of new technologies, new requirements are needed regarding hospital and personnel administration for nursing assistance, as well as new centers to training nurses in different States of Brazil. Also, the nursing department has among its attributions to develop an educational program in service to guarantee the greatest use of abilities and potential of the nursing team, capacitating the human resources as well^{(7, 13)}.

The aim of the present study was to characterize the profile of nursing capacitating program for nurses in a Teaching Hospital Complex from the supervisor's point of view.

By means of data analysis it was possible to note that in spite of not having an official policy to capacitate the nurse, there is a stimulus from the nurses and nursing command to improve the professional capacitating program.

The Coordination of the Nursing Activities (CAENF) consists of a board of directors of the Nursing Division of the Institutions. The CAENF is institutionalized and has its internal rules, and holds monthly meetings to deal with Hospital Complex issues and, promotes, every two years, a Nursing Congress coordinated by one of these Institutions. The CAENF has, among other upcoming objectives, a proposal to create a group/source for capacitating professionals. However, this objective is not satisfactory to overcome the economic and political factors involved in the Public Hospital Complex.

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• ¹³
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*

Trabalho extraído da Tese de Mestrado Perfil de capacitação profissional do enfermeiro de um Complexo Hospitalar de Ensino, defendida na Escola de Enfermagem da Universidade de São Paulo – USP – São Paulo (SP), Brasil.

Publication Dates

• Publication in this collection
  16 Apr 2009
• Date of issue
  Feb 2009

History

• Accepted
  11 Dec 2007
• Received
  02 May 2007