Contributions and challenges of hospital nursing management: scientific evidence

Abstract

AIM

Analyze the scientific evidence, national and international, about contributions and challenges of nursing management in hospital care.

METHOD

Integrative literature review, with guiding question: What are the scientific evidence about nursing management in hospital care? Data was collected in LILACS, PubMed, Scopus, CINAHL and EMBASE databases. The final sample of 14 articles resulted in two categories: "Contributions" and "Challenges."

RESULTS

Contributions refer to aspects that facilitate the development and organization of work from a technical-political perspective, by qualifying the productive processes. The challenges were related to professional development, work satisfaction, overload, quality of service, conflict resolution and teamwork.

CONCLUSION

Management and care processes are inseparable, requires adequate and up-to-date knowledge to provide a better care experience for the health services user and coordinate team actions.

Keywords:
Organization and administration; Hospital administration; Health services administration; Nursing

Resumo

OBJETIVO

Analisar as evidências científicas, nacionais e internacionais, sobre contribuições e desafios do gerenciamento de enfermagem na atenção hospitalar.

MÉTODO

Revisão integrativa da literatura, com questão norteadora: Quais evidências científicas sobre o gerenciamento de enfermagem na atenção hospitalar? Dados coletados nas bases de dados LILACS, PubMed, Scopus, CINAHL e EMBASE. A amostra final de 14 artigos resultou em duas categorias: “Contribuições" e “Desafios”.

RESULTADOS

As contribuições referem-se a aspectos que facilitam o desenvolvimento e organização do trabalho na perspectiva técnico-política, ao qualificar os processos produtivos. Os desafios estão atrelados à formação profissional, à satisfação com o trabalho, à sobrecarga, à manutenção da qualidade dos serviços, resolução de conflitos e trabalho em equipe.

CONCLUSÃO

Processos gerenciais e assistenciais são indissociáveis, requerem conhecimento adequado e atualizado para oferecer melhor experiência de cuidado ao usuário e coordenar ações da equipe.

Palavras-chave:
Organização e administração; Administração hospitalar; Administração de serviços de saúde; Enfermagem

Resumen

OBJETIVO

Analizar las evidencias científicas, nacionales e internacionales, sobre contribuciones y desafíos del manejo de enfermería en la atención hospitalaria.

MÉTODO

Revisión integrativa, con cuestión-guia: ¿Cuáles son las evidencias científicas sobre gestión de enfermería en la atención hospitalaria? Datos recogidos en las bases de datos LILACS, PubMed, Scopus, CINAHL y EMBASE. La muestra final de 14 artículos resultó en dos categorías: "Contribuciones" y "Desafíos".

RESULTADOS

Las contribuciones se refieren a aspectos que facilitan el desarrollo y organización del trabajo desde la perspectiva técnico-política, al calificar los procesos productivos. Los desafíos están vinculados a la formación profesional, satisfacción con el trabajo, sobrecarga, mantenimiento de calidad, resolución de conflictos y trabajo en equipo.

CONCLUSIÓN

Procesos gerenciales y asistenciales son indisociables, requieren conocimiento adecuado y actualizado para ofrecer la mejor experiencia de cuidado y coordinar acciones del equipo.

Palabras clave:
Organización y administración; Administración hospitalaria; Administración de los servicios de salud; Enfermería

Introduction

The nursing work process is organized in the dimensions of assisting, administering, researching, teaching and participating politically¹, each with specific objects, means, instruments and activities, coexisting temporally and institutionally, in a heterogeneous and hierarchical composition of its agents. Actions related to the planning, organization, coordination, execution and evaluation of nursing services are the exclusive attributions of the nurse, assured in Law n. 7,498/1986 that regulates the professional practice of nursing in Brazil².

The National Curricular Guidelines (DCN) recommend for nurses a profile that includes a set of desirable competencies for professional practice: attention to health, decision making, communication, leadership, administration and management, and continuing education³, five of these are characterized as managerial competencies. This fact evidences the relevance of management in nursing work, understood as a possibility to coordinate the team, resources and strategic actions that favor care.

The nurse plays an important role through management actions, based on means, instruments and competencies⁴. Especially in the hospital environment, due to the complexity and dependence of the care, the managerial work of the nurse has been key, in the articulation of the health team, in the organization and search of strategic actions of improvements directed to the user⁵.

Thus, although the dimension of care is the central purpose of the profession, management has affirmed importance in the set of rationally formulated strategies, in objective and subjective actions that impact on better care and work conditions of the nursing team⁶.

Based on the above, it is questioned: What are the scientific evidences of contributions and challenges of nursing management in hospital care?

In this sense, when considering the incorporation of new technologies in the hospital setting that affects the work of the nursing team, the relevance of managerial dimension legitimized by the law of professional practice and national curriculum guidelines as well as the procedural dynamics inherent in these approaches justified the aim of this study was to analyze national and international scientific evidence on the contributions and challenges of nursing management in hospital care.

Method

This is an Integrative Revision (IR), a method that summarizes the theoretical literature to provide broad understanding about a given phenomenon. In this way, IR has the potential to build nursing science, transforming research, practices and political initiative. This IR covered the following steps: formulation of the guiding question of electronic search for publications, selection of data, analysis, interpretation of data and presentation of results⁷.

It was used the strategy called PICO (acronym for population, intervention, comparison e outcome)⁷ for the formulation of the guiding question. Thus the guiding question of the study: What are the contributions and challenges of nursing management in hospital care?

The electronic search for publications was conducted in the databases: Latin American and Caribbean Health Sciences Literature (LILACS), Scopus, PubMed, EMBASE and Cummulative Index to Nursing and Allied Health Literature (CINAHL).

For the search, we used controlled descriptors according to the language of each database (DeCS, MeSH, MH e EMTREE), it should be pointed out here that the Scopus database does not have its own language for searching data. It was also used keywords that were defined by the authors, according to previous readings on the subject. The searches were conducted in the months of February and March of 2018.

Thus, in LILACS by means of DeCS were used the descriptors: “Administration of health services”; “Management”; “Organization and Administration”; “Hospital administration” and the following keywords: “Hospital; “Nursing”; “Nursing management”. In the PubMed was selected in the MeSH: Hospital Administrators"; "Chief Executive Officers, Hospital"; "Nursing Administration Research/organization and administration"; "Health Services Administration"; "Organization and Administration"; "Nursing Care/organization and administration" and the following keywords: "Nursing"; "Nursing Management". In the Scopus it was used the keywords: "Hospital Administrators"; "Nursing Administration"; "Nursing Management"; "Health Services Administration"; "Hospital"; "Nursing". In the CINAHL by means of the MH was selected: "Nursing Management"; "Nurse Administrators"; "Nurse Managers"; "Management"; "Health Facility Administration"; "Hospital Unit" and as keywords: "Hospital"; "Nursing". In the EMBASE it was used the EMTREE to select the following descriptors: "Hospital Organization"; "Nursing Management"; "Nursing Administration Research"; "Health Care Organization"; "Nursing Manager" and the keywords used were: "Hospital" and "Nursing Administration".

Boolean operators were used AND and OR to perform combinations between the descriptors in the databases. In the searches, year and language filters were used in order to restrict the results of the articles in Portuguese, English or Spanish, according to the temporal cut.

For the selection of data, inclusion criteria were: primary studies, indexed in the selected databases, in Portuguese, Spanish and English, published between 2007 and 2017 that answered the question guiding the study. The period was chosen to have access to recent publications.

Exclusion criteria were: publications in the form of theses, dissertations, monographs, books, reviews (narrative, systematic or integrative review), letter-response, repeated articles in the bases and that did not relate to the theme, annals of congresses and editorials.

The selection of articles, analysis and interpretation of data were recorded in an instrument built by the authors, taking into account the identification of the articles, methodological characteristics and evaluation of the level of evidence. The classification of evidence considered the following hierarchical levels: N1: obtained from the meta-synthesis of qualitative studies; N2: obtained from a single qualitative study; N3: derived from syntheses of descriptive studies; N4: from a single descriptive study and N5 The result of expert opinion⁸, being the level of evidence used to strengthen the conclusions of the results achieved in the selection of articles.

After the searches, the results were exported to the bibliographic reference manager EndNote (X7 version, Thomson Reuters), which allowed for selected duplicate studies, the title and abstract reading. The identified articles were stored in folders, which allowed a new revision at any time after the selection. For the selection of the final sample, the title and abstract of the articles were read, applying the inclusion criteria by a pair of independent researchers, the divergences were discussed one by one, mediated by a third researcher, and the articles that composed the final sample were all read in full. The analysis of the results was carried out in a descriptive way, grouping the synthesis among the included surveys by similarity that resulted in two categories: contributions to nursing management and challenges.

Results

The review sample consisted of 14 primary studies. The capture of these references is illustrated in Figure 1.

Figure 1:
Flowchart of the selection of studies according to exclusion and inclusion criteria.

The analysis of the professional profile of the set of authors of each publication found that 11 articles were written by nurses, an article was written by nurses with the collaboration of a graduate student in psychology and a graduate student in pedagogy and two articles made no mention of the profession of the authors.

Among the included studies, 11 were written in Portuguese and three in English. The articles were published in 12 different journals (nine national and two international), with two journals having two selected journals. In relation to the country of origin of the authors, 12 are from Brazil, one from the United Kingdom and one from Colombia. The largest number of studies was published in the years 2013 with four studies and, 2011, 2012 with three studies in each year.

Regarding the method used by the authors, there were predominant studies with a qualitative approach, thus, 11 articles were in Level of Evidence 2, two in Level of Evidence 4 and one was not contemplated in levels of evidence.

Of the 14 articles, 11 address in their content challenges to be overcome in nursing management, and eight bring contributions from nursing management to health services.

To support the analysis, the results are presented in the form of a summary chart (Chart 1).

Chart 1:
Characterization of selected studies in databases, according to title, authors, periodical, year of publication, database, objective, method and main results

Study Title	Authors/Periodical/ Country/Year/Database	Objectives and Method	N. Evid.	Main results
Conflict in nursing management in the hospital context	Guerra ST, Prochnow AG, Trevizan MA, Guido LA. Rev Latino-Am Enfermagem. Brazil 20119 CINAHL	To analyze how the conflicts are manifested in the interpersonal relations and the magnitude that they assume in the managerial exercise of the nurse, in hospitals. Descriptive exploratory study, with a qualitative approach.	N2	The internal conflicts are remarkable for nurse managers, managing the conflicts ends up being the main movement of the nurses managers. Often the best thing to do is to ponder, observe the movements of the agents, articulate support and be aware. It is necessary that the team feel part of the processes, the approach to the activities with the nurse manager can guarantee solidarity and support for the work of these professionals. The future of the profession is associated with the scientific, theoretical and practical qualification, to fill the administrative voids in hospital organizations.
The nursing management work: knowledge of nursing professionals about their managerial competencies	Damasceno CKCS, Campelo TPT, Cavalcante IB, Sousa PSA, Moreira WC, Campelo DS. Rev Enferm UFPE online Brazil. 201610 CINAHL	To know the competences of nurses in the field of management in public health institutions. Descriptive study, qualitative approach.	N2	The coordination, control and continuity of the service is settled in nurses, however there is a growing concern about the quality of nursing care. Supervision and coordination are emphasized as important parts of the manager's work process. During undergraduate nursing, the theoretical bases have not been sufficient for the managerial understanding that occurs with the daily practice exercised in the position of manager. It should be noted that this deficiency remains in institutions, without support in continuing education.
Management profile of nurses working in a public teaching hospital	Nobrega MFB, Matos MG, Silva LMS, Jorge MSB Rev Enferm UERJ. Brasil, 200811 LILACS	To know the managerial profile of nursing unit managers in a federal public teaching hospital. Descriptive study, with a quantitative approach.	N2	The managerial function is characterized by: leadership, technical competence and the establishment of good interpersonal relationship, used predominantly for the performance of administrative and bureaucratic activities. It is necessary to reflect on the managerial actions and their relationship with nursing care, so that when assuming innumerable administrative activities the nurse does not move away from the user, from the essence of care, becoming only managers of human resources, processes and tools.
Meaning of management of Intensive Care Unit for the nurse	Martins JT, Robazzi MLCC, Marziale MHP, Garanhani ML, Haddad MCL Rev Gaúcha Enferm. Brasil, 200912 LILACS	Understand the meaning of being a nurse in a managerial role in intensive care units and the feelings that come from this function. Exploratory, descriptive study, with a qualitative approach.	N2	Managing ICUs means providing care to the patient, administering nursing care and administering the health team. The management of care is linked to the purposes of nursing, it is possible to use it as an aid instrument for the development of nursing and in the planning of tasks. The feelings of pleasure in managing are fruits of an environment that favors them to use their abilities, individualities, beliefs, potentialities, solidarity, harmony, competence and dialogue.
Profile and competencies of nurse managers at accredited hospitals	Furukawa PO, Cunha ICKO Rev Latino-Am Enfermagem. Brasil, 201113 LILACS	Characterize the profile of nursing managers in accredited hospitals and identify the competencies of these managers from the perspective of their hierarchical superiors. Descriptive study, with a quantitative approach.	N4	One of the few ways to growth as a nurse in health care organizations has been the shift to a managerial career path. The managerial career is seen as a bonus, or recognition of the contribution of the person to the organization and not as a new career. There is a preference for professionals with experience to occupy the positions of management, being considered as part of the trajectory of the nurse. The labor market asks nurses for the knowledge and application of leadership and customer-focused competence, aligning organizational goals with customer needs. Teamwork is among the three most important competencies, promoting the integration of the members of your team for better results as a way to survive the labor market.
Knowledge, skills and attitudes about the management of graduates in nursing of Brazilian public university	Almeida ML, Peres AM. Invest Educ Enferm. Brasil, 201214 LILACS	Identify the knowledge, skills and attitudes seized by graduates for the management in Nursing during their formation in a Nursing Course. Descriptive study, with cross-sectional	N4	The graduates prefer to have an approach that allows them to develop more knowledge and skill than management related attitude, depicting that they have greater difficulty in the attitudinal field because it develops in professional practice. It is necessary to provide teaching-learning situations that allow the acquisition of knowledge to support the attitudes to be mobilized in their insertion in the labor market.
Challenges for the management of emergency care from the perspective of nurses	Santos JLG, Lima MADS, Pestana AL, Garlet ER, E rdman AL Acta Paul Enferm, Brasil, 201315 LILACS	Analyze the challenges for the management of care in an emergency hospital service based on the perspective of nurses. Exploratory-descriptive study, with a qualitative approach.	N2	The main challenges for management are the overcrowding of unity, the maintenance of quality of care and the use of leadership as a management tool. As suggestions the nurses indicate the need for reorganization of the health system for the attention to emergencies, change in the flow of patients care, expansion of the physical structure of the unit and the conduction of training in nursing management.
Pleasure and suffering in the managerial exercise of the nurse in the hospital context	Santos JLG, Prochnow AG, Silva DC, Silva RM, Leite JL, Erdman AL Esc. Anna Nery. Brasil, 201316 LILACS	Analyze the factors of pleasure and suffering in the managerial exercise of the nurse in the hospital context. Exploratory-descriptive study, with a qualitative approach.	N2	Management is considered a source of pleasure when there is personal growth, professional recognition and satisfaction; is a source of suffering due to the difficulties in the relationship with the team and the work overload. It is suggested greater attention from undergraduate nursing courses to strengthen the development of management activities, mainly related to conflict management and teamwork.
(Dis) articulation between management and care in a surgical intensive care unit	Borges MCLA, Silva LMS. R Pesq: Cuid Fundam. [Online], Brasil, 201317 LILACS	Understand the perception of the nursing team about the (dis) articulations between management and care actions implemented by the nurse in a surgical intensive care unit. Exploratory study, with a qualitative approach.	N2	Nurses are divided between those who consider care and management as inseparable and those who consider that managing represents a departure from direct care, implying conflicts with the rest of the team. The perception of assistant nurses about management and care was different, evidencing that most understand that these two dimensions are important and essential to the work of nurses.
Relevance and level of application of management competencies in nursing	Jímenez GMA, Arrubla CPL. Invest Educ Enferm, Colômbia, 201318 LILACS	Identify the main management skills for the performance of nursing professionals and indicate some strategies that should be implemented within the educational structure. Descriptive study with mixed approach (qualitative and quantitative).	*	It was identified that the most relevant management skills were: leadership (81.4%), teamwork (75.0%), effective communication (55.7%); while the specific skills are quality management and care. It is noteworthy the knowledge component (scientific and technological domain) and the component of skills, interrelation (leadership, effective communication and teamwork). These are complex constructions that should be considered in nursing training. It is imperative to opt for integrative visions.
Dimensions of nursing work in the hospital context	Presotto GV, Ferreira MBG, Contim D, Simões ALA Rev RENE. Brasil, 201419 LILACS	To understand the perception of nurses about the dimensions of the work they perform in the daily life of a university hospital. Exploratory-descriptive study, with a qualitative approach.	N2	Nurses perceive the development of their work linked to four different dimensions: care, administration, education and research. The care dimension of the nursing work is characterized as human care based on science and technology. The administrative dimension highlights the role in the management of care, material and human resources, as well as the hospital organization, ensuring safe care. The educational dimension refers to the qualification of social practices, in favor of a common goal. The research dimension of the nurse indicates the need for the professional to study continuously, produce and read research, to subsidize the caring process.
Manage hospital admission unit: What do the nurses think?	Lima RS, Lourenço EB, Rosado SR, Sanches RS, Fava SMCL, Dázio EMR. Rev Enferm. Cent-Oeste Min. Brasil, 20165 LILACS	Understand the meanings of managing hospitalization units from the perspective of nurses. Exploratory-descriptive study, with a qualitative approach.	N2	The managerial activities are limited to their technical dimension in order to reach the institutional objectives, being that the direct care does not occupy central space in the representation elaborated by the nurse, reproducing the dichotomy management/care.
Leadership support for ward managers in acute mental health inpatient settings	Bonner G, McLaughlin S. J Nurs Manag. Reino Unido, 201420 PUBMED.	Explore how leadership is developed and identify the difficulties and challenges in the work of managers. Action research study with qualitative approach.	N2	The roles of managers are and vary according to individual perspectives and personalities, ward type and work group. The managers demonstrated that they wanted to carry out assistance activities, but they felt unable to allocate sufficient time for this aspect. Recording activity routinely reduced their time, but allowed them to reflect on priorities.
Nurses' perception of management activities in the care of the user	Giordani JN, Bisogno SBC, Silva LAA. Acta Paul Enferm. Brasil, 201221 SCOPUS	Identify the perception of nurses on the management activities in assisting the user. Exploratory-descriptive study, with a qualitative approach.	N2	The managerial activities vary according to the unit, and the direct assistance is delegated to other members of the team, a fact that can be a source of conflicts. The management is planned and performed with the purpose of assuring the quality of the assistance and as it is an activity that should not be delegated, it is through this process that the nurse performs the assistance to the user. The effectiveness of the work process is also linked to the organization of the unit and the planning of activities and the education of the team in order to qualify care and services.

• ^Source:
  Research data, 2018.
• ^*
  Study not included in the levels of evidence used

Discussion

The results were grouped into the categories: contributions to nursing management and challenges.

The category "Contributions" includes studies that address the managerial actions of nurses that facilitate the development and organization of work in a technical-political perspective, qualifying the productive processes.

The nurse has assumed an important role in health services, especially in the hospital environment, for being responsible for the management of services and for adopting measures that integrate administrative, care and teaching/research areas, to qualify care. In addition to nursing management, the demands regarding its performance have included knowledge and interaction with the entire organizational environment, thus allowing greater contribution to the achievement of institutional goals¹³.

Leadership is an essential competence for the work of the nurse, since it favors the development of teamwork and contributes to the qualification of services.

The purpose of nurses' work is health care. However, in order to achieve this goal, the professional is also responsible for planning care, carrying out more complex procedures, supervising care, coordinating the team, and performing bureaucratic and administrative activities. Thus, the supervision and coordination of the team are highlighted as important parts of the nursing work¹⁰, which, effectiveness is linked to the organization of the unit, the planning of activities and lifelong learning in service sectors²¹.

Thus, it is possible to understand that nursing management is articulated to the purposes of nursing work, as an aid to planning, developing and coordinating nursing activities¹². In this sense, it is noticed that the nurse in the exercise of managerial functions, focuses his actions, mainly, to allocate the team in their respective functions with the purpose of avoiding possible conflicts⁹ and achieve care goals.

The nursing manager operates as an administrator of nursing care, with activities not only for the admission of employees and work scales that contribute to the adequacy of the environment and for the care, but also provides desirable conditions for the execution of the activities, favoring the well being of patients and the safe care¹⁰.

Thus, nurses assume the role of articulator for the operationalization of the health system, services and health care⁹. From this perspective, it is pertinent to consider the need to reconfigure nursing education in order to guarantee subsidies for the development of specific management skills that characterize the professional practice of nurses in a hospital unit.

In the category "Challenges", there are evidences of studies on nursing management work immersed in issues related to professional training, work satisfaction, work overload related to multiple tasks, maintenance of quality of services, conflict resolution and team work. These challenges need to be overcome by the professional in the course of nursing management of hospital care, being a hard work and of continuous construction.

The challenges of nurse, in general, are related to inadequate preparation, given that there are gaps in the education of nurses for management, even though undergraduate nursing courses follow their own curricular guidelines related to the managerial scope¹¹. In the education, the theoretical bases are not enough for the managerial understanding, so the learning about this dimension of the work is often executed in the daily practice of the nurse¹⁰.

Newly graduated nurses have more experience regarding knowledge and skills than attitudes, and attitudes are developed in professional practice¹⁴. However, it is emphasized that nursing management, based on knowledge and skills, has a strong attitudinal aspect, whose development during training, inserted in the world of work, becomes necessary and presents itself as a challenge.

Reflecting on the possibilities of training nursing undergraduates to become managers, requires contemplating the plurality of skills and attitudes that will be developed in everyday practice, needs a collective effort in the search for theoretical and practical tools that are offered during graduation/post graduation to support this nurse in his/her praxis.

It is desirable to pay more attention to undergraduate nursing courses to strengthen the development of managerial activities, mainly related to conflict management and teamwork^15-16. Leadership and ethical commitment are complex constructions that must also be considered in training, by making choices for integrative visions, for conceptualizing and developing competencies in undergraduation¹⁸.

Most of the professionals in the nursing management exercise who occupy managerial positions do not have specific training for the area, but the performance of the function in the work environment can favor the development of skills and attitudes, since these professionals present ideas of coordination, continuity and control of the service¹⁰.

Maintaining quality of care using leadership is challenging for the management of emergency hospital services. In this environment, the nurse who was not prepared to perform the role of manager finds difficulty in performing a sequenced work due to excessive demand from team and patient¹¹.

When looking at the world of work that is characterized by competitiveness and the pursuit of high levels of productivity with low production costs, related to the increase in work pace and lack of professional satisfaction, the workload of nurses is mainly related to the incorrect design of professionals, excessive demands and irregular work structure. This favors the devaluation of the professional, hinders the development of the managerial role, entails disorganization of the service^15-16. Thus, promoting the integration of team professionals in favor of better results may be one way to face the complexity of this work challenge¹³.

Different interpretations of nurses who are divided between those who think that care and management are inseparable and those who consider that management represents a departure from direct care is another challenge to be overcome in the dichotomy between management and care¹⁷.

This dichotomy is reinforced by the restriction of managerial activities to only the administrative technical dimension often imposed by the institutions, thus the direct care cannot occupy central place in the work of the nurse⁵, even when they have an interest and goal in exercising the clinical part of care, making them unable to manage adequate time for the administrative dimension²⁰, i.e., the administrative function is lost in amid activities, to the detriment of managing activities.

The lack of support from continuing education by hospital management has contributed to strengthen the challenges of nursing management¹⁰. It is worth emphasizing that the immediacy of health services that do not have a definition of their organizational structure, the functions and attributions of the nurse, including those who have and do not apply it in practice, are influencers for the increase of nursing management challenges.

The future of the profession is associated to the search for scientific, theoretical and practical qualification, so as to overcome managerial gaps in hospital organizations⁹.

Conclusion

The results highlight contributions to teaching by pointing out that there are weaknesses and/or gaps and/or limitations in nurse training in issues related to nursing management, particularly in the development of attitudinal aspects in this sense it is present the challenge to review the processes of formation and continuing education. For the assistance, the contribution of the results is highlighted, showing the relevance of overcoming dichotomy between management and care as well as the potential to understand nursing management as an instrument for coordination and leadership of the team focused on the practice of care. For institutions and managers, the findings of this study can add knowledge by showing that nursing management brings benefits to care, to the management of people and can constitute a possibility of career progression and professional qualification.

The evidence allows to characterize as challenges to nursing management gaps in professional training, aspects related to job satisfaction, work overload and lack of preparation to assume such function related to knowledge, skills and attitudes, in addition to professional devaluation, imposition and administrative technical constraint often imposed by the institutions.

The included articles provide relevant scientific evidence. However, the analysis of the results allows to infer that the investigation and sharing of knowledge about strategies and successful managerial interventions are presented as a gap, i.e., there is little dissemination of management approaches in hospital care that can be replicated in other similar scenarios. It is noteworthy that this fact may result not only from the options of researchers, but from the limitations of the design of this review when including literature, without contemplating, for example, annals of scientific events that notably aggregate publications of service-linked nurses and may perhaps add a greater volume of successful experiences to be disseminated.

The results allow us to conclude that the managerial activities that are essential for the nursing work are permeated with aspects related to leadership, interpersonal relationships, effective communication, adequate management of conflicts to favor teamwork.

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Publication Dates

• Publication in this collection
  05 Aug 2019
• Date of issue
  2019

History

• Received
  25 Aug 2018
• Accepted
  20 Nov 2018