Os ruídos encontrados na construção de um modelo democrático e participativo de gestão hospitalarObstacles found in the construction of a democratic and participatory hospital management model
Na prática profissional, os enfermeiros concentram-se na função administrativa distanciando-se do cuidado direto ao paciente. Articular essas dimensões está difícil. Essa dificuldade talvez se deva ao despreparo do enfermeiro e a maneira desarticulada com que as instituições de ensino abordam esses conteúdos e os relacionam com a prática cotidiana do trabalho. O trabalho apresentado é um estudo descritivo, na forma "pesquisa de opinião" que busca conhecer a opinião de um grupo de pessoas acerca de um assunto. Foram realizadas entrevistas com alunos egressos do curso de enfermagem (2002), que ainda não estejam atuando na prática profissional com o objetivo de verificar como eles vêem a atuação gerencial do profissional enfermeiro e como eles avaliam o conhecimento adquirido na escola sobre as questões gerenciais. Os resultados demonstram que existe uma dicotomia entre assistência e gerencia em enfermagem tanto no mercado de trabalho como durante a formação profissional.
The study presents some reflections on the possibilities and limitations of the rationalization and flexibilization of the management process of the health services under the economic perspective, focussing on the introduction of mechanisms and instruments centred in the economic and organizational responsibilization of the resources and nursing participation in these processes. Authors discuss the adoption of a system of economic control in order to coordinate the interests of the several subjects involved; to privilege the results of the processes and to improve the economic combination of the resources. Under this perspective, two concepts are considered relevant in the elaboration of the budget of the Nursing Services: the controllability of the resources and the negotiation in the processes of allocation and utilization of these resources. The use of these concepts in the organization of health services, especifically in nursing area, creates new possibilities of participation in the processes of services production, enabling more transparency in the decision processes and restructuring new modalities of management for the nursing services.
There are few studies on the delivery of nursing services in hospitals participating in the Brazilian universal public health system (Sistema Unico de Saúde), which was put in place in 1988. This study, which examined possible changes in the delivery of these services since universal health care was implemented, was based on interviews carried out between July and September 1995 with 31 nurses working at a teaching hospital in the city of Ribeirão Preto, in the state of São Paulo. The nurses had begun working at the hospital between May 1980 and May 1987. Thematic analysis was used to assess their answers. According to the nurses, patients treated after the universal system was implemented have had more complex medical needs and a higher socioeconomic status. In addition, nurses reported an increase in the complexity of patient demands and in the variety of medical specialties offered by the hospital, as well as a decrease in the length of inpatient stays. Forty-six percent of the interviewees reported a change in the work done by nursing staff (for example, nurses have less time available for each patient). Not all of the problems the nurses mentioned are related to the public health system (understaffing is one example). It is essential that nurses examine national health policy and that they engage in the (re)construction of the practice of health care delivery. Nurses ought to understand the reality of their institutions and carry out a management process geared towards the expectations of patients and of health care workers.
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