ABSTRACT
Objective:
To analyze the scope and support of the nursing procedures table based on resolutions of the Federal Nursing Council from 2005 to 2021.
Method:
A quantitative documentary study was carried out on the Federal Nursing Council website to identify the resolutions published between 2005 and 2021. The analysis, conducted in three screening stages, covered resolutions between No. 301/2005 and 673/2021 related to the table of minimum fee procedures for nursing.
Results:
In comparison, resolution No. 673/2021 extends the table of nursing procedures in Resolution No. 301/2005 in four areas of activity and adds 34 procedures, totaling 174 nursing procedures, backed by 48 current resolutions.
Conclusion:
The expansion of nursing procedures, supported by legal grounds, reinforces the entrepreneurial side of nurses. This aspect, when pointed out, can instigate reflection and recognition on the part of the category to expand its activities.
KEYWORDS:
Nursing; Nursing Legislation; Role of the Nursing Professional; Remuneration; Entrepreneurship.
RESUMO
Objetivo:
analisar o escopo e respaldo da tabela de procedimentos de enfermagem a partir de resoluções do Conselho Federal de Enfermagem de 2005 a 2021.
Método:
estudo documental quantitativo, realizado no site do Conselho Federal de Enfermagem a fim de identificar as resoluções publicadas entre 2005 e 2021. A análise, conduzida em três etapas de triagem, abrangeu resoluções situadas entre os números 301/2005 e 673/2021, relacionadas à tabela de procedimentos honorários mínimos da enfermagem.
Resultados:
em comparação, a resolução n. 673/2021 amplia a tabela de procedimentos de enfermagem da Resolução n. 301/2005 em quatro áreas de atividades e acresce-a em 34 procedimentos, totalizando 174 procedimentos de enfermagem, respaldados por 48 resoluções vigentes.
Conclusão:
a ampliação de procedimentos da enfermagem, respaldada por fundamentação legal, reforça a faceta empreendedora do enfermeiro. Este aspecto, ao ser indicado, pode instigar uma reflexão e reconhecimento por parte da categoria em expandir sua atuação.
DESCRITORES:
Enfermagem; Legislação de Enfermagem; Papel do Profissional de Enfermagem; Remuneração; Empreendedorismo.
RESUMEN
Objetivo:
analizar el alcance y el apoyo de la tabla de procedimientos de enfermería basada en las resoluciones del Consejo Federal de Enfermería de 2005 a 2021.
Método:
estudio documental cuantitativo realizado en la página web del Consejo Federal de Enfermería para identificar las resoluciones publicadas entre 2005 y 2021. El análisis, realizado en tres fases de cribado, abarcó las resoluciones comprendidas entre los números 301/2005 y 673/2021, relacionadas con la tabla de procedimientos de honorarios mínimos de enfermería.
Resultados:
en comparación, la resolución n. 673/2021 amplía la tabla de procedimientos de enfermería de la Resolución n. 301/2005 en cuatro áreas de actividad y añade 34 procedimientos, con un total de 174 procedimientos de enfermería, respaldados por 48 resoluciones vigentes.
Conclusión:
la expansión de los procedimientos de enfermería, respaldada por fundamentos jurídicos, refuerza la faceta empresarial del enfermero. Este aspecto, cuando se señala, puede suscitar la reflexión y el reconocimiento por parte de la categoría para ampliar sus actividades.
DESCRIPTORES:
Enfermería; Legislación de Enfermería; Papel del Profesional de Enfermería; Remuneración; Emprendedorismo.
HIGHLIGHTS
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Legal backing is an important factor for entrepreneurship in the area.
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Expanding the scope of procedures strengthens the nurse’s role.
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The expanded role of nurses benefits access to healthcare.
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Professional nurses have the prerogative to undertake.
HIGHLIGHTS
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Legal backing is an important factor for entrepreneurship in the area.
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Expanding the scope of procedures strengthens the nurse’s role.
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The expanded role of nurses benefits access to healthcare.
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Professional nurses have the prerogative to undertake.
INTRODUCTION
In Brazil, the professional practice of nursing is guaranteed by Law No. 7.498/86 and Decree No. 94.406/87, which establishes legal support for the regulation of the profession in Brazil, allowing individuals who are qualified and registered with the Regional Nursing Council (COREN) in their jurisdiction to practice legitimately11 Brasil. Lei n. 7.498, de 25 de junho de 1986. Dispõe sobre a Regulamentação do Exercício da Enfermagem e dá outras providências. Diário Oficial da República Federativa do Brasil [Internet] 26 jun. 1986 [cited 2022 Jan 26]. Available from: https://www.planalto.gov.br/ccivil_03/leis/l7498.htm#:~:text=Disp%C3%B5e%20sobre%20a%20regulamenta%C3%A7%C3%A3o%20do,observadas%20as%20disposi%C3%A7%C3%B5es%20desta%20lei
https://www.planalto.gov.br/ccivil_03/le...
.
The system made up of the Federal Nursing Council (COFEN) and its Regional Nursing Councils, created by Law No. 5905/1973, is a reference for regulations aimed at guaranteeing the legal exercise of nursing, supervising, standardizing and directing practice, promoting excellence in the services provided. It is the authority’s responsibility to propose changes to professional practice legislation in line with updates and advances in the duties of nursing professionals22 Brasil. Lei n. 5.905, de 12 julho de 1973. Dispõe sobre a criação dos Conselhos Federal e Regionais de Enfermagem e dá outras providências. Diário Oficial da República Federativa do Brasil [Internet] 13 jul. 1973 [cited 2022 Jan 26]. Available from: https://www.planalto.gov.br/ccivil_03/leis/l5905.htm
https://www.planalto.gov.br/ccivil_03/le...
-33 Conselho Federal de Enfermagem (Brasil). Resolução COFEN n. 481, de 15 fevereiro 2012. Aprova o Regimento Interno do Conselho Federal de Enfermagem e dá outras providências [Internet]. Brasília: COFEN; 2012 [cited 2022 Jan 26]. Available from: http://www.cofen.gov.br/resolucao-cofen-no-04812015_32076.html
http://www.cofen.gov.br/resolucao-cofen-...
.
It is through the drafting and approval of resolutions by COFEN that it is possible to broaden the scope of practice and ensure professional performance is recognized in the job market, especially concerning paid practice, making decisions on this issue important. Nursing is a profession in constant progress and updating. It is guaranteed by ethical and legal precepts and is guided by technical and scientific knowledge44 Conselho Federal de Enfermagem (Brasil). Resolução n. 564, de 6 novembro 2017. Aprova o novo Código de ética dos profissionais de enfermagem [Internet]. Brasília: COFEN; 2017 [cited 2022 Jan 26]. Available from: http://www.cofen.gov.br/resolucao-cofen-no-5642017_59145.html
http://www.cofen.gov.br/resolucao-cofen-...
.
Along these lines, entrepreneurship in nursing, especially in business, is the process that is mobilizing the expansion of professional practice and autonomy. This movement has increased the profession’s visibility, stimulating the creation of new areas of activity and generating a range of possibilities for nurses, especially in paid practice55 Copelli FH da S, Erdmann AL, Santos JLG dos. Empreendedorismo na enfermagem: revisão integrativa da literatura. Rev. Bras. Enferm. [Internet]. 2019 [cited 2022 Jan 28]; 72: 301-10. Available from: https://doi.org/10.1590/0034-7167-2017-0523
https://doi.org/10.1590/0034-7167-2017-0...
.
Legal certainty and institutional strengthening present new possibilities for fields of practice and professional autonomy. In this respect, the COFEN/COREN system is directly involved in regulating and guaranteeing the pricing of nursing services.
In 2005, COFEN Resolution No. 301, which focused on the implementation of minimum fees for the provision of nursing services, and was updated by COFEN Resolution No. 673/2021, which establishes the Nursing Work Reference Unit (URTE), and proposes new minimum values for nursing procedure fees in URTE66 Conselho Federal de Enfermagem. Resolução n. 301, de 16 mar 2005. Atualiza os valores mínimos da Tabela de Honorários de Serviços de Enfermagem [Internet]. Rio de Janeiro: COFEN; 2005 [cited 2022 Jan 26]. Available from: http://www.cofen.gov.br/wp-content/uploads/2012/03/RES%20301-05.pdf
http://www.cofen.gov.br/wp-content/uploa...
-77 Conselho Federal de Enfermagem. Resolução n. 673, de 30 jul 2021. Estabelece a Unidade de Referência de Trabalho de Enfermagem (URTE) para indexar os valores mínimos dos seus Honorários e atualiza os valores mínimos dos honorários da enfermagem em URTE [Internet]. Brasília, 2021. [cited 2022 Jan 26]. Available from: http://www.cofen.gov.br/resolucao-cofen-no-673-2021_89412.html
http://www.cofen.gov.br/resolucao-cofen-...
.
To standardize remuneration for services provided by nurses, COFEN Resolution no. 301/2005 set minimum fees for providing services, divided into 16 areas of activity, integrating the procedures carried out by nurses with their respective values. Suppose the values are updated by establishing the URTE, as a result of COFEN Resolution No. 673/2021, totaling 20 areas with their appropriate procedures carried out by nursing staff.
Over the 16 years that separate one resolution from the other, new decisions have emerged that have led to an increase in procedures evident in establishing a reference unit for nursing work for the setting of values approved in 2021. Examples are the approval of Resolution No. 529/2016, which regulates work in aesthetics, and Resolution No. 585/2018, establishing and recognizing acupuncture as a specialty and qualification for nursing professionals. Table 1 shows the areas of nursing practice, the practical procedures in the different resolutions, and how many resolutions per area appeared in this period.
Given the above, this article aimed to analyze the scope and support of the nursing procedures table based on resolutions of the Federal Nursing Council from 2005 to 2021.
METHOD
A quantitative documentary study was conducted, analyzing official documents that had not yet received analytical treatment or that could be approached according to the research objective88 Sá-Silva JR, Almeida CD de, Guindani JF. Pesquisa documental: pistas teóricas e metodológicas. RBHCS. [Internet]. 2009 [cited 2022 Jan 31]; 1(1): 1-15. Available from: https://periodicos.furg.br/rbhcs/article/view/10351
https://periodicos.furg.br/rbhcs/article...
. To continue to provide answers on expanding the professional scope and supporting paid nursing practices, the resolutions published by COFEN between 2005 and 2021 were analyzed. The selected period is in relation to the COFEN Resolution no. 301/2005 and COFEN Resolution No. 673/2021 set benchmarks for minimum nursing fees.
Data was collected in December 2022 electronically by accessing the COFEN portal, identifying all the resolutions produced within the period proposed for analysis, after which they were grouped in a table, prepared in the Microsoft Excel spreadsheet editor, taking into account the year of publication, the title and the menu.
The first screening was then carried out, identifying which resolutions were in force, excluding those revoked, duplicated, or annulled. The second screening was carried out, which consisted of identifying which of the resolutions in force standardized professional practices that could be remunerated. Afterward, the resolutions included were associated and compared to the areas of activity included in COFEN Resolution No. 301/2005 (administrative, teaching, and care) and COFEN Resolution No. 673/2021 (administrative, didactic-educational, childbirth and newborn care, operating room support, and assistance).
RESULTS
As for the scope, when comparing the 2005 and 2021 resolutions, it was observed that four areas of activity were added in COFEN Resolution No. 673/2021: childbirth and newborn care, surgical support, alternative and complementary therapies, and aesthetics. The number of procedures was also increased from 140 to 174, all backed by current resolutions.
Between 2005 and 2021, COFEN published 385 resolutions, of which 93 have been repealed, and 292 are still in force. Of the resolutions in force, 48 support the nursing procedures table, as shown in Figure 1.
Flowchart describing the resolutions passed between 2005 and 2021. Chapecó, SC, Brazil, 2022.
Areas and procedures considering COFEN resolutions No. 301/2005 and n. 673/2021, showing the resolutions approved between 2005 and 2021. Chapecó, SC, Brazil, 2022.
Description of the procedures subject to remuneration with the resolutions that support them. Chapecó, SC, Brazil, 2022.
DISCUSSION
Brazil is a country that highlights health as a right in its Magna Carta and has a system of universal access. As a Member State of the United Nations, it has committed to achieving universal health coverage (UHC) by 2030 as part of the Sustainable Development Goals (SDGs). Despite the political controversies surrounding this concept, particularly in the Americas, where there is a discussion about adopting a universal health strategy as an element to reconcile the different paradigms, what we can see is the continuing challenge of promoting access for the population to health services and actions, from health promotion to prevention, treatment, rehabilitation, and palliative care99 Giovanella L. Atenção básica ou atenção primaria à saúde? Cad. Saúde Pública. [Internet]. 2018 [cited 2022 Jan 31]; 34 (8). Available from: https://doi.org/10.1590/0102-311X00029818
https://doi.org/10.1590/0102-311X0002981...
.
In a pandemic and post-pandemic scenario, with projections of an economic crisis and budget restrictions1010 Bhuiyan MA, Crovella T, Paiano A, Alves H. A Review of research on tourism industry, economic crisis and mitigation process of the loss: analysis on pre, during and post pandemic situation. Sustainability [Internet]. 2021; [cited 2022 Jan 31]; 13(18):10314. https://doi.org/10.3390/su131810314
https://doi.org/10.3390/su131810314...
, this challenge will tend to increase, with governments turning to strategies of essential services, baskets of services, concentrated in certain areas. Therefore, the concern and commitment of the state must remain in failing to promote universal access, to have a backup, and to create conditions so that all people can also have alternatives to meet their health needs with quality without exposing themselves to financial difficulties.
Part of a country’s success in guaranteeing UHC depends on the availability, access, and capacity of health services and professionals to provide integrated, quality, people-centered care. Health needs, time, and the cost of access to certain services are some of the main intervening elements that have led to the emergence of a parallel market beyond the health plan operators and the medical profession, a market that has supplied the state’s pent-up demands, but whose relationship is not cooperative and based on the principles of the Unified Health System (SUS). In this sense, achieving UHC in Brazil by 2030 could involve investing in Nursing Entrepreneurship1111 Menegaz JCM, Trindade LL, Santos JLG. Entrepreneurship in nursing: contribution to the health and well-being sustainable development goal. Rev. Enferm.UERJ. [Internet]. 2021 [cited 2023 Jul 13]; 29: e61970. Available from: https://doi.org/10.12957/reuerj.2021.61970
https://doi.org/10.12957/reuerj.2021.619...
.
The World Health Organization (WHO) and the Pan American Health Organization (PAHO) have called on countries to invest in nursing professionals to advance toward universal health1212 World Health Organization. State of the world’s nursing 2020: investing in education, jobs and leadership. [cited 2022 Feb 02]; Available from: https://www.who.int/publications/i/item/9789240003279
https://www.who.int/publications/i/item/...
. This investment has sometimes been understood only in the context of the public sphere, which is limited for a health system such as the Brazilian one, This is limited for a health system like Brazil’s, which is gradually admitting limitations, highlighting in national and state health plans the need to expand access coverage in the face of epidemiological data that suggests that people’s health needs are not being fully met.
In Brazil, COFEN, in partnership with the Pan American Health Organization, has sought to broaden the scope and backing for its work and provide support for this discussion, especially about its implementation in Primary Care, with residency and professional master’s degree programs being key training spaces for preparing professionals1313 Rewa T, Neto MV de M, Bonfim T, Leonello VM, Oliveira MA de C. Práticas avançadas de enfermagem: percepção de egressos da residência e do mestrado profissional. Acta Paul Enferm. [Internet]. 2019 [cited 2022 Jan 31]; 32(3). Available from: https://doi.org/10.1590/1982-0194201900035
https://doi.org/10.1590/1982-01942019000...
.
However, when compared to other countries such as the United States and Canada, especially the former, which introduced the organization of professionals into Advanced Practice Registered Nurses (APRN), divided into four types: clinical specialists, nurse practitioners, nurse midwives, and nurse anesthetists, there is still room for expansion of the role of nurses in the health system and consequently an expansion of procedures and areas in which Brazilian nurses could work1414 APRN Consensus Work Group & the National Council of State Boards of Nursing APRN Advisory Committee Consensus model for APRN regulation: licensure, accreditation, certification & education [Internet]. 2008 [cited 2022 Jan 31]; Available from: http://www.aanp.org/publications/position-statements-papers
http://www.aanp.org/publications/positio...
.
Expanding the scope of nurses’ work in areas and procedures is not just a market issue but also an expansion of access to healthcare, a constitutional right. One of the many elements for making this movement a reality is regulation, and in this respect, countries have invested in areas and legislation according to their needs1515 Judith M. Parker, Martha N. Hill. A review of advanced practice nursing in the United States, Canada, Australia and Hong Kong Special Administrative Region (SAR), China. International Journal of Nursing Sciences. [Internet]. 2017 [cited 2022 Feb 02]; 4(2):196-204. Available from: https://doi.org/10.1016/j.ijnss.2017.01.002
https://doi.org/10.1016/j.ijnss.2017.01....
.
In the context of entrepreneurship, this also becomes a crucial element. Nurses are recognized as liberal professionals and, therefore, have the prerogative to undertake. However, it is only recently that this perspective has taken shape in Nursing, especially since February 2018, when COFEN published Resolution No. 0568/2018.
FINAL CONSIDERATIONS
Considering the objective of analyzing the scope and support of the table of nursing procedures in resolutions of the Federal Nursing Council from 2005 to 2021, the results indicate an expansion of the scope of procedures and their support in the law of professional practice and resolutions.
A limitation of the study is that the analysis was limited to documents. In the field of professional practice, the scope and support can be different. The COFEN-COREN system has played an active role in expanding the scope and possibilities for nurses. There are challenges for business entrepreneurship in macro aspects, such as the recognition by the profession and society of nurses performing these procedures outside traditional care establishments such as hospitals, clinics, and basic health units, and being recognized by health insurers, expanding their entrepreneurial activities.
There is also the challenge of positioning yourself, establishing your price, and selling your services on the market in a compatible way. Resolution No. 673/2021 provides a basis for this purpose. Still, knowledge and skills are needed so that professionals can use them according to their context, in addition to the demand for constant expansion and support of professional practice based on entrepreneurship.
ACKNOWLEDGMENTS
Fundação de Amparo à Pesquisa e Inovação do Estado de Santa Catarina - FAPESC.
REFERÊNCIAS
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1Brasil. Lei n. 7.498, de 25 de junho de 1986. Dispõe sobre a Regulamentação do Exercício da Enfermagem e dá outras providências. Diário Oficial da República Federativa do Brasil [Internet] 26 jun. 1986 [cited 2022 Jan 26]. Available from: https://www.planalto.gov.br/ccivil_03/leis/l7498.htm#:~:text=Disp%C3%B5e%20sobre%20a%20regulamenta%C3%A7%C3%A3o%20do,observadas%20as%20disposi%C3%A7%C3%B5es%20desta%20lei
» https://www.planalto.gov.br/ccivil_03/leis/l7498.htm#:~:text=Disp%C3%B5e%20sobre%20a%20regulamenta%C3%A7%C3%A3o%20do,observadas%20as%20disposi%C3%A7%C3%B5es%20desta%20lei -
2Brasil. Lei n. 5.905, de 12 julho de 1973. Dispõe sobre a criação dos Conselhos Federal e Regionais de Enfermagem e dá outras providências. Diário Oficial da República Federativa do Brasil [Internet] 13 jul. 1973 [cited 2022 Jan 26]. Available from: https://www.planalto.gov.br/ccivil_03/leis/l5905.htm
» https://www.planalto.gov.br/ccivil_03/leis/l5905.htm -
3Conselho Federal de Enfermagem (Brasil). Resolução COFEN n. 481, de 15 fevereiro 2012. Aprova o Regimento Interno do Conselho Federal de Enfermagem e dá outras providências [Internet]. Brasília: COFEN; 2012 [cited 2022 Jan 26]. Available from: http://www.cofen.gov.br/resolucao-cofen-no-04812015_32076.html
» http://www.cofen.gov.br/resolucao-cofen-no-04812015_32076.html -
4Conselho Federal de Enfermagem (Brasil). Resolução n. 564, de 6 novembro 2017. Aprova o novo Código de ética dos profissionais de enfermagem [Internet]. Brasília: COFEN; 2017 [cited 2022 Jan 26]. Available from: http://www.cofen.gov.br/resolucao-cofen-no-5642017_59145.html
» http://www.cofen.gov.br/resolucao-cofen-no-5642017_59145.html -
5Copelli FH da S, Erdmann AL, Santos JLG dos. Empreendedorismo na enfermagem: revisão integrativa da literatura. Rev. Bras. Enferm. [Internet]. 2019 [cited 2022 Jan 28]; 72: 301-10. Available from: https://doi.org/10.1590/0034-7167-2017-0523
» https://doi.org/10.1590/0034-7167-2017-0523 -
6Conselho Federal de Enfermagem. Resolução n. 301, de 16 mar 2005. Atualiza os valores mínimos da Tabela de Honorários de Serviços de Enfermagem [Internet]. Rio de Janeiro: COFEN; 2005 [cited 2022 Jan 26]. Available from: http://www.cofen.gov.br/wp-content/uploads/2012/03/RES%20301-05.pdf
» http://www.cofen.gov.br/wp-content/uploads/2012/03/RES%20301-05.pdf -
7Conselho Federal de Enfermagem. Resolução n. 673, de 30 jul 2021. Estabelece a Unidade de Referência de Trabalho de Enfermagem (URTE) para indexar os valores mínimos dos seus Honorários e atualiza os valores mínimos dos honorários da enfermagem em URTE [Internet]. Brasília, 2021. [cited 2022 Jan 26]. Available from: http://www.cofen.gov.br/resolucao-cofen-no-673-2021_89412.html
» http://www.cofen.gov.br/resolucao-cofen-no-673-2021_89412.html -
8Sá-Silva JR, Almeida CD de, Guindani JF. Pesquisa documental: pistas teóricas e metodológicas. RBHCS. [Internet]. 2009 [cited 2022 Jan 31]; 1(1): 1-15. Available from: https://periodicos.furg.br/rbhcs/article/view/10351
» https://periodicos.furg.br/rbhcs/article/view/10351 -
9Giovanella L. Atenção básica ou atenção primaria à saúde? Cad. Saúde Pública. [Internet]. 2018 [cited 2022 Jan 31]; 34 (8). Available from: https://doi.org/10.1590/0102-311X00029818
» https://doi.org/10.1590/0102-311X00029818 -
10Bhuiyan MA, Crovella T, Paiano A, Alves H. A Review of research on tourism industry, economic crisis and mitigation process of the loss: analysis on pre, during and post pandemic situation. Sustainability [Internet]. 2021; [cited 2022 Jan 31]; 13(18):10314. https://doi.org/10.3390/su131810314
» https://doi.org/10.3390/su131810314 -
11Menegaz JCM, Trindade LL, Santos JLG. Entrepreneurship in nursing: contribution to the health and well-being sustainable development goal. Rev. Enferm.UERJ. [Internet]. 2021 [cited 2023 Jul 13]; 29: e61970. Available from: https://doi.org/10.12957/reuerj.2021.61970
» https://doi.org/10.12957/reuerj.2021.61970 -
12World Health Organization. State of the world’s nursing 2020: investing in education, jobs and leadership. [cited 2022 Feb 02]; Available from: https://www.who.int/publications/i/item/9789240003279
» https://www.who.int/publications/i/item/9789240003279 -
13Rewa T, Neto MV de M, Bonfim T, Leonello VM, Oliveira MA de C. Práticas avançadas de enfermagem: percepção de egressos da residência e do mestrado profissional. Acta Paul Enferm. [Internet]. 2019 [cited 2022 Jan 31]; 32(3). Available from: https://doi.org/10.1590/1982-0194201900035
» https://doi.org/10.1590/1982-0194201900035 -
14APRN Consensus Work Group & the National Council of State Boards of Nursing APRN Advisory Committee Consensus model for APRN regulation: licensure, accreditation, certification & education [Internet]. 2008 [cited 2022 Jan 31]; Available from: http://www.aanp.org/publications/position-statements-papers
» http://www.aanp.org/publications/position-statements-papers -
15Judith M. Parker, Martha N. Hill. A review of advanced practice nursing in the United States, Canada, Australia and Hong Kong Special Administrative Region (SAR), China. International Journal of Nursing Sciences. [Internet]. 2017 [cited 2022 Feb 02]; 4(2):196-204. Available from: https://doi.org/10.1016/j.ijnss.2017.01.002
» https://doi.org/10.1016/j.ijnss.2017.01.002
Edited by
Publication Dates
-
Publication in this collection
27 Nov 2023 -
Date of issue
2023
History
-
Received
09 Mar 2023 -
Accepted
19 July 2023