Nurse managers in the Unified Health System: profile and prospects with emphasis on the 2017-2020 Management Cycle

Carvalho, Andre Luis Bonifácio de; Ouverney, Assis Luiz Mafort; Carvalho, Mércia Gomes Oliveira de; Machado, Nadia Maria da Silva

doi:10.1590/1413-81232020251.29312019

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Brasil

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ARTICLE • Ciênc. saúde coletiva 25 (1) • Jan 2020 • https://doi.org/10.1590/1413-81232020251.29312019 copy

Nurse managers in the Unified Health System: profile and prospects with emphasis on the 2017-2020 Management Cycle

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

This paper aims to analyze the profile and perceptions of the municipal health secretaries on the agendas and challenges for the SUS in the 2017-2020 cycle, with emphasis on the participation of nurses in management. The data were collected through an online electronic questionnaire, containing closed-ended questions, answered by municipal managers, within the National Survey of Municipal Health Secretaries, a national study carried out in 26 states in 2017 and 2018. We could understand to what extent nurse managers perceive the main challenges, the performance of strategic actors, the dynamics of interagency spaces, and federative agendas necessary to strengthen SUS management in the management process.

Key words
Health management; Unified Health System; Nurse

Variables	Regions / Country
Variables	Other Managers	Nurse Managers	BR
Personal Data
Gender	51% F	79% F	58 % F
Age	66% (31-50 years)	73% (31-50 years)	67 % (31-50 years)
Ethnicity/Skin color	59% White	57% White	59% White
Schooling	76% (Complete Higher Education/, 40% postgraduate studies)	99% (Complete Higher Education/, 75% postgraduate studies)	81% (Complete Higher Education) 49% postgraduate studies
Professional path	Other Managers	Nurse Managers
Profession	19% (administrator)	26% (nurse)	26% (nurse)
Manager Position	55% (no)	59% (no)	56% (no)
Management Positions	16% (Primary Care)	54% (Primary Care)	25 % (Primary Care Coordination)
Motivation to assume the position	Other Managers	Nurse Managers	BR
Strengthening the SUS	79%	85%	80%
Assuming new challenges	70%	75%	71%
Serve the city	77%	75%	76%
Positive points for appointment	Other Managers	Nurse Managers
Personal Trust	64%	63%	64%
Capacity and Leadership	59%	61%	59%
Technical competence	56%	69%	59%
Other Characteristics	Other Managers	Nurse Managers	BR
Ability to Dialogue	34%	29%	34%
Ability to Mobilize	25%	31%	26%

Actors and decision-making situations	Regions / Country
Actors and decision-making situations	N	NE	S	SE	MW	BR
Influential Actors (Except Nurses)
Mayor	62%	62%	54%	58%	53%	59%
Health Council	47%	52%	51%	47%	46%	50%
Ministry of Health	51%	53%	46%	40%	44%	48%
(Influential Actors (Nurse Managers )
Mayor	69%	62%	60%	62%	66%	63%
Health Council	54%	49%	42%	46%	49%	48%
Ministry of Health	56%	47%	37%	35%	47%	44%
Agendas Strategies (except nurse managers)
Agendas of the CMS	51%	54%	51%	57%	54%	54%
Agendas of the CIR	40%	50%	42%	49%	50%	48%
Audit Report	42%	46%	41%	46%	43%	45%
Agendas Strategies (Nurse managers)
Agendas do CMS	46%	59%	50%	54%	56%	55%
Audit Report	57%	54%	52%	49%	53%	53%
Agendas CIR	53%	53%	51%	48%	54%	51%

Dimensions of SUS Organization and Management	Gestores
	BR (Demais gestores)		BR Gestores (as) enfermeiros (as)		Brasil
	Desafio	%	Desafio	%	Desafio	%
Primary Care	Implementation of the State's counterpart	47	Implementation of the State's counterpart	51	Implementation of the State's counterpart	50
Specialized care	Ensuring the quantity and quality of appointments, exams, and hospitalizations.	69	Ensuring the quantity and quality of appointments, exams, and hospitalizations	67	Ensuring the quantity and quality of appointments, exams, and hospitalizations	71
Regionalization	Strengthening of CIRs as regional planning and agreement bodies	56	Strengthening of CIRs as regional planning and agreement bodies	57	Strengthening of CIRs as regional planning and agreement bodies	56
Planning	Qualification of municipal management teams to the health planning practice	66	Qualification of municipal management teams to the health planning practice	66	Qualification of municipal management teams to the planning practice	66
Social control	Supporting the process of social and institutional mobilization to advocate for the SUS	44	Supporting the process of training health counselors	48	Supporting the process of training health counselors	43
Judicialization	Expanding the knowledge of the control body on the dynamics of management of health actions and services within the SUS	60	Expanding the knowledge of the control body on the dynamics of management of health actions and services within the SUS	61	Expanding the knowledge of the control body on the dynamics of SUS management	57
Work management	Implementation and agreement of guidelines for education and work management policies that favor the provision and establishment of health workers at the municipal level	53	Implementation and agreement of guidelines for education and work management policies that favor the provision and establishment of health workers at the municipal level	53	Implementation and agreement of guidelines for education and work management policies (establishment of municipal health workers)	52
Financing	Ensuring stable and sustainable funding for the SUS, improving spending pattern and qualifying tripartite financing and resource transfer processes	69	Ensuring stable and sustainable funding for the SUS, improving spending pattern and qualifying tripartite financing and resource transfer processes	69	Ensuring stable and sustainable funding for the SUS (improving spending pattern and resource transfer processes)	68

Managers	Agenda Nurse Managers		Agenda other managers		Managers Brazil
Managers	Agenda	%	Agenda	%	Agenda	%
Ministry of Health	Expanding financial support for strategic programs aimed at improving population access	72	Expanding financial support for strategic programs aimed at improving population access	74	Expanding financial support for strategic programs aimed at improving population access	73
	Investing in improving information systems to assist managers in decision-making	37	Expanding support for primary care and health surveillance actions, aiming to strengthen the health system's gateway actions	33	Expanding support for primary care and health surveillance actions, aiming to strengthen the health system's gateway actions	32
	Invest in the restructuring of MS centers in the states to expand support to municipal managers	30	Invest in the restructuring of MS centers in the states to expand support to municipal managers	30	Invest in the restructuring of MS centers in the states to expand support to municipal managers	30
State Secretariat	Expanding financial support for strategic programs aimed at improving population access	65	Expanding financial support for strategic programs aimed at improving population access	67	Expanding financial support for strategic programs aimed at improving population access	66
	Investing in improving access to appointments, hospitalizations, tests, and medicines in quantity and quality	53	Investing in improving access to appointments, hospitalizations, tests, and medicines in quantity and quality	59	Investing in improving access to appointments, hospitalizations, tests, and medicines in quantity and quality	58
	Implementing a comprehensive training process for municipal managers	40	Implementing a comprehensive training process for municipal managers	37	Implementing a comprehensive training process for municipal managers	38
COSEMS	Assisting managers in dialogue with control bodies and the judiciary	50	Assisting managers in dialogue with control bodies and the judiciary	48	Assisting managers in dialogue with control bodies and the judiciary	49
	Strengthening the Regional Actions of the Council of Health Secretaries - COSEMS	40	Strengthening the Regional Actions of the Council of Health Secretaries - COSEMS	43	Strengthening the Regional Actions of the Council of Health Secretaries - COSEMS	42
	Holding workshops and courses on priority topics seizing the opportunity of the week of CIR meetings	39	Holding workshops and courses on priority topics seizing the opportunity of the week of CIR meetings	36	Holding workshops and courses on priority topics seizing the opportunity of the week of CIR meetings	36

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E-mail: cienciasaudecoletiva@fiocruz.br

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[1] Collaborations

ALB Carvalho: conception and design of the study, analysis, and interpretation of results, and drafting the paper; ALM Ouverney: analysis and interpretation of the results, and drafting the paper, with criticism and suggestions to the text; MGO Carvalho and NMS Machado collaborated with criticism, suggestions to the text and review.