Profile and competencies of nurse managers at accredited hospitals

This descriptive study identified the profile and competencies of nurse managers of accredited hospitals from the their perspective and that of their hierarchical superiors. It was conducted in 14 hospitals certified by the National Organization of Accreditation and the Joint Commission International in São Paulo, SP, Brazil. Data were collected through two questionnaires that were applied to 24 professionals. The nurse managers' profiles showed that 69.2% came from private colleges, all with more than 10 years experience since graduation and 92.3% had attended a post-degree program in health management. The nurse managers' most frequent competencies according to their superiors were: leadership, focus on patients, and teamwork. The conclusion is that the profile and competencies of most of the nurse managers were compatible with the expectations of their superiors, who collaborate in the selection of candidates for the nurse manager position and evaluate their professional performance.


Introduction
Transformations that arise from globalization and consequent increased competitiveness have required organizations to change, even health facilities, which have begun to review their management models to improve the quality of their services through accreditation programs. Criteria used by these programs concerning the evaluation of nursing services include primarily administrative and organizational areas followed by care and teaching-research fields (1) .
From this perspective, the nurse manager has   their inclusion in the job market (2) .
But what is the profile and competence necessary

Results
The thematic categories that resulted from the analysis of results and that allowed the study to achieve the proposed objectives were: profile of nurse managers, selection of nurse managers, characteristics of directors, view of directors versus the nurse managers' profiles, and evaluation of competencies.

Nurse managers' Profile
The profiles described in Table 1 show that the nurse managers were 44 years old on average, with a range from 38 to 49 years old. The sample was predominantly female and married, with one to two children. In relation to education, most graduated from private colleges more than 10 years ago and had a specialization; a minority had an MBA. In Brazil, individuals who attend these two post-degree programs are not entitled to a degree, however while a specialization program allows the individual to specialize in his/her field, the latter is designed to educate executives in the management field.
Almost all the individuals attended some management program in the health field. About half of the individuals attended a master's or doctoral program.
Most of the nurse managers had worked for more than 10 years in the institution and worked in other care and administrative functions before becoming nurse managers. Of these, few had any experience in management before assuming the job. process. Four nurses in total were hired through selective processes. All these reported that psychological evaluation and interviews were used as instruments of selection, while three also reported their resumes were evaluated, two underwent technical testing, one to a redaction test and the references of another candidate from other institutions were considered.
Only five (45.5%) reported post-degree programs in health management: two nurses and three physicians.

View of Directors versus Nurse managers' Profile
Considering that only 11 directors and 13 nurse managers participated in the study, the opinions of directors or the profile and competencies of the nurse managers of two institutions were not compared.     (Table 3).

Discussion
The predominance of women in this role refers to the profession socio-historical aspects. Even though the number of male nurses has increased in recent years, the attractiveness of college education has not been sufficient for men to view nursing as a professional option (6) . It explains, in part, the difference of this profession in relation to other professions included in the Brazilian largest organizations', in which women occupy in average 24.6% of the management positions (7) .
Because it is a predominantly female profession, nursing professionals deal with the dynamics of the organizations in the performance of their activities at the same time they manage their lives as people, wives and mothers (8) . A study addressing the stress of nurses indicated that the activities related to the personal life such as: responsibilities with the house, with children, and other activities at home, can function as a support instead of being stressors (9) .  (10) .
To complement and qualify this education in specific fields, nurses seek post-degree programs. All the nurse managers in the studied group had attended specialization programs and few of these also pursued an MBA. However, almost all nurse managers attended some post-degree program in health management.
Therefore, after attending a specialization program, a large number of these professionals opted to attend master's and doctoral programs, which are academic and research-oriented, with an essentially scientific goal, while specialization has a practical professional nature.
Master's and doctoral programs are a system that educates an essential stratum higher in the hierarchy of educational programs that composes higher education.
Hence, the nature of these programs implies a high intellectual selectiveness, which attributes a special status to them (11) .
In relation to professional experience, most of the with the potential to work in the managerial field need to be gradually developed and challenged to apply newly acquired competencies (5) .
The facilities are managed by a nurse (12) .
The ideal profile for nurse managers, according to directors, concerning professional experience shows that there is a preference among these institutions for nurses with greater professional experience to occupy this position instead of newly graduated nurses, which is compatible with the profile presented by the nurse managers. This fact also aligns with another study addressing nurse managers who had in general more than 10 years experience since graduation, as well as having professional experience. This position was considered by these professionals as part of a strategy of nurses based on previous education and experiences (13) .
In relation to a post-degree degree, specialization programs and MBAs are among the requirements; a master's or a doctoral degree is not valued by directors, which is contrary to the tendency of nurse managers working in the care field and who seek such degrees. not as a predominant practice (15) , while the work is oftentimes performed in a fragmented way.
Florence Nightingale showed the importance of applying science in the administration of hospitals and aiming to improve care delivered to patients, nurses assumed administrative function in health institutions (16) .
However, these professionals ended up become detached from their object of work -care delivery. In this context, nurses developed a management style mainly focused on the needs of the service, compliance with regulations, standards and tasks, reproducing what is recommended by the organization and other professionals, which have often led them to not meet the needs of patients, causing dissatisfaction within the nursing team (17) .
Given the movement of nurses to recover what should be their main object of work and the concern of institutions to meet the needs of patients, whether this concern is motivated by quality programs or by the  (18) .
A little more than half of nurse managers had this competence according to their superiors. Hence, these professionals need to be able to develop a strategic view.
Process management has also been valued in hospitals, especially through the search for quality through accreditation that evaluates the organization in a systemic way where structures and processes are related and interfere in the entire organization (19) . Therefore, the management of processes is another competence that needs to be developed by nurse managers.
Resource management is the only competency that presented, on average, a disagreement between the two professionals; the nurse managers classified it as one of the least important. The management of resources in the hospital field is related to costs in addition to the need to ensure appropriate working conditions for professionals to deliver care to patients. Nurses have been responsible for managing material and physical resources that demand a large volume of financial resources. Depending on the facility, human resources in nursing represent 30% to 60% of the total of the personnel (20) . Hence, nursing has an important impact on hospital costs and the rational use of resources and reduced waste. Nursing also favors not only the survival of organizations but also the delivery of care at lower costs, enabling larger investments in quality. This competency was more valued by directors than by nurse managers as shown in the study's results.

Final considerations
This study revealed similarities in the profile and