Profile of nursing graduates: competencies and professional insertion*

Objective: evaluate the profile of the graduates of Nursing a public college from the perception of skills developed during graduation and the process of professional insertion. Method: quantitative, exploratory and descriptive study. The sample was composed of 216 graduates. The data was collected by a validated questionnaire and sent to a population of 470 egresses via electronic mail. For the analysis of the data, frequencies, mean and standard deviation were applied and, for the correlation, the chi-square test. Results: the majority of the participants were female (88%) and the mean age was 29.62 years. The majority (65%) had an employment relationship, 14% worked in a single institution and 48% started working six months after graduation. Regarding the form of work, 56% work in care, with an average of 4.5 minimum wages and a weekly workload between 37 and 44 hours. The majority reported competence acquisition to practice the profession, assisting the patient in his integrality with ethics and applying technical and scientific concepts in care. Conclusion: the study made it possible to describe the singularities of nurses’ education, their insertion in the world of work and the impact on the educational institution, as well as the presentation of specific competences from the perspective of the graduates themselves.


Introduction
The training of health professionals, throughout Brazil's historical trajectory, has been inclined to follow the demands of the world of work and the political, social and economic context. In this sense, the curricular organization of the training schools, with a view to attending to the dominant biomedical model, sometimes contributed to a technical, hospital and curative education (1) . This model approaches the Flexnerian standard, created in the United States in 1910, to attend to the medical-industrial complex, based on the professionals' precocious specialization, to act recovering mismatches (1) .
Nevertheless, with the movement of social medicine (2)(3) and the creation of the Unified Health System (UHS), training was redirected with a view to promoting, preventing and recovering health, with a focus on the community (3)(4) . In addition, there was a stimulus in the curricula bases to the essential competences, like the critical thinking, the initiative, the autonomy, the creativity and the problem solving capacity (4)(5) . Competencies are defined as a set of skills, knowledge, attitudes and values that are interdependent and necessary for the execution of actions, aiming at an efficient performance in the exercise of professional activity (5)(6) .
In the context of the health area, more specifically in the training of nurses, skills extrapolate psychomotor skills, expanding to development based on cognitive, emotional and social skills that converge for decision making and problem solving (5)(6)(7) . In Brazil, nursing graduates are expected to have a generalist, humanistic, critical and reflexive education, with a view to acting, in a resolutive way, on health indicators, from integral and transdisciplinary care (7)(8)(9) .
In view of the above, it is understood that the profile of the nurse expressed in the National Curricular Guidelines of the Undergraduate Nursing Course (NCD/ NUR) is of a professional with competencies, skills, attitudes and values to make assertive decisions in the different needs / realities and levels of attention (7)(8)(10)(11) .
Thus, training that promotes professional autonomy, inter and trans-disciplinarity, capacity for self-learning, approximation of health services and focus on ethical and integral care becomes decisive in the qualified preparation of future nurses (9)(10) .
In this sense, a study conducted with 505 graduates assessed the skills and abilities developed during graduation from aspects expressed in the NCD/ ENF. For these graduates, it was evidenced the need for greater stimulation of autonomy, exchange of experiences and early insertion in health services (5) .
Other studies (10)(11)(12) consider promising the curricular proposal that works the competences from the early insertion of the student in the scenarios of practices.
This process facilitates the integration of teachingservice-community by mediating the student's contact with the unique and plural challenges of the profession.
These proposals include the National Program for the Reorientation of Vocational Training in Health (Pró-Saúde) and the Health Work Education Program (PET-Saúde), which propose, in their bases, the inseparability between teaching, research, extension and service (11)(12)(13)(14) .
However, despite the fact that NCDs/NUR act as the guiding axis in the construction of the egress profile, studies (5,(13)(14)(15)  did not complete and / or dropped out of the course and who did not respond the request to complete the questionnaire even after five attempts.
A sample calculation was established for the finite population, with 95% confidence and error of 5%, considering an estimate of the proportion equal to 50%. A sample size of 212 was obtained to meet the statistical validity requirement. In this sense, a sample of 216 graduates.
The data was collected by applying a validated instrument (16) , adapted for online research using the Google Docs Forms tool with semi-open, multiple-choice and Likert-type scales.
The instrument (16) is composed of three dimensions:

Results
Of the total of 470 eligible graduates, two (0.4%) were excluded because they did not have electronic mail registered at the university, 89 (18.9%) dropped out / did not complete the course and 163 (34.7%) did not respond to the questionnaire. Thus, 216 graduates (46%) participated in this study, of which 56% completed the course between 2011 and 2016.
Regarding the sociodemographic data, the majority were female, with a mean of 29.62 years (SD = 8.2) and with a self-declared white color. As for the place of residence, the majority were residing in the State of Minas Gerais and 23.1% in other Brazilian states, especially Rio de Janeiro (Table 1). In the block that evaluates competence for health management, items 26 to 28, the cooperation with the health management team was highlighted in relation to the items that evaluated aspects of work process management and cost-effectiveness, cost-benefit and cost-utility of health products and procedures.
It should be noted that, following the application of the questionnaire, the Cronbach Alpha Coefficient was tested, and high reliability ( > 0.8) was verified for the instrument used in data collection.

Discussion
From the sociodemographic data, it was observed that the participants of this study were predominantly young adults, whites and females. Corroborating this result, further research (5,(17)(18) carried out with Nursing graduates have indicated the predominance of women and the average age group below 32 years.
Globally, international studies (17)(18)(19) highlight the growing insertion of women under the age of 30 in the world of work, with emphasis on Nursing in the health area. However, regarding employability, Nursing has experienced a demand for jobs below the market's offer in the South and Southeast regions of the country (20) .
Similar to other studies (5,18,20) , the majority of graduates remained in the region in which they graduated.
In Brazil, there is a significant number of nurses in the Southeast region, with the states of São Paulo (24.6%), Rio de Janeiro (11.1%) and Minas Gerais (10.4%). On the other hand, it is evident the shortage of professionals in poorer regions such as North and Northeast, provoking inequalities of healthcare coverage in these localities (21) .
In relation to the extra-class activities developed by the graduates during graduation, there was mention of extension and monitoring, followed by the research.
These activities, with emphasis on the university extension, enable a critical, creative and resolute training, geared towards the attendance of the most varied social demands of health linked to the world of work. It should be noted that in Nursing, the insertion of academics into groups and scientific productions is still incipient and indicates the need to work on the inseparability between teaching, extension and research (5,(22)(23)(24) .
With regard to specialization, it was evidenced that part of the graduates sought qualification in postgraduate courses Stricto sensu and Lato sensu.
However, a congener study, conducted in the State of São Paulo, found a greater insertion in Lato sensu postgraduate courses (63.9%) (5) .
Regarding the insertion in the world of work, it was verified that the majority began to exercise the profession within 12 months after graduation, with prevalence of the assistance area, receiving, on average, 4.5 minimum wages, for up to 44 weekly hours of work.
It was found, corroborating the data, that a study carried out with 172 graduates from a public college found that 52.9% of the nurses entered the profession within six months after graduation (5) .
However, another study showed that, although most of the participants were employed, there were reports of difficulties in entering the labor market (25) .
In this sense, it is pertinent to highlight the natural difficulties to obtain the first job, mainly due to the lack of previous experience, the saturation of the labor market in regions such as the Southeast or even the incompatibility with the profile demanded by the employer. The realization of extracurricular internships and specialization in the modality of residence has been a good option of in-service training that mediates the transition from university to the world of work (24) . However, studies (5,25) carried out with nurses revealed that, upon reaching the labor market, they identified limited preparation, difficulty to make decisions and to confront the specific healthcare reality of hospitals, and it was necessary to search for specialization courses.
It should be noted that, in this investigation, few agreed that, upon graduation, they were able to participate in comprehensive health care programs.
Unlike programs that have historically achieved advances, such as maternal and child health, the man's health program is a recent policy, necessitating, therefore, strategies that will qualify future nurses to intervene in the health of this population. In this sense, studies (26)(27) have indicated low adherence of men to health services, which raises, in the undergraduate curricular strategies transversal on the health of the man and programs of permanent education in service.
Regarding the competence to act on the ethical issues, it was observed that, like other investigations, the graduates felt able to act before legal and humanistic aspects of the profession based on the principles of bioethics (5,25) . A Finnish study (28) highlighted the perceived ability of newly graduated nurses to decisionmaking guided by ethical values (86.8%). Another study (29) , conducted with newly trained nurses, found a strong correlation between basic competences to the exercise of Nursing and ethical and bioethical aspects.
In this study, the majority of graduates and cost-effectiveness. In some way, this is related to the specifics of each organization / institution, in addition to a formation that is not linked to real situations of work practice. Studies (25,(29)(30)(31)  In this sense, it is necessary to emphasize on the need of strategies that approach the academic experiences of nurses' daily work. In addition, permanent education, mediated by educational institutions and/or services, is an important tool for the production of skills, professional values and qualification of care (31) .
Finally, it is necessary to reflect on the Nurse of the future nursing core competencies (32) , which strategically lists ten essential competences for the training and practice of the nurse of the future, namely: patientcentered care; professionalism; leadership; systemsbased practice; ability in computer science and technology; Communication; collaborative teamwork; safety; quality improvement and evidence-based practice (32)(33) . These competences (re) outline the contemporary profile of the egress, socially, ethically and politically committed to the profession and the health of the population (33) . Regarding