The nurses' work process in different countries: an integrative review

We have used the integrative review method and selected 84 publications (articles, theses and dissertations) in national and foreign thesis banks and databases. We analyzed the evidence based on dialectical materialism.

Results:

The rejection of managerial tasks hides the singularity of nurses' work, due to the failure to understand the inseparable nature of managerial and healthcare tasks, given that it is what provides the expertise to coordinate the nursing work process and guide the healthcare work processes. The social and technical division is present in the work process in all countries studied, albeit in different ways. The nurse's position in the healthcare work process is subordinated to that of the physician.

Conclusion:

The characteristics are similar. The rejection of the dual nature of the work by nurses themselves due to alienation results in the non-recognition of their own work.

Descriptors:
Nurses; Nursing; Work; Capitalism; Role of the Nurse

Title	Country and year of study	Delineationno. of patients	Interventions	Outcomes
The deskilling of registered nurses: the social transformation of nursing work in a New South Wales hospital, 1970-1990⁽⁴4 Herdman E. The deskilling of registered nurses: the social transformation of nursing work in a New South Wales hospital, 1970-1990[Tese]. [Internet]. Austrália: University of Wollongong; 1992 [cited 2014 Jan 20]. Available from: http://ro.uow.edu.au/theses/1729 http://ro.uow.edu.au/theses/1729... ⁾	Australia 1992	Ethnographic study Locus - hospital	Interview Participant observation	Changes in nursing work; rhetoric of the dominant groups does not reflect nurses' work reality; precariousness
The process of nursing work in hospitals⁽⁵5 Presotto GV. O processo de trabalho do enfermeiro no contexto hospitalar[Tese]. [Internet]. Universidade Federal do Triângulo Mineiro; 2011 [cited 2014 Jan 12]. Available from: http://www.uftm.edu.br/upload/ensino/enfermsaude/atencao_a_saude_Giovanna_Valim_Presotto.pdf http://www.uftm.edu.br/upload/ensino/enf... ⁾	Brazil 2011	Qualitative research(N=19)Locus - hospital	Interview Participant observation	Nurses' managerial tasks prevail over healthcare ones; regarding healthcare - procedures of greater technical complexity
Clinical governance and nursing - a sociological analysis⁽⁶6 Staniland KM. Clinical governance and nursing: a sociological analysis[Tese]. [Internet] University of Salford; 2007 [cited 2014 Mar 04]. Available from: http://usir.salford.ac.uk/2062/1/Thesis_2008_Final_May_2009.pdf http://usir.salford.ac.uk/2062/1/Thesis_... ⁾	United Kingdom 2007	Ethnographic studyLocus - hospital	Field observation/document analysis/ interview	The confusing history of nursing as a profession; subordination to physicians; managerial tasks considered bureaucratic
Nurse management work process analysis in a private hospital in São Paulo: possibilities for care management⁽⁷7 Hausman M. Análise do processo de trabalho gerencial do enfermeiro em um hospital privado no município de São Paulo: possibilidades para o gerenciamento do cuidado[Tese]. [Internet]. Universidade de São Paulo; 2006 [cited 2014 Mar 01]. Available from: http://www.teses.usp.br/teses/disponiveis/7/7131/tde-03102006-102248/pt-br.php http://www.teses.usp.br/teses/disponivei... ⁾	Brazil 2006	Qualitative study(N=10)Locus- hospital	Interviews	Execution of managerial tasks to increase quality of care provided and streamline costs; nurses mediate interactions between employees; marked technical division
Constituting Modern Matron: exploring role, identity and action in an English NHS trust⁽⁸8 Kiewicz LM. Constituting Modern Matron: exploring role, identity and action in an English NHS trust[Tese].[Internet]. Inglaterra: University of York; 2011 [cited 2014 Jun 15]. Available from: http://etheses.whiterose.ac.uk/id/eprint/1907 http://etheses.whiterose.ac.uk/id/eprint... ⁾	United Kingdom 2011	Ethnographic study/ multi-methods(N=16)Locus - Health system	Interview Observation Document analysis	The contradictions and tensions between the healthcare and managerial natures are reflected in the data from modern matrons; Indefinition of the object of intervention in the work
Performances of nurses in the Family Health Strategy - building competence in the work process⁽⁹9 Kawata LS. Os desempenhos da enfermeira na Saúde da Família - a construção da competência no processo de trabalho[Tese].[Internet]. Universidade de São Paulo; 2011 [cited 2014 Mar 29]. Available from: http://www.teses.usp.br/teses/disponiveis/22/22133/tde-30112011-083404/pt-br.php http://www.teses.usp.br/teses/disponivei... ⁾	Brazil 2011	Qualitative research(N=4)Locus - Primary health care	Participant observationInterviewsWorkshops	Nurses carry out healthcare and managerial tasks; complexity of nurses' attitudes: coordination of processes, supervision, organization and planning.
Factors impacting staff nurse care coordination⁽¹⁰10 Duva IH. Factors impacting staff nurse care coordination[Tese]. [Internet]. Emory University; 2010[cited 2014 Feb 18]. Available from: http://pid.emory.edu/ark:/25593/8kdsv http://pid.emory.edu/ark:/25593/8kdsv... ⁾	United States 2010	Descriptive/ quantitative study	Questionnaire	Examines relationships between the nurse practice environment, patient and hospital characteristics; nurses coordinate nursing work process; care coordination is a key process to nurses.
Singularities of management work in an accredited hospital⁽¹¹11 Oliveira AG. Singularidades do trabalho gerencial em um hospital acreditado[Tese]. [Internet]. Universidade Federal de Minas Gerais; 2012 [cited 2014 Mar 06]. Available from: http://hdl.handle.net/1843/GCPA-8UMGTG http://hdl.handle.net/1843/GCPA-8UMGTG... ⁾	Brazil 2012	Qualitative research(N=12)Locus - hospital	Interview	Contributions of nurses' managerial tasks to hospital accreditation process; place of articulation and duties of the organization
Ideal typical comprehension of professional nursing practice at public hospitals⁽¹²12 Banda MMZ. Compreensão típico ideal da prática profissional do enfermeiro em hospitais públicos[Tese]. [Internet]. Universidade de São Paulo; 2004 [cited 2013 Dec 04]. Available from: http://www.teses.usp.br/teses/disponiveis/22/22132/tde-13102004-150910/pt-br.php http://www.teses.usp.br/teses/disponivei... ⁾	Mexico 2004	Phenomenological study(N=14)Locus - hospital	Interview	The work of nurses is complex in nature; social aspects and paradigms interfere in the nurses' work process
The work of registered nurses and care assistants with older people in nursing homes: can the outcomes be distinguished?⁽¹³13 Heath HBM. The work of registered nurses and care assistants with older people in nursing homes: can the outcomes be distinguished?[Tese]. [Internet]. Brunel University; 2006 [cited 2014 Jan 08]. Available from: http://europepmc.org/theses/eth/488676 http://europepmc.org/theses/eth/488676... ⁾	United Kingdom 2006	Hermeneutics/Multi-methods(N=52)Locus - hospital	ObservationInterviewDocument analysis	Nurses are responsible for managing the organizations; recognition of healthcare tasks; shows the technical division in nursing work
The development of a nursing technology: making visible the nursing contribution to development of critical care⁽¹⁴14 Crocker C. The development of a nursing technology: making visible the nursing contribution to development of critical care[Tese]. [Internet]. UK: University of Nottingham; 2006 [cited 2014 Mar 04]. Available from: http://eprints.nottingham.ac.uk/11903/ http://eprints.nottingham.ac.uk/11903/... ⁾	United Kingdom 2006	Ethnographic studySocial representation(N=12)Locus - hospital	InterviewObservationField observation	Low social recognition, despite performing the duties of a physician; social and technical division of work
Status morality and the politics of transformation: an ethnographic account of nurses in KwaZulu-Natal, South Africa⁽¹⁵15 Hull EA. Status morality and the politics of transformation: an ethnographic account of nurses in Kwa Zulu-Natal. [Tese]. [Internet]. London School of Economics and Political Science; 2009[cited 2014 Feb 09]. Available from: http://etheses.lse.ac.uk/320/ http://etheses.lse.ac.uk/320/... ⁾	South Africa 2009	Historical -ethnographic studyLocus - hospital	ObservationRepresentations	Reshaping nurses' status and professionalism within a broader social and political context post-apartheid
The identity work of leadership in a professionalized context: the case of nursing⁽¹⁶16 Ogilvie C. The identity work of leadership in a professionalized context: the case of nursing. Inglaterra[Tese]. [Internet]. University of Warwick; 2012 [cited 2013 Dec 15]. Available from: http://wrap.warwick.ac.uk/id/eprint/53812 http://wrap.warwick.ac.uk/id/eprint/5381... ⁾	United Kingdom 2012	(N=32)Case StudyLocus - Health system	InterviewParticipant observation	Nurses with an ideal position in the context of organizations; ideologies and social stereotypes are at odds with the position of articulator of organizations.
The nature and use of knowledge by district nurses in decision making relating to first assessment visits⁽¹⁷17 Kennedy CM. The nature and use of knowledge by district nurses in decision making relating to first assessment visits[Tese]. [Internet]. Queen Margaret University; 2000 [cited 2014 Mar 24]. Available from: http://etheses.qmu.ac.uk/id/eprint/169 http://etheses.qmu.ac.uk/id/eprint/169... ⁾	United Kingdom 2000	Qualitative study	InterviewObservation	Recognition of the healthcare nature of nurses' work; rejection of the managerial nature and leadership in the organizations
The relationship between staff nurse perception of nurse manager leadership behavior and staff nurse job satisfaction in a hospital applying for magnet recognition status⁽¹⁸18 Bormann LB. The relationship between staff nurse perception of nurse manager leadership behavior and staff nurse job satisfaction in a hospital applying for magnet recognition status[Tese]. [Internet]. University of Louisville; 2011 [cited 2014 Feb 24]. Available from: http://dx.doi.org/10.18297/etd/129 http://dx.doi.org/10.18297/etd/129... ⁾	United States 2011	Quantitative study(N=500 Staff Nurses)(N=15 Managers/ Nurses)	QuestionnaireMultifactor Leadership Questionnaire 5X Short (MLQ) and the Abridged Job Descriptive Index/Abridged Job in General (aJDI/aJIG)	Leadership behavior related to the nature of managerial work
Caring on: how nurses find meaning in their work⁽¹⁹19 Uhrynuk BG. Caring on: how nurses find meaning in their work[Internet]. Canadá: Royal Roads University; 2000 [cited 2013 Dec 09]. Available from: http://www.collectionscanada.ca/obj/s4/f2/dsk1/tape4/PQDD_0019/MQ49236.pdf http://www.collectionscanada.ca/obj/s4/f... ⁾	Canada 2000	Qualitative(N=10)Locus - hospital	Interviews -Nurses	Nurse values and features that help provide meaning to the work; profession influenced by the social and political spheres
Nursing perspectives on women, health and work in the socio-cultural context of poor communities in Northeast Thailand⁽²⁰20 Jongudomkarn D. Nursing perspectives on women, health and work in the socio-cultural context of poor communities in Northeast Thailand[Tese]. [Internet]. UK: Robert Gordon University; 2001 [cited 2014 Mar 06]. Available from: http://hdl.handle.net/10059/603 http://hdl.handle.net/10059/603... ⁾	Thailand 2001	Ethnographic studyLocus - community /Primary health care	Interviews (N=102)Focus group (N=102)Case study (N=49)	Intervention between gender, poverty, work, health and the contribution of nursing services to women care in low-income communities.
Articulating between management and care dimensions in the nursing work process⁽²¹21 Hausmann M, Peduzzi M. Articulação entre as dimensões gerencial e assistencial do processo de trabalho do enfermeiro. Texto Contexto Enferm [Internet]. 2009[cited 2014 Mar 06];18(2):258-65. Available from: http://www.scielo.br/pdf/tce/v18n2/08.pdf http://www.scielo.br/pdf/tce/v18n2/08.pd... ⁾	Brazil 2009	Qualitative research(N= 10 nurses)Locus - hospital	Interviews	Describes the managerial and healthcare dimensions of nurses' work; shows the dual nature of said work and how the two dimensions are articulated
The nursing work process: the separation between planning and care delivery⁽²²22 Peduzzi M, Anselmi ML. O processo de trabalho de enfermagem: a cisão entre planejamento e execução do cuidado. Rev Bras Enferm [Internet]. 2002[cited 2013 Dec 09];55(4):392-8. Available from: http://www.scielo.br/pdf/reben/v55n4/v55n4a06.pdf http://www.scielo.br/pdf/reben/v55n4/v55... ⁾	Brazil 2002	Qualitative research(N= 3 nurses)(N= 2 physicians)(N= 3 nursing assistants)Locus - hospital	Interviews	Presents the rigid technical division of nursing work; separation between intellectual work and handwork
The concept of "management of care" in Chilean law: interpretation and scope⁽²³23 Milos P, Bórquez B, Lorrain AI. La "Gestión del Cuidado" en la legislación chilena: interpretación y alcance. Cienc Enferm[Internet]. 2010 [cited 2014 Jan 26];16(1):17-29. Available from: http://dx.doi.org/10.4067/S0717-95532010000100003 from: http://dx.doi.org/10.4067/S0717-95... ⁾	Chile 2010	Theoretical study	Document analysis	Definition of care management equivalent to coordination of the work process; managerial tasks exclusive to nurses
Nursing services classification: proposal to ensure quality care in times of nursing shortages⁽²⁴24 Milos, P, Lorrain, AI, Simonetti M. Caracterización de servicios de enfermería. Propuesta para asegurar una atención de calidad en tiempos de escasez de enfermeras. Cienc Enferm[Internet]. 2009[cited 2014 Jan 26];15(1):17-24. Available from: http://dx.doi.org/10.4067/S0717-95532009000100003 http://dx.doi.org/10.4067/S0717-95532009... ⁾	Chile 2009	Theoretical studyLocus - Health system	Historical narrative	Definition of the scope of nursing work; social recognition of nurses' work
Academia and the social division of nursing work in the Government sector: sinking or surpassing?⁽²⁵25 Bujdoso YLV, Trapé CA, Pereira EG, Soares CB. A academia e a divisão social do trabalho na enfermagem no setor público: aprofundamento ou superação. Ciênc Saúde Colet [Internet]. 2007[cited 2014 Jan 26];12(5):1363-74. Available from: http://www.scielo.br/pdf/csc/v12n5/28.pdf http://www.scielo.br/pdf/csc/v12n5/28.pd... ⁾	Brazil 2007	Qualitative meta-analysis	Analysis of three research pieces related to work division	Shows the trends of social and technical division in the work
Nurses and the Collective Care Practices Within the Family Health Strategy⁽²⁶26 Fortuna CM, Matumoto S, Pereira MJB, Mishima SM, Kawata LS, Camargo-Borges C. O enfermeiro e as práticas de cuidados coletivos na estratégia saúde da família. Rev Latino-Am Enfermagem [Internet]. 2011[cited 2014 Jan 26];19(3):581-8. Available from: http://www.scielo.br/pdf/rlae/v19n3/pt_18.pdf http://www.scielo.br/pdf/rlae/v19n3/pt_1... ⁾	Brazil 2011	Qualitative research(N=11 nurses)Locus- Primary health care	Interviews	Nurse practice in collective care initiatives; nurses' role as organizers and evaluators of collective health initiatives
Technological changes and their impact on the work process in the healthsector⁽²⁷27 Peduzzi M. Mudanças tecnológicas e seu impacto no processo de trabalho em saúde. Trab Educ Saúde. 2002;1(1):75-91.⁾	Brazil 2002	Study	Document analysis	Organization of the work in the health sector; social and technical division of work in the health sector
The nurse's perceptions on administrative actions in their work process⁽²⁸28 Vaghetti H, Reis D, Kerber NC, Azambuja E, Fernandes G. Percepções dos enfermeiros acerca das ações administrativas em seu processo de trabalho. Rev Bras Enferm[Internet]. 2004 [cited 2014 Aug 01];57(3):316-20. Available from: http://www.scielo.br/pdf/reben/v57n3/a12v57n3.pdf http://www.scielo.br/pdf/reben/v57n3/a12... ⁾	Brazil 2004	Qualitative research(N=10)Locus - hospital	Interview	Nurses carry out managerial duties for the health organization to work; they exercise control; management practice makes nurses differ from other sector employees
The nursing work process in the pediatric wing of public university hospitals in Parana, Brazil⁽²⁹29 Yamamoto DM, Oliveira BRG, Vieira CS, Collet N. O processo de trabalho dos enfermeiros em unidades de alojamento conjunto pediátrico de instituições hospitalares públicas de ensino do Paraná. Texto Contexto Enferm [Internet]. 2009[cited 2014 Aug 01];18(2):224-32. Available from: http://www.scielo.br/pdf/tce/v18n2/04.pdf http://www.scielo.br/pdf/tce/v18n2/04.pd... ⁾	Brazil 2009	Historical research(N=9)Locus - hospital	Interview Participant observation	Nurses' healthcare practice is subordinated to the physician; nurses are responsible for care management
The case for clinical nurse leaders: guiding nursing practice into 21st century⁽³⁰30 O'Grady TP, Clarck JS, Wiggins MS. The case for clinical nurse leaders: guiding nursing practice into 21st century. Nurse Leader[Internet]. 2010[cited 2013 Dec 15];8(1):37-41. Available from: http://dx.doi.org/10.1016/j.mnl.2009.11.002 http://dx.doi.org/10.1016/j.mnl.2009.11.... ⁾	United States 2010	Case study		Expertise in medical knowledge, hierarchy and work division present in the formation of the field of work; nurses are responsible for process intersection and the liason between employees.

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[1] CORRESPONDING AUTHOR: Juliana Alves Leite Leal. E-mail: julianaal.leal@gmail.com