Moral suffering in nurses of inspection departments in Brazil

Cross-sectional study with 28 professionals of managerial competence and 113 professionals of inspection competence. The sample was intentional and non-probabilistic. Data were collected through a questionnaire and submitted to descriptive and bivariate analysis.

Results

Participants revealed the causes of moral suffering in two stages: firstly, associated with the slow inspection process by the inspected institutions and Corens, and insufficient human resources. Secondly, associated with ethical problems; work conditions; and quality of nursing care.

Conclusion

To reflect on the causes of moral suffering in this scenario is to recognize the need for changes that should take place on the basis that sustains the profession’s ethical precepts and moral conducts, so as to strengthen the category.

Health care coordination and monitoring; Ethics, nursing; Ethics; Moral damage

Subcategories	Managers’ MS causes	Inspectors’ MS causes
Ethical issues	Inability to act against foul committed by an inspector; Reckless conduct related to the legal sector; Political interference in the activities of Corens; Lack of transparency of some councils; Unawareness of the councils work by some professionals of the institution (inspectors/managers); Lack of work autonomy; Authoritarian attitude of councilors; Conflicting or hostile situation with inspectors; Feeling of professional devaluation by Cofen.	Lack of transparency of some councils; Lack of transparency of some council professionals; Political interference in the activities of Corens; Impotence of leadership in solving internal conflicts; Disputes regarding the conduct of co-workers; the conduct of the nursing staff and the conduct of councilors; Oppressing management; Disrespect by nursing and health institutions’ professionals to fail to comply with what is established; Access denied in health institutions; Lack of autonomy in face of inspection demands; Impunity of public and private managers.
Quality of nursing care	Nurses’ actions not consistent with their role; Lack of commitment/knowledge of health institutions’ managers	Impotence in face of health institutions that do not commit to the safe exercise of nursing practice; Poor working conditions offered to nursing professionals; Ethical violations committed by nursing professionals due to circumstances/ political issues; Absence of 24-hour nurses; Health managers’ lack of commitment and knowledge; Difficulty in producing evidence in face of the harassment experienced by nursing professionals.
Work organization	Lack of referrals and agility of ethical processes by the legal area; Lack of legal support during activities; Lack of inspection activities standardization; Bureaucratic issues involving the inspection process.	Lack of inspection activities standardization; Lack of support/endorsement of the legal area of councils; Insufficient legal support in face of the diversity of situations faced in inspections; Solitary work during inspection activities; Lack of training.
Image of the Coren and Cofen system	Dissatisfaction of nursing professionals with Corens; Unawareness of the roles of Cofen/Corens system by nursing professionals.	Unawareness of the role of Cofen /Corens system by nursing professionals; Distorted and disrespectful attitude towards Cofen/Corens by health institutions and nursing professionals.
Work conditions	Dissatisfaction with workload (claim for 30 hours); Low pay and/or unequal pay among regions; Human and financial resources (mainly transport) insufficient to carry out inspection actions.	Lack of financial resources, materials and insufficient or inadequate human resources; Low pay; Dissatisfaction with workload (claim for maximum workload of 30 hours); Inadequate facilities; Work overload.

Escola Paulista de Enfermagem, Universidade Federal de São Paulo R. Napoleão de Barros, 754, 04024-002 São Paulo - SP/Brasil, Tel./Fax: (55 11) 5576 4430 - São Paulo - SP - Brazil
E-mail: actapaulista@unifesp.br

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[1] Corresponding author Flávia Regina Souza Ramos Ângela Chaves bystreet 81, 88062-305, Florianópolis, SC, Brazil. flavia.ramos@ufsc.br