The profile of EEUSP graduates of the stricto sensu program in nursing management

Abstracts

O presente estudo teve como objetivos identificar e discutir o perfil dos egressos da pós-graduação stricto sensu na área de concentração de Administração/Gerenciamento em Enfermagem, da Escola de Enfermagem da Universidade de São Paulo, no período de outubro de 2008 até junho de 2011, no tocante às áreas de conhecimento a que esses egressos estavam vinculados no mestrado e no doutorado. Trata-se de um estudo exploratório, descritivo, retrospectivo, pautado em análise documental. A população foi constituída por 250 egressos, sendo 169 mestres e 81 doutores. O perfil dos egressos permitiu apreender e discutir o percentual de continuidade para o programa de doutorado; o tipo de instituição que absorve o egresso de mestrado e de doutorado; e as áreas de atuação dos mesmos.

Educação de Pós-Graduação em Enfermagem; Pesquisa em administração de enfermagem; Gestão em saúde

ORIGINAL ARTICLE

The profile of EEUSP graduates of the stricto sensu program in nursing management

Perfil de los egresados del postgrado sticto sensu en el área de gerenciamiento en enfermería

Vanda Elisa Andres Felli^I; Paulina Kurcgant^II; Maria Helena Trench Ciampone^III; Genival Fernandes de Freitas^IV; Taka Oguisso^V; Marta Maria Melleiro^VI; Daisy Maria Rizatto Tronchin^VII; Raquel Rapone Gaidzinski^VIII

^INurse. Free-Lecturer, Department of Professional Guidance. Coordinator of the Graduate Program in Nursing Management, University of São Paulo School of Nursing. São Paulo, SP, Brazil. [e-mail]

^IINurse. Full professor, Department of Professional Guidance and Graduate Program in Nursing Management, University of São Paulo School of Nursing. São Paulo, SP, Brazil. [e-mail]

^IIINurse. Full professor, Department of Professional Guidance and Graduate Program in Nursing Management, University of São Paulo School of Nursing. São Paulo, SP, Brazil. [e-mail]

^IVNurse. Ph.D. Professor, Department of Professional Guidance and Graduate Program in Nursing Management, University of São Paulo School of Nursing. São Paulo, SP, Brazil. [e-mail]

^VNurse. Full Professor, Department of Professional Guidance and Graduate Program in Nursing Management, University of São Paulo School of Nursing. São Paulo, SP, Brazil. [e-mail]

^VINurse. Free Lecturer, Department of Professional Guidance and Graduate Program in Nursing Management, University of São Paulo School of Nursing. São Paulo, SP, Brazil. [e-mail]

^VIINurse. Full Professor, Department of Professional Guidance and Graduate Program in Nursing Management, University of São Paulo School of Nursing. São Paulo, SP, Brazil. [e-mail]

^VIIINurse. Full Professor, , Department of Professional Guidance and Graduate Program in Nursing Management, University of São Paulo School of Nursing. São Paulo, SP, Brazil. [e-mail]

ABSTRACT

The objectives of the present study were to identify and discuss on the profile of the graduates form the stricto sensu program in Nursing Administration/Management of the University of São Paulo School of Nursing, from October 2008 to June 2011, regarding the knowledge areas the graduates worked on during their master and doctoral program. This is an exploratory, descriptive, retrospective study, using documental analysis. The study population consisted of 250 graduates, 169 of which were masters and 81 doctorates. The graduates' profile permitted to identify and discuss on the retention rate for the doctorate; the type of institution that absorbs the master and doctorate graduate and the fields they work in.

Descriptors: Education, Nursing, Graduate; Nursing administration research; Health management

RESUMEN

El presente estudio tuvo como objetivos identificar y discutir el perfil de egresados de posgraduación stricto sensu en el área de concentración de Administración/Gerenciamiento en Enfermería, de la Escuela de Enfermería de la Universidad de San Pablo, en el período entre octubre 2008 a junio 2011, en lo relativo a las áreas de conocimiento a las que los egresados estaban vinculados en la maestría y en el doctorado. Se trata de un estudio exploratorio, descriptivo, retrospectivo, pautado en análisis documental. La población se constituyó con 250 egresados, de los que 169 eran maestros y 81 doctores. El perfil de los egresados permitió aprender y discutir el porcentual de continuidad hacia el programa de doctorado; el tipo de institución que contrata al egresado de maestría y de doctorado y las áreas de actuación de los mismos.

Descriptores: Educación de Postgrado en Enfermería; Investigación en gestión de enfermería; Gestión en salud

INTRODUCTION

In the Brazilian context, nursing practice follows four working processes: healthcare, management, education, and research. In health institutions, nurses mostly perform the first two processes in association with management, which is preeminent over the others, as it is through this means that nurses organize work and administrate human resources⁽¹⁾.

Some decades ago in Brazil, nursing management was seen as a dysfunction, i.e., a distortion of the role that nurses should actually play in health institutions - nursing care. Working with management was a synonym for doing bureaucratic activities, referred to as paper work⁽²⁾.

Although historically described as part of the nursing work, since the early pre-professional period, management activities became legally assigned to nurses through the Law of Professional Practice, regulated by the Federal Nursing Council⁽³⁾, by establishing that it is an exclusive duty of nurses to assume a leading position; plan, organize, coordinate, and evaluate nursing services⁽⁴⁾. The COFEN 194 Resolution makes the management work of nurses official, stating that:

Nurses can occupy, in any domain, the position of general management in public and private health institutions, and it is their exclusive duty to coordinate nursing services.

Studies show that nursing work has suffered influences from the classic-scientific model of management, thus incorporating the principles of control, hierarchy and discipline, among others stated by the general theory of administration. These influences predisposed maintaining techniques, norms, and regulations that do not follow the dynamicity and current transformations that aim at quality and efficiency. Furthermore, they do not promote the autonomy of nursing workers^(5-7).

Management is currently seen as an essential and predominant activity in nursing, regardless of the job positions or functions they assume in health institutions.

Recognizing management as an activity performed by nurses started to take effect when studies were performed to give evidence of nursing practice based on the conception of the working process in a historical perspective^(8-9).

In this context, management activities do not prescind an individual and his/her relationships with other individuals and the subjectivity present inherent to this process, as well as its determinations⁽¹⁰⁾. According to the authors, the management that emerges with the appearance of capitalism and collective work answers the (...) need for an instance or function that takes on the responsibility for integrating activities, in the search for agreement in the working process⁽¹⁰⁾.

Health management, from this perspective, is an activity that functions as a means, and its central action consists to associate and integrate, which, at the same time, allows for transforming the working process and implies its alteration considering the determinants of the everyday life of organizations⁽¹⁰⁾.

Therefore, management is configured as a tool in the process of care and can be learned as a specific working process and divided into its constituting elements⁽²⁾.

More emphatic discussions on management have occurred since the 1980s, when researchers⁽¹¹⁾ gave evidence that this process is guided by an immediate and a mediate purpose, which are, respectively, to organize work and develop conditions to perform the process of individual and collective care. In this analysis, authors point to the organization of care and continuing education for workers as object of management work, and workforce and administrative materials, models, and methods as its means and instruments.

Nevertheless, studies show that there is still an important gap regarding the management competences of professionals that assume, in practice, the administration and management of health services or units in the national health system (Sistema Único de Saúde - SUS)⁽¹²⁾.

Therefore, management consists of a focus of interest for further studies and discussions considering the purpose of knowing the profile of the graduates from Graduate Programs specific to this area of knowledge, with the purpose to evaluate if education is consistent with the needs of healthcare services and Higher Education Institutions (HEI).

Graduate Studies in Nursing Management at EEUSP

The creation and evolution of the concentration area Nursing Care Management, as well as the knowledge production in this area of the Graduate Program at EEUSP has been described in a study that found that this university is the one of the precursors of nursing education in the country, which was implemented one year after establishing the Master in Nursing Program at EEUSP and the opening of the Department of Professional Guidance in 1974⁽¹³⁾.

The priority in the first years of activity of this teaching area was for the faculty to obtain the degree, as the mission of the master course was to prepare individuals to work in education. The doctorate degree course of the program was only established in 1989⁽¹³⁾.

Many changes have occurred since the master and doctorate courses in Nursing Administration/Management were established, culminating with the creation of the Graduate Program in Nursing Management, in November 2009, which activities started in February 2010.

The Program answers the need to prepare researchers, expand and enhance investigations in nursing management and in the production of specific knowledge. It is also an answer to the growing use of technology in the complex setting of nursing care organization, and the education of nurses involved in research and innovation.

This context contemplates the education of researchers considering three conceptual-theoretical axes: technical-scientific, social-educational, and ethical-political.

The technical-scientific axis assumes that investigations are founded on different theories in the field of Health Administration/Management, in the dialogue with Social Sciences, which generate specialist knowledge on evidence-based health administration and planning. The social-educational axis assumes guiding pillars of the Program that integrate theoretical foundations of Social Sciences, particularly Sociology, Anthropology and Education. These pillars support the education of nurse researchers, as well as other health professionals, in master and doctorate degree courses. The investigations that contemplate the socio-educational dimension of the Program have the purpose to generate knowledge and offer products that innovate and equip the managerial and educational processes in nursing and health, optimizing the use of virtual networks. The ethical-political axis is supported by the theoretical presuppositions of history, professional ethics and bioethics, as well as of public health and education policies. This domain supports the research that makes advances in the knowledge of political, social, and economic elements, present in the interprofessional and interdisciplinary work relationships, and in the individual-organization, user and society power relationships, whose dialogue represents one of the pillars of the healthcare management in the country⁽¹⁴⁾.

These approaches permit performing instrumental investigations to develop matrixes, and innovating management models and tools that outline guidelines to monitor the health management process.

The theoretical-conceptual axes of the program presuppose and associate the themes of Management, Ethics and Bioethics, Education, History and Legislation, which have the following objectives: to prepare researchers and qualified leaders in Nursing and Health Management and in relation to other disciplines to produce a innovative knowledge to transform healthcare practices; prepare researchers to work in different settings that demand them to expand and disseminate knowledge in nursing and health management, resulting in intervention matrixes and models that have social impact; and, exchange knowledge resulting from investigations with researchers from equivalent national and international excellence centers⁽¹⁴⁾.

In this context, the Program expects to prepare masters and doctorates with the following profiles:

Masters - with the potential to: produce innovative knowledge in the area of investigation, using appropriate methodological instruments; develop a critical-reflexive ability when analyzing realities and studies, skills to search and interpret studies/texts, scientific writing skills; propose and implement interventions in the different practice settings, evaluating results.

Doctorates - with the potential to: aggregate the potentialities expected of masters with greater depth and dissemination; master the theme of investigation and/or their interfaces in the national and international contexts, developing/creating innovating knowledge that is capable to provide the necessary support and visibility to nursing science and other health areas; establish dialogues with national and international peers within the discipline and across disciplines; argue and support ideas in different contexts of science; master theoretical-methodological research references and the capacity to create new methods/techniques/technologies, as well as the ability to disseminate knowledge in qualified journals and collect resources to develop projects; continue advancing in their scientific career and promote graduate studies in nursing and health.

Knowledge production in nursing graduate studies focusing on nursing management was the object of studies that revealed how this production is disseminated in the different regions of the country, as well as its themes, lines of research, decade, method and chain of thought. Furthermore these studies also permitted to outline considerations about the trajectory, needs and perspectives of research in Nursing Management⁽¹⁵⁾.

In this sense, and in view of the need to develop new evaluation processes based on the profile of the graduate students of the referred program, the objectives outlined for the present study consist of: identifying and discussing on the profile of the stricto sensu graduate program on nursing management of the University of São Paulo School of Nursing, from September 2008 to June 2011, in terms of the areas of knowledge inherent to the master and doctorate course.

METHOD

This descriptive, exploratory, documental study was performed with a retrospective data collection on the Administrative System of the University of São Paulo Graduate Program (Sistema Administrativo da Pós-Graduação da Universidade de São Paulo - JANUS). The JANUS is an internal system that helps manage the data of graduate programs in USP.

The data permitted to create a database tabulated on an Excel worksheet with the following variables: each student's name and USP number, the course attended (master or doctorate), name of the adviser, year of the defense, the student's current institution. In addition to the JANUS system, data were collected from the Lattes platform of each student and by contacting their respective advisers in the graduate program.

RESULTS

The title Nursing Management Area (Área de Gerenciamento em Enfermagem - AGE) refers to the focus area in which master and doctorate students have graduated since 1978. This area of focus was established, at EEUSP, in the master course referred to as Nursing Service Administration (Administração dos Serviços de Enfermagem - ASE) of the Nursing Graduate Program since 1974, and was discontinued on February12^th 2010 on the account of the beginning of the Graduate Program in Nursing Management (Programa de Pós-Graduação em Gerenciamento em Enfermagem - PPGEn). Therefore, this study addresses the AGE graduates and presents data in their regard.

FIGURE 1

FIGURE 2

In the ASE (nursing service administration) area of concentration, as from the first degree given in 1978 until March 2010, there were 158 master and 73 doctorate graduates. From March 2010 to June 2011, within the domain of the PPGEn graduate program, there were 25 master and eight doctorate graduates. Therefore, in the management area, 183 master and 81 doctorates graduated from 1978 to June 2011, i.e., a total of 264 graduates.

The profile of the graduates of the management area was considered according to their gender and age.

Regarding the graduates' gender, Figure 3 shows that most graduates are women, both masters (59.8%) and doctorates (29.9%), and that the highest percentage of males occurs among the master graduates (7.5%).

Figure 4 shows that the predominant age group of the graduates is 31 to 40 years for masters and 41 to 50 for doctorates. There were, however, younger masters and doctorates (22% and 1%, respectively) and older doctorates, with more than 61 years (1%).

Figures 5 and 6 show that about 30% of the master graduates work in Private Universities and Colleges; 15% in Public Universities; 20% in Private Healthcare Services; 25% in Public Healthcare Services.

Regarding the work areas of the graduate nurses, it was found that education is the area that most absorbs the masters (42%) and doctorates (80%) from the nursing management area, as shown in figures 7 and 8.

Furthermore, figures 7 and 8 show that master graduates are absorbed in education (42%), management (25%) and healthcare (23%), whereas doctorates concentrate mostly in healthcare management compared to the practice itself.

DISCUSSION

By knowing the profile of the graduates from the studies program it is possible to infer their insertion in the labor market, despite of it being academic or not, regarding the possibility of generating knowledge, products, and technologies that ultimately boost the country's development⁽¹⁶⁾. The analysis of the graduates' profile presented herein aims at supporting that reflection.

By recovering the profile of the studied graduates, we aim at supporting the analysis of how graduate studies affect their insertion in the labor market and to what extent they have answered the country's needs for development. Therefore, we will first address the number of graduates per year and per course; and then, the data related to gender and age groups; and, finally, the data concerning their insertion in the labor market.

Since 1978, when the first graduate degree was delivered, until March 2010, a total of 158 masters and 73 doctorates graduated in the ASE concentration area. From March 2010 until June 2011, the PPGEn program graduated 25 masters and eight doctorates. Therefore, the management area graduated 183 masters and 81 doctorates, corresponding to 264 graduate students.

The analysis of the number of students reveals the potential of the PPGEn program, which, in about one year, prepared 45% more graduates than in the past 22 years. This data also represents an increment in the number of masters and doctorates for the academic and healthcare service markets. However, different from other current graduate programs and other areas, this figure is still small⁽¹⁷⁾. In this sense, it should be emphasized that the first graduates that obtained their degrees in the referred area were nursing school faculty who would later become advisers at their schools. Nevertheless, when the period from 1999 to 2002 is considered and compared to another nursing graduate course⁽¹⁷⁾, the area graduates a significantly greater number of masters (over 57%) and doctorates (over 50%).

The data also show there was an increment in the number of master and doctorate degrees as from the year 2000, when the number of advisers was also higher (noting that in 2011 data were collected until the month of June). The same increment in the period is observed in other courses, because of the demands of the Education Regulation and Guidelines, which established that faculty must have stricto sensu graduate degree⁽¹⁸⁾. An additional fact is the expansion of the market of nursing courses in private universities.

The analysis of the students regarding their gender and age suggests that, although the workforce in nursing consists mainly of women, they have been investing more on their careers, compared to men. This fact occurs despite women having other activities, such as parenting and homemaking, besides their job. This aspect reveals a relevant gender population that has social determinants of women's insertion in the labor market.

Studies⁽¹⁹⁾ also show that most nursing graduates are women (96.5%).

Other graduate courses⁽²⁰⁾ present the same gender population, which suggests that health and education are work areas where women predominate.

The insertion of women in education meant a transformation, because teaching was a profession with more esteem in the 19^th century, before its feminization started in the 20^th century⁽¹⁷⁾.

Regarding the graduates' age, Figure 4 shows that nurses begin their master studies soon after completing the undergraduate course, and begin the doctorate course in their early 30's. It is observed that, among nurses, doctorate education is more expressive for those between 40 and 50 years of age. This data could be related to the majority being women, thus it is likely that most begin the graduate studies later in life, after having completed their home and family responsibilities.

In Brazil, the Ministry of Education demands of college and university faculty an established percentage of masters and doctorates as a qualification parameter in the evaluation process of HEI. On the other hand, on objective of graduate programs is to prepare masters and doctorates to improve the qualification of higher education, which complies with the demand of the Ministry of Education⁽¹⁷⁾. Therefore, it is important to analyze how the studied graduates are entering universities and healthcare in order to improve the quality of nursing practice as well.

These data reveal that over one third of the masters graduated in the area of nursing management are working in university education, which meets the expectations according to the degree. Furthermore, it is also verified there is a higher absorption of master graduates in private universities, and that 45% of the graduates were absorbed by public and private healthcare services, which suggests the quality of healthcare and management processes at the referred institutions is improving, as they can now count with nurses who are better skilled at developing and using research outcomes.

On the other hand, most doctorate graduates are absorbed by public universities (62%), which develop more research and concentrate most stricto-sensu graduate courses.

Results also show that, besides working in education and research, master and doctorate graduates also contribute with the improvement of professionals working in healthcare and managerial processes at the their workplace.

CONCLUSION

The review of the trajectory of a Graduate Program in Nursing Administration/Management, focused on the graduates' professional practice, contributes with important information to evaluate this proves of professional development.

Therefore, the present study findings, i.e. 183 masters and 81 doctorates in the period from 1978 to 2011, is also evidence that the Nursing School of a Public University has met part of its mission.

The finding regarding the predominance of women is referred by the trajectory of nursing, itself, drawing attention to the nurses entering masters courses soon after completing undergraduate education, but with a late entrance in the doctorate program.

Although there is no confirmation, the current entrance of graduates in this doctorate program suggests that master graduates are starting the doctorate program earlier, thus reducing the time of education and providing their return contribution to society quicker.

The absorption of master graduates by private universities (30%), and doctorates (62%) by public universities, also shows that they (universities) have assured a better qualification of the faculty with a consequent improvement of the conditions of teaching and research production. The presence of masters and doctorates in private and public healthcare institutions remains incipient, and this occurs mainly because of an individual initiative of nurses than through the proposition of human resource policies that contemplate this type of preparation.

In view of this reality, nurses' participation in proposing public and institutional policies that rule education, healthcare and management should be a subject considered in graduate programs.

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Correspondence addressed to:

Publication Dates

• Publication in this collection
  24 Jan 2012
• Date of issue
  Dec 2011

History

• Received
  07 Nov 2011
• Accepted
  11 Nov 2011