Supervision of professional nursing practice in Brazil: a scoping review

this is a scoping review, anchored in the JBI framework, with the guiding question: what is the evidence of the audit process of legal practice of nursing by class councils (COFEN/COREN system)? The searches were carried out in October and November 2022 without limitation of language and year.

Results:

of the 9 selected studies, all are Brazilian and published from 2014 onwards. Among the topics addressed are the role, challenges, costs and difficulties in nurse auditors’ daily work process, in addition to the contribution of the audit sector in Brazil.

Conclusions:

the studies gathered discuss aspects related to costs, challenges and difficulties, but there is no focus on corrective, disciplinary and educational activities as well as little is said about the audit process, its reporting, referral and outcomes.

Descriptors:
Nursing; Nursing Audit; Professional Review Organizations; Review; Ethics Nursing

Mnemonics	Descriptors	DeCS/MeSH/Emtree
Population Nursing councils	Professional Review Organizations	Organizações de Normalização Profissional Círculos Médicos Comissão de Avaliação de Exercício Profissional Federações Médicas Normalização de Padrões Profissionais Organizações de Controle da Profissão Organizações de Controle de Padrões Profissionais Organizações de Revisão por Pares Professional Review Organizations Review Organizations, Professional PRO Professional Review Organizations Organizations, Professional Review Organization, Professional Review Professional Review Organization Professional Standards Review Organizations PSRO Peer Review Organizations Organizations, Peer Review Organization, Peer Review Peer Review Organization Utilization and Quality Control Peer Review Organizations Professional standards review organization
Concept Audit of professional practice of nursing class councils	Sanitary Audit	Fiscalização sanitária Fiscalização Fiscalização da Saúde Fiscalização em Saúde Monitoramento da Saúde Monitoramento em Saúde Monitoramento Sanitário Nursing Audit Audit, Nursing Audits, Nursing Nursing Audits Nursing Audit
Context Legal practice of nursing	Ethics, Nursing	Ética em enfermagem Ética de Enfermagem Ethics, Nursing Ethic, Nursing Nursing Ethic Nursing Ethics Medical ethics

ID^* * ID - study identification.	Objective	Region	Approach	Mais results	Contributions
S1(¹⁰10 Costa EO, Germano RM, Medeiros SM. The fiscalization of the professional practice in the Nursing Federal Council. Reme: Rev Min Enferm. 2014;18(1):208-12. https://doi.org/10.5935/1415-2762.20140016 https://doi.org/10.5935/1415-2762.201400... )	Analyze the audit process of professional practice in the COFEN/COREN system, identifying the difficulties related to its implementation.	-	COFEN/COREN system	There was a need to strengthen an audit process focused on the educational and participatory dimension, in accordance with COFEN Resolution 374/2011.	The strengthening of the audit process focused on COFEN Resolution 374/2011 principles contributes to patient care quality, nursing service regulation, in accordance with the law of professional practice and development of the health sector in Brazil.
S2(¹¹11 Silveira LR, Ramos SRF. Os maiores desafios e dificuldades para realizar o trabalho de fiscal do COREN/SC. Enferm Foco. 2014;5(1):33-36. https://doi.org/10.21675/2357-707X.2014.v5.n1/2.602 https://doi.org/10.21675/2357-707X.2014.... )	Know the challenges and difficulties encountered in nurse auditors’ daily work process.	South region	COREN	Among the challenges cited by auditors are a lack of knowledge of regulation of professional practice, code of ethics and resolutions and decisions, and an outdated and/or negative view attributed to the council. Among the difficulties are issues related to the slowness resulting from the bureaucracy involved and the lack of standardization of the audit process.	It offered subsidies to improve nurse auditors’ work process, contributing to greater knowledge of all professionals about this work, since nurse auditors have the perception that they are an agent of change in this conception, strengthening professional work.
S3(¹²12 Silveira LR, Ramos FRS, Schneider DG, Vargas MAO, Barlem ELD. Sofrimento moral em enfermeiros dos departamentos de fiscalização do Brasil. Acta Paul Enferm. 2016;29(4):33-36. https://doi.org/10.1590/1982-0194201600062 https://doi.org/10.1590/1982-01942016000... )	Identify the frequency and intensity of causes of moral distress experienced by nurses.	South, Southeast, North, Northeast Midwest regions	COREN	Participants revealed a higher frequency of causes of moral distress in two moments: first, associated with the slow audit process and insufficient human resources; second, associated with ethical problems, working conditions and difficulty ensuring quality of nursing care.	Reflecting on the causes of moral suffering is recognizing the need for an assessment of professional behavior and discussion on professional ethics, because changes must take place in the base that sustains the profession’s ethical precepts and moral conduct, in order to strengthen the category.
S4(¹³13 Rodrigues MA, Santana RF, Paula RCC, Silva MTN, Santo FHE. Exercício profissional de enfermagem em instituições de longa permanência para idosos: estudo retrospectivo. Texto Contexto Enferm. 2018;27(2):1-9. https://doi.org/10.1590/0104-070720180001700016 https://doi.org/10.1590/0104-07072018000... )	Assess the results of the ethical-professional audit of nursing in Nursing Homes.	Southeast region	COREN	A significant improvement was verified between the first and the last audit in relation to the legality of professional practice. Issues such as irregular registration in the council, classification of care without a standard and professionals from other classes on the nursing scale showed greater resolution, however, regarding the dimensioning of nursing, there was no difference.	The observed results are sensitive to audits when they translate parameters of advances in the quality of services offered to institutionalized residents and also in comprehensive nursing care.
S5(¹⁴14 Pereira LH, Rodrigues ACC, Santos PT, Ribeiro LCM. Fiscalização do exercício profissional na área da saúde. Enferm Foco. 2019;10(6):28-35. https://doi.org/10.21675/2357-707X.2019.v10.n6.2253 https://doi.org/10.21675/2357-707X.2019.... )	Identify the characteristics of the audit of professional practice carried out by four professional councils in health.	-	COFEN	All professions in health analyzed have a law creating their class councils. In nursing, medicine and pharmacy resolutions regulate the audit system operation; however, in dentistry, it was not identified. Nursing was the only class that showed characteristics of an audit process with educational precepts, encouraging ethical values and valuing the work process in its regulation.	The importance of making national norms available by the councils is highlighted, in order to ensure the uniformity of audit and guarantee patient safety from the professions’ legal and regular exercise. Moreover, health audit standardization is important for the development of professions with an interdisciplinary focus.
S6(¹⁵15 Persegona MFM, Silva MCN, Freire NP, Almeida WC, Filete M, Medeiros GC, et al. Conselho federal de enfermagem: governança e gestão estratégica orientada para resultados das atividades finalísticas. Enferm Foco 2019;10 (6):6-15. https://doi.org/10.21675/2357-707X.2019.v10.n6.3385 https://doi.org/10.21675/2357-707X.2019.... )	Discuss the results-oriented governance and strategic management process of the COFEN and COREN system final and administrative activities.	-	COFEN/ COREN system	CORENs’ audit sector is part of the Division of Audit of Professional Exercise (DFEP) of COFEN. COFEN works by carrying out technical visits, training and monitoring the conduct adopted by CORENs.	Audit activities correspond to 2.27% of the autarchy’s total budget, an amount destined to seek uniformity and strengthen the audit work process.
S7(¹⁶16 Costa IZK. Fiscalização de enfermagem no município do rio de janeiro: assistência neonatal (2010-2019) [Dissertação] [Internet]. Universidade Federal do Estado do Rio de Janeiro; 2021[cited 2022 Dec 01]. 104 p. Available from: http://www.unirio.br/ppgenf/dissertacoes-ppgenf-unirio-ano-2021/ingrid-zuvanov-kahl-costa/view http://www.unirio.br/ppgenf/dissertacoes... )	Analyze audit acts in public institutions in Rio de Janeiro related to neonatal care.	Southeast region	COREN	The precariousness of audited health institutions and the lack of material and human resources were identified during document analysis, in addition to verification of the course time of the process, which was considerably long.	The process of audited institutions made it possible to observe the delay in progress, the lack of closure of processes and the growing process of judicialization, reflecting the audit sector’s and COREN’s legal department in that state.
S8(¹⁷17 Alves VLS, Lima AFC. In loco nursing practice inspection costs in a Brazilian setting. Rev Esc Enferm USP. 2022;56:e20210382. https://doi.org/10.1590/1980-220XREEUSP-2021-0382 https://doi.org/10.1590/1980-220XREEUSP-... )	Identify the average direct cost related to the direct labor of the auditors involved in the “on-site audit” of the audit process carried out at the COREN-SP Headquarters Unit.	Southeast region	COREN	The average cost of the initial “on-site audit” is 1.29 times greater than that of the return “on-site audit”, corresponding to R$ 331.67 (US$66.33) and R$ 256.16 (US$51.23) on average, respectively. Time (p ≤ 0.001) and cost of the initial “on-site audit” (p ≤ 0.001) are greater than for the return “on-site audit”.	Contributions related to costs can be justified by the fact that, in order to perform the initial “on-site audit”, the auditor needs to request information and assess the questions contained in the terms used, in addition to auditing the sectors where there is a nursing service, since, in the return audit, it is verified that the inadequacies reported in the initial audit have been remedied.
S9(¹⁸18 Alves VLS, Lima AFC. Supervision of the professional practice of nursing: case study describing the “on-site inspection” sub-process. Rev Bras Enferm. 2022;75(2):e20210823. https://doi.org/10.1590/0034-7167-2021-0823pt https://doi.org/10.1590/0034-7167-2021-0... )	Describe the “on-site audit” sub-process of the “audit” macro-process, carried out at the COREN-SP Headquarters Unit.	Southeast region	COREN	The description of the initial and return “on-site audit” subprocess facilitated the identification of activities that add value and relevance to the audit process.	The activities and tasks pre-established in the audit script, inserted in the respective audit terms, need to be carried out in a detailed and sequential manner, aiming at compliance with current legislation.

Associação Brasileira de Enfermagem SGA Norte Quadra 603 Conj. "B" - Av. L2 Norte 70830-102 Brasília, DF, Brasil, Tel.: (55 61) 3226-0653, Fax: (55 61) 3225-4473 - Brasília - DF - Brazil
E-mail: reben@abennacional.org.br

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[1] Corresponding author: Andrezza Gabrielly dos Santos Soldera, E-mail: andrezzasoldera@hotmail.com