Investigación de métodos mixtos con triangulación concomitante de datos, desarrollada en un hospital universitario del Sur de Brasil. Los participantes en el estudio cuantitativo fueron 94 enfermeros asistenciales y 12 enfermeros gerentes. Los datos fueron recogidos a partir del Brazilian Nursing Work Index − Revised (B-NWI-R) y analizados mediante la estadística descriptiva e inferencial. Para el estudio cualitativo, fueron entrevistados ocho enfermeros gerentes y 18 enfermeros asistenciales. Los datos fueron valorados según el análisis temático.

Resultados

El promedio total del B-NWI-R para los enfermeros gerentes fue de 2,15±0,39 y para los enfermeros asistenciales fue de 2,22±0,39. No fue identificada significación estadística en la comparación entre los grupos (p=0,508). Los resultados cualitativos muestran la existencia de relaciones colaborativas entre enfermeros gerentes y enfermeros asistenciales.

Conclusión

El ambiente laboral fue evaluado de modo semejante por los enfermeros gerentes y asistenciales en el marco hospitalario.

Enfermería; Ambiente de Trabajo; Supervisión de Enfermería; Investigación en Administración de Enfermería; Hospitales Públicos

Nurses	Managers (n=12)		Nursing assistants (n = 94)

Variables	n(%)	AM±SD*	n(%)	AM±SD*
Age (years)		35.92±7.98		38.3±9.66
Gender
Female	12(100)		86 (91.5)
Male	-		8 (8.5)
Marital status
With a partner	5(41.7)		48(51.1)
Without a partner	6(50)		40(42.5)
Others	1(8.3)		6(6.4)
Profissional experience (years)		11.55±8.26		13.96±8.72
Experience at the hospital (years)		9.77±7.8		12.53±9.89
Experience in the sector (years)		6.27±6.26		7.99±7.68
Training
Specialization	6(50)		43(45.7)
Master’s degree	5(41.7)		36(38.3)
Undergraduation	1(8.3)		9(9.6)
Doctorate degree	-		6(6.4)
Weekly workload (hours)		40.91±13		36.98±11.6
Other part-time work
No	9(75)		80(85.1)
Yes	3(25)		14(14.9)

Nurses	Managers (n=12)		Nursing assistants (n=94)		p-value

Subscales	AM*	SD**	AM*	SD**
Control over the environment	2.59	0.54	2.46	0.54	0.381
Organizational support	2.21	0.42	2.20	0.41	0.971
Physician-nurse relationship	2.02	0.54	2.16	0.54	0.466
Autonomy	1.93	0.95	2.09	0.51	0.365

Total B-NWI-R	2.15	0.39	2.22	0.39	0.508

MANAGER	ASSISTANT
Autonomy
We (nurse managers) have autonomy in part. They (nursing assistant) can have a greater autonomy, especially in care management (P21). They are the ones (nursing assistants) who define the patients that go to another part of the sector, the medication schedule (...), who indicates what to use for dressings (P22). All managers participate at meetings with the Director, and each of them raises the problems of their unit for discussion (P24).	I know everything that happens in the sector. (...) Everything goes by me (P17). It has happened that I had to (...) admit the patient myself (...) and do a delivery (P15). Unfortunately the institution is still centered on the hegemonic medical model. So we lose some autonomy (P4). Things do not always happen as you wish they would because there are hierarchies to be followed and to obey (P14).
Control over the environment
You cannot be choosing things to do. If you need to do a certain activity, you end up helping them (nursing assistants) (...) (P20). The quality of care is not reaching what is desired. (...) We are understaffed, we don’t have the complete team every day and a lot of things don’t get done (P22).	Workload is one of the things that hurts me. (...) Stress due to lack of material, lack of sufficient staff, (...) you can’t do anything (P10). (...) the number of doctor’s notes for staff medical leave is increasingly higher and this ends up hurting the team because it overloads some individuals, and these things make me feel helpless in this situation (P13).
Relationship with the physicians
In the care (as an assistant) I had a much better relationship with the physicians than I do now in a leading role. (...) Before the nurse was recognized as a leader (...), everything the physician wanted to do they would question the nurse if they could it and about what was best, and now the doctors simply come and do whatever they want (P23). Ninety-nine percent of the medical staff relates very well to the nursing staff, (...) one complements the activity of the other (P19).	Here, being a school hospital, we have a better opening than in other hospital settings. We are closer. (P8). It’s a good relationship. (...) We still can’t work in a multiprofessional way, not as we should. But it has improved a lot (P12). It’s easy to get along with the doctors. Of course there’s always someone that you pray it isn’t their shift. (P13).
Organizational support
We also participate in all the decisions that come from the Nursing Director (...) (P24). The nursing board is very close to the managers. We have a forum every 15 days where several issues of the sectors are discussed (...), the nursing director is a nurse who is above us, but they work with us (P19).	I can only thank both the immediate supervisor and the nursing director for how much our relationship is peaceful and open (P6). She (the director) is in the same “boat” as we are (...) (P10). The manager sends all the decisions that are made to us by email (...) (P13).

Universidade de São Paulo, Escola de Enfermagem Av. Dr. Enéas de Carvalho Aguiar, 419 , 05403-000 São Paulo - SP/ Brasil, Tel./Fax: (55 11) 3061-7553, - São Paulo - SP - Brazil
E-mail: reeusp@usp.br

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[1] Corresponding author: José Luís Guedes dos Santos. Universidade Federal de Santa Catarina, Centro de Ciências da Saúde. Departamento de Enfermagem Bloco I, Sala 404, Trindade. CEP 88040-970 – Florianópolis, Santa Catarina, Brazil. jose.santos@ufsc.br