“Dar conta do plantão”: as vicissitudes da organização do trabalho de enfermagem em um hospital público de cardiologia, no Rio de Janeiro

Abstract

The institutionalization of care, the hospital environment and the characteristics of health work have repercussions on hospital nursing work. Nursing services, in general, are characterized by hierarchy, division of labor into tasks, doing rather than thinking, and a strong concern with procedure manuals, standards, routines and shifts. This research is an ethnography of the work organization of nurses who work in two surgical wards of a teaching hospital in the city of Rio de Janeiro, the National Institute of Cardiology (INC). The guiding question is: How do nurses working in the surgical wards of the aforementioned hospital organize their work to “get through their shifts”? The objectives were (1) to identify and analyze how nurses organized their work throughout their shifts in two INC wards; (2) to understand the meanings that nurses attributed to the priorities they established for their professional actions; (3) to understand and analyze the actual work of nurses manifested in the oral and written dyad in the professionals’ work. Data collection was carried out over a period of ten non-consecutive months using participant observation and ethnographic interviews. Based on the observations, a script was developed and then five nurses, managers and care professionals were interviewed, where issues related to professional training, nursing care, work organization, appreciation and professional satisfaction were addressed. Data were analyzed based on the anthropological concept of culture. Three categories were highlighted in the data analysis: the organization of nurses' work in the surgical wards of the National Institute of Cardiology (INC); professional interdependence in hospital care management and in nurses' work - between oral and written communication. The results obtained showed that nurses faced the precariousness of their work in order to "keep up with the shift" by constantly establishing priorities in view of the dynamism of health work in the hospital environment. The challenges highlighted by the nurses were the role of mediator in the health team, where their professional position interferes with their daily actions, preventing interprofessional work from being carried out; lack of effective communication; excessive demands and the shortage of professionals that configured the organization of work throughout the shift. However, the relational aspect strongly linked to the profession that materialized during nursing visits was highlighted. Nursing visits were a priority highlighted by them because it was a way for nurses to become aware of the health needs of patients, allowing the continuity of their therapy. This ethnography revealed the importance of qualitative research to identify aspects that are not measurable, but that have a significant impact on health care, with particular emphasis on the precariousness of work.