Contributions and challenges of hospital nursing management: scientific evidence

Ferreira, Victor Hugo Souto; Teixeira, Veronica Modolo; Giacomini, Márcia Aparecida; Alves, Larissa Roberta; Gleriano, Josué Souza; Chaves, Lucieli Dias Pedreschi

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Revista Gaúcha de Enfermagem

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Sumário

Integrative Review • Rev. Gaúcha Enferm. 40 • 2019 • https://doi.org/10.1590/1983-1447.2019.20180291 copy

Contributions and challenges of hospital nursing management: scientific evidence

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

AIM

Analyze the scientific evidence, national and international, about contributions and challenges of nursing management in hospital care.

METHOD

Integrative literature review, with guiding question: What are the scientific evidence about nursing management in hospital care? Data was collected in LILACS, PubMed, Scopus, CINAHL and EMBASE databases. The final sample of 14 articles resulted in two categories: "Contributions" and "Challenges."

RESULTS

Contributions refer to aspects that facilitate the development and organization of work from a technical-political perspective, by qualifying the productive processes. The challenges were related to professional development, work satisfaction, overload, quality of service, conflict resolution and teamwork.

CONCLUSION

Management and care processes are inseparable, requires adequate and up-to-date knowledge to provide a better care experience for the health services user and coordinate team actions.

Keywords:
Organization and administration; Hospital administration; Health services administration; Nursing

Study Title	Authors/Periodical/ Country/Year/Database	Objectives and Method	N. Evid.	Main results
Conflict in nursing management in the hospital context	Guerra ST, Prochnow AG, Trevizan MA, Guido LA. Rev Latino-Am Enfermagem. Brazil 2011⁹9. Guerra ST, Prochnow AG, Trevizan MA, Guido LA. Conflict in nursing management in the hospital context. Rev Latino-Am Enfermagem. 2011;19(2):362-9. doi: https://doi.org/10.1590/S0104-11692011000200019. https://doi.org/10.1590/S0104-1169201100... CINAHL	To analyze how the conflicts are manifested in the interpersonal relations and the magnitude that they assume in the managerial exercise of the nurse, in hospitals. Descriptive exploratory study, with a qualitative approach.	N2	The internal conflicts are remarkable for nurse managers, managing the conflicts ends up being the main movement of the nurses managers. Often the best thing to do is to ponder, observe the movements of the agents, articulate support and be aware. It is necessary that the team feel part of the processes, the approach to the activities with the nurse manager can guarantee solidarity and support for the work of these professionals. The future of the profession is associated with the scientific, theoretical and practical qualification, to fill the administrative voids in hospital organizations.
The nursing management work: knowledge of nursing professionals about their managerial competencies	Damasceno CKCS, Campelo TPT, Cavalcante IB, Sousa PSA, Moreira WC, Campelo DS. Rev Enferm UFPE online Brazil. 2016¹⁰10. Damasceno CKCS, Campelo TPT, Cavalcante IB, Sousa PSA, Moreira WC, Campelo DS. The nursing managerial work: professional nurses' knowledge about their skills management. Rev Enferm UFPE online. 2016 [cited 2017 ago 27];10(4):1216-22. Available from: http://www.revista.ufpe.br/revistaenfermagem/index.php/revista/article/view/9006/pdf_9948 http://www.revista.ufpe.br/revistaenferm... CINAHL	To know the competences of nurses in the field of management in public health institutions. Descriptive study, qualitative approach.	N2	The coordination, control and continuity of the service is settled in nurses, however there is a growing concern about the quality of nursing care. Supervision and coordination are emphasized as important parts of the manager's work process. During undergraduate nursing, the theoretical bases have not been sufficient for the managerial understanding that occurs with the daily practice exercised in the position of manager. It should be noted that this deficiency remains in institutions, without support in continuing education.
Management profile of nurses working in a public teaching hospital	Nobrega MFB, Matos MG, Silva LMS, Jorge MSB Rev Enferm UERJ. Brasil, 2008¹¹11. Nobrega MFB, Matos MG, Silva LMS, Jorge MSB. Perfil gerencial de enfermeiros que atuam em um hospital público federal de ensino. Rev Enferm UERJ. 2008 [citado 2017 ago 27];16(3):333-8. Disponível em: http://www.facenf.uerj.br/v16n3/v16n3a06.pdf. http://www.facenf.uerj.br/v16n3/v16n3a06... LILACS	To know the managerial profile of nursing unit managers in a federal public teaching hospital. Descriptive study, with a quantitative approach.	N2	The managerial function is characterized by: leadership, technical competence and the establishment of good interpersonal relationship, used predominantly for the performance of administrative and bureaucratic activities. It is necessary to reflect on the managerial actions and their relationship with nursing care, so that when assuming innumerable administrative activities the nurse does not move away from the user, from the essence of care, becoming only managers of human resources, processes and tools.
Meaning of management of Intensive Care Unit for the nurse	Martins JT, Robazzi MLCC, Marziale MHP, Garanhani ML, Haddad MCL Rev Gaúcha Enferm. Brasil, 2009¹²12. Martins JT, Robazzi MLCC, Marziale MHP, Garanhani ML, Haddad MCL. Significados do gerenciamento de unidade de terapia intensiva para o enfermeiro. Rev Gaúcha Enferm. 2009 [citado 2017 ago 27];30(1):113-9. Disponível em: http://seer.ufrgs.br/RevistaGauchadeEnfermagem/article/view/8883/5125. http://seer.ufrgs.br/RevistaGauchadeEnfe... LILACS	Understand the meaning of being a nurse in a managerial role in intensive care units and the feelings that come from this function. Exploratory, descriptive study, with a qualitative approach.	N2	Managing ICUs means providing care to the patient, administering nursing care and administering the health team. The management of care is linked to the purposes of nursing, it is possible to use it as an aid instrument for the development of nursing and in the planning of tasks. The feelings of pleasure in managing are fruits of an environment that favors them to use their abilities, individualities, beliefs, potentialities, solidarity, harmony, competence and dialogue.
Profile and competencies of nurse managers at accredited hospitals	Furukawa PO, Cunha ICKO Rev Latino-Am Enfermagem. Brasil, 2011¹³13. Furukawa PO, Cunha ICKO. Profile and competencies of nurse managers at accredited hospitals. Rev Latino-Am Enfermagem. 2011;19(1)106-14. doi: https://doi.org/10.1590/S0104-11692011000100015. https://doi.org/10.1590/S0104-1169201100... LILACS	Characterize the profile of nursing managers in accredited hospitals and identify the competencies of these managers from the perspective of their hierarchical superiors. Descriptive study, with a quantitative approach.	N4	One of the few ways to growth as a nurse in health care organizations has been the shift to a managerial career path. The managerial career is seen as a bonus, or recognition of the contribution of the person to the organization and not as a new career. There is a preference for professionals with experience to occupy the positions of management, being considered as part of the trajectory of the nurse. The labor market asks nurses for the knowledge and application of leadership and customer-focused competence, aligning organizational goals with customer needs. Teamwork is among the three most important competencies, promoting the integration of the members of your team for better results as a way to survive the labor market.
Knowledge, skills and attitudes about the management of graduates in nursing of Brazilian public university	Almeida ML, Peres AM. Invest Educ Enferm. Brasil, 2012¹⁴14. Almeida ML, Peres AM. Conhecimentos, habilidades e atitudes sobre a gestão dos formados de enfermagem de uma universidade pública brasileira. Invest Educ Enferm. 2012 [citado 27 ago 2017];30(1):66-76. Disponível em: http://www.scielo.org.co/scielo.php?script=sci_arttext&pid=S0120-53072012000100008&lng=en&nrm=iso&tlng=pt. http://www.scielo.org.co/scielo.php?scri... LILACS	Identify the knowledge, skills and attitudes seized by graduates for the management in Nursing during their formation in a Nursing Course. Descriptive study, with cross-sectional	N4	The graduates prefer to have an approach that allows them to develop more knowledge and skill than management related attitude, depicting that they have greater difficulty in the attitudinal field because it develops in professional practice. It is necessary to provide teaching-learning situations that allow the acquisition of knowledge to support the attitudes to be mobilized in their insertion in the labor market.
Challenges for the management of emergency care from the perspective of nurses	Santos JLG, Lima MADS, Pestana AL, Garlet ER, E rdman AL Acta Paul Enferm, Brasil, 2013¹⁵15. Santos JLG, Lima MADS, Pestana AL, Garlet ER, Erdman AL. Challenges for the management of emergency care from the perspective of nurses. Acta Paul Enferm. 2013;26(2):136-43. doi: https://doi.org/10.1590/S0103-21002013000200006. https://doi.org/10.1590/S0103-2100201300... LILACS	Analyze the challenges for the management of care in an emergency hospital service based on the perspective of nurses. Exploratory-descriptive study, with a qualitative approach.	N2	The main challenges for management are the overcrowding of unity, the maintenance of quality of care and the use of leadership as a management tool. As suggestions the nurses indicate the need for reorganization of the health system for the attention to emergencies, change in the flow of patients care, expansion of the physical structure of the unit and the conduction of training in nursing management.
Pleasure and suffering in the managerial exercise of the nurse in the hospital context	Santos JLG, Prochnow AG, Silva DC, Silva RM, Leite JL, Erdman AL Esc. Anna Nery. Brasil, 2013¹⁶16. Santos JLG, Prochnow AG, Silva DC, Silva RM, Leite JL, Erdman AL. Prazer e sofrimento no exercício gerencial do enfermeiro no contexto hospitalar. Esc Anna Nery. 2013;17(1):97-103. doi: https://doi.org/10.1590/S1414-81452013000100014. https://doi.org/10.1590/S1414-8145201300... LILACS	Analyze the factors of pleasure and suffering in the managerial exercise of the nurse in the hospital context. Exploratory-descriptive study, with a qualitative approach.	N2	Management is considered a source of pleasure when there is personal growth, professional recognition and satisfaction; is a source of suffering due to the difficulties in the relationship with the team and the work overload. It is suggested greater attention from undergraduate nursing courses to strengthen the development of management activities, mainly related to conflict management and teamwork.
(Dis) articulation between management and care in a surgical intensive care unit	Borges MCLA, Silva LMS. R Pesq: Cuid Fundam. [Online], Brasil, 2013¹⁷17. Borges MCLA, Silva LMS. (Des) articulação entre gerência e cuidado em uma unidade de terapia intensiva cirúrgica. R Pesq: Cuid Fundam Online. 2013 [citado 2017 ago 27];5(1):3403-10. Disponível em: http://www.seer.unirio.br/index.php/cuidadofundamental/article/view/2069. http://www.seer.unirio.br/index.php/cuid... LILACS	Understand the perception of the nursing team about the (dis) articulations between management and care actions implemented by the nurse in a surgical intensive care unit. Exploratory study, with a qualitative approach.	N2	Nurses are divided between those who consider care and management as inseparable and those who consider that managing represents a departure from direct care, implying conflicts with the rest of the team. The perception of assistant nurses about management and care was different, evidencing that most understand that these two dimensions are important and essential to the work of nurses.
Relevance and level of application of management competencies in nursing	Jímenez GMA, Arrubla CPL. Invest Educ Enferm, Colômbia, 2013¹⁸18. Jímenez GMA, Arrubla CPL. Relevance and level of application of management competencies in nursing. Invest Educ Enferm. 2013 [citado 29 out 2017];31(1):9-19. Disponível em: http://www.scielo.org.co/scielo.php?script=sci_arttext&pid=S0120-53072013000100002&lng=en&nrm=iso&tlng=en. http://www.scielo.org.co/scielo.php?scri... LILACS	Identify the main management skills for the performance of nursing professionals and indicate some strategies that should be implemented within the educational structure. Descriptive study with mixed approach (qualitative and quantitative).	*	It was identified that the most relevant management skills were: leadership (81.4%), teamwork (75.0%), effective communication (55.7%); while the specific skills are quality management and care. It is noteworthy the knowledge component (scientific and technological domain) and the component of skills, interrelation (leadership, effective communication and teamwork). These are complex constructions that should be considered in nursing training. It is imperative to opt for integrative visions.
Dimensions of nursing work in the hospital context	Presotto GV, Ferreira MBG, Contim D, Simões ALA Rev RENE. Brasil, 2014¹⁹19. Presotto GV, Ferreira MBG, Contim D, Simões ALA. Dimensões do trabalho do enfermeiro no contexto hospitalar. Rev Rene. 2014 [citado 2017 ago 27];15(5):760-70. Disponível em: http://www.periodicos.ufc.br/rene/article/view/3237. http://www.periodicos.ufc.br/rene/articl... LILACS	To understand the perception of nurses about the dimensions of the work they perform in the daily life of a university hospital. Exploratory-descriptive study, with a qualitative approach.	N2	Nurses perceive the development of their work linked to four different dimensions: care, administration, education and research. The care dimension of the nursing work is characterized as human care based on science and technology. The administrative dimension highlights the role in the management of care, material and human resources, as well as the hospital organization, ensuring safe care. The educational dimension refers to the qualification of social practices, in favor of a common goal. The research dimension of the nurse indicates the need for the professional to study continuously, produce and read research, to subsidize the caring process.
Manage hospital admission unit: What do the nurses think?	Lima RS, Lourenço EB, Rosado SR, Sanches RS, Fava SMCL, Dázio EMR. Rev Enferm. Cent-Oeste Min. Brasil, 2016⁵5. Lima RS, Lourenço EB, Rosado SR, Sanches RS, Fava SMCL, Dázio EMR. Gerenciar unidade de internação hospitalar: o que pensam os enfermeiros? Enferm Cent O Min. 2016;6(2):2190-8. doi: https://doi.org/10.19175/recom.v6i2.1128. https://doi.org/10.19175/recom.v6i2.1128... LILACS	Understand the meanings of managing hospitalization units from the perspective of nurses. Exploratory-descriptive study, with a qualitative approach.	N2	The managerial activities are limited to their technical dimension in order to reach the institutional objectives, being that the direct care does not occupy central space in the representation elaborated by the nurse, reproducing the dichotomy management/care.
Leadership support for ward managers in acute mental health inpatient settings	Bonner G, McLaughlin S. J Nurs Manag. Reino Unido, 2014²⁰20. Bonner G, McLaughlin S. Leadership support for Ward managers in acute mental health inpatient settings. Nurs Manag (Harrow). 2014;21(2):26-9. doi: https://doi.org/10.7748/nm2014.04.21.2.26.e1206. https://doi.org/10.7748/nm2014.04.21.2.2... PUBMED.	Explore how leadership is developed and identify the difficulties and challenges in the work of managers. Action research study with qualitative approach.	N2	The roles of managers are and vary according to individual perspectives and personalities, ward type and work group. The managers demonstrated that they wanted to carry out assistance activities, but they felt unable to allocate sufficient time for this aspect. Recording activity routinely reduced their time, but allowed them to reflect on priorities.
Nurses' perception of management activities in the care of the user	Giordani JN, Bisogno SBC, Silva LAA. Acta Paul Enferm. Brasil, 2012²¹21. Giordani JN, Bisogno SBC, Silva LAA. Perception of nurses regarding management activities for user assistance. Acta Paul Enferm. 2012;25(4):511-6. doi: https://doi.org/10.1590/S0103-21002012000400005. https://doi.org/10.1590/S0103-2100201200... SCOPUS	Identify the perception of nurses on the management activities in assisting the user. Exploratory-descriptive study, with a qualitative approach.	N2	The managerial activities vary according to the unit, and the direct assistance is delegated to other members of the team, a fact that can be a source of conflicts. The management is planned and performed with the purpose of assuring the quality of the assistance and as it is an activity that should not be delegated, it is through this process that the nurse performs the assistance to the user. The effectiveness of the work process is also linked to the organization of the unit and the planning of activities and the education of the team in order to qualify care and services.

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[1] Corresponding author:
Lucieli Dias Pedreschi Chaves. dpchaves@eerp.usp.br