ORIGINAL RESEARCH

Portrait of undergraduate nursing courses in Rio de Janeiro State

Luiza Mara Correia^I; Ligia de Oliveira Viana^II; Ricardo de Mattos Russo Rafael^III; Elizabeth Teixeira^IV; Maria Manuela Vila Nova Cardoso^V

PhD in Nursing. Rio de Janeiro State University. Brazil. E-mail: luimara.uerj@gmail.com
PhD in Nursing. Nursing School Anna Nery. Federal University of Rio de Janeiro. Brazil. E-mail: ligiaviana@uol.com.br
PhD in Sciences. Rio de Janeiro State University. Brazil. E-mail: prof.ricardomattos@gmail.com
PhD in Sustainable Development of the Unique Tropic. Rio de Janeiro State University. Brazil. E-mail: etfelipe@hotmail.com
PhD in Nursing. Nursing School Anna Nery. Federal University of Rio de Janeiro. Brazil. E-mail: manuela.ufrj@gmail.com

DOI: http://dx.doi.org/10.12957/reuerj.2017.28358

ABSTRACT

Objective: to analyze the spatial distribution of undergraduate nursing courses in Rio de Janeiro State and their policies for expansion, organization, education and assessment. Method: this ecological study took Rio de Janeiro State as its unit of analysis. Data were collected from November 2015 to July 2016 and analyzed using Stata SE 13 and Quantum Gis 2.0 software. Results: 67.8% of in-person courses were situated in the metropolitan region, and three were public. A similar situation was found with the distribution of distance learning hubs (59.4%). Conclusion: the expansionist logic behind undergraduate courses in the state has apparently resulted in a private hegemony concentrated in large urban centers. This scenario tends to constitute a higher education in nursing that has become naturalized in hybrid educational spaces modeled on a productivist rationale, thereby marginalizing the principles of vocational training.

Keywords: Nursing; education, higher; education, nursing, baccalaureate; education, nursing.

INTRODUCTION

The guiding of this study considers the configuration of the educational area of the Graduation Courses in Nursing of the State of Rio de Janeiro.

In Brazil, the higher education area encompasses a complex and diversified set of public and private higher education institutions (IES), whose normatization is formalized in the Constitution of 1988¹, in the National Education Guidelines and Bases² (LDB) and in other legal provisions, such as decrees, regulations and complementary ordinances, especially promulgated after 1995.

In the 1990s, the adoption of neoliberal policies advocated a labor market as the founding, unifying and self-regulating principle of competitive global society. In this scenario of structural adjustments, Brazil defined reforms in the State and in education, almost always in perfect harmony with the concept of minimizing the role of the State, especially in the social policies, reducing the role of the public sphere and, consequently, amplifying the action of the private sphere.³

Through different dynamics and policies, especially after 1995, the scenario of higher education is translated by federal public regulations for power in a centralized way, mainly for federal private and public institutions. Such legal provisions will naturalize the diversification and differentiation of higher education and encourage the intensification of the IES expansion processes and, at the same time, contribute to change the logic and organizational dynamics of public IESs, especially the federal ones.⁴

Axes of educational policy permeated the establishment of an objective and universalist mechanism of collection and transfer of minimum resources to educational institutions. For example, it was verified the incorporation by the Ministry of Education of the axes of the financing policy suggested by international organizations and the business sector in the movement of regulations. Thus, the guidelines began to emphasize funding and evaluation as the basis of educational reform, which should implement quality control mechanisms, focusing on the definition of resources within explicit universalist criteria.⁵

In this sense, the Brazilian educational reforms caused by the LDB took the fulfillment of some principles directed to higher education as a requirement, basing the formation process through the development of skills and abilities, the cultural, technical and scientific improvement of the citizen, flexibilization of the curricula and the implementation of Pedagogical Projects of courses, in a perspective of change for the professional formation.

These principles pointed to new configurations for the curricular standards currently in force, indicating the need for a restructuring of the Graduation Courses, with changes in the academic context, reflecting in the construction of Curricular Guidelines directed to the expansion of courses and vacancies in higher education by the greater autonomy granted to educational institutions.²

Also with the expansion of courses and vacancies in higher education, data from the "Education at a Glance" Report in 2014 (EAG 2014), prepared by the Organization for Economic Cooperation and Development (OECD) and resulting from annual studies by the Indicators Program of the Educational Systems (INES), reflect that Brazil is the penultimate country in the position that evaluates investment per student in primary, secondary and higher education, among 35 countries surveyed, but acknowledges that there has been significant growth in public investment in the last decade, from 3.5% to 5.6% of the Gross Domestic Product (GDP) between 2000 and 2010. ⁶

It is believed that this investment pointed out in the aforementioned Report and the set of public policies instituted, acting in a synergic and sometimes complementary way, provided a scenario of vertiginous expansion of higher education. This expansion has taken place mainly through the quantitative growth of the number of educational institutions and, consequently, of courses and vacancies offered by them, which can be translated as a massification of higher education, especially since the second half of the century.

According to the Education at a Glance 2016 (EAG 2016) it is a worldwide movement the significant expansion of higher education in the last decades, with significant variation between the different countries. Thus, although the proportion of people between 25-64 years old with higher education has been more than 50% in countries such as Canada, Israel, and Japan, this percentage does not reach 10% in countries such as China and Indonesia. These variations are even greater in the younger generations (25-34 years), ranging from 69% in South Korea and 60% in Japan to 16% in Brazil, 14% in South Africa and 11% in Indonesia.⁷

Accompanying this complex international scenario, the field of Nursing Education in Brazil also showed significant growth, from 826 courses in 2011 - of which 160 were from public IES and 666 from private IES - to 888 courses in 2013. The scenario of growth of the educational system, with significant participation of the private sector and concentrated in the South and Southeast regions, represents 71.2% of the universe of Nursing Courses in Brazil⁸, generating reflection on the aspects that motivate the production of inequities in the distribution of vacancies in the country.

A specific and attentive look at the Nursing Higher Education in the State of Rio de Janeiro shows the expansion of the training system by the increase of vacancies in private courses, predominantly from 2000.

In November 2001, there were 26 courses, and until July 2016, 83 e-MEC courses were identified in the e-MEC system, located in 25 municipalities, representing an expansion of 331% in the last 14 years³ and 37 poles in the distance modality, distributed in 18 municipalities of the State of Rio de Janeiro, one being in the process of extinction.

Based on these considerations, this study aims to analyze the spatial distribution of Nursing Undergraduate Courses in the State of Rio de Janeiro and its political-expansionist, political-organizational, political-pedagogical and political-evaluative characteristics.

METHODS

It is a descriptive-exploratory study of the ecological type, using the State of Rio de Janeiro, its mesoregions, and municipalities as a unit of analysis. The undergraduate and distance courses included in the e-MEC system of the Ministry of Education were excluded and information was duplicated in the system, using the institution's address, the number of places available, the number of hours total of the course and the time of payment as criteria.

Data collection took place from November 2015 to July 2016, using the E-MEC systems and the Brazilian Institute of Geography and Statistics (IBGE) website. In the E-MEC system, the variables related to the maintaining institution, legal nature, academic organization, date of authorization and recognition, total workload, time of payment, number of vacancies offered, modality of offer, result of the National Exams Students/National Institute of Education and Research (ENADE/INEP) in 2013, and finally the addresses with the respective Postal Address Codes (CEP), used to obtain the geographical coordinates (degree, longitude and latitude) of each subsidizing the spatial processing of data.

On the IBGE site, the population data were collected by state mesoregion, calculated from the 2010 Census. Also, the maps of the municipalities and mesoregions of the State were obtained in archives for the geo-processing of the data.

A database was built in Microsoft Excel 2010 software. Stata SE 13 software was cleaned, processed and analyzed statistically, and the proportions, averages, and medians were calculated.

The spatial analysis, using a geo-processing technique, was performed in Quantum Gis 2.0 software to determine the geographic concentration of the courses and the distribution of vacancies by area, calculating the vacancy rate per 10,000 inhabitant/year (ratio between the number of places in a given area and the population of the same area). For the calculation of the ratio of vacancies per distance teaching pole, the ratio between the number of distance education places in a given course and the number of poles in this type of education was calculated. In both calculations, the basis of the 10,000 population indicator was used.

This study is a thesis clipping approved in the Nursing Graduate Program of the Anna Nery School of Nursing of the Federal University of Rio de Janeiro, titled Metamorphosis of the Graduation Nursing Courses of the State of Rio de Janeiro. The study was approved by the Research Ethics Committee of the Anna Nery School of Nursing/São Francisco de Assis Health Care Institute/UFRJ, approved under number 629.961.3.

RESULTS

Figure 1 shows the geographical distribution of Nursing Graduation Courses in the face-to-face modality, being 77 private courses and six public courses, according to mesoregions and municipalities, pointing to political-expansionist characteristics. It is observed the concentration in the metropolitan region, which holds 71.1% (n=59) of the state courses, and 55 of them (93.2%) belong to the private sector.

Taking the city of Rio de Janeiro as an analytical unit, it is possible to show that 40 courses are located in this area, 37 of the private sector and three of the public sector. It should be noted that the municipality holds 42.2% of the state courses and 67.8% of the metropolitan mesoregion, hosting three of the four public courses in the mesoregion and 50.0% of the state. On the other hand, the distribution of courses in other regions of Rio de Janeiro, especially in the Fluminense Center is highlighted.

The state presented a ratio of face-to-face vacancies per 10,000 inhabitants per year of 10.6, while the mesoregions obtained the following results in descending order as shown in Figure 1: 15.8 in the North of Fluminense, 13.5 in the Northwest Fluminense, 10.8 in the Metropolitan of Rio de Janeiro, 8.6 in the Baixadas, 8.3 in the South Fluminense, and 3.3 vacancies per 10,000 inhabitants/year in the Fluminense Center. The metropolitan region holds 79.9% of these state vacancies (n=13,552), while the municipality of Rio de Janeiro has 52.1% (n=8837) and presents a ratio of 14.0 vacancies per 10,000 inhabitants/year.

Figure 1: Spatial distribution of Nursing Graduation Courses in the face-to-face modality (n=83) according to the activity sector (public and private) and the vacancy rate per 10,000 inhabitants/year in the mesoregions of the State of Rio de Janeiro.

Figure 2 shows the spatial analysis of the five Nursing courses offered under the Distance Education modality and the 37 poles implanted in the State of Rio de Janeiro, all of the private teaching sector. The poles are distributed in 18 municipalities, although the concentration (n=22; P=59.4%) in the Metropolitan Region of the State is evident. Of them, 40.9% (n=9) are located in the city of Rio de Janeiro, also representing 24.3% of the state poles.

Figure 2: Spatial distribution of Nursing Graduation Courses in Distance Education modality (n = 5) and their supply poles (n = 37) in the mesoregions of the State of Rio de Janeiro.

The distance education courses are mostly organized (n=4) in university and with time of completion of 10 academic semesters. They have an average daily workload of 4012 hours, with a course, which is in extinction, with 3740 and the observed maximum of 4274 hours. Only two institutions, with 17 poles, have authorization from 2006. The remaining ones were created between 2013 and 2016. None of these institutions has a course or concept recognition at the ENADE 2013. The number of vacancies varies according to the institution, from 60 to 16,800 annual vacancies, with an average of 4297.5 and a median of 165 vacancies. The ratio of vacancies per pole varied from 60 to 1050, with a mean of 360 positions per pole and a median of 165, demonstrating the concentration in an institution.

Table 1 presents the political-organizational, political-pedagogical, political-evaluative characteristics of the Nursing face-to-face courses according to the activity sectors. The offer of courses takes place in 48 Institutions of Higher Education, being 42 institutions in the private sector and six in the public sector.

Observing the academic organization of the institutions, it is identified that the courses are offered in colleges and university centers (n=56, P=59.8%), while the totality of the public sector is organized academically in universities. It is also observed that two educational institutions have Nursing Courses with less than 4000 hours.

The number of vacancies in the private sector is greater than 100 in more than 85.0% of the sample studied, with an average of 212.5 vacancies per year, while the public sector has an average of 99.7 vacancies offered per year. It should be noted that five private institutions hold more than 50.0% of the 16,961 vacancies of Nursing Graduations in the State.

More than 90.0% of private institutions scored below 3 or had no concept at ENADE 2013, while 100% of public institutions scored 3 or higher. The average time of authorization and recognition also showed distinctions between the two sectors, as can be observed: 14.5 and 12.2 years in private institutions and 64 and 58 years in public institutions, respectively.

Table 1: Analysis of the political-pedagogical, political-organizational and political-evaluative characteristics of the face-to-face Graduation Courses by activity sector in the State of Rio de Janeiro, 2016 (n=83)

Analyzing the total of vacancies in the State has 16,061 places in face-to-face and 18,550 in distance education format, totaling 35,511 vacancies offered annually. Thus, there are 22.2 jobs per 10,000 inhabitants per year in the State of Rio de Janeiro.

DISCUSSION

The main findings of this study reveal the spatial inequities in the distribution of vacancies in Nursing in the state of Rio de Janeiro, especially in areas of greater population density and concentration of income, such as metropolitan, north, and northwestern Fluminense. A similar study carried out in Minas Gerais indicates that expanding health services, there is also an explicit inequality in the relation between the formation of new nurses and the number of inhabitants, although there is an increasing demand on the training of nursing professionals⁹.

Similarly, there was a clear imbalance between the offer of public and private education, which invites us to reflect on the complex scenario of public policies in the country. It is believed that flexibility in the provision of higher education was strengthened by building consensus on the inefficiency and inefficiency of public services in general. In the specific case of the public university, the argument for the need to diversify the sources of financing via the private sector and the strengthening of the expansion of private higher education through the liberalization of educational services and the tax exemption have gained strength.

It is a scenario marked by State reform, anchored in the perspective of minimizing the role of the State in the face of public educational policies.^10-11 In this perspective, the Education Development Plan (EDP) has introduced a new educational order with measures to improve the performance of educational institutions at all levels. Regarding the higher education, the words expansion and democratization would be the guiding axes for achieving the goals of the EDP.¹²

The expansionist political characteristics of the Federal University Restructuring and Expansion Plans Support Program (REUNI) are considered as determinants for the analysis of the expansionist political characteristics; the University for All Program (PROUNI); the reformulation of the Student Financing Fund (FIES); and the National System for the Evaluation of Higher Education (SINAES) via the National Examination of Student Performance (ENADE).

The goals to be achieved by the government were reconfigured into a form of interpenetration between the public and private spheres, so the state was the financier of policies and programs to support both institutions and students.

This reality is reflected in the creation of PROUNI, which grants 50% partial and full scholarships to Brazilian students without a higher education degree in private institutions of higher education, and FIES, which finances tuition fees for students who are enrolled in private higher education institutions. Such public policies have been set up to meet the state's interests of expanding access to this level of education at low cost, as well as to address market interests and the guidelines emphasized in the International Bank for Reconstruction and Development documents.

It can be considered that, although partial scholarships are not the mode that prevails in relation to those offered, it is a type of scholarship in which the student pays part of the cost of the undergraduate course. The financing of the expansion via PROUNI is shared between the State, Fies, and the students³.

In the Nursing undergraduate course, until May 2014, they had completed 17,412 graduates with scholarships.¹³ The issue points to Nursing that obtained broad access to institutionalized capital through the flexible and diversified process of student financing, especially in the metropolitan region of the state of Rio de Janeiro, due to the transformations of the economic field influenced by neoliberalism. ⁷

It is also worth noting the REUNI, which listed as main goals: reducing the average completion rate of undergraduate courses to ninety percent; the ratio of undergraduate students per teacher to eighteen in five years, practically doubling the relation of students by professors in face-to-face undergraduate courses; and the minimum increase of twenty percent in undergraduate enrollment and the five-year term, starting in 2007, the year in which the program began to meet the goals.¹⁴

As part of the expansion project of REUNI, there was an expansion of Federal Institutions of Higher Education campuses, with the creation of new campuses in the interior of the State, favoring the internalization of higher education and allowing access to the university with people living in the interior and who are unable to move to large urban centers. ¹⁵

It is explicit that the policy for higher education was reconfigured amid between the guarantee of the right to education and the pressures for commodification, directing public resources to the private initiative, especially through PROUNI and REUNI. In this educational scenario, Lula government sought to produce a new discursive matrix to re-signify the expansion of access and expansion of higher education through the thematization of democratization of access and social justice.¹⁶

The profound change in the higher education system of Nursing Fluminense, unplanned, portrays the organizational policy associated to the factor of the diversification of academic organization, which corresponds to the expansion of Nursing Graduation Courses. This social transformation indicates the spraying and concentration of Higher Education Institutions regulated by private sector companies. This unequal social process expresses the (re) organization of the private higher education system in the state of Rio de Janeiro, which for the public sector has maintained the opposite tendency, retracting the resources and the teaching staff. However, they expanded their practice mainly in post-graduation strictu sensu.^3-17

Regarding the political-pedagogical characteristics, the study highlighted the minimum workload and the time of completion of courses that are based on Resolution CNE/CES nº 4/2009.¹⁸ In this line of thought, it is enlightening to recall the implementation of the new order in the field of education Nursing, Resolution CNE/CES Nº 3/2001¹⁹, which establishes the National Curricular Guidelines, being the legal definition derived from the LDB, which guide the formative processes of the baccalaureate in Nursing.

From these legal provisions, higher education institutions had the prerogative of flexibilization of undergraduate curricula, breaking with the rigidity of minimum curricula, and could incorporate complementary activities, interdisciplinarity, predominance over information, articulation of theory and practice, and inseparability between teaching, research, and extension. From this perspective, the reformist contexts resulting from public policies for the educational micro spaces influenced changes in the higher education system in Nursing, redefinitions of institutional purposes and pedagogical goals.³

Reflection on the Curriculum instituted in the Nursing Graduation Courses with a 4000 hour workload with five years or ten academic periods, because the institutional curricular conception needs to have proposals for the exercise of autonomy, creativity, social responsibility and commitment in relation to the methods to be chosen and applied in the process of teaching-learning. The choice of the curricular proposal is not merely a technical option but consists of an ethical and political decision by all the social actors of the institution.

In the universe of the evaluation policy of Nursing courses, this process is done through institutional evaluation, course evaluation and the National Student Performance Examination (ENADE). The institutional evaluation involves two stages: self-assessment coordinated by the Self Evaluation Committee (CPA) and external evaluation carried out by committees designated by Inep/MEC. This process has the function of regulation through administrative acts for accreditation/re-accreditation, course authorization, recognition of course/renewal, accreditation, deactivation of the course. The procedure involving this process is carried out through pedagogical evaluation and physical facilities with emphasis on infrastructure, such as library and laboratories.

However, the intensification of the process of expansion in a disorderly way, in response to the pressures of the demand for higher education and groups interested in acquiring or accumulating cultural capitals, as well as penetration in the private education field show a strong regional imbalance in the state of Rio de Janeiro.

Also, it should be noted that the growth of the courses and the number of students and faculty members was not accompanied by rigorous mechanisms for the management and evaluation of this expansion, nor was it a policy to foster academic improvement in terms of articulation of the teaching/research/extension triad.

CONCLUSION

The logic of the expansionist policy in the state of Rio de Janeiro, based on a policy of flexibilization, diversification and institutional differentiation for nursing undergraduate courses, allowed the increase of enrollments and the expansion of vacancies. This process, consequently, resulted in the consolidation of the hegemony of the private sector, which expanded the scope of its action in the higher education system, starting to delineate the process of formation of the baccalaureate in Nursing by the system of non-university education.

This identified in the offer of graduates is a disproportion of the number of professionals per inhabitant in the state of Rio de Janeiro. This fact brings us a fundamental question for the formation of the baccalaureate in Nursing because it is allied to the proliferation of undergraduate courses primarily private, both face-to-face and in the distance modality, aggravating the massification of the training process combined with a vertiginous drop in the quality of teaching.

The configuration of higher education in Nursing in the state of Rio de Janeiro was naturalized from hybrid educational micro spaces, which provided the (re) configuration of the Nursing educational field, with new academic standards based on the productivist logic, which contributed to the (re) pedagogical practices, causing distance from the main objective of education. Thus, Nursing Higher Education - public and private - deserves that each social agent reflects on their role in the process of formation.

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