ORIGINAL RESEARCH

The nursing profession: its status – that is the question

Maria Lígia dos Reis Bellaguarda^I; Maria Itayra Padilha^II; Maria Angélica de Almeida Peres^III; Lygia Paim^IV

^INurse. PhD in Nursing. Professor at the Nursing Course, Estácio Santa Catarina. Brazil. Email: bellaguardaml@gmail.com
^II Nurse. PhD in Nursing. Professor, Department of Nursing, Federal University of Santa Catarina. Brazil. Email: itayra.padilha@ufsc.br
^III Nurse. PhD in Nursing. Professor of the Anna Nery School, Federal University of Rio de Janeiro. Brazil. Email: angelica.ufrj@uol.com.br
^IVNurse. PhD in Nursing. Anna Nery School of Nursing, Federal University of Rio de Janeiro, Brazil. Email: lypaim@matrix.com.br

DOI: http://dx.doi.org/10.12957/reuerj.2016.8591

ABSTRACT

Objective: to examine the accreditation of the Federal Nursing Council and its influence on the professional status of nursing on the State Santa Catarina. Method: this socio-historical study based on the theoretical arguments of the sociological ideas of Eliot Freidson for the professions. Data were organized based on thematic oral history and document research. The participants were eight nurses involved in establishing and developing the Santa Catarina Regional Nursing Council from 1975 to 1986. Results: the analysis revealed two categories: Professional Council and credentials that give legitimacy to a profession; and the status of the nursing profession in Santa Catarina. The main focus was the political and historical dimension of nursing, its relations with State and society, and the profession's social reconfiguration through its legal representation by the Council. Conclusion: the Nursing Profession Council has furthered the development and legitimation of nursing in Santa Catarina, and strengthened its status.

Keywords: Nursing; history; sociology; professional review organizations.

INTRODUCTION

The transformation or evolution of the character of activity for the development of professions establishes in itself a relative status for a given professional position. This feature refers to the condition of technical and legal authority of the occupation. Professional status is defined as social prestige derived from the "belief that society has that the occupation has such attributes and the belief in its dignity and importance of its work"^1:211.

The status of a profession is directly linked to the commitment, values ​​and control of the actions of its members, within an esoteric skill and standardizations that guarantee to society goods and services that translate into safety and well-being. Professionals are trained in specific skills for the job, which are exercised through political power organized in society and the importance they gain from the laity. They are, thus, holders of formal and official positions^2,3.

Thus, this paper aims to examine the accreditation of the Federal Nursing Council (COFEn) and its influence on the professional status of nursing in Santa Catarina, from a sociological perspective advocated by Eliot Freidson, with regard to professions.

THEORETICAL FRAMEWORK

From the thought - we are all social beings -, the sociological perspective brings forward the relevance of the nursing profession. Nursing serves society in its weaknesses and potential health and disease, in education/research, in the care and in the management of health services ^4,5.

The sociology of professions specifically described by Eliot Freidson remains considering nursing as a sociologically recognized profession ⁶. In these terms, it is a health care profession based on scientific knowledge, self-regulation and autonomy of its actions through care practices, education and cooperatives management of personnel in interdependence with its peers and other health professionals⁷.

This text focuses on accreditation defined by Freidson as encompassing knowledge, self-regulation in legislation and professional offices, which give the profession a certain autonomy. Here, accreditation is described as a set of formal rules and regulations embodied in laws or regulations and resolutions related to political institutions, professional associations and educational organizations. "It determines the political and legal and inter-professional structures that establish the general limits within which the professional may exercise activity"^1:102.

With this concept in mind, the legitimacy of the nursing profession is in the organization and development of the Federal Nursing Council (COFEn) and in this study, of the Regional Nursing Council of Santa Catarina (COREn/SC).

Nursing began to be organized and expanded with the Brazilian Nursing Association (ABEn), with the initiative of creating a Professional Council of Nursing. In Santa Catarina, the number of nursing professionals was small between the 1960s and 1970s, and credentials for qualification of a profession were decisive for the status of such occupation as care profession.

METHODOLOGY

Qualitative and socio-historical study of the time frame from 1975 to 1986, when the creation of the COFEn/COREn System took place, followed by the regulations of Law nº 7498 of 1986 on Professional Practice. It is based on the new history and precepts of sociology of professions held by Eliot Freidson. Study with eight nurses, a man and seven women, identified by the initial names with proper authorization: Rosita Alves da Silva Morgado (RM), Ingrid Elsen (IE), Lúcia Herta Rockenbach (LR), Nelcy Terezinha Coutinho Mendes (NM), Lydia Ignes Rossi Bub (LB), Solange Wink (SW), Eloita Pereira Neves (EN) and Edison José Miranda (EM).

Inclusion criteria were observed, which refer to nursing professionals, who have integrated the organizational and administrative structure of COREn/SC in the moment of its creation and development.

This study was approved by the Ethics Committee on Human Research of the Federal University of Santa Catarina (CEPSH / UFSC), under Opinion nº 2329 FR 474 453 of November 28, 2011, concerning Resolution nº 466/2012. The organization of data followed the oral history and documentary research between December 2011 and March 2013. Semi-structured interviews were carried out, recorded in digital device, transcribed, presented and validated by the collaborators. Primary documentary sources were laws, ordinances, resolutions, decisions, reports, meetings and public deeds minutes, biographies and personal photos.

Content analysis conducted the examination of the information and documentary data, through analysis of enunciation. This technique relies on communication as a process, in the qualification of speeches, the convergence of theoretical and methodological influences through the discourse coherence⁸. Exhaustive reading of documents was made and interviews were transcribed. Tables that composed complete testimony of each research subject and units that meant each rhetoric were organized. Two categories were revealed: Professional Council and the credentials of profession legitimacy, the status of the nursing profession in Santa Catarina.

RESULTS AND DISCUSSION

Professional Council and the credentials of profession legitimacy

In the process of development of COREn/SC, accreditation was inherent in the path taken by the precursor of the profession in the state, since the credentials of qualifications of the profession intensified the prospect of making nursing to emerge in own identity aspects. And this is how the professional identity is reconfigured through consciousness of its members, sometimes agents, sometimes applicants of the benefits granted by the status of the profession, coming largely from its credentialism ^9,10.

The nursing work in Santa Catarina was very incipient. Prospects of educational qualification in the area would come from the organized practice in health institutions. The precursors of the ABEn-SC were also pioneers in the organized development of nursing within health institutions.

We had the support of the hospital management [...] So I say this with pride. And this took the credibility into the University [...] because it was a school that started within the university reform. (EN)

We would assume the commitment with the group, which had to grow, develop, motivate people to take the course, bring more people here. (NM)

In the 1970s and 1980s, new nursing schools arise from government incentives, creating new undergraduate courses in the Brazilian setting along with postgraduate courses, promoting research and scientific production.

In Santa Catarina State, ABEn-SC focused efforts in education/training and organization of nursing, emphasizing its mobilization for creation of the COREn/SC. In this context, the Nursing Undergraduate Program of the UFSC was created in 1969. This meant a milestone for the development of the profession in the State^11,12.

The struggle of this group was intensive, given the endeavor to organize the profession in areas that would expand its visibility and recognition. The Undergraduate Nursing Course remitted formalized institutional attributes that, while externalized from the dialogue between the occupation and the society, would set the status of the profession in society and the division of labor¹. Political, legal and training aspects bring out the professional credentials to be potentiated in Santa Catarina State.

We got into everything. The Council was needed, I thought it was for the nursing care to be like we had learned (IE).

Labor relations circulating in related areas, such as in education, in hospitals and in the management of health services at the time, would be understood as a divided and fragmented structure, in the sense of "a profession as a whole"^1:223.

The legitimacy of nursing evolved through the effort in health institutions, which were also builded in the state. The Nightingale Model of training was strong leading to the thinking of giving priority to assistance nursing where the credit to the council was in the management of care of professional dedication. And in a way, the nursing at the time followed the precepts of self-sacrifice and dedication shown by Florence.

This model cannot be overlooked when thinking about the identity of nursing professionals, since was ground at that time in the social and political mobilization for the occupation¹³. And today, it continues to figure the technical skill of nursing as a simple task, as the practical knowledge was not knowledge, that all the acumen and skill in caring did not include critical and decisive reasoning.

For the aspects of legitimacy, and for protecting the profession from certain weaknesses, specific training in the area and legal guarantees of the practice of the nursing profession were essential. Amid the dynamism to expand the profession in the State, the movement of creation and development of the COREn/SC appeared. The official organization of the profession founded in ethics plays an important role in persuading the State and the public opinion. This organization makes up the stable professional and legal relationships, standardized among peers, and define the division of labor within the profession¹.

What is the meaning of the Associations and Councils, really, to develop the profession and most importantly, to improve the quality of the service provided to the public? (RM)

It was difficult, no doubt, but there was a dialogue needed in the direction of establishing the profession. (SW)

The surprising thing is that the fear of the ownership and value of the COREn/SC and its legitimacy to confirm its function had its origin within the nursing, through the constituent members of the profession and of the leadership. Here appears the need for persuasion, to convince society of the legitimacy that the council gives to the profession¹. This must be defended by the professional group, through professionalism and self-regulation.

For this, professionals need through the whole category act within ethical standards in labor relations and under regulations of activities, for the standardization of professional conduct. The nursing accreditation was punctuated by the professionalism of its members and the profession certification as a result of response to social demand, through the qualification of a professional service¹³. This was something conquered by the nurses with their nursing teams, as the need to consolidate the profession, to make it known and recognized as a profession of care by society under support of the State.

The status of the nursing profession in Santa Catarina

The way professionals behave and govern the work, with a view to the collective interest, determines the ethical effectiveness, the professional status ¹. Thus, status in this study is understood as the condition of relevance and empowerment of the action of a specific profession, certified by law and ethics and accepted by society as something of indispensable utility for its well-being.

According to the oral sources, the institutionalization of nursing in the State, into Professional Council, has legitimacy in accreditation in organizing the profession, but some reported specificities bring to light an object to reflection.

[...] the current movement be a movement of academicism, what I want in the record, that academically we have advanced a lot. And the point of view of contact with the community, we lost a lot [...] this makes me a little sad (EN).

The discipline to be guaranteed by the regulatory board was below expectations for changes in health-care practices, where the professionalism of its members brings to the health context a nursing that is timid in identity. This may be due to weakness in the process of insertion of actions that affirm the safe professional practice in the context of society. Or still, due to the limited adherence of professionals to the universe of the Council, what is proper and empowerment resource of the professional collective.

In this perspective, the organization of professional action presents a permissive regulation on work performance, and shows to be less relevant in comparison to professional experience, which privileges and assigns responsibility as a personal act¹.

Regarding the sociology of professions, the law and the purposes assigned to the Council legitimate this as professional representation. The profession was not instituted by the Council, neither its autonomy; its status depends on the professional members respect the limits of the ethical of practical experience and regulatory of the profession ¹.

As for know-how in healthcare practices, the link of nursing to other health professions is shown as limiting in the process of own autonomous identity, as well as expresses the difficulty in forming a group united for professional causes.

We have a profession that is still linked to other health professions [...] Today, we develop about 90% of the activities in health. [...] you have to be every day proving that your profession is important [...]. (EM).

See that the professional group of nursing is the majority in the development of health actions is already a good reason to break the reductionism related to professional identity^14,15. Notably, the value of the nursing profession, its responsibility, importance and credibility flow from the core of the profession, from the attributes of professional and peer members.

It is considered that the COREn/SC accredits nursing as a profession in the health field, within specific normalization and guarantees of autonomy in the scope of its responsibilities, fosters sharing and cooperation at work and in a diversity of services. However, if the professional set sees a gap in the regulatory body in socializing the profession as occupation with expertise, accreditationand autonomy that weakens the recognition by society of the importance of nursing. This compromises its professional status and also the value of professionalism of its members.

The nursing professional enjoys an identity that puts him in a complex process of negotiation^1,8. This reflects, therefore, the position in the relationship that is established between other health professionals and users of the service. When considering that nursing consists of paraprofessionals, the philosophy of professional care of nursing and the power and autonomy of the profession would be denied in negotiation with society.

Nursing is a profession of intervention and institutionally organized ^16,17. The mobilization of resources, assistance and of rescue of the health system depend on the professional group of nursing and its capacity for social mobilization to professional recognition.

From a sociological point of view about the professions, the status is considered a position of importance of the profession recognized by society, based on its technical and legal authority exercised in the division of labor¹.

The challenges in the consolidation of autonomy and of the status earned depend on the commitment to ensure and expand the training of quality, working conditions and employability. Given this, the profession is committed to the capacity/power of solving needs in the health-disease process, in the management and training in nursing as a profession in the health field.

The weakness in the recognition of status is in the very understanding that professionals stand out in the profession, considering that its members are the body, the life of the occupation and thus, the professionalism characterizes the power and guarantees the social recognition. Thus, to reveal and to value the historical trajectory of the profession in the context of skill, knowledge and health care to people, involves the empowerment of the profession¹⁵.

The historical arguments of nursing, internally to the profession, from the recognition of its professional members, are shown as arguments to compose the status of nursing. The COREn/SC is committed to accredit professionals as legitimated and qualified to practice the profession and has a duty to ensure the quality and effectiveness of services. It is observed that the expectations of the deponents are divergent when it comes to the Council in the State.

Would characterize the COREn/SC as increasing [...] a gradual growth. (LB)

The Coren is critical over the status of the profession [...]. (RM)

Today I contribute with my annuity because I want to belong to this group of COREn/SC [...]. (LR)

The relevance of the council, directly linked to labor functions and valuation and assurance of qualification of nursing care, gave status to the profession. There is a persistent, noticeable relationship in the speech of oral sources in the sense that the Council accredited quality to the work of the professional. It is important to clarify that accreditation has the role of preserving the monopoly of the service, the specific work, with a view to qualifying the income of professional members⁸.

It is understood, in that sense, that the view that the profession has of itself values ​​the specificity of doing and recognizes the diversity of the environment that integrates, searches expertise and finds support in self-regulation. This is how it will influence the social structure and will reaffirm the professional status. Strategies of enhancement of nursing and of its professionals are declared as necessary in many instances, national and international^16,18. Authors refer to the inability of the profession, both through its representations and through its members, to defend its relevance. This threatens the profession's visibility and hence its status. Moreover, there is a lack of interest of nursing professionals to step into the political arena and assume greater responsibilities in relation to the struggles of the category^19,20.

The political and economic influence of a segment of society that seems to be convinced of the value profession is, probably, linked to this whole process. What further weakens the merits of nursing for most of its professional members is related to the working conditions and the capital value of this work.

CONCLUSION

The status is the importance and recognition of the value that nursing has while acting in health. It comes from acting in a competent manner and from professional attitudes committed to the success. This fact relates to the respect to health care and to the social commitment with the effectiveness of health practices, since its origin.

It is observed that the documents examined at the regional level contributed to the cross analysis of information along with the oral sources. However, a limitation of the study was the unavailability of documentation for the period researched at the level of the Federal Council.

The relevant accreditation of COREn/SC confers the status of profession that nursing needs for social endorsement. Nursing needs to potentiate the status among society and thus ensure the broad and real recognition of the profession. It is considered that the COREn/SC, since its creation and in the course of its development, retains the status focused on professional legality in municipal responsibilities on the nursing functionality.

It seems that the COREn/SC failed to make the nursing professionals feel empowered to make this work which is specific and essential to human life. Even the deponents showed understandings that were dissonant between each other, but that came together to bring out the weaknesses of action and inclusion of the Council in the practice of the profession.

The status that nursing in Santa Catarina nursing needs, from the perspective of the subjects of this study, is of appreciation of their doing amid rules that may establish sustainable priorities of practices in direct action of care to humans.

The COREn/SC has, in its history, a weakness when it comes to convince its members of the uniqueness that strengthens the profession. It is necessary to review the involvement of the professional group on the causes of nursing and on the effectiveness of the council in operationalizing its discipline.

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