RESEARCH ARTICLES

Military nurses: roles from 1980 to 1997

Camilla Telemberg Sell^I ; Maria Itayra Padilha^II ; Maria Angélica de Almeida Peres^III

^I Nurse. Master from the Postgraduate Nursing Program of the Federal University of Santa Catarina. Nurse of the Health Secretariat of Santa Catarina. Brazil. E-mail: camillasell@hotmail.com
^II Nurse. Post-Doctorate in Nursing from the University of Toronto. Associate Professor, Department of Nursing and the Postgraduate Nursing Program of the Federal University of Santa Catarina. Brazil. E-mail: padilha@nfr.ufsc.br
^III Nurse. PhD in Nursing. Associate Professor, School of Nursing Anna Nery of the Federal University of Rio de Janeiro. Brazil. E-mail: aguaonda@uol.com.br

DOI: http://dx.doi.org/10.12957/reuerj.2015.9686

ABSTRACT

This socio-historical, qualitative study aimed to identify the roles played by nurses in Brazil's Women's Auxiliary Navy Reserve Corps (CAFRM) from 1980 to 1997. The conceptual framework of this study is guided by the ideas of feminists including Simone de Beauvoir and Joan Scott as regards the concepts of gender, equality, hierarchy and power relations. Data were collected in February 2012 in Rio de Janeiro using the thematic oral history technique through semi-structured interviews of eight nurses who belonged to the CAFRM during the study period. The results showed that the Brazilian Navy provided the nurses with knowledge and professional developement, which were imparted at various different locations, in addition to a military identity built up over their career.

Keywords: Nursing; nursing care; women; military nursing.

INTRODUCTION

In Brazil, the first among the Armed Forces (AF) to admit the entry of women in the military carrer was the Brazilian Navy (BN). In 1980, the Minister of the Navy, Squadron Admiral Maximiano Eduardo da Silva Fonseca, approved Law No. 6807 of July 7, 1980, which created the Women's Auxiliary Board of the Navy Reserve (CAFRM in Portuguse)^1,2. The creation of this Board aimed to enter these women in the BN to act in the areas: technical, administrative, health and others ³, as well as to meet, with skilled labour, the health staff in the newly opened Marcilio Dias Navy Hospital (HNMD in Portuguese), in Rio de Janeiro ^4,5. At the same historical period of creation of CAFRM, a movement of nursing professionals emerged in Brazil to validate their work process, an effort that resulted in the approval of Law 7498 of June 25, 1986⁶. This law regulated some private actions of the nurse, such as planning, organization, coordination, implementation and evaluation of nursing care services ⁷. Thus, with the conquest of space in military sphere and with the consolidation of the nursing work process, the nurses had a chance to develop, over the years, a remarkable and active historical background in nursing areas such as care, management and teaching.

This research aims to identify the roles performed by CAFRM nurses, from 1980 to 1997. The choice of the initial historical period of the study - 1980 - was due to the creation of CAFRM; the final delimitation of the research - 1997 - coincides with the extinction of that Board and the integration of women to the Bodies and Boards, with the beginning of new achievements of rights, equivalent to those of military men.

THEORETICAL FRAMEWORK

To support reflection and understanding of how occurred the integration of military female nurses in BN and which activities they performed, a conceptual framework was necessary, as a foundation. For this reason, the search for a conceptual framework with feminist assumptions was carried out^8-13, using the ideas of Simone de Beauvoir^11,13 and Joan Scott^8,10 about gender concepts and their relationships, gender equality, hierarchy and power relations.

Historical knowledge acquired over the years is not only the simple record of the changes in social organizations of men and women, but, above all, an instrument that participates in the production of knowledge about sexual difference. Historians have sought to understand how this area of knowledge requires attention to the assumptions, practices and rhetoric of discipline, and especially to the practices developed usually and daily, which often escape the historian's view. This field of knowledge has contributed to the construction about sexual difference. For Scott, the history is considered as both a focus of analytical attention as a method of analysis. The combination of these two aspects provides a way to understand and contribute for the process through which gender is produced⁸.

Given this perspective, it can be said that historical knowledge on military women of CAFRM is not a faithful document of lived reality, nor it is large enough to record the real and only condition experienced by nurses during the study period. This knowledge helps to understand the historical process through which gender is produced, and underlies the search for better ways to faithfully document the lived reality.

The 1980s gave rise to a new concept for women's historiography, which until recently was characterized by the absence of questions and controversies. The American historian Joan Scott began the discussion on the emergence of studies on women, which highlight academic legitimacy and uses the term gender as a category of analysis, becoming depoliticized and impartial^8,10. Some feminist authors believe that the basis for this concept of gender were grounded in the ideas of the feminist Simone de Beauvoir, with her phrase: one is not born, but rather becomes, a woman ^11,12. The impact of the book The Second Sex, urged women to fight for their rights and for improvement of living.

Translating these theoretical concepts to the object of this research study, this choice helped to understand the roles played by CAFRM nurses. In this sense, it is appropriate to emphasize that these feminist concepts will support the development of this study, through further discussion of the results obtained.

METHODOLOGY

It is a qualitative study of socio-historical approach. Oral history was used as one of the research sources, given that there are few written documents that tell the history of female nurses in BN.

The context of the study was the First Naval District (ND), located in the city of Rio de Janeiro, since it concentrated the majority of Military Organizations (MO) in health, with higher concentrations of nurses.

The study subjects were eight nurses, who worked at CAFRM, from 1980 to 1997. The oral sources were obtained through semi-structured interviews, in February 2012. To ensure anonymity, nurses were identified with the letter N, followed by year of entry in BN.

The discourse was interpreted as the analysis of thematic data ¹⁴, which was based in historical studies of the AF and also in the gender frame of Simone de Beauvoir and Joan Scott ^11,13. After transcription and exhaustive reading of the material collected, the raw data were interpreted and transformed into the following main categories: Nursing care in the Brazilian Navy; Nursing management in the military context; and Being a military nurse. The project was approved by the Ethics Committee in Research with Human Beings (CEPSH) of the Federal University of Santa Catarina (UFSC) under Protocol 2406/2011.

RESULTS AND DISCUSSION

Nursing care in the Brazilian Navy

The nursing care provided in military environment follows the same ethical and legal principles of the profession: anywhere they work, nurses try to take a critical and scientific look, seeking a special care to militar officers, in war or peacetime¹⁵. The HNMD was the first workplace to most nurses belonging to CAFRM. Upon completion of the training course, on August 14, 1981, lasting four months, they were assigned to the various hospital departments. Here are testimonials:

The first and only Military Organization which I served was the Marcilio Dias Hospital. When the course was over, the distribution was made: I was placed as supervisor of outpatient units. (N1, 1981)

The first place I served was the Naval Hospital Marcilio Dias. I worked with pregnant and postpartum area. (N2, 1993)

The entry of the first officials in the HNMD corresponds to the motivation of creating the CAFRM to meet the need for health personnel in the new hospital. However, this hospital complex, that excels in quality of care, was experiencing at the time an evasion of their health professionals, due to unfavorable situations, such as the absence of career plan, and career progression would be granted only after a period of 9 years. These women, with strong personalities and ambitious for knowledge, could not undergo a stagnation that could lead them to a mediocre situation ³.

Despite being called mediocre and at the risk of being disconnected from the corporation until their stability, the interviewees did not report at any time such demotivating factors: on the contrary, they praised the institution, especially the HNMD.

As this interviews extract shows, the personnel was distributed the different sectors of HNMD. The newly formed military female officers, mostly young and inexperienced, took supervisory positions as leader nurse and sector superior. Such functions demanded from women, in short time, knowledge, leadership and decision-making, activities that gave positions of power to the fledgling military officers. Here are reports:

After the training course I was assigned to the Marcilio Dias Hospital, where I stayed for six years; I was in charge of inpatient unit, which was surgical, oncology, hematology, neurosurgery [...] (N4, 1993)

The Marcilio Dias [Hospital] was my first workplace, I stayed five years as a leader nurse, then I went to pediatrics, as a nurse in charge of the sector. (N5, 1981)

The historical reasons for the creation of CAFRM were the driving element for the foundation of the HNMD. Because of its magnitude, it lacked human resources for its activation ³. According to this rationale, the nurses were unanimous in reporting that the first MO they served was this hospital, in its various sectors, such as pediatrics, outpatient, surgical complex, obstetrics, emergency, chemotherapy and others, where they received the opportunity to perform nursing care to users of the Navy Health System (SSM).

Another important aspect mentioned in the reports was the contribution that CAFRM nurses brought to the health care of the military officers. Since their arrival, women took a stand that stood out in the military environment, through knowledge, innovation and multidisciplinary work. Despite the mostly male environment, this did not prevent nurses from occupying leadership in nursing. The speeches highlighted:

[...] I also worked as emergency supervisor, deployed the nursing consultation that did not exist at the time. (N1, 1981)

I set up a female ward in UISM [...] I worked a lot with the occupational therapist, I was the only nurse there, so I was in charge of all wards. (N3, 1981)

At Marcilio [Hospital] we had a lot of autonomy as nurses, there was a very good relationship with the team. We deployed self-help groups together with the social service, with the chaplain, with nursing, so it was a nice environment to work. (N4, 1993)

By performing the activities described above, the nurses entered a predominantly male military environment, with great determination and esprit de corps. This teamwork can be seen as a movement of struggle of women working at CAFRM, where a woman is anchored in the other to provide support and solidarity, still driven by a positive and effective leadership in a continuous and dynamic process during career¹⁰.

In this context, nurses report that despite their insertion in the military environment is recent, they have already entered the BN with a distinct look, highlighting the importance of teamwork and overcoming obstacles to implement newly reformulated care activities, such as the nursing consultation, which entered the Brazilian legal system of the nursing profession in 1986, through Law No. 7498/86.

Nursing management in the military context

The study highlighted the active participation of military female officers in the managerial nursing process as well as their satisfaction in developing bureaucratic functions. This reality appears when they describe the fulfillment of various administrative activities during their military career. Here is a testimonial:

The great opportunity that the Navy gave me was meeting health management and planning. But it is this notion of management that perhaps I would not have in the civil environment, maybe I would end up retiring as a common, clinical nurse. [...] Plan and provide care was the biggest gain I had. (N6, 1988)

As shown, the interviewee makes clear her gratitude to the institution for having given her the opportunity to manage. Not without reason, she compares her military career with the civil environment and concludes that certainly she would not have had the same opportunity to plan and manage care as held in BN. The speech in question also shows love for the military corporation of which she is part, since she calls the civil nurse as common. This reveals a feeling that a military nurse is unusual, different. This feeling is usually manifested by those who acquired a military identity.

Also, over the years and the rise of hierarchical level, authority and responsibility grow, as well as demands directed to the administrative sector. Another respondent reiterates that the management functions are seen as privileges, that not all military officers have the opportunity to share during career.

[...] regardless of your profession, there is a certain level that, due to the position you occupy, the Navy and your position require you to act administratively. I had opportunity to manage, which some colleagues did not have, they experience health and care all day long; I do not, I experience the role. So they have difficulty to do, to command, hierarchy issues, that I do not have. I am privileged because I experienced things they did not experience . (N2, 1993)

The nurse relates with pride the opportunity given bt BN to deal with command and hierarchy, with subordinates, men or women. However, in the past, women were hierarchically subordinate to men, they were concerned to maintain the hierarchy between the genders, in which the submission was reason for pride; and the social hierarchy, with family organized by women before the society, expressed their standard of living and their financial achievements, being confined to their homes and unable to be inserted into the working world¹³.

However, nurses reported the difficulties they had to master the content present in the peculiar laws of BN, as well as to manage and formulate official documents, which are used as a means of communication between different MOs and the civil environment, as the following speeches show:

Entering to the Health Board of the Navy was despairing, because I was going to work with messages, I had never seen a message, and with other legislation that was not part of my daily life here in the hospital. I workes as head of the technical department in the HBN [...] I like the Navy, I think it is a good place to work, I am proud; but I'll tell you: I think I learned a lot more within the management than in care, I think the Navy has invested a lot in me administratively, I stayed for a long time in the management. (N7, 1981)

The work of management, command and leadership on men and women was not introjected in military women because gender is a social and historical construction based on perceived differences between the sexes⁸. Yet, in Brazilian society, the beginning of nurses' work has been characterized by a position of subordination, reflected in the history of nursing, distinct from the power between men and women, in which was attributed to men the management of services. So, despite being satisfied with the performance of management functions, some nurses faced difficulties in adapting to the bureaucracy of the BN. In accordance with these findings, a study on the social service in BN; these managerial actions that permeate the military field, together with the accumulation of side functions, condition and limit the realization of the work, distancing the military officers from their basic training¹.

Another important aspect concerns the management and direction positions occupied by nurses. In this study, important duties, such as manegement, occurred by the end of the career, when they already occupied the position of commanding officers, which requires responsibility, professional commitment and leadership from the nurse officers:

[...] I was doing well in the nursing leadership of Marcilio Dias, we have transformed the Section into a Nursing Division, and now it is a Department. Everything was with me, the Admiral gave such autonomy for the people. I finished my last period in the Navy as Director of the Health School. (N1, 1981)

[...] when I went to the Navy reserve, I was in Charge of the Health School. (N5, 1981)

As stated, the management positions give pride for military nurses. Despite the difficulties encountered since their arrival, suffering the hierarchical pressure arising from military men in the course of their career, in which they alone possessed the knowledge and power, the female officers described the advances achieved during the years of leadership, complemented that this was consolidated through the knowledge and confidence gained by the hierarchical superior.

The testimonies corroborate the study of women in BN between 1980-2008, when they say that those with higher hierarchical level exert more leadership positions than the latest officers. They also refer that the challenges of managing, found by the officers, are valid to acquire personal and professional knowledge, contributing to a new way of leading, more sensitive and with a more measured talking².

Being a military nurse

The mission of the BN consists of

Preparing and employing the Naval Power in order to contribute to the defense of the country. Being ready to act to guarantee the constitutional powers and, at the initiative of any of these, of law and order; acting in actions under the aegis of international organizations and in support to the foreign policy of the country; and meeting the subsidiary duties set forth by law, with emphasis on those related to the Marine Authority in order to contribute to the safeguarding of national interests^16:1.

So, the military activities that nurses perform demonstrate commitment to the BN, resulting in liability, exclusive dedication and often abdication of their primary academic training, as exemplified by the following statements:

[...] you enter as a nurse and also develop various activities because you are seen as military officer, you will not be seen only as a nurse. You reach seniority, and starts receiving responsibilities. (N7, 1981)

[...] we did the course for this, to meet the other tasks that the Navy requires, not only professional nursing but also other military situations that arise and we have to act: we are military officers, in addition to being nurses. (N5, 1981)

On the exclusive dedication, such a process is inherent to the military career and is introjected early from the officers training course. It is not without reason that nurses are dedicated and often give up on nursing, to go down a path full of exclusively military chores.

Historically, the search commanding positions by women is still low, and this situation is not different in the military institutions. However, with the inclusion of women in the AF, they begin to assume a leadership positions, as a result of their knowledge and hierarchical position sought throughout the career¹⁷.

The testimonies of the nurses evidence that they perform military duties or collateral assignments, as they are called in the military environment, which are run parallel to the position of their formation:

I finished my service time in the Navy as in charge of general services, it had nothing to do with nursing. (N3, 1981)

[...] I went back to Marcilio Hospital in another role, as an assistant, working in the office, I was public relations, controlling everything! (N2, 1993)

There are some activities that impair us a little bit from the nursing work, because we have to confer: the safe, the storehouse, the gender, the material, everything that is paid and bought in the Navy [...] often we get removed from our function and end up doing these parallel activities. (N5, 1981)

The dedication of the nurses in the various sectors of the BN is significant. They assume functions for which they were not prepared at graduation, such as being in charge of general services, for various reasons, such as: lack of staff and expertise to take over that position. And these activities, governed by a rigid regulation, caused hindrance and disrupted the daily lives of these officers, who stopped what they were doing to run side chores.

The military officers recognize their importance and commitment to the country. They often give up from interacting in their homes and with their families, to devote themselves exclusively to their work in the naval force.

By joining the BN, military nurses are unaware that they will often have to run military activities parallel to those activities from the training they received in graduation. It was possible to identify they are satisfied with their career and that they have overcame any revolt or stress because, above all, they are military officers! Supporting this idea, a study on the formation of identity in military environment evidenced that military training has as one of its goals to destroy the civil identity and develop military identity, and that this identity should prevail over the identity of healthcare professional arising from the civil environment¹⁸.

CONCLUSION

In this research it was possible to identify the roles played by nurses working at CAFRM during its 17 years of existence, revealing the functions performed in the health MOs and emphasizing nursing care and management as strengths of their activity.

Another aspect mentioned concerns the HNMD, which was the nurses' learning cot and today is a reference hospital of the Armed Forces due to its human resources, technology and the excellence of the service provided to users of the SSM.

Besides enabling learning more about the career of nurses in the military context, the discourses of the nurses gave us access to this typically male and rigid universe, in which parallel to nursing numerous unique activities private of the Armed Forces are carried out. In this area, a successful career requires esprit de corps, leadership, respect for hierarchy and discipline.

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