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RESEARCH ARTICLES

 


 

Neoliberal model and its implications for the health of nursing workers

 

Francisco Gleidson de Azevedo GonçalvesI; Norma Valéria Dantas de Oliveira SouzaII; Ariane da Silva PiresIII; Déborah Machado dos SantosIV; Camila Arantes Ferreira Brecht D'OliveiraV; Liana Viana RibeiroVI

INurse. Master in Nursing by the Graduate Program of Nursing School. University of Rio de Janeiro State. Specialist in Occupational Health Nursing by Anna Nery School of Nursing, Federal University of Rio de Janeiro. Substitute Professor at Medical-Surgical Nursing Department of Nursing College, University of Rio de Janeiro State. Brazil.E-mail: gleydy_fran@hotmail.com
IINurse. PhD in Nursing. Deputy Director of Nursing School at the University of Rio de Janeiro State. Associate Professor of Medical-Surgical Nursing Department and Permanent Professor of the Post-graduate Studies Program at the Nursing College at University of Rio de Janeiro State. Brazil. E-mail: norval_souza@yahoo.com.br
IIINurse. Masters in Nursing Student by the Graduate Program of Nursing School, at the University of Rio de Janeiro. Substitute Professor at Medical-Surgical Nursing Department, University of Rio de Janeiro. Brazil. Specialist in Occupational Health Nursing by the University of Rio de Janeiro. Scholar of the Research Foundation of the State of Rio de Janeiro. Brazil. E-mail: arianepires@oi.com.br
IVNurse. Master in Nursing by the Graduate Nursing Program, of Nursing College at the University of Rio de Janeiro. Specialist in Occupational Health Nursing by Anna Nery School of Nursing, Federal University of Rio de Janeiro. Substitute Professor at Medical-Surgical Nursing Department of Nursing College of the University of Rio de Janeiro. Brazil.E-mail: debuerj@yahoo.com.br
VNursing College Student of University of Rio de Janeiro. Former Scholar of Scientific Initiation PIBIC / CNPq. Brazil. E-mail: camilabrechuerj@gmail.com
VINurse. Masters in Nursing Student by the Graduate Program of Nursing School at the University of Rio de Janeiro. Scholar of the Coordination of Improvement of Higher Education Personnel. Brazil. E-mail: liana_vian@hotmail.com


ABSTRACT: The present study aimed to identify the effects of neoliberal model on the health of nursing workers and analyze its influence on the health-disease process of these professionals. Qualitative, descriptive research, developed in a university hospital in the city of Rio de Janeiro. The subjects were 34 nurses. The collection was done from March to July 2013, through semi-structured interviews. The technique used was thematic content analysis. There were negative effects on the health of nursing workers as stress, tachycardia, hypertension, drowsiness, sweating, physical and mental exhaustion, depression, physical fatigue. It was concluded that such manifestations are due to the precariousness of working conditions, characteristics of an irrational and strongly ruled in neoliberal precepts organization of work.

Keywords: Working conditions; occupational health; nursing work; neoliberalism.


 

INTRODUCTION

This study relates the implications of the neoliberal model for the health-disease process of nursing workers. It is a clipping from dissertation defended at the University of the State of Rio de Janeiro1.

Issues of occupational health are also permeated by a macrostructural context, citing, for example, the phenomenon of globalization and neoliberalism. These phenomena have arisen on the world scene, and are strongly related to the pressure to expand the free market, with increasing deregulation, decentralization and privatization. In this context, there was an effort by the developed countries and the International Monetary Fund, jointly with the World Bank, to prevent the collapse of the capitalist system, establishing the foundations of neoliberalism2.

Globalization is understood as a process that goes beyond the economic sphere, involving also social and cultural aspects. It has been presenting to the world, since the last three decades of the twentieth century, elements never seen before, such as the consolidation of a truly global market; the transnationalization of companies; the elimination of borders for the movement of capital; privatization of the economy and the minimal state; the fall of protectionist barriers in the market; ease of movement of people and goods between the countries; and the emergence of the information society, expanding the possibilities of communication, especially with the advent of the internet3. And neoliberalism - whose origin is in liberal thought - can be preliminarily defined as the economic policy of indiscriminate opening of the domestic to the international market. However, neoliberalism is not only an economic doctrine; it is primarily a social and moral values philosophy, which radically transformed life in society and the relations of work4.

Neoliberalism values ​​individualism over collectivism, defending the ideal that the individual must take responsibility for the social welfare and the state assumes the role of a minimal state, being greatly reduced its power to interfere in government policies; in this scenario, the health sector was greatly affected5.

Accordingly, among the consequences of neoliberal precepts in this sector is the lack of public service exams, justifying flexible hiring, multiple employment relationships (even for certified professionals, with the aim of supplementing the income) and inserting young professionals in a working world of wide deregulation of labor relations6.

The work of nursing has undergone great influence of neoliberal and globalized politics, in which the precarious conditions and labor relations are a major and damaging results for this scenario and for the quality of care, also negatively impacting the health of these professionals7.

In this perspective, the objectives of this research were defined: to identify the effects of the neoliberal model in the health of nursing workers and to analyze the influence of this model in the health-disease process of these professionals.

This study seeks to contribute to a greater understanding of neoliberalism and its impact on working conditions, helping to spark the interest of nursing workers on a work reality often perverse, that they are submitted and that impacts negatively on health. Therefore, with a deeper understanding, workers can expand their capacity to claim and fight for better working and health conditions, together with supervisors and team leaders, with the organization of work.

Moreover, this study can assist in the development, by the nursing staff, of a more critical and reflective view about the organization and the labor process in which they operate, extending the analytical capacity and enabling the understanding that the work of nursing is linked to a macroeconomic and political context which, in turn, relates to the dominant production model in the society. From this understanding, causal links will be indicated in relation to the labor process, labor organization and the health professional group.

LITERATURE REVIEW

The world of work is marked by changes like globalization, technological modernization and new management models; this whole situation implies changes in content, nature and meaning of work. Many processes and labor organizations are set up currently by excessive workload, intense pace of work, strict control of activities, time pressure and need for multivalent and multifunctional professionals. These characteristics are grounded in neoliberalism8.

Neoliberalism emerged after World War II, in North America and Europe, as a reaction against the State of Social Welfare, supported by social democracy. The neoliberal model in Brazil began at the end of Sarney administration, pervaded Collor and Itamar administrations, deepening and consolidating itself with President Fernando Henrique Cardoso4,9.

Programmatic foundations of neoliberalism focused on minimal state and maximum market, governed by the sovereignty of the market, which becomes minimum for workers and maximum for capital, as private interests outweigh the public interests4.

From this phenomenon, there has been the emergence of various forms of hiring workers, and increasing structural unemployment. It has been noticed cooperatives, outsourced, temporary workers, among other forms of hiring, which withdrawed from workers rights before granted, for example, paid holidays, illness aid, the 13th salary, leaving them abandoned in terms of worker social protection10.

[...] globalization and neoliberalism mark the life of each person and, for employees, in the form of personal dramas. There is a contemporary paradox that feeds these dramas: requirement of multivalent workers, educated, with initiative, but no margin to decide on the means and ends11:1006.

With all these changes in the world of work, the Brazilian state takes a more liberal feature with regard to deregulation of labor and welfare, and internalizes the process of precariousness in the labor relations in various sectors, among them, the health5.

The nursing sector is inserted in the healthcare work, characterized as collective, permeated by rules and routines, complex in its organization and in its work processes, which use bold technologies, sophisticated hospital inputs and exhibit hierarchical and power relations extremely demarcated12.

Nursing workers - who work in the hospital setting - are nurses, technicians and assistants, each of these components developing specific assignments. These workers are required both cognitive and physically because it is required from them, by the health institution, skills like flexibility, versatility and multifunctionality in order to account for the multitude of activities that are assigned to them, which are increasingly complex due to changes in technical scientific and social context12.

On the other hand, in that same work context, there is the expansion of the devaluation of work, rising unemployment, the intensification of precarious work and the adoption of nursing workers hired and/or outsourced. As a consequence, it is evident the reduction of wages, the cost of labor and labor charges13.

Low wages mark the work of nursing and cause psychophysical suffering among professionals due to poor remuneration for high responsibility. The decrease in wages induces nursing professionals to seek more than one job, causing them to stay most of the time of their lives in ocupcional environment. In this sense, there is greater psychophysical wear, incurring negatively on the health-disease process and resulting in poor quality of life13.

From the introduction of the neoliberal model in productivity, especially in the health sector, a framework of disrespect and devaluation of the health worker is established, affecting directly on their quality of life. Therefore, it is extremely necessary to find effective ways to solve this problem and thereby recover the respect, dignity and autonomy of the working class, leading to the promotion of health, prevention of injuries, to physical, mental and social integrity of the class working. It still needes to search for solutions that  meet the reality found in the healthcare environment, permeated by fear and insecurity, in addition to various risks inherent in this environment.

METHODOLOGY

This is a descriptive research, with qualitative approach, performed at a university hospital in the state of Rio de Janeiro. This institution is classified as a general large hospital, as it has 525 beds distributed in various medical, pediatric and surgical specialties, and closed units.

Study participants were 34 employees of the nursing staff: 14 nurses and 20 nursing technicians in the effective exercise of their activities, this means they were not on vacation or any kind of license. Inclusion criteria for participants were: professionals that necessarily have been developing their activities in the institution before or since the 1990s, a period marked by profound transformations in the world of work, characterized by changing the Taylorist/Fordist production model to neoliberal; requirement for nursing professionals that work in the form of statutory employment; and requirement for nursing professionals that have available time for study participation.

Data collection occurred between March and July 2013, during the morning, afternoon and night, through semi-structured interviews with four questions, which created opportunity for dialogue and, in turn, to better capture the object of study.

It is emphasized that this research followed ethical requirements for research involving humans. Thus, the project was approved by the ethics committee of the hospital with protocol under number 365.716/2013. It is worth mentioning that in order to preserve the anonymity of the subjects, we used the coding for each nursing worker who participated in the research, in order to prevent any kind of identification between the interviews and the participants in the descriptions of the results. Thus, when interviews were transcribed, they received codes in the order of transcription, represented by the letter R of respondent accompanied by a consecutive Arabic numeral. Thus, the excerpts from the interviews were flagged as R1, R2, R3, successively.

It was observed data saturation. The interviews were conducted until obtaining the original information, terminating the collection of data in the 34th participant.

Data analysis was done by analyzing content, technique that seeks to test hypotheses and/or questions and the discovery of what lies behind the manifest content, beyond the appearance of what is being communicated14.

After performing transcription, the interviews were subjected to content analysis14: careful reading of the material; decoding the text in several elements, which were classified into analog groupings; applying the criteria of representativeness, homogeneity, reclassification and aggregation of elements of the set, emerging the following category: the impacts of the neoliberal model in the health-disease process of workers and three subcategories.

RESULTS AND  DISCUSSION

The impacts of the neoliberal model in the health-disease process of workers

Through data analysis it is evident that, because of the way the organization of work is established, heavily influenced by the neoliberal model, there are many negative repercussions for the health-disease process of workers. Thus, manifestations such as stress, tachycardia, hypertension, drowsiness, sweating, physical and mental exhaustion, depression, fatigue, headache, epigastric pain, irritability were featured.

Such manifestations are due to the precariousness of working conditions, highlighting the scarcity of material, inadequate quantity of human resources, hiring of non officialized employees, increasing the pace of work and inadequate physical plant. These are characteristics of an organization of work that shows irrational and misguided, which seeks to reduce spending and increase productivity, but with reduced concern for the health of the worker. Three subcategories emerged from this category. They are discussed below.

Work overload

I think the workload increased, but the amount of employees remained the same or even, over the years, it is decreasing, so it is very hard to work, everybody is overloaded. (R9)

What bothers me is going up and down the stairs, to come here, trying to reach supervision, not to be heard and to be charged every day to work harder. So since the emotional frame to the disease frame, even joint disease and hypertension. (R28)

There are few people to work here, so we are overloaded. Standing 12 and a half hours is not easy, walking around in search of material, it gives us leg pain, headache, tachycardia, everything. And with few people to work, it is a lot of things to do. You have to do everything: go to pharmacy, to X-ray, it is too much. Therefore, our health is going away,I had many problems, my blood pressure went up, due to the stress of being unable to work. (R1)

It is evident that these negative manifestations in the body of the worker have nexus with the conditions under which the work develops. Therefore, in the current management models introduced in hospitals, it occurs prolonged and excessive working hours, day and night work shifts, limited number of professionals, psychological and emotional wear resulting from the performed tasks, direct contact with situations of high stress level. So it is a stressful environment both for the specifics of the work - for dealing with people at risk of death and psychophysical suffering - as, and particularly, for the determinants related to the organization of work, which further despoil the worker15.

Thus, it is also mentioned high staff turnover, high absenteeism, very heterogeneous work teams in their training, inconsistent continuing education, little professional culture of support, service and altruism, generating the need to reorientate health services16.

Occupational Stress

Deficits in human and material resources - associated with little compromised manegement, poorly trained professionals, excessive workload, unworthy salaries, characteristics of the nursing work process - lead to a conducive environment for stress in professional. Furthermore, the increased volume of tasks, due to inadequate staffing and material, prevents the realization of some activities, making it virtually impossible to conduct a quality work. These factors directly affect the production method, generating an inappropriate product, which translates into poor quality of care or less than the expectation of the worker. All these circumstances consequently generate feelings of insecurity and fear in relation to the quality of work done17. This issue also arose in participants' speech, highlighting the presence of psychophysical exhaustion and uncertainty regarding the quality of work.

So it is also mentally wearys, because you feel sad, when you see that people are not responding to treatment. And depending on the work, you get out exhausted by fatigue, for you to want to do better and see that it is difficult for lack of material, basic resources and, sometimes, for a few hassles. Then you come out mentally exhausted. (R11)

The analysis of this speech indicates that workers have an intense psychological distress resulting from precarious working conditions, causing physical and emotional exhaustion, translated by expressions such as: tiredness, frustration, depression, irritability, sadness, insecurity and fear. All these feelings and manifestations negatively affect the subjective dimension of workers, causing other impacts: absenteeism, presenteeism, overload, burnout, violence in workplace, suicide attempts, abandonment of the profession18. In other words, damaging repercussions for the employee, family and even their own labor organization.

Associated with this problem, it appears that the process of working in the hospital environment is too stressful because it involves dealing with pain, suffering, misery and death of patients, affecting workers psychically. However, when the work organization is guided on misguided principles, which aim to profit and productivity, without privileging subjectivity and workers' health, the quality of service suffers from adverse impacts, since the saying that the happy worker produces more and better is not in relief19,20.

Musculoskeletal changes

Another negative impact on health, which emerged from the interviews was represented by musculoskeletal changes in nursing staff. This issue was verified in interviews of 15 participants, who reported back pain, pain in the upper limbs and lower limbs, pain in the spine. In their reports, workers correlate the pain with excessive workload, with excess weight lifted during the workday, with inadequate postures during technical procedures, with high work rate and the use of little or nothing ergonomic furniture.

I will tell you the truth: due to the problem of loading weight, having materials and tools that do not facilitate working, I had back problems, and back pain was very strong, it made ​​my blood pressure rose up. (R7)

There was a period that I was in the unit that received critical and serious patients and the workload was too big. So when I arrived in the hospital, I used to feel a strong plucking in level of the spinal column and I started to have pain in the spine, I started to have pain in the back, legs, everything hurt. (R5)

Musculoskeletal disorders poses a serious public health problem, also characterized as one of the most serious diseases in the field of occupational health. The musculoskeletal disease affects workers worldwide and leads to different degrees of disability, which results in increased levels of absenteeism and temporary or permanent absences of workers, which, in turn, also generate significant costs for treatment and compensation21,22.

The current nursing occupational conditions are characterized by long working hours, overwork, frequent changes of services, night and day work shifts, high psychological burden for dealing with critical situations. This team is permanently exposed to biological, chemical and physical hazards that threaten the health.

Related to this work context, according to research presented at the Pan American Nursing Research Colloquia, the main health problems identified in the collective nursing are: musculoskeletal and joint diseases, followed by sharp injuries and disorders of the sleep pattern23.

It is noteworthy that the major risk factors at work for the development of musculoskeletal disorders are related: to the organization of work - increased working hours, excessive overtime, fast pace, shortage of workers; to environmental factors - inadequate furniture, insufficient lighting; and possible overloads of body segments in certain movements - excessive force to perform some tasks, repetitiveness and inadequate postures in the development of labor activities24-26. Many of these factors are linked to the neoliberal model that fosters capital and productivity over quality of life for workers27.

Diseases and demonstrations presented by participants show a causal link with the occupational context, in which the workers themselves perceive the factors that trigger changes in the health-disease process. In this sense, among the factors related to the configuration of work organization fleecing workers, the shortage of staff, the qualitative and quantitative shortages of material resources, lack of investment in hospital physical structure - which proves obsolete for process of nursing work - the fast pace of work and the increasing volume of work activities are mentioned.

In turn, these factors that trigger disease and negative manifestations in the body of workers are tied to management features, which are based on many neoliberal precepts, whose main goals are streamlining the public administration, reduction of staff costs and privatization of health to reduce state spending27.

As to the limitations of the study, it can be highlighted the nature of the qualitative approach, which is not intended to generalize findings, and the complexity of the subjectivity of the participants’ speeches.

CONCLUSION

The study identified the category - the impacts of the neoliberal model in the health-disease process of nursing workers - showing a complex situation in which there are severe changes to the process and to the organization of work, affecting negatively the health of these professionals. These effects also have an impact on social, cultural, economic and political aspects of the worker’s life. Subcategories were highlighted – work overload, occupational stress and musculoskeletal changes.

It was learned that workers had the following manifestations/diseases: tachycardia, mental hypertension, sweating, headache, dizziness, epigastric pain, pain in upper and lower limbs, back pain, irritability, sadness, stress, insomnia, physical and mental fatigue. As an extension of such events, it is verified also increased absenteeism, absence from work due to illness, functional retraining, early retirement.

With so many complex consequences for workers' health and  for the health and nursing care, it is considered that the influence and the application of neoliberal principles in the health sector does not show adequate. This sector distinguishes itself by dealing with human lives and the fact that its product demands high quality and is consumed in the same time it is produced, as distinguished from all other productive sectors. Such workers need to be in health conditions that ensure the safe health care delivery and without risk of iatrogenesis complications. Pathological processes that may lead to occupational error, to low concentration and attention, jeopardizing the safety and lives of clients assisted, and the professionals themselves, must be avoided.

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