The Work of Nurses in Primary Health Care: Crossings of the New Public Management
2. Materials and Methods
2.1. Study Design
2.2. Theoretical-Methodological Framework
2.3. Study Setting
2.5. Sampling, Sample Size and Non-Participation
2.6. Research Instruments, Collecting and Organizing Data
2.7. Data Analysis
2.8. Ethical Aspects
When these two units [UBS + ESF] were merged, we had 70 h of clinical doctors for 60,000 thousand inhabitants... it was a huge demand... Everything we tried to implement in previous years, the nurse’s reception was ruined because when you open the door in the morning and there are 50 people waiting and in your agenda there are 20 appointments available... either it is Sofia’s choice or the person who arrived at 4:30 in the morning, even if she is not the most important one in the queue, do you have the courage to say that she is not going to get what she wants? In the end, the reception ended and inevitably became a form because... (…), so all the work we tried to implement in the previous years, we had enough nurses, we had enough technicians, went down the drain... when in 2013... the unit came with 20, with three nursing technicians, even though they are all 40 h.... (…), so there was a fabulous scrapping over the years since I entered, it comes in a huge scrapping... so it was a kind of torturing thing, and with the “Health on the Hour”, the order was the (educational) groups should be done by nursing technicians and community agents, that is, it is taking away from the nurses all the work of prevention and health promotion and... the goal at that moment... what was important was this: even if they want to say no, they get angry, the management. I say, they get angry with this speech; in fact it is a big trick. We became an ER, we became an Emergency Room. The order is 75% of consultations are spontaneous demand; that is, you don’t have anything scheduled(N15-BRA Health Center).
And we also have... the CMP has... has been around since then, so I said since the 1970s, and at that time there was a certain number of inhabitants, and there was a CMP for a certain number of inhabitants, and since then there has been a lot more... more people living in the city and there is only one CMP, and normally it should create... open a second CMP, but that will be in the future... because there are many patients who need psychiatric care... so there are patients we cannot serve. (…) when the patient has means (purchasing power), I ask him to see a doctor... to see a liberal psychiatrist, to see a liberal nurse; we cannot take care of everybody(N14-FRA CMP).
(...) since the other PMI doesn’t have a doctor, so we did the consultation here to put it there, in concrete terms. So, normally there were consultations on Mondays, Tuesdays, Wednesdays, and Thursdays... except that we split the time, we no longer fully meet the needs of the population, there is a lack of consultations, we do not meet all the demand we have... we meet the minimum(N12-FRA PMI).
(...) we work with advanced access, so we schedule from one day to the next... 70% of it is free demand, 30% scheduled. Today I have these three patients scheduled, but per shift our schedule is eight appointments/shift, which is half an hour (30 min). The doctor is 12, which is every 20 min(N5-BRA USF).
(...) I think that each one has their own field of knowledge and performance. We are a team, we need physicians, not validating horrible protocols and putting us ahead of things... there are nurses who like and think that they don’t need physicians for anything. I have another thought; I disagree a lot with that. I think this is dangerous, you know. The nurse that likes it, he will like this power of having the prescription, but he doesn’t see that behind this, the work overload and also the precariousness, you know, we are a cheaper labor force than the doctor.(N4-BRA Street office).
Today I had a difficulty while you were waiting for me. It frustrates me, a thousand crosses, ah, I had to be a doctor, no, I had to be a nurse, for example, when we talk about advanced nursing practice of expanded nursing practice, we need to have protocols or change in legislation for this. I saw a woman today, who came here for a women’s health consultation, for cervical cytology (…) she demanded pharmacological treatment, which in places that have adequate protocols, nurses are prescribers. (…) I really can’t, and it is not because I don’t know how to solve it, I would know today what to prescribe for the patient, the dose, how the patient should use it, how to write the prescription, but in the municipality where I work, if the patient comes with a prescription stamped by me, but the nurse did this? Wow, I’ll end up in the Federal Council of Medicine to answer a lawsuit. (…) I had no way to solve the patient’s problem, autonomously(E1-BRA NSF–individual interview).
The health project includes patient therapeutic education for diabetes, hypertension, childhood obesity, chronic obstructive pulmonary disease (COPD) patients, smokers, vaccinations, cancer tests, and Pink October activities(N9-FRA Maison de Santé).
The protocols followed are the testing and management of patients with high cardiovascular risk, plantar perforating malady, wound monitoring, oral anticoagulants, low back pain, and COPD. The team plans today the insulin therapy protocol(N9-FRA Maison de Santé).
(...) the implicit philosophy is that there is a difference between being responsible for an activity and doing it yourself. The state can be responsible and the activity performed or implemented by a private body. The idea is not new in French law, but the techniques are. Does the state necessarily have to be an owner or employer to provide services to citizens, or can it buy services from the best providers? This is how the question of reviewing missions in OECD countries is posed  (p. 3).
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
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Kasper, M.S.; Santos, F.L.d.; Oliveira, P.S.d.; Silva, J.P.d.; Santos, K.d.S.; Araujo, P.N.d.; Souza, G.C.; Quintão, C.B.d.S.; Viana, A.L.; Matumoto, S.; Mishima, S.M.; Fermino, T.Z.; Abrahão, A.L.; Righi, L.B.; Monceau, G.; Fortuna, C.M. The Work of Nurses in Primary Health Care: Crossings of the New Public Management. Healthcare 2023, 11, 1562. https://doi.org/10.3390/healthcare11111562
Kasper MS, Santos FLd, Oliveira PSd, Silva JPd, Santos KdS, Araujo PNd, Souza GC, Quintão CBdS, Viana AL, Matumoto S, Mishima SM, Fermino TZ, Abrahão AL, Righi LB, Monceau G, Fortuna CM. The Work of Nurses in Primary Health Care: Crossings of the New Public Management. Healthcare. 2023; 11(11):1562. https://doi.org/10.3390/healthcare11111562Chicago/Turabian Style
Kasper, Maristel Silva, Felipe Lima dos Santos, Poliana Silva de Oliveira, Janaina Pereira da Silva, Karen da Silva Santos, Priscila Norié de Araujo, Gabriella Carrijo Souza, Cássia Bianca de Souza Quintão, Angelina Lettiere Viana, Silvia Matumoto, Silvana Martins Mishima, Tauani Zampieri Fermino, Ana Lucia Abrahão, Liane Beatriz Righi, Gilles Monceau, and Cinira Magali Fortuna. 2023. "The Work of Nurses in Primary Health Care: Crossings of the New Public Management" Healthcare 11, no. 11: 1562. https://doi.org/10.3390/healthcare11111562