DOI: /reuol ED

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1 ORIGINAL ARTICLE THE NEOLIBERAL MODEL AND ITS IMPLICATIONS FOR WORK AND THE WORKER OF NURSING O MODELO NEOLIBERAL E SUAS REPERCUSSÕES PARA O TRABALHO E PARA O TRABALHADOR DE ENFERMAGEM EL MODELO NEOLIBERAL Y SUS IMPLICACIONES PARA EL TRABAJO Y LOS TRABAJADORES DE ENFERMERÍA Francisco Gleidson Azevedo Gonçalves 1, Gabriela Fontes Pessanha Leite 2, Norma Valéria Dantas de Oliveira Souza 3, Déborah Machado dos Santos 4 ABSTRACT Objectives: to identify the characteristics of the organization of hospital work in view of the neoliberal model and analyze the repercussions that the neoliberal model impose on the nursing work in the hospital environment. Method: a qualitative study developed in ten sectors of nursing in a public hospital in Rio de Janeiro/RJ, Southeastern Brazil. The subjects were 14 nurses. The instrument used was a semi-structured interview. The data analysis was done by Thematic Content Analysis. The research project was approved by the Ethics Committee in Research, CAAE Results: the results showed that there is a shortage of human and material resources in the institution and that this creates an overload work and increased improvisations and adaptations. Conclusion: the labor relations, with the advent of globalization and neoliberalism, configured themselves more unstable and precarious, focusing negatively on the lives of the workers. Descriptors: Occupational Nursing; Working Conditions; Workers Health; Neoliberalism. RESUMO Objetivos: identificar as características da organização do trabalho hospitalar na perspectiva do modelo neoliberal e analisar as repercussões que o modelo neoliberal impõe ao trabalho de enfermagem no ambiente hospitalar. Método: estudo qualitativo desenvolvido em dez setores de enfermagem de um hospital público do Rio de Janeiro/RJ, Sudeste do Brasil. Os sujeitos foram 14 profissionais de enfermagem. O instrumento utilizado foi a entrevista semiestruturada. A análise dos dados deu-se pela Análise temática de conteúdo. O projeto de pesquisa foi aprovado pelo Comitê de Ética em Pesquisa, CAAE Resultados: os resultados evidenciaram que há um déficit de recursos humanos e materiais na instituição e que isto gera sobrecarga de trabalho e aumento das improvisações e adaptações. Conclusão: as relações trabalhistas, com o advento da globalização e do neoliberalismo, configuraram-se mais instáveis e precarizadas, incidindo negativamente na vida dos trabalhadores. Descritores: Enfermagem do Trabalho; Condições de Trabalho; Saúde do Trabalhador; Neoliberalismo. RESUMEN Objetivos: identificar las características de la organización del trabajo hospitalario en vista del modelo neoliberal y analizar el impacto que el modelo neoliberal impone en el trabajo de enfermería en el ambiente hospitalario. Método: estudio cualitativo, desarrollado en diez sectores de enfermería en un hospital público en Rio de Janeiro/RJ, Sureste de Brasil. Los sujetos fueron 14 enfermeros. El instrumento utilizado fue una entrevista semi-estructurada. El análisis de los datos fue el Análisis de Contenido Temático. El proyecto de investigación fue aprobado por el Comité de Ética en Investigación, CAAE Resultados: los resultados mostraron que hay una escasez de recursos humanos y materiales en la institución y esto crea trabajo extra y el aumento de las improvisaciones y adaptaciones. Conclusión: las relaciones laborales, con el advenimiento de la globalización y el neoliberalismo, se configuran más inestables y precarias, centrándose negativamente en la vida de los trabajadores. Descriptores: Enfermería Ocupacional; Condiciones de Trabajo; Salud Laboral; Neoliberalismo. 1 Nurse, Substitute Professor, Department of Medical-Surgical Nursing, Faculty of Nursing, University of the State of Rio de Janeiro/ENF/UERJ, Masters in Nursing, Postgraduate Program, Faculty of Nursing, University of the State of Rio de Janeiro/ENF/UERJ. Scholarship Student at the Coordination for Improvement of Personnel for Higher Education /CAPES. Rio de Janeiro (RJ), Brazil. gleydy_fran@hotmail.com; 2 Nurse Resident of Medical-Surgical Nursing of Traumatology and Orthopedics, National Institute of Traumatology and Orthopedics/INTO. Rio de Janeiro (RJ), Brazil. gabrifpl@hotmail.com; 3 Nurse, PhD in Nursing, Department of Medical-Surgical Nursing / Postgraduate Stricto Sensu Program, Faculty of Nursing, University of the State of Rio de Janeiro/ENF/UERJ. Pro-scientist of UERJ. Rio de Janeiro (RJ), Brazil. norval_souza@yahoo.com.br; 4 Nurse, Master in Nursing, Substitute Professor, Department of Medical-Surgical Nursing, Faculty of Nursing, University of the State of Rio de Janeiro/ENF/UERJ. Rio de Janeiro (RJ), Brazil. debuerj@yahoo.com.br J Nurs UFPE on line., Recife, 7(11):6352-9, Nov.,

2 INTRODUCTION The object of this research is the precariousness of hospital work and their implications for nursing work, in view of the neoliberal model. This object emerged from a clipping of the final monograph of a graduate course entitled The neoliberal model and its implications for nursing work, presented at the Faculty of Nursing at the State University of Rio de Janeiro (ENF/UERJ); Rio de Janeiro/RJ, Brazil The choice of this subject was motivated by empirical observations made in the field of practical classes throughout the undergraduate program in nursing in the city of Rio de Janeiro, when he noticed an increasing casualization of labor conditions and human resources, resulting in deterioration of interpersonal relationships, the loss of labor rights, the quantitative and qualitative inadequacy of material resources and the negative consequences of all these circumstances on the health of workers. Sensitized by this context, we deepen the preliminary studies in an attempt to understand the phenomenon studied, it was found then that this was linked to a macrostructural context: globalization and neoliberalism. Both were present in the world since the 1980s, when it became apparent efforts of both the developed countries and the International Monetary Fund, jointly with the World Bank, to prevent the collapse of the capitalist system, laying the foundations of neoliberalism. 2 Neoliberalism has its roots in liberal thought, which can be preliminarily defined as the economic policy of indiscriminate opening of the domestic market to international. 3 However, neoliberalism is not just an economic doctrine, but also a philosophy of social and moral values, which radically transformed life in society and labor relations. From the advent of globalization and neoliberalism, we observe the emergence of various forms of hiring workers and increasing structural unemployment. There are, for example, workers cooperative, contractors and temporary workers, among other forms of employment that withdrew workers rights before granted, for example, paid holidays, the sickness and the 13 th salary, leaving the worker left alone in terms of social support and at the mercy of diseases psychophysical and labor intensive and demeaning. 4 Given this economic and social framework, and considering the empirical observations made in field placements, we selected the following objectives for this research: (i) to identify the characteristics of the organization of hospital work in view of the neoliberal model, and (ii) to analyze the repercussions that the neoliberal model impose on the nursing work in the hospital environment. Therefore, this study aimed to help workers understanding the work dynamics linked to an economic model and social in force; such a model, in turn, produces negative and/or positive health and quality of work provided by the collective professional. Faced with this deeper understanding, workers may increase its ability to demand and fight for better working conditions. THEORETICAL FRAMEWORK The work can be influenced by factors related to the institution or the personal characteristics of the worker. The work may also be responsible for integrating people into society, is also an essential element that influences human health and contributes to the construction of identity and subjectivity of individuals. 5 Labor relations have undergone many changes after the consolidation of flexible accumulation, arising from neoliberal precepts. Thus, the pursuit of profit maximization has produced a new form of exploitation and control of the labor force, generating the deregulation of social and labor rights, reducing the number of employees, increasing outsourcing and subproletarianization, encouraging the precarious and partial work and increasing the structural unemployment. 4 With the occurrence of so many changes, the world of work becomes characterized by high rates of unemployment, structural unemployment and the increased pace of work and temporary work, scaring not only the unemployed but also the employees themselves, since begin to experience the fear of demission. 6 reflecting these changes, show the reduction of cost and labor as labor charges. Also evident flattening wage. 7 As a result of this neoliberal model, there is increasingly in healthcare and nursing, low employment growth, with contract workers and contractors, receiving lower wages than statutory professional. Working conditions also become precarious because there is a lack of medical supplies, which often hinders or impedes the process of hospital work. 8 With all these changes in the working world, the Brazilian state, assuming a feature more liberal with regard to deregulation of labor and welfare, internalizes the process of J Nurs UFPE on line., Recife, 7(11):6352-9, Nov.,

3 precarious labor relations in various sectors, among them, the health. 9 In this sector, there are the nursing professionals, i.e. nurses, and technicians, each with specific responsibilities. In fact, these professionals are influenced by changes occurring in society, in particular those that succeed in the working world, among which are mentioned the implementation of technologies, the precariousness of human resources and materials, and changes in how is executed the care. In this last aspect, there is profound change in the process of nursing work, with increasing pressure on the employee in relation to their performance and their training. 10 On the other hand, this same work context there are the expansion of the devaluation of labor, rising unemployment, precarious work intensification and adoption of nursing workers hired and/or outsourced. Given this context about the problem of the study, we believe that the hospital work, in particular that of nursing has undergone great political influence of neoliberal and globalized, in which the precarious conditions and labor relations are a major and detrimental outcomes for this scenario and the quality of care provided. In this perspective, reinforce the desire and importance of investigating the object previously shown. METHOD This is a qualitative, descriptive and exploratory research in a general public hospital, located in Rio de Janeiro/ RJ/Southeastern Brazil. We collected data in the following locations: Ward Medical Clinic, Clinic of Ophthalmology, Clinic of Nephrology, Cardiac Intensive Care Unit, Unit of Infectious and Parasitic Diseases, Clinical Hemodialysis, Clinical Neurology; Coronary Care Unit, Ward Surgery, Clinical and Nutritional Support. We chose this scenario because it was the place where the authors observed more reflections of neoliberalism in the organization and work process, moreover, these were places where the activities took place primarily practices of ENF/UERJ. Thus, already knew the organization and work processes, as well as many of the managers, which facilitated the integration scenario for the development of research. The research subjects were 14 nursing workers, seven of whom are nurses and seven technicians of nursing. To participate in the study, the subjects should: (i) be professional nursing care to develop their work activities in the institution and who were on active duty, or were not on vacation and licenses, (ii) work in the form of statutory employment, and (iii) act in the institution since at least the 1990s, a period marked by intense changes in the working world, characterized by the transition from productive model Taylorist/Fordist to neoliberal. The quantity of 14 subjects was due to the fact that this study is characterized as a monograph by the end of the graduate course, so there is an availability of research development in eight months, four of which are intended for the preparation of the project and its approval in ethics committee, within four months next proceeded to the collection and processing of data, as well as the preparation of the final report. In this sense, we have not had sufficient time to increase the number of subjects. However, it is important to emphasize that this quantity did not affect the wealth of data collected, since it was found that after the eighth interview, the contents of the reports began to repetir. 11 Furthermore, it was found that the numerical criterion of subjects research, a qualitative search becomes less of a concern, because what is most relevant is the quality of the subject, and not just quantity. The ideal sampling that is able to reflect the totality of the object of study in its multiple dimensions. 11 The instrument for data collection was the semi-structured interview applied in July and August The questionnaire was composed of the following questions: 1) Since joining this hospital, have you noticed any change in the work process? Talk about changes in: Human Resources; Material Resources; Income Wage and Interpersonal Relationships. 2) What factors do you think may have contributed to this setting on your desktop? 3) What impact these changes interfere in your work? It is emphasized that the project was submitted to an evaluation and subsequent approval by the Ethics Committee in Research of the University Hospital Pedro Ernesto (CEP/HUPE), under protocol registration number 2966/2011, Certificate of Presentation and Consideration for Ethics (CAAE) under number on June 8, 2011, as required by Resolution 196/96 of the National Council for Research involving humans. J Nurs UFPE on line., Recife, 7(11):6352-9, Nov.,

4 It is worth mentioning that, to meet the said Resolution, the confidentiality and anonymity of the subjects participating in the research were respected and guaranteed, being served all participants' rights by signing the consent form, which is signed in two copies, one of which remained in the possession of the respondent, the other via remained in power researchers. Note also that to ensure the anonymity of the subjects, was created an encoding in which reference was made to each research participant by the letter "E", interview, and a cardinal number on the sequence in which she was held. Thus, the first respondent received code E01, and so on. The technical treatment of the collected data was thematic analysis of conteúdo.12 Through the application of this technique, two categories emerged: 1) Neoliberalism and the impact to the process and organization of hospital work, and 2) Impact of the neoliberal model for the life of professional nursing. RESULTS AND DISCUSSION Category 1: Neoliberalism and the impact for the process and organization of hospital work The construction of this category originates in the reports of the subjects obtained in interviews that allowed the construction of the following themes: the inadequate sizing of professionals related to places in competitions, the casualization of labor relations, and the context of the materials in health facilities. The theme called scaling professionals related to inappropriate places in competitions corresponds to 60 register units (UR), which is equivalent to 7,9% of UR category. Here are questions about the changes in human resources. In this context, eight interviewees reported that there is currently a decrease in the number of tender and quantitative statutory professional. In this regard, the respondents reported that there has been prolonged due to licensing, vacation, retirement and deaths of these professionals without proper replenishment with civil servants. With that comes causing an inadequate sizing professionals in hospitals, since there is no tender for the replacement of these professionals. Watch the following excerpts: [...] As our major competition was the 1st in Then had another, after twenty years, and the former were already retiring, I am 21 [...] and many people died, were replacing all gazetted. [...] Employees were retiring, dying, some were getting extended license, right here has a number of others who have retired. (E07) [...] The hospital does not have this contest. Have enough time we paid contest and people retire, not replacing people who have retired. People get sick, does not spare the people who get sick. (E10) Difficulty in opening contest, difficulty in opening positions. (E01) Currently there is a deficit in the opening of tenders, which generates other forms of contracting to mitigate the reduction of personnel. However, alternatives that present themselves do not guarantee the rights of workers, thus there is a decrease in professional or statutory governed by the Consolidation of Labor Laws (CLT). Highlights that labor relations over the years, have suffered many changes, with the consolidation of flexible accumulation in companies and institutions. Thus, the pursuit of profit maximization has produced a new form of exploitation and control of the labor force, generating the deregulation of social and labor rights, reducing the number of employees, increasing outsourcing and subproletarianization, encouraging precarious and partial and increasing structural unemployment. 3,4 Thus, the aim of restoring the number of staff, and before the constant budget cuts to public machine and the increased demand for health services, the management found a strategy already in place in other dimensions of the world of work to minimize the shortage human resources: the flexible employment relationships, i.e. temporary contracts or grants for job training. Such analysis can be detected in the transcripts below: The hospital has greatly increased the supply of service [...] So with that there was a need for hiring nurses [...] So the resource used by the institution to obtain this professional in the hiring through job training scholarship (TPB). (E04) [...] But it is a contract of time and after that time it will go away [...] Because they change frequently. Sometimes they get two or three months [...] the rest all contract is precarious, like TPB or contract [...] (E07). [...] Because they are not contracts, they are fellow professional training, professional training volunteer [...] (E02). Such transcripts corroborate findings of 13 previous research, which shows some determinants to conform flexible labor relations, such as the absence of tenders, the need for multiple employments in order to complement the income, and the inclusion of young professionals on deregulation of labor relations. J Nurs UFPE on line., Recife, 7(11):6352-9, Nov.,

5 With respect to changes in material resources in hospitals, was observed in the subjects' statements that the quantity of materials depends on the time of year, i.e., according to time there is a abundance or scarcity of resources materials. This results in an offering of resources for nursing job fickle, generating insecurity about how to give assistance. This theme had 86 reporting units, totaling the equivalent of 11,4% of records, one of which is transcribed below. [...] It has phases that the hospital is well equipped; nothing is missing and has phases that lack many things [...] It had to save with his own glove [...] (E01). Some aspects affecting the quality and quantity of nursing productivity and, in turn, the health-disease process of these workers. One of these aspects is exactly the lack of material resources and/or their inconsistency in the delivery of hospital supplies, resulting in psychological distress and psychosomatic repercussions that affect the health of staff as well as increased work rate and cadence labor. 14 From this lack of material resources also arise other developments, as anxiety in the professional to provide care, just performing improvisations and adaptations of materials and equipment to get the job done. This practice contributes to the increase of waste materials, for further quantitative and qualitative lack of materials and more precarious work, 15 as can be seen in the following lines: [...] I think so, is that it has a waste. Has no such culture for employees to know the cost of this material and learn to enjoy it as well, there goes improvising to accomplish what has to perform. (E12) [...] Have to improvise some stuff, some things you have to improvise because they lack material, then you use a material that ends up missing for other care. (E06) It appears from their comments that the quantity of material is not enough, although they mention that there was an improvement in the distribution of resources due to greater control of managers with the guard, the release and use of materials, minimizing waste and miscarriages. Also emphasize the creation of the Material Distribution Center as an important administrative arrangement that helped to control the distribution of material resources for the units, by receiving requests daily, weekly or monthly. Category 2: Impact of the neoliberal model for the life of the nursing staff In this category was discussed how the neoliberal model influences the lives of nursing in biological, psychological, social and economic dimensions. There were a total of 249 RUs in this category, accounting for 33% of total RUs built, which were grouped in the following themes: biopsychosocial repercussions for workers, with 179 RUs (23,9%), and labor rights, with 18 RUs (2,4%). It is inferred that the effects of this economic model arise through relationships unstable and deteriorating working with no labor rights, which implies unjust wages, excessive working day, insecurity of attachment and lack of benefits. Moreover, the working process is fragmented and surrounded by both the stress generated by the accelerated pace as insecurity in relation to employment status. 16 The wages below the expectations and needs of workers represent a strong impact on the lives of individuals. Professionals suffer from the wage gap with respect to time of service. Ie, over the years the salary has not grown in proportion to the demand for health services. Thus, there is a greater workload than the 1990s, but there was no increase in salary that accompanied the increased workload seen since. The salary is a serious business, we're frozen, not increased for eight years. Had an installment of 12 times, a business is surreal, it passes the values that society, ie, health care, wages are lower. (E11) I think the diversification of earnings, I think it's absurd, you know the person sometimes caught by the same necessity, not to be without work. But there is a difference, you know, on remuneration. End up working more than effective. (E03) We play monthly, because our salary was so outdated in relation to the market, that there, as it cannot be increased, we gained like, a month off to give a relief to us. (E13) With wages below their expectations, these workers in search of better living conditions, are often compelled to seek other sources of income. In this sense, they are forced to double or triple employment, to try to maintain their living standards compatible with the requirements of the capitalist world. It demonstrates the relevance of such aspect since 13 of the 14 respondents have other employment contract. In addition to the salary problem, grasped another repercussion was the high rate of work due to the volume of activities that workers have to perform on account of reduced quantitative human resources. According to the testimonies of the subjects, the increase in work pace is related to the increased complexity of care, in this sense, J Nurs UFPE on line., Recife, 7(11):6352-9, Nov.,

6 there is a heavy workload, as patients are staying longer in hospital, requiring more care and a demand of time. Another important aspect was the perceived increase in the number of patients and the limited availability of beds; such circumstances lead to overwork some wards with critically ill patients, leading to obviously wear not only physical but also, and especially mental. When you work alone, you work very stressed, you work too overwhelmed. Works tense. It is exalted. So it's very bad for you. When you work with the most suitable professionals for service, need not be exaggerated the amount of an employee, but an adequate amount for the service, you work more smoothly. (E04) It is a reality of the hospital, because although I always felt very overwhelmed, had no effect on my health, my physical integrity, more so, mentally I feel overwhelmed, stressed. 'm Kind of a nurse who complain, get stressed, why accumulate tasks, have to deal with a large number of activities with few people to work. (E12) It is known that the high level of stress in daily life can generate a framework of emotional exhaustion with negative feelings, unfavorable attitudes toward work, changes in behavior with colleagues and depersonalization toward the object of their work. 17 Another analysis deduced refers to the problem of growth of recent college graduates in the hospital setting, which are most threatened by unemployment. Such a situation leads them to accept any kind of bond, as observed in the speech mentioning the growth of hired through job training, which may or may not be paid. Moreover, the fear of losing a job makes that worker hired not express their opinions, because it has nothing to endorse and give security to manifest. Today we have half of our workforce nursing top-level professional training in this condition scholar, or professional training volunteer [...] So, the resource used by the institution to achieve this was to the professional employment through vocational training scholarship [...] This fellow does not have a relationship with the institution. So he is not a worker. It is a training that you receive a scholarship for that. This creates many problems. (E09) I knew of a case, even outside the hospital, where the nurse was hired by the hospital and the nurse that was effective and she slept in the bed, in the hour of rest, slept on the floor, even if the bed was empty, she rested. This is a difference, is an unbelievable deal, the staff does the same job and earn less. It is an unbelievable deal, which point we reached. (E11) This is reflected in the collective professional health since, pressured by certain characteristics of neoliberal management, these workers accept any form of attachment, even volunteering, targeting effect when they finish their training time or absorbed by private hospitals due to the experience who acquired a large hospital. However, these differences in ways of hiring generate voltage entire order starting wage inequalities, through the increase of tasks these professional contractors and culminating in the devaluation of workers with precarious employment relationship. All this affects their own work context. Besides the fear of unemployment and dissatisfaction with wage income and the increase in the pace and volume of work, respondents demonstrate the existence of a physical and emotional distress as a result of lack of material. This circumstance makes the professional often can not provide the adequate care due to lack or shortage of medical supplies, causing frustration for failing to perform quality work. The effect is that we get things inventing, inventing-around here and there, is working more. Is running, asking the other sectors, you do not have a material and looking to see who has saved anyone who has kept an amount greater reserve, still left a little and you go there and get you more work. [...] You work more and you improvise too. But you do not know how much you hurt some principle, takes something to the patient and the worker, the feeling of being carrying some infection. (E 10) And the difficulty of meeting the users with the quality we want and that he deserves. You have to adapt, improvise, you have to create, and you consequently exposes the employee is exposed to errors, and damage to the user. (E14) Thus, adaptations and improvisations in everyday practice ensure patient care, but result in suffering for the workers, as professionals need to develop a process to achieve mental and physical adapt and improvise materials and equipment. All this process involves spending time that could be used in direct client care. This unnecessary expenditure of time results in feelings of anxiety, irritability and stress professional. 18 CONCLUSION The results showed different impacts generated by neoliberalism in the work and life of nursing professionals. In this sense, J Nurs UFPE on line., Recife, 7(11):6352-9, Nov.,

7 there was decrease in the quantity of professional gazetted in the institution studied, there was an increase in the number of professional contractors, which do not have many rights as workers are characterizing as a precarious job. It is emphasized that this quantity insufficient causes an inadequate sizing Professional professionals in their jobs, resulting in overload and employee attrition. It was found that there is a growing underemployment/unemployment this job category, receiving lower salaries than professionals gazetted, as there precariousness of labor relations and working conditions. This situation has generated conflicts and anxieties for the professional group, because the forms of contracting rights and duties bring very different from one another, sometimes overwhelming and increasing the workload of outsourced workers, now intensified work pace of those with statutory bond. Another impact of neoliberalism in the hospital environment is the reduction of hospital supplies: a deficit of material resources that hinders professionals to develop their routine activities. Thus, these workers use strategies to try to ensure the care, thereby increasing the adaptations and improvisations in the hospital environment. The workload is evidenced by the professionals of the study, and the results revealed that this overload is associated with several aspects, among which are: the lack of professionals, the intense work pace, workload, excessive, or even double triple employment, precarious work and the high risks involved in the hospital environment. This situation impacts negatively on the lives and health of workers, with emphasis on the psychological distress and stress. The flexible employment is evident in the study, is associated with several determinants such as the insecure employment contracts, lack of labor rights, the fear of unemployment and outsourcing companies. There was also an increase of flexible working through unpaid volunteer work or paid through scholarships. Coupled to these forms of employment is evident the increase in turnover of professionals, since, in search for better conditions and better pay, it is common for professionals to easily turn off the precarious ties. The results of this research contributed to the process of reflection on the work done by nurses in institutions, in the dimension management and care. This study therefore seeks to contribute to broadening the analysis on the world of work and about the configuration of nursing work in Brazil, since helped us in understanding and deepening of this issue. REFERENCES 1. Gonçalves FGA, Leite GFP. O modelo neoliberal e suas repercussões para p trabalho de enfermagem [trabalho de conclusão de curso]. Rio de Janeiro (RJ): State University of Rio de Janeiro; Haddad MCL. Qualidade de vida dos profissionais de enfermagem [Internet]. Rev Espaço Saúde [cited 2011 Oct 05];1(2): Available from: 2/doc/artigos2/QUALIDADE.htm 3. Antunes R. O Caracol e sua Concha: ensaios sobre a nova morfologia do trabalho. 5ª ed. São Paulo: Boitempo; Antunes R. Adeus ao Trabalho? ensaios sobre as metamorfoses e a centralidade do mundo do trabalho. 14th ed. São Paulo: Cortez; Cavalcante CAA, Enders BC, Menezes SMM. Riscos Ocupacionais do trabalho em enfermagem: uma análise contextual. Cienc cuid e saúde [Internet] Jan/Apr [cited 2011 Nov 15];5(1): Available from: ccuidsaude/article/view/5144/ Larangeiras SMG. As Transformações do Trabalho num Mundo Globalizado. Sociologias [Internet] July/Dec [cited 2011 Oct 20];2(4): Available from: df 7. Góis OS, Guimarães J, Medeiros SM. Neoliberalismo e programa Saúde da Família: A propósito do trabalho precarizado. J Nurs UFPE on line [Internet] May/June [cited 2011 Sept 20];4(3): Available from: x.php/revista/article/view/1098/pdf_96 8. Santos PR. Estudo do Processo de Trabalho da Enfermagem em Hemodinâmica: cargas de trabalho e fatores de riscos à saúde do trabalhador [dissertação]. Rio de Janeiro (RJ): National School of Public Health; Costa DO, Tambellini ATA. Visibilidade dos escondidos [Internet]. Physis: Rev de Saúde Coletiva [Internet] [cited 2011 Sept 25];19(4): Available from: 4a03.pdf 10. Murofuse NT. O adoecimento dos trabalhadores de enfermagem da fundação hospitalar do Estado de Minas Gerais: Reflexo das mudanças no mundo do trabalho. [tese]. São Paulo (SP): University of São Paulo; J Nurs UFPE on line., Recife, 7(11):6352-9, Nov.,

8 11. Minayo MCS. (org.). Pesquisa social: teoria, metodologia e criatividade. 21 a ed. Petrópolis (RJ): Vozes; Bardin L. Análise de conteúdo. Lisboa: Edições 70; Baraldi S, Car MR. Flexibilização e desregulamentação laboral dos trabalhadores da área de enfermagem no Brasil: O caso Profae. Rev Latino-am Enfermagem [Internet] Mar/Apr [cited 2011 Oct 10];16(2): Available from: pdf 14. Souza NVDO. Dimensão subjetiva das enfermeiras frente à organização e ao processo de trabalho em um hospital universitário [tese]. Rio de Janeiro (RJ): Federal University of Rio de Janeiro; Cunha LS. As Adaptações e improvisações no trabalho hospitalar e suas implicações na saúde do trabalhador de enfermagem [dissertação]. Rio de Janeiro (RJ): State University of Rio de Janeiro; Baraldi S. Supervisão, flexibilização e desregulamentação no mercado de trabalho: antigos modos de controle, novas incertezas nos vínculos de trabalho da enfermagem [tese]. São Paulo (SP): School of Nursing of U.S.P.; Parfaro RC, Martino MMF. Estudo do estresse do enfermeiro com dupla jornada de trabalho em um hospital de oncologia pediátrica de Campinas. Rev esc enferm USP [Internet] June [cited 2011 Aug 11];38(2): Available from: df 18.Souza NVDO, Santos DM, Anunciação CT, Thiengo PCS. O trabalho da enfermagem e a criatividade; adaptações e improvisações hospitalares. Rev enferm UERJ [Internet] June/Sept [cited 2011 Sept 10];17(3): Available from: pdf Submission: 2012/05/27 Accepted: 2013/08/24 Publishing: 2013/11/01 Corresponding Address Francisco Gleidson de Azevedo Gonçalves Universidade do Estado do Rio de Janeiro Centro Biomédico Faculdade de Enfermagem Av. Boulevard 28 de Setembro, 154 / Vila Isabel CEP: Rio de Janeiro (RJ), Brazil J Nurs UFPE on line., Recife, 7(11):6352-9, Nov.,