MEANING OF WORK FOR NIGHT NURSES OF A UNIVERSITY HOSPITAL: DESCRIPTIVE STUDY

Rosângela Marion da Silva¹, Carmem Lúcia Colomé Beck², Regina Célia Gollner Zeitoune³, Francine Cassol Prestes⁴, Juliana Petri Tavares⁵, Soeli Teresinha Guerra⁶

1,2,4,5,6 Federal University of Santa Maria, Santa Maria, RS

3 Federal University of Rio de Janeiro, School of Nursing Anna Nery, RJ

ABSTRACT

Type of Study: Descriptive study with qualitative approach. Objective: Identify the meaning of work assigned by nurses working in the night shift, connecting it to professional satisfaction or dissatisfaction. Methodology: The sample consisted of 42 nurses at a teaching hospital of high complexity located in Rio Grande do Sul / Brazil. The data collection technique used was semi-structured interview. The thematic analysis allowed the construction of categories called working are: a central element of life, satisfaction and pleasure; economic performance, and work means dissatisfaction. Results: It can be stated that by the prevalence of positive expressions concerning work, the majority of the nurses assign positive meaning the task accomplished, taking into account that these nurses are professionally satisfied. Conclusion: Understanding the meaning of work allows managers to create and implement strategies to expand activities related to workers' health from the perspective of improving services and professional satisfaction.

Keywords: Job Satisfaction, Nursing; Tolerance to Scheduled Work.

INTRODUCTION

The Industrial Revolution opened a new historical period both by discoveries in physics, chemistry and mechanization, and by extension of the working day beyond the day shift, which caused profound changes in the labor world.

At that time, the development of industrial and commercial activities, accompanied by the transition from an agrarian to an industrial society, led thousands of people to dedicate themselves to work in emerging industries. In this context, one of the limitations to the realization of work in the night shift was the poor lighting made by oil lamps, which was abandoned when it appeared the gas lighting and after kerosene lighting. Later, Thomas Edison invented the light bulb and promotes further expansion of the working day to the night shift (¹) This event also had repercussions in Nursing, one of those professions that carries out its activities in shifts.

Nursing has its work organization during daytime and nighttime and continuously due to users' demand for health services and, in particular, the need for continuity of care in hospital, which has uninterrupted operation.

Nursing workers who perform activities in the night shift have the availability of the morning shift for the realization of other activities like having another job, studying, performing activities at home, taking care of their children and being with family. In addition, shorter commuting time to work and the possibility of greater autonomy in the work process constitute factors that may contribute to the demand for this shift⁽²⁾ These conditions offered to the employee may make sense to work, translating in job satisfaction.

Meaningful work³ is the one that provides knowledge and skill acquisition, enabling the improvement of skills of the individual. It is suggested therefore that the worker who gives meaning to work is able to grow professionally in the organization and feels fulfilled professionally.

It is considered professional satisfaction or satisfaction at work the momentary state of happiness influenced by the organization and working conditions, by the subjectivity of the worker at any given moment of his life and relationship with other workers. As for job dissatisfaction it is the momentary state of adversity and that has influence of the same factors of professional satisfaction, but with an antagonistic sense.

It is noteworthy that the variables that affect job satisfaction in nursing may be related to the intrinsic values of work, understood as the fulfillment of tasks during working hours, autonomy and emotional challenges of nursing work, or on the values extrinsic to the work, such as remuneration, career development and working conditions⁽⁴⁾.

Another variable that may affect job satisfaction it is the shift, since the workers who work in the night shift face physical and organic changes due to the completion of the activity at a time when the body prepares for the rest. The physical and mental wear, that could cause the manifestation of physical and psychic pathologies as muscle aches, fatigue, mood changes and slow thinking, predisposes the worker to changes in his health.

Thus, understanding the meaning given to work may influence the professional satisfaction of workers, this study aimed at identifying the meaning of work assigned by nurses working in the night shift, connecting it to professional satisfaction or dissatisfaction.

METHODOLOGY

This is an exploratory-descriptive study with qualitative approach developed in a teaching hospital of high complexity, size IV, located in the state of Rio Grande do Sul.
The study participants were the nurses who worked in the night shift at the time of data collection, March-April 2008. Inclusion criteria were: to work as a nurse for at least a year in the night shift in the institution analyzed and belong to the effective staff. We excluded those who were on leave of any kind and on vacation.

The technique of data collection was semi-structured interview that was guided by a script with open questions: Tell me about your work; tell me about your feelings regarding your work; how do you feel about your work? It was carried out from a previous schedule ; individually and on the specific work site , after information about the study objectives. Rcordings were also done in a micro digital recorder (MP3) with verbal authorization and signature of the consent form. We respected the other ethical issues recommended by Resolution 196/96 of the National Health Council

The interviews were transcribed and its contents submitted to thematic analysis technique; one of the methods of content analysis^(5).

Initially, we performed a thorough reading of the interviews and then the data were classified and aggregated according to similarity, which allowed the construction of empirical categories.

For the strata of the speeches presented in this article; it was assigned the letter N (Nurse) followed by the serial number of the interviews (N1; N2; N3; ...) in order to preserve the identity and anonymity of the nurses. The study was submitted to the Ethics Committee in Research of Federal University of Santa Maria and was approved by the Presentation Certificate for Ethical Appreciation (CAAE) under number 0012.0.243.000-08 to case number 23081.000770/2008-61.

RESULTS

The participants were 42 nurses assigned to different work units (Internment Units Adult and Child; Adult Intensive Care Units, Pediatric and Neonatal Adult and Children's Emergency Room, Surgical Centre, Material and Sterilization Centre; Anesthetic Recovery Room, obstetrics Centre). Most females (90.48%); predominant age group over 41 years of age (64.28%), marital status, married / living with partner (64.29%), with more than two children (38 10%) who opted to work night shift (90.48%) and has over 15 years as an evening service at the institution (28.57%).

The analysis of interviews allowed us to build the empirical categories: work is satisfaction and pleasure, work is central to life, work is economic performance and work is dissatisfaction.
In the category of work is satisfaction and pleasure, nurses mentioned that the work is personal and professional satisfaction and fulfillment, according to the statements bellow:

[...] For me, work is my personal and professional satisfaction, both are interconnected, because I love what I do. I am passionate about what I do, like it a lot. (N26)

[...] I love what I do [...] to me is an accomplishment, I could not imagine myself without work. Most people see the work with sacrifice. I do not see it! I see it as personal and professional fulfillment. It is what magnifies you, makes you feel as a person, you feel important, productive, which is essential for humans. (N60)
[...] To me it's everything [...] I'm retiring, but I love it and am into it [...] I love life, I strive to help saving people, I don't like thinking about retiring [.. .] I'll miss it here. (N12)
We observe in N12' report the difficulty of assimilating of that worker when he reflects on the proximity of his retirement, signaling the strong link of the individual with work.
For the study participants, work is central to life because it is the essence, the most important factor. The centrality of work³ is defined as the degree of importance that work has on a person's life at some point, which can be seen in the following reports:

[...] it is extremely critical because it is the most important factor in my life and the other things: entertainment, personal life, even today, remain in the background [...] work comes first in my life! (N45)
[...] Work is fundamental; it is the essence of life. I think that without work there is no meaning to my existence. Why not working [...] especially when it is so good. (N48)

In the category work means economic performance, the nurses signaled that the remuneration arising from work also takes an important place in life and can sometimes be more important than personal fulfillment, as evidenced in the statements bellow:
[...] First of all comes work, then personal fulfillment [...] but one depends on another. (N62)
[...] this is where my money comes from [...]. In nursing today, we think a lot about money, unfortunately, because we work in two or three places, because working in only one job is very little [...]. (N23)

In the category work is dissatisfaction, nurses reported that the meaning of work has been lost over the years due to situations such as the negligence of some health workers with patients, lack of humanization in care associated with the lack of appreciation and recognition of nursing, which constitutes discouragement for workers, as reported bellow:

[...] What I notice is that lately I'm feeling a little frustrated [...] I realize that the direct care to the patient is losing quality. We see it through all the teams in the health area a bit of neglect with our patients [...] so this is really what is bothering me right now. I am about to retire and I never thought the day that I was going to retire would come [...] but, lately, is the thing I want more [...] I am currently unsatisfied due to neglect! Now it is a sacrifice to come to work! (N05)
[...] The meaning of work gets a little lost of what the humanized care is for patient [...] we cannot see quality service, cannot provide assistance, have no solution [...] I'm discouraged [...] because it's been 11 years in the same battle, we keep trying to solve it, to humanize the service, trying to give appropriate treatment, and now I wonder: What am I still doing here? (N24)

The analysis of interviews enabled us to identify other negative perception attributed to the work as the lack of recognition, as strata of speech:

[...] The nurse is a professional of great value and great need, only that people do not recognize our profession, do not value it, don't give the importance it deserves. (N46)

The lack of recognition may result in discouragement, spiritual wear and suffering. The nursing worker needs to feel consistently recognized and encouraged for his work.

DISCUSSION

The relationship between man and his work is related to his mental health, that is, the more harmonious and balanced this relationship between man and work is, more capable this worker will be to utilize his full potential in the development of his skills, which will enable him to feel pleasure in the performance of his tasks. It is necessary that the employee feels stimulated with the task he is performing so it can be established a relationship of pleasure with work, because, otherwise, work may become a source of tension and displeasure^(6).

The participants of this study pointed out that work is satisfaction and pleasure, suggesting that these workers give meaning to work. Personal satisfaction is achieved through the task performed when this task brings a contribution to whom is running it, which invariably will reflect on the professional satisfaction.

From this perspective, work requires personal effort of each worker (7), subjective engagement, mobilization and acceptance of risks to physical and mental health, as expectations for self-realization, the construction of health, personal recognition and organization of strategies for defenses against suffering.

To achieve personal and professional fulfillment you must have satisfactory working conditions, which provides opportunities for the worker to feel involved and motivated to work, which may give meaning to work. Unsatisfactory working conditions may impact on physical and mental burden of nurses, leading them to a progressive suffering.

Therefore, strategies for these situations should be built daily and collectively by nurses of the night service as well as it is expected that there is a sharing of responsibilities between managers, nurses and multi professional team^(8).

In a survey conducted with the nurses who investigated the factors of motivation and dissatisfaction at work has identified that "enjoying what you do" as being a prominent motivational factor which is a similar data in the present study. Therefore, the meaning attributed to work, or else, enjoying the activity performed is a factor that is related to job satisfaction^(9).

Another highlight refers to the centrality of work, mentioned by study participants. Work is the means through which the individual establishes personal contacts, reaches survival through the payment received for its realization and finds information that may help in the valuation of himself and in the construction of his personal and professional identity. Researchers report that the professional identity, for being built within the daily work, may be susceptible to interference of factors such as low pay, long working hours, lack of social recognition and little professional autonomy, understood as professional challenges for nursing which are reconfigured over time^(10).

From this perspective, it is necessary that the worker finds motivation to work and feels fulfilled professionally, because otherwise, frustration and dissatisfaction may arise since worker's realization is linked to productivity and his contribution to the work itself.

Motivation may be related to freedom in decision making and autonomy. The night shift, in particular, allows nurses greater autonomy, as situations that require their decision occur since in many institutions there is a lack of leadership and direction in this work period. This decision may impact favorably on the construction of professional identity, relate to the job satisfaction.

Another situation that may be an incentive for the worker in the development of his work is the economic factor, which has an impact on personal and professional satisfaction. The remuneration, as a result for the work done is related to the prospect of independence and autonomy of the worker, the family income on goods acquisition and achievement of a better quality of life. It is noteworthy that the financial autonomy provides freedom of choice and decision, which gives meaning to work and may be related to job satisfaction.

However, the fact of nursing being a predominantly feminine profession, often associated with low wages, depicts a situation of concern: women engaged in double or triple working hours in order to maintain better living conditions and family income. This situation may echo negatively on worker's health, especially the one who exerts his activities during the night, causing mental, physical and social overstrain, often impeding him of acting with speed and attention in certain situations and prevent him from enjoying social events and festivities with his social network.

Participants of this study expressed their distress related to patient care, a factor that can result in professional dissatisfaction since no service improvements are perceived over the years.
Participants of this study expressed their distress related to patient care, a factor that can result in professional dissatisfaction since no service improvements are perceived over the years.
Study indicates that in the organizations it is proved that a worker who is satisfied with the location and type of work he performs, has better performance.⁶ In this sense, it is necessary that the managers seek to identify the causes of the suffering of workers and devise strategies to motivate them in daily work.

The hospital work performed by the nurse on the night shift is characterized by unpredictability of the activities, that is, unexpected situations that change almost instantly the status of work and the perception of the worker in relation to it, which may lead him from job satisfaction to job dissatisfaction, which needs to be investigated in order to find strategies to improve the work process.

It is worth noting another aspect of the work on the night shift which is the lack of recognition and appreciation. This fact may be related to lower number of visitors and managers to the hospital departments during this shift, such as bosses and directors. Despite this situation, it is essential to have the habit of recognizing the work done by people, which gives those who receive recognition positive feelings regarding the institution where they work, which may influence their motivation and the pursuit of similar attitudes in the expectation of regaining recognition.

The recognition is a specific form of symbolic and moral retribution given to the ego as compensation for its contribution to the effectiveness of the organization of work⁽⁷⁾.
It is considered as one explanation for the lack of proper value and recognition of nursing work both by peers and patients, the fact that it is a type of work in which the final product, care, cannot be touched, felt but perceived, being called immaterial labor.

Finally, the analysis of data made clear that nurses, in general, indirectly expressed that the meaning of work is linked to personal and professional achievement and satisfaction, expressed by the feeling of belonging for work and for the financial return. However, there are reports of dissatisfaction with the organization of work which may result in job dissatisfaction, aspects that need to be discussed in the context of work in pursuit of strategies for improvement of services and occupational health.

CONCLUSION

From the analysis of the interviews, one can identify that the meaning of work is related to the context in which it is performed, as the singularity of workers. Sometimes work is identified as the central element of life, economic performance and personal and professional achieving, which are situations related to job satisfaction. However, the disincentive of some nurses who perceive at work the negligence in of certain professionals with users, associated with the lack of appreciation and recognition may compromise job satisfaction.

Thus, the analysis of the meaning of work assigned by nurses working at night presented itself in an ambiguous way. Overall, we identified the prevalence of positive reports regarding the work, suggesting professional satisfaction.

Remember that the meaning attributed to the work may impact on the organization of the work process, in the quality of care provided and in occupational health. In this understanding, it is believed that understanding the meaning of work enables managers to create and implement strategies to expand activities related to workers' health from the perspective of improving services and job satisfaction.

Finally, the study presents relevance by the reflections raised and suggests, to health care, new studies to investigate the meaning of work for the other categories of nursing professionals who perform their activities during the day period, in order to establish possible comparisons or disagreement with the results of this study.

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Contribution of authors: Bibliographical research: Silva, Tavares, Prestes, Guerra – Data collection - Silva - Conception and design: Silva, Beck - Analysis and interpretation: Silva, Beck, Zeitoune, Tavares, Prestes, Guerra - Critical revision of the article: Silva, Beck - Analysis and interpretation: Silva, Beck, Zeitoune, Tavares, Prestes, Guerra - Final approval: Silva, Beck, Zeitoune.