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EDITORIAL

No freedom is complete if it is not achieved by one's own hands


Dalmo Valério Machado de Lima1, Elizabeth Teixeira2, Adriana Lemos3

1Fluminense Federal University
2University of the State of Rio de Janeiro
3Federal University of the State of Rio de Janeiro

ABSTRACT

In the Brazilian National Congress, the law project No. 4930/2016 was drafted with a view to amending Law No. 7,498 of June 25, 1986, which regulates the exercise of nursing, in order to include in it the obligation to carry out a sufficiency test for obtaining professional registration. The Brazilian Nursing Association, the National Executive Committee of Students and the National Federation of Nurses - representatives of Brazilian nursing, made public a position contrary to this examination. It is necessary to reinforce the regulatory rigor on nursing education in Brazil, which meets the specificities of the area, expanding the evaluation mechanisms of higher education courses and institutions and expanding the movement for the quality of nursing education.

Descriptors: Legislation, Nursing; Education, Nursing, Baccalaureate; Educational Measurement


In the middle of the 16th century, more specifically in 1568, at the age of 14, D. Sebastião became king of Portugal and Algarve, under the nickname "O asleep" and with great military ambitions. At the time, Portugal was well established and enjoyed the colonial prerogatives in Brazil, Africa and the East.

For allegedly mercantile reasons in North Africa, once the Turks dominated the entire region, with the exception of Morocco, a request for help was prompted to the young and intrepid King of Portugal. A clash occurred between a nephew, a deposed prince, and a coup-plotting uncle, Mulei Mohamed and Mulei Moluco, respectively. The young impetuous and belligerent European king was not limited to financially supporting the new friend Mulei Mohamed in terms of logistics, armaments or food, as he himself went to the so-called Journey to Africa.

Using this real history as an introduction, background and analogy with the challenges of the nursing profession, one wonders: Why are we always called to intervene or give an opinion on what is not our concern? Or worse: Why, on many occasions, do those, who have nothing to do with the nursing profession, feel anointed as propagators of a new old order? In moments of crisis, which almost always have an economic etiology that is expressed in the most different forms, such as ethics, violence, social upheaval, etc., inevitably emerge opportunistic legislative currents. Examples are numerous: in the face of an epidemic, urgent laws are proposed to change a health model; in the face of a barbarous crime committed by a teenager, the proposals to reduce the age of criminality, to review the disarmament status and so on, are intensified. This chaotic environment favors distortions of state-religion, civic-military fusion that ultimately contribute to the growth of peer intolerance, economic division, class struggle and right and left Manichaeism.

However, just as in each of our private lives, it is not usually very productive to make big decisions in the acute phase of the crisis or during an event that is apparently out of control. However, great decisions should not be confused with contingency measures, since the second is essential. In that sense, Minister Marco Aurelio de Mello, of the Supremo Tribunal Federal (STF - Federal Supreme Court), recently expressed his fears in terms of normalization "in a time of crisis because they avenge the exacerbated passions". The declaration was given on account of the receipt by the STF of a Proposta de Emenda Constitucional (PEC - Proposed Constitutional Amendment) that deals with the lowering of the age of minors with regard to criminal responsibility.

It would be natural for the regulations of the nursing profession to materialize from the legitimate representation of its members in the legislative and executive branches. However, notwithstanding the fact that nursing is the most dense professional segment in the health system, with more than 2 million active professionals, meaning, holders of professional cards and annuity collection to the class council(1), of the 513 federal deputies in Brazil's current legislative framework, there is only one nurse and two nursing assistants. It should be remembered that the nursing assistant was no longer formed under Resolution COFEN-276/2003(2), later revoked by 314/2007(3). Imbroglios aside, in practical terms, there has been no training of nursing assistants for 15 years, that is, since 2003. Thus, even considering a universe of three nursing professionals, these correspond to less than 0.6% of the Chamber of Federal Deputies of Brazil(4).

A recurring error of humans, and therefore potentially their groupings, is to adopt experiences of other groups that do not resemble the day-to-day of their own processes as a paradigm to be followed. In other words, what worked for one group will not always work for another. Imagine, however, what to say if you do not even know for sure that it worked out for the first group.

The profession of lawyer, whether by the professional's age or his social representation, has always torn historically from other professions, even if they are contemporary to it. For example, the lawyer receives the doctor's pronouncement of treatment, conferred by Royal Charter granted by D. Pedro I in 1827. Therefore, it does not have to do with what is established by the Law of Guidelines and Bases of Education(5), ascertained and granted by the Universities to academics.

The Examination of the Ordem dos Advogados do Brasil (OAB - Brazilian Bar Association) was created by Law No. 4,215/63; however, it was only regulated in 1994 by Law No. 8906, dated July 4 of that year, which established the Estatuto da Ordem dos Advogados do Brasil (Brazilian Bar Association Statute), attributing to the OAB the power to regulate the provisions of the said "exame da ordem" (bar exam)(6). The most immediate consequence of this normalization was the occurrence of preparatory courses for the OAB examination, which were either directly or indirectly owned by judges and prosecutors, so that the original idea was distorted, giving rise to a new market. Since it is impossible to measure the increase in the quality of the new "adevogados" (pejorative expression for lawyer in Brazilian Portuguese) from the approval in the Examination of the Order, what, in fact, can be affirmed, is that this examination is not consensus not even between the lawyers.

Accounting was another professional category that also adopted this examination in 1999, through the Resolution of the Conselho Federal de Contabilidade (CFC - Federal Accounting Council) No. 853/99; however, this examination was suspended by a judicial measure requested by the Public Prosecutor's Office in the year 2005, due to its lack of legal support, which was only achieved in 2010 through Law No. 12,249/2010 and CFC Resolution No. 1,301/2010. However, after its implementation, the expected improvement in the quality of the courses was not verified(7).

In the marasmatic area of legislative leadership graduated in the nursing category, a representative of a historic family of cocoa barons, the champion of the professional qualification of nurses, emerges from the micro region of Ilhéus-Itabuna: Lúcio Quadros Vieira Lima, the savior. The distinguished federal deputy from Bahia is a cattle rancher, agronomist and cacao farmer who, although in his second federal term, presented "relevant" projects to Brazilian society, among which the PEC 221/2012, which changes the wording of the Constitution Reducing the minimum age for Governors and Vice Governors to twenty-five years; Provisional Measure 712/2016, which obliges the radio program "A Voz do Brasil" to include a minute dedicated exclusively to the dissemination of actions to combat and raise awareness of the mosquito transmitting the Dengue Virus, Chikungunya Virus and Zika Virus, and of Law No.

4,930/2016(8), with a view to amending Law No. 7,498 of June 25, 1986, which regulates the exercise of nursing, in order to include in it the obligation to carry out a sufficiency examination to obtain professional registration. In the justification of the project it is written: "... it has the purpose of guaranteeing better safety in terms of the health care provided to the Brazilian population, when it is necessary for the profession and for the users of the health system to place professionals who are proven to be prepared for the immediate technical response in the health labor market" and "... it will be an important evaluation tool for such professionals, as it will analyze the minimum skills and abilities...". It is asked: Does the eminent colonel believe that a written test will be able to guarantee better safety? A written test aims to analyze the skills and abilities for the proper performance of the profession? Would not it be wiser to create mechanisms for measuring, monitoring, opening criteria and providing continuity to undergraduate courses in nursing rather than to punish those who survived a poor training, however, legalized? The compulsory examination therefore discriminates against the "sufficient" and "insufficient" criteria, and for the latter it can be said that it represents nothing more than the "blame of the victim" or a "predatory selection"(9). Is the problem in the individual or in the institution?

In the United States, for example, nursing undergraduates who are examined as "insufficient" by the National Council Licensure Examination (NCLEX) suffer physical consequences, such as depression, social consequences, such as isolation and financial consequences, since, even unemployed, they continue to pay the student loan without the support of the institution that formed them. And yet, schools are under pressure to maintain high approval rates, worrying about recruiting qualified students, etc(10).

But who is the bastion of the nurses and defender of the population's safety, Lúcio Quadros Vieira Lima? Why had no one heard of the distinguished parliamentarian until the recent past? It happens that the congressman, known as "Bitelo", is mentioned in the bribery list of the contractor Odebrecht. More than that, the liberator of the nursing profession is the brother of Geddel Quadros Vieira Lima, the chief minister of the Secretariat of the Government of Brazil of President Temer, denounced multiple times, arrested and whose fingerprints were found in the 51 million Reais in the apartment belonging to a person intimate of Brother Bitelo, the nursing redeemer. There is a third brother, Afrísio Vieira Lima Filho, legislative director of the Chamber.

The Associação Brasileira de Enfermagem (ABEn - Brazilian Nursing Association), on the occasion of the 14th National Seminar of Guidelines for Nursing Education (14th SENADEn), which took place in Curitiba in 2016, was against the examination and its positioning is based on the understanding that the sufficiency test for access to the Nursing career is a measure of individual accountability that accentuates social injustice and conditions of inequality and inequity, as well as penalizing those who seek to ascend socially through the nursing pathways.

In an open letter to the Nursing community, the Associação Brasileira de Enfermagem (Brazilian Nursing Association), the Executiva Nacional dos Estudantes (National Student Executive Commission) and the Federação Nacional dos Enfermeiros (National Federation of Nurses), representative entities of Brazilian nursing, made public a position contrary to this examination. As stated in the open letter it is questionable whether the examination alone can assess skills and attitudes sufficiently to ensure the safe and competent care provided by the nurse.

The reality of nursing education in Brazil demonstrates a consequent expansion of the democratization of access, with the increase in the number of courses and vacancies in nursing graduation, associated to the incentives for the inclusion and permanence of the students, through governmental policies and programs. These measures had a significant influence on nursing education, in which the predominance of female students from the less educated social strata was observed; many individuals begin their careers at maturity and continue their qualification as a graduate student in nursing.

Thus, the sufficiency exam for nursing professionals in Brazil implies an inopportune, inadequate and perverse selection that will promote the exclusion, for the most part, of Brazilian women who believed in the dream of education, particularly those who believed it was possible to ascend, socially and professionally, through the paths of Nursing. In view of this, the three entities recognize that it is necessary to reinforce the regulatory rigor on nursing education in Brazil, which responds to the specificities of the area, expanding the evaluation mechanisms of courses, higher education institutions (courses, schools and colleges) and expanding the movement for the quality of education in nursing.

Returning to the history of the 16th Century, D. Sebastião led the Battle of Alcácer-Quibir, where he was surrounded and simply disappeared. His last words are believed to be: "Real liberty is only to be lost with life." His disappearance, without established heirs, led to a series of developments, culminating in the annexation of the Kingdom of Portugal and its colonies to the Spanish Crown for 60 years. Even today, in Portugal, the legend that everything will improve after the return of the Sleeper is perpetuated.

It is definitely not reasonable to assume that the examination defended by COFEN is to solve the problems of the profession, especially when carried out from the Bitelo proposal. Nursing does not need and does not deserve to be guided by D. Lúcio Vieira Lima, King of Cacao and usufructuary of Odebrecht, because everything suggests that, unlike D. Sebastião, the Tupiniquim version will not disappear, but will be imprisoned for a long time: nursing wins and Brazil wins.


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All authors participated in the phases of this publication in one or more of the following steps, in according to the recommendations of the International Committee of Medical Journal Editors (ICMJE, 2013): (a) substantial involvement in the planning or preparation of the manuscript or in the collection, analysis or interpretation of data; (b) preparation of the manuscript or conducting critical revision of intellectual content; (c) approval of the version submitted of this manuscript. All authors declare for the appropriate purposes that the responsibilities related to all aspects of the manuscript submitted to OBJN are yours. They ensure that issues related to the accuracy or integrity of any part of the article were properly investigated and resolved. Therefore, they exempt the OBJN of any participation whatsoever in any imbroglios concerning the content under consideration. All authors declare that they have no conflict of interest of financial or personal nature concerning this manuscript which may influence the writing and/or interpretation of the findings. This statement has been digitally signed by all authors as recommended by the ICMJE, whose model is available in http://www.objnursing.uff.br/normas/DUDE_eng_13-06-2013.pdf

Received: 05/18/2017 Approved: 06/16/2017





 

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