O trabalho de enfermeiras da Atenção Primária à Saúde no Brasil: aspectos multidimensionais da precarização

Abstract

The precarization of work, as an emerging mechanism of the process of labor force exploitation by global capitalism, is an old phenomenon. However, although it is evident in more recent studies, the precarious characteristics underlying nurses' work in Primary Health Care (PHC)—such as multiple employment ties, low wages, compromised labor rights, and degrading working conditions—there is still conceptual and methodological imprecision regarding how to capture this construct in research practice in a way that allows greater accuracy and comparability with similar studies. Thus, the objective was to develop an indicator for the methodological analysis of the multidimensionality of the precarization of nurses' work in PHC in Brazil and to assess the reliability and internal consistency of this measurement instrument; as well as to estimate the prevalence of precarization of PHC nurses' work in Brazil and the factors associated with this outcome. This is a national multicenter descriptive and analytical study with a cross-sectional design. The participants were nurses working in PHC across Brazilian territory. The research was conducted in the 26 federative units and the Federal District, from November 2019 to August 2021. Quantitative data collection was carried out through an electronic questionnaire using the web survey method. For the multidimensional assessment of work precarization, a conceptual representation model was developed, comprising the following dimensions: Insecurity in the contractual relationship; Temporariness in the contractual relationship; Monthly income; and Lack of affiliation with representative entities of the professional category. To analyze the construct's reliability, Cronbach's alpha was used, along with descriptive analyses and prevalence measures. For the association analysis, Pearson's Chi-square test and Poisson regression models were used. A statistical significance level of 20% was adopted for the inclusion of candidate variables in the multivariate models, and 5% for the final adjustment. Statistical analyses were performed using STATA®, version 16.0. The results of this study were organized into two articles. The first article, “Precarization of nurses' work in Primary Health Care in Brazil: a reliability study”, showed that the average score of the precarious work construct was 2.26 ± 0.90 points and the reliability coefficient was 0.61. Insecurity in the contractual relationship had the lowest score (0.85). After refinement, Cronbach's alpha increased to 0.70. The prevalence of precarization was 79.72% (95%CI: 78.63 - 80.77) and varied across the studied regions. The second article, entitled “Prevalence and factors associated with the precarization of nurses' work in Primary Health Care in Brazil”, revealed that nurses aged between 19 and 38 years, those who reported being unmarried, who did not reside in the same municipality where they worked, who had other degrees in addition to nursing, and who worked in Primary Health Units (UBS), showed higher prevalence of work precarization in PHC. It is concluded that Cronbach's alpha coefficient was effective for reliability analysis and that the prevalence of the precarization of nurses' work in PHC in Brazil is high and has multidimensional characteristics. Public policies aimed at ensuring decent work for the category are necessary, as well as incentives for the development of similar research focusing on the replicability of this construct.