Estratégias de liderança dos enfermeiros em hospitais universitários frente às mudanças no cuidado na COVID-19: sob a perspectiva do modelo de Kotter

Abstract

This study aimed to analyze nurses' leadership strategies in the face of changes in care management during the COVID-19 pandemic in federal university hospitals in Brazil from the perspective of John Kotter's model. This is a multi-center, qualitative, analytical study based on the concepts of John Kotter's model of change. It is part of a national multicenter matrix project called "Evaluation of Nursing Care for Patients with Covid-19 in Brazilian University Hospitals". To this end, the scenario consisted of 10 University Hospitals in Brazil, representing the five Brazilian regions of North, Northeast, South, Southeast and Center-West. After being approved by the research ethics committee, data was collected from March 2021 to April 2022 using a semi-structured interview technique. The research participants were 139 nurses working with COVID-19 patients at these 10 university hospitals. The interviews were conducted virtually via Google Meet, and in person, due to the still delicate COVID-19 situation at the time of the interviews, these were scheduled in advance contact with the participants. The data was then analyzed using webQDA software, Bardin's content analysis and the methodological theoretical framework adopted in this study, which was John Kotter's eight-stage model of change. The results, therefore, were timely to be related from the perspective of Kotter's model, revealing that nurse leaders showed determination to mitigate the Sense of Urgency arising from COVID-19, such as issues regarding the provision of material resources, for example, EPI´s; selection processes for hiring health professionals; new protocols or changes to existing ones, among others. In the face of an Administrative Coalition, the elements of trust and respect for the nurse and his or her nursing team stood out. The nurse leaders demonstrated that they created an inspiring Vision and Strategies in an agile way to contribute to quality care. Communication was an element that emerged as an enabler of trust and good teamwork, in a clear and safe manner. Empowerment also emerged in the face of the training that the nurse leaders undertook in the search for new learning about COVID-19 and training for their nursing team. Short-term Achievements were the implementation of video calls, which brought patients closer to their families. The Consolidation of gains and New methods of culture were evidenced by the learning of new knowledge in the face of a pandemic. It can be concluded that research into leadership in nursing is essential for the development of nurse leaders, and if it includes tools that help these professionals in their leadership role, it will be valuable in contributing to improvements in the quality of care. It is suggested that further research be carried out into the approach to nurse leadership, which could point to new tools to facilitate their practice as leaders and in the decision-making process, as well as suggesting the application of the eight-stage change model in healthcare organizations.