The teaching of nursing and its relation with a hospital-university of Natal / RN ( 1973-2005 ) La enseñanza de enfermería y su relación con un hospital universitario en Natal / RN ( 1973-2005 )

Objective: To analyze the relationship between the teaching of Nursing graduation at the Federal University of Rio Grande do Norte and Nursing of the Hospital-University Onofre Lopes. Methods: A qualitative study with a historical/documentary approach, that used oral history. The empirical research was based on certain documents: reports, minutes, letters, regulations, statutes, laws and decrees. These sources were complemented with the interviews of six professionals who participated in this story and it still has bright memories about it. Results: It appeared that the teaching/hospital remained and remains very close, but do not always follow a linear way. Conclusion: Along the way there were moments of tension, donation, ruptures and rapprochement, but with a well-defined objective, to conquer new horizons, opening up spaces for new developments in the improvement of the profession and its professionals.


INTRODUCTION
In Natal, capital of Rio Grande do Norte (RN), the creation of the graduate education in nursing in the early 1970, coincides with the restructuring of the Federal University of Rio Grande do Norte (UFRN), regarding its organizational, administrative and academic structure.
In this period, there are some achievements, such as: beginning of the implantation of the University Campus; creation of the TV Universitária; public tender for teachers; creation of the Câmara Cascudo Museum; internalization of the University; creation of Pro-Office; fusion of the universities, Schools and Institutes in Centers and Departments resulting in the creation of the Centre of Human Sciences and Arts (CCHLA), Applied Social Science Center (CCSA), Health Science Center (CCS), Technology Center (CT) and Center for Biosciences (CB) 1 .
This season records intense political repression, including within the Universities, despite this context, heyday of the military regime, represented a moment of renewal and expansion to the RN Nursing, as a result of educational policies resulting from the University reform of 1968.
The Graduate education in Nursing in UFRN approval occurred in 1973 and in the following year, with the completion of vestibular exam, the first class.was admitted The functioning of this course, although it has not been a pioneer in the state, gave the need for training of nurses, by qualification and improvement of health care.
At this time, in Natal, the few existing nurses had been formed in other states of the country and almost all worked at the University, at University Hospital Onofre Lopes (HUOL) or in the Maternity Health School (MEJC).It is known that these nurses accumulated functions like nurse assistance and as teachers or supervisors of training courses of the school of nursing assistants, today the Nursing school (NS), operating since 1956 and incorporated into the UFRN, in 1964.It is important to note that these nurses took turns, until 1989, between the leadership of the Nursing Service of HUOL, the Direction of NS and head of the Department of Nursing.
Thus, the historical time marker has its beginnings with the creation in 1973, of the Graduate Course in Nursing from UFRN, and its completion in 2003, the year it completed 40 (forty) years of operation.
In this way, the development of this study, whose objective is to analyze the relationship between the HUOL Nursing and the Graduation Nursing education in nursing from UFRN, is justified by the originality, as the fact of rescuing a story not yet registered and of paramount importance to the history and memory of nursing, as for the history of higher education from UFRN and the State.

METHOD
This study is characterized as being a qualitative research of social-historical approach.About historical research, it is known that serves to elucidate the context lived, related to different motivations and resulting from consultations at a variety of sources, whether they are primary (documents, pictures, records, newspapers, letters, diaries, official reports, etc.) or secondary (generalization, analysis, synthesis, interpretation of primary sources) 2 .
It is then a systematized analysis through which new connections, comparisons, and meanings of the facts studied are established, with prospects for a new knowledge 3 , favoring therefore the understanding of the past of a social group 4 .When conceived, the historical research serves to understand the trajectory of humanity and causing reflections whose objectives are the understanding of reality in the present and in the future 5 .
Thus, the historian will play a dual role: to satisfy the need to establish or reestablish historical truths, clarifying facts and events from the available sources without losing sight of the social structures in their respective context; and, the appropriation of appropriate methods that lead to new understanding of rational, critical and systematic ways 6 .
Under this optics, to perform historical research is to have a challenge that requires organizing traces and signs, take arguments from the knowledge, seeking to deepen in the universe to know 7 .Also, it represents possibilities for breaks, for the constitution of new speeches 8 .
The sources of historical research should be viewed as the route by which the researcher meets the problem.They make it possible to examine and analyze a society in its time, contributing to the recovery of the memory, helping to save the past to serve the present and the future 9 .
Thus, this research was in a documentary research and Oral History for the historical reconstruction.As source/technique, the Oral History allows the collection of information about facts and events experienced by subjects of the story about a specific period and of interest to the researcher 10 .
Data collection occurred between the months of February and April 2005 from the acquiescence of the General Archives of the State, from the UFRN and Direction of HUOL, whose documentary sources -reports, minutes, letters, regiments, statutes, laws, decrees and ordinances -were of the highest significance by containing records that relate to the Hospital and the Nursing Department/UFRN.These data were supplemented by the realization of 06 (six) semi-structured interviews between the months of May and June 2005.The interviews were an average duration of 50 (fifty) minutes and obeyed to scheduling and venue suggested by employees.As a criterion for participation, it was established that would be university professionals -teachers and serverswho maintained bonds with the HUOL and Graduate education in Nursing from UFRN, during the 1970-80, i.e. those who have experienced part of that history and that have vivid memories.As a criterion for sample closing was the saturation of answers.
Using interviews as method emphasizes direct contact with people who witnessed or participated in the events.In this way, the researcher can check the worldview and the situations, thus resulting in a greater rapprochement with the study object 8 .

The teaching of nursing and hospital university
Carlos DJD, Germano RM, Padilha MICS On the opportunity of carrying out the interviews, the objectives of the study were clarified, stressing the guarantee of anonymity, confidentiality of information, the right to refuse and the intention to disclose the results.Once this was done, the participants were asked to sign the informed consent term (TFCC).The interviews were recorded, transcribed and subsequently transcribed.It was decided to identify the participants with the letter I, meaning interviewed, accompanied by numeration in which occurred the interviews (I1, I2, I3, etc.).
The analysis and interpretation of data occurred through close reading and detailed material, seeking the understanding of the objective, scientific and systematically meanings.It was used therefore the thematic analysis, by specific issues related to the historical reconstruction of the ratio between the Nursing of HUOL/UFRN with the Graduate education in Nursing/UFRN.Thereby, it can be said that this investigation was being slowly built.
Their realization followed the guidelines of Resolution nº 196/96 of the National Council of Health 11 and its development became possible after the project approval by the Ethics Committee in Research of UFRN, as Opinion nº 81/2004.

RESULTS AND DISCUSSION
In the year 1972, as result of the agreement signed between UFRN and the United States, the ship HOPE (Health Opportunity for People Everywhere) arrived to Natal, in service of the Peopleto-People Foundation, based in Washington.It had for objective the education and update of biomedical professionals, as well as to develop welfare activities by the population.This agreement, with duration of 10 (ten) months, provided exchanges between health professionals from the ship, HUOL and the secretariats of State and Municipal Health 12,13 .About this period, the rectorate of Professor Genário Alves da Fonseca (1971-75), it is important to highlight that new undergraduate courses at UFRN were created, including nursing, through Resolution Nº 58, of the University Council (CONSUNI) 14 .This same Resolution, also created the following courses: Architecture, Chemical Engineering, Statistics, and Physical Education.
On higher education in Nursing of RN it is important to highlight that, despite Natal being the capital, the first initiative occurred in the city of Mossoró, in 1968, with the founding of the School of Nursing, but by lack of material and human resources conditions only began operations in the early 1970.
As for Nursing, in particular, another benefit with the ship was the permanence of the nurses Anne Mary Small, Margareth Mein da Costa, Jane Marie Shima, Tyana Payne and Shirley Myers Snowe, on condition of visiting teachers of the Course of Nursing.About them, it is known that played their roles in the classroom and in the field of training courses in the subjects of mother and child, medical-surgical and public health, and that some of them remained until 1977 12 .
Returning the restructuring of UFRN and continuing to the acts related to the organization of new courses, Resolution Nº 78/73-CONSUNI 15 assisted the creation of the Department of Nursing.For its leadership, the nurse of HUOL was designated, and also a teacher at the School of Nursing of Natal, Lêda de Melo Morais, the principal of the school at that moment.With her, the other nurses at the Hospital and school teachers began to practice their activities also in the Department of Nursing 12,13 .
It was then necessary to have efforts to take forward the requirements necessary for the operation of Graduate education, newly created, without neglecting, however, professional education.With the creation of the Department of Nursing, NS continued working in the same physical space as before, i.e. a single building 13 sheltering the different levels of education (auxiliary, technical and higher) in Nursing.
To the curriculum organization, the teachers of Nursing Department of UFRN relied on the advice of the Brazilian Association of Nursing (ABEn Nacional), Anna Nery School of Nursing (EEAN), the Federal University of Rio de Janeiro (UFRJ) and the School of Nursing at the Federal University of Bahia (UFBA) 12,17 .Legally protected by the regulatory legislation of minimum curriculum of Nursing Course 17 at the time.
For implementation and operation of graduation in Nursing, in 1974, some names were indicated for occupancy of position and held internal elections among teachers, getting the following result: Teacher Lêda de Melo Morais for the head of the Department of Nursing, Teacher Raimunda Medeiros Germano elected internally to the vice-head, and in April of the same year, in the same process the school teacher Maria Élida Santos de Sousa was elected to represent the course next to the Health Science Center (CCS) of UFRN 12,13 .
This new situation has brought new opportunities to the School of Nursing of HUOL, as opened spaces for the training of technicians and assistants there exist, naturally subjecting to the selection through the vestibular.Thus, it appears, because the city of Natal, until then, it does not have a degree course in nursing, public or private, and by the difficulty of these professionals in travel to neighboring States to attend the course.
At this point, as regards the relationship between the nursing of HUOL and the Nursing Department, it is worth mentioning that the head of the Hospital's Nursing, throughout the Decade of 1970 and a few years of the Decade of 1980, was in charge of a teacher, teaching-service facilitating the exchange between the institutions.
However, this period was marked by the crisis of the public service, without calling for competition, augmented by some retirements and that in the words of one interviewee, led the University to The teaching of nursing and hospital university Carlos DJD, Germano RM, Padilha MICS

[...] hire the teachers collaborators. In the case of nursing, these teachers were crowded in the various hospitals belonging to UFRN, as nurses (I1).
It should be noted that difficulties are expressed not only in the shortage of human resources.Also, it hit the hospital structure.Regarding the availability of beds, there was a significant decrease in supply.This reality is seen in two employees of this study:

[...] harmful consequences to a hospital with teaching function. There were not enough patients so that academics could have this learning with continuity (I2). [...] When I first came here in that hospital there were two hundred and forty beds, then it was diminishing, decreasing, reaching seventy few beds (I3).
With regard to teachers collaborators, despite the difficulties, this group not only approached the teaching process-service as boosted some services at the Hospital, as expressed as following:

[...] the hospital have improved in quality. Hemodialysis
Service was created, the intensive care Unit, the Surgical Center and the Department of Neurology were reorganized (I4).

[...] the service of Neurology, for example, became a reference, employees commented: you work in a hospital and I in another (I1).
Another relevant aspect of this period, the same respondents relate to: [...] the nursing staff was insufficient to assist the demand, so this group of teachers contributed to the operation of the Hospital, although their activities were also linked to the Department of Nursing through teaching activities (I1).

[...] We had a larger approach to the teaching of the other nurses at the Hospital and it was noticeable (I4).
In this context the HUOL services reorganization, aiming at improving the teaching of the courses of the CCS from UFRN, which developed and develop their practices in this institution, the departments also went through restructuring.thus a collaborator said:

[...] There was a project that consisted in the training of the teachers, forming masters and doctors for teaching (...) the hiring of teachers staff favored the removal of teachers of the Department to other centers to perform postgraduate courses (I5).
In the case of Nursing, the teachers' employees who were providing services in other institutions, including the University Hospital, have joined the Board of the Department of Nursing, through internal competition.
[...] This selection was to present a monograph.If approved, they had to go teaching.We did not teach directly, we received the students at the Hospital (I4).
This new reality, the framing of the effective framework of employees teachers of the Nursing Department, from 1989, adopted the holding of elections, among nurses, in pairs, for Chief of Nursing at the Hospital.This event brought developments for Nursing as the relationship teaching-service, where two respondents said:

[...] When only the nurse headed the Division of Nursing, it was a decrease in the relationship between teaching and service (I6).
[...] at the time of the teachers' collaborators, there was a greater rapprochement in the training, education and the Hospital.While we were as a teacher-director, we kept the bond with the Department, with the students and with graduation (I4).
From this new reality, regarding the internships, there is the following report:

[...] nurses colleagues didn't want more students. They claimed it was the teacher's work, they don't understand about internship policy (I6).
It can be observed that this represented a low teachingservice ratio, different from other, when a nurse-teacher answered by the head of the Nursing Service of the Hospital and the head of the Department of Nursing.About this situation: [...] When meeting with students in the classroom, were placed on the board, all fields of internships in public hospitals, private and basic network, HUOL never was the option they (...) there are those of us who spent the graduate program in nursing in one piece, complete and has never entered the HUOL (I4).
Analyzing this frame of difficulties, didactic and administrative order arising out of relations between the (education) Department and the Hospital (service), it must be recognized The teaching of nursing and hospital university Carlos DJD, Germano RM, Padilha MICS that these obstacles, if on the one hand represented an academic setback, on the other hand, allowed the ripening of the Hospital's Nursing Corps.
Looking at the recent history, it is seen that the Nursing of HUOL grew up in this transition, in spite of all the difficulties faced in winning its autonomy.This phase has been overcome and attach not only the Chief of Nursing at the Hospital, but also to renew and increase the nurses with new invitations to public tenders.
It is understood that this new relationship with guard scenario with the country's re-democratization process (1980-90), opening spaces to the claims and struggles of public servers.
Coupled with that context, it is shown the intention of Nursing, as their qualification, given its participation in Graduate Programs and in other events of Nursing.This new attitude is partly because of this respondent:

[...] the pedagogical training for nurses through the Project of Professionalization of Nursing Workers (PROFAE)
was of great importance for the group, because we had professionals here for many years without studying (...) from then on, there were improvements in the relationship between the teaching and service (...) after all, it is a teaching Hospital (...) it is a big responsibility (I3).
Given this emerging new relations between teaching and service, pretending to believe that with greater maturity, and enabling the development of works in a system, in fact, result from partnerships between the Nursing Department and the Hospital.
Regarding the expansion of higher education in Nursing in UFRN, it is worth mentioning that the Department, in 1982, started its first Course of Specialization (lato sensu), under the coordination of Professor Léa Tavares de Melo Arce Águila, following others in the areas of Medical-Surgical Nursing, Public Health, Maternal and Child Nursing, Safe Motherhood, in different periods 13 .
This successful experiment resulted in the proposal, in the early 1990s, of creating a Master's Course.At this point, the Nursing Department/UFRN featured two research bases that contributed to the realization of this project.Thus, a study group was created under the coordination of Professor Bertha Cruz Enders to structure the post-graduation stricto senso.
Therefore, Resolution 17/95, of CONSUNI/UFRN 18 assisted the operation of Master's in Nursing, and then selected thirteen nurses for the first group that started in August of the same year.Other classes have come and because of the lack of doctors, the selection, initially occurred every two years, from 2003, has been happening regularly every year.
The most important to emphasize in this context that the nurses teachers and specialists who integrate the nursing framework of HUOL, most of them were formed in the Graduate Program in Nursing from UFRN.In contrast, nurses of HUOL have contributed effectively to the professional education and graduation on the condition of teachers, some of the effective framework, others as substitutes of the Nursing Department and the NS, hired provisionally by public tender, for a period of two years.About this reality, it can be seen how close is the relationship between the teaching of nursing of UFRN and Nursing Service of HUOL 13 .Thus, everything that was possible to register for this course, it appears that the relationship between the teaching of Graduation in nursing and the Nursing Service of HUOL remained and remain very close.In a few moments, even physically, when functioning the NS, in 1956, inside the Hospital, called Hospital Miguel Couto, where there were the first steps to Professional Nursing of RN 13 .
Therefore, it is important to highlight that this trajectory has not always occurred in a linear way.There were moments of tension, donation, ruptures and rapprochement, as record the facts and the lines of the respondents of this study.

FINAL CONSIDERATIONS
By completing this survey, it is important to reaffirm that the information contained in this study were obtained by querying the relevant documents of HUOL and the Nursing Department from UFRN.Equally important was the conduct of interviews with those who lived this story.
For its accomplishment, it became necessary to overcome some challenges, among them the precariousness of institutions file services, in general, and the UFRN, This situation is reflected in the absence of cataloging, packaging, conservation, and the inadequacy of document archiving and even the lack of records of relevant occurrences.Another difficulty concerns the few studies conducted on Nursing of RN.
Of the research, it is important to highlight that the accumulation of functions by nurses-Nursing Service of HUOL, direction of NS and Department of Nursing Direction-during 1970-80, given the dearth of these professionals at that time can be seen as crucial to good relationship teaching-Nursing Service at UFRN.
It is important also to highlight the session by NS, of its physical structure and human resources -nurses teachers and servers -from which it was possible to create the Department, responsible for teaching Graduate in Nursing of UFRN.This event represented the beginning of a new era for nursing from the Hospital, years later, incremented by the operation of the Graduate Program in Nursing.
As for the nurses of the Hospital, as teachers collaborators, it was evidenced that contributed to maintain close relations between the teaching-service.They collaborated with the teaching supervising students in the fields of training, teaching classes and in some opportunities here to contribute in opening of new service sectors and, also, in the Chief Nursing Course at the Hospital.
In the participation of nurses of HUOL, the research has shown that they have contributed over time with teaching nursing in supervision of stages of NS and Department of Nursing and, at times, provided substitute teachers.

The teaching of nursing and hospital university
Carlos DJD, Germano RM, Padilha MICS As the realization of public tenders for UFRN, this meant the composition of a new scenario in the context of the nurses of HUOL, as new professionals were admitted, integrating that institution, representing therefore improvements in healthcare.
Therefore, when analyzing the relationship between the teaching of Nursing of UFRN and HUOL, it is concluded that their career is marked by comings and goings, by situations of overruns and redemptions, however with a well-defined purpose, to conquer other horizons, opening spaces for new ventures in the improvement of the profession and their professionals.