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Publication details

Postprint of: Nelson, SA, Azevedo, PR, Dias, RS, de Souza, SMA, de Carvalho, LDP, Silva, ACO & Rabelo, PPC 2013, 'Nursing work: challenges for health management in the Northeast of Brazil', Journal of Nursing Management, vol. 21, no. 6, pp. 838-849.

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Social exchange theory is used as the framework to examine the interaction between supervisor–subordinate relationships, training and affective commitment for Northeast Brazilian public sector nursing professionals.


There are continuing challenges to nursing management worldwide in terms of the supply of nursing professionals, their work relationships, nurse training and commitment to their employing organisations. The interplay between these factors for nurses in the Northeast of Brazil has not been well understood.


Quantitative data were collected from 550 nursing professionals using a cross-sectional, survey-base design. Qualitative data were collected from 25 participants using in-depth interviews and focus group discussions.


Using path analysis, and the ordinary least squares approach, the findings demonstrated a significant, but weak, linkage between supervisor–subordinate relationships, training and organisational commitment. The qualitative data suggest that contracting out may be a causative factor.


Healthcare managers in Brazil need to create more positive environments to strengthen supervisor–nurse relationships, improve the provision of training and to strengthen organisational commitment.

Implications for nursing management

Healthcare policy-makers in hospital can make significant contributions to improving organisational commitment by reducing multiple job holding, improving the ratio of registered nurses to nursing technicians/assistants and beginning nurse supervision training in effective people management.

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