The nursing team represents 40.6% of the hospital's professionals, being the largest workforce in patient care, therefore, the certification of this service supports the repositioning of nurses, as well as the development of the team, integrating them into the strategy of high care performance in pursuit of excellence in management. The objective is to demonstrate the perception that Nursing undergoes a restructuring of its knowledge through the management tools of the Certification Program for Nursing Services Distinction. Information from assessments in a digital model, followed between January 2021 and June 2022, in three hospitals with different profiles, funding and complexity, was gathered. The experience report was carried out through the collection of information using focus groups with Governance, Nursing Leadership and Nurses. It was identified by the development of the program a greater integration of the assistance team with the leadership, autonomy of the nurse in the management of the sector and involvement of the nursing technician in the multidisciplinary team. Professionals reported greater professional recognition, empowerment and personal fulfillment, reflected in the climate of safety and satisfaction at work. Communication about the patient's condition with the doctor improved, bringing good results in care, such as the identification of early signs of clinical deterioration. Changes were identified in the position of nurses as clinical care managers. It is therefore concluded that this Program made it possible to observe the advancement of nurses' performance in patient-centered care, with information and data that helped in decision-making, favoring greater autonomy and action, based on the ethical principles of the profession.

In addition to causing damage to the health of patients, the Covid 19 pandemic has brought a greater burden to health systems directly affecting professionals, leading many to physical and emotional exhaustion. The present study aims to demonstrate the perceptions of the professional practice environment of nurses, technicians and nursing assistants through the use of the Environment of Professional Practice research (Practice Environment Scale of the Nursing Work Index – PES/NWI) and the Maslach Burnout Inventory (MBI), in addition to comparing them. The researches were applied in private and public administrative institutions in four Brazilian states, these being Amazonas (AM), Minas Gerais (MG), Mato Grosso do Sul (MS) and Rio de Janeiro (RJ) that are part of the IQG Nursing Certification, from December 2020 to June 2021, with the participation of 1484 professionals from the six invited institutions. The nursing team-physician relationships are identified as the most favorable characteristics of the work environment in the PES/NWI, and the foundations for nursing practice, however, identified as unfavorable to the participation of nursing in hospital affairs and adequacy of personnel and resources. Regarding the dimensions of the MBI research the best results are related to emotional exhaustion. However, the rates of low professional fulfillment were 69.1%. There are impacts on burnout related to emotional exhaustion and professional fulfillment related to the work environment, more frequently in the group of nurses. The analysis showed differences in the perceptions of nurses when compared to nursing assistants and technicians, with attention to inter-professional working relationships and the availability of resources. Therefore, the importance of guiding actions aimed at the management of these health resources is portrayed, with attention to the risk to the quality and safety of care, but also to the health of these professionals. The role of the leader, represented by the nurse, needs more attention and preparation, given its potential in guiding the best practices, professional engagement and promoting changes in the environment of professional practice.

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BACKGROUNDDoes a healthcare facility with accreditation certification still have opportunities for improvement in its quality processes? This is a constant doubt for these services managers. Therefore, the objective of this study was to survey the impacts and improvements perceived after the Distinction Certification of Assisted Infusion Therapy Services. METHODSAfter the consolidation cycle of the certification of the Distinction for Assisted Infusion Therapy Services in a public institution that distributes high-cost medications, a structured interview was conducted with the person in charge of the service to understand which improvements in processes are attributed to this program, benefiting an institution that already has full accreditation. RESULTSAmong the main impacts, it is worth mentioning the process standardization, with the management of assisted therapy indicators, which brought opportunities to identify robust improvement cycles. Because it is a distinction with a very specific look, there was an improvement in the information transition, strengthening the barriers to care risks, promoting greater planning and continuity of care due to effective communication and engagement of professionals. There was a relationship with the decrease in patient absenteeism due to the actions in access management, leading to better use of resources, greater compliance with protocols, and regularity in the use of medications, with greater safety in the medication chain and sustainability in the use of these inputs. Currently, the greatest strength in the service is the added value that exists in the pharmacy sector, with great accuracy in the availability of treatment to patients. CONCLUSIONWe all know that quality is a rush without a finish line, so there are always opportunities for process improvement in already accredited organizations. Focused on value creation and competitive advantage, certification programs by distinction of services or protocols are an important tool to fill these gaps in services while raising the degree of maturity in the quality and safety management of the organization.