The concurrence of 'ever-growing job demands' and 'work going unrewarded' contributed to a feeling of being taken advantage of by the employer. The 'waste of human resources' and 'competence drain' that followed redundancies provoked anger. Unfulfilled collaboration with doctors was a major stress producer, which related to both the downsized work organization, and the complex 'deference-dominance' doctor-nurse relationship. The well-being of nurses depends on being an equal/parallel health professional in a comprehensive team that shares knowledge and improves collaborative care of patients. A consciously formulated nursing philosophy emerged as a health-promoting resource. This study demonstrates the importance of analysing feelings relating to professional ambiguity and gaining influence in a gender-related, hierarchical environment, and the need to support professional assertiveness in relation to superiors and doctors. It is also important to stress considerations that relate to differences in the age, care philosophy, and psychosocial health conditions of nurses.

Background: This study focuses on determinants of a healthy work environment in two departments in a Swedish university hospital. The study is based on previously conducted longitudinal studies at the hospital (1994)(1995)(1996)(1997)(1998)(1999)(2000)(2001), concerning working conditions and health outcomes among health care personnel in conjunction with downsizing processes. Overall, there was a general negative trend in relation to mental health, as well as long-term sick leave during the study period. The two departments chosen for the current study differed from the general hospital trend in that they showed stable health development. The aim of the study was to identify and analyse experiential determinants of healthy working conditions.

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Swedish hospital personnel were followed over an 8-year period, characterized by staff redundancies and restructuring processes. Self-rated and administrative data sets from 1994 to 2001 allowed for studying long-term consequences of organizational instability for staff health and work conditions. The aim was to identify, on a work-unit level, trends in work and health conditions and their interdependence. Regression analysis showed a downward trend in mental health and an upward trend in long-term sick leave. Increasing trends of work demands were accompanied by deteriorating mental health, and decreasing time to plan work showed the strongest association with increasing long-term sick leave. Job satisfaction and support were decreasing. A stable short-term sick leave rate over years related to lack of support.

Background: The objective of this study was to assess potential physiological changes associated with downsizing/reorganisation in the health care sector. The personnel reductions (1995–1997) in the studied regional hospital corresponded to one fifth of the personnel. Methods: In a longitudinal study, female personnel had blood sampled twice (8 a.m. and 4 p.m.) during a working day in 1997 (in connection with the last completed round of personnel redundancies) and 1 year later in 1998. The participants were 31 women (82% of those initially sampled ); there were 14 registered nurses, 11 assistant nurses and 6 medical secretaries. No additional drop outs took place during follow-up. Outcome variables were changes in the difference in serum cortisol levels between the morning and afternoon and in serum/plasma concentrations of immunoglobulin G (IgG), oestradiol, dehydroepiandrosterone sulphate (DHEAS), prolactin and apolipoproteins AI and B. Results: Significantly decreased serum/plasma concentrations of IgG (p < 0.001), apolipoprotein AI (p < 0.001) and oestradiol (p < 0.001) were found. The difference between morning and afternoon serum cortisol decreased, with a change at the significance level of p = 0.05. No significant changes were observed regarding prolactin, DHEAS and apolipoprotein B. Conclusions: These results could be an indication that protective and anabolic functions had suffered in these remaining ‘ageing’ female work groups. The circadian cortisol rhythm was possibly flattened, which could be a sign of physiological dysfunction associated with the long-lasting adaptation process. These conclusions are tentative, given the small size of the sample and the lack of a control group. However, the findings point to the significance of studies of physiological changes possibly associated with restructuring of the health care sector.