Downsizing and reorganization: demands, challenges and ambiguity for registered nurses.

Background: The 1990s were characterized by substantial financial cuts, and related staff redundancies and reorganizations in the Swedish health care sector. A large hospital in Sweden was selected for the study, in which downsizing had occurred between 1995 and 1997. The number of staff in the hospital was reduced by an average of 20%, and 10% were relocated to other departments.

Objective: The aims of this study were to explore registered nurses' experiences of psychosocial 'stressors' and 'motivators', and how they handled their work situations, following a period of personnel reductions and ongoing reorganization.

Method: Interviews were undertaken with 14 nurses working in one Swedish hospital. Nurses were interviewed in 1997 about the recent and last round of redundancies, and were followed up 1 year later in 1998 and again in 2001. Interviews were audiotaped, transcribed and analysed for thematic content.

Results: Five themes emerged in relation to nurses' perceived stressors, motivators, and coping options: 'distrust towards the employer', 'concurrent demands and challenges', 'professional ambiguity, 'a wish for collaboration', and 'efforts to gain control'. A common feature was duality and ambiguity in nurses' descriptions of the phenomena studied, meaning that identified themes had underlying sub-themes with both negative and positive dimensions.

Conclusions: 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.