title: Personnel reductions and structural changes in health care: work-life experiences of medical secretaries.
abstract: OBJECTIVE
  To explore the experiential aspects of 'psychosocial stressors and motivators' for medical secretaries, following a period of personnel reductions and structural changes in Swedish health care. The focus was to understand and describe work-life experiences for this specific group of women and how they managed in what can be presumed to be a more demanding work situation.
  
  
  METHODS
  A descriptive qualitative study with repeated in-depth interviews of six medical secretaries (mean age: 45 years) in a large hospital in Sweden. The first interview took place in the autumn of 1997 (in connection with the last round of the 20% staff redundancies), 1998 and 2000. Thematic content analysis from audiotaped and transcribed interviews was used to obtain understanding.
  
  
  RESULTS
  The study provided three main themes from the women's perceived stressors, motivators and coping options. The descriptions of their stressors provided the metaphor, 'energy thieves' with three underlying subthemes: 'too much work,' 'lack of recognition' and 'the dilemma of health, family and finances.' Experienced motivators, labeled as 'energy givers' had two subthemes: 'professional pride' and 'the comprehensive whole.' The women's descriptions about managing increasing demands were thematized as altering between 'being submissive and taking actions' with three subthemes: 'unequal communication,' 'resigned and passive reactions' versus 'cautious and solution-oriented coping.' Expressions concerned mainly 'energy thieves,' inclusively worries about 'lacking energy' (intrinsic stressor), combined with passive and cautious coping behavior. However, the descriptions became somewhat more varied and balanced with enriching and solution oriented factors in the follow-up interviews.
  
  
  CONCLUSIONS
  There is an evident contrast between a demanding reality of work, described by medical secretaries in this study, and their expressed desire to have a more reasonable work environment that allowed them to be able to complete their work. They also wanted to be heard regarding their requests about work options and decent salaries. This study demonstrates the importance of making feelings of inferiority and injustice visible as well as to support professional pride and more assertive coping behavior. This is also valid for the need to enhance equal/congruent communication between interdependent workers. The study has implications for managers and health workers supporting and empowering women, providing administrative service in a clinical health care context. The subthemes being identified within the metaphor 'energy thieves,' in relation to resigned/passive reactions and cautious coping styles, could be used in stress prevention, while the understanding of 'energy givers' and the support of active and solution-oriented coping conducts could be used in health promotion work.
authors.affiliation: National Institute of Psychosocial Medicine, Box 230, 17177 Stockholm, Sweden. anna.hertting@ipm.ki.se
authors.forename: Anna
authors.initials: A
authors.lastname: Hertting
authors.forename: Kerstin
authors.initials: K
authors.lastname: Nilsson
authors.forename: Töres
authors.initials: T
authors.lastname: Theorell
authors.forename: Ullabeth Sätterlund
authors.initials: US
authors.lastname: Larsson
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D004651:Employment; D005260:Female; D006801:Humans; D008502:Medical Secretaries / Q000523:psychology* / Q000600:supply & distribution; D008875:Middle Aged; D009042:Motivation; D010564:Personnel, Hospital; D011446:Prospective Studies; D011788:Quality of Life; D012456:Salaries and Fringe Benefits; D013315:Stress, Psychological; D017132:Workplace