title: Assistant nurses in the Swedish healthcare sector during the 1990s: a hard-hit occupational group with a tough job.
abstract: OBJECTIVE
  The aim of the study was to explore hospital-based assistant nurses' experiences of psychosocial "stressors", following a period of substantial layoffs (43%) and ongoing healthcare reorganizations.
  
  
  METHODS
  An interview study was carried out with 11 assistant nurses working in the same hospital. The interviews took place in 1997, in connection with the last round of redundancies, and were followed up in 1998 and then in 2001. Interviews were audiotaped and transcribed; the content was then analysed.
  
  
  RESULTS
  Two main themes were identified from the women's perceived stressors: (a) a hard-hit occupational group experiencing "energy-consuming adjustments", and a "weak position" at the continuing workplace. Job insecurity meant fear of losing valued work tasks in nursing care (de-skilling). The common feature was the duality in the women's descriptions of feeling qualified in nursing care but being treated like a maid, or having intimate practical knowledge but no formal competence; (b) a tougher but underpaid job including "heavy workload" concurrent with "organizational shortcomings", and "frozen salary trends" with a simultaneous feeling of lacking the power to improve their situation.
  
  
  CONCLUSIONS
  Our results underscore the importance of the employer's attention to the remaining workers in connection with downsizing, particularly when the reduction of the workforce has been as dramatic as in this case. It is also important to understand the ongoing dilemma (strain) for the assistant nurses, who are faced with increasing demands for further formal qualifications in hospital care, while maintaining a strong occupational desire to keep their highly valued job working close to the patient.
authors.affiliation: National Institute for Psychosocial Medicine (IPM), Stockholm/Department of Public Health Sciences, Division of Psychosocial Factors and Health, Karolinska Institutet, 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; D005260:Female; D006754:Hospital Restructuring; D006801:Humans; D009728:Nursing Assistants / Q000523:psychology*; D009741:Nursing Staff, Hospital / Q000523:psychology*; D016273:Occupational Exposure / Q000009:adverse effects; D020415:Personnel Downsizing; D011361:Professional Competence; D012456:Salaries and Fringe Benefits; D013315:Stress, Psychological; D011795:Surveys and Questionnaires; D014931:Women, Working / Q000523:psychology*; D016526:Workload; D017132:Workplace