Work experiences among healthcare professionals in the beginning of their professional careers : a gender perspective

Sammanfattning: Swedish healthcare organizations have undergone substantial organizational and economic restructuring during the 1990s due to financial cutbacks. Little is known about recently graduated healthcare professionals´ work experience in healthcare and their future career preferences. The overall aims of this thesis was, to increase knowledge about how recently graduated healthcare professionals in Sweden perceive their work in healthcare organizations. A gender perspective is adopted. In this national cross-sectional study, four stratified random samples were separately drawn from the 1999 Swedish university graduates who were nurses (NS), occupational therapists (OT), physical therapists (PT) and (registered) physicians (PN) and who at the time of the sampling procedure were living in Sweden. Stratification was performed by sex. A total of 3989 were eligible and of those, 1434 were selected: 535 NS, 250 OT, 250 PT and 399 PN. A questionnaire was constructed containing questions about socio-demographic factors, working conditions, career preferences,  work satisfaction and questions about the responsibility for and actual work with home and family, the so called unpaid household work. The questionnaires also contained questions measuring psychosocial working conditions: the effort-reward imbalance questionnaire (ERI-Q) and the demand-control questionnaire (DCQ). Collection of the data for NS, OT and PT was completed in March 2002 and for PN in May 2003. The response rate was 81% and 76% respectively. The total sample thus consists of 1145 participants; 423 nurses, 212 occupational therapists, 205 physiotherapists and 305 physicians.  Most of the respondents were employed in the public sector, but many desired privately employment within the coming five year period, men more often than women. Career preferences for future work differed between women and men. A majority indicated that they did not have the opportunity to pursue knowledge development in the professional field during working hours and nearly one half could not work as independently as they wished. Satisfaction with work in general was high, but many were dissatisfied with management at work and a majority was dissatisfied with the work organization. This dissatisfaction was associated with the opportunity to work as independently as they wished and the opportunity to pursue knowledge development in the professional field. Significantly more women than men had the main responsibility for home and family and did most of the unpaid household work. Among the OT and PT working for county councils and municipalities, the results revealed that those working for municipalities, experienced low control at work compared with those working for county councils. No differences were found between OT and PT or between men and women in the two professions regarding the DCQ and the ERI-Q except for the WOC scale. Women had significantly higher scores on the WOC scale compared with men. Logistic regression analyses revealed a significant association between WOC and ERI, effort, reward and sex. One fourth of the OT and PT working for county councils and municipalities was dissatisfied with their job and this dissatisfaction was significantly associated with type of employer, reward and effort-reward imbalance (in the ERI-Q) and control (in the DCQ). Differences regarding scoring on the ERI-Q were found between nurses and physicians working in county councils but not between women and men in the same group, with the exception of the scores on overcommitment. Significantly more nurses were defined as having high effort, low reward and effort-reward imbalance compared with the physicians. More women in the NS and PN group were defined as experiencing WOC compared to men.  Logistic regression analyses revealed significant associations between experiences of WOC and ERI, effort and reward. Nearly one fifth in the NS and PN group were dissatisfied with work and this dissatisfaction was particularly high among those with high effort, low reward, those with the greatest imbalance between effort and reward and those who experienced high overcommitment. In conclusion, in order to limit future work related problems and to be able to retain well educated professionals in healthcare work, dissatisfaction among the recently graduated must be taken seriously. Healthcare employers should better utilize the knowledge that recently graduated possess, regarding for example how to be a part of the development of the profession and the job. It is also important that healthcare employers address gender (in) equality at work and that work environments allow both women and men to combine careers with family duties.