Emotions of Medical Personnel versus the Status and Power at Work in Hospital Wards

The hospital is characterized by one of the most formalized structures with a strict division of tasks and responsibilities. An essential element of any formal organization is the system of authorities and power. There is a hierarchy and a system of power between hospital departments and within each of them. This hierarchy structure overlaps with the level of power and status felt and perceived by each employee, which implies the emergence of specific emotions. They influence interactions, shaping their course. When describing emotions in the context of power and status, I will refer to Theodore Kemper’s concept that interactions and changes in the relative power and status (prestige) of individuals have an impact on arousing both negative and positive emotions. The aim of this article is to show how an individually-determined level of power and status can shape relations between employees, their methods of communication, and emotions in the workplace. The paper answers the question of whether and how having and/or feeling a certain status and level of power implies the emergence of certain emotions. It is important to reveal those activities and interactions which, as a result of a specific position in the hospital structure, shape and modify the emotions of medical personnel. All the considerations are based on ethnographic qualitative research conducted in three hospital departments, differing in terms of the nature of work in the department and the type of patients treated in each of them. The article describes three of the distinguished categories, i.e. “disrespect game,” ”holding emotions,” and pride. In the course of the analyses, it was found that hierarchy and a specific level of power implies the appearance of emotions of pride, satisfaction, and contentment, as well as it leads to an increase in the level of trust between members of medical personnel. Pride results from belonging to a specific profession and a specific group of employees, and it appears as the consequence of a well-conducted procedure or performance of a difficult activity that took time to master. Pride also emerges as a result of the prestige of the profession or workplace (hospital,

the subject of this article, 1 the requirements of a job (profession) often define the emotions expected to be expressed by employees regardless of the level of their feeling by the individual (Hochschild 1983;Rafaeli and Sutton 1987). The aim of the ar-  Kemper's concept (1978;2005; fore the perspective of the sociology of medicine was omitted. Secondly, the discussed research can 2 It is worth mentioning at this point that research in the field of medical sociology in Poland as early as in the 1960s was conducted by Helena Csorba, who described in her monograph the social system of an internal medicine clinic (1966). Her work was continued, among others, by Magdalena Sokołowska, a doctor and sociologist who is called the founder of Polish medical sociology. Many authors conducting analyses in the field of medical sociology focus in their works on the issues of health and disease, as well as the socio-cultural and economic determinants of the doctor-patient relationship. I should mention here, for example, Barbara Uramowska-Żyto, Beata Tobiasz-Adamczyk, Renata Tulli, Anna Titkow, Anna Firkowska-Mankiewicz, Antonina Ostrowska and Zofia Kawczyńska-Butrym. As Justyna Klingemann (2011:217 [trans. BP]) writes: "The impact of socio-cultural factors on the health of societies is not questioned by anyone today, and the sociology of health, disease, and medicine is one of the most dynamically developing areas of sociology in Poland. This is evidenced by both the growing group of medical sociologists and the growing number of publications and academic textbooks on health issues in recent years (Barański and Piątkowski 2002;Ostrowska 2009;Piątkowski and Płonka-Syroka 2008;Piątkowski and Titkow 2002;Piątkowski 2004;Tobiasz-Adamczyk 2000." be analyzed from the perspective of the sociology of work and organization. Although this approach is much closer to the author of this article, it also does not constitute an interpretative framework. Certainly, the hospital as an organization and bureaucratic-stratification system is a very interesting subject of research and deserves a separate article. Thirdly, the subject of the article fits within the framework of human resource management, and the management of emotions itself can be included in this trend.
Fourth, when describing the professional relationship between a doctor and a nurse, we can refer to gender issues. The nursing profession is highly feminized and perhaps that is why it is often analyzed in terms of gender. 3 It is less important to address this fact in the following considerations. The possessed and / or perceived levels of power and status described below apply to both genders. Apart from female nurses, there are male nurses, and female doctors work next to male doctors. Therefore, for the analysis of empirical material, the fact of occupying a specific position in the structure of the examined hospital ward was more important than belonging to a specific gender. Therefore, this issue has also been omitted in this article. Therefore, although the analysis of the collected research material would be possible from many theoretical perspectives, this article focuses on the sociology of emotions. It is the framework of the sociology of emotions, and more specifically the 3 In the considerations of many authors, the profession of a nurse is combined with that of a midwife, and so both professional groups are treated jointly. Perhaps this is due to the functioning of a trade union common to both professional groups, i.e. the National Trade Union of Nurses and Midwives. In her 2014 book titled Bunt białych czepków, Julia Kubisa described the creation, activity, and commitment of both of these professional groups in the functioning of a trade union. By describing the struggle to improve working conditions and pay, she applied the feminist perspective.

structural-interactive perspective used in Theodore
Kemper's approach to the study of emotions which forms the basis of the following analysis.

Power, status and emotions-theoretical considerations
Generally speaking, a social organization is a group of people who work together in an orderly and coordinated manner to achieve a certain set of goals (see Griffin 1996:34 et seq.;Nogalski, Śniadecki 1998:51).
It is people who make up an organization. Without them, it would not have come into being, developing and fulfilling its assumptions. In every organization, the mutual dependence and cooperation of all entities present in the organization is important.
Changing one of the elements of this system leads to changing the others. Having a particular amount of financial and material resources, each organization carries out the assigned tasks and goals (see Leavitt 1964:55).
In this article, organization is understood as an organized system of action and interaction (see Bernard 1938), the operation of which is continuous and processual (see Konecki 2007). Each organization sets the social and professional role models for employees by creating a perfectly positive, ideally negative, and average image of staff member. This allows for the determination of the way of work, performance of individual activities, and behavior in the workplace, the implementation of which is subject to control and evaluation (cf. Januszek and Sikora 2000:38-39;see Byczkowska-Owczarek, Kubczak, and Pawłowska 2020:7-8 ).
The organization is characterized by one of the most formalized structures with a strict division of tasks and responsibilities that correspond to the goals and tasks carried out by the organization is the hospital. "Hospital life is governed by regulations and procedures-implemented by the management and implemented by both medical and non-medical personnel" (Byczkowska-Owczarek, Kubczak, and Pawłowska 2020:33 [trans. BP]). An important element of the formal organization is the system of authorities and power: one results from the management of the facility, the other -from the professional skills of doctors (Domaradzki 2018:2). In hospital departments, but also between them, there is a hierarchy and a system of government through which "basic values and beliefs about culture are revealed" (Van der Geest andFinkler 2004:1995). There is a strict organizational division, a highly hierarchical structure, and a specific system of positions and roles. On the one hand, it is defined in organizational charts (director, ward manager, ward nurse, And although status and power are terms more often associated with the structural paradigm, by giving them an interactive character and analyzing them in the processual context, they fit into the description made in the interpretative paradigm. It is social actors who, when interpreting the rise or fall in their own or others' status and/or level of power, give them meanings and contexts. The mutual relations of the actors lead to changes in the expression of each of them as well as to changes in the actions taken (Kemper 2008:128;cf. Kemper 1978;2005;see Pawłowska 2013:69-71;2014:39-52;Byczkowska-Owczarek, Kubczak, and Pawłowska, 2020:127). They are also a motivating force, because "they not only organize people's subjective experiences, but also energize their reactions and give them direction" (Turner and Stets 2009:25 [trans. BP]).

Research methodology
The analyses presented below are the result of research conducted by the author 4 in a clinical hospital in a large provincial city, in three departments (wards) indicated by the hospital management: neu-4 The research was conducted by the author of this article together with two colleagues from the Institute of Sociology of the University of Lodz: Dominika Byczkowska-Owczarek and Anna Kubczak. Although the research was conducted jointly, separate areas of analysis were distinguished in line with the individual interests of each of the researchers. A book was prepared as a research report, which is also the basis of this article: (Byczkowska-Owczarek, Kubczak, and Pawłowska 2020). rosurgery, laryngology, and intensive care. 5 The research was field and exploratory research based on two methodological approaches, namely ethnography and the methodology of grounded theory, using the symbolic interactionism paradigm.
Ethnography, including the ethnography of organizations (see Kostera 2003;2011;, is a research strategy that enables the study of social aspects of the life of various communities and phenomena (see Konecki 2012:77) in their real context (see Becker and Geer 1960;Atkinson and Hammersley 1994). Entering the studied world allows for a description of the organization in question along with the presentation of the interactive processes, mutual relations, and contexts that constitute it (see Prus 1997:192). In addition, unstructured and conversation interviews were used in the study. The data was supplemented with the already existing materials (regulations, announcements placed in the corridors and/ or rooms of medical staff, materials indicated by the medical staff and/or the hospital management). The interviews (Konecki 2000:169;Kvale 2004:17, 38, 47) were conducted with medical personnel at the managerial level, respecting the confidentiality rules. As a result of their application, the researcher can develop concepts about the studied phenomena and processes that he/she finds in the data (Charmaz 2006:17). In the case of the discussed research, such terms were "safety strategies," "types of emotional behavior," or "intragroup jokes." One type of a sensitization concept is, according to Anselm Strauss and Juliet Corbin (1990:69), in vivo codes.
They make it possible to maintain the meanings at-tached by the participants of the research to their actions or phenomena taking place in the studied area (see Charmaz 2006:55). The in vivo codes in this study included book making, a trusting patient, individual anatomy, errand girls, and hand punching.
One central category was not distinguished in the research. The category discussed in this article is status and power, which is related to the second category relevant to research, i.e. emotions. The categories distinguished during the analysis, and discussed below, are also "holding emotions," "playing disrespect" or "being infected with disrespect." Data analysis, including testing the hypotheses emerging during the study, was carried out, among others, on the basis of comparing different groups at a similar time point and making sure that the answers to the interview questions and narratives coincided with the data from the observation (see Becker and Geer 1960;Silverman 2007;, i.e. with what the respondents said and how they behaved in "natural" situations, e.g. during conversations in the doctor's/nursing room, an exchange of information in hospital corridors, or during more or less formal meetings (e.g. during briefings or celebrations). 6

Brief characteristics of the studied hospital wards -introduction to the empirical analysis 7
The study was conducted in three departments (wards) indicated by the hospital management.
Each of the departments had a different specificity and was managed in a different way. 6 More information on the course of the study and subsequent analyses can be found in the already mentioned authors' book (Byczkowska-Owczarek, Kubczak, and Pawłowska 2020). 7 The characteristics are also taken from the said book. It should be noted that the described activities take place between persons performing a specific profession, which implies a specific position in the hospital hierarchy. Doctors are both men and women, and the profession of nursing is also practiced by men, an example of which is the intensive care unit. Thus, the analyzed interactive game refers to people-medical employees-and is not assigned to a specific gender. When writing about doctors or heads/managers, I refer to both men and women. cleaners). Having the lowest status in the hierarchical structure of a hospital ward, they are most exposed to the accumulation of negative emotions. 10 Observing the work in the surveyed hospital wards (especially in the laryngology and neurosurgery wards), it was easy to notice that nurses showed their higher level of power and status in relation to the hospital attendants (auxiliary nurses, matrons, cleaners). In the neurosurgery department, the nurses (all women) refused to eat lunch in front of, e.g., the attendants. In the common break room, auxiliary nurse (matron, cleaner) who were in the room, [C]ooperation with doctors is usually good, but the doctor is always you! doctor! It is best if we fulfill for some of their duties, which they are aware of, and they know that they belong to them, and they try to pass them on to us, that is, they are great, they are smiling and happy. Sometimes they treat us literally as errand girls and those who rebel… I think they don't have high ratings. And there are quite a lot of such in this team, because we know our value […]. Cooperation with some doctors with whom we work safely is efficient and runs smoothly. Some doctors, those who feel insecure, create a nervous atmosphere, they are disturbed by everything, then a person feels nervous and restless. We often feel that they do not appreciate our work, which causes unnecessary nervousness and negative emotions, such as anger, frustration. [neurosurgery, nurse] The observations show that it happens that an experienced nurse assisting/participating in the procedure takes over the emotions of the operating doctor. Both the doctor and the nurse know very well that the operating physician is responsible for the life of the operated or intubated patient.
In the event of unexpected difficulties, the doctor, especially the less experienced one, may panic and break down. Therefore, the nurse sometimes adjusts her actions, taking some of the responsibility, but also of the doctor's negative emotions.
For example, it does not inform about the drop in blood pressure in the patient, so as not to distract the doctor who performs the brain surgery, but takes the action of equalizing the pressure on its own. Sometimes it is the nurse who tells the doctor what activities he should take or how to solve a given situation, for example regarding the course of a difficult conversation with the patient or the patient's family. However, they always do it in such a way that the doctor does not feel the risk of a drop in his/her level of status. Often doctors do not notice the help of nurses who perform emotional work for the doctor. This phenomenon can be called "holding" the emotions of the doctor by the nurses. 12 12 A similar phenomenon was observed by Jennifer Pierce when she conducted research in 1995 in two legal offices (a private law firm and the legal department of company X). She distinguished several types of lawyers due to the use of certain emotional strategies by them. And so, "lawyers-Rambo" are people (mostly men) who demonstrate strategic thinking. They play a double emotional game. On the one hand, they are forced to show sympathy to their client, courtesy to the judge and jurors, sometimes also to witnesses, and on the other hand, signs of aggression and a show of strength in the courtroom. The second distinguished group included "mother assistants." They are caring, which means: giving support to lawyers, clients, witnesses; being nice; showing gratitude to other people (work performed on behalf of the lawyer-boss); acting as an intermediary and translator in communicating the lawyer's feelings to other people (e.g. attorney has a bad day). Peace, self-control, thoughtfulness, and comfort are all expected of them. They are often treated as invisible. They are ignored and sometimes treated as a litigation opponent. "Pierce has shown that the scope of emotional work is different for men and women-in many ways these differences reproduce gender relations across society" (Turner and Stets 2009:61-62).
Asymmetric doctor-nurse relations may be accompanied by negative emotions such as anger, frustration, anger, dissatisfaction, but also a feeling of low value, which may have a real impact on the man- Kazimiera Zdziebło and Ewa Kozłowska (2010:218) write that health care workers, including nurses, are in the professional group that is most exposed to mobbing, because doctors often create situations that cause conflicts, misunderstandings, and a negative atmosphere in cooperation.
Referring to Theodore Kemper's concept, it can be stated that people in power (doctors) have the possibility of humiliating and deprecating people who are lower in the professional hierarchy (nursing personnel). A higher status gives one the opportunity to give and receive respect, accept recognition, but also the requirement to show submission and Emotions of Medical Personnel versus the Status and Power at Work in Hospital Wards obedience. It happens that the operating doctors blame the nurses for the lack of equipment, shouting in a raised voice, "How can it be?! What should I work with?!" In fact, each of the surveyed nurses was able to cite a situation in which they felt negative emotions in contact with the doctor. For some, it was demeaning and frustrating. Others described actions such as incidental. They rationalized, claiming that these are behaviors that should not be worried about; they summed them up with the saying "something bit him," "he had a bad day," "she got up with her left leg," "she is before her menstruation" (see Byczkowska-Owczarek, Kubczak, and Pawłowska 2020:129-130).
It should be noted that the inequality of statuses results mainly from its perception by the respon- believe that "someone has to do these things." They say they help patients and keep the hospital clean.
They believe that the hospital would not be able to function efficiently without them. This technique of managing emotions is very effective and can protect against frustration and apathy. One of the measures to protect nurses from negative emotions is to avoid situations that cause these feelings. It can be, for example, setting up schedules and rosters in such a way as not to work with a doctor whose behavior causes negative emotions. A strategy that protects against negative emotions is also feeling proud of performing a profession whose mission is to help the sick and the suffering (see Byczkowska-Owczarek, Kubczak, and Pawłowska 2020:130).
Research conducted by Agnieszka Bielemuk and her team (2007:27-33) shows that interpersonal relations between doctors and nurses are influenced by the length of service of the latter professional group.
Nursing staff with a long experience of employment definitely more often describe these relations with doctors as good, as opposed to nurses with short work experience. Among nurses with a short period of work, contacts with doctors were described much more often as sufficient or even insufficient. The re-

Pride in the context of the level of power and status
Pride is a positive emotion that causes individuals to tune in to each other's reactions (assuming the role of the other) (see Turner and Stets 2009:174). Pride is Emotions of Medical Personnel versus the Status and Power at Work in Hospital Wards a signal of the intact bond between the partners of the interaction. It is a secondary emotion built on positive emotions and is part of the "happy emotions family" (Goleman 1997). Pride in Kemper's (2005) concept is the result of satisfaction arising from the increase in our status and/or power, which, in our opinion, we deserve as a result of actions taken by ourselves or actions taken by someone else (Pawłowska 2013:198).
The emotion of pride was most clearly noticed in the doctors of the neurosurgery department. They are proud of the specialization they have chosen, believing that the neurosurgeon is a top-class specialist, knowledgeable and working in the least foreseeable area of the human body, namely the brain.
Such a perception of oneself as a person "chosen" to perform the most serious procedures and thus having the highest prestige and status is socialized at an early stage of medical education and maintained from the beginning of professional work. From choosing a specialization to which the best students are admitted, to working in a department consid- It is also important that the employees of the department are mostly men. Women are unlikely to be admitted to the profession of neurosurgeon, and if they complete their specialization, they do not do surgery. The jokes, mainly observed in the neurosurgery department, also concern the doctor-patient relationship: Since we are quite familiar here, how to say, relationships, when I was sitting in the doctor's room, some woman would come and say: "Is there any doctor," then XY said: "There is no doctor?" "Oh, the deputy physician is here!" [head of neurosurgery] While joking can be one of the methods of reducing emotional tension, they certainly emphasize the neurosurgeon's status, prestige, and position in the hospital hierarchy. They definitely maintain the sense of group elitism and maintain the status quo, reproducing the established social order. In this case, pride resulting from the performance of a specific profession-as well as belonging to a spe-cific social group, related to the status and scope of power-influences the feeling of job satisfaction.
Referring to research conducted by myself in another professional group-namely teachers-I can say that the frequency of the feeling of pride translates into perceived job satisfaction and motivation to work (see Pawłowska 2020).
In the described studies, the nursing staff of the intensive care ward and the doctors of the neurosurgery ward most often spoke about the feeling of pride and prestige at work. The respondents pointed to the prestige of the profession, including specialization and work in a specific branch. The high level of job satisfaction among the nursing personnel in the intensive care ward can be a consequence of the relatively young age of the staff (average age is 27). The only nurse deviating from this average is the main ward nurse. The nature of working in an intensive care unit can also affect the way nurses feel pride. The work here is extremely responsible and emotionally difficult, and the difficulty of medical cases requires intensification of efforts, and perhaps that is why a relatively high rotation of the nursing personnel employed in this ward is noticeable here. As the interlocutors pointed out, this results in gaining vast experience in a relatively short time: "experience gained in the intensive care ward in one month is 3 years of work in another ward." The difficulty of working in the department implies the perception of their work as more important and more prestigious. This leads to an increase in their perceived status in relation to the status of people working in other departments. The increase in the "I" status that we believe we deserve leads to satisfaction (including job satisfaction) and, as a consequence, a feeling of happiness and pride. This process is most apparent among the nursing staff in the intensive care unit. They point out that "not ev-eryone can work here" and "it is very burdensome." They emphasize that they become an authority for the nursing staff of other wards when they change jobs to another ward.