A catalogue of concerns raised by NHS staff including aggression from managers, overcrowded buildings and low morale are detailed in a leaked report.
The draft document, written after a series of focus groups with employees in NHS Lanarkshire, refers to an "us and them culture" where frontline workers do not feel supported in their jobs.
Ambition to meet political treatment targets by pressuring staff to "get through the numbers" rather than focus on quality patient care is among the concerns described in the nine-page report. Staff are also said to be under "extreme pressure" because vacancies have not been filled.
Although the research was conducted with nurses and other community health professionals in Hamilton, union officials said many of the issues raised are echoed across Scotland. Hamilton Locality Management Team set up the focus groups to help address concerns initially identified through a staff survey.
Mary Samson, health secretary for the Lanarkshire branch of union Unison, said the raft of changes introduced to the local health service was behind the discontent.
As well as elongated transfer to a new pay and conditions deal called Agenda for Change, staff have seen a shake-up of community nursing and a major redesign of hospital and community health facilities.
The latter is now being re-worked because the SNP overruled a key component, the downgrading of Monklands Hospital A&E, when they took office. Mrs Samson said: "What came out of the survey was a bit alarming about how people were feeling.
"However, we recognised we were going to get feedback like that because of the amount of change and how that has hit us over the last three years - and it is particularly acute this year. Hamilton were, I think, one of the first lot to actually say, let's get the staff in and try to address some of the issues'."
While a small number of people reported no serious problems with line managers, others said they felt they were "just told" what to do.
No-one listening to frontline employees, even when they brought forward solutions to problems, was among the responses noted. Raised voices and more subtle bullying with people being ignored was also an issue for some workers.
Other comments included: "The management approach was turning the focus from patient care to people being seen as a number within a target culture." Under the heading "time management", the report stated the "overwhelming view from all groups" was that people could not do a professional job in their contracted hours.
Further on it noted most staff felt health and safety was not taken seriously by management. Poor heating systems, lack of drinking water and defective windows were among the problems raised, with conditions described as "unacceptable" for patients as well as workers.
Towards the end, the report said: "Morale was described as the lowest people can remember". It also noted: "Some new, young members of staff say they will not stay."
Theresa Fyffe, director of the Royal College of Nursing Scotland, said: "There is no question these are issues members bring up to us all the time." Geoff Sage, general manager of Hamilton Locality, said: "We are committed to listening to our staff and acting on their feedback. We know that if this is to be effective, it means addressing an issue head on."
Alan Lawrie, director of South Lanarkshire Community Health Partnership which includes the Hamilton Locality, commended staff for delivering excellent patient care during a period of change.
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