Emotion labour, emotion work and occupational strain in nurses.

Abstract

Concerns about the psychological health of South Australian hospital nurses have been raised on account of nursing shortages, retention difficulties, and the associated resource constraints on the existing pool of nursing staff. According to workers compensation statistics, the nursing profession is prominent with respect to occupational stress claims, resulting in substantial costs for both the individuals and organisations concerned. This thesis addresses the question of if, and how, emotion labour and emotion work influence job stress and strain and job satisfaction in nurses. In a first study, 238 nurses (35 males) employed at a large public hospital completed a questionnaire comprising predictive measures addressing individual factors, workload and work environment, and outcome measures focussing on health, job strain and satisfaction, impressions of organisational commitment and intention to leave. The relationships of emotion labour and emotion work with the outcomes were assessed with regard to demographics, individual differences, workload and work environment factors. The association of emotion labour performance with individual differences, workload and work environment factors, as well as health and organisational outcomes, differed from that of emotion work. Performance of emotion labour associated more strongly with negative health outcomes when compared with emotion work performance, and can be likened to a demand, whereas emotion work performance, particularly in the form of companionship, was associated with a reduction in negative affect, and can be likened to a resource for nurses. To extend these findings, a second study explored similar variables, as well as autonomy, in 176 nurses (8 males) working at private hospitals. The questionnaire package used in the first study was refined and vignettes were included in order to further explore the emotion labour and work concepts via qualitative analysis. In general, the findings from this study were consistent with those from the first study. However, emotion work in the form of companionship was negatively related to patient-related burnout once emotion work performance was restricted to the workplace. The factor structure of emotional exhaustion, measured by the Copenhagen Burnout Inventory was also confirmed. As a final element of the research, the views and perspectives about occupational strain and its management and prevention, from eight work-based consultants (Employee Assistance Providers) were investigated using a structured interview format. This led to a greater understanding of how their knowledge of occupational stress in nursing staff might be applied in the refinement of management policies, as well as what individual, team and organisational interventions are currently used for managing occupational stress in hospital nurses. The research demonstrates the importance of emotion variables in the prediction of job well being and satisfaction. The Conservation of Resources Theory, along with the UK Health and Safety Executive Stress Management Standards, are consistent with the empirical findings and are judged to be useful for the design of policies and interventions aimed at improving job health, satisfaction and retention. It is recommended that emotion work and labour be factored into organisational level stress management interventions and that psychological health practitioners be involved with the evaluation of the intervention implementation and outcome.