Overview of Interview Analysis

The interview data address the first research aim and three of its associated questions first posed in section 4.1 and presented again below:

1. To assess how employees are aware of necessary and appropriate emotional management, how they assess their level of responsibility for this and how these perceptions may differ depending on their role and the context.

Research questions:

a. Which emotional displays are considered appropriate by employees?

b. How do these perceptions of the appropriate emotional displays differ according to the role or context?

All interviewees from all four groups indicated that there are only very general impressions as to what specific emotions were expected either from the organisation professionally, or from co-workers or clients. When pressed to give an impression of what was expected, the inappropriateness of anger and the display of a calm demeanour were over-riding themes. Regardless of the setting, the type and level of emotional expressivity proceeded very much according to the requirements of the individual interactions, supporting previous findings of nurses engaging in emotional labour (Smith, 1992; Theodosius, 2008).

A further question relating to this research aim:

e. What role does emotional intelligence play in emotional labour?

Is best addressed by reference to the four branch model of emotional intelligence (Davies et al., 1998; Mayer et al., 2004a; Salovey & Mayer, 1990). This model explains how employees from all groups were able to evaluate emotions and respond emotionally to clients in order to ensure optimal outcomes, as has been found previously in nursing (McQueen, 2004). Evidence that patient registration clerks also used emotional

intelligence to guide interactions indicates a less scripted approach to interactions than for other employees in similar clerical or process oriented type roles (e.g. Goldberg & Grandey, 2007; Rafaeli, 1989).

The final research question related to this research aim:

c. Do perceptions of the responsibility for emotional engagement with clients differ according to the role or context?

was answered unequivocally by the interviewees: The perceived level of

emotional engagement as a role requirement differed markedly between the four groups. Palliative care nurses explained that emotional engagement with clients was a central aspect of their role and an aspect they actively pursue, supporting previous findings (e.g. Holmberg, 2006; James, 1992; Li, 2005; McIlfatrick, 2007; Melin-Johansson, Mok & Chiu, 2004; Seymour, Ingleton, Payne, & Beddow, 2003; Skilbeck & Payne, 2005). Emergency nurses also described instances in which they engaged with clients; however this was mainly to facilitate the efficient running of the emergency department and to protect themselves, co-workers, and other clients. Patient registration clerks, working alongside emergency nurses, showed far less inclination to become involved with difficult interactions with clients and generally did not see this as part of their role. Occasionally there was evidence that interactions between clerks and clients were of greater depth, but this was always of secondary importance to the information gathering aspect of the role. For renal nurses, the more predictable environment of renal wards, combined with the formation of long term relationships with clients, means that engagement with clients proceeded more naturally and was not generally associated with highly emotive interactions as was the case for the palliative care or emergency nurses. However, when asked specifically about their responsibility for the emotional state of clients and their preparedness to engage emotionally, the renal nurses indicated that they considered this to be an important aspect of their role.

Interviews with the emergency and palliative care nurses and the patient registration clerks suggest a relationship between the level of emotional engagement, and the prominence of emotional labour and other emotional management strategies.

Where the perceived emotional engagement in the role was high (i.e. for palliative care nurses) there were extensive descriptions of the use of emotional labour and other emotional management strategies, particularly reflected in instances of deep acting, with palliative care nurses showing a greater need to prepare themselves for their emotional interactions with clients than other employees. Conversely, the clerks‟ comparatively low level of a perceived requirement for engagement with clients was associated with fewer instances of the use of emotional labour or other emotional management

strategies. The case for renal nurses differs compared with the other groups and is more difficult to understand. While these nurses engaged readily, except for the provision of information as a possible emotionally protective mechanism and some instances of surface acting, renal nurses did not describe as many instances of emotional

management strategies compared to the palliative care or emergency nurses.

The finding that the perceived level of emotional engagement varied markedly between groups, and how this perception appears to have influenced the likelihood of employees to engage emotionally with clients are important issues to understand. There seems to be a distinction between occupations, with the clerks indicating less emotional engagement responsibilities, however the situation amongst the nursing groups is not completely clear due to uncertainty surrounding the renal nurses. In addition, there were no clear indications of how the perceived level of emotional engagement was related to wellbeing. Therefore, the likely impacts of the perceived level of emotional engagement on emotional labour and wellbeing require more clarification and a broader

The second research aim and its associated questions, presented again below, can be summarized together.

2. To examine the methods by which employees manage their own and others‟ emotions in the workplace.

Research questions:

a. How is emotional labour conducted by employees in the four health care contexts?

b. What is the role of natural emotion in emotional labour?

c. Does the context or occupation have an impact on which emotional labour strategies are used?

An important finding from Study 1 was that the management of natural emotion was identified as a prominent and adaptive emotional labour strategy throughout the interviews. Employees mainly used the management of natural emotion to display grief and to show anger to correct disruptive, violent or abusive client behavior, and the distinctions between the management of natural emotion and instances of emotional deviance and their differing consequences were also important findings. As expected, surface and deep acting were also identified as important emotional labour strategies, supporting previous research (e.g. Brotheridge & Lee, 2003; Diefendorff et al., 2005; Grandey, 2000; Hochschild, 1983).

In addition to the use of emotional labour as a means of controlling the emotions of the self and clients, other non-expressive emotion management strategies were

identified as being used for the same purpose. This highlights the importance of considering emotional management as more than just emotional labour. Rather, emotional labour should be seen as just one aspect of emotional management.

Non-expressive emotional management strategies included the provision of information and the use of proximity and space. Information was used by all groups although for different purposes. Employees with established relationships with clients (i.e. renal and palliative care nurses), used information to inform clients of the best health care options available, thereby distancing themselves from poor client outcomes due to poor health care decisions. In these cases, the provision of information can be seen as emotionally protective for these employees. Alternatively, for emergency nurses and patient registration clerks, the provision of information was used to establish trust and alleviate stress in the uncertain circumstances of the emergency department. In these cases, employees were focused on reducing the emotionality and stress of the client and allowing the department to function efficiently.

Limited use of proximity and space was also demonstrated as emotion

management strategies. The clerks were particularly mindful of being able to remove themselves from situations in which clients were abusive, describing how they remained calm at these times and were able attribute the discord in the interaction solely to the client. The propensity for clerks to remove themselves from interactions was associated with them being physically separated from clients as well as their perception of a lower level of emotional engagement with clients, compared to the nursing groups.

The importance of the use of natural emotion as an emotional labour strategy was evident across the four groups in the 21 interviews. However, wider evidence if its dimensionality as an emotional labour strategy in addition to surface and deep acting is needed. Given the differing relationships between surface and deep acting, and

wellbeing outcomes found previously, the consequences of the management of natural emotion is crucial to understand. The interviews suggested that the management of natural emotion was associated with positive wellbeing outcomes, however the exact relationships require clarification. In addition, group differences in these relations is also important given the differing purposes for managing natural emotion as an emotional labour strategy.

The findings for the third research aim and its associated questions, reproduced below, can be considered together.

3. To examine the differences in emotional management, well being outcomes of emotional management and factors impacting on these, dependent on context and role.

Research questions:

a. What are the relationships between emotional labour strategies and wellbeing?

b. Do wellbeing outcomes differ depending on the context or occupation?

c. What are the relationships between emotional labour, social support, and wellbeing?

d. Do the relationships between emotional labour, social support and wellbeing differ depending on context or occupation?

e. What role do individual differences such as personality play in emotional labour?

The relationship between the perceived emotional engagement requirements of the role and the prevalence of emotional management strategies was further extended to the importance of social support. In line with Hobfoll‟s (1989) COR model, the

interviews suggested that the level of emotional expenditure resulted in a similar need for the replenishment of emotional resources. The current findings emphasize what is already known about the importance of social support (e.g. Abraham, 1998; Brotheridge & Lee, 2002; Lewig & Dollard, 2003; Wilk & Moynihan, 2005), and go further to suggest that co-worker support may be crucial in situations with intense and difficult interactions with clients due to a sense of shared experience and collegiality. In addition, the form of support accessed from various sources matched the purpose of the emotional expenditure, further strengthening the applicability of COR theory. For example,

emergency nurses dealt with clients emotionally mainly for instrumental purposes, while palliative care nurses engaged emotionally with clients largely as an end in itself, to assist clients coming to terms with end of life issues. In both cases, support matched what was expended. Previous measures of support in emotional labour research have taken a fairly general focus (e.g. Abraham, 1998; Lewig & Dollard, 2003; Wilk &

Moynihan, 2005) and the importance of co-workers as a source of support has not been found to be as strong as suggested in the current research. It is clear that it may indeed be more appropriate to assess support specifically in terms of its emotional component and its instrumentality, rather than in general terms. This is a research focus for Study 2.

The interviews showed that employees from all four groups derived satisfaction from their emotional involvement with clients, and to some extent, from the emotional labour aspect of their roles as well. In particular, the palliative care nurses talked about a deep satisfaction with their work, which was closely associated with supportive

relationships with co-workers and the organisation more broadly. Previous research has also shown that palliative care nurses may experience less stress despite the emotionally taxing nature of their work if supportive mechanisms are available (Valchon, 1995). While the association between emotional labour and wellbeing deficits has generally been consistently established (e.g. Abraham, 1998; Brotheridge & Grandey, 2002; Diefendorff & Richard, 2003; Grandey, 2000, 2003; Grandey et al., 2004; Hochschild, 1983; Näring & van Droffelaar, 2007; Yoon & Lim, 1999; Zerbe, 2000), occupational differences have been noted. Nurses in this study, like those in other studies (e.g. Bolton, 2000b; Henderson, 2001; McCreight, 2005; McMillen, 2008; Smith, 1992) derive satisfaction with their emotional work, however, the findings from the interviews with clerks have not been reported elsewhere. Study 2 will investigate the relationships between emotional labour, emotional engagement and wellbeing in all four groups of employees, and differences between these groups.

Most of the research examining nurses‟ views and attitudes towards their

as surface and deep acting, so broad-based investigations of these elements in specific situations are needed. If more broad based evidence of the same themes and associations found in the current study is established, it will become obvious that specific sources of social support are crucial for these employees to maintain their emotional wellbeing and to continue to function effectively in their role. Therefore, Study 2 will assess the prominence of emotional labour strategies and the perceived emotional engagement in the role, as well as how these factors are associated with wellbeing outcomes. In addition, the role of social support and its association with wellbeing will be investigated, particularly social support that is provided in relation to the emotional expenditure with clients. Finally, the management of natural emotion emerged in the current study as a third emotional labour strategy. As there is no available measure of this aspect of emotional labour, quantitative assessments of its relationship with social support, burnout and job satisfaction and how these relationships compare to surface and deep acting are essential as a prelude to the development of any such instrument.

Previous research consistently demonstrates negative associations between surface acting and various measures of wellbeing in comparison to deep acting, highlighting the importance of investigating similar relationships when employees manage natural emotion as an emotional labour strategy. These associations will be investigated in Study 2.