Tuesday October 22nd 2019

Mitigating the risks of emotional labor

Pamela Cipriano

As caregivers, we relieve or prevent the physical and emotional suffering of others. Sometimes it is the obvious — pain relief; other times, it is the not so obvious — ensuring privacy for grieving or setting up an undisturbed period of sleep to promote healing and reduce confusion. But less apparent, and sometimes hiding in plain sight, is the suffering of clinicians and caregivers. Often this suffering is a result of the emotional labor demanded by our roles. (The term “emotional labor” is credited to Arlie Russell Hochschild in her book The Managed Heart: The Commercialization of Human Feeling.)

In any service industry, some degree of emotional labor is requisite for serving others. Emotional labor is part of nurses’ work that demands we exhibit required emotions — from a smile, to a sign of deference, to a comforting gesture — even when we do not genuinely feel the emotion. This work can exact a toll on the nurse or other caregiver who, conversely, must not show certain emotions such as disgust, fear, uncertainty, stress, sadness or disinterest. In our education, we learn the necessity of turning off real, sensed emotions with the simultaneous demand to turn on and demonstrate positive emotion.

When we provide the obligatory positive emotion in the absence of feeling that emotion, we are surface acting. Repeated surface acting, by pretending to be authentic, can lead to emotional exhaustion and burnout. However, when we work to adapt our emotional state so that it matches the necessary emotional response, we are deep acting. By getting in touch with our own emotional state and trying to understand the experiences of others, we can produce a more genuine response that does not conflict with our own values and feelings. Deep acting allows us to invoke empathy and to connect with patients in order to show compassion and an understanding of their experiences and concerns. After all, empathy is fundamental to ethical practice and is the basis of emotional labor.

Mylod, D. (2014, November). Suffering model for clinicians and caregivers. PowerPoint presentation at the meeting of the Institute for Innovation Founding Executive Council, Orlando, FL.

While some caregiver suffering can be inherent to the role, some can be avoided. The Press Ganey Institute for Innovation has characterized inherent to avoidable clinician and caregiver suffering. (See graph.) It is important to note that the more serious and avoidable triggers of clinician suffering can cause harm and must be mitigated. That’s why one of the American Nurses Association’s current professional issues panels is focused on violence and incivility in the workplace. We know it is critical to eliminate these threats to ensure a healthy and ethical work environment.

We want nurses to focus on their health and well-being, yet we know many of our work settings inflict stress and other suffering on clinicians today. We expect staff to deal with constant challenges and change as well as competing priorities, often in an environment that offers little encouragement, support, concern for personal safety or recognition. This can only predispose the environment to moral distress and strain in nurses and others.

Provision 6 of the 2015 Code of Ethics for Nurses with Interpretive Statements addresses the duty of the nurse to individually and collectively ensure an ethical environment in the work setting to provide safe, quality health care. It is well known that a healthy and morally good environment supports quality patient care and creates higher professional satisfaction, a key ingredient to minimizing and addressing moral distress. Likewise, a healthy nurse, along with a healthy and ethical work environment, contributes to better patient outcomes and satisfaction.

We can offer better care to patients by ensuring a healthy and ethical practice environment that eliminates avoidable clinician suffering. As nurses, we don’t run from the emotional labor of our work, but at the same time, we need the support to be able to be empathic caregivers, remain healthy and avoid moral distress. What’s good for nurses is good for patients.

— Pamela F. Cipriano

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