Development and validation of an emotional labour scale for nurses

Emotional labour in nursing research: A bibliometric analysis

AIM

This study aims to conduct a comprehensive bibliometric analysis to explore the trajectory and thematic developments of emotional labour research in nursing.

DESIGN

Utilizing descriptive and bibliometric analysis techniques.

METHODS

The data analysis and graphical presentation were conducted using the Bibliometrix Package in R software.

DATA SOURCES

The Web of Science Core Collection (WoSCC) database was searched on October 20, 2023.

RESULTS

From 1992 to 2023, 842 authors published relevant articles, yielding 779 author keywords. There has been a general upward trend in the number of articles published over the past 30 years, with an annual growth rate of 11.71%. Keyword co-occurrence cluster analysis revealed the main focus areas of research on emotional labour antecedents and consequences, regulatory modalities, training and education, as well as research methods and application scenarios.

CONCLUSION

Emotional labour significantly influences nursing staff's well-being and patient care outcomes. Effective management and education regarding emotional labour are crucial for enhancing nursing staff performance and patient care quality. Future research should focus on long-term effects, training efficacy, regulatory strategies across clinical settings, and innovative approaches to address current challenges.

IMPACT

This study provides valuable insights into the unique trajectory and thematic developments of emotional labour research in nursing. The findings underscore the importance of addressing emotional labour in nursing practice and education to improve patient care outcomes and nursing staff well-being.

REPORTING METHOD

Adherence to recognized bibliometric reporting methods, following relevant EQUATOR guidelines.

NO PATIENT OR PUBLIC CONTRIBUTION

This study is based solely on existing literature and did not involve patients or the public in its design, conduct, analysis, interpretation, or preparation.

Emotional labour and turnover intention among nurses in China: Mediating effects of nurse-patient relationship and self-rated health

AIM

This study tested the mediating role of the nurse-patient relationship and self-rated health in the effect of emotional labour on turnover intention among nurses in China.

BACKGROUND

The underlying mechanism behind the effect of emotional labour on turnover intention remains inadequately understood.

INTRODUCTION

Nurses with a high level of emotional labour are predisposed to experiencing poor health and tension in their relationships with patients, which may increase turnover intention.

METHODS

A cross-sectional survey of 527 nurses in a public tertiary hospital in Qiqihar, located in China's Heilongjiang province, was conducted. Emotional labour and turnover intention were assessed using existing validated scales containing multiple items, while the nurse-patient relationship and self-rated health were assessed using single items, respectively. Baron and Kenny's causal steps and the Karlson/Holm/Breen method were adopted to test the mediating effects of the nurse-patient relationship and self-rated health in the association between emotional labour and turnover intention after adjusting for variations in sociodemographic and job characteristics.

RESULTS

Emotional labour was positively associated with turnover intention. Self-rated poor health and a disharmonious nurse-patient relationship partially mediated the positive effect of emotional labour on turnover intention.

CONCLUSIONS

Emotional labour significantly affects the turnover intention of nurses working in public tertiary hospitals in China, and this effect is partially mediated by self-rated health and the nurse-patient relationship.

IMPLICATIONS FOR NURSING PRACTICE AND NURSING POLICY

Giving more attention to nurses' negative emotions and work attitudes is crucial. Developing comprehensive strategies for enhancing nurses' emotional management ability, promoting their physical and psychological well-being, and improving nurse-patient relationship to reduce nurses' turnover.

Competence in managing workplace violence among nursing interns: Application of latent class analysis

AIM

To identify subtypes of competence in managing workplace violence (WPV) among nursing interns and to assess between-group differences.

BACKGROUND

Nursing interns are reported to be a vulnerable population for experiencing workplace violence during their clinical placement. Although WPV could have a negative impact on nursing interns' health and attitudes towards the nursing profession, little is known about nursing interns' competence in workplace violence management or its influencing factors.

DESIGN

A cross-sectional study.

METHODS

Between March to April 2023, nursing interns at three tertiary general hospitals in Anhui Province, China, completed questionnaires including a general information questionnaire, the Management of Workplace Violence Competence Scale (MWVCS), the Utrecht Work Engagement Scale (UWES-9), the Emotional Labour Scale for Nurses (ELSN) and were classified into subtypes by latent class analysis. Subsequently, univariate analysis and multivariate logistic regression were performed to identify the influencing factors by subtypes.

RESULTS

A total of 264 questionnaires were valid and the overall mean age of the participants was 21.06 ±1.41 years. Four classes were identified: low competency group (15.5%), low cognition-low coping competency group (18.2%), low cognition-medium to high competency group (21.6%) and high competency group (44.7%). The results of multinomial logistic regression analysis showed that placement hospitals with a WPV management department, emotional control effort in profession dimension and emotional pretense by norms dimension in the Emotional Labour Scale for Nurses, pursuing further education and vigour dimension in the Utrecht Work Engagement Scale were influencing factors of the potential categories of WPV management competence.

CONCLUSIONS

Four classes were identified and there was competence variability among nursing interns. More attention should be given to nursing interns who did not receive WPV-related training in their school or placement hospital.

Emotional labor and job satisfaction among nurses: The mediating effect of nurse-patient relationship

Emotional labor is considered an important part of the role in the nursing field. Previous studies have found inconsistencies between emotional labor and job satisfaction of nurses, this is due to the relationship between them being affected by other factors. However, the current nurse-patient relationship is tense and leads to an unsafe and unstable working environment for nurses. It has yet to be confirmed whether the nurse-patient relationship can be used as a mediating variable to further explain the association that exists between emotional labor and job satisfaction. Therefore, this study tested the mediating effect of the nurse-patient relationship between emotional labor and job satisfaction among Chinese nurses. A total of 496 nurses were included in the study. Data collection was from December 2021 to March 2022 using the convenience sampling method. SPSS 26.0 and AMOS 23.0 software were used to perform structural equation modeling and analyze the relationship between variables. The results showed surface acting negatively affected nurse-patient relationships and job satisfaction, contrary to deep acting and naturally felt emotions. The parallel mediation of nurse-patient trust and patient-centered nursing in the relationship between emotional labor and job satisfaction was found to be statistically significant. Our study highlighted the important mediation of nurse-patient trust and the importance of the positive effects of emotional labor. Future studies can use these findings as a reference to develop interventions.

Measurement Invariance and Latent Mean Differences in the Nurses' Emotional Labour Scale

BACKGROUND

The measurement invariance and latent mean differences in emotional labor across different hospital and monthly salary levels among registered nurses have never been confirmed for the Emotional Labour Scale. These issues may influence the application and efficacy of this scale in practice.

PURPOSE

This study was developed to evaluate the factor structure of the nurses' Emotional Labour Scale and to examine the measurement invariance and latent mean differences for this scale across different hospital and monthly salary levels.

METHODS

Data were collected from 461 registered nurses working in four general hospitals and 12 long-term care hospitals. Confirmatory factor analysis and a multigroup confirmatory factor analysis were performed to determine the internal structure and measurement invariance of the Emotional Labour Scale.

RESULTS

The results of the confirmatory factor analysis indicate that the factor structure model proposed by the original scale fits well with our data as well as configural invariance, factor loading invariance, intercept invariance, and uniqueness invariance. Moreover, factor variance/covariance invariance across two hospital levels as well as configural invariance, factor loading invariance, and intercept invariance across two monthly salary levels were supported. The mean score for emotional control effort in the profession of general hospital nurses was lower than that for long-term care hospital nurses. No statistically significant latent mean differences were found across monthly salary levels.

CONCLUSIONS/IMPLICATIONS FOR PRACTICE

The findings show the Emotional Labour Scale to be a valid and reliable tool for assessing registered nurses and also comparing the mean score for emotional labor across hospital and monthly salary levels to be feasible. The scale may contribute to the development of human resource strategies.

Aspects of emotional labor of public health nurses engaged in interpersonal support

AIM

Clarifying the emotional labor of public health nurses while providing interpersonal support.

DESIGN

Qualitative descriptive study conducted using content analysis to clarify the aspect of emotional labor of PHNs regarding interpersonal support.

METHODS

Individual semi-structured interviews were conducted with 28 public health nurses employed by seven city governments in Japan. The data items obtained were categorized using deductive content analysis.

RESULTS

When attempting interpersonal support, PHNs showed the following aspects of emotional labor: (1) negative emotions towards residents and resident-focused emotions; (2) emotional rules based on duty performance, emotional rules based on fairness, emotional rules based on intimacy; (3) adaptive emotional regulation, maladaptive emotional regulations and (4) emotional expressions based on friendliness, emotional expressions based on calmness.

CONCLUSION

PHNs used adaptive emotional regulation in some cases and sometimes resorted to maladaptive forms. A system of support should be established to ensure the smooth and effective provision of interpersonal support.

Relationship between perceived organizational support and professional values of nurses: mediating effect of emotional labor

Objectives

Perceived organizational support was a benefit for the work performance of nurses, which may affect emotional labor and the development of professional values. This study aimed to explore the relationship between nurses’ perceived organizational support and professional values, and investigate the mediating role of emotional labor.

Methods

This was a cross-sectional study. The study was conducted in 3 tertiary hospitals in Wuhan from October 2020 to January 2021. The data were collected by a questionnaire consisting of demographic characteristics, the Emotional Labor Scale for Nurses, the nurses’ Perceived Organizational Support Scale, and the Nursing Professional Values Scale (NPVS-R). A convenience sample of 1017 nurses responded to the questionnaire survey. Pearson’s correlation analysis was used to test the relationship between variables. Predictor effects were tested using hierarchical multiple regressions. The structural equation model (SEM) was used to test the mediation effect of emotional labor on the pathway from perceived organizational support to professional values.

Results

A positive moderate correlation was observed between the perceived organizational support and emotional labor (r = 0.524, P < 0.01), and a positive strong correlation was observed between perceived organizational support and professional values (r = 0.609, P < 0.01). Emotional labor and perceived organizational support were positive predictors of professional values (B = 0.531, 95%CI = 0.414 ~ 0.649; B = 0.808, 95%CI = 0.715 ~ 0.901, respectively). The association between perceived organizational support and professional values was mediated by emotional labor.

Conclusions

Results showed that perceived organizational support was positively related to nurses’ emotional labor, which was in turn associated with high professional values. For nurses, improving organizational support and training nurses to engage in emotional labor through providing multiple support systems, establishing appropriate incentive mechanisms, and training nurses to regulate emotions can be effective ways to promote nurses’ professional values.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12912-022-00927-w.

Capturing Interactive Work for Nurses-First Validation of the German IWDS-N as a Multidimensional Measure

The theoretical framework of interactive work provides a multi-dimensional perspective on the interpersonal demands of nurses in nurse-patient interactions. It is defined by four dimensions: emotional labor directed to the self and others, cooperative work, and subjective acting. While the framework stems from qualitative research, the aim of the current study is to translate it into a quantitative scale to enable measurement of the high interpersonal demands that so often remain implicit. For this reason, we conducted an online survey study (N = 157; 130 women, 25 men, 2 divers) among professional nurses in Germany (spring 2021) to test the derived items and subscales concerning interactive work, which resulted in a 4-factor model that was verified with confirmatory factor analysis (CFA). The survey further captured additional information on established constructs concerning job-related well-being (e.g., burn out, meaningfulness), job characteristics (e.g., work interruptions, time pressure) and individual resources (coping strategies) that are supposed to correlate with interactive work demand scales for nurses (IWDS-N), to determine the quantitative nature of their relations. The results show that the subscales of the IWDS-N have adverse effects on indicators of work-related well-being. Moreover, negative job characteristics, such as time pressure, are positively correlated with subscales of the IWDS-N and are therefore problem-focused coping strategies as an individual resource. The results emphasize that a multidimensional consideration of self-regulatory processes is useful to capture the subtle and complex nature of the interactive work demands of nurses. The current study is the first that developed a quantitative, multi-dimensional measure for interactive work demands, which can help make implicit demands in service work explicit.

Curvilinear relationship between emotional labour and work engagement in nurses: A correlational study

AIMS AND OBJECTIVES

To examine if there was a curvilinear relationship between emotional labour and work engagement in Chinese nurses.

BACKGROUND

Emotional labour has both positive and negative effects on work engagement, but the curve relationship between the two has not been tested.

DESIGN

Correlational design.

METHODS

Multi-stage stratified random sampling was used to recruit samples, and 528 nurses from 5 tertiary first-class general hospitals were recruited in Henan Province. Data were collected by using Hong and Kim's Emotional Labor Scale for nurse and the Utrecht Work Engagement Scale-9. Curve estimation was used to explore the functional model between emotional labour and work engagement. Results were reported according to the STROBE Statement.

RESULTS

The three dimensions of emotional labour, 'emotional control effort in profession', 'patient-focused emotional suppression' and 'emotional pretense by norms', had a function relationship of quadratic (R²  = .57, p < .001), quadratic (R²  = .569, p < .001) and cubic (R²  = .238, p < .001), respectively, with work engagement.

CONCLUSIONS

There was a one-way increasing quadratic function relationship between 'emotional control effort in profession' and work engagement. However, 'patient-focused emotion suppression' and 'emotional pretense by norms' had an inverted U-shaped curve relationship with work engagement. Below the moderate level, 'patient-focused emotion suppression' and 'emotional pretense by norms' were positively related to work engagement. After a certain level, they were negatively related to work engagement.

RELEVANCE TO CLINICAL PRACTICE

Our results may provide evidences to manage nurses' emotional labour and improve their work engagement. It seems that encouraging or training nurses to learn and master more strategies of emotional control may improve work engagement. Moreover, nursing managers should fully recognise the positive and negative effects of different levels of emotional suppression and emotional pretense on work engagement, so as to develop targeted management strategies.