Centre for Health Innovation, Leadership and Learning (CHILL)
Emotional labour in the emergency department feeling rules, gender stereotypes and emotional stoicism
The National Health Service (NHS) in England is under significant pressure. Sources of this pressure include the changing demographics of the population, significant advances to medical treatments and intervention, and a shift in expectation from the public regarding the standard of care they receive (Ham, 2004). Additionally, there is now an emphasis for NHS services, and public services more generally, to be accountable to the public (Ham, 2004).
An area of care which is under considerable strain, and spends much time within the media, is that of emergency care. Emergency Departments (ED's - as they are now known), are struggling to meet patient demand. There has been an upward trajectory of patient attendance since the 1970's (Jones, 2008). Furthermore, governmental targets, and organisational pressures such as the '4-hour wait' increase the challenges for those working within emergency care (Mortimore and Cooper, 2007). It is perhaps undeniable that the challenges facing the NHS have implications for those staff tasked with delivering care.
In 2009, The Boorman Report on the Health and Well-being of NHS Staff (Boorman, 2009), found significant problems with high rates of poor well-being, this also had a direct, negative impact on the quality of care that patients received. Financial implications are also significant, estimated cost savings in reducing absenteeism are predicted at £555 million (Boorman, 2009).
In examining the well-being of the nursing workforce specifically, English nurses also fare poorly when compared on an international perspective (Aiken et al, 2012). The rates of stress, burnout, and the intention to leave are amongst the highest against other European countries, and America (Aiken et al, 2012). Aiken et al (2012) also found a strong relationship between nurse well-being and the standard of care that is delivered to patients. Despite the strong evidence showing the importance of positive nurse well-being, the emotional component of the nurse's role, a great influencer in well-being (Warren, 2016; Johnson and Spector, 2007), is overlooked in clinical practice (Smith, 2012, Theodosius, 2008). Emphasis is given to the physical nursing tasks, with little value allocated to those which are less visible, and as such, less quantifiable (Philips, 1996; Bone, 2002). As a consequence, a significant component of the role is left unsupported and depreciated (Sawbridge and Hewison, 2011), described as the emotional labour of nursing.
This study therefore, aims to develop theoretically the concept of emotional labour, through the case study setting of the highly charged ED, where arguably services are at their most stretched.
Empirical: To understand the emotional labour of the ED setting.
Theoretical: To develop and contribute to the theory of emotional labour.
PI: Dr Stephen Timmons
CHILL team: Kate Kirk (PhD Student) Professor Laurie Cohen, Dr Alison Edgley (Supervisors)
Email to find out more