COMMENTARY

When Nurses Need Nursing: The Toll of Emotional Labor

Laura A. Stokowski, RN, MS

Disclosures

May 13, 2014

In This Article

The Need to Nurse the Nurse: Emotional Labor in Neonatal Intensive Care

Cricco-Lizza R
Qual Health Res. 2014;24:615-628

Calm on the Outside, Rolling on the Inside

The term "emotional labor" is like the word "eccedentesiast" (pronounced "ex-ced-den-tee-she-ist"): You might not have heard of it, but when someone tells you what it means, you recognize it instantly.

In fact, you might recognize yourself as an eccedentesiast -- someone who hides his or her true emotions behind a smile -- as well as someone burdened by "emotional labor," which is (at least in the context of nursing) the energy you expend to present that smiling face to patients, visitors, coworkers, and healthcare colleagues, regardless of how you are really feeling. One's true emotions, tossed about by the daily demands of nursing practice, are hidden beneath the demeanor of the cool, calm, and collected nurse, and tears are saved for the drive home.

An Ethnographic Study of Emotional Labor

A researcher from the University of Pennsylvania, Roberta Cricco-Lizza, recently examined the nature of emotional labor in neonatal intensive care unit (NICU) nurses. The NICU is a stressful work environment.[1] Not only is the work demanding, but the parents of sick infants typically spend a great deal of time at their infants' bedsides, and the responsibility of meeting the emotional needs of parents falls largely to the nurses. Visiting hours of most NICUs are liberal, often permitting 24-hour access to the unit, so nurses rarely get a break from the nonstop effort of emotional labor.

Ethnographic research requires the investigator to become embedded in the everyday lives of the group being studied, and to interact with participants in their natural settings over an extended period. Cricco-Lizza used this approach to study emotional labor in a group of 114 nurses over 14 months in a level 4 NICU located within a children's hospital.

During that time, the investigator conducted observation sessions and interviews with nurses and parents on all shifts, and observed the nurses' behavior during interactions with babies, families, other nurses, and staff members. She conducted informal interviews about day-to-day work and the meaning that these nurses derived from providing care. She also conducted formal interviews with a sample of 18 "key informants" about the challenges of working in the NICU and their life outside of the unit, to gain a deeper and more nuanced exploration of everyday practice, emotional labor, and coping strategies of NICU nurses. She then put all of these data together to understand the undercurrent of emotional labor that ran throughout nursing staff of the NICU.

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