COMMENTARY

When Nurses Need Nursing: The Toll of Emotional Labor

Laura A. Stokowski, RN, MS

Disclosures

May 13, 2014

In This Article

Unrecognized Emotional Labor

Cricco-Lizza found that the emotional labor undertaken by nurses in their day-to-day care of babies in the NICU was little recognized by nurses or anyone else. Emotional labor was hidden behind the calm, capable deportment of the nurses and was a tacit part of the NICU culture. Cricco-Lizza uncovered emotional labor only through the painstaking development of trust over time, having many discussions with the nurses, and making repeated observations in varied NICU situations.

A close examination of emotionally demanding situations and the nurses' coping strategies opened up a window into the complicated picture of emotional labor. Although the nurses appeared unflustered and proficient as they worked to save infants and support parents, their work was actually highly taxing on their emotions. The nurses effectively controlled and hid these emotions to present to families and coworkers an outward persona of competent and composed professionalism.

The data analysis revealed that NICU nurses experienced 3 main sources of emotional labor:

Caring for babies. Emotional labor arose from the challenges of caring for babies, the high acuity level of the patients, and dealing with parental anxiety. The need for constant vigilance, the small margin for error with preterm infants, and having to multitask contributed to the grueling nature of working in the NICU. Some nurses became very attached to babies and parents and experienced grief when these babies did not do well.

Employer demands. These sources of emotional labor stemmed from the demands of being an employee in the organization -- the constant change, fear of making a mistake, short staffing, dealing with technology, equipment shortages, difficult schedules and rotating shifts, and having to continually train new nurses because of staff turnover. The stress from constant change was prominent in Cricco-Lizza's conversations with nurses. Even something that sounds simple -- having to answer the phone -- was a source of stress, because the nurses often had to interrupt their care of the infant to answer the phone promptly, out of pressure to maintain a priority on "customer service."

Personal life. Emotional labor also originated in the nurses' private lives. The experience of being a mother was, for many nurses, closely tied to how they responded to situations in the NICU. Pregnant nurses experienced anxiety about their unborn children. Many nurses carried the emotional burden of demands from their personal lives, such as caring for elderly parents, into the workplace. Furthermore, it was common for nurses to report that they could not easily discuss their work-related emotions with family and friends outside of the NICU.

Coping With Emotional Labor

Cricco-Lizza investigated strategies used by the nurses to cope with the emotional labor of working in the NICU. These proved to be fairly standard and were probably the same coping mechanisms used by almost any cohort of nurses. A focus on personal wellness, having a social life outside of the unit, sleep, exercise, and spiritual renewal were among the methods reported by these nurses to rejuvenate on days off. Nurses favored 12-hour shifts, despite their being long, because the schedule allowed for more days completely away from work to recover.

At work, nurses coped by trying to be "super nurses." They focused on tasks and skill-based work, believing that it was their care that made a difference between a baby having a good or a bad day. They shared and talked with nurse colleagues and used humor, both with each other and with families, to keep tension at bay. When emotional labor became too much, some transferred out of the NICU or to a less demanding level of care. Some nurses attended memorial services for babies who died. Cricco-Lizza also observed withdrawal behavior on the part of some nurses, evidenced by minimal interaction with parents and a lack of eye contact.

Cricco-Lizza concluded that organizations needed to more closely examine the complexity of nursing care taking place within the NICU and find ways to support the emotional labor of nurses. Essentially, organizations should develop resources that would "nurse the nurses" so that nurses, in turn, are in a better state of mind to nurture and care for babies and families.

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