Influence of Emotional Labour on Burnout among Nurses: A Sem Approach

Introduction

Human Resource Department is facilitating the organizations for the better utilization of human potential as they are the most precious asset of all the organizations. Human being has the capacity to direct the world. They have the power of logic, reasoning, will and most importantly the emotions which separate them from the other living beings. Development of the service sector and an increase in the level of interaction between the employees and the customers has made emotions of employees an important and integral part of labour which they have to do for their job. Over the last few years, India is experiencing a revolution in the health care sector. Indian healthcare sector, especially the hospitals are at par with western countries. The people living in other countries are coming to India for the best health care facilities at the cheapest rates as medical tourism. For providing best services to the patients, employees of these hospitals have to undergo through emotional labour process which results in negative outcomes like burnout. The present empirical study is conducted to find the influence of emotional labour on burnout.

Emotional labour had been used in describing emotion as part of work. Emotional labour was the control of the behavior to display the appropriate emotions. Hochschild [1] found that emotional labour was required in jobs that involved face-to-face or voice-to-voice contact with the public; required a worker to produce an emotional state in another person; allowed the employer, through training and supervision, to exercise a degree of control over the emotional activities of employees. Ashforth and Humphrey [2] defined that “emotional labor occurred when labourer deliberately attempted to direct his or her behavior towards others in order to foster both a certain social perception and a certain interpersonal climate. Morris and Feldman [3] described that during interpersonal transactions emotional labor could be defined as an effort, planning and control needed to express organizationally desired emotion. Frequency of interactions, attentiveness like intensity of emotions, duration of interaction, variety of emotions required and emotional dissonance were the four proposed dimensions of emotional labour. According to this perspective, emotional labor was a characteristic of the job. Grandey [4] defined emotional labour as the process of regulating both feelings and expression for the organizational goals. Bernard [5] admitted that these days the expression mainly used in service sector are “labour of love”, and “labour with a smile”, “comforting labour”. Emotional labour could be considered as a subjective effort as there is capacity for self-development.

There are two types of emotional labour namely: surface acting and deep acting.

• Surface Acting: Surface acting involved "painting on" an affective displays or faking of emotions. In surface acting an employee would be presenting his or her emotions without actually feeling them. He put on a "persona (a mask)” and pretend as if the emotions were felt within.
• Deep Acting: Mainly, there are two different emotional actions in deep acting. First is to exhibit the actual emotions that one could feel. The second emotional action means ability to allow past emotional experiences to encourage real emotion that one might not have felt otherwise. Hsieh and Yang [6] confirmed that emotional labour was important for public service work and recently had gained significant attention from public administration scholars. Hennig, et al. [7] examined the effects of two impacts of employee emotions on customers. They investigated the influence of these display of positive emotions on service employees and found that authenticity of employee’s emotional labor of employees which directly affected consumer’s, emotional state. The smiles of employees did not influence customer emotions.

Many professions like hospitality sector, hospitality professionals, counselors and therapists, psychologists, actors, receptionists, air-hostesses had emotional labour as integral part of their profession.

These days, due to heavy workload, high competition and organizational role stress, a large number of qualified, energetic and productive employees are in the flames of burnout. Burnout was first coined by American psychiatrist Freudenberger in 1970s. Burnout could be considered as a feeling of emotional and physical exhaustion attached with a deep sense of frustration and failure. A social psychologist Christina Maslach [8] with her colleagues began to explore the loss of emotional feeling and concern for clients among human services professionals. Burnout was primarily a work-related illness caused by an imbalance in an individual’s personal goals, ideals, and needs as related to their job, but sometimes stresses and factors outside the workplace could also contribute to the problem. Wolfe [9] found burnout to be a pervasive and unbearable syndrome within the services professions. The causes of burnout were namely: failure to meet the goal; work overload, role conflict and strategies for coping were suggested. In Mosby's Dictionary of Complementary and Alternative Medicine, Jonas [10] defined burnout as a state that occurs when energy is used up faster than it is restored. The main dimensions of burnout were emotional exhaustion, depersonalization and personal accomplishment. Emotional exhaustion could be referred as a depletion of emotional resources. Emotionally exhausted employees typically felt as though they lack adaptive resources and could not give any more to their job. Depersonalization was also known as cynicism and disengagement in the academic literature. Depersonalization was an attempt to get distance between oneself and service recipients by actively ignoring the qualities that made them unique. The third component of burnout was characterized by a tendency to evaluate one’s behavior and performance negatively.

Review of Literature

Researchers have confirmed that job demand, job control and job burnout were very much high in employees who were performing emotional labour in comparison to those who were not performing it. Following are the few studies advocating the above said: Grandey, et al. [11] found that there was a positive relationship between stress, appraisal of customer aggression with emotional exhaustion and this mediated the relationship of stress appraisal with absences. The employees who felt threatened by customer aggression used surface acting while deep acting was used by those who were less threatened by their customers. Warhurst, et al. [12] claimed that workers who perform emotional labour under conditions of low job autonomy or high job involvement were more at risk of emotional exhaustion than others who did not perform this. Mohammedyfar, et al. [13] expressed that emotional intelligence and occupational stress were explained 43.9% of variance of mental health in Indian teachers sample. The teachers who had reported higher emotional intelligence had better mental health. Emotional intelligence and burnout explained 13.5% of variance of physical health. Noor, et al. [14] showed that there was a positive association of surface acting with emotional exhaustion and depersonalization. Work–family conflict mediated the relationship between emotional labor and burnout. Kim, et al. [15] showed that the mean values of job satisfaction, job insecurity, and the level of depressive symptoms of the employees who were working in the area of emotional labor were higher than the others. Brotheridge, et al. [16] compared two perspectives of emotional labor as predictors of burnout beyond the effects of negative affectivity i.e. job-focused emotional labor and employee focused emotional labor. It was reported by five occupational groups that there existed significant differences in emotional demands. Surface level emotional labor (faking) predicted depersonalization beyond the work demands. Celik, et al. [17] found relationship between the emotional labour and burnout displayed by the nurses, the employees of one of the career groups in which high level of interaction with the human beings occur, it had been determined that there was a correlation between emotional labour with its sub- dimensions, and burnout with its sub-dimensions.

Results

Descriptive statistics, correlation and regression analysis was done on SPSS 17.0 version. The following table 1 presents the frequency distributions of demographic variables of nurses in selected hospitals.

Table 1 describes the complete description of the respondents on demographic variables namely: age, gender, marital status and years of experience.

Descriptive statistics for emotional labour and burnout is given in table 2. The mean score of emotional labour is 3.03 and for burnout is 2.86 which means that comparatively emotional labour is on higher level and burnout is on the moderate level among nurses of selected hospitals of Punjab. The results were in line with Patrick and Lavery. They found Victorian nurses were not experiencing high levels of burnout and the vast majority was satisfied with their career choice.

* Correlation is significant at the 0.05 level and ** at 0.01 level of significance. Table 2: Means, standard deviations and inter-correlations of dimensions of Emotional labour and Burnout.

Table 2 also represents inter-correlations between emotional labour, four strain outcomes (surface acting, deep acting, emotional consonance and suppression) and burnout (physical exhaustion, mental exhaustion and emotional exhaustion). Among all the dimensions of emotional labour, emotional consonance was on higher side. Surface acting was the least adopted strategy among nurses which means that, nurses were not faking emotions rather they can easily express their feelings to their patients. Burnout level was on moderate level. Significant positive correlation r= .578 was observed between the dimensions of emotional labour and burnout. The results of the present study are in line with Ndetei, et al. [20]. They found that out of a sample of 530 nurses working in psychiatric hospitals, 95% of the respondents reported low to high emotional exhaustion while 87.8% reported depersonalization. Low accomplishment was reported by only 38.6% while 61.4% reported average to high personal accomplishment. Several work- and non- work-related factors including young age, number of own children, number of years worked, heavy workload and low morale were positively associated with various syndromes of burnout. Relationships at work, with family and society were generally rated as average.

Structural Equation Modeling

Structural equation modeling was applied to develop a relationship among independent variable i.e. emotional labour and dependent variable i.e. burnout. The results of AMOS output proved that there was a positive correlation between emotional labour and burnout. The regression coefficient of emotional labour in burnout was 0.74. From the analysis, it was found that all the dimensions of burnout had a positive regression coefficient i.e. which indicated that if the emotional labour increased then burnout also increased. For 1% change in emotional labour there would be .74% change in burnout.

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For the relationship between burnout and its dimensions, it was found that emotional consonance and suppression have less influence on burnout.

Recommendations

From the findings of current study, it was found that emotional labour had a positive significant influence on burnout. In the fourth coming years, hospital sector is expected to get a boom and then a surge to compete is predicted in the tough competitive environment. To fight with the fatal diseases, employees have to increase their level of emotional labour as the other service sectors i.e. hospitality sector, air crews sector are doing for their survival. As rightly said, prevention is better than cure. Following are some recommendations to be followed to avoid burnout.

• Since heavy work load has made employees helpless to spend time with their families so management should introduce recreational clubs, fun activities for employees and their families on every alternate weekend to give them a break from their monotonous and perceived boring schedules.
• It has been observed that employees also feel physically exhausted. They feel tired, wiped out, sleepy and less energetic. To improve their physical fitness: their work load should be minimized. If it is not possible, then employees can choose a time during the day to shut out the outside world and indulge in some meditative music. Doing some deep breathing, visualizations and positive affirmations can help them to get rid of fatigue.
• It is observed that employees in hospitals also feel mental exhaustion. So it is recommended that that they should be trained to do yoga and meditation. For this, workshops on yoga should be arranged.
• From the findings, it has been found that employees sometimes feel depressed and anxious. They see themselves in trouble and feel trapped. The best way to reduce emotional exhaustion among employees is to provide them emotional support from their colleagues, management and from the relatives of the patients.
• The hospital management should support the decisions of their employees in critical and difficult situations so that they feel emotionally supported.

• Employees should be sent to training programmers to develop necessary skills to adopt deep acting.
• Hospitals authorities should help their employees to deal with eccentric behavior of patients as difficult and threatening patients are also a source of burnout.
• Management should create cohesive environment where employees can openly discuss their frustrations caused by patients and their relatives.

Limitations and Future Research

The present study has a number of limitations that need to be addressed in future research. The sample consist of employed doctors, nurses and paramedical staff, so separate research can be conducted on nurses, doctors and paramedical staff to have a in depth insight into the variables and their effect. Future studies also need to examine the impact of emotional labour on employees’ well-being and their performance. The researchers also need to explore the moderating effect of emotional intelligence on the relationship between emotional labour and emotional exhaustion. Emotional intelligence is the ability to understand own emotions and managing these emotions so its mediated role should be considered.