This is confirmed by a general practitioner in the same paper who observes that “feelings can get in the way if you’re trying to make a diagnosis . . . you’ve got to try and remain objective. It’s better to get on with the medicine and let the nurse’s deal with the emotions”. Because of the degree of potentially heightened emotion that can occur within the medical relationship, doctors and consultants often attempt to limit their emotional investment with precautionary or protective strategies (Lupton, 1997). An example of this is given in McCreight (2004) who noted that although the consultant tends to deliver bad news of pregnancy loss, it is left to the nurses to deal with the patient’s subsequent emotional distress. One study that did look at emotion management amongst doctors (albeit medical students) was that of Smith and Kleinman (1989).



In these cases, it could be that performance of emotional labor has quite severe negative consequences on their mental well-being (see later section too) since the dissonance is such that they want to genuinely feel emotionally appropriate but simply cannot. If feeling the right emotions is intimately linked in their minds to being good at their job, how will they feel when they do not feel these emotions but have to, instead, rely on faked expression in order to fulfill their own criteria of doing their job well? It is possible that this could affect their self-esteem and self-efficacy more than the worker who is performing emotional labor only to meet organizational demands (and who thus does not expect that genuine feeling is an indication of being good at the job).




Charles et al. (1999) suggest that an increasing interest in partnership in patient-professional relationships is associated with the rise in consumerism with patients seeing themselves as consumers with associated rights and expectations. McQueen (2000) highlights that the changing terminology reflected in the medical literature from patient to client implies participation and the “buying” of a service with the expectation, by patients, of certain standards; these standards usually include an expectation with regard to the emotional way in which the medical care is carried out.



She takes this idea further in her own study of 45 nurses by distinguishing the “professional face”, the “smiley face” and the “humorous face” which she feels nurses use to manage some of the emotional demands made of them. Various studies highlight the importance of a nurse’s ability to manage emotion and to present the desired demeanor in a number of health-care settings; for example, James’ (1989, 1992) study of nursing the dying shows how working on one’s emotions can be described as “hard” and “productive” work; Staden (1998, p. 149) used three case studies to “recognize and value emotional labor” whilst Phillips (1996) commented on the gap that seems to have appeared between the supposed elevated status since the 1970s of the emotional components of nursing and the reality; Smith (1988, 1991, 1992) notes how student nurses have to learn to be competent emotional laborers and Strauss et al. (1982) were one of the first to coin a phrase, “sentimental work”, in recognition of the emotional component of the role.




Despite the examples of emotional labor inducing events provided by the above review, there is a lack of clarification in terms of why such events are emotionally charged. For example, why and under what circumstances are patients hostile or uncooperative? What kinds of things do elicit disgust in nurses or health careers? Why do nursing staff get irritated with patients? It is the lack of this kind of clarification that makes managerial attempts to control emotional labor performance more difficult; if the general categories of emotional labor inducing events were documented, it would be somewhat more realistic for health-care managers to try to implement interventions at this stage. This issue will be returned to with the development of the healthcare model of emotional labor.



A range of reasons for this is offered; according to Smith and Gray (2000), within nursing, the length and uncertainty of some treatments, together with the often repressed feelings that the patient and nurse may have about a very difficult medical experience, mean that professionals inevitably have to adopt strategies to manage emotions. In addition, nurses may well at times feel negative emotions such as disgust, irritation and anger, the expression of which would not be conducive to the patient experience.




Although emotional labor has been the focus of much debate and empirical enquiry within a range of health-care settings over the past decade or so, the most prominent of these is nursing with studies conducted in the context of general nurses (de Castro, 2004; de Raeve, 2002; Smith and Gray, 2000; Kelly et al., 2000; Henderson, 2001; Staden, 1998; Rafaeli and Sutton, 1987), learning disability nurses (Mitchell and Smith, 2003), mental health nurses (Mann and Cowburn, 2005; Majomi et al., 2003), midwives (Hunter, 2001), gynaecology nurses (McCreight, 2004; Bolton, 2000) and hospice nurses (James, 1989).


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