Kirk K, Cohen L, Edgley A, Timmons S. "I don't have any emotions": an ethnography of emotional labour and feeling rules in the emergency department. J Adv Nurs 2021; 77: 1956-1967.

...nurses have unwritten rules for coping.

Nurses working in emergency departments (EDs) in the United Kingdom are at high risk of anxiety, stress and burnout due to increased patient attendance and intense government targets. 'Changes in provider-patient relationship, acuity of patients, their complex needs, associated financial constraints and availability of resources have an impact on the pressures facing nurses.' While the emphasis in nursing is on the physicality and clinical skills of their work, many tasks are invisible and difficult to quantify. Emotional labour is defined as 'the management of feeling to create a publicly observable facial and bodily display.' It takes work to create that calm, coping carapace of the caring nurse.

Ethnography is a form of qualitative research, used to study behaviours with communities. In this study, ED nurses (n = 18) completed semi-structured interviews after 200 hours of authorial observation in their departments, in order to understand what underpins the values and beliefs which drive their behaviours - how they 'do' emotional labour. Four 'feeling rules' were established:

  1. 1.

    Feeling rule 1 - feel tough, fearless and detached. The 'feminine' side of nursing (showing warmth, connection and affection) frequently has to be subsumed into 'masculine', task-based behaviours in a busy ED. This results in a degree of tension as emotional labour is used as defence against building relationships and connection with patients

  2. 2.

    Feeling rule 2 - feel calm yet in control. In the face of time pressures, organisational priorities and a patient with a more serious condition than they realise, nurses work to mask their busyness both from the patient and from colleagues

  3. 3.

    Feeling rule 3 - feel empathy and do not feel resentment. All patients should be treated equally yet nurses use emotional labour 'to suppress resentment towards patients who appear to perceive that that their clinical condition should be a higher priority than it is'

  4. 4.

    Feeling rule 4 - do not feel (too much) distress and grief. ED nurses need to be seen to be stoic and hiding personal sadness while showing care is a difficult balancing act. There is frequently no space to process their own upset, other than the sluice room or the corridor.

Understanding emotional labour is complex but is closely associated with staff wellbeing. Different roles will have other, more diverse emotional challenges. The consequence of these challenges - anxiety, stress and burnout - could equally apply to dentistry. The authors conclude that their findings 'may offer a starting point for research into other distinctive healthcare contexts.'