Emotional Labor Strategies, Stress, and Burnout Among Hospital Nurses: A Path Analysis

Purpose This study aimed to examine the associations among emotional labor strategies, stress from emotional labor, and burnout in nurses. Design We employed a descriptive cross-sectional design. Data were collected from May to November 2018 in South Korea using structured questionnaires. Participants were 303 nurses from 27 hospitals, who were recruited by convenience sampling. Methods Emotional labor strategies (surface acting, deep acting, and expression of naturally felt emotions), stress, and burnout were self-reported. A path analysis using structural equation modeling was performed to examine the associations among the study variables. Findings Bivariate analyses revealed that surface acting was positively correlated with stress and burnout, deep acting was negatively correlated with burnout, and naturally felt emotions were negatively correlated with stress and burnout. The path analysis revealed that surface acting was positively associated with stress, naturally felt emotions were negatively associated with burnout, and the stress from emotional labor was positively associated with burnout. Although surface acting was not directly associated with burnout, it was indirectly associated through stress. Conclusions Surface acting involves regulation and suppression of one's felt emotions. The findings of this study suggest that hospitals need to reduce expectations for surface acting to reduce nurses' stress and burnout. Organizational efforts to provide interventions that improve nurses' ability to manage their emotions in interactions with patients might effectively foster nurses' well-being. Clinical Relevance Surface acting might contribute to nurses' burnout, and naturally felt emotions might reduce nurses' burnout. Nurse managers should thus provide opportunities to discuss the utilized emotional labor strategies and encourage appropriate responses depending on the patient context. Programs that promote emotional competence may reduce the adverse effects associated with nurses' emotional labor and foster effective coping strategies.