5.5.1 Job satisfaction and employee wellbeing. The current research showed that, not only can emotional management strategies be functional, but employees in many different circumstances can enjoy the interactions with clients. Evident from the interviews in this research was that the level of satisfaction with this type of work varied from the deep and profound experiences of palliative care nurses to the much more incidental and less outcome focused experiences of the patient registration clerks.
Many descriptions of emotional management in workplaces have taken a negative view of the effects of this aspect of work on the wellbeing of employees. Emotional management (particularly emotional labour) has been associated with the disempowerment of employees and the requirement of slavish and diligent adherence to organisational demands to please the customer, ensure return business, and improve bottom line returns (Hochschild, 1979, 1983; Williams, 2003).
In the public health care sector, a profit motive and focus on customer
satisfaction as the primary goal of emotional management may be less important than for other situations such as the airline industry. As has already been shown, the employees in this research were driven by quite different motives for managing emotions than purely for ensuring return business and profits. Therefore, wellbeing outcomes and satisfaction from this aspect of the role can be considered in quite a
different light than for situations in which employees are pressured to conform to strict rules and satisfy customer demands.
The bleak view of emotional labour as being detrimental to employee can be challenged in this research as has been argued elsewhere (e.g. Ashforth & Humphrey, 1995; Wouters, 1989; Zapf & Holz, 2006). In particular, the palliative care nurses derived much satisfaction from being emotionally engaged with clients and helping them to come to terms with death related issues. The notion of helping client to achieve a good death was of prime importance;
“…but actually it can be quite rewarding if you have what we would call a good death. So a client gets to where … he or she needs to be or wants to be and the family also travel that journey. You know, to be able to pull out of a driveway and go that went quite well. That‟s perhaps an odd kind of satisfaction.” [PN5].
In the comment below, the nurse compared palliative care to other nursing work; “I think out of all the nursing I‟ve ever done that‟s the most rewarding. I mean you can restore somebody after their appendix or something but … that‟s a run of the mill thing it‟s common and you know… I think
because of the emotional side of grief and loss I feel like I can do a lot … lot more and it‟s very rewarding” [PN6].
As was evident throughout descriptions of the manner in which the palliative care nurses engage with clients, there was a good deal of commitment to helping their clients come to terms with either their own death or the death of loved ones. The palliative care nurses displayed a lot of pride in their work and their level of self-
Emergency nurses took a different perspective on the enjoyable or satisfying aspects of their role. The explanations of elements of the role that were satisfying were much more diffuse than was the case for the palliative care nurses. For example, when the emergency nurses described managing natural emotion by displaying a measured amount of anger to control the abuse of clients, there was certainly a type of satisfaction related to their ability to achieve this affectively;
“And he‟s being dragged out the door yelling [unclear] and I said well we did give you two warnings and you still didn‟t take any notice so I said the cops are here to take you away and he‟s like but you can‟t do that, I said yes I can…things like that do happen and you just take it in your stride … there is a sense of power…” [EN3].
An indication of the dynamic and changing environment of the emergency department could be seen from this nurse‟s comment on how she found the ability to persuade clients to come to terms with the fact that a family member should not be resuscitated, as rewarding;
“…I guess the things that I find very enjoyable is when you‟ve been able to negotiate for ... people that somebody is not for resuscitation, you‟ve actually been able to take the patients and the relatives side and help them come to the conclusion that medical science is not going to help them any more and… we can actually do this better so that they can actually die with some dignity… It is difficult but I just talk to them and just say… have you actually thought that there‟s nothing else that we can do for them? And they will say oh is it that serious?” [EN1].
Associated with the emotional difficulties of dealing with children was this comment in which this emergency nurse explained that he enjoyed successful outcomes and delivering positive news to parents;
“So if the kid comes in pale and not breathing, that‟s a really pretty terminal sign, you know but most things are treatable. So it‟s not hard to be optimistic in those sort of cases because really things are going to go fine and I‟m a big optimist anyway so I don‟t think about the negative sides of those things.” [EN4]
There were also non-specific references to generally enjoying the environment and the people with whom the emergency nurses interacted with;
“I like to be able to look after the ones that aren‟t making a lot of noise. And I like managing a difficult situation, I like that. But personally I just like the people… They‟re just really nice people.” [EN5]
The way in which the emergency nurses talked about aspects of their interaction with clients as being rewarding was focused on achieving successful treatment related outcomes or ensuring that the department continued to run successfully. This was in accordance with the overall aim for emotional management for emergency nurses. The management of emotion was not an end in itself but had the functional aim to assist the department to work efficiently.
The patient registration clerks also derived satisfaction from their interactions with clients. The clerks described a much more detached approach to clients and were able to disengage from clients due to their physical separation and perception of their role. Due to this more detached approach and lower level of responsibility, the clerks were able to choose the times and situations in which they interacted with clients to a greater degree;
“Some people are just too sick so you just get through the basics you can with them and that‟s it but then there are other people like visitors from overseas who might be travelling and you‟ll have a conversation with them and you know what? That‟s actually a good point because I really love that aspect of the job…Sometimes you do just little things like go and take them a flannel or a drink of water or something like that and it‟s really appreciated and you just kind of put yourself in their shoes, you know… I like doing stuff like that. It makes me feel good.” [EC1]. “ I just like being part of it and I like to be amongst people with different emotions and different situations and being able to help somebody if I can or just show them a bit of sympathy or whatever and hope that it made their time in there a little bit better, a little bit easier.” [EC2].
All of the renal nurses talked of satisfying aspects of their role. These nurses derived much of their satisfaction from the establishment of long-term relationships with clients. The nurses spoke of their enjoyable aspects of the job as being linked to the good health outcomes of patients and the satisfaction derived from developing a rapport with patients;
“Sometimes you really enjoy looking after some patients and it‟s really nice to see them so that is quite a joy. Sometimes the patients that you look after are incredibly interesting people that have had interesting lives, they‟ve done interesting things so you can have some really nice
conversations and along the way as well you learn a lot about people and about life.” [RN3].
“I have a good old laugh. I go to work and have a laugh…I‟ve got some photos that I take in of my boy today and show one of the patients and she tells me all about her grandkids…we have a good old laugh…and I love patient education and I love explaining about their treatments…” [RN5].
Also of importance were the clinical outcomes of their clients.
“Other things that are enjoyable, I mean the success if they do get a transplant to see them not worse and seeing them move on and
sometimes it is hard actually seeing somebody get to the position when they don‟t want to continue is actually a good outcome… sometimes it‟s really a relief and…you actually do feel almost joy but you feel relief that
they‟ve actually managed to get to that place themselves and they‟ve made a decision and that they‟re at peace and content with their decision in life.” [RN4].
There was clear evidence from all four groups that these employees derived a great deal of satisfaction from their interactions with clients. Some of this satisfaction was due to being able to persuade clients to make a particular decision or to help them grapple with the most profound and emotionally distressing issues. Conversely, the clerks appeared able to be choosier about with whom and when they interacted with clients at a deeper level. Furthermore, these interactions were much less weighty than the life and death topics that typified the interactions of the nursing groups.