A Simulated Study of Emotional Labor During Patient Intake

Maintaining high levels of patient centered service while balancing clinical tasks or decisions during patient intake in the Emergency Department (ED) can increase workload in the form of emotional labor (EL). EL is the effort required to adhere to job role expectations such as speaking calmly while dealing with a high stress situation or with an angry patient. Strategies such as changing the way someone thinks about an event can mitigate EL, but more research is needed to better understand EL in the ED and strategies used to regulate EL. Our objective was to measure EL experienced and the impact on interpersonal and problem-solving performance during a simulated ED patient intake experience.

Undergraduate students from a large southeastern university participated in a hospital-based simulation playing the role of ED patient service representative. Participants were provided job role expectations including how to communicate professionally (e.g. smiling, speaking in a positive tone). Post simulation surveys measured stress, EL, and regulation strategies. Trained raters observed simulation videos and coded interpersonal performance. A problem-solving task about events during the simulation was completed. Pearson correlations and multiple regression analysis were used to test the relationship between EL, interpersonal communication, and problem-solving performance.

75 participants completed the simulation task. Higher self-reported EL was related to worse problem solving performance (r = -.26, p < .05) but not related to communication performance. The use of more deep acting emotion regulation was related to lower heart rate (r = - .71), lower self-reported negative mood (B = -.43, p < .01), more positive mood (B = .18, P <. 05), and worse performance on the problem-solving task (B = -.21, P < .05). Positive mood was positively related to interpersonal performance (r = .33).

Results supported previous research linking mood to work behaviors. EL negatively impacted performance on a problem-solving task. Changing how you think about a situation reduced negative mood, increased positive mood, was associated with lower EL and improved problem-solving performance. Suppression of negative emotions resulted in higher EL than changing thoughts. ED teams can train to use more adaptive strategies to reduce negative aspects of EL.